Prescription drugs

Just imposing generic prescribing is not enough

Dear Editors,

New evidence reveals that, every year, 1 billion euros worth of pharmaceuticals are thrown away from households alone, in Greece. [1][2]

This figure does not include public hospital pharmaceuticals!

Furthermore, only a small percentage of these are generics.

It is evident that over-prescription of pharmaceuticals in Greece is still widespread, despite tough austerity measures and constant IMF-EU-ECB surveillance.

Dr Stavros Saripanidis is a diligent Greek taxpayer who pays for all these expensive pharmaceuticals that get thrown away.

References

[1] http://www.ekathimerini.com/4dcgi/_w_articles_wsite1_1_08/02/2012_426697

[2] http://www.athensnews.gr/portal/1/53081

Extensive off label prescriptions of proton pump inhibitors in Greece.

Dear Editors,

Many Greek medical doctors prescribe expensive proton pump inhibitors for everything, in order to “protect the stomach” from various other pills or therapies.

This widespread off label use of proton pump inhibitors in my Country is the result of under the table deals with pharmaceutical Companies. [3]

Despite increasing debt, Greece continues to spend the most on pharmaceuticals. [1]

Results from this research study demonstrate that this practice is harmful both financially and clinically. [2]

Let us hope Ministry officials in Greece manage to limit this phenomenon.

Dr Stavros Saripanidis is a diligent Greek taxpayer who pays for all these expensive pharmaceuticals that get prescribed for presumed off label benefits.
References

[1] http://www.bmj.com/content/343/bmj.d4803?tab=responses

[2] http://www.bmj.com/content/344/bmj.e372

[3] http://www.bmj.com/content/342/bmj.d2408?tab=responses

Greece stalling signed mandatory generic prescribing

Dear Editors,

Compulsory prescription by active substance was supposed to be established in the first months of year 2012, according to this signed Greece-IMF memorandum. [1]

“Mandating the substitution of prescribed medicines by the lowest–priced product of the same active substance in the reference category by pharmacies”(compulsory "generic substitution"). [Q1-2012]

There is absolutely no cost in implementing this measure.

Indeed it is going to save billions!

Yet, for months, politicians in my Country have been deliberately stalling implementation.

IMF money has saved my Country from economic destruction.

Why should politicians risk breaking this pact by non implementing signed conditions?

Dr Stavros Saripanidis wants to prescribe cheap generics by active substance but the Greek Government won’t let him!

Reference

[1] http://www.imf.org/external/np/loi/2012/grc/030912.pdf

Doctors uncaring is the cause of opioid problems today. For over 150 years the most prescribed pain medicine is morphine-despite opioids causing slepp apnea, overdose, mental fog, addiction. hormone problems-doctors and medicien have failed to come up with safer and more feffective medications and treatments- Dr Turk who was on the IOM study on pain indicated pills wont cure pain- and he indicated our best medicines are only 15 effective for pain. Less then 1% of the NIH budget goes for chronic pain research. In a study last year nurses were asked about barriers to pain care- 25% said its because doctors really dont care about peoples pain. In another study last year 70% of physicians indicated they are unable to diagnose pain. In another study 70% of physicians failed basic test of musculokeletal knowledge- 80% of pain is musculoskeletal. Not a single institute at NIH has as their goal lowering the prevalence of painful conditions. The prevalence of painful conditions has risen very rapidly over the past decades -with no vision or plan in medicine or government to energetically address such. Its clear tha neither government nor medicine care about the suffering or costs of chronic pain. We pay 4X as much per capita for pain as the EU-that certainly wasnt in the IOM report on pain. The IOM, government, and medicine want people to receive "treatments" for pain but are not concerned enough to see that people in pain have the benefit of doctors with education in pain care-and even the so called pain specialists are undereducated- a point which the AAPM was able to convince the AMA of -less then a few years ago. Everywhere you turn the negligence of government and medicine is apparent when it comes to pain care- the ones who pauy for such are not government or pain care-but people suffering pain and the rest of the public. The sorry state of affairs in pain care will continue until the government hears too much complaints from people in pain.

