The doctor just didn't want to have to deal with the any extra scrutiny of his practice!!!!

"Many doctors and pharmacists responding to POLITICO’s survey acknowledged such patients’ predicament. But they said they feel under enormous pressure to limit the powerful painkillers and fearful of consequences, such as losing their licenses or even prison time, for inappropriate prescribing."

He had chronic pain that could not be treated with anything else long term.

The bigger issue for him anyway is building resistance to the drug.

and if found to be necessary, treatment for addiction. According to the story, that isn't what happened.

Unless someone interviews the doctor, there's no way to know and I don't think the doctor can say one way or another unless the patient okays it.

Pain is not the same thing as withdrawl induced symptoms like anxiety, so imo your assertion is wrong.

Virtually everyone taking benzos (like zanax) is physically addicted to the drug, should doctors cut off their anxiety meds to help them "beat the addiction"?

incapable of movement because they MIGHT be addicted?

I recently had surgery for a spinal injury I had sustained about 40 years ago. When the pain became unbearable, I was prescribed hydrocodone which I took between 2 and 4 per day to stay upright. I finally found a surgeon who could repair the broken places in my spine and that relieved much of the pain, but the years of incorrect posture and stance created crippling arthritis in my hip. After my hip surgery, I stopped taking pills and except for some days of deep sorrow for the earth and all her inhabitants, I really suffered no withdrawal. I believe that they are life savers for pain. When you take them for pleasure, that's where the addiction comes from. JMHO

Because of unrelenting pain. Or lived with it yourself.

Only someone without real life experience with chronic pain could read of individuals so desperate for relief that not existing seems preferable to living without relief from it, and dismiss them as addicts.

"Every day, more than 115 people in the United States die after overdosing on opioids."

https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis

As a former foster parent, I've seen first hand the harm drug addicted parents have done to their infants, toddlers or young children.

are not the ones overdosing - unless they are forced into the streets to seek relief from their chronic pain. At that point, they are overdosing from the fentanyl lacing - which would not occur had they been uncer the care of their physicians.

These individuals should not be punished, driven to suicide - or to the far riskier street drugs - in order to obtain relief from chronic pain.

Address drug addiction, and fentanyl lacing - the most significant problem with illegal opioids - without depriving driving those who need medical relief to suicide. We don't ban swimming merely because some people die - and that is effectively what is happening wtih the demonizing - and outfight bans - of narcotic pain relief.

Well stated. Thanks

My wife is on them for disabling (otherwise) back pain.

The doctor can issue a one month prescription. No refills. After a month, you have to go back and get a brand new scrip.

The pharmacy keeps track of the number each patient gets. Now, we live in a small town so only one pharmacy, but there are others within easy driving distance. All the same chain. They keep corporate records.

Try to doctor shop and the pharmacy is legally obligated to say no.

My wife only takes what is prescribed (actually less as she can do up to 15 a week, but generally takes only 9 or 10). She never runs out and is not an abuser.

The epidemic of usage is due to people (doctors, pharmacies, and users) actually violating already existing laws.

Legitimate pain sufferers on these meds are not the problem. And making them pay because some people do it wrong makes no sense at all.

"The doctor can issue a one month prescription. No refills. After a month, you have to go back and get a brand new scrip. "

One can sell just a few pills to make some cash. Addicts around here know the folks who are willing to sell even just one pill and when they get their scripts filled.

"My wife only takes what is prescribed (actually less as she can do up to 15 a week, but generally takes only 9 or 10). She never runs out and is not an abuser. "

The sellers I'm talking about are like your wife. They are prescribed a certain amount but can get by with less and they sell what they don't need.

"Legitimate pain sufferers on these meds are not the problem. "

The ones who sell are a major problem.

And insulting, to boot.
You must be fun at parties.

Imagine what beer would be like if the alcohol content ranged from zero to one hundred percent and there was no way to tell the difference until after you'd drunk the forty ounces.

