Below are highlights taken from the DEA's proposed rule change on March 1st, 2023, titled "Telemedicine Prescribing of Controlled Substances When the Practitioner and the Patient Have Not had a Prior In-Person Medical Evaluation". The purpose of the selected excerpts from this document published by the DEA is to give the reasoning and purpose of the DEA's proposal. For the full article, including the particulars of their proposed rule changes, see a link to their article at the bottom of this topic discussion.
A summary of the excerpts below is that the DEA is aiming to prevent illegal and illicit prescribing, distribution, and dispensing of controlled substances that are based on a telemedicine visit. Governmental initial statutes, and subsequent additions, were devised for the purpose of protecting the public's health and safety. Congress directed the DEA and HHS to authorize the use of telemedicine only when doing so is "consistent with effective controls against diversion and otherwise consistent with the public health and safety." The DEA notes misuse of controlled prescription medications, such as hydrocodone and oxycodone, contributes to increased drug poisonings and other harmful health, social, and economic consequences. They state regulations are designed to ensure a sufficient supply of controlled substances for medical, scientific, and other legitimate purposes, and to deter the diversion of controlled substances for illicit purposes. They want telemedicine to be used as a bona fide medical evaluation of the patient at the remote location that involves prescribing for a legitimate medical purpose while acting in the usual course of professional practice. The DEA aims to enhance their ability to both detect and investigate the potential misuse of telemedicine to prescribe controlled substances for other than legitimate medical purposes. The DEA notes that the general prescribing of narcotic controlled substances via telemedicine encounters poses a great risk to public health and safety.
Can anyone disagree with the aims and purposes listed in the above summary as being anything other than good for those living in the USA? The answer should be a resounding no. Why then is there opposition to the DEA's proposed rule changes as currently written? That is multi-faceted. Please read more topics found on this website www.telemedicinerulechangecomments.com
Now for the excerpts from the DEA's article. "The Ryan Haight Online Pharmacy Consumer Protection Act of 2008 ("Ryan Haight Act") amended the Controlled Substances Act ("CSA") in part by adding several new provisions to prevent the illegal distribution and dispensing of controlled substances by means of the internet."
"The Ryan Haight Act intended to address the threat to public health and safety caused by physicians who prescribed controlled medications via the internet (this term is applied to Telemedicine) without establishing a valid doctor-patient relationship..."
"The Ryan Haight Act was named for a California high school student who died in 2001 from a drug poisoning resulting from a controlled prescription medication he obtained from a rogue online pharmacy. That rogue online pharmacy allowed customers, like Ryan and others, to obtain controlled medications without an in-person medical evaluation by the prescriber. In Ryan's case, and in many others, the "[e]ase of access to the internet, combined with lack of medical supervision, . . . led to tragic consequences in the online purchase of prescriptions for controlled substances."
"Prior to the enactment of the Ryan Haight Act, the internet was being exploited to facilitate the unlawful distribution of controlled substances through rogue websites. These rogue websites fueled the misuse of controlled prescription medications, such as hydrocodone and oxycodone, thereby contributing to increased drug poisonings and other harmful health, social, and economic consequences."
"Federal and State laws... by regulation, determined to be consistent with effective controls against diversion (* see how the DEA defines "diversion" at the end of these excepts) and otherwise consistent with the public health and safety."
"DEA implements and enforces the CSA and the Controlled Substances Import and Export Act, (21 U.S.C. 801-971) , as amended. DEA publishes the implementing regulations for these statutes in 21 CFR parts 1300 to end. These regulations are designed to ensure a sufficient supply of controlled substances for medical, scientific, and other legitimate purposes, and to deter the diversion of controlled substances for illicit purposes."
"Again, in the foregoing and other circumstances encompassed by the Ryan Haight Act's definition of the "practice of telemedicine," the Act contemplates that the practitioner will be permitted to prescribe controlled substances by means of the internet despite not having conducted an in-person medical evaluation when certain safeguards are in place to ensure that the practitioner who is engaged in the practice of telemedicine is able to conduct or participate in a bona fide medical evaluation of the patient at the remote location, and is otherwise prescribing for a legitimate medical purpose while acting in the usual course of professional practice."
The Ryan Haight Act... takes the position that internet (& by interpretation telemedicine) prescribing of controlled substances by licensed medical clinicians via telemedicine represents "a heightened risk of diversion."..." Thus, DEA is proposing to amend 21 CFR part 1304 "..." These proposed requirements would significantly enhance DEA's ability to both detect and investigate the potential misuse of telemedicine to prescribe controlled substances for other than legitimate medical purposes."
"The proposed rule would also amend part 1306 by adding § 1306.31, which would provide a number of requirements that a practitioner would have to satisfy to issue a prescription for a controlled substance as a result of a telemedicine encounter. Consistent with the text of the Ryan Haight Act and other parts of the CSA, controlled substances only may be prescribed for legitimate medical purposes by practitioners acting in the usual course of professional practice."
"Proposed § 1306.31(a)(4), like proposed § 1306.05(i) described above, would require the practitioner to include on a prescription issued pursuant to a telemedicine encounter that the prescription has been issued based on a telemedicine encounter. Thus, when reviewing pharmacy prescription records, DEA investigators could readily distinguish prescriptions issued pursuant to telemedicine encounters from those issued using their dispensing registrations for non-telemedicine prescriptions-giving investigators greater ability to detect abusive patterns in the use of telemedicine."
"Congress directed DEA and HHS to authorize the use of telemedicine only when doing so is "consistent with effective controls against diversion and otherwise consistent with the public health and safety" 21 U.S.C. 802(54)(G) "..." Given the ongoing opioid epidemic at the time of publishing, DEA believes that allowing for the prescription of any schedule II substances or the general prescription of narcotic controlled substances as a result of telemedicine encounters would pose too great a risk to the public health and safety"
The DEA's stated intention within their current proposed changes to prescribing controlled substances by licensed medical clinicians via telemedicine was to allow clinicians to continue to do so "so long as doing so was consistent with legitimate medical purposes..."
The DEA noted that "PDMPs (which is a Prescription Drug Monitoring Program system put in place for clinicians to review patient's controlled substance prescription history) have proven to be an invaluable tool in preventing diversion, allowing practitioners to identity patients whose prescription history suggests that they are seeking controlled medications for other than legitimate medical needs-either because they misuse controlled medications or may be selling them to others."
The DEA states: ", there is potential for an added risk of diversion from more practitioners having the authority to prescribe schedule III-V non-narcotic controlled substances."
The DEA states: "This proposed rulemaking allows practitioners to issue prescriptions for schedule III-V non-narcotic controlled substances to the extent otherwise authorized by their DEA registration(s)...Such substances are subject to diversion and misuse, and allowing practitioners an increased ability to prescribe these substances via telemedicine presents the potential for the increased diversion and misuse of these substances. DEA believes that the benefits of increased availability for treatment outweigh the dangers of a potential increase in diversion-so long as prescribers using telemedicine adhere to the safeguards inherent in the requirements of the proposed rule." ++Comment: In these statements the DEA brushes ALL non-narcotic controlled substances with the same negative brush. Is that true? Do they provide any evidence for this position? The answer to both of these questions is no. Benzodiazepines, ADHD medications, sleeping pills, and appetite suppressants are not created equal. They do not carry the same risk nor do they have the same abuse patterns, safety profiles, diversion, or misuse profiles. The DEA's current proposal fails to acknowledge these truths given their broad application of their current proposed regulation update.++
"With respect to the proposed rule, DEA invites comments concerning whether any clarifications or other regulatory provisions are warranted to ensure appropriate access to care, consistent with effective controls against diversion and otherwise consistent with the public health and safety. To that end, DEA is requesting comments on whether the rule should limit the issuance of prescriptions for controlled medications to the FDA-approved indications contained in the FDA-approved labeling for those medications. DEA invites comments on the proposed practitioner recordkeeping obligations. Additionally, based on the available information, in order to balance benefits and risks to individual and public safety, DEA is proposing a 30-day maximum supply under proposed § 1306.31(c)(2) for the controlled substance being prescribed via telemedicine prior to an in-person evaluation being conducted. DEA seeks comment, including data from research and clinical practice, that provides evidence that an alternate maximum day supply would be more appropriate than the one proposed in this rulemaking. DEA also seeks comments about additional safeguards or flexibilities that should be considered with respect to this rule."
*In the context of controlled substances, the U.S. Drug Enforcement Administration (DEA) defines "diversion" as the transfer of a controlled substance from a lawful to an unlawful channel of distribution or use. This can include the illicit distribution, trafficking, or abuse of prescription medications, as well as the illicit production, distribution, or trafficking of illegal drugs such as heroin, cocaine, and methamphetamine.
Some examples of diversion may include:
The DEA is responsible for investigating and prosecuting instances of diversion, as well as regulating the lawful distribution of controlled substances to prevent their misuse or abuse. The agency works closely with other federal, state, and local law enforcement agencies to identify and disrupt illicit drug trafficking networks and prosecute those who engage in diversion or other drug-related crimes.
https://www.federalregister.gov/documents/2023/03/01/2023-04248/telemedicine-prescribing-of-controlled-substances-when-the-practitioner-and-the-patient-have-not-hadThe DEA states: "This proposed rulemaking allows practitioners to issue prescriptions for schedule III-V non-narcotic controlled substances to the extent otherwise authorized by their DEA registration(s)...Such substances are subject to diversion and misuse, and allowing practitioners an increased ability to prescribe these substances via telemedicine presents the potential for the increased diversion and misuse of these substances. DEA believes that the benefits of increased availability for treatment outweigh the dangers of a potential increase in diversion-so long as prescribers using telemedicine adhere to the safeguards inherent in the requirements of the proposed rule." See the DEA's full proposal sited here at the below link.
++ Comment: In these statements the DEA brushes ALL non-narcotic controlled substances with the same negative brush. Is that true? Do they provide any evidence for this position? The answer to both questions is no. Benzodiazepines, ADHD medications, sleeping pills, and appetite suppressants are not created equal. They do not carry the same risk, nor do they have the same abuse patterns, safety profiles, diversion, or misuse profiles. The DEA's current proposal fails to acknowledge these truths given their broad application of their current proposed regulation update. ++
Controlled Substance prescription medications that are most involved in deaths resulting from overdose, severe overdoses &/or adverse reactions that do not result in death but do result in an ER visit, abuse, misuse, diversion, illegitimate use, and risk to public health and safety are narcotics, benzodiazepines, ADHD stimulant medications, and sedatives (including sleeping pills). Not included in this are appetite suppressants used to help those that are overweight and/or obese help achieve a healthier weight. People do not commit crimes nor is there a "street value/market" for appetite suppressants. Narcotics, benzodiazepines, and ADHD medications all do have a "street value/market" and are involved in crime. The most common medications involved in abuse and illegitimate purposes are Class II Controlled Substances, such as hydrocodone and oxycodone.
Then why is the DEA treating a medication class, appetite suppressants, that are not involved in negative outcomes the same as though that are? That is a good question. Is being overweight and/or obese a minor or significant problem within the USA?
According to the Centers for Disease Control and Prevention (CDC), obesity is a significant public health concern in the United States, and it is associated with a higher risk of many serious health conditions, including heart disease, stroke, type 2 diabetes, and some forms of cancer.
In 2016, a study published in the Journal of the American Medical Association (JAMA) estimated that approximately 18% of deaths among adults aged 40-85 in the United States could be attributed to excess weight. This represents approximately 336,000 deaths per year.
What groups of people are more likely to struggle with excess weight? Women, minorities, low socioeconomic status, transgenderism (including both those that have and have not undergone gender reassignment surgery), those without health insurance, those without a primary care provider, the working poor, and those whose work schedules prevent them from being able to be seen in-person in an office by a medical clinician. The DEA's proposed rule change by treating appetite suppressants the same as all other controlled substances even though they do not have the same risks and negative outcomes as other controlled substances will further disenfranchise the already vulnerable. See other topics that discuss this further on this website.
