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Health Capsules: May 1

Wisdom tooth removal, opioid addiction linked

Prescriptions for opioid pain medications following wisdom tooth removal have unfortunately become a gateway to addiction for many young people, recent research shows.

Having all four wisdom teeth removed is an extremely common procedure – in fact, it has become something of a rite of passage for high school and college students. More than two-thirds of those young people [70%] are also prescribed opioid medication to control pain after wisdom tooth removal, and a significant number of them are becoming addicted to opioids as a result, according to new research.

The Stanford University study examined opioid use and abuse in a large group of privately insured patients across the U.S. during 2015. Of nearly 15,000 young people in the group who received initial opioid prescriptions from their dentists that year, 6.8% of them – or just over 1,000 – had additional opioids prescribed more than three months later, and 5.8% were diagnosed with opioid abuse during the 12 months after their initial prescription.

The youngest patients in the group, those between the ages of 16 and 18, were more likely to have persistent opioid use and misuse problems than the oldest [ages 22 to 25]. Females were more likely than males to have longer-term problems related to their dental opioid prescriptions.

These alarming statistics are already leading to changes in the way some leading health insurers handle opioid prescriptions for wisdom tooth extractions.

For example, United HealthCare now requires first-time opioid prescriptions for patients age 19 and under written by dentists or oral surgeons to be capped at three days and fewer than 50 morphine milligram equivalents per day, a limit also recommended by the Centers for Disease Control and Prevention. United HealthCare has notified both their most frequent dental prescribers of opioids and families of teens covered under their plans of the potential hazards related to dental opioid prescriptions.

More research is also urgently needed around wisdom tooth extractions and opioids, said the Stanford study’s lead author, Dr. Alan Schroeder, a clinical professor of pediatrics. “This work raises two really important related but separate questions …  No. 1, ‘Why are we prescribing such a high quantity of opioids so frequently?’ And No. 2, ‘Are all the procedures that are driving these opioid prescriptions necessary?’” he said.

To recognize signs of a stroke, BEFAST

Nearly 800,000 Americans suffer a stroke every year. That statistic averages out to one person every 40 seconds – and when strokes happen, every second truly is critical. Getting stroke victims to an emergency room as early as possible both improves their odds for survival and increases their chances of making a full recovery.

During Stroke Awareness Month each May, Americans are reminded to be watchful for the most common symptoms of stroke in both men and women. Experiencing any one of these symptoms, or noticing any of them in a friend or loved one, warrants an immediate call to 911. They include the sudden onset of numbness or weakness in the face, arm, or leg, especially on one side of the body; confusion, trouble speaking, or difficulty understanding speech; trouble seeing in one or both eyes; trouble walking, dizziness, loss of balance or lack of coordination; or a sudden very severe headache with no known cause.

The American Stroke Association currently uses the acronym F.A.S.T. – which stands for Face, Arms, Speech and Time – to quickly summarize the most common warning signs of a stroke. A growing number of medical centers and health authorities also have added two other types of symptoms, Balance and Eyes, to that summary.  Following is a description of the symptoms included in that easy-to-remember acronym, B.E.F.A.S.T. Knowing it can help you take action when seconds count:

Balance: Watch for a sudden loss of balance or trouble walking.

Eyes: Is there a sudden loss of vision in one or both eyes? Or double vision?

Face: Ask the person to smile. Does one side of the face droop?

Arms: Ask the person to raise both arms. Does one arm drift downward?

Speech: Ask the person to repeat a simple phrase. Does the speech sound slurred or strange?

Time: If you observe any of these signs, call 911 immediately.

Novel new depression drugs receive FDA approval

Two fast-acting new medications for depression may provide hope for many patients battling the illness.

As rates of depression continue to climb in the U.S., two completely new types of drugs to treat it – specifically, for adults whose serious depression fails to respond to other medications and for new mothers suffering from postpartum depression – recently received limited-use approval from the U.S. Food and Drug Administration [FDA].

The first, to be marketed under the brand name Spravato, is a nasal spray form of esketamine, which is related to the anesthetic and “party drug” ketamine. Spravato is to be used in conjunction with an oral antidepressant in adults who have tried other medications which have failed to help their depression. It is currently available on a restricted basis only, to be administered in a healthcare facility under close monitoring, and patients will not be able to take it home due to a risk of hallucinations or other significant side effects.

Esketamine works in the brain in a completely different way than any previous antidepressant. And unlike other drugs which may take weeks or months to work, esketamine nasal spray has been shown to reduce severe depression symptoms, including suicidal thoughts, very quickly – within hours to days for many. Because it is so fast-acting, esketamine has been heralded by many mental health care professionals as a life-saving drug.

