Join Early Retirement Today
Reply
 
Thread Tools Display Modes
Old 03-06-2018, 09:05 PM   #41
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
 
Join Date: Jul 2006
Posts: 11,401
I thought you might be interested to see the 2017 guideline on opioid prescribing from the CMA (Canadian Medical Association). This applies to CMA members everywhere in Canada, though individual Provinces have their own regulations.

https://www.cma.ca/En/Pages/opioids.aspx

The screenshot is a paragraph relevant to this discussion. The tone is a typical Canadian one: compromise.
Attached Images
File Type: jpg E1CEF1B6-3CFF-48F3-8268-40D90A51442C.jpg (329.5 KB, 74 views)
Meadbh is offline   Reply With Quote
Join the #1 Early Retirement and Financial Independence Forum Today - It's Totally Free!

Are you planning to be financially independent as early as possible so you can live life on your own terms? Discuss successful investing strategies, asset allocation models, tax strategies and other related topics in our online forum community. Our members range from young folks just starting their journey to financial independence, military retirees and even multimillionaires. No matter where you fit in you'll find that Early-Retirement.org is a great community to join. Best of all it's totally FREE!

You are currently viewing our boards as a guest so you have limited access to our community. Please take the time to register and you will gain a lot of great new features including; the ability to participate in discussions, network with our members, see fewer ads, upload photographs, create a retirement blog, send private messages and so much, much more!

Old 03-06-2018, 09:11 PM   #42
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
 
Join Date: Jul 2006
Posts: 11,401
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/healt...ers/index.html

http://www.cbc.ca/news/health/opioid...2017-1.4455518
Meadbh is offline   Reply With Quote
Old 03-06-2018, 09:42 PM   #43
Moderator Emeritus
aja8888's Avatar
 
Join Date: Apr 2011
Location: Conroe, Texas
Posts: 18,645
If you watch some of the episodes of Drugs, Inc recorded on the National Geographic Channel, (now found On Demand) you will see that the drug cartels are stepping up heroin supply to meet the needs of the people who can't get opioids anymore, but are still hooked. (thanks, Doc!)
__________________
*********Go Astros!*********
aja8888 is offline   Reply With Quote
Old 03-06-2018, 09:48 PM   #44
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
Sunset's Avatar
 
Join Date: Jul 2014
Location: Spending the Kids Inheritance and living in Chicago
Posts: 17,010
Some doctors are drug pushers, and they give the rest of doctors a bad rep. Just like a street corner drug pusher, some doctors are selling drugs

In 'pill mill,' Pa. doctor prescribes millions of opioids, 5 patients die: feds | PennLive.com

Shouldn't the punishment for him be a lot worse than a fine and loss of license in 1 State (which means he could still get a license for the other States).
How about 20 yrs in the prison, as is done to "regular" drug pushers.

This is not prescribing 5 extra pills to someone, no it is prescribing an average of 900 pills per patient in 1 year!!
__________________
Fortune favors the prepared mind. ... Louis Pasteur
Sunset is offline   Reply With Quote
Old 03-06-2018, 09:57 PM   #45
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
 
Join Date: Jul 2006
Posts: 11,401
Quote:
Originally Posted by Sunset View Post
Some doctors are drug pushers, and they give the rest of doctors a bad rep. Just like a street corner drug pusher, some doctors are selling drugs

In 'pill mill,' Pa. doctor prescribes millions of opioids, 5 patients die: feds | PennLive.com

Shouldn't the punishment for him be a lot worse than a fine and loss of license in 1 State (which means he could still get a license for the other States).
How about 20 yrs in the prison, as is done to "regular" drug pushers.

This is not prescribing 5 extra pills to someone, no it is prescribing an average of 900 pills per patient in 1 year!!
I agree!
Meadbh is offline   Reply With Quote
Old 03-06-2018, 11:53 PM   #46
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
harley's Avatar
 
Join Date: May 2008
Location: No fixed abode
Posts: 8,764
Quote:
Originally Posted by Meadbh View Post
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/healt...ers/index.html

