The Opiod Epidemic

[Anung Un Rama]

Last bit first that's clearly a problem and i syill can't see any reason for it. Numerous against but not a single one for it.

First bit. Fucking wow. If America wants to cut health care costs look no further.

I work in finance and if I did that i would be in jail. And i mean they have locked up white collar guys for taking commissions of a smaller scale than those in the article.

My suggestion is either straight out ban this clearly conflicted remuneration or just disclose it on every script.
Ie "in 2017 dr smith received $5,056 from the manufacturer of the drug he has prescribed you".

In my experience whenever fees, commissions or costs are hidden they rise, when they are disclosed they drop.

Regarding the cash for Rx practice. Its shady af, but as long as the prescriber does things by the book with examination and diagnosis (something like fabromyalgia, which can be faked), and don't prescribe so much that they get flagged, then they can keep the DEA and Board of Medicine off their backs (assuming their Rx are associated with multiple deaths).

As for the kickbacks, its so well masked and there are so many ways to legitimize it that it can't be enforced.
If I'm Pfizer and I identify a doctor that sees a lot of patients I want to target with my new drug, I can make him a KOL (key opinion leader) and put him on some advisory board that may pay him $15-30K/ year. That is a lot of money for a pcp or family doc. Thats the cover.

 

[Anung Un Rama]

Definitely. My dad died from an overdose, so I'm biased, but they're killers when misused, and it's so easy. I'd say a large and growing number of heroin users are pill addicts whose presciptions ran out, not that it's too hard to get a new one.

My condolences. I just lost a cousin to it.

 

[HIMBOB]

Regarding the cash for Rx practice. Its shady af, but as long as the prescriber does things by the book with examination and diagnosis (something like fabromyalgia, which can be faked), and don't prescribe so much that they get flagged, then they can keep the DEA and Board of Medicine off their backs (assuming their Rx are associated with multiple deaths).

As for the kickbacks, its so well masked and there are so many ways to legitimize it that it can't be enforced.
If I'm Pfizer and I identify a doctor that sees a lot of patients I want to target with my new drug, I can make him a KOL (key opinion leader) and put him on some advisory board that may pay him $15-30K/ year. That is a lot of money for a pcp or family doc. Thats the cover.

That still should be disclosed.

If you are supposed to be impartial but are receiving payments from specific companies your patients should be aware of it.

 

[HIMBOB]

Definitely. My dad died from an overdose, so I'm biased, but they're killers when misused, and it's so easy. I'd say a large and growing number of heroin users are pill addicts whose presciptions ran out, not that it's too hard to get a new one.

Sorry for your loss.

I don't think its disputed that many heroin users started out on prescription. Only question is the the %age.

 

[Strychnine]

I've posted this in other threads, but I think people need to know...

Two generations.
That's how many will be lost to the opioid epidemic. That's how many were lost to the crack epidemic. Two generations will be raised by their grandparents because their parents will be incarcerated/strung out.

A&E starts a documentary tonight in the "Opioid Triangle" tonight. I've set the DVR. I've got to see this.

 

[Omni1]

We have it on station in the event that an arrest drops on you or if an officer is exposed while testing. Last week, we were serving a felony arrest warrant on a guy that was known to run and fight. We get there and see him in the kitchen and start talking to him through the window trying to get him to give up. The negotiations go on for almost an hour trying to avoid kicking in the door and fighting him. He is a known heroin addict and they are desperate, so we would rather avoid exposure to his blood, or have him do something extreme to himself or to us.

As we are talking to him, he starts getting real dope sick. Shaking, spitting, having panic attacks, begging to just let him get to the heroin he just bought, then he will give up. Then he says he will come out, he just wants to get his “shoes” which he is wearing-just making up any excuse to go to the back room.


Anyway, after negotiating for an hour in 10 degree weather, we are getting ready to go in. He makes the decision real easy when he suddenly runs to the back room. We kick in the door and go after him, tackling him, which sends a cloud of heroin into the air. I order my guys out of the house. They want to gather the drug paraphernalia and remaining heroin. I tell them to get the fuck out of the house. They think their old lieutenant has lost his shit, not realizing that getting a small amount of dope is not worth the risk of inhaling some of that shit and getting a nose full of narcan for their trouble.

Have you ever heard of the organization L.E.A.P.? Law Enforcement Action Partnership https://www.youtube.com/user/CopsSayLegalizeDrugs/videos
https://lawenforcementactionpartnership.org

 

[FierceRedBelt]

I've posted this in other threads, but I think people need to know...

Two generations.
That's how many will be lost to the opioid epidemic. That's how many were lost to the crack epidemic. Two generations will be raised by their grandparents because their parents will be incarcerated/strung out.

A&E starts a documentary tonight in the "Opioid Triangle" tonight. I've set the DVR. I've got to see this.

Who's raising the third generation if their grandparents are on heroin or dead? Heroin addicts can live long lives too; which as horrible as it sounds is a bad thing for their children.

Crack hit hard no doubt but your average person will not have access to cocaine in any form. The average person can run into an opiate addiction from one trip to the hospital.

