Opioid Addiction and Pain Management

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Re: Opioid Addiction and Pain Management


Post by Volkonski » Sun Oct 29, 2017 8:44 am

Meanwhile on Long Island-

1.1 Million Doses Of Fentanyl Seized From Home; Trio Arrested

https://patch.com/new-york/northfork/s/ ... aign=alert
Customs officials intercepted two postal packages from Hong Kong destined for a residence in Mastic Beach and on Friday around 4 p.m., a search warrant was executed at 30 Edwards Road where authorities seized about 725 grams of fentanyl, $7,400 cash, numerous 9mm rounds two cellphones and a 2007 Mercedes-Benz.

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Opioid Addiction and Pain Management


Post by AndyinPA » Sun Oct 29, 2017 11:22 am

RVInit wrote:
Sat Oct 28, 2017 9:54 am
There are many aspects to whether or not a person gets addicted when they are prescribed opioids for a legitimate severe pain condition. One issue I think that can't be ignored is whether a person has a tendency for addiction in general. Also, most doctors who are not pain management doctors don't necessarily have the experience to prescribe the proper drug for the type of pain, and the proper amount. Prescribing more than what is necessary is common in situations where the pain is not chronic, i.e. the person will only be using the medication for a limited amount of time. If a person is prescribed a strength and amount of medication that is more than necessary to get pain under control, they will get high from it. That would put a person at risk for getting addicted.

Most people who haven't given birth will live their entire lives without ever experiencing severe pain. Even those who give birth typically experience that severe pain for a limited amount of time, i.e. it doesn't become a chronic pain that won't go away. These are situations where it isn't as likely for a prescription opioid to become an addiction problem, because it's for a limited amount of time. Unless the person is a very addictive personality and the pain medication is far enough above what the person needs that they are getting high from it.

A person who has a legitimate severe pain condition who is getting treatment from an ethical pain management doctor would not be getting an amount of pain medication that will make them pain free, for a number of reasons, one being that inevitably this would create a situation where it would take increasingly larger amounts of the medication to continue allowing the person to be pain free. A person with chronic severe pain under treatment from an ethical pain management doctor will typically only get enough of the medication to bring their pain to a level where they can still have a decent quality of life, but will typically have to adjust activity and use additional methods and/or additional non-opioid medications to help keep this kind of pain under control.

I am all for any efforts to help people who really are addicted and also to get pill mill type of doctors out of business. But there is a population of people who really do have severe chronic pain that is not their fault, are not abusing any medications, are not addicted, and are not requiring increasing amounts of medications, and it is imperative that whatever efforts are made to reduce the problem of opioid addiction, that people who have a legitimate need for these medications be able to continue having access to using, not abusing, those medications, because for those people it is the difference between being able to cope and live, in spite of having a very difficult row to hoe and having a life that is not worth living.
There is nothing here I disagree with. It's a really good summary of a lot of the complicated issues surrounding the use of opiod drugs.

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There are many people who need opiod pain management, and whether short term or long term, people who need it should have access to doctors who understand the use and misuse of those drugs and a quality medical system to provide what they need. We also need to find a way to help people who are addicted and help them, not punish them.

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Re: Opioid Addiction and Pain Management


Post by Chilidog » Sun Oct 29, 2017 12:21 pm

MN-Skeptic wrote:
Sat Oct 28, 2017 2:42 pm
Per my city's website -
Take-back programs are the best way to dispose of old drugs. If you can not attend a drug take-back programs,

Take the medications out of their bottles
Mix them with something unappealing such as used kitty litter or coffee grounds
Seal them in a bag or disposable container and throw that away
it still winds up in the water table that way.

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Re: Opioid Addiction and Pain Management


Post by Slartibartfast » Sun Oct 29, 2017 12:43 pm

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Re: Opioid Addiction and Pain Management


Post by RVInit » Sun Oct 29, 2017 1:42 pm

It is a difficult problem. And requires more than a simple-minded solution, which is, I am afraid the only thing we will get from this administration.

"Who knew drug addiction was such a difficult problem!"

Basically, that is about all that can be said about the current inhabitant of the White House.

"Who knew ____________ would be so hard!"

