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The Opiate and Heroin Epidemic in America


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I blame the medical industry. And make no mistake, it's an industry just like steel, cars, and insurance. They push pills and subbies and don't give one #### about the consequences. Pain management my ###.

This is 100% on the medical industry. Called this back in 2006

https://www.uab.edu/uabmagazine/summer2006/features/drugs

I have had two friends die from drug overdoses, one from heroin the other from inhalants. Both were originally addicted to painkillers.

I have had four friends have to go to rehab for opiate addiction, and all four started with painkillers. Three moved on to Heroin, one stopped himself before he got there. One friend is clean and living a great life but damn near lost everything. Was originally prescribed because of back issues. One is supposedly clean but we never speak anymore probably because he doesn't want to hang around the people he know when he was an addict. Another has been in and out of rehab and has never gotten clean. Has no life and I am sure one day he will overdose and die.

In high school, kids would steal all kinds of pills from their parents. Started out with Lortabs and Percocets and the occasional Xanax or Valium. Then right around 95 OCs hit the market and it was all over. Everyone was taking them.

The medical industry has leaned way too far in favor of big Pharma and the almighty dollar. There are tons of doctors out there practicing legally that are nothing but drug dealers, letting anyone come in and give some sob story about back pain to get a scrip.

So we flooded the market with high-powered opoids, doctors handed them out like candy, and now we have a national epidemic of opoid abuse. Who could have seen this coming?

Too conveniant a call here. Especially when Hospitals are being critiqued like Hotels with pt questionarres asking questions like "Was your pain adequately controlled?" We aren't ALLOWED to refuse to treat a patients pain.

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Well-said, Jack. Though, I think it's more of a socioeconomic/cultural thing than is suggested in your post. There are plenty of white crackheads and methheads in jail.

The constipation meds would be good for people who actually need the opiates. Post-surgery, extreme chronic pain, etc. There are people who will benefit. It's not like constipation is such a deterrent that it's better to not have a treatment for it.

Give them pot. Seriously. Nobody should have opiates. Flammable as ####. Opiates only when you are terminal.

This is much easier to say when it is not you in pain. Pot is nowhere near as effective in pain management as opiates.

I hate to say it but maybe some pain is good. Today's society relies too much on a quick fix in pill form, imo.

Study after study shows this idea to be false. Mild pain is one thing, but strong pain isn't just miserable, it slows down healing and greatly increases the incidence of dangerous complications.

The problem comes in that we don't allow our nurses and doctors to draw a line.

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Well-said, Jack. Though, I think it's more of a socioeconomic/cultural thing than is suggested in your post. There are plenty of white crackheads and methheads in jail.

The constipation meds would be good for people who actually need the opiates. Post-surgery, extreme chronic pain, etc. There are people who will benefit. It's not like constipation is such a deterrent that it's better to not have a treatment for it.

Give them pot. Seriously. Nobody should have opiates. Flammable as ####. Opiates only when you are terminal.

This is much easier to say when it is not you in pain. Pot is nowhere near as effective in pain management as opiates.

I hate to say it but maybe some pain is good. Today's society relies too much on a quick fix in pill form, imo.

Study after study shows this idea to be false. Mild pain is one thing, but strong pain isn't just miserable, it slows down healing and greatly increases the incidence of dangerous complications.

The problem comes in that we don't allow our nurses and doctors to draw a line.

Your initial assertion is that no pain is good so there is obviously no line to be drawn.

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  • 2 months later...
On December 9, 2015 at 10:19 AM, heckmanm said:

I was listening to a podcast that talked about a doctor back in the late 70s (I think) who noticed very low addiction rates among patients given opiates for pain at his hospital. He wrote a letter to the editor to the New England Journal of Medicine, sort of pointing out that this was an unexpected finding and possibly worth someone doing additional research.

Over the years, pharma companies took that letter and gradually started treating it as an extensive formal study "proving" that opiate painkillers were not addictive, and started pushing doctors to prescribe them much more broadly for pain management, despite little or no actual research supporting their position.

I'm reading Dreamland right now, which details the rise of the opiate epidemic- very good read, and it highlights the letter above as one of the early justifications for the massive opiate prescription boom.  The "Porter and Jick" letter referred to only their very limited experience for patients in their database, who were prescribed morphine while patients in the BU hospital.  Purdue Pharma took that letter and used it as foundational proof upon which a boom was born.

 

 

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On 6/9/2015 at 3:40 PM, Bonfire said:

Epidemic seems like a strong term, if 9k in a population of 320 MM. I would have expected the number to be much higher than 9k had I guessed for overdose deaths.

Quoting a very old post here but I didn't see anyone else address it:

Quote from the Centers for Disease Control: Posted Jan 1st 2016

 

More persons died from drug overdoses in the United States in 2014 than during any previous year on record. From 2000 to 2014 nearly half a million persons in the United States have died from drug overdoses. In 2014, there were approximately one and a half times more drug overdose deaths in the United States than deaths from motor vehicle crashes (4). Opioids, primarily prescription pain relievers and heroin, are the main drugs associated with overdose deaths. In 2014, opioids were involved in 28,647 deaths, or 61% of all drug overdose deaths; the rate of opioid overdoses has tripled since 2000. The 2014 data demonstrate that the United States' opioid overdose epidemic includes two distinct but interrelated trends: a 15-year increase in overdose deaths involving prescription opioid pain relievers and a recent surge in illicit opioid overdose deaths, driven largely by heroin.

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6450a3.htm

------------------------------ 

I never once thought this issue was something that would ever affect my "white bread" middle class family but it did ... in the worst possible way.

Unfortunately the realization of how huge this issue is wasn't known to me (and probably many others) until it was too late.

As more and more of us lose loved ones or just deal with family / friends addiction issues, the "epidemic" is acknowledged.

