Day: January 28, 2021

Categories : Addiction Pain ManagementTags :

Opioid Deaths Drop when Cannabis Stores are Near

On By ModernMedia

A new US study suggests that opioid-related mortality rates fall in counties where there are legal cannabis stores.

Cannabis was first legalised for medical use in the US in 1996; recreational legalisation began in 2012 with a number of states following suit. Previous research on the effect of legal access to cannabis on opioid overdose mortality had produced conflicting results, with a 2014 study showing a slow increase in deaths, but a subsequent study showing that it reversed over time.

Data on opioid mortality for adults 21 and over was drawn from 2014-2018 CDC data, and a website called Weedmaps for cannabis dispensary details in the 23 states plus the District of Columbia where cannabis dispensaries were allowed to operate as of 2017.

The number of cannabis dispensaries in a county was negatively related to log-transformed age-adjusted opioid mortality rate (β -0.17, 95% CI -0.23 to -0.11). An increase in the number of storefront dispensaries from one to two was linked to a 17% reduction in death rates of all opioid types, and an increase from two to three stores was associated with a further 8.5% drop in mortality.

Eight states plus the District of Columbia allowed recreational storefronts and 15 allowed only medical dispensaries. An increase in medical dispensaries from one to two resulted in a 15% drop in mortality rate; an increase in recreational dispensaries from one to two led to an 11% drop.

Co-author Balázs Kovács, PhD, of Yale University School of Management, said: “We find this relationship holds for both medical dispensaries, which serve only patients who have a state-approved medical card or doctor’s recommendation, as well as for recreational dispensaries, which sell to adults 21 years and older.”

An accompanying editorial pointed out that the relationship was not clear, noting that were was no evidence of substitution. Additionally, individual experiences of benefits and harms could not be inferred.

Although findings are suggestive of a possible link between the increased prevalence of cannabis dispensaries and reduced opioid-related mortality, they do not show causality, Kovács emphasised. “While we find a particularly strong association between the prevalence of storefront dispensaries and fentanyl-related opioid deaths, it is not clear whether cannabis use and fentanyl mortality rates are more specifically linked, or if the strength of the association is due to the rise in fentanyl use and mortality rates during the study period,” he said. 
He added that the potential harms of cannabis, including cognitive development of adolescents, schizophrenia and other medical conditions, and public safety risks, should not be ignored.
Source:MedPage TodayJournal information:  Hsu G and Kovács B “Association between county level cannabis dispensary counts and opioid related mortality rates in the United States: panel data study” BMJ 2021; DOI: 10.1136/bmj.m4957.

Categories : Cardiovascular DiseaseTags :

Moderate Alcohol Has an Immediate Effect on the Heart

On By ModernMedia

One or two drinks a day may make for a healthy heart, but people with atrial fibrillation (AFib) may experience immediate impacts, as a new study reveals.

University of California, San Francisco (UCSF) researchers found that alcohol immediately changed the electrical properties driving heart muscle contraction in patients undergoing a treatment for AFib. These subjects were randomised to receive an infusion of alcohol maintained at the lower limit of legal intoxication, An equal number of control subjects who instead received a placebo infusion did not have this occur. The work was published January 27, 2021 in the Journal of the American College of Cardiology: Clinical Electrophysiology,

Senior study author Gregory Marcus, MD, professor of medicine in the Division of Cardiology at UCSF explained: “The acute impact of exposure to alcohol is a reduction in the time needed for certain heart muscle cells in the left atrium to recover after being electrically activated and to be ready to activated again, particularly in the pulmonary veins that empty into the left atrium.”    

AFib is the most common cardiac rhythm disorder, affecting some 1% of the world’s population, and is characterised by tachyarrhythmia. It is caused by abnormal electrical activity in the atria of the heart, making them fibrillate. This causes the atria to pump blood inefficiently, leading to feelings of the heart pounding, fluttering or skipping a beat. Due to turbulence caused by the irregular rhythm, a clot could form which could lead to a stroke. This results in some 158 000 deaths in the US annually. Other negative impacts include fatigue, weakness, dizzy lightheadedness, difficulty breathing and chest pain.

The study patients were undergoing a catheter ablation procedure. This is commonly used to suppress AFib by severing the electrical connection between the pulmonary veins and the left atrium. This areas was also the area noted to be affected by alcohol in the study.

Preparation for the ablation therapy required installation of catheters and electrodes in the heart chambers to monitor and pace the heart, and destroy selected tissue. The study measured refractory time before cells could again transmit electrical signals, and conduction speeds, as well as a stimulus inducing more AFib events. Electrical conduction speed and induced AFib events did not vary, but a 12 millisecond delay was seen in tissue around the pulmonary vein in the alcohol infusion group.

