2014’s top posts: #4

CVS is selling Narcan in Rhode Island

NARCAN-KITHere’s an interesting development in access to Narcan:

CVS Pharmacy announced that it would offer the opiate antidote Narcan without a prescription at all of its 60 pharmacies in Rhode Island by the end of month.

Narcan, also known as naloxone, offers immediate help for anyone overdosing from an opiate such as heroin or a prescription painkiller such as OxyContin. If given in time, Narcan can reverse an overdose by restoring breathing.

“Over half of our pharmacies are now under a collaborative agreement that allows them to dispense Narcan without a prescription,” CVS spokesman Michael DeAngelis said Friday. “It’s part of our commitment to combat prescription drug abuse. We think it’s a great public service.”

Read the rest here.

Faith of a different sort

athiesm-and-faithDJ Mac wraps up a series of posts on pharmacology with a post focused on our faith in pharmacology.

Holy grails are few and far between. Pharmaceutical holy grails are no different. They are as rare as a moderate position in the Scottish independence debate. We have a few prescription drugs licensed to treat addiction and some make things significantly better, some have modest impacts, and some appear to have little impact. Regardless of impact, what a great deal of faith we place in molecules to manage complex bio-psycho-social problems like addiction – or depression for that matter. It looks as if our faith often exceeds the pharmacology.

. . .

If we encourage our clients to trust in medication to do the work at the expense of doing the tough job of behavioural change, then we let our clients down. Too high a faith in pharmacology is disempowering. It’s not that medication doesn’t make an impact; it clearly does. My worry is that we place too much belief in medication and this may cause us to miss out on the otherwise rather obvious fact that recovery from addiction does not take place primarily because the prescription is right. While many recovering people can identify the part that prescribing played and are grateful for it, we don’t often see clients coming back to their prescribers saying “I want to thank you because your prescription was just right and because it was great it met my pharmacological deficits and I got into recovery.”

No, what they will say is “Thank you, you were great. You helped get me on my way, you connected me up to the right people and assisted me to sort out my problems. You had time for me and you listened to me. You supported me and believed in me.” That’s more efficacious than any drug.

It’s a great post. Read the rest here.

More benzos, more deaths

A recent study finds increases in deaths for people prescribed benzos:

We found evidence of an association between prescription of anxiolytic and hypnotic drugs and mortality over an average follow-up period of 7.6 years among more than 100 000 age and general practice matched adults. In patients who were prescribed these drugs, there was an estimated overall statistically significant doubling of the hazard of death (hazard ratio 2.08), after adjusting for a wide range of potential confounders, including physical and psychiatric comorbidities, sleep disorders, and other drugs. 

Another study looks at benzo prescribing patterns:

To better understand prescribing trends in their preliminary stBenzo-Detox-300x225udy, Dr. Kao and his colleagues evaluated a database of 3.1 billion primary care visits documented in the National Ambulatory Medical Center Survey (NAMCS) between 2002 and 2009.

They found that 12.6% of the primary care visits involved benzodiazepine or opioid prescriptions.

After adjustment for demographic factors, payer status, psychiatric illnesses, and pain diagnoses, the prescription of benzodiazepines was found to increase by a rate of 12.5% per year (95% confidence interval [CI], 9.4% – 15.7%), while coprescribing with opioids increased by 12.0% per year (95% CI, 5.0% – 19.4%).

The researchers also evaluated data on 733 million emergency department visits in the same time period and found 32.4% of patients had benzodiazepine or opioid prescriptions.