TIME medicine

Soon You Can Send Your Expired Painkillers Through the Mail

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The DEA has a new way to get rid of extra meds

How to get rid of leftover medication is a tricky question—keep it around and it can get into the wrong hands, but dispose of it improperly and you risk contaminating the environment.

That’s why in the past, the U.S. Drug Enforcement Administration (DEA) has held National Prescription Drug Take-Back Day. Last April, the DEA reported that it collected 780,000 pounds of prescription drugs, and during the event on Sept. 27, a single county in Virginia dropped off 1,200 pounds of drugs. But even though half a ton of drugs for one county is certainly a coup, it was the last event of its kind—because soon, through an innovative new program, Americans will be able to safely abandon their unused pills at any time.

The DEA first recognized the leftover pill problem because the Controlled Substances Act had no outlined provisions for how people could get rid of their unused or expired prescription drugs. According to the DEA, people would keep them in their medicine cabinets (which made it possible for them them to be abused), toss them in the trash or flush them down the toilet. The latter method was discovered to contaminate water supplies.

In 2010, the Drug Disposal Act gave the DEA the authority to create a framework for how the general public and facilities could dispose of prescription pills properly and safely. On Sept. 9 the regulations were approved, and the DEA says it will start implementing the plan in early October. The new regulations allow Americans to get rid of their excess drugs at pharmacies or police departments with drop-off receptacles. Patients will also be able to grab envelopes from places like hospitals that they can use to mail their pills to authorized collectors, who will make sure the pills are properly incinerated. “It will be more convenient because once these rules are implemented, then people can do it all the time,” a DEA spokesperson told TIME.

The number of Americans abusing prescription drugs has dropped in the last couple years, but the DEA says the 6.5 million people who reportedly abused prescription drugs in 2013 is double the number of people who use hard drugs like cocaine, heroin, LSD and Ecstasy combined.

TIME medicine

For Back Pain or Headache, Painkillers Do More Harm than Good

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For the first time, a major medical organization takes a stand on rampant overuse of opioids for treating back pain, headaches and migraines

Powerful painkillers do little to improve patients’ daily functioning, finds the American Academy of Neurology in a new position statement on opioid painkillers for chronic pain not related to cancer. Written by Dr. Gary Franklin, research professor in the departments of occupational and environmental health sciences and neurology at the University of Washington, the paper outlines the growing epidemic of overdose deaths—most of them unintentional—linked to opioid use. It concludes that in the majority of these cases, pain killers may ease some pain but fall short of truly improving patients’ health. Coupled with the potential hazards of addiction and overdose, the Academy says that doctors should be looking for other ways to help these patients manage their pain.

“This is the first position paper by a major American specialty society saying that there is a real problem here, and the risk might not be worth the benefit for certain conditions,” says Franklin.

MORE: Stopping America’s Hidden Overdose Crisis

The statement traces the rise of the opioid prescribing epidemic to loosening of previously strict regulations put in place in the 1940s, when opioid-based opium and heroin gained popularity as narcotic drugs of abuse. Recognizing the potential for addiction and overdose, states implemented rigorous controls over who could prescribe opioids and how much of the medications were dispensed; violating the rules meant doctors could lose their medical licenses or face criminal prosecution. Therefore, most physicians shied away from the drugs, leading to under-treatment of chronic pain, particularly among the growing number of cancer patients.

To address that trend, advocacy groups and pharmaceutical makers of opioids lobbied to change state laws to remove sanctions against doctors prescribing them—and ended up making them too lenient, says Franklin. “The language in Washington state, for example, said that no doctor shall be sanctioned for any amount of opioids written. So even if a doctor is handing out bags of opioids, it made it hard for the medical board or disciplinary board of the state to do anything about that doctor.”

MORE: FDA Approves New Pain Pill Designed To Be Hard to Abuse

That push to begin treating pain more aggressively began with cancer patients and those who were terminally ill, but drug makers saw another opportunity in people with chronic pain. The problem, say experts, is that for most such chronic pain, including low back pain, headaches and fibromyalgia, there is little evidence to support the idea that opiates are effective, and even less data suggesting that escalating doses and keeping patients on opioids for months or even years to treat persistent pain would benefit them. Most studies only followed patients for about a month on average.

