Opioid "epidemics"?
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22-06-2017, 04:56 PM
RE: Opioid "epidemics"?
(22-06-2017 03:30 PM)Dr H Wrote:  
(22-06-2017 11:12 AM)Deesse23 Wrote:  Thats why i mentioned teeth. In Germany no dentist, ever, would prescribe you opioids, never.ever. That was my whole point: toothaches arent the kinda pain you want to counter with such potent drugs.

In parts of the US, hydrocodone, in the form of Vicodin, has been a pretty standard script for dental pain, for a long time. I have noticed that some time in recent years the size of the caps they prescribe has decreased by about 30%.

The stuff works, for sure. But the dosages prescribed -- generic, I'm sure -- are ridiculously large. At least for me; maybe I'm particularly sensitive to the drug. I was told to take two 750m caps every 4 hours "as needed" -- I took one, and was prostrated for most of the day.

Pain did go away, though. Big Grin
At one point I was directed to take 90mg of Oxycontin every eight hours with oxycodone or hydrocodone for break-through pain.

Kinda glad that's over. For now.
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22-06-2017, 04:59 PM (This post was last modified: 22-06-2017 05:02 PM by GirlyMan.)
RE: Opioid "epidemics"?
(22-06-2017 01:41 PM)unsapien Wrote:  On further review I think you maybe right, the articles I just re-read were about law enforcement warning of the possibility of weed being laced with fentanyl, but none of the articles sighted any cases where any "laced weed" has ever actually been seized by police.

I think people no doubt do lace weed with fentanyl. Hell I've heard reports of people smoking the used patches they find in gramma's trash can. But you would know that when you're buying it because you'd be paying a premium. "Cutting" usually means diluting it with a cheaper substitute to increase profits. Only point I'm making here is that it is unlikely that anyone is going to unwittingly overdose on laced weed because it wouldn't accidentally end up in a street batch mixed with non-laced weed. Still could easily accidentally overdose from it though.

I think we will come up with other synthetic painkillers which act on something other than the opioid receptors, it's just that we know a lot about how the opioid receptors work. We are working on synthetic opioids now which act on the opiate receptors without increasing dopamine to minimize the addictive aspects while still retaining the analgesic properties. Here and here.

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22-06-2017, 05:49 PM (This post was last modified: 22-06-2017 06:19 PM by Jeanne.)
RE: Opioid "epidemics"?
Those who have intractable pain are the ones getting screwed by this witch hunt. First their Primary Care Physicians got hounded about prescribing and then the hoops to jump through just to prescribe got smaller and more numerous.

Yes...there were doctors who were over-prescribing and wrongfully prescribing, but they had been "taught" by their associations to control ALL pain, to make their patients pain-free at all times and were penalized if on a survey the patient indicated that they left the ER still in any pain. And...pharma pushed the heavy pain killers. A lot of them got caught and paid for their misdeeds.

So...now, the old docs are retiring and those who are still practicing do not want the headache and danger of prescribing for their chronic pain patients. They get shifted over to regional pain clinics and once they are a registered patient of a pain clinic, they can never be treated for pain by another PCP.

Okay...this is our experience in Maryland.

Pain clinics are limited as to what and how much they are allowed to prescribe. Forget about stopping the pain. If the drug of choice doesn't work, then it is the patients job to work to get them to change it. Most of these people are in desperate condition and they are treated as if they are drug addicts, now.

Intractable pain, such as, cancer and adhesive arachnoiditis takes opioids to lessen. It isn't going to get better. But since we have an "epidemic" of high school kids and other young people who MAKE A CHOICE to take a opioid pill with alcohol at a party and then go on to become addicted to opioids and maybe die from it or develop a heroin addiction and die from it...the people with chronic pain and intractable pain must now suffer.

So...they give them Extended Release Opioids, which are "addiction proof" but do not work nearly as well as the Standard Release Opiods. "And...no, we can't prescribe a "break-through" medication for you. You can take tramadol or ibuprophen in between."

Patches were thought to be a good addiction proof way of dealing with the problem, but addicts chewed the patches. And addicts chew the ER opioids, often killing themselves in the process.

And...still the chronic pain and intractable pain people get screwed and treated like addicts. Pee test every month when you pick up your prescription, which cannot be filled a day too early. And you are allowed one time a year for someone else to pick up your prescription...maybe, if we think you are worthy. "We know you are all selling your opioid meds and you don't really have such bad pain." Or at least that is the way they are made to feel.