 

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Consider the following:

  1. In 2011, the Institute of Medicine showed that 116 million Americans suffer from chronic pain.
  2. From Prevalence of Chronic Pain in a Representative Sample in the United States: "Chronic pain is the most common symptom for which patients seek medical care."
  3. From CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016: "Opioids are commonly prescribed for pain. An estimated 20% of patients presenting to physician offices with noncancer pain symptoms or pain-related diagnoses (including acute and chronic pain) receive an opioid prescription."

So we can see that chronic pain is a very serious and widespread problem that affects over 100M Americans. And we can assume from these numbers that approximately 20M Americans are prescribed opioid medications. So the need for opioid medications is extensive and real.

Facts on drug overdose deaths:

  1. Per the American Society of Addiction Medicine, in 2014, there were 47,055 drug overdose deaths, which they break down as follows:
    • 18,893 prescription opioid overdose deaths
    • 10,574 heroin overdose deaths
    • 17,588 non-opioid overdose deaths
  2. However:
    • This data is flawed. Some overdoses were counted twice and some deaths blamed on prescription medications were caused by illegal opioids.
    • This metric also includes situations where individuals chose to end their lives with an overdose. Many people who suffer from chronic pain also suffer from chronic depression, and many patients on opioid medication face severely declining quality of life and/or end of life situations. Many of those people who chose to end their life with a prescription opioid overdoes would have found another method if necessary.
    • Altogether, it seems likely that the number of accidental prescription opioid overdose deaths is much lower... which incidentally means they are likely not the leading accidental cause of death in America as has been reported.

So there are likely 15K or fewer accidental prescription opioid deaths annually. Meanwhile, more than 20M Americans use their opioid prescriptions responsibly to treat their pain. I'm sorry, but I don't see an 'epidemic' here.

Also, while overdose deaths have been increasing, as with all statistics, you have to look at context. From 1999-2010, opioid prescription sales increased 300%. So it stands to reason that prescription opioid overdose deaths would increase.

The reason for that increase in opioid prescribing over the past 15-20 years is that prescribing policies changed in the late 1990s, when pain was introduced as the "fifth vital sign." The rationale behind that change was good -- patient advocacy groups and pain specialists successfully lobbied state medical boards and state legislatures to change statutes and regulations to lift any prohibition of opioid use for non-cancer pain. There is a lot of funded cancer research and thus a lot of funded research on cancer pain, and comparatively very little funded research on non-cancer or general pain. There is no reason to believe cancer pain is by definition different or worse than non-cancer pain. So it is not appropriate to reverse these policy changes.

The bigger problem with these changes is that it led to physicians prescribing opioids without any specialty or significant education in pain management. This led to some unquantifiable amount of overprescribing. This is a hard problem to solve, since there are only an estimated 10K pain management specialists in the US... only 1 for every 11K+ Americans suffering from chronic pain. This is the primary issue that needs solving to address these deaths.

Unfortunately, the CDC has now published new opioid prescribing guidelines with questionable validity that are likely to harm tens of millions of Americans who are already suffering in the name of trying to reduce a relatively small number of accidental overdose deaths. These guidelines were developed without patient or pain expert involvement and are universally opposed by national pain organizations

I'm all for taking steps to reduce those deaths, but those steps should be carefully designed and employed to avoid harming those who need opioids and use them responsibly. Unfortunately, the CDC has not done that. Not only that, but CDC has been exclusively focused on how to reduce these deaths for several years rather than on how to improve our understanding and standard of care for pain management, which should be their focus with regard to pain. :thumbdown:

Edited by Just Win Baby
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haven't read most of the posts in here, but these kinds of articles are 3-5 years too late. I work at a bunch of high schools for part of my job. Urban, rural, doesn't matter because pills have become the #1 drug. And when the kids talk pills, it is 80% optiates. 

Anybody who says anything about "drugs" and lumps these kinds of things in with something like pot couldn't be farther off. Just an utter disaster this country has done with a war on "drugs" and not explaining/differentiating differences chemically. Would be nice to have some science and knowledge included in things

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One in three Americans has chronic pain needing medication?

Jeebus wept, is this what you mean when you are talking about the wussification of America?

(That estimate is either ridiculously high compared to reality or there is serious over diagnosis and prescription going on)

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1 hour ago, msommer said:

One in three Americans has chronic pain needing medication?

Jeebus wept, is this what you mean when you are talking about the wussification of America?

(That estimate is either ridiculously high compared to reality or there is serious over diagnosis and prescription going on)

That does seem pretty high.  And I assume that these are mostly adults (and the article claims that the number could be a low estimate), suggesting that about half of American adults suffer from chronic pain.  Though between obesity and sedentary lifestyles, maybe.  

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I'm certainly no expert and would welcome input from others who are, but this veto makes no sense to me.

LePage vetoes bill aimed at increasing access to overdose antidote

Gov. Paul LePage vetoed a bill Wednesday that would allow pharmacists to dispense an anti-overdose drug without a prescription, saying that allowing addicts to keep naloxone on hand “serves only to perpetuate the cycle of addiction.”

The Legislature passed the bill “under the hammer” – or unanimously without a roll call – this month as part of lawmakers’ attempts to address Maine’s growing opioid addiction epidemic.

Maine already allows family members of addicts to receive prescriptions for naloxone hydrochloride – also commonly known by the brand name Narcan – which quickly counteracts the potentially deadly effects of an opiate overdose. The bill, L.D. 1547, aims to make the antidote even more readily available by allowing a pharmacist to dispense naloxone without a prescription to individuals “at risk of experiencing an opioid-related drug overdose” or to a friend or family member of someone at risk.

The legislation would also allow police and fire departments to obtain a supply of naloxone and provides immunity to pharmacists or health care professionals who dispense the antidote when “acting in good faith and with reasonable care.”

