There are now 44 cases reported in Minnesota, and all but two of the cases involve unvaccinated patients
From: http://www.cbsnews.com/news/doctors-warn-minnesota-measles-outbreak-still-early-as-cases-increase/
Friday, May 5, 2017
Opioid addiction: Long-term treatment for a chronic condition
In 2015, motor vehicle accidents claimed the lives of more than 35,000 Americans. Sadly, the toll exacted by motor vehicle accidents has now been eclipsed. Data from the American Society of Addiction Medicine show that more than 52,000 of we Americans lost our lives to opioid overdose in 2015. Here in the Commonwealth, the story is even more grim; even accounting for differences in average age from community to community — younger people are still more likely to be affected than older people — the opioid overdose death rate has climbed to 23 per 100,000 residents as compared to 9 per 100,000 for the nation as a whole. The causes are numerous and a subject for another day. Similarly, approaches to solve the crisis are numerous and no one solution works for everyone who decides he or she has developed an opioid problem.
Medication Assisted Treatment (MAT)
One approach to treat people who are addicted to opioids is Medication Assisted Treatment (MAT) that combines medications to treat addiction with more traditional counseling approaches. One medication often used in MAT programs is buprenorphine-naloxone (trade name Suboxone, among others). This preparation — hereafter BN — combines buprenorphine, an opioid medication with partial activity that blunts cravings, and naloxone, an opioid overdose reversal medication that discourages abuse of the medication. When we compare groups of people addicted to opioids who are treated with and without BN, we see that those who receive the medication have a significantly higher rate of remaining free of other opioids. But how long should one continue the medication? A month? A year? A lifetime? And is it safe to continue the medication? We do not have the full answers yet, but early signals from the research indicate that not only is it safe but that longer treatment is better than shorter treatment.
Long-term treatment for a chronic condition
Many in the medical community have come to view addiction as a chronic disease. And, like many chronic diseases, it is one that can be managed but not yet cured. The thinking goes that just as those of us with high blood pressure take high blood pressure fighting medication each day for years, those of us with addiction would take addiction-fighting medication every day over years. The evidence shows that long-term proper treatment for high blood pressure lowers the risk for heart attack; evidence is now beginning to grow that long-term MAT can similarly decrease risk for relapse in those with addiction. As reported in a 2008 study in the American Journal on Addictions, patients who were successfully stabilized with a short course of BN could then be switched to long-term treatment with the medication. Forty percent of patients remained in treatment at two years and 20% at five years. When we remember that nearly half of people prescribed medication for blood pressure do not take their pills, we see that people on BN are not more likely to skip their medication than are people with better-studied chronic diseases. More importantly, though, greater than 90% of urine samples from those in the study remained free of opioids other than BN.
Long-term treatment with BN works.
How do people do without longer-term buprenorphine-naloxone treatment?
It is one thing to say that someone on a medication has a good outcome, but it is something else to prove that without the medication the person would not do well. Many advocate short-term treatment with BN. Help a person become stable and then taper off the medication. We now have evidence that this approach, however well intentioned, may be misguided. A 2014 study reported in the Journal of the American Medical Association demonstrates that over half of people who continued on BN maintenance remained free of opioids compared to just a third of those who were stabilized on BN and then tapered off. Further, far more of those treated with maintenance BN remained in the study compared to those who were tapered, suggesting that people remain committed to treatment while receiving BN.
Is long-term MAT safe?
Even if many people can be helped by extended BN treatment, it is important to consider possible side effects. Though we do not know the effects of being on BN for many decades, the 2008 American Journal on Addictions study looked for but did not find any serious adverse effects on the people treated. Earlier concerns that BN could cause liver damage also appeared to be unfounded as blood tests did not show signs of liver problems in any of the patients in the study.
More research is needed, of course, but the early evidence suggests that BN can safely help people remain off unwanted opioids over the long term just as blood pressure medication can protect people from the effects of high blood pressure. That is good news because each day off unwanted opioids is a day a person can focus on improving his or her life. Of course, buprenorphine-naloxone maintenance is not for everyone, but when it works it can work well and can give people room to breathe and rebuild their lives.
