Heroin deaths double after painkiller crackdown

[OhioChick]

Source: Newsnet5.com

1:18 PM, Oct 2, 2014

Heroin deaths are exploding.

Deaths from heroin overdose doubled in the United States from 2010 to 2012, according to a new report released Thursday by the Centers for Disease Control and Prevention.

“If it’s your family member, the human cost is severe. This is a true public health crisis,” said Michael Lyons, assistant professor of emergency medicine at the University of Cincinnati Health Center. “It’s not just someone else’s problem.”

In 2012, 3,635 people died from heroin overdose in the United States. The deaths reached across all age ranges, but more occurred in the northeast and the south. Ohio and Kentucky were among the hardest states hit.

Many people who become addicted to heroin are living a normal life until they become addicted to opiate painkillers like Morphine or Oxycontin. The increase in heroin use is due in part to cracking down on the prescription painkillers, Lyons said.

Read more: http://www.newsnet5.com/news/national/heroin-deaths-double-after-painkiller-crackdown

[Horse with no Name]

1. These docs have handed out pain pills like candy for lots of years

because it was easier to do than try to come up with another solution to their pain issues and now someone is cracking down on them and they are hanging their addicted patients out to dry.

In our area, Pain Management clinics have shot up all over the landscape because these docs cut these patients off cold turkey and are now handing them to someone else.

It is a bullshit move and will leave lots of people suffering.

[ChairmanAgnostic]

3. I was a long term recipient.

Despite increasing dosages, the pills had no impact on pain. They only made you not care so much. Even so, the side effects were many and bad. Especially the memory impact. Finally, they moved me up to fentenyl patches. That was the final straw. I quite them all. Cold. Had some bad days, worse nights, but those meds are just horrible.

[Horse with no Name]

10. Pain medicine terrifies me

I have had several friends addicted to prescription drugs and it destroyed their lives. I am GLAD that they finally are making Hydrocodone a Schedule II so that the docs can't give it out like they were doing. Yes some are going to suffer but it will keep them from getting new addicts anyway.
But now they need to clean up the mess they already made with this.
and I hope you are able to get through this easily from here on out. And you are right. They are horrible.

[ballyhoo]

24. No, the only thing it has done is raise

the street price and have the junkies add the stuff to their wares in greater quantities. Oh, it also makes it harder on doctors, who now has to write up to three separate prescription when a person on Hydrocondone visits him, thereby doubling the appointments for people who need the drug every day and have been on it for years. There's other stuff happening too, but it can't be discussed here. It involves a new bump in the murder rate.

[freebrew]

28. For some of us, it's the only answer...

or taking 2,3 or 4 ibuprofen every 8 hours. That's BS.

What is wrong with being addicted to pain killers if it relieves the pain?

I'm really tired of you moral people shoving your morals down my throat.
It's like being in freeperville, only different.

Pain meds also SAVE people's lives and now they can't get them.

Thanks.

[Worried senior]

30. As someone who has lived with

someone in a lot of pain I agree. I've also heard that if a person is really in pain and taking the medication for that pain it doesn't become addicting like it would for someone else.

It would be wonderful to cure the cause of the pain but since the medical community isn't all that good at that what do you suggest someone do that would like to have as normal a life as possible.

Constant pain drags a person down to the point they don't care if they live or die.

[catbyte]

78. You're so right

If it weren't for those "evil" opiates, I would either be curled up in the fetal position, sobbing--or dead. Those "evil" meds allow me to live an almost-normal life & also allows me to work 45+ hours a week. I would be completely incapacitated without them. Anti-seizure drugs of the Lyrica family cause intolerable side effects & I developed an anaphylactic allergy to aspirin/NSAIDS from trying to deal with this nerve pain on my own. I took NSAIDS all the time. Then one morning I popped a naprosyn & 30 minutes later I was in the ER with my throat closing up & hives from head to toe--even on my eyelids, palms, & soles of my feet. They released me, but 4 hours later I was back because while the adrenalin had worn off, the naprosyn hadn't. They stabilized me & released me again. Six hours later I was back. That time they admitted me until the meds were all out of my system. Now I have to carry an Epi-Pen because aspirin is hidden in so many things.

Opiate pain meds are probably over presccribed, but the anti-pain med zealots are making it more difficult for people who would suffer immeasurably without them to get them. Pain doctors who cut people off cold turkey are doing immeasurable harm. My pain doctor tapers off the meds over a month for those no longer needing them and that works well. Only 10% of legitimate pain patients develop an addiction to them. I am physically dependent on the meds, but have never even really gotten "high" off of them. My pain seems to suck up all of the meds or something. To others upthread, please don't demonize these meds--they literally ARE lifesavers when used properly.

[Worried senior]

91. Well it has begun

This week when husband called for the refill on his medication Walmart told him he had to call the clinic for a written rx. This of course will have to be done every month.

He saw the dr. a couple months ago, had a urine check for meds I guess, the medication didn't even show up in his urine and he had taken the prescribed dose. Now, he was scheduled to go back in March, he has to make an appt for a med check again. More inconvenience, he's been on this medication for months.

We live rural, luckily we are only six or seven miles from the clinic but a lot of people around here are 40-50 miles away, then you get to add another 30 miles one way to Walmart because that is where our Part D plan prefers we get the meds. This is going to be a real hardship for people but apparently they aren't concerned about that.

The medication he takes only takes the edge off of the pain, there is no way that it controls it so what the next steps will be remain to be seen. Surgery won't work, he has way too much scar tissue and the drs. all say they wouldn't touch him.

