Opioid State Of Emergency

[Lady Florida.]

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.

 

 

 

There's a difference between addiction and dependence. By "treated like addicts" they mean they are treated like they're getting these meds for enjoyment and that they shouldn't be getting them.They're treated as though they're trying to get high. Most people who take pain medication for actual chronic pain don't even experience a high.They just experience a reduction (not elimination) of pain to the point where they can function normally.

 

Edited for clarity

Edited August 1, 2017 by Lady Florida.

[Lecka]

It ended up working out fine for us, but several years ago after removing wisdom teeth (edited I don't know why I said root canal) my husband was only given 3 Tylenol 3s. They said I could come back to pick up more if he needed them.

 

This was before we had kids, and I could easily go to pick them up if he needed more.

 

But I was concerned he would be in pain, or run out over the weekend, etc. He had had a lot of pain when he got his other wisdom teeth removed, and I was worried about it.

 

It turned out he didn't need more.

 

But when I had a C-section, I was worried they would only give me a limited amount, and that it would be logistically very challenging for me to go back and get more.

 

They ended up giving me a big bottle of Vicodin, which was a relief to me because I didn't have to worry about running out, herding kids, taking a baby around sick people, my husband having to take off work, etc.

 

But then I don't think I used the Vicodin bc I was nursing. But I was glad to have it just in case I needed it. Iirc by the time I got home my pain was controlled by OTC and I had an easy recovery.

 

But I can see how that is a problem, but also I have been in a situation where I think it would be a burden to have to make repeated trips, especially if someone would have to take off work, or if was just difficult to make plans to go out.

 

I can see it seeming like a simple thing to do, but I think a lot of times it is not so simple.

 

But at the same time, giving out so much at once seems to have horrible consequences for many people.

 

But when I read about docs and dentists handing them out cavalierly, I think they are often just trying to save people from missing work or having to drive a long way, etc.

Edited August 1, 2017 by Lecka

[Lady Florida.]

I think one long-term solution is to try and come up with safe, effective pain medications that don't have the addictive properties. That's a tall order but I think I read some time ago that at least one drug company is working on it. Acetaminophen, naproxen, and ibuprofen come with their own set of problems and don't relieve more moderate to severe pain, at least not in safe doses. 

 

I don't know what the solution is for the short term or for current addicts.

Edited August 1, 2017 by Lady Florida.

[Murphy101]

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.

There are some cases like that, but MOST people even those people, don't end up addicted. Most people don't finish their antibiotics either.

 

Post surgery is a huge time of mental illness vulnerability for many people. It can very much be a chicken/egg situation. And we know that depression/mental illness can affect genuine pain. Fear can also affect pain. A person's pain is not less real or worth treating just because someone else doesn't feel it to the same or any extent.

 

Childbirth is also not one size fits all wrt to pain either. For one thing, afterbirth pains often get worse with each delivery. There can be more adhesions with each surgery. And that's not even getting into individual pain tolerances and other factors.

 

I've rarely taken pain meds more than a couple days. If then. But I also have mitigating factors for both depression and illicit drug use. Namely, a commitment at home that makes it a hard choice for me. I am the only care for my kids. So that at least rules out daytime use. And I'm usually leery of nighttime use unless Dh is home. There are a LOT of people who go home to isolation, depression, and feeling they have no purpose in life. I can see how adding physical pain to that could be a set up for addiction even without an opioid rx.

 

And for many years now, our drs have only rx two to three days worth of pain meds with the requirement to return if pain still needs managed after that point. Though it isn't unusual for the worst pain to be a week or two after initial whatever. Because that's right around when a person starts to feel almost normal again and usually pushes themselves too much too soon and it brings on the pain for a few days to a week. That's also often the most anyone can get off work, so healed or not, they have to go to work.

 

None of this is going to be solved by another damned drug war.

 

We need systemic social policy changes to family and work policies and healthcare.

[Lanny]

When I was a very young boy, my mother had a friend who lived a few blocks from our house. She had a DD who got into Heroin in High School.  She was sent to the Federal Penitentiary for Women in Lexington KY as I recall.  

 

The Opioids I see on TV and in the news that are available in the USA at this time are incredibly inexpensive and are available everywhere. Easy access, very low cost and lots of demand.

 

The worst part is that they are incredibly powerful. And then the adulterated drugs coming in from China that are mixed with them or sold in their place.

 

This is a horrible situation and if people in the WH or anywhere else  can come up with something that might begin to reduce any of this, it would be a positive step.

[mom2scouts]

My teen son had surgery last month and was prescribed a powerful opioid. We were told to give it to him the day of surgery and then he could have it every 4 hours, as needed. He was prescribed 30 pills! He took one the first day, about every four to eight hours the next day, and then one a day for the next few days before he felt he didn't need them. The rest went to the police drop box. I'm not sure how they can decide how many to prescribe without leaving too many unused while also providing enough for pain relief. I've been told I have a particularly high pain tolerance, so maybe he's like me and others would use all the pills. OTOH, my dad had pain meds after surgery and my mom had to hide them because he was using them too frequently and she thought he was at risk of addiction.

 

I have no idea what the balance is between providing people with the pain relief they need to live productive lives and preventing addiction.

[StephanieZ]

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.

 

What happens is . . .

 

People get legal RX opioids for some reasonable thing (injury, surgery, etc.) They don't get good support about how to use them safely and how to get off of them/wean/etc. They take them for a while, become addicted, then can't get more legal RX. They might try to buy them off the street for a while. Then they find they are too expensive, and heroin is much cheaper. Then they become heroin addicts. This is *exactly* what happened here in WV over the least 5 years. Our state cracked down on pill mills, etc a few years ago. The heroin dealers moved in. We now have a huge heroin problem. A pill of oxy/whatever might cost $40 on the street, whereas a dose of heroin $10 . . .

 

I saw this, up front and personal, with a construction worker on my house. He had back/etc injuries a few years back from a car wreck +/- the brutally hard physical work he did (as do most of the low wage men in WV in construction, mining, etc.) . . . got addicted . . . when I knew him, he was in and out of jail, on and off Suboxone both legal and illegally -- depending on whether he could access medical care  . ..  He lived 90 min away from the Suboxone clinic and had limited transportation. He worked 7 long days a week when he was out of jail/rehab/etc. Eventually, he died in a car wreck in the summer of 2015, surely drug-related. He was fighting to good fight. He wanted to be well. He wanted help. One time, he was waiting until his next (drug related) court date, hoping to get put in rehab by the court, because that was the only way he could get into a detox. I tried to help; there was nothing I could do, even after consulting with my MD-addiction medicine friend. There are just not enough beds, and getting the bed is not at all easy. He couldn't get the help he needed. He's dead now. His young daughter and her drug-addicted mom may or may not be alive by now. 

 

In our (relatively well off) county here in WV, we observed a sudden and dramatic spike in all sorts of crime when the pill-mills got cracked down on because out-of-state (mostly from NJ, according to the police blotter in local papers) drug dealers moved in to sell heroin. All of a sudden, murders, armed robberies, etc were in the news routinely. There are some areas of our town where I wouldn't ever allow someone I loved to live or work. This was not the case before. The "need" for heroin access to replace the once-easily-and-cheaply-bought RX opioids drew in these nasty out-of-state drug cartels/gangsters/etc. They brought violence . . . People are dying day after day. Zillions. 

