Opioid Overreaction (1 Viewer)

[bigmarc27]

Based on your posts, I'm confident that I know a lot more about the subject than you, so I'm fine with that. I can see why you wouldn't want to engage on the merits of your posts.

A lot of what I have is proprietary at the moment, once it’s published I can link it here and then you can tell me how the media is causing all the outrage and fake news. 

 

[Terminalxylem]

Seriously, can anyone say why I shouldn't take medication that allows me to have a normal life?

This might be the craziest thing I've ever heard of.  

I have no problem with taking medications to improve one’s quality of life, but opioids specifically should be relegated to second line, after other modalities are attempted for chronic musculoskeletal pain.

It sounds like you’re not having issues with it, so no reasonable doctor would abruptly discontinue your med. Still it isn’t ridiculous to revisit alternatives from time to time, and understand increasing scrutiny is being applied to the prescription habits of all clinicians.

And the people telling you to avoid physical activity, including golf, are off base.

 

[FBG Moderator]

You can't answer my question.  I'd be out to.  You seem like a good guy.  But you're an idiot in here.  

Don't

 

[bigmarc27]

I have no problem with taking medications to improve one’s quality of life, but opioids specifically should be relegated to second line, after other modalities are attempted for chronic musculoskeletal pain.

It sounds like you’re not having issues with it, so no reasonable doctor would abruptly discontinue your med. Still it isn’t ridiculous to revisit alternatives from time to time, and understand increasing scrutiny is being applied to the prescription habits of all clinicians.

And the people telling you to avoid physical activity, including golf, are off base.

For the record, I don’t think anyone would/should have issue with physical activity. My particular note is in regards to saying he has debilitating back pain, but also plays golf. It makes me think the pain classification is a bit off. 

 

[Tau837]

A lot of what I have is proprietary at the moment, once it’s published I can link it here and then you can tell me how the media is causing all the outrage and fake news. 

I look forward to seeing it and likely refuting it. 

 

[Terminalxylem]

i went in for a sore throat. doctor gave me a 30 day supply of vicodin.

told him that i didn't have pain aside from typical sore throat but it had lasted several days and i was figuring maybe an antibiotic of some sort instead? he gave me that, too 

Seems like this thread has at least as many stories of overprecription as under treating pain. It’s hard to know what the overall balance of appropriate opioid use is.

 

[Patrick Bateman]

I've lost 2 relatives, and my college roommate's son to opioids. It all started with post-op treatment that spiraled. Tell their families that it's an "overreaction". It's an epidemic in Ohio, Kentucky, and W. Virginia. 

 

[Ramblin Wreck]

I look forward to seeing it and likely refuting it. 

I hate jumping in these conversations where guys are overly emotional because of personal stuff (You've posted about your wife on this board for years).  I don't think many are stating someone in that condition shouldn't have access to certain drugs.  What I think I'm reading and what I'm saying is if someone needs opiods just to sit and work every day then it's not a very wise decision to be playing something like golf, which is extremely tough on the back.  And the person doing that has been asked many times about other types of lifestyle changes and treatments to help his back and those questions have been ignored which kind of tells you the answers.  He's also extremely defensive about being asked about them so not that hard to assume answers.  My 2 cents.

 

[bucksoh]

If you think prescription opioids are the root of an epidemic, how do you feel about NSAIDs, alcohol, and tobacco? Annual deaths:

• Solely from prescription opioids: 7K to 10K
  
• From NSAIDs (i.e., aspirin, acetaminophen, ibuprofen, etc.): 7K to 10K
  
• From alcohol: 88K
  
• From tobacco: 480K
  

The op said it is just a small problem.  I was just stating it is closer to epidemic than a small problem.

 

[ghostguy123]

Wow, lot of terrible in this thread.  

 

[Cowboysfan8]

Wow, lot of terrible in this thread.  

Amen 

 

[Terminalxylem]

These pills never should have been pushed to market. That’s too far gone. For your future, you’ll undoubtedly be taking them for life because your tolerance to all other pain medication is shot.  If you want to be literal about it, you’re likely at some level of addiction now. If you stopped, you would surely have some form of withdrawal already and there aren’t pain meds that will work with you. If there are safer alternatives and you’re still able to make that jump, I would have that conversation with your doctor ASAP. 

