Fragrance ingredients used in perfumes, personal care products, cleaning products, and air fresheners can trigger asthma. Fragranced products are used in many California workplaces and have been associated with over 300 cases of work-related asthma.
A new analysis of fragrances and work-related asthmafound that perfume was the ninth most common exposure reported by all work-related asthma cases tracked by the California Department of Public Health's Work-Related Asthma Prevention Program (WRAPP). The report also found that almost a quarter of the fragrance cases were new-onset asthma, meaning that workers reported no prior history of asthma. WRAPP published the findings in the Journal of Asthma in March 2017.
To help California workers and employers address fragrances and work-related asthma, WRAPP created a new web page dedicated to this issue. The web page features relevant publications, a model fragrance-free workplace policy, and resources to find products that do not contain fragrances.
(PAINT.ORG) The U.S. Environmental Protection Agency (EPA) is considering the first 10 chemicals undergoing risk evaluation under the amended Toxic Substances Control Act (TSCA). The agency will be accepting comments on the chemical/clusters through Sept. 19. ACA is seeking input from its members on comments. Based on comment, EPA will refine scoping documents published earlier this summer to publish draft problem formulations as the next step in risk evaluation. Upon publication, EPA intends to accept public comment on problem formulations, prior to proceeding to risk evaluation. EPA is offering this interim step for the first 10 risk evaluations since there was insufficient time for comment on scoping documents during the last public comment period.
EPA's scoping documents will shape evaluations of the first 10 chemicals for initial risk evaluation: asbestos; pigment violet 29; 1,4-dioxane; cyclic aliphatic bromides cluster; carbon tetrachloride; 1-bromopropane; methylene chloride; n-methylpyrrolidone; trichloroethylene; and tetrachloroethylene.
The Frank R. Lautenberg Chemical Safety for the 21st Century Act, signed into law on June 22, 2016, mandates the agency to restrict chemicals already in commerce that pose unreasonable risks to public health and the environment.
The following addresses some EPA considerations for the first risk evaluations as described in initial scoping documents, including what the agency deems associated hazards for chemicals.
First 10 Chemicals for Risk Evaluation NMP (N-Methylpyrolidone) In the risk evaluation for NMP, EPA expects to consider the following potentially exposed groups of human receptors: workers, occupational non-users, consumers, and bystanders associated with consumer use. EPA may identify additional potentially exposed or susceptible subpopulations that it will consider based on greater exposure.
EPA expects to consider hazards of NMP to terrestrial organisms including aquatic plants, birds and mammals exposed under acute and chronic exposure conditions. Based on reasonably available information, EPA will focus its analysis on the hazards of acute toxicity and reproductive / developmental toxicity. The plan includes analysis of environmental releases, environmental fate, environmental exposures, occupational exposures, consumer exposures and general exposures.
Methylene Chloride EPA will evaluate environmental exposures. EPA expects to consider three broad categories of human exposures: occupational exposures, consumer exposures, and general population exposures. Subpopulations within these exposure categories will also be considered.
EPA will evaluate for liver toxicity, neurotoxicity and irritation. In prior assessments EPA concluded that methylene chloride is likely to be carcinogenic by all routes of exposure.
HBCD (Cyclic Aliphatic Bromide Cluster) EPA expects to consider exposures to the environment and ecological receptors. EPA expects to consider three broad categories of human exposures: occupational exposures, consumer exposures and general population exposures. Subpopulations within these exposure categories will also be considered as described herein. EPA expects to consider worker activities where there is a potential for exposure.
EPA expects to consider hazards of HBCD to aquatic and terrestrial organisms. Regarding non-cancer health hazards, EPA will evaluate acute toxicity, liver toxicity, thyroid toxicity, reproductive/developmental toxicity, neurotoxicity, immunotoxicity, sensitization, and irritation. Unless new information indicates potential as a carcinogen, EPA does not expect to conduct additional in-depth analysis of genotoxicity or cancer hazards in the risk evaluation of HBCD, due to prior studies failing to demonstrate a hazard.
Carbon tetrachloride EPA expects to consider exposures to the environment and ecological receptors. EPA expects to consider three broad categories of human exposures: occupational exposures, consumer exposures, and general population exposures. Wastewater/liquid wastes, solid wastes or air emissions of carbon tetrachloride could result in potential pathways for oral, dermal or inhalation exposure to the general population. EPA will consider each media, route and pathway to estimate general population exposures.