Opioid deaths in Canada expected to hit 4,000 by end of 2017 - Health - CBC News
It's not prescription opioids that are killing people, it's street drugs (heroin) mixed with fentanyl. Prescription opioid deaths have Overdose Deaths Fall in 14 States been falling, but fentanyl and heroin related deaths have skyrocketed. This is a direct result of the war on drugs and the crackdown on prescription drugs. Shutting down the supply is not a solution to the problem. It just drives addicts into the black market, resulting in more deaths. There's no easy solution, but 40 years of the war on drugs should show that pushing people into an unregulated black market is pretty much the worst possible solution.
__________________
"Good judgment comes from experience. Experience comes from bad judgement." - Anonymous (not Will Rogers or Sam Clemens)
DW and I - FIREd at 50 (7/06), living off assets
harley is offline   Reply With Quote
Old 03-07-2018, 04:54 AM   #47
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
 
Join Date: Jul 2006
Posts: 11,401
Quote:
Originally Posted by harley View Post
It's not prescription opioids that are killing people, it's street drugs (heroin) mixed with fentanyl. Prescription opioid deaths have Overdose Deaths Fall in 14 States been falling, but fentanyl and heroin related deaths have skyrocketed. This is a direct result of the war on drugs and the crackdown on prescription drugs. Shutting down the supply is not a solution to the problem. It just drives addicts into the black market, resulting in more deaths. There's no easy solution, but 40 years of the war on drugs should show that pushing people into an unregulated black market is pretty much the worst possible solution.
I don’t disagree with you, but it’s important to understand that many of those addicts were “normal” people who became addicts after being prescribed opioids for chronic pain.
Meadbh is offline   Reply With Quote
Old 03-07-2018, 06:26 AM   #48
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
harley's Avatar
 
Join Date: May 2008
Location: No fixed abode
Posts: 8,764
You're definitely right about that. However, I'm willing to bet that making people come in once a month or whatever method is used to try to fight the epidemic will not work to end the addiction crisis. And having addicts die because the black market drugs they are buying are laced with fentanyl while still leaving legitimate pain sufferers in agony is not a good solution. Especially old people who will live the rest of their life in pain due to their condition. Personally, I'd take addiction (with medically supplied legitimate painkillers) over living my last few years in constant pain.

However, I admit I don't know what a good solution would be. I'm not that smart. I just know a bad one when I see it.

Edit: By the way, Meadbh, I don't blame the doctors one bit for all of this. This is obviously a government initiated edict, and I'm sure doctors will do as they always have and try to work within (or mostly within) the rules while doing the best they can for their patients. I like doctors, but I'm not a fan of strict rules and policies. Especially ones that don't accomplish their intent.
__________________
"Good judgment comes from experience. Experience comes from bad judgement." - Anonymous (not Will Rogers or Sam Clemens)
DW and I - FIREd at 50 (7/06), living off assets
harley is offline   Reply With Quote
Old 03-07-2018, 08:13 AM   #49
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
MRG's Avatar
 
Join Date: Apr 2013
Posts: 11,078
Aa someone who has lived with severe pain, been treated with opiods, and have had them withheld, I have opinions.

Severe pain is better with opiods, than without. My doc in 2000 was too busy counting the pills to listen to my complaints. I could have been given effective treatments 3 weeks sooner if they'd have listened to me say, "I can't feel my left hand anymore"!

He was worried about me becoming dependent on opiods. I was fantasizing about self amputation of my left forearm and suicide.

Amputation seemed reasonable. Then I realized there's nothing wrong with my arm, I could remove it and still experience the same pain. Suicide seemed to be a good option, if it was just me and no DW?

Finally month's after my accident, I get to pain management and a cervical epidural.
Minutes later, the pain is subsiding. Yes, despite the fact my PCP withheld pills, I was addicted. The pain management doc said reduce your dosage by 25% every 3-4 days. It wasn't terrible to come off, once the pain was managed.

