Some hurt more than others


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Migrants climb atop a truck as a caravan of thousands of Central Americans continues its slow march toward the U.S. border, outside Arriaga, Mexico, Saturday, Oct. 27, 2018. Many migrants said they felt safer traveling and sleeping with several thousand strangers in unknown towns than hiring a smuggler or trying to make the trip alone.(AP Photo/Rebecca Blackwell)

Migrants climb atop a truck as a caravan of thousands of Central Americans continues its slow march toward the U.S. border, outside Arriaga, Mexico, Saturday, Oct. 27, 2018. Many migrants said they felt safer traveling and sleeping with several thousand strangers in unknown towns than hiring a smuggler or trying to make the trip alone.(AP Photo/Rebecca Blackwell)


A family walks among other migrants in the Central American migrant caravan that slowly making its way toward the U.S. border, outside Arriaga, Mexico, before dawn on Saturday, Oct. 27, 2018. Many migrants said they felt safer traveling and sleeping with several thousand strangers in unknown towns than hiring a smuggler or trying to make the trip alone. (AP Photo/Rodrigo Abd)


Mexican federal police in riot gear block the highway to keep a thousands-strong caravan of Central American migrants from advancing on their way to the U.S. border, outside Arriaga, Mexico, Saturday, Oct. 27, 2018. Hundreds of Mexican federal officers carrying plastic shields briefly blocked the caravan of Central American migrants from continuing toward the United States, after several thousand of the migrants turned down the chance to apply for refugee status and obtain a Mexican offer of benefits. (AP Photo/Rebecca Blackwell)


Migrant caravan to rest following report of abducted child

By CHRISTOPHER SHERMAN

Associated Press

Sunday, October 28

TAPANATEPEC, Mexico (AP) — Coordinators of a caravan of several thousand Central American migrants moving through southern Mexico urged its members to rest Sunday. At first the migrants vowed to press on anyway but later changed their minds amid reports that a child had been abducted.

The migrants said they would stay and hold a meeting Sunday in Tapanatepec. Late Saturday night, groups of migrants were running through the town’s streets saying a migrant’s child had been snatched. Something similar led to a panic at an earlier stop, but was not confirmed.

After being delayed for a couple hours when federal police halted their exit from the town of Arriaga Saturday morning, most of the migrants arrived in Tapanatepec in the searing heat. Dozens headed down to the Novillero river below the central square to bathe, wash clothing and cool off. Others lined up at a medical aid station mostly for attention to their battered feet.

For the first time an arm of the federal government seemed to be directly helping the migrants advance rather than trying to diminish the caravan. In this case Grupo Beta, Mexico’s migrant protection agency, gave rides to stragglers and passed out water.

At the caravan’s regular evening meeting in the town square, its coordinators tried to force a little chivalry.

Many of the migrants have depended on hitchhiking to move between towns rather than walking the entire way. When trucks stop it’s usually young men who sprint to reach them first. Women carrying children or pushing strollers are at a disadvantage.

On Saturday night, a nun scolded the men and urged the women to be more aggressive in pursuing the rides. She said the church would help arrange five trucks to transport only women with children on the next trek to Niltepec about 33 miles (54 kms) away.

“To me it’s bad because there has to be equality because we are all struggling on this path,” said Hector Alvarado. The 25-year-old from Atlantida, Honduras said he had to quit school and leave his wife and 2-year-old daughter to try to make a living in the U.S.

Rosa Bonilla is traveling with a 10-year-old daughter and a son who will turn 2 this year. The single mother conceded that she never beat the men to the trucks that stopped, but said some men looked out for the mothers and made sure they got on.

“I don’t agree that it should only be women with children,” she said. She argued that husbands should be allowed on because they help protect the women.

“If we go alone anything could happen,” she said.

The Mexican government seems torn between stopping the migrants from traveling toward the U.S. border or burnishing its international human rights image.