I developed a serious respect for NSAIDS after they started making my stomach bleed. That was Celebrex, which was falsely advertised not to do that. Now I get by with my CBD potions, effectiveness which may or may not be all in my head, placebo effect. But I buy it at the dispensary alongside the THC enthusiasts, so it must be good, right? (FYI, me and THC do not play well together... THC is too much like when I quit my prescribed psych meds, except that I'm less likely to run. Off my meds I've been known to run all night on bloody bare feet.)

I think addicts should get free drugs, whatever it takes to get them through the day, and so long as they tolerate some supervision and their lives are on a positive trajectory.

Abstinence only is fucking bullshit, just as it is in sex education.

well, I won't live in constant pain. THAT I CAN TELL YOU

and a companion disease that dramatically increases her risk for a half-dozen (painful) cancers, or more, I know what you mean. She has informed me that she is still here becuase she chooses to be. If life becomes so hard becuase of chronic pain (either physical or emotional), it is pretty clear that she will - at some point - choose not to be.

People who want to hang the opioid crises on individuals living with chronic pain ought to try it for a hot minute, and see how long it takes before they understand who bears the brunt of this witchhunt, and the extent of the cost to those individuals and their families.

Some days even with pain meds it feels horrible.

I have talked with my doc about what to do when I have taken my allowed pain meds and the pain is so strong still.

He says that is when I go to the ER and let them shoot morphine overnight.

Thank god for insurance. How many can not afford to do that?

Most docs wont do this of course, but if this CHILDISH reaction to an opioid crisis is allowed to continue, docs will hve no choice and people in pain will either become street junkies or kill themselves.

If you have chronic debilitating pain from which there is no cure, what does it matter if one is addicted?

If it's helping them, let them be. Unless there's a side effect (worse than debilitating pain and suicidal urges) that I'm unaware of.

Some people are in such great pain that without a strong opiate they will become junkies from another source or just kill themselves.

Last edited Tue Aug 28, 2018, 08:54 PM - Edit history (1)

Physical dependence or even tolerance is NOT the same thing as addiction, though, and they should know that as well. If they're conflating them, they shouldn't be prescribing opiates at all.

I do find it a little more ethical to cut a person off of opiates without a taper than benzos, however. Actually, any doctor prescribing a benzo for more than two months had better taper their patient down, or they're risking a malpractice lawsuit should the abrupt withdrawal cause status epilepticus or manic psychosis.

I also think pain management doctors really should manage most non-cancer, non-acute pain requiring opiates, for the sheer fact that GPs don't always know the best ways to manage dependence, reduce likelihood of tolerance, and certainly aren't qualified to handle addicts who also suffer from chronic pain. My father's meth addiction shouldn't have stopped him from getting treatment for his pain, but it did make them choose methadone over other long-acting opiates (edit: and if he preferred downers to uppers, it'd probably have been Suboxone instead). It's (edit: both are) quite effective at relieving pain.

The addiction is a given. Dropping someone who is addicted is incredibly irresponsible and this irresponsibility extends well past the doctors to those who make irresponsible public policy.

I see mostly pediatric patients and the doses of morphine oxycodone fentanyl or methadone that are required for comfort in some of the kids with metastatic cancer is mind blowing. Luckily, we are seeing less kids with cancer in our program due to medical advances. We have had situations where we weren't sure if the pharmacy could get us as much medication as we need before a child dies.

We have been told by our hospice pharmacy it's about vulture capitalism. (Ok the pharmacist didn't use that phrase but I do.) One pharmaceutical company buying out other and deciding that morphine isn't profitable so they won't produce a lot of morphine.

I fear for our future when the FDA limits it even further.

people taking low doses for long periods of time because of chronic pain ARE addicted. So what? The medication enables them to live comfortably and function. They aren't getting high or obtaining drugs on the black market.

There are legitimate reasons for prescribing these drugs long term. People like Mr. Fowlkes are not going to OD. Will the suicide deaths be counted against the OD toll?

It's collateral damage as far as drug warriors are concerned. They'll rationalize it. They were just addicted anyway, see?

We have to have priorities, you know.

A person can make some decent money selling a few extra pills.