 

[Makani]

Sorry for your loss.

I don't think its disputed that many heroin users started out on prescription. Only question is the the %age.

I'd say it's gotta be the majority soon enough. People know how addictive heroin is, but they trust their doctors and their friends, which is where most of these pills end up coming from. I've never taken painkillers, even after a car crash I had in my teens, I know it's an irrational fear but it's embedded.

My condolences. I just lost a cousin to it.

It's tragic, my condolences to you too. It happened when I was 14, which seems like a lifetime ago, but a part of me has never forgiven him. I have tons of happy memories of him, but he robbed my brother and sister of those with his addiction. I hadn't seen him in a few years when it happened, but I still remember him visiting his parents in Pennsylvania and not making the trip up to Ontario to see us because he had to get back to Hawaii and the drugs. I was hardened by then, but my brother cried all week, it's to this day the most emotion I've felt.

 

[Anung Un Rama]

I'd say it's gotta be the majority soon enough. People know how addictive heroin is, but they trust their doctors and their friends, which is where most of these pills end up coming from. I've never taken painkillers, even after a car crash I had in my teens, I know it's an irrational fear but it's embedded.


It's tragic, my condolences to you too. It happened when I was 14, which seems like a lifetime ago, but a part of me has never forgiven him. I have tons of happy memories of him, but he robbed my brother and sister of those with his addiction. I hadn't seen him in a few years when it happened, but I still remember him visiting his parents in Pennsylvania and not making the trip up to Ontario to see us because he had to get back to Hawaii and the drugs. I was hardened by then, but my brother cried all week, it's to this day the most emotion I've felt.

Off topic, and you don't have to answer, but have you ever talked to a professional about that?
I think if you could forgive it would lighten your load, thats a lot to carry. Peace, brother.

 

[Desdinova]

Would be rational to suggest that we go after doctors who supply 30-120 day scripts for broken toes?

On a toothache, I can understand a prescription of like 10 pills. But many doctors treat their patients like they're Rush Limbaugh or something, giving them a hundred pills.

I would love to see CBD and THC medicines sweep in and destroy the opioid craze.

Where are these doctors that are "handing opioids out like Skittles"? I couldn't even get a prescription for an effective painkiller when I was passing a 6mm kidney stone (as shown by my CT scan). I don't do any drugs, I don't even drink alcohol anymore, but the urologist I saw was afraid to prescribe opioids and instead told me that if I was in severe pain I should just go to the ER. I would rather pop a few pills, drink a lot of water, and pass it at home at the cost of about $20 than go to the ER and spend $1,500 just so I can once again get treated like some drug seeker.

What people don't seem to realize (or dont care about because it doesn't affect them) is that this war on opioids is going to hurt the doctor patient relationship and people that really need them the most.

Abuse is always going to be a problem. Alcohol abuse accounts for about 88,000 deaths a year, but I don't see anybody talking about that.

 

[GtehMVP]

That doesn't seem dangerous at all.

I only took a couple of codeine pills after a small surgery, it relieved the pain a little, I didn't really feel any pleasure. I don't intend in ever using that stuff anymore.

There's a big difference between codeine (Tylenol 3's?) and oxycontin (no caffeine acetaminophen added) . A lot depends on the dose too. Most people who take oxycontin initially will feel quite nauseous from it, percocets as well. Once your body adapts to it though, it's all pleasure. It only takes a couple of days, so that can be dangerous for someone given an extended prescription. The problem is that we build a tolerance and some continually up the dosage to recapture either the pain relief, or most likely the high. Brett Favre was taking ludicrous amounts of pain pills per day. The NFL is a haven for addicts, or at least it was.

Anyways, I'm glad you stopped taking them. Most people do, even if they derive pleasure. It's the prone to addiction segment that are the biggest causes for concern. They should be the focus of opioid addiction prevention IMO. Those kickbacks to doctors need to be axed asap too.

 

[Makani]

Off topic, and you don't have to answer, but have you ever talked to a professional about that?
I think if you could forgive it would lighten your load, thats a lot to carry. Peace, brother.

Eh, I don't think it's something that has a tremendous effect on my every day life, well, in certain areas, my fear of rejection and lack of assertiveness are pretty highly correlated. I have a good job and good friends, I made a sort of peace with him, it's mostly anger by proxy for my siblings. I've seen a couple very lovely therapists when I was really depressed in my early 20's and we kind of ended up going in circles, I am what I am at this point, as long as I'm not a danger to myself or others I'm pretty happy.

 

[Anung Un Rama]

Where are these doctors that are "handing opioids out like Skittles"? I couldn't even get a prescription for an effective painkiller when I was passing a 6mm kidney stone (as shown by my CT scan). I don't do any drugs, I don't even drink alcohol anymore, but the urologist I saw was afraid to prescribe opioids and instead told me that if I was in severe pain I should just go to the ER. I would rather pop a few pills, drink a lot of water, and pass it at home at the cost of about $20 than go to the ER and spend $1,500 just so I can once again get treated like some drug seeker.

