Vaping boom: Twice the amount of teens vaping than last year, survey finds

Twice as many high school students used nicotine-based electronic cigarettes in 2018 compared with last year, according to a new survey exploring teen smoking, drinking and drug use. In the survey’s 44-year history, this was the largest single-year increase, surpassing even the surge in marijuana smoking during the mid-1970s, according to the Associated Press. The … Continue reading “Vaping boom: Twice the amount of teens vaping than last year, survey finds”

Twice as many high school students used nicotine-based electronic cigarettes in 2018 compared with last year, according to a new survey exploring teen smoking, drinking and drug use.

In the survey’s 44-year history, this was the largest single-year increase, surpassing even the surge in marijuana smoking during the mid-1970s, according to the Associated Press.

The federally funded survey, conducted earlier this year by researchers at the University of Michigan, has prompted regulators to press for measures making it harder for kids to purchase the vaping devices.

STRANGE BUT TRUE: SHOCKING MEDICAL ODDITIES OF 2018

Experts credit the increase to modern versions of the e-cigarettes, like the Juul, which looks like a USB thumb drive and can be easily disguised.

"They can put it in their sleeve or their pocket. They can do it wherever, whenever. They can do it in class if they're sneaky about it," Trina Hale, a junior at South Charleston High School in West Virginia said of the increased popularity of vaping.

Of the 45,000 students in grades 8, 10 and 12 who were surveyed across the country, one in five reported having vaped in the previous month.

Behind vaping and alcohol, teens also use marijuana, with one in 17 high schoolers smoking it every day. While marijuana smoking, in general, is about the same level as previous years, vaping marijuana did increase.

‘MIRACLE BABY’ SURVIVES AFTER BEING GIVEN LESS THAN 1 PERCENT CHANCE OF SURVIVAL

Use of other drugs, like cigarettes, cocaine, LSD, ecstasy, heroin and opioid pills, all declined.

The nicotine present in e-cigarettes is harmful to developing brains and can make kids more likely to take up cigarette smoking later in life or even try other drugs, researchers believe.

The Associated Press contributed to this report.

White House nominee for Drug Czar: Hope and healing amid the horrors of addiction this holiday season

The most recent data from the Centers for Disease Control and Prevention tells us that in 2017, someone in the U.S. died of a drug overdose every seven minutes.  Our national conversations about the epidemic revolve around numbers and statistics – as it often must.

At the White House Office of National Drug Control Policy (ONDCP), we rely on sound research and information to develop federal policy on illicit drug issues — but numbers are just a part of the story. As the president’s nominee for Drug Czar, my priority is to ensure the people impacted by this addiction are at the forefront of our work. Each statistic on addiction and overdose is more than a number – these are individuals who deserve to be remembered.

I frequently visit a small chapel by my home that has a mural above the altar with the scripture verse “Be not afraid, I am with you.”  I often reflect that this is the message we should share with those on the long, arduous road of recovery.

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People struggling with an addiction should know that we unequivocally walk with them on their journey.  Even when they are scared, we will be with them.  We need to lovingly support them on their path to freedom from despair.

To demonstrate our collective responsibility to help others, the White House has erected the Recovery and Remembrance Tree as part of its Christmas decorations.

Like many Christmas trees, this one is decorated with lights, ornaments, and a star on top.  However, this tree is also adorned with notes sharing the stories of people battling against an addiction.  It is a poignant reminder of the impact addiction has had on our country.

People struggling with an addiction should know that we unequivocally walk with them on their journey.  Even when they are scared, we will be with them.  We need to lovingly support them on their path to freedom from despair.

The Remembrance and Recovery Tree gives us a chance to celebrate with those that are in recovery.  Their road may be marked with triumphs and setbacks, but we will endeavor to always stand with them.

It tells the stories of people like the Robertsons. Chaplain Farris and Ruth Robertson are celebrating 28 years of sober marriage.  They met in a 12-step program, and now, after more than 30 years in recovery, they own and operate a ministry that houses 70 men who are seeking to maintain their newly-found sobriety.

But the Remembrance and Recovery Tree also keeps us mindful of those we have lost to addiction.  It has ornaments that tell the story of people like Kevin, a talented writer and filmmaker.  After representing his university at the Toronto International Film festival, he got a job working in the film industry.  Kevin was talented, passionate, and highly intelligent. Unfortunately, he succumbed to this affliction that does not discriminate.

Kevin is just one of the examples of the many loved ones whom we have lost to the disease of addiction. Tragically, this is happening out in homes all over America.  My hope and prayer is that those who have lost a loved one can find peace and healing.

The stories that adorn our Remembrance and Recovery Tree reflect the triumph and tragedy that happens all across America.  It represents an important dichotomy that we must remember this holiday season.  Namely, it is about finding hope and recovery amidst pain and tragedy.

For many who are in the recovery process, it is not an easy journey.  We must let those in recovery know we are standing lovingly by their side.  We need to remember they are not a number, and we are ready to celebrate their progress.

James Carroll is the Deputy Director of the White House Office of National Drug Control.

Fentanyl now deadliest drug in America, meth overdoses growing, CDC says

Fentanyl is now the deadliest drug in America, beating out heroin and oxycodone which had previously been involved in the most overdose fatalities between 2011 and 2016. In fact, the report released Wednesday by the Centers for Disease Control and Prevention (CDC), discovered a 113 percent increase per year between 2013 and 2016 in the number of deaths involving fentanyl.

Fentanyl is a synthetic opioid that is both cheap to produce and up to 50 times more powerful than heroin and 100 times more potent than morphine. The drug can be absorbed through the skin, posing a risk to first responders or those unaware of its presence, and can be inhaled in powder form which also presents a danger.

“Among drug overdose deaths that mentioned at least one specific drug, oxycodone ranked first in 2011, heroin ranked first from 2012 through 2015, and fentanyl ranked first in 2016. Cocaine ranked second or third throughout the study period,” according to the report.

DOCTORS CAUGHT BETWEEN STRUGGLING OPIOID PATIENTS AND CRACKDOWN ON PRESCRIPTIONS

Researchers compiled data from 64,000 death certificates on U.S. overdose deaths and compared them with the five previous years. Meth use also played a larger role in fatalities than previous years, with the number of overdose deaths more than tripling between 2011 and 2016.

“From 2011 through 2016, the number of drug overdose deaths increased by 54 percent, from 41,340 deaths in 2011 to 64,632 deaths in 2016. The most frequently mentioned drugs involved in these deaths were the opioids heroin, oxycodone, methadone, morphine, hydrocodone and fentanyl; the benzodiazepines alprazolam and diazepam; and the stimulants cocaine and methamphetamine, the report said.

The percentage of overdose deaths involving meth grew from less than 5 percent to nearly 11 percent.

AS DOCTORS TAPER OR END OPIOID PRESCRIPTIONS, MANY PATIENTS DRIVEN TO DESPAIR, SUICIDE

“It’s a very dangerous drug to mess around with,” Theodore Cicero, a Washington University researcher who studies the rise of meth use among people who use opioids, told the Associated Press.

Cicero said some opioid abusers or heroin users have been turning to meth, which is a stimulant, to offset the down effects of other drugs.

The Associated Press contributed to this report.

Health experts offer solutions for unintended consequences of opioid crackdown

This is the third of a three-part series on the nation's struggle to address its crippling opioid crisis, and the unintended victims left in its wake. Read Part 2 here: Doctors caught between struggling opioid patients and crackdown on prescriptions

Many Americans today will attend several funerals before they get their first gray hair.

That’s in large part because of drug overdoses, now the leading cause of death among Americans aged 50 and younger. More than 70,000 people in the U.S. last year died from overdoses, most of which involved illegal opioids.

The overdose problem – and a rise in suicides, another byproduct of the drug epidemic — is so pervasive it’s being blamed for a drop in U.S. life expectancy.

The crisis has led to a rush of public health and law enforcement initiatives at all levels of government. The federal government has vowed to cut prescription opioids by a third. More than 30 states have passed some type of legislation aimed at attacking the opioid epidemic.

“Defeating this epidemic will require the commitment of every state, local, and federal agency,” President Donald Trump said in a March speech in New Hampshire. “Failure is not an option. Addiction is not our future. We will liberate our country from this crisis.”

We’re targeting the most vulnerable and sickest people who have been on opioids a long time.

— Dr. Stefan Kertesz, addiction specialist and professor at the University of Alabama at Birmingham School of Medicine.

The government response to the epidemic has many medical professionals, patients and their families welcoming the long overdue debate about the risks vs. benefits of opioid use. But it has also set off alarm bells for many of the millions of Americans with chronic pain who legally take opioids, under their doctor’s supervision, and are suffering a range of unintended consequences that have left them undertreated, ignored, and desperate for alternatives.

The root of the problem, according to dozens of pain patients, doctors, scholars, and others who spoke to Fox News for this story, are the Centers for Disease Control and Prevention (CDC) guidelines for opioid prescribing that were issued in 2016. While the guidelines are credited with focusing attention on prescribing practices, critics say they’ve been adopted by too many as hard and fast rules that must be enforced across the board, rather than serve their intended advisory purposes.

“We’re targeting the most vulnerable and sickest people who have been on opioids a long time,” said Dr. Stefan Kertesz, an addiction specialist and professor at the University of Alabama at Birmingham School of Medicine.

TOUGH NEW OPIOID POLICIES LEAVE SOME CANCER AND POST-SURGERY PATIENTS WITHOUT PAINKILLERS

Striking the right balance between getting control of the overdose epidemic and protecting access to treatment that brings relief to pain sufferers is a public health imperative.