 

The drug companies POURED opioids into our state over recent years. I read something like 300+ opioid doses for every man, woman, and child per year were legally sold in our state a few years back.  . . Much of these were pouring through pharmacies in tiny towns that have residents in the hundreds . . . It is all a huge, nasty, evil conspiracy. People should go to jail. Those people should include the pharmaceutical companies who knew *exactly* what they were doing.

 

A few weeks ago, in the midst of my as-yet-undiagnosed excruciatingly painful case of Lyme meningitis . . . A primary care doc prescribed me 120 count of 10mg hydrocodone. That's the highest dose available. 5 to 10 count of 5 or 7.5 mg is typically what you get post-surgery (and is what I had in my medicine cabinet left over from oral surgery). 120 count . . . If I had taken them as prescribed (every 6 hours, around the clock, for 30 days), I would DEFINITELY have been addicted. Instead, I kept fighting for a diagnosis and was finally put on the appropriate antibiotic for Lyme a week later. My excruciating week+ long debilitating pain was resolved in 12 hours . . . but I took 10 more days to taper off the hydrocodone. . . No one told me how to taper -- I just knew how to do it because I am well educated in pain management and addiction. No one talked to me or my husband (who was with me) about addiction or warned/advised/etc about how to be safe with the addictive drug. No one even OFFERED a re-check appointment or helped me (I was begging) get in with a specialist to diagnose my incredible pain. Nope, they just RX'ed opioids + OTC pain meds . . . all for an as-yet-undiagnosed VERY painful condition. I didn't have any more DR appts until nearly 90 days later!! (I was BEGGING and SCREAMING for help, sooner.) I *needed* pain relief. For sure. But, I should have been sent to a specialist immediately or an inpatient facility if that's what it took to access specialists to diagnose the CAUSE of the pain. At the same appointment I was RX/ed the opioid, I was DENIED a Lyme test . . . Note, I have good insurance and plenty of $$ to pay DRs, am available any time for going to the DR w/o risking being fired or not having childcare, and I have decade+ relationship with the primary care practice that I was seeing. It took me 5 medical visits including 2 ER and 1 overnight hospitalization . . . to DX the root of my pain -- Lyme that had gotten into my brain/central nervous system -- and get appropriate antibiotics -- which nearly immediately resolved my pain. Not many people in our community have the connections to doctors/financial resources/ability to advocate for themselves, etc, that I do. If I hadn't had all those resources, I'd very likely be dead or addicted today. Instead, I'm not in pain, not on pain meds, and vacationing with my family in the Bahamas. It makes me incredibly angry and sad thinking of the alternate path my life might have taken if I hadn't been as fortunate as I am. I *strongly* believe that docs tend to RX higher doses/numbers of pills to avoid patients needing care after hours/coming back in/etc. If your surgeon only RXes 3 doses of opioids, and you need a second day of them due to being the 1 in 5 who needs more . . . then you call/hassle/need help. Good luck with that, because surgeons and other specialists don't want to waste their time dealign with post-op pain  . . . when they could be doing another $1000 procedure in that 30 minutes instead of dealing with your re-check appointment or phone call, etc. If health care was free/cheap and readily available, I guarantee this would be a huge help in reducing addictions. 

 

Universal single payer comprehensive health care is what we need.

[Mergath]

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.

 

That's how it always seems to work for my dh. When he's having a minor issue, they'll try to give him a prescription for vicodin with multiple refills. (Or when he was having anxiety, they were throwing bottles of benzos at him.) But last week, he had to have two teeth extracted. The dentist screwed it up somehow and the novacaine had already worn off by the time he walked out to the car, and I have never seen a human being in that much pain. By the time we got home he was hyperventilating and shaking so hard from the pain that he couldn't walk. I almost called an ambulance.

 

When I called the dentist for him (since he couldn't actually speak at that point) they told me to give him a glass of juice and have him lie down. (What that was supposed to do, I have no idea.) When I asked them to prescribe something just for a day or two to keep him from having a heart attack from the pain, they freaked out and were really rude and told me that under no circumstances would they prescribe anything for the pain. Neither of us has any history of opioid overuse or addiction, but they treated me like a junkie for even asking for one day's worth of painkillers after a botched tooth extraction.

 

There's no consistency at all in how this stuff is being prescribed.

[Murphy101]

My teen son had surgery last month and was prescribed a powerful opioid. We were told to give it to him the day of surgery and then he could have it every 4 hours, as needed. He was prescribed 30 pills!

So what? 1 pill every 4 hours is 6 pills over 24 hour period, so 30 pills was a 5 day rx.

 

I don't think planning that they might need pain relief for 5 days after surgery is terribly unreasonable.

 

 

OTOH, my dad had pain meds after surgery and my mom had to hide them because he was using them too frequently and she thought he was at risk of addiction.

If he was using them as prescribed, then that can reasonably be considered abuse to purposely deny someone their pain medications just because a caregiver doesn't think their pain is valid or they are a wuss who should suck it up. If she was concerned about addicition, she should have taken him to the doctor. If he thought the pain was not being managed or not healing according to expectations, they should have gone back to the doctor.

[ChocolateReignRemix]

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.

 

Excellent points.

[goldberry]

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. 

 

 

 

Thank you very much for sharing this information.

[goldberry]

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.

 

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

 

 

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.

 

 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.

 

These two lower comments show why I don't think addressing only the supply side is the answer.  If rehab is not working, it needs to be changed/updated to be more effective. I think addiction, along with mental illness are two of the most horrible things we deal with as a society.  They literally take away people we love, and people who have value to offer to society, and turn them into someone else.  It's not going to be enough to just try to stop the supply.

Edited August 1, 2017 by goldberry

[goldberry]

It's clear from these comments that the complete randomness and inconsistency of doctor behavior has a lot to do with the supply side problem.  I know there have been programs to educate physicians, so I don't know what else could be done there.  I wonder if pharmacists could be engaged to also give warnings directly to patients? But after surgery and procedures, don't patients usually get the medication directly from the doc or hospital?  Then the pharmacist wouldn't help.  

[SKL]

I don't see how bureaucracy is going to improve things.  I would love to be convinced that the feds, or anyone else, has a real solution.  But history teaches.

 

My dad was extremely careful to follow the doctor-recommended weaning process after pain meds.  It was excruciating for him.  I hope a lot of effort is going into the development of non-addictive pain killers.  Never say never, but I could see myself refusing meds rather than getting into that mess.

 

As far as the criminal aspect of things, I think the feds already have the ability to fight drug crimes.  Really not sure what a "state of emergency" would add.

[Lanny]

These two lower comments show why I don't think addressing only the supply side is the answer.  If rehab is not working, it needs to be changed/updated to be more effective. I think addiction, along with mental illness are two of the most horrible things we deal with as a society.  They literally take away people we love, and people who have value to offer to society, and turn them into someone else.  It's not going to be enough to just try to stop the supply.

