The University of Michigan is teaming up with Coursera to create Teach-Outs which are week-long MOOC lecture series which address problems currently faced in society today. The following are notes for lecture set 3 of Solving the Opioid Crisis.
This lecture was given by Daniel Clauw, Professor of Anesthesiology, Medicine (Rheumatology) and Psychiatry at the University of Michigan. He serves as Director of the Chronic Pain and Fatigue Research Center. Until January 2009 he also served as the first Associate Dean for Clinical and Translational Research within the University of Michigan Medical School, and PI of the UM Clinical and Translational Sciences Award (CTSA).
People are mainly focused on the deaths by overdose due to opioids, but another aspect of the epidemic is that many people are on opioids long term due to chronic pain. This is not a good use of opioids, since they do not target many forms of chronic pain, so doctors are no longer prescribing them (as often) for this purpose. Chronic pain that is located in a certain body part (such as in osteoarthritis) can be helped by a small dose of opioids, but pain originates in the nervous system (like fibromyalgia) is not helped by opioids.
Opioids bind the same receptors as endorphins, so when people are given opioids their endorphin systems are being hijacked. When someone has been on opioids for years, it is difficult to take them off because they no longer have a normally functioning endorphin system. There should be two sets of rules for prescribing opioids: those for people who have been on opioids chronically and those who are newly starting with a pain control regimen.
Until the 1990s, people who died of opioid overdose were heroine addicts that started on heroine. They were lower socioeconomic class, inner city, and black. Therefore, it wasn’t considered a major problem by the privileged classes. However, in the 90’s, doctors started over-prescribing opioids so that now, 60 to 70 percent of people who die of opioid overdose started with a prescription. That’s something the privileged majority is willing to pay attention to.
This lecture came with the following discussion question: Dan Clauw mentions the pharmaceutical industry’s argument that access to opioids are “a human right”. Do you agree with this sentiment? If so, why? If not, why?
I believe that healthcare and access to proper medications is a human right. However, I do not believe that there is a human right to be pain-free. If the risks of giving opioids outweighs the benefits, then opioids should not be prescribed.
This post is notes from an interview with Mike Smith, a Clinical Assistant Professor in the Department of Clinical Pharmacy at the University of Michigan College of Pharmacy and Clinical Pharmacist in Pain and Palliative Care at Michigan Medicine.
The first lecture was by Professor Arun Agrawal, who explained how modern democracy can become authoritarian. In both older and modern authoritarianism, the leader/regime attempts to disable the basic building blocks of democracy, such as elections, free press, check and balances on their power, and rule of law. They may also unfairly enforce laws against people of certain race, ethnicity, sexual orientation, etc. For instance, the regime might promote what they call a democratic election, but undermine the election by keeping some populations from voting (like the modern ID laws, which make it difficult for very poor and homeless people to vote) and by calling the election fraudulent when they don’t agree with the outcome. They might undermine the rule of law by criticizing the judicial system when it disagrees with the regime’s own point of view. (Or by removing the Judicial Branch from the list of government branches on the White House webpage.) They can undermine free press by calling it “fake news” and handing out awards for the “fakest” news. They might claim that they are above the law (for instance, are unable to be sued). [Specific examples aimed at Donald Trump are my own insertions.]
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