Journal of pain & palliative care pharmacotherapy
-
Buprenorphine is a partial mu agonist opioid that is FDA-approved to manage opioid addiction in settings outside of traditional methadone clinics. The clinical uses, pharmacokinetics, pharmacodynamics, toxicology, and management of overdoses of buprenorphine are reviewed.
-
J Pain Palliat Care Pharmacother · Jan 2009
ReviewMedical marijuana: the conflict between scientific evidence and political ideology. Part two of two.
In Part I of this article, I examined the role of the Food and Drug Administration (FDA) in drug approval and then detailed the known risks of medical marijuana (any form of Cannabis sativa used--usually by smoking--to treat a wide variety of pathologic states and diseases). Part II of the article will begin by reviewing the benefits of Cannabis sativa as documented by well designed scientific studies that have been published in the peer-reviewed literature. ⋯ I will conclude that political advocacy is a poor substitute for dispassionate analysis and that neither popular votes nor congressional "findings" should be permitted to trump scientific evidence in deciding whether or not marijuana is an appropriate pharmaceutical agent to use in modern medical practice. Whether or not marijuana is accepted as a legitimate medical therapy should remain in the hands of the usual drug-approval process and that the statutory role of the Food and Drug Administration should be dispositive.
-
J Pain Palliat Care Pharmacother · Jan 2009
ReviewMedical marijuana: the conflict between scientific evidence and political ideology. Part one of two.
Whether "medical marijuana" (Cannabis sativa used to treat a wide variety of pathologic states) should be accorded the status of a legitimate pharmaceutical agent has long been a contentious issue. Is it a truly effective drug that is arbitrarily stigmatized by many and criminalized by the federal government? Or is it without any medical utility, its advocates hiding behind a screen of misplaced (or deliberately misleading) compassion for the ill? Should Congress repeal its declaration that smoked marijuana is without "current medical benefit"? Should cannabis be approved for medical use by a vote of the people as already has been done in 13 states? Or should medical marijuana be scientifically evaluated for safety and efficacy as any other new investigational drug? How do the competing--and sometimes antagonistic--roles of science, politics and prejudice affect society's attempts to answer this question? This article examines the legal, political, policy, and ethical problems raised by the recognition of medical marijuana by over one-fourth of our states although its use remains illegal under federal law. ⋯ Instead, the specific focus of this article will be on the conflict between the development of policies based on evidence obtained through the use of scientific methods and those grounded on ideological and political considerations that have repeatedly entered the longstanding debate regarding the legal status of medical marijuana. I will address a basic question: Should the approval of medical marijuana be governed by the same statute that applies to all other drugs or pharmaceutical agents, the Food, Drug, and Cosmetic Act (FD&C Act), after the appropriate regulatory agency, the Food and Drug Administration (FDA), has evaluated its safety and efficacy? If not, should medical marijuana be exempted from scientific review and, instead, be evaluated by the Congress, state legislatures, or popular vote? I will argue that advocacy is a poor substitute for dispassionate analysis, and that popular votes should not be allowed to trump scientific evidence in deciding whether or not marijuana is an appropriate pharmaceutical agent to use in modern medical practice.
-
J Pain Palliat Care Pharmacother · Jan 2009
Impact of constipation on opioid use patterns, health care resource utilization, and costs in cancer patients on opioid therapy.
Patterns of opioid use, resource utilization, and costs in cancer patients with and without constipation were compared using retrospective insurance claims data. Inclusion criteria were > =30 days of opioid use and continuous plan coverage for > or =6 months before and > or =12 months following first opioid claim (index date). Constipation was defined as > or =1 ICD-9-CM diagnosis codes in the range of 564.0x during the 12 months postindex date. ⋯ Compared with controls, patients with constipation had substantially higher total costs (P < .0001). This study suggests that in opioid-treated cancer patients, constipation significantly impacts opioid-use patterns, resource utilization, and costs. Alleviation of constipation may optimize opioid therapy and reduce costs.
-
J Pain Palliat Care Pharmacother · Jan 2009
Do international model drug control laws provide for drug availability?
A preliminary review of the United Nations Office on Drugs and Crime (UNODC) model drug control laws was conducted by the Pain & Policy Studies Group (PPSG) to determine whether the models provided governments with language they can use to carry out the obligation to ensure adequate availability of opioid analgesics for the relief of pain and suffering, specified in the Single Convention on Narcotic Drugs, 1961 as amended, and as recommended by the International Narcotics Control Board in 1995. The results showed that current model laws lack the drug availability provisions. Based on initial positive feedback from the International Narcotics Control Board, the UNODC, and the World Health Organization, the PPSG developed preliminary recommendations based on existing provisions in the Single Convention. ⋯ If these models convey the dual obligations of governments, the models would be considered "balanced," and national governments would have model policy language not only for control of licit drugs, but also for their availability. Most governments have already adopted laws to implement the Single Convention; however, it is not known if they followed the Single Convention itself or model laws. The PPSG conducted this preliminary assessment of whether the models published by the United Nations Office on Drugs and Crime are balanced, using as a guide the 1995 recommendations of the International Narcotics Control Board (www.incb.org/pdf/e/ar/1995/suppl1en.pdf) and the 2000 WHO publication Achieving Balance in National Opioids Control Policies: Guidelines for Assessment (www.painpolicy.wisc.edu/publicat/00whoabi/00whoabi.htm).