 

Stop the supply?   That was the idea of the so-called "War on Drugs".   In my house, and probably most people here in Colombia, and probably most people who work for the DEA, believe that is not possible.

 

Even if it were possible, those who use/need illegal drugs would get them from some other country.

 

Or, Synthetic drugs made of locally manufactured chemicals in the USA.

 

WHEN THERE IS DEMAND FOR A PRODUCT, THERE WILL BE SUPPLY.   If there is no demand, there will be no supply. The key is to reduce/eliminate the demand, but how to do that is the 64 million dollar question. 

[luuknam]

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.

 

Don't fill the script for 25, and just use the ones you already have rather than turning them in. They stay good for 10+ years after their expiration date anyway (according to the US Army). 

 

Tramadol  in particular is not my friend anymore.  

 

Somehow I got prescribed Tramadol for migraines by my GP. I took it less than once a week, but I ran out, and asked a different doctor (this one at the university health center) if they could write a refill, and got read the riot act. I don't think I even was aware that it was an opiate... it for sure didn't *feel* like an opiate... not remotely a feeling of being 'high' at all, just somewhat less pain. They wouldn't prescribe anything else either though... told me to make an hour-long appointment to look into that migraine. Which, uh, was not realistic, since the university was 75 miles away from home and the migraine doc only was there on the days I did not have class, i.e. they were telling me to get my wife to take time off from work so I could drive 150 miles round trip for that... nope (ironically, my migraines were almost always in the evenings after doing that 150 mile roundtrip to have 3 hours of evening classes, which made me even less inclined). Btw, I agree that an opioid for migraines is probably not a good choice, but it's beyond me why they couldn't prescribe something that was not an opioid. Of course, the same university once prescribed me hydroxyzine (and antihistamine) for itching (I have eczema), and then after I used it as prescribed accused me of using it for anxiety (which I hadn't even noticed it had any impact on... I mean, the internet tells me it works for mild anxiety, which is much less than I have). That was seriously the most absurd accusation I've ever encountered... I mean, for real... even *if* it had been effective for my anxiety, then so what? Taking an antihistamine for anxiety is hardly being a drug addict (their psychiatrist agreed that if it worked for anxiety she'd happily prescribe me hydroxyzine). 

[kroe1]

What happens is . . .

 

People get legal RX opioids for some reasonable thing (injury, surgery, etc.) They don't get good support about how to use them safely and how to get off of them/wean/etc. They take them for a while, become addicted, then can't get more legal RX. They might try to buy them off the street for a while. Then they find they are too expensive, and heroin is much cheaper. Then they become heroin addicts. This is *exactly* what happened here in WV over the least 5 years. Our state cracked down on pill mills, etc a few years ago. The heroin dealers moved in. We now have a huge heroin problem. A pill of oxy/whatever might cost $40 on the street, whereas a dose of heroin $10 . . .

 

I saw this, up front and personal, with a construction worker on my house. He had back/etc injuries a few years back from a car wreck +/- the brutally hard physical work he did (as do most of the low wage men in WV in construction, mining, etc.) . . . got addicted . . . when I knew him, he was in and out of jail, on and off Suboxone both legal and illegally -- depending on whether he could access medical care . .. He lived 90 min away from the Suboxone clinic and had limited transportation. He worked 7 long days a week when he was out of jail/rehab/etc. Eventually, he died in a car wreck in the summer of 2015, surely drug-related. He was fighting to good fight. He wanted to be well. He wanted help. One time, he was waiting until his next (drug related) court date, hoping to get put in rehab by the court, because that was the only way he could get into a detox. I tried to help; there was nothing I could do, even after consulting with my MD-addiction medicine friend. There are just not enough beds, and getting the bed is not at all easy. He couldn't get the help he needed. He's dead now. His young daughter and her drug-addicted mom may or may not be alive by now.

 

In our (relatively well off) county here in WV, we observed a sudden and dramatic spike in all sorts of crime when the pill-mills got cracked down on because out-of-state (mostly from NJ, according to the police blotter in local papers) drug dealers moved in to sell heroin. All of a sudden, murders, armed robberies, etc were in the news routinely. There are some areas of our town where I wouldn't ever allow someone I loved to live or work. This was not the case before. The "need" for heroin access to replace the once-easily-and-cheaply-bought RX opioids drew in these nasty out-of-state drug cartels/gangsters/etc. They brought violence . . . People are dying day after day. Zillions.

 

The drug companies POURED opioids into our state over recent years. I read something like 300+ opioid doses for every man, woman, and child per year were legally sold in our state a few years back. . . Much of these were pouring through pharmacies in tiny towns that have residents in the hundreds . . . It is all a huge, nasty, evil conspiracy. People should go to jail. Those people should include the pharmaceutical companies who knew *exactly* what they were doing.

 

A few weeks ago, in the midst of my as-yet-undiagnosed excruciatingly painful case of Lyme meningitis . . . A primary care doc prescribed me 120 count of 10mg hydrocodone. That's the highest dose available. 5 to 10 count of 5 or 7.5 mg is typically what you get post-surgery (and is what I had in my medicine cabinet left over from oral surgery). 120 count . . . If I had taken them as prescribed (every 6 hours, around the clock, for 30 days), I would DEFINITELY have been addicted. Instead, I kept fighting for a diagnosis and was finally put on the appropriate antibiotic for Lyme a week later. My excruciating week+ long debilitating pain was resolved in 12 hours . . . but I took 10 more days to taper off the hydrocodone. . . No one told me how to taper -- I just knew how to do it because I am well educated in pain management and addiction. No one talked to me or my husband (who was with me) about addiction or warned/advised/etc about how to be safe with the addictive drug. No one even OFFERED a re-check appointment or helped me (I was begging) get in with a specialist to diagnose my incredible pain. Nope, they just RX'ed opioids + OTC pain meds . . . all for an as-yet-undiagnosed VERY painful condition. I didn't have any more DR appts until nearly 90 days later!! (I was BEGGING and SCREAMING for help, sooner.) I *needed* pain relief. For sure. But, I should have been sent to a specialist immediately or an inpatient facility if that's what it took to access specialists to diagnose the CAUSE of the pain. At the same appointment I was RX/ed the opioid, I was DENIED a Lyme test . . . Note, I have good insurance and plenty of $$ to pay DRs, am available any time for going to the DR w/o risking being fired or not having childcare, and I have decade+ relationship with the primary care practice that I was seeing. It took me 5 medical visits including 2 ER and 1 overnight hospitalization . . . to DX the root of my pain -- Lyme that had gotten into my brain/central nervous system -- and get appropriate antibiotics -- which nearly immediately resolved my pain. Not many people in our community have the connections to doctors/financial resources/ability to advocate for themselves, etc, that I do. If I hadn't had all those resources, I'd very likely be dead or addicted today. Instead, I'm not in pain, not on pain meds, and vacationing with my family in the Bahamas. It makes me incredibly angry and sad thinking of the alternate path my life might have taken if I hadn't been as fortunate as I am. I *strongly* believe that docs tend to RX higher doses/numbers of pills to avoid patients needing care after hours/coming back in/etc. If your surgeon only RXes 3 doses of opioids, and you need a second day of them due to being the 1 in 5 who needs more . . . then you call/hassle/need help. Good luck with that, because surgeons and other specialists don't want to waste their time dealign with post-op pain . . . when they could be doing another $1000 procedure in that 30 minutes instead of dealing with your re-check appointment or phone call, etc. If health care was free/cheap and readily available, I guarantee this would be a huge help in reducing addictions.

