Category: Diseases and Conditions

STOP Act: Implementation and Effects on the Opioid Epidemic in North Carolina

The rise of the opioid epidemic nationwide has led to an increase of attention from both media and policy makers. Here in North Carolina, a recently passed policy is the Strengthen Opioid Misuse Prevention, or STOP Act, which aims to reduce the amount of Opioids prescribed a one approach to tackle the epidemic. The STOP Act was signed into law by Governor Roy Cooper on June 29, 2017, and since then its four stage implementation has been put into effect, which will continue until 2020.

The first step of implementation occurred almost immediately after the law’s passage, on July 1st 2017, requiring Physician Assistants (PAs) and Nurse Practitioners (NPs) to personally consult with a supervising physician. This applied to Pas and NPs at facilities that primarily engage in treating pain, and the prescription will, or is expected to, last longer than 30 days. Additionally, PAs and NPs have to consult with a supervising physician every 90 days for patients for are continuously prescribed opioids.  Providers are also required to provide information on the disposal of controlled substances, both written and orally, when a patient concludes a course of treatment. The second aspect, implemented on September 1st, 2017, requires that pharmacies report targeted prescriptions to the North Carolina Controlled Substance Reporting System within a day of the prescription is dispensed.

The most recent aspect of the STOP Act was implemented on January 1st, 2018, and limits the amount of opioids prescribed for acute pain. Practitioners are not able to prescribe more than five days’ worth of any Schedule II or III Opioid or Narcotic, with an exception to things like pain after surgery, where the prescription cannot for longer than seven days. The final part of the law will be implemented on January 1st, 2020, and will require practitioners to electronically prescribed targeted controlled substances, with a few exceptions.

While it is still unclear what impact the law will have on overdose deaths in the state, it appears that the State government is attempting to address this issue. While more resources could be devoted to mental health services, naloxone access and syringe exchanges, and more programs geared toward injecting drug users rather than only those who use prescription drugs, it’s commendable that a joint effort was reached to combat this ongoing epidemic.

 

Sources:

New! Summary of NC’s new opioids law, the STOP Act: North Carolina Medical Board – https://www.ncmedboard.org/resources-information/professional-resources/publications/forum-newsletter/notice/new-summary-of-ncs-new-opioids-law-the-stop-act

FAQs: The STOP Act of 2017: North Carolina Medical Board – https://www.ncmedboard.org/resources-information/professional-resources/publications/forum-newsletter/article/faqs-the-stop-act-of-2017

STOP Act Provision Takes Effect Jan. 1, Will Limit Opioid Prescriptions: NC Governor Roy Cooper – https://governor.nc.gov/news/stop-act-provision-takes-effect-jan-1-will-limit-opioid-prescriptions

STOP Act Bill Summary: North Carolina Medical Board – https://www.ncmedboard.org/images/uploads/article_images/The_STOP_Act_summary-OnLetterhead.pdf

 

UNC alumnus writes about journalism’s role in stopping stigma against obesity

Chioma Ihekweazu is a recent doctoral graduate from our very own School of Media and Journalism here at UNC. Not only was I thrilled to see a kind peer’s work showcased in my newsfeed, I was also drawn in by her accurate criticism of how we talk about weight–obesity in particular.

She makes the very important point that while it’s not likely to hear patients who are suffering from cancer referred to as “cancerous” or “diseased”, it is quite common, even among respected news sources, to see the descriptor “obese people”. Chioma advises us to avoid playing into shaming language and “put the person before the condition”.

Please read her article here, though a few key takeaways are outlined below:

  • Avoid headless imagery (this is a form of shaming)–if needed, use non-stigmatizing stock photos
  • Recognize that weight loss is influenced by many factors–such as location, time, and access to food/physical activity
  • Do not use value-laden language; use “classes”, based on BMI, defined by CDC and NIH to talk about obesity
  • Have an appropriate headline
  • Report on facts

Chioma also provides some great examples and resources in her article, to not only help writers and reporters change their words, but also to recognize the flaws in our perspective.

 

 

Top 5 “Wins” for Health in 2017

2017 has been one for the books! Our country inaugurated a new president, two major hurricanes swept through the South, the first solar eclipse in a 100 years, the riots in Charlottesville, and most importantly the royal engagement of Prince Harry and Meghan Markle. In the health-related realm there were many notably scientific and policy advances that occurred this year. Here is my top 5 list of these occurrences.