The failure to do so threatens to exact a heavy price on the tens of millions of Americans whose pain is severe and disabling, and who are not driving the drug overdose epidemic.

Neglect of this large population of patients has the potential to prompt many to seek illegal opioids, or to become another statistic in the crisis of the rising U.S. suicide rate. Some have told Fox News that they have traveled, or plan to go to another country to obtain prescription opioids from doctors or pharmacies — a risky move for manifold reasons.

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So what’s the solution? Medical professionals, patients and others familiar with the opioid crisis and the fallout from the government crackdown have offered a variety of ideas.

RESETTING CDC GUIDELINES

Many believe the most urgent need is to address misunderstandings about the CDC guidelines. Clinicians and health experts say the CDC needs to make clear, in a high-profile way, what the guidelines were – and were not – meant to address. A letter signed by more than 300 health professionals, including former drug czars in the Clinton, Nixon and Obama administrations, calls on the CDC to examine the impact of the guidelines and publicly clarify them.

“Many doctors and regulators incorrectly believed that the CDC established a threshold of 90 MME as a de facto daily dose limit,” the letter said. “Soon, clinicians prescribing higher doses, pharmacists dispensing them, and patients taking them came under suspicion.”

The letter said that because the guidelines do not offer alternative pain care options, “patients have endured not only unnecessary suffering, but some have turned to suicide or illicit substance use. Others have experienced preventable hospitalizations or medical deterioration.”

The letter added: “We urge the CDC to issue a bold clarification…particularly on the matters of opioid taper and discontinuation.”

Richard A. Lawhern, a prominent advocate on behalf of chronic pain patients and co-founder of the Alliance for the Treatment of Intractable Pain, goes even further, suggesting the CDC should scrap its guidelines, and write new ones.

"The resulting document is fatally flawed,” Lawhern said, “and needs to be withdrawn for a major revision in an open public process by qualified experts in community practice for chronic pain treatment, assisted by representatives or advocates from chronic pain communities.”

CLARITY ON LEGAL PAINKILLERS

Many have acknowledged the need for better data about opioid use, on everything from the precise role that legal vs. illicit drugs have played in the national overdose crisis to more accurate information on the effect of dosage changes.

Over the summer, a U.S. Health and Human Services special task force on pain management formulated a draft report of recommendations for the guidelines and noted muddled data on deaths involving illegal opioids vs. prescribed drugs.

“The national crisis of illicit drug use along with overdose deaths are confused with the appropriate therapy of patients who are being treated for pain,” the draft report said. “This confusion has created a stigma that contributes to barriers to proper access to care.”

Federal data on overdose deaths generally do not offer specific statistics on how many involved patients who were prescribed opioids, though other data – such those compiled by states – indicate they account for a small minority.

AS DOCTORS TAPER OR END OPIOID PRESCRIPTIONS, MANY PATIENTS DRIVEN TO DESPAIR, SUICIDE

In November, a data and software company serving emergency medical services, fire departments and hospitals, released national opioid overdose data based on approximately 15,000 records collected between January and October of this year, and found that 94 percent of opioid overdoses involved illicit drugs, with only 4 percent being prescribed.

But that hasn’t stopped political leaders from developing policies and initiatives around cutting prescriptions as well as the supply of opioids. Trump vowed to cut opioid prescriptions by 30 percent over three years.

And many state and government officials are boasting about opioid prescription reductions, giving a misleading impression, Kertesz said, that progress is taking place in the drug overdose epidemic.

The [CDC opioid guideline] document is fatally flawed and needs to be withdrawn for a major revision in an open public process by qualified experts in community practice for chronic pain treatment, assisted by representatives or advocates from chronic pain communities.

— Richard Lawhern, co-founder of the Alliance for the Treatment of Intractable Pain

Many medical groups and health researchers also are calling for the CDC to address the fallout – such as reports of pain patients suffering withdrawals — from misguided implementation of its guidelines.

Kertesz, a lead author of the letter to the CDC, said that the many anecdotal reports of suicides and suicidal plans coming from pain patients who are being undertreated or cut off by doctors must be studied by the agency.

“It’s a large number of anecdotes,” he said, adding that if forcibly tapering or cutting off patients from opioids is leading to suicidal thoughts, “who will stand up to defend that policy, would we be ethically comfortable with that?”

The American Medical Association (AMA) recently released a resolution critical of the CDC guidelines that said: “We urge the CDC to follow through with its commitment to evaluate the impact by consulting directly with a wide range of patients and caregivers, and by engaging epidemiologic experts to investigate reported suicides, increases in illicit opioid use and, to the extent possible, expressions of suicidal ideation following involuntary opioid taper or discontinuation.”

In an interview with Fox News in 2017, Richard Baum, then-acting director of the Office of National Drug Control Policy, said the dialogue about the opioid epidemic has been misleading.

“This is framed as an opioid epidemic. But when you look under the hood at the report of people who overdose on fentanyl and heroin, they often have other drugs on board – cocaine, methamphetamine, other pharmaceuticals,” Baum said. “So we have a multi-drug threat that’s complicated. It means people often aren’t using [just] heroin, fentanyl, they’re also using cocaine.”

“Sometimes we inadvertently simplify it,” Baum said, “[saying] that it’s only one drug that’s causing the problem, but a lot of drug users use multiple drugs so we absolutely have to focus and are focusing on heroin and fentanyl and the opioids as the number one threat.”

LOOKING BEYOND DOSAGES

Health experts say the Drug Enforcement Administration (DEA) and state authorities must not be so narrowly focused on quantity and dosage when looking at prescribers who might require disciplinary action.

“No entity should use [morphine milligram equivalent] – thresholds as anything more than guidance, and physicians should not be subject to professional discipline, loss of board certification, loss of clinical privileges, criminal prosecution, civil liability, or other penalties or practice limitations solely for prescribing opioids at a quantitative level above the MME thresholds found in the CDC Guidelines for Prescribing Opioids,” according to the AMA.

The DEA and other authorities told Fox News they are judicious when taking action against prescribers, stressing the number who face punitive measures are just a small part of the more than 1 million registered with the agency to handle controlled substances.

Ronald Chapman II, a Michigan attorney who represents doctors accused of overprescribing, said sometimes a prescribing problem doesn’t rise to the level of a crime, and should be addressed administratively. Many prescribers trigger so-called “red flags” by errors or omissions in pain patients’ medical records, he said, and shouldn’t automatically be treated as sinister.

“We have a lot of hammers out there looking for a nail,” Chapman said.

Physicians should not be subject to professional discipline, loss of board certification, loss of clinical privileges, criminal prosecution, civil liability, or other penalties or practice limitations solely for prescribing opioids at a quantitative level above the MME thresholds found in the CDC Guidelines for Prescribing Opioids.

— American Medical Association

John Martin, the DEA’s administrator of the Diversion Control Division, said his agency has taken steps to reach out to pharmacists and clarify how investigators go about opening cases.

“I’m sure there are doctors … out there that are afraid” to prescribe opioids now, Martin said, “but that’s part of our responsibility in communication. We had that issue with pharmacists over the years.”

Martin said DEA officials have met with more than 15,000 pharmacists and pharmacy technicians “to educate them on proper prescribing on the regulations, diversion and so forth.”

Martin said the agency is undertaking a similar effort aimed at doctors.

“We’re making them aware of what we’re actually looking for, so ways that they can reduce diversion and education so they understand the different regulations out there, what they can and can’t do,” he said.

But when prescribers are targeted by authorities, sometimes they lose access to their patients' medical records, and either are forced to stop treating them because they lose their controlled substance prescribing rights or their medical license through suspension or revocation. Often, their patients are left to scramble, with nothing to fill the void of a doctor taken out of commission, and an abrupt loss of a medical treatment plan. Pain patient advocacy groups, and health care experts, say that authorities undertaking an investigation or disciplinary action  must have a plan in place for patients who are under the care of such health care providers.

Health professionals also argue that regulators and law enforcement authorities must stay in their lane, so to speak, and not interfere in the doctor-patient relationship in an effort to address the largely illegal opioid crisis.

"The key is to get the government out of medicine entirely," said Dr. Kenneth W. Fogelberg, who specializes in obstetrics and gyneacology. "Let the politicians and lawyers do what they do and let us practice medicine. We have licenses and DEA certificates and most of us know what we're doing."

"In 2006, we were required to take a course in pain management. The thrust of the course was that we were underprescribing and our patients were in pain. If a patient said she had pain  I was expected, by the patient and the hospital nurse, to medicate. If I did not, I was written up. She might be sitting in bed reading a comic book but, if she said, 'my pain is an 8' (out of 10) she was to be medicated."

"Now, MDs are blamed for overprescribing," Fogelberg said. "Pain is subjective and I only can judge by what a patient tells me, but we are pretty good at separating legitimate pain from drug-seeking behavior. If the governments, both state and local, would let doctors doctor, we could handle this, but with their insatiable thirst for control of everything, the situation just keeps getting worse."

MORE RESEARCH ON RISKS – AND BENEFITS

Most health experts agree more studies are needed on the effectiveness and dangers of opioid use.

“In medical school in the 1990s, it was taught that dosage does not matter if you go up slowly,” Dr. Deborah Dowell, lead author of the CDC guidelines, told Fox News. “Now we know there is an increased risk of opioid overdose.”