Of course they work for you for pain management. They’re f’ing powerful as hell. It’s legal Heroin in pill form instead of finding a vein. 

This is inaccurate. If he is truly taking the medication as he describes, he’s neither addicted nor tolerant. The former would require addictive behavior (see the definition of opioid use disorder), while the latter requires consistent use of the med with increase in dose required to reach the same level of pain control. Moreover, opioid use doesn’t have anything to do with tolerance to most other analgesics.

I agree he should revisit alternative pain control options.

 

[Terminalxylem]

If you think prescription opioids are the root of an epidemic, how do you feel about NSAIDs, alcohol, and tobacco? Annual deaths:

• Solely from prescription opioids: 7K to 10K
  
• From NSAIDs (i.e., aspirin, acetaminophen, ibuprofen, etc.): 7K to 10K
  
• From alcohol: 88K
  
• From tobacco: 480K
  

This is a terrible argument. What are the denominators for all those numbers, ie. How many people use them versus how many deaths they cause?

Also you cannot exclude the role of opioids in deaths due to multiple drug ingestions. Same goes for alcohol or any drug of abuse.

And Tylenol isn’t an NSAID.

Agree that tobacco and alcohol are given too much leeway in our country. But their under regulation has nothing to do with opioid use and abuse.

 

[Terminalxylem]

 
Regarding the bolded, I'm not aware that is the case. Are you? If so, please share.

I already gave you links showing increases in prescription opioid abuse.

 

[Terminalxylem]

You are misrepresenting some of the facts. At least you have seemingly backed off some of your earlier statements that were more adamant that there is no benefit. See, we can actually improve our perspectives through discourse.  

I think you are arguing semantics at this point. What facts am I misrepresenting?

 

[Mr.Pack]

That’s weird. I don’t know anyone who hasn’t been prescribed pain meds when needed- even when they have said they didn’t think they needed them. 

After my wife had her hip replaced, her doctor told her take as much Vicodin as she needs and if she runs out he'll prescribe more. He didn't want her in pain.

I was shocked

 

[Terminalxylem]

Why would you ask such questions, as if you assume he did not try those things? This is the kind of stigmatization that pain patients who appropriately use prescription opioids face every day. It is inappropriate at best.

Because of the way he described his pain, and intermittent opioid use. I’m not accusing him of anything, just asking as often all alternatives aren’t explored before opioids are prescribed.

And for the record, I don’t think his use is problematic.

 

[TwinTurbo]

I've lost 2 relatives, and my college roommate's son to opioids. It all started with post-op treatment that spiraled. Tell their families that it's an "overreaction". It's an epidemic in Ohio, Kentucky, and W. Virginia. 

This. I have also lost two friends to opioid addiction and a third in jail. All three got hooked as a result of being over prescribed pain pills for minor sports related injuries or an accident. 

I'm sure there are plenty of folks that need these pills but there were 1000x more that had it ruin their lives and their families. So I have zero issues with the current knee jerk reaction to the other extreme after the #### show this country has been watching first hand due to greedy pharmas and doctors that played along to create this nationwide epidemic.

Every single person on this board knows somebody that got hooked on pain pills or worse. Yeah and we all know someone affected by alcoholism too but that wasn't prescribed by a doctor.

 

[Terminalxylem]

For the record, I don’t think anyone would/should have issue with physical activity. My particular note is in regards to saying he has debilitating back pain, but also plays golf. It makes me think the pain classification is a bit off. 

That’s a fair criticism, and part of the problem with treating pain: it’s completely subjective. Although it doesn’t sound like he’s misusing the medication at all, it wouldn’t surprise me if he could find alternative treatments that were also effective. But I can understand not wanting to mess with his regimen if it works.

 

[James Daulton]

This. I have also lost two friends to opioid addiction and a third in jail. All three got hooked as a result of being over prescribed pain pills for minor sports related injuries or an accident. 

I'm sure there are plenty of folks that need these pills but there were 1000x more that had it ruin their lives and their families. So I have zero issues with the current knee jerk reaction to the other extreme after the #### show this country has been watching first hand due to greedy pharmas and doctors that played along to create this nationwide epidemic.

