Opioid State Of Emergency

[goldberry]

Please discuss non-politically.  This is an issue affecting all Americans regardless of party or political view.

 

http://thehill.com/business-a-lobbying/344674-white-house-opioid-commission-urges-trump-to-declare-federal-state-of

 

The White House's opioid commission is recommending that President Trump declare a federal state of emergency over the epidemic, which has struck dozens of states.

 

"The first and most urgent recommendation of this Commission is direct and completely within your control. Declare a national emergency under either the Public Health Service Act or the Stafford Act," the commission wrote in its interim report. 

 

"Your declaration would empower your cabinet to take bold steps and would force Congress to focus on funding and empowering the Executive Branch even further to deal with this loss of life."

Thoughts on how/if this would help?  What actions could be taken under a national emergency that couldn't be taken otherwise?  I don't have a good understanding of it.

[catz]

I don't know about how we should handle opiod addiction.  I certainly don't want it to make them easier to get.  I do think doctors should be checking in with patients about pain killer use as follow up to surgery or injury recovery.  I think this discussion could get political so maybe it won't last long.

 

However, I keep seeing c-sections in particular being referenced in the discussion.  Are opiods really subscribed much more for c-sections than other open abominable surgeries?  I just highly doubt it.  My husband had hernia surgery and had a similar prescription for pain killers with much smaller incisions.  Anyway, not that doctors shouldn't have tight reigns on opiods - they should.  I think pain killers and PPD symptoms should be talked about in follow up.  It just enrages me that pain killers after c-section in particular are in the spot light. 

 

http://www.huffingtonpost.com/entry/mothers-opioids-after-c-sections_us_5969121be4b03389bb17376c

[goldberry]

However, I keep seeing c-sections in particular being referenced in the discussion.  Are opiods really subscribed much more for c-sections than other open abominable surgeries?  I just highly doubt it.  My husband had hernia surgery and had a similar prescription for pain killers with much smaller incisions.  

 

That's bizarre, I've never heard that connection before, but I agree it hardly seems like a root cause sort of thing.  Maybe just another thing to pick on that doesn't really solve anything.

 

When Dh had a certain surgery, he was prescribed 10 pain pills.  He used two of them.  Maybe his doc was being careful not to over-prescribe.

 

I know that pain management places have been really cracking down over the last several years, but in some cases it makes things really difficult.  My mom is under a pain management clinic in Texas.  She used to come to Colorado in the summer, and a pain management doctor would see her here while she was in the state.  Now that clinic will not even see her unless the clinic in Texas totally terminates her from there.  ??  They were already in communication with the Texas clinic, so they could verify she wasn't "double dipping".  It has now made it impossible for her to be away from Texas for any longer than 2-3 weeks, because she has to go back for a clinic appointment to get medicine refills.

[goldberry]

What I was thinking with that experience above, is that even though the pain clinics are cracking down, etc., it does not seem to be helping.  That has been going on over the last ten years.

[Guest]

No, declaring a state of emergency won't help. We have been dealing with this ad nauseum on a state level and it's a complex problem to which solutions from the top down are not particularly helpful. Managing it on the subscriber side has been in effect for years in most states and is improving every quarter. Managing it from the patient side is the problem, and much trickier to solve.

[kroe1]

This epidemic will not be solved until government gets out of the practice of medicine. They have benchmarks in place which include patient satisfaction. Patient satisfaction includes, "was your pain controlled?" In addition, Medicare also has a reimbursement portion tied to pain control via patient satisfaction.

 

Until doctors have the freedom to prescribe based on their medical knowledge rather than administrative surveys, we will get nowhere in this war.

 

Finally, more states are allowing nurse practitioners and physician assistants to prescribe opioids. On average, they prescribe more pills per diagnosis than physicians. To some extent, this is irrelevant since they will quickly follow suit when physicians quit prescribing.

 

Sadly, the medical industry was trying to get a better handle on this epidemic it created right before the satisfaction scores were tied to reimbursements. Now our country is screwed again.

 

Things that do help include pharmacy sharing of databases. Fortunately, some states are over-riding HIPPA laws and allowing shared databases. Florida, for example, is very good about alerting providers to frequent controlled substance prescriptions to the same person. Before HIPPA, physicians all talked among themselves about local doctor shopping patients. This kept at least some control on the problem.

 

Medical schools are notorious for teaching the importance of pain control without teaching many methods outside of opioids. This is starting to change.

 

If one does choose more government intervention, then it should be directed at fining physicians who overprescribe, as well as quickly closing pill mills.

[Murphy101]

I don't see how it will help.

 

The war on drugs (aka our own citizens) doesn't work.

 

Universal healthcare.

Improved mental healthcare

Improved addiction services

[Farrar]

On my way to drop off ds at camp in rural PA a week ago, I was behind an SUV for a long time that had only one bumper sticker - an extremely large sticker that just said "[Expletive removed] Heroin." I felt like it summed something about rural areas up these days sadly. :(

 

I think universal health care is a big, key part of the solution, though not a total one. There needs to be a new approach with doctors and pain and total care. 

[Murphy101]

Pain control is important. When done right, it reduces pain relief needs and speeds healing.

 

In some cases, pain not being properly managed can lead to addiction.

 

We do not have to leave patients' pain untreated to curb the opioid addiction problem.

[gaillardia]

NPR did a story on the opioid epidemic last summer. 

