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Opioid State Of Emergency

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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)

In post op with my 4th csection my pain was unmanageable. I don't remember what they were giving me through the IV but it would only work for a few minutes and then I'd be in unbearable pain again but they couldn't give me more yet. One nurse thought I just wanted the pain meds for the feel and continued to try to get me to nurse the baby while in so much pain. My dh had to take the baby from my hands and not give her back when the nurse insisted I try to nurse her. I have no idea why it was so bad that time and not the others.

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I showed them studies of people having less pain who were given local anesthesia at each incision point.

 

 

 

My husband had bilateral hernias repaired and they injected some kind of slow release gel with lidocaine in it into the places he had surgery. I thought that was brilliant!

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I think the fact that most of the focus of this discussion about in drugs shows the underlying problem: As a nation we need to help people learn to prevent pain to begin with. People need good diets, exercise to keep range of motion, mobility work to restore limited range of motion, strength training, etc. Office workers need to learn how to counteract the negative effects of sitting so they don't end up with pain or limited range of motion. Research needs to be done on how diet, exercise, or supplements may reduce joint wear. People need to be told that simple, but crazy sounding things, like using a car buffer on your body as a massager, will help loosen up tight muscles and reduce many types of pain without drugs or surgery. They also need to be told that many knee surgeries are no more effective to placebo - in trials, fake surgeries worked as well as real surgeries.

 

I understand that people will need pain drugs after car accidents, surgery, etc. But collectively, I have to say, it appears that little effort is put into promoting awareness or research of non-drug alternatives. What percent of the population has even heard of a TENS unit?

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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). 

 

Sam Quinones talks about this in his book Dreamland. It's been a couple of years since I read it, but iirc, he basically puts the blame for the black tar heroin epidemic at the feet of the executives at the drug company which produces Oxycontin.They trained their salespeople to tell doctors that oxy was non-addictive and could be used as much as the patient desired. Many of those patients then ended up addicted and when insurance quit paying for the scrips switched to black tar heroin. 

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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.

 

Good for your mom and good for you!!

 

I am in total agreement with your mom's priorities, and I'm so glad she has her family who supports her choices.

 

 

 

I'm glad you mentioned the book. I bought it a couple years ago after hearing the author on NPR, but my own mom's death was stills too fresh for me to be able to read it comfortably. I've got it on my kindle. I'll have to pick it back up and finish reading it now. 

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I think the fact that most of the focus of this discussion about in drugs shows the underlying problem: As a nation we need to help people learn to prevent pain to begin with. People need good diets, exercise to keep range of motion, mobility work to restore limited range of motion, strength training, etc. Office workers need to learn how to counteract the negative effects of sitting so they don't end up with pain or limited range of motion. Research needs to be done on how diet, exercise, or supplements may reduce joint wear. People need to be told that simple, but crazy sounding things, like using a car buffer on your body as a massager, will help loosen up tight muscles and reduce many types of pain without drugs or surgery. They also need to be told that many knee surgeries are no more effective to placebo - in trials, fake surgeries worked as well as real surgeries.

 

I understand that people will need pain drugs after car accidents, surgery, etc. But collectively, I have to say, it appears that little effort is put into promoting awareness or research of non-drug alternatives. What percent of the population has even heard of a TENS unit?

I agree. We need to study other methods for pain treatment.

 

PEMF devices can help a lot with certain kinds of pain. I used to use an Almag device and now use a Sota which is fabulous. Now I'm saving up for a full body mat.

 

Laser light for pain reduction should be studied more as well.

 

Nanotechnology could also be helpful.

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I believe the discussion is different for the very old and the terminally ill.

 

 

Absolutely. For one, they don't have the possibility of decades of addiction ahead of them. Also, they aren't parents of little kids whose lives could be ruined. I have assumed that most people here are thinking of the non-elderly when they discuss this.

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I'm glad people have come along who actually needed more serious pain control after c-sections.  I had referred pain that had me sobbing in a heap, infections (both urinary and incision), and as it turned out I had a reaction to morphine that had me tearing violently at my skin.  My entire face peeled I'd torn it up so badly.