But in his veto letter sent to lawmakers on Wednesday, LePage said the bill would allow pharmacists “to dispense naloxone to practically anyone who asks for it.”

“Naloxone does not truly save lives; it merely extends them until the next overdose,” LePage wrote, repeating a contention that has caused controversy before. “Creating a situation where an addict has a heroin needle in one hand and a shot of naloxone in the other produces a sense of normalcy and security around heroin use that serves only to perpetuate the cycle of addiction.”

Pharmacy chains such as Rite Aid and CVS already dispense naloxone without a prescription in other states. About 30 states allow sales of the drug without a prescription.

CVS requested the bill in Maine after receiving a letter from U.S. Sen. Angus King of Maine asking the chain to expand the availability of the antidote. The bill got support from both law enforcement and health organizations during the legislative hearing.

LePage has stirred controversy before with his suggestions that naloxone has become a sort of life-saving crutch for opioid addicts as he points to reports of drug users who have been revived multiple times from overdoses by police or rescue squads. Bill supporters reacted strongly on Wednesday to his statement that the antidote merely extends lives “until the next overdose.”

“With this insensitive statement, Gov. LePage is insinuating that Mainers suffering from addiction are beyond reach – that they cannot be saved,” Sen. Cathy Breen, D-Falmouth, said in a statement. “I disagree. Narcan can be the difference between an early grave and an intervention that can put an addict on the path to recovery. We know that Narcan saves lives. It is incumbent on us to make sure it is readily available.”

There were 272 drug overdose deaths in Maine in 2015, representing a 31 percent increase over the previous year.

“If we have the chance to save even one life, we must seize it,” House Assistant Majority Leader Rep. Sara Gideon, D-Freeport, said in a statement. “Putting this proven life-saving medication into more hands will save lives and spare families the unthinkable loss of a loved one to a preventable overdose.”

In his veto letter, LePage said the state must address the “root causes of the problem” by stopping drug traffickers bringing heroin into Maine, expanding education and prevention efforts and addressing prescribing practices that provide a gateway to heroin abuse.

The Legislature will take up L.D. 1547 and all other vetoed bills during a session on April 29. It takes a two-thirds vote in both the House and Senate to override a gubernatorial veto.

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5 hours ago, whoknew said:

I'm certainly no expert and would welcome input from others who are, but this veto makes no sense to me.

LePage vetoes bill aimed at increasing access to overdose antidote

Gov. Paul LePage vetoed a bill Wednesday that would allow pharmacists to dispense an anti-overdose drug without a prescription, saying that allowing addicts to keep naloxone on hand “serves only to perpetuate the cycle of addiction.”

The Legislature passed the bill “under the hammer” – or unanimously without a roll call – this month as part of lawmakers’ attempts to address Maine’s growing opioid addiction epidemic.

Maine already allows family members of addicts to receive prescriptions for naloxone hydrochloride – also commonly known by the brand name Narcan – which quickly counteracts the potentially deadly effects of an opiate overdose. The bill, L.D. 1547, aims to make the antidote even more readily available by allowing a pharmacist to dispense naloxone without a prescription to individuals “at risk of experiencing an opioid-related drug overdose” or to a friend or family member of someone at risk.

The legislation would also allow police and fire departments to obtain a supply of naloxone and provides immunity to pharmacists or health care professionals who dispense the antidote when “acting in good faith and with reasonable care.”

But in his veto letter sent to lawmakers on Wednesday, LePage said the bill would allow pharmacists “to dispense naloxone to practically anyone who asks for it.”

“Naloxone does not truly save lives; it merely extends them until the next overdose,” LePage wrote, repeating a contention that has caused controversy before. “Creating a situation where an addict has a heroin needle in one hand and a shot of naloxone in the other produces a sense of normalcy and security around heroin use that serves only to perpetuate the cycle of addiction.”

Pharmacy chains such as Rite Aid and CVS already dispense naloxone without a prescription in other states. About 30 states allow sales of the drug without a prescription.

CVS requested the bill in Maine after receiving a letter from U.S. Sen. Angus King of Maine asking the chain to expand the availability of the antidote. The bill got support from both law enforcement and health organizations during the legislative hearing.

LePage has stirred controversy before with his suggestions that naloxone has become a sort of life-saving crutch for opioid addicts as he points to reports of drug users who have been revived multiple times from overdoses by police or rescue squads. Bill supporters reacted strongly on Wednesday to his statement that the antidote merely extends lives “until the next overdose.”

“With this insensitive statement, Gov. LePage is insinuating that Mainers suffering from addiction are beyond reach – that they cannot be saved,” Sen. Cathy Breen, D-Falmouth, said in a statement. “I disagree. Narcan can be the difference between an early grave and an intervention that can put an addict on the path to recovery. We know that Narcan saves lives. It is incumbent on us to make sure it is readily available.”

There were 272 drug overdose deaths in Maine in 2015, representing a 31 percent increase over the previous year.

“If we have the chance to save even one life, we must seize it,” House Assistant Majority Leader Rep. Sara Gideon, D-Freeport, said in a statement. “Putting this proven life-saving medication into more hands will save lives and spare families the unthinkable loss of a loved one to a preventable overdose.”

In his veto letter, LePage said the state must address the “root causes of the problem” by stopping drug traffickers bringing heroin into Maine, expanding education and prevention efforts and addressing prescribing practices that provide a gateway to heroin abuse.

The Legislature will take up L.D. 1547 and all other vetoed bills during a session on April 29. It takes a two-thirds vote in both the House and Senate to override a gubernatorial veto.

