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Opioid epidemic emergency... ok, so now what?

Fearandloathing said:
That's minor.

But wait . When you get old enough you get all sorts of cures that bind you up, make you stupid, gain weight....
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I know several people who have skipped or delayed getting operations because they didn't want to go through the constipation from opiates.

I hear they have another pill that helps with that now.
 
Goshin said:
What are we realistically going to do about it?


The rules are already so strict that people in real need of pain management have trouble getting what they need.


Tightening down on that is mainly going to make it harder for people with real needs... causing people in pain to suffer more for the sake of trying to stop people from getting high, which has proven over and over to be ****ing futile.



Are there any realistic plans that won't just cause more suffering while having little effect on high-seekers?
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My own solution would be to do what we did with Quaalude back in the 80's--the opioids should be withdrawn from the market, either by responsible and conscientious corporate action, or government coercion.

Obviously much discussion would take place about which products would be targeted.

Old fashioned opiates, those substances used since the beginning of time essentially, work very well. Yes, they too are addicting, but it seems the OxyContin type drugs have a special quality about them that many humans simply cannot deal with.

I've been administered both, and do not like the newer drugs. IMO, the efficacy of both is about the same, recognizing there are always individual differences in the effects of most drugs.

With the 60 Minutes/WaPo piece a few weeks back, the veil has been pulled back exposing the deep corruption within the system. Once again, the regulators serve at the pleasure of those being regulated, and the public be damned.
 
Thoreau72 said:
The loss of money will not change anything in the way Purdue markets and distributes its product. If it has now acknowledged it misled the public and the industry, the product should be declared too dangerous and withdrawn from the market.
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I don't agree with that conclusion. Drugs are tools. Oxy is not a "bad" drug. It does what it's supposed to do. It was misrepresented by Purdue as being basically non-addictive. The docs did not do enough of their own DD on it, and some were so bad that they went hog wild with the drug knowing they'd end up with a line of addicts coming back every month for more. Purdue is where the problem began, but there are a lot of villains in this story.

Opioids have also been over prescribed because doctors in this country get paid according to how many patients they can process, not the outcomes the patients get from treatment.

We need to change a lot of things, but a ban of Oxy imo is not a smart thing to do.
 
Goshin said:
It's a mess, to be sure.


I blew my knee out at work almost a year ago. Workman's comp. Got sent to a place for rehab.

In the first session the guy hurt me so bad I could barely walk back to my car. I was set back a week in terms of recovery. Literally, he damaged me despite me telling him he was manipulating my knee too far and too hard.

Let me be clear here, I am no stranger to pain and have a high tolerance for it; that therapy was gonna hurt was no surprise to me, but I wasn't simply subjected to a little pain, I was *damaged*.

Second time I requested a new therapist. I was asked why and stated my case as calmly as I could, specifying that I wasn't going to make an issue of it but I wasn't going to put up with being injured either. Well, the Dr didn't believe me and acted like I'd dropped in at the Vatican and took a crap in the Pope's hat. She made it clear that my opinion (never mind that it was my own personal knee here) was a pile of steaming dog poop in her eyes and her therapist guy could do no wrong.

So I said "right, frack the lot of you", and didn't go back. I got a cheap gym membership and did my own @#$#-durn therapy. It cost me my WC payments and ultimately my job, but I was at the point I didn't care. I had a knee to rehabilitate.


So sometimes, ****ty therapy by people who don't really care is worse than no therapy...
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Doctors who don't listen drive me insane.

I've had laparoscopic surgeries in the past, which leave behind a bit of air in your abdomen which gets reabsorbed by the body over a day or two. The feeling of free-floating air in your body is a weird one. It even rises to find higher ground when you invert yourself. Truly bizarre -- can't really explain it.

A few years ago, I had a partial lung collapse. It was small enough that I was still breathing fine -- I just had a bit of pain on the inhale. And I got that same weird feeling of air inside me.

I flipped myself upside down, and felt it push down my body, finding higher ground. "Yup, that's air. Ok, to the ER we go." I didn't really know what it was, but I knew it was acting like air, and air isn't supposed to be there.

I went to the doc and told them what I just told you. Guy refused to listen to me. Insisting it must be muscular, or a chest infection. Absolutely refused to do an X-ray. "No, dude. I've had TOS, and I've had chest infections. I've also had air inside me. I know what all three of those things feel like. This thing moves like air. Please? Just humor me and do the X-ray?"

Eventually I got him to do it, and hey, guess what, I was right.

He did at least apologize for not listening to me. It wasn't like I was coming in hysterical about space aliens inside me. I came in trying to be reasonable about the possibility I was wrong, but also with the knowledge of what air feels like inside my body from previous experience, and it's not like lung collapses are some super out-there thing, especially not under my circumstances (lots of weight loss due to bereavement -- being too thin is a risk factor). And I got treated like I was ****ing crazy.

This is why it's important to be our own advocates. Doctors are human like you and I. There are good ones and bad ones.

Yes, all of them know more about bodies than we lay people. But that doesn't mean they'll apply that knowledge properly.

