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Opioid Overreaction (1 Viewer)

I will try to dig into this more.. but purely based off of my decade of first/secondhand experience, that number is way low, and I am betting it is due to a restricted definition of a term.

Will be awhile to look at it respond.. off to DC for vacation.
Of course it is low - he is limiting his numbers to surgical patients who were diagnosed with opioid use disorder by the prescribing physician. Surgeons aren't adept at diagnosing OUD, nor are primary care providers, for that matter. More importantly, most of the patients were receiving opioids for acute, severe post-op pain, which is a noncontroversial use of the drugs. 

That being said, he is ignoring the spectrum of abuse involving opioids. Many people use their drugs for non-approved indications , including recreationally, without meeting diagnostic criteria for OUD. 

Nonmedical use of prescription opioids more than doubled among adults in the United States from 2001-2002 to 2012-2013, based on a study from the National Institute on Alcohol Abuse and Alcoholism (NIAAA), part of the National Institutes of Health. Nearly 10 million Americans, or 4.1 percent of the adult population, used opioid medications in 2012-2013 a class of drugs that includes OxyContin and Vicodin, without a prescription or not as prescribed (in greater amounts, more often, or longer than prescribed) in the past year. This is up from 1.8 percent of the adult population in 2001-2002.

More than 11 percent of Americans report nonmedical use of prescription opioids at some point in their lives, a considerable increase from 4.7 percent ten years prior.
He also conveniently ignores diversion of the prescriptions, which is increasingly common, especially among teens :

Abusing prescription opioid pain relievers is a major problem among young people, and a new study shows users are combining those drugs with other substances. In data from the annual Monitoring the Future survey for the years 2002-2006, 1 out of 8 high school seniors reported having used prescription opioids nonmedically; 7 out of 10 nonmedical users reported combining prescription opioids with at least one other substance in the past year
And there are more subtle ways they are abused. Overstating one's degree of pain in an attempt to receive opioids is fairly common, as anyone who works in healthcare can attest. Ten out of ten pain is usually not accompanied by normal vital signs, ability to carry out one's usual daily activities or doze off comfortably, for example. Not returning unused pain meds is also very common, which increases the likelihood they'll be diverted and used inappropriately in the future.

The OP's point was valid, even though he didn't consider legitimate reasons opioids weren't prescribed. And I don't think Just Win Baby is trying to misrepresent things, but his experience dealing with his wife's chronic pain certainly influences his opinions.

As you suggested, the truth isn't likely quite as bad as either side is depicting, but prescription opioid abuse and untreated pain are both major problems facing the medical community.  Considering ~30% of the population is experiencing pain at any given time, with higher rates of chronic pain in the elderly, physicians need to be judicious in their prescribing practices, more so than in years past.

 
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While the ED may have had medical reasons to not prescribe opioids to my friend, as someone who works directly in heatlhcare I can tell you that there is indeed a concerted effort to reduce opiod scripts from hospital providers.  And it's far from as easy as just asking for them, many providers now seem to err on the side of caution if there's even a question.  And while I don't agree with the old practice of sending people home with 50 percs after a laparoscopic knee surgery, sending people home with only a day or two's supply at best is also wrong. 

We shouldn't need to tolerate pain simply because a small percentage of people are irresponsible with them.  There's a happy medium to be had, but we're too far off to the other side now.  

 
While the ED may have had medical reasons to not prescribe opioids to my friend, as someone who works directly in heatlhcare I can tell you that there is indeed a concerted effort to reduce opiod scripts from hospital providers.  And it's far from as easy as just asking for them, many providers now seem to err on the side of caution if there's even a question.  And while I don't agree with the old practice of sending people home with 50 percs after a laparoscopic knee surgery, sending people home with only a day or two's supply at best is also wrong. 

We shouldn't need to tolerate pain simply because a small percentage of people are irresponsible with them.  There's a happy medium to be had, but we're too far off to the other side now.  
You're right, there are efforts to reduce opioid prescriptions. And some providers are ridiculous in their reluctance to prescribe them. I think a happy medium can be had, but that might mean a 2-3 day prescription with close follow up post hospitalization. There's no magic number of days needed for pain to resolve.

My own experience with opioids is limited, but I definitely had severe pain after I broke my leg skiing. I only required one dose of IV morphine post-op and a couple days of orals to control it.

