Lets talk about the opioid crisis

Turdacious · Post by **Turdacious** » Thu Apr 13, 2017 12:14 pm

In a cohort of previously opioid-naive patients, approximately 6% continued to use opioids more than 3 months after their surgery, and as such, prolonged opioid use can be deemed the most common postsurgical complication. New persistent opioid use is not different among patients who underwent minor and major surgical procedures, thereby suggesting that prolonged opioid use is not entirely due to surgical pain

http://jamanetwork.com/journals/jamasur ... ultClick=1

nafod · Post by **nafod** » Thu Apr 13, 2017 1:17 pm

They gave me 30 opioid pills following my knee procedure, and I took 4 total. One the night of, two about a week later when I was tired of not sleeping, and 1 more after. Ibuprofen otherwise. I thought 30 was way more than needed. I could easily see someone figuring they gave me 30, I'm gonna take 30.

As an OBTW, I got a prescription for Meloxicam (NSAID athritis med) and that was the bomb for relieving the pain I had.

Sangoma · Post by **Sangoma** » Thu Apr 13, 2017 10:18 pm

To me this topic brings an interesting parallel: guns. Pretty much all the arguments can be used for both opioid and gun control. Guns kill, opioids kill. Both can do good if used appropriately and responsibly. If opioids prescription should be limited so should be the sale of guns. Conversely, if guns can be sold to anyone wishing - so should be opioids. Opioids most often harm the user himself, while guns most commonly harm the people around the "user".

Following this logic I find "Jesus!" in response to the development of an efficient and indeed safer opioid Oxycontin misplaced. It's not the drug that kills, it's the user.

Turdacious · Post by **Turdacious** » Thu Apr 13, 2017 11:13 pm

Sangoma wrote:To me this topic brings an interesting parallel: guns. Pretty much all the arguments can be used for both opioid and gun control. Guns kill, opioids kill. Both can do good if used appropriately and responsibly. If opioids prescription should be limited so should be the sale of guns. Conversely, if guns can be sold to anyone wishing - so should be opioids. Opioids most often harm the user himself, while guns most commonly harm the people around the "user".

Following this logic I find "Jesus!" in response to the development of an efficient and indeed safer opioid Oxycontin misplaced. It's not the drug that kills, it's the user.

I'm guessing you've never lived in an area with a lot of junkies.

Sangoma · Post by **Sangoma** » Thu Apr 13, 2017 11:28 pm

I am guessing you have never lived in the area with a lot of broken bus stops.

TerryB · Post by **TerryB** » Sat Apr 15, 2017 1:46 am

Sangoma wrote:To me this topic brings an interesting parallel: guns. Pretty much all the arguments can be used for both opioid and gun control. Guns kill, opioids kill. Both can do good if used appropriately and responsibly. If opioids prescription should be limited so should be the sale of guns. Conversely, if guns can be sold to anyone wishing - so should be opioids. Opioids most often harm the user himself, while guns most commonly harm the people around the "user".

Cf. U.S. Const., Amend. II.

Sangoma · Post by **Sangoma** » Sat Apr 15, 2017 1:58 am

It's not the point: the use of drugs is also constitutional.

tonkadtx · Post by **tonkadtx** » Sat Apr 15, 2017 4:27 pm

This is an interesting topic. As someone who is a libertarian training to be a healthcare provider, it hits a lot of buttons. I feel that you own your body, and should be able to put what you want in it. But there is no denying the shit is poison, and massively over prescribed. Interesting story, I have a bad hip from years of judo. I went to my ortho a few years ago with shooting pains, he sent me for an x-ray and an mri, finally gave me a cortisone shot. In the interim he offered me all kinds of scrips, he said I was the only person that ever turned him down. Every single person in his office besides me was getting a scrip refilled. This is not a shitty pain management clinic, and it's in a very nice neighborhood in Manhattan. Dr. Feelgood. I found a new ortho....

Old Mother · Post by **Old Mother** » Sun Apr 16, 2017 9:58 pm

Sangoma wrote:To me this topic brings an interesting parallel: guns. Pretty much all the arguments can be used for both opioid and gun control. Guns kill, opioids kill. Both can do good if used appropriately and responsibly. If opioids prescription should be limited so should be the sale of guns. Conversely, if guns can be sold to anyone wishing - so should be opioids. Opioids most often harm the user himself, while guns most commonly harm the people around the "user".