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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.

Well, you'll be glad to know that last Thursday when my dh was in the ER because he pulled a back muscle so badly at work that he couldn't move at all for a half hour and his coworkers called an ambulance, the first thing he said in the ER was, "NO OPIOIDS!" He's the one I posted about earlier who got just addicted enough when he had neck issues that he suffered through withdrawl. He won't walk down that road again if there's any way he can avoid it.

 

 

I'm glad people have come along who actually needed more serious pain control after c-sections. I had referred pain that had me sobbing in a heap, infections (both urinary and incision), and as it turned out I had a reaction to morphine that had me tearing violently at my skin. My entire face peeled I'd torn it up so badly.

That is horrible. I never even knew something like that was possible. :( Edited by Garga
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More programs like the ANGEL program in Gloucester, Mass. would be great.

 

http://gloucesterpd.com/addicts/

 

The official ANGEL policy at Gloucester PD.

 

http://paariusa.org/wp-content/uploads/sites/46/2015/08/Angel-program-policy-Aug-7-2015.pdf

 

There is a great need to fund mental health care in this nation as well. It's all fine and well to say we need to stop drug addiction, but unless we provide the tools for ongoing mental health support, the talk is useless.

 

Scientific American, in an article by Peter Urban dated January 16, 2017, provides the following information:

"A study in The New England Journal of Medicine in December 2016 found the program in Gloucester had shown notable signs of success. Between June 2015 and May 2016, the program’s first year, 94.5 percent of the 376 individuals seeking help were offered placement into a detox or treatment program and 89.7 percent enrolled—a rate far higher than the 50 to 60 percent for similar, hospital-based initiatives. (The researchers noted that further study is needed to determine how many successfully completed the programs and remain drug free.)"

 

I am not linking the Scientific American Article because it has a political bent.

Edited by TechWife

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That is horrible. I never even knew something like that was possible. :(

They also left a sponge in me and had to reopen the incision in my 2nd c-section. While they were an excellent solution to get out a couple of transverse babies, I much prefer the alternative.

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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. 

 

 

In NL, the most recent numbers I can find are 118 OD-deaths in 2012, out of which 28 were due to opiates. NL's population is about 17 million, so, adjusting for size, for the US you'd expect about 534 opiate OD deaths per *year* (or 2249 OD deaths for any kind of drug). 

 

Nationale Drug Monitor - Rijksoverheid

 

 

Numbers for US (looks like for 2012 20-something thousand opiate OD deaths, and about 40,000 overall OD deaths):

 

https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates

 

(I suspect that it's more complicated than having universal health care, though it probably helps, and I also wonder what impact the semi-legality of cannabis in NL has on these numbers)

Edited by luuknam
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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)

Tapentadol works on the Mu opiate receptors so addiction issues are certainly a concern and a reality for some. I think the DEA was doing the right thing when they classified it as a schedule 2 drug.

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Btw, I should probably add that doctors in NL lean more towards underprescribing than overprescribing (in general, not just opiates, but also antibiotics, etc), so that's a big difference too, that's largely cultural. But still, 40 times as many opiate OD deaths per capita in the US as in NL is crazy (or 20x as many overall OD deaths per capita). 

Edited by luuknam
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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.

 

 

A similar thing happened to my grandmother, but it made her end of life pain (via cancer) very very difficult to manage.  Probably she was happy to make the trade, though.

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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.

But such a thing does not exist, correct? If there was, certainly I would. I'm just talking about current pain control. I'm all for research into non addictive pain med.

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I'm glad people have come along who actually needed more serious pain control after c-sections. I had referred pain that had me sobbing in a heap, infections (both urinary and incision), and as it turned out I had a reaction to morphine that had me tearing violently at my skin. My entire face peeled I'd torn it up so badly.

I wasn't that bad, but I was definitely in pain requiring serious meds. In a c section you are having your whole abdominal wall cut open, things moved around, and if it's not your first, adhesions separated. You could have a much more minor surgery but wouldn't be expected to go without meds. And you would be told to rest for weeks after! With a c section you have to take care of a new baby too.