  1. US Federal Court requires tobacco companies to put out corrective statements about harmful health effects of smoking as a consequence for misleading the public about this through advertisements
  2. First diagnosis of CTE in an alive patient (traumatic brain injury typically seen in football players)
  3. First baby born from a uterus transplant
  4. Development of a digital ingestion tracking system. This is a new technology with the ability to monitor drug adherence after the pill has been taken
  5. Decrease in daily consumption of sugary beverages consumed by Americans since 2014

There were many more significant health-related achievements over this year. What is your top 5 list?

 

References:

https://www.nytimes.com/2017/11/14/health/soda-pop-sugary-drinks.html?rref=collection%2Fsectioncollection%2Fhealth&action=click&contentCollection=health&region=stream&module=stream_unit&version=search&contentPlacement=2&pgtype=sectionfront

 

http://abcnews.go.com/US/nfl-player-confirmed-1st-diagnosis-cte-living-patient/story?id=51181721

 

https://www.cbsnews.com/news/first-baby-born-from-a-uterus-transplant-in-the-u-s-delivered-in-texas/

 

http://www.cnn.com/2017/11/14/health/fda-digital-pill-abilify/index.html

 

https://www.tobaccofreekids.org/media/2017/corrective-statements

Lady Gaga Reveals Battle with Fibromyalgia

This past week, music sensation Lady Gaga revealed on her Twitter account that she has been battling fibromyalgia, and was recently taken to the hospital for severe pain, leading her to cancel one of her performances. While it may not have been easy to do, Lady Gaga’s decision to open up about her condition sheds an important light on the debilitating condition that is fibromyalgia.

According to the Centers for Disease Control, fibromyalgia affects about 4 million US adults. It is a chronic condition characterized by widespread pain and can include symptoms of fatigue, depression, and headaches that can negatively affect quality of life. While it is unclear what causes fibromyalgia,  some possible risk factors include age, stressful or traumatic experiences, family history, and sex. According to the Centers for Disease Control, women are twice as likely to have fibromyalgia as men.

Treatment for fibromyalgia often involves a team of different health professionals, and can be effectively managed with a combination of medication, exercise, and stress management techniques.

Check out the following resources for more information about fibromyalgia and how you can get involved in raising awareness of this condition:

The National Fibromyalgia Association

The American Fibromyalgia Syndrome Association, Inc.

Fibromyalgia | Centers for Disease Control and Prevention

Questions and Answers about Fibromyalgia | National Institute of Arthritis and Musculoskeletal and Skin Diseases  

Note: Lady Gaga has been working on a documentary entitled “Lady Gaga: Five Foot Two,” in which she discusses her battle with fibromyalgia. This film will be available on Netflix on September 22.  

References:

Fibromyalgia. (2017, September 6). Retrieved from https://www.cdc.gov/arthritis/basics/fibromyalgia.htm

Park, Andrea. (2017, September 13). Lady Gaga opens up about having fibromyalgia. https://www.cbsnews.com/news/lady-gaga-opens-up-on-fibromyalgia-on-twitter/

Questions and Answers about Fibromyalgia. (2014, July). Retrieved from https://www.niams.nih.gov/Health_Info/Fibromyalgia/default.asp#c

Are You Healthy?

To understand whether or not your healthy, you have to first understand what it means to be healthy. It seems straightforward, but in the modern age, this is a complex question.

We might at first be inclined to think that being healthy means that you don’t have any illness or injury. But is this always true? What if you have an illness that is managed by medication? What if a person has a disability but the disability doesn’t disrupt their daily life? What if you’ve been diagnosed with pre-hypertension but have no symptoms?

Joseph Dumit, Director of Science and Technology Studies and Professor of Anthropology at the University of California, Davis, discusses various changes to our view of health and illness since the rise of the randomized control trial in his book Drugs for Life: How Pharmaceutical Companies Define Our Health (Duke University Press, 2012). He argues “that being at risk for illness is often treated as if one had a disease requiring lifelong treatments, drugs for life” (6).

Dumit discusses a few prediseases in depth, looking at pre-hypertensive, pre-diabetes, and borderline high cholesterol. “Literally, a disease-sounding syndrome is produced by correlating risk factors and naming it in such a way that it becomes common sense to think about treating ‘it’ as a disease in and of itself” (165). Hence, health becomes a matter of risk where we are all bodies constantly at risk of disease. If you have pre-diabetes, are you healthy? How do we understand our health in a risk economy of health?

This intersects interestingly with Donald A. Barr’s claim, in his book Health Disparities in the United States: Social Class, Race, Ethnicity, & Health, that despite investing so much of our economy in health, US health indexes rank rather low; “[p]erhaps, our basic assumption–that more health care will lead, necessarily, to better health–is flawed.”