Also of note, a TSA agent tried to steal my meds, which I only noticed by chance after they asked to double check my carry on. And I never completed all the pills I was prescribed.

 
Because you posted this:

Sorry if it hurts to hear it, but that is an ignorant take. Read the articles linked in the thread. Doctors are being persecuted and are reluctant to write prescriptions they would have written a few years ago. Pain patients have been abandoned. Other pain patients have been forcibly tapered. Some of those patients have committed suicide as a result. Others have turned to illegal drugs. These are facts, not opinions. Those things didn't happen simply because the patients weren't "proactive."

ETA: Also much respect to you @Chaka. I appreciate your response. I am not intending this to be combative.
It does not "hurt to hear" and you are being a bit combative but no big deal.

I am not disputing that there are instances of improper pain treatment but those existed before this shift in pain management standards.  Holding up those examples as some kind of standard across the board also comes off as an ill considered position.

 
Because of my back, I take pain meds almost on a daily basis.  It's pretty much the lowest level opioid out there, but without it my life would be miserable.  I wouldn't be able to do probably 3/4 of the things I do, such as golf, walk, sit in a car, etc.  3 years ago, I would get a prescription for 90 of them that would last me about 3-4 months.  Sometimes longer.  Then the insurance only allowed a prescription for 30 to be written with 3 refills.  (Also, I loved how the price stayed the same for 60 less pills.)  About a year and half ago, no more refills were allowed.  I have to go get an actual paper prescription each time I need a new bottle.  I know have to break each pill in half and use them only when the pain becomes unbearable.

Starting in January, I'm now required to take a piss test about every 2 months.  That runs me about $120 with insurance.  My doctor keeps telling me they are tightening the screws on him more and more and he worries they will eventually not allow for refills to go on forever.  

Thing is, I can't imagine living without them.  Nothing takes that pain away except for that small dose of that pain pill.  But I'm being treated like a drug addict.  And I worry about what will happen to my life if I can no longer get that medicine.  It's scary.  

This is another example of "10% of the population is doing something wrong, so let's punish everyone."

 
Because of my back, I take pain meds almost on a daily basis.  It's pretty much the lowest level opioid out there, but without it my life would be miserable.  I wouldn't be able to do probably 3/4 of the things I do, such as golf, walk, sit in a car, etc.  3 years ago, I would get a prescription for 90 of them that would last me about 3-4 months.  Sometimes longer.  Then the insurance only allowed a prescription for 30 to be written with 3 refills.  (Also, I loved how the price stayed the same for 60 less pills.)  About a year and half ago, no more refills were allowed.  I have to go get an actual paper prescription each time I need a new bottle.  I know have to break each pill in half and use them only when the pain becomes unbearable.

Starting in January, I'm now required to take a piss test about every 2 months.  That runs me about $120 with insurance.  My doctor keeps telling me they are tightening the screws on him more and more and he worries they will eventually not allow for refills to go on forever.  

Thing is, I can't imagine living without them.  Nothing takes that pain away except for that small dose of that pain pill.  But I'm being treated like a drug addict.  And I worry about what will happen to my life if I can no longer get that medicine.  It's scary.  

This is another example of "10% of the population is doing something wrong, so let's punish everyone."
This is a good example of what I was initially complaining about. 

 
Because of my back, I take pain meds almost on a daily basis.  It's pretty much the lowest level opioid out there, but without it my life would be miserable.  I wouldn't be able to do probably 3/4 of the things I do, such as golf, walk, sit in a car, etc.  3 years ago, I would get a prescription for 90 of them that would last me about 3-4 months.  Sometimes longer.  Then the insurance only allowed a prescription for 30 to be written with 3 refills.  (Also, I loved how the price stayed the same for 60 less pills.)  About a year and half ago, no more refills were allowed.  I have to go get an actual paper prescription each time I need a new bottle.  I know have to break each pill in half and use them only when the pain becomes unbearable.

Starting in January, I'm now required to take a piss test about every 2 months.  That runs me about $120 with insurance.  My doctor keeps telling me they are tightening the screws on him more and more and he worries they will eventually not allow for refills to go on forever.  

Thing is, I can't imagine living without them.  Nothing takes that pain away except for that small dose of that pain pill.  But I'm being treated like a drug addict.  And I worry about what will happen to my life if I can no longer get that medicine.  It's scary.  

