Opioid Overreaction (1 Viewer)

[Tau837]

It's not a failure of the health care industry, it's a failure of the media and government in shouting about prescription pain pills being the cause of all this death.

 

Amen, brother.

 

[Terminalxylem]

There’s another unfortunate side effect as a result of this manufactured scapegoating of prescription opiates. 

People believe that when you overdose on oxycontin your breathing stops and you die.  That’s what happens on fentanyl and heroin. 

OxyContin makes your organs shut down, and while you generally breathe in enough vomit to cause pneumonia symptoms, you don’t usually die quickly.  So terminal patients are trying to commit suicide with their pain medication because of the news talk about overdose deaths and find that they’re starving to death or dying of thirst on a DNR in hospice care for a week or two while their families watch.

Sure makes great news to blame the pain pills, though. 

What organs do you think OxyContin shuts down? Are you advocating for more effective means for terminal patients to expedite their demise?

For the record, any opiate can cause respiratory arrest. Heroin and fentanyl are just more potent and rapid acting, so it's easier to OD. But your hypothetical hospice patient could overdose on OxyContin, too. People are injecting and snorting it to get around the slow release formulation.

 

[Henry Ford]

What organs do you think OxyContin shuts down? Are you advocating for more effective means for terminal patients to expedite their demise?

For the record, any opiate can cause respiratory arrest. Heroin and fentanyl are just more potent and rapid acting, so it's easier to OD. But your hypothetical hospice patient could overdose on OxyContin, too. People are injecting and snorting it to get around the slow release formulation.

I’m certainly discussing anecdotal evidence and yes, I think terminal patients should be afforded more humane methods of terminating their own lives on their own terms. 

But the patient I’m discussing is not hypothetical and was not in hospice prior to the incident, it’s just necessary now. 

 

[Terminalxylem]

The hard, "cold equations" decision: The delivery of opioids to pain patients -- as an overarching nationwide system -- is going to have to guiltlessly bear a certain baseline number of addicts. Dropping the number of addicts down to zero shouldn't even be countenanced. It's OK if a given delivery system -- one that ends up helping pain patients -- allows a given small number of addicts to take advantage.

Hammering out acceptable levels of the items in red above is where the rubber meets the road.

Sure. Does anyone think the number of addicts is anywhere near acceptable?

 

[Henry Ford]

Sure. Does anyone think the number of addicts is anywhere near acceptable?

Intellectually, probably not.  In reality, enough people think it's at least near acceptable that we don't do enough to address the root causes of addiction in our society.

 

[Terminalxylem]

If that is happening then it is a failure on the part of the providers caring for these patients. The whole point of hospice is comfort-directed care. And hospice care is a fully covered benefit that should not be burdensome to family.

Opioids are effective first line agents for multiple symptoms during end of life care. One minor consequence I’ve seen from the (mostly accurate) media portrayal of the opioid epidemic is the occasional end-of-life patient or family that doesn’t want to use opioids due to fear of addiction or sedation.

This guy gets it. Additionally, I've seen non-terminal patients suffer for fear of getting hooked. Acute, severe pain treated with opioids rarely leads to problems. Chronic pain is another animal, where some concern is warranted. Addiction potential shouldn't even be considered in end-of-life care. 

 

[Terminalxylem]

I’m certainly discussing anecdotal evidence and yes, I think terminal patients should be afforded more humane methods of terminating their own lives on their own terms. 

But the patient I’m discussing is not hypothetical and was not in hospice prior to the incident, it’s just necessary now. 

OK, we're on the same page. The patient you mentioned just didn't factor pharmacokinetics into their suicidality, but I doubt that scenario is very common.

 

[Henry Ford]

OK, we're on the same page. The patient you mentioned just didn't factor pharmacokinetics into their suicidality, but I doubt that scenario is very common.

Having discussed it with the hospice doctor, it depends on what you mean by "very common."  A single hospice care facility that has seen a similar circumstance happen at least four times this year is at least far too common in my opinion.

 

[Doug B]

The hard, "cold equations" decision: The delivery of opioids to pain patients -- as an overarching nationwide system -- is going to have to guiltlessly bear a certain baseline number of addicts. Dropping the number of addicts down to zero shouldn't even be countenanced. It's OK if a given delivery system -- one that ends up helping pain patients -- allows a given small number of addicts to take advantage.

Hammering out acceptable levels of the items in red above is where the rubber meets the road.

