Forum adverts like this one are shown to any user who is not logged in. Join us by filling out a tiny 3 field form and you will get your own, free, dakka user account which gives a good range of benefits to you: No adverts like this in the forums anymore. Times and dates in your local timezone. Full tracking of what you have read so you can skip to your first unread post, easily see what has changed since you last logged in, and easily see what is new at a glance. Email notifications for threads you want to watch closely. Being a part of the oldest wargaming community on the net. If you are already a member then feel free to login now.

 Ouze wrote:

 BobtheInquisitor wrote:
We end up telling them no narcotics please and throwing away bottles of Vicodin.

(cries internally)

Most of the doctors we visited were more interested in prescribing painkillers than finding out what was actually wrong. There was a real sense for us that they already assumed she was an addict and were just humoring her on the medical side. It threw them for a loop when she refused the painkillers and demanded tests be done. We ended up going to the ER a few times just to find someone, anyone who would treat the cause and not the symptoms.

 BobtheInquisitor wrote:
My wife has had multiple surgeries, and the doctors always seem to prescribe the hardest-hitting painkillers they can. We end up telling them no narcotics please and throwing away bottles of Vicodin.

I just had that vague feeling like I saw someone throwing away books or burning art.

What else would you recommend?

Well, I know what I'd do with them. That's not popular opinion though.

I dunno, keep them for an emergency or maybe not accept the prescription for them, I guess. I still have a couple I don't touch, because they're for backpacking in case someone gets hurt while we're days away from medical facilities.

Just kind of seems like a waste of an otherwise hard to get thing and unless you have kids, it's not like they're going to sneak into your mouths.

 Desubot wrote:
Hang on so are they just shipping it there or was it all prescribed there?

That was my question as well. That and just because a large quantity exists in the town doesn't mean the population needs the prescriptions or the doctors should be prescribing it.
There is a disconnect on the business side of things I don't get:
are these place distribution centers?
are the doctors writing prescriptions they shouldn't (and literally dragging people into appointments they don't need and making stuff up)?
are the pharmacies filling prescriptions they shouldn't (and handing them out like candy to get people addicted)?

There is a supply/demand issue going on that doesn't really match up- a huge supply, a low demand, and yet the coverage of this suggests that everyone in these towns is on it, somehow. And the 'somehow' is really vague and undefined.

 BobtheInquisitor wrote:
What else would you recommend?

I'm not giving you a hard time. It's just that I'd never throw away vicodin; I sometimes have knee problems and having a few laying around is always handy.

Part of the opioid issues, and frequently a cause of the initial “just throw pills at the problem” approach, is societies view on pain and medical treatment.

Our approach to pain is to pretend that being pain-free is a realistic expectation in life. People think that they shouldn’t have everyday aches and pains, they think they shouldn’t have an aching knee after working, they think that it’s remotely reasonable to expect to have zero pain a few days after major orthopedic surgery. People don’t like being told “it’s pain, and we can’t make it go away completely, but we can make it manageable and help you learn to live with it”. People are busy and want an instant solution, rather than therapy. People don’t want to hear “you’ll have pain that’s a 4 our if 10, and that’s as good as it’s gonna get”.

On the institutional side, this is exacerbated by providers being tracked according to patient satisfaction scores. One of the Medicare score card questions is “how well did the hospital treat your pain”, and your survey rate is compared to other facilities competing with you. There are consequences if your rate is below the other facilities, or regional and national averages. If your satisfaction rates are not adequate you are punished by your employer as well. Then there is the realty that there are many areas where there are not enough providers for patients, and you have less than 10 minutes with each patient. You can’t really examine and treat them during that time, so you give them pills because that’s at least something.

There are plenty of pill mills and unethical patients and providers out there. But for many the initial entry into opioids is caused by societies unrealistic view in pain, and a medical model that is focused on perceived outcomes and satisfaction over realistic goals.


Automatically Appended Next Post:

 Ouze wrote:

 BobtheInquisitor wrote:
What else would you recommend?

I'm not giving you a hard time. It's just that I'd never throw away vicodin; I sometimes have knee problems and having a few laying around is always handy.