“There has been a long-standing need for additional effective treatments for treatment-resistant depression, a serious and life-threatening condition,” said Dr. Tiffany Farchione, acting director of the Division of Psychiatry Products in the FDA’s Center for Drug Evaluation and Research.

The FDA granted its approval for Spravato on March 5th through its FastTrack and Breakthrough Therapy designations program.

• • •

A second antidepressant medication called brexanolone, which specifically targets postpartum depression [PPD] in women, also has just received FDA approval. The drug, to be marketed under the brand name ZULRESSO, will be given to patients by injection.  Similar to esketamine, it will be administered only under supervision in a healthcare setting because of the risk of side effects.

This new drug could be a game-changer in women’s health, according to researchers involved in the clinical trial process prior to its approval. “Given the results of the ZULRESSO clinical trials, we believe that this will be an important treatment option which could provide relief for women with PPD, a disorder with a range of postpartum severity,” said Dr. Samantha Meltzer-Brody, the academic principal investigator of the trials.

Brexanolone also works differently than existing anti-depressant medications, and has been shown to help many women feel better within days of having an injection. It is the first FDA-approved drug specifically indicated for PPD.

The mood disorder, which is triggered by fluctuations in reproductive hormones, produces symptoms including low mood, feeling overwhelmed, anxious and ruminating thoughts, potential withdrawal from the baby and a new mother’s own family, and suicidal thoughts in the most severe of cases.

PPD is one of the most common complications of pregnancy; about one in nine women in the U.S. experiences symptoms after giving birth, according to the Centers for Disease Control and Prevention.

Clinical trial of universal influenza vaccine begins

Every year, health authorities both in the U.S. and worldwide face the challenge of predicting the predominant influenza strains which will circulate during that year’s flu season, and creating a vaccine that will be effective against them. This can be a hit-or-miss process, as was seen during the 2017-2018 flu season when a minimally effective vaccine led to a severe and widespread flu outbreak in many countries.

But as the more moderate flu season of 2018-2019 ends, the first clinical trial of a universal influenza vaccine is beginning in the U.S. The experimental vaccine, developed by scientists at the National Institute of Allergy and Infectious Diseases [NIAID], is designed to teach the body to create a protective immune response against many diverse influenza subtypes, including those that might cause a pandemic. The goal of the research is to create a “universal” influenza vaccine that can provide long-lasting protection for people of all ages.

“Seasonal influenza is a perpetual public health challenge, and we continually face the possibility of an influenza pandemic resulting from the emergence and spread of novel influenza viruses,” said NIAID Director Anthony S. Fauci, M.D. “This Phase 1 clinical trial is a step forward in our efforts to develop a durable and broadly protective universal influenza vaccine.”

Initial phases of the trial are expected to be complete by the end of 2019, and researchers hope to begin reporting results in early 2020. More information about the trial is available online at ClinicalTrials.gov [search identifier NCT03814720].

On the calendar

St. Louis Children’s Hospital sponsors a Staying Home Alone class on Tuesday, May 7 from 6:30-8 p.m. at the Spencer Road Branch Library, 427 Spencer Road in St. Peters, in Room 112. This class, designed for parents and children to attend together, will help determine a child’s physical, mental, social and emotional readiness to stay home alone and prepare them for this experience. The course fee is $25 per family. To register, call (314) 454-5437.

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BJC sponsors a free Lunch and Learn program, Antibiotic Overuse, on Thursday, May 9 from noon-1 p.m. at Middendorf-Kredell Branch Library, 2750 Hwy. K in O’Fallon. Join Angela Hoelscher, an antimicrobial stewardship pharmacist, to learn more about the issue of antibiotic overuse and its impacts on public health. The event is presented in partnership with Barnes-Jewish St. Peters and Progress West hospitals. To register, call (636) 928-9355.

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BJC of St. Charles County sponsors a special “Evening with the Experts” presentation, Diet Fads and Healthy Eating Hacks, on Wednesday, May 22 from 6:45-8 p.m. at Siteman Cancer Center, 150 Entrance Way in St. Peters. Learn what keto, paleo and gluten-free diets are and who should try them; find out how much caffeine you can safely drink each day; and discover substitutions for fresh fruits and vegetables. The session will be followed by a Q&A session and a bonus wellness demonstration on meditation. Attendance is free. Advance registration is preferred and is available online at BJCStCharlesCounty.org/Events.

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