Are you trying to suggest that there is a connection between chronic pain and crime? Selling/giving away your RXs to others has always been a crime. It isn't a reason to ban pain medicine.

I'm talking about the infants, toddlers and young children of drug addicts and the emotional and physical abuse and neglect they suffer.

I'm glad I'm not part of your world.

However, it's the effects of alcohol and crack abuse while she was pregnant that make them unable to live independently today as adults, not painkillers.

If you think you can stop a determined addict by cutting off painkillers for old ladies (or anyone else with a legitimate need for a prescription), you might have seen the effects of addiction, but you've never lived with an addict.

I had enough of his antics while he was living with us so I was able to convince my wife that we call the state police. A stint in jail along with outpatient treatment turned his life around and he's been clean for two years now and is living on his own. I also was a foster parent and dealt with parents who were( and most likely still are) addicts. So yes, I do a a great deal of experience.

It was an eye opener when he told me who he bought his pills from. I know 7 of them personally. One has since died of cancer, another was busted and spent time in jail and the other 5 are still active sellers the last I heard. Middle aged people.

It took jail to get your stepson to hit bottom. (Despite several stints in jail/various rehabs, my Dad never did -- but his HIV diagnosis might have altered what "bottom" could be for him, if that wasn't it.)

Would your stepson have really stopped drug use if the sellers of diverted prescription drugs just agreed not to sell to him, while he still had the physical freedom to seek opiates in other forms or substitute one substance for another? Honestly? The fact you decided he *didn't* need that physical freedom of movement kinda says what you thought was the answer at the time, at least...

Having watched my dad attempt to extract the mild upper in 90's formula Benzadrex nasal inhalers to shoot up when he couldn't find meth.... well, I've seen how creative and persistent addicts will do whatever it takes if they haven't found motivation within themselves to clean up. You can't supply that motivation externally -- it has to come from the person themselves.

Of course, there's no reason to shelter them from dealing with the consequences of their addiction, either. That sort of enabling keeps them from ever finding that motivation. Even if I disagree with you that trying to prevent diversion by policing old ladies pills would be effective, I do want to say good on you for NOT enabling him by allowing illegal activity in your home or letting him escape the consequences of possessing diverted pills. You probably did save his life, as if he lost enough contacts for diverted but at least genuine pills but had the freedom to seek elsewhere... well, we know what's lurking in fake pills and powders.

His first pills came from a friend who stole them from his grandmother and aunt. The two women choose to suffer from pain until they could get their scripts filled again rather then turn in a family member. The former friend of my step son still occasionally steals from the two. But their refusal to turn him in makes them enablers.

I'm not arguing that rescription opioids be banned but I believe it needs to be very tightly controlled because of the well documented devastation the prescribed meds have caused.

I had the questionable benefit of having a dire warning very close to home (if you can't have a shining example...), combined with the unquestionable benefits from early talks with other children of alcoholics and addicts in rooms where you went by your first name and shared your experience, strength, and hope. I had enough education to know the "escape" from emotional pain substances bring is temporary, and often isn't even an escape at all.

The difficulty of overcoming the view that you're "turning in" someone vs potentially saving their lives, the amount of pain being at the crossroads of that decision brings, is why I felt compelled to affirm (even if you already knew, there are some things that bear repeating) you did the right thing.

As far as systemic drivers for diversion, though, as you said, selling is more the issue than theft -- even if you don't follow through, saying that you're going to have to go down to the police station and file a report that *someone* stole them might be a first-time solution if you know a teen has been sneaking pills. During various injuries, I did keep a decoy bottle in my medicine cabinet after realizing one of my friends apparently had a problem because my pill count was off, identified the friend by watching the decoy bottle's count, and told them to get help if they felt they had to steal. Safes/locks/etc. Usually people who need, and especially people who really like, their pills will protect them after theft is noticed, unless they are incapable of protecting themselves (which is why I'm more concerned about policing caregivers than little old ladies themselves).