"I know that human being and fish can coexist peacefully"
--- George W Bush


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Re: Opioid Addiction and Pain Management


Post by Azastan » Sun Oct 29, 2017 1:44 pm

Many years ago, as I was trying to solve the mystery of the horrendous headaches I would get on a regular basis (couple of times a week, for years), I went into the local hospital, as usual, for a shot of dilaudid. The doctor informed me that I was getting just a little too regular with my coming in for the pain, and told me that I would not get any more demerol until I went to see a neurologist.

The neurologist recommended that I have a CAT scan, because I might have a brain tumour. I went in and got prepped for the scan, which included being given an injection of iodine. The nurse belatedly asked me if I was allergic to anything. I'd never mentioned before that I am allergic to shellfish when answering the 'are you allergic to any medication', because I never thought about shellfish being 'medication'. But that day I told her that I was not allergic to any medication, but I was allergic to shellfish. She blanched, and immediately went to get me a shot of, yes, you guessed correctly, demerol.

When being given a shot of demerol for the migraines (since that's what the horrendous headaches were), I never experienced anything except for an urgent need to just go to sleep.

Let me tell you, getting demerol when not having a migraine was AWESOME. I felt GREAT. I could understand how people could get addicted to the stuff. But that wasn't why I needed demerol.

At any rate, I am not an addictive personality except for when it comes to horses. Also, I don't handle opiods very well, as I get rebound migraines from taking them. A prescription for 20 tablets of oxycodone, prescribed for me when I had my appendix out almost a year ago, still has 10 tablets left.

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Re: Opioid Addiction and Pain Management


Post by Volkonski » Wed Jan 10, 2018 4:13 pm

NBC News‏
Verified account

Following @NBCNews

Pennsylvania Gov. Tom Wolf declares disaster emergency for opioid crisis http://nbcnews.to/2mftOtC via @NBCPhiladelphia
With opioids killing more people than any other health crisis in Pennsylvania's modern history, Gov. Tom Wolf on Wednesday declared a disaster emergency that suspends regulations hindering access to addiction care.
It's the first time a disaster emergency has been declared for a public health crisis in the commonwealth. Usually, disaster emergencies are reserved for major weather events such as a hurricane or for a terrorist attack.
"I don't take this action lightly. We know that this crisis has taken far too many lives. It has broken far too many families. It has decimated far too many communities and it has gone on for far too long," Wolf said at an event formally announcing the declaration at the State Capitol in Harrisburg.
The move eases some regulations that have been barriers to help for the addicted and their families. It will expire in 90 days as required by the state Constitution.

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Re: Opioid Addiction and Pain Management


Post by Lani » Wed Jan 31, 2018 7:58 pm

I stumbled across this article by accident a few days ago, and I keep thinking about it. There is a lot of chatter on the innertubes about it, both pro and con. I wonder if anyone here has read it and has some thoughts to share.

The Likely Cause of Addiction Has Been Discovered, and It Is Not What You Think
https://www.huffingtonpost.com/johann-h ... 06936.html
Professor Alexander argues this discovery is a profound challenge both to the right-wing view that addiction is a moral failing caused by too much hedonistic partying, and the liberal view that addiction is a disease taking place in a chemically hijacked brain. In fact, he argues, addiction is an adaptation. It’s not you. It’s your cage.
Don't rely on the brief quote. The article goes deeper.

The reason I keep thinking about it has to do with a youth treatment center being promoted in our county. The idea is to keep the kids close to their community and family while they recover. An attorney serving on the planning committee changed his mind and opposed the the center. (He was then shut out of meetings.) He told me that recovering teens and young adults who were interviewed did not want treatment near their families. They wanted distance from them instead.

Then I attended a neighborhood meeting about possibly locating the center near it. The neighbors were angry that "those kids" would wreak havoc on their community. And then a woman stood up and called out the complainers by name. She told her story of abuse by drunken parents and the neighbors they drank with. She pointed to people and named them, then recalled the times they looked away while she was living through hell. It was a tragic story that included beatings, sexual abuse, addiction and years in prison. And then she told the complainers (now hunched in their seats, heads down) that they were AGAIN looking away and pretending that children weren't being hurt.