Ya know, last time I checked, the emergency services in Portland are currently having this debate.  People working in the community -- drug counselors, homeless advocates, rehab centers, and the like -- are strongly in support of having this drug easily accessible. Considering that prescription overdoses are more common than car crash deaths, this is increasingly an issue that affects people in the non-traditional addict lifestyle.

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On 4/17/2016 at 2:50 PM, Just Win Baby said:

Consider the following:

  1. In 2011, the Institute of Medicine showed that 116 million Americans suffer from chronic pain.
  2. From Prevalence of Chronic Pain in a Representative Sample in the United States: "Chronic pain is the most common symptom for which patients seek medical care."
  3. From CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016: "Opioids are commonly prescribed for pain. An estimated 20% of patients presenting to physician offices with noncancer pain symptoms or pain-related diagnoses (including acute and chronic pain) receive an opioid prescription."

So we can see that chronic pain is a very serious and widespread problem that affects over 100M Americans. And we can assume from these numbers that approximately 20M Americans are prescribed opioid medications. So the need for opioid medications is extensive and real.

Facts on drug overdose deaths:

  1. Per the American Society of Addiction Medicine, in 2014, there were 47,055 drug overdose deaths, which they break down as follows:
    • 18,893 prescription opioid overdose deaths
    • 10,574 heroin overdose deaths
    • 17,588 non-opioid overdose deaths
  2. However:
    • This data is flawed. Some overdoses were counted twice and some deaths blamed on prescription medications were caused by illegal opioids.
    • This metric also includes situations where individuals chose to end their lives with an overdose. Many people who suffer from chronic pain also suffer from chronic depression, and many patients on opioid medication face severely declining quality of life and/or end of life situations. Many of those people who chose to end their life with a prescription opioid overdoes would have found another method if necessary.
    • Altogether, it seems likely that the number of accidental prescription opioid overdose deaths is much lower... which incidentally means they are likely not the leading accidental cause of death in America as has been reported.

So there are likely 15K or fewer accidental prescription opioid deaths annually. Meanwhile, more than 20M Americans use their opioid prescriptions responsibly to treat their pain. I'm sorry, but I don't see an 'epidemic' here.

Also, while overdose deaths have been increasing, as with all statistics, you have to look at context. From 1999-2010, opioid prescription sales increased 300%. So it stands to reason that prescription opioid overdose deaths would increase.

The reason for that increase in opioid prescribing over the past 15-20 years is that prescribing policies changed in the late 1990s, when pain was introduced as the "fifth vital sign." The rationale behind that change was good -- patient advocacy groups and pain specialists successfully lobbied state medical boards and state legislatures to change statutes and regulations to lift any prohibition of opioid use for non-cancer pain. There is a lot of funded cancer research and thus a lot of funded research on cancer pain, and comparatively very little funded research on non-cancer or general pain. There is no reason to believe cancer pain is by definition different or worse than non-cancer pain. So it is not appropriate to reverse these policy changes.

The bigger problem with these changes is that it led to physicians prescribing opioids without any specialty or significant education in pain management. This led to some unquantifiable amount of overprescribing. This is a hard problem to solve, since there are only an estimated 10K pain management specialists in the US... only 1 for every 11K+ Americans suffering from chronic pain. This is the primary issue that needs solving to address these deaths.

Unfortunately, the CDC has now published new opioid prescribing guidelines with questionable validity that are likely to harm tens of millions of Americans who are already suffering in the name of trying to reduce a relatively small number of accidental overdose deaths. These guidelines were developed without patient or pain expert involvement and are universally opposed by national pain organizations

I'm all for taking steps to reduce those deaths, but those steps should be carefully designed and employed to avoid harming those who need opioids and use them responsibly. Unfortunately, the CDC has not done that. Not only that, but CDC has been exclusively focused on how to reduce these deaths for several years rather than on how to improve our understanding and standard of care for pain management, which should be their focus with regard to pain. :thumbdown:

This gave me a lot to think about, but when reading this post, and in particular the article from TIme that you posted, I believe there are some serious questions that need to be raised with some of these stats you are using:

  1. In 2011, the Institute of Medicine showed that 116 million Americans suffer from chronic pain---This doesn't seem way too high to you?  Does this include the fakes, the people complaining form chronic pain just to get pills?  Ask any emergency room staffer what percentage of people are there just looking for drugs, the answer will shock you. 1 in 3 Americans are suffering from a condition that requires incredibly addictive drugs?  Which cure NOTHING, leave the patient dependent on them, and always have the risk of the prescription stopping when the doctor gets nervous, leading the new addict to score smack.  
  2. From Prevalence of Chronic Pain in a Representative Sample in the United States: "Chronic pain is the most common symptom for which patients seek medical care."-It sure is, and for things like muscle and back pain, it's pretty much impossible to prove.  Prescribing an opioid should be the last resort, however........
  3. From the Time article you linked:  Although prescribing of opioids has almost doubled — going from 3.2% of the population in 1988-94 to 5.7% in 2005-08 — it’s not clear that this is out of line with the rise in pain in the population or that the drugs are going to the right people.--Prescribing of opioids has doubled. So, does that mean the number of people suffering from chronic pain has doubled??  If so, we have some other kind  of epidemic on our hands.  Or is it possible the doctors have gotten a bit too free with the scrips?
  4. You break down the overdose deaths, and point to a smaller percentage of opioid deaths.  Come on man!!  How do you think heroin has found its way into small towns?  You think kids saw Trainspotting, and wanted to stick needles in their arms?  No, they got Oxy pills, and then one day, they couldn't get Oxy pills.  It is not that simple, but it's pretty darn close.  Opioids are the ultimate gateway drug.
  5. Also, while overdose deaths have been increasing, as with all statistics, you have to look at context. From 1999-2010, opioid prescription sales increased 300%. So it stands to reason that prescription opioid overdose deaths would increase.--Yes it does stand to reason.  Maybe we should ask why opioid sales have increased 300%.  Does that seem acceptable to you?  Something as dangerous as opioids, getting handed out 300% more?  