1-Bromopropane Associated hazards include: acute toxicity (acute lethality at high concentrations only), blood toxicity, immunotoxicity, cardiovascular toxicity, liver toxicity, kidney toxicity, reproductive toxicity, developmental toxicity, and neurotoxicity.
Pigment Violet 29 (PV-29) Regarding environmental hazards, EPA expects to evaluate acute hazards to aquatic and terrestrial organisms. Existing information available from the European Chemicals Agency (ECHA) does not identify environmental hazards. Regarding health hazards, EPA is obtaining existing studies from ECHA and other sources related to acute toxicity (oral/inhalation), skin and eye irritation, in vivo skin sensitization, in vitro genotoxicity, and reproductive/developmental toxicity. EPA will not conduct in-depth analysis of genotoxicity or cancer hazards in the risk evaluation of Pigment Violet 29, due to structure-activity evaluation and genotoxicity studies that do not indicate cancer.
This conference will show attendees how to leverage sustainable practices and resources to strengthen Ohio communities and businesses.
A large part of the conference is targeted to businesses and communities that are moving beyond basic environmental requirements into cost-effective sustainable strategies to improve environmental performance and save valuable resources. The agenda focuses on ways to become a part of the circular economy, how sustainability can improve communities, how our water resources can benefit from sustainable approaches, and the resources and incentives that can help your sustainability efforts. During the event, you will hear from business and community leaders eager to share their insight as to how they've gone above and beyond to implement sustainable practices.
The purpose of this manual is to summarize environmental, health, and safety requirements most relevant to wood manufacturers. It has been designed for small and medium businesses, particularly those that finish, stain, or glue wood furniture. The primary focus the National Emission Standard for Hazardous Air Pollutants (NESHAP) affecting wood furniture manufacturers. The manual also provides an overview of other air, water, wast, and occupational health and safety requirements and presents compliance options. Pollution prevention and waste reduction are encouraged, along with examples of cost savings and the environmental benefits they provide.
While the company has not done anything illegal, it's worth noting that establishing self-affirmed GRAS is nothing to brag about. GRAS is an antiquated system that allows novel chemicals and ingredients into the food supply without stringent testing and safety review. The problem stems from the fact that the concoctions used in processed foods today didn't exist in the 1950s when the GRAS amendment was written into law.
At the time, GRAS was meant to apply to common food ingredients like vinegar and baking soda — regular cooking ingredients known through their historical use as being safe. Nowadays, however, novel GE and/or manufactured ingredients end up slipping through this loophole. The introduction of man-made ingredients into the food supply without stringent testing and verification of safety was never the intention of this law.
A significant part of the problem is that food companies are allowed to determine, on their own, whether an ingredient is GRAS. Food companies do not even need to submit their GRAS findings for FDA review. Again, this would not be a problem if we were talking about baking soda or vinegar but, today, all sorts of man-made ingredients are being self-affirmed GRAS.
All a company needs to do is hire an industry insider to evaluate the ingredient, and if that individual determines that it meets federal safety standards, it can be deemed GRAS.
In the quote above, Impossible Foods admits the safety of their Impossible Burger is based on "a panel of food safety experts," which determined the soy leghemoglobin proteins are similar to natural proteins and hence safe. But similar and identical are two different things. Moreover, who are those experts? Do they have conflicts of interest? The mere fact that such experts are being paid by the food company increases the likelihood they'll give the food two thumbs-up.
In this case, Impossible Foods appears to write off the allergen concern relating to their GE substance because their product already carries a wheat and soy allergen warning. But what if the proteins turn out to have allergenic properties unrelated to wheat and soy? If that's the case, a wheat and soy allergen warning is insufficient.
Are Consumers Placed in Harm's Way?
So, does self-affirmed GRAS comply with federal food regulations? Yes. Does that mean the product has been proven safe? Not necessarily. Jim Thomas, research program manager for the ETC group, noted that Impossible Foods did not seek FDA approval for its GE heme additive as a color additive, which has stricter safety regulations, despite touting the GE heme as the core component that gives the Impossible Burger its distinct red "blood" qualities. According to Thomas:24
"The FDA told Impossible Foods that its burger was not going to meet government safety standards, and the company admitted it didn't know all of its constituents. Yet it sold it anyway to thousands of unwitting consumers. Responsible food companies don't treat customers this way. Impossible Foods should pull the burgers from the market unless and until safety can be established by the FDA and apologize to those whose safety it may have risked."
