Month: April 2016

Narcotics, opioids, and addiction – important facts

Posted on by Michelle Fritsch, Pharm.D.
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Learn the facts about safe use, natural physiologic changes when you take opioids, and addiction.

There is a lot of information in the news about narcotics, opioids, overdose, death, and a heroin epidemic. Now there is new legislation to try to stop this downward spiral. Have you found it confusing? If you say yes, you are not alone!

First, narcotics = opioids

The correct medical term for these pain medicines is ‘opioid’. This refers to the way they work. These pain medications interact with the mu-receptors and other opioid receptors throughout the brain (and the gastrointestinal tract). As they trigger the mu-receptors, they block pain sensations. They can also cause euphoria, dysphoria, or sedation. So, they can make you feel really good, really laid back, or really sleepy.

There are several medicines that fall in this category of opioids. Here are a few (and some brand names):

  • Morphine (MS Contin, Avinza)
  • Hydromorphone (Dilaudid)
  • Codeine – combined with acetaminophen (Tylenol #3)
  • Hydrocodone – combined with acetaminophen (Lortab, Norco, Vicodin)
  • Oxycodone (OxyContin, Roxicodone)
  • Meperidine (Demerol)
  • Fentanyl (Sublimaze, Duragesic)
  • Methadone (Dolophine)

These medications have been used for decades to treat moderate to severe pain. Pain relief is important in many instances not only for your quality of life but also to get you moving again after a painful event. For instance, it is critical that you get moving again soon after a knee replacement, back surgery, or other similar surgery. As you get moving again you increase your chance of really getting back to full function. You also decrease the risk of a blood clot from lack of use. But, those surgeries are painful. The opioid medication helps relieve that pain allowing you to start your rehabilitation.

When used short term for pain, addiction is not likely

Addiction is usually associated with long term use and/or use for the feeling you get from the medication beyond the pain relief. It is also associated with using more than you are prescribed. To safely use opioid pain medication, use the lowest dose that allows you to move through your pain. Also, use it for the shortest time possible. As the pain level decreases, you can move from an opioid  to a nonopioid pain medicine. Work with your prescriber to determine when you are ready for this change and which option will work best for your pain.

Key terms

The body contains a wonderfully complex system of signals and receivers to transmit and control pain sensations. The body and these communication pathways in the brain and the central nervous system are well organized. When the pain signals are too distressing and an opioid pain medicine is added, the normal body signals and receivers adapt to the effect of the opioid pain medicine. There are natural, physiologic changes that occur in your body as these medicines are used over time. I want you to understand these changes. When they occur, they do not mean you are addicted!

Physical dependence – As the body lets the medicine treat the pain, the body’s normal pain process relaxes.

Tolerance – When you take an opioid pain medicine over time, those nerve transmitters (signals) in your body adapt. Over time doses have less effect and last a shorter period of time. So, over time, the dose needed for the same pain relief goes up.

Withdrawal – When the opioids are suddenly taken away, the body can’t take over the pain control immediately. If this sudden stopping of the medicine happens, you will feel body aches, irritability, fast heart rate, weak. and have difficulty sleeping. You might also yawn, shiver, and have an upset stomach.

These are the body’s normal reaction to having the opioid pain medicine take care of the pain. When your pain level drops to mild to moderate pain, your prescriber will start to slowly decrease your dose of opioid pain medicine. This will allow your body’s normal process to take back over in controlling your pain.

Next week we will cover more about addiction and steps being taken to stop the current epidemic of opioid pain medicine abuse. Addiction involves continued use over time, inability to control drug use, compulsive drug use, continued use even when you know the drug is hurting you, and craving of the drug.

These opioid medications can play a very healthy role in controlling your pain when dosed appropriately and used for the shortest time possible.

If you would like to know more about opioid pain medicines and how they affect you, please contact us at www.medsmash.com.

BIBLICAL APPLICATION

Addiction is so very complex. It is one of many examples of how something good for you can become something bad for you.

It is not possible to look at someone and say, ‘He is an addict.’ Or ‘She is likely to be an addict.’ It is not true that ‘bad people’ become addicts while ‘good people’ avoid that outcome. Parts of the addiction process seem to be within our control while others take us by surprise. We will go in to more detail next week.

So, this is a key area when we can share our compassion and the love of Christ.

It is also a reason to reflect on our self-control. This is one of the fruits of the spirit.

Galatians 5:22-23 ESV

But the fruit of the Spirit is love, joy, peace, patience, kindness, goodness, faithfulness, gentleness, self-control; against such things there is no law.

We are all tempted by various things. One of Christ’s messages to us is to let Him be our strength and shield.  This was shared by Paul as he was explaining why and how we should stay away from idols and temptations that lead off the path to Christ.

