Opioid Overreaction (1 Viewer)

[Tau837]

I feel there are a lot of cases where people are too lazy to want to overcome and deal with pain management. Rather a quick fix than deal with it on their own. 

I'm sure there are plenty of those cases. But I know that legitimate chronic pain patients who don't fit that situation have been harmed by opioid hysteria in recent years. Don't take my word for it, I linked the AMA saying so.

 

[rascal]

This attitude is a significant part of the problem. It's great that you overcame your situation without the need for long term use of opioids to relieve pain, but not everyone can do that. There are a lot of situations worse than 3 herniated discs. Yet you seemingly apply a blanket statement to everyone in serious, chronic pain.  

I don't disagree that there are things worse than what I went through.  I watched a good friend die from renal failure.  Watching his body die piece by piece from vascular calcification was simply horrific.

You must have missed my statement, "While the opioids were absolutely necessary at the initial onset, my Dr did me no favor in continuing to prescribe them.  While I understand it's need and purpose, the fact is that it's over prescribed."

The point is that taking of opioids for everything is asking for trouble.  There are better options than to take a highly addictive drug with extensive side effects.

 

[Tau837]

I don't disagree that there are things worse than what I went through.  I watched a good friend die from renal failure.  Watching his body die piece by piece from vascular calcification was simply horrific.

You must have missed my statement, "While the opioids were absolutely necessary at the initial onset, my Dr did me no favor in continuing to prescribe them.  While I understand it's need and purpose, the fact is that it's over prescribed."

The point is that taking of opioids for everything is asking for trouble.  There are better options than to take a highly addictive drug with extensive side effects.

If there are better options, then they should be used. For millions of people, there are no better options. That is my point. 

 

[Honus]

It's tricky to manage the pain of rib fractures, and opioids can compound one of the big complications (development of pneumonia) by suppressing your respiratory drive. Multimodal pain control is recommended, typically starting with non-opioid pain relievers, reserving opioids for breakthrough pain. Your options are:

1. Acetaminophen, or Tylenol

2. NSAIDS like ibuprofen

3. Opioids

4. Local nerve blocks

And I'm sure somebody will advocate cannabinoids (CBD stuff), though I have no idea on their use for this indication.

Rather than getting pissed off and determining a priori you'll need more opioids than were offered, I suggest you try to optimize the non-opioid options. Assuming you have neither heart, liver, kidney failure or stomach ulcers, I'd start with scheduled acetaminophen +/- NSAIDS. Something like:

1. Tylenol, 1g three times a day, scheduled.

2. Ibuprofen 400-600mg three to four times a day for breakthrough pain. 

3. Lortab for pain than persists despite both of the above. If you take Lortab, you have to be cognizant how much acetaminophen is included (typically 325 mg), as you shouldn't take more than 4 g Tylenol per day. And you shouldn't drink any alcohol.

4. If all that fails, contact you primary care provider and ask for a referral to a pain specialist, as they have several other therapies at their disposal + are more likely to be comfortable using opioids for severe, refractory pain.

Also, make sure you are using an incentive spirometer (device to keep your lungs inflated) and have a cough suppressant handy, as coughing can really exacerbate the pain. While it will take several weeks for the ribs to heal, there's no guarantee severe pain will be present for the duration. Good luck.

First of all, thank you for such a thorough and well thought out response. I assume you are in the medical field, so I don’t doubt that you know what you’re talking about. Yes, the Lortab is 5-325, so I’ve been staying away from the acetaminophen altogether. I’ve been skittish about ibuprofen lately – a few years back I had a herniated disc and took 800 mg of ibuprofen every six hours. That had, let’s just say, an undesirable and rather alarming side effect that ceased as soon as I cut back. So this time I’ve been taking two at a time every six hours or so. That puts a small, but noticeable dent in the pain.

I live in Appalachia, upper East Tennessee to be specific, so opioid abuse is a major concern around here. Given that, I still feel that she was rather stingy, for lack of a better word, given her prognosis. Telling me that once these are gone I will just have to deal with it makes for a pretty lousy bedside manner. So maybe the delivery helped fuel the rant.

Oh, and good call on the cough suppressant. I was thinking about starting an Allegra regimen after a sneeze today.