I know this isn’t a factor in your situation, but an important general reminder is that any pills in your medicine cabinet are generally available to anyone in your house. If you have kids, they or their friends can easily take them and use them. Even a visiting friend with an addiction could easily swipe them. So just as a general reminder, please store any prescriptions securely and dispose of them safely when they are no longer needed.

 daedalus wrote:
Well, I know what I'd do with them. That's not popular opinion though.

I dunno, keep them for an emergency or maybe not accept the prescription for them, I guess. I still have a couple I don't touch, because they're for backpacking in case someone gets hurt while we're days away from medical facilities.

Just kind of seems like a waste of an otherwise hard to get thing and unless you have kids, it's not like they're going to sneak into your mouths.

We have a young child. We also live in a bad neighborhood. I don't want to sell them for a whole lot of reasons, or accidentally let someone know we have them in the house. We usually don't accept the prescriptions if we know about them in advance, but these days some doctors will just electronically send the prescriptions to the pharmacy on their own initiative or send us home with a bag of drugs, so they can bill our insurance we assume.

I come from a family with a history of addiction and my wife's has a similar history, so we would very much prefer to win that war by not fighting it at all.

 d-usa wrote:
Part of the opioid issues, and frequently a cause of the initial “just throw pills at the problem” approach, is societies view on pain and medical treatment.

Our approach to pain is to pretend that being pain-free is a realistic expectation in life. People think that they shouldn’t have everyday aches and pains, they think they shouldn’t have an aching knee after working, they think that it’s remotely reasonable to expect to have zero pain a few days after major orthopedic surgery. People don’t like being told “it’s pain, and we can’t make it go away completely, but we can make it manageable and help you learn to live with it”. People are busy and want an instant solution, rather than therapy. People don’t want to hear “you’ll have pain that’s a 4 our if 10, and that’s as good as it’s gonna get”.

On the institutional side, this is exacerbated by providers being tracked according to patient satisfaction scores. One of the Medicare score card questions is “how well did the hospital treat your pain”, and your survey rate is compared to other facilities competing with you. There are consequences if your rate is below the other facilities, or regional and national averages. If your satisfaction rates are not adequate you are punished by your employer as well. Then there is the realty that there are many areas where there are not enough providers for patients, and you have less than 10 minutes with each patient. You can’t really examine and treat them during that time, so you give them pills because that’s at least something.

There are plenty of pill mills and unethical patients and providers out there. But for many the initial entry into opioids is caused by societies unrealistic view in pain, and a medical model that is focused on perceived outcomes and satisfaction over realistic goals.


Automatically Appended Next Post:

 Ouze wrote:

 BobtheInquisitor wrote:
What else would you recommend?

I'm not giving you a hard time. It's just that I'd never throw away vicodin; I sometimes have knee problems and having a few laying around is always handy.

I know this isn’t a factor in your situation, but an important general reminder is that any pills in your medicine cabinet are generally available to anyone in your house. If you have kids, they or their friends can easily take them and use them. Even a visiting friend with an addiction could easily swipe them. So just as a general reminder, please store any prescriptions securely and dispose of them safely when they are no longer needed.

I would like to offer the other side of the opoid crisis and what the war on it is doing to people with debilitating disease and chronic pain from auto-immune disorders and botched surgeries. MY wife was dropped by a doctor when several pain management referrals went unanswered or ignored upon further investigation. We medicate in illegal manner now with the devils lettuce and it does help manage some symptoms, it can exacerbate others as she has a bad problem with anxiety. So really low levels of opoids daily allows her to function with some discomfort but otherwise lead a perfectly normal life, where she can play with the kids, go to the zoo all day, etc. Now there is none of that, and we risk losing our everything to include kids in the state of Oklahoma if we are caught. While the crisis is a real one, the pendulum in the USA has swung too far in the other direction and now it is hurting normal people who are dependent on these to simply lead a normal life. I offer citation.

Update of pain related suicides

The other opoid crisis

Jeff Sessions sucks

TL-DR
over-reaching CDC restrictions have led to a response far past proportional leaving chronic pain users not being able to be treated, ignored by doctors, dropped from being seen at all, and finally a surge in pain related suicide.

I don’t have access to any research right now, but what has the effects of legalization done to opioid use rates in those states?

But it seems that the mindset of “legal drugs = good and safe” and “illegal drugs = bad and dangerous” has a big role in the opioid crisis.