Some in the pain community called out a red flag when they saw that a growing proportion of pain patients were still taking opioids but not reporting any improvements. In 2003, Dr. Jane Ballantyne and Dr. Jianren Mao, then at Massachusetts General Hospital and Harvard Medical School, published a review of the existing data on opioid use for chronic pain in the New England Journal of Medicine. It was among the first studies to highlight the fact that the skyrocketing number of prescriptions was doing little to actually reduce reports of chronic pain. “The real problem is physicians who are practicing with the best intentions and not understanding what the limited role of opiates is,” says Ballantyne, now a professor of anesthesiology and pain medicine at the University of Washington. “For 20 years they have been taught that everybody deserves an opiate, because they really don’t know what else to do. It’s a cultural thing and it’s hard to reverse that.”

The result, Franklin notes, is that since the 1990s, more than 100,000 people have died from opioid overdoses – more than the total number of American soldiers who lost their lives in the Vietnam War. In addition, studies have linked opioid use to serious health problems, from changes in hormone levels that can contribute to infertility, abnormal immune function, heart problems, and even worsening of pain symptoms.

MORE: Viewpoint: FDA Approval of Overdose Antidote Leaves Lives on the Table

Ballantyne says that the opioids can backfire in excessive doses; in the same way that neurons become over-sensitized to pain and hyper-reactive, high doses of opioids could prime some nerves to respond more intensely to pain signals, rather than helping them to modulate their reaction. “The idea is that we have the answer to all chronic pain, and that is to give opiates. That’s simply not true,” she says. “A lot of chronic pain isn’t appropriate for opiates.”

To stop the epidemic of deaths by opioids, Franklin says, states have to reinstate stricter oversight over doctors who prescribe these medications and implement guidelines that call for clear limits to opioid use that both doctor and patient agree upon, particularly for chronic conditions outside of cancer or terminal care. A handful of states and the Centers for Disease Control, for example, have already instituted so-called yellow-flag warning doses that require providers to get additional opinions if a patient reaches daily opioid doses of 80 mg to 120 mg and continues to complain of pain.

MORE: FDA Expands Access to Overdose Antidote to Stem Opiate Addiction Epidemic

But perhaps the best way to move the needle in the epidemic is to reset expectations that doctors and the public have about pain treatment. “In this country we expect everything to be fixed, and that doctors have the answer and can take pain away,” says Ballantyne. Yet many of the first strategies for alleviating pain might start with patients and their lifestyles rather than a prescription. Exercise and a healthy weight can ease much of the chronic pain associated with the back and joints, for instance. “We shouldn’t be resorting to pills as a first resort; they should very much be a last resort,” she says.

Alternative approaches to managing pain, including cognitive behavioral therapy, should also be given strong consideration. The Academy is urging insurers to step in and cover more such pain management approaches so that drug therapy doesn’t continue to be the default. “The important message is that we should not use opioids chronically for most people because they don’t work,” he says. “But at the same time we ought to be paying for things that do work.”

TIME Crime

How Poisoned Tylenol Became a Crisis-Management Teaching Model

Tylenol 1982
Bottles and boxes of Tylenol products which were taken off the shelves or returned to a Safeway store, on Oct. 1, 1982 Jim Preston— The Denver Post / Getty Images

Sept. 29, 1982: The first three of seven victims are killed by poisoned Tylenol in the Chicago area

The killer’s motives remain unknown, but his — or her, or their — technical savvy is as chilling today as it was 30 years ago.

On Sept. 29, 1982, three people died in the Chicago area after taking cyanide-laced Tylenol at the outset of a poisoning spree that would claim seven lives by Oct. 1. The case has never been solved, and so the lingering question — why? — still haunts investigators.

According to TIME’s 1982 report, Food and Drug Administration officials hypothesized that the killer bought Extra-Strength Tylenol capsules over the counter, injected cyanide into the red half of the capsules, resealed the bottles, and sneaked them back onto the shelves of drug and grocery stores. The Illinois attorney general, on the other hand, suspected a disgruntled employee on Tylenol’s factory line. In either case, it was a sophisticated and ambitious undertaking with the seemingly pathological goal of killing strangers entirely at random. Their symptoms and sudden deaths confounded doctors until the link was discovered, traced back to identical pill bottles that each smelled like almonds — the telltale scent of cyanide. The perpetrator left no margin for error, filling the capsules with poison at thousands of times the amount needed to be fatal.

One victim, 27-year-old Adam Janus, took Tylenol for minor chest pain and died within hours. His younger brother and sister-in-law were killed after taking pills from the same bottle while grieving the sudden, shocking loss at Janus’ house.