Financial Toxicity

By Shauna Ayres MPH candidate 2017

CDC data estimates that 26.8% of families report significant financial burden due to medical costs (Cohen & Kirzinger, 2014) and this figure is expected to grow as insurance premiums, drug prices, medical procedures, and health facility overhead costs continue to rise each year. In addition, the aging US population is using more health services which drives everyone’s costs higher (Patton, 2015; Mitka, 2013).

Unfortunately, cancer is one of the most common and most expensive medical conditions. Cancer diagnosis, treatment, and rehabilitation are all lengthy, complex processes that require a variety of medical experts (Mitka, 2013). All of the visits, time, supplies, machines, therapies, medicines, personnel, etc. required adds to a patient’s out-of-pocket costs. (Zafar & Abernethy, 2013). However, there are not just monetary costs. Depending on the type and stage of cancer, thousands of dollars of lost wages can accumulate due to the time taken off from work to travel to appointments and receive treatments. This causes more financial stress on the patient because they are earning less income while their expenses are increasing (Zafar & Abernethy, 2013).

In the cancer community, the term financial toxicity has gained popularity. Financial toxicity refers to how the cost of a disease and its treatment impacts quality of life (University of Chicago, 2016), like how chemical toxicity effects health. Financial toxicity encompasses all aspects of wellness: physical, emotional, social, occupational, financial, and spiritual. Increased medical costs, and thus financial toxicity, is associated with decreased treatment adherence, worse patient outcomes, and lower self-reported quality of life (Shankaran & Ramsey, 2015; Zafar & Abernethy, 2013).

Financial toxicity should be treated as a symptom of cancer. Discussing personal finances in America is largely taboo, but this cultural norm should be challenged in the healthcare field. Doctor’s should assess the financial situations of their patients and use that information to help inform what the best mode of treatment will be (Shankaran & Ramsey, 2015). There are numerous ways to treat cancer and some are drastically more expensive than others. People may argue that the price tag of a treatment can never outweigh the price of life and that is valid; however, a health professionals must assess each patient’s priorities, both personally, medically, and financially to determine the healthiest individualized treatment path (Emanuel & Steinmetz, 2013; Shankaran & Ramsey, 2015). This does not necessarily mean that poor patients with receive cheaper and lower quality care. If a doctor is aware of a patient’s financial status, he/she can refer the patient to a hospital social worker who can assist in securing charitable funding or grant money to help pay for treatment (Shankaran & Ramsey, 2015). Until the issues of medical spending and insurance are solved, which will unfortunately not occur overnight, health professionals and patients must communicate more effectively to find the optimal comprehensive treatment to achieve the best overall quality of life for each individual (Emanuel & Steinmetz, 2013).

Resources:

Cohen, R.A. & Kirzinger, W.K. (2014) Financial burden of medical care: A family perspective. NCHS data brief, no 142. Hyattsville, MD: National Center for Health Statistics.

Emanuel, E.J., & Steinmetz, A. (2013) Will Physicians Lead on Controlling Health Care Costs?. JAMA; 310(4):374-375.

Mitka, M. (2013). IOM Report: Aging US Population, Rising Costs, and Complexity of Cases Add Up to Crisis in Cancer Care. JAMA; 310(15):1549-1550.

Ramsey, S., Blough, D., Kirchhoff, A., Kreizenbeck, K., Fedorenko, C., Snell, K., Newcomb, P., William Hollingworth, W., & Overstreet, K. (2013) Washington state cancer patients found to be at greater risk for bankruptcy than people without a cancer diagnosis. Health Aff; 10.1377/hlthaff.2012.1263.

Shankaran, V. & Ramsey, S. (2015) Addressing the Financial Burden of Cancer treatment from Copay to Can’t Pay. JAMA Oncol; 1(3):273-274.

Shankaran, V., Jolly, S., Blough, D. & Ramsey, S. (2012). Risk factors for financial hardship in patients receiving adjuvant chemotherapy for colon cancer: A population-bases exploratory analysis. J Clinical Onclology; 14:1608-1614.

Zafar, S.Y. & Abernethy, A.P. (2013). Financial toxicity, part I: A new name for a growing problem. Oncology; 27(2):80-149.

University of Chicago (2016). Financial toxicity facts. Cost of Cancer Care. https://costofcancercare.uchicago.edu/page/financial-toxicity-facts

Patton, M. (2015, Jun 29) U.S. health care costs rise faster than inflation. Forbes. http://www.forbes.com/sites/mikepatton/2015/06/29/u-s-health-care-costs-rise-faster-than-inflation/#1226e08f6ad2