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The Opiate and Heroin Epidemic in America (3 Viewers)

MikeIke said:
:(

Sorry you and she had to go through that, Wikkid. 
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Uwe Blab said:
:(  Jeez...what he said. That's gob smackingly horrific. 
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Yeah, i HATE junkies. They like the jackpots they get in and get you in cuz it makes it a better escape when they hit up. I'm still here from all my #### cuz i'm a careful dude and that scene sucked and it goes wrong i'm a dime in stir. And Mary woulda pissed em off into rat####in us so i hadda do it and it blew a lot of my dough, too. Still werent a tenth of what she went thru.... 6'1, 135 in her mud-wrestling prime, 5'6, 79 when she died.

Just watched a special on Hendrix and it reminded me - it's all worth it to be with someone aint like nobody else ever was. And memories don't know pain. Thx for the thoughts....

 
This is an outstanding article: WARNING TO THE FDA: BEWARE OF “SIMPLE” SOLUTIONS IN CHRONIC PAIN AND ADDICTION

From postings by tens of thousands of chronic pain patients in social media, it is clear that the existing CDC opioid guidelines have directly resulted in an exodus of physicians out of pain management practice. Patients are being summarily discharged or unilaterally tapered down from opioid dose levels that have safely controlled pain and promoted function for many years.  Suicides have occurred and more should be anticipated as ever more patients are plunged into agony, disability, and depression by denial of care. 17,18

Given the substantial body of published medical and popular literature which contradicts the CDC de facto standard to which the FDA proposes to train doctors, the only ethically and scientifically sound direction for present FDA training efforts must be to publicly acknowledge that the CDC opioid guidelines must first be withdrawn and rewritten to correct their many errors and omissions. On the second time around, ethics consultants should be included in the writing group. Pain management specialists active in community practice should lead the effort. Pain patients or advocates must be voting members of the group.

This time, the CDC and FDA need to develop a practice guideline that is truly “patient centered,” rather than being a knee-jerk response to political pressure to “do something” even if that something is clearly the wrong thing. 19
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Another one from the same author: THE CDC IS WRONG. A SPEECH BY RICHARD LAWHERN, PHD, Excerpts from Address to the Rally Against Pain
Washington DC, October 22, 2016

Papers in science and medicine are generally begun with a short summary called an “abstract”. This is where the authors record their “take away ideas” before getting into details. The first two paragraphs of Martin, Poteet, and Lazris’ paper are really eye-opening. So let’s read them aloud:

“The American crisis of opioid addiction and overdose compels our strongest efforts toward successful prevention and treatment. Recommendations from the Centers for Disease Control and Prevention (CDC) for chronic opioid use, however, move away from evidence, describing widespread hazards that are not supported by current literature. This description, and its accompanying public commentary, are being used to create guidelines and state-wide policies.

“These recommendations are in conflict with other independent appraisals of the evidence or lack thereof and conflate [confuse] public health goals with individual medical care. The CDC frames the recommendations as being for primary care clinicians and their individual patients. Yet the threat of addiction largely comes from diverted prescription opioids, not from long-term use with a skilled prescriber in [an ongoing] clinical relationship. By not acknowledging the role of diversion and instead focusing on individuals who report functional and pain benefit for their severe chronic pain, the CDC misses the target.

This is a startling summary. What it tells us is that the CDC screwed up BIG TIME last March when they issued guidelines for prescribing opioids – medicine that literally millions of people need in order to maintain any quality of life in the face of chronic pain.

...

The CDC needs to withdraw its unscientific and damaging opioid guidelines. Revisions should acknowledge that at the present state of medical knowledge, opioids are an indispensable part of managing agonizing pain, and trained doctors are the best decision makers on how much is needed to relieve pain in each individual patient.

Standards of practice and doctor training are needed. But the present CDC guidelines are a poor basis for such standards. Re-writing should be accomplished by professionals who actually understand chronic pain and its management, and not by addiction specialists who have a financial self-interest in diverting limited government resources away from proven pain treatments.