In order to be admitted to rehab a person has to be having an actual emergency (for instance, a guy had an "accident" due to his abuse of opioids then was able to be admitted to a rehab instead of waiting on the long list or being denied due to health insurance or lack of...)

ANYWAY, besides the obvious (how to stop addictive behavior before it starts), the biggest problem is availability of rehabs and the intensive long-term treatment needed by some. 

That to me is the sad part of this story, decent, efficient, affordable rehabs with high quality counseling and treatment programs.

Maine is having a very difficult time with heroin addiction, overdoses, deaths.

In some areas of the country, emergency services can't hardly keep EMTs due to the increase of overdoses and deaths they have to attend to and dangerous circumstances surrounding those situations.

 

Edited to add: I think I might be spinning off in a direction this thread wasn't intended but it is still a branch of the tree.

Edited August 1, 2017 by Gaillardia

[MaeFlowers]

First, I have to say I'm surprised that opiods are sent home with patients after c-sections. I was given Tylenol for one and Advil for my second, so I simply didn't know they did that.

 

Two, I thought that pharmacies shared info everywhere (not just in Fl). If they are not, I think they should be.

 

I don't know how a national emergency declaration is going to improve the situation. I think doctors need to take the lead here in being responsible for what they prescribe. They also need to be having very real conversations with their patients regarding risks and discussing other options. (Pharmacists should also be having these conversations with clients.)

 

But, I curious how much of this opiod problem is caused by written prescriptions. I have a sneaky suspicion that much of these drugs are being bought on the street. Maybe that's where a task force may be useful?

Edited August 1, 2017 by MaeFlowers

[Wheres Toto]

I don't know about how we should handle opiod addiction.  I certainly don't want it to make them easier to get.  I do think doctors should be checking in with patients about pain killer use as follow up to surgery or injury recovery.  I think this discussion could get political so maybe it won't last long.

 

However, I keep seeing c-sections in particular being referenced in the discussion.  Are opiods really subscribed much more for c-sections than other open abominable surgeries?  I just highly doubt it.  My husband had hernia surgery and had a similar prescription for pain killers with much smaller incisions.  Anyway, not that doctors shouldn't have tight reigns on opiods - they should.  I think pain killers and PPD symptoms should be talked about in follow up.  It just enrages me that pain killers after c-section in particular are in the spot light. 

 

http://www.huffingtonpost.com/entry/mothers-opioids-after-c-sections_us_5969121be4b03389bb17376c

 

I was just given Advil after my c-sections.  I think 800 mg, so a large dose but still just ibuprofen.  

 

I always heard that dental surgery was a big one for opioids.  I know I was prescribed oxycodone when my wisdom teeth were removed.   All narcotics make me nauseous though, so it was back to the Advil.

 

ETA:  All the pharmacies around here track the Sudafed you buy.  They are connected and you can only get so many at a time, even if you go to a different pharmacy.  They scan your drivers license.  So, if they can do it for Sudafed, I would think they could do something to track opioid prescriptions. 

Edited August 1, 2017 by Where's Toto?

[nixpix5]

This epidemic will not be solved until government gets out of the practice of medicine. They have benchmarks in place which include patient satisfaction. Patient satisfaction includes, "was your pain controlled?" In addition, Medicare also has a reimbursement portion tied to pain control via patient satisfaction.

 

Until doctors have the freedom to prescribe based on their medical knowledge rather than administrative surveys, we will get nowhere in this war.

 

Finally, more states are allowing nurse practitioners and physician assistants to prescribe opioids. On average, they prescribe more pills per diagnosis than physicians. To some extent, this is irrelevant since they will quickly follow suit when physicians quit prescribing.

 

Sadly, the medical industry was trying to get a better handle on this epidemic it created right before the satisfaction scores were tied to reimbursements. Now our country is screwed again.

 

Things that do help include pharmacy sharing of databases. Fortunately, some states are over-riding HIPPA laws and allowing shared databases. Florida, for example, is very good about alerting providers to frequent controlled substance prescriptions to the same person. Before HIPPA, physicians all talked among themselves about local doctor shopping patients. This kept at least some control on the problem.

 

Medical schools are notorious for teaching the importance of pain control without teaching many methods outside of opioids. This is starting to change.

 

If one does choose more government intervention, then it should be directed at fining physicians who overprescribe, as well as quickly closing pill mills.

I couldn't agree more.

[Ottakee]

My daughter went to ER for neck pain and she got Valium and Norco. I refused to fill them as pain was not that bad. She was to Er as she has a genetic brain malformation and we needed to rule.out an issues with that.

[jewellsmommy]

I was just given Advil after my c-sections.  I think 800 mg, so a large dose but still just ibuprofen.  

 

I always heard that dental surgery was a big one for opioids.  I know I was prescribed oxycodone when my wisdom teeth were removed.   All narcotics make me nauseous though, so it was back to the Advil.

 

ETA:  All the pharmacies around here track the Sudafed you buy.  They are connected and you can only get so many at a time, even if you go to a different pharmacy.  They scan your drivers license.  So, if they can do it for Sudafed, I would think they could do something to track opioid prescriptions. 

 

I took 800mg ibuprofen after my c-section and after my hysterectomy. It's great for pain and inflammation. I was relying on it for my dental problem -a strange cyst above 3 teeth and below my nose. It was the only thing I needed until I developed an ulcer  :glare: .  After that I had to rely on narcotic meds. I hate them. I can take them for maybe 2-3 days before I can't stand them anymore. 