The population most likely to sell any prescription for subsistence are low-income disability beneficiaries -- the population that likely needs the meds the most, but also needs to pay the electric bill. Most disabled people eligible for public or subsidized housing (expected to pay only 30% of their income for housing) are paying substantially more because the basic funds aren't there in the programs that are supposed to help them, the waiting lists are full, etc. States run out of LIHEAP money. Addressing those gaps in financial assistance to people likely being prescribed "good shit" IMHO *will* lower the amount of routinely diverted prescription drugs we see. And improve their quality of life, so they aren't having to sacrifice functionality for lights.

I admit I'm in the camp of believing non-acute pain requiring routine opiates should be managed by a specialist. But in their efforts to lower diversion, perhaps less should be spent on monthly urinalysis to make sure they are taking the medication (random would probably be just as effective), and more on hiring a social worker to coordinate assistance to make sure people aren't in the position of having to divert even a few of the high-street value meds they need to be taking, not selling. Would definitely make for happier patients, too -- many may desperately need such case management assistance and can't get it.

Maybe a few do it to make ends meet. But the ones I personally know do it for the easy cash.

Your comment:

"I admit I'm in the camp of believing non-acute pain requiring routine opiates should be managed by a specialist."

How does one separate those who truly do suffer from acute pain from those who claim to but actually don't? The latter may have pain but not acute pain.

Another insidious aspect of illicit use of prescription opioids compared to drugs such as heroin is that with the former, there's the potential of having one or more drug dealers in every small town.

The typical dosage to treat moderate to severe pain is nor more the 6-8 pills per day. The street value of a 5 mg or 2.5 mg hydrocodone is around $5.00 per pill. Skip 2 to 3 pills a day and one can potentially make about $300 to $350 extra a month or $3600 to $4200 a year.

https://www.medicalnewstoday.com/articles/322547.php

https://streetrx.com/

... then you're coming dangerously close to a position I firmly disagree with, which was exemplified by my ex's family.

When he was 14 he had his four wisdom teeth surgically extracted and four premolars yanked for braces, the doctor wrote about a week of painkillers. His father tore up the prescription in front of the doctor and said his son was going to "deal with pain like a man".

ER docs -- who fortunately can access state PMP databases to see if there have been other recent opiate prescriptions, but don't have the benefit of years treating the pt -- should only give enough to last until they can get to their GP. And GPs, who are not trained to deal with all complications of chronic pain management with routine opiates, should not be writing for much longer than a month -- if the original self-limiting injury isn't healed enough by then, they likely need an orthopaedic specialist if not also a PM specialist.

But I've never had my GP question if my pain was "acute" vs "chronic" when I presented with a unilateral discolored cankle that could bear weight but was obviously not what it preferred to do. Or the broken arm as a kid (didn't feel the pain for several hours from shock, but DAMN that fucker hurt once the initial endorphins wore off). Or when I dislocated my kneecap and the swelling made that knee twice the size of the other.

And fortunately I haven't had that "unilateral discolored cankle" presentation since ankle ligament repair surgery.

because of health conditions

Your whole approach to this is based on your ONE personal experience, and if up to you, you would sentence millions of sufferers to unbelievable pain and suffering.

so don't assume

If I have extra, I stash them away for the just in case scenario such as the doctor retires, goes on vacation or the holiday is longer and the pharmacy is closed.

" More than half (53 percent) of prescription opioid users got their last painkillers from a friend or relative, with 40.4 percent paying nothing for the pills.1"

https://talbottcampus.com/prescription-drug-abuse-statistics/

Is it your argument that opioid addicts steal all the pills they get?

"Prescription opioid drugs contribute to 40 percent of all US opioid overdose deaths.8
In 2016, more than 46 people died each day from overdoses involving prescription opioids.8"

https://talbottcampus.com/prescription-drug-abuse-statistics/

you said


https://www.democraticunderground.com/?com=view_post&forum=1002&pid=11068319


What you are being told is ANYONE selling their painkillers is NOT themselves dependent on them or needing them for legitimate pain. NOBODY in either condition sells their pills.

Someone who got one RX for a broken arm and didnt take them all and then sold them, has nothing to do with this.

Unless you want to have a round up of people after they were prescribed to see if they have remaining pills to sell, you cant regulate this.