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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.

So true, just going through the blood thinner vs fall risk in an elderly friend. Tough place to be.

 

What about acetaminophen? I think a person on Coumadin can typically take around 2500mg daily.

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I feel like just a smidge of patient education would go a long way. My DH just had a wisdom tooth out. The doc told him what OTC pain meds he could take and in what dose, and then wrote him an Rx for Vicodin to be filled ONLY if the OTC meds weren't working. We didn't fill it. 

 

I wish more doctors were that way. We have a great GP who will do that with antibiotics when you come in with a borderline ear infection or sinus infection. Only fill this if X, Y, or Z happens. We fill it less than 1/3 of the time. 

 

Sure, I have met a few people who think pills are the cure all and the more the better, but I know way more who try to be careful with what meds they take. Presenting OTC as the preferred option and opiates only as a plan B I think is a painless/free way to put a dent in new addictions. 

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Good for your mom and good for you!!

 

I am in total agreement with your mom's priorities, and I'm so glad she has her family who supports her choices.

 

 

 

I'm glad you mentioned the book. I bought it a couple years ago after hearing the author on NPR, but my own mom's death was stills too fresh for me to be able to read it comfortably. I've got it on my kindle. I'll have to pick it back up and finish reading it now.

I will just add that the choice to drop the anticoagulant (or to substitute something less effective) than Coumadin is also a "Beung Mortal" sort of choice. The regular blood sticks for INRs can have an diminishing effect in quality of life, particularly for those with anemia. Add anemia and gastric issues, and it's an equal but opposite choice. Operative word, choice, for end of life care.

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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'm so sorry, that's horrible.  Obviously pain killers are often necessary at the beginning especially.

 

I was referring more to pain killers being used long term INSTEAD of physical therapy.  I had a friend in particular who had a shoulder injury from a fall.  Her doctor just kept prescribing pain killers for TWO years.  She didn't have insurance, so she kept saying she couldn't afford physical therapy.  Eventually she was able to, and within 6 weeks she was off the pain killers.  Availability and affordability are a definite factor.

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I believe the discussion is different for the very old and the terminally ill.

 

 

Sent from my iPhone using Tapatalk

 

Absolutely, it becomes a quality of life issue.  My mother would not have been functioning the last 10-15 years without opioids.  So what if she's addicted (dependent) at this point?  I'm all for research, but in the meantime, people that need it to function should get it. 

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So true, just going through the blood thinner vs fall risk in an elderly friend. Tough place to be.

 

What about acetaminophen? I think a person on Coumadin can typically take around 2500mg daily.

To clarify, my husband is in his forties, so not elderly. He does take acetaminophen but all pain, like surgery pain or back trouble, doesn't respond to just acetaminophen. And you can easily poison yourself with Tylenol if you aren't careful. Most normal people can take care of a lot of pain by using both Advil and tylenol together but you can't do that on Coumadin.

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Ds was in the doc's office yesterday. He is having a ton of leg pain and is unfortunately developing arthritis in the injury. Poor boy is only twenty.

 

No opioids. He did not want them and doc said she would not offer until he reached a place that it was unmanageable.

 

Ice pack regimen, warm bath before bed, aspirin and Advil - much higher dose of Advil than he had been taking and more regularly - low impact exercise overseen by his PT and if need be, referral for water therapy at the PT pool. She is hoping to avoid that unless she can force the car insurance to pay for a private therapist because usually it is done in a group and nearly everyone is elderly. She feels that would be depressing for him.

 

I would give my right arm to get car insurance to give us an indoor pool and jacuzzi because he feels ALOT better when he is in the water. I think if he could do a couple laps everyday and a soak at night, his quality of life would greatly increase. In a three county radius, there is no indoor community pool. One high school has one and during the school year it is only open for lap swimming. He cannot swim a full length yet so they won't let him have a lane during lap swim time.

 

Anyway I felt like it was a good consultation. He was up front that since this is a permanent disability he is not willing to entertain opioids.