For the longer term, the US National Institutes for Health needs to allocate far more research and resources to the study and treatment of chronic pain. At present, less than 1% of NIH research funds are directed to chronic pain – for one quarter of the US population.

It is time to STOP THE WAR AGAINST PAIN PATIENTS!
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Comments from Training Health Care Providers on Pain Management and Safe Use of Opioid Analgesics, Exploring the Path Forward – An FDA Workshop:

Day 1:

MR. LAWHERN: Good afternoon. I am Richard Lawhern, known to my friends as "Red". For the past 21 years, I've supported chronic neurologic face-ain patients and others, as a non-physician research analyst, writer, and moderator for peer-to-peer online groups. I daily interact with Facebook forums in which the membership is over 20,000 patients and family members. I have no financial conflicts of interest.

To begin this short presentation, I would draw the attention of the members in front to the fact that at present, millions of people either hyper metabolize or poorly metabolize opioid medications. This is due to variations in what is called the CYP2D6 genotype.

As a direct consequence of this reality in the patient population, there can be no universally applicable threshold of risk in MMED. Tens of thousands of patients are now stably maintained with zero opioid addiction risk on dose levels exceeding 200 MMED or even 400 MMED, and there are case reports of patients maintained stably on 2500 MMED. If you deny these people opioid therapy, you might as well shoot them because you will be killing them.

Beyond that, I wish to convey a message from those whom I support. Some FDA participants may find this a bit jarring, but if you're truly concerned with the patient safety, then the first thing you can do in this organization is to adjourn without disseminating one more guideline.

This is true because the CDC guidelines on opioid prescription are egregiously incomplete, scientifically ill-supported, and are extremely damaging to patient interests. The document, as it has been issued last March, is desperately flawed. It needs to be taken down, retracted, and done over from scratch.

Since the CDC released its guidelines, tens of thousands of patients have been summarily discharged without referral. Many have been denied medical care, and some have been deserted in opioid withdrawal. Many more have been arbitrarily tapered down from opioids, which have been effective and safe for them for years; plunged into agony and disability, losing whatever quality of life they had. Suicides due to unbearable pain have occurred in numbers, and you may anticipate more. We are seeing evidence of that every day in social media.

Doctors are now leaving practice in part because they fear a campaign of extra judicial persecution by the DEA. DEA regularly seizes patient medical records before filing indictments, and then prolongs legal action for years in a knowing attempt to bankrupt the practitioner or bludgeon them into a consent decree. This is something widely understood and widely accepted by tens of thousands of people who have been affected.
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Day 2:

MS. CHAMBERS: Hi. My name is Jan Chambers. I'm the founder and president of the National Fibromyalgia and Chronic Pain Association. We focus on education, advocacy, research, and support. I've served as a working group member on the National Pain Strategy to develop that. I was on the service and delivery working group, and then I was also honored to work on the Federal Pain Research Strategy, which is just now coming to a finish, and then working there in the transition from acute to chronic pain to basically develop a blueprint for the research for the United States.

My concern, my alarm is up here after these meetings and the recent events, and so my comments are a little bit strong. I feel that the -- especially the different agencies, the federal agencies who are making policies and the different service providers that they rely on or are giving them recommendations are completely out of touch with patients.

There have been no assessments, no national assessments that have been discussed as a main tool to measure how are people with chronic pain doing and what do we do as they transition from acute to chronic pain. We're only measuring the opioid misuse and abuse.

My concern is that the policy is ignoring and actually having an unintended consequence to cause torture to millions of people, the fear of pain, the experience of severe pain. And when I talk about the disabling chronic pain, I'm not talking about people with common chronic pain ailments. I'm talking about people who can't get out of bed, people who can't work, people who can't help their families.

