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Blog articles are provided as informational purposes only and are not intended to constitute medical advice. Medication protocols are subject to patient’s medical provider’s authorization.

 

In the US, drug overdose is the leading cause of death for persons under age 50, and those  between ages 18-25 are the most likely to use addictive drugs. Nine out of 10 people with substance problems started using by age 18. Those aged 18-25 years with substance use disorder (SUD) report getting 37.5% of their opioids from a friend or relative for free, and 19.9% report getting them from a friend or relative that they pay. 

 

1.  Inhalers with valved holding chambers (VHCs): use over nebulizers if clinically appropriate for your hospice patients with confirmed or suspected COVID-19.

A number of hospice COVID19 cases will still be more appropriate for nebs (e.g. if patient has severe, life-threatening respiratory symptoms, or is unable to use a chamber). The recommendations to prefer inhalers with VHCs over nebulizers is to reduce the amount of potentially infectious aerosol dispelled into the air during nebulization.1

 

 

Methadone was first developed in Germany in the 1930s and was used extensively during World War II as an alternative to morphine during shortages. Over the past twenty years, methadone has experienced a revival due to its unique characteristics, versatile administration, and utility in managing nociceptive and/or neuropathic pain in hospice and palliative care (Figure 1).

 

The U.S. Food and Drug Administration (FDA) has identified that some ranitidine products, including those commonly known as the brand name drug, Zantac®, contain a nitrosamine impurity called N-nitrosodimethylamine (NDMA) at low levels. NDMA is classified by U.S. government organizations, such as the Environmental Protection Agency (EPA), as a probable human carcinogen (a substance that could cause cancer).

Photo from Pixabay.com

Last month, a meta-analysis1 of 1,442 patients and 5 randomized controlled trials found cannabinoids did not reduce cancer pain any better than placebo, when these were added to stable doses of opioids. Change in pain score using the numeric rating scale (NRS) was the primary outcome. The analysis also found statistically significant increased frequencies of somnolence and dizziness as compared with placebo. The cannabinoids were administered in a pump oromucosal spray formulation (not currently available in the US), using equal parts CBD (cannabidiol) and THC (tetrahydrocannabidiol) mixture.

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