 

I have kept anecdotal evidence out of it, but I am sure a lot of people in here have the same sort of anecdotes I have:

Grew up in a small town, I never heard about Oxy till I as in my 20's (43 now).  Heard about the addictiveness, how it was a pill that they gave to people that were just about dead.  Then I was hearing about friends getting it after a surgery.  Kids getting their hands on leftover pills.  The insane prices  for Oxy pills ($1 a milligram) which led to increase in crime, and eventually, it was just cheaper and easier to get heroin.  

I know a LOT of athletes that had surgery, got painkillers, and either had a tough time coming off of them, or simply became addicted, and found other ways to get high.  People should not need powerful painkillers that didn't used to exist after surgery. 

And doctors shouldn't hand out opioids every time a patient complains.  These doctors are handing out pain pills like candy, just to shut up annoying patients, and it's creating a population of heroin addicts in the suburbs.  

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8 hours ago, elbowrm said:

Serious question - do you work for Purdue Pharma, another Pharma do, or a service provider for a Pharma co?

Serious answer: no. I do not and never have worked in any industry relating to healthcare/pharmaceuticals.

However, my wife suffers from very severe chronic pain and must take opioid medication as a result, so I have a lot of personal experience with opioid medication and the associated pros and cons, as well as the related Government policies and actions. My wife has been and continues to be harmed by the Government's 'war' on this opioid 'epidemic.'

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On 4/22/2016 at 9:05 AM, massraider said:

In 2011, the Institute of Medicine showed that 116 million Americans suffer from chronic pain---This doesn't seem way too high to you?  Does this include the fakes, the people complaining form chronic pain just to get pills?  Ask any emergency room staffer what percentage of people are there just looking for drugs, the answer will shock you. 1 in 3 Americans are suffering from a condition that requires incredibly addictive drugs?  Which cure NOTHING, leave the patient dependent on them, and always have the risk of the prescription stopping when the doctor gets nervous, leading the new addict to score smack.

Suffering from chronic pain does not equate to suffering from a condition that requires "incredibly addictive drugs," i.e., opioids. In fact, I posted that 20% of patients presenting to physician offices with non-cancer pain symptoms or pain-related diagnoses (including acute and chronic pain) receive an opioid prescription. Meaning 80% do not.

Like all healthcare conditions, there is a spectrum of chronic pain, both in terms of time and severity, and there is also a spectrum of treatments, including exercise, yoga, meditation, physical therapy, acupuncture, electrical stimulation, and non-opioid medications in addition to opioid medications.

While it is true that opioids do not cure, many people suffering from severe chronic pain require them to have any semblance of quality of life. My wife is one of them. If she was denied her current opioid meds, I expect she would ultimately commit suicide as a result.

Yes, 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. The difference is explained here and here.

 

On 4/22/2016 at 9:05 AM, massraider said:

From Prevalence of Chronic Pain in a Representative Sample in the United States: "Chronic pain is the most common symptom for which patients seek medical care."-It sure is, and for things like muscle and back pain, it's pretty much impossible to prove.  Prescribing an opioid should be the last resort, however........

I agree that opioids are not always the answer. Whether or not they should be the "last resort" depends upon the patient/situation.

 

On 4/22/2016 at 9:05 AM, massraider said:

From the Time article you linked:  Although prescribing of opioids has almost doubled — going from 3.2% of the population in 1988-94 to 5.7% in 2005-08 — it’s not clear that this is out of line with the rise in pain in the population or that the drugs are going to the right people.--Prescribing of opioids has doubled. So, does that mean the number of people suffering from chronic pain has doubled??  If so, we have some other kind  of epidemic on our hands.  Or is it possible the doctors have gotten a bit too free with the scrips?

No, this does not indicate that the number of people suffering from chronic pain has doubled. In my post that you quoted, I pointed out that in the late 1990s, prescribing policies changed to lift any prohibition of opioid use for non-cancer pain. That was a good thing, and obviously should have been expected to increase the prescribing of opioids. Prior to this policy change, there were millions of people suffering from non-cancer pain that was undertreated.

It is also true that we have an aging population and continually improving healthcare that helps extend life even with serious health conditions. These factors should also be expected to increase the number of people suffering from chronic pain over time. As a simple example, in 1990, the US population included 31M persons of age 65 or higher; in 2010, that had risen to 40M.

As for your last question, I pointed out in my post that you quoted that those policy changes led to physicians prescribing opioids without any specialty or significant education in pain management, which led to some unquantifiable amount of overprescribing. As I stated, this is a hard problem to solve, since there are only an estimated 10K pain management specialists in the US... only 1 for every 11K+ Americans suffering from chronic pain. As I stated, this is the primary issue that needs solving to address these deaths.

 

On 4/22/2016 at 9:05 AM, massraider said:

You break down the overdose deaths, and point to a smaller percentage of opioid deaths.  Come on man!!  How do you think heroin has found its way into small towns?  You think kids saw Trainspotting, and wanted to stick needles in their arms?  No, they got Oxy pills, and then one day, they couldn't get Oxy pills.  It is not that simple, but it's pretty darn close.  Opioids are the ultimate gateway drug.

I'm not qualified to answer this. It may very well be that overprescribing opioids led to this problem in many small towns. I agree overprescribing should be stopped, since it is by definition inappropriate. However, that needs to be done without doing harm to a much larger population of Americans who have legitimate need for opioids and are using them responsibly and appropriately. The Government's current approach is doing harm to those people. IMO that is unacceptable.