This is another example of "10% of the population is doing something wrong, so let's punish everyone."
What's wrong with your back?  Fix the source of the pain not just cover it up with meds.   If you're in enough pain it hurts to walk and you need prescription meds you shouldn't be playing golf.  Not trying to be preachy just saying golf is going to make your problems worse.

 
OK, Why didn't you choose to include the largest meta analysis regarding opioids for CNCP? 
I was not aware of it. It didn't come up in my Google search yesterday. Thanks for linking it.

So, opioids may help CNCP to a small extent, less than the minimally important difference in pain and functionality scales and comparable to non-opioid modalities. If you read the actual paper, you'll see the median duration of therapy was relatively short (60 days), and most of the studies (79%) received funding from the pharmaceutical industry - a potential red flag for the findings, as underwhelming as they may be. And many excluded patients with mental illness (45%), or history of substance use disorders (72%), so one would expect abuse potential would be less than the general chronic pain population. 

This is the most recent, biggest data set we have, to my knowledge. It ain't very compelling.
Well, first of all, this tangent began when you posted this: "the data shows no long term benefit from using opioids for non-cancer pain". You didn't say the benefit is not shown to be very compelling, you said there was no benefit.

This is from the conclusion:

In this meta-analysis of RCTs of patients with chronic noncancer pain, evidence from high-quality studies showed that opioid use was associated with statistically significant but small improvements in pain and physical functioning, and increased risk of vomiting compared with placebo. 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.
A small benefit is a positive benefit, so this study supports my response to you on your original statement.

Furthermore, the study outlines several limitations. Primary among them is the median of 60 days and the fact that not a single study went beyond 6 months. Thus, this is of limited utility in determining long term benefits.

This study also says the average dose across the patient population was 45 mg, which CDC defines as a low dose. It is possible that one reason for the small observed benefit was the low dose. This study offers very little information about other dose levels.

ETA: Here is an older study which looked at risk of OUD and duration of opioid use for non-cancer pain. As one might expect, the likelihood of abuse increases the longer one receives opioids, with a 122x greater risk in those receiving high dose opioids chronically.
Facts from the study:

  • Overall, 197,269 patients were prescribed opioids within the sample. 0.18% of them were diagnosed with OUD during the post-index period.
  • The study used 6 categories. 6.1% of patients in the high dose, chronic group were diagnosed with OUD during the post-index period. No other group topped 1.28%, and all other groups collectively were at 0.16%.

    6.1% for the high dose, chronic group was based on 23 instances of diagnosed OUD among 378 patients in that group. That is a fairly small sample size, given that the study accounted for 568,640 individuals.

[*]Many limitations were identified in the study, including: "current Diagnostic and Statistical Manual (DSM) IV diagnostic criteria are likely not optimal for prescription drug disorders. That is, individuals on chronic opioid therapy will likely develop tolerance, and withdrawal if they stop using opioids (2 of the 7 seven symptoms for opioid dependence), even if they are using opioids as prescribed by their physician." This implies that the actual OUD rate was overestimated in this study.

 
Of course it is low - he is limiting his numbers to... he is ignoring... He also conveniently ignores...
I'm not limiting or ignoring anything. I posted links to at least 10 studies in this thread with varying subject populations. I also responded to every linked study you posted.

As you suggested, the truth isn't likely quite as bad as either side is depicting, but prescription opioid abuse and untreated pain are both major problems facing the medical community.  Considering ~30% of the population is experiencing pain at any given time, with higher rates of chronic pain in the elderly, physicians need to be judicious in their prescribing practices, more so than in years past.
I agree with this. Unfortunately, the pendulum has swung far beyond physicians being judicious. The Government is interfering in physician-patient care and is harming them by doing so.

 
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What's wrong with your back?  Fix the source of the pain not just cover it up with meds.   If you're in enough pain it hurts to walk and you need prescription meds you shouldn't be playing golf.  Not trying to be preachy just saying golf is going to make your problems worse.
There is no "fix."  I could get surgery, but that might not fix it and could make it worse.  Back surgery is not something you just do.

On top of that, a simple pill fixes the issue.  Why would I choose to have a surgery if there's a pill that fixes it?  And I'm supposed to not do enjoyable things like hike and play golf just because some people might get addicted to a drug???  Do you know how ridiculous that sounds?  We have developed a pill that allows me to enjoy life like a normal person and you're saying I should stop doing those things?  I mean, no offense, but that might be the dumbest thing I've ever heard.