Impossible Foods CEO Aims to Eliminate Meat From Human Diet
According to Impossible Foods' founder and CEO, Pat Brown — a self-professed vegan — his incentive for producing the meatless, "bleeding" burger is to eliminate the need for animal foods in the human diet.25 Part of his argument is that plant-based diets are more sustainable and environmentally-friendly. While I agree with his view that people eat too much meat, and the worst kind — factory farmed meat — monocultured GE crops are hardly the picture of sustainability.
I also don't think eating GE yeast excretions readily qualifies as a "plant-based" diet. It really falls under ultra-processed food, all of which are best avoided if you care about your health and longevity. In addition to that, there's the issue of the Impossible Burger failing to provide certain key nutrients typically obtained from meat. For example, the Impossible Burger does not contain cholesterol.
Ultimately, Impossible Foods wants to "produce all the foods we [traditionally] get from animals much more sustainably using scalable ingredients from plants … We're after 100 percent of the market, not a niche of people avoiding meat or being health conscious." According to the company website, "We are already developing other types of meat and dairy. Our team of scientists and food researchers can make chicken, pork, fish or yogurt entirely from plants."26
It's one thing to be vegan by choice. It's another entirely to eliminate animal foods for everyone. There are a number of problems with strict veganism, as you eliminate many necessary nutrients. Once you start talking about a GE-based vegan diet the risks are bound to be even higher.
Where to Find the Most Wholesome Food
Brown dismisses the notion that livestock play an important role in sustainable agriculture. In my view, this is a fatal error, as the evidence shows grazing livestock are indeed part of the overall, long-term answer to many of our environmental problems. It may not be readily evident how food animals contribute to our ecological stability and sustainability, but agricultural and soil experts who understand the system as a whole have done a great job explaining it, and I've interviewed several such experts over the years.
One of the best things you can do if you want to eat meat and care about environmental sustainability is to purchase animal products certified 100 percent grass fed by the American Grassfed Association. Many can also easily reduce their meat consumption, as most people eat far more than they need for optimal health. Fake foods are, in my view, not a viable answer to our environmental problems. Organic, regenerative farming is.
You can help steer the agricultural industry toward safer, more sustainable systems by supporting your local farmers and choosing fresh, local produce or grow some of your own. If you live in the U.S., the following organizations can help you locate farm-fresh foods:
The goal of the American Grassfed Association is to promote the grass fed industry through government relations, research, concept marketing and public education.
Their website also allows you to search for AGA approved producers certified according to strict standards that include being raised on a diet of 100 percent forage; raised on pasture and never confined to a feedlot; never treated with antibiotics or hormones; born and raised on American family farms.
EatWild.com provides lists of farmers known to produce raw dairy products as well as grass fed beef and other farm-fresh produce (although not all are certified organic). Here you can also find information about local farmers markets, as well as local stores and restaurants that sell grass fed products.
Weston A. Price has local chapters in most states, and many of them are connected with buying clubs in which you can easily purchase organic foods, including grass fed raw dairy products like milk and butter.
This website will help you find farmers markets, family farms and other sources of sustainably grown food in your area where you can buy produce, grass fed meats and many other goodies.
The Eat Well Guide is a free online directory of sustainably raised meat, poultry, dairy and eggs from farms, stores, restaurants, inns, hotels and online outlets in the United States and Canada.
The FoodRoutes "Find Good Food" map can help you connect with local farmers to find the freshest, tastiest food possible. On their interactive map, you can find a listing for local farmers, CSAs and markets near you.
The Cornucopia Institute maintains web-based tools rating all certified organic brands of eggs, dairy products and other commodities, based on their ethical sourcing and authentic farming practices separating CAFO "organic" production from authentic organic practices.
If you're still unsure of where to find raw milk, check out Raw-Milk-Facts.com and RealMilk.com. They can tell you what the status is for legality in your state, and provide a listing of raw dairy farms in your area. The Farm to Consumer Legal Defense Fund27 also provides a state-by-state review of raw milk laws.28 California residents can also find raw milk retailers using the store locator available at www.OrganicPastures.com.