Every single person on this board knows somebody that got hooked on pain pills or worse. Yeah and we all know someone affected by alcoholism too but that wasn't prescribed by a doctor.

This is just blatantly false.  Opiods have helped people handle severe pain for decades.  Yes they were severely over prescribed.  And yes they are now being severely scrutinized to the point of being held back from patients in needs.  I'm certainly not suggesting that we go back to how they were prescribed nor am I suggesting that the opioid addiction issue is a small one, but there is a happy medium where minimum needed levels can be prescribed safely.

 

[BassNBrew]

How many tens of millions have used opiods without getting addicted?  But because a very small % do, we all have to suffer?

I work in healthcare, docs are extremely gun shy about prescribing them and in fact most hospitals have specific goals to reduce their use.  If you don't understand yet, just make sure that if you need them you make sure to advocate to yourself to your doc if he doesn't give them. Which I can almost guarantee he either won't or you'll get a small supply.

Find different docs?  I could pick up the phone right now and the pharmacy would be calling in about 60-90 minutes saying my prescription is available.

 

[Terminalxylem]

This is just blatantly false.  Opiods have helped people handle severe pain for decades.  Yes they were severely over prescribed.  And yes they are now being severely scrutinized to the point of being held back from patients in needs.  I'm certainly not suggesting that we go back to how they were prescribed nor am I suggesting that the opioid addiction issue is a small one, but there is a happy medium where minimum needed levels can be prescribed safely.

 But like a lot of things, US prescribing practices were/are so out of whack in comparison to the rest of the world, it stands to reason we can cut back a lot and still adequately treat those in genuine need. We use about 30% of the world's supply of opioids for ~5% of the world population, and even higher percentages of more addictive opiates like hydrocodone and oxycodone.  We also have much higher rates of disability associated with chronic pain. 

I think some of the different perspectives are related to regional variations in prescribing practices. It's well known places like WV, OH, PA, etc. had disproportionate opioid overdose deaths, and some of the highest rates of opioid prescription before stricter regulations were enacted. This site emphasizes the variability in prescribing/regulation by state. There's probably no good medical justification 2.3% of NJ residents have opioid prescriptions versus 12.5% in Arkansas, nor do the limits on prescriptions make much sense, which range from 3-7 to 30+ days. 

 

[Tau837]

I already gave you links showing increases in prescription opioid abuse.

You quoted my response to a post that referenced the rate of addiction to prescription opioids increasing substantially for one particular type. You have not provided any link showing that the overall rate of prescription opioid addiction is increasing... much less increasing substantially... much less increasing substantially for a particular type of prescription opioids.

 

[Tau837]

I think you are arguing semantics at this point. What facts am I misrepresenting?

You posted "the findings of the largest meta analysis I linked effectively shows no benefit". The conclusion of the study says "evidence from high-quality studies showed that opioid use was associated with statistically significant but small improvements in pain and physical functioning".

You posted "opioids were no more effective than alternative treatments". The conclusion of the study says "Comparisons of opioids with nonopioid alternatives suggested that the benefit for pain and functioning may be similar, although the evidence was from studies of only low to moderate quality."

You also ignored the study limitations and the implications of the average dose, which was low.

I view that as misrepresenting facts. If you want to call it semantics, go ahead. I'll call it being accurate.

Furthermore, you are referencing just one study, apparently because that one study best fits the perspective you had when you first entered this thread. I linked 10 other studies that had varying populations and all showed positive benefits of long term opioid use for treatment of CNCP.

 

[Terminalxylem]

You quoted my response to a post that referenced the rate of addiction to prescription opioids increasing substantially for one particular type. You have not provided any link showing that the overall rate of prescription opioid addiction is increasing... much less increasing substantially... much less increasing substantially for a particular type of prescription opioids.

This post shows increase in the abuse of prescription opioids. 

 

[Tau837]

We use about 30% of the world's supply of opioids for ~5% of the world population, and even higher percentages of more addictive opiates like hydrocodone and oxycodone.

As you said to me earlier in the thread, your denominator is wrong here. Opioids aren't available to the entirety of the world's population.

