07 November 2018
WEDNESDAY, Nov. 7, 2018 (HealthDay News) — Although the herbal supplement kratom is still legal and widely available, its opioid-like effects have caused significant withdrawal symptoms in at least two newborns in the United States and that should raise concerns, researchers say. A case study of a baby boy exposed to kratom during his mother’s pregnancy — only the second American case reported — likely signifies a broader trend among pregnant women toward seeking alternatives to opioid painkillers such as morphine, heroin and oxycodone (OxyContin), said study author Dr. Whitney Eldridge. “I think mothers are becoming increasingly aware of the dangers of using prescription and non-prescription opioids during pregnancy,” said Eldridge, a neonatologist at Morton Plant Hospital and St. Joseph Women’s Hospital, both in Florida. “As opioid use among pregnant women has increased, I fear they may see kratom as a potentially safe, legal, non-opioid alternative aid for opioid withdrawal, as its opioid-like properties are not well-advertised,” Eldridge added. In February, the U.S. Food and Drug Administration classified compounds in kratom as opioids, basing its findings on a computer analysis showing it activates receptors in the brain that also respond to opioids. But controversy over kratom — which is sold as a dietary supplement, typically to manage pain and boost energy — remains, as it continues to be sold as a non-opioid remedy for opioid withdrawal. Non-opioid alternatives to treat opioid dependence continue to be researched and scrutinized, experts said. The case study, published online Nov. 7 in the journal Pediatrics, centered on a newborn boy whose mother had a seven-year history of oxycodone use, but who had successfully completed drug rehabilitation. She had last used oxycodone two years before her baby was born, and her urine test was negative for drug use. Kratom — which grows naturally in the Southeast Asian countries of Indonesia, Malaysia, Papua New Guinea and Thailand — is less potent than morphine and doesn’t slow breathing. But 33 hours after his birth, the baby boy in this case study began showing symptoms consistent with opioid withdrawal, including sneezing, jitteriness, excessive suck, scratching at the skin around his face, and irritability. His mother denied using prescription medications, supplements or illegal drugs during her pregnancy, but the baby’s father reported that the mother drank kratom tea daily during pregnancy. She had bought the tea to help with sleep and her own opioid withdrawal symptoms. Treated with morphine and a common blood pressure drug over the next several days, the boy’s condition improved and he was discharged from the hospital at 8 days old. “Prior to this case, I was unfamiliar with kratom and unaware of its potential to be a source of withdrawal for [newborn babies],” Eldridge said. “After caring for this infant, I started to pay attention to how heavily kratom is advertised and realized pediatricians and obstetricians need to be familiarized with its potential to affect our patients.” Further research is needed to “make an educated decision as to how to classify kratom,” she suggested. “It may have a role to play in opioid dependency, [but] currently there is too little data to say what role it should be,” Eldridge added. “Meanwhile, pregnant women should disclose kratom use to their physicians just as they would alcohol or tobacco, and physicians have a responsibility to educate pregnant women about the potential impact of kratom for their newborn.” Eldridge’s sentiments were echoed by Dr. Martin Chavez, chief of maternal-fetal medicine at NYU Winthrop Hospital in Mineola, N.Y. “I think what hit home most with this case study … is that we really have to do a thorough job inquiring what type of alternate medications — whether over-the-counter, holistic or something being provided by a family member — a pregnant woman may be taking,” said Chavez. “The most important thing is, just because it’s not being prescribed doesn’t mean it’s not having a potential impact [on the baby],” he added. “When in doubt, when you’re pregnant or have a newborn, be totally open with your clinician not only about prescription medications, but any other type of medication you may be taking to alleviate symptoms you’re having.” More information The U.S. National Institute on Drug Abuse has more on kratom.
16 October 2018
WEDNESDAY, Oct. 17, 2018 (HealthDay News) — Adding to growing alarm about America’s opioid crisis, cases of a potentially deadly heart infection have jumped 10-fold among North Carolina’s injection drug users, new research shows. The infection is endocarditis, which strikes one or more of the heart’s four valves. Usually a byproduct of aging, it can also develop when bacteria is introduced into the body through use of injected drugs such as heroin. “We know that drug-associated endocarditis is increasing nationally, but the magnitude of the rise has been somewhat stunning,” said study author Dr. Asher Schranz, a fellow in the Division of Infectious Diseases at the University of North Carolina at Chapel Hill. Between 2007 and 2017, endocarditis-related hospitalizations and surgeries involving injection drug users in North Carolina rose more than 10-fold, with most of the rise occurring since 2013, the study found. The median age of patients who had surgery for drug-related endocarditis was 33, meaning half were older, half younger. That’s far younger than the norm. The North Carolina findings echo a similar trend in West Virginia. In April 2018, Charleston Area Medical Center experts reported a statewide doubling of drug-related endocarditis admissions between 2008 and 2015. Still, North Carolina’s dramatic spike surprised investigators. Up until the early 2010s, other studies had shown drug-associated endocarditis increasing two- or threefold, Schranz said. A North Carolina study last year, however, reported a 12-fold rise between 2010 and 2015. “In our study,” Schranz said, “we found that this problem has continued to sharply rise through at least mid-2017.” Schranz explained why: Typically, endocarditis risk is driven by age, as heart values weaken over time, he said. The weakened valves can become infected if bacteria or fungi enter the blood, which, he noted, can make an otherwise routine event such as a dental cleaning a high-risk venture for seniors. The damage can also occur when people inject drugs. “Those damaged heart valves may then become infected if that person injects bacteria into the