"And...really we consider that if your pain level is a 4, then you are one of our successes. We aren't here to get you to be pain free. It doesn't matter that for 12 years you were mostly pain-free under your PCPs care, using Standard Release opioids. The government won't allow that anymore."

My family has had the sorrowful experience of knowing two young people who could not get the pain meds that they needed for the intractable pain they suffered. It was so ridiculous. One was allowed 7 pills per month for pain they had nearly every day for years...and yes, they used other means of trying to dull the totally debilitating pain. Finally, they each "overdosed."

We are hoping that our new medical pot clinics that will open next year in Maryland will be of some help.

When my husband can no longer get a prescription for his opioids...well, he will be in no condition to do anything, so I will call an ambulance. If such a time exists when there is no ambulance and no hospital, then he will choose to die by his own hand or by mine.

That is the kind of pain that many people try to numb with opioids and it is getting harder and harder to get any help from the medical institutions to do it.

I say let the addicts kill themselves with opioids and heroin and leave the people who actually need the pain control alone. If a kid is so stupid as to pop that pill and drink and move on to heroin and finally kill himself, well I hope he didn't breed.

Jesus Christ! I am sick to death of the whine about bored children who get into trouble despite the "fact" that they were just good kids looking for fun. Let them get a fucking job and make something of themselves.

Is this post dripping with venom? So sorry...

Really...I am sorry. I have so much anger over this issue. I barely let it out in this rant. I know there is another side to this tragic story and I am sorry for that side and for any who have experience with it.

-Jeanne

"The Ox is slow, but the Earth is patient."
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22-06-2017, 06:41 PM
RE: Opioid "epidemics"?
(22-06-2017 10:34 AM)Vera Wrote:  Only, opioids actually have a primary reason for existing which is NOT the entertainment (or however you want to call it) value.

The fact that people would abuse anything that comes their way shouldn't mean that people living in excruciating pain should be denied the only thing we have so far that can help them.

It isn't about denial of the pain, it is about NOT KILLING THEM by allowing them to become addicted.

There is a huge difference between being terminal and pain management outside of being terminal. Doctors have to weigh the risks and benefits. There are risks to taking pain pills and it isn't just about the pain itself. If a doctor thinks giving it to them can speed up body damage, or cause them to be uncoordinated like a drunk person, that can cause that person to have accidents in the home which could in tern cause them to fall or break bones, especially with elderly with mobility problems.

Like heroine and alcohol it becomes your brain screaming for it beyond your own will power. Ethical doctors will ask you questions and check your blood, and if they feel you are on too much of a high dose OF ANYTHING, they will try a different medication or a lower dose or take you off of it completely. Having taken care of an elderly mother for several years I can tell you you don't keep someone on something and not monitor it, and that is with any medication, not just pain pills.

With any medication, not just pain pills, the issue is risk vs benefit and frequent monitoring. If a doctor is not doing that, they should lose their licence.

What good would a pain pill do you if it destroys your liver or kidneys or if you become so incoherent and rubbery you have an accident in your home, or worse, you drive on them and have an accident?

Pain pills in general are only meant for short term relief. They are not meant to be taken forever. The only time you can say they are far more appropriate is for terminal people.

Poetry by Brian37(poems by an atheist) Also on Facebook as BrianJames Rational Poet and Twitter Brianrrs37
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22-06-2017, 06:55 PM
RE: Opioid "epidemics"?
Do people who use opioids for chronic and intractable pain become addicted?

In only the same way a diabetic becomes addicted to his or her insulin.

Yes, no doubt there are addictive withdrawal symptoms when a chronic/intractable pain victim is taken off or weans off the opioid meds. But...the symptoms pale in comparison to the EXCRUCIATING PAIN that they have again.

Using for pain does not create a high like a drug addict gets. There is a time of slight general well-being when the meds kick in and start relieving the unrelenting pain. Oh gosh, that might be an addicting feeling.

If you need pain pills for short term relief, then you don't need opioids and you don't have chronic or intractable pain. I will agree with you there.

There are many non-terminal people who need opioids. Well...we are all terminal, but you know what I mean.