1 Corinthians 10:13 ESV

No temptation has overtaken you that is not common to man. God is faithful, and he will not let you be tempted beyond your ability, but with the temptation he will also provide the way of escape, that you may be able to endure it.

Psalm 28:7 ESV

The Lord is my strength and my shield;

    in him my heart trusts, and I am helped;

my heart exults,

    and with my song I give thanks to him.

Peter sums up our role to work on our own self control and in the process share love and compassion with our fellow humans.

2 Peter 1:5-7 ESV

For this very reason, make every effort to supplement your faith with virtue, and virtue with knowledge, and knowledge with self-control, and self-control with steadfastness, and steadfastness with godliness, and godliness with brotherly affection, and brotherly affection with love.

Blessings,

Michelle

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Appropriate medications – same at 30, 60, and 90?

Posted on by Michelle Fritsch, Pharm.D.
ID-10093880
Appropriate medications over age 60

Should the same medications and doses be prescribed for all ages? No! However, we find that often they are.   If a medication was a good choice for you at 30, is it still a good choice at 60 or 90? Not necessarily. So, why does age matter?  How do you know that you are taking all appropriate medications?

What changes as we age?

Even if you eat right, exercise regularly, and make good choices about alcohol and tobacco, changes occur over time.

  • Kidney function starts a very gradual decline in your late 30’s or early 40’s.
  • Liver size and blood flow to your liver diminish. The number of cells shrinks. There is less activity of the enzymes that break down medications.
  • Food and medications move through the intestine more slowly.
  • The volume of urine that the bladder can hold decreases. Bladder muscles weaken.
  • For men, the prostate gland increases in size.
  • For women, the urethra shortens and comes thinner. So, risk of urinary tract infection goes up.
  • Muscles weaken as growth hormone levels decline.
  • Aldosterone levels decrease, so risk of dehydration goes up.
  • The immune system slows down. So, risk of infection and cancer go up. Also, it can take longer to treat an infection.
  • Heart muscle and blood vessels get stiffer. This can increase risk of high blood pressure. Also, with exercise, the heart can’t pump as much blood or speed up as much as it did at younger ages. So, exercise capacity is lower.
  • The muscles involved in breathing weaken. There is a decline in the number of small sacs in the lungs where oxygen is passed to the blood.
  • The amount of water in the body goes down while the body fat goes up.

This list is not meant to depress anyone. These are just some of the very natural changes that occur in all of us. So with all of this change, the need for medication, the types of medications that are needed, and the doses of medications are all different.

Nearly all medications leave the body through the urine or the stool. Most medications are changed as they pass through the liver. There are enzymes in the liver that break down those medications. When the kidneys and liver become less functional, it takes longer to get the medications back out of your body. This means a single dose can last longer or have a bigger impact.

Most medications have a preference for water (hydrophilic) or fat (lipophilic). Since body water and fat both change, medication concentrations also change.

Guidelines for taking appropriate medications

There are so many changes to manage that guidelines have been written to try to decrease some of the more common mistakes that are made. These are oriented to people over age 65. The Beer’s List was first developed by a group of doctors in 1991. It has since been updated many times. It contains a list of medications not to use and another list to use with special precautions. There is also a guideline called STOPP that lists medications to avoid in adults over 65. For both guidelines, there are safe options to use in place of the medications on the lists.

If you are 60+, is there a specialist in medication use for people of your age monitoring your medication use? Can you really afford to avoid this review? We have found there is some issue to address 98% of the time we provide an assessment. For your personal assessment, contact us at www.medsmash.com.

BIBLICAL APPLICATION

Medications change as you age. And so do so many other things. Many of these changes are wonderful! You benefit from the many lessons you’ve learned through your life so far. You are able to share those experiences, insights, and lessons with others. You probably sweat the small stuff less. You also tend to enjoy the little things more.

I heard a message today that really captured my attention. A picture was painted about grace and faith and their relationship.

As stated by John Stott, ‘Faith’s exclusive function is humbly to receive what grace offers. Grace gives and faith takes’.

Grace is offered to you on a constant basis. But, it has been my experience, it takes time and lessons learned to really develop faith so that grace can be received. Faith tends to grow with time and experience.

Ephesians 2:8 ESV

For by grace you have been saved through faith. And this is not your own doing; it is the gift of God,

Hebrews 11:1 ESV

Now faith is the assurance of things hoped for, the conviction of things not seen.

Romans 10:17 ESV

So faith comes from hearing, and hearing through the word of Christ.

Salvation by grace is a gift. Faith is how you receive that gift.

