Your weekly BMJ digest – 21/10/17

Another month down the line, another three instalments of our favourite periodical. It’s a bit of a lucky dip, whenever I make it to the library to peruse the BMJ – what will it be this week? Sex, drugs, rock and rolandic epilepsy, perhaps? No matter how saucy the cover though, the BMJ remains as tightly sellotaped as ever when I get to it.

This week the BMJ led with a loaded topic – the US opioid epidemic. Tying in with Louis Theroux’s recent startling episode of “Dark States,” the BMJ details the medical aspects of this shocking phenomenon.

Cover Story – Opioids in America: It serves as a warning to all medical practitioners. In the 1990s in the US there was an upsurge in the prescribing of opioid analgesics for non-cancer conditions. Trying to meet the needs of many labourers living with chronic pain and egged on by pharmaceutical companies, American doctors prescribed opioids more liberally, unable to envisage the consequences a few decades later.

Flash forward to the present day, where many communities in the US, particularly in rural areas, have high proportions of their populace dependent or affected by opioid misuse. The figures are startling: 300,000 people are estimated to have died from opioid overdoses in the US since 2000 according to the CDC. It is difficult to even conceive of what that means, the figures are that extreme. Another startling stat. is that in the US one in 16 surgery patients becomes a chronic opioid user.

And where drug misuse occurs, social problems also follow. The article details the problems faced by a Police Department in one such affected town, with their repeated calls to break-ins, which they believe are all linked to the pressures drug users have to fund their habits.

So it’s here now, what are they doing about it? Different programs have been implemented to make conditions safer for users, who run a substantial risk of overdosing. Clean needle exchanges and provision of naloxone has tried to minimise the immediate risk of using. Longer term strategies are also being implemented e.g. drug rehabilitation and mental health programs to help people break the cycle, however, there is variability between states and the US is waiting for a Federal plan of action. Considering this administration’s approach to healthcare in general, I wouldn’t hold your breath.

And then there is (one of the) sources of the problem: prescribers. Better education against over-enthusiastic prescribing is key, especially considering the prevalent 90s medical attitude that opioid use was harmless and non-addictive. Surveillance may be the next step with auditing and comparison of individual physician’s opioid prescribing habits in comparison to their peers. Given the variability in physician practice that characterises US healthcare in comparison to the NHS, this may be more difficult to monitor and enforce.

However, the example of the US is prudent to physicians all over the globe, not just in terms of opioid prescribing. We all know a similar issue is approaching with antibiotic misuse. Maybe we all need a picture of Louis Theroux in our clinic rooms to remind us of the power and consequences of prescribing…

The best of the rest: I got rather caught up in the opioid crisis (plus, I got a little distracted by my MASSIVE crush on Louis Theroux) so I don’t have that much space for the rest of the BMJ. Here are some highlights from the rest of the journal:

• Measles outbreaks continue to sweep Europe (damn you Andrew Wakefield) and protest groups are also having a negative effect on the uptake of the HPV vaccine in Ireland. Some countries e.g. Italy have implemented enforced vaccination and France will follow in 2018. Epidemiologists await the data with baited breath.
• The UK Food Standards Agency have said it’s safe to eat runny eggs after finding low levels of salmonella in British eggs. I completely ignored the previous memo and survived off soldiers and soft-boiled eggs for most of my university years.
• Our favourite earthworm-in-human-form has been romancing GPs at their annual conference. Jeremy Hunt promises national indemnity cover for all GPs from 2019 as well as a £2000 golden hello to recruit more new GPs to unpopular areas. The time is ticking, Jezza, I’ll be checking back on you in 14 months to see if you’ve delivered.

Chuckle of the Week: The CQC, high inquisitors and holders of the fates of many a failing Trust, have failed to deliver on their own targets of publishing their reports in a timely fashion. The CQC’s CQC (the NAO – National Audit Office) have found the CQC “consistently missed their targets” for 2016-2017. Very much a case of “do as I say and not as I do”, it would seem.