On Saturday, more than a hundred federal police dressed in riot gear blocked a rural highway in southern Mexico shortly before dawn to encourage the migrants to apply for refugee status in Mexico rather than continuing the long, arduous journey north. U.S. President Donald Trump has urged Mexico to prevent the caravan from reaching the border.

Police let the caravan proceed after representatives from Mexico’s National Human Rights Commission convinced them that a rural stretch of highway without shade, toilets or water was no place for migrants to entertain an offer of asylum. Many members of the caravan have been traveling for more than two weeks, since a group first formed in San Pedro Sula, Honduras.

Not long after the caravan resumed its advance Saturday, government officials lent them a hand.

Martin Rojas, an agent from Mexico’s migrant protection agency Grupo Beta, said he and his fellow agents planned to use agency pickup trucks to help stragglers catch up with the caravan.

“There are people fainting, there are wounded,” said Rojas, who spoke to The Associated Press after dropping off a group of women and children in Tapanatepec, where the caravan planned to spend the night. Rojas transported the group to their destination after spotting them on a highway trudging through temperatures approaching 104 degrees Fahrenheit (40 degrees Celsius).

The caravan still must travel 1,000 miles (1,600 kilometers) to reach the nearest U.S. border crossing at McAllen, Texas. The trip could be twice as long if the 4,000 or so migrants head for the Tijuana-San Diego frontier, as another caravan did earlier this year. Only about 200 in that group made it to the border.

Most of the migrants in the caravan appeared determined to reach the U.S., despite an offer of refuge in Mexico.

Mexican President Enrique Pena Nieto launched a program on Friday dubbed “You are home,” which promises shelter, medical attention, schooling and jobs to Central Americans who agree to stay in the southern Mexico states of Chiapas or Oaxaca, far from the U.S. border.

Mexico’s Interior Ministry said that temporary identity numbers have been issued to 111 migrants under the program. The IDs, called CURPs, authorize the migrants to stay and work in Mexico, and the ministry said pregnant women, children and the elderly were among those who had joined the program and were now being attended at shelters.

Associated Press writers Julie Watson and Amy Guthrie contributed to this report.

Bridgeport Used Car Seller Accused of Failing to Transfer Vehicle Titles to Consumers

Ohio Attorney General Mike DeWine

October 30, 2018

(ST. CLAIRSVILLE, Ohio)—Ohio Attorney General Mike DeWine today announced a consumer protection lawsuit against a Bridgeport used car seller accused of failing to deliver vehicle titles to consumers.

The lawsuit accuses Tri State Auto Group LLC and its owners, Chad E. Anthony and Candice L. Anthony, both of Wheeling, West Virginia, of violating Ohio consumer protection laws.

Tri State Auto Group was located at 6 Cadiz Pike in Bridgeport. More than 40 complaints were filed against the dealership in 2018, with many consumers saying they hadn’t received the title to a vehicle they bought from Tri State. Some consumers also complained that they traded in a vehicle to the dealership but the dealership failed to make promised payments on the trade-in, causing problems for the consumer.

The Ohio Attorney General’s Office worked to assist consumers, in some cases making payments from the Title Defect Recision Fund, which helps resolve certain title problems. Payments from the fund have totaled about $70,000 thus far in the case.

The Attorney General’s lawsuit, filed in the Belmont County Court of Common Pleas, seeks reimbursement for consumers, reimbursement for the Title Defect Recision Fund, and an order to prohibit the dealership’s owners from being granted an auto dealer license in Ohio.

Consumers who suspect an unfair or deceptive sales practice should contact the Ohio Attorney General’s Office at www.OhioProtects.org or 800-282-0515.

The Conversation

Why do some people hurt more than others?

October 26, 2018 6

Author

Erin Young

Assistant Professor, University of Connecticut School of Nursing; Assistant Director, UCONN Center for Advancement in Managing Pain, University of Connecticut

Disclosure statement

Erin Young receives funding from National Institutes of Health. Erin Young is an Assistant Professor, University of Connecticut School of Nursing and Assistant Director of the Center for Advancement in Managing Pain (CAMP).