 

On 4/22/2016 at 9:05 AM, massraider said:

Also, while overdose deaths have been increasing, as with all statistics, you have to look at context. From 1999-2010, opioid prescription sales increased 300%. So it stands to reason that prescription opioid overdose deaths would increase.--Yes it does stand to reason.  Maybe we should ask why opioid sales have increased 300%.  Does that seem acceptable to you?  Something as dangerous as opioids, getting handed out 300% more?

I addressed this in the very next paragraph of my post you quoted and also above in this post. While I don't doubt that there is some fraud and some additional irresponsible/inappropriate prescribing, I believe the vast majority of this increase is justifiable, for the reasons I have presented.

All forms of healthcare are subject to fraud and irresponsible/inappropriate practice, and I see no reason to believe prescription opioids stand out in this area. If you believe they do, let's see some credible evidence of that. And then let's fix that specific problem without harming others.

 

On 4/22/2016 at 9:05 AM, massraider said:

I have kept anecdotal evidence out of it, but I am sure a lot of people in here have the same sort of anecdotes I have:

Grew up in a small town, I never heard about Oxy till I as in my 20's (43 now).  Heard about the addictiveness, how it was a pill that they gave to people that were just about dead.  Then I was hearing about friends getting it after a surgery.  Kids getting their hands on leftover pills.  The insane prices  for Oxy pills ($1 a milligram) which led to increase in crime, and eventually, it was just cheaper and easier to get heroin.  

I know a LOT of athletes that had surgery, got painkillers, and either had a tough time coming off of them, or simply became addicted, and found other ways to get high.  People should not need powerful painkillers that didn't used to exist after surgery. 

And doctors shouldn't hand out opioids every time a patient complains.  These doctors are handing out pain pills like candy, just to shut up annoying patients, and it's creating a population of heroin addicts in the suburbs.

Anecdotal evidence is not an appropriate basis for policy that will harm tens of millions of Americans who are already suffering. Any doctors who are handing out prescription opioids "like candy," i.e., inappropriately, should be stopped and punished. That does not require sweeping policy change.

Edited by Just Win Baby
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23 hours ago, Short Corner said:

Wait, so anyone who doesn't OD is a responsible user?

No, that is a fair point. One of the articles I linked states that 1.9M people had substance use disorders associated with prescription opiates in 2014. Doing the rough math, if there are 116M Americans who suffer from chronic pain, and 20% of them are prescribed opiates, then roughly 8% of those who are prescribed opiates have substance use disorders.

That still means more than 20M Americans are prescribed opiates and do not have either of these negative outcomes. IMO it is close enough to say they are using their prescription opiates responsibly.

In 2014, 21.5M Americans had substance use disorders, meaning that prescription opiates accounted for 8.8% of those.

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http://www.asam.org/docs/default-source/advocacy/opioid-addiction-disease-facts-figures.pdf

 

 Drug overdose is the leading cause of accidental death in the US, with 47,055 lethal drug overdoses in 2014. Opioid addiction is driving this epidemic, with 18,893 overdose deaths related to prescription pain relievers, and 10,574 overdose deaths related to heroin in 2014.5

 From 1999 to 2008, overdose death rates, sales and substance use disorder treatment admissions related to prescription pain relievers increased in parallel. The overdose death rate in 2008 was nearly four times the 1999 rate; sales of prescription pain relievers in 2010 were four times those in 1999; and the substance use disorder treatment admission rate in 2009 was six times the 1999 rate. 6

 In 2012, 259 million prescriptions were written for opioids, which is more than enough to give every American adult their own bottle of pills.

7  Four in five new heroin users started out misusing prescription painkillers. As a consequence, the rate of heroin overdose deaths nearly quadrupled from 2000 to 2013. During this 14-year period, the rate of heroin overdose showed an average increase of 6% per year from 2000 to 2010, followed by a larger average increase of 37% per year from 2010 to 2013. 8  94% of respondents in a 2014 survey of people in treatment for opioid addiction said they chose to use heroin because prescription opioids were “far more expensive and harder to obtain.”

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19 minutes ago, massraider said:

http://www.asam.org/docs/default-source/advocacy/opioid-addiction-disease-facts-figures.pdf

 

 Drug overdose is the leading cause of accidental death in the US, with 47,055 lethal drug overdoses in 2014. Opioid addiction is driving this epidemic, with 18,893 overdose deaths related to prescription pain relievers, and 10,574 overdose deaths related to heroin in 2014.5

 From 1999 to 2008, overdose death rates, sales and substance use disorder treatment admissions related to prescription pain relievers increased in parallel. The overdose death rate in 2008 was nearly four times the 1999 rate; sales of prescription pain relievers in 2010 were four times those in 1999; and the substance use disorder treatment admission rate in 2009 was six times the 1999 rate. 6

 In 2012, 259 million prescriptions were written for opioids, which is more than enough to give every American adult their own bottle of pills.

7  Four in five new heroin users started out misusing prescription painkillers. As a consequence, the rate of heroin overdose deaths nearly quadrupled from 2000 to 2013. During this 14-year period, the rate of heroin overdose showed an average increase of 6% per year from 2000 to 2010, followed by a larger average increase of 37% per year from 2010 to 2013. 8  94% of respondents in a 2014 survey of people in treatment for opioid addiction said they chose to use heroin because prescription opioids were “far more expensive and harder to obtain.”

I linked this article previously, and I already posted that the data in your first bullet here is flawed. Still too many deaths, but likely 15K or less, not 19K.

I already posted reasons for your second bullet.

Your third bullet is a valid fact followed by a phrase meant to sensationalize. Most patients who are prescribed opioids receive those prescriptions every month. Many of them receive more than one such prescription per month (for example, my wife receives 6 such prescriptions per month). Assuming the majority of these prescriptions go to patients with chronic pain and the rest go to short term users (e.g., after accidents, surgery, etc.) probably puts the number of adults who receive opioid prescriptions in a given year nowadays at around 20M, in line with the data I posted previously. That is 6% or less of the US population.

