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As Opioid Epidemic Continues, Steps to Curb It Multiply

The overdose death toll from opioids, both prescription drugs and heroin, has almost quadrupled since 1999. In 2014 alone, 28,000 people died of opioid overdoses, more than half from prescription drugs.

Just last month, public awareness of the opioid epidemic reached a new level when Prince was found dead with prescription narcotics on him and authorities began to investigate their role in his demise. In recent weeks, lawmakers and regulators have moved to augment treatment options for addiction and to require more education for doctors who prescribe opioids. The U.S. House of Representatives is voting on a package of bills this week; the Senate passed its own bill in March.

Also in that span, the Los Angeles Times has published an investigation of Purdue Pharma, the maker of the blockbuster pain pill OxyContin, and CNN held a town hall meeting on the consequences of addiction to narcotics. Dr. David A. Kessler, former commissioner of the Food and Drug Administration, wrote an op-ed in the New York Times, calling the embrace of opioids "one of the biggest mistakes in modern medicine."

Today, ProPublica added warnings labels to the pages of narcotic drugs in our Prescriber Checkup news app, prompted by indications that some readers are using the tool to find doctors who will prescribe these drugs with few or no questions asked (See our editor's note).

The effectiveness of any of these steps remains to be seen. There is broad consensus on the need for more treatment options, more education, more careful prescribing by doctors. But there's still much debate about the details2014and funding2013for each of those steps.

What's clear is that in recent months there has been an increasing emphasis on the role of health providers and the agencies that oversee them to stem access to widely abused prescription drugs:

  • In March, the Centers for Disease Control and Prevention released guidelines on prescribing of opioids for chronic pain, defined as pain that lasts for more than three months (excluding pain related to cancer, end-of-life and palliative care.) The guidelines call on doctors to choose therapies other than opioids as their preferred option; to use the lowest possible doses; and to monitor all patients closely.

  • That same month, the FDA announced tougher warning labels on immediate-release opioids, such as fentanyl, hydrocodone, and oxycodone, to note the "serious risks of misuse, abuse, addiction, overdose and death."

  • Nonprofit groups and medical experts in April asked the federal Centers for Medicare and Medicaid Services to remove questions about pain control from a survey of hospital patients' satisfaction to remove any incentive to overtreat pain. And they asked The Joint Commission, which accredits health facilities, to revise its standards to deemphasize "unnecessary, unhelpful and unsafe pain treatments." The commission pushed back, saying its standards do no such thing.

Just yesterday, Dr. Steven J. Stack, president of the American Medical Association, called on doctors to do more. He encouraged doctors to use their state's Prescription Drug Monitoring Program to ensure their patients aren't shopping for multiple doctors to prescribe them drugs. He called on them to co-prescribe a rescue drug, naloxone, to patients at risk of overdose. And he told them to generally avoid starting opioids for new patients with chronic, non-cancer pain.

"As physicians, we are on the front lines of an opioid epidemic that is crippling communities across the country," Stack wrote in a statement, published on the Huffington Post. "We must accept and embrace our professional responsibility to treat our patients' pain without worsening the current crisis. These are actions we must take as physicians individually and collectively to do our part to end this epidemic."

