Popular Posts

Popular Posts

Popular Posts

Monday, April 30, 2018

Naloxone’s Effect on Opioid Use

Does access to naloxone influence an opioid user’s decision to use?

That is the crux of a recently published (on-line) economics paper, The Moral Hazard of Lifesaving Innovations: Naloxone Access, Opioid Abuse, and Crime, which argues that increasing access to Naloxone sanctions risky behavior, unintentionally increases opioid abuse, leads to greater crime, and may increase the death rate.

The paper has generated a great deal of controversy. (The authors have rewritten some of their paper to accommodate some of these expressed concerns.)

The moral hazard of life-saving innovations: Naloxone access, opioid abuse, and crime (Blog Post)

The ‘moral hazard’ of naloxone in the opioid crisis

Why a Study on Opioids Ignited a Twitter Firestorm

Research Analysis: Conclusions about ‘moral hazard’ of naloxone not supported by methodology

Their underlying assumption seems to be that naloxone creates a safety net whereby opioid usage will increase because users have less risk  knowing if they overdose they can be revived. The authors cite a legislator who told a Congressional hearing “Kids are having opioid parties with no fear of overdose,” news reports of police finding naloxone at overdose scenes, and an Ohio police officer who is quoted as saying “We’ve Narcan’d the same guy 20 times.” The researchers say their data proves these anecdotes represent valid concerns, even if the “Narcan Parties” anecdote seems to have little substance in truth.

I am not well enough versed in economic theory and concepts to discuss the quality of the paper or the methods they have used to build their findings. I can say other papers have found the opposite.

No evidence of compensatory drug use risk behavior among heroin users after receiving take-home naloxone

Are take‐home naloxone programmes effective? Systematic review utilizing application of the Bradford Hill criteria

The authors use the concept of moral hazard, which is an economic term, that suggests that people may not do what is right for them if the consequences of their action are covered by someone else. It is a term used often in insurance, where if you have car insurance, you may drive with less care than someone driving without insurance who would have to bear the full cost of an accident.

Translated to the opioid crisis, a user doesn’t have to worry about overdosing because a system is in place to revive him. He will consequently use when otherwise he might not have and/or will use with less concern than he might otherwise have had.  I have doubts that this risk/reward thought process applies well to addicted individuals who no longer have a good concept of risk due to the damaged circuitry in their brains that opioids have inflicted on them.

As as a paramedic with experience dealing with opioid users, and as member of an overdose working group that seeks to increase access to naloxone, I can say the following:

1. Users are going to use. I don’t think they are going to put off their next hit because they are out of narcan or there is no person available to call 911 if they keel over.

2. Users hate Naloxone. They will have it around to save their lives if they have to, but no one is deliberately dosing with the intention to let themselves get “Narcan’d.”

3. Yes, by keeping people alive, Naloxone will allow a user to use again. The user instead of dying, may commit more crimes (if that is how the user supports his habit). That is a trade-off I am sure we all are willing to make as human beings.

4. No one has ever said that Naloxone alone is the key to ending the epidemic. Naloxone is about keeping people alive until they are ready to recover. I agree with the mantra of the Harm Reduction Community: Dead people can’t recover.

Here is the CDC’s three pronged response to the Heroin Epidemic:





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Monday, December 12, 2016

lower right abdominal pain radiating to back and leg

 Pain in side or flank pain: right or left - in back and above the hip. Which indicates pain they on? What are the possible side pain causes right and left? Pain in side or flank refers to pain or discomfort in the side of the abdomen, immediately above the hip. You may experience pain in the right side or left side. If you suffer from your side (pain in your side) may have a number of possible causes. The main causes of pain in the right side and / or left side (pain in the right side behind back or pain they left behind back) let pass by. Pain they may be associated with symptoms such as nausea, vomiting, motion and urge other complaints. Thus, for example, is a pneumonia accompanied by coughing. And in it in back pain or pain on one or both sides which is accompanied by pain when urinating, may indicate a kidney infection.

What is pain in the flank?