In an editorial in the “Annals of Internal Medicine,” Dowell noted “little evidence has been available to help weigh the benefits and harms of reducing or discontinuing opioids in patients already receiving long-term therapy or to guide clinicians in how to taper opioids safely and effectively.”

Other agencies, such as the Department of Health and Human Services (HHS) and the Food and Drug Administration (FDA), are moving ahead with their own guidelines on opioid prescribing and pain management. In August, FDA Commissioner Scott Gottlieb referred to the CDC guidelines as a commendable initial step, and said that his agency was working on developing evidence-based guidelines that would look at opioid prescribing.

In a rare acknowledgment of the depth of desperation among pain patients whose long-time opioid treatment had been abruptly cut down or cut off, Gottlieb expressed concern about suicides.

"In select patients and for certain medical conditions, opioids may be the only drugs that provide relief from devastating pain," Gottlieb said in a statement on the agency's website. "We’ve heard from some of these patients, and listened carefully to their concerns about having continued access to necessary pain medication. We’ve heard their fear of being stigmatized as a person with addiction, and the challenges they face in finding health care professionals willing to work with patients with chronic pain."

"Tragically, we know that for some patients, loss of quality of life due to crushing pain has resulted in increased thoughts of or actual suicide," Gottlieb said. "This is unacceptable."

Little evidence has been available to help weigh the benefits and harms of reducing or discontinuing opioids in patients already receiving long-term therapy or to guide clinicians in how to taper opioids safely and effectively.

— Dr. Deborah Dowell, lead author of the 2016 CDC guidelines on opioid prescribing

And this fall, Trump signed into law a bipartisan measure that calls on the FDA to assess “existing opioid…guidelines, examine how these guidelines were developed and any potential gap” in data.

Some experts say more should be done in the classroom to help better educate health professionals on treating pain.

“We have to look at our culture and attitude toward people with pain – and people with addiction – but mostly with pain,” said Dr. Lynn Webster, former president of the American Academy of Pain Medicine and author of “The Painful Truth: What Chronic Pain Is Really Like and Why It Matters to Each of Us.” “In our medical schools, there are less than seven hours on average of education about pain. Even though it affects more people than any other problem, it is the number one public health problem. But we’ve spent little on research to try to find a solution to this. We need to make pain and addiction a core of our medical education curriculum.”

RESEARCH INTO NON-OPIOID ALTERNATIVES

Webster has called for major funding in alternative pain treatment, which could offer relief with fewer risks and side effects. There’s also a need for quicker treatments for patients in urgent need of relief.

Stricter pre-authorization policies for prescription and non-opioid treatments, such as physical therapy, many times mean delays that leave patients in pain.

Several physicians told Fox News they’ve had to wait several days, or longer, for prescription pre-authorization. They also said there is much more paperwork required now in connection to pain management, leaving more room for error and, by extension, more potential for red flags that could lead to disciplinary action.

Most people interviewed by Fox News agreed there should be a concerted move toward a multi-faceted, more comprehensive way to treat pain. And, they stressed, because severe, unrelenting pain can lead to anxiety and depression, mental health must be an important part of treating the condition.

DOCTORS CAUGHT BETWEEN STRUGGLING OPIOID PATIENTS AND CRACKDOWN ON PRESCRIPTIONS

“There is a lack of multidisciplinary physicians and other health care providers who specialize in pain,” the AMA noted. “These physicians and other health care providers include pain specialists, addiction psychiatrists, psychologists, pharmacists, and others who are trained to be a part of the pain management team.”

Among the AMA recommendations was “Expand graduate medical residency positions to train in pain specialties including adult pain specialists, pediatric pain specialists, behavioral health providers, pain psychologists, and addiction psychiatrists,” and “expand availability of non-physician specialists including, but not limited to, physical therapists, psychologists, and behavioral health specialists.”

Some physicians and pain patients would like to see medical marijuana legalized in more states, and on the federal level. Military veterans who get their medical treatment from Veterans Administration health facilities say that even if they reside in states where cannabis is legal for health reasons, they cannot get a prescription because it is not legal on a federal level.

"My patients have benefitted by many opiate alternatives," said Montana-based Dr. Mark Ibsen, who stopped prescribing opioids after running into trouble with state medical officials and the DEA over allegations, which he said were untrue, that he was unjustifiably giving high doses to pain patients. "Eighty percent of my patients on opiates got off with cannabis."

Ibsen, whose license was reinstated, and who was never charged, said: "The key is to create a context for healing, which empowers the patient to interact with pain and their life in the most effective manner possible, and let go of what no longer works."

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Dr. Daniel Alford, the associate dean at Boston University’s School of Medicine’s Office of Continuing Medical Education, is on a mission to ensure that the next generation of doctors are better equipped to make decisions about safe opioid prescribing.

"We've been over-reliant, too opioid-centric in terms of our prescribing for chronic pain," Alford said. "Opioids shouldn't be the first choice, they should really be the last choice. But if opioids are to be prescribed, how do you do it in a way that maximizes risk to that patient. We should try to minimize dose escalation."

A prioirty, Alford said, is to improve the patient's quality of life.

"It's important to acknowledge and appreciate a person's pain, for them it's real," Alford said. "Until we have some method to say 'This is exactly where [the] pain is, our responsibility is to say 'I believe you.'"

Most of the time, he said, there's "zero percent risk" of being deceived by the patient.

"Based on their risk profile, to the best of your ability, you think about what treatment is best for them," he said.

If tapering is necessary, "I'm going to taper over a long period of time, I'm going to try to keep the patient engaged and I'm going to try to do what's really really hard, I'm going to try to get the patient into other forms of treatment," Alford said, adding that multi-modal treatment plans, combining medication and other therapy, often are successful.

But the approach won’t go very far if insurers won’t cover non-opioid or multidisciplinary treatments, health experts said.

“Insurance won’t pay for many evidence-based treatments,” said Michael Schatman, a clinical psychologist who runs Boston Pain Care, which uses an array of programs – including exercise, psychotherapy as well as prescription painkillers—to treat pain. “My program loses money every year.”

“Some patients need to be tapered, some need to be taken off opioids, they’re not good for everyone, but there’s a void because of our health care system,” he said.

At Boston Pain Care, patients go through multiple treatments simultaneously. Shatman claims it is more effective than the status quo approach, which often involves trying one treatment, perhaps two, which may not work. Often, patients are pressed to try different therapies, one at a time, until one offers some improvement.

“Sequential pain management is an incredible failure,” Schatman said. “As long as we have a for-profit insurance agency, it’s not going to get much better. We’re seeing the devolution of the profession of pain medicine to the business of pain medicine.”

MORE DIVERSE VOICES IN DISCUSSIONS ABOUT SOLUTIONS

The debate over opioids and pain management has become emotional, with the overdose crisis and the dearth of reliable data fanning the flames.

Some of the leading voices on different sides of the debate are calling for unity toward working on finding solutions to both pain management and the overdose crisis.

Schatman said he would like to see health experts who are firmly opposed to opioids sit at a table with peers who are supportive of them as a beneficial treatment and bat around ideas.

Many pain experts and health researchers say that committees for agencies such as CDC should include specialists in pain and pain patients.

Dr. Stephen Gelfand, a rheumatology consultant from South Carolina, was quoted in OpioidInstitute.org saying that forced tapering is concerning. But, he added, “there is also a significant percentage of these patients who actually have the disease of addiction and need addiction treatment services including medication-assisted therapy.”

And so, he said, “we also need to have victim advocates who have survived and overcome the scourges of addiction as the result of opioid overprescribing to sit on these patient advisory boards at every level of decision-making.”

Elizabeth Llorente is Senior Reporter for FoxNews.com, and can be reached at Elizabeth.Llorente@Foxnews.com. Follow her on Twitter @Liz_Llorente.

Tough new opioid policies leave some cancer and post-surgery patients without painkillers

Despite protestations that new federal and state hard lines on painkiller prescriptions do not affect cancer patients or people fresh out of major surgeries, many of those in health care’s trenches feel differently.

Dr. Dan Laird was treating an elderly man in Nevada who, despite efforts by the physicians and other doctors to save his leg, ended up having to undergo an amputation. “He lost the battle, his leg was cut off,” Laird said.

The surgery took place on a weekend in the fall. On Monday, the man called Laird in agony and desperation. He had been discharged from the Valley Hospital Medical Center in Las Vegas during the weekend, with no painkiller prescription.

DOCTORS CAUGHT BETWEEN STRUGGLING OPIOID PATIENTS AND CRACKDOWN ON PRESCRIPTIONS

“No pain medication!” Laird told Fox News in an interview. “Having a limb amputated is one of the most painful things you can have done. And the tibia is one of the most painful parts of the leg. He had unimaginable, horrific pain. I was so mad, I called the hospital.”

“They said that the new [Nevada] law means we can’t prescribe to patients when we discharge them,” Laird said, recalling what he said he was told.

But Laird is also a malpractice attorney – and knew the state law chapter and verse.

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Laird said confusion over national and state policies and regulations concerning opioid prescribing is common among health practitioners. “The state law is ridiculously long. I’d prescribed my patient opioids for months, and because he had been receiving opioids from another physician," a hospital doctor did not prescribe any painkillers.

A spokesperson for the hospital contacted by Fox News did not offer comment for the story.

AS DOCTORS TAPER OR END OPIOID PRESCRIPTIONS, MANY PATIENTS DRIVEN TO DESPAIR, SUICIDE

Nevada’s opioid law, which took effect in January, limits the first prescription of opioid for acute pain to seven days and increases the amount of paperwork that must be filed for preauthorization for long-term painkillers.