 

Universal single payer comprehensive health care is what we need.

If single payer healthcare was the answer, then the US should have more addicts than single payer countries. However, there is no correlation.

 

The answer does lie in the money. If all of a sudden, doctors quit writing the narcotic prescriptions, then pharmaceutical companies would start releasing the non addicting medications they have been working on. Right now, there is more money in narcotics.

 

At least with the number of deaths spiraling and a few doctors getting sued by their part in the addiction, there has been a slight decline in prescriptions. Once a few class action lawsuits against the pharmacies come to trial, we will see a huge drop in prescriptions.

 

There is a huge mind over matter factor with pain. I am glad a previous poster mentioned it. This is not to say pain sensors are all in our heads and not real. But, other factors like norepinephrine, cortisol, etc. can change our response to pain. This is why people who exercise heavily, on average, have less pain. They are producing more endorphins. These enzymes and hormones can greatly change our response to pain.

 

While obviously not a scientific study of any merit, I did my own experiment. I had vomited for days after taking a narcotic when my wisdom teeth were removed. I decided all the pain in the world was more manageable than the nausea. When I needed multiple surgeries I decided I would try major surgery without narcotics of any kind at any time. I had a surgeon and anesthesiologist who was willing to give it a try, although both were very reluctant. I showed them studies of people having less pain who were given local anesthesia at each incision point.

 

So, I elected for one dose of toradol (an NSAID like ibuprofen) just prior to surgery. All incisions were given a local anesthetic of lidocaine, and then I was put to sleep with only diprovan (the stuff that killed Michael Jackson and is used to put most people to sleep everywhere). I took no pain medicine after the surgery other than acetaminophen and ibuprofen regularly for 2 days. I took those scheduled without waiting for unbearable pain. Guess what? No pain other than minor discomfort.

 

I have now had 5 or 6 surgeries this way without any narcotics. I have yet to have any pain. And I have yet to vomit.

 

There was a really neat study showing toradol for broken bones was more effective than high dose morphine. I believe it.

 

We have been programmed to expect this ridiculous amount of pain post-surgical. Medical providers have been programmed to treat this ridiculous amount of pain with narcotics. The irony is that narcotics might not be the best thing to do.

 

There is roughly a 10% addiction rate with each first time narcotic prescription. So, let's just say there was a 10% chance your daughter would get mugged going to the local grocery store. Would you let her go? I would guess addiction is much worse a problem than a little mugging.

[Lady Florida.]

 

 

WHEN THERE IS DEMAND FOR A PRODUCT, THERE WILL BE SUPPLY.   If there is no demand, there will be no supply. The key is to reduce/eliminate the demand, but how to do that is the 64 million dollar question. 

 

That's exactly why Prohibition didn't work. There was still a demand so there was a supply. 

[Scarlett]

If single payer healthcare was the answer, then the US should have more addicts than single payer countries. However, there is no correlation.

 

The answer does lie in the money. If all of a sudden, doctors quit writing the narcotic prescriptions, then pharmaceutical companies would start releasing the non addicting medications they have been working on. Right now, there is more money in narcotics.

 

At least with the number of deaths spiraling and a few doctors getting sued by their part in the addiction, there has been a slight decline in prescriptions. Once a few class action lawsuits against the pharmacies come to trial, we will see a huge drop in prescriptions.

 

There is a huge mind over matter factor with pain. I am glad a previous poster mentioned it. This is not to say pain sensors are all in our heads and not real. But, other factors like norepinephrine, cortisol, etc. can change our response to pain. This is why people who exercise heavily, on average, have less pain. They are producing more endorphins. These enzymes and hormones can greatly change our response to pain.

 

While obviously not a scientific study of any merit, I did my own experiment. I had vomited for days after taking a narcotic when my wisdom teeth were removed. I decided all the pain in the world was more manageable than the nausea. When I needed multiple surgeries I decided I would try major surgery without narcotics of any kind at any time. I had a surgeon and anesthesiologist who was willing to give it a try, although both were very reluctant. I showed them studies of people having less pain who were given local anesthesia at each incision point.

 

So, I elected for one dose of toradol (an NSAID like ibuprofen) just prior to surgery. All incisions were given a local anesthetic of lidocaine, and then I was put to sleep with only diprovan (the stuff that killed Michael Jackson and is used to put most people to sleep everywhere). I took no pain medicine after the surgery other than acetaminophen and ibuprofen regularly for 2 days. I took those scheduled without waiting for unbearable pain. Guess what? No pain other than minor discomfort.

 

I have now had 5 or 6 surgeries this way without any narcotics. I have yet to have any pain. And I have yet to vomit.

 

There was a really neat study showing toradol for broken bones was more effective than high dose morphine. I believe it.

 

We have been programmed to expect this ridiculous amount of pain post-surgical. Medical providers have been programmed to treat this ridiculous amount of pain with narcotics. The irony is that narcotics might not be the best thing to do.

 

There is roughly a 10% addiction rate with each first time narcotic prescription. So, let's just say there was a 10% chance your daughter would get mugged going to the local grocery store. Would you let her go? I would guess addiction is much worse a problem than a little mugging.

 

 

I am glad to hear this.  I am violently allergic to narcotics of all kinds.  Seriously many have been tried on me over the years up until before my 17 year old was born when I knew I just couldn't handle them ever again.  I did childbirth drug free (which I realize many women do) and I also had an emergency appendectomy with no narcotic.  I took some sort of super Ibuprofen in the hospital and 800 mg of ibuprofen for a couple of days at home.  I was fine.  

 

Dh has severe chronic back pain and tramadol keeps it at a level where he can function.  He just discovered it about 6 months ago....before that he would take Norco if he got bad enough but it makes him sick and he hates it.  

 

I worry that the Tramadol is addictive but what can he do? He can't just lie down and die.  

[MotherGoose]

Doctors should educate patients better about possible addiction.  That might help.  People definitely become addicted to pain pills accidentally.  It's not like they are out seeking a high, like smoking crack or something.  They have a legitimate medical need and then become addicted.  (There are, of course, people who become addicted seeking a high, but that's a whole other matter).  So if doctors say, (and many do) "I am prescribing this pill to help manage your pain.  You can become addicted, so try not to take any more than necessary.  I won't be refilling this prescription," it might help.  And don't give them a giant bottle--just enough for a several days doses.    I had three c sections and got (and took) a few percocet every time after I got home.  You are talking about major abdominal surgery, plus children to take care of.  I didn't become addicted and never even finished the meds.  So it's not just that people are whiny about pain.  Pain is real, and people's perceptions of pain differ.  I do think expecting pain to be gone is not a good goal.  Tolerable is a good goal, and Advil can take care of most pain.  Unless, of course, you are on another med, like Coumadin (blood thinner) where you can't take any advil.  I am not but DH is and he also has a very low tolerance for pain.  He is able to use pain pills wisely when needed.  My sister is a doctor and says sometimes parents are concerned about giving their 6 month old narcotic pain meds after they have had open heart surgery with their chest cracked open because of the addiction potential.  Wise parents, but she tells them that she is only giving them a few doses, and they are in charge of giving it to baby, so baby can't have more than needed and become addicted.  Baby needs pain control.  That's an extreme case, obviously, but it's good that the parents are aware.  