Dire means horrible, as in the consequences of action on or in view of the complacent.

I agree with Balko often enough but there's a parallel lexicon for the hyperbole of libertarians when they talk about government intervention and the hyperbole of liberals and conservatives when they talk about human behavior.

Some simple facts:

* Colombia, Peru, Mexico or Afghanistan with their coca leaves, marijuana buds or poppy sap are not igniting temptation in the minds of our weak, innocent citizens. These countries are duly responding to the enormous demand that comes from within our own borders. Invading or destroying these countries, thus creating more hate, violence, instability, injustice and corruption, will not fix our problem.

* A rather large majority of people will always feel the need to use drugs such as heroin, opium, nicotine, amphetamines, alcohol, sugar, or caffeine.

* The massive majority of adults who use drugs do so recreationally - getting high at the weekend then up for work on a Monday morning.

* Apart from the huge percentage of people addicted to both sugar and caffeine, a small minority of adults (5%) will always experience the use of other drugs as problematic. - approx. 3% are dependent on alcohol, and 1.5% dependent on other drugs.

* Just as it was impossible to prevent alcohol from being produced and used in the U.S. in the 1920s, so too, it is equally impossible to prevent any of the aforementioned drugs from being produced, distributed and widely used by those who desire to do so.

* Prohibition kills more people and ruins more lives than the drugs it prohibits.

* Due to Prohibition (historically proven to be an utter failure at every level), the availability of most of these mood-altering drugs has become so universal and unfettered that in any city of the civilized world, any one of us would be able to procure practically any drug we wish within an hour.

* Throughout history, the prohibition of any mind-altering substance has always exploded usage rates, overcrowded jails, fueled organized crime, created rampant corruption of law-enforcement - even whole governments, while inducing an incalculable amount of suffering and death.

* The involvement of the CIA in running Heroin from Vietnam, Southeast Asia and Afghanistan and Cocaine from Central America has been well documented by the 1989 Kerry Committee report, academic researchers Alfred McCoy and Peter Dale Scott, and the late journalist Gary Webb.

* It's not even possible to keep drugs out of prisons, but prohibitionists wish to waste trillions of dollars in an utterly futile attempt to keep them off our streets.

* The United States jails a larger percentage of it's own citizens than any other country in the world, including those run by the worst totalitarian regimes, yet it has far higher use/addiction rates than most other countries.

* Prohibition is the "Goose that laid the golden egg" and the lifeblood of terrorists as well as drug cartels. Both the Taliban and the terrorists of al Qaeda derive their main income from the prohibition-inflated value of the opium poppy. An estimated 44 % of the heroin produced in Afghanistan, with an estimated annual destination value of US $ 27 Billion, transits through Pakistan. Prohibition has essentially destroyed Pakistan's legal economy and social fabric. - We may be about to witness the planet's first civil war in a nation with nuclear capabilities. - Kindly Google: 'A GLOBAL OVERVIEW OF NARCOTICS-FUNDED TERRORIST GROUPS' Only those opposed, or willing to ignore these facts, want things the way they are.

* The future depends on whether or not enough of us are willing to take a long look at the tragic results of prohibition. If we continue to skirt the primary issue while refusing to address the root problem then we can expect no other result than a worsening of the current dire situation. - Good intentions, wishful thinking and pseudoscience are no match for the immutable realities of human nature.

* The urge to save humanity is almost always a false-face for the urge to rule it. - H. L. Mencken (1880-1956) American editor, essayist and philologist.

In addition to the many societal costs of prohibition, it has a long history of driving the spread of harder or more dangerous drugs.

* Poppies to morphine to heroine to krokodil
* Coca to cocaine to crack
* Ephedra to ephedrine to speed to methamphetamine
* Marijuana to skunk to dangerous synthetic concoctions such as 'spice' or 'bath salts'
* Mushrooms to ecstasy to 2CB/designers

At every step the reasons for the rise in popularity of the new form of the drug are one or more of the following:

* It may easier to smuggle.
* It may be more addictive, thus compelling the buyer to return more frequently.
* It may be cheaper to produce therefore yielding more profit.
* Like a game of "whack a mole" a shutdown of producers in one area will mean business opportunities for another set of producers with a similar product.