 
There is no "fix."  I could get surgery, but that might not fix it and could make it worse.  Back surgery is not something you just do.

On top of that, a simple pill fixes the issue.  Why would I choose to have a surgery if there's a pill that fixes it?  And I'm supposed to not do enjoyable things like hike and play golf just because some people might get addicted to a drug???  Do you know how ridiculous that sounds?  We have developed a pill that allows me to enjoy life like a normal person and you're saying I should stop doing those things?  I mean, no offense, but that might be the dumbest thing I've ever heard.
:goodposting:  

 
There is no "fix."  I could get surgery, but that might not fix it and could make it worse.  Back surgery is not something you just do.

On top of that, a simple pill fixes the issue.  Why would I choose to have a surgery if there's a pill that fixes it?  And I'm supposed to not do enjoyable things like hike and play golf just because some people might get addicted to a drug???  Do you know how ridiculous that sounds?  We have developed a pill that allows me to enjoy life like a normal person and you're saying I should stop doing those things?  I mean, no offense, but that might be the dumbest thing I've ever heard.
Agree on your surgery angle, but a guy with a bad back insisting on golfing seems a bit odd. 

 
There is no "fix."  I could get surgery, but that might not fix it and could make it worse.  Back surgery is not something you just do.

On top of that, a simple pill fixes the issue.  Why would I choose to have a surgery if there's a pill that fixes it?  And I'm supposed to not do enjoyable things like hike and play golf just because some people might get addicted to a drug???  Do you know how ridiculous that sounds?  We have developed a pill that allows me to enjoy life like a normal person and you're saying I should stop doing those things?  I mean, no offense, but that might be the dumbest thing I've ever heard.
:lmao:

About the response I expected.  Enjoy your golf and opiods.  Good luck!

 
Agree on your surgery angle, but a guy with a bad back insisting on golfing seems a bit odd. 
:confused:

Why?  Again, we designed a pill that takes away the pain.  Isn't that what all drugs do?  Golf doesn't make my back worse.  Not taking the meds would mean I'd lay on the couch all day in terrible pain for the rest of my life.  And that life would probably only last until I finally had enough and just decided to put myself out of my misery.

With meds, I can walk, go hiking, sit at a desk and work, go on car rides with my daughter and wife to see new places and enjoy life.  

But you're saying I shouldn't take meds to help me do those things?  Again, I've been taking these things for a decade.  I'm not an addict.  I don't have a drug problem.  It's not different than stronger aspirin.  Should people who need to take aspirin after exercising not do those things?  Should people with arthritis stop doing things because if they do them, they'll need to take their arthritis meds?

Again, I'm not trying to be a jerk, but I'm not sure I understand these arguments.  They are some of the dumbest arguments I've ever heard on this board.  And that's saying a lot.

 
:lmao:

About the response I expected.  Enjoy your golf and opiods.  Good luck!
Please elaborate.  You've turned "opiods" into a bad word.  But why is it different than Advil?  

Can you seriously answer me this question:

If someone goes running, and afterwards they have knee pain, but can take Advil and have it go away, should they stop taking Advil and just stop running?  What's the difference?  I'm being serious.  I'm not calling you dumb.  I'm saying your argument is.  So, please, elaborate to help me understand why it's not a dumb argument.  Please.

Because I'm afraid you're just caught up on the word "opiod" and you think it has some evil connotation to it.

 
:confused:

Why?  Again, we designed a pill that takes away the pain.  Isn't that what all drugs do?  Golf doesn't make my back worse.  Not taking the meds would mean I'd lay on the couch all day in terrible pain for the rest of my life.  And that life would probably only last until I finally had enough and just decided to put myself out of my misery.

With meds, I can walk, go hiking, sit at a desk and work, go on car rides with my daughter and wife to see new places and enjoy life.  

But you're saying I shouldn't take meds to help me do those things?  Again, I've been taking these things for a decade.  I'm not an addict.  I don't have a drug problem.  It's not different than stronger aspirin.  Should people who need to take aspirin after exercising not do those things?  Should people with arthritis stop doing things because if they do them, they'll need to take their arthritis meds?