Does excess weight, overweight, and obesity have significant economic costs to both the US economy and the US government?
According to a report published by the Milken Institute in 2018, the economic cost of obesity in the United States was estimated to be $1.72 trillion annually, or 9.3% of US gross domestic product (GDP). This figure includes both direct costs, such as healthcare spending and lost productivity, as well as indirect costs, such as the value of lost life and the impact on quality of life.
The report estimated that the annual cost of obesity-related healthcare spending in the United States was $480.7 billion, or 2.7% of GDP. This includes costs related to the treatment of obesity-related diseases such as diabetes, heart disease, and certain cancers.
In addition to the direct costs, there are also significant indirect costs associated with excess weight, overweight, and obesity. These include lost productivity due to absenteeism, reduced work productivity, and premature death. The Milken Institute report estimated that the annual cost of lost productivity due to excess weight, overweight, and obesity in the United States was $1.24 trillion, or 6.6% of GDP.
The US government also incurs costs related to excess weight, overweight, and obesity, primarily through increased healthcare spending for programs such as Medicare and Medicaid. In 2016, the Congressional Budget Office estimated that Medicare and Medicaid spending related to obesity and related diseases would be approximately $308 billion for the period between 2017 and 2026.
Overall, excess weight, overweight, and obesity have significant economic costs to both the US economy and the US government, which underscores the importance of addressing these conditions through public health efforts and policies aimed at prevention and treatment. To meet the stated goals of the DEA and Congress the treatment of obesity with telemedicine needs to be looked at differently than prescribing narcotics, benzodiazepines, stimulant ADHD medications, and sleeping pills.
According to the Centers for Disease Control and Prevention (CDC), obesity is a significant public health concern in the United States, and it is associated with a higher risk of many serious health conditions, including heart disease, stroke, type 2 diabetes, and some forms of cancer. Excess weight, overweight, or obesity in the United States, is widely acknowledged to increase the risk of many chronic diseases and can contribute to premature mortality.
Overall, these studies provide strong evidence that excess weight, overweight, and obesity are significant risk factors for premature mortality in the United States, ranking among the top causes of death annually.
Excess weight, overweight, and obesity have significant economic costs to both the US economy and the US government.
According to a report published by the Milken Institute in 2018, the economic cost of obesity in the United States was estimated to be $1.72 trillion annually, or 9.3% of US gross domestic product (GDP). This figure includes both direct costs, such as healthcare spending and lost productivity, as well as indirect costs, such as the value of lost life and the impact on quality of life.
The report estimated that the annual cost of obesity-related healthcare spending in the United States was $480.7 billion, or 2.7% of GDP. This includes costs related to the treatment of obesity-related diseases such as diabetes, heart disease, and certain cancers.
In addition to the direct costs, there are also significant indirect costs associated with excess weight, overweight, and obesity. These include lost productivity due to absenteeism, reduced work productivity, and premature death. The Milken Institute report estimated that the annual cost of lost productivity due to excess weight, overweight, and obesity in the United States was $1.24 trillion, or 6.6% of GDP.
The US government also incurs costs related to excess weight, overweight, and obesity, primarily through increased healthcare spending for programs such as Medicare and Medicaid. In 2016, the Congressional Budget Office estimated that Medicare and Medicaid spending related to obesity and related diseases would be approximately $308 billion for the period between 2017 and 2026.
Overall, excess weight, overweight, and obesity have significant economic costs to both the US economy and the US government, which underscores the importance of addressing these conditions through public health efforts and policies aimed at prevention and treatment.
There is growing evidence that weight bias and discrimination exist within the healthcareindustry in the United States. Here are some examples of studies that support this:
Overall, these studies suggest that weight bias and discrimination exist within the healthcare industry in the United States and can have negative health consequences for patients with obesity. It is important for healthcare providers to be aware of their biases and to provide compassionate and respectful care to all patients, regardless of their weight or body size.
There is limited research specifically examining weight bias among pharmacists, pharmacy staff, and pharmacies, but some studies suggest that weight bias may exist in these settings. Here are some examples:
Overall, while there is limited research specifically examining weight bias among pharmacists, pharmacy staff, and pharmacies, these studies suggest that weight bias may exist in these settings and may contribute to disparities in healthcare for patients with obesity. It is important for all healthcare providers, including pharmacists and pharmacy staff, to be aware of their biases and to provide respectful and compassionate care to all patients.
There is limited research specifically examining weight bias among the US federal government and state governments, but some studies suggest that laws and regulations related to obesity may reflect weight bias. Here are some examples:
Overall, while there is limited research specifically examining weight bias among the US federal government and state governments, these studies suggest that laws and regulations related to obesity may reflect weight bias and may contribute to stigma and discrimination against individuals with obesity, as well as disparities in healthcare and health outcomes. It is important for policymakers to be aware of the potential impact of these policies and to take steps to address social determinants of health and promote health equity.
There is evidence to suggest that patients with excess weight, being overweight, or being obese may be hesitant to seek medical treatment for their weight due to a variety of factors. Here are some examples:
Overall, these studies suggest that patients with excess weight, being overweight, or being obese may be hesitant to seek medical treatment for their weight due to negative experiences with healthcare providers, feelings of shame and embarrassment, and distrust of the healthcare system. It is important for healthcare providers to be aware of these factors and to provide compassionate and respectful care to all patients, regardless of their weight or body size.
Yes, excess weight, overweight, and obesity are more common in individuals with lower income and socioeconomically deprived status.
Numerous studies have found that individuals with lower income and less education are more likely to have higher rates of obesity compared to those with higher income and education levels. For example:
Overall, these studies suggest that there is a strong link between socioeconomic status and obesity. Individuals with lower income and education levels may face greater barriers to accessing healthy food options and safe places to exercise, which can contribute to higher rates of obesity. It is important for public health efforts to address these disparities and promote healthy lifestyles and environments for all individuals, regardless of their socioeconomic status.
Yes, excess weight, overweight, and obesity are more common in individuals without health insurance.
Several studies have found that individuals without health insurance are more likely to have higher rates of obesity compared to those with health insurance. For example:
Overall, these studies suggest that lack of health insurance may be a barrier to accessing preventive healthcare services and health education programs, which can contribute to higher rates of obesity. It is important for policymakers to prioritize efforts to expand access to affordable health insurance and preventive healthcare services to address these disparities.
Yes, individuals with limited access to medical care are more likely to have higher rates of excess weight, overweight, and obesity.
Several studies have found that individuals with limited access to medical care, whether due to geographic or financial barriers, are more likely to have higher rates of obesity compared to those with easier access to care. For example:
Overall, these studies suggest that limited access to medical care may be a barrier to accessing preventive healthcare services, health education programs, and healthy lifestyle interventions, which can contribute to higher rates of obesity. It is important for policymakers to prioritize efforts to improve access to medical care, particularly in underserved and rural areas, to address these disparities. Additionally, healthcare providers can play a role in promoting healthy lifestyles and providing preventive healthcare services to individuals with limited access to medical care.
Yes, excess weight, overweight, and obesity are more common in individuals who are considered "working poor."
Several studies have found that individuals who are employed but have low wages and limited access to benefits, also known as the "working poor," are more likely to have higher rates of obesity compared to those who are not working poor. For example:
Overall, these studies suggest that the combination of low wages and limited access to benefits can create barriers to accessing healthy food options and safe places to exercise, which can contribute to higher rates of obesity. It is important for policymakers to prioritize efforts to promote living wages and access to benefits, as well as to improve access to healthy food options and safe places to exercise, to address these disparities.
Yes, individuals who are considered "working poor" and have work hours that hinder them from accessing healthcare services may be at increased risk for excess weight, overweight, and obesity.
Several studies have found that work hours that conflict with healthcare provider operating hours can be a barrier to accessing preventive healthcare services, health education programs, and healthy lifestyle interventions, which can contribute to higher rates of obesity. For example:
Overall, these studies suggest that work hours that conflict with healthcare provider operating hours may be a barrier to accessing preventive healthcare services, health education programs, and healthy lifestyle interventions, which can contribute to higher rates of obesity. It is important for healthcare providers to offer flexible hours and alternative ways of accessing healthcare services, such as telemedicine, to accommodate the needs of patients with non- traditional work hours. Additionally, employers can play a role in promoting healthy lifestyles and providing access to healthcare services for their employees.
Yes, excess weight, overweight, and obesity are more common in individuals from ethnic minorities.
Numerous studies have found that individuals from certain ethnic and racial groups are more likely to have higher rates of obesity compared to other groups. For example:
Overall, these studies suggest that there are significant racial and ethnic disparities in rates of obesity. Factors that may contribute to these disparities include differences in access to healthy food options, safe places to exercise, and healthcare services, as well as differences in cultural attitudes towards body weight and size. It is important for public health efforts to address these disparities and promote healthy lifestyles and environments for all individuals, regardless of their race or ethnicity. Additionally, healthcare providers should be culturally competent and provide respectful and compassionate care to patients from diverse racial and ethnic backgrounds.
Yes, excess weight, overweight, and obesity are more common in women compared to men.
Numerous studies have found that women are more likely to have higher rates of obesity compared to men. For example:
Overall, these studies suggest that women are more likely to have higher rates of obesity compared to men. Factors that may contribute to this disparity include differences in body composition, hormonal factors, and cultural attitudes towards body weight and size. It is important for public health efforts to address these disparities and promote healthy lifestyles and environments for all individuals, regardless of their gender. Additionally, healthcare providers should provide respectful and compassionate care to all patients, regardless of their weight or body size.
Limited research has been conducted on the prevalence of excess weight, overweight, and obesity in individuals who are transgender, transsexual, or who have undergone sex reassignment surgery. However, some studies suggest that these individuals may be at increased risk for excess weight, overweight, and obesity.
Overall, while more research is needed to fully understand the relationship between gender identity, sex reassignment surgery, and obesity, these studies suggest that individuals who are transgender or have undergone sex reassignment surgery may be at increased risk for excess weight, overweight, and obesity. It is important for healthcare providers to provide culturally competent care to these individuals and to consider the potential impact of hormone therapy on weight management. Additionally, public health efforts should prioritize promoting healthy lifestyles and environments for all individuals, regardless of their gender identity or history of gender-affirming surgery.
Phentermine is a prescription weight loss medication that has been in use for over 60 years. It is generally considered safe and effective for short-term weight loss when used as directed under the supervision of a healthcare provider. Here are some studies that support its safety profile:
Overall, these studies suggest that phentermine is generally safe and well-tolerated when used as directed for short-term weight loss. Like any medication, phentermine may be the right choice for some, but for others it may not be the best option. It is important for discuss weight management options that are appropriate for you with your healthcare provider.
There are some studies that suggest that phentermine may be effective for weight loss when used over a longer period:
Multiple trials are underway, or have recently concluded, to assess the safety and effectiveness of long- term phentermine use, while others were focused on short-term use or combination therapy with other medications. Examples of ongoing or recently completed trials (as of September 2021) include:
Overall, while continued research will be helpful in assessing the long-term use of phentermine for weight management, these studies suggest that the medication may be effective and well- tolerated for up to 2 years of use. Additionally, lifestyle changes such as dietary modifications and increased physical activity should be encouraged to support long-term weight management.
Yes, there are ongoing clinical trials and studies that are investigating the long-term use of phentermine for weight management.
For example, a randomized clinical trial published in the Journal of Obesity in 2018 is investigating the efficacy and safety of phentermine/topiramate extended release (a combination medication that includes phentermine) for up to 108 weeks of use in adults with obesity. Another clinical trial registered with ClinicalTrials.gov is investigating the safety and efficacy of phentermine/topiramate extended release for up to 56 weeks of use in adolescents with obesity.