Defense Fund27 also provides a state-by-state review of raw milk laws.28 California residents can also find raw milk retailers using the store locator available at www.OrganicPastures.com.
CDC... a previously healthy male employee of a Wisconsin beef farm was found dead near the edge of an outdoor 60,400 square foot (1.4 acre) manure storage basin (Figure). The basin was approximately 15 feet (4.6 meters) deep and nearly full. The victim, aged 29 years, was discovered by another worker; the coroner was notified at 6:50 a.m., and he pronounced the victim dead at the scene. Thirteen dead cattle were discovered in an adjoining pen; three others were struggling to stand and were euthanized. The owner of the farm reported that at 3:00 a.m., the victim had used a tractor-powered agitator to agitate the manure,* which a contractor was scheduled to pump and spread on cropland later that morning. The last contact from the victim was a social media post at 4:10 a.m. At the time he was discovered, he was approximately 3 feet downslope from the rear of the tractor, which was running.
Weather conditions from a nearby airport reported temperatures at 4:15 a.m., 5:15 a.m., and 6:15 a.m. of 54.5°F (12.5°C), 53.6°F (12.0°C), and 52.9°F (11.6°C), respectively, with no wind. The high temperature the previous day was 80°F (26.7°C), and reached 87°F (30.6°C) the preceding week (August 7–13), which was 10°F (5.6°C) warmer than the historical weekly average. Relative humidity measured at the nearby airport during these same time intervals ranged from 97% to 100%. The National Weather Service's Green Bay office documented a temperature inversion in the area that morning, citing warmer air temperatures 1,000–1,300 feet (300–400 meters) above ground level.
The man's death was initially attributed to methane, a physiologically inert gas produced through anaerobic decomposition of organic matter in manure and released through liquid manure. Methane deaths are usually the result of asphyxiation (1). The coroner reported foam coming from the decedent's mouth and nose, suggesting pulmonary edema; there was no indication of external trauma, and an autopsy was not conducted. A University of Wisconsin farm safety expert advised the coroner to test the decedent's blood for evidence of hydrogen sulfide exposure; blood thiosulfate level was 9.2 μg/mL, consistent with lethal hydrogen sulfide exposure as the cause of death (2). The cattle deaths were also assumed to have resulted from hydrogen sulfide exposure, although this was not laboratory-confirmed.
University staff members visited the farm on September 26, 2016, to ascertain potential sources of sulfur that might have caused elevated hydrogen sulfide levels in the stored manure, such as gypsum animal bedding (3). Ambient air was not tested, because no agitation was occurring at the time of the visit, and weather conditions were considerably different than they had been on the day of the event. Although no gypsum was used, the animals' diet did include distiller's syrup, a by-product of corn-based ethanol production. The sulfur concentration in a tested syrup sample (collected the day of the visit, stored in a refrigerator, and tested on January 20, 2017) was 1.53% of dry matter; 18–20 pounds of syrup were fed per day to each animal. At the recommendation of a cattle nutritionist, the farmer was providing thiamine supplementation to prevent polioencephalomalacia, a neurologic disease of ruminants that has been associated with thiamine status and high sulfur intake (4). Previous laboratory tests of the herd's mixed feed analyzed on September 16, 2016, found a sulfur concentration of 0.44% of diet dry matter. Cattle nutrition references recommend that for feedlot cattle, the maximum tolerable limit for dietary sulfur is 0.3% of diet dry matter, with 0.15% considered sufficient (5).
Manure tested twice during the previous year had sulfur levels of 9.67 and 6.94 pounds per thousand gallons for samples tested on April 15, 2015, and November 9, 2015, respectively. No additional manure samples were taken immediately before or after the incident. The average manure sulfur level for Wisconsin beef operations is 1.6 pounds per thousand gallons (6).
Asphyxiation deaths associated with manure storage typically occur in confined spaces not intended for continuous occupancy (1). This incident was unusual because human and cattle deaths occurred in an outdoor, ambient air environment. It is possible that the temperature inversion and zero wind velocity suppressed air mixing, leading to an accumulation of lethal concentrations of hydrogen sulfide at ground level as agitation occurred.† Additional research on the impact of weather and other environmental conditions on outdoor gas dispersion, as well as production practices that increase hydrogen sulfide exposure risk is needed. Monitoring for toxic gases and adequate oxygen is important even near outdoor manure storage sites. Improved understanding of factors that contribute to toxic outdoor hydrogen sulfide concentrations is needed to develop worker safety recommendations and to inform outdoor air monitoring strategies. Public health officials and forensic toxicologists who evaluate manure gas incidents should always consider tests for hydrogen sulfide exposure. Farm owners, operators, and employees, as well as professional and volunteer responders in rural areas, should receive additional manure gas education that includes information about hydrogen sulfide, other lethal gases, and the production practices and conditions that increase risk.