Getting old sucks for the person going thru it and the people watching it happen.

[catbyte]

92. I'm so sorry you are going through this. It may be impossible, but is there a pain clinic in your

area? It sounds like your husband should be on a timed-released med like Oxycontin or long acting morphine instead of Vicodin or Norco. The acetaminophen is also very bad for your liver, especially in those of us over 50. Another thought--ask your doctor if they can mail the prescription to you so you don't have to make so many new trips to the office.

Again, I am sorry for your troubles. I wish you only the best.

[Worried senior]

93. Thanks

Just felt I had to vent. We will make it but so many are in much worse circumstances, he's on hydrocodone, so far we've avoided the oxycontin and with all the other meds he has to take I'm sure many drugs would interact with each other.

It was almost humorous; the last time he was at the clinic they wanted a urine sample, the medication didn't even show up so apparently his body was using it to try to control the pain. Now, he has to see the dr. again; I'm sure for the same thing.

[Agony]

37. Yes, everything you are saying is true.

But apparently you have to be walking in your shoes or close by for empathy to kick in…

So thank you for speaking up.

Agony

[LiberalLovinLug]

45. thankyou

Here in Canada they are also following the trend to crack down on Oxycontin. I suffer from disk disease and arthritis. It is possible to use it sparingly. I do not take it every day. I purposely stretch it out so as to NOT get addicted. Only use it when I absolutely have to. I can't use the antiinflamatory method as it conflicts with my stomach and mood.

I hate that a few, well more than a few, addict prone patients abuse it and the press gets a hold of something they can overblow into an "epidemic" which it has been called here. It gets more difficult to refill my prescription each time.

And...even IF I had such chronic pain that I needed to take enough consistently to become addicted...I STILL don't get the problem. If it works, and you willingly accept becoming addicted to your medication, why should anyone else care?

I would like to see all these holier-than-thou do-gooders also stop drinking coffee. An actual addiction that people freely accept, to make their lives more productive.

[NutmegYankee]

47. People who are not living with pain won't understand.

No one with chronic pain disagrees with you.

[Horse with no Name]

49. Has nothing to do with morals...I was talking about addicted patients

Not chronic pain patients. Those are generally two different classifications of patients.
Has to do with watching SEVERAL friends destroy their lives and one of them DIE because incompetent practitioners kept shoveling this shit at them longer than they ever should have and longer than it was ever needed.
Don't pretend to know me, you don't.
I stated an opinion and as usual, someone twisted it to jump up on a fucking soap box. Typical. JUST like freeperville.

[enlightenment]

62. Seems to me that

you started your soapbox with your comment - and now you're upset that people don't agree with your position.

If you don't want other people to express their opinion on the matter, perhaps you should say so in your comment. Maybe something like:

"I am not interested in seeing how you feel about it, because I think doctors hand the stuff out like candy. End of story. Please do not respond unless you agree with my assessment of the situation."


Edited because I thought you had started the thread.

[Horse with no Name]

63. I didn't start this thread

I simply gave an opinion on what I have personally seen in my practice as a nurse for 25 years as well as the addiction issue in the area that I live.

I am simply not talking about chronic pain and if you looked upthread to the very first comment that I made I said "It is a bullshit move that will leave lots of people suffering". That is said from a general and overall position.

I then proceeded to respond to ONE comment on my personal feelings from what I have seen and then all of the sudden, I am some type of evil nasty person who has no empathy towards people with chronic pain. You don't know me and you simply have no idea what you are talking about.

I live in a small area and several doctors in this area have fucking gone to JAIL for drug trafficking. A local doctor used to admit his girlfriend to the hospital for Demerol drug holidays--that is, until she died of an overdose leaving three small children (one of whom found her stone cold in the garage after school) and he went to prison. So please do not pretend to know where I am coming from, because you obviously do not.

I couldn't even get a prescription filled in this area for codeine cough syrup for a sick child. The doctor in Dallas was mortified at that. I am speaking from MY experience and mine alone.

I have friends who went to these docs and were given this shit like candy and then became addicted. Everyone KNEW these docs were their dealers. It was common knowledge. The patients lost their jobs, their homes, their families, their friends...and everything else they could. One lost her life. These were NOT chronic pain issues. These were people who had a small ache or pain that could have been handled with a lesser agent, but instead were given narcotics and then became addicted. Totally unnecessary use of the medication.
However...THESE are the patients and the doctors that got the laws changed. Not the chronic pain sufferers. Since I happen to see this on an everyday basis in the area that I live, that is perspective that I have from it.

In our area, they formed a coalition of hospitals, doctors and pharmacies and it is next to impossible to get stuff filled because the local doctors have stopped cold turkey--leaving addicts without and sending all of their chronic pain patients to Pain Management doctors. This was done to directly combat the overall issue--and if you REALLY need something for legitimate pain or suffering, it will take the local pharmacies 2-3 days to get it and if you REALLY need it, you have to leave the area.

I cannot pretend to speak about how it works elsewhere. But, this is how it works where I live.

[enlightenment]

65. I suspect that had you

been as thoughtful in your initial response (and yes, I realized after I posted that you did not start the thread and edited. My apology for that mistake) as you were in this one that a lot of the angry responses would have been avoided.

I don't pretend to know where you're coming from. I don't need to have an intimate understanding of your personal experiences to opine on the method you have chosen to address this issue - which is what I was doing in my initial response to you and in this post, as well. Sticking to your opinion is great - you're entirely entitled to do that. Telling others that they are out of line for disagreeing with you is a bit different than expressing and defending your opinion. That was what I responded to - not your opinion on the new law.