If you don't like how you're being treated, go with your gut.
 
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SmokeAndMirrors said:
You make a good point that it needs to come from a prioritization of the best possible healthcare, not just government control of said healthcare.

I had the weirdest problem in the UK. I still take ibuprofen for aforementioned pain problem once every few weeks as I need it (it's pretty random). But in the UK, you can't buy more than 2 boxes at once, and boxes have fewer pills than they do in the US. In the US, normally I just stock up for a few months so I can manage it if I get caught off guard, but I couldn't do that. I go through a box in a day, since I take a doctor-prescribed dose.

So one time, I ran out because I hadn't been permitted to buy enough to get through a day, and got hit off guard. I had stuff to do, and I couldn't function (it's a fair bit of pain -- which goes to show how much non-opioid painkillers really can handle on their own). The only thing we had left in the house... was my roommates's opioid-based medication from a dentist.

I hemmed and hawed, but eventually I took it because I couldn't get out the door, and I needed to be able to get on with my day. I needed to at least be able to GET to the store so I could ACQUIRE ibuprofen.

Basically, I had to take opioids because the government got in the way of me getting ibuprofen. How ****ing crazy is that?

Some government healthcare doesn't prioritize what might be longer-term treatments that can help people avoid opiods any more than our private system does. Some do -- Sweden's a good example. But others don't, and overprescribe opiods just like we do, like the UK. After years of battling their street heroin problem and finally making some headway, now they're just replacing it with a pill problem.

This needs to come from the medical industry itself. They have to make their own effort to make non-opioid pain management a priority for as many people as possible -- which is the vast majority of people, apart from end-of-life care.

Single payer alone won't fix that lack of prioritization. It needs to come from the medical industry, and the medical community.
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it can't come from the medical industry and the medical community. WE KNOW what to do for the most part. The issue is reimbursement... because its the insurance.. or government insurance.. or program that drives the bus on how healthcare is done.

The issue you had was not due to your physician... Most likely they would have absolutely agreed its stupid to push you to taking someone elses opiod because you couldn;t get ibuprofen. The problem is who is dictating to the dr.. what he could order or not.
 
Goshin said:
It's a mess, to be sure.


I blew my knee out at work almost a year ago. Workman's comp. Got sent to a place for rehab.

In the first session the guy hurt me so bad I could barely walk back to my car. I was set back a week in terms of recovery. Literally, he damaged me despite me telling him he was manipulating my knee too far and too hard.

Let me be clear here, I am no stranger to pain and have a high tolerance for it; that therapy was gonna hurt was no surprise to me, but I wasn't simply subjected to a little pain, I was *damaged*.

Second time I requested a new therapist. I was asked why and stated my case as calmly as I could, specifying that I wasn't going to make an issue of it but I wasn't going to put up with being injured either. Well, the Dr didn't believe me and acted like I'd dropped in at the Vatican and took a crap in the Pope's hat. She made it clear that my opinion (never mind that it was my own personal knee here) was a pile of steaming dog poop in her eyes and her therapist guy could do no wrong.

So I said "right, frack the lot of you", and didn't go back. I got a cheap gym membership and did my own @#$#-durn therapy. It cost me my WC payments and ultimately my job, but I was at the point I didn't care. I had a knee to rehabilitate.


So sometimes, ****ty therapy by people who don't really care is worse than no therapy...
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Just some free advice for what its worth.

The first thing is that you should have gone back to the original therapist and explained your concerns and your pain. now its certainly possible your therapist was just a douche. but its also highly possible that the therapist was trying to do exactly what was necessary for your knee at the time and he did not expect the overall response that your knee had to the therapy. Patients often have a difficult time with pain and deciding what pain is appropriate and whats not. I have people that come in and tell me they have high pain tolerances (everyone says that). I look at the chart for pain and they have walked into my clinic and written down a pain rating of 10/10. THEY WALKED IN without any signs of distress. I explain that a 10/10 would mean that the pain is so bad.. "its like you just had your leg ripped off and are screaming and moaning in pain".

I then ask.. based on that.. what would you say your pain level is"? And they say "11"! :doh

So.. its possible that the therapist would have been surprised about setting your pain level so high for a week. In fact.. if you had gone back to them on the next appointment.. its possible or even probably that the therapist would have done something to try and get you OUT of pain and get you back on track.. and then would have backed off or done therapy differently because of your pain response.

Now. if you had done that. and your therapist was simply an idiot (it happens. lots of education.. no clinical reasoning). then you could and should request another therapist within that clinic. If that isn;t possible or they are unwilling.. then you have to the right to go whatever clinic will accept your workers comp insurance.

Based solely on what you posted (which I clearly understand is limited) , it does not surprise me that your physician acted the way she did, because unintentionally you appeared like every other pain in the ass, non compliant, workers comp patient that she has had to deal with.
 
jaeger19 said:
Just some free advice for what its worth.