bloodstream by not properly sterilizing the skin, or by injecting non-sterile water or drugs,” Schranz explained. The upshot: Endocarditis has become “a severe consequence of the opioid crisis that has received insufficient attention,” Schranz said. Besides compromising heart valve integrity, endocarditis can raise the risk for heart failure, strokes and/or joint infections. Open-heart surgery to replace a damaged heart valve with a prosthetic is often required. Schranz and his team’s analysis of a statewide database revealed that nearly 23,000 patients were hospitalized with endocarditis between 2007 and 2017, and more than 1,650 underwent surgery. As recently as 2013, fewer than 10 surgeries a year were done to treat drug-related endocarditis, the study found. By 2017, that figure stood at 109. Compared with other cases, drug-related endocarditis patients were more likely to be women, white, uninsured, Medicaid recipients, and young. “The opioid crisis has dramatically impacted the health of young persons in the U.S.,” Schranz said. “There has been increasing hepatitis C and a large outbreak of HIV in Indiana due to drug use. However, we feel that endocarditis is a severe consequence of the opioid crisis that has received insufficient attention.” Dr. Arthur Williams is an assistant professor at Columbia University’s Division on Substance Use Disorders, in New York City. He said the rising heart infection rates among injection drug users underscore the urgent need to get the nation’s opioid epidemic under control. “Sky-high rates of endocarditis reflect the total failure of our treatment system to successfully shepherd patients with opioid use disorders into quality care with FDA-approved medications — such as buprenorphine — which have repeatedly shown to reduce injection-related behaviors and reduce or eliminate opioid use,” said Williams. He was not involved with the study. Schranz and his colleagues presented their findings earlier this month in San Francisco at IDWeek, a joint meeting of experts from the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Disease Society. Research presented at meetings is typically considered preliminary until published in a peer-reviewed journal. More information The American Heart Association has more on endocarditis.
06 September 2018
THURSDAY, Sept. 6, 2018 (HealthDay News) — Many patients who have nose surgery use far fewer opioid painkillers than they’re given, evidence that doctors are overprescribing the highly addictive drugs, a new study suggests. For the study, researchers reviewed 173 nose surgery (rhinoplasty) cases performed at Massachusetts Eye and Ear Infirmary. Of those, 168 patients were prescribed opioids (such as OxyContin) along with acetaminophen (Tylenol), at an average of 28 opioid pills per patient. Only two patients refilled their opioid prescriptions, and 11 percent did not fill their initial prescription, the study authors said. “When we looked at the number of patients who needed refills, we found this near-negligible number,” corresponding author Dr. David Shaye said in a hospital news release. Shaye is a facial plastic and reconstructive surgeon at Mass Eye and Ear in Boston. “This tells us that, as a field, we’re probably overprescribing in rhinoplasty,” he added. Study co-author Dr. Linda Lee said, “After analyzing our data, we were pleasantly surprised by the lack of opioids patients actually required after rhinoplasty, which is especially significant given the current opioid epidemic.” Lee is also a facial plastic and reconstructive surgeon at the hospital. “Understanding this data, we as surgeons have a duty to responsibly prescribe opioids and limit the potential for abuse, particularly for cosmetic or elective surgeries,” Lee said. As a result of their findings, the study authors have reduced by at least half the number of opioid tablets they prescribe. The study was published online Sept. 6 in JAMA Facial Plastic Surgery. The United States is facing an opioid epidemic, the study authors noted in the news release, with less than 5 percent of the world’s population using two-thirds of the world’s opioid painkiller supply. Opioid-related deaths in the United States have increased 200 percent since 2000. And studies have found that nearly 60 percent of the nation’s households have leftover prescription opioids. More information The U.S. Centers for Disease Control and Prevention has more on prescription opioids.
22 June 2018
FRIDAY, June 22, 2018 (HealthDay News) — Health insurers may have helped fuel the U.S. opioid epidemic by not encouraging use of less addictive pain medications, a new study contends. In 2016, more than 2.1 million Americans had an opioid addiction. And more than 42,000 died from opioid overdoses, government data show. “Our findings suggest that both public and private insurers, at least unwittingly, have contributed importantly to the epidemic,” said study senior author Dr. G. Caleb Alexander, of Johns Hopkins Bloomberg School of Public Health in Baltimore. Opioid-based painkillers like oxycodone (OxyContin) and hydrocodone (Vicodin) are just one tool in the pain management tool box, said Alexander, co-director of Hopkins’ Center for Drug Safety and Effectiveness. “Unfortunately, many of the plans that we examined didn’t have well-developed policies in place to limit their overuse,” he said in a university news release. Alexander’s team examined Medicare, Medicaid and large private insurers’ 2017 coverage policies for drugs to treat chronic lower-back pain. Chronic back pain is frequently linked to overuse of prescription opioids. The analysis included 30 prescription opioids and 32 non-opioid medications. Non-opioids included nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants and pain relievers applied to the skin. The researchers concluded that the insurers’ drug coverage policies should have done more to get patients to use safer and more effective treatments than prescription opioids. Insurers can more strictly limit painkiller quantities and require use of less risky drugs before proceeding to powerful narcotics, the researchers said. They can also require the prescriber to obtain authorization from the insurer before ordering opioids for non-cancer pain, the study authors added. The study was published June 22 in the journal JAMA Network Open. Efforts by HealthDay to get a comment from the trade association America’s Health Insurance Plans were unsuccessful. More information The U.S. National Institute on Drug Abuse has more about prescription opioids.