References
Abegaz et al. Nonadherence to antihypertensive drugs: A systematic review and meta-analysis. Medicine, 2017.
Fiellin, DA, et al. Long-Term Treatment with Buprenorphine/Naloxone in Primary Care: Results at 2–5 Years. The American Journal on Addictions, 2008.
Fiellin, DA, et al. Primary Care–Based Buprenorphine Taper vs Maintenance Therapy for Prescription Opioid Dependence: A Randomized Clinical Trial. JAMA Internal Medicine, 2014.
Opioid Addiction 2016 Facts & Figures. American Society of Addiction Medicine.
Woody, GE, et al. Extended vs Short-term Buprenorphine-Naloxone for Treatment of Opioid-Addicted Youth: A Randomized Trial. JAMA. 2008.
The post Opioid addiction: Long-term treatment for a chronic condition appeared first on Harvard Health Blog.
From: Glen Buchberger, MD http://www.health.harvard.edu/blog/opioid-addiction-long-term-treatment-for-a-chronic-condition-2017050511379
Zika-infected mom's baby faces uncertain future
Rising temperatures, and the start of mosquito season, have the Rio Grande Valley in southern Texas worried about Zika
From: http://www.cbsnews.com/news/mosquito-season-pregnant-women-texas-zika/
From: http://www.cbsnews.com/news/mosquito-season-pregnant-women-texas-zika/
How will GOP health bill affect Medicaid?
Nearly one in five Americans rely on Medicaid for their health coverage, including 10 million who were added under Obamacare. The House GOP replacement bill would place caps on Medicaid funding for the first time. Nancy Cordes has more.
From: http://www.cbsnews.com/videos/how-will-gop-health-bill-affect-medicaid/
From: http://www.cbsnews.com/videos/how-will-gop-health-bill-affect-medicaid/
Zika outbreak in Texas ahead of mosquito season
Spring is here and with it comes the threat of Zika, the virus spread by mosquitoes. So far this year, 18 women in the Rio Grande Valley have been infected with the virus linked to birth defects. Dr. Jon LaPook reports from Brownsville, Texas.
From: http://www.cbsnews.com/videos/zika-outbreak-in-texas-ahead-of-mosquito-season/
From: http://www.cbsnews.com/videos/zika-outbreak-in-texas-ahead-of-mosquito-season/
Are pregnancy and rape pre-existing conditions?
Some of the claims spreading on social media are misleading, experts say
From: http://www.cbsnews.com/news/acha-pre-existing-conditions-rape-pregnancy/
From: http://www.cbsnews.com/news/acha-pre-existing-conditions-rape-pregnancy/
What it's like to battle insurance companies
Rocky Schwartz and her husband have paid $300,000 out of pocket for medical expenses and have lost insurance appeals seven times
From: http://www.cbsnews.com/news/what-its-like-to-battle-insurance-companies/
From: http://www.cbsnews.com/news/what-its-like-to-battle-insurance-companies/
Is Drinking Diet Soda a Health Risk?
This story looks at recent studies about diet soda and their health risks.
From: http://www.webmd.com/diet/news/20170505/diet-soda-health-risks?src=RSS_PUBLIC
Pot a Factor in ER Admissions for Colorado Teens
Number of urgent care cases where teen showed pot use rose 4-fold after legalization, study finds
From: http://www.webmd.com/mental-health/addiction/news/20170505/pot-a-factor-in-more-er-admissions-for-colorado-teens-after-legalization?src=RSS_PUBLIC
#IAmAPreexistingCondition highlights health care fears
Cancer survivors, veterans, rape victims and parents of sick kids are among those taking to Twitter, distraught over what the health care bill could mean
From: http://www.cbsnews.com/news/health-care-pre-existing-conditions-iamapreexistingcondition-ahca/
From: http://www.cbsnews.com/news/health-care-pre-existing-conditions-iamapreexistingcondition-ahca/
GOP health care bill attacks Planned Parenthood funding
The GOP's health care bill that House Republicans passed includes a provision that could defund Planned Parenthood. The group's Executive Vice President Dawn Laguens joins CBSN with her reaction.