Partners

University of Connecticut provides funding as a member of The Conversation US.

Anyone who came of age in the 1990s remembers the “Friends” episode where Phoebe and Rachel venture out to get tattoos. Spoiler alert: Rachel gets a tattoo and Phoebe ends up with a black ink dot because she couldn’t take the pain. This sitcom storyline is funny, but it also simply illustrates the question that I and many others in the field of “pain genetics” are trying to answer. What is it about Rachel that makes her different from Phoebe? And, more importantly, can we harness this difference to help the “Phoebes” of the world suffer less by making them more like the “Rachels”?

Pain is the single most common symptom reported when seeking medical attention. Under normal circumstances, pain signals injury, and the natural response is to protect ourselves until we have recovered and the pain subsides. Unfortunately, people differ not only in their ability to detect, tolerate and respond to pain but also in how they report it and how they respond to various treatments. This makes it difficult to know how to effectively treat each patient. So, why isn’t pain the same in everyone?

Individual differences in health outcomes often result from complex interactions of psychosocial, environmental and genetic factors. While pain may not register as a traditional disease like heart disease or diabetes, the same constellation of factors are at play. The painful experiences throughout our lifetime occur against a background of genes that make us more or less sensitive to pain. But our mental and physical state, previous experiences – painful, traumatic – and the environment can modulate our responses.

If we can better understand what makes individuals more or less sensitive to pain in all kinds of situations, then we are that much closer to reducing human suffering by developing targeted personalized pain treatments with lower risks of misuse, tolerance and abuse than the current treatments. Ultimately, this would mean knowing who is going to have more pain or need more pain-killing drugs, and then being able to effectively manage that pain so the patient is more comfortable and has a quicker recovery.

Not all pain genes are the same

With the sequencing of the human genome, we know a lot about the number and location of genes that make up our DNA code. Millions of small variations within those genes have also been identified, some that have known effects and some that don’t.

These variations can come in a number of forms, but the most common variation is the single nucleotide polymorphism – SNP, pronounced “snip” – representing a single difference in the individual units that make up DNA.

There are approximately 10 million known SNPs in the human genome; an individual’s combination of SNPs makes up his or her personal DNA code and differentiates it from that of others. When a SNP is common, it is referred to as a variant; when a SNP is rare, found in less than 1 percent of the population, then it is called a mutation. Rapidly expanding evidence implicates dozens of genes and variants in determining our pain sensitivity, how well analgesics – like opioids – reduce our pain and even our risk for developing chronic pain.

A history of pain tolerance

The first studies of “pain genetics” were of families with an extremely rare condition characterized by the absence of pain. The first report of congenital insensitivity to pain described “pure analgesia” in a performer working in a traveling show as “The Human Pincushion.” In the 1960s there were reports of genetically related families with children who were pain-tolerant.

At that time the technology did not exist to determine the cause of this disorder, but from these rare families we know that CIP – now known by wonkier names like Channelopathy-associated insensitivity to pain and Hereditary Sensory and Autonomic Neuropathy – is the result of specific mutations or deletions within single genes required for transmitting pain signals.

The most common culprit is one of a small number of SNPs within SCN9A, a gene that encodes a protein channel necessary for sending pain signals. This condition is rare; only a handful of cases have been documented in the United States. While it might seem like a blessing to live without pain, these families must be always on alert for severe injuries or fatal illnesses. Typically children fall down and cry, but, in this case, there’s no pain to differentiate between a scraped knee and a broken knee cap. Pain insensitivity means that there is no chest pain signaling a heart attack and no lower right abdominal pain hinting at appendicitis, so these can kill before anyone knows that there is something wrong.

Supersensitivity to pain

Variations within SCN9A not only cause pain insensitivity, but have also been shown to trigger two severe conditions characterized by extreme pain: primary erythermalgia and paroxysmal extreme pain disorder. In these cases, the mutations within SCN9A cause more pain signals than normal.