 

Can I admit here without judgement that his suffering has triggered my PTSD, and I am feeling some strong anger today towards the texting and driving fool who nearly killed us?

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Can I admit here without judgement that his suffering has triggered my PTSD, and I am feeling some strong anger today towards the texting and driving fool who nearly killed us?

 

:grouphug: I can imagine myself thinking very unChristian thoughts...

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Can I admit here without judgement that his suffering has triggered my PTSD, and I am feeling some strong anger today towards the texting and driving fool who nearly killed us?

 

Texting and driving makes me bristle - always.  Yours is an example why.  So many who wouldn't think of driving after drinking or using drugs think nothing of texting and driving even though it's just as dangerous.  NBC ran a story on it when Washington State made using an electronic device while driving an illegal offense of its own (DUIE - driving while under the influence of electronics if I recall correctly).  They said something like 1 in 4 crashes are caused by electronic devices and 9 deaths occur daily from it.  They didn't mention debilitating injuries like your family has.  Even so, 1 in 4 crashes could be prevented if only folks would use some common sense instead of brushing it off and saying, "Oh, I can do it just fine."  :banghead:

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In post op with my 4th csection my pain was unmanageable. I don't remember what they were giving me through the IV but it would only work for a few minutes and then I'd be in unbearable pain again but they couldn't give me more yet. One nurse thought I just wanted the pain meds for the feel and continued to try to get me to nurse the baby while in so much pain. My dh had to take the baby from my hands and not give her back when the nurse insisted I try to nurse her. I have no idea why it was so bad that time and not the others.

I've been hesitant to contribute much on this thread because a) I'm a pharmacy board member and am very involved in managing this and the prescription monitoring database in our state and b) I'm a big fan of opioids for acute pain relief. With my last c-section I needed heavy narcotics for two weeks afterward. They only gave me four days worth and it barely covered my pain - then I had to go to the ER on a holiday weekend to try and obtain more so I could move enough to function in the nicu. With my first c section? No problem.

 

Pain is very personal and it is impossible for someone on the outside to really judge what someone else is feeling. Some people are more stoic, some more demonstrative, some feel remarkably little with one surgery and a ton with another. Sometimes a particular drug is well tolerated.

 

In my case, Percocet worked better than Vicodin for the pain I was feeling, and lower doses more frequently worked ether than higher doses less frequently. Each baby I've also had worse and worse afterpains, especially during nursing, and have needed meds to manage those for a week or so.

 

And despite having familial struggles with substance abuse that I'm prone to, I've taken narcotics probably a dozen separate occasions and never developed physiological dependency. And sometimes I've been way less and other times, way more.

 

Making it more difficult for people to access drugs for legitimate needs doesn't stop abuse by those who are addicted. It just makes their efforts more aggressive, more b&e, and more doctor shopping.

 

At last check of our PMP database, only something like 10% of logged patients hit our flagging criteria for possible abuse whereby the provider is sent a letter asking them to verify the dosages and therapies for their patient. And only a handful of those were addicts and not legitimate conditions being treated. Most of the abuse is not the kind that is caught with the program, but diversion of the opioids by pharmacy personnel, nurses, and robberies. And making it harder for the guy with a fused spine to make it through his day isn't helping anyone, quite frankly.

 

Alternative treatments and pain therapies are definitely being pushed on a state level, and that's all gravy. But it's only a small part of the equation.

Edited by Arctic Mama
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A similar thing happened to my grandmother, but it made her end of life pain (via cancer) very very difficult to manage.  Probably she was happy to make the trade, though.

 

I'm sorry to hear about your grandmother.  I could definitely see that being an issue with my mum.  Her living will states that she would like pain killers used to make her comfortable even if they have the side-effect of shortening her life (this is legal here, so long as shortening life is not the main aim).  I know that this isn't always possible.

 

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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?

Forget csection. They offered me pain medicine after I gave birth compmetely naturally. Ummm, hello I just gave birth with no drugs, no thanks.