Again, I'm not trying to be a jerk, but I'm not sure I understand these arguments.  They are some of the dumbest arguments I've ever heard on this board.  And that's saying a lot.
I didn’t say don’t take the meds. I said it’s nuts to perform strenuous activities in a bad back. Just because you can’t feel it, doesn’t mean you should do it. 

 
I didn’t say don’t take the meds. I said it’s nuts to perform strenuous activities in a bad back. Just because you can’t feel it, doesn’t mean you should do it. 
But I'll ask again, what's the difference between this and Advil?  

 
Please elaborate.  You've turned "opiods" into a bad word.  But why is it different than Advil?  

Can you seriously answer me this question:

If someone goes running, and afterwards they have knee pain, but can take Advil and have it go away, should they stop taking Advil and just stop running?  What's the difference?  I'm being serious.  I'm not calling you dumb.  I'm saying your argument is.  So, please, elaborate to help me understand why it's not a dumb argument.  Please.

Because I'm afraid you're just caught up on the word "opiod" and you think it has some evil connotation to it.
Jobber has it covered.   I’m not saying never take the pill but if your body can play golf or other activities that are hard on the back then you’re clearly not physically disabled to the point of needing daily medicine.  In most cases there are other ways to relieve pain.  Lose weight, stretch and be flexible, etc...

Seriously good luck.  Not going back and forth when you jump in with that’s the dumbest argument ever.  

 
Jobber has it covered.   I’m not saying never take the pill but if your body can play golf or other activities that are hard on the back then you’re clearly not physically disabled to the point of needing daily medicine.  In most cases there are other ways to relieve pain.  Lose weight, stretch and be flexible, etc...

Seriously good luck.  Not going back and forth when you jump in with that’s the dumbest argument ever.  
So because I can golf, I don't need medicine?  What college of medicine did you go to?

 
So because I can golf, I don't need medicine?  What college of medicine did you go to?
:lmao:

And you said earlier " I mean, no offense, but that might be the dumbest thing I've ever heard."    :lmao: :lmao:

Seriously, this has to be a fishing trip.  Yeah, medicine has no side effects.  It was designed to be taken daily for life so you could have a golfing career.   I'm out.

 
Dude. Where did I say anything advocating NOT taking your pills? I merely wondered why a guy with a bad back golfs!
I didn't say you did.  Why shouldn't I golf?  It's something I enjoy.  Same with hiking.  These are things that make me happy.  And modern medicine has made a pill that allows me to take one and not feel any pain.  I don't abuse it.  There is no downside for me.  Why wouldn't I golf?  Just like if someone has arthritis, I wouldn't tell them they shouldn't play tennis or work in the garden if it was going to hurt their bones.  That's what the medicine was made for.

 
:lmao:

And you said earlier " I mean, no offense, but that might be the dumbest thing I've ever heard."    :lmao: :lmao:

Seriously, this has to be a fishing trip.  Yeah, medicine has no side effects.  It was designed to be taken daily for life so you could have a golfing career.   I'm out.
You can't answer my question.  I'd be out to.  You seem like a good guy.  But you're an idiot in here.  

ETA:  All medicine has side effects.  Again, if I don't golf, I still have back pain.  Not golfing doesn't make my back better.  So I can take the pills and do things that make me happy.  Or I can not take the pills, have no side effects, and live the rest of my life in horrible pain not being able to move.

 
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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.  

 
No, you're actually reading a non-typo. I meant addition. The mg dosage Orton is talking about, which is that 200 mg plus four equals 800 mg. That's where my family says I'm wrong about ibuprofen. I feel like they shouldn't vote.
I think you may be the one with the problem.  200 + 4 = 204.      Hahahah.   Maybe if you explained to them 200 + 200 + 200 + 200 = 800 or introduce them to the new fangled math called multiplication where 200 x 4 = 800.  Maybe they will understand it then....hahah

 
Booze and Aspirin. Both can be used to treat pain. That doesn't mean they are remotely similar in anything else. 

 
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Booze and Aspirin. Both can be used to treat pain. That doesn't mean they are remotely similar in anything else. 
Booze is not a medicine.  A hammer over the head to knock you out can also help alleviate pain for a short period of time.  And also has side effects.  But it's an odd comparison.

 
I hope the people on this board arguing against pain relief never have to deal with chronic pain.  A pain that never goes away and keeps you from living life to your fullest.  Seriously.  I wouldn't wish it on anyone.