These types of heritable pain conditions are extremely rare and, arguably, these studies of profound genetic variations reveal little about more subtle variations that may contribute to individual differences in the normal population.

However, with the growing public acceptance of genome-based medicine and calls for more precise personalized health care strategies, researchers are translating these findings into personalized pain treatment protocols that match a patient’s genes.

Do genetic variations affect pain in everyone?

We know some of the major genes that influence pain perception and new genes are being identified all the time.

The SCN9A gene is a major player in controlling the body’s response to pain by activating or silencing the sodium channel. But whether it amplifies or dampens pain depends on the mutation an individual carries.

Estimates suggest that up to 60 percent of the variability in pain is the result of inherited – that is, genetic – factors. Stated simply, this means that pain sensitivity runs in families through normal genetic inheritance, much like height, hair color or skin tone.

Turns out that SCN9A also plays a role in pain in the normal population. A relatively more common SNP within SCN9A, called 3312G>T which occurs in 5 percent of the population, has been shown to determine sensitivity to post-operative pain and how much opioid medication is needed to control it. Another SNP in SCN9A gene causes greater sensitivity for those with pain caused by osteoarthritis, lumbar disc removal surgery, amputee phantom limbs and pancreatitis.

New painkillers from sea creatures

Therapeutically, we have been using local anesthetics, including lidocaine, to treat pain by inducing a short term block of the channel to stop pain transmission. These drugs have been continuously used to safely and effectively block pain for more than a century.

Interestingly, researchers are evaluating tetrodotoxin, a potent neurotoxin produced by sea creatures like pufferfish and octopuses, which works by blocking pain signal transmission, as a potential pain killer. They have shown early efficacy in treating cancer pain and migraine. These drugs and toxins induce the same state that is present in those with congenital insensitivity to pain.

If there’s one silver lining to the opioid crisis, it is the realization that we need more precise tools to treat pain – ones that treat pain at the source and come with fewer side effects and risk. By understanding the genetic contribution to pain sensitivity, susceptibility to chronic pain and even analgesic response, we can then design treatments that address the “why” of pain and not just the “”where.” We’re beginning to design precision pain management strategies already, and the benefit to humankind will only increase as we know more about why pain differs among people.

Ohio State to lead national study of same-gender couples

Research will help answer questions about health disparities

COLUMBUS, Ohio — The Ohio State University, along with Bowling Green State University, has been selected to conduct a first-of-its-kind national, five-year study of health in same-gender couples.

The National Couples’ Health and Time Study is the first population-representative study ever to focus on couples of the same gender in the United States. Data will also be collected from couples of different genders. The researchers plan to put extra emphasis on recruiting racial and ethnic minorities.

Ohio State and BGSU received $2.3 million from the Eunice Kennedy Shriver National Institute of Child Health and Human Development to conduct the study.

Claire Kamp Dush, associate professor of human sciences at Ohio State, leads the research.

Kamp Dush noted that the number of married or cohabiting same-gender couples in the United States increased by 45 percent between 2008 and 2014.

“Families headed by sexual and gender minorities are a growing part of our population and we know that their health lags behind other Americans,” she said.

“But we have very little data that could help explain why those disparities exist. This study will help answer those questions.”

The team will recruit 2,690 adults who are cohabiting or married, along with their partners.

Kamp Dush said the research should help answer questions about health in these minority couples. One important source of data will come from time diaries. Participants will use their smartphones to record what they are doing and feeling throughout one weekday and one weekend day.

The findings should shed light on how the stress of discrimination associated with being gay or a racial minority – or both – may affect the health and well-being of couples.

“If you report that you’re feeling stress related to discrimination or stigma, does your partner also feel more stressed from talking to you about it? Or could partners help each other relieve their stress?” Kamp Dush said.

“A good relationship may help buffer some of the negative health effects of the stress you feel from homophobia or racism.”