The fourth bullet is tragic. But my sympathy goes to the millions of Americans who are suffering from chronic pain, not the minority of individuals who overdose on illegal drugs, whether heroin or illegal use of prescription opioids. :shrug:

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7 minutes ago, massraider said:

Yeah, see, your anecodotal evidence doesn't get to trump my anecdotal evidence.  

 

Your wife suffering from legit chronic pain doesn't mean millions of others are not just seeking drugs.  

I have posted facts about the number of people suffering from chronic pain. Show me some facts that tell us how many people (a) fake it to seek drugs and (b) are successful in getting them. Until then, my facts trump your unsubstantiated opinions.

ETA: I'm sure there are millions who are drug seekers. But I also expect that most of them are unsuccessful at getting them prescribed. I base this on how my wife is treated when we have to take her to the ER or to a new doctor. They always treat her initially like a drug seeker, and it requires a lot of time and effort to convince them she isn't. It is one of the terrible side effects of this situation for those who are truly suffering. As long as we are trading anecdotal evidence...

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4 hours ago, Just Win Baby said:

Serious answer: no. I do not and never have worked in any industry relating to healthcare/pharmaceuticals.

However, my wife suffers from very severe chronic pain and must take opioid medication as a result, so I have a lot of personal experience with opioid medication and the associated pros and cons, as well as the related Government policies and actions. My wife has been and continues to be harmed by the Government's 'war' on this opioid 'epidemic.'

Sorry to hear, that must be very difficult to deal with.

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I made up some crap about a pain in my foot that was keeping me awake and the doctor prescribed Tramadol. It's a synthetic opiate but considered mild and less addicting. It's not as heavily scrutinized as oxy or Vicodin, so I was able to keep refilling it over and over for about a year before the doctor said he wanted to see me before he'd refill it again. That stuff is awesome.

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22 minutes ago, urbanhack said:

legalize marijuana federally and get people on medicinal CBD instead of opiates.  It's not addictive and would make our states a hell of a lot of additional tax revenue.   

Legalize weed and decriminalize all other drugs except heroin and far fewer people will want to try illegal opiates.

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21 hours ago, urbanhack said:

legalize marijuana federally and get people on medicinal CBD instead of opiates.  It's not addictive and would make our states a hell of a lot of additional tax revenue.   

Makes too much sense so it will be another 50 years before it happens.  The war on drugs is a cash cow for the Feds and the prison system.  Besides, big Pharma needs to get their mitts on weed before any legality at the federal level will happen.

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  • 2 weeks later...
  • 2 months later...

Not completely on topic but it seems there is big problem in the US concerning retail pharmaceuticals...

4 times the per capita spend (in PPP dollars) comparing the US to Denmark. And almost the same ratio between prescription and non prescription medicine.

50% more than number two, twice the average of OECD countries.

Pretty scary

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  • 3 weeks later...

http://www.cbsnews.com/news/26-heroin-overdoses-over-4-hours-huntington-west-virginia/

I doubt an small town like this would be the first batch containing this       but, stories like this could become more and more common. Although, one thing I will say about the drug trade is by and large they know that bad publicity is bad for business and there is no worse pub than a spike in ODs.

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On 7/30/2016 at 10:56 AM, msommer said:

Not completely on topic but it seems there is big problem in the US concerning retail pharmaceuticals...

4 times the per capita spend (in PPP dollars) comparing the US to Denmark. And almost the same ratio between prescription and non prescription medicine.

50% more than number two, twice the average of OECD countries.

Pretty scary

If only we could negotiate drug prices like other countries do.

 

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On 8/20/2016 at 9:43 AM, Apple Jack said:

http://www.cbsnews.com/news/26-heroin-overdoses-over-4-hours-huntington-west-virginia/

I doubt an small town like this would be the first batch containing this       but, stories like this could become more and more common. Although, one thing I will say about the drug trade is by and large they know that bad publicity is bad for business and there is no worse pub than a spike in ODs.

Welp, that's what it is. This is really, really scary. And sadly, heroin's grip is so strong that it won't discourage many people from accepting the risk and continuing to use.

http://www.cnn.com/2016/08/24/health/elephant-tranquilizer-carfentanil-heroin/index.html

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On April 21, 2016 at 5:48 PM, elbowrm said:

Exhibit 1,000 that the governor of Maine is a ####### idiot.

I guess this is Exhibit 1001:

 

PORTLAND, Maine (AP) — Republican Gov. Paul LePage has unleashed an obscene tirade on a Democratic legislator, leaving him a voicemail message that said "I am after you" and telling reporters he wished it were 1825 so he could challenge the lawmaker to a duel and point a gun between his eyes.

LePage said in the Thursday morning voicemail that he wanted to talk with Rep. Drew Gattine of Westbrook about the legislator calling him a racist. Gattine has denied calling LePage a racist.

"I want you to prove that I'm a racist," LePage said, adding that he had spent his life helping black people. "I want you to record this and make it public because I am after you."

LePage, who's white, was accused of making racially insensitive comments Wednesday at a town hall in North Berwick, where he said photos he's collected in a binder of drug dealers arrested in the state showed that 90 percent of them "are black and Hispanic people from Waterbury, Connecticut; the Bronx; and Brooklyn."

House and Senate Democrats and the Maine Democratic Party on Friday questioned LePage's capacity to lead. LePage's office didn't immediately comment.

After leaving the voicemail, LePage later invited reporters to the governor's mansion, where he confirmed that he had left the message and said he wished he and Gattine could face off in a duel.