This kind of brain-seizing pain is the pain that we need to focus on. This is what our prescriber education needs to understand. This often leads to suicidal ideation. We know from our national surveys by our organization that 27 percent of patients when they don't have access to pain relief, some kind of medication or treatment, that 27 percent of them are considering suicide as a way out. This is alarming.
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Here is another excellent article: Neat, Plausible, and Generally Wrong: A Response to the CDC Recommendations for Chronic Opioid Use

With these new recommendations concerning the use of opioids, the CDC has taken available data and developed a narrative that H.L. Mencken would generally have described as “neat, plausible, and wrong.”

The narrative is as follows: People in chronic, severe pain are readily provided unproven opioids in ever-increasing doses, get easily addicted and die of overdose either from the opioids prescribed to them or from a switch to lethal heroin.

Neat? Yes. Plausible? Yes. Wrong? Unfortunately, yes.
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I know it's just anecdotal, but when I was in rehab last year almost every one of the oxy/heroin guys had their start from a legit medical reason.  Dental work, sports injuries, the stories were pretty much all the same.

That being said, the govt cracking down on legit chronic pain patients is a typically ridiculous reaction to the problem.

 
Homer J Simpson said:
I know it's just anecdotal, but when I was in rehab last year almost every one of the oxy/heroin guys had their start from a legit medical reason.  Dental work, sports injuries, the stories were pretty much all the same.

That being said, the govt cracking down on legit chronic pain patients is a typically ridiculous reaction to the problem.
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Yeah I don't understand how anyone thinks prescription painkillers are not a huge part of the problem. There are large numbers of addicts that would have never started if they didn't get hooked on painkillers first. Yeah it's anecdotal, but almost everyone on this board probably knows someone that got hooked on heroin that started with oxy first. I know too many people that went down this path. And the large number of pill mills and pain clinic fraud cases in recent years are not anecdotal. Just google it.

 
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TwinTurbo said:
Yeah I don't understand how anyone thinks prescription painkillers are not a huge part of the problem. There are large numbers of addicts that would have never started if they didn't get hooked on painkillers first. Yeah it's anecdotal, but almost everyone on this board probably knows someone that got hooked on heroin that started with oxy first. I know too many people that went down this path. And the large number of pill mills and pain clinic fraud cases in recent years are not anecdotal. Just google it.
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Amazing how different the takes are now that its mostly white people getting hooked. "Poor victms" vs "Animals/vermin". If you are old enough to have lived through the crack epidemic in the eighties you know what I mean. Oddly enough its the "personal responsibility" voters.   

 
Jackstraw said:
Amazing how different the takes are now that its mostly white people getting hooked. "Poor victms" vs "Animals/vermin". If you are old enough to have lived through the crack epidemic in the eighties you know what I mean. Oddly enough its the "personal responsibility" voters.   
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Meth is probably the most analogous to crack - its ripping up a lot of the rural areas around here still.  They are mostly white and, when caught, tend to be locked up for quite a while (and they are viewed much less kindly than folks on painkillers).  

 
Jackstraw said:
Amazing how different the takes are now that its mostly white people getting hooked. "Poor victms" vs "Animals/vermin". If you are old enough to have lived through the crack epidemic in the eighties you know what I mean. Oddly enough its the "personal responsibility" voters.   
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Yeah I am old enough to have lived through that epidemic. I grew up in Detroit in the 80's, so I've seen what crack can do. My take is not "poor victims" or personal responsibility, rather that there is a serious problem with excessive opioid prescribing. If this news from today is true, then one-third of US adults used prescription opioids in 2015. That is absolutely insane. 

http://www.cbsnews.com/news/more-than-one-third-americans-prescribed-opioids-in-2015/

https://ca.news.yahoo.com/more-third-us-adults-prescribed-opioids-2015-102126736.html

Like Sand pointed out, Meth is probably most analogous to crack, but I've never seen so many people dying from heroin and fentanyl. Drug overdoses are now the leading cause of death for Americans under 50. 