Some people will always need chronic pain management, not to get that pain from a 3-4 to a 0, but to be able to have a pain that is at least tolerable enough to function. And there are illegal options that appear to have better and safer long-term outcomes than the legal options.

I had a family member who lives in the states and for a very long time she was on extremely high doses of opiate based painkillers and even ketamine at one point.

It took her a ridiculously long time for the doctors to take her description of how bad the pain was seriously and then an even longer time for them to actually go beyond prescribing painkillers to actually finding the root cause (bone growths all over her body, the surgeon who removed them said he didn't understand how she could function at all with the levels of pain she must've been in).

Thankfully, she has massively improved after the surgery. Hopefully it stays that way.

I wonder why the states appears to (at least in this thread) be showing a sign that they'd rather focus on painkillers and drugs than on treatment. I wonder if its linked to the insurance based health system and whereby they can expect insurance/people to be able to pay up easily for pills; but for actual treatment the (often very high )costs are harder to recover? Hence a potential interest in pushing more pills and less focus on actual treatment?

And there are illegal options that appear to have better and safer long-term outcomes than the legal options.

Some of these are also based upon use for the elderly. Where the long term effects are basically a non issue; and also where pain can become a very debilitating aspect of daily life for which there is no viable cure.

That's an interesting notion. The guy I would get them from back when I was doing it for funsies told me that supposedly the original source for them was old people who were handed them like candy but needed the money more than they needed the pain management. I'm uncertain of what the supply chain looks like beyond that.

For whatever it's worth, last time I got a legit prescription, it was I think something like 6 USD for (IIRC) 14 vicodin. The going rate for street vicodin some 4-5 years ago (before they became the boogyman drug) was about 3-4 USD / pill. I can only imagine that they've become more expensive nowadays.

 Overread wrote:
I wonder why the states appears to (at least in this thread) be showing a sign that they'd rather focus on painkillers and drugs than on treatment. I wonder if its linked to the insurance based health system and whereby they can expect insurance/people to be able to pay up easily for pills; but for actual treatment the (often very high )costs are harder to recover? Hence a potential interest in pushing more pills and less focus on actual treatment?

And there are illegal options that appear to have better and safer long-term outcomes than the legal options.

Some of these are also based upon use for the elderly. Where the long term effects are basically a non issue; and also where pain can become a very debilitating aspect of daily life for which there is no viable cure.

What you're seeing is basically the outcome of defensive medicine strategies and an industry that pushes the "zero pain" mindset.

 whembly wrote:
There are distinct differences between the recreational users vs. those are chemically dependent on opiods.

The former is what I'd call "self-medicating" while the latter is incredibly dangerous for the user, such that if they were to go cold-turkey, will feth you up emotionally...not to mention the shock can kill...

'Self-medicating' and 'recreational use' are two very different things - and really should not be confused.

Self medicating is treating symptoms or perceived symptoms of a psychological or physiological nature - a person using a pain reliever to combat pain, without getting a doctor's say so.

Which can lead to dependency just as easily as recreational use - but with the added problem of there being an actual purpose beyond just 'feelin' the groove, man'.

My father was an alcoholic - which began as self-medicating depression.

I am a depressive as well, but avoid alcohol as a self treatment. (I can honestly say that my drinking multiplied twelve times its original level when I started dating my wife - I went from drinking a six pack a year to drinking a six pack a month.)

The Auld Grump - I do not self-medicate.

Other Side of the opiod epidemic...

There are major fears that any new rule / regulation changes would inhibit valid treatment plans.

This isn't a black or white issue.

There are nuances that need to be navigated here...

 BobtheInquisitor wrote:
What else would you recommend?

Its a bit of an aside but in Greece they've developed an app, GIVMED, that helps people give unneeded medication to other people. A guy thought of it after his dad passed, and he was left with a large stockpile of unopened bottles of very expensive medicines that he had to throw out.

Not really an answer to your question, but something to think about given the high cost of medications.


Automatically Appended Next Post:

 daedalus wrote:
That's an interesting notion. The guy I would get them from back when I was doing it for funsies told me that supposedly the original source for them was old people who were handed them like candy but needed the money more than they needed the pain management. I'm uncertain of what the supply chain looks like beyond that.