"When a snot-nosed little guy from Westbrook calls me a racist, now I'd like him to come up here because, tell you right now, I wish it were 1825," LePage said, according to the Portland Press Herald. "And we would have a duel, that's how angry I am, and I would not put my gun in the air, I guarantee you, I would not be (Alexander) Hamilton. I would point it right between his eyes because he is a snot-nosed little runt and he has not done a damn thing since he's been in this Legislature to help move the state forward."

Police in Westbrook said Friday that they had received a citizen complaint about the voicemail. A police official said the complaint came from someone who didn't live in the city. It's unclear if there will be an investigation.

Gattine, who is running for re-election, has clashed with the governor on how to address welfare reform, drug addiction and eligibility for developmental disabilities programs.

Gattine said he wasn't concerned about his safety, but he called the voicemail a distraction and the latest of LePage's personal vendettas against lawmakers. Gattine shared the voicemail's audio with the Press Herald.

"The fact is he sits around fantasizing about having duels with legislators or obsessing over the race of people who are arrested for crimes," Gating said.

Democratic U.S. Rep. Chellie Pingree said in a statement that it's "embarrassing" that LePage is contributing to the "steady loss of civility in politics."

LePage, in his second term as governor, has a history of drawing attention for his blunt remarks. In January, Paul LePage said drug dealers with names like "D-Money, Smoothie, Shifty" are getting Maine's white girls pregnant. He later apologized, saying he meant to say "Maine women" and not "white women."

LePage has compared his style to that of Republican presidential nominee Donald Trump, whom he supports, though he recently said Trump was his third choice for president after Chris Christie and Jeb Bush.

"I was Donald Trump before Donald Trump became popular, so I think I should support him since we're one of the same cloth," he told radio show host Howie Carr in February.

LePage this week called the father of a dead Muslim U.S. Army captain a "con artist" for criticizing Trump. LePage's daughter Lauren LePage has been hired by Trump and vice presidential candidate Mike Pence to work as the state's coalition director.

--

I wonder why this Gattine thinks the Gov is a racist.

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  • 1 month later...

Seems to be ramped in the DMV area.  These kids are going to have their kidneys dropping out by the time they're 30.

I really hope the crackdown on prescription pills saves the next generation from getting hooked on opiates but currently the progression from popping pills early in high school to all-out heroin use before they finish seems way too common. 

A friend of my is a child phycologist and says I need to start talking to my daughter now about it (she's 9) as many of the kids are even starting in Junior High.

I don't smoke weed nor care but now It's even making me lean towards NOT legalizing weed because the crap is so strong now that it's priming these kids to want a better high.

Concerned dad here.  :(

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On 10/20/2016 at 7:50 AM, Arizona Ron said:

I don't smoke weed nor care but now It's even making me lean towards NOT legalizing weed because the crap is so strong now that it's priming these kids to want a better high.

That's like banning caffeine or sugar because you don't want to prime kids for meth/coke.  Keeping it illegal is the real primer as they begin to see circumventing the law as not as big of a personal risk.  There's no reason to group a drug that is impossible to fatally OD on in the same "schedule" as the drugs that destroy lives. 

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7 minutes ago, cockroach said:

That's like banning caffeine or sugar because you don't want to prime kids for meth/coke.  Keeping it illegal is the real primer as they begin to see circumventing the law as not as big of a personal risk.  There's no reason to group a drug that is impossible to fatally OD on in the same "schedule" as the drugs that destroy lives. 

A friend and I used to say...

"Nobody ever robbed a store for weed money"

 

Maybe shoplift a can of pringles but that's it.

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If kids are people they can try almost anything and find their way back. If they aint people, you can lock em in a padded Mormon tower and they will #### it up. Be their anchor, not their umbrella and they'll be fine*.

*By 'fine', wikkidpissah means prey to the normal limits of accident probability as the average young person. Warning: some people have had changes in behavior, hostility, agitation, depressed mood, suicidal thoughts or actions after listening to wikkidpissah. Some people had these symptoms when they began following his advice and others developed them after several weeks of or after stopping wikkidpissah. If you, your family, or caregiver notice agitation, hostility, depression, or changes in behavior, thinking, or mood that are not typical for you, or you develop suicidal thoughts or actions, anxiety, panic, aggression, anger, mania, abnormal sensations, hallucinations, paranoia, or confusion, stop listening to wikkidpissah and call your doctor right away. Also tell your doctor about any history of gullibility or other mental health problems before listening to wikkidpissah, as these symptoms may worsen while following his advice.

 

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On 4/22/2016 at 7:39 PM, McGarnicle said:

I made up some crap about a pain in my foot that was keeping me awake and the doctor prescribed Tramadol. It's a synthetic opiate but considered mild and less addicting. It's not as heavily scrutinized as oxy or Vicodin, so I was able to keep refilling it over and over for about a year before the doctor said he wanted to see me before he'd refill it again. That stuff is awesome.

Schedule 2 drugs are very, very difficult to get.

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7 hours ago, RokNRole said:

A friend and I used to say...

"Nobody ever robbed a store for weed money"

 

Maybe shoplift a can of pringles but that's it.

But in Arizona Ron's case, that aint no can of Pringles in his pants.

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On 10/20/2016 at 7:50 AM, Arizona Ron said:

Seems to be ramped in the DMV area.  These kids are going to have their kidneys dropping out by the time they're 30.

I really hope the crackdown on prescription pills saves the next generation from getting hooked on opiates but currently the progression from popping pills early in high school to all-out heroin use before they finish seems way too common. 

A friend of my is a child phycologist and says I need to start talking to my daughter now about it (she's 9) as many of the kids are even starting in Junior High.

I don't smoke weed nor care but now It's even making me lean towards NOT legalizing weed because the crap is so strong now that it's priming these kids to want a better high.

Concerned dad here.  :(

If it's so strong, why would kids want to risk ####ing around with opiates?

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