Someone I love has chronic pain managed with (legally prescribed) opioids, and they have constant low-level anxiety that a bureaucratic mixup will result in their medication being denied (or heaven forbid they lose a prescription, or that they'll need a refill when their doctor is on vacation and the locum will be 'suspicious of drug seeking behavior'.
They had to sign a document that if they lost a prescription, they understood that they would be denied a refill, even though (a) there isn't actually any reason to physically hand them the piece of paper, it could all be done between the doctor and pharmacy, and (b) people with chronic pain typically also exhibit various degrees of 'being distracted' due to that same pain.
I could go on, and TBH, my friend hasn't had any gaps in getting their medication, but the current wave of anti-opioid hysteria is concerning.
This is not the media's fault, nor is this is not chronic pain patients' faults. This is the result of criminal corruption and abuse in the pharmaceutical industry and distribution system. There is a real and enormous problem https://www.drugabuse.gov/related-topics/trends-statistics/o... (opioid overdose death rates have more than quadrupled in 20 years, are at a high level already versus other causes of death at 50k annually, and are accelerating). Opioids are some of the most dangerously addictive medicines that exist, and habituation and pill selling is a huge problem that is also ruining and ultimately costing lives.
Finally the sizable majority of prescription drug abusers in this country do not source from a doctor or the healthcare system at all. The vast majority get their drugs either from the black market or a friend or relative. On the National Drug Use Survey only 18% of prescription drug abusers report doctors as their primary source. And among street prostitutes (a high at-risk group) only 5%[3].
All of this goes to show that there is very little evidence of any sort of over-prescription of opiates in America. To begin with the vast majority of the opiate crisis has to do with fentanyl, not prescription drugs. But even when it comes to prescription drug abuse, the intersection with medical users is vanishingly small.
[1] https://www.ncbi.nlm.nih.gov/pubmed/18489635 [2] http://www.ncsl.org/portals/1/documents/health/APeeples0118_... [3] http://sci-hub.tw/https://www.tandfonline.com/doi/abs/10.108...
You are correct that chronic pain patients are not a high overdose risk and that there is little to no benefit to treating their prescriptions with suspicion. (People who don't have to operate in a black market are MUCH safer.)
Here is here you go wrong:
> All of this goes to show that there is very little evidence of any sort of over-prescription of opiates in America.
There is very clear evidence for over-prescription of opioids. There is very clear evidence that the risks of addiction were deliberately minimized by drug companies and doctors were incentivized to over-prescribe for as many off-label uses as possible.
The issue is: Anyone who does develop a problematic addiction to pill they are prescribed tends to have their access cut off and are thus forced into the black market where their chances of overdose increase dramatically.
Thus while users with drug prescriptions may not be overdosing at high rates, that does NOT mean that the black market overdoses are not directly causally related to the over-prescription of opioids.
> Finally the sizable majority of prescription drug abusers in this country do not source from a doctor or the healthcare system at all. The vast majority get their drugs either from the black market or a friend or relative.
They may not source directly from the healthcare system, but prescription diversion and fraud do indirectly source a lot of product from the the healthcare system. I suspect that crackdowns on this diversion helped spike the blackmarket opiod overdoses as it decreased the quality of the blackmarket supply (and thus increased the prevalence of Fentanyl.)
Ridiculous. It certainly does not, in any way, shape or form. Your "analysis" also excludes the very clear evidence that people get hooked on opioids from prescription pills and transition to black market products like fentanyl.
"The volumes of the pills handled by the companies climbed as the epidemic surged, increasing 51 percent from 8.4 billion in 2006 to 12.6 billion in 2012. By contrast, doses of morphine, a well-known treatment for severe pain, averaged slightly more than 500 million a year during the same period." https://www.washingtonpost.com/investigations/six-takeaways-...
Completely false. You refer to data about a subsection of opioid prescriptions (chronic pain patients), and asserting broad claims that are not accurate.
"In just 10 months, the sixth-largest company in America shipped more than 3 million prescription opioids — nearly 10,000 pills a day on average — to a single pharmacy in a Southern West Virginia town with only 400 residents, according to a congressional report released Wednesday."
https://www.wvgazettemail.com/news/health/drug-firm-poured-m...
