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Managing Increasing Liability Risks Related to Opioid Prescribing

The increase in prescription opioid-related overdose deaths has increasingly led to liability and sanctions for physicians. For instance, in January 2010, Maurice Conte, MD was found negligent for prescribing a combination of Vicodin, Xanax, and Soma, which caused an overdose death, and was fined over $9 million.1 Conte, as the Medical Director of pain clinics, rarely […]

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Curious Crosses: Injection-Induced Lesions

Skin biopsy provided an elusive diagnosis and evidence that the patient had likely omitted important information during medical interviews. A 43-year-old man with a history of alcohol and opioid use was admitted to the inpatient ward from the infectious disease clinic. For 2 weeks, he had experienced recurrent, painful skin nodules that expressed bloody, purulent […]

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Mindfulness Meditation Modulates Pain Through Endogenous Opioids

  Recent evidence supports the beneficial effects of mindfulness meditation on pain. However, the neural mechanisms underlying this effect remain poorly understood. We used an opioid blocker to examine whether mindfulness meditation-induced analgesia involves endogenous opioids. Methods Fifteen healthy experienced mindfulness meditation practitioners participated in a double-blind, randomized, placebo-controlled, crossover study. Participants rated the pain […]

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A Tool to Assess Risk of De Novo Opioid Abuse or Dependence

Readily available demographic, clinical, behavioral, pharmacy, and geographic information can be used to predict the likelihood of opioid abuse or dependence. Determining risk factors for opioid abuse or dependence will help clinicians practice informed prescribing and may help mitigate opioid abuse or dependence. The purpose of this study is to identify variables predicting opioid abuse […]

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Painful Violaceous Purpura on a 44-Year-Old Woman

Returning to the fundamentals of our medical training, eliciting a full social history, including the use of illicit drugs, can be the key to making a correct diagnosis. This point is illustrated in the following case. A 44-year-old woman with a past medical history notable for asthma and heroin abuse, presented to the Emergency Department […]

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