As far as this issue goes; I believe that like so many regulations, it goes too far and does not adequately address the needs of those who require management of chronic pain that cannot be effectively treated with non-drug therapies.

[hunter]

68. Yep. Ibuprofen and acetaminophen are less effective and much more damaging.

These days, ibuprofen destroys my stomach. Whenever I take ibuprofen my stomach ends often ends up hurting worse than my messed up knees do. And I don't even like thinking about what acetaminophen does to my liver.

Maybe I'd take opiates, but I don't, mostly because they make me feel gross and constipated, both in my head and my guts. I don't have any great fears about addiction. But they do work for pain, and if you are only taking a few pills a day then opiates are not nearly so damaging as chronic use of ibuprofen or acetaminophen.

The drug war needs to end.

Chronic pain patients are not addicts, and addicts ought to be treated as ordinary medical patients too.

Why is it we'd rather deal with drugs in ways that escalate the pain and violence and involvement of criminal gangs, than simply deal with the problems of addictions as an ordinary public health issue?

When you look at the actual problems, not the problems caused by the "War on Drugs," opiates are very similar to alcohol.

Any alcohol addict can legally obtain a big bottle of cheap vodka, but somebody with severe pain issues has to just sit and suffer or jump through hoops to get a little relief.

[freebrew]

75. Opiates work for me...

codiene relieves my OA in my cervical spine. Funny, it does nothing for the lumbar problem I have.
But when my neck spasms, nothing else helps. And I only need to take 2 or three times. With ibuprofen it takes 12 or more at 3 or 4 at a time. Acetaminophen is processed through the liver, so it's out by itself, why I only do a few hydrocodones.

When I was younger, opiates were OTC with a signature. Used it for teething pain and a myriad of other ailments.
Saw the other day, some teething med was being investigated for harm. Bet it cost more, too.

I'm on beer today, so consider...please.

[catbyte]

81. Popping NSAIDS caused my body to rebel & I developed an anaphylatic reaction to them.

Now I have to avoid everything containing aspirin too, and carry an Epi-Pen everywhere I go just in case. My doctor also told me to severely limit taking Tylenol because I seem to develop allergies to meds. I also developed an anaphylactic allergy to penicillin. Arrgh.

[mrmpa]

44. Yes, some are going to suffer.......

Well that could well be me. I take 2 hydrocodones daily, have for 6 years. The pain is from a poorly repaired broken hip and spinal stenosis. You seem to have a cavalier attitude toward those with pain. Along with the medication I was in physical therapy for 3 years, nothing controls the pain but the medication.

I went to my doctor today, the first time I've seen her since hydrocodone was placed on the class II list. Now instead of seeing her every 4 months, I need to see her every two months, which means my costs have doubled. I'm one of those good patients who have never abused the medication, or gone to the pharmacist with some stupid excuse for wanting my prescription filled early.

I know the risks of the medications. I also know the risks if I don't take the medication. Those who are going to suffer are those who have been compliant taking the medications and are "good" patients. So let's please take the cavalier attitude off the table.

[catbyte]

79. "Yes some are going to suffer..."

That is an unbelievably cruel attitude. You have no idea what unrelenting, soul-crushing pain is like, and I hope you never do. Please grow some compassion. Wow.

[SpankMe]

13. I hear you.

After 2 shoulder surgeries I went on narcotic meds. They did nothing for the pain. They just made me high and they made me throw up a lot. I discovered I can't tolerate them. OTC Ibuprofen ended up working the best for pain reduction.

[shanti]

64. For many people, opiates don't work

At least, not for me. I have chronic back pain (not at the moment, thank god), but once I was prescribed vicodin for the pain, as well as flexaril. Neither one did a thing for the pain, so I stopped taking them. Ibuprofin is the only thing that works for pain for me, but unfortunately, it's not so great for the liver or stomach.

[cali]

74. and for me they're pretty effective

I am a long term user of opiates. I have CRPS. I have tried everything- sympathetic nerve blocks, an array of drugs like lyrica, etc. No dice. Finally, after over 2 years, I've worked out a protocol for myself that included a change of diet, exercise and targeted exercise and yes, staying on the opiates. I am not addicted even a little bit. I can go days without taking any on my good days. The problem for me is generally nights. I'm quite good at distracting myself from pain- except at night. Lying there in pain sucks. So I generally take 10 mg of oxycodone at night. Rarely, I take it during the days. All the docs I've seen think I've done a great job at dealing with this nasty condition and my PCP has no problem prescribing for me.

[irisblue]

33. Chronic pain patients

could still use some opioid pain relievers and still continue to work, working at an auto body shop and using heroin not so likely.

[DLnyc]

2. Increase also perhaps due to fighting a decade of war in heroin capital of the world.

Just saying. The strategy of not talking about it doesn't change the fact that huge amounts of heroin originate in Afghanistan. An endemic state of war gives convenient cover to traffickers and the addicting, and corrupting, influences of that drug gradually seep into everyone in the area, of course including US soldiers and officers who eventually bring their addictions, and/or business relationships, back home. Same thing happened during the Vietnam era, the flow of addicts and drugs into the US was immense.

[libodem]

19. Yep

You got it.

Lot's of people think pain control is for weaklings and that suffering is a virtue.

I'll manage my discomfort with the medication I see fit. Its tough to find the right combination and then use it correctly. Not all drug use equals abuse.

