Wednesday, November 14, 2012

Let's end the prescription drug death epidemic

It's the biggest man-made epidemic in the United States. That's how a doctor in Washington state described it to me as we sat outside the state Capitol in Olympia.
He was talking about accidental death from prescription drug overdoses. The doctor, Gary Franklin, medical director for Washington state's Department of Labor and Industries, recounted terrifying case after case and told me it was the saddest thing he had ever seen.
I remember him telling me about a teenager dying because he had taken too much narcotic medication after a dental procedure.
The most common scenario, he said, involves a man in his 40s or 50s who visits a doctor with a backache and walks out with a pain pill prescription. About three years later, typically, the man dies in his sleep from taking too many pills, or mixing them with alcohol.
Dr. Sanjay Gupta
Dr. Sanjay Gupta
They don't intend to die, but more than 20,000 times a year -- every 19 minutes, on average -- that is exactly what happens. Accidental overdoses are now the No. 1 cause of accidental deaths in the United States, surpassing car crashes.
As a neurosurgeon working in a busy level 1 trauma hospital, I had an idea that the problem was growing -- but the numbers still boggle the mind.
The number of pain prescriptions increased 600% from 1997-2007, according to the U.S. Centers for Disease Control and Prevention. In the United States, we now prescribe enough pain pills to give every man, woman and child one every four hours, around the clock, for three weeks.
Clinton: U.S. popping to many pills
Prescription drug overdoses on the rise
'Prescription pain meds can be risky'
We often pay close attention if a celebrity dies of an overdose, but truth is, it's our friends, neighbors and yes, our own family members who are dying.
In fact, the person who really brought the issue to my attention was former President Bill Clinton. He called me a few months ago, and I could immediately tell he was broken up about something. I had worked for him in the White House in the late '90s, talked to him countless times since then, and I had never heard him like this.
Two of his friends had both lost sons, he told me. The cause: accidental overdose.
I will never forget how he put it. "Look, no one thinks having a few beers and an Oxycontin is a good idea, but you also don't expect to die." I knew at that moment we needed to do our part in the media to shine a bright light on this issue and find solutions that work.
As a starting point, 80% of the world's pain pills are consumed right here in the United States, according to 2011 congressional testimony from the American Society of Interventional Pain Physicians.
No doubt, many are for perfectly legitimate reasons and are not misused or abused. Yet culturally, we have become increasingly intolerant of even minor amounts of pain and increasingly comfortable with taking heavy-duty medications.
We know, however, that after just a few months of taking the pills, something starts to change in the body. The effectiveness wears off, and patients typically report getting only about 30% pain relief, compared with when they started. Even more concerning, a subgroup of these patients develop a condition known as hyperalgesia, an increased sensitivity to pain.
As you might guess, all of this creates a situation where the person starts to take more and more pills. And even though they are no longer providing much pain relief, they can still diminish the body's drive to breathe.
If you are awake you may not notice it, but if you fall asleep with too many of these pills in your system, you never wake up. Add alcohol, and the problem is exponentially worse. People who take pain or sleeping pills and drink a couple glasses of wine are playing Russian roulette.
I am not at all sorry for coming off dramatic or scary as I write this. I only wish I had been this dramatic years ago.
Truth is, it is easier for a doctor to write a prescription than to explore other effective options to combat pain. And it is easier for patients to take those prescription pills than to search for alternatives themselves. Both those things must absolutely change.
In my upcoming documentary, I will explain how we arrived in this deadly situation, but more importantly, explore solutions to address it.
I crisscrossed the country finding what worked and what didn't. I spoke to doctors, patients and families who lost a loved one -- even one man I met who shares my last name. As I said, it hits close to home.
Clinton has dedicated a significant part of his post-presidency domestic efforts to this cause, and it will not come as a surprise that he has identified areas where we can all make a difference. You will hear his thoughts on this issue for the first time in the documentary.
Throughout my career, I have traveled the world and seen problems so intransigent that I thought solutions would never come. With accidental deaths due to prescription drugs, however, we have an opportunity to fix the problem and end this large man-made epidemic.

Global Warming and Rising Pollen


Global warming may bring pollen onslaught

Climate change, we've all heard, is problematic. Major shifts in climate patterns in the future may affect the spread of disease, devastate coastal areas and cause the extinction of some of our beloved species of wildlife. It may even contribute to future violence.
But if Superstorm Sandy didn't bring climate change concerns home for you, here's something else that might: Allergy mayhem.
New research presented at the American College of Allergy, Asthma and Immunology (ACAAI) conference last week suggests that pollen counts are going to get a lot worse in the next 30 years. Dr. Leonard Bielory showed predictions that pollen counts will more than double by 2040.
Bielory is part of an ongoing study at Rutgers University modeling what climate change has in store for pollen. The study analyzes various allergenic plants being grown in climate chambers modeling future conditions, and researchers are incorporating factors including weather patterns and changes in precipitation and temperature.
Pollen counts averaged 8,455 in the year 2000, and by 2040 they are expected to reach 21,735, according to this model. And the allergy season will begin earlier each year, too.
A conference presentation does not come with the same level of scrutiny as publication in a peer-reviewed journal. But the findings make sense to Dr. Clifford Bassett, a New York allergist and ACAAI fellow who was not involved in this particular study.
"As you increase CO2 (carbon dioxide), it tells the allergenic plants to produce more pollen to the tune of three to four times more, and the pollen itself, we think, may actually be more potent," Bassett said.
I've already spent many springs of my life feeling like a total wreck, between the sneezing, itchy eyes and sinus headaches, no matter which antihistamine I'm taking. How will we survive with longer, stronger allergy seasons and a pollen apocalypse?
Bassett tells me that immunotherapy - in other words, allergy shots - are the only effective means to prevent these symptoms. When pollen counts are at their highest, people who have received the injections may still need some antihistamine medications. But generally they have minimal to no allergy unpleasantness.
The shots are given over a period of three to five years. An allergist tests to see which plants you are allergic to, and then gives injections of tiny doses of those offending substances so that you become desensitized.
Other allergy symptom prevention tips from Bassett include:
– Wash your hair at night after you've been outside
– Take antihistamines before the allergy season begins
– Try to avoid exercising outdoors when the pollen count is high
– Don't line-dry your clothes when there's a lot of pollen in the air
Consult an allergist to get a treatment plan that's best suited for you