 

Yes, the pharmacy tracks them. I had to have an awkward conversation with the pharmacist when my general doc prescribed xanax and a narcotic at the same time. I was having tremendous anxiety at the time. The combo flagged me, and I felt like I was being accused of being up to something nefarious in filling legitimate scripts.

Edited August 1, 2017 by jewellsmommy

[StephanieZ]

I live in the heart of it . . . 

 

and, no, we don't need a state of emergency. 

 

We need funded rehab, funded mental health, funded regular medical care (to treat pain properly, with follow up/recheck appointments, etc), funded child care for kids whose parents are in rehab -- in or out patient. We need more doctors allowed to prescribe suboxone. 

 

If rehab and health care were available and affordable, it would do a lot to heal the problem. 

 

Waiting lists are weeks to months long. 

 

I have a friend who is an MD working in addiction medicine (suboxone treatment, etc). 

 

There are a lot of problems that can be addressed to decrease the damage done by addiction. We just need the money to deal with it. 

[JumpyTheFrog]

I'd like to see more research and emphasis in using things like TENS units instead of or in addition to drugs. DH once had a coworker who was in a car wreck. He eventually got a TENS unit for his shoulder, but only after they had him try drugs that made him too loopy to work. Finally, someone suggested a TENS unit and it helped enough he could work and still think clearly.

 

Also, I'd like to see more emphasis on physical therapy, preventative exercise, trigger point therapy, etc to help back and knee pain. So many people are in pain, often from being sedentary and overweight. DH commented a few months ago that he was people watching during the kids' gymnastics practice. He couldn't believe how many people in their late 40s to early 50s shuffled or waddled rather than actually walking. We both see this all the time...people under 55 who look like they can barely walk. Not just a small percent, many, many people. My dad is 65, diabetic, and over a hundred lbs overweight and he can walk better than these people.

[JumpyTheFrog]

I read an article a few months ago that stated that part of the reason for addiction increasing was that the drug companies push doctors to prescribe higher doses twice a day rather than a lower dose three times a day. Apparently, the twice a day regiment doesn't work as advertised and leads to more addictions.

[goldberry]

If one does choose more government intervention, then it should be directed at fining physicians who overprescribe, as well as quickly closing pill mills.

 

What do you think about the role of mental health/addiction treatment and rehab?  There are two sides, the supply side and the demand side.  Most states don't have the funding to increase mental health and rehab services to a level that is needed.

 

It seems that over the last several years the focus as been on the supply side, with good but not good enough results.

Edited August 1, 2017 by goldberry

[AmandaVT]

First, I have to say I'm surprised that opiods are sent home with patients after c-sections. I was given Tylenol for one and Advil for my second, so I simply didn't know they did that.

 

Two, I thought that pharmacies shared info everywhere (not just in Fl). If they are not, I think they should be.

 

I don't know how a national emergency declaration is going to improve the situation. I think doctors need to take the lead here in being responsible for what they prescribe. They also need to be having very real conversations with their patients regarding risks and discussing other options. (Pharmacists should also be having these conversations with clients.)

 

But, I curious how much of this opiod problem is caused by written prescriptions. I have a sneaky suspicion that much of these drugs are being bought on the street. Maybe that's where a task force may be useful?

 

When I had my c-section in 2008, the Dr's and nurses kept trying to push Percoset (or Vicodin, can't remember which one) on me. I had one, and it made me so nauseous that I requested that I only be given Tylenol or Advil for the rest of my hospital stay. I was lectured about needing to stay on top of my pain and that I needed the stronger drugs to do so. I replied that I'd rather deal with pain than pain and nausea so I'd stick with the OTC stuff. I was fine. 

 

Some Dr's up here are notorious for pushing pain killer prescriptions. My neighbor is dealing with this right now. He blew out his knee a couple of years ago and was given a script for Oxy after. Then another script (same Dr.) and another. By then he was addicted and has been working to get clean since. He's been in the methadone clinic and he told me that he ended up with 11 different prescriptions from his Dr for the side effects of getting off the Oxy. I've known this guy for a long time, and feel for him. He's a bit older than us and he trusted his Dr. He's not a big computer guy and it didn't occur to him to ask Dr. Google about side effects of the Oxy. He went off of everything cold turkey about 6 weeks ago and has had a really hard time. He's been in and out of the hospital with side effects from dropping the methadone, but he doesn't want to be on any medication.

 

It's such a crap situation that's really been affecting Vermont (and all the other states). It seems like every week now, police are arresting heroin dealers. My friend has been doing a ton of research on it for our local newspaper - she's been writing a series of articles. I'm her pre-editor before she sends it to her editor, so I've been reading all of her research. I think it is an emergency situation. 

[luuknam]

At my first c-section the hospital nurse was pushing me to take more painkillers (opioids) than I felt I needed. I was not amused by that (and simply took only as much as I felt I needed). 

 

Later, a dentist didn't do a filling right and I ended up needing a root canal or the tooth pulled. This started hurting like crazy on a Friday evening, of course, and I ended up using up all of the hydrocodone I had left over from a surgery a few years prior. My dentist looked at it on Monday and said he couldn't get me in until Wednesday, and told me to just take 800mg of ibuprofen. Um, I'd been doing that all weekend, and the hydrocodone was the only way that the pain didn't make me go postal (it still HURT, but it's easier to be chill about it hurting like mad when on an opioid). Luckily, he referred me to a dental surgeon who got me in that same day to pull that molar, and who was kind enough to prescribe a few more hydrocodone pills for emergencies when I explained what happened (which I still have, even though that's been a couple of years, but I'm really glad that if another emergency arises I won't be at the mercy of some doctor who might be like "ibuprofen works just fine"). 