Back in the ADHD obsessed 90s a few kids in my school would sell their whole prescriptions to other kids.

 sebster wrote:


Back in the ADHD obsessed 90s a few kids in my school would sell their whole prescriptions to other kids.

At the Texas school where my wife worked, one kid was selling his ADHD (Adderol?) medicine to sports players and using the money to buy his marijuana.

 kronk wrote:

 sebster wrote:


Back in the ADHD obsessed 90s a few kids in my school would sell their whole prescriptions to other kids.

At the Texas school where my wife worked, one kid was selling his ADHD (Adderol?) medicine to sports players and using the money to buy his marijuana.

Better living through chemistry. Everybody wins!

 whembly wrote:
Other Side of the opiod epidemic...

There are major fears that any new rule / regulation changes would inhibit valid treatment plans.

This isn't a black or white issue.

There are nuances that need to be navigated here...

Its not they are afraid it will happen, it is happening. Even though the prescribing protocols recommended are simply that, recommendations, it has not stopped the DEA from literally harassing doctors when they do prescribe opioids. The state I am in has similar actual rules which put doctors under a lot of scrutiny before Cheetoh started his war against opioids. As with most over-reach its only the ones doing the right thing that get hurt, since laws generally mean nothing to those who would seak it out illegally in the first place the only difference is actual patients who are dependent on these for a normal day are left out hurting.

Interesting read:
https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3135264

Abstract
The United States is experiencing an epidemic of opioid abuse. In response, many states have increased access to Naloxone, a drug that can save lives when administered during an overdose. However, Naloxone access may unintentionally increase opioid abuse through two channels: (1) saving the lives of active drug users, who survive to continue abusing opioids, and (2) reducing the risk of death per use, thereby making riskier opioid use more appealing. By increasing the number of opioid abusers who need to fund their drug purchases, Naloxone access laws may also increase theft. We exploit the staggered timing of Naloxone access laws to estimate the total effects of these laws. We find that broadening Naloxone access led to more opioid-related emergency room visits and more opioid-related theft, with no reduction in opioid-related mortality. These effects are driven by urban areas and vary by region. We find the most detrimental effects in the Midwest, including a 14% increase in opioid-related mortality in that region. We also find suggestive evidence that broadening Naloxone access increased the use of fentanyl, a particularly potent opioid. While Naloxone has great potential as a harm-reduction strategy, our analysis is consistent with the hypothesis that broadening access to Naloxone encourages riskier behaviors with respect to opioid abuse.

This study goes against conventional wisdom...and once again shows the problems when confronting the opioid epidemic: ITS COMPLICATED.

You would think at the least, easy access to Naloxone would reduce opioid-mortality...but this study hasn't found that.

https://poseidon01.ssrn.com/delivery.php?ID=667085003073001070124119090023113107001083027043001020067123122118106117027072094105058102060121102009115066105090098066092110060005035015015069102021111115103073124007001053116002100117124081007078002031023078091069107099112019113064068023102093089100&EXT=pdf

That "study" was something else...

The writer basically assumes that because Google searches for Narcan increased by 7% after laws to increase access to Narcan were passed, it means that people decided to get hooked on opiods because it's now safe to do so.

What happened to the concept of "correlation =/= causation"?

I dunno...

Narcans stops you from OD'ing... it does nothing for the underlining reasons/addiction to opioid itself.

Please understand that this isn't an argument that we shouldn't have easy access to narcans... (quite the contrary really).

Also... I just realized that paper hasn't been peer-reviewed either (or at least, I didn't see any). So there is that...

 whembly wrote:
Interesting read:
https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3135264

Abstract
The United States is experiencing an epidemic of opioid abuse. In response, many states have increased access to Naloxone, a drug that can save lives when administered during an overdose. However, Naloxone access may unintentionally increase opioid abuse through two channels: (1) saving the lives of active drug users, who survive to continue abusing opioids, and (2) reducing the risk of death per use, thereby making riskier opioid use more appealing. By increasing the number of opioid abusers who need to fund their drug purchases, Naloxone access laws may also increase theft. We exploit the staggered timing of Naloxone access laws to estimate the total effects of these laws. We find that broadening Naloxone access led to more opioid-related emergency room visits and more opioid-related theft, with no reduction in opioid-related mortality. These effects are driven by urban areas and vary by region. We find the most detrimental effects in the Midwest, including a 14% increase in opioid-related mortality in that region. We also find suggestive evidence that broadening Naloxone access increased the use of fentanyl, a particularly potent opioid. While Naloxone has great potential as a harm-reduction strategy, our analysis is consistent with the hypothesis that broadening access to Naloxone encourages riskier behaviors with respect to opioid abuse.

