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Time trends of acute hepatitis C incidence by age groups: 2003-2016.

Hepatitis C Infection Screening and Management in Opioid Use Epidemics in the United States

Acute hepatitis C infection is on the rise in the United States, with a more than twofold increase in incidence rate from 2003 to 2016 overall and a threefold increase among young adults1, 2 (Figure). In 2016, a total of 2967 cases were reported from 42 states, and the Centers for Disease Control and Prevention estimates the […]

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Tramadol: Understanding the Risk of Serotonin Syndrome and Seizures

Tramadol is commonly prescribed for pain control because it presents a lower risk for addiction and respiratory depression compared to other opioids. However, tramadol’s serotonin and norepinephrine reuptake inhibitory effects result in a unique adverse effect profile. Two such adverse events are serotonin syndrome and seizures. The prevalence of tramadol-induced serotonin syndrome and seizures is […]

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Present locations of drug cartels operating in the United States. Adapted from Reference 23.

Backstories on the US Opioid Epidemic. Good Intentions Gone Bad, an Industry Gone Rogue, and Watch Dogs Gone to Sleep

Epidemics of opioid use are old news in the United States, but an epidemic that kills over 200,000 Americans is not. A multiplicity of intertwined factors have brought us to this place. From 30,000 feet, it is the story of good intentions gone bad, a drug industry gone rogue, and government watch dog agencies gone […]

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white tablets spilling out of a pill bottle

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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The patient had diffuse nodules in various stages of healing on the extensor surfaces of his legs.

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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