[HARMRED] Opium Study Raises Questions About Opium-Derived Painkillers

Thu Apr 19 14:58:25 CDT 2012

Nice. thanks Matt.

On Thu, Apr 19, 2012 at 3:51 PM, Matt Curtis <mattcurtisnyc at gmail.com>wrote:

> OK, I decided to read the study carefully over lunch, so here goes...
>
> Here's the full CNN story<http://thechart.blogs.cnn.com/2012/04/17/opium-study-raises-questions-about-painkillers/?hpt=he_c2>,
> which has a bit more than the blurb. First of all, the story is totally
> inflammatory and grasps at a number of conclusions that have little or
> nothing to do with the Iranian study. The leap in the BMJ editorial toward
> using this research as a basis for further steering people away from opioid
> analgesics is even worse, and I hope someone responds to it.  Anyway, the
> study is about use of oral and smoked opium products, which for many
> reasons are different than opioid pharmaceuticals.
>
> The study methodology isn't so flawed as to outright negate their
> findings, which raise some interesting questions. If the researchers did
> everything they say they did it's actually a pretty amazing effort. But the
> study conclusions are not on as firm ground as they think they are. The
> authors describe this as a prospective observational study when in fact
> it's a cross-sectional survey + medical exam and the only follow up was in
> determining who died and evaluating COD. That means that they asked people,
> on a single occasion, to recall detailed information about lifetime opium
> use (among other things) and didn't follow up after baseline to assess any
> changes in opium use or other factors. Weirdly, while they exclude from
> analysis people who started opium use after heart or vascular disease or
> diabetes, they didn't exclude people who started after getting cancer,
> developing chronic pain, or other conditions that may be associated with
> mortality. Given their methods for collecting COD data, the location from
> which it was collected and the sheer number of events I think there's
> reason to suspect how accurately COD is represented. Together these issues
> could lead to significant bias.
>
> It's also important to note that the study population isn't actually 50k,
> but rather only the 2145 who died, so this doesn't represent overwhelming
> statistical power. The hazard ratios are positive but by no means large. In
> stratification, the associations that do look huge are based on very small
> samples and have enormous confidence intervals (e.g. men who used opium
> appear to be 21.5 times more likely to die from asthma than those who
> didn't use it... but this is based on only 23 asthma deaths among men *and
> * women, and the CI is 2.6 to 177).
>
> The authors point to a number of previous studies that have shown
> associations between opioids and disease or hypothesized risk factors for
> disease. There may be something to this, but it's not a well understood
> area of research, many of the studies cited are on animals (and likely
> using volumes of opioids or other conditions not found in human use), and
> there are few studies in this area that have been replicated.
>
> So yeah, I'm unconvinced though I think the subject warrants further
> investigation.
>
> Matt
>
> On Thu, Apr 19, 2012 at 2:45 PM, Lieving, Bernard, DOH <
> Bernard.Lieving at state.nm.us> wrote:
>
>>  after perusing this article, the increase in respiratory disease is
>> from * smoking* opium...i didn't get that from the cnn blurb...
>>
>>
>>
>> Bernie Lieving, LMSW
>>
>> Buprenorphine Program Coordinator
>>
>> NMDOH Stanford Public Health Office
>>   ------------------------------
>> *From:* harmred-bounces at drcnet.org [harmred-bounces at drcnet.org] on
>> behalf of Ryan Wythe [rwythe at gmail.com]
>> *Sent:* Thursday, April 19, 2012 12:22 PM
>> *To:* Allan Clear
>> *Cc:* Harm Reduction Forum
>>
>> *Subject:* Re: [HARMRED] Opium Study Raises Questions About
>> Opium-Derived Painkillers
>>
>>  I haven't had a chance to read the full article, but here is the actual
>> journal (that isn't technically cited at all in the news story):
>> http://www.bmj.com/highwire/filestream/579661/field_highwire_article_pdf/0.pdf
>>
>>
>> On Thu, Apr 19, 2012 at 11:21 AM, Allan Clear <clear at harmreduction.org>wrote:
>>
>>> As reported in the now sadly defunct World Weekly News.