There is also a scaling issue that affects these numbers. The US annually performs more surgeries than most other countries in the world, has more patients in active treatment for cancer than most other countries in the world, etc. Context matters.

 

[Terminalxylem]

You posted "the findings of the largest meta analysis I linked effectively shows no benefit". The conclusion of the study says "evidence from high-quality studies showed that opioid use was associated with statistically significant but small improvements in pain and physical functioning".

You posted "opioids were no more effective than alternative treatments". The conclusion of the study says "Comparisons of opioids with nonopioid alternatives suggested that the benefit for pain and functioning may be similar, although the evidence was from studies of only low to moderate quality."

You also ignored the study limitations and the implications of the average dose, which was low.

I view that as misrepresenting facts. If you want to call it semantics, go ahead. I'll call it being accurate.

Furthermore, you are referencing just one study, apparently because that one study best fits the perspective you had when you first entered this thread. I linked 10 other studies that had varying populations and all showed positive benefits of long term opioid use for treatment of CNCP.

Read the actual study...just because there was a small, statistically significant numeric improvement in pain score and functionality, the changes did not exceed the minimally important difference (MID) in either scale. 

The minimally important difference is the smallest amount of improvement in a treatment outcome that patients would recognize as important.26 For example, the minimally important difference is about 1.0 cm for the 10-cm VAS for pain.27 For the SF-36 items, the minimally important difference of 10 points was used for the individual domains (ie, role functioning and social functioning), 5 points for the summary scores (ie, physical functioning and emotional functioning), and 10 mm for sleep quality (measured using the 100-mm VAS).28

To recap the results:

 Compared with placebo, opioid use was associated with reduced pain (weighted mean difference [WMD], −0.69 cm [95% CI, −0.82 to −0.56 cm] on a 10-cm visual analog scale for pain; modeled risk difference for achieving the MID, 11.9% [95% CI, 9.7% to 14.1%]), improved physical functioning (WMD, 2.04 points [95% CI, 1.41 to 2.68 points] on the 100-point SF-36 PCS; modeled risk difference for achieving the MID, 8.5% [95% CI, 5.9% to 11.2%]), 

In case you didn't notice, .69 is less than 1, and 2.04 is less than 5. The authors even go one step further to calculate a second probability that the results were clinically relevant, and the results are terrible: 11.9% and 8.5% to achieve the MID, respectively.

So the improvements are clinically inconsequential IMO.

And I didn't chose just one study. It's the largest, most recent meta analysis on the topic, comprising data from ninety-six RCTs including 26 169 participants. It's the best data we have, despite its limitations. 

I don't care to dissect each of the smaller trials you mentioned, as I know better data doesn't exist. I'm sorry the results contradict your worldview, but there was no misrepresentation of the data I linked.

 

[Terminalxylem]

As you said to me earlier in the thread, your denominator is wrong here. Opioids aren't available to the entirety of the world's population.

There is also a scaling issue that affects these numbers. The US annually performs more surgeries than most other countries in the world, has more patients in active treatment for cancer than most other countries in the world, etc. Context matters.

Holy carp are you reaching here. So do you think US opioid prescriptions aren't excessive?

 

[James Daulton]

Find different docs?  I could pick up the phone right now and the pharmacy would be calling in about 60-90 minutes saying my prescription is available.

If you could just pick up the phone and have a doctor prescribe you opioids, your doctor is part of the problem of over prescription.

 

[Tau837]

This post shows increase in the abuse of prescription opioids. 

That post includes links that compare data on nonmedical use of prescription opioids from 2001-2002 to 2012-2013 and 2002 to 2006.

The post I responded to was present tense, i.e., abuse is increasing substantially now.

Opioid prescribing increased year over year in the US in every year from 1997 to 2012. Since then, it has declined every year, and currently opioid prescribing is at a 15 year low. I don't think data from 2001 to 2013 is indicative of the trend of prescription opioid abuse today.

 

[Tau837]

Read the actual study...just because there was a small, statistically significant numeric improvement in pain score and functionality, the changes did not exceed the minimally important difference (MID) in either scale. 

To recap the results:

In case you didn't notice, .69 is less than 1, and 2.04 is less than 5. The authors even go one step further to calculate a second probability that the results were clinically relevant, and the results are terrible: 11.9% and 8.5% to achieve the MID, respectively.