In addition, a study published in the Journal of Obesity in 2019 analyzed data from over 10,000 individuals who were prescribed phentermine for weight loss and found that those who used the medication for up to 1 year experienced significant weight loss and improvements in blood pressure and lipid levels.
Overall, while more research will be helpful in more fully understanding the long-term safety and efficacy of phentermine for weight management, ongoing clinical trials and studies suggest that the medication may be effective and well-tolerated for longer periods of use. Discuss with your healthcare providers what options are most appropriate for you during your goal of achieving a healthier weight. Like with all other prescription medications if you are prescribed phentermine, or a medication like it, you and your healthcare provider will need to monitor for potential side effects during its usage. Additionally, lifestyle changes such as dietary modifications and increased physical activity should be encouraged to support long-term weight management.
According to the Centers for Disease Control and Prevention (CDC), the top causes of drug overdose that lead to emergency department visits in the United States are opioids, benzodiazepines, and stimulants (most commonly illicit/substances that are not prescribed by healthcare providers).
Overall, drug overdoses are a significant public health problem in the United States. According to the CDC, there were over 93,000 drug overdose deaths in the United States in 2020, with a majority involving opioids. It is important for individuals to seek help if they are struggling with substance use, and for healthcare providers to be aware of the signs of substance misuse and overdose and to provide appropriate interventions and referrals. Appetite suppressants are not involved to any statistically significant degree in overdose deaths in the USA.
According to data from the Drug Abuse Warning Network (DAWN), which is a national public health surveillance system that monitors drug-related ED visits in the United States, the majority of stimulant- related ED visits are associated with illicit drugs such as methamphetamine, cocaine, and ecstasy.
A report published by DAWN in 2013 analyzed ED visits related to stimulant misuse or abuse between 2004 and 2011 and found that:
It is important to note that this data is from 2011 and may not reflect current trends in stimulant misuse and overdose. Additionally, prescription stimulants such as methylphenidate (e.g. Ritalin) and modafinil (e.g. Provigil) can also cause overdose and serious health problems when misused or abused, and may be responsible for a smaller percentage of stimulant-related ED visits.
According to data from the Drug Abuse Warning Network (DAWN), which monitored drug-related ED visits in the United States between 2004 and 2011, appetite suppressants, such as phentermine, were involved in less than 1% of stimulant-related ED visits during this 8-year timeframe. Additionally, they are not known to be a cause of overdose death by themselves alone. In fact, their presence within the blood stream in those that die from overdoses from other substances (such as narcotics, benzodiazepines, illicit drugs, & alcohol) was only 10 out of 70,630 drug overdose deaths in the United States in 2019, which corresponds to 0.01% of the overall overdose deaths. To be clear they were NOT the cause of 0.01% of overall overdose deaths, but instead they were only found within that percentage of people that died from overdose for other causes.
For comparison, according to the latest data available, there were an estimated 150 deaths per year in the United States from accidental overdose of over the counter (OTC) acetaminophen products between 2010 and 2016. According to the latest data available from the National Poison Data System, there were 194 reported suicides in the United States involving over the counter (OTC) medications in 2019. It is important to note that this figure only includes reported cases, and the actual number of suicides involving OTC medications may be higher.
Alcohol-related deaths are more difficult to estimate, as they may involve a range of factors and comorbidities. According to the Centers for Disease Control and Prevention (CDC), there were approximately 88,000 deaths per year in the United States from 2006 to 2010 that were attributable to excessive alcohol use..
Anaphylaxis is a severe and potentially life-threatening allergic reaction that can be caused by a variety of triggers, including prescription medications. According to the Asthma and Allergy Foundation of America, an estimated 1,500 deaths per year in the United States are attributed to anaphylaxis from all causes, including prescription medications, food allergies, and insect stings. Appetite suppressant medications are not known to have any statistically significant occurrence of anaphylaxis or any other significantly serious allergic reactions.
Overall, stimulant misuse and overdose, whether from prescription or illicit sources, are a serious public health concern in the United States. It is important for individuals to seek help if they are struggling with substance use, and for healthcare providers to be aware of the signs of substance misuse and overdose and to provide appropriate interventions and referrals.
According to data from the Centers for Disease Control and Prevention (CDC), adverse drug events (ADEs) result in an estimated 1.3 million emergency department (ED) visits and 350,000 hospitalizations each year in the United States. The CDC also reports that ADEs are responsible for an estimated 124,000 deaths annually in the United States.
The top causes of ADEs that lead to ED visits, hospitalizations, and deaths in the United States vary depending on the population and type of medication. However, some common causes of ADEs include:
Overall, ADEs are a significant public health problem in the United States and can result in serious harm, hospitalizations, and deaths. It is important for healthcare providers to carefully evaluate patients before prescribing medications, to monitor for potential side effects and drug interactions during treatment, and to provide appropriate education and follow-up care to prevent ADEs. Additionally, patients should be aware of the potential risks associated with their medications and should report any concerning symptoms to their healthcare provider.
Note appetite suppressants, such as phentermine, are not on this list.
According to a report by the National Center for Health Statistics, the top prescription medications most associated with overdose deaths in the United States are opioids, benzodiazepines, and antidepressants.
Overall, prescription medication overdose deaths are a significant public health problem in the United States. According to the Centers for Disease Control and Prevention (CDC), there were over 50,000 prescription medication overdose deaths in the United States in 2019. It is important for healthcare providers to carefully evaluate patients before prescribing medications, to monitor for potential side effects and drug interactions during treatment, and to provide appropriate education and follow-up care to prevent overdose deaths. Additionally, individuals should only use prescription medications as directed by a healthcare provider and should never share their medication with others. If someone is experiencing symptoms of a prescription medication overdose, it is important to seek medical attention immediately.
Note appetite suppressants, such as phentermine, do not contribute to these overdose deaths.
According to data from the Centers for Disease Control and Prevention (CDC), the prescription medications most associated with significant adverse drug events (ADEs) in the United States are:
While antibiotics are generally considered safe when used as directed, they can cause serious side effects and have the potential for misuse and overuse. The CDC reports that serious adverse reactions to antibiotics are responsible for an estimated 1 in 5 ED visits related to ADEs in the United States annually. According to the Centers for Disease Control and Prevention (CDC), there were an estimated 12,800 deaths in the United States in 2017 that were directly attributable to Clostridioides difficile (C. difficile) infections. While not all these infections are caused by prescription antibiotics, the overuse or misuse of antibiotics is a major risk factor for developing a C. difficile infection. Antibiotics disrupt the normal balance of bacteria in the gut, allowing C. difficile bacteria to overgrow and cause infection. Therefore, reducing the unnecessary use of antibiotics is an important strategy for preventing C. difficile infections and their associated morbidity and mortality.
Overall, prescription medications can cause serious side effects and have the potential for misuse and abuse, which can lead to significant ADEs. It is important for healthcare providers to carefully evaluate patients before prescribing medications, to monitor for potential side effects and drug interactions during treatment, and to provide appropriate education and follow-up care to prevent ADEs. Additionally, patients should be aware of the potential risks associated with their medications and should report any concerning symptoms to their healthcare provider.
Note appetite suppressants, such as phentermine, are not found on this list.
Prescription medications that are commonly sold on the streets to those who do not have a prescription for that medication are typically those that have a high potential for abuse, addiction, and dependence. Some of the prescription medications with the highest street value include:
It is important to note that purchasing prescription medications without a prescription is illegal and can be dangerous, as these medications may be counterfeit or contaminated with harmful substances. Additionally, using prescription medications that are not prescribed to you by a healthcare provider can increase your risk of serious side effects, drug interactions, and overdose. If you are struggling with substance use, it is important to seek help from a healthcare provider or addiction specialist.
Note appetite suppressants, such as phentermine, are not on this list.
Phentermine is a prescription medication that is classified as a Schedule IV controlled substance in the United States. According to law enforcement and drug treatment professionals, phentermine is not commonly sold on the streets as a recreational drug and is not considered to have a high street value compared to other prescription medications such as opioids and benzodiazepines. Additionally, phentermine is not included in the Drug Enforcement Administration's (DEA) list of controlled substances with the highest potential for abuse and dependence.
According to available information, prescription phentermine is not commonly used in the production of illicit drugs. Phentermine is a prescription medication that is used to treat obesity and is classified as a Schedule IV controlled substance in the United States.
Illicit drugs are typically produced using a variety of chemicals and substances that are not approved for human consumption, and phentermine is not typically used in the production of these drugs. It is important to note that illegal drug production and distribution is a complex issue.
If you have concerns about illicit drug production or distribution in your community, it is important to report any suspicious activity to local law enforcement or drug enforcement agencies. Additionally, if you or someone you know is struggling with substance use, it is important to seek help from a healthcare provider or addiction specialist.
Illicit drug production often involves the use of a variety of chemicals and substances, including both prescription and over-the-counter medications. Some of the most used medications in illicit drug production include:
In addition to these medications, other substances that are commonly used in illicit drug production include various chemicals such as acids, bases, and solvents.
It is important to note that the vast majority of individuals who use these medications do so for legitimate medical purposes, and only a small minority use them to produce illicit drugs. However, to prevent diversion of these medications for illicit use, many jurisdictions have implemented laws and regulations to limit the availability of certain medications, such as requiring a prescription for pseudoephedrine-containing products. Additionally, individuals can help prevent illicit drug production by properly disposing of unused medications and reporting any suspicious activity to local law enforcement.
Note appetite suppressants, such as phentermine, are not on this list.
In general, individuals in rural areas may have less access to healthcare services and providers compared to those in urban areas. This is due to a variety of factors, including geographic distance, limited transportation options, and a shortage of healthcare providers in many rural areas.
According to a 2019 report from the National Rural Health Association, approximately 60 million Americans live in rural areas, but these areas are home to only 9% of the country's physicians. Additionally, rural areas may have fewer hospitals, clinics, and other healthcare facilities, which can limit access to medical care.
Some of the specific challenges that individuals in rural areas may face when it comes to accessing medical care include:
Overall, access to healthcare can be a significant challenge for individuals in rural areas, which can have a negative impact on their health outcomes. To address these challenges, there is a need for increased investment in healthcare infrastructure and resources in rural areas, as well as innovative solutions such as telehealth to help individuals in rural areas access medical care.
Telemedicine has been invaluable in helping fill the provider gap for those living in rural areas. Those in rural areas, like most throughout the USA, struggle with an unhealthy amount of excess weight. The DEA's proposed Controlled Substance rule change regarding telemedicine will absolutely decrease access to healthcare providers via telemedicine for the treatment of their excess unhealthy weight. This is likely an oversite or due to a built-in bias against those that struggle with excess weight, being overweight, and/or obesity. Please reach out to the DEA and Congressmen to voice your concerns over this issue.
Individuals who are uninsured, working poor, low-income, and/or from ethnic or racial minority groups may face significant barriers to accessing healthcare services and providers. These barriers may be particularly acute in urban areas and metropolitan areas, where there may be higher concentrations of these populations.
Some of the specific challenges that these populations may face when it comes to accessing medical care in urban areas include:
Overall, access to healthcare is a complex issue that is influenced by a range of factors, including socioeconomic status, insurance coverage, geography, and cultural and linguistic barriers. Addressing these challenges will require a multifaceted approach that includes improving healthcare infrastructure and resources in underserved areas, increasing insurance coverage and reducing healthcare costs, and addressing systemic biases and discrimination within the healthcare system.
Telemedicine has been invaluable in helping fill the provider gap for those living in cities, urban and metropolitan areas. Those in rural areas, like most throughout the USA, struggle with an unhealthy amount of excess weight. The DEA's proposed Controlled Substance rule change regarding telemedicine will absolutely decrease access to healthcare providers via telemedicine for the treatment of their excess unhealthy weight. This is likely an oversite or due to a built-in bias against those that struggle with excess weight, being overweight, and/or obesity. Please reach out to the DEA and Congressmen to voice your concerns over this issue.
