does this make any sense to you?

[braumeister]

The pendulum swings back and forth. Thirty years ago, I recall my then wife, a nurse, recounting that docs withheld pain killers from cancer patients in their last days on earth for fear they would become addicted.

That was exactly the case with DW's late mother, in 1980.

 

[harley]

Here's a very good and detailed article about this issue. Like me, they don't really offer solutions other than stop making things worse.

America's War on Pain Pills Is Killing Addicts and Leaving Patients in Agony - Reason.com

 

[Bamaman]

The deal with $450 monthly office visits is Catch 22.

Every other month, you will get a urine drug screen to make sure you have enough drugs in your body--and that you are not selling your meds. The test is also looking for abusers because they often take other drugs not prescribed by pain management--very common.

Then every other month, you will have to use a tablet to answer a bunch of questions. It is their version of a mental acuity test. And it is just about dumb. They are looking for mental zombies.

Pain management clinics are very expensive to run. The physician in my wife's office is an aneshesiologist with a post doctorate fellowship in pain management. He is assisted by four Nurse Practioners and.or Physicians Assistants that have high salaries. Pain management is very expensive on malpractice insurance because there are accidents--and patients that are quick to sue.

 

[TrvlBug]

I had an interesting conversation with spine dr. the other day. Got kicked out of PT because my hip bursitis wasn't getting any better; in fact it was getting worse causing all sorts of excruciating throbbing pain in leg, back and then other side and inability to sleep more than 4-5 hours a night when I need 8-9. PT thought my issues might be eminating from the spine rather than just the hip.

The spine dr. quizzed me on my pain mgmt (ibuprofin) and how was that working. Didn't think anything of it until this thread. I hadn't realized how the constant pain was affecting my psyche. After a cortisone shot in the hip, it's like a cloud has lifted. Next time I see my GP, I'm going to smack her for not suggesting cortisone shot right away knowing how much pain i was in.

 

[MBSC]

For the more commonly abused drugs there are talks of scrips no longer than 3 days, no renewals without a new scrip.

The following article was brought to my attention and reminded me of your post.

Starting April 1, BlueCross BlueShield of South Carolina will limit short-acting opioid prescriptions to seven days. On May 1, the South Carolina Medicaid agency will limit opioid prescriptions to five days. Together, BlueCross BlueShield and Medicaid cover more than two-thirds of all South Carolinians.

The South Carolina Medicaid agency wrote exceptions to the five-day rule. Doctors may prescribe a longer course of drugs for patients who have been diagnosed with chronic pain; cancer-related or sickle cell disease-related pain; or those who are receiving hospice care, palliative care or medication-assisted treatment for substance use disorder.

Similarly, BlueCross BlueShield of South Carolina wrote exceptions to its seven-day rule for cancer and sickle cell patients, as well as those in hospice care.

Full Story: https://www.postandcourier.com/heal...cle_6652447c-2216-11e8-8891-2f173d28f415.html

 

[NW-Bound]

Just to give you an idea of the magnitude of the problem: opioids now kill more people than breast cancer. We got into this situation because the drug companies encouraged doctors to prescribe opioids and doctors could see that their patients had better pain control. Meanwhile, they were getting addicted in their thousands and some were selling their prescriptions on the street.

https://www.cnn.com/2017/12/21/health/drug-overdoses-2016-final-numbers/index.html

Opioid deaths in Canada expected to hit 4,000 by end of 2017 - Health - CBC News

From the CNN article above:

More than 63,600 lives were lost to drug overdose in 2016, the most lethal year yet of the drug overdose epidemic...

... in 2016, prescription drugs were involved in 23% of all deadly overdoses...

...The states with the highest rates of overdose in 2016 were West Virginia, Ohio and New Hampshire, the report said...

... These increases have contributed to a shortening of the US life expectancy for a second year in a row...

The fact pointed out in the last sentence above has been noted multiple times before by statisticians, and it was noted that it impacted more white males with poor economic prospects.

But back on prescription drug, I do not understand the following statistics:

...Studies have shown that while rates of opioid prescribing remain high in the US, they have decreased from a peak of 81 prescriptions for every 100 people in 2010 to about 70 per 100...

What does "70 prescriptions per 100 people" mean? I don't believe 70% of the population are on pain killers. I count a couple of dozen people in my family (siblings and their offsprings), and nobody is on long-term pain killers.

It is probably the number of prescriptions in 1 year. Also, it is more likely that they count each 1-month prescription for long-term users (12 prescription/yr per user), and also the many one-time prescriptions for dental work. We need better break-down of this statistics.

 

[Meadbh]

What does "70 prescriptions per 100 people" mean? I don't believe 70% of the population are on pain killers. I count a couple of dozen people in my family (siblings and their offsprings), and nobody is on long-term pain killers.

It is probably the number of prescriptions in 1 year. Also, it is more likely that they count each 1-month prescription for long-term users (12 prescription/yr per user), and also the many one-time prescriptions for dental work. We need better break-down of this statistics.

From the CNN article.....