So the improvements are clinically inconsequential IMO.

And I didn't chose just one study. It's the largest, most recent meta analysis on the topic, comprising data from ninety-six RCTs including 26 169 participants. It's the best data we have, despite its limitations. 

I don't care to dissect each of the smaller trials you mentioned, as I know better data doesn't exist. I'm sorry the results contradict your worldview, but there was no misrepresentation of the data I linked.

I read the study and quoted it, just as you have done. Your dismissal of its conclusions speaks for itself.

 

[Terminalxylem]

I read the study and quoted it, just as you have done. Your dismissal of its conclusions speaks for itself.

Perhaps you should take a class in critical appraisal of medical literature to understand what is clinically relevant.

 

[Tau837]

Holy carp are you reaching here. So do you think US opioid prescriptions aren't excessive?

US opioid prescribing is at a 15 year low. Like in every area of healthcare, there likely remains a low level of inappropriate prescribing, whether due to ignorance or malice, but I think the excessive prescribing has been driven out to the maximum extent possible.

I think that is evident from all of the pain patients being denied prescription opioids, the forced tapering, the persecution of pain physicians for prescribing, etc. There is a wealth of information available demonstrating that all of those things are happening. To the point that the AMA and other respected organizations are speaking out against these things, as I have posted in this thread.

 

[Tau837]

I read the study and quoted it, just as you have done. Your dismissal of its conclusions speaks for itself.

Perhaps you should take a class in critical appraisal of medical literature to understand what is clinically relevant.

Same to you. I stand by my points.

 

[Terminalxylem]

That post includes links that compare data on nonmedical use of prescription opioids from 2001-2002 to 2012-2013 and 2002 to 2006.

The post I responded to was present tense, i.e., abuse is increasing substantially now.

Opioid prescribing increased year over year in the US in every year from 1997 to 2012. Since then, it has declined every year, and currently opioid prescribing is at a 15 year low. I don't think data from 2001 to 2013 is indicative of the trend of prescription opioid abuse today.

I don't think the data set is complete for more recent years, but if the 15 year low you suggest is accurate, it would be a great start to reverse the damage that's been done by "fifth vital sign" and other policy changes in the early 2000's which promoted the surge in opioid prescriptions.

 

[Terminalxylem]

US opioid prescribing is at a 15 year low. Like in every area of healthcare, there likely remains a low level of inappropriate prescribing, whether due to ignorance or malice, but I think the excessive prescribing has been driven out to the maximum extent possible.

I think that is evident from all of the pain patients being denied prescription opioids, the forced tapering, the persecution of pain physicians for prescribing, etc. There is a wealth of information available demonstrating that all of those things are happening. To the point that the AMA and other respected organizations are speaking out against these things, as I have posted in this thread.

I disagree, but we shall see.

 

[Tau837]

if the 15 year low you suggest is accurate

From Opioid Prescriptions Plunge to 15-Year Low:

The volume of opioid prescriptions in the United States has fallen sharply and now stand at their lowest levels since 2003, according to data released by the Food and Drug Administration...

"This graph confirms the perception that many of us have, that prescribing continues to decline," said Bob Twillman, PhD, Executive Director of Academy of Integrative Pain Management. "But, the question remains -- what is the effect of this decreased prescribing on people with chronic pain?

"Measures of prescribing need to be matched with measures of patient function and quality of life, especially given evidence that decreased prescribing may actually be associated with increased suicide. All this measure really tells us is that the intense pressure from legislators, regulators, and payers has had its desired effect of driving down prescribing, even if there’s no evidence that it’s done anything else helpful."

 

[urbanhack]

Wow, lot of terrible in this thread.  

less terrible, more cannabis.

 

[TwinTurbo]

This is just blatantly false.  Opiods have helped people handle severe pain for decades.  Yes they were severely over prescribed.  And yes they are now being severely scrutinized to the point of being held back from patients in needs.  I'm certainly not suggesting that we go back to how they were prescribed nor am I suggesting that the opioid addiction issue is a small one, but there is a happy medium where minimum needed levels can be prescribed safely.