[former9thward]

42. I have seen no reports of troops addicted to heroin in Afghanistan.

None. I was in Afghan in 2002, first full year of the war, and I saw no drug use whatsoever.

[DLnyc]

58. Interesting

But perhaps not everything that exists is reported, or seen by you.

Here is one report, but I wonder if there is more behind the scenes. http://www.cnn.com/2012/04/21/us/afghanistan-soldier-drug-overdoses/

[former9thward]

60. Afghan is similar to Vietnam only with respect it is a hopeless losing war.

In Vietnam there was massive drug use due to the fact that most troops there were draftees and did not want to be there. They just wanted to do their one year and get out. So many of them started to do drugs out of their resentment and to pass the time in the best way they could. They did not care about how it affected the mission.

Afghan is a different animal. Everyone there is a volunteer and everyone there knew exactly what they were getting into. The report at the link you gave shows the amount of drug use is petty compared with the tens of thousands of troops in the area. Yes, not everything is reported but to compare Afghan with Vietnam is not accurate.

[wave_maker]

48. Dark Side of the Boom

And then there is this...

"But there is a dark side to the multibillion-dollar boom in the oil fields, which stretch across western North Dakota into Montana and part of Canada. The arrival of highly paid oil workers living in sprawling “man camps” with limited spending opportunities has led to a crime wave -- including murders, aggravated assaults, rapes, human trafficking and robberies -- fueled by a huge market for illegal drugs, primarily heroin and methamphetamine."

http://www.washingtonpost.com/sf/national/2014/09/28/dark-side-of-the-boom/

However, it is average people with chronic disabilities and pain -- almost all war veterans and almost anyone over 60 has something chronic -- and the doctors who are trying to help them live their lives productively that are terrorized and demonized by the DEA as agents of death and addiction.

[tridim]

4. In States With Medical Marijuana, Painkiller Deaths Drop by 25%

http://www.newsweek.com/states-medical-marijuana-painkiller-deaths-drop-25-266577

Do the math, idiot politicians.

[Prophet 451]

43. Roll on legalisation

I'm on large doses of dihydrocodeine to cope with joint pain. I'd much prefer to cope with my pain with a joint but medical cannabis is a non-starter here (UK).

[Nictuku]

77. The new law makes you have to choose between pain meds and marijuana

In addition to having to see the doctor in person to get the triple script, now Pee tests are required to get your prescription filled.

Having grown up in Hawaii in the 70's, this is the first time since I was 18 where I was not able to smoke. My first pee test is coming up in the next 30 days.

I wasn't an abuser of marijuana, but I was a daily smoker. Just a little after work each evening. Like some people use alcohol - to unwind after a long days work.

Until now, I have never had any problems sleeping. I am livid about this new law. Because of this law, now will have to take a day off work each month to make this doctor visit (because of my long commute on public transportation to the city.)

I had back surgery which was a miricle in that the sciatica pain has pretty much been absolved. But I also have DDD, spinal stenosis, and arthritis (which is deforming my fingers) and the pain in my hands was so bad that I can barely function in the mornings without the prescription.

I take no more than 2 per day, 1 at 3 am so I can get up at 4 and actually have my hands work like they should. I take another one around noon which gets me through the rest of the work day. I take only ibuprofen in the evenings because vicoden did keep me up later than I had to be to sleep. I was able to get up at 4 am, do a 4 hour commute (Round trip) and work a 9 hour day, even with my chronic pain. It was managed. It worked, and I was able to work.

Now I'm having trouble getting to sleep. Needless to say, I'm really pissed off. And I have to take a pee test for gods sake. I am not a criminal! I contribute to society, I pay my taxes, I support my mother.

[Dopers_Greed]

5. Weird that they are singling out the "painkiller crackdown"

When it was the glut of painkiller prescriptions that helped start this mess in the first place.

Do the owners of this media outlet own shares in Big Pharma or something?

[99th_Monkey]

9. It is a rather circular argument.

Saying ...
1) Painkiller abuse is a "gateway" to heroin, AND
2) painkiller crackdown pushes people to heroin.

Seems like they're trying to have it both ways, or something like that.

[Spitfire of ATJ]

6. "The increase in heroin use is due in part to cracking down on the prescription painkillers"

I just pictured Rush bent over a candle with a spoon.

[jtuck004]

8. " I just pictured Rush bent over..." < I can't finish the rest of the post.

ick.


lol

[Shrike47]

31. Yes, it's not the spoon and the candle, it's the bend.

Please oh please no butt crack.

[jtuck004]

36. Did you ever see that video where the guy is texting and walks around the corner to find a moose

or bear in his path? He drops the phone, squeals, and does the fastest 180 exit I have seen in a while. Wise man.

I think I would be like that if I came around a corner and saw a heaving blob of rush upside down and oozing into place to do a line of cocaine. Like that fella in the video, I would be...gone.

[Marrah_G]

38. The bear! that was a crazy video!

[hunter]

76. Here's the bear. I think I've seen a moose video too.

[jtuck004]

85. That's the one I was thinking of. Thank you. n/t

[Akoto]

7. As a side-effect, those of us with legit chronic pain are struggling.

Someone above said that doctors were handing out painkillers like candy and not finding other solutions to pain. I might agree that some doctors were doing the former.

For many of us, there is no other solution to the pain.

My syndrome, for example, has no cure and no real therapeutic treatment of any kind. It wasn't until I entered into pain management at the University of Miami that I received any relief from the agony. I never, ever stray from my prescribed dosages and am just one example of the countless people in similar positions. We're now dealing with the confusion of drug schedule changes and so on when our conditions are difficult enough.