“Studies have shown that while rates of opioid prescribing remain high in the US, they have decreased from a peak of 81 prescriptions for every 100 people in 2010 to about 70 per 100. Kolodny also pointed to recent surveys indicating that opioids were being less-frequently abused by teens.”

If you follow the hyperlink in the CNN article at the text that I have bolded, it will take you to this CDC page, the Morbidity and Mortality Report, which has all the information you require. In particular, read the Methods paragraph.

https://www.cdc.gov/mmwr/volumes/66/wr/mm6626a4.htm

 

[NW-Bound]

I read it, and did not see if there is a "standard prescription" definition that I might have missed.

The article talks about 640mg per capita in the US in 2015. To have a perspective, I recall that after a major surgery, I was given a prescription of 60 pills of Oxycodone, each of 5 mg. The instruction was to take 1-2 pills every 4 hours as necessary for pain. No refills.

So, that's 300mg prescribed total for that surgery incidence. How much is that compared to the "standard prescription", or what given to long-term users?

By the way, I ended up using only about 1/2 of that prescription, or about 30 pills total during recovery.

PS. From the 640mg per capita and the 70 prescriptions per 100 persons, that works out to 914 mg per prescription, whatever that is for 30 days or per surgery or palliative incidence.

We still do not know the percentage of people who need this on a routine basis, which I am curious to know. It cannot be very high, meaning only a few percentage of people need this, and they need a lot.

 

[MRG]

I read it, and did not see if there is a "standard prescription" definition that I might have missed.

The article talks about 640mg per capita in the US in 2015. To have a perspective, I recall that after a major surgery, I was given a prescription of 60 pills of Oxycodone, each of 5 mg. The instruction was to take 1-2 pills every 4 hours as necessary for pain. No refills.

So, that's 300mg prescribed total for that surgery incidence. How much is that compared to the "standard prescription", or what given to long-term users?

By the way, I ended up using only about 1/2 of that prescription, or about 30 pills total during recovery.

PS. From the 640mg per capita and the 70 prescriptions per 100 persons, that works out to 914 mg per prescription, whatever that is for 30 days or per surgery or palliative incidence.

We still do not know the percentage of people who need this on a routine basis, which I am curious to know. It cannot be very high, meaning only a few percentage of people need this, and they need a lot.

I think the article is talking about MME, which I belive is different from the milligrams of medication. I have no training in this so someone else might have better ideas.

From the article
:*The amount of opioids prescribed in the United States peaked at 782 morphine milligram equivalents (MME) per capita in 2010 and then decreased to 640 MME per capita in 2015


Here's a handy calculater for different opiods to MME.

http://www.agencymeddirectors.wa.gov/calculator/dosecalculator.htm

 

[NW-Bound]

Thanks.

The 5mg/pill of oxycodone I was prescribed was equivalent to 7.5mg of morphine, according to the link you posted. Not that much difference.

Fentanyl is super strong! A dosage of 1 microgram/hr (24mcg/day) is equivalent to 2.5mg/day.

This means fentanyl is 100x stronger than morphine. Holy mackerel!

 

[NW-Bound]

Learned something everyday.

Here's a photo from the Web comparing a lethal dose of heroin vs. one of fentanyl.

 

[MissMolly]

Learned something everyday.

Here's a photo from the Web comparing a lethal dose of heroin vs. one of fentanyl.

Holy mackerel is right!

 

[MRG]

Here's another article about fentanyl and it's strength. A hundred pounds kills all of NYC and NJ.


https://www.cnn.com/2018/01/29/health/nj-largest-fentanyl-seizure-trnd/index.html

 

[NW-Bound]

I always read that opiods give an intense feeling of euphoria, but having been through 4 surgeries (part of the same illness treatment in 2013), 2 being major and 2 being minor, I never experienced that.

For a day or two after coming out of the operating room, I was given Dilaudid (hydromorphone) intravenously, switching to oral Oxycodone for the remaining stay and given 60 pills after each major surgery for home use. Never felt any euphoria. I did feel the pain if I did not have the drug.

I was afraid of getting addicted, so tried not to take any during home recovery. The pain was bad, so I took some, and had 1/2 the pills unused.

And reading about this in the media, I always wonder what's there to be addicted to. Is that feeling of euphoria something that depends on the person's physiology somehow? Or is it because the dosage was not high?

Not that I want to find out, or want to experiment, but I have always been curious how people get addicted.

PS. It may be the same as with alcohol. Many drunks get violent. When I got drunk, I just wanted to go to sleep. Not everybody feels the same with a substance.

 

[Teacher Terry]

A doctor here just got 10 years in prison for running a pill mill. One of his patients died.

 

[Walt34]

I always read that opiods give an intense feeling of euphoria, but having been through 4 surgeries (part of the same illness treatment in 2013), 2 being major and 2 being minor, I never experienced that.

I never did either and I've had occasion to take them four or five times myself. I also had Dilaudid by injection for a couple of days. Both made me sleepy but I never got a "high" off it.

I think one has to overdose to get the "high".