TIME’s Susan Tifft wrote of the tragedy’s victims on Oct. 11, 1982:

Twelve-year-old Mary Kellerman of Elk Grove Village took Extra-Strength Tylenol to ward off a cold that had been dogging her. Mary Reiner, 27… had recently given birth to her fourth child. Paula Prince, 35, a United Airlines stewardess, was found dead in her Chicago apartment, an open bottle of Extra-Strength Tylenol near by in the bathroom. Says Dr. Kim [the chief of critical care at Northwest Community Hospital]: “The victims never had a chance. Death was certain within minutes.”

Without a suspect to revile, public outrage could have fallen squarely on Tylenol — the nation’s leading painkiller, with a market share greater than the next four top painkillers combined — and its parent corporation, Johnson & Johnson. Instead, by quickly recalling all of its products from store shelves, a move that cost Johnson & Johnson millions of dollars, the company emerged as another victim of the crime and one that put customer safety above profit. It even issued national warnings urging the public not to take Tylenol and established a hotline for worried customers to call.

Tylenol relatively quickly reestablished its brand, recovering the entire market share it lost during the cyanide scare. Though things could have gone very differently, the episode’s most lasting legacy has been in the annals of public relations, not poison control: the case has since become a model for effective corporate crisis management.

Read the 1982 report on the poisonings, here in TIME’s archives: Poison Madness in the Midwest

TIME medicine

Male ‘Enhancement’ Drugs Called Dangerous Amid FDA Crackdown

Turns out, bigger can be badder: Many products claiming to enlarge men’s genitals are deceptive and potentially even deadly, according to federal experts

Turns out, bigger can be badder: Many products claiming to enlarge men’s genitals are deceptive and potentially even deadly, according to federal experts and doctors.

The U.S. Food and Drug Administration, seeking to curb what it calls “an emerging trend,” has issued 20 public notifications this year concerning 20 “tainted” Internet products with names like Weekend Warrior and O.M.G. that promise male “sexual enhancement.”

Yet months after the FDA warnings, some of these supplements are being sold on mainstream retail websites…

Read the rest of the story from our partners at NBC News

TIME medicine

Look Up Your Meds On This Massive New Drug Database

Iodine

The Yelp of medicine is here

Iodine, a new health start-up from a former Wired editor and Google engineer offers an easy-to-use database of drug information.

The database, which launched on Wednesday, uses Google surveys to get consumer information on a wide variety of both over-the-counter and prescription drugs. Users can search a specific drug from Aleve to Xanax and see how people generally feel about its efficacy, about the side effects from actual users, tradeoffs, comments from users, warnings, costs, and a readable versions of the drug’s package insert.

And the database will continue to grow. According to the New York Times, Iodine uses Google Consumer Surveys, of which they have 100,000 ones completed, and they add to their website every day. Iodine also uses data from clinical research, pharmacist surveys, adverse event reports made to the Food and Drug Administration (FDA) and the National Average Drug Acquisition Cost (NADAC)–which reports the average wholesale price pharmacies pay for over 20,000 drugs.

Thomas Goetz, the former Wired editor and co-founder of Iodine told the Times that Iodine is developing the largest survey of American’s drug use and experiences which could not just help consumers but help impact policy.

The folks behind Iodine may have actually succeeded in making Big Data useable—and helpful.

TIME Innovation

Five Best Ideas of the Day: September 24

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

1. Because of America’s unique relationship with Liberia, we have an obligation to help fight the Ebola outbreak there.

By James Ciment in Slate

2. Medical research often doesn’t account for different ethnicities, and underrepresented groups suffer.

By Estaban G. Burchard in Nature

3. One way to head off sexual violence in professional sports: start with high school coaches.

By Libby Nelson in Vox

4. Beyond the sharing economy: Is “reputation” the next important currency?

By Heather Schlegel on CNN

5. Powerful protests over climate change target corporations – and new leadership is needed to restore faith in capitalism.

By Judith Samuelson in the Huffington Post

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME medicine

When Doctors Ignore Their Own Advice

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What to do about docs who smoke, drink, and tan

I live near a health clinic, and on more than one occasion, have walked by men and women in scrubs smoking cigarettes. No human being is immune to nicotine’s addictiveness, but since health care professionals are supposed to advise patients against such behaviors, it’s extremely hard to justify the habit.