 

In other words, ime, often medical providers either push too many opioids on you, or they refuse to give you any altogether.

 

I have never had opioids for wisdom tooth removal, and ime ibuprofen is just fine for that. Here in NY they do put opioids in a database, so my GP grilled me about the hydrocodone the dental surgeon gave me. I don't have a problem with a database like that, but seriously, chill, unless you see a pattern of frequent opioid prescriptions. 

 

Same thing with benzodiazepines... doctors seem to either not want to prescribe any at all, or be happy to prescribe way more than I'm willing to take. It's so weird. 

[tdbates78]

I really wish insurance companies would finally recognize the value in naturopathic medicine and cover the costs of services. I am a firm believer in alternative medicine and alternative pain management in the the form of acupuncture, chiropractic health, physical therapy etc. I came about naturopathic medicine after exhausting seemingly all healthcare routes to get to the bottom of some health care issues that my doctors were too quick to write an RX for. Taking control of my own health via supplements, diet and lifestyle has been life changing.

 

I get extremely nauseous on any kind of narcotic so RX strength Advil,Tylenol Ibuprofen is all I can take after a surgery.

Edited August 1, 2017 by tdbates78

[Farrar]

In one of the articles I read they had a statistic that was something like a third of people who take the full dose that's given as standard for many common surgeries get hooked to the point that they experience withdrawal symptoms. I was astounded by that. Obviously not everyone takes the full dose and some people - perhaps even the majority - will deal with the withdrawal symptoms instead of seeking out more drugs. However, that really brought home for me the extent to which medical practices are helping drive this.

 

I agree with something someone said above - doctors are very uneven about this - some won't take your pain seriously, others hand out this stuff like it's no big deal.

 

The whole pain scale thing is definitely feeding into it. I don't think doctors should ignore pain, but it also seems like a comprehensive approach would include counseling people about their options and the risks beforehand. I mean, there's no reason that everyone needs to walk out of a wisdom teeth removal with a pile of serious drugs without understanding the risks.

[ktgrok]

I read an article a few months ago that stated that part of the reason for addiction increasing was that the drug companies push doctors to prescribe higher doses twice a day rather than a lower dose three times a day. Apparently, the twice a day regiment doesn't work as advertised and leads to more addictions.

 

This makes sense to me. I often end up taking a dose sooner than expected, but a lower dose more often would work fine. 

[luuknam]

Btw, I have no clue how declaring a state of emergency would help (since I have no clue what options that would bring to the table that currently are unavailable). 

[laundrycrisis]

I feel that opioids are almost pushed onto patients. I refuse them, even after surgery. I've been offered Rx for them multiple times, for pain that was totally manageable without them. When I say no,they ask if I'm sure. Medical professionals always seem so surprised when I do not want them. I know they give me vertigo and make me nauseous, and they are habit forming, and have dangerous side effects. Save them for the people who really need them ! And support exploration of alternative drugs, supplements, techniques like acupuncture, and all other possible ways to manage pain with no or at least less of this class of drug.

[Vida Winter]

I don't know a lot about it but had the impression that illegal opioid drugs (stronger than from the pharmacy) were the cause of the spike in deaths.

[luuknam]

I don't know a lot about it but had the impression that illegal opioid drugs (stronger than from the pharmacy) were the cause of the spike in deaths.

 

 

People die from prescription ones too, afaik usually from the tylenol that's part of, for example, hydrocodone. Some of those people got prescribed too much by one doctor, more commonly they get multiple doctors to prescribe it or just buy it on the street. But either way, they're still normal prescription opioids. Obviously people die from heroin and fentanyl and the like as well, sometimes when they're addicted to prescription opioids and their doctors won't prescribe those anymore so they turn to illegal drugs. And some people simply seek out illegal or prescription drugs from dealers without ever having had a pain issue. It's complicated. 

 

ETA: actually, iirc fentanyl is a prescription drug as well. But w/e. You get the idea... Multiple sources, multiple reasons, complicated to solve. 

Edited August 1, 2017 by luuknam

[Lanny]

I don't know a lot about it but had the impression that illegal opioid drugs (stronger than from the pharmacy) were the cause of the spike in deaths.

This is part of the problem. There's something they import from China that is extremely potent. Begins with the letter N I think. Adulterated drugs. The FDA recently removed one drug from the market because so many people were abusing it. Many people get addicted because they had a pain issue and got hooked. Others use those drugs because they are available very cheap. Very sad.

 

Sent from my SM-G355M using Tapatalk

[Murphy101]

Opioid addiction is not about wussy people not knowing how to suck it up after surgeries or other medical procedures with just Tylenol.

 

*sigh*

[Lanny]

Far more people are abusing Opioids than probably ever used Cocaine for one example. If the government can do something else to reduce the number of Opiod deaths that would be great. Wars on Drugs normally fail but in the case of Opiod deaths if they could reduce the number of deaths that would be wonderful.

 

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[EmseB]

Opioid addiction is not about wussy people not knowing how to suck it up after surgeries or other medical procedures with just Tylenol.