And I hope you never have someone tell you that you shouldn't take your meds that take that pain away because there are bad side effects.  Because it's honestly one of the most callous things I think I've ever heard.  To have someone tell you that you don't deserve to live a full life.  To tell you that you shouldn't be allowed to feel pain free.  

I've gone through years of physical therapy.  Years of getting injections into my spine.  Years of having procedures where nerves are burned away from the spine.  And maybe once every three days, I pop a pill that takes away 80% of that pain and allows me to live again. Not a perfect life.  But a life worth living. And it honestly breaks my heart to hear people say things like "You shouldn't be doing those things" or "Those pills have side effects."  I'm sure you mean well, but you have no idea the pain people live with.  And how a small little pill can make a lot of that go away.  And to tell people they should live with their pain probably makes me madder than it should.  And that's on me.  

I just can't imagine ever telling someone how they should deal with their pain.

 
Booze is not a medicine.  A hammer over the head to knock you out can also help alleviate pain for a short period of time.  And also has side effects.  But it's an odd comparison.
What's odd? 

Asking if there is a meaningful difference between Advil and anything opium-based.

 
Every single piece of medicine has side effects.  Which one should I be worried about here?  I ask because I'm trying to figure out if it's worse than horrible, debilitating, constant pain.  Can you list some so I can compare them?
Are you seriously suggesting Advil's side effects are similar to opium's side effects? Or one isn't entirely more serious than another? 

I lost a sister-in-law to opium addiction. Sadly, she sounded just like you. She too had a lot of pain right up until the point she didn't.

 
Are you seriously suggesting Advil's side effects are similar to opium's side effects? Or one isn't entirely more serious than another? 

I lost a sister-in-law to opium addiction. Sadly, she sounded just like you. She too had a lot of pain right up until the point she didn't.
Sorry to hear that.  But I'm not addicted.  Not everyone who takes it is an addict.  I think that's your problem.  You're looking at everyone who takes it as an addict who is on the verge of overdose.  

Again, you still haven't told me what the side effects are so I can compare them to horrible, everyday pain.  I want to see which would be worse.  

 
I’d like to hear some experience of folks who’d recently had surgery.  I’ll bet they tell you the docs were stingy with the pain meds.  I get that there are issues out there but to make most of us suffer in pain unnecessarily isn’t fair.  And I’m telling you that most hospitals have initiatives to drastically reduce opiate prescriptions.

It won’t be cool if we or a loved one are someone who just has to deal with significant pain.
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  :shrug:

 
Sorry to hear that.  But I'm not addicted.  Not everyone who takes it is an addict.  I think that's your problem.  You're looking at everyone who takes it as an addict who is on the verge of overdose.  

Again, you still haven't told me what the side effects are so I can compare them to horrible, everyday pain.  I want to see which would be worse.  
Let's start with addiction as a harmful side effect.

How do you know you aren't addicted?

 
Sorry to hear that.  But I'm not addicted.  Not everyone who takes it is an addict.  I think that's your problem.  You're looking at everyone who takes it as an addict who is on the verge of overdose.  

Again, you still haven't told me what the side effects are so I can compare them to horrible, everyday pain.  I want to see which would be worse.  
Dependence is another harmful side effect. Do you understand the difference between addiction and dependence?

 
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  :shrug:
Within the last two years?  And I hate to break it to you but your doctor is an idiot.

 
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Let's start with addiction as a harmful side effect.

How do you know you aren't addicted?
Well, let's see.  I take about 40mg once every three days on average.  I have to take a piss test every 2 to 3 months to show I don't have a large amount in my system.  

Before we go any further, do you take Aetna?  

Also, do you not find it odd that you're accusing someone over the internet of possibly being addicted to something when you know nothing about that person?  Because, to me, that comes off as a little high and mighty.  Maybe even a little overreaching.  But you do you.

 
Within the last two years?  And I hate to break it to you but your doctor’s an idiot.
probably little more than 2 years ago. 2 1/2'ish. 

it's become a running gag in our house.. stub your toe "better head to urgent care and get a month's worth of pain pills for that :thumbup: "

 
Dependence is another harmful side effect. Do you understand the difference between addiction and dependence?
I do.  It's kind of confusing because I'm actually having trouble keeping track of whether you're my doctor or my English teacher now.  

Notice I keep answering your questions.  But you still haven't answered mine.  

 

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