Pain in the side or flank refers to pain or discomfort in the side of the abdomen, just above the hip. Flank pain actually refers to pain in your side and back. Usually, the pain is worse on one side of the body. Most people experience at least once in their lives flank pain, and it is usually short-lived. Constantly present and / or severe pain can be caused by a serious underlying medical condition, such as an infection in the urinary tract or kidneys or dehydration (dehydration). In acute pain that arises without obvious cause can be thought of a kidney stone, the so-called colic. Kidney stones may also present themselves by chronic sided flank pain, sometimes referred to as back pain. Chronic pain can also point to several other causes.

  Pain in the side, but no underlying condition

Pain they do not necessarily indicate an underlying disease. For example, in the side flank pain or a stitch occur after exercise (running). When you sleep after waking up with pain in your back or side pain, this can be a bad mattress or bed base.

nephritic pain
If people think they suffer from kidney pain, it often indicates pain in the kidney area or pain in either flanks, indicating pain in the back or the area between the lower ribs and the buttocks. Here we discuss several causes of kidney pain.

What are the possible causes of flank pain or pain in the side?

Various conditions ranging from serious to relatively harmless, can cause pain in the flank. Some common causes (the main symptoms) are:


main complaints
Urinary tract infection
A kidney infection (pyelonephritis) indicates fever, flank pain, malaise.
renal colic
Often begins a jammed stone with a faint, inconspicuous pain in the lower back (flanks). Gradually, the pain becomes brighter, and comes in increasingly intense attacks (renal colic), usually on the side of the abdomen. The pain often travels through the groin, thigh or genitalia.
kidney Infarction
Sharp, intense pain in the lumbar region.
ureteral stenosis
Pain in the side, left and / or right.
kidney Cyst
Dull pain in the loin, which is whether or not associated with hematuria (blood in the urine).
kidney Tumor
Blood in the urine, pain in the kidney area (you can feel in it) and palpable swelling in the abdomen.
Ectopic pregnancy (also called ectopic pregnancy, abbreviated EUG)
The subacute form displays symptoms such as one-sided abdominal pain, vaginal bleeding, pain in the shoulder region, fainting and nausea.
Disorders of ovary or ovarian
These disorders may go under another associated with pain in the side.
biliary colic
Paroxysmal pain right upper abdominal pain, sometimes radiating to the back or right shoulder blade, with urge to move.
Mechanical bowel obstruction or obstructive ileus
Worsening episodic, crampy abdominal pain (colic).
Usually begins with a sudden severe pain in the upper abdomen: right or left, but rarely left.
acute appendicitis
A novice appendicitis are typically characterized by a dull ache in the middle of the abdomen and often at the level of the navel. The pain will gradually shift to the right lower abdomen in the next 24 hours.
Mild, moderate, or heavy, or may not be long-lasting abdominal pain in the lower abdomen, or abdominal pain that radiates to one side of the abdomen (more localized in the side).
When a diverticulum gets infected, you get abdominal pain, usually in the lower left abdomen.
Lumbago refers to intractable to describe pain and stiffness in the lumbar or lower back pain. The back pain than are located between the lower ribs and the buttocks. The pain may prevent the left or right, or even on both sides of the spine.
Arthritis (in particular, arthritis that affects the spinal column)
Low back pain, sometimes towards the side.
Infection in the spine
vertebral Fracture
Sudden pain or could indicate a chronic dull pain in your back on a spinal fracture.
Pinched nerve in the back
You feel pain everywhere go through the nerve, for example, in your buttock, leg, calf or foot, and this pain is often worse than the pain in your back.
muscle spasms
Spasm of the back muscles can cause provoking pain in the lower back and the flanks.
Sometimes pain and itching in a spot on the trunk, often in the flank or on the back.
Dehydration or dehydration
Slap feel and suffer from headaches, dizziness and nausea.
Pain when breathing, are stuffy, coughing up yellow or green mucus, sometimes with some blood, fatigue, a higher or even a lower body temperature, muscle aches and pain in the lungs, shivering and chattering teeth, loss of appetite and in severe cases confusion. Pain it sometimes occurs.
Inflammatory diseases of the bowel, such as Crohn's disease
Inflammatory diseases of the intestine may lead to, inter alia, abdominal pain, and pain in the side.
Floating-Rib syndrome
Include flank pain, often one-sided.

These conditions will be discussed in brief below.