 

*sigh*

No, but there are cases where people don't know what narcotics can do and just take the prescription their doctor gives them after surgery. I have a family member who became addicted this way and for a long time got all he wanted legally from a pill mill.

 

I was offered Norco after my last birth, which was not a c section, nor did I even have any injuries. But the doc was going to give me two weeks worth just so I could "make it through". I can't imagine spending two weeks on that stuff and not having trouble coming off it.

[nixpix5]

I have come at this from an interesting perspective. When I was working as a neurobiologist, my first couple of years was in addiction brain research. When I did a mid life career change I became a mental health therapist. By chance I ended up working in a school for teens with drug and alcohol as well as tech addiction for my internship and then they hired me on after I graduated. I worked with addicted teens (and their addicted family members) for a number of years before moving on. It was an eye opening time because it was on the rise in pain med abuse. Many of my students smoked the pills (which they referred to as smoking beans). When the prescription crack down started happening many of our students ended up arrested for stealing them out of homes. Once black tar heroine really hit the scene it took the place of the pain meds that became time release. Heroine was once the drug that most addicts wouldn't even consider due to the stigma of it. Once pain med addiction became a thing heroine was the next step. It was ugly and painful to watch. Here's the thing, you could throw money at it for days and it won't make much difference if you cannot get the detoxed for atleast 2 months. That means in house treatment. Once they detox they need to stay there and do intensive therapy. If the root issue that led to addition isn't dealt with then the slippery slope is to steep. Post in house treatment is the tricky part. NA can be useful for some but a way to meet up and relapse for others. Outpatient therapy success rates can be low. When someone emerges from treatment they often have the "pink cloud of sobriety" which means they are usually bought into staying clean and working a program. Once the cloud drops away it can be brutal. Often times it is lonely because their friends are using friends and going back into the same environment results in relapse.

 

The other issue is the reason for use. Yes, some people get on them for a legitimate pain issue and become addicted. More often than not though the addiction occurs in the same way any other addiction happens. Someone has a level of sadness, depression, avoidance, etc in their life that drives them towards finding artifical happiness. Therapy does not work on someone using becasue they are thinking with an addicted brain and faulty thinking patterns. It just doesn't work. They must be in house and clean.

 

This is the problem. How can we provide enough inpatient facilities and keep people from walking out of them when treatment gets hard? Opiate addiction is such an aggressive issue. Is is really hard to beat. Once the person is clean their brain goes into a compensatory response. From driving opiate receptors for so long the receptors recycle and the neurotransmitters turn down becasue the brain feels "too much" and once you remove the drug the brain is running on less neurotransmitter and receptor until it readjusts. This time period can be dark and depressing. It makes the person want to use even more.

 

So no, I don't think declaring a state of emergency will do much unless it prompts those in power to provide the resources necessary and then convince the people using the drug to seek help and stick with it. It was the most devastating job I ever had and relapse was high. Even those who went into inpatient ended up relapsing most of the time.

 

Please excuse typos. I am typing on my phone and my spell check often has a mind of its own.

Edited August 1, 2017 by nixpix5

[Bluegoat]

I don't know about how we should handle opiod addiction.  I certainly don't want it to make them easier to get.  I do think doctors should be checking in with patients about pain killer use as follow up to surgery or injury recovery.  I think this discussion could get political so maybe it won't last long.

 

However, I keep seeing c-sections in particular being referenced in the discussion.  Are opiods really subscribed much more for c-sections than other open abominable surgeries?  I just highly doubt it.  My husband had hernia surgery and had a similar prescription for pain killers with much smaller incisions.  Anyway, not that doctors shouldn't have tight reigns on opiods - they should.  I think pain killers and PPD symptoms should be talked about in follow up.  It just enrages me that pain killers after c-section in particular are in the spot light. 

 

http://www.huffingtonpost.com/entry/mothers-opioids-after-c-sections_us_5969121be4b03389bb17376c

 

I think its simply that c-sections are one of the most common surgeries - its referenced because of numbers.  And I suppose, really, also a type that's inflated, so it could be brought down, unlike things like hernia repair.

 

I'm not convinced c-sections are a big driver of addiction, though.

[Bluegoat]

I don't know what the answer is.  I know my step dad has found that there is a lot of pressure now to get all patients off them, even when they are known, long-term but stable addicts who have serious chronic pain, and the drugs are improving quality of life without causing a problem.  This is the problem I think with fads or trends like this - they tend to sweep up everything even if it doesn't make a lot of sense.

 

 

[MaeFlowers]

At my first c-section the hospital nurse was pushing me to take more painkillers (opioids) than I felt I needed. I was not amused by that (and simply took only as much as I felt I needed).

 

Later, a dentist didn't do a filling right and I ended up needing a root canal or the tooth pulled. This started hurting like crazy on a Friday evening, of course, and I ended up using up all of the hydrocodone I had left over from a surgery a few years prior. My dentist looked at it on Monday and said he couldn't get me in until Wednesday, and told me to just take 800mg of ibuprofen. Um, I'd been doing that all weekend, and the hydrocodone was the only way that the pain didn't make me go postal (it still HURT, but it's easier to be chill about it hurting like mad when on an opioid). Luckily, he referred me to a dental surgeon who got me in that same day to pull that molar, and who was kind enough to prescribe a few more hydrocodone pills for emergencies when I explained what happened (which I still have, even though that's been a couple of years, but I'm really glad that if another emergency arises I won't be at the mercy of some doctor who might be like "ibuprofen works just fine").