 
TitusIII said:
I grew up playing baseball, all state my senior year, straight As, full ride to an amazing academic institution. Had my wisdom teeth taken out a year after finishing undergrad, was given a 30 count of vicodin... Within one year was shooting heroin on the west side of Chicago. 3 years clean today, seen it all, done it all, and it isn't pretty out there. Took me 5 years of consistent relapses and multiple stints in jail/rehab to get this right, and I'm still scared of what could easily happen again if I let it.  This crap is in the high schools, in your neighborhood, wherever you live. This disease can hit anyone, please educate your children on the horrors of addiction and if nothing else, hide your Rxs from them. Good luck and God bless to anyone fighting the good fight. 
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Worst funeral I've ever went to.  Great baseball player, our LL all star team got honored on the field at Dodger Stadium, I coached him for several years.  Left handed pitcher, right handed masher at the plate.  Got a scholarship to University of Reno, had arm problems, dropped out, rumors started.  Then transferred to a JC in Vegas.  Next thing you know he's arrested for intent to distribute.  Dead 2 years later at 26.  We poured dirt from his HS baseball field on his coffin.  Centerpieces at the reception were about 15 signed home run balls from me.  Absolutely heartbreaking to see the family and community go through that.  We've also had Erik Kramer's son OD and die in our town, several others.  Just horrific.

 
Homer J Simpson said:
I know it's just anecdotal, but when I was in rehab last year almost every one of the oxy/heroin guys had their start from a legit medical reason.  Dental work, sports injuries, the stories were pretty much all the same.

That being said, the govt cracking down on legit chronic pain patients is a typically ridiculous reaction to the problem.
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That's what pisses me off.  Been in a lot of pain lately after breaking my neck and already had degenerative disc disease before that. I've had about a dozen injections in my spine this year alone but it always kind of hurts to really ####### hurts.  Anyone that has hurt their back knows what I mean.  I get Vicodin and really only use them when  I'm in a lot of pain and after the work day is done.  I used to stretch a script of 28 Vicodin to 2-3 months but the last few months I've taken one almost every day, until last week.  The last injection finally seemed to do the trick where the pain is only moderate.  Of course I took the script, which I can't get without a doctor's visit which generally takes 3 weeks notice and $50 co-pay now, and also need to jump through hoops with insurance to actually get the ####### thing filled.  Like everything else, the stupid government paints everything and everyone with a broad stroke exasperating the problem they are trying to solve.

 
mquinnjr said:
Of course it would. Pharm lobbying is the only reason the real poison of synthetic opiates are the current medical standard of care and marijuana is not moving off of Schedule 1 vs. THC-based derivative possibilities for pain treatment. 
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I smoke my fair share of weed, for oh, 33 years, does nothing for my back and neck pain.  I also get randomly drug tested before before getting a script for Vicodin too which I didn't realize and tested positive for weed.  The doc said he didn't mind and understood but he couldn't write another script for me if I were to test positive again.  So now I drug test myself before appointments to make sure I'm clean in case I have to pee.

 
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St. Louis Bob said:
I smoke my fair share of weed, for oh, 33 years, does nothing for my back and neck pain.  I also get randomly drug tested before before getting a script for Vicodin too which I didn't realize and tested positive for weed.  The doc said he didn't mind and understood but he couldn't write another script for me if I were to test positive again.  So now I drug test myself before appointments to make sure I'm clean in case I have to pee.
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Seriously? I've never heard of this.

 
Steed said:
It may sound counterintuitive but the reason  being is they have to make sure the Vicodin/opiates are being used by the patient and not ending up on the street 
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Yeah, I also remembered a story about a junkie being tested for suboxone renewals for the same reason.

 
In a claimed effort to help with the Opioid epidemic, large insurer Cigna will no longer cover OxiContin on most of their employer group plans. 