Sure. Does anyone think the number of addicts is anywhere near acceptable?

Dunno.

Question -- is it medically possible to be "safely" addicted to opioids. Better phrased: can opioid addiction be managed so that the addict can keep using (a replacement like methadone) and still function in society? Does it have to be a cold-turkey "stop-the-opioids-NOW!" solution for each addict?

 

[Terminalxylem]

Dunno.

Question -- is it medically possible to be "safely" addicted to opioids. Better phrased: can opioid addiction be managed so that the addict can keep using (a replacement like methadone) and still function in society? Does it have to be a cold-turkey "stop-the-opioids-NOW!" solution for each addict?

You can certainly be dependent on opioids and remain a functional member of society. Addiction implies a lack of control over opioids and maladaptive behaviors resulting from drug use. 

 

[culdeus]

It's not a failure of the health care industry, it's a failure of the media and government in shouting about prescription pain pills being the cause of all this death.

What is the cause then?

 

[Henry Ford]

What is the cause then?

Usually street drugs being sold to people as other street drugs or as prescription medication. 

 

[D_House]

Dunno.

Question -- is it medically possible to be "safely" addicted to opioids. Better phrased: can opioid addiction be managed so that the addict can keep using (a replacement like methadone) and still function in society? Does it have to be a cold-turkey "stop-the-opioids-NOW!" solution for each addict?

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.

 

[ILUVBEER99]

It's not a failure of the health care industry, it's a failure of the media and government in shouting about prescription pain pills being the cause of all this death.

I'd love to know the real stats of people who overdosed solely from prescription opioids.

Most of the overdose deaths attributed to prescription opioids are people with multiple drugs in their system.

 

[Henry Ford]

I'd love to know the real stats of people who overdosed solely from prescription opioids.

Most of the overdose deaths attributed to prescription opioids are people with multiple drugs in their system.

Or people who weren’t actually prescribed the medication. 

 

[Terminalxylem]

I'd love to know the real stats of people who overdosed solely from prescription opioids.

Most of the overdose deaths attributed to prescription opioids are people with multiple drugs in their system.

This link probably contains the stats you desire. But why does it matter if people are ODing on multiple substances? Do you think that makes prescription opioid abuse less of a problem?

 

[Terminalxylem]

Or people who weren’t actually prescribed the medication. 

Diversion is certainly a big issue, one that is partially addressed by more restrictive prescribing practices. There also are drug formulations with less abuse potential, but they tend to be pricier than the original drugs.

All the cost and inconvenience is passed on to those with legitimate pain, unfortunately. But I don't have a better solution.

You mentioned addressing the root cause(s) of addiction instead. What cause(s) do you think are amenable to correcting?

 

[Terminalxylem]

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.

Do you think addiction medicine should be added to training curricula? Should more providers be prescribing methadone and Suboxone?

 

[Henry Ford]

Diversion is certainly a big issue, one that is partially addressed by more restrictive prescribing practices. There also are drug formulations with less abuse potential, but they tend to be pricier than the original drugs.

All the cost and inconvenience is passed on to those with legitimate pain, unfortunately. But I don't have a better solution.

You mentioned addressing the root cause(s) of addiction instead. What cause(s) do you think are amenable to correcting?

Lack of options, lack of hope, lack of future, lack of community in general. Lack Poverty, fear, hopelessness, homelessness. Powerlessness. The feeling that things have been the best they’ll ever be and they’re only getting worse.  Failure of the social safety net and social contract  

As they say, the opposite of addiction isn’t sobriety.  The opposite of addiction is connection. 

 

[Terminalxylem]

Lack of options, lack of hope, lack of future, lack of community in general. Lack Poverty, fear, hopelessness, homelessness. Powerlessness. The feeling that things have been the best they’ll ever be and they’re only getting worse.  Failure of the social safety net and social contract  

As they say, the opposite of addiction isn’t sobriety.  The opposite of addiction is connection. 

Sounds plausible, but how do you address those problems quickly and cost effectively? UBI and guaranteed housing + improved mental health infrastructure? How do you restore hope?

 

[Henry Ford]

Sounds plausible, but how do you address those problems quickly and cost effectively? UBI and guaranteed housing + improved mental health infrastructure? How do you restore hope?

Investment in education and work initiatives, especially in low income and currently underserved communities. Community programs.  Demilitarization of law enforcement.  Universal healthcare, including mental healthcare. 