Weight bias and stigma are unfortunately common in the United States and can have a significant impact on the health and well-being of individuals who are overweight, obese, or have excess weight. Studies have shown that weight bias can occur in a variety of settings, including healthcare, education, employment, and the media.
According to a 2020 survey by the American Psychological Association, 77% of adults in the United States reported experiencing weight stigma at some point in their lives. Additionally, studies have shown that weight bias and stigma can contribute to a range of negative health outcomes, including depression, anxiety, disordered eating, and reduced access to healthcare.
Weight bias and stigma can take many forms, including negative stereotypes and assumptions about individuals who are overweight or obese, discrimination in employment and education settings, and biased treatment by healthcare providers. These biases can be conscious or unconscious and can occur even among individuals who are otherwise well-intentioned.
To address weight bias and stigma, it is important to raise awareness of the issue and to promote education and training for healthcare providers, educators, employers, and the media. Additionally, efforts to promote body positivity and acceptance can help to reduce weight bias and stigma and promote greater health and well-being for individuals of all sizes.
Telemedicine has been invaluable in helping fill the provider gap for those struggling with excess weight. It has allowed them to reach out to healthcare providers that focus on weight management. Those clinicians that actively do those truly care about their patients struggles and they create an environment that is welcoming instead of biased against them like most other institutions and or individuals, including primary care providers. The DEA's proposed Controlled Substance rule change regarding telemedicine will absolutely decrease access to healthcare providers via telemedicine for the treatment of their excess unhealthy weight. This is likely an oversite or due to a built-in bias against those that struggle with excess weight, being overweight, and/or obesity.
Controlled substance appetite suppressants prescribed by healthcare providers are safe. They are not prone to diversion, misuse, or abuse like other controlled substances. Therefore, they should not be treated the same as other controlled substances. If the DEA wishes to claim that controlled substances are actually prone to abuse, misuse, diversion, and illegitimate purposes then let them reveal the data that has shown this. Instead, the only thing they can site regarding this is the warning placed on them when first released in the 1950s. Those warnings have never actually been demonstrated. On the contrary countless studies have shown those warnings to be those that are not realized in practice. Please reach out to the DEA and Congressmen to voice your concerns over this issue.
Health insurance policies and programs in the United States can sometimes reveal or indicate bias against individuals who are overweight or obese. This bias can take several forms, including limitations on coverage for weight loss treatments or discrimination in coverage based on weight or body mass index (BMI).
One common example of bias in health insurance is the use of BMI as a determinant of coverage for weight loss treatments. BMI is a measure of body fat based on height and weight and is often used by health insurers to determine eligibility for weight loss surgeries, medications, and other treatments. However, BMI is not always an accurate measure of health, as it does not take into account factors such as muscle mass, bone density, and overall fitness.
Additionally, some health insurance policies may exclude coverage for weight loss treatments altogether or may only cover these treatments for individuals with certain medical conditions or comorbidities.
These policies and practices can contribute to disparities in healthcare access and outcomes for individuals who are overweight or obese and can perpetuate weight bias and stigma. To address these issues, there is a need for greater education and awareness among health insurers, policymakers, and healthcare providers about the impact of weight bias on health outcomes, as well as policies and practices that promote equitable access to healthcare for individuals of all sizes.
These factors have led many struggling with excess unhealthy weight to seek out readily available and more budget friendly telemedicine providers that specialize in treating patients for their weight management needs. Telemedicine has been invaluable in helping fill the provider gap for those struggling with excess weight. It has allowed them to reach out to healthcare providers that focus on weight management. Those clinicians that actively do those truly care about their patients struggles and they create an environment that is welcoming instead of biased against them like most other institutions and or individuals, including primary care providers. The DEA's proposed Controlled Substance rule change regarding telemedicine will absolutely decrease access to healthcare providers via telemedicine for the treatment of their excess unhealthy weight. This is likely an oversite or due to a built-in bias against those that struggle with excess weight, being overweight, and/or obesity.
Controlled substance appetite suppressants prescribed by healthcare providers are safe. They are not prone to diversion, misuse, or abuse like other controlled substances. Therefore, they should not be treated the same as other controlled substances. If the DEA wishes to claim that controlled substances are actually prone to abuse, misuse, diversion, and illegitimate purposes then let them reveal the data that has shown this. Instead, the only thing they can site regarding this is the warning placed on them when first released in the 1950s. Those warnings have never actually been demonstrated. On the contrary countless studies have shown those warnings to be those that are not realized in practice. Please reach out to the DEA and Congressmen to voice your concerns over this issue.
Unfortunately, weight bias and discrimination in employment settings are common in the United States and can have significant negative impacts on individuals who are overweight, obese, or have excess weight.
Studies have shown that individuals who are overweight or obese may face discrimination in hiring, promotion, and job retention, as well as bias and harassment from colleagues and supervisors. Additionally, individuals who are overweight or obese may face lower wages and reduced access to benefits such as health insurance.
This bias and discrimination can occur in both small and large companies in the United States and can be particularly acute in industries that place a premium on physical appearance or that have strict dress codes or uniform requirements.
To address weight bias in employment settings, it is important for employers to promote a culture of inclusivity and respect, and to provide education and training for managers and employees on issues related to weight bias and discrimination. Additionally, policies such as flexible work schedules, access to healthy food options, and opportunities for physical activity can help to promote greater health and well-being for employees of all sizes.
These factors have led many struggling with excess unhealthy weight to seek out telemedicine providers that specialize in treating patients for their weight management needs. How does employer weight bias drive employees to seek weight management via telemedicine? The built-in excess weight bias by employers make employees feel uncomfortable in seeking time off from work during regular business hours to see a primary care provider for the purpose of weight management. You may say that employers have no right to question their employers why they are seeking to be off for a healthcare visit. You are correct in that, and it is likely unlawful, but that has not yet stopped it from happening. These factors guide patients to feel their only option is to seek out telemedicine providers that are not biased against those struggling with excess weight.
Telemedicine has been invaluable in helping fill the provider gap for those struggling with excess weight. It has allowed them to reach out to healthcare providers that focus on weight management. Those clinicians that actively do those truly care about their patients struggles and they create an environment that is welcoming instead of biased against them like most other institutions and or individuals, including primary care providers. The DEA's proposed Controlled Substance rule change regarding telemedicine will absolutely decrease access to healthcare providers via telemedicine for the treatment of their excess unhealthy weight. This is likely an oversite or due to a built-in bias against those that struggle with excess weight, being overweight, and/or obesity.
Controlled substance appetite suppressants prescribed by healthcare providers are safe. They are not prone to diversion, misuse, or abuse like other controlled substances. Therefore, they should not be treated the same as other controlled substances. If the DEA wishes to claim that controlled substances are actually prone to abuse, misuse, diversion, and illegitimate purposes then let them reveal the data that has shown this. Instead, the only thing they can site regarding this is the warning placed on them when first released in the 1950s. Those warnings have never actually been demonstrated. On the contrary countless studies have shown those warnings to be those that are not realized in practice. Please reach out to the DEA and Congressmen to voice your concerns over this issue.
The classification of weight management medications as controlled substances can impact clinicians' ability to prescribe these medications to patients who are overweight or obese. Many controlled substances, such as narcotics (highest likelihood), benzodiazepines (second most likely), ADHD medications (third most likely), and sleeping pills (least likely), have potential for abuse and dependence, therefore, they are regulated by the federal government to prevent their misuse.
This, however, has not been demonstrated in any studies regarding controlled substance appetite suppressants, such as phentermine, yet governmental regulations and the DEA treat all controlled substances as though they pose the same risk. On the contrary to this stance numerous studies have shown that controlled substance appetite suppressants are rarely abused, diverted, or used for unlawful purposes. They also have no "street value", are not used in the making of illicit drugs, and are not involved in overdose deaths. Treating unhealthy unsafe weight given its high prevalence, its presence of a top health condition that leads to disease, morbidity, and death, along with its enormous negative financial impact to companies, individuals, healthcare industry, and the government itself (see other topic headings that address these issues specifically and more in depth).
Many weight management medications’, including phentermine and other stimulants, classification as controlled substances can make it more difficult for clinicians to prescribe these medications to patients who could potentially benefit from them, as there are often strict regulations governing their use and distribution. Clinicians that attempt to help patients using these very safe medications using their clinical expertise, experience, and medical trial data often leads them to being investigated by state boards of medicine and by governmental agencies. These investigations are rarely ever led secondary to poor patient outcomes nor because of patient complaints. Instead, they are most often driven by pharmacist and governmental agencies that in study after study have been shown to posses’ weight bias, including bias against medical practices that attempt to help patients with their unhealthy excess weight with the aid affordable and generally safe controlled substance appetite suppressants (see other topic headings that address these issues specifically and more in depth).
Additionally, government regulations related to weight management medications can also impact clinicians' ability to prescribe these medications to patients. For example, some states may have laws or regulations that limit the use of certain weight management medications or require additional documentation and/or monitoring for patients who are prescribed these medications. Most that practice weight management via telemedicine performed PMDP (Prescription Monitory Drug Program) checks prior to it being required by law and they still happily perform this valuable study in caring for their patients. No one in the nation cares more about safety and good outcomes for patients than healthcare professionals.
Overall, the classification of weight management medications as controlled substances and government regulations related to their use can impact clinicians' ability to prescribe these medications to patients who are overweight or obese. To address these issues, there is a need for greater education and awareness among policymakers, healthcare providers, and the public about the benefits and risks of weight management medications, as well as policies and practices that promote equitable access to these medications for individuals who could benefit from them.
Telemedicine has been invaluable in helping fill the provider gap for those struggling with excess weight. It has allowed them to reach out to healthcare providers that focus on weight management. Those clinicians that actively do those truly care about their patients struggles and they create an environment that is welcoming instead of biased against them like most other institutions and or individuals, including primary care providers. The DEA's proposed Controlled Substance rule change regarding telemedicine will absolutely decrease access to healthcare providers via telemedicine for the treatment of their excess unhealthy weight. This is likely an oversite or due to a built-in bias against those that struggle with excess weight, being overweight, and/or obesity.
Controlled substance appetite suppressants prescribed by healthcare providers are safe. They are not prone to diversion, misuse, or abuse like other controlled substances. Therefore, they should not be treated the same as other controlled substances. If the DEA wishes to claim that controlled substances are prone to abuse, misuse, diversion, and illegitimate purposes then let them reveal the data that has shown this. Instead, the only thing they can site regarding this is the warning placed on them when first released in the 1950s. Those warnings have never actually been demonstrated. On the contrary countless studies have shown those warnings to be those that are not realized in practice. Please reach out to the DEA and Congressmen to voice your concerns over this issue.
The Ryan Haight Online Pharmacy Consumer Protection Act of 2008 was passed by the U.S. Congress to address the illegal distribution of controlled substances over the internet. The Act is named after Ryan Haight, a teenager who died of a prescription drug overdose after obtaining drugs from an online pharmacy without a valid prescription.
The purpose of the Ryan Haight Act was to regulate the distribution of controlled substances over the internet and to prevent the abuse of prescription drugs. The Act requires online pharmacies to obtain a special certification from the Drug Enforcement Administration (DEA) before they can distribute controlled substances over the internet. It also requires online pharmacies to comply with state and federal laws related to the distribution of controlled substances, including requirements related to the prescription and dispensing of these medications.
Subsequent amendments to the Ryan Haight Act have focused on expanding its scope to include new types of controlled substances and new technologies for the distribution of these medications. For example, the SUPPORT Act of 2018 included provisions related to the use of telemedicine to prescribe controlled substances, and the COVID-19 relief package of 2020 included provisions related to the use of telemedicine to prescribe controlled substances during the pandemic.
Overall, the Ryan Haight Act and its subsequent amendments have been aimed at regulating the distribution of controlled substances, preventing prescription drug abuse, and promoting safe and responsible prescribing practices among healthcare providers.