From: http://www.cbsnews.com/videos/gop-health-care-bill-attacks-planned-parenthood-funding/
From: http://www.cbsnews.com/videos/gop-health-care-bill-attacks-planned-parenthood-funding/
White House says Senate will retain "main pillars" of health care bill
But Senate Republicans have signaled that they will craft their own version of the bill
From: http://www.cbsnews.com/news/white-house-says-senate-will-retain-main-pillars-of-health-care-bill/
From: http://www.cbsnews.com/news/white-house-says-senate-will-retain-main-pillars-of-health-care-bill/
Health Bill Faces Uncertain Future in the Senate
Several leading Republican lawmakers express concern with House proposal
From: http://www.webmd.com/health-insurance/news/20170505/gop-health-reform-push-faces-uncertain-future-in-the-senate?src=RSS_PUBLIC
Speed management key to saving lives, making cities more liveable
Managing speed, a new report from WHO, suggests that excessive or inappropriate speed contributes to 1 in 3 road traffic fatalities worldwide.
From: http://www.who.int/entity/mediacentre/news/releases/2017/speed-management-cities/en/index.html
From: http://www.who.int/entity/mediacentre/news/releases/2017/speed-management-cities/en/index.html
Video: Endoscopy
This video shows how your doctor can view your esophagus, stomach and part of your duodenum using a fiber-optic endoscope.
From: http://www.mayoclinic.com/tests-procedures/endoscopy/multimedia/endoscopy/vid-20084761
From: http://www.mayoclinic.com/tests-procedures/endoscopy/multimedia/endoscopy/vid-20084761
Experts warn of deadly tick-borne Powassan virus
Lyme disease isn't the only reason you'll want to take extra precautions to avoid ticks
From: http://www.cbsnews.com/news/experts-warn-of-deadly-tick-borne-powassan-virus/
From: http://www.cbsnews.com/news/experts-warn-of-deadly-tick-borne-powassan-virus/
What you need to know about Lyme disease in dogs
It's a mysterious and dangerous disease in humans, but did you know it poses a serious threat to pets as well?
From: http://www.cbsnews.com/news/lyme-disease-in-dogs-10-things-you-need-to-know/
From: http://www.cbsnews.com/news/lyme-disease-in-dogs-10-things-you-need-to-know/
Dangerous tick-borne viruses on the rise
Lyme disease is increasing in areas around the country, and researchers warn that's not the only tick-borne disease to watch out for. One called Powassan virus is rare but can be deadly. Dave Delozier of WISC-TV reports.
From: http://www.cbsnews.com/videos/dangerous-tick-borne-viruses-on-the-rise/
From: http://www.cbsnews.com/videos/dangerous-tick-borne-viruses-on-the-rise/
Mayo Clinic Minute: Tanning beds and OCD
From: Mayo Clinic https://www.youtube.com/watch?v=I5BYfaBwPd0
Facebook Live about Thyroid Nodules and Cancer
From: Mayo Clinic https://www.youtube.com/watch?v=rhoPUlCRWSU
Prestigious doctors' groups denounce health care vote
The Obamacare replacement bill passed by the House "violates our principles," six of the nation's top physician groups said in a joint statement
From: http://www.cbsnews.com/news/doctors-health-groups-denounce-ahca-health-care-vote/
From: http://www.cbsnews.com/news/doctors-health-groups-denounce-ahca-health-care-vote/
Scientists hit milestone in 3D printing human cartilage
The story of 3D bioprinting in medical care is quickly moving from abstract hope to concrete progress
From: http://www.cbsnews.com/news/scientists-hit-milestone-in-successful-3d-printing-of-cartilage/
From: http://www.cbsnews.com/news/scientists-hit-milestone-in-successful-3d-printing-of-cartilage/
WHO: Road safety, Save LIVES strategies: Speed Management
From: World Health Organization https://www.youtube.com/watch?v=DTErGhOZ_Yw
FDA Warns of Tattoo Dangers
Unsafe practices cause infections, contaminated ink a common culprit, agency says
From: http://www.webmd.com/skin-problems-and-treatments/news/20170505/fda-warns-of-tattoo-dangers?src=RSS_PUBLIC
Knee 'Crackle' Might Mean Arthritis is Coming
It could mean arthritis is coming
From: http://www.webmd.com/osteoarthritis/news/20170505/do-your-knees-crackle-and-pop?src=RSS_PUBLIC
‘Social Smoking’ Still Boosts Health Risks
Study found lighting up occasionally as damaging to blood vessel health as regular smoking
From: http://www.webmd.com/smoking-cessation/news/20170505/just-a-social-smoker-toll-on-your-health-still-high?src=RSS_PUBLIC