Prohibition's distortion of the immutable laws of 'supply and demand' subsidizes organized crime, foreign terrorists, corrupt cops & politicians and feeds the prejudices of self-appointed culture warriors. So called Tough-On-Drugs politicians have happily built careers on confusing drug prohibition's horrendous collateral damage with the substances that they claim to be fighting, while the big losers in this battle are everybody else, especially taxpayers.

How come so many of us have been deluded into believing that big government is the appropriate response to non-traditional consensual vices?

Imagine if we were to chop down every single tree on the planet as a response to our failure to prevent tree-climbing accidents. That's what our misguided drug policy looks like. Isn't it time we all stood up and told the government we're tired of being beaten and jailed so that pharmaceutical companies can poison and kill us for obscene profits?

Prohibition Prevents Regulation : Legalize, Regulate and Tax!

For a publication that has, in the past, admirably supported the legalization of drugs, the positon taken in this post is appalling. Nowhere in the Constituition does it give the government the right to regulate what we put in our bodies nor does it state that the gov't is empowered to protect us from ourselves. Better to eliminate all gov't controls over access to drugs, both recreational and prescription (with the likely exception of antibiotics due to the impact on their effectiveness of overuse). Insurance coverage would, however, only be provided with a doctor's prescription. If some people choose to use these drugs in a manner that results in their deaths, that is neither the gov't's nor my business and may actually result in a useful culling of the herd.

Oh good, we're phasing out the drug war. And here I was thinking we'd keep shooting ourselves in the foot for another four decades.

I have conflicted feelings about this. In the area where I grew up (Appalachian Ohio) pills seem like an increasingly serious problem. Poverty is very high and people tend to have a life of physically punishing work and federal/state assistance with health care when their spines or other joints explode. The area is literally awash in pharmaceuticals and they are readily available to nearly anyone. People get fairly generous subscriptions, and I can't really blame folks with little money for selling what they don't consume.

synthetic opioids may turn to real opiates like heroin

Heroin is the ultimate synthetic opiate. Opium is the only non-synthetic opiod, it is found in poppies. Opium is then modified to produce all of the synthetic derivitives. You could argue that the popppy also synthesizes the stuff, so opium is also, strictly speaking, synthetic, but we usually divide the world up into stuff that we make and everything else.

I believe the post phrases the issue slightly off: law enforcement is encroaching not because of pill mills but because the pills themselves are dangerous. The emphasis is different; it's not merely that pill mills exist but that the pills kill people. Large numbers of people.

And to agree with another commenter, pot is shown to have very few bad effects. The latest is that pot doesn't even constrict breathing, that regular use of pot below the level of "heavy user", had a positive effect on lung function. Cigarettes, by contrast, materially constricted lung function.

End the Military Aggression, eXcessive Incarceration, and Police Action on Drugs AKA MAXI PAD! It's bloody and there are better alternatives according to Tobacco, Alcohol, Meth, and Pharmaceutical Addiction eXperts.

Oh please- if the cdc was really concerned with painkillers they ask the president to come up with better medications then opioids-after all opioids have been in use for over 2500 years- you think in the postgenomic era our genius medical system would come up with safer more effective treatments? But of course the problem of opioids is a red herring representing the moral and menal laziness both government and medicine has toward people in pain. The doctors fight against having any education in pain care- a study last year showed they know all of three medications for pain. And government is captured by the intersts of medicine and refuses to serve recognize the needs of people in pain. They have no vision to lower the prevealence of pain. The CD lke the rest of government continues to fiddle while people in pain burn. Their so called concerns ring false given their lack of vision and refusal to address the sad truths about pain care that medicine has a history of not caring about people in pain and government just goes along with what medicine wants- i challenge any one in government or medicine to debate me publically on this issue-but lazy cowards arent my match

This is another example of the "war on drugs" agents choosing the greater evil.

Wouldn't it be wonderful if there was a painkiller that did not cause physical addiction or death? How about a natural painkiller that couldn't be patented and thus helped lower healthcare costs?

No one has ever overdosed on cannabis.