That's to say nothing of the fact that there are so many people in the United States whose pain is seriously undertreated.

It's tragic that these folks are dying from heroin overdoses, naturally. However, the article says that they had already become addicted to painkillers - addiction being excessive abuse, as opposed to dependency. Take away one half of their collective addiction and it's no wonder they double up on heroin, to fatal results. You can't just go off of pain management drugs like those cold turkey, without weaning. It's very dangerous.

[Aristus]

18. Unfortunately, the perception of providers trying to find other solutions to pain

is pretty low.

Even right here on DU. In the past, I have posted about my reluctance to prescribe narcotics for patients in chronic pain (my medical organization's policy against casual prescribing of opiates notwithstanding), and instead detail my treatment plans regarding more efficacious treatments like TCA's and SSRI's, physical therapy, orthopedic treatments, etc.

I was torn up on side and down the other by DU-ers reportedly suffering from chronic pain. They called me every name in the book, a lot that aren't, incompetent, indifferent to suffering, "not a real doctor" (which is true; I'm a real Physician Assistant), and wished comparable levels of suffering on me because I don't hand narcotics out like candy.

It's a damned-if-you-do, damned-if-you-don't situation.

[Dopers_Greed]

20. A friend of mine with chronic pain got it under control with antidepressants and marijuana

Not trying to write a prescription or anything, but it's very possible to go without narcotics.

[Aristus]

23. My job is made a lot easier by the fact that marijuana is now legally available over-the-counter

here in Washington State. I don't prescribe it at all, or encourage my patients to use it. I just don't discourage them from using it if it helps their pain. Certainly far fewer adverse side effects than narcotics.

I discourage them from smoking it, though, and advise them to try edibles instead.

[Marrah_G]

39. I am lucky that my pain in nerve pain

I know, strange thing to say since nerve pain is horrible....but at least it is controlled with meds that are not considered narcotics (neurotin) so getting it is not a problem. I do have a relative with a cronic pain illness and unfortunately its so hard to be controlled without turning her into a zombie.

[Akoto]

41. Re: Unfortunately

Last edited Thu Oct 2, 2014, 10:27 PM - Edit history (10)

I am not a doctor, a physician assistant, or anything else of the like. I'm just a patient with an incurable syndrome which has little to no alternative treatment. I've had it since I was 17, and I'm now approaching 30. I think that part qualifies me to speak as a proponent of appropriate medication usage.

I'd first like to say that people come from around the world to be seen at the Univerity of Miami / UM/Sylvester. They do not, by any means, hand out narcotics or any other drug like candy at their pain management department. However, there *are* people for whom it's the only answer. Coincidentally, with respect to your recommendation of physical therapy, I went through that prior to medication and only got worse. It was the one and only alternative treatment which showed any peer reviewed efficacy for my condition, and some patients were intolerant to it. Unfortunately, I was one of them.

With full confidence, I can say that I would not have made it for as long as I have without UM's pain management. It has made the torture bearable, slightly so, enough that I can function around the house. I also see a psychiatrist for my chronic pain (who happened to be in pediatric pain management years before), and I receive medication for anxiety and depression from him. These conditions are natural companions of unending pain, and he agrees that I should take the medication.

I don't believe you're indifferent to suffering. I also *do* believe that, if there is a legitimate alternative treatment for a condition which has shown successful results in peer reviewed studies, then absolutely go with that. However, if a doctor is shooting in the dark because there's no obvious solution to a confirmed syndrome or other condition save for medicinal pain management, then I think they do the patient a disservice by refusing to prescribe. Pain is insufficiently addressed in our country due to an illogical fear of using opiates, even when the patient's circumstances clearly warrant it and the statistics are heavily against the likelihood of addiction.

These drugs are not evil, and people with legitimate chronic pain are statistically highly unlikely to become addicts. Dependency is a different animal, as I'm sure you know, and it's an inevitable consequence of long term use with many kinds of medications. However, a dependent is not abusing or receiving a high.

Lastly, a personal note: I fully acknowledge that I do not have your professional credentials. I don't intend to preach. However, I would ask you to realize that unless you're going through it yourself, the torture which accompanies chronic pain is something you simply can't comprehend. You can have an academic understanding of what patients go through, but you never truly grasp it until you're there; the human brain isn't meant to bear or process this kind of burden. Sometimes, people who seem desperate for help truly are and can't wait to go through every experiment there is.

I don't know if this is something you look at when deciding how to treat a patient, but I hope that you do or that it's something you'll give thought to. Naturally, you decide how your practice runs beyond your obligation to the Hippocratic Oath. I've come to know many physicians over my years of illness, from students to professors, each of them with their own style. However, I personally believe that "Above All, Do No Harm" should include the relief of intractable suffering.

[UglyGreed]

57. My PA is a wonderful person

who I was passed to after the doctor realized I was not cash cow lining up for injections which never did help me. She is only person who actually talks to me and more importantly listens.

[Aristus]

59. Thank you.

My patients all tell me the same thing: "You listen to me!" Of course I do. I find it a little shocking that their experience with doctors is that MD's don't listen to their patients. My job, indeed, my sworn vocation, is to diagnose and treat illness. The best way to diagnose my patient is by listening to the history of their condition. My instructor for adult medicine in PA School told us that we will be able to get roughly 80% of our diagnoses from the history alone. So, yeah. I listen. A doctor who breezes into the exam room, doesn't even look at the patient, and then breezes right back out two minutes later is practicing bad medicine.