All couples will also complete a survey examining a wide range of health and well-being issues, including measures of physical function, sleep, depression, alcohol use, anxiety, sexual function and social support. Participants will report on their family support, relationship quality, parenting issues, and experiences with racism and homophobia.

The study examines community-level factors, as well, such as whether couples live in a state that has employment protections for same-gender couples. That could help answer questions about whether couples feel more stress if they live in states or areas that have fewer protections.

Kamp Dush said the wide range of questions will provide data never before available to researchers.

“Many large-scale population surveys do not include detailed measures of family functioning, or do not have data from a sufficient number of same-gender couples. We are asking questions about a lot of other issues that may be influencing health outcomes,” she said.

Team member Wendy Manning, distinguished professor of sociology and Director of the Center for Family and Demographic Research at BGSU, said the study is necessary because the changes in American families aren’t reflected in research done to date.

“Same-sex couples have been left out of much social science research on American family life. This study will rectify this omission and fill an important gap in our understanding of how all families function,” Manning said.

Ohio State’s Institute for Population Research also supports the research. John Casterline, director of the institute, said the study will be a boon for researchers and policymakers.

“These data will be immensely useful for informing better policy and programs for families of all types,” Casterline said.

Kamp Dush said the team will spend four years collecting the data. The data will eventually become available to researchers around the world for their studies.

Additional co-investigators on the project from Ohio State are JaNelle Ricks, assistant professor of public health; and Corinne Reczek and Hui Zheng, both associate professors of sociology.

URL : http://news.osu.edu/ohio-state-to-lead-national-study-of-same-gender-couples/

OHIO TO IMPLEMENT A BOLD, NEW LAW TO DETER DISTRACTED DRIVING

COLUMBUS – Effective October 29, House Bill 95 becomes law and enacts a significant distracted driving deterrent and an effective tool for law enforcement to enforce dangerous driving. House Bill 95 establishes Ohio’s unique approach of combating distracted driving by enhancing existing moving violations. For example, law enforcement officers no longer will need to prove a driver is texting, but only that a moving violation has occurred and the driver was distracted at the time.

The law requires an enhanced financial penalty in addition to existing fines or alternatively the completion of a distracted driver course, for drivers who commit a specific traffic violation while distracted. For example, a driver operating a vehicle outside marked lanes who is also engaging in a distracted behavior, will face an enhanced fine of up to $100 in addition to a fine for the lane violation. Other violations such as red light, stop sign, speeding, and other moving violations similarly would result in potentially higher fines.

The Ohio Department of Public Safety was tasked with creating a distracted driver course for offenders who plead guilty or are convicted of a specific traffic violation while distracted. This course is available in lieu of paying the enhanced court fine of $100 or less, providing the offender pays the total amount of the fine established by the violation and submits written evidence of completion of the distracted driver course.

The one-hour course discusses what distracted driving is, who is a distracted driver, cell phone distractions, the risks and consequences of driving distracted, and combating distracted driving.

The distracted driver course will be available on October 29, 2018 and can be found on the Ohio Bureau of Motor Vehicle’s Driver Training website (https://www.drivertraining.ohio.gov).

ODOT reminds motorists about importance of pedestrian safety with upcoming time change – clocks “falling back”

2017 was the deadliest in a decade for pedestrians in Ohio

(COLUMBUS, October 29, 2018) — With this week’s time change on Nov. 4 at 2 a.m., Ohioans will gain an extra hour of sleep. It also means it is getting darker even earlier, reducing visibility and making it more important than ever for motorists to watch out for pedestrians during evening commutes, especially in residential areas and near schools.

In 2017, 145 pedestrians were killed on Ohio roadways, with 78% of those deaths happening at dawn, dusk or after dark. This is the highest number of pedestrian fatalities in the state in more than 10 years. November and December are the deadliest months for people walking in the Buckeye State.

“Roadway safety is a shared responsibility and with the time-change impacting visibility for all road users, we are asking drivers to slow down and watch for pedestrians,” said Cait Harley, ODOT’s Safe Routes to School and Active Transportation Manager.

