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A Look at Opioid Use During Pregnancy

A Look at Opioid Use During Pregnancy

According to NIH data, prescriptions for opioids have increased dramatically in the general population, rising by more than 200 million between 1991 and 2009. In 2014, the American Society of Anesthesiologists distributed a list as part of the American Board of Internal Medicine Foundation’s Choosing Wisely campaign to help physicians and patients engage in conversations about treatments or medications that are commonly prescribed in pain medicine but are not always necessary. The list noted that opioid analgesics should not be prescribed as first-line therapy to treat chronic non-cancer pain. Little is known, however, about the use of opioids during pregnancy. Assessing Prevalence & Patterns of Opioid Use In a study by Brian T. Bateman, MD, MSc, and colleagues, researchers sought to define the prevalence and patterns of opioid use in a large cohort of pregnant women. Published in Anesthesiology, the study looked at data from more than 530,000 pregnant women enrolled in commercial insurance plans who delivered babies between 2005 and 2011. “We found that 14.4% of pregnant women were prescribed opioids at some point in their pregnancy,” says Dr. Bateman. “Most opioid exposures were for short courses, typically lasting less than a week.” The study also found that 5.7% of women were given an opioid in the first and second trimester, and 6.5% were given one in the third trimester. Overall, 2.2% were dispensed opioids three or more times during their pregnancy. Back pain was the most common condition for which opioids were prescribed. Other conditions included abdominal pain, migraine, joint pain, and fibromyalgia. Rates of opioid use also varied throughout the United States, with the highest occurring...

Doc’s Defamation Lawsuit: The Patient’s Side

Are you familiar with a case in Minnesota where a doctor sued a patient’s son for defamation over a negative review he posted? Dr. David McKee’s defamation lawsuit, a 4-year legal battle ended up in the Minnesota Supreme Court. The story recently came up again because BuzzFeed posted an article entitled “Insult And Injury: How Doctors Are Losing The War Against Trolls” discussing how doctors are having trouble defending themselves against negative reviews. I tweeted a link to that article, and Dennis K. Laurion, whose father was the patient in the Minnesota, case wrote to me. He says no one ever asks him about his side of the story. He’s agreed to let me publish his comments: As one of the “trolls” detailed in the article, I have no issue with the accuracy of the text—at least as it pertains to me—but the tone of the title fails to distinguish sincere complaints about bedside manner from attacks on mental stability, attacks on medical prowess, fake websites, allegations of dangerous injections, and use of multiple identities. The author said “McKee [the doctor in the case] and Laurion agree on substance…”  (View excerpts of the case from various media outlets in unabridged letter here.) This entire experience has been distressing to my family. We were initially shocked and blindsided by “jocular” comments made so soon after my father’s stroke by somebody who didn’t know us. We were overwhelmed by my being sued after posting a consumer opinion, and we were shocked by the rapidity with which it happened. It has been the 800 pound gorilla in the room. My parents would...
Updated Guidelines for Assessing Cardiovascular Risk

Updated Guidelines for Assessing Cardiovascular Risk

Cardiovascular disease (CVD) caused by atherosclerosis continues to be the leading cause of death and is a major cause of disability as well as a significant source of healthcare costs in the United States. In 2013, the American College of Cardiology (ACC) and the American Heart Association (AHA) released an updated clinical practice guideline to help clinicians better identify adults who may be at high risk for developing atherosclerotic CVD. The update, published jointly in the Journal of the American College of Cardiology and Circulation, also provides recommendations for identifying patients who could benefit from lifestyle changes or drug therapy to help prevent CVD. “These guidelines were last updated about 10 years ago,” says David C. Goff, Jr., MD, PhD, who co-chaired the ACC/AHA risk assessment guideline writing group. “Since that time, we have collected a large amount of research that has further enhanced our understanding of how best to care for these patients and improve our approaches to determining who should get specific types of preventive treatments.” Risk Assessment A key goal of the ACC/AHA guideline is to ensure that preventive treatments—especially lifestyle changes and drug treatment—are used in those who are most likely to benefit from them. To do this, the guideline includes high-quality risk assessment methods that use risk factors that are known to lead to atherosclerosis (Table 1). Factors such as age, cholesterol levels, blood pressure, smoking, and diabetes can be easily collected by clinicians and then integrated into a risk score to guide care and prompt discussions with patients.   “The vast majority of heart attacks and strokes could be prevented if patients knew...
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