Journal Errors

aaaaaaaamis

 

 

Each morning before getting ready for work, I try to read at least part of a medical journal. Usually I read tediously boring things about diabetes, hypertension, and the like. However, recently, with the overall increased focus on opioid use disorder, I’ve noted more articles about this issue.

Sometimes, the authors don’t get it exactly right. I suppose to some doctors, treatment of opioid use disorders is as boring and confusing as I find diabetes treatment to be. But then, I don’t write about diabetes. I do think if you are writing for a medical journal, you ought to take care to be accurate.

Last week I read Internal Medicine News. This is not a pre-eminent journal. It does not have the reputation of the New England Journal of Medicine, or the Journal of the American Medical Association. In fact, it is what we commonly call a “throw-away” journal. It’s really more of a newspaper, a summary of other medical journals, that a publisher of original studies. For that reason, it’s a more informal publication.

While I understand all of that, I was chagrined when I read a short article titled “Interdisciplinary approach to opioid withdrawal can aid successful long-term recovery.” In this article, the author names three medications that can be used to “wean patients off opioids:” naloxone, buprenorphine, and acamprosate.

Huh? Surely that’s got to be an error. Maybe the editor cut out some text essential to accurate understanding. You know I love to write letters to tell people when they are wrong, so I emailed the following letter to the journal’s editor:

Dear Sirs:

I read some information on page 18 of the November 1, 2016, issue of the Internal Medicine News that I feel needs to be clarified. Likely due to space limitations, Dr. Lorenzo Norris M.D. may have given the wrong impression about medications used to treat patients with opioid use disorder.

Dr. Norris mentions naloxone, buprenorphine, and acamprosate as medications that can be used to “wean a patient from opioids.”

In fact, naloxone is an opioid antagonist, and though it can be life-saving in the face of an opioid overdose, it should not be used to wean patients from opioids. As an antagonist with a high affinity for the mu opioid receptor, it would precipitate immediate and severe opioid withdrawal. Therefore, naloxone is not recommended to wean a patient. However, the related opioid antagonist naltrexone can be used after a patient is through acute opioid withdrawal, to help prevent a relapse to opioid use. It can be used in either daily oral formulation or the depot monthly intramuscular injection.

Acamprosate, while approved for use in patients after undergoing alcohol withdrawal, has no indication for use in patients with opioid use disorder.

The third drug, buprenorphine, can be used to wean a patient off opioids, but multiple studies have shown extremely high relapse rates when it is used in this manner. Buprenorphine gives much better results (lower incidence of opioid-positive urine drug screens, lower risk of use of illicit opioids, reduced risk of death) – when used as a maintenance medication.

Giving Dr. Norris the benefit of the doubt, I’m sure he would have elaborated on buprenorphine for maintenance treatment of opioid use disorder, had space permitted. However, this is such an important concept that I feel it deserves elaboration.

Thank you for your coverage of this critical issue.

Sincerely,

Jana Burson M.D.

Maybe I’m being too picky. Maybe the editor will think I’m being a know-it-all smarty pants. After all, at least this publication is trying to cover opioid use disorder treatment, which is a wonderful thing.

I don’t know. If we give out information, let’s make sure it is correct, given the depth of misunderstanding that already abounds in the field of Addiction Medicine.

I’ll let you know if I get any reply.

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4 responses to this post.

  1. Posted by Ronny Freedom on November 21, 2016 at 12:17 pm

    If I would have read the article on 04/01/2016 instead of 11/01/2016, I would have thought it to be satire.

    Reply

  2. Posted by Matthew McClure, D.O. on November 21, 2016 at 4:23 pm

    I didn’t see the article but my response was a face palm and an ‘oh my’. I am not all that impressed with Acamprosate for alcohol dependence although my ‘N’ is not very large.
    We need know it all smarty pants to look out for us. Keep it up.

    Reply

  3. Posted by Tracie Walker on February 28, 2017 at 4:31 am

    Dt Burson. I was wondering if neurontin was afdictive. I know a lot of people are abusing it as well

      May God Bless you Tracie

    Reply

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