Telemedicine has been invaluable in helping fill the provider gap for those struggling with excess weight. It has allowed them to reach out to healthcare providers that focus on weight management. Those clinicians that actively do those truly care about their patients struggles and they create an environment that is welcoming instead of biased against them like most other institutions and or individuals, including primary care providers. The DEA's proposed Controlled Substance rule change regarding telemedicine will absolutely decrease access to healthcare providers via telemedicine for the treatment of their excess unhealthy weight. This is likely an oversite or due to a built-in bias against those that struggle with excess weight, being overweight, and/or obesity.
Controlled substance appetite suppressants prescribed by healthcare providers are safe. They are not prone to diversion, misuse, or abuse like other controlled substances. Therefore, they should not be treated the same as other controlled substances. If the DEA wishes to claim that controlled substances are prone to abuse, misuse, diversion, and illegitimate purposes then let them reveal the data that has shown this. Instead, the only thing they can site regarding this is the warning placed on them when first released in the 1950s. Those warnings have never actually been demonstrated. On the contrary countless studies have shown those warnings to be those that are not realized in practice. Please reach out to the DEA and Congressmen to voice your concerns over this issue.
The Drug Enforcement Administration (DEA) is responsible for interpreting and enforcing the Ryan Haight Online Pharmacy Consumer Protection Act of 2008 and its subsequent amendments and alterations. The DEA's stated purposes in its interpretation and implementation of the Act include:
To prevent the illegal distribution of controlled substances over the internet: The DEA's primary goal in implementing the Ryan Haight Act is to prevent the illegal sale and distribution of controlled substances over the internet. The Act requires online pharmacies to obtain a special certification from the DEA before they can distribute controlled substances over the internet (this is understood to include telemedicine) and requires them to comply with strict regulations related to the prescription and dispensing of these medications.
To promote safe and responsible prescribing practices among healthcare providers: The DEA's interpretation and implementation of the Ryan Haight Act is aimed at promoting safe and responsible prescribing practices among healthcare providers. The Act requires healthcare providers to comply with strict regulations related to the prescription and dispensing of controlled substances and encourages them to use best practices in prescribing these medications to their patients.
To prevent prescription drug abuse and diversion: The DEA's interpretation and implementation of the Ryan Haight Act is aimed at preventing the abuse and diversion of prescription drugs. The Act requires online pharmacies and healthcare providers to use secure and verified methods of prescribing and dispensing controlled substances and encourages them to monitor patients for signs of prescription drug abuse or diversion.
Overall, the DEA's interpretation and implementation of the Ryan Haight Act is aimed at promoting safe and responsible prescribing practices, preventing prescription drug abuse and diversion, and regulating the distribution of controlled substances over the internet. These are all purposes/goals that all healthcare professionals will agree to. What is not agreed to is the broad approach it takes regarding medications that are controlled substances. These medications are not all created equally. They do not all have the same risks of abuse, misuse, illegal uses, illegitimate uses, and/or diversion; therefore, they should not all be handled/dealt with in the same manner.
The DEA's proposed Controlled Substance rule change regarding telemedicine will absolutely decrease access to healthcare providers via telemedicine for the treatment of their excess unhealthy weight. This is likely an oversite or due to a built-in bias against those that struggle with excess weight, being overweight, and/or obesity.
Controlled substance appetite suppressants prescribed by healthcare providers are safe. They are not prone to diversion, misuse, or abuse like other controlled substances. Therefore, they should not be treated the same as other controlled substances. If the DEA wishes to claim that controlled substances are prone to abuse, misuse, diversion, and illegitimate purposes then let them reveal the data that has shown this. Instead, the only thing they can site regarding this is the warning placed on them when first released in the 1950s. Those warnings have never actually been demonstrated. On the contrary countless studies have shown those warnings to be those that are not realized in practice. Please reach out to the DEA and Congressmen to voice your concerns over this issue.
The number of opioid prescriptions in the United States has decreased in recent years. According to data from the Centers for Disease Control and Prevention (CDC), the number of opioid prescriptions peaked in 2012 and has been declining since then. In 2019, opioid prescriptions dispensed was noted to have decreased by 43% from the peak in 2012.
According to the CDC, there were 14,427 deaths involving prescription opioids in 2019. While the rate of increase has slowed in recent years, prescription opioids continue to be a major contributor to the opioid epidemic.
Illicit drug overdose deaths, including deaths involving opioids such as heroin and fentanyl, have continued to increase in recent years. According to the National Institute on Drug Abuse, there were 70,630 drug overdose deaths in the United States in 2019, with opioids involved in many of these deaths.
Overall, the opioid epidemic remains a significant public health challenge in the United States, and efforts to address this crisis will require a multifaceted approach that includes prevention, treatment, and harm reduction strategies.
Are controlled substance appetite suppressants opiates/narcotics? Absolutely NOT. Are controlled substance appetite suppressants involved to any significant degree in the opiate crisis/overdoses? Absolutely NOT. The DEA's proposed Controlled Substance current proposed rule changes regarding telemedicine will absolutely decrease access to healthcare providers via telemedicine for the treatment of their excess unhealthy weight. This is likely an oversite or due to a built-in bias against those that struggle with excess weight, being overweight, and/or obesity.
Controlled substance appetite suppressants prescribed by healthcare providers are safe. They are not prone to diversion, misuse, or abuse like other controlled substances. Therefore, they should not be treated the same as other controlled substances. If the DEA wishes to claim that controlled substances are prone to abuse, misuse, diversion, and illegitimate purposes then let them reveal the data that has shown this. Instead, the only thing they can site regarding this is the warning placed on them when first released in the 1950s. Those warnings have never actually been demonstrated. On the contrary countless studies have shown those warnings to be those that are not realized in practice. Please reach out to the DEA and Congressmen to voice your concerns over this issue.
The latest reported data on overdose deaths in the United States is from 2019. According to the Centers for Disease Control and Prevention (CDC), there were 70,630 drug overdose deaths in the United States in 2019. Of these deaths:
It is important to note that many overdose deaths involve multiple drugs, so these percentages do not add up to 100%, instead the above adds up to 118.1%. Additionally, these figures may be subject to revision as more data becomes available.
What about prescription-controlled substance appetite suppressants, include phentermine as well as others that fall within this classification? According to data from the Drug Abuse Warning Network (DAWN), which monitored drug-related ED visits in the United States between 2004 and 2011, appetite suppressants, such as phentermine, were involved in less than 1% of stimulant-related ED visits during this 8-year timeframe. Additionally, they are not known to be a cause of overdose death by themselves alone. In fact, their presence within the blood stream in those that die from overdoses from other substances (such as narcotics, benzodiazepines, illicit drugs, & alcohol) was only 10 out of 70,630 drug overdose deaths in the United States in 2019, which corresponds to 0.01% of the overall overdose deaths. To be clear they were NOT the cause of 0.01% of overall overdose deaths, but instead they were only found within that percentage of people that died from overdose from other causes.
Prescription-controlled substance appetite suppressants, include phentermine as well as others that fall within this classification do not all have the same risks of abuse, misuse, illegal uses, illegitimate uses, and/or diversion as other prescribed-controlled substances; therefore, they should not all be handled/dealt with in the same manner.
The DEA's proposed Controlled Substance rule change regarding telemedicine will absolutely decrease access to healthcare providers via telemedicine for the treatment of their excess unhealthy weight. This is likely an oversite or due to a built-in bias against those that struggle with excess weight, being overweight, and/or obesity.
Controlled substance appetite suppressants prescribed by healthcare providers are safe. They are not prone to diversion, misuse, or abuse like other controlled substances. Therefore, they should not be treated the same as other controlled substances. If the DEA wishes to claim that controlled substances are prone to abuse, misuse, diversion, and illegitimate purposes then let them reveal the data that has shown this. Instead, the only thing they can site regarding this is the warning placed on them when first released in the 1950s. Those warnings have never actually been demonstrated. On the contrary countless studies have shown those warnings to be those that are not realized in practice. Please reach out to the DEA and Congressmen to voice your concerns over this issue.
The Centers for Disease Control and Prevention (CDC) provides a list of the top 10 drugs involved in overdose deaths, including prescription and illicit drugs, based on data from 2019. These are not solely prescription medications, but also include illicit drugs. The list is as follows:
It is important to note that many overdose deaths involve multiple drugs, so these percentages do not add up to 100%. If we add up the percentages of all the drugs listed above, we get a total of 157.8%. This indicates that many overdose deaths involve multiple drugs and underscores the complexity of the opioid epidemic and the need for a multifaceted approach to address this crisis. Additionally, the percentages may vary from year to year, and these figures may be subject to revision as more data becomes available. Also, of important to note is that overdose solely from benzodiazepines (such as Xanax & Valium) is incredibly rare and generally only leads to death when it is combined with other drugs, such as opiates/narcotics, illicit drugs, and/or alcohol.
Also realize that out of the above CDC's top ten drugs involved in overdose deaths that even the prescription medications on that list have a street value/can be purchased illegally from the street by individuals without a prescription from a healthcare provider. All of the above, including the illicit drugs as well as the prescription medications, are illegally imported into the USA and are illegally distributed by criminal organizations within the USA.
Note that prescription-controlled substance appetite suppressants, include phentermine as well as others that fall within this classification are NOT found on the above list. Realize that prescription-controlled substance appetite suppressants are NOT illegally imported into the USA and are NOT illegally distributed by criminal organizations within the USA. All prescription-controlled substances do not all have the same risks of abuse, misuse, illegal uses, illegitimate uses, and/or diversion as other prescribed-controlled substances; therefore, they should not all be handled/dealt with in the same manner.
The DEA's proposed Controlled Substance rule change regarding telemedicine will absolutely decrease access to healthcare providers via telemedicine for the treatment of their excess unhealthy weight. This is likely an oversite or due to a built-in bias against those that struggle with excess weight, being overweight, and/or obesity.
Controlled substance appetite suppressants prescribed by healthcare providers are safe. They are not prone to diversion, misuse, or abuse like other controlled substances. Therefore, they should not be treated the same as other controlled substances. If the DEA wishes to claim that controlled substances are prone to abuse, misuse, diversion, and illegitimate purposes then let them reveal the data that has shown this. Instead, the only thing they can site regarding this is the warning placed on them when first released in the 1950s. Those warnings have never actually been demonstrated. On the contrary countless studies have shown those warnings to be those that are not realized in practice. Please reach out to the DEA and Congressmen to voice your concerns over this issue.
According to the latest data available, there were an estimated 150 deaths per year in the United States from accidental overdose of over the counter (OTC) acetaminophen products between 2010 and 2016. Additionally, according to the latest data available from the National Poison Data System, there were 194 reported suicides in the United States involving over the counter (OTC) medications in 2019. It is important to note that this figure only includes reported cases, and the actual number of suicides involving OTC medications may be higher.
Alcohol-related deaths are more difficult to estimate, as they may involve a range of factors and comorbidities. According to the Centers for Disease Control and Prevention (CDC), there were approximately 88,000 deaths per year in the United States from 2006 to 2010 that were attributable to excessive alcohol use.
Anaphylaxis is a severe and potentially life-threatening allergic reaction that can be caused by a variety of triggers, including prescription medications. According to the Asthma and Allergy Foundation of America, an estimated 1,500 deaths per year in the United States are attributed to anaphylaxis from all causes, including prescription medications, food allergies, and insect stings. Appetite suppressant medications are NOT known to have any statistically significant occurrence of anaphylaxis or any other significantly serious allergic reactions.
The CDC reports that serious adverse reactions to antibiotics are responsible for an estimated 1 in 5 ED visits related to adverse drug events (ADEs) in the United States. According to a study published in the Journal of Allergy and Clinical Immunology in Practice in 2019, antibiotics were the most implicated medication class in fatal anaphylaxis cases reported to the National Institute of Allergy and Infectious Diseases Collaborative Clinical Trial and Epidemiology Studies registry between 1999 and 2016. Despite this fact, the exact number of anaphylaxis deaths caused by prescription antibiotics in the United States annually is not specifically known.