 

[Terminalxylem]

Investment in education and work initiatives, especially in low income and currently underserved communities. Community programs.  Demilitarization of law enforcement.  Universal healthcare, including mental healthcare. 

All sound great, but we'd be lucky to move forward with even one of those suggestions. I'd go with universal healthcare to start.

 

[Henry Ford]

Intellectually, probably not.  In reality, enough people think it's at least near acceptable that we don't do enough to address the root causes of addiction in our society.

All sound great, but we'd be lucky to move forward with even one of those suggestions. I'd go with universal healthcare to start.

Yeah, that’s the point. 

 

[Henry Ford]

Addiction isn’t the disease. It’s a symptom.   Much like Trump and our dysfunctional government in general, like racism and sexism and xenophobia. 

 

[D_House]

Do you think addiction medicine should be added to training curricula? Should more providers be prescribing methadone and Suboxone?

Yes to both.

 

[tonydead]

So we seemed to have transitioned from a society where pain pills were handed out like candy, to one where prescribing pain pills is now so scrutinized that people with real need are left to suffer.

My friend was in a freak accident the other day, got hit by a double truck tire that flew off the truck's axel.  He's lucky to be alive but as you can imagine he's pretty banged up with 15 stitches in his noggin, a concussion, and massive bruising on one side.  Was in the ED all night, given IV pain killers there, but sent home with nothing.  He's the classic case of someone who'll need meds for a couple of days afterwards and if he didn't have any left over from a prior surgery, he'd end up back in the ED if he couldn't get through to his doctor.

Sometimes this country is dumb. 

Just noticed this thread and haven't read it all, but, have to say I agree 100%.  I had my wisdom teeth taken out (late in life) several years ago.  A few months back my jaw bone had grown incorrectly and poked out the side of my inner gum wall.  While numb the dentist had to shave off my jaw bone and mentioned he would give me something for the pain.  But, something clicked in his head and I left with ibuprofen and tylenol.  I have a high tolerance for pain, but, I didn't sleep for two nights.  I called my dentist and talked to him about it, and he did offer me a script at that time, but it's all complete BS.

 

[Tau837]

The Contribution of Prescribed and Illicit Opioids to Fatal Overdoses in Massachusetts, 2013-2015

• 2916 decedents
  
• 491 (16.8%) had 1 or more active opioid prescriptions on the date of death
  
• Only 39 (1.3%) had an active prescription for each opioid detected in toxicology reports on the date of death
  

That is not indicative of a prescription opioid problem. And that was in 2013-2015. Opioid prescribing has been reduced significantly since then.

 

[Tau837]

Opioid Policies Based On Morphine Milligram Equivalents Are Automatically Flawed

Below is a chart published by the CDC, a "guide" (2) for physicians who prescribe pain drugs. Morphine is normalized to 1.0 and the conversion factor reflects the relative potency of other opioid drugs. So, if the daily MME - the maximum dose of drug allowed - is 90 mg (3) then a patient may receive no more than 90 mg of morphine, 90 mg of hydrocodone, 60 mg of oxycodone, or 30 mg of oxymorphone per day. Although the conversion table seems to be straightforward enough, it is based on an assumption that all opioids behave similarly in the body. But this assumption could not be less accurate. Once we see the profound differences in the properties of the drugs and the difference between individuals who take them it becomes clear that not only is the CDC chart flawed, but the MME is little more than a random number...

Conclusion

The CDC MME chart, in fact, the entire concept of morphine milligram equivalents may be convenient for bureaucrats but because of differences in the absorption of different drugs into the bloodstream, half-life of different drugs, the impact of one or more other drugs on opioid levels, and large differences of the rate of metabolism caused by genetic factors, is not only devoid of scientific utility, but actually causes far more harm than help by creating "guidelines" that are based upon a false premise. When a policy is based on deeply flawed science, the policy itself will automatically be fatally flawed. It cannot be any other way.

 

[Tau837]

New Survey Data Confirm That Opioid Deaths Do Not Correlate With Pain Pill Abuse or Addiction Rates

New data from the National Survey on Drug Use and Health (NSDUH) provide further evidence to support a counterintuitive conclusion: The dramatic increase in deaths involving prescription analgesics since 2000 cannot be explained by a dramatic increase in misuse or addiction rates, because there was no such increase...