 

In other words, ime, often medical providers either push too many opioids on you, or they refuse to give you any altogether.

 

I have never had opioids for wisdom tooth removal, and ime ibuprofen is just fine for that. Here in NY they do put opioids in a database, so my GP grilled me about the hydrocodone the dental surgeon gave me. I don't have a problem with a database like that, but seriously, chill, unless you see a pattern of frequent opioid prescriptions.

 

Same thing with benzodiazepines... doctors seem to either not want to prescribe any at all, or be happy to prescribe way more than I'm willing to take. It's so weird.

Kind of off topic but...

 

When I had my first, thr nurse pushed the button for the iv as soon as I woke up. She didnt even ask if I had any pain. I didnt take any more that night but the next morning, when the shift changed, the nurse walked in and went straight for the button before I even had the chance to say stop. I puked on her. She was lecturing me on how I needed the pain meds and I has to explain to her that I wasnt in any pain. Because I wasnt in any pain, they pulled my iv. Of course, then they started bringing me tylenol. I didnt need that either but they insisted I take it.

 

With my second, I was in pain. It wasn't foul language pain but just a very annoying pain. I told them that the pain meds were not working but they just kept telling me how strong a pain med it was. Uh, no. It was not working but they didnt care.

 

So, when I was in pain, I got nuttin. When I wasn't, I was given medicine anyway. Awesome.

 

And I have had the same experience with benzos. Some drs treat you like a drug seeking junkie while others give it out like candy. It's really awful when you're struggling and need help and you're made to feel bad about it. I'm sure drs struggle with that, too.

[MistyMountain]

I don't know a lot about it but had the impression that illegal opioid drugs (stronger than from the pharmacy) were the cause of the spike in deaths.

It often starts with legal prescription opioids which lead to withdrawal symptoms and then the person gets either more prescribed from pill mills or on the street from people who sell prescribed pills for profit typically altering them so they are no longer time release but they eventually switch to street drugs like heroin because it is much cheaper. A big part of the increase in addiction to heroin is from an opioid dependency that was originally prescribed legally. Fentanyl is responsible for a lot if the overdoses.

Edited August 1, 2017 by MistyMountain

[Supertechmom]

I was just given Advil after my c-sections.  I think 800 mg, so a large dose but still just ibuprofen.  

 

I always heard that dental surgery was a big one for opioids.  I know I was prescribed oxycodone when my wisdom teeth were removed.   All narcotics make me nauseous though, so it was back to the Advil.

 

ETA:  All the pharmacies around here track the Sudafed you buy.  They are connected and you can only get so many at a time, even if you go to a different pharmacy.  They scan your drivers license.  So, if they can do it for Sudafed, I would think they could do something to track opioid prescriptions. 

 

They also do that for spray paint at my local Target.....  i so don't understand the problem with tracking drugs that have to be written and carried to a pharmacy

 

 

As to why my fellow medical professionals and myself are shocked when people don't want pain medicine  because the majority of the pts are screaming for their pain meds and demanding them long before safe to give them another dose.  Many will set the alarms on their phones to wake themselves up at night to get their next dose.   Most feel they should not ever have any pain.

 

I lay blame on the fact the hospital reimbursement from gov insurance is tied to how well controlled pts feel their pain was.  If they leave without a script, negative scores.  If they didn't get pain medication as they wanted - regardless of why we couldn't give it - negative scores.  Too many negative scores, less money given back to the hospital.  Then private insurance companies see those same scores and renegotiate their rates. Pain control  should not be tied to reimbursement.  

[MistyMountain]

There are no easy answers to this problem. Access to treatment that people do not need to worry about the cost of does need to improve but even afterwards there is a good chance of relapse.

 

There definitely was a problem with prescribing too many opiods when they are not needed and even very shady doctors who set up prescription mills. At the same time people who live with high levels of pain do need that controlled and there seems to be no middle ground sometimes. People are more likely to become addicted when they are depressed or lonely so affordable access to mental health preventively is another thing that is needed.

[kroe1]

What do you think about the role of mental health/addiction treatment and rehab? There are two sides, the supply side and the demand side. Most states don't have the funding to increase mental health and rehab services to a level that is needed.

 

It seems that over the last several years the focus as been on the supply side, with good but not good enough results.

Rehab does not work. Long term effectiveness is less than 10%. We need to stop physicians from prescribing the crap in the first place. If one never tries it, one doesn't get addicted. Opioids addiction can begin within 48 hours of first time use.

[Seasider]

With 6 reproductive-related procedures, I think I only took about two days' worth of a narcotic - less than 5 pills - following two of them. The rest were pretty much followed up with Tylenol.

 

My kids have had a number of oral surgery procedures over the last 6-8 years. Each time the oral surgeon sends them home with a prescription for about 25 oxycodone pills. The most any of my kids have ever taken is 2 following any procedure. Last time I was there, I asked them to only write an Rx for about 8 pills. They wouldn't do it. Said they really wanted us to have them on hand rather than have to call back in for more if we ran out. 😡 So I have this box of unused narcotics waiting to be taken to the annual Rx drug turn-in that a nearby police department does, only I never can seem to not have a schedule conflict on the day that happens.

 

I really think smaller doses and alternative pain control methods need investigation. I also believe there need to be systems in place to detect doctor-hopping for multiple prescriptions. But I'm not sure what designating it a state of emergency is supposed to do.