John M. Shutske, PhD1; Rebecca A. Larson, PhD1; Daniel M. Schaefer, PhD2; Liz Y. Binversie, MS4; Scott Rifleman5; Cheryl Skjolaas1
The law, which goes into effect Jan. 1, follows years of frustration in communities such as Paramount, Boyle Heights and Maywood — where regulators have struggled to stop highly polluting operations after discovering hot spots of Chromium-6, lead and other dangerous pollutants.
Currently, air regulators seeking orders to curtail operations that violate rules and threaten public health must go through an administrative hearing board. The process can take months, while the pollution continues unabated.
As a result, residents "were being told: 'You are in grave danger, but we can't do anything about it,' " said Assemblywoman Cristina Garcia (D-Bell Gardens), who wrote the legislation.
"What we're saying today is that when we have imminent health threats, that trumps the right to do business," Garcia said.
The new law will give pollution control officers the power to issue immediate orders to stop polluting operations when violations pose an "imminent and substantial" danger. The orders are temporary, pending a hearing before an administrative board.
South Coast Air Quality Management District Executive Officer Wayne Nastri welcomed the legislation as "an important new tool to protect public health."
The district, which sponsored the legislation, has pointed to five recent cases where inadequate enforcement authority prevented it from taking swift action to stop a facility's harmful emissions.
Questions remain as Gov. Brown signs legislation to address neighborhood-level air pollution
At Anaplex Corp., a metal-finishing facility in Paramount, it took the South Coast air district months to secure an administrative order to curtail operations after the carcinogen Chromium-6 was detected last fall at levels up to 350 times normal. The district has said it would have used the new authority to stop dangerous levels of lead from the now-shuttered battery recycler Exide Technologies in Vernon and Chromium-6 from Hixson Metal Finishing in Newport Beach, among other cases.
Some industry groups opposed the legislation, while cities backed it as giving air districts the tools they need to protect residents.
Nastri said the law "provides additional protection for the breathing public and also ensures due process for any affected businesses."
The new powers come as state lawmakers are imposing requirements that local air districts do more to monitor and reduce toxic pollutants. Brown last month signed legislation aimed at improving neighborhood-level air quality as part of a deal to extend the state's cap-and-trade program to fight climate change.
Stronger enforcement authority also is key to a $47-million air toxics plan that the South Coast district announced earlier this year to find and reduce emissions from the worst-polluting facilities over the next seven years. The initiative targets an estimated 1,100 metal-processing facilities that may be releasing toxic pollutants such as Chromium-6, lead, arsenic, cadmium and nickel.
It's one of the most wide-ranging freshwater monitoring systems in the U.S., researchers say, and some of its pieces soon will be watching for harmful algae on hundreds of lakes nationwide.
Researchers are creating an early warning system using real-time data from satellites that in recent years have tracked algae bloom hotpots such as Florida's Lake Okeechobee and the East Coast's Chesapeake Bay.
The plan is to have it in place within two years so that states in the continental U.S. can be alerted to where toxic algae is appearing before they might detect it on the surface, said Blake Schaeffer, a researcher with U.S. Environmental Protection Agency.
"You don't have to wait until someone gets sick," said Schaeffer, one of the leaders of the project.
Across the nation, farm runoff, sewage overflows and lawn fertilizers have washed into lakes and rivers and left behind unsightly algae blooms that can sicken people and pets and harm wildlife.
But often the first reports of harmful algae on a lake come from boaters seeing something strange in the water, said Rick Stumpf, of the National Oceanographic and Atmospheric Administration.
He began using satellites in 2008 to monitor algae on Lake Erie. That work took on a new urgency after a bloom near Toledo's shoreline contaminated the drinking water for more than 400,000 people three years ago.
The EPA in recent years has been testing using the satellite data to watch for algae in lakes in California, Vermont, New Hampshire, Massachusetts, Connecticut and Rhode Island.