Personally, I think the decision is more financial than anything (they are subbing in a cheaper alternative "Xtampza ER" which they claim has "abuse deterrent properties").  Carriers often alter their drug formularies - just like with doctors joining and leaving the carrier's network.  If a cheaper alternative becomes available, they will put the cheaper version on their formulary, but often allow the individual to "buy up" to the more expensive or name brand version.  I see this all the time now with ADHD type drugs - and people get PISSED because their kids have been on the one drug for years and "it works better than anything else we've tried." 

Thoughts?

 
matttyl said:
In a claimed effort to help with the Opioid epidemic, large insurer Cigna will no longer cover OxiContin on most of their employer group plans. 

Personally, I think the decision is more financial than anything (they are subbing in a cheaper alternative "Xtampza ER" which they claim has "abuse deterrent properties").  Carriers often alter their drug formularies - just like with doctors joining and leaving the carrier's network.  If a cheaper alternative becomes available, they will put the cheaper version on their formulary, but often allow the individual to "buy up" to the more expensive or name brand version.  I see this all the time now with ADHD type drugs - and people get PISSED because their kids have been on the one drug for years and "it works better than anything else we've tried." 

Thoughts?
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It is a BS move by Cigna, likely driven by dollars, as you suggest. Oxycontin and Xtampza ER are not identical, which makes it a certainty that there will be individuals for whom Xtampza will be less effective than Oxycontin. That is not speculation, that is a fact.

 
Just Win Baby said:
It is a BS move by Cigna, likely driven by dollars, as you suggest. Oxycontin and Xtampza ER are not identical, which makes it a certainty that there will be individuals for whom Xtampza will be less effective than Oxycontin. That is not speculation, that is a fact.
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Oh, of course.  I said the same about the ADHD drugs - I've had parents in tears about drugs being altered on the formulary.  Anyone abusing the system now, though, will just buy a policy from someone other than Cigna who still has the drug they want on their formulary.

 
It's like if you were a drug kingpin operating out of some backwater town and you offered all the sherriff's deputies big bucks to work as your personal security, and they were able to write laws legalizing heroin and meth, and the mayor rubber stamped it. 

If it seemed weird that these pills are so widely available, now we know. Fairly stunning, if not necessarily surprising once taken into context of how DC operates. 

Lots of folks in business suits need to be in prison.

 
Asked this in the Trump thread, is there a synopsis of the 60 minutes thing? I'm willing to watch it but I don't really like the 60 minutes style of news media. Too much filler and lead up to get to a point that could be hammered out in 3-4 minutes.

 
culdeus said:
Asked this in the Trump thread, is there a synopsis of the 60 minutes thing? I'm willing to watch it but I don't really like the 60 minutes style of news media. Too much filler and lead up to get to a point that could be hammered out in 3-4 minutes.
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Well, it's pretty much the consistent 60 Minutes thing, with an industry hiring people off the rolls of an enforcement agency (DEA) to come up with workarounds and eventually throwing enough money to have private entities actually writing the governing legislation. The kicker on this one was that the bad guy in this story, the conduit of the corruption in govt is about to be appointed Drug Czar, which was their big reveal at the end.

 
One thing that really struck me in the 60 minutes piece was the drug company vid from ~2001 where they claim these drugs were not addictive at all.  I had shoulder surgery in 2001 and was prescribed Tylenol 3--basically Tylenol with codeine--a low level prescription pain pill.  After my second surgery ~2 years later, the same doctor prescribed vicodin (mid level pain pill) and oxycontin (high level pain pill).  I remember taking an oxy and understanding how people got hooked on these pills--I flushed them soon after. 

 
chet said:
One thing that really struck me in the 60 minutes piece was the drug company vid from ~2001 where they claim these drugs were not addictive at all.  I had shoulder surgery in 2001 and was prescribed Tylenol 3--basically Tylenol with codeine--a low level prescription pain pill.  After my second surgery ~2 years later, the same doctor prescribed vicodin (mid level pain pill) and oxycontin (high level pain pill).  I remember taking an oxy and understanding how people got hooked on these pills--I flushed them soon after. 
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Not defending the drug manufacturers here, but I already posted links to two things earlier in the thread that bear on the bolded:

  1. Opioids result in physical dependency. That is not the same thing as addiction. It is an important distinction rarely made by those who do not deal with these issues every day.
  2. The percentage of those who take opioids who develop addiction disorder is less than 5%.
 