I thought of her and those kids who were interviewed when I read the article.

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Re: Opioid Addiction and Pain Management


Post by maydijo » Wed Jan 31, 2018 9:44 pm

I really have no background or expertise in this, but I've heard similar things, Lani. I keep thinking of a friend I met on a student exchange several years ago. She'd been heavily involved in drugs - she said it was because she'd just started hanging out with the wrong sort of people; she didn't enjoy it, but her friends did it and so she did too. Finally her dad gave her a choice: go overseas or go to rehab. She chose to spend a year in another country and really liked the fresh start it gave her. I was one of the few people who she told about her past; she liked that she didn't have a reputation, and it gave her the space she needed to get herself cleaned up.

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Re: Opioid Addiction and Pain Management


Post by AndyinPA » Thu Feb 01, 2018 12:06 am

That's a great article, Lani. And it makes a lot of sense. I've heard some of it before, and I particularly have read a lot about the Portuguese experiment, which has worked out so well. i also think Michael Moore had a bit on that in his movie "Where to Invade Next?" or something like that title.

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Re: Opioid Addiction and Pain Management


Post by RTH10260 » Thu Feb 01, 2018 9:16 am

Lani wrote:
Wed Jan 31, 2018 7:58 pm
I stumbled across this article by accident a few days ago, and I keep thinking about it. There is a lot of chatter on the innertubes about it, both pro and con. I wonder if anyone here has read it and has some thoughts to share.

The Likely Cause of Addiction Has Been Discovered, and It Is Not What You Think
https://www.huffingtonpost.com/johann-h ... 06936.html
One thing about this article, its research is centered on heroine / cocaine addiction only. It does not address the effects of other drugs on the human body that prevent letting go of the addiction. Cocaine has long ago been found to be little disruptive to life when consumed in recreational quantities. No wonder it is called the Wall Street drug. In the UK they have for like two decades ago switched from persecution to providing controlled purchase of cocaine. The effect is that criminality is removed from the great picture. The addict is not haunted in finding extra cash, he/she will not put to prison, no record against employment. In Switzerland the doctors fill out prescriptions for the substitute Methadon. Back over a decade when Switzerland made the switch in thinking the USA tried to put pressure onto the authorities to uphold a world wide treaty on the war against drugs. The US had to be put into their place, either accept out tolerance principles or we drop the treaty altogether.

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Re: Opioid Addiction and Pain Management


Post by Judge Roy Bean » Sat Feb 03, 2018 6:24 pm

There may be a reluctance among those addicted to prescription medications to seek help.

A life-long dear friend of mine lost a high-profile professional career after decades of addiction that he kept successfully hidden from colleagues, friends and family. When he finally had an episode of blacking out that hospitalized him with a serious head injury, it soon became apparent to his doctor that he was an closet oxy addict. He managed to recover, kept quiet about it, went back to work and all seemed well but as he tells it now, he wound up back on the pills in a matter of weeks.

We still had no idea and he eventually had another blackout, and this time, wound up in a coma for several months. When he finally was coherent he decided it was time to get serious about becoming a non-abuser. After therapy (said to be as a result of a stroke) and months in bed at home, he even went so far as to volunteer time in private, anonymous social groups, speaking to attendees and even prison groups to raise awareness of the problem with bootlegged prescription meds.

Unfortunately, those supposedly confidential efforts turned out to be his demise. He was soon recognized and when his employer became aware that he had been an oxy addict they would not renew his contract.

Sadly, it did not end well for him. He couldn't find work in his life-long profession. He was effectively blackballed, although in truth, he was never as mentally keen as he once had been but he was still among the upper layer of talent in his profession. He literally lost everything and wound up in a job in a completely different line of work that paid him less than a fourth of what he was accustomed to. He went from a 20-room suburban mini-mansion to a two-bedroom apartment.

What he eventually learned from a friend in the business was that if he had been a heroin addict and managed to beat that, he probably would have been welcomed back and even been heralded for it; the fact that it was "just" oxy apparently meant the executives thought it was more of a moral failing than a "real" addiction like heroin.

This was over a decade ago, but I believe there are still those who harbor that kind of thinking, and it's going to be hard to turn the tide.