Earlier this year, the data helped detect an algae bloom in a Utah Lake near Salt Lake City before officials on the ground knew about it.
"That's exactly what we we're trying to accomplish," Schaeffer said.
The system in development will cast a wider net at a time when many states can't afford to monitor every lake threatened by harmful algae. The goal is to use the satellite data to watch for algae on 1,800 lakes across the nation and provide four different types of water quality measurements on close to 170,000 lakes.
What satellites can't measure is the amount of toxins in the water. That's where samples gathered by researchers come into play. That too can be expensive so researchers have developed an underwater lab that sits at the bottom of Lake Erie and both collects water and tests the levels of toxins before sending the results back remotely.
The whole process takes four hours — much less than the day or two it takes to test samples from a boat.
"We call it the 'lab in a can,'" said Tim Davis, a Great Lakes researcher with the National Oceanographic and Atmospheric Administration.
The first robotic lab was launched this summer and two more are in the works. While it's still in the early stages, Davis said it could work in other lakes plagued by algae.
Other researchers are testing drones on Lake Erie to see if digital images they capture can be effective monitoring the algae blooms. Already in use on the lake are buoys that measure algae in the water.
Those leading all of these research efforts say the key is provide as much information as possible. "It's really about using a combination of all of these," Schaeffer said.
MERCOLA - Opioids kill patients more frequently than any other medication used for nonfatal conditions,1 yet disturbing statistics reveal more than one-third of American adults were prescribed these dangerous drugs in 2015.2 Even more shocking, opioid overdoses are now the leading cause of death for Americans under the age of 50.3
More than half of all opioid prescriptions in the U.S. are also issued to patients suffering from anxiety and depression,4 despite the fact that this increases their risk for addiction. Overall, studies show addiction affects about 26 percent of those using opioids for chronic non-cancer pain.5
While back pain is one of the most common reasons for receiving a prescription for a narcotic pain reliever,6 a surprising number of people — especially teens and young adults — receive these potent drugs from their dentist. Women are also increasingly being prescribed opioids during pregnancy and after delivery,7 creating addicts in the womb and destroying families by creating drug-dependent mothers and infants.
Of the 1.1 million pregnant women enrolled in Medicaid in 2007, nearly one-quarter of them filled a prescription for an opioid drug.8 Not surprisingly, statistics9 reveal a disconcerting rise in neonatal abstinence syndrome (NAS). Between 2000 and 2009, the prevalence of NAS increased from 1.2 to nearly 3.4 per 1,000 live births.
1 in 3 American Adults Prescribed Opioids Every Year!
According to Dr. Wilson Compton, deputy director of the National Institute on Drug Abuse in Bethesda, Maryland, 38 percent of adults (about 92 million people) in the U.S. were prescribed an opioid drug in 2015.10,11,12,13 Women, people over the age of 49 and those without college degrees were most likely to receive a prescription, and the unemployed, uninsured and adults with an annual family income below $50,000 had the highest prevalence of opioid misuse and addiction.
An estimated 5 percent of adults (11.5 million people) misused the drugs, and nearly 1 percent (some 1.9 million people) reported addiction. Interestingly, while women are prescribed opioids more frequently than men, men have a higher rate of misuse — 13 percent compared to 9 percent respectively. Of those misusing the drug:
41 percent reported getting leftover medication from family or friends14,15
64 percent said their use of the drug was motivated by need for physical pain relief
11 percent said they took the pills to relax or get high
"Overall, the results indicate that the medical profession is doing a poor job of appropriately prescribing opioid painkillers. Even though the rates have leveled off, we have a long way to go in improving medical care so these are not as overprescribed as they are currently … [T]here are a lot of leftover medications. In many cases, physicians could write smaller prescriptions, or avoid them completely for those who benefit from ibuprofen or acetaminophen."
Nearly 70,000 Physicians Were PAID to Prescribe Opioids
A recent paper17 hints at one of the reasons why opioids are still so vastly overprescribed. Between 2013 and 2015 alone, 68,177 physicians received in excess of $46 million in payments from drug companies marketing narcotic pain relievers.18 In all, that amounts to 1 out of every 12 doctors in the U.S. As noted by pediatrician Scott Hadland, who led the study, "The next step is to understand these links between payments and prescribing practices and overdose deaths."