Let's just take your example. What do you believe is more plausible? That a town of 400 people are collectively prescribed 10,000 pills a day by well-meaning doctors? Or that the pharmacy from your example is a front for organized crime to funnel prescription opiates into the black market?
That prescription opioids are significantly reduced, yet the death rate continues to climb indicates the focus on the current solution is in the wrong place.
No one, including me, denies "pill selling" is a problem. However that has zero to do with the people with Chronic Pain that are doing everything within the law.
There are bad doctors, and other bad actors, they need dealt with of course. Not at the expense that need such medication.
False. There has only been a minor reduction in sales. https://www.fda.gov/media/111695/download
Also, it just means those easy pain pill scripts are drying up, and people are turning to black market alternatives. It's cheaper and easier to import fentanyl from PRC and press it. Also leads to dosing errors (overwhelming cause of deaths).
The crisis was directly contributed by over-prescription ande the deliberate minimization of addiction risks. The crisis was exacerbated by then pushing these people off their legal prescription once they become addicted, forcing them into the black market.
> That prescription opioids are significantly reduced, yet the death rate continues to climb indicates the focus on the current solution is in the wrong place.
When you push more people into the black market, it is reasonable to expect that over-doses will rise.
> There are bad doctors, and other bad actors, they need dealt with of course. Not at the expense that need such medication
Yes, I agree. We are much better served by educating about and being aware of addiction risks than we are by limiting access to prescription medication because we are concerned a person is already addicted.
Also, as long as we're here, the reason pill-selling and whatnot exists is because of the war on drugs. But that's a larger discussion than what I/we can do here.
The thing that is the hardest is that ultimately the best pain control for me is a safe and calm lifestyle and decent healthcare in the right conditions I can survive without medication, but with the loss of health and money goes your access to that lifestyle and healthcare, increasing the need for meds, at a time and situation in which you can least get them. I've tried nearly everything, at least that I can access, and that access, mainstream and alternative just gets worse here in the USA. I just need a small flat and a simple life in a city with connections and resources. I am stuck in the opposite.
I had a great, once in a lifetime, accomodative job opportunity abroad from a member here that I couldn't get to because of worsening pain and life stability and I sunk further as a result. Should have just gone and failed and gotten it over with rather than suffering more in worse conditions. It's a pit of quicksand once you get in it. It's hard enough in countries with good systems, but in the USA it's hopeless. I am now stuck in rural nowhere in so much pain with no good healthcare and transport and a horrid quality of life. I am over the debate and the "opiod crisis" and people's judgement here...I just want out and stable if thats even possible anymore, or it over. Tired of suffering every day.
Dextromethorphan and grapefruit juice can potentiate to stretch out doses in times of drought.
Sorry to hear that our medical system is failing you. Truly immoral.
https://www.fda.gov/news-events/public-health-focus/fda-and-...
Definitely risky, and not something I'd ever suggest for recreational purposes. Also important to know that many opiate tests look for non-intoxicating metabolites that are directly available in the poppy, so doctors may overestimate the amount of morphine the individual consumed: leading to overprescription in replacement therapies or overdose treatments, both of which can be dangerous.
At some point, she realized that she may be developing a bit of a pill problem. She went to her doctor, to see what could be worked out.
He listened her out, marked her down as drug-seeking, and cut her off, cold turkey.
Surprise, fucking surprise, the very next thing she did was to turn to black market oxy.
Eight years of rehab, rehab again, fighting, bargaining, threatening, and pleading, she's once again relapsed, and their marriage is falling apart.
I speculate that if it does, she'll likely be dead in a few years.
http://medicaleconomics.modernmedicine.com/medical-economics...
This is my reply to Dr Gart's editorial, edited to fit the format here the best I can.
“… First and foremost, we must bury the claim of pain being the fifth vital sign and replace it with a 21st Century pain assessment tool that incorporates objective evidence and measures of pain. …”
Dr Gart, at this moment are you hungry? In your lifetime have you ever been hungry? Hunger is a type of pain. Did you treat that pain by consuming a substance?
Please correct me if I am wrong. To my knowledge there is no objective test, no simple Pain Meter, that will show me that you are hungry. Yes we could look at enzymes and such. Will that truly tell me just how hungry you are objectively?
If there is no objective test for a pain as simple as hunger, that each of us experience most every day, what hope does a person in Chronic Pain have?