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Nifty, Sensex could be under pressure – Thursday closing report
We had mentioned in Wednesday’s closing report that Nifty, Sensex were still in an upmove. The major indices of the Indian stock markets went higher on positive domestic cues. The trends of the major indices in Thursday’s trading are given in the table below:
Parliamentary approval for key economic legislation and value buying, buoyed the Indian equity markets on Thursday. Consequently, the key indices of the Indian equity markets traded in the green since morning, went down for a while and closed strongly. The BSE market breadth was tilted in favour of the bulls - with 1,545 advances and 960 declines. The Rajya Sabha on Wednesday had passed the Insolvency and Bankruptcy Code 2016, which is seen as a key reform that will encourage entrepreneurship. 
However, gains could be capped in the coming days as India's factory output growth turned flat in March after rising during the month before, even as the annual retail inflation for April rose to 5.39% from 4.83% in March, official data showed on Thursday. The factory output for February, based on the index of industrial production, which had turned positive at 2%, after two straight months of decline, rose negligibly by 0.1% in March, as per data released by the Central Statistics Office. As regards annual retail inflation, based on consumer price index, the rise came after two straight months of decline. The inflation rates for the preceding three months were 4.83% for March, 5.26% for February and 5.69% for January. At the same time, the annual food inflation rose sharply to 6.32% from 5.21%. This apart, the annual retail inflation in the rural economy was relatively higher at 6.09%, against 4.68% in the urban areas. Worryingly for industry, the index for manufacturing, which has the maximum weight in the overall index, actually fell by 1.2% in the month under review. While the index for mining also fell, albeit marginally by 0.1%, that for electricity grew by a robust 11.3%.
Nestle India on Thursday said its net profit for the first quarter of 2016 dropped by 19%, at Rs259 crore compared to Rs320 crore posted during the corresponding quarter in 2015. Net sales for the quarter stood a Rs2,296 crore, a drop of 8.4% compared to the same period in 2015, the company said in a statement, adding the results for the quarter have been impacted by the Maggi noodles issue in 2015. "Our results show further improvement in sequential performance, both in sales and margins. This is extremely satisfying as we move ahead and rebuild our business, particularly Maggi noodles, after a tough year. Maggi noodles have already regained leadership with over 50% of market share within five months of re-launch," said Nestle India chairman and managing director Suresh Narayanan. "We are gearing up for volume growth with renewed focus and commitment on consumer relevant innovation and renovation," he added. Around the same time last month, there was much to cheer as official data forecast the rains during the upcoming monsoon season to be above normal, and that retail inflation fell to a six-month low while factory output rose after three months of decline. Nestle India shares closed at Rs5,703.85, up 1.90% on the BSE.
Government-owned Bank of Maharashtra said on Thursday that its net profit for 2014-15 saw a drastic slide down to Rs100.69 crore as against Rs450.69 crore in 2014-15. In a regulatory filing in BSE the bank said loans and advances amounting to whopping Rs95.45 crore has been classified as fraud, and it has debited a sum of Rs54.21 crore -the unamortised fraud amount- to 'Other Reserves' account. The bank's total income for the period under review stood at Rs14,072.27 crore, as against Rs13,671.42 crore in the previous fiscal while its provisions towards bad loans and others went up to Rs1,927.41 crore last fiscal up from Rs1,541.71 crore. The bank's gross and net non-performing assets (NPA) at the end of 31 March 2016 stood at Rs10,385.85 crore and Rs6,832.03 crore. On the other hand the gross and net NPA as on 31 March 2015 were Rs6,402.06 crore and Rs4,126.57 crore. Bank of Maharashtra shares closed at Rs29.70, down marginally on the BSE.
Arvind Ltd, one of India's largest integrated textile players, on Thursday posted a 14% increase in its net profit to Rs110 crore in the quarter ended March 2016 as against Rs97 crore in the same quarter a year ago. The apparel maker's consolidated revenue grew by 14% to Rs2,320 crore for the fourth quarter of 2015-16 as compared to Rs2,041 crore in the corresponding period last year. Consolidated earnings before interest, taxes, depreciation and amortisation (EBITDA) are up by 14% at Rs297 crore as compared to Rs260 crore in the corresponding quarter of the previous year, the company said in a filing to Bombay Stock Exchange (BSE). "Our textiles business continues to deliver a strong performance as we continue to pursue a calibrated growth strategy. The brands business continues to demonstrate strong growth with 30% compound annual growth rate (CAGR) for fourth quarter," said company's director and chief financial officer Jayesh Shah. The company reported 8% growth in revenue to Rs8,450 crore in 2015-16 while its profit after tax and exceptional items for the year 2015-16 stood at Rs363 crore as compared to Rs341 crore in the previous year. Arvind shares closed at Rs301.35, up 2.19% on the BSE.
The top gainers and top losers of the major indices are given in the table below:
The closing values of the major Asian indices are given in the table below:


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