Following this logic I find "Jesus!" in response to the development of an efficient and indeed safer opioid Oxycontin misplaced. It's not the drug that kills, it's the user.

This is a good comparison, but what about the factor of an authority figure, that you trust wholly, telling you that this medication is a necessity to get better.

Because if it's not necessary, why would it be prescribed?

An individual places their faith in a doctor's intelligence and experience to make the best choices when it comes to recovering from illness or injury. When a doctor says "Here, take these. They will make you feel better." Most patients will take them unquestionably.

There's no equal scenario when it comes to gun ownership. There's no authority figure of the same status telling you to take a gun and more importantly no one has ever bought a gun without understanding how powerful they really are.

Gene · Post by **Gene** » Mon Apr 17, 2017 1:00 am

Sangoma wrote:To me this topic brings an interesting parallel: guns. Pretty much all the arguments can be used for both opioid and gun control. Guns kill, opioids kill. Both can do good if used appropriately and responsibly. If opioids prescription should be limited so should be the sale of guns. Conversely, if guns can be sold to anyone wishing - so should be opioids. Opioids most often harm the user himself, while guns most commonly harm the people around the "user".

In the US most "gun deaths" are suicides. About three quarters of them.

Turdacious · Post by **Turdacious** » Mon Apr 17, 2017 1:42 am

Along the lines of what Old Mother suggested, there's Subsys...

The drug, called Subsys, is so powerful, and the risk of addiction and overdose so formidable, that the Food and Drug Administration requires doctors to undergo special training before they are allowed to prescribe it. And it has approved Subsys only for cancer patients who suffer intense flares of pain.

Fuller didn’t have cancer. She had been in two car accidents and been diagnosed with painful fibromyalgia [...]
Just over a year after that January 2015 office visit, 32-year-old Sarah Fuller was found dead in her bedroom by her fiance. The county medical examiner ruled her death the result of the “adverse effect of drugs.” A toxicology screen revealed a level of fentanyl in her blood that experts consulted by STAT said is lethal. There was also a small amount of the anti-anxiety medication Xanax in her system. Synthetic forms of fentanyl, most of it illegally shipped from China, have flooded into the US and Canada in the past year, causing hundreds of overdose deaths. But Sarah Fuller’s case shows that the prescription version of the drug can also be dangerous when it’s prescribed “off-label” for conditions it’s not approved for — and that Insys Therapeutics sales reps have encouraged doctors to do just that.

https://www.statnews.com/2016/09/30/fen ... ys-subsys/

Turdacious · Post by **Turdacious** » Mon Apr 17, 2017 3:49 pm

Half the teenage Medicaid patients in Alabama prescribed opioids in 2016 got them from dentists or oral surgeons, according to agency data, but experts warn such early exposure can set the stage for later abuse.

The analysis focused on teens because research shows that high school students who use prescribed opioids have a 33 percent increased risk of misuse after graduation. Overall, about one in six patients between the ages of 13 and 18 on Medicaid received an opioid from a provider in 2016.

http://www.al.com/news/index.ssf/2017/0 ... _firs.html

The report is where it gets interesting-- makes a correlation between teenage opioid use and increased Medicaid cost.

Sangoma · Post by **Sangoma** » Tue Apr 18, 2017 1:06 am

Old Mother wrote:
Sangoma wrote:To me this topic brings an interesting parallel: guns. Pretty much all the arguments can be used for both opioid and gun control. Guns kill, opioids kill. Both can do good if used appropriately and responsibly. If opioids prescription should be limited so should be the sale of guns. Conversely, if guns can be sold to anyone wishing - so should be opioids. Opioids most often harm the user himself, while guns most commonly harm the people around the "user".

Following this logic I find "Jesus!" in response to the development of an efficient and indeed safer opioid Oxycontin misplaced. It's not the drug that kills, it's the user.

This is a good comparison, but what about the factor of an authority figure, that you trust wholly, telling you that this medication is a necessity to get better.

Because if it's not necessary, why would it be prescribed?

An individual places their faith in a doctor's intelligence and experience to make the best choices when it comes to recovering from illness or injury. When a doctor says "Here, take these. They will make you feel better." Most patients will take them unquestionably.

There's no equal scenario when it comes to gun ownership. There's no authority figure of the same status telling you to take a gun and more importantly no one has ever bought a gun without understanding how powerful they really are.

