Make Pain a Thing of the Past – Roseanne Barr – Physician Partners of America

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Could this be the year that turns the tide of the opioid crisis?

Opioid overdose deaths, which reached 47,600 across the nation in 2017, continue to ravage many parts of the country. New laws and new ways of looking at pain management are offering glimmers of hope.

The use of opiate drugs continues to skyrocket; however, healthcare and law enforcement agencies aim to stem the opioid crisis by finding alternatives to pain medication, expand treatment and stop overdose deaths. So far, there are only patchwork solutions, but they show promise.

Many addictions start in the physician’s office. PPOA distinguishes itself by focusing on interventional pain management procedures, and such minimally invasive procedures as laser spine surgery and SI joint injections.

For patients who come to PPOA clinics already taking opioids for chronic pain, PPOA has long relied on medication management and pharmacogenomics, a drug-genes test that ensures each patient gets the right dose of genome-compatible medication.

Drug genes testing is now being used by other respected healthcare operations like Mayo Clinic and Cleveland Clinic.

Legislation to fight opioid abuse

As of October 2018,  at least 33 states have enacted legislation related to opioid prescription limits. Different communities around the nation are taking different approaches to stem the tide of addictive painkillers.

Last July, Florida lawmakers enacted stiffer rules governing prescriptions, and allocated $60 million toward treatment resources and a wider availability of the opioid antidote naloxone. Read more about the law.

In Texas, prescriptions now contain advanced security features to prevent fraud during the filling process. As of June 1, 2019, doctors will have to order new prescription forms and join the states’ prescription monitoring program (PMP), known as PMP Aware. This allows physicians to check a patient’s prescription history for information related to drug abuse and doctor shopping.

In Ohio, the Cincinnati area has cut opioid deaths by over 30 percent in six months since widely handing out Narcan, a nasal spray form of the opioid antidote Naloxone, to the public.

While naloxone remains controversial – it doesn’t prevent addiction – its use has increased around the nation. PPOA offers it with every painkiller prescription. In Burlington, Vermont, the mayor and police chief have teamed up to arm law enforcement, emergency workers and the public with the antidote.  The state is also focusing on long-term treatment, as are others.

In Rhode Island, a program providing recently released inmates with medication-assisted treatment has cut overdose deaths by more than 60 percent.

Finally, the federal government has taken steps to fight the opioid crisis. The SUPPORT for Patients and Communities Act, passed Oct. 3, 2018, took effect Jan. 1. Among other measures, it creates grants for more addiction recovery centers, expands naloxone access, and focuses on best practices in prescribing.

While it’s too early to tell which approach will work, PPOA continues to lead the way by focusing on non-opioid pain treatments and personalized medicine.


Ambien is back in the news, blamed by comedienne Roseanne Barr for some racially charged tweets and leading to the cancellation of her new show.

Details aside, there’s no question the popular sleep prescription – medical name zolpidemcan have some unsettling side-effects.  Ten million prescriptions are written each year for the medication, but headlines are forcing people to ask, is Ambien safe to take?

The answer is yes, if it is used correctly and under a doctor’s supervision.

Lower doses are best

“Ambien is a good drug in the treatment of insomnia. However, like many medications, there are side effects,” said Rodolfo Gari, M.D., MBA, founder of Physician Partners of America. “Particularly in women, Ambien is associated with strange behavior and hallucinations. This is because women are known to be slow metabolizers of Ambien.”

While metabolism may or may not factor into Barr’s claims, the Food and Drug Administration has long recognized the potential for side effects and the disparity in metabolization between genders.

“The recommended doses for women and men are different because women clear zolpidem from the body at a lower rate than men,” the FDA declared on its website. “The higher dose is more likely to impair next-morning driving and other activities that require full alertness.” In 2013, the agency lowered the recommended dosage from 10 to 5 mg for Ambien and 12.5 to 6.25 mg for extended-release Ambien CR.

Eating buttered cigarettes and sleep-driving

Ambien is classified as a hypnotic, and was approved for short-term insomnia by the FDA in 1992. It slows down the brain and brings on sleep faster than usual. For that reason it should be taken within 20 minutes of bedtime – in bed.

Not everyone heeds that warning, and stories abound of people doing strange things under its influence and having no memory of it the next day.

Blogs, Facebook groups and sub-Reddits detail the antics of people who pop an Ambien and fail to go straight to bed as directed.

Roseanne Barr is not the first celebrity to point fingers at the drug. Former congressman Patrick Kennedy caused a late-night car accident in 2006, bizarrely claiming he was late for a vote.  Zolpidem users realized they were not alone in reporting strange blackout behavior, and some sued the manufacturer, Sanofi (now Sanofi-Aventis). The attorney for the class action suit claims “people were eating things like buttered cigarettes and eggs, complete with the shells, while under the influence” of the sleep aid.

The suit was unsuccessful, but the company enhanced its warning flyer. It reads: “After taking AMBIEN, you may get up out of bed while not being fully awake and do an activity that you do not know you are doing. The next morning, you may not remember that you did anything during the night…Reported activities include: driving a car (“sleep-driving”), making and eating food, talking on the phone, having sex, sleep-walking.”

Preventing Ambien reactions with drug-genes testing

Ambien’s hypnotic side-effects are not the only issue. The pills can also cause severe allergic reactions in some people. This may include hives, breathing difficulty, swelling of the face, lips, tongue, or throat.

Knowing whether you should take Ambien at all depends on more than just your gender, health conditions, weight or age. Drug-genes testing, or pharmacogenomics, is a good safety check. It uses a cheek swab to determine how individual patients’ genomes metabolize certain classes of medication. Physician Partners of America offers this service to all its patients.

“This is yet another reason why pharmacogenomics is such an important diagnostic evaluation in all patients taking medications,” Gari said.

A far better choice is to practice good sleep hygiene, use this drug correctly and sparingly after a discussion with your doctor – and go straight to bed.