#AsktheMayoMom about Proton Beam Therapy to Treat Children with Brain Tumors
From: Mayo Clinic https://www.youtube.com/watch?v=FGpoHwS4qHQ
Opioid addiction: Long-term treatment for a chronic condition
In 2015, motor vehicle accidents claimed the lives of more than 35,000 Americans. Sadly, the toll exacted by motor vehicle accidents has now been eclipsed. Data from the American Society of Addiction Medicine show that more than 52,000 of we Americans lost our lives to opioid overdose in 2015. Here in the Commonwealth, the story is even more grim; even accounting for differences in average age from community to community — younger people are still more likely to be affected than older people — the opioid overdose death rate has climbed to 23 per 100,000 residents as compared to 9 per 100,000 for the nation as a whole. The causes are numerous and a subject for another day. Similarly, approaches to solve the crisis are numerous and no one solution works for everyone who decides he or she has developed an opioid problem.
Medication Assisted Treatment (MAT)
One approach to treat people who are addicted to opioids is Medication Assisted Treatment (MAT) that combines medications to treat addiction with more traditional counseling approaches. One medication often used in MAT programs is buprenorphine-naloxone (trade name Suboxone, among others). This preparation — hereafter BN — combines buprenorphine, an opioid medication with partial activity that blunts cravings, and naloxone, an opioid overdose reversal medication that discourages abuse of the medication. When we compare groups of people addicted to opioids who are treated with and without BN, we see that those who receive the medication have a significantly higher rate of remaining free of other opioids. But how long should one continue the medication? A month? A year? A lifetime? And is it safe to continue the medication? We do not have the full answers yet, but early signals from the research indicate that not only is it safe but that longer treatment is better than shorter treatment.
Long-term treatment for a chronic condition
Many in the medical community have come to view addiction as a chronic disease. And, like many chronic diseases, it is one that can be managed but not yet cured. The thinking goes that just as those of us with high blood pressure take high blood pressure fighting medication each day for years, those of us with addiction would take addiction-fighting medication every day over years. The evidence shows that long-term proper treatment for high blood pressure lowers the risk for heart attack; evidence is now beginning to grow that long-term MAT can similarly decrease risk for relapse in those with addiction. As reported in a 2008 study in the American Journal on Addictions, patients who were successfully stabilized with a short course of BN could then be switched to long-term treatment with the medication. Forty percent of patients remained in treatment at two years and 20% at five years. When we remember that nearly half of people prescribed medication for blood pressure do not take their pills, we see that people on BN are not more likely to skip their medication than are people with better-studied chronic diseases. More importantly, though, greater than 90% of urine samples from those in the study remained free of opioids other than BN.
Long-term treatment with BN works.
How do people do without longer-term buprenorphine-naloxone treatment?
It is one thing to say that someone on a medication has a good outcome, but it is something else to prove that without the medication the person would not do well. Many advocate short-term treatment with BN. Help a person become stable and then taper off the medication. We now have evidence that this approach, however well intentioned, may be misguided. A 2014 study reported in the Journal of the American Medical Association demonstrates that over half of people who continued on BN maintenance remained free of opioids compared to just a third of those who were stabilized on BN and then tapered off. Further, far more of those treated with maintenance BN remained in the study compared to those who were tapered, suggesting that people remain committed to treatment while receiving BN.
Is long-term MAT safe?