Our productivity goals are increased all the time. (My current quota is 24 patients a day. ) But I take the time as often as I can to assess the patient properly. Not doing so is a prescription for malpractice, followed by lots and lots of lawsuits.

[UglyGreed]

61. You're welcome

Empathy IMO is a very helpful tool to those who are suffering, especially those who suffer from chronic conditions which there is no cure yet not going kill you.

I understand that you and other doctors must walk a tightrope, no one wants to lose their livelihood. It is tough on all those who truly care. Wish you the best and please do not become jaded and lose your compassion for those who suffer like many who are in your field of work.

[UglyGreed]

66. A little off topic

but I thought you may like this article I came across.

http://www.hospitalimpact.org/index.php/2011/02/08/what_a_lack_of_empathy_does_to_our_healt


Thirty years ago, medical schools taught that the most important component of a mental health healing encounter is empathy, human connection, and authentic relationship between a physician and a patient. And beyond this connection, and much less important to positioning the patient for optimal healing, was the specific technical approach to the healing, (for example, Cognitive Behavioral Therapy; pharmaceutical intervention; surgery).

Of course, I immediately went to see if this "New Age" teaching was consistent with the Hippocratic Oath and lo and behold I found this in the Oath: "I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug."


[More:]

They're aligned. Love it!


As I considered these questions I received the JAMA article, "Empathy in Medicine--A Neurobiological Perspective," from a friend of mine. Funny how the universe works.

According to this article, "lack of empathy dehumanizes patients and shifts physicians' focus from the whole person to target organs and test results." What's more, "evidence supports the physiological benefits of empathic relationships, including better immune function, shorter post-surgery hospital stays, fewer asthma attacks, stronger placebo response, and shorter duration of colds."

[Delphinus]

80. Ooh, that is so right!

I'm glad you brought this to our attention - thank you.

[UglyGreed]

84. You're Welcome :) n/t

[Horse with no Name]

50. I am sorry for your pain

however, I have been a nurse for over 25 years and yes, many doctors do hand it out because they simply do not want to deal with the problems the patient has.
That is the population I am talking about.
I never once mentioned the chronic pain patients.

[catbyte]

82. I don't know where you live, but here most GPs refuse to prescribe narcotic pain meds.

Mine won't, that's why he referred me to a pain clinic. I keep hearing about all these Dr. Feelgoods, but have never actually encountered one.

[Psephos]

11. The law of unintended consequences is both cold and certain.

Wouldn't it be nice if we *could* just legislate our problems away instead of commit to do what it actually takes?

[looks dreamily off at the horizon...]

[Spitfire of ATJ]

14. In this case it would be to follow the recomendation of Timothy Leary...

He wanted the government to allow the development of a safe, non addictive hallucinogenic.

Face it, that would save lives.

The PROBLEM is the government considers it immoral to get high.

[jtuck004]

12. Look at this answer by the CDC whoseits...

...

“Reducing inappropriate opioid prescribing remains a crucial public health strategy to address both prescription opioid and heroin overdoses,” said CDC Director Thomas Frieden. “Addressing prescription opioid abuse by changing prescribing is likely to prevent heroin use in the long term.”
...

Here.

I wonder if that was his reaction to this report?

If so, more of the same, regardless of what is happening?

[postulater]

15. US neurologists warn against long-term opioid use for non-cancer pain

"Half of patients taking opioids for at least three months are still taking them five years later, with long-term use associated with serious risk of overdose or addiction.

Long-term use of opioids as pain relief in chronic non-cancer conditions can have serious side effects and may be fatal, study by American Academy of Neurology suggests.

The risk of death, overdose, addiction and serious side effects of opioids outweigh their pain relieving benefits in chronic non-cancer conditions, such as headache, fibromyalgia and chronic lower back pain, the American Academy of Neurology says in a paper published in Neurology[1] (online, 30 September 2014).

More than 100,000 people have died in the United States from prescribed opioids, directly or indirectly, since the 1990s when the drugs started to be used more widely for non-cancer chronic pain, the paper says. In the highest-risk group (35-54 years), mortality rates exceed those of both motor accidents and incidents with firearms.

The paper says studies have shown that half of patients taking opioids for at least three months are still taking them five years later and, while opioids may provide significant short-term pain relief, the evidence suggests they do not maintain pain relief or improved function over long periods of time without serious risk of overdose, dependence or addiction."


http://www.pharmaceutical-journal.com/news-and-analysis/news/us-neurologists-warn-against-long-term-opioid-use-for-non-cancer-pain/20066675.article

[UglyGreed]

53. Wow

[/The paper says studies have shown that half of patients taking opioids for at least three months are still taking them five years later and, while opioids may provide significant short-term pain relief, the evidence suggests they do not maintain pain relief or improved function over long periods of time without serious risk of overdose, dependence or addiction lockquote]

Hmmm I wonder how many of those people have chronic conditions that there are no cure for??? What are they suppose to do stop after three months and then suffer for the rest of their lives???

[hunter]

83. I'll bet more than half of all alcohol users taking alcohol for three months...

... are still using alcohol five years later, and a very significant number of them become alcoholics.

And OMG, what about the coffee users? That shit is really hard to kick. I'm a coffee addict. If I don't get my fix in the morning, damned right, I do become dysfunctional.

Throwing "dependence" in those statistics makes them bullshit. Of course chronic pain patients are "dependent." They don't want to hurt, and they don't want the extra aggravation of withdrawal symptoms on top of that.