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Re: Opioid Addiction and Pain Management


Post by Dan1100 » Mon Feb 05, 2018 1:11 am

I haven't been following this thread, so I hope this isn't a repeat, but an interesting article about pain management in Germany for a women who had a laparoscopic hysterectomy.

https://www.nytimes.com/2018/01/27/opin ... codin.html

To paraphrase, "you'll be recovering from surgery. It is supposed to hurt."

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Re: Opioid Addiction and Pain Management


Post by Fortinbras » Mon Feb 05, 2018 3:05 am

Opioid addiction is now replacing cocaine and heroin as the gravest addiction menace. My wife, who was (until retirement a couple of years ago) a retail pharmacist in the DC suburbs, saw evidence of this. In Appalachia, such as West Virginia and Kentucky - and, yes, even in the DC region - some doctors had gotten lazy about earning a living and had allowed themselves to become licensed drug pushers. In some cases their patients began with genuine ailments or surgery that required painkillers, in some other instances the patients had previous been using street drugs. One attraction to the addicts is that a legal defense is infinitely easier when the narcotic is prescribed by a bona fide physician who can at least fake a reason in medical jargon (and this is not limited to narcotics - there is also a lively traffic in Adderal and other drugs of abuse), another reason is that (unlike street drugs) prescription drugs purchased at a real apothecary are assured of being uncontaminated and of a consistent strength.

Efforts have been made to discourage this sort of pill pushing by inducing pharmacies to stop carrying certain prescription painkillers, but that only drove addicts to travel farther and farther to get their prescriptions filled. My wife was seeing, just outside DC, pickup trucks loaded with youthful prescription addicts park in front of her pharmacy (where management persisted in honoring such prescriptions when the CVS chain refused them), all the addicts have prescriptions for the same drug, all for the maximum dosage allowed by law on a prescription, all written by the same doctor in West Virginia or Kentucky. These people had endured an entire day on the back of a truck, no matter the weather, just to get their drugs. My wife counted up the addicts and figured at one point that a particular doctor, who was seeing these "patients" on a monthly basis (because a narcotics prescription was good for only a month), was writing so many prescriptions that he had barely enough time to count their money and write the prescriptions - with no time to check their physical condition.

Oxycontin turns out to be more dangerous and more addictive than heroin. But even heroin and cocaine are enormous difficult to break away from. The usual story, told a thousand times with slight variations, is of someone in the family, usually a young adult, spending four or six or a dozen weeks in a rehab facility, whether it resembles a spa, a hospital, or a concentration camp, and coming home, bright-eyed and bushy-tailed and declaring loudly and sincerely that never again will they be enslaved by drugs. And then, within a few hours of returning home, they get a phone call from an old classmate who invites them on a drive around the neighborhood, and all those good intentions are blown to hell in less than a day.

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Re: Opioid Addiction and Pain Management


Post by Tiredretiredlawyer » Mon Feb 12, 2018 9:18 am

https://www.msn.com/en-us/news/msn/oxyc ... ar-BBIZxeN
Oxycontin Maker Purdue Pharma Will Stop Marketing the Drug to U.S. Doctors

As reported by the Wall Street Journal, Purdue will continue selling the drug, but will no longer send salespeople to doctors’ offices to promote it. Purdue will cut its U.S. sales staff by more than half.

The move comes as opioid addiction continues to take a devastating toll on large swathes of the United States. Deaths from drug overdoses accelerated sharply in 2016 and 2017, and are now the leading cause of death among Americans under 50. Many of those overdoses are attributed to other opioids, including fentanyl and heroin, which OxyContin users often switch to after becoming addicted to the painkiller.

The boom in OxyContin prescriptions, and the resulting expansion of the deadly abuse of opioids, has been consistently blamed on Purdue’s aggressive and misleading marketing of the drug. Purdue for years made the case that OxyContin was less addictive than other opioid painkillers, and that the risks of opioid addiction in general were overblown — claims partly rooted in a decades-old anecdotal letter rather than scientific research.

In 2007, Purdue Pharma and three of its executives pleaded guilty to criminal charges of misrepresenting their product’s addictiveness, and paid a total of $635 million in fines.

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