Pain in side by UTI

A urinary tract infection indicates an infection or inflammation of the mucous membrane on the inside of the urinary tract (renal pelvis, ureters, bladder and urethra). Usually, a urinary tract infection is limited to the lining of the bladder. This is coupled with known bladder problems, pain that radiates to the lower back. The infection-causing bacteria (often derived from the intestinal flora) intrude the bladder through the urethra inside. Women are more prone to urinary tract infections, since the distance between the urethra and rear in women is much shorter than in men. If a urinary tract infection ascends from the lower to the upper urinary tract (eg an undetected or inadequately treated cystitis), a kidney infection can develop.

renal colic

A renal colic or -aanval out in paroxysmal, cramping pain in the side, which radiates to the groin. This severe pain attacks are often accompanied by nausea (and vomiting) and need to move. You can not sit still through the severe pain or lying. Blood in the urine, frequent and painful urination belong there too. At the moment, it belongs to the possibilities to crush kidney stones, in which a surgical procedure is no longer needed.

kidney Infarction

A kidney infarction occurs when a clot is formed in one of the larger arteries of the kidney, causing a part of the kidney no blood, and therefore, no oxygen will get more. The part of the kidney which is deprived of oxygen will get may die as a result. Such a clot can be formed by, for example, severe arteriosclerosis (atherosclerosis). Although atherosclerosis rarely, renal infarction is rare. By means of computer tomography scanning, the diagnosis of renal infarction are made.

ureteral stenosis

A ureteral stenosis refers to a narrowing (stenosis) of the ureter (ureter). As a result, creates an accumulation of urine in the renal pelvis. This can damage the kidney. The kidney may even completely lose its function.

Pain in side by kidney cyst

A kidney cyst is a vesicle filled with fluid and a renal cyst it resides in the kidney. Sometimes, there may occur several of these cysts in the kidney. When there are very many of these cysts on both kidneys, it is called polycystic kidney disease. Here several causes may underlie. Kidney cyst can give all kinds of complaints. These complaints can often consist of pain and an uncomfortable feeling at the level of the lower back or they. Kidneys with cysts are often larger than normal, healthy kidneys.

kidney Tumor

In the Netherlands annually diagnosed with kidney cancer about 2,000 times. Renal cell carcinoma which arises in the renal tubules, is the most frequent tumor of the kidney in adults. This type of cancer is usually gives no complaints at the beginning and that is why it is so difficult to diagnose the disease at an early stage. Later, you can see blood in the urine or you suffer from persistent pain in the back or sides.

Ectopic Pregnancy

In an ectopic pregnancy (also called ectopic pregnancy, abbreviated EUG,), the fertilized egg is outside the uterus, usually in the fallopian tube. Approximately one percent of all pregnancies ends in an ectopic pregnancy. An ectopic pregnancy often does not result in a full-term pregnancy. Blood loss is in many cases, the first clear phenomenon of an ectopic pregnancy. This is often accompanied by pain (cramping of the fallopian tube). This pain usually manifests itself on one side of the abdomen or in the lower abdomen.

Disorders of ovary or ovarian

Disorders of the ovaries concern especially inflammations and tumors. These conditions may include involvement accompanied by pain in the side.

biliary colic

In the gall bladder bile concentrated can go crystallize causing small crystals are formed which can form gallstones. If such a stone is driven out of the gall bladder, the terminal may get stuck in front of the gall bladder or output in the bile duct, with the result that there is a biliary colic. The bile duct is trying with all his might to drive the galsteentje by contraction to the intestine. This causes episodic pain right upper abdominal pain, sometimes radiating to the back or right shoulder blade. Nausea and vomiting are also common. Furthermore, there is urge to move; you can not sit still or lie down during an attack; you must move the pain.

Mechanical bowel obstruction or obstructive ileus

One speaks of "ileus" as the passage of food stopped in the intestine. In mechanical obstruction or obstructive ileus is intestinal clogged due to mechanical obstruction or obstacle that blocks the passage. Possible causes are:
a twisting of the intestine known as volvulus or volvulus;
the clincher chairing the intestine by scar tissue (called adhesions);
a tumor or tumor which blocks the passage.


Pancreatitis is an inflammation of the pancreas. Acute pancreatitis usually begins with a sudden severe pain in the upper abdomen: right or left, rarely left. This pain may radiate to the back, left side and left shoulder and worsens when you move.

acute appendicitis

Acute appendicitis or appendicitis often begins with pain around or above the navel, which eventually sinks to the right lower abdomen. Sometimes you first suffer from nausea and vomiting you should. You often have a slight temperature and you do not feel good. Touching the belly and then let go of hurts, especially right. In addition, sometimes doing cough and laugh pain. Transportation pain is also common, for example, if you're in a car driving over a speed bump or other bump.