There are ways to solve the problem. Let's stop treating actual addictions as a moral failing or character flaws, and recognize it as something biological. The monitoring system ought to be sensitive enough to discriminate between people who actually hurt and do not escalate their opiate use, and those who become addicted.

And then divert addicts, any kind of addict, to addiction specialists who can help them with that problem.

Legalizing cannabis would also be helpful.

There are ways of dealing with these problems in a humane fashion. But no, we have to fight a fucking "war on drugs" which destroys the lives of so many people, and only enriches corrupt pharmaceutical corporations, corrupt medical providers, drug gangs, private prisons, drug warriors, and religious cults.

[Scairp]

16. It will only get worse now

Since they made formerly schedule III drugs schedule II we will see a marked increase in this public health crisis. And leave people in pain.

[ballyhoo]

25. Whenever the government tries to solve a problem they always

create five other problems of equal or greater magnitude. Course, there is nothing the government likes better than attacking "the least of these".

[FloriTexan]

17. In some cases the alternative drugs are worse...

I have pretty chronic knee pain and need two new knees but am too young for them (per my doctor). I have issues taking large and continual dosages of NSAIDS as they cause much stomach pain. I've recently had a flare up in one of my knees and my doctors and I are going to begin using Supartz (a gel cushion) injected into the knee but the red tape and insurance approvals take several weeks. In the meantime, a cortisone shot helped for about a week and the anti-inflamatory they gave me (Voltaran 75 mg) kept me comotose, gave me severe nightmares and blurred vision. Not to mention perpetual belching. When I called the ortho to tell them about my reactions they treated me like an addict and said that I would just have to take 1000 mg of tylenol as that was the ingredient in hydrocodone that they were really prescribing for pain. What?!

I asked if I could come in for an appointment to discuss it or get another cortisone shot, as I was unable to drive and walk any real distance. They said take tylenol. So I called my regular family doctor and went to him for a visit where he prescribed the same drug but in a newer, lower dosage without the side effects. Unfortunately, I just found out its going to cost me upwards of $200 because it is a Tier 3 drug. I would kill for a $5 20 or 10 day supply of hydrocodone right now. Just to get me through to the gel injections.

Sorry for the rant, been dealing with this all day.

[UglyGreed]

56. Don't be sorry

people need to speak up. They want us to just sit and suffer. It's not about feeling sorry for one's self, in my case it's all I know, pain and suffering and having to pay for the privilege to do so on monthly basis.

[ColesCountyDem]

21. Bad docs put good docs on the spot, and junkies screw chronic-pain patients, to be blunt.

I suffer from long-term, chronic pain, the result of a spinal injury. I was and am 'lucky', in that my injury was diagnosed and treated at a university teaching hospital by both a top-notch orthopedist and a top-notch neurosurgeon. Everything that could and should have been done to treat my injury for the best possible outcome was done, and done in a timely manner. In other words, I received world-class care, and will always be grateful that I did.

Though greatly improved after the above treatment, I was left with moderately-severe, chronic pain. I was referred to a pain-management specialist, and tried the whole spectrum of 'non-pharmaceutical' therapies: physical therapy, a TENS unit, steroid injection, nerve blocks, etc., none of which proved as effective as a combination of NSAIDS and narcotics.

As a result of 'pill mill' physicians and recreational pain-medication junkies, I now submit to a monthly drug screen. Yes, it does help my doctor monitor the serum level of my narcotics, to ensure that it remains at a therapeutic level, but it also serves to protect us both: my doctor can prove that he is treating my pain correctly and monitoring my usage, and I can prove to any neo-Nazi cop or drug-enforcement group that I'm taking, not selling my medication. The price of this testing is $1500/year, thirteen times the cost of the medication itself!

I feel sorry for folks who become addicted through the (initially) casual use of narcotics, and I want them to get help, but they're also causing me and my doctor problems, and I don't appreciate that.

[Warren Stupidity]

22. 'cause the WOD is such a rational approach to drug abuse. nt.

[Xithras]

26. Less than 4% of prescription opiate users become addicts.

And if you factor out the people who already exhibited addictive personality traits prior to using the opiates, the numbers drop to less than 2%

The rescheduling of opiates is simply more fear mongering bullshit by the drug warriors.

[ballyhoo]

27. That is exactly what it is. I'll find out more when

I see my arthritis doctor later this month. I already know what he'll say.

[Akoto]

46. I agree wholeheartedly. Addiction versus Dependency is little understood.

An addict is someone who abuses their medication, taking more than has been prescribed and/or possibly seeking out more from other sources. They have a mental craving for more than what they should be taking.

A dependent is someone who would experience withdrawal if they don't have their medication, but they otherwise do not abuse it and take it only as prescribed. Dependency forms with all sorts of drugs, opiates being only one of them.

People who have genuine chronic pain almost never react by developing an addiction. The brain no longer works that way. Instead, they get the pain relief, but not the high. This is described in many peer reviewed studies.

[frylock]

29. probably going to increase even further with hydrocodone being rescheduled to CII

[Shrike47]

32. I have a chronic pain condition and use 1 5 mg hydrocodone per day, on average. You'd think it

was 40 a day, the hoops I go through. They've already told me 1) I need a knee replacement and 2) they don't want to do the knee replacement due to a history of severe infection in that leg.

The current crackdown just seems malicious to me.

[demigoddess]

34. someone we know had surgery

and in the aftermath got hooked on these pills the doctor prescribed. They blamed it on her. After reading about these pills, I think it would have been a miracle if she didn't get hooked.