There is no question opioids should be prescribed with caution, and I personally don't like the idea of a patient going home with an opioid prescription - therefore I avoid it when possible and/or resort to lower doses and presumably safer drugs, such as Targin (a mix of Oxycontin and Naloxone). On the other hand, I can appreciate the pressure doctors are under dealing with patients with chronic pain. And it's not as simple as "Take these pills". Opioids are - at least are supposed to be - the last line of options for the treatment of pain, and most doctors resort to them when other options are exhausted. Prescribing them as the first drug for treating pain is negligence.

Sangoma · Post by **Sangoma** » Tue Apr 18, 2017 3:57 am

Turdacious wrote:Along the lines of what Old Mother suggested, there's Subsys...
The drug, called Subsys, is so powerful, and the risk of addiction and overdose so formidable, that the Food and Drug Administration requires doctors to undergo special training before they are allowed to prescribe it. And it has approved Subsys only for cancer patients who suffer intense flares of pain.

Fuller didn’t have cancer. She had been in two car accidents and been diagnosed with painful fibromyalgia [...]
Just over a year after that January 2015 office visit, 32-year-old Sarah Fuller was found dead in her bedroom by her fiance. The county medical examiner ruled her death the result of the “adverse effect of drugs.” A toxicology screen revealed a level of fentanyl in her blood that experts consulted by STAT said is lethal. There was also a small amount of the anti-anxiety medication Xanax in her system. Synthetic forms of fentanyl, most of it illegally shipped from China, have flooded into the US and Canada in the past year, causing hundreds of overdose deaths. But Sarah Fuller’s case shows that the prescription version of the drug can also be dangerous when it’s prescribed “off-label” for conditions it’s not approved for — and that Insys Therapeutics sales reps have encouraged doctors to do just that.
https://www.statnews.com/2016/09/30/fen ... ys-subsys/

The idea of advertising drugs directly to the patient is criminal. One thing that patients need to be explained is that not every kind of pain can be completely controlled, and in some cases learning to live with it and developing coping techniques is the only solution. However, I can already picture a frontage newspaper title "Doctor told patient to live with pain!"

Turdacious · Post by **Turdacious** » Tue Apr 18, 2017 1:59 pm

Sangoma wrote:
Turdacious wrote:Along the lines of what Old Mother suggested, there's Subsys...
The drug, called Subsys, is so powerful, and the risk of addiction and overdose so formidable, that the Food and Drug Administration requires doctors to undergo special training before they are allowed to prescribe it. And it has approved Subsys only for cancer patients who suffer intense flares of pain.

Fuller didn’t have cancer. She had been in two car accidents and been diagnosed with painful fibromyalgia [...]
Just over a year after that January 2015 office visit, 32-year-old Sarah Fuller was found dead in her bedroom by her fiance. The county medical examiner ruled her death the result of the “adverse effect of drugs.” A toxicology screen revealed a level of fentanyl in her blood that experts consulted by STAT said is lethal. There was also a small amount of the anti-anxiety medication Xanax in her system. Synthetic forms of fentanyl, most of it illegally shipped from China, have flooded into the US and Canada in the past year, causing hundreds of overdose deaths. But Sarah Fuller’s case shows that the prescription version of the drug can also be dangerous when it’s prescribed “off-label” for conditions it’s not approved for — and that Insys Therapeutics sales reps have encouraged doctors to do just that.
https://www.statnews.com/2016/09/30/fen ... ys-subsys/
The idea of advertising drugs directly to the patient is criminal. One thing that patients need to be explained is that not every kind of pain can be completely controlled, and in some cases learning to live with it and developing coping techniques is the only solution. However, I can already picture a frontage newspaper title "Doctor told patient to live with pain!"

In the US, medical oversight is laughably bad at nearly every level.

Protobuilder · Post by **Protobuilder** » Mon May 01, 2017 1:52 am

Sassenach wrote:Over-prescribing is an enormous part of the problem in my opinion. I recently had my tonsils out and discussed with my doctor at length about NOT wanting opioids (for a variety of issues but mostly because they make me feel fucking disgusting) only to be told my only option for take home medication was a less potent opioid - which I still have half a bottle of left because I was prescribed 50 of them. I woke up in the recovery room to hear the nurse saying "okay, I'm giving you fentanyl for short term pain and dilaudid for long-term pain". I had to tell her three times not to give me any more. I had to stay overnight for observation and every single time the nurse came in to give me my 325mg of tylenol and shot of toradol I was reminded I could have up to 15mg of oxy whenever I wanted.

