More people died from drug overdoses in the United States in 2014 than during any previous year on record, with increases in opioid overdose deaths the driving factor, according to new statistics released today by the US Centers for Disease Control and Prevention (CDC).
In 2014, opioid overdose deaths, including deaths from the use of opioid painkillers and heroin, hit record levels, with an "alarming" 14% increase, the CDC said.
The death rate from the most commonly prescribed opioid pain relievers (natural and semisynthetic opioids) rose 9%, the death rate from heroin jumped 26%, and the death rate from synthetic opioids, a category that includes illicitly manufactured fentanyl and synthetic opioid pain relievers other than methadone, spiked 80%.



"Nearly every aspect of the opioid overdose death epidemic worsened in 2014," the CDC said.
Their analysis of National Vital Statistics data was reportedDecember 18 in the Morbidity and Mortality Weekly Report.
During 2014, a total of 47,055 drug overdose deaths occurred in the United States, representing a 1-year increase of 6.5%, from 13.8 per 100,000 persons in 2013 to 14.7 per 100,000 persons in 2014. Rates of opioid overdose deaths jumped significantly, from 7.9 per 100,000 in 2013 to 9.0 per 100,000 in 2014, a 14% increase.
In 2014, opioids were involved in 28,647 deaths, or 61% of all drug overdose deaths; the rate of opioid overdoses has tripled since 2000, the CDC said.

"Increases in prescription opioid pain reliever and heroin deaths are the biggest driver of the drug overdose epidemic. Deaths from heroin increased in 2014, continuing a sharp rise that has seen heroin overdoses triple since 2010. Deaths involving illicitly made fentanyl, a potent opioid often added to or sold as heroin, also are on the upswing," the CDC notes in a news release.

Drug overdose deaths have increased in both men and women, in non-Hispanic whites and blacks, and in adults of nearly all ages, the CDC said. Rates of drug overdose deaths were highest in West Virginia, New Mexico, New Hampshire, Kentucky, and Ohio.

Intertwined Drivers
The CDC says two distinct but intertwined trends are driving the overdose epidemic in the United States: a 15-year increase in deaths from prescription opioid pain reliever overdoses as a result of misuse and abuse, and a recent surge in illicit drug overdoses driven mainly by heroin overdoses. Both of these trends worsened in 2014.

The agency reports that more than 6 of 10 drug overdose deaths in 2014 involved opioids, including opioid pain relievers and heroin. The largest increase in opioid overdose deaths involved synthetic opioids (not including methadone), which were involved in 5500 deaths in 2014, nearly twice as many as in 2013.

Heroin-related death rates jumped 26% from 2013 to 2014, totaling 10,574 deaths in 2014. "Past misuse of prescription opioids is the strongest risk factor for heroin initiation and use — especially among people who became dependent upon or abused prescription opioids in the past year. The increased availability of heroin, its relatively low price (compared to prescription opioids), and high purity appear to be major drivers of the upward trend in heroin use, overdoses, and deaths," the CDC notes.

Call to Action
"The increasing number of deaths from opioid overdose is alarming," CDC Director Tom Frieden, MD, MPH, said in a statement. "The opioid epidemic is devastating American families and communities. To curb these trends and save lives, we must help prevent addiction and provide support and treatment to those who suffer from opioid use disorders. This report also shows how important it is that law enforcement intensify efforts to reduce the availability of heroin, illegal fentanyl, and other illegal opioids."

The CDC said the new data point to four ways that overdose deaths may be prevented:

• Limit initiation into opioid misuse and addiction through education of healthcare providers;
• Expand access to evidence-based treatment of substance use disorder, including medication-assisted treatment, for people with opioid use disorder;
• Protect people who have opioid use disorder by expanding access to and use of naloxone;
• Get state and local public health agencies, medical examiners and coroners, and law enforcement agencies to work together to improve detection of and response to illicit opioid overdose outbreaks.

Earlier this year, US Health and Human Services Secretary Sylvia Burwell announced a targeted initiativeaimed at reducing prescription opioid- and heroin-related overdose, death, and dependence. The evidence-based approach focuses on three areas: informing opioid prescribing practices, increasing the use of naloxone, and using medication- assisted treatment to cure people of opioid addiction.
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MMWR Morb Mortal Wkly Rep. Published online December 18, 2015. Full text


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Another great article brought to you by www.MedicalExpert.com
Physicians favor expert medical panels that screen claims for merit before they proceed in court more than any other kind of tort reform, a new Medscape survey on malpractice litigation finds.

