States that have medical marijuana laws have lower rates of death due to unintentional opioid narcotic overdoses according to a new study. (An intentional overdose is suicide.) Perhaps those with pain don’t have to turn to opioid pain relievers if they have access to medical marijuana. I know this was true in my practice in San Diego. When the police took all the equipment of a marijuana dispensary, some of my patients were in such pain, that I had to prescribe opiates such as Norco®. It is a hassle being on a narcotic for the clinic and patient. If this lowered narcotic use is true, then it is estimated to have prevented 1,729 fewer deaths in 2010. For each year after legalization, there were even more fewer deaths. It takes time for the complete rollout of a new medical cannabis bill. San Diego and Riverside Counties took the rollout to court for many years. There are some authorities who do not feel there is this association between medical cannabis and opiate deaths.
There was a push in the 1990s to prescribe more opioids for pain since many were suffering and could have been relieved with opioids like Oxycontin® and Fentanyl Patch®. After this push, we had many people, including teens, dependent on opioids along with a great increase in death from overdoses. So lately, there is a push to avoid opioids if possible and if they are needed, a Pain Specialist referral may be a good idea. Chronic opioid use can cause difficult constipation and an increased sensitivity to pain which is separate from tolerance (needing more medication to get the same effect). Many clinics have behavioral problems from those who sell them, lose them, or use them to get high. IEHP is requiring providers to have the patient sign a pain contract and have the provider fill out forms for those who need above a certain amount. We are using physical therapists to help manage pain and lower the doses of medication.
GOUT AND HEART DISEASE
Like HIV, gout has been shown to increase the risk of strokes and heart attacks a little more than in patients without gout.
HIGH CHOLESTEROL MEDS NOT FOR YOU?
If you have one of the 5 main risks for artery disease (heart attacks and strokes)–smoking, (close) family history of the same early enough in their lives, hypertension, diabetes, and of course high cholesterol–then these medications lower your risk for artery disease. If you don’t, then cholesterol medications are not going to help you, according to the latest research. If you are on one of these and you have muscle pain, brain slowing, liver or kidney damage, fatigue, or sexual dysfunction then you should discuss this with your provider. These medications are to lower your long-term risk so stopping them for a week or two to see if you are better from the suspected side effects is not going to make a major difference in the long run. As always, this column is not a substitute for thoughtful consultation with a primary medical provider. Lifestyle changes (e.g. diet, exercise, not smoking) have greater impact than medications usually. This makes sense if you know that medications can alter just one chemical pathway, but a lifestyle change modifies many things.
Funny that one study found that patients taking high cholesterol medications were fatter and exercised less. Did the medications do this or did they feel they shouldn’t change their lifestyles and let the medication work its “magic?” Many feel it is easier in the short term to take a pill for many problems. The authors recommend further study.
There are some important studies showing that moderate sodium intake causes less artery disease problems than low sodium or high sodium intake. So a very low sodium diet may not be necessary.
MORE VITAMIN D NEWS
A major study suggests that Vitamin D levels below 30 should be supplemented and taking 1000 mg once a day is a safe and effective dose.
CELL PHONES DANGEROUS FOR FETUSES AND CHILDREN?
Studies do not agree much on this problem. This is difficult to study and takes probably 30 years to prove since some cancers take that long to develop. We are talking about breast, testicular, and brain cancers. Radiation does change brain tissue so it is a good idea to not have a cellphone near a pregnant mother’s abdomen, remove cellphones from being close to children at night (many put them under their pillows), do not place the baby monitor in the crib, boys should not pocket cell phones (near their testicles), and girls shouldn’t place them near their breasts (in their bra). Children have less tissue protection from radiation, including thinner skulls and they have the time to develop a cancer.
Tivicay® (dolutegravir) is the medication that had great results and rose to a preferred pill quickly. Combined with lamivudine (Epivir®) and abacavir (Ziagen®)–which together make Epzicom®–a new triple drug, single pill combination is now available. It is well tolerated. The chance of a serious drug reaction to the abacavir is prevented if a blood test comes out right. There are some drug-drug interactions your provider and pharmacist should check on.
Keep those questions coming. Be Safe!
Daniel Pearce, D.O., FACOI, AAHIVS
Clinical Associate Professor of Medicine, Loma Linda University School of Medicine
Adjunct Professor of Internal Medicine and HIV, Touro University California College of Osteopathic Medicine and Midwestern University Arizona College of Osteopathic Medicine
Researcher, Veterans Administration Hospital, Loma Linda
HIV Specialist, Riverside County Public Health Department
Hepatitis C Specialist and Researcher, Southern California Liver Centers, Riverside