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Forget csection. They offered me pain medicine after I gave birth compmetely naturally. Ummm, hello I just gave birth with no drugs, no thanks.

The after pains were worse after my completely natural precipitous labor than the one with induction and the self starter with epidural. Probably were the most painful part of that birth! Evening breastfeeding sessions were awful. Of course I was still puking (a day later, a week later, a year later...) after that birth so narcotic meds weren't a good option.

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Just wondering what you think....I was thinking about this thread and about how short hospital stays are compared to what they used to be--for example I think my mom stayed in the hospital close to a week with me. And maybe outpatient surgery was quite rare? I have no basis for this thought except my own vague memories of things. But you were "better" when you left the hospital and therefore didn't need as many narcotic pain meds when you went home. The pain was managed in the hospital by professionals. Now you are sent home the same day with a prescription. Those of you who are older or more knowledgeabiut such things what do you think?

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I am just so angry with all the proposals to make it much harder for legitimate pain patients to get needed medication. I am not an addict to anything. For those who say only for elderly or teminally ill, why would you want to subject people like me to horrible pain for decades? An article, probably in Arthritis Today, a few years ago said that new studies find that RA patients have much worse quality of life and pain issues than most cancer patients. I don;t have one joint that hurts, I have them from my jaw and neck down to my toes. I am a poster child of what is wrong with the anti-opiod policy of harassing legitimate patients. I was put on strong NSAIDS- first ibuprofen and quickly changed to stronger and stronger ones. I took those for about 10 years until I one day thought I was having a heart attack when I was in my later 30s. (and I had reason to be concerned because my younger sister had just recently died from a heart attack then). I did not have a heart attack--I had esophageal spasms which are described inthe literature as feeling like a heart attack. It was caused by the years of NSAIDS and I had to quit them immediately. My rheumatologist then prescribed my small doses of hydrocodone-acetominophen. Took those for a while and then the new NSAIDS that weren't supposed to hurt the stomach came out. Tried I think Celebrex. Right back to the esophageal spasms.So after taking the nitroglycerin which is the medicine for the esophageal spasms, I went back to opiods. No, I was never addicted. NO, I did notwake myself up to take them. No I didn;t need to increase my dose for well over 10 years, I wasn't always taking them because it depended on my pain level at a given time, I didn't take more frequently than prescribed- usually I took less. They didn't take away all my pain but enough to make me be able to function. With menopause and better dose of my true arthritis drugs, I now take a pill maybe once a month maybe none some months and a few another month. Oh, and I got a second reason I can;t take NSAIDs 7 years ago when I was put on coumadin. I never got any high from the drugs and they didn't make me sleepy or anything except get rid of pain. I also am able to use VOltaren skin cream and on some days, I do use that one not exactly as prescribed because I am in much pain but also have bad brain fog and don;t want to take any pain pill. I don't take plain tylenol. I haven't found it to help with pain at all and I found out that it has been indicated in hearing loss- which I have- and in the form of skin cancer that I had. (It is required to be mixed in with opioids here in the state but I am thankful for Norco which reduced the amount of it. So for me, there are no alternatives now. For many people, there are no alternatives now. But don't tell people like me who have lived with painful arthritis since early 20s so over 30 years now to go suck it up. And no, I never even had any dependence since I never had any withdrawal symptoms ever when I stopped. People are different and while some few people overall become addicts--and most of the deaths seem to be coming from people who never were prescribed anything at all, to deny true pain patients nor matter what age appropriate care. It broke my heart to hear of a relative of someone i know who had a painful disease but wasn't old who committed suicide after he couldn't get adequate pain care which he had had for years before but with doctors running scared, he coudlnt' get anymore.

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Dh is having his tendon reconstructed today. He was told that OTC Tylenol or Advil is all he will get. I find it rather cold and heartless that they have no idea beforehand what his pain level will be, but have decided in advance that he is getting nothing.

 

In my opinion that is just an extreme swing of the pendulum that does not serve patients well. Typical in America. Seems like common sense is so rare now it is practically a super power for those that possess it!