I read this a few days ago: https://www.washingtonpost.com/news/to- ... 113deb5a75

I thought the results were pretty interesting - but the scarier part to me was that they don't really seem to teach doctors how much pain meds someone would need for a particular surgery.

From a law enforcement perspective - I think I've seen an institutional change over the past four years or so. I think law enforcement is slowly starting to realize these people don't necessarily need to be caught up in the justice system but at the same time we don't always have the resources to help them. We see the same people over and over, and sometimes the person just escalates things to the point of having to be put in jail either because that's where they want to go or they've done something really criminal trying to get money for more drugs.

It's definitely a big community health issue.

I've had wisdom teeth removed in three countries.

In two of the three I was either offered pain killers if I wanted or told to take a Tylenol if I needed it.

However, in the US, I was so high after removal that I couldn't drive home and don't remember anything for the rest of the day. The next morning I took the first of the two-week prescription of Vicodin I had been prescribed, realized that I could learn to like this far too much and trashed the rest. I believe that the prescription had one refill on it as well.

Sangoma · Post by **Sangoma** » Tue May 02, 2017 5:12 am

The treatment of pain is a complex issue. Adult tonsillectomies are known to be very painful, and most patients do require opioids. On the other hand, after five days pain subsides significantly, and limiting opioids for that duration should take care of the majority. Also, the likelihood of overdose is far less on the background of severe pain. The trouble is that a lot of patients - Anglo-Saxons are prominent here - are not good at tolerating pain. I regularly see patients in the recovery room - called by nurses because "he is still sore" - who expect the pain rated 3/10 taken care of. Most of them are displeased when I tell them that this amount of pain should be tolerated.

We are getting softer. I marvel at occasional patient - usually first generation Asian immigrant - who will rate his/her pain at 8/10 yet will not ask for pain relief.

terra · Post by **terra** » Thu May 04, 2017 2:11 am

DrDonkeyLove wrote: Feels like the behavior of a people who have lost their way and don't have the tools to cope with it.

Yeah but the 'tools to cope' are threads connected to everything else... If people are given the real tools to cope, if they get why and how it happens and how to turn the ship around, then there's a risk they'll also gain clarity on a few other areas of life. It's way too risky to have the plebs start to wake up, that's the antithesis of 'control'...

'Panem et circenses' works for the controlling classes, and what's good for them is good for you.

Booze, pills, pron, facebook, shiny cars, reality tv, new shoes, gossip, whatever...
All misguided efforts to self-medicate the emptiness. An unconscious and futile strategy to reach across the void of disconnection from self.

"Ordinary reasonableness, sound judgement, science as a compendium of common sense, these certainly help us over a good part of the road, but they never take us beyond the frontiers of life’s most commonplace realities, beyond the merely average and normal.
They afford no answer to the question of psychic suffering and its profound significance. A psychoneurosis must be understood, ultimately, as the suffering of a soul which has not discovered its meaning. But all creativeness in the realm of the spirit as well as every psychic advance of man arises from the suffering of the soul, and the cause of the suffering is spiritual stagnation, or psychic sterility" (Jung 1932).

Or as Victor Frankl might see it, a suffering facilitated for by a chemically sustained lack of meaning.

DrDonkeyLove · Post by **DrDonkeyLove** » Thu May 04, 2017 2:53 am

terra wrote:
DrDonkeyLove wrote: Feels like the behavior of a people who have lost their way and don't have the tools to cope with it.
'Panem et circenses' works for the controlling classes, and what's good for them is good for you.

Booze, pills, pron, facebook, shiny cars, reality tv, new shoes, gossip, whatever...
All misguided efforts to self-medicate the emptiness. An unconscious and futile strategy to reach across the void of disconnection from self.

...Or as Victor Frankl might see it, a suffering facilitated for by a chemically sustained lack of meaning.

Sad and true. A lot of white Americans in opioid damaged communities didn't have to face this stuff head on in the past because they had good jobs, a G_d who favored them, and AMERICANISM to fill the void. That stuff is fading for many and they've caught up to (or got stuck behind with) our black neighbors in disfunction.

IGX

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