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With a 10-day supply of opioids, 1 in 5 become long-term users

It sounds like we're in agreement on pretty much all of this. I'm glad you are aware of and have discussed other addictions/health risks and I will accept that and thank you for it. Although my primary concern on this issue is how we treat addicts - meaning society and health care professionals. What you're saying makes sense, I'll leave it at that. I have no problem with discussing studies on addiction, but with both addiction and dietary/lifestyle choices, we basically are a nation that binges on crap and goes to the doctor to purge.

But it's also very concerning to me that we have so many people in chronic pain. We're overworked and unhealthy, and that is a recipe for disaster.

I think many of our problems with chronic pain are due to diet and lifestyle issues. For example, nothing destroys your knees like being overweight or obese. Many if not most back issues are due to muscle weakness and imbalances in the back. If you sustain a severe injury to your back or shoulder, its much less likely that you will need surgery if you have strong muscle development around that injury.
 
Your straw men are BS. If you want to debate, before insulting me, how about you find out what I believe, FIRST, because YOU ARE WRONG.

Insult you? How did I insult you?

And I'm not arguing with you. I said you and I clearly have different perspectives on things due to different experiences and I never, ever said I don't care about people dying from overdoses of any sort. I said that society, in general, views opiate addicts - and probably methamphetamine addicts - in a completely different light than people addicted to equally dangerous (if not more) substances that include tobacco, alcohol and fast food. The difference is that the latter three substances have no medicinal value, and that we should push for meaningful education (meaning not DARE), prevention and safe administration of any and all opiates so that we address death and destruction without making the lives of tens of millions of people miserable.

If you eliminated the "pill mills" from this country, the number of prescriptions written would go way, way down. Your graphs address prescriptions written, those are coming from a small group of doctors who make a ton of money by not accepting insurance and writing for anybody, then bailing out before getting arrested. We have to get rid of those doctors because they're making the problems I'm talking about worse. That said, the laws changed dramatically starting at the beginning of this decade. The impact those changes are having on people with legitimate pain is very real.

But at the end of the day, I'm not really sure what we disagree on. Do you agree that people addicted to opiates are demonized more than the people I mentioned above (plus benzodiazepines)? Do you agree that we are capable of responsibly prescribing opiates to people with chronic pain? Do you agree that education, prevention and discontinuation of opiate prescriptions is pretty lousy right now? If so, we are basically discussing opposite sides of the same coin.
 
I think many of our problems with chronic pain are due to diet and lifestyle issues. For example, nothing destroys your knees like being overweight or obese. Many if not most back issues are due to muscle weakness and imbalances in the back. If you sustain a severe injury to your back or shoulder, its much less likely that you will need surgery if you have strong muscle development around that injury.

I agree and I would add that people often can't afford surgery or the preventative care needed to avoid decades of chronic pain. Every girlfriend I've had has one parent who suffers from chronic pain due to either one of the things you mentioned or one of the things that I mentioned. I'd give up everything I own for my health. Unfortunately, I was never in a position to make that choice unless I took a trip through the Twilight Zone I don't remember.
 
Insult you? How did I insult you?

"I'm not sure what you're advocating for, but it sounds like your intention is the same as the OP's: demonize drugs and drug users. But just opiate users. Keep killing yourself every other way. That makes you a good old fashioned American."

I don't believe the bolded, nor am I buying that "'that makes you a good old fashioned American" was a compliment. I mean, give me a break. :roll:

And I'm not arguing with you. I said you and I clearly have different perspectives on things due to different experiences and I never, ever said I don't care about people dying from overdoses of any sort. I said that society, in general, views opiate addicts - and probably methamphetamine addicts - in a completely different light than people addicted to equally dangerous (if not more) substances that include tobacco, alcohol and fast food.

First of all it isn't just my own personal experiences - the data show big differences between prescribing practices in TN and AL versus MN.

I don't see it - tobacco users have to practically find an open field to light up nowadays, and there is an enormous amount of attention on alcohol use and abuse. Obese people are viewed as weak and discriminated against in nearly every walk of life. The big difference I see between opiate and other addicts is the former is often FAR harder to get over and keep straight than alcoholism. Not sure about cigarettes...

The difference is that the latter three substances have no medicinal value, and that we should push for meaningful education (meaning not DARE), prevention and safe administration of any and all opiates so that we address death and destruction without making the lives of tens of millions of people miserable.

I agree... never said otherwise.
If you eliminated the "pill mills" from this country, the number of prescriptions written would go way, way down. Your graphs address prescriptions written, those are coming from a small group of doctors who make a ton of money by not accepting insurance and writing for anybody, then bailing out before getting arrested. We have to get rid of those doctors because they're making the problems I'm talking about worse. That said, the laws changed dramatically starting at the beginning of this decade. The impact those changes are having on people with legitimate pain is very real.

They might have changes in MN, but we just recently changed the laws in Tennessee, in 2016, in large part because of all that attention you called unfair on the issue. The evidence is in the numbers - MN doctors write half the number as TN doctors.

But at the end of the day, I'm not really sure what we disagree on. Do you agree that people addicted to opiates are demonized more than the people I mentioned above (plus benzodiazepines)? Do you agree that we are capable of responsibly prescribing opiates to people with chronic pain? Do you agree that education, prevention and discontinuation of opiate prescriptions is pretty lousy right now? If so, we are basically discussing opposite sides of the same coin.