Constipation or constipation can generate intestinal spasms that can lead to light or heavy, either prolonged abdominal pain in the abdomen or abdominal pain that radiates to one side of the abdomen (more in it).


A diverticulum refers to a benign bulge in the large intestine. When it becomes inflamed, it is called diverticulitis. A common complaint is abdominal pain, usually in the lower left abdomen. How diverticulitis arises, is not clear. The inflammation is usually self-limiting; with pain you can use paracetamol.


Lumbago refers to sudden (acute) low back pain, which is often accompanied by cramping of muscles and irritation of the lower spine. Several things can cause lumbago, where overloading is one of them. Inadequately treated spit can cause lumbago.


Arthritis, in particular arthritis that affects the spinal column, can be a source of significant low back pain.

Infection in the spine

An inflammation of the spine usually gives pain localized in the lower back.

vertebral Fracture

As a result of a fall from a height, a traffic accident, or a fracture may be caused by other causes, in one or
multiple vertebrae.

Pinched nerve in the back

By osteoarthritis of the lumbar spine (ie the lower vertebrae of the spine) may uncontrolled formation and bulges occur in the vertebrae. These growths constrict the space between the vertebrae, bringing it closer to come to lie against each other. This makes getting pinched nerve roots.

muscle spasms

Spasm of the back muscles exasperating sometimes cause pain in the lower back and the flanks.

Shingles (herpes zoster) is an infection of a nerve as a result of a virus and does the VIRIS that causes chickenpox in children. The virus dive after chickenpox the bottom of the body and then is latent in the ganglia. In later life the virus can become active again and resurface. Usually this is done in the nerve center of one of the hull or abdomen nerves. That explains the name "shingles." Shingles usually begins with pain and sometimes with itching in one spot on the body, often in the side or on the back.

Dehydration or dehydration

Dehydration can occur after the loss of lots of fluids and salts, eg due to high fever, vomiting, severe diarrhea, (considerably) blood loss, heavy sweating, use of certain drugs or excessive heat.


Pneumonia (pneumonia), inflammation of the alveoli and the surrounding tissue, and this is accompanied by coughing (sometimes dry and painful and sometimes with green slime), shortness of breath and chest pain or pain in the side. Furthermore, do you suffer from fever and malaise.

Inflammatory diseases of the intestine

Inflammatory diseases of the bowel, such as Crohn's disease, can give rise to, inter alia, abdominal pain, and pain in the side. Crohn's disease can include display the following symptoms:
loose stools or diarrhea, often accompanied by blood and mucus;
abdominal pain;
Sometimes constipation (constipation);
weight loss;
wounds, fistulas and abscesses, often around your back.

Floating-Rib syndrome

With flank pain may also be considered floating ribs. The pain at the floating Rib syndrome, also rib-tip syndrome or costo-iliac syndrome called, is described as aching, more or less constantly present, sometimes increasing in severity. Often you see a clear correlation with movement or posture. The floating rib syndrome can be caused by a leaning or sitting posture. Certain sports that run sideways like can cause the symptoms fitness and stretching exercises. Old age may also play a role. In older people, you see that the discs are thinner, thus collapsing the spine. The end of the lower rib can hereby tap to bulge against the pelvis. This causes annoying pain.

Saturday, December 10, 2016

Lower right abdominal pain after ovulation


In many women, abdominal pain occurs during ovulation. Almost half of all women are affected. This abdominal pain is ovulation pain or Intermenstrual pain and can take vary long.

In some women the pain last only a few minutes, others can take days. The intensitywith which the pain occurs is very different. Some women notice only a pulling in the abdomen, whereas other women feel verysevere abdominal pain and abdominal cramps. This can occur during each cycle or irregular too.

Lower right abdominal pain after ovulation
Lower right abdominal pain after ovulation

Ovulation takes place in the middle of the female menstrual cycle, when a regular 28-day cycle so on the 14th day. One of the eggs, which are previously mature in the ovaries is ejected during the ovulation of the ovarian and enters the fallopian tube, where it can be fertilized if it meets a sperm cell.