“Although epidemiological studies have found an association between self-reported alcohol consumption and the development of an atrial fibrillation diagnosis, ours is the first study to point to a mechanism through which a lifestyle factor can acutely change the electrical properties of the heart to increase the chance of an arrhythmia,” Marcus said. The same changes caused by alcohol infusion in the study have earlier been associated with episodes of AFib in previous computer models and animal studies, he said.
“Patients should be aware that alcohol can have immediate effects that are expected to increase risk for arrhythmias,” Marcus concluded.

However, in a separate study, injecting ethanol into the vein of Marshall when performing a catheter ablation seemed to increase the odds of treatment success compared to catheter ablation alone.

Source: MedicalXpress

Categories : COVID PoliticsTags :

EU Demands AstraZeneca Vaccine Produced by UK Plants

On By ModernMedia

In another twist to the EU’s seemingly never-ending vaccine procurement problems, the EU health minister has demanded that vaccine production from AstraZeneca’s UK operations be sent to EU countries to make up for the company’s shortfall at its two European plants. 

EU health commissioner Stella Kyriakides dismissed AstraZeneca’s argument that it the UK take precedence.

“We reject the logic of first come, first served,” the commissioner declared. “That may work at the neighbourhood butcher’s [shop] but not in contracts and not in our advanced purchase agreements. There’s no priority clause in the purchase agreements.”

The Anglo-Swedish company had triggered fury in Brussels when it was revealed that it would only be able to deliver 25% of the agreed vaccine doses when they received approval as expected this Friday. However, AstraZeneca assured the UK government that it would meet its commitment of supplying 2 million doses a week. UK government sources insisted that only once AstraZeneca had fulfilled its order to provide the UK with 100 million doses would its vaccine production be allowed to be released to serve other countries.

The EU meanwhile is flagging far behind, with only 2% of its adult population vaccinated compared to 10% of the UK’s. Kyriakides pointed out that in its contract with AstraZeneca, four European plants were listed as suppliers and two of those were located in the UK, and she expected them to work for EU citizens.

An AstraZeneca spokesperson said: “Each supply chain was developed with input and investment from specific countries or international organisations based on the supply agreements, including our agreement with the European commission.

“As each supply chain has been set up to meet the needs of a specific agreement, the vaccine produced from any supply chain is dedicated to the relevant countries or regions and makes use of local manufacturing wherever possible.”

Kyriakides said the argument was unacceptable, emphasising that the company had a moral duty to treat the EU similarly to the UK, adding that there was no “priority clause” that would justify UK residents benefiting first from doses made there.

Germany meanwhile has said that it is facing 10 weeks of vaccine shortage.
However, there is encouraging news as Israel reported a 92% effectiveness with the Pfizer/BioNTech vaccine outside trials. Only 31 of 163 000 Israelis caught COVID within ten days of the innoculation reaching its full strength. None were hospitalised.

Source: The Guardian

Categories : Addiction Pain ManagementTags :

New Study Challenges the Need for Some Post-surgical Opioids

On By ModernMedia

Doctors must carefully weigh the pain relief value of opioids for patients against their potential for misuse and inducing opioid addiction even in patients with no history of substance abuse. Now, a new study challenges current practice by showing the effectiveness of an approach that takes a middle way to giving opioids.

Some 16 million people around the world suffer from opioid use disorder, which can result from opioid administration from surgery and for chronic pain. Opioids are highly addictive, with tolerance reached in days and addiction can occur within a matter of weeks, so there is every incentive to minimise exposure of patients to these effective but potentially dangerous medications.

To investigate the effectiveness of minimising opioid use, a team from Michigan Medicine at the University of Michigan conducted a study with 620 patients who had surgery in hospitals across Michigan, had their anaesthetic usage tracked, and filled in surveys within one to three months following their surgeries. The patients were split equally into two groups.
The first group received pre-surgery counseling emphasising non-opioid pain treatment as their first option. Some patients in this group received small, “just in case” prescriptions, but a third of them didn’t receive any opioid prescription at all after surgery.

The patients in the other group received standard care, that is, receiving the usual amount of opioids prescribed after such operations. The prescriptions received in fact were larger than in the opioid sparing group. Most patients didn’t take all of the pills, which if left lying around could be used inappropriately.

Patients in the two groups had the same surgery: either gallbladder removal, full or partial thyroid removal or hernia repair. However, both groups reported equal levels of quality of life and satisfaction with care when followed-up. Most surprisingly, the opioid-sparing group reported less pain overall.

First author Maia Anderson, MD, a resident in the U-M Department of Surgery, said: “It’s so exciting to think about the potential for opioid sparing postoperative pathways to not only reduce the risk of opioids for our patients, but also to substantially decrease the risk of opioid diversion into our communities.”

Senior author Ryan Howard, MD, Surgical Resident, Michigan Medicine commented: “We know that opioids pose serious risks to patients after surgery. We can protect patients from those risks by reducing or eliminating opioids after surgery. But that idea always raises the concern that patients will have uncontrolled pain and feel miserable. This study suggests that’s not the case – patients who get small opioid prescriptions, or even no prescription, are just as satisfied with their recovery after surgery.”