I don't really agree with your characterization "demonized." It's not, for example, demonizing them to recognize that a person is addicted, or for doctors to watch usage like a hawk for signs of abuse or misuse, or to require a large hurdle to prescribe them long term for chronic pain, given the poor results that I've seen in the studies. You're right that I don't see a lot of attention on benzodiazepines, but I'm not aware of any data that show they are nearly as large a problem, and growing, as opiates. But again, if that's true, that's a good argument for focusing attention on benzodiazeprines, not ignoring opiates or even less attention to opiates and opiate abuse.

I agree education is terrible on use of opiates because I've recounted my experiences with them and counseling is next to nil that I've seen, but I do see signs of that improving, and it's because of the media attention on the issue. I cannot speak to experiences of those in chronic pain because I haven't seen any data on that. E.g. if the issue is whether doctors are withholding pain meds from patients with a legitimate need for them, I have not seen that or evidence that it's happening. I know two years ago, my mother in law had no problem getting opiates for a month - 2 weeks of oxy post surgery in hospital and rehab, and then another 45 capsules 'as needed' after that. The latter was hydrocodone 5/325 which is the weakest dose, but she's about 100 pounds and frail and old and at that point her pain was minor - a nuisance at best. I know because she got ZERO opiates at our house and never complained about pain when we limited her to non-opiate options.
 
I agree and I would add that people often can't afford surgery or the preventative care needed to avoid decades of chronic pain. Every girlfriend I've had has one parent who suffers from chronic pain due to either one of the things you mentioned or one of the things that I mentioned. I'd give up everything I own for my health. Unfortunately, I was never in a position to make that choice unless I took a trip through the Twilight Zone I don't remember.

Some people save like hell for retirement but take poor care of their own health. I would be willing to bet that if you maintain a healthy weight, get regular strenuous exercise and strength training, and eat a pretty strict whole foods diet, that you will potentially save hundreds of thousands of dollars in retirement due to your being in good health.
 
So, my own needless pain pill prescription.



I had an infection because stuff got jammed under a gum and I couldn't get it all out it in time. When the infection really caused inflammation - in the middle of a restaurant meal the next day - I had trouble focusing on the conversation and didn't sleep that night, and I do have a rather high tolerance for discomfort in general. By the next morning, the pain was down - I suspect a lot of it had to do with pressure on the outside of the inflammed tissue while eating.

Anyway, I tell them I'm just there for a course of antibiotics and I have no pain at the moment. What am I handed? Prescriptions for a course of antibiotics and six Vicodin. A few days worth.


Granted, hydrocodone is one of the weaker opioids - the real problems surround Oxycodone, morphine, oxymorphine (but curiously, not hydromorphone so much, of dilaudid - makes people out of it, but not in the same bitingly good euphoric way as the other two I just mentioned), di-acetyle-morphine (heroin), and fentanyl.

I figured.....what the hell, I might as well fill it in case I manage to fall down the stairs and break something, then want to dull the pain until I get it set. But still, why'd you give me that? I told you I didn't need it.

 
So, my own needless pain pill prescription.



I had an infection because stuff got jammed under a gum and I couldn't get it all out it in time. When the infection really caused inflammation - in the middle of a restaurant meal the next day - I had trouble focusing on the conversation and didn't sleep that night, and I do have a rather high tolerance for discomfort in general. By the next morning, the pain was down - I suspect a lot of it had to do with pressure on the outside of the inflammed tissue while eating.

Anyway, I tell them I'm just there for a course of antibiotics and I have no pain at the moment. What am I handed? Prescriptions for a course of antibiotics and six Vicodin. A few days worth.


Granted, hydrocodone is one of the weaker opioids - the real problems surround Oxycodone, morphine, oxymorphine (but curiously, not hydromorphone so much, of dilaudid - makes people out of it, but not in the same bitingly good euphoric way as the other two I just mentioned), di-acetyle-morphine (heroin), and fentanyl.

I figured.....what the hell, I might as well fill it in case I manage to fall down the stairs and break something, then want to dull the pain until I get it set. But still, why'd you give me that? I told you I didn't need it.


Simple- he gave it to you for the exact same reason you got it filled.

You might need it, and when you do, it's a bigger hassle to deal with if you don't have them.

For you, it's a trip to the pharmacy. For him, it's a PITA after hours call to call in an expert to a pharmacy.
 
"I'm not sure what you're advocating for, but it sounds like your intention is the same as the OP's: demonize drugs and drug users. But just opiate users. Keep killing yourself every other way. That makes you a good old fashioned American."

I agree education is terrible on use of opiates because I've recounted my experiences with them and counseling is next to nil that I've seen, but I do see signs of that improving, and it's because of the media attention on the issue. I cannot speak to experiences of those in chronic pain because I haven't seen any data on that. E.g. if the issue is whether doctors are withholding pain meds from patients with a legitimate need for them, I have not seen that or evidence that it's happening.

I realize that demonizing addicts was not your intention. So I apologize for that but I don't think we disagree on much. I think - again - we have different experiences because we live in different states that have different doctors, policies, etc. Here is a study of 2,000 pain patients that show the new guidelines are cutting off necessary medication. You clearly have a personal relationship to this issue but you admittedly aren't aware of the details of recent changes in DEA laws.
 
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