Earlier this month, a report published in The BMJ showed that one in 10 doctors admit to using tanning beds. The survey sample was small at only 163 U.K. doctors, but considering skin cancer is the most common cancer in the U.S., the fact that any physician would choose to partake in an activity that puts them at a direct risk for cancer is pretty mindboggling.

But indoor tanning isn’t the only doctor vice. Smoking, poor eating habits, being sedentary, and heavy drinking–while still not the norm–are behaviors not completely eradicated from the medical community.

An unforgiving culture

“It’s unrealistic to expect that knowledge should prompt physicians to avoid unhealthy behaviors,” says Anthony Montgomery, an associate professor of work and organizational psychology at the University of Macedonia in Greece. “Just like everybody else, they have a low risk perception with regard to their health.”

Montgomery says a big part of the problem is how physicians cope when they encounter health problems. In a 2011 study, Montgomery and his colleagues conducted an analysis published in Occupational Medicine that looked at 27 studies on doctors self-medicating. They wanted to examine the implications of a persisting culture within medicine where doctors do not expect themselves or their colleagues to be sick.

“We found that there was considerable evidence that physicians and medical students engage in high levels of inappropriate self treatment for reasons that include avoiding the patient role and occupational norms–keeping things inside the profession,” he says.

The study concluded that these behaviors could be occupational hazards for doctors, and that these problems are not benign for patients. Congruent research finds that doctors with bad health habits are less likely to counsel their patients on the same issues.

“Fifty years ago smoking was very common among physicians and nurses, though fortunately we’ve reduced that significantly,” says Shiv Gaglani, co-founder of a pledge for medical students called The Patient Promise. “Now however, physicians and nurses have the same level of obesity as the general population. Our caregivers are human too and can succumb to same behaviors that everyone else can.”

Montgomery, who typically studies doctor burnout, is working on a report that collected data from health care professionals in Croatia, Portugal, Macedonia, Greece, Turkey, Romania and Bulgaria and found that the effects of burnout were significant predictors of fast food consumption, infrequent exercise, drinking alcohol and using painkillers.

“Certainly most physicians I’ve met understand the paradox between what they preach and what they practice,” says Gaglani. “Seeking help is often complicated by the fact that you don’t want word to spread about your issues because it would spread within the community you practice. In some cases it could even mean the end of your career.”

Solutions

Gaglani created The Patient Promise in 2008 with his roommate at Johns Hopkins Medical School after they attended a course on obesity and motivational interviewing of patients.

“We realized that many of the harmful lifestyle behaviors we were learning to counsel against as future physicians were actually becoming part of our daily lives,” says Gaglani.

The pressure and stress of medical school was causing Gaglani and his peers to eat less nutritious food, exercise fewer times each week, and get significantly less sleep. “We asked the simple question: How can we counsel patients on important lifestyle behaviors if we couldn’t practice them ourselves?” says Gaglani.

And so the Patient Promise was created, and still serves as a pledge for health care workers to live the lifestyles they are recommending for their patients. The movement calling for doctors to be healthy has spread to many health care facilities.

Some hospitals have even incentivized healthy behaviors, like the Cleveland Clinic, which took staff health to task in 2014 and asked all of its employees to wear an activity tracker called Pebble. Target goals were set across the board, and participating in the program allows employees to get lower health insurance premium rates. So far out of the 26,790 employees and spouses participating, 18,302 have already met their target goal for the year: 100,000 steps a month or 600 activity minutes a month for six months.

The Patient Promise is available for all health care workers to sign as a pledge to patients and themselves. “We believe in the power of partnership and shared accountability between clinicians and their patients to lead healthier lives,” says Gaglani.

TIME medicine

Generic Drug Discount Programs Work — for Everyone

Americans are increasingly participating in programs that fill cheaper versions of prescription drugs

More and more Americans are buying the cheaper generic versions of prescription drugs, new research published in JAMA Internal Medicine shows.

In 2006, Walmart introduced what would become one of many generic drug discount programs that allowed people to pay just $4 to fill prescriptions of generic drugs. The program was meant to help people meet difficult medical costs–especially more vulnerable groups like the elderly and low-income populations.

At first, the program didn’t appear to gain a lot of traction. In 2007, only 3.6% of patients receiving prescription drugs were partaking in a program. But similar programs popped up at other pharmaceutical retailers like Rite Aid, CVS and Walgreens and has since gotten much more popular.