The pain probably triggered by muscle contractions, leading to the ejection of the egg. The fertile days of the woman is considered to be the days around ovulation. Because for each cycle, an egg only from one of the two ovaries is discharged, it is pain in the middle usually sided abdominal pain. The localization can vary but from time to time, right or left, depending on which of the ovaries is currently active. This can be to differentiate it clearly from the menstrual pain that occur during or before the period, as they occur on either sides, or just one.

Depending on the intensity of the pain that may radiate in the back and occasionally to slight bleeding during midcycle pain. These are however harmless. If the abdominal pain persists however longer than 2 to 3 days, or increase in intensity, the doctor should be consulted.

Other serious illnesses could be based. These include for example appendicitis, an inflammation of ovaries or fallopian tubes, or other inflammatory bowel disease. Even kidney stones or inflammation of the stomach mucosa should be considered when severe pain into consideration.

As well, an ectopic pregnancy can cause symptoms similar to the ovulation pain.Come here often have fever and bleeding to the single-sided abdominal pain. An ectopic pregnancy can be a very serious history and existing suspected a doctorshould be consulted immediately.

Construction of pain from ovulation or implantation of the egg?

It comes to the implantation of a fertilized egg in the lining of the uterus about a week after ovulation. After the mature ovum from the ovary has been expelled, she approached their way through the fallopian tube toward the uterus. She meets within the first 24 hours after ovulation on a sperm cell, which leads to fertilization. The fertilized egg produces certain hormones that prepare the lining of the uterus on the impending implantation.

When implantation even get parts of the fertilized egg in the lining of the uterus. This can cause slight bleeding at the woman and to the occurrence of mild pain. These can manifest as similar as the midcycle pain at the onset of ovulation. Exactly like this, they can express themselves differently from woman to woman and varies and longoccur.

The abdominal pain after ovulation

Pain which is caused by implantation, however usually centred occurs in the lower abdomen, as they are localized in the uterus. The difference with the abdominal pain during ovulation is the time in which they occur. The midcycle pain occur at the time of ovulation, while the abdominal pain abouta week later occur during implantation of a fertilized egg. However, many women do not feel implantation.

Abdominal pain with ovulation or pregnancy?

Abdominal pain during ovulation are not signs of a pregnancy. They occur regardless of whether or not fertilized the egg in the course. The midcycle pain can be also. This does not mean that no ovulation takes place; it will not be only concomitant pain. Conversely, ovulation pain does not necessarily mean that the woman is fertile.

For the purpose of determining the fertility of the woman, this means that the medication can be a help in the calculation of the fertile days but does not allow a reliable determination. In connection with the measurement of basal body temperature, they can be of advantage for family planning. It should be known that the medication is about two to three days before the basal temperature rises.

But the medication is not a reliable means of determining the fertile days or preventing them. They can vary from cycle to cycle and also simply fail.

Lower abdominal pain after ovulation pain during ovulation despite pill The effect of the pill is that it suppresses the ovulation and thus no egg is ejected from the ovary, which can be fertilized. Ovulation is therefore stopped when the pill is taken correctly.

Due to some influences, however, the effect of the pill can be influenced and, despite correct administration, ovulation may occur. These include the occurrence of diarrhea or vomiting, taking antibiotics and taking other medicines.

If one or more of these things occur, it may lead to ovulation with the possible medication, despite taking the pills. An additional contraceptive method should be used to prevent unwanted pregnancy.

Lower right abdominal pain after ovulation treatment

right abdominal pain after ovulation
In most cases no medication or other expensive treatment is necessary to alleviate the discomfort. Since these are naturally occurring symptoms, they usually also disappear naturally. It is often enough to put a hot water bottle or a spelled pillow on the stomach. The heat causes possible tensions in the abdomen and the woman can relax. Many women also use a hot bath to relax and relieve the pain. Also, a light massage of the abdominal wall can help resolve the cramps.

In some cases, the medication pain occurs due to nutrient deficiency of the female body. The intake of magnesium can help to relieve the symptoms.

If the pain is severe or lasting for several days, a doctor should be consulted. This also applies if additional symptoms such as vomiting are added. In these cases, other diseases of the abdomen must be excluded and possibly a drug therapy with painkillers is necessary.