Source: News-Medical.Net

Journal information: Anderson, M., et al. (2020) Patient-Reported Outcomes After Opioid-Sparing Surgery Compared With Standard of Care. JAMA Surgery. doi.org/10.1001/jamasurg.2020.5646.

Categories : COVIDTags :

Six Key Takeaways of SA’s Vaccination Programme

On By ModernMedia

From a webinar held by the Department of Health late Wednesday night, there are six key points that were learned about the government’s vaccination programme.

1: To receive a vaccine, people will need an internet connection, cellphone and an ID. The internet connection is needed for self-enrolment on the Electronic Vaccine Data System (EVDS), and the cellphone is needed to receive an SMS detailing the time and place for vaccination. An ID book is required for identification. After the second vaccination (if a two-dose vaccine), an “electronic vaccination certificate” can be accessed from the EVDS. No mention was made of alternatives for those without ID books or internet access to the EVDS.

2: Private doctors and nurses will be paid R50 to R60 per shot administered. However, the government would prefer to use public healthcare facilities wherever possible.

3: Medical aids will pay double or triple for the vaccine doses. As reported in early January, medical aid schemes will pay for some of the costs of achieving herd immunity. The single exit price (SEP) of vaccines will be higher. Whether medical aids cover the number of additional doses for uninsured people at 1:1 or 2:1 is yet to be determined.

4: Mines have significant vaccination capacity – assuming they have enough doses on hand. The head of health for the Minerals Council, Thuthula Balfour, explained: “We’ve actually worked out that the industry can administer about 60 000 to 80 000 vaccines a day, so within two months we could vaccinate between 2.5 million to 3 million people.” This would equate to some five extra people per mineworker.

5: Rural clinics without generators will not receive vaccines. The distribution will use a hub-and-spoke model with hubs that are able to guarantee security and available electricity receiving vaccine stocks.

6: The auditor-general is already involved, to forestall corruption. Health Minister Zweli Mkhize said that “all the approaches that we’re taking to make sure that at the end of it they can give us a sense of checks and balances they are going to suggest as we deal with the risks associated with this process.”

Source: Business Insider

Categories : Cardiovascular Disease ExerciseTags :

Large Study Casts Doubt on “Fat but Fit”

On By ModernMedia

New Spanish research casts doubt on the “fat but fit” paradox, where it is thought that physical fitness is enough to eliminate cardiovascular disease (CVD) risk.

Overweight and obesity is a worldwide problem that is greatly contributing to the burden of noncommunicable diseases, including CVD. A high body mass index (BMI) is strongly associated with CVD risk factors, such as hypercholesterolaemia, hypertension and diabetes. The cardiovascular complications arising from overweight and obesity are driven by processes such as inflammation, insulin resistance, endothelial dysfunction, coronary calcification. Some evidence suggested that physical activity was cardioprotective, partly or completely eliminating the CVD risk from disease – the “fat but fit” paradox.

A recent meta-analysis showed that cardiovascular fitness was a better predictor of cardiovascular disease over overweight/obesity, suggesting that perhaps public health programmes should emphasise fitness over control of body weight. To this end, the researchers sought to confirm if the “fat but fit” paradox was real.

The researchers gathered data from workers’ health insurance, with participants aged 18-64 grouped into normal weight, overweight and obesity by BMI, and into regularly active ( >150 min moderate physical activity or equivalent per week), insufficiently active (less than regularly active) and inactive (no physical activity at all). They were further separated by age, sex, smoking status and residential address.

Approximately 42%, 41%, and 18% of participants had normal weight, overweight, or obesity, respectively; 63.5%, 12.3%, and 24.2% were inactive, insufficiently active, and regularly active; and 30%, 15%, and 3% had hypercholesterolaemia, hypertension, and diabetes.

However, the protective effect of physical activity was far less than the excess risk from overweight/obesity. So much so that even regularly active obese participants had two to five-fold risk increases over their inactive but normal weight peers in the risk factors.

The protective effect of physical activity in overweight/obesity remains controversial. Shortcomings of the study were that they did not control for diet, and only accounted for self-reported leisure time activities. However, the large study size, with over 500 000 participants, should put paid to the theory that a physically active lifestyle can completely eliminate the deleterious effects of overweight/obesity.

The researchers concluded that, “weight loss per se should remain a primary target for health policies aimed at reducing CVD risk in people with overweight/obesity.”

Journal article source: European Journal of Protective Cardiology

Journal information: Pedro L Valenzuela, et al., Joint association of physical activity and body mass index with cardiovascular risk: a nationwide population-based cross-sectional study, European Journal of Preventive Cardiology, 2021;, zwaa151, https://doi.org/10.1093/eurjpc/zwaa151