The first thing is that you should have gone back to the original therapist and explained your concerns and your pain. now its certainly possible your therapist was just a douche. but its also highly possible that the therapist was trying to do exactly what was necessary for your knee at the time and he did not expect the overall response that your knee had to the therapy. Patients often have a difficult time with pain and deciding what pain is appropriate and whats not. I have people that come in and tell me they have high pain tolerances (everyone says that). I look at the chart for pain and they have walked into my clinic and written down a pain rating of 10/10. THEY WALKED IN without any signs of distress. I explain that a 10/10 would mean that the pain is so bad.. "its like you just had your leg ripped off and are screaming and moaning in pain".

I then ask.. based on that.. what would you say your pain level is"? And they say "11"! :doh

So.. its possible that the therapist would have been surprised about setting your pain level so high for a week. In fact.. if you had gone back to them on the next appointment.. its possible or even probably that the therapist would have done something to try and get you OUT of pain and get you back on track.. and then would have backed off or done therapy differently because of your pain response.

Now. if you had done that. and your therapist was simply an idiot (it happens. lots of education.. no clinical reasoning). then you could and should request another therapist within that clinic. If that isn;t possible or they are unwilling.. then you have to the right to go whatever clinic will accept your workers comp insurance.

Based solely on what you posted (which I clearly understand is limited) , it does not surprise me that your physician acted the way she did, because unintentionally you appeared like every other pain in the ass, non compliant, workers comp patient that she has had to deal with.
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Yeah that is exactly the way she acted, and I wasn't putting up with it.

I KNOW when I've been injured. It wasn't about PAIN. It was about a substantial reduction in FUNCTION of my knee after "therapy".

I walked in barely limping. I hobbled out on my cane and barely made it to my car. I experienced continuing reduction in knee functionality for about a week.


I explained this to the DR. She wasn't interested in hearing it, so **** her and **** her therapist and the horse they rode in on.
 
<alt>doxygen said:
I don't agree with that conclusion. Drugs are tools. Oxy is not a "bad" drug. It does what it's supposed to do. It was misrepresented by Purdue as being basically non-addictive. The docs did not do enough of their own DD on it, and some were so bad that they went hog wild with the drug knowing they'd end up with a line of addicts coming back every month for more. Purdue is where the problem began, but there are a lot of villains in this story.

Opioids have also been over prescribed because doctors in this country get paid according to how many patients they can process, not the outcomes the patients get from treatment.

We need to change a lot of things, but a ban of Oxy imo is not a smart thing to do.
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I understand my suggestion has a snowball's chance in hell, no question. All your points are good, and for many reasons including human greed and arrogance and deception, we do have a problem, Houston.

My opinions about the problem is partly colored by my experience in the Army in Vietnam. There, perhaps the majority of the enlisted men where I was smoked heroine, either in joints or in cigarettes. An though I was living in a large hospital compound, nobody used needles to inject it. It was everywhere, but stolen needles were never a problem. You never saw a needle. The problem was widespread, and because they were smoking it and not injecting it, nobody ever died from it, at least that I can remember. The problem of GI addiction to heroine was very public. Everybody had to pass a urine test in order to go back to the US. But nobody died.

Today with the opioids, some being crushed and injected, some I guess being crushed and snorted, death from overdose is very common indeed. I am personally aware of the deaths or 8 or 10 youngsters, sons and daughters of friends of mine, from the opioids. Not from old fashioned heroine, but from the diverted opioids.

So I am biased, but I do not consider the general opioid class of drugs to be beneficial to mankind or society. It is a scourge, far worse than the wide open use of heroine in 1970. They may be 'state of the art' in the chemistry lab, but in society they are a scourge.
 
Thoreau72 said:
I understand my suggestion has a snowball's chance in hell, no question. All your points are good, and for many reasons including human greed and arrogance and deception, we do have a problem, Houston.

My opinions about the problem is partly colored by my experience in the Army in Vietnam. There, perhaps the majority of the enlisted men where I was smoked heroine, either in joints or in cigarettes. An though I was living in a large hospital compound, nobody used needles to inject it. It was everywhere, but stolen needles were never a problem. You never saw a needle. The problem was widespread, and because they were smoking it and not injecting it, nobody ever died from it, at least that I can remember. The problem of GI addiction to heroine was very public. Everybody had to pass a urine test in order to go back to the US. But nobody died.

Today with the opioids, some being crushed and injected, some I guess being crushed and snorted, death from overdose is very common indeed. I am personally aware of the deaths or 8 or 10 youngsters, sons and daughters of friends of mine, from the opioids. Not from old fashioned heroine, but from the diverted opioids.

So I am biased, but I do not consider the general opioid class of drugs to be beneficial to mankind or society. It is a scourge, far worse than the wide open use of heroine in 1970. They may be 'state of the art' in the chemistry lab, but in society they are a scourge.
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I understand. I'm torn about fentanyl and especially carfentanil. We had a local LOE who responded to an OD need treatment for an OD of the latter substance here - from slight skin contact. That sh*t? No problem if they ban it.

I have seen legit uses for Oxy (father in law dying of cancer) and hydrocodone. There really isn't anything else that works which can replace those, to my knowledge.
 
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