According to the Centers for Disease Control and Prevention (CDC), there were an estimated 12,800 deaths in the United States in 2017 that were directly attributable to Clostridioides difficile (C. difficile) infections. While not all these infections are caused by prescription antibiotics, the overuse or misuse of antibiotics is a major risk factor for developing a C. difficile infection. Antibiotics disrupt the normal balance of bacteria in the gut, allowing C. difficile bacteria to overgrow and cause infection. Therefore, reducing the unnecessary use of antibiotics is an important strategy for preventing C. difficile infections and their associated morbidity and mortality.
Other medications commonly implicated in fatal anaphylaxis cases included nonsteroidal anti-inflammatory drugs (NSAIDs), chemotherapeutic agents, and intravenous contrast media.
According to the Centers for Disease Control and Prevention (CDC), an average of 62 deaths per year in the United States are attributed to insect sting anaphylaxis.
Below are statistics regarding prescription-controlled substance appetite suppressants, such as phentermine, but in reviewing this date keep in mind the above information about the incidence of adverse reactions and deaths from over-the-counter (OTC) medications, non-controlled substance prescriptions (including antibiotics), alcohol, and even insect stings as a comparison. All of these are far more lethal and much more common to cause serious adverse reactions than prescription-controlled substance appetite suppressants, such as phentermine. If the purpose of governmental regulations and the DEA is public safety, why are they restricting these prescription appetite suppressants so heavily? The DEA's current proposed rule change will essentially end all telemedicine treatment of weight management by healthcare providers with the aid of these medicines. The DEA will argue this view is false, but in another topic discussion we will address exactly while this statement is absolutely true.
According to data from the Drug Abuse Warning Network (DAWN), which monitored drug-related ED visits in the United States between 2004 and 2011, prescription-controlled substance appetite suppressants, such as phentermine, were involved in less than 1% of stimulant-related ED visits during this 8-year timeframe. Additionally, they are not known to be a cause of overdose death by themselves alone. In fact, their presence within the blood stream in those that die from overdoses from other substances (such as narcotics, benzodiazepines, illicit drugs, & alcohol) was only 10 out of 70,630 drug overdose deaths in the United States in 2019, which corresponds to 0.01% of the overall overdose deaths. To be clear they were NOT the cause of 0.01% of overall overdose deaths, but instead they were only found within that percentage of people that died from overdose from other causes.
Overall, the classification of weight management medications as controlled substances and government regulations related to their use can impact clinicians' ability to prescribe these medications to patients who are overweight or obese. To address these issues, there is a need for greater education and awareness among policymakers, healthcare providers, and the public about the benefits and risks of weight management medications, as well as policies and practices that promote equitable access to these medications for individuals who could benefit from them.
Telemedicine has been invaluable in helping fill the provider gap for those struggling with excess weight. It has allowed them to reach out to healthcare providers that focus on weight management. Those clinicians that actively do those truly care about their patients struggles and they create an environment that is welcoming instead of biased against them like most other institutions and or individuals, including primary care providers. The DEA's proposed Controlled Substance rule change regarding telemedicine will absolutely decrease access to healthcare providers via telemedicine for the treatment of their excess unhealthy weight. This is likely an oversite or due to a built-in bias against those that struggle with excess weight, being overweight, and/or obesity.
Controlled substance appetite suppressants prescribed by healthcare providers are safe. They are not prone to diversion, misuse, or abuse like other controlled substances. Therefore, they should not be treated the same as other controlled substances. If the DEA wishes to claim that controlled substances are prone to abuse, misuse, diversion, and illegitimate purposes then let them reveal the data that has shown this. Instead, the only thing they can site regarding this is the warning placed on them when first released in the 1950s. Those warnings have never actually been demonstrated. On the contrary countless studies have shown those warnings to be those that are not realized in practice. Please reach out to the DEA and Congressmen to voice your concerns over this issue.
In the context of controlled substances, the U.S. Drug Enforcement Administration (DEA) defines "diversion" as the transfer of a controlled substance from a lawful to an unlawful channel of distribution or use. This can include the illicit distribution, trafficking, or abuse of prescription medications, as well as the illicit production, distribution, or trafficking of illegal drugs such as heroin, cocaine, and methamphetamine.
Some examples of diversion may include:
The DEA is responsible for investigating and prosecuting instances of diversion, as well as regulating the lawful distribution of controlled substances to prevent their misuse or abuse. The agency works closely with other federal, state, and local law enforcement agencies to identify and disrupt illicit drug trafficking networks and prosecute those who engage in diversion or other drug-related crimes.
None of the above apply to prescription-controlled substance medications, such as phentermine. Then why treat them the same as other prescription-controlled substance medications that do, such as narcotics/opiates, benzodiazepines, certain ADHD medications, and sleeping pills? Good question. See other topics on this website for various reasons that explain this bias and inappropriate application to prescription-controlled substance medications. See below for some general brief highlights of important features to note as you consider reviewing this topic further.
Realize that prescription-controlled substance appetite suppressants are NOT illegally imported into the USA and are NOT illegally distributed by criminal organizations within the USA. All prescription-controlled substances do not all have the same risks of abuse, misuse, illegal uses, illegitimate uses, and/or diversion as other prescribed-controlled substances; therefore, they should not all be handled/dealt with in the same manner.
The DEA's proposed Controlled Substance rule change regarding telemedicine will absolutely decrease access to healthcare providers via telemedicine for the treatment of their excess unhealthy weight. This is likely an oversite or due to a built-in bias against those that struggle with excess weight, being overweight, and/or obesity.
Controlled substance appetite suppressants prescribed by healthcare providers are safe. They are not prone to diversion, misuse, or abuse like other controlled substances. Therefore, they should not be treated the same as other controlled substances. If the DEA wishes to claim that controlled substances are prone to abuse, misuse, diversion, and illegitimate purposes then let them reveal the data that has shown this. Instead, the only thing they can site regarding this is the warning placed on them when first released in the 1950s. Those warnings have never actually been demonstrated. On the contrary countless studies have shown those warnings to be those that are not realized in practice. Please reach out to the DEA and Congressmen to voice your concerns over this issue.
There are various types of office visits with a healthcare provider that may not necessarily involve performing a physical exam. Here are a few examples:
It is important to note that the specific type of office visit and the necessity of a physical exam may vary depending on the patient's medical history, current symptoms, and the healthcare provider's assessment of the situation, but a physical exam does not always have to be performed by a healthcare provider to treat a patient appropriately.
The standard of care for medical practice can vary depending on several factors, such as the patient's medical history, symptoms, the provider’s clinical experience, and the healthcare provider's expertise and training. In some cases, a physical exam may not be necessary to provide appropriate medical care. In other cases, a physical exam may be considered necessary to diagnose or monitor a medical condition.
In general, healthcare providers are expected to follow the standard of care for their specific field of practice and provide medical care that is consistent with what a reasonably prudent healthcare provider with a similar background and training would provide under similar circumstances.
Whether or not the lack of a physical exam during an in-office visit is considered following the standard of care would depend on the specific circumstances of the case and whether a physical exam was necessary for the medical care being provided.
The specific components of an in-office healthcare provider visit for weight management can vary depending on the healthcare provider's practice and the patient's individual needs. However, in general, it is common practice for healthcare providers to take measurements such as weight, height, and body mass index (BMI) during a weight management visit. They may also review the patient's medical history, ask about symptoms, and discuss the patient's goals for weight management. With the advent of live 2- way interactive audio-video technology these can be carried out via a telemedicine visit.
Weight management visits, whether in-person or via telemedicine, routinely involve checking the patient's blood pressure and heart rate. Signs and symptoms of various disease processes are commonly discussed. Additionally, the health care provider is likely to document your age, biological gender, ethnicity since these all factor in determining a healthy weight target for a patient. Likewise, your past medical history, past surgical history, social history, allergies, medications, and activity levels will be discussed and documented. Some clinicians will discuss other health topics as well in assessing a patient for weight management of those with excess unhealthy weight.
The decision to perform a physical exam during a weight management visit will depend on the specific circumstances of the patient's case and the healthcare provider's judgment.
Weight management can be safely assessed via a telemedicine visit in many cases, although the appropriateness of a telemedicine visit will depend on the patient's individual needs and circumstances, including healthcare access options as well as financial means.
During a telemedicine visit for weight management, a healthcare provider can review the patient's medical history, discuss their weight management goals, provide education on healthy lifestyle habits, and offer guidance on diet and exercise. They may also review the patient's medications and adjust as necessary. Often medical management of excess unhealthy weight involves prescription medications. The patient's history, risk, other factors, and the ability of the patient to pay for prescription medications may determine the available prescription medication options.
Healthcare provider commonly ask the patient to take their weight and other measurements at home and report the results during the telemedicine visit. More stringent telemedicine healthcare providers require the patient to do this, as well as checking their blood pressure and heart rate, live during their 2- way interactive audio-video telemedicine visit. Sometimes, but not always, a telemedicine weight management provider may direct the patient to be seen in an office by a primary care provider and/or by another medical sub-specialist.
It's important to note that telemedicine visits for weight management may not be covered by all insurance plans, and the availability and accessibility of telemedicine services may vary depending on the patient's location and healthcare provider. Patients should consult with their healthcare provider to determine if a telemedicine visit is appropriate for their weight management needs.
Undocumented immigrants and residents in the USA may face challenges in accessing medical care due to a lack of health insurance, language barriers, fear of deportation, and other factors. This can lead to delays in seeking care and potentially worsen health outcomes, including those related to excess weight, being overweight, or obesity.
Studies have shown that undocumented immigrants may have higher rates of overweight and obesity than other populations. One study published in the Journal of Immigrant and Minority Health found that undocumented Latino immigrants had a higher prevalence of obesity compared to documented Latino immigrants and US-born Latinos. This may be due to a combination of factors, including limited access to healthy foods and safe physical activity, as well as cultural beliefs and values surrounding body weight.
It's important to note that immigration status should not be a barrier to accessing healthcare services in the USA. Some healthcare providers and community organizations offer services to undocumented residents, and there are also programs that provide healthcare coverage for children and pregnant women regardless of immigration status. However, fear of deportation and other factors may still prevent some individuals from seeking care.
The percentage of people who die from overdoses with prescription-controlled substances and have a valid prescription for the medication is difficult to determine precisely. However, research suggests that a significant proportion of individuals who misuse prescription opioids obtained them from sources other than their own prescriptions, such as from friends, family members, or illicit sources.
According to data from the National Survey on Drug Use and Health, in 2019, only 22.6% of people who misused prescription pain relievers obtained them through a valid prescription from a healthcare provider. The majority of those who misused these medications obtained them from a friend or family member for free (35.1%) or bought them from a friend or family member (17.9%). Only a small percentage obtained them from a drug dealer or other stranger (4.2%).
Similarly, a study published in the Journal of the American Medical Association in 2018 found that among individuals who had died from prescription opioid overdoses in 2016, only 27% had received an opioid prescription in the 90 days before their death. The majority had obtained opioids from other sources, such as friends or family members (22.4%), or illicit sources such as drug dealers or theft (42.4%).
It's important to note that these data specifically relate to prescription opioids and may not be representative of other types of controlled substances. Additionally, the specific percentage of individuals with a prescription for a controlled substance who die from an overdose may vary depending on the substance and other factors.
Per the CDC in 2019, there were 70,630 overdose deaths. Most of those deaths (70.8%) were from illicit drugs. Illicit drugs are NOT prescribed to patients by a healthcare provider. Also, note that a medication, being a medicine that can be prescribed for, does not mean that the medication involved in the overdose deaths was prescribed to that person. Per a study cited below only 22.6% of the prescription medications involved in an overdose death were prescribed to the person that overdosed.