It's 100% true that there was an epidemic created in this country due to pill mills and it has ruined countless lives. The problem is you still have doctors prescribing 50 pills when 5 would do or none at all. Also the "patients in need" is really what this is all about. There were countless people that didn't "need" these pills but got them anyway including children. 

 

[Terminalxylem]

It's 100% true that there was an epidemic created in this country due to pill mills and it has ruined countless lives. The problem is you still have doctors prescribing 50 pills when 5 would do or none at all. Also the "patients in need" is really what this is all about. There were countless people that didn't "need" these pills but got them anyway including children. 

The objection to your statement was the assertion that "1000X" more people had their lives ruined by the drugs than received benefit from prescription opioids. That's as inaccurate an extreme as posters who suggest prescription opioid abuse isn't much of a problem. While it's true opioids were (are) floridly overprescribed, millions of people have used them legitimately for control of their pain.

From the CDC/NIH

A new analysis of data from the 2012 National Health Interview Survey (NHIS) has found that most American adults have experienced some level of pain, from brief to more lasting (chronic) pain, and from relatively minor to more severe pain. The analysis helps to unravel the complexities of a Nation in pain. It found that an estimated 25.3 million adults (11.2 percent) experience chronic pain—that is, they had pain every day for the preceding 3 months. Nearly 40 million adults (17.6 percent) experience severe levels of pain.

Opioids are the mainstay for treating severe pain, so it's likely many of those ~40 million were prescribed strong pain meds appropriately. They are most well studied for acute, severe pain (post-op, for example), but are also indicated for chronic pain (especially that due to cancer) when other modalities have been exhausted.

Meanwhile, opioid abuse is also fairly common

Of the 20.5 million Americans 12 or older that had a substance use disorder in 2015, 2 million had a substance use disorder involving prescription pain relievers and 591,000 had

a substance use disorder involving heroin.

And ~17,000 overdose deaths resulted from prescription opioids. While this doesn't include all deaths (hard to estimate, but some accidents, infections, etc. are probably the result of substance use) from all opioids (esp. heroin and illicit fentanyl), or the debility and harm to an individual and their friends/family resulting from drug addiction, you can hopefully agree that these totals are unlikely to exceed the number of people who benefitted from appropriately prescribed meds. And certainly not 1000X the number who used opioids in the treatment of their pain.

The challenge, of course, is figuring out the ideal balance between their intended use and misuse. It's impossible to avoid some drug abuse, but we don't want undue suffering due to overly restrictive prescribing practices either. 

 

[Tau837]

ABC57 investigation uncovered startling number of nurses stealing, abusing drugs

In a review of just 90 days of complaints filed against nurse licenses across the state, ABC57 found 39 of 66 involved the abuse or theft of medications. That’s nearly 60 percent of all of the cases.

It’s such a problem, the state has a contract with a company aimed at treating addictions of nurses, doctors and pharmacists.

“We currently have 417 in active monitoring.” Tracy Traut, a Clinical Case Manager with Indiana Professionals Recovery Program, said. “Indiana professionals recovery program is what we refer to as an alternative to discipline program for medical professionals in the state of Indiana.”

IPRP took over the state contract less than a year ago. In the 11 months it’s been working with the state, they’ve dealt with nearly 650 medical professionals, mainly Nurses. Traut says it’s a national problem.

“3 to 6 percent of nurses currently engaged in active practice, have an alcohol or drug addiction problem.” She said.

So here is a source of non-trivial diversion that doesn't come from recipients of prescription opioids.

 

[The_Man]

Excellent new book in this topic, “In Pain,” out this week from a Johns Hopkins bioethicist who became opioid dependent after a motorcycle crash:

https://www.harpercollins.com/9780062854643/in-pain/

Makes a compelling argument for a new medical speciality that helps people wean themselves off opioids after they’re no longer needed, or to help manage long term use if they’re needed for chronic pain. Basically they’re a medicine like any other, but there’s no one overseeing their use in patients. Surgeon sends you home with 30 after a surgery or whatever, and there’s no one tracking your use or helping make sure you step down in a responsible way that manages pain while avoiding dependence 

Author of this book is about to be interviewed on NPR's "Fresh Air" by Terry Gross

 

[TheIronSheik]

In my 15+ years on this board, I've never even gotten as much as a warning.  Yet I managed to get a week suspension from this thread.  So if anyone is wondering, it's ok to accuse people over the internet of being a drug addict, but not cool to say that making such accusations makes them the "i-word".