What people don't seem to realize (or dont care about because it doesn't affect them) is that this war on opioids is going to hurt the doctor patient relationship and people that really need them the most.

Abuse is always going to be a problem. Alcohol abuse accounts for about 88,000 deaths a year, but I don't see anybody talking about that.

That urologist was an asshole for forcing you to pass stones without an opioid; not just because he knew you would need them, but because he knew the ER would prescribe them. He just passed the buck and liability to the ER doc.

The drugs aren't outlawed, so something like a kidney stone evidenced by a CT shouldn't prevent a doctor from prescribing pain meds.
And not every prescriber is an unethical p.o.s. but they're out there. The good news is that its getting more and more difficult for them to justify their practice. Eventually anybody needing pain meds will be referred to a pain management clinic who will try and alleviate pain for some the best they can, treat some patients like its a methadone clinic, and refer others to substance abuse specialists.

 

[Anung Un Rama]

There's a big difference between codeine (Tylenol 3's?) and oxycontin (no caffeine acetaminophen added) . A lot depends on the dose too. Most people who take oxycontin initially will feel quite nauseous from it, percocets as well. Once your body adapts to it though, it's all pleasure. It only takes a couple of days, so that can be dangerous for someone given an extended prescription. The problem is that we build a tolerance and some continually up the dosage to recapture either the pain relief, or most likely the high. Brett Favre was taking ludicrous amounts of pain pills per day. The NFL is a haven for addicts, or at least it was.

Anyways, I'm glad you stopped taking them. Most people do, even if they derive pleasure. It's the prone to addiction segment that are the biggest causes for concern. They should be the focus of opioid addiction prevention IMO. Those kickbacks to doctors need to be axed asap too.

Another thing to note is that not everybody is going to become addicted to, or even get a feeling of euphoria from, opioids.
Many people, likely most (I don't have a statistic, but will try and find if one is available), who take them for long periods of time are able to ween off them safely (so long as the ween is done appropriately) without any residual effects.

 

[Cuauhtemoc]

There's a big difference between codeine (Tylenol 3's?) and oxycontin (no caffeine acetaminophen added) . A lot depends on the dose too. Most people who take oxycontin initially will feel quite nauseous from it, percocets as well. Once your body adapts to it though, it's all pleasure. It only takes a couple of days, so that can be dangerous for someone given an extended prescription. The problem is that we build a tolerance and some continually up the dosage to recapture either the pain relief, or most likely the high. Brett Favre was taking ludicrous amounts of pain pills per day. The NFL is a haven for addicts, or at least it was.

Anyways, I'm glad you stopped taking them. Most people do, even if they derive pleasure. It's the prone to addiction segment that are the biggest causes for concern. They should be the focus of opioid addiction prevention IMO. Those kickbacks to doctors need to be axed asap too.

Mark Kerr was also addicted to painkillers, not sure of the compounds he took, but I remember he was in Japan and he asked the japanese doctors for some pills and the doctor thought he wanted something along the lines of tylenol and he said he wanted something a little stronger and the doctor denied it. However, back in the US, he was able to get as many pills and injections as he wanted to.
His fighting ability also went to 0. Really sad.

 

[Anung Un Rama]

@GtehMVP - just from an effortless search:
http://www.cnn.com/2017/07/17/health/chronic-pain-opioid-tapering-study/index.html

It supports what I've seen in my work as a healthcare professional.
I've seen people on doses as high as 30mg qid completely weened off opioids and the transformations have been amazing.
People who were riddled with pain and seemingly, and understandably, miserable have not only gotten off pain meds, but other, seemingly unrelated meds as well.

 

[GtehMVP]

Another thing to note is that not everybody is going to become addicted to, or even get a feeling of euphoria from, opioids.
Many people, likely most (I don't have a statistic, but will try and find if one is available), who take them for long periods of time are able to ween off them safely (so long as the ween is done appropriately) without any residual effects.

I agree. Like I said in the post you quoted most people do stop taking them, without much issue either. Opioids are a great painkiller, there just needs to be better awareness/prevention strategies for addiction.

 

[Omni1]

After reading all of these comments throughout this thread I am saddened by the needless deaths & lives ruined from opiates. Are most people really that ignorant about using the kratom plant to get off opiates? It's such an easy solution. I can't believe how many people have never heard of this miracle plant. Rehab centers should be ashamed of themselves for not promoting it's use! The leaves have been safely consumed by humans for hundreds of years all over the world. It also has anti cancer properties for goodness sake.

 

[LMP]

There are a lot of problems with big pharmaceuticals pushing drugs and the protections the government grants. In case you guys don't know, if you take a ganeric drug and it fucks you up, you wont be able to sue for damages.

 

[Fawlty]

I couldn't even get a prescription for an effective painkiller when I was passing a 6mm kidney stone (as shown by my CT scan).

That's insane. Mine was under 4mm and it was morphine at the hospital into 2 days of Vicodin. Needed it too. Was there some other reason they held back on you? That's kinda sadistic.