The evidence does not favor a simple narrative in which more opioid prescriptions led to more abuse and addiction, which in turn led to more deaths. The "opioid crisis," which seems to be part of a long-term upward trend in drug-related deaths that began in 1979, might more accurately be described as a problem of increasingly reckless polydrug use, a problem that cannot be solved—and may be worsened—by demanding wholesale reductions in pain pill prescriptions.

 

[[scooter]]

The Contribution of Prescribed and Illicit Opioids to Fatal Overdoses in Massachusetts, 2013-2015

• 2916 decedents
  
• 491 (16.8%) had 1 or more active opioid prescriptions on the date of death
  
• Only 39 (1.3%) had an active prescription for each opioid detected in toxicology reports on the date of death
  

That is not indicative of a prescription opioid problem. And that was in 2013-2015. Opioid prescribing has been reduced significantly since then.

Why are you only reporting the percentage of people who had "active" prescriptions?

Without knowing the percentage of people who had inactive prescriptions, we won't be able to tell whether or not this is "indicative of a prescription opioid problem".

 

[Tool]

The Contribution of Prescribed and Illicit Opioids to Fatal Overdoses in Massachusetts, 2013-2015

• 2916 decedents
  
• 491 (16.8%) had 1 or more active opioid prescriptions on the date of death
  
• Only 39 (1.3%) had an active prescription for each opioid detected in toxicology reports on the date of death
  

That is not indicative of a prescription opioid problem. And that was in 2013-2015. Opioid prescribing has been reduced significantly since then.

Yeah those stats seem pretty meaningless. What about someone who starts with opioids, moves onto heroin and than overdoses on heroin, I doubt they're counted.

 

[Tool]

Just noticed this thread and haven't read it all, but, have to say I agree 100%.  I had my wisdom teeth taken out (late in life) several years ago.  A few months back my jaw bone had grown incorrectly and poked out the side of my inner gum wall.  While numb the dentist had to shave off my jaw bone and mentioned he would give me something for the pain.  But, something clicked in his head and I left with ibuprofen and tylenol.  I have a high tolerance for pain, but, I didn't sleep for two nights.  I called my dentist and talked to him about it, and he did offer me a script at that time, but it's all complete BS.

While a couple days of pain obviously sucks and is inconvenient, I think that's preferable to someone getting addicted to a drug and ruining there lives. I understand that's not everyone but can't really fault prescribers of these drugs to err on the side of caution and not prescribe something at first and then offering to give a prescription if pain persists.

 

[Tau837]

Why are you only reporting the percentage of people who had "active" prescriptions?

Without knowing the percentage of people who had inactive prescriptions, we won't be able to tell whether or not this is "indicative of a prescription opioid problem".

I reported what is in the study I linked. I suppose you would have to ask the authors.

 

[Tool]

I reported what is in the study I linked. I suppose you would have to ask the authors.

Think the point is the study doesn't seem to be very indicative of the point you're trying to make.

 

[Tau837]

Yeah those stats seem pretty meaningless. What about someone who starts with opioids, moves onto heroin and than overdoses on heroin, I doubt they're counted.

It is true that this scenario would not be specifically identifiable in this particular study.

But I completely disagree that the fact that just 1.3% of people who died of opioid overdoses over a 3 year period had prescribed opioids in their systems is meaningless.

 

[Tau837]

Think the point is the study doesn't seem to be very indicative of the point you're trying to make.

The point I made in my post is that the data in the study is not indicative of a prescription opioid problem. I think that is fairly obvious and non-controversial.

If you think the study doesn't support that point, you must believe that the data in the study is indeed indicative of a prescription opioid problem. That doesn't really appear to be what you are saying, since the absence of other data seems to be what you are really getting at.

 

[Tool]

The point I made in my post is that the data in the study is not indicative of a prescription opioid problem. I think that is fairly obvious and non-controversial.

If you think the study doesn't support that point, you must believe that the data in the study is indeed indicative of a prescription opioid problem. That doesn't really appear to be what you are saying, since the absence of other data seems to be what you are really getting at.

You're not very good at logic, are you? It's ok, we all have our strengths and weakness.

Also, the data isn't at all indicative that there is not a prescription drug problem.

Also, it's not at all fairly obvious and non-controversial. You're either being intentionally or non-intentionally ignorant - I'm not sure which is worse.

 

[Tau837]

You're not very good at logic, are you? It's ok, we all have our strengths and weakness.

