Treating pain without opioids, unsafe drugs, and not paying for bad care

June 16, 2016

In order to bring you more of the news you want to read, RightCare Weekly summarizes and interprets three important articles and provides headlines linking to the many other articles and editorials you’ll find interesting. As always, RightCare Weekly presents articles related to moving our healthcare system toward the right care for all patients.

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In 2014, nearly 2 million Americans had a substance use disorder that involved prescription pain relievers, and more than half a million had substance use disorders tied to heroin. Opioids remain important drugs for relieving pain. The ER can be a starting point for opioid addiction, as once patients leave the hospital, they seek drug refills—or heroine—to ease more pain. One hospital in New Jersey is successfully taking novel steps to find other ways to relieve pain. Doctors in he emergency department at St Joseph’s Regional Medical Center in Paterson, as reported in The New York Times, have been experimenting with pain relief alternatives that include laughing gas, ultrasound guided nerve blocks, nonnarcotic infusions and calming harp music. In five months, they have treated 500 acute patients with non-opioids, reduced opioid use by 38 percent and say that 75 percent of their patients get the relief they seek without addictive drugs.

Each year in the United States, there are 2 million serious adverse drug reactions, which cause approximately 100,000 deaths. A study released this week, published in The International Journal of Health Services, examines safety concerns for drugs that are uncovered after they’ve been on the market. Between 1993 and 2010, 17 drugs that would ultimately be recalled by the Food and Drug Administration for safety reasons had been prescribed at 112 million doctor office visits. Nine of these drugs had been prescribed more than a million times before they were pulled. The authors, Drs. Sonali Saluja, Steffi Woolandler, David Himmelstein, David Bor and Danny McCormick, conclude that policies encouraging the rapid approval and dissemination of new drugs will harm patients. (Full disclosure: David Bor is a member of the Lown Institute board of directors.)  They also note that the FDA approves new drugs faster than its counterparts in Europe, Canada and Japan. Moreover, these nations prohibit direct-to-consumer advertising of drugs, which in the United States has increased three-fold since 1997 when the FDA relaxed marketing regulations.

Why do we continue to pay for bad health care? Right Care Alliance network member Ira Byock, MD, a leading light in the palliative care movement, underscores in STAT this week, that too much of what we spend on healthcare goes to ineffective treatments for patients near the end of life, such as feeding tubes for those in late-stage dementia and multiple doses of radiation therapy for patients after cancer has spread to their bones. One way to curtail such services, he asserts, is for insurers to have in place financial disincentives for high-risk, low yield procedures. Choosing Wisely lists could perhaps serve as a resource for payers, he said. And in order to avoid the perception of rationing, payers could first require a palliative care consult for patients with advanced disease, or insist, at the very least, that benefits and risks of proposed procedures be discussed with patients and families. “An openness for bold, corrective actions across the political spectrum has been fostered by the overwhelming evidence and, perhaps more important, the painful personal experiences of leaders in government, business, and religion who have witnessed the effects of ill-considered treatments on their own family members,” Byock writes. “There is no moral imperative to pay for ineffective or harmful treatments; indeed there is a moral imperative not to.”




End of life

Public health




Cost of care

Care model

 Mental health






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