The Ongoing Man Made Opiod Catastrophe

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The Ongoing Man Made Opiod Catastrophe

Post by Stercutus » Wed Mar 13, 2019 9:14 pm

The various states are getting organized and preparing major push back to the drug companies for the current state of affairs in the highly addictive, life taking opioid crisis that is sweeping the United States.

Hundreds of thousands of people have died directly and indirectly due to the crisis and millions of others have been profoundly effected. The economic cost is in to the hundreds of billions, likely truly incalculable. I see it, live it and deal with it every single day as a cog in an enormous machine.

https://www.npr.org/sections/health-sho ... public-eye
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Re: The Ongoing Man Made Opiod Catastrophe

Post by NT2C » Thu Mar 14, 2019 4:16 am

And here we go, tossing the baby out with the bathwater again. :gonk:

Are opioids addictive? Yes. Is there an opioid crisis? Yes, but actually there's two of them. Unfortunately, we're only fighting one and that's making the second one worse by the day.

What's the second one? The crisis of patients who genuinely need opioids, because they are their only effective pain reliever, being cut back or denied them completely and suffering debilitating pain. It's a real problem these days, one with far-reaching consequences. Let me tell you about a friend of mine named Larry...

Larry is a medically retired Air Force vet. He had almost 19 years in, multiple tours, first Gulf War, etc., etc. He was up for E7 and considering going beyond 20 if the AF wanted him. On his way to work one morning all that changed when a drunk driver ran a stoplight and broadsided him on his motorcycle. Medics were on the scene very quickly and that's a good thing because his heart stopped three times before they could get him in an OR and stabilize him. He had a whole shopping list of injuries but the worst was the 7 breaks in his spine. He was MEDEVAC back to the States and spent a little over a year in Walter Reed, getting his back worked on (he has a steel cage around his entire lumbar spine now) and was told several times that he would never walk again. Thankfully, he proved his docs wrong on that and not only walked again but eventually became capable of caring for himself again and living a normal life. Well, normal except for the painkillers he had to take in order to function. He was prescribed a wide selection of pain meds that he could take, as needed, depending on his pain level. Everything from morphine on down to Tylenol, and he did well with them. He never abused them, never shared or let anyone else have access to his supplies, tailored his dosages to his activities (such as driving - he's an excellent driver and I ride with him often) and just lived by himself in a house out in the middle of a soybean field. As a ham radio operator, he became very active in public service and emergency communication work and volunteered with FEMA, the state, county, and city emergency management departments, not just where he lives but also surrounding areas, and events like the Marine Corps Marathon and Historic Half. Then the FDA started cracking down on opioid abuse and his life became a living hell again. Currently, he's been cut back to about half of what he actually needs, and his docs have been trying all kinds of other "therapies" on him that have some pretty nasty side effects. The VA no longer sends him his meds every month, now he has to drive 60 miles each way every week to get them in person... except for a few months where his driver's license was suspended, not for anything he'd done wrong, but because he answered honestly when DMV asked about any prescription meds he was taking when he went to renew his license. It took three months to get all his docs to sign off on the paperwork to get his license back, and DMV says he now has to do that every 6 months. In order to drive though he has to stop taking his new meds 24 hours before, because they give him double vision and make him disoriented. It then takes about two days to build the levels back up again to where they actually help him at all. Meanwhile, every now and then the VA changes one of his docs and the new one refuses to give him the meds he needs and insists all he needs is to go to the pain management program (which he's done, three times, and three times been told they can't help him). The FDA has docs so cowed on this issue that they are denying meds to patients who have no alternative, out of fear of losing their licenses to practice or going to prison. Larry is now at the point where he's being faced with the very real possibility of being unable to care for himself any longer and losing his home, his ham radios, his guns (his farm is where I go to shoot), his camper, his motorcycle, his beloved '65 Mustang that he wants to restore, all of it, and be put in an assisted living facility. All because the opioid crisis you read about and see stories about on the news has spawned this whole second opioid crisis, one that you don't hear about and that no one campaigns to put an end to, and that's unacceptable to me but I lack any way to change it.
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Re: The Ongoing Man Made Opiod Catastrophe

Post by Stercutus » Thu Mar 14, 2019 6:04 pm

Let me tell you a story about my son. A few years ago he was in a bicycle crash that required some stitches. I took him up to the ED and he got stitches. After the Doc asked him what his pain level was and my son truthfully told him a "2" out of "10". The doc promptly wrote him a script for Percocet. That simply was not happening. But guess what? Many parents would have gotten that filled and started feeding their child dope.