[MotherGoose]

If single payer healthcare was the answer, then the US should have more addicts than single payer countries. However, there is no correlation.

 

The answer does lie in the money. If all of a sudden, doctors quit writing the narcotic prescriptions, then pharmaceutical companies would start releasing the non addicting medications they have been working on. Right now, there is more money in narcotics.

 

At least with the number of deaths spiraling and a few doctors getting sued by their part in the addiction, there has been a slight decline in prescriptions. Once a few class action lawsuits against the pharmacies come to trial, we will see a huge drop in prescriptions.

 

There is a huge mind over matter factor with pain. I am glad a previous poster mentioned it. This is not to say pain sensors are all in our heads and not real. But, other factors like norepinephrine, cortisol, etc. can change our response to pain. This is why people who exercise heavily, on average, have less pain. They are producing more endorphins. These enzymes and hormones can greatly change our response to pain.

 

While obviously not a scientific study of any merit, I did my own experiment. I had vomited for days after taking a narcotic when my wisdom teeth were removed. I decided all the pain in the world was more manageable than the nausea. When I needed multiple surgeries I decided I would try major surgery without narcotics of any kind at any time. I had a surgeon and anesthesiologist who was willing to give it a try, although both were very reluctant. I showed them studies of people having less pain who were given local anesthesia at each incision point.

 

So, I elected for one dose of toradol (an NSAID like ibuprofen) just prior to surgery. All incisions were given a local anesthetic of lidocaine, and then I was put to sleep with only diprovan (the stuff that killed Michael Jackson and is used to put most people to sleep everywhere). I took no pain medicine after the surgery other than acetaminophen and ibuprofen regularly for 2 days. I took those scheduled without waiting for unbearable pain. Guess what? No pain other than minor discomfort.

 

I have now had 5 or 6 surgeries this way without any narcotics. I have yet to have any pain. And I have yet to vomit.

 

There was a really neat study showing toradol for broken bones was more effective than high dose morphine. I believe it.

 

We have been programmed to expect this ridiculous amount of pain post-surgical. Medical providers have been programmed to treat this ridiculous amount of pain with narcotics. The irony is that narcotics might not be the best thing to do.

 

There is roughly a 10% addiction rate with each first time narcotic prescription. So, let's just say there was a 10% chance your daughter would get mugged going to the local grocery store. Would you let her go? I would guess addiction is much worse a problem than a little mugging.

I'm pretty sure I got toradol in the hospital after my last c-section.  They didn't send me home with it, gave me percocet.  Maybe toradol is only IV?  Don't know.  

[LMV]

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?

I had one cesarean section and four vaginal births. Three were VBACs. I didn't take narcotics after any of my births. I think that was probably a bit atypical in the initial twenty four hours after my cesarean and I won't say I wasn't in pain but it was manageable albeit not completely eliminated with non narcotic options. Interestingly after the birth of our final daughter a little under two years ago the nurse I had in post partum was aghast that the only thing my OB had written for pain was ibuprofen. She made a big deal of paging and "advocating" for me to get something (while ignoring my attempts to explain my OB probably knew I didn't want anything else and if I was in sufficient pain to need something else then I was probably having some horrible complication and needed re-evaluation much more than narcotics).

 

I don't disagree that physicians need to take responsibility for what/when they prescribe. However, I think there are some regulatory and reimbursement scenarios that penalize physicians who do prescribe responsibly. I don't offer that as an excuse because I firmly believe that when you are sacrificing your clinical judgment for external forces and pressures then it is time to stop practicing. I stand by that and I know I am fortunate to work for a medical director and healthcare system that respects my profession and my professional judgment. Not all physicians are so fortunate and some of that is part of our physician shortage. Then of course there is last week's tragedy in Indiana.

 

At this point the opioid epidemic is shifting back into heroin partly because it truly has less street value than prescription opiates. [based on my statistics as a toxicologist not personal experience.] Controlled substance restrictions are also making prescription opiates harder to procure which contributes to the shift.

[LMV]

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.

I can agree with a lot of your post. Unfortunately, I do not think Suboxone is the answer so many believe it will be. I do not favor increasing suboxone caps or allowing non physician members of the healthcare team to prescribe.

[LMV]

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.

Statistically where I practice this is the case but the issue is a bit more complicated and multifaceted than that. A lot of communities now are also seeing heroin contaminated with fentanyl, and carfentanil which are increasing the overdose and death rate.

[goldberry]

If single payer healthcare was the answer, then the US should have more addicts than single payer countries. However, there is no correlation.

 

Single payer may not be the answer in itself, but availability and affordability of services is definitely a factor.   I'm thinking physical therapy in particular, for which opioids are often a very poor substitute.  I have known several people who just kept taking pain killers rather than addressing the root of the problem because they could not afford extensive physical therapy.

 

But also as some have mentioned, in-house treatment rehab facilities, as well as availability of mental health services is a definite factor.  If people can get help for mental issues BEFORE self-medicating, for some the problem can be derailed before it starts. Some people think of mental health services as an "extra" that nobody really needs though.

[LMV]

I'm pretty sure I got toradol in the hospital after my last c-section. They didn't send me home with it, gave me percocet. Maybe toradol is only IV? Don't know.

Oral ketorolac does exist and actually has been shown to have similar/superior in some studies efficacy to hydrocodone/acetaminophen.

[MotherGoose]

Statistically where I practice this is the case but the issue is a bit more complicated and multifaceted than that. A lot of communities now are also seeing heroin contaminated with fentanyl, and carfentanil which are increasing the overdose and death rate.

The case I know about personally and other things I've read say that people become addicted to pain pills and then when they can't get them prescribed anymore they switch to heroin, which is cheaper. The person I know of who died from it did this, and then his heroin was actually pure fentanyl, which killed him. They put fentanyl in it because it's cheaper than heroin.

[MotherGoose]

Oral ketorolac does exist and actually has been shown to have similar/superior in some studies efficacy to hydrocodone/acetaminophen.

Good to know.

[eternalsummer]

My grandmother got shingles maybe 10 years before she died, and was prescribed Oxycodone for the pain.  She wasn't ever able to get off of it; when she died from oral cancer, her pain was unmanageable.  The hospice nurse told my mom that this was because she had such a high tolerance from the Oxy, so nothing could touch the pain until they basically put her in a coma and she died.  Mom said it was pretty horrific.

 

My dad died from COPD complications (pneumonia); he'd had back pain for the last 25 years, but was never willing to take anything stronger than OTC drugs. His going was much more peaceful (although to be fair pneumonia is not as painful as oral cancer in the late stages, I imagine).