I do believe more education for the public would help. When that doc wasn't treating my pain, I still was. Mixing benzos, muscle relaxers, opiods and alcohol is a sure fire way to die.
MRG is offline   Reply With Quote
Old 03-07-2018, 11:20 AM   #50
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
travelover's Avatar
 
Join Date: Mar 2007
Posts: 14,328
Quote:
Originally Posted by MRG View Post
................He was worried about me becoming dependent on opiods. I was fantasizing about self amputation of my left forearm and suicide.....................
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.
travelover is offline   Reply With Quote
Old 03-07-2018, 11:26 AM   #51
Moderator
braumeister's Avatar
 
Join Date: Feb 2010
Location: Flyover country
Posts: 25,198
Quote:
Originally Posted by travelover View Post
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.
braumeister is offline   Reply With Quote
Old 03-08-2018, 08:12 AM   #52
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
harley's Avatar
 
Join Date: May 2008
Location: No fixed abode
Posts: 8,764
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
__________________
"Good judgment comes from experience. Experience comes from bad judgement." - Anonymous (not Will Rogers or Sam Clemens)
DW and I - FIREd at 50 (7/06), living off assets
harley is offline   Reply With Quote
Old 03-08-2018, 11:31 AM   #53
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
 
Join Date: Dec 2014
Location: Huntsville, AL/Helen, GA
Posts: 6,002
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.
Bamaman is offline   Reply With Quote
Old 03-08-2018, 02:29 PM   #54
Thinks s/he gets paid by the post
 
Join Date: Feb 2012
Posts: 1,468
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.
TrvlBug is offline   Reply With Quote
Old 03-09-2018, 06:12 AM   #55
Thinks s/he gets paid by the post
 
Join Date: Jan 2014
Posts: 1,174
Quote:
Originally Posted by Aerides View Post
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.

Quote:
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/healt...73d28f415.html
MBSC is offline   Reply With Quote
Old 03-09-2018, 08:48 AM   #56
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
NW-Bound's Avatar
 
Join Date: Jul 2008
Posts: 35,712
Quote:
Originally Posted by Meadbh View Post
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/healt...ers/index.html

Opioid deaths in Canada expected to hit 4,000 by end of 2017 - Health - CBC News
From the CNN article above:

Quote:
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:

Quote:
...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.
__________________
"Old age is the most unexpected of all things that happen to a man" -- Leon Trotsky (1879-1940)

"Those Who Can Make You Believe Absurdities Can Make You Commit Atrocities" - Voltaire (1694-1778)
NW-Bound is offline   Reply With Quote
Old 03-09-2018, 08:59 AM   #57
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
 
Join Date: Jul 2006
Posts: 11,401
Quote:
Originally Posted by NW-Bound View Post
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
Meadbh is offline   Reply With Quote
Old 03-09-2018, 10:12 AM   #58
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
NW-Bound's Avatar
 
Join Date: Jul 2008
Posts: 35,712
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.
__________________
"Old age is the most unexpected of all things that happen to a man" -- Leon Trotsky (1879-1940)

"Those Who Can Make You Believe Absurdities Can Make You Commit Atrocities" - Voltaire (1694-1778)
NW-Bound is offline   Reply With Quote
Old 03-09-2018, 10:35 AM   #59
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
MRG's Avatar
 
Join Date: Apr 2013
Posts: 11,078
Quote:
Originally Posted by NW-Bound View Post
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.htm
MRG is offline   Reply With Quote
Old 03-09-2018, 01:06 PM   #60
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
NW-Bound's Avatar
 
Join Date: Jul 2008
Posts: 35,712
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!
__________________
"Old age is the most unexpected of all things that happen to a man" -- Leon Trotsky (1879-1940)

"Those Who Can Make You Believe Absurdities Can Make You Commit Atrocities" - Voltaire (1694-1778)
NW-Bound is offline   Reply With Quote
Reply


Currently Active Users Viewing This Thread: 1 (0 members and 1 guests)
 
Thread Tools
Display Modes

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off
Trackbacks are Off
Pingbacks are Off
Refbacks are Off


Similar Threads
Thread Thread Starter Forum Replies Last Post
Does it make any economic sense to replace a running 200k Trailblazer with a 100k Tra Mulligan Other topics 13 05-27-2014 07:28 AM
Popularity of Baby Names - Does This Make Sense to You? grumpy Other topics 21 12-17-2006 02:06 PM
Am I crazy or does this make sense? dumpster56 Hi, I am... 66 01-26-2006 05:46 PM
does my plan make sense? smileygrrl1 Young Dreamers 5 07-21-2005 03:13 PM
Does it Make Sense to Get a Government Job? Craig Other topics 18 02-16-2005 05:54 AM

» Quick Links

 
All times are GMT -6. The time now is 02:19 PM.
 
Powered by vBulletin® Version 3.8.8 Beta 1
Copyright ©2000 - 2024, vBulletin Solutions, Inc.