The Ohio Department of Transportation’s bicycle and pedestrian safety campaign, Your Move Ohio, offers these safety tips.

Time change safety tips for motorists include:

  • Slow down: During the early morning and evening hours, more time is needed to see pedestrians. Increase the recommended safe distances. The more space, the more time there is to react. Slow down during rain and fog too.
  • Always stop: for pedestrians crossing the street. Do not pass vehicles stopped at crosswalks.
  • Be extra cautious: Decreased visibility calls for more vigilant driving. Watch for bicyclists and pedestrians. Know that people who are walking or biking bundled up may not be able to hear or see as well and may take more time to react or maneuver especially with wet or icy conditions. Honking can startle or alarm pedestrians and bicyclists, creating a dangerous situation. Watch for children and families in neighborhoods and along school bus routes, at intersections and when backing out of driveways.
  • Be seen: Turn on headlights to be more visible during early morning and evening hours.
  • Eliminate distractions: Put away the Change the time on car clocks before starting to drive.
  • Beware of glare: Clean windshields inside and out. Dirty windshields can magnify glare. Also keep windows, headlights and mirrors clean. Do not use high beams when other cars or pedestrians are around.

Time change safety tips for pedestrians fall into four main categories:

  • See and be seen: Drivers need to see you to avoid you. Pedestrians can help drivers see them better by wearing reflective clothing and/or accessories. Consider attaching reflective stickers or fluorescent tape to clothing, backpacks, purses and briefcases. These materials reflect light from headlights back to drivers, making it easier to be seen. Carry a flashlight when walking in the dark.
  • Be aware: Avoid distractions – put the phone away and turn down the volume on music players to hear approaching danger. Don’t assume that drivers or bicyclists see pedestrians. Make eye contact with drivers when crossing streets. Do not let umbrellas or jacket hoods block views of approaching traffic.
  • Walk defensively: Ohio law says that motorists must yield to pedestrians crossing a street. However, especially at this time of year, be extra aware of drivers who are driving toward the sunrise or sunset, as it is harder to see pedestrians. Walk on sidewalks whenever possible. If there are not sidewalks, walk on the shoulder or berm, in the opposite direction of traffic.
  • Cross consciously: Remember look left, right, and left again and only cross when it is clear. Always cross at an intersection or crosswalk, where lighting is often better. Watch out for cars at every driveway and intersection.

About Your Move Ohio

Your Move Ohio (YourMove.ohio.gov) is a response to a multi-year surge in fatal and serious bicycle and pedestrian crashes and epidemic levels of chronic diseases — obesity, high blood pressure and diabetes — in the state. The goal is to encourage more Ohioans to choose active transportation and to make it safer for them to walk, bike and bus.

Details about the campaign and free tip cards, bike lights, reflectors, and more are available at YourMove.ohio.gov and on Facebook.com/YourMoveOhio. Share your active transportation story with the hashtag: #YourMoveOhio.

Dear EarthTalk: Considering all the well-publicized problems with plastic in our oceans, do you think that plastic has any kind of future? — Lea Mauduit, via EarthTalk.org

As much as environmentalists shudder at the proposition, it looks like plastics are here to stay. Most experts agree that there’s no way to get humans to stop using plastic even if it would benefit the environment. This modern petrochemical-derived material is inexpensive to make, easy to form into various shapes and sizes, and is tough and strong enough to be used in a wide range of applications. We all make use of it in various forms hundreds of times a day just going about our business.

“Plastics are the workhorse material of the modern economy,” reports the consulting firm McKinsey & Co., adding that global production has surged from 15 million to 311 million metric tons yearly between 1964 and 2014. That number is projected to double to over 600 million metric tons in the next 20 years.

But the functional benefits of plastic come at a steep price, mostly as non-recyclable waste. Single-use plastics represent a quarter of the total volume of plastics produced and around 95 percent of the value of plastic-packaging material. McKinsey estimates that the single-use plastics industry is worth some $80-$210 billion annually. Plastic’s useful life is often less than a year, yet the material lives on for centuries.