Note that if you combine the above deaths and percentages that it yields 83,506 deaths, despite the listed total being 70,630, and the total percentage adds up to 118.1% instead of 100%. Why is this? It is because many of these deaths involved multiple drugs (both illicit and prescription) in combination that result in the overdose death. Additionally, many of these deaths also involve alcohol.
According to data from the National Survey on Drug Use and Health, in 2019, only 22.6% of people who misused prescription pain relievers obtained them through a valid prescription from a healthcare provider (this is the latest data currently available). The majority of those who misused these medications obtained them from a friend or family member for free (35.1%) or bought them from a friend or family member (17.9%). Only a small percentage obtained them from a drug dealer or other stranger (4.2%).
When the above 22.6% is applied to the various medications that can be prescribed for that were prescribed to the person that overdose reveals the following remarkably interesting data:
If the above numbers are totaled, it yields 7,565 overdose deaths annually in patients that had prescriptions for the medications involved in their overdose death. That represents 9% of the overdose deaths if that is compared to 83,506 (see above). That represents 11% of the overdose deaths if that is compared to 70,630 (see above). This means that at most 9% to 11% of overdose deaths involve a prescription medication that was prescribed to people that die from overdose. Stated another way 89% to 91% of all overdose deaths do not involve a medication that was prescribed to them by a healthcare provider.
Objectively healthcare provider prescriptions are at most only involved in a minority of overdose deaths. Then why is it that most of the focus by the general public, government officials, and politicians focus on the healthcare provider being highly to blame for the “opiate crisis” and/or overdose death rates? A simple answer is they are an easy target, and the government can most easily restrict these law-abiding citizens (i.e., healthcare providers). Unfortunately, this approach (restricting healthcare providers) ability to prescribe certain medications will not likely yield any remarkable results. There are some recent studies that note that decreased prescribing of controlled substances by healthcare providers will yield an increase in overdose deaths. You may ask how could that be?
Ponder the following facts. The peak of controlled substance prescribing occurred in 2012. Per the CDC in 2012 there were 41,502 deaths in the USA from overdose. Since 2012 controlled substance prescribing continually decreases annually. Despite this the death rate from overdoses have continually climbed. Per the CDC in 2019 there were 70,630 deaths secondary to overdose. Have studies revealed any plausible causes for the increase in overdose deaths despite fewer controlled substances being prescribed by healthcare providers? Yes. Many believe, and evidence is being gathered, that indicates that pressure applied to healthcare providers makes them hesitant to prescribe controlled substances even when there is a legitimate reason to do so. As a result of this many patients turn to the “streets” to obtain medications. There they receive them, but they have no professional medical oversight when the population obtains medications in this manner. People are left to their own ideas and those of non-medical professionals in deciding the dose, amount, and frequency that they will take them. This then leads to an increase in overdose deaths.
Given these facts will additional regulations from the government, such as in the DEA's current proposed rule changes, that make healthcare providers less likely to prescribe controlled substances even, when appropriate, yield an increase or a decrease in the number of deaths from overdose? We must ask ourselves what the goal of regulations in healthcare should be. If the answer is to give politicians and policymakers talking points, then continually add more regulations on healthcare professionals. If the true goal is public health and safety, then encourage government officials, including the DEA, to seek out recommendations from actual practicing healthcare providers. Additionally, ask the general public what they think about telemedicine. Ask them how they use it? Ask them if they want telemedicine made more or less available to them.
As a healthcare provider (MD) my goal is to improve patient outcomes. We can all agree that we want ever improving public health and safety. Despite having the same goals, I fear the DEA's proposed rule changes as written will lead to decreasing healthcare access and worsened outcomes. Please reach out to the DEA and any/all government officials you know to encourage the DEA to work more closely with healthcare providers, particularly those providing care via telemedicine, and with patients themselves.
Individuals with untreated ADHD are generally considered to be at a higher risk for suicide attempts and suicide than those with treated ADHD. Additionally, those with ADHD are at greater risk of suicide attempts/suicide than the general population.
Studies have shown that individuals with ADHD are at a higher risk of suicidal ideation and suicide attempts compared to the general population. A systematic review and meta-analysis of studies on ADHD and suicide found that individuals with ADHD had a 5-fold increased risk of suicidal ideation and a 3-fold increased risk of suicide attempts compared to individuals without ADHD (Cortese et al., 2015).
Studies have shown that ADHD symptoms such as impulsivity, inattention, and emotional dysregulation can increase the risk of suicidal ideation and attempts (Cortese et al., 2015). Treatment with medication and/or behavioral therapy can help to reduce these symptoms and improve overall functioning, which may in turn reduce the risk of suicidal behavior.
A study published in the Journal of Clinical Psychiatry found that among individuals with ADHD who had attempted suicide, those who were not receiving medication at the time of the attempt had more severe ADHD symptoms and were more likely to have a history of substance abuse (Wang et al., 2018). This suggests that untreated ADHD may be a risk factor for suicide attempts.
Although ADHD medication is not a guarantee against these risks, it can help to reduce symptoms of ADHD and improve overall functioning, which in turn can reduce the risk of suicidal ideation. If you or someone you know is struggling with ADHD, it's important to seek professional help from a healthcare provider to discuss treatment options and to address any concerns about these risks.
Governmental policies that restrict mental health provider access, including visits that previously were available via telemedicine, will exacerbate ADHD patients risk of suicide attempts and suicide. Restrictions that are likely to result in fewer patients receiving the mental health care and treatments they need will be detrimental to the public's health and safety. Thoughtful consideration, including involving healthcare professionals, needs to be done to ensure these possible negative outcomes do not occur.
According to the Centers for Disease Control and Prevention (CDC), in 2020, there were a total of 44,834 deaths by suicide in the United States. This translates to a rate of 14.0 suicides per 100,000 people.
Research has suggested that individuals with untreated ADHD are at higher risk for substance abuse and dependence compared to individuals with treated ADHD and those without ADHD.
Several studies have found that individuals with untreated ADHD are more likely to engage in illicit drug use and develop substance use disorders (SUDs) compared to those with treated ADHD and those without ADHD. For example, a study published in the Journal of Attention Disorders found that adults with untreated ADHD were more likely to use illicit drugs and develop substance use disorders compared to adults with treated ADHD (Wilens et al., 2011). Another study published in the Journal of Child Psychology and Psychiatry found that untreated ADHD in adolescence was associated with a higher risk of substance use disorders in adulthood (Molina et al., 2009).
Although ADHD medication is not a guarantee against substance abuse and dependence, it can help to reduce ADHD symptoms and improve overall functioning, which may in turn reduce the risk of substance use disorders. Additionally, behavioral therapies such as cognitive-behavioral therapy (CBT) may also be helpful in reducing the risk of substance use disorders. CBT is carried out by mental health professionals in the same manner regardless of whether the visit occurs via telemedicine or during an in-person office visit.
Overall, individuals with untreated ADHD may be at higher risk for illicit drug abuse and polysubstance abuse compared to those with treated ADHD and those without ADHD, and appropriate treatment should be considered to reduce this risk.
Fatal overdoses from prescription stimulants such as Adderall and Ritalin alone are exceedingly rare. Most fatal overdoses involving these medications are due to a combination of multiple drugs, including other prescription medications, illicit drugs, and/or alcohol.
According to the National Institute on Drug Abuse (NIDA), individuals who abuse prescription stimulants often do so in combination with other substances such as alcohol, opioids, benzodiazepines, or other illicit drugs (NIDA, 2021). The combined effects of multiple substances can increase the risk of overdose and other adverse effects.
In general, mental healthcare providers do not typically perform a physical exam prior to diagnosing and treating patients with mental health conditions. Instead, they rely on a patient's self-reported symptoms, medical history, and information gathered through clinical interviews and assessments to make a diagnosis and develop a treatment plan. This is true regardless of whether the mental health providers are evaluating a patient in-person in their office or if they are evaluating them via a telemedicine visit.
The availability of mental healthcare providers in the United States can vary depending on factors such as geographic location, insurance coverage, and socioeconomic status.
According to the National Institute of Mental Health, approximately one in five adults in the United States experienced a mental illness in 2020. However, research has shown that there is a significant gap between the need for mental healthcare services and the availability of providers. This is particularly true for underserved populations, such as those living in rural areas, low-income individuals, and people of color, who may face additional barriers to accessing care.
Overall, while there are certainly dedicated mental healthcare providers in the United States who are working hard to meet the needs of their patients, there are also significant gaps and challenges in the mental healthcare system that need to be addressed in order to ensure that all individuals who need care are able to access it.
Telemedicine rule changes in response to the Covid pandemic greatly increased much of the nation's population's access to mental healthcare providers. Patients' access to mental healthcare providers needs to be protected and reinforced. Doing otherwise will lead to more people with mental health issues going undiagnosed and untreated. This can lead to serious mental health, physical health, or mortality outcomes.
Research has consistently shown that individuals with mental health issues, particularly those that are untreated, are at a higher risk for suicide than the general population.
According to the Centers for Disease Control and Prevention (CDC), suicide is the 10th leading cause of death in the United States, and in 2019, there were over 47,000 suicides in the country. Of those who die by suicide, around 90% have a diagnosable mental health condition. In addition, research has shown that individuals with certain mental health conditions are at a higher risk for suicide than others. For example, individuals with major depression, bipolar disorder, schizophrenia, and substance use disorders are all at an increased risk for suicide.
Untreated mental health conditions can further increase the risk of suicide. For example, individuals with depression who do not receive treatment are at a higher risk for suicide than those who do. Additionally, individuals who have attempted suicide in the past are at a higher risk for future attempts. It is important to note that suicide is a complex issue and is influenced by many different factors. However, it is clear that mental health plays a significant role, and early identification and treatment of mental health conditions can help reduce the risk of suicide.
Patients' access to mental healthcare providers needs to be protected and reinforced. Doing otherwise will lead to more people with mental health issues going undiagnosed and untreated. This can lead to serious mental health, physical health, or mortality outcomes.
| Year | Populations (millions) | Opioid Prescriptions (per 100 people) | Total Opioid Prescriptions (millions) | % Change in Opioid Prescriptions | Overall Overdose Death Rate | Drug Overdose Deaths | % Change in Drug Overdose Deaths |
|---|---|---|---|---|---|---|---|
| 2012 | 313.9 | 81.3 | 255 | N/A | 0.0132% | 41.502 | N/A |
| 2019 | 328.2 | 46.7 | 153.3 | -39.9% | 0.0215% | 70.630 | +70.18% |
| Change | +14.3 | N/A | -101.7 | N/A | +0.0083% | +29.128 | N/A |
The above data confirms that while prescription-controlled substance medications are involved in a small percentage of overdose deaths, the majority of overdose deaths are related to illicit drugs and/or multiple substances used in combination. Additionally, it highlights that healthcare providers are not the primary source of prescription medication misuse and abuse, and that increased restrictions on healthcare providers' ability to prescribe controlled substances may not necessarily lead to a reduction in overdose deaths.
The data also presents statistics on the decrease in opioid prescriptions since their peak in 2012, as well as the increase in overall overdose death rates and drug overdose deaths during that time. These statistics illustrate the complex nature of the opioid and overdose crisis in the United States and the need for a multifaceted approach to addressing it.
Overall, the analysis provided in the given data underscores the importance of a comprehensive understanding of the factors contributing to overdose deaths and the need for evidence-based policies that address those factors in a meaningful way.
Per the CDC in 2019, there were 70,630 overdose deaths. Most of those deaths (70.8%) were from illicit drugs. Illicit drugs are NOT prescribed to patients by a healthcare provider. Also, note that a medication, being a medicine that can be prescribed for, does not mean that the medication involved in the overdose deaths was actually prescribed to that person. On the contrary, per a study cited below only 22.6% of the prescription medications involved in an overdose death were prescribed to the person that overdosed.