This study goes against conventional wisdom...and once again shows the problems when confronting the opioid epidemic: ITS COMPLICATED.

You would think at the least, easy access to Naloxone would reduce opioid-mortality...but this study hasn't found that.

Maybe more people are visiting the emergency room for opioid related issues because they know their lives can be saved with Narcan. Maybe more people are dying despite Narcan being introduced because the opioid epidemic is getting worse and Narcan is like slapping a bandaid on a bursting dam. Maybe people are turning to using fentanyl because it is handed out like candy, works incredibly quickly, and it can be put on with a patch that can be concealed easily,

Serious question. Is this a real study or some national lampoons stuff? It is seriously attempting to say that maybe Narcan isn't all that good, despite literally saving peoples lives, just because they think people will abuse that to get higher. You know, because people love getting SUPER HIGH really fast and then having the cops/paramedics called so their high and all the money they paid for it can be 100% ruined and thrown in the trash. Then, if it was the cops that were called/showed up because they do have Narcan on them, it is likely they are now in the persons home and can now see everything illegal they have in there.

This study is clearly based on logic. It is like when DARE was going hard and they kept telling all the kids that there were adults that would try to give them free drugs in their candy. Still waiting for my jawbreaker laced with LSD. :(

No doubt. And here I am, still paying for my drugs like a god-damned chump.

 feeder wrote:

 kronk wrote:

 sebster wrote:


Back in the ADHD obsessed 90s a few kids in my school would sell their whole prescriptions to other kids.

At the Texas school where my wife worked, one kid was selling his ADHD (Adderol?) medicine to sports players and using the money to buy his marijuana.

Better living through chemistry. Everybody wins!

The good ole days.


Automatically Appended Next Post:

 redleger wrote:

 whembly wrote:
Other Side of the opiod epidemic...

There are major fears that any new rule / regulation changes would inhibit valid treatment plans.

This isn't a black or white issue.

There are nuances that need to be navigated here...

Its not they are afraid it will happen, it is happening. Even though the prescribing protocols recommended are simply that, recommendations, it has not stopped the DEA from literally harassing doctors when they do prescribe opioids. The state I am in has similar actual rules which put doctors under a lot of scrutiny before Cheetoh started his war against opioids. As with most over-reach its only the ones doing the right thing that get hurt, since laws generally mean nothing to those who would seak it out illegally in the first place the only difference is actual patients who are dependent on these for a normal day are left out hurting.

No kidding - the docs I know just straight up refuse to prescribe strong pain meds. The pill seekers just keep moving around till they find someone who will prescribe them but your average person doesn't have time for that - those people get to suffer through it. It is absolute garbage.

6 month old article from the Brookings institute that's still a good one on the topic of the opioid crisis

https://www.google.com/amp/s/www.brookings.edu/blog/brookings-now/2017/10/25/the-far-reaching-effects-of-the-us-opioid-crisis/amp/

Excerpt "The Centers for Disease Control and Prevention (CDC) reports that for chronic non-cancer pain, opioid dependence occurs in 26 percent of patients using them.

Tragically, one out of every 550 patients started on opioid therapy dies from opioid-related causes a median of 2.6 years after their first prescription."

What a surprise:

https://www.npr.org/sections/health-shots/2018/04/02/598787768/opioid-use-lower-in-states-that-eased-marijuana-laws

It does state that they haven't confirmed that there is a direct relation between the two; it mostly seems that they've simply compared numbers and not done an in depth study to ensure that it is a direct relationship taking place between the selection of one drug over the other.

If you're in an area where one is legal and the other is not, you're more likely to go for the legal one. If both are illegal, you'll go for the one that's easier to get, and it's sad to say that opioids are often easier to get.