 

 

[winterbaby]

Single payer may not be the answer in itself, but availability and affordability of services is definitely a factor.   I'm thinking physical therapy in particular, for which opioids are often a very poor substitute.  I have known several people who just kept taking pain killers rather than addressing the root of the problem because they could not afford extensive physical therapy.

 

But also as some have mentioned, in-house treatment rehab facilities, as well as availability of mental health services is a definite factor.  If people can get help for mental issues BEFORE self-medicating, for some the problem can be derailed before it starts. Some people think of mental health services as an "extra" that nobody really needs though.

 

I'm still resentful over having been refused pain killers several years ago when I had a severe neck/back spasm involving multiple muscles which compressed a major nerve and left me in excruciating, 9/10 pain day and night for months. I was told to go to physical therapy. Well I went once. It felt like a mockery because I was out of my mind with pain, hyperventilating and blinking back tears, and the guy was trying to get me to move this way and that and it was just impossible. I never went back. Maybe I could have gotten some benefit if I hadn't been in too much pain to move. All I could do was let it resolve on its own with hot showers, ice, and massive back to back doses of ibuprofen which barely took the edge off. I was a SAHM at the time - if my family had depended on me to make a living we would have been screwed because I was in so much pain that not only could I have not have done physical work, I couldn't have sat in an office and typed or conducted a normal conversation. But I couldn't get anything. I think my pain was minimized because it wasn't attributable to an easily identified accident or injury. (And I had to figure out why it happened on my own through reading.) I think my sex and relative youth (35ish) may have been factors as well. I have had opioids after surgery and handled them well. I do not think I am an addiction risk. Denying me pain relief did nobody any good. And physical therapy was definitely not the solution. You can't do movements and exercises in that kind of pain.

[luuknam]

I'm still resentful over having been refused pain killers several years ago when I had a severe neck/back spasm involving multiple muscles which compressed a major nerve and left me in excruciating, 9/10 pain day and night for months. I was told to go to physical therapy. Well I went once. It felt like a mockery because I was out of my mind with pain, hyperventilating and blinking back tears, and the guy was trying to get me to move this way and that and it was just impossible. I never went back. Maybe I could have gotten some benefit if I hadn't been in too much pain to move. All I could do was let it resolve on its own with hot showers, ice, and massive back to back doses of ibuprofen which barely took the edge off. I was a SAHM at the time - if my family had depended on me to make a living we would have been screwed because I was in so much pain that not only could I have not have done physical work, I couldn't have sat in an office and typed or conducted a normal conversation. But I couldn't get anything. I think my pain was minimized because it wasn't attributable to an easily identified accident or injury. (And I had to figure out why it happened on my own through reading.) I think my sex and relative youth (35ish) may have been factors as well. I have had opioids after surgery and handled them well. I do not think I am an addiction risk. Denying me pain relief did nobody any good. And physical therapy was definitely not the solution. You can't do movements and exercises in that kind of pain.

 

 

I got some muscle relaxant/anti-spasm medication for neck spasms a year ago. And 800mg ibuprofen. That combination did the trick. I'm not a doctor, but I'm surprised you didn't get a muscle relaxant/anti-spasm med.

[winterbaby]

I got some muscle relaxant/anti-spasm medication for neck spasms a year ago. And 800mg ibuprofen. That combination did the trick. I'm not a doctor, but I'm surprised you didn't get a muscle relaxant/anti-spasm med.

 

You know what, I did. I forgot to mention it because it had so little effect. I really needed something for the pain. ETA and it was only a two week course. Problem persisted for four or five months and it stayed at peak agony 24/7 for at least the first five or six weeks.

 

Edited August 2, 2017 by winterbaby

[luuknam]

You know what, I did. I forgot to mention it because it had so little effect. I really needed something for the pain. ETA and it was only a two week course. Problem persisted for four or five months and it stayed at peak agony 24/7 for at least the first five or six weeks.

 

 

I think I got 4-6 weeks worth (don't remember, but I do remember that the doctor said it would probably take that long to get better, though it helped more or less right away - it just didn't fix it right away). I did have an x-ray from urgent care showing that my neck was excessively straight from the muscle spasming (who knew having a straight neck was a bad thing). Again, not a doctor, but I'm thinking maybe you should've gotten a higher dose (and for longer). Wondering if that might be a more effective approach to take with your doctor if this were to happen again - to insist that the spasming hurts, and that they get the spasming under control more effectively. That kind of circumvents the whole opioid paranoia thing. 

 

ETA: maybe it was even 8 weeks. Certainly at least 4 weeks. 

Edited August 2, 2017 by luuknam

[winterbaby]

I think I got 4-6 weeks worth (don't remember, but I do remember that the doctor said it would probably take that long to get better, though it helped more or less right away - it just didn't fix it right away). I did have an x-ray from urgent care showing that my neck was excessively straight from the muscle spasming (who knew having a straight neck was a bad thing). Again, not a doctor, but I'm thinking maybe you should've gotten a higher dose (and for longer). Wondering if that might be a more effective approach to take with your doctor if this were to happen again - to insist that the spasming hurts, and that they get the spasming under control more effectively. That kind of circumvents the whole opioid paranoia thing. 

 

ETA: maybe it was even 8 weeks. Certainly at least 4 weeks. 

 

I'm taking steps to minimize the chance of it happening again. My whole neck, shoulder, and the paraspinal muscles all the way down on one side were like concrete - I'm inclined to think that any muscle relaxant powerful enough to touch it would have been worse for mental functioning etc. than opioids. I think it's fair to say that my experience was minimized in general, but the pain was hugely in excess of what I've been given opioids for post-surgically, so it just underscores the irrationality of the whole system. It seems that they treat an abstract hierarchy of what kind of condition (and what kind of patient) "deserves" relief, rather than the particular situation of the patient in front of them.

[Garga]

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.

 

 

 

That's not quite fair, unless you exclusively mean people who try to take doses before they're supposed to. The bottle tells you something like, "Take every 6 hours." People sleep for 8 or more hours a night. So, you have to set an alarm to take the pill when you're told to on the bottle.

 

And then you're also told, "Don't stop taking the meds because you have to stay on top of the pain. If you let the pain spiral out of control, the meds won't be effective anymore."

 

So, yeah. When my dh was on opioid pain meds, we set an alarm and he took them at 2 in the morning, because that was 6 hours (or however many) after his last dose. He wasn't trying to get high. He was just in debilitating pain and wanted his life back.

 

 

When my dh was in horrible pain from a neck issue, he was given a bunch of meds. I had no clue about addiction or the opioid problem. This was back in 2015 and it just wasn't on my radar. I made a careful chart and made sure my dh took all his pills as prescribed exactly on time, as instructed on the bottle, complete with alarms in the middle of the night. I thought we were being good patients.

 

Yup. He got addicted. Once the meds were done, he was stuck with jitters, insomnia, restless leg syndrome, feeling like he had bugs crawling on him and I don't even remember what else. He toughed it out and got through it, but it was pretty awful for him. The doctors never explained a word of any of this to us. I had no idea that I was giving him drugs that he'd become addicted to. We weren't told how to come off of them. Wait...they did say they could be addictive but told us that since he was in so much pain, all the drugs would do would take the edge off--which is all they did. They said that you only get addicted when the pain is gone and you take them to get a high. Well, my dh's withdrawl told us otherwise. He stopped taking them before the pain was anywhere near gone, and then suffered through the withdrawl symptoms.

