People’s Pharmacy: Will new opioid warnings cause more pain for patients?
Q. I have complex regional pain syndrome, fibromyalgia and rheumatoid arthritis that put me in intractable pain 25 years ago. Until recently, I have managed with the opioids my doctors prescribed. Now that the doses are being lowered, I am in severe pain again.
I often wonder: If I have to take my life because I can no longer stand the horrible pain, how will I do it? It frightens me that I am thinking this way. I suspect others with chronic pain are, too. The Drug Enforcement Administration, Food and Drug Administration and the Centers for Disease Control and Prevention are punishing us by taking away our medications, even though we have done nothing wrong. The changes intended to restrict opioids are harming the most vulnerable.
A. We have heard from hundreds of patients like you who have been deprived of opioids for their excruciating pain. The government does not seem to understand how to help people with severe chronic pain.
The FDA is poised to require changes to the labeling of opioid pain medications. The new information will have stronger warnings about the risks of addiction, misuse and overdose. In addition, labels will stress that prescribers should avoid long-acting or extended-release opioids unless there are no other options.
These changes may make life even more difficult for people like you with persistent agonizing pain. The FDA will remind prescribers “not to stop opioids suddenly in patients who may be physically dependent, as it can cause serious harm.”
Q. I have started using senna to treat my constipation. The ads say it is natural and gentle, and I like that. It seems to work, but I am curious about long-term effects. What can you tell me?
A. Senna is certainly natural. It comes from a plant that has been used as a laxative since before the ninth century, when Arabian physicians brought it to Europe.
To say that senna is gentle would not be accurate, though. It is a strong laxative that stimulates the bowel to secrete fluid and minerals into the large intestine and move everything along to evacuation. Not surprisingly, the most common side effect is diarrhea.
Long-term use can weaken the bones and darken the lining of the colon. Nutritional complications such as loss of potassium and other minerals can put people at risk for heart rhythm problems, among other things. There may also be interactions with other medications.
Rather than rely on senna, we suggest you explore other options. You will find several in our “eGuide to Controlling Constipation.” This online resource may be found under the Health eGuides tab at www.PeoplesPharmacy.com.
Q. Is hair loss a side effect of HCTZ? I had been taking triamterene for edema for over a year. When my doctor added HCTZ, I started having excessive hair loss. My family and my hairdresser both noticed. The only part of my health routine that changed was the addition of HCTZ.
A. You surprised us with this question. Most health care professionals perceive hydrochlorothiazide as a very safe diuretic to help lower blood pressure. Hair loss (alopecia) is not generally recognized as a side effect of this old medication.
When we checked the official FDA prescribing information, however, we discovered that alopecia is listed as a possible adverse reaction. Although it may be rare, you should mention this to your physician. A different diuretic or blood pressure medication might not cause the same problem.
In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of King Features, 300 W. 57th Street, 41st Floor, New York, NY 10019, or email them via their website: www.PeoplesPharmacy.com. Their newest book is “Top Screwups Doctors Make and How to Avoid Them.”