Dr. Karen Lasser, associate professor of medicine and public health at the Boston University School of Medicine's Clinical Addiction Research & Education (CARE) Unit, told CBS News pain management needs significant revision:19
"Doctors need to adopt a stepped-care approach to pain management. With this approach, doctors would first try to manage pain using nondrug means — such as physical therapy, yoga or acupuncture — or prescribe milder pain medications, including aspirin, ibuprofen or acetaminophen.
There would be guidelines for all the medications you should try before you get to opioids. In addition, patients should have to sign an opioid treatment agreement outlining the risks and benefits of such therapy, so they understand the potential for addiction."
Oral Surgeons and Dentists Are Major Opioid Prescribers
Oral surgeons and dentists, in particular, need to reconsider their prescribing habits. Each year, about 3 million Americans, most under the age of 25, have their wisdom teeth removed, and most if not all receive a prescription for opioids. This, despite research20,21 showing a combination of ibuprofen and acetaminophen actually works better than opioids for the treatment of pain following wisdom tooth extractions.
As noted by The New York Times,22 "dentists and oral surgeons are by far the major prescribers of opioids for people ages 10 to 19," and even short-term use is associated with future opioid misuse and addiction among teens and young adults.
In fact, children who receive an opioid have a 1 in 3 chance of "lifetime illicit use." According to recent research,23 of the people who received a mere 12-day supply of an opioid, 1 in 4 were still taking the drug one year later, and that includes all age groups. Children and teens are at higher risk for continued use once they're exposed.24
Overdose Deaths Continue to Climb
While you certainly hear more about the dangers of opioids these days, growing awareness has yet to impact death statistics. According to the latest data from the National Center for Health Statistics, more Americans died from opioid overdoses in the first nine months of 2016 than in the first nine months of 2015. When broken down into quarters, you can see the death toll from drug overdoses steadily climbing, quarter by quarter.25
First quarter of 2015: 16.3 overdose deaths for every 100,000 people
Second quarter of 2015: 16.2 overdose deaths per 100,000
Third quarter of 2015: 16.7 overdose deaths per 100,000
First quarter of 2016: 18.9 overdose deaths per 100,000
Second quarter of 2016: 19.3 overdose deaths per 100,000
Third quarter of 2016: 19.9 drug overdose deaths per 100,000
Other recent research drives home the severity of the problem, showing opioid deaths have been significantly underestimated. According to this report,26 published in the American Journal of Preventive Medicine, mortality statistics involving drug overdoses from 2008 through 2014 underestimated opioid-related deaths by 24 percent. Overdose deaths involving heroin was underestimated by 22 percent.
Spike in Fatal Car Crashes Linked to Opioid Use
Overdose deaths are not the only problem associated with skyrocketing opioid use. It's also causing people to die on our roadways. Statistics reveal driving under the influence of drugs now causes more fatal car crashes than drunken driving.
According to a report27,28,29 compiled by the Governors Highway Safety Association and the Foundation for Advancing Alcohol Responsibility, prescription and/or illegal drugs were involved in 43 percent of fatal car crashes in 2015, while 37 percent involved illegal amounts of alcohol.
Another recent report30 found drivers killed in car crashes while under the influence of opioids specifically rose sevenfold between 1995 and 2015. Among male drivers killed, the prevalence of prescription narcotics in their system increased from 1 percent in 1995 to 5 percent in 2015. Among women, narcotic pain relievers were implicated in 1 percent in 1995 and 7 percent in 2015.
According to lead author Stanford Chihuri, staff associate in the department of anesthesiology at the College of Physicians and Surgeons at Columbia University Medical Center in New York, "The significant increase in proportion of drivers who test positive for prescription pain medications is an urgent public health concern.31 "
Co-author Dr. Guohua Li, professor of epidemiology at Columbia's Mailman School of Public Health, added,32 "The opioid epidemic has been defined primarily by the counts of overdose fatalities. Our study suggests that increases in opioid consumption may carry adverse health consequences far beyond overdose morbidity and mortality."
Avoid Driving Under the Influence of Narcotics
It's important to realize that illegal drugs are far from the only drugs capable of impairing your judgment behind the wheel. Hundreds of medications can impair your driving ability, including some sold over-the-counter. Opioids are certainly part of that list. Drugs — both prescription and illegal — in combination with alcohol is particularly risky.