[Joules]

I don't know what the answer is.  I know my step dad has found that there is a lot of pressure now to get all patients off them, even when they are known, long-term but stable addicts who have serious chronic pain, and the drugs are improving quality of life without causing a problem.  This is the problem I think with fads or trends like this - they tend to sweep up everything even if it doesn't make a lot of sense.

 

Yes, as a patient with chronic pain, the main result of the crackdown is preventing actual pain patients from getting meds or demeaning them by treating them like drug addicts if they ask.  I don't ask anymore, but my quality of life was better with a small amount of painkillers even if it is just a couple of pain-free nights of sleep each week.

 

I agree with Murphy that this isn't just about pain patients sucking it up.  It's about doctors spending enough time with patients to know if they have a problem and seriously instructing patients to prevent inadvertent addiction.  It's about looking at the reasons people take the drugs.  It's not just that they are available.  People have untreated mental, emotional, situational (poverty), or medical problems.  Our medical system sucks at treating the causes of the problem.

 

I think a state of emergency is helpful if it releases lots of funds, like for a hurricane.  If they are just going to start locking people up, it won't do any good at all.

Edited August 1, 2017 by Joules

[Pawz4me]

I think it's an incredibly complex issue but that a lot of it is maybe rooted in ignorance and misunderstanding.

 

I think too many patients don't have an understanding of pain and the role it plays -- that it's not something that has to be completely avoided/minimized at all costs because it's often our body's way of saying "take care."  But at the same time too much can slow healing and cause other issues (elevated blood pressure, etc.).

 

I think that too many doctors and dentists prescribe too many high powered pain pills for relatively minor things. Would it be all that difficult or time consuming to just prescribe enough for a day or two and then have the patient call if they need more? That would give doctors' more oversight to ensure prescriptions aren't being abused.

 

I'm not sure that relying on ibuprofen is always a safer or wiser choice.

 

I think we have to be very, very careful to ensure there's not too much of a backlash and that people who really truly need opiods and use them responsibly aren't stigmatized or prevented from getting the pain control they need. And aren't made too afraid to use it. I know too many elderly relatives who are already afraid to take the pain control they desperately need.

[JFSinIL]

For the first time ever I left the hospital after abdominal surgery without a prescription for Norco.  I had had to ask them to stop opiates for pain (that initial morphine is so, so sweet - warm fuzzies almost as good as nursing a newborn) after the first day as vivid almost nightmares and waking dreams were starting - just like I "enjoyed" while in the hospital for weeks post car crash a few years back. Tramadol  in particular is not my friend anymore.  Me for Tylenol asap after surgery.  A degree of pain is acceptable since it prevents one from moving too fast or trying to do too much too soon after surgery. 

 

I can see how folks can get hooked on opiates - a very fine line between using them for the worse pain and avoiding addition.

 

I do have a bottle of Norco at home from last fall's root canal - i did not need to take any, but want it on hand since hubby in particular tends to get a bad toothache and need emergency root canals late on a Saturday night.....one the hospital nurses said they do the same, hang onto not really needed prescriptions so they can quickly treat whatever crops up at home (invariably on a weekend). :-)

 

 

Edited August 1, 2017 by JFSinIL

[Hilltopmom]

Well, now that it's harder to get prescription opioids, our little rural area now that a huge heroin problem.

 

And a directly related HUGE shortage of foster homes for kids affected by it.

 

And limited treatment options.

 

Could a state of emergency perhaps make funding available for drug treatment & mental health treatment and recruitment & support for more foster homes?

Edited August 1, 2017 by Hilltopmom

[AmandaVT]

Opioid addiction is not about wussy people not knowing how to suck it up after surgeries or other medical procedures with just Tylenol.

 

*sigh*

 

Not at all no. And I hope that's not the impression I gave from my earlier post. All I was trying to convey was how much the Drs and nurses pushed opioids on me even after they made me sick to my stomach. 

 

My friend (the one who's been doing tons of research on this for work) learned that some people can become addicted to opioids after just 10 pills. That's not a lot. My dentist prescribed me 30 Tylenol w/ codeine when I was in so much pain before my root canal. DH was given 15 Vicodin in the ER to take home when he was in the middle of a gout attack. It's so easy to get addicted and can take so few doses, that the medical professionals need to be prescribing less. 

[Harriet Vane]

Rehab does not work. Long term effectiveness is less than 10%. We need to stop physicians from prescribing the crap in the first place. If one never tries it, one doesn't get addicted. Opioids addiction can begin within 48 hours of first time use.

 

I agree that rehab is limited in effectiveness, but I think it can be attributed to two main factors:

 

--It's really never, ever long enough. This is the crux of the issue. Rehab needs to be much longer.

 

--Not all rehab is equal. There are far too many facilities that simply do not offer the intense level of support needed.

 

I lived next door to one for years--the inmates patients' treatment plan consisted of a requirement to attend AA or NA meetings. That was it. Just live at the facility and attend NA or AA meetings somewhere else. No individual therapy. No group therapy. Almost no accountability other than what the facility could fine them for (like coming home after curfew). No re-education in addictions and dysfunction, and no individualized support at all. This was not rehab--it was a money-making scheme. A different example is a young friend of mine who needed hospitalization for suicide risk. In a week in a state facility, he was assessed once for about fifteen minutes. No group therapy. No individual therapy. No classes or anything. Just a really boring stay in a locked-down facility. Honestly, that's just jail and it's not going to help anyone.