Most people with AA take more than one opioid to relieve their pain to a bearable degree. And..OTC stuff and maybe an implant, as well. It is cruel shit, is Adhesive Arachnoiditis.

"The Ox is slow, but the Earth is patient."
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22-06-2017, 06:58 PM (This post was last modified: 22-06-2017 07:11 PM by Fireball.)
RE: Opioid "epidemics"?
I see "Not One More" bumper stickers on cars. I had to go look it up. It refers to heroin deaths. The problem is there for other drugs, as well- adulteration. There's shit like fentanyl and carfentanyl added to heroin, both of which can give a "nice" high, but which can cause death, in minute quantities.

People generally die from an overdose because the source isn't reliable. One time it will be fine (as cut), but then the unfortunate addict will get a purer dose, or have an adulterant added by some person who knows exactly dick about what they are doing, and die. Jimi Hendrix and Janice Joplin are classic examples, though Jimi died because the accepted method for treating a heroin overdose in the drug culture was to pour milk in the victim's mouth. Jimi drowned in milk. Dodgy Dying customers is a bitch, but there are people lined up behind them.

Legalize drugs, control them for purity. I drink alcohol, and am lucky not to drink to excess (for the most part). But I buy most alcoholic beverages (in a sealed container- I very seldom buy alcohol when I am at a restaurant, and I don't go into bars, since the Navy- another story for another time) for that reason.
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22-06-2017, 07:07 PM
RE: Opioid "epidemics"?
Completely agree Jeanne
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22-06-2017, 07:08 PM
RE: Opioid "epidemics"?
People die from heroin overdoses because they made a choice to stick a heroin needle in their arms.

Because of that, people with chronic/intractable pain suffer with poor choices in medication from physicians who have been made afraid to treat their pain as individual suffering needing individualized relief. And they are treated as if they are addicts. Elderly victims are penalized for being in pain as they have even more trouble getting to and from clinics and pharmacies. Those who are still working, struggle to make do with what they are allowed to have and it is hard and painful and exhausting.

"The Ox is slow, but the Earth is patient."
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22-06-2017, 07:32 PM (This post was last modified: 22-06-2017 07:37 PM by GirlyMan.)
RE: Opioid "epidemics"?
(22-06-2017 06:41 PM)Brian37 Wrote:  Pain pills in general are only meant for short term relief. They are not meant to be taken forever. The only time you can say they are far more appropriate is for terminal people.

Not true. My brother had chronic debilitating pancreatitis and was on every sorta pain pill there was for over a decade until the damn pancreas finally just healed itself. The only other treatment option available for his chronic intense pain was a nerve block. Problem with a nerve block is that if his appendix or gall bladder burst he might die before he even felt it. My wife's been on like 4 vicodine/day for the last 5 years for a back injury from a car accident. Her only option is also a nerve block. There are drugs out there which can help with tolerance so at least she doesn't need higher and higher dosages (doesn't hurt that it also potentiates weed and Wellbutrin Smile ). What are other options do you know of for treating chronic pain?

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22-06-2017, 07:59 PM
RE: Opioid "epidemics"?
(22-06-2017 05:49 PM)Jeanne Wrote:  We are hoping that our new medical pot clinics that will open next year in Maryland will be of some help.

I'm kind of just assuming that we've already voted on and passed recreational weed in Maryland. It's kind of embarrassing that we weren't first out of the block given that we pride ourselves on our progressiveness. I checked out the decriminalization statutes and it looks like I can grow 6 plants and have up to 50 lbs and it's now just a misdemeanor so the cops in my area don't give a shit about it. They can deal with the bigger problems like heroin in and around Baltimore.

The pharmacies in my area of Maryland (near College Park and the DC line) have stopped stocking opioids (and some have stopped dispensing them completely) so there's no way for my wife to get it early even though she's friendly with the pharmacist. Think the wife only has to take a pee test every 3 months and its a ridiculous way to make sure she's not selling them anyway. It only stays in your system for a day or two so all she has to do would be to sell all but 2-3 days worth and start taking them before the pee test. They'd have to do hair testing if they wanted to make sure she was taking them the whole time. Also, she hasn't had the problems with her pain doc that you describe. She did have problems with one of his PAs who started to get the attitude you're describing but he didn't last a month before the pain doc fired him. A doctor who specializes in chronic pain management should have a higher degree of empathy than your average proctologist I should think.

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