Sadly, only 14 percent of plastic, single-use or otherwise, is recycled, even though much more of it could live another life if recycling processors were equipped and willing to handle it. Europeans manage to re-use a third of their plastic waste; the U.S. has only been able to re-use 10 percent.

Some are looking to so-called “bio-plastics” made from plant wastes instead of petroleum as one solution, but experts worry that even these nouveau greener formulations still won’t break down and go away, especially out at sea. “A lot of plastics labelled biodegradable, like shopping bags, will only break down in temperatures of 50°C and that is not the ocean,” says Jacqueline McGlade of the UN Environment Programme. “They are also not buoyant, so they’re going to sink, so they’re not going to be exposed to UV and break down.”

According to McKinsey, we need to start applying “circular-economy” principles to global plastic-packaging if we want to stem the tide of plastic waste. To get this ball rolling, UK-based sailor Ellen MacArthur, who set the world record in 2005 for fastest solo circumnavigation of the globe, is using her personal foundation to fund the Circular Design Challenge to inspire creative solutions in reducing plastic packaging. Ten early-stage ideas will each receive $10,000 in funding to help get their concepts into production, while bigger operations with more established solutions already in the works can apply for one of three $100,000 awards to further prototyping and production goals. While this funding may represent a drop in the bucket of the kind of resources we’ll need to beat the problem of plastic waste, it sets the wheels in motion to thinking sustainably about the future of plastics and the long term health of our environment.

The Conversation

Beating breast cancer only to die of opioid use – a sad Appalachian story

October 29, 2018

Author: Rajesh Balkrishnan, Professor, Public Health Sciences, University of Virginia

Disclosure statement: Rajesh Balkrishnan receives funding from the National Institutes of Health and Merck and Company.

The availability of life-prolonging treatments such as hormonal therapies and other targeted chemotherapy has led to a sharp decline in breast cancer deaths in the United States.

But despite these advances, there’s a troubling discrepancy in America. Breast cancer death rates continue to remain abnormally high in the Appalachian region of the United States, and it’s partially due to a different epidemic in the U.S: opioid use.

I am an epidemiologist who specializes in cancer, and I began investigating this issue five years ago to try to come up with a picture of what was happening. One thing that struck me when I looked at health insurance and cancer registry data was the extremely high and prolonged rate of use of dangerous medications like opioids in this population, sometimes as high as 50 percent in some areas.

Life-saving hormone treatments are often associated with side effects such as pain and muscle weakness. Although opioids are not considered first-line treatment for cancer-related pain, they are increasingly used to manage unbearable pain in breast cancer survivors. And that, my research shows, could be influencing breast cancer death rates to the tune of 60 percent in rural Appalachia.

A deadly mix

The Appalachian region of the U.S. is at the epicenter of a well-documented opioid epidemic, which preceded the current national epidemic by more than a decade.

Cancer disparities have existed in Appalachia for a while, but now we need to add the opioid epidemic to the mix as well for this region. My team’s analysis found that counties with the highest opioid prescribing rates in the U.S. are disproportionately found in Appalachia, with rates 50 to 65 percent higher in Kentucky and West Virginia than over national averages. And, West Virginia has led the nation in both the total number of opioid-related deaths and opioid-related deaths among elderly cancer patients for decades.

The picture that emerges is indeed a grim one. We find many patients in Appalachia who undergo successful breast cancer treatment and then start life-prolonging hormone treatments along with opioids to manage side effects such as pain. But many (over half in some counties) continue to remain on opioids, which are usually supposed to be prescribed only for the short term, and then discontinue long-term survivorship treatments such as hormones. The reasons these women discontinue traditional treatments is not completely clear, but my colleagues and I suspect it is related to people’s dependence on opioids.

The addictive nature of the opioids, the overall feelings of hopelessness and other regional issues such as poverty and drug diversion make this a complex and complicated treatment issue and one that needs more awareness and education of both survivors and their medical providers.