 

Urgh. I have such love-hate feelings toward doctors. They have all the power and control and withhold so much information. I know they're overworked and stressed, but...

Edited August 2, 2017 by Garga

[Danestress]

 

 

There is roughly a 10% addiction rate with each first time narcotic prescription. So, let's just say there was a 10% chance your daughter would get mugged going to the local grocery store. Would you let her go? I would guess addiction is much worse a problem than a little mugging.

Do you have a source for this?

[MistyMountain]

Toradol is what works for when I have kidney stone pain. They do not like you to use it for very long because it can cause stomach issues. I did manage to convince them to to prescribe a few pills to take only when needed if another attack comes on but they are very reluctant to. They had no problem prescribing vicaden which I would prefer not to take and higher dose ibuprofen which is an NSAID or an anti inflammatory like toradol. I like the idea of more options besides opiods that work for pain but other drugs can have their own issues to but it is good if they are less addicting.

[MistyMountain]

I'm still resentful over having been refused pain killers several years ago when I had a severe neck/back spasm involving multiple muscles which compressed a major nerve and left me in excruciating, 9/10 pain day and night for months. I was told to go to physical therapy. Well I went once. It felt like a mockery because I was out of my mind with pain, hyperventilating and blinking back tears, and the guy was trying to get me to move this way and that and it was just impossible. I never went back. Maybe I could have gotten some benefit if I hadn't been in too much pain to move. All I could do was let it resolve on its own with hot showers, ice, and massive back to back doses of ibuprofen which barely took the edge off. I was a SAHM at the time - if my family had depended on me to make a living we would have been screwed because I was in so much pain that not only could I have not have done physical work, I couldn't have sat in an office and typed or conducted a normal conversation. But I couldn't get anything. I think my pain was minimized because it wasn't attributable to an easily identified accident or injury. (And I had to figure out why it happened on my own through reading.) I think my sex and relative youth (35ish) may have been factors as well. I have had opioids after surgery and handled them well. I do not think I am an addiction risk. Denying me pain relief did nobody any good. And physical therapy was definitely not the solution. You can't do movements and exercises in that kind of pain.

OMG that is horrible that they did not take you seriously when you had that much pain all the time. I am sorry you went through that ordeal.

[mom2scouts]

 

If he was using them as prescribed, then that can reasonably be considered abuse to purposely deny someone their pain medications just because a caregiver doesn't think their pain is valid or they are a wuss who should suck it up. If she was concerned about addicition, she should have taken him to the doctor. If he thought the pain was not being managed or not healing according to expectations, they should have gone back to the doctor.

 

Except he wasn't using them as prescribed. I never said that she thought his pain wasn't valid or she thought he was a wuss and I'm not sure where you got that idea. Every time he felt a little pain, he would go take one. He doesn't pay attention to the time or when he had his last one, he just knew he was starting to feel pain and would go take a pain pill. OTOH, my OCD mom knew the exact time he should have the next one, when he had the last one, what dose, and how many he had left. They went back to the doctor who pretty much just told him he was doing well and told him again to take them as prescribed. My mom hid them because he refused to take them as prescribed and she would get them for him at the prescribed time. Maybe you've never cared for an elderly person before, but they can't or don't always follow instructions.

[bookbard]

Just had a look at the situation in Australia - around 4 Australians die each day from prescription drug addictions. I think the US has ten times the population of Australia, so you'd expect say 40 people in the US per day? But it's about 150.

 

So perhaps having access to universal health care would make a big difference to your problem. 

[kroe1]

I'm still resentful over having been refused pain killers several years ago when I had a severe neck/back spasm involving multiple muscles which compressed a major nerve and left me in excruciating, 9/10 pain day and night for months. I was told to go to physical therapy. Well I went once. It felt like a mockery because I was out of my mind with pain, hyperventilating and blinking back tears, and the guy was trying to get me to move this way and that and it was just impossible. I never went back. Maybe I could have gotten some benefit if I hadn't been in too much pain to move. All I could do was let it resolve on its own with hot showers, ice, and massive back to back doses of ibuprofen which barely took the edge off. I was a SAHM at the time - if my family had depended on me to make a living we would have been screwed because I was in so much pain that not only could I have not have done physical work, I couldn't have sat in an office and typed or conducted a normal conversation. But I couldn't get anything. I think my pain was minimized because it wasn't attributable to an easily identified accident or injury. (And I had to figure out why it happened on my own through reading.) I think my sex and relative youth (35ish) may have been factors as well. I have had opioids after surgery and handled them well. I do not think I am an addiction risk. Denying me pain relief did nobody any good. And physical therapy was definitely not the solution. You can't do movements and exercises in that kind of pain.

This is tragic and one reason why most physicians associated with hospitals now have at least part of their reimbursement tied to pain management. But, then there is the increase of opioid deaths. We fix one thing by breaking something else.

 

Bottom line, we need to eliminate opioids and substitute a non-addictive alternative even in emergencies and intense pain. Luckily, pain is understood now better than ever. We are starting to understand the difference between neuropathic pain, nociceptive pain, visceral pain, etc. Physicians are beginning to understand that narcotics do not work for some of this pain and getting wiser in their prescriptive practices. Pharmaceutical companies are researching alternatives. It is a great area of medicine to be involved in. I look forward to a day when narcotic prescriptions are a thing of the past. I am really tired of reading in the paper everyday about another young death.

 

I have mentioned before that I work in an ER. I realize I see the worst of the worst. But, it is disheartening to see just how bad the epidemic has become. Patients now scream for opioids and threaten to turn the physicians in for not treating their pain. Administrative benchmarks are threatened and physicians will lose their jobs if there are complaints or low satisfaction scores.

 

For example, as I am helping an elderly patient to the door, I have seen one tear up a non-narcotic prescription and mumble how he will report the doctor for not giving him Norcos. It is quite sad and something I did not used to see when I started twenty years ago. What is even sadder is the number of parents who now want narcotics prescribed for their children. I am not in a position to say anything. These parents seem to fuss about the child not being able to sleep. I think to myself why anyone would care about one night of sleep when the complication risk of the medicine was so high.

 

The American Academy of Pediatrics basically stopped all cold medicine in children under the age of 2, and even hard to get under the age of 6. The risk of that causing a problem was way less than 1%. But, we have a class of drugs with a much higher risk of complication and risk and no one says anything.

Edited August 2, 2017 by Minniewannabe

[MotherGoose]

This is tragic and one reason why most physicians associated with hospitals now have at least part of their reimbursement tied to pain management. But, then there is the increase of opioid deaths. We fix one thing by breaking something else.

 

Bottom line, we need to eliminate opioids and substitute a non-addictive alternative even in emergencies and intense pain. Luckily, pain is understood now better than ever. We are starting to understand the difference between neuropathic pain, nociceptive pain, visceral pain, etc. Physicians are beginning to understand that narcotics do not work for some of this pain and getting wiser in their prescriptive practices. Pharmaceutical companies are researching alternatives. It is a great area of medicine to be involved in. I look forward to a day when narcotic prescriptions are a thing of the past. I am really tired of reading in the paper everyday about another young death.