 

[Terminalxylem]

First of all, thank you for such a thorough and well thought out response. I assume you are in the medical field, so I don’t doubt that you know what you’re talking about. Yes, the Lortab is 5-325, so I’ve been staying away from the acetaminophen altogether. I’ve been skittish about ibuprofen lately – a few years back I had a herniated disc and took 800 mg of ibuprofen every six hours. That had, let’s just say, an undesirable and rather alarming side effect that ceased as soon as I cut back. So this time I’ve been taking two at a time every six hours or so. That puts a small, but noticeable dent in the pain.

I live in Appalachia, upper East Tennessee to be specific, so opioid abuse is a major concern around here. Given that, I still feel that she was rather stingy, for lack of a better word, given her prognosis. Telling me that once these are gone I will just have to deal with it makes for a pretty lousy bedside manner. So maybe the delivery helped fuel the rant.

Oh, and good call on the cough suppressant. I was thinking about starting an Allegra regimen after a sneeze today.

In the absence of liver disease (viral hepatitis, cirrhosis) or co-ingestion of liver toxic drugs (including alcohol), 3 grams of Tylenol daily is pretty safe. 3200 mg of ibuprofen daily is a lot, which is why I recommended it at a lower dose as a second analgesic, after scheduled Tylenol. Even with 3g, you could take a single Lortab daily with some wiggle room in the maximum allowed, but if really concerned could start with 500-650 mg Tylenol thrice daily as your standing dose. Or could alternate scheduled 500mg Tylenol with 400mg ibuprofen every 4 hours, with a Lortab or two daily for breakthrough pain.

But I agree the provider could have chosen her wording more carefully.

 

[Tau837]

New CDC study shows Nearly 85% of U.S. Overdose Deaths Linked to Street Drugs

The study, reported in the CDC’s Morbidity and Mortality Weekly Report, analyzed data from 24 states and the District of Columbia enrolled in the State Unintentional Drug Overdose Reporting System (SUDORS) from January to June, 2019. SUDORS captures detailed information from toxicology reports and death scene investigations, and is considered more reliable than overdose data gathered from death certificates.

Among the 16,236 overdose deaths reported by SUDOR during the study period, illicitly manufactured fentanyl (IMF), heroin, cocaine or methamphetamine were involved 83.8% of deaths, either alone or in combination with other drugs. Nearly half of those deaths involved two or more illicit drugs.

About one in five overdoses involved prescription opioids such as hydrocodone, oxycodone, morphine and buprenorphine. The study did not indicate whether the medication was obtained legally or if it was borrowed, stolen or purchased illicitly. What is clear, however, is that street drugs are the primary driver of the U.S. overdose crisis.

More evidence that the Government's focus on reducing and constraining opioid prescribing is misguided.

 

[Tau837]

The search function on this site is awful. Searching for 'opioid' provided no results. Had to resort to Google.

Anyway, more evidence that this "opioid epidemic" is not driven by prescription opioids, from Prescription Opioid Use at 20-Year Lows:

Prescription opioid use in the United States is expected to decline for the ninth consecutive year in 2020, with per capita consumption of opioid medication falling to its lowest level in two decades, according to a new report by the IQVIA Institute, a data analytics firm. 

...

Despite the historic decline in prescription opioid use, U.S. overdose deaths hit a record high last spring, according to a new report from the CDC.  For the 12 months ending in May 2020, over 81,000 people died of a drug overdose.

"This represents a worsening of the drug overdose epidemic in the United States and is the largest number of drug overdoses for a 12-month period ever recorded," the CDC said in a health advisory, adding that the deaths were largely driven by illicit fentanyl, heroin, cocaine and psychostimulants such as methamphetamine. Opioid pain medication is not even mentioned in the CDC report.

Despite this data, the Government continues to press its opioid hysteria agenda against opioid manufacturers and doctors who prescribe pain medication, despite the fact that this does significant harm to chronic pain patients. It has been absurd all along, but grows even moreso as time passes, and we see that the misguided Government crusade is having zero positive effect.

 

[D_House]

Yes there is evidence-based effective medical treatment for opioid use disorder. Many people regain normalcy and can function on the treatment. These meds are currently thought to be safe for lifetime use.

There is an access problem though. Methadone when used to treat addiction can only be dispensed at certain facilities. And buprenorphine/naloxone prescribing requires providers to undergo additional training and apply for a special waiver.

Meanwhile a brand new MD can prescribe fentanyl on their first day of internship.

Trump Administration Will Let More Doctors Prescribe Drug To Fight Opioid Addiction

They've waived the need for an X-waiver. This is an important step towards providing greater access to life-saving treatment.