The researchers looked at a 2010 national household survey of health care usage among patients over age 18 who had at least one prescription during that year. They found that among the 13,486 adults identified in the survey as having at least one drug prescription, 3,208 were users of generic drug discount programs, and overall program use was at about 23%–much higher than the 3.6% participation rate three years earlier.

Researchers also found that people who were elderly, sick, uninsured and living in rural areas were more likely to participate in the programs, but interestingly, there were no significant differences across education levels or race/ethnicity groups. “Generic drug discount programs were not considered inferior despite the common perception that generic drugs are of poor quality,” the study authors write. “In fact, generic drug discount programs offer convenience by not requiring insurance claims to be filed.”

The researchers think the mere fact that more pharmaceutical retailers have offered similar programs is one of the reasons there’s greater uptake across the board, and while participation could still be higher, plenty of people of different backgrounds are taking part in the cost savings programs.

TIME medicine

5 Signs Your Hormones Are Out of Whack

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When it's normal, and when to see your doctor

Raise your hand if, in the last few weeks, you’ve felt tired, bloated, or cranky. Sound familiar? Then you know the drill: Every month, your hormones—the body’s itty-bitty secret weapon—come out to play, wreaking havoc on your mood, skin, and mind. While levels generally stabilize after your period, various factors, like stress (yup, keep those hands raised) and anxiety can throw them off balance. So how can you tell if your symptoms require an office visit? Alyssa Dweck, MD, an OB-GYN at the Mount Kisco Medical Group in New York shares the five red flags that might merit a doctor’s note.

Fatigue

Exhaustion is one of the most, well, exhausting symptoms to a doc, since it has so many possible causes. “If you’re tired after a week of final exams or late nights at work, then you’re probably fine,” says Dr. Dweck. “But if you constantly feel worn out and notice weight gain, appetite fluctuations, and a change in bowel movements, it could be a sign of an underactive thyroid.” Yes, fatigue happens to everyone, but if yours doesn’t feel logical, then it’s worth getting it checked out.

Skin changes

You’re breaking out—again. While those sudden zits could be caused by one too many nights of going to bed without washing your face, they may be indicative of something more. “Adult acne or cystic acne around the lower half of your face could suggest a high level of testosterone,” says Dr. Dweck. Although not a life-threatening problem, breakouts can take a toll on your psyche. Luckily, your doc can prescribe you medication to stabilize your hormone levels and clear up skin.

Hair growth

We’re talking really fast hair growth. “If you all of a sudden grow a beard within a month or notice coarse, dark hair popping up on your chest, back or arms, that could be indicative of a testosterone-secreting tumor,” explains Dr. Dweck. But don’t freak out: Tumors are rare, she notes, and can often be treated with drugs or surgery.

Weird periods

Just like fatigue, a messed-up menstrual cycle can be the result of many factors, like stress, thyroid issues, low estrogen, or polycystic ovary syndrome (PCOS). “The hallmark of PCOS is irregular or absent periods, but it could also present with difficulty losing weight or strange hair growth,” says Dr. Dweck. Generally, PCOS is managed through diet, exercise and birth control pills, but your doctor will work with you to develop a multi-faceted plan if she finds this to be the cause of your period problems.

Night sweats

Unless it’s unusually warm in your bedroom, waking up feeling overheated and sweaty could be the result of lower estrogen levels and infrequent ovulation—aka perimenopause. “Perimenopause can occur up to 10 years before you’re even near the age of menopause,” says Dr. Dweck, “so unless you’re having major menstrual issues before age 40, there’s a good chance your phantom sweating could actually be early menopause.” Either way, Dr. Dweck recommends making an appointment with your doc to make sure it’s nothing more serious.

This article originally appeared on Health.com.

TIME Innovation

Five Best Ideas of the Day: September 22

1. A global transformation from a carbon-based economy to a cleaner, more sustainable energy future will create jobs and add wealth.

By Christiana Figueres and Guy Ryder in Project Syndicate

2. Antibiotic resistance causes 23,000 deaths and two million illnesses every year. Concerted government action is necessary to fight the crisis.

By the Editorial Board of the Washington Post

3. China can improve its global standing and U.S. relations by joining the fight against Islamic State.

By Dingding Chen in the Diplomat

4. The economic future of manufacturing is to be an incubator of innovation: “where new ideas become new products.”

By Nanette Byrnes in MIT Technology Review

5. In the future, a book could be a living thing.

By Wendy Smith in Publisher’s Weekly

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

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