What are the answers?

Now that we know this problem, what can we do for Appalachia?

Overall, greater attention is desperately needed for Appalachian women with breast cancer, who have the worst breast cancer survivorship outcomes in the U.S.

However, given the current political context in which the elimination of the Appalachia Regional Commission (ARC) is being considered, it is unclear how to best proceed with this endeavor. The ARC is charged with the economic development of Appalachia and releases periodic reports on the economic status of the region. As a result, I believe that universities and other research centers need to take a more active role in monitoring and surveillance related to both the health and economic development of the region, to aid better health policy related to this vulnerable and underserved population.

It is heartbreaking to see a woman able to beat cancer, only to die because of sub-optimal use of a life-prolonging treatment or misuse of a short-term relief treatment such as opioids. We need to work harder to educate and empower Appalachian breast cancer survivors about their treatment choices and decision-making that can be most beneficial to improving their life quality and quantity. Patient and health care professional education in Appalachia related to safe and effective use of medicines could be effective in improving patient outcomes for the most vulnerable and under-served of us all in the United States.

Migrants climb atop a truck as a caravan of thousands of Central Americans continues its slow march toward the U.S. border, outside Arriaga, Mexico, Saturday, Oct. 27, 2018. Many migrants said they felt safer traveling and sleeping with several thousand strangers in unknown towns than hiring a smuggler or trying to make the trip alone.(AP Photo/Rebecca Blackwell)
https://www.sunburynews.com/wp-content/uploads/sites/48/2018/11/web1_121659340-c2cdb49610ad45baa24aefcfbe5282a4.jpgMigrants climb atop a truck as a caravan of thousands of Central Americans continues its slow march toward the U.S. border, outside Arriaga, Mexico, Saturday, Oct. 27, 2018. Many migrants said they felt safer traveling and sleeping with several thousand strangers in unknown towns than hiring a smuggler or trying to make the trip alone.(AP Photo/Rebecca Blackwell)

A family walks among other migrants in the Central American migrant caravan that slowly making its way toward the U.S. border, outside Arriaga, Mexico, before dawn on Saturday, Oct. 27, 2018. Many migrants said they felt safer traveling and sleeping with several thousand strangers in unknown towns than hiring a smuggler or trying to make the trip alone. (AP Photo/Rodrigo Abd)
https://www.sunburynews.com/wp-content/uploads/sites/48/2018/11/web1_121659340-8373c0bb6f7b47eb90d69511fd7b5228.jpgA family walks among other migrants in the Central American migrant caravan that slowly making its way toward the U.S. border, outside Arriaga, Mexico, before dawn on Saturday, Oct. 27, 2018. Many migrants said they felt safer traveling and sleeping with several thousand strangers in unknown towns than hiring a smuggler or trying to make the trip alone. (AP Photo/Rodrigo Abd)

Mexican federal police in riot gear block the highway to keep a thousands-strong caravan of Central American migrants from advancing on their way to the U.S. border, outside Arriaga, Mexico, Saturday, Oct. 27, 2018. Hundreds of Mexican federal officers carrying plastic shields briefly blocked the caravan of Central American migrants from continuing toward the United States, after several thousand of the migrants turned down the chance to apply for refugee status and obtain a Mexican offer of benefits. (AP Photo/Rebecca Blackwell)
https://www.sunburynews.com/wp-content/uploads/sites/48/2018/11/web1_121659340-9f06aa315dd74f888b99dac557cd39ba.jpgMexican federal police in riot gear block the highway to keep a thousands-strong caravan of Central American migrants from advancing on their way to the U.S. border, outside Arriaga, Mexico, Saturday, Oct. 27, 2018. Hundreds of Mexican federal officers carrying plastic shields briefly blocked the caravan of Central American migrants from continuing toward the United States, after several thousand of the migrants turned down the chance to apply for refugee status and obtain a Mexican offer of benefits. (AP Photo/Rebecca Blackwell)
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