Even if many people can be helped by extended BN treatment, it is important to consider possible side effects. Though we do not know the effects of being on BN for many decades, the 2008 American Journal on Addictions study looked for but did not find any serious adverse effects on the people treated. Earlier concerns that BN could cause liver damage also appeared to be unfounded as blood tests did not show signs of liver problems in any of the patients in the study.
More research is needed, of course, but the early evidence suggests that BN can safely help people remain off unwanted opioids over the long term just as blood pressure medication can protect people from the effects of high blood pressure. That is good news because each day off unwanted opioids is a day a person can focus on improving his or her life. Of course, buprenorphine-naloxone maintenance is not for everyone, but when it works it can work well and can give people room to breathe and rebuild their lives.
References
Abegaz et al. Nonadherence to antihypertensive drugs: A systematic review and meta-analysis. Medicine, 2017.
Fiellin, DA, et al. Long-Term Treatment with Buprenorphine/Naloxone in Primary Care: Results at 2–5 Years. The American Journal on Addictions, 2008.
Fiellin, DA, et al. Primary Care–Based Buprenorphine Taper vs Maintenance Therapy for Prescription Opioid Dependence: A Randomized Clinical Trial. JAMA Internal Medicine, 2014.
Opioid Addiction 2016 Facts & Figures. American Society of Addiction Medicine.
Woody, GE, et al. Extended vs Short-term Buprenorphine-Naloxone for Treatment of Opioid-Addicted Youth: A Randomized Trial. JAMA. 2008.
The post Opioid addiction: Long-term treatment for a chronic condition appeared first on Harvard Health Blog.
From: Glen Buchberger, MD http://www.health.harvard.edu/blog/opioid-addiction-long-term-treatment-for-a-chronic-condition-2017050511379
Video: Endoscopy
This video shows how your doctor can view your esophagus, stomach and part of your duodenum using a fiber-optic endoscope.
From: http://www.mayoclinic.org/tests-procedures/endoscopy/multimedia/endoscopy/vid-20084761
From: http://www.mayoclinic.org/tests-procedures/endoscopy/multimedia/endoscopy/vid-20084761
Guns Send About 16 Kids to the Hospital Every Day
Many of those injuries are accidental, study finds
From: http://www.webmd.com/parenting/news/20170504/guns-send-about-16-us-kids-to-the-hospital-every-day?src=RSS_PUBLIC
Trump, House Republicans celebrate health care victory
Republicans in the House passed a bill Thursday that would dismantle much of the Affordable Care Act. With no Democratic support, Republicans voted "yes" and acquired just one vote over the number required for passage. It now goes to the Senate, where Democrats vow to stop it. Nancy Cordes reports.
From: http://www.cbsnews.com/videos/trump-house-republicans-celebrate-health-care-victory/
From: http://www.cbsnews.com/videos/trump-house-republicans-celebrate-health-care-victory/
OMS : Le mal de vivre, parlons-en ! Prévention du suicide chez les adolescents
From: World Health Organization https://www.youtube.com/watch?v=MnQUfb2MXPA
Making Mayo's Recipes: 3 Healthy Ways to Cook with Nuts
From: Mayo Clinic https://www.youtube.com/watch?v=L29NcuMycBA
WHO: Feeling down? Let's talk - Prevention of suicide among adolescents
From: World Health Organization https://www.youtube.com/watch?v=h0-lUWKywJU
J&J slammed with biggest verdict yet in talcum powder suit
St. Louis jury orders company to pay more than $110M to Va. woman who says she got ovarian cancer from using products with the powder; J&J has faced some 2,400 such suits
From: http://www.cbsnews.com/news/johnson-johnson-110-million-verdict-biggest-yet-talcum-powder-lawsuit/
From: http://www.cbsnews.com/news/johnson-johnson-110-million-verdict-biggest-yet-talcum-powder-lawsuit/
Video: Endoscopy
This video shows how your doctor can view your esophagus, stomach and part of your duodenum using a fiber-optic endoscope.
From: http://www.mayoclinic.com/tests-procedures/endoscopy/multimedia/endoscopy/vid-20084761
From: http://www.mayoclinic.com/tests-procedures/endoscopy/multimedia/endoscopy/vid-20084761
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