In his 25 years of practicing medicine, Laird said, “I’ve never seen anything like this, an environment where it’s acceptable to mistreat chronic pain patients, where there’s an animus toward chronic pain patients.”

No pain medication! Having a limb amputated is one of the most painful things you can have done. And the tibia is one of the most painful parts of the leg. [The patient] had unimaginable, horrific pain. 

— Dr. Dan Laird

Like many health care providers, Laird said it’s right to take a hard look at opioids, and prescribing practices that needed tightening.

“Opioids are dangerous drugs. They have to be prescribed with extreme caution,” he said. “But for people who’ve had their leg cut off, or someone who has cancer, or has been in a bad car crash, there’s nothing worse than leaving them in pain.”

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“There’s anticipatory panic, (among physicians)” Laird said. “Doctors perceive a liability for prescribing opioids.”

In Michigan, Dr. Fran Van Alstine, a specialist in palliative and hospice care at the Munson Medical Center, has also seen how far the long arm of the war on opioids can reach.

HEALTH EXPERTS OFFER SOLUTIONS FOR UNINTENDED CONSEQUENCES OF OPIOID CRACKDOWN

The state has a 14-day day limit on opioid prescriptions, even for patients like his, who have advanced cancer, chronic lung disease, congestive heart failure.

He said he recently had to jump through hoops to get a painkiller refill for a terminally ill patient who was released from a hospital, and about to enter hospice care. The insurer denied the prescription because the man’s medication record showed “red flags” – opioids prescribed by more than one doctor, at high dosages.

“Our patients have been in and out of hospitals. They get prescriptions from different doctors, they have serious, life-limiting illnesses,” Van Alstine said. “They’re actively dying and in pain. We put in a diagnosis in his records, so there’s no question what we’re using the opioids for. [The restrictions] are an exercise in silliness. In hospice, addiction is the last of our concerns.”

The man died 24 hours after finally getting a refill – spending his final days in pain.

Elizabeth Llorente is Senior Reporter for FoxNews.com, and can be reached at Elizabeth.Llorente@Foxnews.com. Follow her on Twitter @Liz_Llorente.

Doctors caught between struggling opioid patients and crackdown on prescriptions

This is the second of a three-part series on the nation's struggle to address its crippling opioid crisis, and the unintended victims left in its wake. Read Part 1 here: As doctors taper or end opioid prescriptions, many patients driven to despair, suicide.

Dr. Stephen Nadeau received a warning from the Gainesville, Fla., hospital where he worked.

Their policy on prescribing opioids was changing, to go beyond federal guidelines aimed at the national overdose crisis that has claimed hundreds of thousands of lives.

The hospital would stop treating pain with opioids. And every doctor, including Nadeau, had to stop prescribing them. Doctors otherwise risked losing hospital admitting privileges – and perhaps even their medical license.

In Helena, Mont., Dr. Mark Ibsen was feeling heat from the state medical board – and the U.S. Drug Enforcement Administration (DEA), for the high-dose opioids he was prescribing to patients in severe, chronic pain. An allegation made by what he described as a disgruntled employee charged Ibsen was overprescribing.

As a result, the state medical board suspended his license. The DEA visited five times, Ibsen said, suggesting he was risking his livelihood and could end up in jail if he kept prescribing.

Both doctors complied and stopped prescribing, affecting roughly 230 of their patients. Tragically, among those were several who committed suicide, the doctors said, when they couldn’t find another health care provider to relieve the pain.

That’s a scenario playing out across the country, as government agencies respond to the staggering rate of drug overdose deaths, involving primarily illegal opioids like heroin and illicit fentanyl. Doctors who maintain they are responsibly prescribing opioids are getting caught up in the crackdown, according to dozens of medical care providers interviewed by Fox News, leaving little room to both play by the rules and properly treat huge numbers of patients who legitimately suffer chronic and intense pain.

Some doctors like Ibsen and Nadeau are opting to simply stop prescribing legal opioids, as insurers, pharmacies, and authorities warn them about overstepping guidelines issued in 2016 by the Centers for Disease Control and Prevention (CDC).

Meanwhile, other doctors, nurses and medical associations accuse the federal government of interfering in the physician-patient relationship, and pursuing simplistic, politically expedient solutions that put tens of millions of Americans at risk.

“Not only is the government legislating the way we care for chronic pain patients,” said Nadeau, a professor of neurology at the University of Florida College of Medicine, “they are substantially taking away our ability to do it.”

CDC GUIDELINES CONTROVERSY

Critics of the way the 2016 guidelines have been applied note they were not intended as law, but as a means to advise primary care physicians. The CDC specifically cautioned against abruptly stopping or forcibly tapering opioid treatment for patients already taking them, because of the danger of withdrawals, or debilitation.

More than 300 health care professionals, including former drug czars in the Clinton, Nixon and Obama administrations, have signed an as-yet unpublished public letter to the CDC, warning of a brewing crisis among pain patients, despite the “laudable goals” of the guidelines.

“Within a year of (CDC) Guideline publication, there was evidence of widespread misapplication of some of the Guideline recommendations,” said the letter, written by three doctors and a pharmacist. “Soon, clinicians prescribing higher doses, pharmacists dispensing them, and patients taking them came under suspicion.”

“Patients with chronic pain, who are stable and, arguably, benefiting from long-term opioids, face draconian and often rapid involuntary dose reductions,” the letter continued. “Often, alternative pain care options are not offered, not covered by insurers, or not accessible … Consequently, patients have endured not only unnecessary suffering, but some have turned to suicide or illicit substance use. Others have experienced preventable hospitalizations or medical deterioration.”

Others argue many authorities have misunderstood, or outright ignored, the CDC’s disclaimer. Health care providers who don’t drop opiate painkillers are setting strict limits on dosage limits, even for chronic pain sufferers who require more medicine because of serious conditions, or the way they hyper-metabolize opioids. Many who do so cite the CDC guidelines, saying they were told to follow them — or took them up as a kind of pre-emptive strike.

Not only is the government legislating the way we care for chronic pain patients, they are substantially taking away our ability to do it.

— Dr. Steve Nadeau, a professor of neurology at the University of Florida College of Medicine

Dozens of pain patients have told Fox News they were dropped or forcibly tapered down by doctors who long treated them quite successfully, but who became fearful about losing their license after being formally admonished, or hearing about other doctors who ran afoul of the government.

Meredith Lawrence, who lived in Tennessee with her husband, Jay, while he suffered decades of pain following a tractor-trailer accident, recalled the helplessness she felt watching him suffer, while his dosage of opioids was being sharply reduced.

Lawrence said the doctor who had treated him successfully for years was very clear about his decision to taper down the dosage.

“He said ‘My patients’ quality of life is not worth risking my practice or my license over,'" she told Fox News. "I’ll never forget that.”

“Jay felt like they gave up on him,” she said, recalling what finally prompted her husband to kill himself. “That was the day Jay gave up. He felt the doctor gave up – and he gave up.”

Dr. Stephen Nadeau

DEA TARGETING ‘WORST OF THE WORST’

Much of the opioid overdose epidemic in recent years stems from illegal drugs, not legitimate prescriptions. But more than a decade of overprescribing – out of ignorance for some, and for others the chance to rake in big profits – played a significant part, according to federal authorities and others who have studied the issue.

Assured by what some charged were deliberately deceptive pharmaceutical companies insisting opioids weren’t very addictive, some health care providers prescribed liberally, even for minor procedures such as a pulled tooth, or non-serious orthopedic injuries. Overprescribing led to greater daily dosages or easy-to-get refills – more than were needed. That, along with the theft and resale of opioids from people who had prescriptions, laid the groundwork for the crisis.

Most prescribers say they recognize many health providers were not prudent enough when prescribing opioids. And many doctors noted they were previously criticized for undertreating pain. Medical schools devoted little time to the study of pain and to opioids, they also say.

“Physicians and particularly medical school residency programs should have been taking more responsibility. Pain is the most common condition, and it’s one of the most difficult to treat,” said Nadeau. “And there [have been] pill mills that have relied on physicians to prescribe and many have done so very irresponsibly. But I think many are compassionate physicians … it’s a reflection of the inadequacy of their training that they basically had to learn the ropes on their own.”

John Martin, the DEA’s Administrator of the Diversion Control Division, said an overwhelming percentage of prescribers followed the rules. Of 1.6 million registrants, he said, less than one percent “operate outside the law.”

But there are still unscrupulous prescribers.

“Remember, with the opioid epidemic, just one practitioner that’s operating outside the law can really have a lot of serious consequences. In a small community, it can wreak havoc,” Martin said. “They’re really going after the worst of the worst of the criminal violators.”

Martin said most prescribers have nothing to worry about.

“Doctors are writing less prescriptions. And that goes down to education with the CDC guidelines," he said. "There's a new and different way of looking at using opioids for chronic pain.”

But that’s not what prescribers and patients see.

“Doctors around the country are terrified because of what happened to me and other doctors,” Ibsen said. “We don’t arrest car dealers if someone drives a car and gets into a fatal accident.”

“Standards of care are being decided by a jury of people without medical training,” Ibsen added. “It’s a very bad situation. We’re playing Whack-a-mole with the wrong mallet.”

Remember, with the opioid epidemic, just one practitioner that’s operating outside the law can really have a lot of serious consequences. In a small community, it can wreak havoc…[the DEA agents] are really going after the worst of the worst of the criminal violators.