 

I have mentioned before that I work in an ER. I realize I see the worst of the worst. But, it is disheartening to see just how bad the epidemic has become. Patients now scream for opioids and threaten to turn the physicians in for not treating their pain. Administrative benchmarks are threatened and physicians will lose their jobs if there are complaints or low satisfaction scores.

 

For example, as I am helping an elderly patient to the door, I have seen one tear up a non-narcotic prescription and mumble how he will report the doctor for not giving him Norcos. It is quite sad and something I did not used to see when I started twenty years ago. What is even sadder is the number of parents who now want narcotics prescribed for their children. I am not in a position to say anything. These parents seem to fuss about the child not being able to sleep. I think to myself why anyone would care about one night of sleep when the complication risk of the medicine was so high.

 

The American Academy of Pediatrics basically stopped all cold medicine in children under the age of 2, and even hard to get under the age of 6. The risk of that causing a problem was way less than 1%. But, we have a class of drugs with a much higher risk of complication and risk and no one says anything.

I agree. But I think eliminating them entirely is unreasonable. My dh is on Coumadin, and he's had several surgeries, back trouble, etc., not to mention the two blood clots that caused a pulmonary embolism. He can't take any NSAIDS because of the Coumadin. So he needs narcotics if he has serious pain. He's educated about their use though, and only takes them when necessary.

[Laura Corin]

Bottom line, we need to eliminate opioids and substitute a non-addictive alternative even in emergencies and intense pain.

 

I think that there are still situations where opioids can make sense.  My 92 year old mother was in intense pain due to age-related joint deterioration in hips, knees, ankles, shoulders, elbows, wrists, hands ....  She has no interest in joint replacement operations at this stage.  The pain was a danger to her mentally and therefore physically.

 

She is now on opioid pain patches, topped up with oral opioids at night time.  I assume that she is addicted, but at this stage of her life, pure comfort is all that matters.

 

[Zinnia]

I had 4 c-sections. I needed narcotics for two weeks for at least 3 of them (one of them only a week). I did not become addicted, but my pain was controlled.

 

It's such a hard subject because controlling access means that some people are going to be in pain for no good reason.

[Lanny]

Just had a look at the situation in Australia - around 4 Australians die each day from prescription drug addictions. I think the US has ten times the population of Australia, so you'd expect say 40 people in the US per day? But it's about 150.

 

So perhaps having access to universal health care would make a big difference to your problem. 

 

I believe it has nothing to do with Universal Health Care. There are some countries, the USA at the top of the list, Canada, most of Europe closely following, that have had Drug Abuse problems for probably the past 70 years, at a minimum. Possibly much longer than that. Legal drugs, illegal drugs, whatever, for drug abuse. To get "high".  

 

The current situation with Opioids in  the USA is critical, because of the huge numbers of people involved and many as you wrote are dying.  And, it seems to be very  different, because many of the people involved apparently began using the Opiods for legitimate reasons, after an injury or surgery.  Not simply because they wanted to get "high" on some drug(s).  

 

Complex problems have no simple solutions and this is a complex problem. I hope they can reduce the number of people who are dying from this.

[kroe1]

I agree. But I think eliminating them entirely is unreasonable. My dh is on Coumadin, and he's had several surgeries, back trouble, etc., not to mention the two blood clots that caused a pulmonary embolism. He can't take any NSAIDS because of the Coumadin. So he needs narcotics if he has serious pain. He's educated about their use though, and only takes them when necessary.

Opioids increase your husband's fall risk. If he falls while on Coumadin, his risk for serious bleeding and death escalates exponentially. So wouldn't you rather have him on pain control that did not have risks? Yes, opioids can be eliminated.

 

The same goes for the elderly. Opioids increase the fall rate exponentially in those over age 65. Hip fractures in the elderly have a 50% mortality within one year. The mortality is not necessarily from the fracture itself, but from the reasons causing the fall or even complications from the surgery. We must have better pain control for the elderly that does not involve narcotics. There is good research ongoing. It is due to this research that doctors have learned to prescribe calcitonin for elderly vertebral fractures instead of narcotics.

[Lanny]

This video is 2 minutes and 4 seconds long.  Interesting to watch,,,

 

http://www.foxnews.com/us/2017/08/02/ag-sessions-to-address-us-opioid-crisis-in-ohio-speech.html

 

ETA: The text on that page is pretty interesting too.  1 in 3 Americans taking Opioids...

Edited August 2, 2017 by Lanny

[ktgrok]

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

 

*sigh*

 

Truth. I'm a redhead. I have a high pain tolerance but I also don't process pain meds well, or rather I process them too well and too quickly. The idea of tylenol working for post surgical pain is laughable to me. Heck, after my bariatric surgery I was BEGGING for more pain meds in post-op, to the point where they finally said, "We've given you a LOT of morphine...we can't give you any more." And i was STILL in the worst pain of my life (and I've delivered a 10 pound baby with no drugs). 

 

I gradually tapered my pain meds as the pain lessened. But I was still taking some nucynta many days later, at least at night so I could sleep. 

 

We need to be better at figuring out who needs how much. And coming up with alternate drugs. The nucynta was nice because it is a synthetic so it supposedly isn't addictive? Worked about as well as vicodin. (I love vicodin, but for all the wrong reasons, so am careful about taking it)

[hjffkj]

I had 4 c-sections. I needed narcotics for two weeks for at least 3 of them (one of them only a week). I did not become addicted, but my pain was controlled.

 

It's such a hard subject because controlling access means that some people are going to be in pain for no good reason.

This was me but I've had 5. The only one I didn't need narcotics for after I got out of the hospital was my first. For the others I mainly only needed them at night so my pain was controlled enough to sleep. Because without them I would not have slept well enough for my recovery and overall mental health.

 

If I had an addictive personality or addiction ran in my family I likely would have chosen to go without and just be in unbearable pain. But those things aren't added risk factors for me so I took the narcotics

[Laura Corin]

The same goes for the elderly. Opioids increase the fall rate exponentially in those over age 65. Hip fractures in the elderly have a 50% mortality within one year. The mortality is not necessarily from the fracture itself, but from the reasons causing the fall or even complications from the surgery. We must have better pain control for the elderly that does not involve narcotics. There is good research ongoing. It is due to this research that doctors have learned to prescribe calcitonin for elderly vertebral fractures instead of narcotics.

 

Have you read Being Mortal, by Atul Gawande?  Long life is not my mum's main aim at the moment - people's goals change at the end of life.  She wants to be comfortable, get out into our field to research the different kinds of grasses, make herself soup, go to the supermarket on her own, complain about the world.  If that ease in moving around leads to an earlier death, then she's fine with that. She has written her living will and does not want to be kept alive if there is little chance of recovery, so she hopes to avoid a drawn-out, medicalised death. 

 

It's good that there is research ongoing into alternatives, but the opioids are fine for now for my mum.

Edited August 2, 2017 by Laura Corin