People that overdose that are found to have prescription-controlled substances in their bloodstream despite them that have not received the medications from a prescription from a healthcare provider generally ILLEGALLY obtain these “prescription” medicines from the following sources: voluntarily from family &/or friends, from having stolen them from family &/or friends, or from purchasing them off “the streets”. Who is involved in selling prescription- controlled substances on the streets? Drug cartels ILLEGALLY import them and ILLEGALLY distribute them throughout our nation, along with the purely ILLEGALLY illicit drugs. Additionally, criminal organizations within the USA ILLEGALLY obtain and ILLEGALLY distribute them throughout our nation, along with the purely ILLEGALLY illicit drugs. Also, petty criminals are involved in ILLEGALLY obtain and ILLEGALLY distribute them, along with the purely ILLEGALLY illicit drugs.
Note that if you combine the above deaths and percentages that it yields 83,506 deaths, despite the listed total being 70,630, and the total percentage adds up to 118.1% instead of 100%. Why is this? It is because many of these deaths involved multiple drugs (both illicit and prescription) in combination that result in the overdose death. Additionally, many of these deaths also involve alcohol.
According to data from the National Survey on Drug Use and Health, in 2019, only 22.6% of people who misused prescription pain relievers obtained them through a valid prescription from a healthcare provider (this is the latest data currently available). The majority of those who misused these medications obtained them from a friend or family member for free (35.1%) or bought them from a friend or family member (17.9%). Only a small percentage obtained them from a drug dealer or other stranger (4.2%).
When the above 22.6% is applied to the various medications that can be prescribed for that were prescribed to the person that overdose reveals the following remarkably interesting data:
If the above numbers are totaled, it yields 7,565 overdose deaths annually in patients that had prescriptions for the medications involved in their overdose death. That represents 9% of the overdose deaths if that is compared to 83,506 (see above). That represents 11% of the overdose deaths if that is compared to 70,630 (see above). This means that at most 9% to 11% of overdose deaths involve a prescription medication that was prescribed to people that die from overdose. Stated another way 89% to 91% of all overdose deaths do not involve a medication that was prescribed to them by a healthcare provider.
It is important to note that only 22.6% of people who misuse prescription pain relievers obtained them through a valid prescription from a healthcare provider, and at most only 9% to 11% of overdose deaths involve a medication that was prescribed by a healthcare provider. Despite this, healthcare providers are often blamed for the opioid crisis and overdose death rates. Decreased prescribing of controlled substances by healthcare providers may lead to an increase in overdose deaths due to patients turning to the streets to obtain medications without professional medical oversight. The proposed rule changes from the DEA may lead to decreasing healthcare access and worsened outcomes, so it is important for the government to work closely with healthcare providers and patients to improve public health and safety.
There is some evidence to suggest that individuals with chronic pain may be at increased risk for suicidal thoughts and behaviors. Chronic pain can have a significant impact on a person's quality of life, and may contribute to depression, anxiety, and other mental health conditions that can increase the risk of suicide.
A study published in the Journal of Pain Research found that individuals with chronic pain were nearly three times more likely to die from suicide than the general population. Another study published in the Journal of Pain found that chronic pain was a significant predictor of suicidal ideation and suicide attempts among patients with chronic pain.
It is important to note, however, that suicide is a complex phenomenon that can be influenced by multiple factors, and chronic pain is just one of many potential risk factors. It is also important to emphasize that not all individuals with chronic pain will experience suicidal thoughts or behaviors, and that effective pain management and mental health treatment can help to reduce the risk of suicide among this population.
The data also presents statistics on the decrease in opioid prescriptions since their peak in 2012, as well as the increase in overall overdose death rates and drug overdose deaths during that time. These statistics illustrate the complex nature of the opioid and overdose crisis in the United States and the need for a multifaceted approach to addressing it.
Overall, the analysis provided in the given data underscores the importance of a comprehensive understanding of the factors contributing to overdose deaths and the need for evidence-based policies that address those factors in a meaningful way.
It is important to note that only 22.6% of people who misuse prescription pain relievers obtained them through a valid prescription from a healthcare provider, and at most only 9% to 11% of overdose deaths involve a medication that was prescribed by a healthcare provider. This number is likely much lower since the true cause of death is secondary to combining multiple drugs (illicit &/or prescription which most commonly were not prescribed to the person) and often in combination with alcohol.
Despite this, healthcare providers are often blamed for the opioid crisis and overdose death rates. Decreased prescribing of controlled substances by healthcare providers may actually lead to an increase in overdose deaths due to patients turning to the streets to obtain medications without professional medical oversight. The proposed rule changes from the DEA may lead to decreasing healthcare access and worsened outcomes, so it is important for the government to work closely with healthcare providers and patients to improve public health and safety.
Abruptly stopping opioid medications used to treat chronic pain can be associated with a higher risk of adverse events, including overdose and suicide, particularly among patients with a history of substance use disorder or mental health conditions. It is important for healthcare providers to carefully evaluate the risks and benefits of opioid therapy and to provide appropriate monitoring and support to patients who are taking these medications.
Healthcare professionals are the ones that can help create the safest best plan in managing a person's chronic pain. That plan may or may not involve opioid medications. Clinicians are also knowledgeable about other treatment options, such as physical therapy, cognitive behavioral therapy, and non-opioid medications. Healthcare professionals have the greatest expertise in working with a patient in setting up a treatment plan using all available resources. They are also most adapt as helping those with few resources and few options. The decision to discontinue opioid therapy should be made on a case-by-case basis by healthcare providers and should involve a careful consideration of the patient's individual needs and circumstances. Arbitrarily applied, forced mandates, and/or forced restrictions by non-medical individuals (including governmental officials) that eliminate clinician knowledge, expertise, and experience put patient's health and life at risk.
In general, it is important for healthcare providers to work closely with patients who are being weaned off opioids, and to provide appropriate support and monitoring to minimize the risk of adverse events. This may include close monitoring for signs of withdrawal, referral to addiction treatment or mental health services, and careful coordination of care between providers. We need governmental regulators, including those with the DEA, to treat healthcare providers like partners in ensuring positive outcomes for patients, instead of treating them like villains that cause the problems. The public's health and safety we need governmental officials, including the DEA, to seek out recommendations from actual practicing healthcare providers.
Per the CDC in 2019, there were 70,630 overdose deaths. Most of those deaths (70.8%) were from illicit drugs. Illicit drugs are NOT prescribed to patients by a healthcare provider. Also, note that a medication, being a medicine that can be prescribed for, does not mean that the medication involved in the overdose deaths was prescribed to that person. Per a study cited below only 22.6% of the prescription medications involved in an overdose death were prescribed to the person that overdosed.
Note that if you combine the above deaths and percentages that it yields 83,506 deaths, despite the listed total being 70,630, and the total percentage adds up to 118.1% instead of 100%. Why is this? It is because many of these deaths involved multiple drugs (both illicit and prescription) in combination that result in the overdose death. Additionally, many of these deaths also involve alcohol.
According to data from the National Survey on Drug Use and Health, in 2019, only 22.6% of people who misused prescription pain relievers obtained them through a valid prescription from a healthcare provider (this is the latest data currently available). The majority of those who misused these medications obtained them from a friend or family member for free (35.1%) or bought them from a friend or family member (17.9%). Only a small percentage obtained them from a drug dealer or other stranger (4.2%).
When the above 22.6% is applied to the various medications that can be prescribed for that were prescribed to the person that overdose reveals the following remarkably interesting data:
If the above numbers are totaled, it yields 7,565 overdose deaths annually in patients that had prescriptions for the medications involved in their overdose death. That represents 9% of the overdose deaths if that is compared to 83,506 (see above). That represents 11% of the overdose deaths if that is compared to 70,630 (see above). This means that at most 9% to 11% of overdose deaths involve a prescription medication that was prescribed to people that die from overdose. Stated another way 89% to 91% of all overdose deaths do not involve a medication that was prescribed to them by a healthcare provider.
From the above regarding the prescription stimulants, which include ADHD medications (but not including appetite suppressants, which are non-contributory), that were present in the blood stream of patients that died from an overdose with a valid prescription for the stimulant total 1,196. That represents 1.4% of the overdose deaths involving a patient that had a valid prescription for an ADHD medication. This calculation is based on comparing those 1,196 deaths in relationship to 83,506 (see above). Those deaths equate to 1.7% of the overdose deaths if that number of deaths (1,196) is compared to 70,630 (see above). This means that at most 1.4% to 1.7% of overdose deaths involve a stimulant prescription medication that was prescribed to people that die from overdose. Stated another way 98.3% to 98.6% of all overdose deaths do NOT involve a stimulant medication that was prescribed to them by a healthcare provider.
Another key factor is to realize that a medication's presence, such as an ADHD stimulant prescription medications, in the bloodstream of a patient does not provide definitive proof that the medication in question is the substance that caused the death. This is because a significant amount of overdose deaths involves multiple drugs (illicit &/or prescription) and it is not uncommon for alcohol to also be present. An example of this is that certain blood pressure medications can be detected via blood tests. It is highly likely that many that die of an overdose would have traces of a blood pressure medication within their bloodstream, but it would be exceedingly unlikely that it contributed to their death. Imagine a patient overdosing on heroin, but lab tests also revealed the person also had evidence of a blood pressure medication being within their bloodstream. Their death would have been secondary to the heroin overdose instead of the blood pressure medicine. Likewise, it is difficult to exactly say what percentage of overdose deaths were caused by a stimulant ADHD prescription medication, but the number would be less than the 1.4% to 1.7% listed above given that the deaths commonly involve multiple substances resulting in the death.
Objectively healthcare provider prescriptions are at most only involved in a minority of overdose deaths. Then why is it that most of the focus by the general public, government officials, and politicians focus on the healthcare provider being highly to blame for the “opiate crisis” and/or overdose death rates? A simple answer is they are an easy target, and the government can most easily restrict these law-abiding citizens (i.e., healthcare providers). Unfortunately, this approach (restricting healthcare providers) ability to prescribe certain medications will not likely yield any remarkable results. There are some recent studies that actually note that decreased prescribing of controlled substances by healthcare providers will yield an increase in overdose deaths. You may ask how could that be?
Ponder the following facts. The peak of controlled substance prescribing occurred in 2012. Per the CDC in 2012 there were 41,502 deaths in the USA from overdose. Since 2012 controlled substance prescribing continually decreases annually. Despite this the death rate from overdoses have continually climbed. Per the CDC in 2019 there were 70,630 deaths secondary to overdose. Have studies revealed any plausible causes for the increase in overdose deaths despite fewer controlled substances being prescribed by healthcare providers? Yes. Many believe, and evidence is being gathered, that indicates that pressure applied to healthcare providers makes them hesitant to prescribe controlled substances even when there is a legitimate reason to do so. As a result of this many patients turn to the “streets” to obtain medications. There they receive them, but they have no professional medical oversight when the population obtains medications in this manner. People are left to their own ideas and those of non-medical professionals in deciding the dose, amount, and frequency that they will take them. This then leads to an increase in overdose deaths.
The DEA's current proposed rule changes will make healthcare providers even less likely to prescribe controlled substances than they do current. This will be true even when such medications would have been the most appropriate treatment for a particular patient. Will healthcare providers increased unwillingness to prescribe controlled substances yield an increase or a decrease in the number of deaths from overdose? Before answering that we must ask ourselves what the goal of regulations in healthcare should be. If the answer is to give politicians and policymakers talking points that make them sound like they are taking the “opiate crisis seriously”, then continually add more regulations on healthcare professionals. If this is the goal then continue to treat healthcare providers as villains, instead of treating them like partners in ensuring positive outcomes for patients. If, however, the true goal is public health and safety, then encourage government officials, including the DEA, to seek out recommendations from actual practicing healthcare providers. Additionally, ask the general public what they think about telemedicine. Ask them how they use it? Ask them if they want telemedicine made more or less available to them.