— John Martin, DEA Administrator of the Diversion Control Division

THE CHALLENGE OF PAIN MANAGEMENT

For many medical professionals, treating pain patients has become a thankless task. The stakes are too high, they say, as even those who try to responsibly manage opioid treatment for their sickest pain patients find themselves hounded by authorities or pharmacists.

Many doctors say they view opioids as a last resort. They are very strong medicines, which often come with strong side effects, ranging from constipation, nausea, liver damage and respiratory problems. Many pain patients said in interviews they were reluctant to take them initially, and eventually did only after other treatments and surgeries failed.

“If we had a good alternative to opioids, every physician would be at the front line of it to prescribe that,” said Dr. Lynn Webster, vice president of PRA Health Sciences, and the past president of the American Academy of Pain Medicine.

In a recent survey by the North Carolina Medical Board of its licensees, 43 percent of 2,661 respondents said they had stopped prescribing opioids. They attributed their decision to concern about getting into trouble.

Patients complained to the board doctors had cut them off, pointing to the CDC guidelines or an initiative by the board aimed at cracking down on health care providers who prescribed high doses of opioids, or who had two or more patients die of overdoses in a year.

And of 3,000 doctors responding to a recent nationwide survey by the SERMO physician network for BuzzFeed News, 70 percent said they had dramatically cut down or altogether stopped prescribing opioids. The main reasons were “too many hassles and risks involved,” “improved understanding of the risks of opioids,” and fear of “getting into trouble,” according to BuzzFeed.

Yet another survey, commissioned by The Physicians Foundation, showed about 70 percent of nearly 9,000 physicians nationwide were prescribing fewer opioids.

In Nevada, where so many doctors stopped taking pain patients after the state implemented strict opioid prescription rules – which increased required record-keeping – physicians like Dan Laird now have a six-month waiting list.

“We turn patients away every day,” said Laird, who last year could fit in patients soon after they called for an appointment. “It’s heartbreaking, but many can’t find doctors.”

Many pain patients told Fox News that after being forcibly tapered down or abandoned by their pain doctors, they have lost much of their ability to function. Many said they have made suicide plans.

"I have heard from — either through email or posts on my blogs – about 1,000 people over past two years who have been denied pain medicine or forced to dramatically reduce their dose who have expressed a desire to die or commit suicide," Webster said.

Karen Nicholson, a former federal prosecutor who credits her opioid treatment with allowing her to function after years of being bedridden, said: “We’re looking only at the supply, and cutting off people who are not abusing the medication. It made all the difference in the world, I couldn’t sit or stand or walk because of nerve damage. I went from being bed-ridden and completely non-functional to doing my work as a prosecutor.”

WARNINGS, RAIDS AND ARRESTS

Health care providers who prescribe opioids, particularly to high-impact chronic pain patients, are finding themselves on the radar of any number of sources – pharmacists, state medical boards, insurers, and law enforcement.

In a speech about the national overdose deaths epidemic in March, President Trump said: “Whether you are a dealer or doctor or trafficker or a manufacturer, if you break the law and illegally peddle these deadly poisons, we will find you, we will arrest you, and we will hold you accountable.”

But the red line triggering disciplinary action often is inconsistent, and murky. The CDC considers an opioid’s benefits to outweigh risks if it improves pain and function by at least 30 percent. But, doctors say, those factors rarely are considered when authorities scrutinize prescribing patterns.

More often, it’s large amounts of opioids and high doses – statistics on a spreadsheet or chart, without the context of a patient’s medical condition — that can bring disciplinary action.

On Nov. 2, Dr. J. Julian Grove posted to Twitter a letter his Phoenix office had received from Walgreens. Grove said he wanted to provide chronic pain patients “an insight to the veiled threats” that health care providers treating pain are getting these days.

The letter said: “Walgreens has determined that you may have issued prescriptions for opioids that exceed the CDC guidelines.”

It said Walgreens had the right to refuse to fill a prescription that falls outside the guidelines, and added: “Walgreens pharmacists may notify appropriate regulatory agencies when prescriptions are refused.”

Grove blasted the letter.

“I am a double board-certified anesthesiologist and pain specialist, treating complex pain and cancer pain always w/comprehensive approach," he said. "Insulting.”

Asked about Walgreen’s pressure on prescribers to follow the CDC guidelines, company spokesman Phil Caruso told Fox News in a statement: “As a key patient touchpoint in the nation’s healthcare delivery system, we regularly communicate with prescribers to help ensure the safe and effective dispensing of medications in the best interest of our customers … Fighting the opioid epidemic requires all parties, including leaders in the community, physicians, pharmaceutical manufacturers, distributors, pharmacies, insurance companies, PBMs (pharmacy benefit managers) and regulators to play a role and coordinate efforts.”

The U.S. Attorney’s Office in Atlanta announced in October that some 30 doctors were put on notice there for prescribing opioids in larger quantities and higher doses than others. Prosecutors enclosed the CDC guidelines with the warning letters.

U.S. Attorney B. Jay Pak called those doctors “outliers,” adding the warning letters were meant to point out “atypical practices.” Significantly, Pak said the doctors may not have done anything wrong.

“It is our plan to strategically reduce the impact of this crisis within our community by notifying outlier prescribers that their opioid prescribing habits are not in conformity with accepted standards, or the prescribing habits of their peers,” the agency said in a statement. “Through this initiative and others, it is the goal of the Department of Justice to reduce opioid prescriptions by one-third over the next three years.”

Prescribers particularly dread getting in the crosshairs of the DEA, which can revoke permission to manufacture, distribute and dispense controlled substances. The agency opens about 1,500 new opioid cases per year and makes more than 2,000 arrests. The arrests include DEA registrants, doctor-shopping patients, and prescription forgery rings.

Martin, the DEA administrator, said that actions against prescribers are not undertaken arbitrarily.

“When we are investigating something like a doctor that may be overprescribing, you know because we're not doctors, in the course of our investigation we are going to solicit medical experts,” Martin said. “We'll try to get what's called prescription drug monitoring program information and that's information that the states have at their level that shows how many prescriptions are being written by a doctor for a patient and being filled at a certain pharmacy."

“So we'll try to look at that stuff and then maybe go out to that pharmacy and do an inspection and look at their records and just see if there's anything more there and then we'll follow up with that,” he said.

Roughly 800 prescribers each year surrender their DEA registration – a kind of license – when the agency opens an investigation. DEA investigations can involve having assets and medical records seized. In some cases that can lead to bankruptcy, doctors said, prompting many to surrender their opioid prescribing rights, rather than fight a battle against a behemoth government.

Ibsen was an emergency room doctor in Montana when he became – as he puts it, an “accidental pain doctor,” taking “pain refugees” whose doctors had been arrested. Many patients were very ill and suffered severe chronic pain, said Ibsen, who added he was able to wean many patients down to lower doses.

Ibsen said he became a target of the state board of medical examiners after an employee he fired filed a complaint, saying he over-prescribed. His license was suspended but eventually reinstated – after four years. But he decided to stop prescribing opioids after five visits from the DEA.

“They were very vague,” he said of the DEA agents. “They said ‘You’re risking your freedom by prescribing to patients like these.’ I said ‘Patients like what?’ They said, ‘Patients who might sell the pills.’”

“Doctors are taking plea deals because they don’t want to go to prison,” said Ibsen, who was not charged. “Once they arrest a doctor, they seize all their medical records. A doctor can’t make any more income. They seize your assets, and can’t afford an attorney.”

Ibsen referred patients to a prominent pain doctor in California, Dr. Forrest Tennant, who became known for taking people cut off by other doctors. Tennant for years had been researching non-opioid alternatives.

Then the DEA raided Tennant’s office. The agency never charged him, but he, too, gave up prescribing opioids.

“It’s immoral and unsafe to forcibly taper down or abandon a patient,” said Tennant, whose patients included those with terminal illnesses. “Some doctors don’t give these patients any withdrawal medication. Who is the worst offender, then? The CDC, the DEA, the U.S. attorneys who are shutting down doctors, or the doctors who abandon patients?”

One Tennant patient, Jennifer Adams, a former Montana police officer who had been treated by Ibsen, died from a self-inflicted gunshot in April, after the California doctor’s office was raided by the DEA.

Tennant said he respects the idea “the DEA has a right and responsibility to investigate.”

“But since I used high doses, they said my patients were going to overdose and die,” Tennant said. “I’ve been practicing a long time, I’ve not had a single overdose. I’ve given patients thousands of opioid equivalents. I know how patients should be monitored.”

Dr. Lesly Pompy was one of a few pain physicians in a rural part of Michigan, serving as many as 1,500, the majority of them referrals from other doctors who could not treat their chronic conditions. A pain specialist since 1995, he kept long hours, sometimes going to hospital emergency rooms when he was summoned to help a patient in severe pain. Sometimes he would try nerve blocks, many other times opioids.

On Sept. 26, 2016, roughly 25 law enforcement officers raised Pompy’s office at the ProMedica Monroe Regional Hospital.

“There were DEA agents, county and local police, they had everybody in my waiting room and who worked in my office put their hands up. Children were crying. There was a helicopter over the building. It was like a scene from a Jason Bourne movie," he said.

Pompy was charged with unlawful distribution of prescription drugs and health care fraud from 2012 to 2016. A federal jury indicted him this summer on 37 counts. The indictment maintained Pompy illegally prescribed some 10 million dosage units of controlled substances that fell outside the realm of standard practice. He was also accused of inappropriately filing claims to insurers.

Pompy denies the charges and claims that because he prescribed large quantities of opioids, some to severe pain patients who require high doses, he became a target.