In Ohio the Governor is now practicing medicine by decreeing that there can be no more than seven days of opiate pain medication. Perhaps he should discuss that with the person that was hit by a train and survived with most every bone broken.
My wife Karen died of suicide to stop the pain she experienced for over over 20 years, due to the failure of the Medical Establishment as a whole. THIS IS THE REALITY OF Chronic Pain.
"Karen's Journal of CSF Leak Headaches and Chronic Pain: How Intracranial Hypotension and Levaquin (Levofloxacin) Killed Me"
is now required reading at Duke School of Medicine to educate future Neurologists about the realities of Chronic Pain.
A local reporter wrote in a Cover Story:
"Karen's first-hand account of her illness gave an honest, heart-wrenching depiction of what it is like to live with debilitating pain day-to-day." – http://www.kpaddock.org
May I humbly suggest you read it.
See for FDA links on the antibiotic issue [at http://www.kpaddock.com/fq ].
In book form it has been edited by a medical doctor that has the same condition has Karen had. When bought through the Spinal CSF Leak Foundation 100% of the royalties go to them, to support them, just in case anyone thinks I'm posting this to promote the book for profit myself. The book can be read for free at http://mystory.kpaddock.com for free.
I do not know what motivated you to write your article. I do know from it that far more time needs to be spent with people in Chronic Pain, to understand the realities of their life.
When a person in Chronic Pain that has been taking opiate pain medication under a competent doctors supervision for ten years, is able to function, take care of their family, hold a job, is without warning told then can not have it any more, “tough luck”. What are they to do? They resort to street drugs and become the very victims this currently policy is trying to prevent.
People in Chronic Pain have typically already tried multiple rounds of physical therapy, bio-feedback, meditation, exercise and the list goes on, with no relief from the pain. What are they to do?
Not having Chronic Pain myself, I will never claim to understand it. I did watch my wife suffer with it for 20+ years. What exactly is the agenda here? None of us such as Advocates like myself nor the sufferers have figured this out yet. Can anyone please explain? To us it appears as an attack on the most vulnerable.
This is one of the many comments I received about your article: “…Chronic problems frustrate doctors and they blame the patient rather than look at themselves. …” or support research to find real solutions to Chronic Pain. No one chooses to live with Chronic Pain each and every moment of their lives.
If you don't eat you die. Do you die if you don't consumer pain killers? No you don't.
This is similar to the nonsense peddled by people who claim anti-depressants are the same as insulin and various other snake-oil salespeople.
Some people want to control others and just don't care what the reality is.
They would never ban alcohol, they consume it.
They would never ban cars; they drive them.
They would never ban fast food; they eat it.
They will never ban sugar; they love it.
All of these things have cause a million times more misery than opioids ever have, by all measurable statistics (deaths, injury, domestic violence, etc)
But if there is something someone is doing that they aren't, their measurement of pros and cons will change. Statistics and comparable things of pleasure/damage will never be considered.
HN is also guilty of this in otver contexts.
The issue with perception is universal. We all feel these things.
How we act though? That's a choice. We can choose to read statistics and let our 'slow thinking' brain take over. But it has to be a choice and that lies with each of us.
Do you notice you are replying to a comment about somebody that did, right?
Not every problem is simple.
Your refusal to believe that illnesses can affect the brain is obsolete thinking.
Those with Chronic Pain are being left to suffer because of abusers. In April of 2019 the CDC stated that their "guidelines" are being miss applied. Sadly the damage is already done.
https://www.cdc.gov/media/releases/2019/s0424-advises-misapp...
"CDC Advises Against Misapplication of the Guideline for Prescribing Opioids for Chronic Pain Some policies, practices attributed to the Guideline are inconsistent with its recommendations.
In a new commentary in the New England Journal of Medicine (NEJM), authors of the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain (Guideline) advise against misapplication of the Guideline that can risk patient health and safety.
CDC commends efforts by healthcare providers and systems, quality improvement organizations, payers, and states to improve opioid prescribing and reduce opioid misuse and overdose. However, some policies and practices that cite the Guideline are inconsistent with, and go beyond, its recommendations. In the NEJM commentary, the authors outline examples of misapplication of the Guideline, and highlight advice from the Guideline that is sometimes overlooked but is critical for safe and effective implementation of the recommendations.
CDC is raising awareness about the following issues that could put patients at risk:..."