So, please, if you absolutely must take a prescription painkiller, carefully assess your ability to drive safely. Ideally, let someone else drive. And, if you know someone who is using an opioid, remember that just as with alcohol, "friends don't let friends drive impaired."
President Trump Declares State of Emergency
In related news, a government opioid commission recently called for President Trump to declare a state of emergency to force Congress to fund strategies to curtail and treat opioid addiction.33,34,35
The commission is chaired by New Jersey Gov. Chris Christie. Other members include Charlie Barker, governor of Massachusetts, North Carolina Gov. Roy Cooper, former U.S. Rep. Patrick Kennedy and Bertha Madra, a psychobiology professor at Harvard Medical School. In their White House report, the commission states:36
"According to the Centers for Disease Control (CDC) … 142 Americans die every day from a drug overdose … The opioid epidemic we are facing is unparalleled. The average American would likely be shocked to know that drug overdoses now kill more people than gun homicides and car crashes combined. In fact, between 1999 and 2015, more than 560,000 people in this country died due to drug overdoses — this is a death toll larger than the entire population of Atlanta …
In 2015, nearly two-thirds of drug overdoses were linked to opioids like Percocet, OxyContin, heroin, and fentanyl … [H]ere is the grim reality: Americans consume more opioids than any other country in the world. In fact, in 2015, the amount of opioids prescribed in the U.S. was enough for every American to be medicated around the clock for three weeks.
Since 1999, the number of opioid overdoses in America have quadrupled … Not coincidentally, in that same period, the amount of prescription opioids … quadrupled as well. This massive increase in prescribing has occurred despite the fact that there has not been an overall change in the amount of pain Americans have reported in that time period.
We have an enormous problem that is often not beginning on street corners; it is starting in doctor's offices and hospitals in every state in our nation."
President Trump declared the opioid epidemic a national emergency on August 10, saying, "The opioid crisis is an emergency … It is a serious problem, the likes of which we have never had … We're going to spend a lot of time, a lot of effort and a lot of money on the opioid crisis."37
Pain and Hopelessness Fuel Opioid Crisis
According to recent research, half of all Americans are living with chronic illness,38 and many addiction specialists believe pain and hopelessness are driving the opioid crisis in the U.S. As noted in The Washington Post:39
"Fatal overdoses from prescription opioids have quadrupled since 1999 and heroin overdoses have gone up about six-fold since 2001. But other drugs also play a role. A Post analysis of federal health data found that white women are five times as likely as white men, for example, to be prescribed drugs for anxiety in tandem with painkillers, a potentially deadly combination.
Meanwhile, the suicide rate among middle-aged white women has risen in parallel with prescriptions for often-ineffectivepsychiatric drugs. Both have roughly doubled since 1999 … According to federal health officials, nearly 1 in 4 white women ages 50 to 64 are [sic] being treated with antidepressants. Binge drinking is also on the rise, as women close the gap with heavier-drinking white males."
Limiting the availability of opioids and making overdose-reversal drugs (naloxone) and treatment for drug addiction more readily available are certainly part of the answer. But it's not enough. We have to take a much deeper look at the root of the problem. What is causing all this physical and emotional pain in the first place?
Clearly, the U.S. health care system is blatantly ineffective at treating chronic health problems. Whether ill health is promoting hopelessness or the other way around is difficult to ascertain, but the two appear to be closely intertwined and need to be addressed together. Somehow or another, we need to refocus our efforts to create lives worth living, and improve access to and information about basic disease prevention, such as healthy foods and foundational health-promoting lifestyle strategies.
Nondrug Solutions for Pain Relief
It's important to realize that in addition to the risk of addiction, opioids can also severely impair your health by suppressing your immune function. In fact, several studies show that one primary risk for HIV and AIDS is opiate exposure.40,41,42,43 In cancer patients, opiates have a tendency to produce a rapid decline in health as the drug causes their immune system to falter.
So please remember, opiates are highly immunosuppressive drugs that raise your risk of any number of diseases, as your immune system is your frontline defense against all disease. It's particularly important to avoid opioids when trying to address long-term chronic pain, as your body will create a tolerance to the drug.
Over time, you may require greater doses at more frequent intervals to achieve the same pain relief. This is a recipe for disaster and could have lethal consequences. Following is information about nondrug remedies, dietary changes and bodywork interventions that can help you manage your pain.