"The damage that the proliferation of opioid distribution has done to our community, like many across the United States has been devastating,” U.S. Attorney Matthew Schneider said, according to published reports. “It’s particularly disturbing when the distributor is a medical professional.”

Pompy’s former patients and some former employees have stood by him, saying he is being scapegoated. Former patients have held rallies and started a Facebook group in support of him.

Janet Zureki, a former patient of Pompy, said that — as often happens after a prescriber's arrest — patients were left in limbo, having to scramble to find another pain doctor. “After the raid and he could no longer prescribe, everyone was dangerously cut off of their medicines, including me,” she said. “It took me three months to find another pain doctor and they put me on a lower dose of medicine. During that three month period, I had to go without medicine and go through withdrawal.”

Zureki defends Pompy.

“As a doctor, I found him to be very compassionate and he also ran a tight ship,” she said. “I have been in his office and have heard him address someone who wasn’t taking their medicine properly, so I know he didn’t stand for that. He worked tirelessly to help the people in our community,” she said.

DOCTORS LAMENT WALKING AWAY

Nadeau is bewildered over having to stop treating his pain patients, at least one of whom died by suicide. And he said his hospital’s decision to stop working with opioids is by no means unique.

Hospitals increasingly see opioids as a liability; an overdose can land them in a lawsuit, he said. But he wrestles with the fact there are people he can no longer help.

“I can’t provide comprehensive care for my patients, meaning treatment of pain, depression, sleep problems, anxiety, and other problems,” Nadeau said. “In patients with chronic pain, there nearly always are a lot of problems.”

Nadeau reached out to fellow physicians to see if they would take his pain patients.

“It’s been extremely difficult to find physicians to provide comprehensive pain therapy,” he said. “I don’t blame physicians for being scared to death and for prescribing to CDC guidelines, but I do blame [some of] them for treating patients badly.”

For his part, Ibsen is treating patients with medical marijuana. Ibsen said he always strived to get patients on opioids to agree to taper down, and about 80 percent did, often using medical cannabis. For the others, opioids were the best treatment, Ibsen said. He understands the threat of the overdose epidemic all too well.

“My nephew died of a heroin overdose” in the summer, he said. “But incarcerating doctors is not going to solve the addiction crisis.”

“There are two things doctors do – we save lives and we relieve suffering. If we’re not willing now to relieve suffering, then what are we about?”

Elizabeth Llorente is Senior Reporter for FoxNews.com, and can be reached at Elizabeth.Llorente@Foxnews.com. Follow her on Twitter @Liz_Llorente.

As doctors taper or end opioid prescriptions, many patients driven to despair, suicide

This is the first of a three-part series on the nation's struggle to address a crippling opioid crisis, and the unintended victims left in its wake.

It happened slowly. The pain caused by a 1980 back fracture, the result of a tractor-trailer crash, crippled more and more of Jay Lawrence’s body and spirit.

By 2006, the Tennessee native and Navy veteran’s arms and legs were going numb. The excruciating pain reduced him to tears. Multiple surgeries, chiropractic adjustments, and physical therapy didn’t work.

He finally found solace in prescription painkillers – 120 milligrams a day of morphine. A high dose, but it dulled the pain enough for him to take walks with his wife, shop for groceries, even take in a few movies.

But last February, the pain clinic doctor delivered jarring news: He was cutting Lawrence’s daily dosage, first to 90 milligrams then, in short stages, down to 30 milligrams. The doctor said the reduced dosage was in response to the Centers for Disease Control and Prevention (CDC) prescribing guidelines released in 2016 as part of a national anti-opioid push, according to Lawrence’s wife, Meredith.

“The doctor said: ‘You know these guidelines are going to become a law eventually. So we've decided as a group that we're going to take all of our patients down,’” she told Fox News in an interview.

Lawrence’s pain returned with a vengeance. He could barely move or sleep. He soiled his pants, unable to make the bathroom in time, Meredith said.

“It feels like every nerve in my body is on fire,” he told his wife.

Meredith said she and her husband went to their primary care physician and asked for a referral to another pain clinic. They were told it would take a minimum of six weeks.

That was too much for Lawrence. In March, on the day of his next medical appointment, when his painkiller dosage was to be reduced again, he instead went to a nearby park with his wife. And on the very spot where they renewed their wedding vows just two years earlier, they held hands.

He raised a gun to his chest and killed himself.

Jay and Meredith Lawrence (Savannah DeAnn Photography)

Lawrence, who was 58, became one of an undetermined number among the nation’s 20 million chronic pain sufferers who chose suicide after being cut back or denied prescriptions for opioids. The suicides have motivated many of those who continue to suffer from pain – and family members and advocates of those who took their lives – to call for a re-evaluation of the rush to reduce opioid dosages for those who most need them.

“We have a terrible problem. We have people committing suicide for no other reason than being forced to stop opioids, pain medication, for chronic pain,” said Thomas Kline, a North Carolina family doctor and former Harvard Medical School program administrator.

“It’s mass hysteria, a witch hunt. It’s one of the worst health care crises in our history,” said Kline, who has 26,000 Twitter followers, and a website where he publishes the names of those who he said committed suicide after having their opioids cut back or eliminated. “There are five to seven million people being tortured on purpose.”

The CDC doesn’t have numbers of those who commit suicide after having their pain medications cut. But most of the doctors who spoke to Fox News said they knew of between one and six patients who took their life after losing access to opioid treatment, and being turned away from other doctors who now see prescription painkillers as a hassle.

Several prominent doctors and pain patient advocacy organizations said they have heard from hundreds who say they have been left in debilitating pain and are considering suicide. The issue earlier this year came to the attention of Human Rights Watch, which launched an investigation.

"Clearly, there are patients now who feel like life is not worth living if they return to living in pain," said Diederik Lohman, director of Health and Human Rights for Human Rights Watch. "Many of the patients we spoke to are very law-abiding, and would turn to suicide before going to the street to get illicit drugs. The government has a duty to respond to the overdose crisis but to do so in a way that is harming people who have a legitimate medical issue is a human rights issue."

We have a terrible problem, we have people committing suicide for no other reason than being forced to stop opioids, pain medication, for chronic pain. It’s mass hysteria, a witch hunt. It’s one of the worst health care crises in our history. There are 5 to 7 million people being tortured on purpose.

— Dr. Thomas Kline, former Harvard Medical School program administrator, and publisher of list of pain patients who have died by suicide.

Many pain patients say they understand the urgent need of political leaders and government agencies to fight the drug overdose epidemic. But targeting the millions who legitimately suffer from chronic pain is grasping for a solution that doesn’t address the preponderance of illegal drugs, they argue – or the rate of overdoses caused by them.

The CDC released a report Nov. 30 showing that despite a drop in painkiller prescriptions over the years, the drug overdose rate continues to soar, with the growth driven by the illicit opioid fentanyl and its cousins. It is a trend that has held for several years.

“People with pain shouldn’t have to suffer because people without pain are abusing opioids,” said Cynthia Toussaint, a former ballerina from California, who has Complex Regional Pain Syndrome (CRPS), which left her bedridden for 10 years, and unable to speak for five. “Pain patients don’t want to take opioids any more than cancer patients want to use chemotherapy. However, many people with pain need opioids to function physically and pursue the joyful aspects of life.”

At a recent American Medical Association (AMA) meeting, the group’s president, Dr. Barbara McAneny, spoke of how an advanced prostate cancer patient of hers attempted suicide after he was denied opioids by an insurer. “The pendulum swung too far when pain was designated a vital sign, and now we are in danger of it swinging back so far that patients are being harmed,” she said, according to published reports.

ISSUES WITH CDC GUIDELINES

Federal officials have said the CDC guidelines weren’t intended to disrupt the proper prescribing and use of opioids. “We’re not telling any doctor that they can’t make a legitimate prescription,” then-U.S. Attorney General Jeff Sessions told Fox News, in an interview before he left office. “Maybe some doctors are getting too cautious. We don’t know.”

Sessions acknowledged “opioid prescribing can be essential for people,” and said, “it’s very clear that people with serious pain problems are in need of real significant pain relief and sometimes [opioids] are the only thing that will provide relief, and it is absolutely legitimate to prescribe it.”

We have heard about the suicides…It’s tragic that anyone takes their life for any reason, including that they had their opioids unilaterally stopped.

— Dr. Debbie Dowell, lead author of the 2016 "CDC Guideline for Prescribing Opioids for Chronic Pain"

CDC officials added they are also aware chronic pain sufferers have committed suicide in their struggle to get by with fewer or no opioids.

“We have heard about suicides,” said Dr. Debbie Dowell, a senior CDC medical advisor, and lead author of the guidelines on opioid prescribing. “We’ve heard the reports. It’s tragic that anyone takes their life for any reason, including that they had their opioids unilaterally stopped.”

Dowell said the scope of suicides caused by under-treatment of chronic pain “isn’t something that’s easy to measure. We’ve looked at how we might measure this. Sometimes patients or their families don’t report it.”

The CDC guidelines focused on primary care physicians and recommended extreme caution in prescribing opioids. It also suggested a maximum daily dosage of 90 morphine milligram equivalents for first-time painkiller patients.

But the guidelines also warned against forcibly tapering or abruptly cutting off severe pain sufferers who have responsibly have taken opioids, noting that a drastic change could lead to withdrawal, and serious illness.