Also, the data isn't at all indicative that there is not a prescription drug problem.

Also, it's not at all fairly obvious and non-controversial. You're either being intentionally or non-intentionally ignorant - I'm not sure which is worse.

Not sure why you felt the need to turn this exchange hostile by calling me ignorant. I'm very well versed on this subject and far from ignorant about it. That said, I will agree to disagree with you about this particular study. I have posted more than 40 links in this thread, including 2 others today. Maybe you might find those more useful.  

Also, on the bolded statement, that isn't what I said. I said the data is not indicative of a prescription opioid problem. Given the nature of the study, it could have found evidence that clearly shows we have a prescription opioid problem, but it did not. That was my point.

I definitely don't believe we have a prescription opioid problem, but I didn't say this study is indicative of that. That is a different and stronger statement about the study than I made.

 

[tonydead]

While a couple days of pain obviously sucks and is inconvenient, I think that's preferable to someone getting addicted to a drug and ruining there lives. I understand that's not everyone but can't really fault prescribers of these drugs to err on the side of caution and not prescribe something at first and then offering to give a prescription if pain persists.

It is complete BS that my heath care suffers because of drug addicts. 

 

[Tau837]

Excellent and informative articles:

• HOW CDC DUPED THE NATION — PART I, How CDC Duped the Nation With Artificially Inflated Data
  
• HOW CDC DUPED THE NATION — PART II, How CDC Duped the Nation by Exploiting Known System Failures
  
• HOW CDC DUPED THE NATION — PART III, How CDC Duped the Nation Using Distorted Conceptions
  
• Unscientific Guidelines Are Being Peddled As ‘Evidence-Based’ Medicine
  
• Policies Fail on Small Scale, Yet Forced Nationally
  
• The Recommendations that Shaped a National Crisis
  

From that last article:

It appears federal agencies have not only been ignoring important stakeholders’ dissent to these low evidence, unscientific interventions, but they also continue to barrel forward with their strategy in partnership with many others no matter the cost; even if the cost is American lives...

Thousands (at least) have died due to these policies and the lack of evidence they’re based on. Millions more have been left to suffer pointlessly. All due to how this crisis has been framed using taxpayer dollars to dupe the American people into believing that we need to spend billions on interventions that have shown no return on investment for the American people...

Please do not wait until armed DEA agents are banging down your door for a pill count after a surgery, injury, or illness to demand that the appropriate stakeholders are immediately included in the developmental process of health policy, that those with conflicts of interest are excluded, and to demand an emergency review of the Drug Enforcement Agency’s conduct by Congress as well as neutral third party watchdog groups.

The process is happening now, sick and injured Americans don’t have time to wait and each of you could be adversely affected by this in the very near future. Don’t wait until you’re lying helplessly in an emergency room before you realize your doctors’ hands are tied.

 

[avoiding injuries]

There’s a good documentary on Netflix called “The Pharmacist” that covets an opioid outbreak in Louisiana. 

 

[Tau837]

AMA: ‘CDC Guideline Has Harmed Many Patients’

About time.

 

[Honus]

I just fractured two ribs and left my PCP with a prescription for TEN Lortab. She (physician’s assistant) advised me to ration them because it will not be getting renewed. Pissed me right off. From what I can tell, it’s going to take 3-8 weeks to feel better and these pills work for, what, 6 hours? So, I just take one before before bed. During the day, it only hurts then I move...or breathe. 

 

[johnnycakes]

States With Medical Marijuana Laws Saw 20% Drop In Some Opioid Prescriptions

https://www.marijuanamoment.net/states-with-medical-marijuana-laws-saw-20-drop-in-some-opioid-prescriptions/

 

[rascal]

A little over ten years ago I herniated three discs in my lower back (11mm, 9mm, 7mm displacement). When it happened I was home alone and literally unable to crawl the ten feet to my phone to call 911.  I laid there in my feces and urine for hours as any movement resulted in excruciating agony.  I've had broken bones (arm and rib), torn knee ligaments, spinal migraine from failed epidural blood patch, regular migraines (thanks to concussions from football) and kidney stones (the big ones that have to be surgically removed and result in a different spray pattern)...those were nothing compared to this.

I started taking a heavy dose of codeine.  After 18 months I graduated to fetanyl.  I was on these pain killers, taking a pill regardless of need, for almost 2 years.  To say the least I became addicted.