Seriously. I do not.

I cannot take NSAIDs unless I wish to die; I do not. I can only take narcotics; I hope everyone who wants them banned can spend just one hour in the pain I endure after taking pain relief. Actually, I’d rather they spend their lives in agony without relief, just as they want for me and people like me.

I have never sold or given away my prescription medicines. I have excellent insurance; I do not need to sell pills to make ends meet or to afford to continue my care. Perhaps that’s the real problem - the expense of long term health problems driving people to do desperate things and people self-medicating because they cannot afford proper treatment. But it’s so so much easier to take the self-righteous route, isn’t it? Easier to enact another prohibition instead of looking for real solutions. Addicts are just scum and pain patients are just scummy addicts, right? Fuck ‘em. Yeah, well fuck that.

my life

Regardless of how individuals are getting them "It affects 2 million Americans and continues to wreak havoc on our nation, killing more than 130 people every day."

[link:https://www.briarwooddetox.com/blog/how-do-you-kick-a-painkiller-addiction/|

With the strongest being Carfentanil

"Carfentanil is a highly potent synthetic opioid and a fentanyl analog. According to the U.S. Drug Enforcement Administration (DEA), carfentanil is about 10,000 times more potent than morphine and 100 times more potent than fentanyl.3 It is used as a tranquilizer for elephants and other large animals so even a very tiny dose can be lethal in humans. Carfentanil has been linked to a significant number of overdose deaths all over the country and continues to be a serious danger to public safety. Occasionally it is found on the black market and has surfaced in communities all over the U.S."

[link:https://www.briarwooddetox.com/blog/pain-medication-list-strongest-to-weakest/|

But it is ok. At least they have some quality of life with the meds. Without them they can't even function.

Horrible choice to have to make.

I have a friend whose back is all messed up. She knows she is addicted but without her pain meds she has no life. With them she can function well enough to stay in her home .

Being drug dependent means you need those drugs to live a life approaching normal. Take away the drugs and the person will not only suffer withdrawal, but all the loss of mobility, and quality of life.

Being ADDICTED means that the person is seeking the *high* of a medication and will continually need to up their dose in order to get that high, and will persist in that behavior in the face of increasing consequences.

Anyone who is intent on cutting off the pain relief of those who are dependent on them for quality of life, I invite you to go fuck yourself.

I would personally like to volunteer to take a sledge hammer and smash the spine daily of these proponents of "buckle up, be a man" chronic pain deniers.

I can't wait until they are passing a kidney stone with no pain relief.


Assholes

thank you

Physical dependence will occur on most any drug, as in taking the drug itself alters brain chemicals in a way that the brain learns to compensate to deal with -- and ideally unlearns by tapering vs abrupt discontinuation. For example, benzodiazepines. GABA is a necessary inhibitory neurotransmitter, and benzo-treated patient's brains learn to compensate in necessary areas when too much GABA is bad. Abrupt discontinuation of the thing making GABA work better leaves the brain still acting like it's used to getting a GABA-enhancer, and worst case scenario is seizures they can't stop. Second-worst is manic psychosis. Both can be fatal and are easily prevented with a proper taper.

A person can become physically dependent on an opiate as a result of even a brief acute episode of use, if the dose isn't titrated by patient or provider correctly, regardless of the actual physical pain levels that would exist after a "knockout withdrawal" process (the European method, using barbiturates to induce a coma through the worst, then tapering the GABA agent). This is why orthopedic surgeons are especially cautious with painkillers, if they expect the operation to be a success. During my ankle ligament repair surgery, they created far more pain than I had from the retear of the ligament itself -- drilled a hole in my fibula. They know that they're creating pain to stop it, and concerns about appropriate tapering was why I took the Tramadol at the end vs just tossing the script. It didn't do anything for my perception of pain during PT, but I recognized it might prevent rebound perception of worse pain after slamming my brain with painkillers I'd never had before during the immediate recovery process.