>>>
>>>
>>> On Thu, Apr 19, 2012 at 2:19 PM, Mark Kinzly <markkinzly at yahoo.com>wrote:
>>>
>>>>   Just a bit usually strange stuff like this comes out of the UK :)
>>>>
>>>>  **
>>>>
>>>> OUR CALLING IS THE PLACE WHERE OUR INNER JOY AND OUR INNER TERROR MEET
>>>>
>>>> http://www.youtube.com/watch?v=y1NIBD2KZtI&feature=related
>>>> http://vimeo.com/moogaloop.swf?clip_id=2539741
>>>> http://overdoseprevention.blogspot.com/
>>>>
>>>> Mark Kinzly
>>>>
>>>> 2 Thunder Hill
>>>>
>>>> York, ME 03909
>>>>
>>>> markkinzly at yahoo.com
>>>>
>>>> 860-724-5339
>>>>
>>>>
>>>> --- On *Thu, 4/19/12, Allan Clear <clear at harmreduction.org>* wrote:
>>>>
>>>>
>>>> From: Allan Clear <clear at harmreduction.org>
>>>> Subject: Re: [HARMRED] Opium Study Raises Questions About Opium-Derived
>>>> Painkillers
>>>> To: "Mark Kinzly" <markkinzly at yahoo.com>
>>>> Cc: "Harm Reduction Forum" <harmred at drcnet.org>
>>>> Date: Thursday, April 19, 2012, 6:15 PM
>>>>
>>>> Anyone else find this an odd study with odd conclusion?
>>>>
>>>> On Thu, Apr 19, 2012 at 1:55 PM, Mark Kinzly <markkinzly at yahoo.com<http://mc/compose?to=markkinzly@yahoo.com>
>>>> > wrote:
>>>>
>>>>   Opium Study Raises Questions About Opium-Derived Painkillers
>>>>
>>>>  <http://www.drugfree.org/join-together/research>
>>>> [image: poppy and syringe]
>>>>
>>>> A new study that links opium use with serious health problems,
>>>> including cancer, circulatory diseases and respiratory problems, has
>>>> implications for opium-derived painkillers such as morphine and codeine,
>>>> CNN<http://thechart.blogs.cnn.com/2012/04/17/opium-study-raises-questions-about-painkillers/?hpt=he_c2>reports.
>>>>
>>>> The study of more than 50,000 people in Iran found an 86 percent
>>>> increased likelihood of death from major causes among those who used opium,
>>>> even at modest levels. The researchers took into account factors such as
>>>> poverty and cigarette smoking, which could affect the outcome. The article
>>>> notes the study does not prove opium causes the increased risk of death,
>>>> since it did not randomly assign participants to use opium or not.
>>>>
>>>> Most opium users in the study did not begin taking the drug because of
>>>> a pre-existing illness, the researchers reported in the British
>>>> Medical Journal <http://www.bmj.com/content/344/bmj.e2502>.
>>>>
>>>> In an accompanying editorial <http://www.bmj.com/content/344/bmj.e2617>,
>>>> Irfan Dhalla, of St. Michael’s Hospital in Toronto, noted other research
>>>> has supported the conclusion that there is an increased risk of death from
>>>> opioids apart from the chance of an accidental overdose. “For the
>>>> management of chronic non-cancer pain, a better prescription may be
>>>> caution,” Dhalla wrote.
>>>>
>>>>
>>>>
>>>>  **
>>>>
>>>> OUR CALLING IS THE PLACE WHERE OUR INNER JOY AND OUR INNER TERROR MEET
>>>>
>>>> http://www.youtube.com/watch?v=y1NIBD2KZtI&feature=related
>>>> http://vimeo.com/moogaloop.swf?clip_id=2539741
>>>> http://overdoseprevention.blogspot.com/
>>>>
>>>> Mark Kinzly
>>>>
>>>> 2 Thunder Hill
>>>>
>>>> York, ME 03909
>>>>
>>>> markkinzly at yahoo.com <http://mc/compose?to=markkinzly@yahoo.com>
>>>>
>>>> 860-724-5339
>>>>
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>>>>
>>>>
>>>>
>>>> --
>>>> Allan Clear
>>>> Executive Director
>>>> Harm Reduction Coalition
>>>> 22 West 27th Street, 5th Fl
>>>> New York, NY 10001
>>>> Tel: 212-213-6376 ext 11
>>>> Fax: 212-213-6582
>>>> http://www.harmreduction.org
>>>>
>>>> Donate to HRC http://www.harmreduction.org/donate
>>>>
>>>>
>>>
>>>
>>> --
>>> Allan Clear
>>> Executive Director
>>> Harm Reduction Coalition
>>> 22 West 27th Street, 5th Fl
>>> New York, NY 10001
>>> Tel: 212-213-6376 ext 11
>>> Fax: 212-213-6582
>>> http://www.harmreduction.org
>>>
>>> Donate to HRC http://www.harmreduction.org/donate
>>>
>>> _______________________________________________
>>> HARMRED mailing list
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>>>
>>
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>

-- 
Allan Clear
Executive Director
Harm Reduction Coalition
22 West 27th Street, 5th Fl
New York, NY 10001
Tel: 212-213-6376 ext 11
Fax: 212-213-6582
http://www.harmreduction.org

<http://www.harmreduction.org/donate>
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