After two years my doctor lost his practice and disappeared.  My new doctor wasn't going to keep giving me those Rx I had become addicted to.  Found out later he filed a report on the extensive fetanyl I had been given.  I knew I was addicted, and instead of searching for a different Dr, I had a "come to Jesus" discussion with my wife.  We decided to have the kids stay away for two weeks and just go cold turkey.  

It was brutal and by far the hardest but best thing I've ever done.  It was during this time that I started to re-find my Christian faith.  Had to reach bottom to start going up I guess.  I was an ####### for months, but my awesome wife, family, and faith were the pillars I needed to pull through.

As part of my going cold turkey I started a healthy dose of ibuprofen which led to other issues.  After developing ulcers, I then went cold turkey with that.  Be careful when taking ibuprofen.  I still have a sensitive stomach today.

While I will always suffer from some long term effects, in both my back injury and addiction to pain meds, my quality of life is about 85% pre back injury.

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.

I had another kidney stone four years ago, see above about requiring removal, and the Dr was going to prescribe codeine.  I refused and just sucked it up with OTC.  While it sucked, and is not something I care to repeat, there was no reason for the Dr to give me codeine.

While it sucks, people need to realize that sometimes pain is not going away and to learn pain management techniques instead of wanting opioids.

Basically, people need to cowboy the #### up.

 

[Terminalxylem]

I just fractured two ribs and left my PCP with a prescription for TEN Lortab. She (physician’s assistant) advised me to ration them because it will not be getting renewed. Pissed me right off. From what I can tell, it’s going to take 3-8 weeks to feel better and these pills work for, what, 6 hours? So, I just take one before before bed. During the day, it only hurts then I move...or breathe. 

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.

 

[DJackson10]

I just saw this thread and won't go through every post but to say DR's are gun shy about opioids is wrong. They are in cahoots with big pharm who is in cahoots with the government. Our Military is not fighting terrorism in Middle Eastern countries like Afghanistan and places near there but protecting and imperializing these countries for their poppy seed fields that control opium. Then selling it to big pharm for prescriptions. The FBI is then selling these opium (Heroine and other opioids to street gangs for either info or other drugs and supplies along with weapons) who sell these drugs on the street to people who became addicts overtime to tolerate pain management. All while big Pharm and the government profit off addicts. 

Afghanistan the new Narcotics country

The Root of Opiod ODS 

This discussion is very near and dear to me as I've lost about 10-15 friends (probably more I've lost count) to this. Most stories start the same. Bad accident prescribe it at the hospital for take home and need more and more to tolerate the pain. Their Dr won't prescribe it but they talk to someone who gives them a wink and a nudge of "hey I know a guy who knows a guy who can get what you need." type of deal. These are not from trusted sources. Also what is given at the hospital is much stronger then what they prescribe you when you leave. There is no withdraw to lower doses while in hospital. They then get addicted to tolerate pain that might be lasting from the accident. Some get help and clean for awhile till the pain returns. They go back to using at the dose they use to take which is where the OD comes into play. 

There's been numerous studies as well as arguments from my Generation (GenXers) that Marijuana is a suitable substitute for this and for pain. I know a few people who have been prescribe medical instead of opioids especially ones who had been addicts. I've seen way too many friends not live their lives because some idiot dr rather take a payday from big pharm while a friend of mine suffers. It's a dam shame because 5-8 of these people (Male and Female) wanted to turn their lives around. The help also isn't there either. People who never have to deal with an addict think they are just idiots or ignorant or trash people. Not a lot of help out there for addicts in terms of clinics and with the rules most places where some of these individuals need to go they have to on their own accord. Family/Friend sends them well they can check themselves out at anytime. I suggest if anyone has had to deal with this unfortunately and lost a loved one do your research. Then when you have it gathered lawyer up and sue the living hell out of the dr/hospital/big pharm and your government. Once more and more people start holding these greedy people accountable maybe we can change things. But until that happens any discussions on topics like this will be for not.   

 

[Tau837]

While it sucks, people need to realize that sometimes pain is not going away and to learn pain management techniques instead of wanting opioids.

Basically, people need to cowboy the #### up.

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.  

 

[Tau837]

to say DR's are gun shy about opioids is wrong

Disagree with plenty in your post, but this is the biggest thing. This is just flat wrong. If it wasn't, the AMA wouldn't be releasing the statement that I linked above.

 

[DJackson10]

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 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.