Sand said:
So evidently in 2015 1/3 of the US adult population was prescribed opiods.  That's effing ridiculous.

 I wonder what the real number of people is who need painkillers this strong? Gotta be way, way less than that.
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I realize this post is a few months old, but I was glancing back through the thread and saw it. Hopefully everyone realizes the breadth of what medications are classified as opioids. For example, Tylenol with Codeine, Robitussin AC and several other cough syrups, and Maxiflu and several other flu medications all contain Codeine, and thus all qualify. I don't know where to find data to determine what portion of the opioid prescriptions referenced in the article here were relatively benign versions like these.

It is also true that people who had many different kinds of surgeries (dental and medical) would be prescribed opioids on a short term basis for pain. In 2009, 48 million people had inpatient surgery in the US, and, as of 2010, more than 50 million outpatient surgeries were performed per year in the US. Not sure if those numbers include dental surgeries. Regardless, this shows that, as of 2010, more than 100M surgeries were performed in the US. I'm sure that is a significant contributor to how many opioid prescriptions are written in a given year.

Just a couple things to consider.

 
Driving home from work on Friday, I heard conservative talk show host Michael Berry say that the "heroin epidemic" is just as overblown as the "obesity epidemic", and that the government shouldn't get involved with a situation that largely amounts to "personal choices" by adults.

Those talking points would have fit right in with 1980s Republicans, but I'm pretty sure most of the country is up to speed by now.

 
For those of you that have done the take back program--do you just take the prescription labels off the bottles before turning it over or what?

It says scratch personal info out, so do they still want to see what type of med it is?

 
I called a local police station that came up in the collection search. Was told the label can be removed. The drugs will be incinerated and don't need to be identified.
They take pills and liquids. No needles.

 
Article from the BBC

Why are opioids such an American problem

A funny anecdote from the article

"I'm 51," he says. "If I go to an American doctor and say 'Hey - I ran the marathon I used to run when I was 30, now I'm all sore, fix me', my doctor will probably try to fix me.

"If you do that in France the doctor would say 'It's life, have a glass of wine - what do you want from me?'"
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We have a drug overdose crisis, not a prescription opioid crisis

...the preliminary 2016 reports of drug overdoses indicate that about 3 out of 4, or 75 percent, of drug-related deaths appear to involve a substance other than a prescribed opioid. Therefore, of the estimated 63,000 overdose deaths, only 1 out of 4 (or 25 percent) - that is, 16,000 - are associated with prescription opioids.

We need to recognize that the opioid epidemic has shifted away from prescription opioids. The number of recent overdoses of non-prescription drugs have eclipsed the original problem of prescribed painkillers.

Yet, most reports, including the President's Commission on Combating Drug Addiction and the Opioid Crisis, conflate the overdose data into one alarming figure that misleads policymakers into proposing interventions that don't address the primary source of the problem.
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The Death of Pain Management

There are now efforts to standardize pain management through the development of “best practices.”  President Trump’s opioid commission, the VA, Medicare, and other government agencies are creating them with input from addiction treatment advocates and insurance payers, without input from pain management experts or people in pain.

Will the art and science of pain management survive these assaults? I certainly want it to. But it will be difficult to re-educate providers and bring back into practice those who have been persecuted by the DEA and the media.

The narrative needs to change. We need to refocus on the harmful effects of inadequate pain management, the maltreatment of people in pain, and what forces are behind this butchery of adequate pain management.

Pain management, according to the World Health Organization, is a human right.  What kind of world and country do we live in when this right is blatantly ignored and the health of many placed in jeopardy by the death of pain management?
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