Do people need pain drugs? Some do. But the lines got badly contorted somewhere along the way. It makes no sense that the US consumes 75% of the world legal supply of opioids. Are pain problems that much worse in the US that we have to dish out dope by the truckload?
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Re: The Ongoing Man Made Opiod Catastrophe

Post by NT2C » Thu Mar 14, 2019 9:54 pm

Stercutus wrote:
Thu Mar 14, 2019 6:04 pm
Let me tell you a story about my son. A few years ago he was in a bicycle crash that required some stitches. I took him up to the ED and he got stitches. After the Doc asked him what his pain level was and my son truthfully told him a "2" out of "10". The doc promptly wrote him a script for Percocet. That simply was not happening. But guess what? Many parents would have gotten that filled and started feeding their child dope.

Do people need pain drugs? Some do. But the lines got badly contorted somewhere along the way. It makes no sense that the US consumes 75% of the world legal supply of opioids. Are pain problems that much worse in the US that we have to dish out dope by the truckload?
I do not dispute that there's a crisis and have not done so here. My point is that the whole focus these days is in completely doing away with opioids, and that's simply not acceptable either. There are people who genuinely need these drugs and they are being made to suffer horribly because there's no real effort being made to ensure that their supply is maintained. Not "cut back"; not switched to something less effective with bad side effects; not told that their pain can be abated "just as well" with pain therapy, essential oils, and positive thoughts. Right now they're being told, "Sorry about that. Sucks to be you."

Why am I so passionate about this? In part, it's because I see what it's doing to my buddy, but it's also because I'm probably looking down the same barrel myself. I have severe post-herpetic neuralgia. When it first happened they gave me opioids to take the edge off the pain while they tried Lyrica to see if it would control it. It did and I stopped taking the opioids because I didn't need them. Then my insurance balked at the cost of the Lyrica (about $450 mo) so my docs took me off it and tried a different drug. That one did not work and I went back on the opioids while they tried higher and higher doses and also petitioned my insurance to pay for the Lyrica since the alternative wasn't effective. My insurance waited until they had me up to 1.5x the maximum dosage before they finally agreed to pay for the Lyrica. I've been on the Lyrica for several years now and we're finding that it slowly loses its effectiveness the longer I take it. Initially, 75mg three times a day did the trick, but it has had to be bumped up and bumped up until you get where I am today, sitting right at the absolute maximum dose that can be prescribed (and which my kidneys and liver can handle) and for the last year I've been battling through a lot of breakthrough pain episodes that are so bad I curl up in bed and cry. My doc tried two different drugs that should have worked together with the Lyrica to make it more effective but my body can't handle either of them. From here I have two paths I can go down, surgery to sever the nerve bundles (my entire right side from shoulder to waist) leaving me with no feeling at all, or supplement the Lyrica with opioids. Except I don't actually have that second option because my doc does not want to risk her license prescribing them for me, and would rather I go for the surgery and then training to teach me to automatically check myself every few seconds to make sure I haven't injured myself, pretty much the same way lepers scan themselves for injuries.

So, yeah, I do not deny that opioid abuse is rampant and out of control and that it needs to be reined in to stop the abuse, but we must do it in a way that does not negatively impact patients with a genuine need for opioids.
Nonsolis Radios Sediouis Fulmina Mitto. - USN Gunner's Mate motto
Whatever doesn't kill you makes you stronger. Except sailors. They will kill you and sing songs about it.

Sic quemadmodum gladius neminem occidit; occidentis telum est - Seneca the Younger, Epistles

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Re: The Ongoing Man Made Opiod Catastrophe

Post by Stercutus » Thu Mar 14, 2019 11:47 pm

So, yeah, I do not deny that opioid abuse is rampant and out of control and that it needs to be reined in to stop the abuse, but we must do it in a way that does not negatively impact patients with a genuine need for opioids.
Due to all the prior abuses there will be quite a bit of clamping down. Too many imaginary cases of back pain and fibromyalgia. Since there is no faith in the system it may be a decade before proper controls are in place. Keep in mind also your health care provider will be resisting the whole way while your insurance company will be all for throttling off the supply of any and all drugs.
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Re: The Ongoing Man Made Opiod Catastrophe

Post by Ellywick » Fri Mar 15, 2019 4:58 am

NT, I very much understand your perspective. One of my Aunts almost died in a terrible car crash when she was young and so has constant chronic pain. She did well on low dose opiods and was able to function well. The new meds she is on knock her on her ass way more than her others did but are "non-narcotics" and so considered better for some bullshit reason. I officially hate Tramidol. It may not be considered addictive, but I have had it before and it made me feel way more stoned and spaced out than any opioid ever has. Now she has to choose most days between gritting her teeth and dealing with the pain to function as best she can or being on something that somewhat takes away the pain, but makes her pretty non-functional. I'm grateful she's tough enough to just struggle through it most days, but I worry about the older she gets. One of my best friends has also had degenerative back disease since she was in her early 20s. They can't discern why and don't know how to stop it. Multiple surgeries and steroid shots have just support her continued mobility and do nothing for the pain. She can barely sleep at night anymore. Low-dose opiods managed it, but they completely refuse to give her any now and nothing else seems to work.

