There are more than 12,000 deaths a year in the United States alone as a result of opioid overdose. These numbers are staggering! Over an 8-year period from 1999 to 2007, the number or deaths from prescription narcotics rose from 4,041 to 14,459. That is over a 300% increase. Such deaths are now more common than deaths from multiple myeloma, HIV, and alcoholic liver disease. Another way to look at it is that far more people are killed by prescription opioids than all those killed by heroin and cocaine combined.

Oxycodone is a major culprit in the staggering rise in opioid related deaths. In the Canadian province of Ontario, between the years of 1991 and 2004, oxycodone prescriptions increased by more than 850 percent, representing about one-third of all the opioid prescriptions given in 2006. In Canada the number of deaths due to prescription opioid use doubled between 1991 and 2004. Following the introduction of oxycodone into Toronto’s drug formulary in 2000, there was a 500% increase in deaths due to the drugs. Sadly, the vast majority of people who died from opioids had visited their doctor and received a prescription for the drug within a month of their death.

Dr. Dhalla believes that physicians have been misled to some degree by experts and pharmaceutical companies into believing that opioids are very effective for chronic non-cancer pain. They have also been misled about the risk for addiction, he says.

“In reality, the evidence for effectiveness is very thin. Our sense anecdotally is that many patients do not end up having significant relief from their pain. When you combine that with the fact that the risk of addiction is much higher than the pharmaceutical companies initially led physicians to believe, that creates a scenario where patients are being exposed to significant risks without certain benefits.”

For many years the pharmaceutical companies and experts suggested that the risk for addiction was less than 1%. Dr. Dhalla said.

“That’s the number you will see in a lot of papers in the 1990s, and even in the early 2000s. But in fact, we know that the risk of addiction for patients who are being treated for chronic pain for several months or longer is 35% — much higher than 1%. So addiction is a much bigger problem than physicians think it is,” he said.

Dr. Jerry Sobel in Phoenix, AZ, maintains that physicians need to be very careful in their prescribing of narcotics on a long-term basis for chronic non-cancer pain. Unfortunately, doctors have little high quality research to go on when writing prescriptions for these drugs. Considering that most patients on long-term opioids get limited relief of their pain, should we be prescribing them at all, especially when the addiction rate is as high as 35%? What are the medical and societal costs for chronic pain patients that get hooked on these drugs? These questions and many others need to be answered. Dr. Sobel at Sobel Spine at Sports is an expert in pain management and strongly favors non-narcotic treatments for chronic low back and other pain related conditions. He does assert that there are patients that can benefit from long-term narcotic use. Those are individuals that clearly have a significant improvement in their function and are working full-time. Further, their drug dose has not increased over time, i.e., development of tolerance to narcotics.

Blood contains 1.4 grams of salt per liter, while some of the best selling sports drinks have only 0.4 grams per liter. This is more dilute than our blood. So, if you consume a lot of a sports drink during a workout, your will actually dilute the blood. Don’t sports drink advertisements tell us that replacing salt is necessary during a workout or performance will suffer? In reality, you cannot elevate your sodium levels by drinking one of these products.

Are sports drinks a better alternative than water? Yes, from the perspective that your blood salt level will not drop as much as water because you are consuming a small amount of sodium. This is however, relative, as it will still drop if you try to drink as much as you can during the workout.

The best advice from the authors is not to overdrink and to listen to your thirst. 

Ross Tucker, PhD and Jonathan Tucker, PhD have a fascinating and very educational blog called The Science of Sports. If you are into the science of all things exercise you will love it.

This is a very timely topic. The rate of Exercise associated hyponatremia (EAH) has been on the rise over the past 30 years. Before that it was very uncommon. Hyponatremia means low blood sodium levels. Many endurance athletes are under the impression this comes from loss of sodium and other electrolytes through sweating. While it is true that we all lose sodium through our sweat, and on really hot days it is more, the body over millions of years has developed complex mechanisms to keep the blood concentration of sodium in a very narrow range. This is even if you lose salt through your sweat. If an athlete overcompensates and takes in more fluid than is necessary to keep up with thirst and dilute their blood and sodium levels drop. This can result in EAH. This can make you very sick and can even lead to death.

It is currently estimated that between 0.3% and 13% of marathon runners finish the race with medical evidence of EAH, and the worldwide incidence is increasing in spite of the mechanisms and causes being well known.

In a recent study of 197 runners solicited by personal solicitation, e-mail and flyers distributed at three local races in autumn 2009, participants were asked about their beliefs regarding fluid replacement during exercise.

Most runners (58%) stated that they drink only when thirsty. Gastrointestinal distress was the most frequently cited (71.5%) reason to avoid overhydration. It was found that runners have a poor understanding of the physiological consequences of hydration behaviours that frequently reflect messages of advertising.The conclusion of the study was that runners at highest risk of EAH exhibit behavior that is shaped by their beliefs about the benefits and risks of hydration. These beliefs are frequently based on misconceptions about basic exercise physiology.

To try and reduce the incidence of EAH the International Marathon Medical Directors Association and United States of America Track and Field now recommend drinking to the dictates of thirst, although, the global marketing of sports drinks continues to promote over drinking.

I’d love to hear your thoughts on this……..when you exercise do you drink only when thirsty?

Another good point from the article- if you are used to running on soft surfaces and want to make the switch to hard  then gradually make the shift as your body has to adapt.

http://www​.nytimes.c​om/pages/h​ealth/inde​x.html