Untreated pain, many health experts say, can also lead to hypertension, more serious pain conditions, and other problems. Health practitioners say this is a plight that could affect anyone — all it takes is a slip, a fall, or a botched surgery that could bring on intense and perhaps long-term pain.

Dowell said patients should be prescribed on a case-by-case basis.

“We believe everyone deserves effective pain management,” she said. “The CDC guidelines are not a regulation or a law – it’s guidance for providers.”

“It never made a recommendation to take people off medication involuntarily, or to taper down involuntary," she said. "It was meant to provide updated guidance about the benefits and risks of opioids for chronic pain so that the provider and the patient – together – could make decisions.”

GUIDELINES BECOME ENFORCEMENT TOOLS

The CDC disclaimer was apparently lost among the headlines about the staggering number of deaths due to opioids. Political leaders and government officials often failed to note the bulk – at least 60 percent, according to the U.S. Department of Health and Human Services — of the overdose epidemic was caused by illicit drugs, not prescription painkillers.

And when officials did address the portion of deaths due to prescriptions, advocates of safe opioid use argue, they often lumped together pain patients and people with addiction who illegally obtained someone else’s prescribed opioids. That made for a perfect storm, which formed the basis for a slew of hardline state and federal policies, including a Trump administration vow to slash prescriptions by 30 percent over the next three years.

Either in response to the CDC guidelines or as proactive measure to deal with the opioid crisis on their own, at least 33 states have enacted some type of legislation related to prescription limits, according to the National Conference of State Legislators. Health care providers and pain patients who have Medicare prescription plans are bracing for January, when the federal insurance program will give its insurers and pharmacists the authority to reject prescriptions that deviate from CDC recommended dosage.

“The CDC guidelines were geared to primary care doctors, but they have been hijacked and weaponized as an excuse for draconian legislation,” said Michael Schatman, a clinical psychologist and director of research and development at Boston Pain Care, a multi-disciplinary pain clinic, and editor-in-chief of the Journal of Pain Research. “Illicit opioids, not prescription opioids, are driving overdose deaths.”

The CDC guidelines…have been hijacked and weaponized as an excuse for draconian legislation.

— Michael Schatman, editor-in-chief of the Journal of Pain

The disproportionate focus on prescription painkillers by officials responding to the overdose epidemic, pain specialists and public health researchers say, is in great part why the drug-related death rate continues to climb while legal opioids becomes less available to pain patients.

“We’re targeting the most vulnerable and sickest people who have been on opioids a long time,” said Dr. Stefan Kertesz, an addiction specialist and professor at the University of Alabama at Birmingham School of Medicine. “Insurers are issuing rules that say we won’t cover long-term opioids for anyone over 90 milligrams. Well, five percent of people who receive opioids account for 60 percent of the milligrams prescribed. With so many milligrams going to a tiny group of very sick people, if you can knock a few people off these opioids you can show a big numeric reduction.”

“What we’re really doing is dragging down the dose on the most disabled people,” said Kertesz, who sits on several state opioid safety committees. “Prescription control seems an easy answer to the epidemic, but that’s not stopping addiction.”

CRIES FOR HELP, AND GIVING UP

On social media, comments sections on news sites, and in emails to Fox News, numerous pain sufferers say they have made suicide plans because their health care provider has forcibly reduced their dose to a deficient level, or cut them off entirely. They speak of being treated like drug abusers, submitting to frequent urine tests and pill counts.

Jay and Meredith Lawrence (Courtesy of Meredith Lawrence)

"I have been on pain management since 2006," said a man from Tampa in a Facebook message. "Have a crippling disease that there is no cure for, and can no longer get the medications I need.  A few months ago I was researching death with dignity and other options for assisted suicide if I wasn’t able to get the help needed down the road."

Some posted comments about a loved one who died by suicide after losing access to a long-term treatment for pain, and finding it intolerable to continue suffering. Others said their spouse’s suffering, together with the frustration and anguish of being turned away or undertreated by doctors, was the reason they came around to accepting their loved one’s suicide plan.

In her new home in Georgia, its walls covered with pictures of her late husband, Meredith Lawrence recalled the helplessness she felt watching him suffer, as the pain worsened, and the drugs were tapered down.

“He said ‘I have three choices,’” Meredith recalled. “He said ‘I could do illegal drugs, I could suffer the rest of my life in pain, or I can end my life. I’m not going to do the first two.’”

Lawrence’s doctor did not respond to email and phone requests to comment for this story.

Meanwhile, hashtags on Twitter like #SuicideDue2Pain, #DontPunishPain, #PatientsNotAddicts have become common.

People with pain shouldn’t have to suffer because people without pain are abusing opioids.

— Cynthia Touissant, pain patient

“I think about suicide every day,” said Dawn Anderson, a former trauma nurse from Indiana, whose doctor cut her opioid dosage after his office was raided by the DEA.

“I recently wrote a suicide note to my family,” said Anderson, a diabetic whose legs were both amputated below the knee. “They have seen all I have gone through. I want to live. But not like this.”

Anderson, 53, now finds it too painful to stand on prosthetics because of what she says is undertreated pain, and is confined to a wheelchair.

“The pain feels like an electrical shock that happens every 30 seconds in some parts of my body,” she said, “and in the back it’s a stabbing pain, like a hot poker that is stuck and never coming out. The pain I endure on a daily basis is taking my will to live.”

Anderson’s doctor did not respond to requests for comment.

Anne Fuqua, a former nurse in Alabama who herself suffers from chronic pain, has logged records of 167 suicides since 2014 that she maintained were directly a result of patients who had their opioids reduced or cut and suffered uncontrolled pain.

Fuqua said she is in the midst of verifying more suicides that have been reported to her.

Caylee Cresta, a 26-year-old Massachusetts woman, has a rare disease, Stiff Person’s Syndrome, that causes muscle spasms and rapid convulsions that fracture her bones and often leave her stuck in an unnatural position for days. She has had the condition since she was 19.

"You're in fear that your doctor will say that your next prescription is your last," Cresta said, adding that when she has "a bad day" it means “I stop being a mother, a wife, a daughter.”

Ending the pain by ending it all has seemed, at times, like the way out.

Dr. Stefan Kertesz

CALLING FOR TOUGHER ANTI-OPIOID POLICIES

Not everyone agrees the problem is the cutting back of legal opioid prescriptions.

Dr. Andrew Kolodny, who directs opioid research at Brandeis University’s Heller School for Social Policy and Management, believes government policies on opioids need to be even tougher.

Kolodny, who also is executive director of the Physicians for Responsible Opioid Prescribing and one of the nation’s most vociferous critics of opioids, balks at the alarm sounding over the decreasing supply of prescription painkillers.

“The effects of hydrocodone and oxycodone produced in the brain are indistinguishable from the effects produced by heroin,” Kolodny said. “So my point is that when we talk about opioid pain medication, we’re essentially talking about heroin pills.”

Kolodny said opioids have an important role – in limited circumstances – such as ending suffering “at the end of life for some patients,” and “for a couple of days after major surgery.”

When we talk about opioid pain medication, we’re essentially talking about heroin pills.

— Dr. Andrew Kolodny, director of opioid research at Brandeis University’s Heller School for Social Policy and Management

Many pain experts and patients blame Kolodny for pushing the federal agencies, particularly the CDC, to treat opioids as if it were heroin, and pain patients as people who are one opioid away from being addicts.

Kolodny said that isn't true.

“No role – none – zilch,” he said. “PROP was one of many organizations that was asked by CDC to offer them feedback on the guideline. Our letter is publicly available. CDC did not make the changes we requested.”

To Kolodny, “It’s a manufactured controversy … They’ll say with my opioid, I can at least get up from bed. For a heroin user it’s the same thing for them. They say they feel horrible, can’t do anything or function until they take their first dose of heroin in the morning.”

Former U.S. Attorney General Jeff Sessions (Reuters)

FEDS SAY THEY’RE AT WAR

Sessions appeared to view the issue as a war that needs to be fought, full-speed ahead.

“This is the greatest health hazard we’ve had,” he said of fatal overdoses.“Let me just say this to the suicide problem and other problems: They’re arising out of addiction to those drugs,” he said. “People don’t know how powerful these addictions are. So people get into a situation where they can’t keep taking the drugs, and some of them might conclude they can’t live without them."

"We need to break that cycle," Sessions said. "We’re making progress at it, but we still prescribe far more pain pills than in any country in the world … we as a nation need to face up to that fact.”

Federal and state officials at the agencies at the forefront of the fight against opioids – including the Drug Enforcement Agency (DEA) – were hard-pressed to provide details to Fox News about just how many overdose deaths involved those legitimately prescribed opioids. A report by the Massachusetts Department of Public Health, widely cited by many pain experts, said that among 477 people whose deaths were opioid‐related in 2018, 90 percent, or 423 of them, tested positive for fentanyl – a telltale sign of illegal opioid use.

Pain management experts said they share the concern and alarm over the terribly high percentage of drug overdoses.

“I share the nation’s concern that more than 100 people a day die of an overdose. But my patient nearly died of an under-dose,” said McAneny, the AMA president.

“My patient suffered, in part, because of the crackdown on opioids… When I visited my patient in the hospital as he was recovering from his suicide attempt, I apologized for not knowing his medication was denied," McAneny said. "I felt I had failed him.”

If you’re thinking about suicide, are worried about a friend or loved one, or would like emotional support, the National Suicide Prevention Lifeline network is available 24 hours a day, 7 days a week, across the United States. The Lifeline is available for everyone, is free, and confidential — 1-800-273-TALK (8255)

The deaf and hard of hearing can contact the Lifeline via TTY at 1-800-799-4889. Nacional de Prevención del Suicidio –1-888-628-9454

Elizabeth Llorente is Senior Reporter for FoxNews.com, and can be reached at Elizabeth.Llorente@Foxnews.com. Follow her on Twitter @Liz_Llorente.