Tolerance is another issue, but closely related. Everyone taking a substance that messes with brain chemicals long enough develops tolerance to its worst effects, and therefore also to its desired effects -- which can require dose escalation and it be proper, if done in a careful manner. Truthfully, one *should* start low and titrate up as base pain and tolerance require.

Therefore, every long-term opiate ingester, whether they need the drugs to keep a standard of life vs just keep them from residing in their bathroom for a week or two, is by definition both dependent and tolerant to opiates. Needing a higher dose isn't always an indication of addiction. If opiate use is titrated appropriately, dose escalation is an expected part of the process -- if none is needed they likely overshot the original necessary dose and the patient did the titration themselves by halving doses to avoid early nausea, etc.

Addiction is, as you said, when the person's use of the drug is causing more harm than it solves for them yet the psychological reinforcing effects of taking it overcome the logic circuit. Yet even addicts may need pain management outside of hospice, and denying appropriate pain relief just because they have an addiction history is inhumane. And when the harm is from, for example with MMJ patients in non-MMJ states, the illegal way they obtain a drug they actually need.... who is really at fault? The doctor who wrote them off and left them seeking fake street pills laced with IMF vs considering Suboxone?

My husband gets his pain pump filled every 3 months. A giant needle goes into a port, he had surgery for an internal device. Nurse anesthetist comes to the house.

Then, every 6 months, he has to fly to another state. In this case the original doctors for rx of lighter pain meds. Cause the pain Cather goes to his spine and works on his back. The car that struck him also hit his pelvis and knee. The pain meds go for those areas. Neat, huh?

People don't get it. His quality of life is good, and I'm grateful for the medical technology and caring doctors in other states. Also thank you national pharmacy chain, because that is why he can refill his medication every month in another state. He's been on them over 15 years.

Damn people, breathe. Don't play doctor, life is hard enough.

My son has suffered from it since he was 29. He is in his 50s now and without pain meds, he probably would have committed suicide years ago.
The pain is indescribable.

If people need pain meds they need it and the regulators should take that into consideration before going off half-cocked.

Except there it is unregulated and people don't know for sure that they are getting.

My cardiologist is having a fit because I have to take 1800 MG of ibuprofen a day to function.

He's telling me if I don't stop, I will die.

Guess what? Since I cannot have anything more than a small dose of tramadol, I'm not going to stop.
Why go on living a life in constant pain?

and I haven't pulled the research on all of this (I have worked with addicts, though - so I have some interest in all of this .

But I just looked quickly and NSAIDS cause far fewer deaths than opioids. They are understood to be less dangerous

Is it that you are using too much? I'm guessing that's part of it? I do know that they are more dangerous than 'we' thought (I saw a study on that not too long ago).

I know that, years ago, Jon Kabat-Zinn did research with chronic pain sufferers - using meditation. That doesn't cure pain, of course, but people who learned meditation techniques did do better (and suffered less).

I hope you find something that works for you

I am using prescription strength ibuprofen, so it is considered "safe" in the short term, but not for long term use.
But, I need it to function, long term due to my arthritis (which is not going to reverse and get better, it's only going to get worse).

I do yoga, meditation, and take ALL the supplements that have been shown to have any helpful benefits.

None of it replaces my need for ibuprofen.

I'm not even allowed to try anything stronger than tramadol, under the current state guidelines under this hysteria.

I'm a bit resentful about having that option off the table, when my life is at stake.

The nsaids worked great until his stomach started bleeding. Then his doctors switched him over to opiates.

for some people.

When my elderly mother was dying, they couldn't prescribe opioids -- and she couldn't take NSAIDs either. Tylenol didn't help. It was crazy. She couldn't get opioids till she was in hospice.

Folks should get what they request.

So, technically, even though she turned out to be "terminal," she wasn't diagnosed with a "terminal illness."

They ran some tests, couldn't find the source of her very sudden, severe back pain, and she died.

Thanks for your kind thoughts, janterry.

their pain is very complicated. They often require 3 types of pain meds. I think cannaboids are a tool in the tool box and should be available. But, they don't do anything for some people and others need opioids as an adjunct.

I think there is a lot of false information going around that no one would be in pain if everyone had some pot around.