Ponder this great news this week!

Blessings,

Michelle

Flu – Not to be Taken Lightly – It’s NOT too late

Posted on by Michelle Fritsch, Pharm.D.
Flu vaccine CDC
Flu vaccine – it is not too late!

People are dying from the flu! Now, this week!

Do you get an annual flu vaccine?

If yes, does that mean you will not get the flu?

If you do not get a flu vaccine, why not?

Let’s review some common responses to these questions…and the truth based on evidence.

There are several varieties of flu vaccine available. A lot of research in recent years is responsible. Remember within the last 10 years when there was a shortage? Not everyone could even get the vaccine. Then, in 2009, a new strain called H1N1, or ‘swine flu’ emerged making many people very sick. Since all of that, these new options protect against H1N1. They cover more specific strains expected to be active this year. Some are now safe for people with egg allergies. Some are specific for people over age 65.

When you get the vaccine, it is NOT LIVE VIRUS that is injected. It is virus that has been grown then ‘killed’ before injection. Most are placed, via needle, in your upper arm muscle just below your shoulder (deltoid muscle). The injected substance then prompts your immune system to develop antibodies to the virus. Antibodies are the parts of your immune system that fight infections. The antibodies will be specific to the strains of virus in the vaccine.

Some flu vaccines cover three strains of flu while others cover four. The strains selected for the vaccine are the most dangerous. There are other milder strains of the flu not covered by the vaccine. So, you can still get the flu, but not the most deadly types.

The type of flu vaccine that is specific for people over age 65 is a bit stronger. In our 60’s and beyond our immune system often isn’t quite as active. So, the stronger vaccine will provide better protection.

There is also a live version of the flu strains that is given in the nose. This is an option for people who really, really hate needles. Note, people with cancer, compromised immune systems, and some other conditions cannot receive the live version. Please check with your doctor or person providing immunizations.

Who should NOT get the flu vaccine?

There are very few people in this category. For people with egg allergies, there is now a type of flu vaccine that does not contain egg. If you had a severe allergic reaction to a flu vaccine in the past, be sure to talk with your doctor before deciding whether to get one. With several varieties of vaccine available, there might be a version that does not contain the substance to which you are allergic. If you have or have had Guillain-Barre Syndrome, talk with your doctor. There is not currently a vaccine approved for children under 6 months of age. Otherwise, you should be seeking your flu vaccine!

The people who are DYING from the flu usually get the flu then get pneumonia while they are sick. Flu deaths tend to occur most often later in the flu season (so now!). Those who die are usually over age 75 or they have other medical conditions involved. Then there are those who no one would have expected.

Don’t let the flu catch you by surprise. It is NOT TOO LATE to get your flu vaccine!

For more information about flu vaccines, contact us at www.medsmash.com.

BIBLICAL APPLICATION

Flu vaccines can protect our physical health. What protects our spiritual health?

The armor of God is the first thing that comes to my mind.

Ephesians 6:10-18 ESV

Finally, be strong in the Lord and in the strength of his might. Put on the whole armor of God, that you may be able to stand against the schemes of the devil. For we do not wrestle against flesh and blood, but against the rulers, against the authorities, against the cosmic powers over this present darkness, against the spiritual forces of evil in the heavenly places. Therefore take up the whole armor of God, that you may be able to withstand in the evil day, and having done all, to stand firm. Stand therefore, having fastened on the belt of truth, and having put on the breastplate of righteousness, and, as shoes for your feet, having put on the readiness given by the gospel of peace. In all circumstances take up the shield of faith, with which you can extinguish all the flaming darts of the evil one; and take the helmet of salvation, and the sword of the Spirit, which is the word of God, praying at all times in the Spirit, with all prayer and supplication.

And all through the Psalms you will find cries for protection and rejoicing for the protection offered!

Psalm 5:11 CEV

“Let all who run to you for protection always sing joyful songs.

Provide shelter for those who truly love you and let them rejoice.”

Psalm 34:8 CEV

“Discover for yourself that the LORD is kind.

Come to him for protection, and you will be glad.”

Psalm 118:8 CEV

“It is better to trust the LORD for protection than to trust anyone else,”

I feel so assured when I read these verses! These are good ones to memorize or carry in your wallet for reference at frightening times.

Blessings,

Michelle

Image source: Centers for Disease Control and Prevention; U.S. Department of Health and Human Services

Four Components of True Health – Emotional Health

Posted on by Michelle Fritsch, Pharm.D.
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Caring for and by others is key

The fourth of the four components of health is emotional health. True health requires health in all four components. Over the last three weeks we covered physical, mental, and spiritual health. Striving to attain health in all four areas enhances your overall health.