James Bond has a ‘severe’ drinking problem, researchers argue

He’s blowing well over a 0.07.

Martini-loving spy James Bond has a severe drinking problem and should seek help, researchers argue in a new paper titled “License to Swill.”

“There is strong and consistent evidence that James Bond has a chronic alcohol consumption problem at the ‘severe’ end of the spectrum,” wrote the researchers from the University of Otago in New Zealand in the paper published Monday in the Medical Journal of Australia.

MILLERCOORS SURPRISES 101-YEAR-OLD VETERAN WITH FRIDGE OF BEER, TRIP TO COLORADO

During his six decades on screen, a drink touched the secret agent’s lips 109 times at an average of 4.5 times per movie, the researchers found.

The dashing spook’s biggest binge was in 2008’s “Quantum of Solace,” where he downed six of his signature Vesper Martinis.

This feat would put his blood alcohol level at 0.36, researchers estimated — well into the range that can be fatal.

When he drinks, Bond engages in risky behavior like having sex with enemies — “sometimes with guns or knives in the bed,” researchers wrote in the study.

He’s also prone to brawls, car chases, high-stakes gambling and operating complex machinery — like the nuclear technology in 1962’s “Dr. No,” they found.

PEOPLE DRINK TWICE AS MUCH ALCOHOL OVER THE HOLIDAYS, STUDY FINDS

Bond might be both shaken and stirred by the findings that he satisfies at least six of the 11 criteria for an alcohol use disorder.

The authors suggested that Bond’s workplace, MI6, should become “a responsible employer” and offer the secret agent support services and “change its own workplace drinking culture.”

“Further, MI6 management needs to redefine Bond’s job to reduce his stress levels. More field support and a stronger team approach are needed so that his duties do not weigh as heavily upon him,” the researchers said.

FOLLOW US ON FACEBOOK FOR MORE FOX LIFESTYLE NEWS

The article won first prize in the Medical Journal of Australia’s Christmas competition, where researchers submit quirky studies.

This article originally appeared in The New York Post.

Overdoses, suicides push down US life expectancy

Suicides and drug overdoses pushed up U.S. deaths last year, and drove a continuing decline in how long Americans are expected to live.

Overall, there were more than 2.8 million U.S. deaths in 2017, or nearly 70,000 more than the previous year, the Centers for Disease Control and Prevention said Thursday. It was the most deaths in a single year since the government began counting more than a century ago.

The increase partly reflects the nation's growing and aging population. But it's deaths in younger age groups — particularly middle-aged people — that have had the largest impact on calculations of life expectancy, experts said.

"These sobering statistics are a wake-up call that we are losing too many Americans, too early and too often, to conditions that are preventable," Dr. Robert Redfield, the CDC's director, said in a statement.

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The suicide death rate last year was the highest it's been in at least 50 years, according to U.S. government records. There were more than 47,000 suicides, up from a little under 45,000 the year before.

A GENERAL DECLINE

For decades, U.S. life expectancy was on the upswing, rising a few months nearly every year. Now it's trending the other way: It fell in 2015, stayed level in 2016, and declined again last year, the CDC said.

The nation is in the longest period of a generally declining life expectancy since the late 1910s, when World War I and the worst flu pandemic in modern history combined to kill nearly 1 million Americans. Life expectancy in 1918 was 39.

Aside from that, "we've never really seen anything like this," said Robert Anderson, who oversees CDC death statistics.

In the nation's 10 leading causes of death, only the cancer death rate fell in 2017. Meanwhile, there were increases in seven others — suicide, stroke, diabetes, Alzheimer's, flu/pneumonia, chronic lower respiratory diseases and unintentional injuries.

An underlying factor is that the death rate for heart disease — the nation's No. 1 killer — has stopped falling. In years past, declines in heart disease deaths were enough to offset increases in some other kinds of death, but no longer, Anderson said.

NURSE ALLEGEDLY FIRED FOR REFUSING FLU SHOT OVER RELIGIOUS BELIEFS, PROTESTERS CLAIM

(The CDC's numbers do sometimes change. This week, CDC officials said they had revised their life expectancy estimate for 2016 after some additional data came in.)

WHAT'S DRIVING IT?

CDC officials did not speculate about what's behind declining life expectancy, but Dr. William Dietz, a disease prevention expert at George Washington University, sees a sense of hopelessness.

Financial struggles, a widening income gap and divisive politics are all casting a pall over many Americans, he suggested. "I really do believe that people are increasingly hopeless, and that that leads to drug use, it leads potentially to suicide," he said.

Drug overdose deaths also continued to climb, surpassing 70,000 last year, in the midst of the deadliest drug overdose epidemic in U.S. history. The death rate rose 10 percent from the previous year, smaller than the 21 percent jump seen between 2016 and 2017.

That's not quite cause for celebration, said Dr. John Rowe, a professor of health policy and aging at Columbia University.

"Maybe it's starting to slow down, but it hasn't turned around yet," Rowe said. "I think it will take several years."

Accidental drug overdoses account for more than a third of the unintentional injury deaths, and intentional drug overdoses account for about a tenth of the suicides, said Dr. Holly Hedegaard, a CDC injury researcher.

OTHER FINDINGS

The CDC figures are based mainly on a review of 2017 death certificates. The life expectancy figure is based on current death trends and other factors.

The agency also said:

—A baby born last year in the U.S. is expected to live about 78 years and 7 months, on average. An American born in 2015 or 2016 was expected to live about a month longer, and one born in 2014 about two months longer than that.

—The suicide rate was 14 deaths per 100,000 people. That's the highest since at least 1975.

—The percentage of suicides due to drug overdose has been inching downward.

—Deaths from flu and pneumonia rose by about 6 percent. The 2017-2018 flu season was one of the worst in more than a decade, and some of the deaths from early in that season appeared in the new death dates.

—West Virginia was once again the state with the highest rate of drug overdose deaths. The CDC did not release state rates for suicides.

—Death rates for heroin, methadone and prescription opioid painkillers were flat. But deaths from the powerful painkiller fentanyl and its close opioid cousins continued to soar in 2017.

The CDC did not discuss 2017 gun deaths in the reports released Thursday. But earlier CDC reports noted increase rates of suicide by gun and by suffocation or hanging.

Artery damage seen in some teenage smokers, drinkers

Teenagers who smoke or who binge on alcohol have signs of artery damage by age 17, a recent study shows.

Researchers found that 17-year-olds who had smoked more than 100 cigarettes in their lifetime or who drank more than 10 drinks on a typical drinking day had stiffer walls in their arteries.

In the long term, stiffer arteries can increase the risk for cardiovascular events, dementia, and death.

"Injury to the blood vessels occurs very early in life as a result of smoking and drinking and the two together are even more damaging, Dr. Marietta Charakida, who carried out the research at UCL Institute of Cardiovascular Science but is now at King's College London, said in a statement.

SMOKERS 'MUCH MORE LIKELY TO DEVELOP DEMENTIA,' DOCS WARN

As reported in the European Heart Journal and at a major cardiology meeting, Charakida and colleagues analyzed data collected from 2004 to 2008 on 1,266 adolescents enrolled in the Avon Longitudinal Study of Parents and Children. Participants reported their smoking and drinking habits at ages 13, 15 and 17.

To assess the stiffness of the teens' artery walls, the researchers used a noninvasive device to measure the speed at which a pulse from the heart travels between the carotid artery in the neck and the femoral artery in the leg.

That speed is called the pulse wave velocity. A slower velocity is a good sign; it means the arterial walls are more elastic.

In 17-year-olds who had smoked more than 100 cigarettes in their lifetime, the average pulse wave velocity was 3.7 percent faster than in teens who had smoked less than 20 cigarettes.

Teenagers who tended to binge drink, or drink more than 10 drinks in a typical drinking day with the aim of becoming drunk, had an average pulse wave velocity that was 4.7 percent faster than kids who drank no more than 2 drinks in a typical drinking day, the study showed.

Furthermore, the authors report, the combination of binge-drinking habits and smoking was linked to even greater arterial damage compared to heavy drinking and smoking separately. In these kids, the pulse wave velocity was 10.8 percent higher than in teens who smoked less and didn't binge drink.

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But while smoking in youth was associated with increased arterial stiffness, stopping during adolescence could restore arterial health. Seventeen-year-olds who had smoked in the past but were not current smokers had arterial health similar to never-smokers.

"Existing research suggests that regular binge drinking during the teen years can damage the developing brain," Dr. Aaron White, a senior scientific adviser at the National Institute on Alcohol Abuse and Alcoholism, told Reuters Health in an email.

"Findings from the current study suggest that the negative health effects of alcohol during adolescence could extend to the cardiovascular system," White said, adding that the findings are consistent with existing evidence that even a single night of binge drinking in adults can temporarily injure the heart.

An observational study like this one can only show associations; it can't prove that smoking or alcohol exposure actually caused arterial changes in these youngsters, the authors acknowledge. Also, they note, the data were reported by the teenagers themselves and might not always have been accurate.

Despite these limitations, they conclude, "Smoking exposure even at low levels and intensity of alcohol use were associated individually and together with increased arterial stiffness. Public health strategies need to prevent adoption of these habits in adolescence to preserve or restore arterial health."