 

[Terminalxylem]

ABC57 investigation uncovered startling number of nurses stealing, abusing drugs

So here is a source of non-trivial diversion that doesn't come from recipients of prescription opioids.

So who do you think is most at fault for our current prescription opioid problem? Pharma, drug distributors, government oversight, doctors, nurses, patients or diverters other than those who were prescribed the meds in the first place?

 

[Terminalxylem]

In my 15+ years on this board, I've never even gotten as much as a warning.  Yet I managed to get a week suspension from this thread.  So if anyone is wondering, it's ok to accuse people over the internet of being a drug addict, but not cool to say that making such accusations makes them the "i-word".

Welcome back. FTR, I think you're neither addict nor idiot.

 

[TheIronSheik]

Welcome back. FTR, I think you're neither addict nor idiot.

I didn't even mean it literal.  I was trying to say, for lack of better words, that he was being stupid with his argument.  I actually like him as a poster, so my intent wasn't malicious.  

But, water under the bridge.

I think one of the problems with this argument (and with a lot of arguments) is we look at it as black and white.  I think there's more than two possible solutions here.  Just like we don't remove all phones because suicides in teens has gone up because of social media, or ban cars because accidents are on the rise, we must look at this problem as multi pronged.  I think it's obvious there was a epidemic of over prescribing these meds.  And society was OK with it for a while.  TV shows and movies joked about getting pain pills from people who didn't use theirs.  It was socially acceptable.  But I don't think the answer is to get rid of the meds.  The meds help a lot of people.  I think there's a way to crack down on over prescribing while still allowing those who need it to access it.  

There can be checks and balances.  A lot of drugs can be abused.  But that doesn't mean we should start banning them.  We can't punish the people that need them because of the people who are abusing them.

 

[Terminalxylem]

I didn't even mean it literal.  I was trying to say, for lack of better words, that he was being stupid with his argument.  I actually like him as a poster, so my intent wasn't malicious.  

But, water under the bridge.

I think one of the problems with this argument (and with a lot of arguments) is we look at it as black and white.  I think there's more than two possible solutions here.  Just like we don't remove all phones because suicides in teens has gone up because of social media, or ban cars because accidents are on the rise, we must look at this problem as multi pronged.  I think it's obvious there was a epidemic of over prescribing these meds.  And society was OK with it for a while.  TV shows and movies joked about getting pain pills from people who didn't use theirs.  It was socially acceptable.  But I don't think the answer is to get rid of the meds.  The meds help a lot of people.  I think there's a way to crack down on over prescribing while still allowing those who need it to access it.  

There can be checks and balances.  A lot of drugs can be abused.  But that doesn't mean we should start banning them.  We can't punish the people that need them because of the people who are abusing them.

Of course. But I think prescribing habits were so far out of whack a big correction needs to take place - not a ban by any means. Hopefully a balance can be found where people in need aren't denied their meds, though I also don't think its reasonable not to expect extra scrutiny if one uses opioids chronically.  That doesn't mean you're being accused of being an addict, nor your doctor a drug dealer. It just recognizes limitations in our knowledge of treating pain and minimizing opioid abuse. 

 

[Tau837]

So who do you think is most at fault for our current prescription opioid problem? Pharma, drug distributors, government oversight, doctors, nurses, patients or diverters other than those who were prescribed the meds in the first place?

I don't agree with the premise of the question. I don't think we have a "current prescription opioid problem."

We had a prescription opioid problem in the past, but the level of regulation and scrutiny that has been put in place by Federal and state goverment organizations has eliminated the problem to the extent that is reasonably possible. In fact, it has gone beyond that point, as has been documented in this and other threads - it has gone to the point of doing considerable harm to pain patients, physicians, and pharmacists. This harm is not disputable, it is well documented.

Who is to blame for the overprescribing that led to the problem in the early 2000s? Pharma, doctors, nurses, patients, and other diverters all shared some level of responsibility. Some of it was intentional, but IMO more of it was due to ignorance and lack of education/training.

 

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