 

[MissMolly]

I never did either and I've had occasion to take them four or five times myself. I also had Dilaudid by injection for a couple of days. Both made me sleepy but I never got a "high" off it.

I think one has to overdose to get the "high".

Same here. Have had a number surgeries. Been prescribed hydrocone an oxycodone. They took the edge off pain but never, ever felt high. Have been given morphine and dilaudid in the hospital and just made me fall asleep. I have never understood what people get addicted to.

 

[MRG]

I always read that opiods give an intense feeling of euphoria, but having been through 4 surgeries (part of the same illness treatment in 2013), 2 being major and 2 being minor, I never experienced that.

For a day or two after coming out of the operating room, I was given Dilaudid (hydromorphone) intravenously, switching to oral Oxycodone for the remaining stay and given 60 pills after each major surgery for home use. Never felt any euphoria. I did feel the pain if I did not have the drug.

I was afraid of getting addicted, so tried not to take any during home recovery. The pain was bad, so I took some, and had 1/2 the pills unused.

And reading about this in the media, I always wonder what's there to be addicted to. Is that feeling of euphoria something that depends on the person's physiology somehow? Or is it because the dosage was not high?

Not that I want to find out, or want to experiment, but I have always been curious how people get addicted.

While I mostly agree, the dose Dilaudid of I was given explained to me why people really like stuff. I went to a very happy place! Pretty amazing cause the reason they gave it to me was it felt like my left testicle was being crushed in vise. I no longer cared. I could have been the hospital's greeter as long as I felt like that.
They had withheld it for sometime as I didn't have a driver, when DW arrived the nurse said they gave me a big dose. Probably to stop the screaming, I think it was upsetting others.

After I was on OXY for a few months I was done taking the crap, my pain was better. I tried stopping cold turkey, it was weird. Felt like I was having a panic attack. DW explained you can't just stop, take one.

When I saw the pain management doc, he said I had to wean off it. cut the initial dosage 25% every 3-4 days was the advise. It wasn't hard to do as I didn't like being stupid. He made it very clear he saw no reason why he need to prescribe more pills.

Based on folks I know who dabbled in the street stuff(my nephew is in recovery), it's much more euphoric than medical. Probably because of dosage.

 

[travelover]

........... I took some, and had 1/2 the pills unused............

Pssst.....wanna sell the remaining ones?

 

[NW-Bound]

I don't think you want these puny 5mg pills.

On the Web, I read of people developing a tolerance, and take up to 80mg of Oxycontin 4 times a day for pain. That's a lot of drug!

 

[MRG]

I don't think you want these puny 5mg pills.

On the Web, I read of people developing a tolerance, and take up to 80mg of Oxycontin 4 times a day for pain. That's a lot of drug!

Wow. That a lot of meds.

My last c-spine issue my PCP gave me 80 mg of Hydrocodone daily to get me to a diagnosis and referral. When I got to the pain management doc he freaked over the dose. Said that was the max dose, an emergency dose! We talked about my pain, he performed a cervical epidural and gave me the exact same prescription. [emoji4]

In fairness he prescribed one bottle at that dosage (7days) and another 14 days at half. I had another epidural and weeks of PT, that was plenty of meds to manage the pain. Since I was only on them a few weeks, this time, the need to taper off was minimal.

One lesson I've learned for my condition is to get in for an MRI ASAP. My last event was treated successfully for 2 weeks by oral steroids. I could have possibly avoided 2 lost weeks of the highest opiod dosage by actively pushing for a cervical MRI and the needed epidurals.

 

[Mr._Graybeard]

Research has shown that most heroin addicts started on prescription opioids. Since heroin abuse comes with a much higher danger of overdose, maybe we should make legal opioids more accessible, even to abusers, to reduce the frequency of accidental death.

If an addict could go to a legit source for his/her drug of choice, perhaps their need to commit crimes to feed their addiction would also diminish.

 

[Mr._Graybeard]

They're on public support now. Their support agencies are the police force, the DEA, the prison system and coroner's offices.

 

[harley]

Research has shown that most heroin addicts started on prescription opioids. Since heroin abuse comes with a much higher danger of overdose, maybe we should make legal opioids more accessible, even to abusers, to reduce the frequency of accidental death.

If an addict could go to a legit source for his/her drug of choice, perhaps their need to commit crimes to feed their addiction would also diminish.

Excellent logic that politicians just don't want to understand. IF the real desire is to decrease deaths, negate the uncontrolled market by opening the controlled market. Some people would still die, but there would be far fewer accidental overdoses and deaths.

 

[Walt34]

If an addict could go to a legit source for his/her drug of choice, perhaps their need to commit crimes to feed their addiction would also diminish.

I have to agree. It's pretty clear that incarceration doesn't work except in fairly rare cases. Rehab clinics only work if the addict wants to quit. Selling them from a legitimate pharmacy would take many of the "unknown" elements of quality and (relative) safety issues away, like using fentanyl in it. There would still be fatal overdoses but I'd think the number would go way down.