#43: The Reality of Opioid Therapy and Testing

Did you know the Sumerians in Mesopotamia were among the first people to cultivate the poppy plant around 3400BC?  Quickly this “joy plant” spread throughout the world to every major civilization in Europe and Asia and was used to treat pain and other ailments.  Opium was used throughout the world and has continued through the use of opioid therapy today.  The challenge health care providers face today is to reduce the likelihood of opioid abuse while not imposing barriers on the legitimate use of opioid medication.  Without getting too deep in the weeds, the term opioid refers to all compounds that bind to specific protein receptors.  The term opiate is used to describe opioids derived from the poppy plant (morphine and codeine).  Heroine, which is derived from morphine and oxycodone, derived from thebaine are examples of semi-synthetic opiates.  Synthetic opioids such as methadone and fentanyl are man-made. 

Most patients who are prescribed opioids for chronic pain behave differently from patients who abuse opioids and don’t ever exhibit behavior consistent with craving, loss of control, or compulsive use.  In other words, they take their meds appropriately for the intended purpose.  However, pain and addiction are not mutually exclusive, and therein lies the problem.  Many patients today are not receiving the appropriate pain care due to perceived and real risks associated with regulatory and legal scrutiny over the prescribing of controlled substances.  Many people have an immediate perception of anyone taking an opioid. 

As the pendulum of opinion regarding prescribing opioid therapy for non-cancerous pain swings back and forth between overtreatment and undertreatment, there is no disagreement when the issue of appropriate drug testing is raised.  Patients on opioid therapy should be tested for the opioid medication they are prescribed as well as any other controlled substance they may be taking.  Additionally, if they have any history of using illicit substances or misusing prescribed medications they should tested for these substances.  Testing is done to ensure the patient has the prescribed medication in their system as well as to verify they do not have any other controlled substance not prescribed.  Granted what to test and the frequency of testing can get confusing, however, ILDP can be a resource to help assist the provider in making those decisions. 

Although we would never tell a provider what to test, with appropriate risk analysis, testing the patient who has had three back surgeries and has been taking prescribed hydrocodone for a year may look a lot different than the patient whose drug test came back positive for two unprescribed medications and THC.  The frequency and amount of drugs tested for these two patients might differ considerably.  We are here to help and have a very low key unpressured approach in answering questions. 

Thank you for continuing to allow us to participate in the care of your patients.

Lance Benedict

President/CEO Industry Lab Diagnostic Partners

        

#42: Flu Season During the Covid Pandemic

With the hyper-focus on the COVID-19 virus this past year, has anyone noticed how low our Influenza numbers have been?  The infamous “twindemic” that infectious disease experts predicted for this past winter, never materialized.  From the start of the current flu season in September 2020 clinical labs in the US reported that 1,766 specimens tested positive for flu out of 931,726-a rate of just 0.2%.  Comparing this to 250,000 specimens out of 1.5 million tested during the 2019-2020 flu season the difference is drastic.  No one has ever seen a flu season this low.  According to one source, one child has died from the flu this year compared to 195 deaths last year.  Why is this?  Scientists and “experts” have come up with three likely reasons. 

-The precautions people take to avoid COVID transmissions such as masking, social distancing, and handwashing.

-Tremendous reduction in human mobility.  In other words, very little extended travel, especially international.

-Higher than normal flu vaccination rates.  Isn’t that interesting?

This is just great news, right?  Well, before you drink the cool-aid let's think through this.  The greatest distributors of the flu are children.  With the severe social restrictions we have incorporated upon our youth this past year it is indisputable that we have succeeded in reducing the flu, but at what cost?  There have been reported delays in speech and language development as well as learning social skills, like sharing, in children.  Learning to read facial expressions has been affected due to masking.  Mental health has been affected along with an increase in obesity due to inactivity. 

So, is the great reduction of flu cases along with the decrease in child deaths worth the cost?  Is there a happy medium?  I think most people would agree that life, as we knew it before COVID, has changed forever.  To what extent is to be determined.  As a person who views life as a glass half full, perhaps this is an opportunity to teach our youth, and many adults, how to thrive and be resilient in challenging times.  Although I will never find myself voting to mask forever, this pandemic has also shown the value of good hygiene. 

After the 1918 flu pandemic, our country ran into the roaring ’20s.  People congregated, mingled, hugged, and kissed.  Everything they had been deprived of during the pandemic.  They attended church, went to theaters, stadiums, and other social events.  Is the Influenza virus sitting in the bushes waiting for this to happen now?  Only time will tell. 

Thank you for trusting ILDP to be your lab.

 

Lance Benedict

President/CEO Industry Lab Diagnostic Partners