[UglyGreed]

67. What did you

want the doctors to do? Get sued because they allowed that person to suffer after the surgery? Do you understand that in some cases surgery can do more harm and cause never ending pain?

[demigoddess]

69. I've been watching doctors be wrong about

things for over 40 years. This does not surprise me. And Ugly is very appropriate for you.

[UglyGreed]

70. So are you

one of those jaded health care professionals I have come across in my 25 years of dealing with a chronic pain issue??? Name calling from a person with a screen name of demigoddess HMM. I may be ugly, that's what happens when you are allowed to suffer half your life.

[demigoddess]

72. I have a 40 some year old daughter who

has been in pain all of her life, been ignored and mistreated by doctors and teachers alike. I am her caregiver since birth and the one who has to go toe to toe with doctors. Can't tell you how many times.

Ps. I am more of a gorgon than a goddess.

[UglyGreed]

73. since

you have a loved one who suffers I would think you would understand about pain and how demonizing medications are not the answer. We really do not need anymore to join the witch hunt.
Perhaps pain medication does not help your loved one but it may ease the pain of someone else. I don't believe in making people suffer needlessly because some people decide to abuse the situation.
I understand your frustration with doctors, my wife, son and myself have had our share, that's why I try to speak up. BTW Caregivers are Goddesses in my eyes.

[fredamae]

35. Is that what will

replace Cannabis after MedCanna and outright legalization expands? It is my understand the reason cannabis was prohibited in the first place was to keep the money flowing to Anslinger and Hoover post the repeal of alcohol.
Gotta keep those LE folk busy, the courts jammed, the bodily fluid testing industry profitable, jail beds full etc.
This is Not ok to allow a likely majority of those in legitimate need Suffer-really, truly-physically Suffer because of a few people who may become or are addicted. Expand medical treatment for them...but for Christ sake Don't deny those in real need.
I don't take Any of these drugs-I can't tolerate the side-effects at all. But having watched family members in physical agony helped me understand PAIN, mind-numbing, tortuous, never-ending constant, throbbing pain.
This is bad. Of course people are going to try "self-medicating". What the hell did they Think people were going to do? They have No voice with the PAB.

[Warpy]

40. Gee whiz, what a fucking surprise

When people can't get pharmaceutical grade painkillers they will turn to the black market.

This is how the war on drugs kills people while making sure the black market thrives.

[DesertFlower]

51. i take norco 10-325 -- 2 a day. i break

them in 1/2 and only take 1/2 at a time. sometimes i can get away with just 3 halves.

i've had 6 epidurals at a pain clinic which did not help.

i have scoliosis, osteoarthritis and herniated discs.

also tried medical marijuana which had the opposite effect -- made the pain worse and raised my BP. i was up till 4 am. didn't even help with sleep. back in the day when i occasionally smoked pot it put me to sleep.

saw my doc last week and he had to write me 4 different prescriptions because of the new laws.

i'm 73. what's going to happen when i'm too old to drive? it will cost a fortune to take a taxi to the doc. i live in a remote area. hopefully i'll be dead by then.

[Humanist_Activist]

52. This is fucking idiocy, seriously, addiction and dependency are public health issues...

no MORE, no less.

This full of complete bullshit war on some drugs that this country has been waging is fucking stupid.

The fact is that criminalizing substance abuse is just fucking stupid. Yes, its profitable for various jurisdictions, but for addicts and the general public, there is NO upside here.

Oh, and to those people putting out sob stories about how they know someone who got addicted to these "evil" pills, etc. Give it a fucking rest, we know they are addictive, so is alcohol and a host of much less restricted substances. Many of which are also more destructive and damaging, both individually and to society. Go join the temperance movement or something.

[UglyGreed]

54. Yeah evil pills

until THEY need them LOL. Tell you the truth and no disrespect to those who have cancer and their families, but I pray that I would get it and die so I don't have to kill myself and leave that hanging over my wife and children for the rest of their lives.

Chronic pain is TORTURE that never ends, I know I live it, 25 years now and I'm 49. But of course I'm just a junkie having a bad day.

[Sunlei]

55. does everyone think this is ALL 'imported' heroin?

[UglyGreed]

71. Many people who become addicted to heroin are living a normal life??????

What?????

[Red State Rebel]

86. You would be surprised....

My daughter was addicted. She has an acquaintance that is still addicted that holds down a great job in middle management.

Also, I somewhat disagree with the statement of the article. My daughter started on pain killers, but heroin is cheaper and easer to get. That is why most people go to heroin from oxy.

[UglyGreed]

87. I was just surprised

by that statement. I'm sure there is always exceptions to the rule. I also agree that it is usually the other way, oxy to heroin. I'm sure there are many people who live normal lives while being on pain medication if it is truly used to treat pain and not to get high. IMO Just like alcohol, some people abuses it but most don't, it really depends on the individual. Thanks for the reply.

[Skittles]

95. is your daughter OK now?

that is a tough addiction indeed

[Doctor_J]

88. Steve Earle

I guess you could call his life normal. He's beaten back the dragon twice.

[UglyGreed]

89. Just like

my father who was alcoholic and lead what some would say was a normal life, of course they did not see what went on behind closed doors.

[Doctor_J]

90. True, Steve's been married 7-8 times

and his chosen profession does not require clock-punching. And his son seems to be doing OK.

Glad you survived.

[Ampersand Unicode]

94. Fucking legalize weed already.

[Corey_Baker08]

96. I Hope People Realize Methadone Centers Saves Lives While Heroin Continues To Kill...