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Dh is having his tendon reconstructed today. He was told that OTC Tylenol or Advil is all he will get. I find it rather cold and heartless that they have no idea beforehand what his pain level will be, but have decided in advance that he is getting nothing.

 

In my opinion that is just an extreme swing of the pendulum that does not serve patients well. Typical in America. Seems like common sense is so rare now it is practically a super power for those that possess it!

 

I hope things go well today.  My prayers are with y'all for a successful surgery and uneventful recovery - then a "dull" life for a wee bit (ok, maybe an exciting, but in a good way, life).

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I could write a book about how having DH on 15 years of prescription opioids has shattered our family. All done legally and on a pain contract from one doctor. We were told that for chronic pain, they weren't addictive and wouldn't cause long-term issues. We tried EVERYTHING, and he even ended up with an internal stimulator and opioid pump from a nationally-ranked pain clinic.

 

DH had significant psychiatric problems on them, and even five months off, he's still got some of the same issues. Professionals have told me that he likely has permanent damage to his brain. 

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I am going to be praying for him.  Faithmanor- here is what I did and do with OTC pain meds with my family - go on a site like Rxlist or drugs.com and see what the prescribing info is- like Ibuprofen is 800mg. every 6 to 8 hours or 925mg of aspirin instead of 325, etc,  Check with what you have just put in prescription whatever dosage and you get your answers.  It did make a difference in all of their pain experiences.

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Oh and have him use anti acid stuff like Prilosec, Zantac, or some other one while taking the stronger NSAID dosages or for anyone taking more than just every once in a while.

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Reading this thread has made me see how fortunate I was. I had 3 c-sections, had extreme post-op pain, took opioids alternating with ibuprofen to stay on top of the pain, tapered down gradually, and then was done. The opioids never gave me a warm fuzzy feeling, they just kept me from feeling like I was William Wallace in the torture scene of Braveheart, and I never had a withdrawal symptom or the desire to take a pill once my body had healed.

 

I didn't realize till now how high the risk of addiction was even when following directions. Yikes!

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I am just so angry with all the proposals to make it much harder for legitimate pain patients to get needed medication. I am not an addict to anything. For those who say only for elderly or teminally ill, why would you want to subject people like me to horrible pain for decades? An article, probably in Arthritis Today, a few years ago said that new studies find that RA patients have much worse quality of life and pain issues than most cancer patients. I don;t have one joint that hurts, I have them from my jaw and neck down to my toes. I am a poster child of what is wrong with the anti-opiod policy of harassing legitimate patients. I was put on strong NSAIDS- first ibuprofen and quickly changed to stronger and stronger ones. I took those for about 10 years until I one day thought I was having a heart attack when I was in my later 30s. (and I had reason to be concerned because my younger sister had just recently died from a heart attack then). I did not have a heart attack--I had esophageal spasms which are described inthe literature as feeling like a heart attack. It was caused by the years of NSAIDS and I had to quit them immediately. My rheumatologist then prescribed my small doses of hydrocodone-acetominophen. Took those for a while and then the new NSAIDS that weren't supposed to hurt the stomach came out. Tried I think Celebrex. Right back to the esophageal spasms.So after taking the nitroglycerin which is the medicine for the esophageal spasms, I went back to opiods. No, I was never addicted. NO, I did notwake myself up to take them. No I didn;t need to increase my dose for well over 10 years, I wasn't always taking them because it depended on my pain level at a given time, I didn't take more frequently than prescribed- usually I took less. They didn't take away all my pain but enough to make me be able to function. With menopause and better dose of my true arthritis drugs, I now take a pill maybe once a month maybe none some months and a few another month. Oh, and I got a second reason I can;t take NSAIDs 7 years ago when I was put on coumadin. I never got any high from the drugs and they didn't make me sleepy or anything except get rid of pain. I also am able to use VOltaren skin cream and on some days, I do use that one not exactly as prescribed because I am in much pain but also have bad brain fog and don;t want to take any pain pill. I don't take plain tylenol. I haven't found it to help with pain at all and I found out that it has been indicated in hearing loss- which I have- and in the form of skin cancer that I had. (It is required to be mixed in with opioids here in the state but I am thankful for Norco which reduced the amount of it. So for me, there are no alternatives now. For many people, there are no alternatives now. But don't tell people like me who have lived with painful arthritis since early 20s so over 30 years now to go suck it up. And no, I never even had any dependence since I never had any withdrawal symptoms ever when I stopped. People are different and while some few people overall become addicts--and most of the deaths seem to be coming from people who never were prescribed anything at all, to deny true pain patients nor matter what age appropriate care. It broke my heart to hear of a relative of someone i know who had a painful disease but wasn't old who committed suicide after he couldn't get adequate pain care which he had had for years before but with doctors running scared, he coudlnt' get anymore.