Eighty-one percent of physicians cited pretrial screening panels as one of the best ways to discourage malpractice suits compared with 62% who chose caps on noneconomic (pain and suffering) damages and 48% who said cases should be tried in special health courts.

Screening panels, found in 17 states, are designed to winnow out nonmeritorious claims and avoid expensive court battles. A panel ruling in favor of a physician does not bar a patient from seeking his or her day in court, but in most states, a defendant can introduce the opinion as trial evidence. Panels have at least one physician member.
Nearly two thirds of states have adopted pretrial screening panels at some point in the last 40 years. Successful constitutional challenges have whittled down that number, as have outright repeals by state legislatures, according to Michelle Mello, PhD, an expert on medical liability at Stanford University. Similar to other experts, Dr Mello said pretrial screening panels have compiled a disappointing track record.

"Panels are popular among physicians, but the evidence for their effectiveness in achieving any of the purposes for which they were set up is just not there," Dr Mello told Medscape Medical News. "One reason is that it's hard to screen out cases at an early stage because more discovery is often necessary to get a real sense of what has happened.
"Panels can throw out obviously frivolous cases, but those are the minority."

A study by attorney Jean Eggen published in the Journal of Health and Life Sciences Law in 2013 reached similar conclusions. Eggen, who teaches at Widener University School of Law in Wilmington, Delaware, writes that "all indicators point to the need for more complete data on the effectiveness of screening panels and other malpractice reforms."

A tort reform further down the list for physicians is banning lawyers from taking malpractice cases on contingency: only 37% of participants named that as a good deterrent to lawsuits in the Medscape survey. Another 13% said physicians should stop making medical errors in the first place. The small percentage of physicians who answered that way reflects the prevailing opinion in the profession that a dysfunctional legal system, not medical error, is the primary driver of malpractice ligation.

Four in 10 Plaintiffs Receive Some Kind of Payment
Medscape's survey on malpractice ligation, completed by almost 4000 primary care physicians and selected specialists, confirmed what previous studies have found: Getting sued by a patient is as common as the common cold. Forty-seven percent of physicians said they were named in a lawsuit that included other defendants, and 12% said they were sued as the sole defendant in the case. Obstetrician-gynecologists reported the highest rates of malpractice litigation; oncologists the lowest. In an interesting sidelight, oncologists were the most likely (26%) to sue another physician whose error harmed him or her, whereas obstetrician-gynecologists were the least likely (15%).

The most common allegations made by malpractice plaintiffs are "failure to diagnose" and "patient suffered an abnormal injury," each cited by 31% of physicians who have been sued. At the tail end of allegations were "failure to follow safety procedures" and "improperly obtaining/lack of informed consent," tied at 4%.

Only 16% of the lawsuits reported by Medscape readers were resolved by a verdict at trial, and when that happened, physicians won about 80% of the time. Roughly 38% of cases were settled, usually before a trial, and the rest were either voluntarily dropped by the plaintiff or dismissed by the court. In all, only about four in 10 cases resulted in the plaintiff receiving a settlement or court-awarded damages.

No matter the outcome, malpractice litigation is convulsing, many Medscape readers said. Twenty-six percent of male physicians and 37% of female physicians said being a defendant was "horrible, one of the worst experiences of my life," and 20% of either sex described it as "bad, very disruptive and humiliating." Especially stinging aspects of litigation, readers said, were self-doubt, the implication of incompetence, negative effects on marriage and family, and "feeling helpless while being lied about by colleagues, patients and lawyers."

And the torture is prolonged: For 45% of sued physicians, the case dragged out for 3 years or more.
Fortunately, healing happens. Forty-five percent of all sued physicians reported no long-term emotional or financial fall-out. However, 30% said they no longer trust patients and treat them differently than before.

If asked whether they would have done anything differently, 51% of sued physicians chose the self-assured response of "Wouldn't change a thing, my work was standard of care." Another 19% said they would have improved their chart documentation, which was a key piece of advice these embattled physicians had for their colleagues.
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Sued physicians also recommended getting good legal advice earlier than later, diligently preparing for their case, and not hitting the panic button. Most physicians hit with a malpractice suit, after all, will likely emerge as a winner, at least legally.

By Robert Lowes
Medscape.com


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