 

Someone dear to me struggled with addiction and was in and out of facilities for many years. There were some that were far better than the two egregious examples I mention above. However, even the best of them couldn't keep this person very long, and even the best facilities lacked some key components of support. There simply were not enough staff and not enough money to make it happen.

[Lady Florida.]

I don't know what the answer is.  I know my step dad has found that there is a lot of pressure now to get all patients off them, even when they are known, long-term but stable addicts who have serious chronic pain, and the drugs are improving quality of life without causing a problem.  This is the problem I think with fads or trends like this - they tend to sweep up everything even if it doesn't make a lot of sense.

 

 

Yes, as a patient with chronic pain, the main result of the crackdown is preventing actual pain patients from getting meds or demeaning them by treating them like drug addicts if they ask.  I don't ask anymore, but my quality of life was better with a small amount of painkillers even if it is just a couple of pain-free nights of sleep each week.

Yes to the above. One of our local stations did a multi-part piece on how people with legitimate need for opioid meds are either having trouble getting them because pharmacies don't want to carry them anymore, or are treated like addicts when they go to fill their prescriptions. The innocent are getting caught up in this issue.

 

Opioid pain medication has a legitimate use and declaring a state of emergency or making them impossible to get without coming up with a good, non-addictive replacement isn't the answer. I don't know what the answer is but that's not it. I do think both patients and doctors need to have a better understanding of such medications. 

[creekland]

The other issue is the reason for use. Yes, some people get on them for a legitimate pain issue and become addicted. More often than not though the addiction occurs in the same way any other addiction happens. Someone has a level of sadness, depression, avoidance, etc in their life that drives them towards finding artificial happiness. Therapy does not work on someone using because they are thinking with an addicted brain and faulty thinking patterns. It just doesn't work. They must be in house and clean.

 

This is the problem. How can we provide enough inpatient facilities and keep people from walking out of them when treatment gets hard? Opiate addiction is such an aggressive issue. Is is really hard to beat. Once the person is clean their brain goes into a compensatory response. From driving opiate receptors for so long the receptors recycle and the neurotransmitters turn down becasue the brain feels "too much" and once you remove the drug the brain is running on less neurotransmitter and receptor until it readjusts. This time period can be dark and depressing. It makes the person want to use even more.

 

So no, I don't think declaring a state of emergency will do much unless it prompts those in power to provide the resources necessary and then convince the people using the drug to seek help and stick with it. It was the most devastating job I ever had and relapse was high. Even those who went into inpatient ended up relapsing most of the time.

 

This is what I see way too often.  Until one can address the root causes and "easy" escape drugs provide, it's not going to get better.  One of the root causes is addiction from real medical issues, but it's only one.  More often from what I've seen and what our news has shown here, people get on them to escape life.  They're now cheaper than alcohol I suppose, and addiction happens quickly.

 

As to why my fellow medical professionals and myself are shocked when people don't want pain medicine  because the majority of the pts are screaming for their pain meds and demanding them long before safe to give them another dose.  Many will set the alarms on their phones to wake themselves up at night to get their next dose.   Most feel they should not ever have any pain.

 

I lay blame on the fact the hospital reimbursement from gov insurance is tied to how well controlled pts feel their pain was.  If they leave without a script, negative scores.  If they didn't get pain medication as they wanted - regardless of why we couldn't give it - negative scores.  Too many negative scores, less money given back to the hospital.  Then private insurance companies see those same scores and renegotiate their rates. Pain control  should not be tied to reimbursement.  

 

:iagree:  I'm not in the medical field, but I know it would have been super easy to get pain meds for things I deal with daily.  Pretty much every doc I've seen has offered them (and for surgery, etc).  A couple even encourage taking them after I decline.  All have told me I'm unusual in preferring to deal with the pain.  I'll admit there are days the pain drives me mentally to bad places... but I'd rather deal with that than potential addictions.  That's definitely unusual though - even in my IRL circle.

 

That said, the pain I deal with is NOT in my joints.  When I had that briefly from taking too much iron... it gave me a bit more sympathy for those who have to negotiate that one all the time.  Mine was easy to fix - stop taking iron and be careful how much I eat.  That won't work for most folks.  I hope other options that work can be found/promoted.

[Bluegoat]

 

 

Yes to the above. One of our local stations did a multi-part piece on how people with legitimate need for opioid meds are either having trouble getting them because pharmacies don't want to carry them anymore, or are treated like addicts when they go to fill their prescriptions. The innocent are getting caught up in this issue.

 

Opioid pain medication has a legitimate use and declaring a state of emergency or making them impossible to get without coming up with a good, non-addictive replacement isn't the answer. I don't know what the answer is but that's not it. I do think both patients and doctors need to have a better understanding of such medications. 

 

Although, I would also want to be careful with saying "treated like addicts."  The people I was thinking of are, in fact, addicts.  They are addicts who use the drugs to deal with chronic pain, they are living their lives and getting along just fine, their use is stable and it makes no sense to try and wean them off, because that is not going to improve their quality of life.

 

Yes, it pays to be careful, especially with people who are likely to only need them short term, who have factors that suggest they might not be stable, and so on. 

 

But there has to be some ability to discern between people for whom there is a problem and people for whom it is a treatment.  And that isn't necessarily going to just be the lable "addict."