It is for reasons like this that I don't think we can have a one-size-fits-all zero-tolerance policy. I'm so sorry for your pain.

 

AND I am sorry for my two friends who have lost adult children to opioids. One death looks to be unintentional, the other... ???

 

There has to be a path that is somewhere between a complete crackdown on everyone and the 80 pills prescribed to me for a broken arm and a cancer removal and follow up plastic surgery, one pill of which I have taken. Kwim? It's complete overdosing. And I didn't even ask for them.

 

Perhaps they could have prescribed a few days worth and gone from there. But two weeks, without even a trial, for each situation? This difference probably would have saved one if my young friends.

 

The problem I really have no clue how to solve is the doctor shopping. The AMA guys have to do s better job here, for one thing. Or we will have to have a registry of some kind. Or maybe this is as hopeless as the war on drugs.

 

I admit to being a naive person. I'm just sad at the loss of two lovely young men and perplexed at the auto-prescriptions I was given.

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I think it is a complex issue and I don't have answers.   However, I do think there some contributing factors that haven't yet been mentioned here (or I missed them).  Namely, the pharmaceutical companies have a vested interested in moving volumes of product and have aggressive salesforces aimed at that goal.  Also, many physicians are overbooked/overworked and are pushed to overprescribe or prescribe as a means of shortening the time spent with a patient (i.e. as a default time management tactic).  

 

Another big piece of the puzzle that's been mentioned, but IMO, deserves more attention is that patients are woefully underinformed about narcotics. 

 

FWIW, I believe that opioid use by people who did not start out their addiction with legal prescriptions is a completely separate issue to tackle and falls under the wider umbrella of treating addictions, for which there is not nearly enough support given nor resources allotted and/or available. 

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I have family members who were very well educated and had careers and were brilliant who ended up addicted to prescription medication. The one of those family members who has children, her children are drug addicts with the youngest, who is a teen, being kicked out of high school and sent to juvenile detention and a mandatory drug rehab program and has been kicked out of 6 high schools and now just is listed as a home schooler even though she does not home school, she is simply strung out on drugs. I really think her jump to illegal drugs started with the prescription drugs and knowing her parents did her. Her dad also did marijuana. The first time she was caught with drugs at schoo and when she first started selling drugs, it was prescription medication she took from her parents. Her parents have seriously faulty judgement. They cover up for her and lie a lot. 

 

These are all people who I never ever thought would go this direction. I grew up in a family that did not even drink alcohol. Now I find out my mother was abusing prescription drugs and two of my siblings are addicts now. 

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I was offered opioids after my two C-sections, but the hospital regulated them very tightly.  I was grateful for them in the few days after surgery, because they really were more effective than ibuprofen and allowed me to get up and walking quickly, but I can see why they are tightly controlled because, oh-boy, if that nurse was 5 minutes late with my fix, I got testy!  When I had foot surgery about 6 years ago, they offered them to me and I refused because I knew how addictive they were.  The doc then actually tried to push them on me, but I really didn't need them and refused.

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

 

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I was just reading somewhere that the majority of deaths in one Ohio county was not due to common opioid painkillers or heroin, but was due to fentanyl and a fentanyl derivative.  If true, the crackdown on legitimate, prescribed pain meds won't really help those who obtain fentanyl on the street. 

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