Emotional health refers to how you deal with life and its ups and downs. Everyone goes through difficult trials. The specifics are different between people. Even for you, there will be a wide variety of difficult times you experience.   Everyone has good days. These can be peaceful, contended days; days where you reach a goal; days where you are celebrated; and days when you feel loved and secure.

Your feelings play a big role in your emotional health. People express their feelings in many different ways. Some people are more visibly emotional. Other people keep their emotions carefully hidden from view. Either way, emotions can impact our behaviors. How we act, how we respond, how we treat people, and how we feel about ourselves can all be affected by our emotions.

Why does my emotional health matter?

When looking at the differences between healthy people and not so healthy people, researchers have found emotional health to be a key factor.

How do you handle your anger? How kind are you to yourself in your ‘self talk’? How do you express your joy? What is your response when someone criticizes you? How often do you put other people’s needs before your own? Do you feel like the world is out to get you? How do you respond when your car breaks down? How do you feel when you forget to send a birthday card on time? What makes you happy? What makes you sad?

Studies have shown that prolonged stress and negativity make you age faster. There are actually measurable changes in your brain (shorter telomere length and less activity). This stress can also make you more susceptible to other diseases. Your blood pressure can go up, risk of heart disease goes up, and risk of diabetes goes up.

Improved health does not come from lack of negative situations. It comes from how you handle those situations.

The research has shown that the people who are more emotionally healthy have:

  • Friend(s) to talk to
  • People who care about you
  • A sense of self-worth
  • Ability to give and receive forgiveness
  • Conflict management skills
  • A desire to be giving toward others
  • Concern for others

As you can see, these are not things you are born with. They are skills and attitudes you can develop. They are choices you can make. They are best navigated with friends and supportive people around you.

Similarly, other researchers found that keys to overall health are:

  • Thinking kindly of people
  • Feeling optimistic
  • Supportive friends & family
  • Ability to bounce back
  • Making healthy choices
  • Being grateful for all you have

I found it interesting that the findings are so similar. Other studies have supported these important areas of emotional health. When you feel good, your thinking of more creative and flexible. You see problems with more possibilities and solutions.

So, I encourage you to take a personal assessment of your current emotional health. Consider the things that delight you and the things that upset you. Where can you incorporate more of the listed items that are shared among people with more emotional health?

Medications can help on a short-term basis when circumstances have you so upset you can’t function or sleep. Long-term emotional health, however, is gained more through self-insight, positive choices, and self-development.

If you would like citations for the studies mentioned or have any questions about the role of your emotional health on your overall health, contact us at www.medsmash.com.

(Note, severe abuse, neglect, and trauma are much different than daily negative situations. This blog is not intended to cover the health effects of these experiences that usually involve severe mental illness of the perpetrator.)

BIBLICAL APPLICATION

Our emotions can guide so many of our behaviors, especially if we don’t have an anchor of hope. Resilience is the result of knowing God’s love and mercy never fail. No matter the situation, you are not alone, and you have the ultimate resource walking with you.

Throughout the Bible we are assured that bad things will happen. Since sin entered the world, this has been a basic fact. Throughout the Bible we are assured there is hope and joy that can get us through any situation.

Philippians 4:6-7 ESV

Do not be anxious about anything, but in everything by prayer and supplication with thanksgiving let your requests be made known to God. And the peace of God, which surpasses all understanding, will guard your hearts and your minds in Christ Jesus.

Joshua 1:9 ESV

Have I not commanded you? Be strong and courageous. Do not be frightened, and do not be dismayed, for the Lord your God is with you wherever you go.”

As we go through difficult times, either big life-altering events or short bursts of anger or frustration, we are encouraged to give those over to God. We aren’t meant to figure it all out or deal with it on our own. Actually, when we do try to handle things ourselves, we often get into trouble.

Proverbs 29:11 ESV

A fool gives full vent to his spirit, but a wise man quietly holds it back.

Proverbs 15:18 ESV

A hot-tempered man stirs up strife, but he who is slow to anger quiets contention.

A focus on God can help calm our storms. Once we learn to navigate the storms, we can be a better support to those around us.

Romans 12:2 ESV

Do not be conformed to this world, but be transformed by the renewal of your mind, that by testing you may discern what is the will of God, what is good and acceptable and perfect.

Romans 12:15 ESV

Rejoice with those who rejoice, weep with those who weep.

Proverbs 15:13 ESV

A glad heart makes a cheerful face, but by sorrow of heart the spirit is crushed.

I love this visual of Romans 5:3-5. With each time around the circle, we grow in hope and joy and the certainty of God’s love. This can then spill over to others.

Slide1Blessings,

Michelle