Stercutus, the data doesn't lie and you are right that many people are terribly abusing the system and many doctors are in the pocket of drug companies. That being said, it is terrible to watch other's shitty personal choices negatively affect innocent people you love.
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Re: The Ongoing Man Made Opiod Catastrophe

Post by JayceSlayn » Sat Mar 16, 2019 7:47 am

It is an inherently complex problem to solve, as each individual in the equation brings their own set of variables to the table. By individual, there are varying levels of pain perception (for the same condition), varying efficacy and suitability of drugs, varying availability and efficacy of non-drug alternative therapies, varying comorbidities, varying insurance applicability, varying socioeconomic status*, list going ad infinitum. Much like the criminal justice system has issues trying to draw hard rules that 100% only apply appropriate punishments to guilty people, there is no inflexible line that perfectly divides who should get what in as "simple" a problem as pain relief. It is why we try to give both judges and doctors some flexibility to apply their sincere intuition to each case, but it also ensures that human fallibility will always factor into the outcomes.

*My wife sees many patients who are disadvantaged (some dramatically so) and it is a great frustration to her that she doesn't have more tools to help them after they leave the office. She can try to set up their medication access for them and refer them to additional services, but ultimately many of these people fall between the cracks in our institutions. E.g. How is a diabetic supposed to store their prescribed insulin when they don't have a refrigerator/electricity?

EDIT: All that being said, as was previously stated: there is strong evidence to show that overuse of opioids is a major problem right now, and so it adds to a hesitancy by doctors to prescribe them. It just serves as another background factor brought into the calculus. I see some promising things in alternatives like cannabis and derived substances - I am not a pothead, but there is some evidence that it may be effective for pain relief for some conditions/individuals where other conventional methods fail. More research is needed in those areas. There has never been a true panacea, and likely will never be, so we'll always want to keep as many and ever-better options available as we can.
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Re: The Ongoing Man Made Opiod Catastrophe

Post by Stercutus » Sat Mar 16, 2019 12:20 pm

I don't want to conflate marijuana in to the issue but I have gone from being mildly skeptical that it has any benefit at all to being fully on board as a substitute for opioids. It is a much safer drug and non-addictive even if habit forming. I have serious doubts that it can control pain the way opioids can but anything to keep people off dope.
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Re: The Ongoing Man Made Opiod Catastrophe

Post by Stercutus » Mon Mar 18, 2019 2:16 am

https://news.vice.com/en_us/article/mbz ... bankruptcy

Looks like Purdue may be the first company sued into oblivion. Doubtful anyone but the lawyers will see much out of it.
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Re: The Ongoing Man Made Opiod Catastrophe

Post by Halfapint » Mon Mar 18, 2019 2:41 am

I see where everyone is coming from. It’s a heated topic, one that many don’t really see eye to eye. I posted something in this forum a while ago (couple years ago actually) where I said opioids are a major issue. I wasn’t belittled directly, however I was told “it’s not a big deal”.

Fast forward a few years and the tune has changed. The difference? It’s no longer a “city” issue, it’s got DEEP into the veins of the country. Now it’s a crisis.... Should big pharma be held responsible? Absolutely! Does banning things work? Tell me, would a gun ban work? Has the “war on drugs” worked? I’ll leave it at that.

I love that Stercutus said straight up that he was a doubter, but now believes that marijuana can help. As he pointed out, docs just drop percs and shit for mild pain when a NSAID will work, or hell, a joint (ok not to minors obviously).

As NT wrote let’s not throw the baby out with the bath water, opioids are wonderful things. They gave my dad a life when the cancer was eating him alive. It gave him the ability to say good bye in a way he wanted to.

Moving forward, researchers think sea cucumbers could be a key to non addictive pain relief. Just a few moments ago I read an article that researchers may have found a way to turn off pain receptors altogether. That’s a Pandora’s box itself, but could be great for the elderly or those with immense pain.

In the mean time the pills I get go into storage and get used for times like this weekend where I tripped fell, landed on a branch that was sticking up. Wasn’t sure what was wrong, took some pain pills, Gabe it some rest as I monitored and realized that it was bruised and not broken or worse. Saved myself a huge repair bill.
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Re: The Ongoing Man Made Opiod Catastrophe

Post by emclean » Mon Mar 18, 2019 7:57 am

Stercutus wrote:
Thu Mar 14, 2019 6:04 pm
Let me tell you a story about my son. A few years ago he was in a bicycle crash that required some stitches. I took him up to the ED and he got stitches. After the Doc asked him what his pain level was and my son truthfully told him a "2" out of "10". The doc promptly wrote him a script for Percocet. That simply was not happening. But guess what? Many parents would have gotten that filled and started feeding their child dope.
of course he was given a script, the amount that the government pays hospitals is effected by how happy you were with your visit. not outcomes, not were you properly treated, but are you happy with it.
so there is a vested interest in making people happy, even if it makes you unwell.

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