How Oxycontin Took Over

[dlockhart]

Just Wow.

[pwd72s]

Worth the time, thanks.

What's sad to me? I see no problem with addiction with terminally ill people in pain, but now this tool has been pretty much removed because it was handed out too freely.

On a personal note...I phreaked when I learned there was fentanyl in the jungle juice I was to be given during eye surgery. So again, there is a legit use for these drugs.

As usual...follow the money, huh?

[TimBer]

There is also this podcast by Malcolm Gladwell
https://www.pushkin.fm/podcasts/revisionist-history/in-triplicate#play

And the book Empire of Pain by Patrick Radden Keefe

[GH85Carrera]

Fentanyl has been used in surgery for a long time. Administered by a anesthesiologist, it is pretty safe. In pill form from a dug dealer, no way.

It is a shame that all pain medications are really hard to get for people in real pain.

I had my hip replaced 10 years ago and I was on "dial a smile" in the hospital. The morphine IV drip that the patient controls for needing more. I was really happy to see that thing go away. I did take the pain pills as directed for a few days after I was sent home. I was happy to get off them.

For terminally ill people, give them all the pain meds they need. I saw my uncle scream in agony when the nurse tried to move him enough to change the sheets. He was on a highest dose of morphine the doctor would prescribe. He died a week later from a horrible cancer. No one should have to suffer through that.

[flatbutt]

I've been using Oxy ever since my spinal cord injury 22 years ago. I should say I HAD been using it. I am blessed with not being prone to addiction so the long-term use has never been a problem. My PCP would write me a script for 30 doses, and it would last me 6 months as I only used it for those really bad days. Now my local pharmacy rejects the script every time asking my Dr. for an alternative. Nothing is as effective for me as the Oxy but now I struggle to get it.

[gchappel]

There are people that really need these meds, and I feel sorry for them when they are not available because of our politics.
I wish they would let oncologists and sub specialty trained pain management physicians order anything, in any amount, they feel the patient needs. But sadly, I have seen that abused as well. There is no good answer.
I do think if you have a prescription for a legal amount of a drug- it is not up to the pharmacist to challenge that order.
No answer will be perfect, but denying needed drugs from some to protect a few does not seem like a legitimate long term solution
gary

[Tobra]

No doctor worth a rat's ass would ever believe that stuff is not habit forming/addictive.

The way we manage narcotics in this country is so stupid. The federal government spent 25 years getting people addicted to opioids. Now they say you can't have them.

I shudder to think how many people with chronic pain issues have committed suicide in the last 5 years. I wonder what percentage of the suicides by our veterans are due to denial of medications.

All this, and it has done nothing but make the "opioid epidemic" explode.


All this

[Seahawk]

Originally Posted by flatbutt

I've been using Oxy ever since my spinal cord injury 22 years ago. I should say I HAD been using it. I am blessed with not being prone to addiction so the long-term use has never been a problem. My PCP would write me a script for 30 doses, and it would last me 6 months as I only used it for those really bad days. Now my local pharmacy rejects the script every time asking my Dr. for an alternative. Nothing is as effective for me as the Oxy but now I struggle to get it.

Your ethos with Oxy is to be admired but unfortunately very rare.

I have had two friends, both addictive personalities, that were/are absolute Oxy junkies.

One went through the withdrawal which he said was horrific, twice. The other is a mess of oxy and other meds he has been on for 30 plus years. He probably took to much six weeks ago, fell and broke his hip and lied on the floor for almost 20 hours alone. I called in a wellness check when he did not answer my texts.

Just evil stuff. Edit: I missed your post Tobra, well written.

The issue to me was the abrupt termination , or severe cutback, of oxy as a prescription medication. The doctors got him hooked 30 years ago and then tried to stop the Oxy train over a chasm.

Great video, btw. I thank god everyday I missed the drug addiction dirt road in life. Like you FB, even after surgeries I try and limit medication intake.

[asphaltgambler]

^^^^could not agree more with this ^^^^^

[matthewb0051]

Originally Posted by Tobra

The way we manage narcotics in this country is so stupid.

More to say on this but only have a minute now.

In England you can purchase OTC ibuprofen with codeine. Yes, OTC no script needed.

[pavulon]

People who routinely deal with acute and chronic pain patients understand the pitfalls as well as the need for opiates in dealing with it. There simply is nothing else as effective and completely explains why opiates are still in use. Until something else replaces opiates, the problems associated with addiction and abuse will persist and those with pain (especially severe chronic pain) will do whatever they can find to escape it.

It's also nothing new. A bit more than a hundred years ago, it was opium then morphine and heroin. Not much has really changed because people and people problems have not fundamentally changed. They remain susceptible to addiction. The vast majority of substance addicts I see each week are alcoholics or food addicts--but that's one kettle of fish over.

[GH85Carrera]

At my first job, we were in a building that was formerly the family owned and operated pharmacy. The pharmacy was long closed, and the building was then a photo studio and photo lab.

The bosses mother worked there from the pharmacy opening in the 1930s to the day her husband died. She told about the very high society women that would send a family servant to their pharmacy for several bottles of Laudanum that her husband would prepare. Most also ordered a laxative as well. Of course it was all very hush hush and even then everyone knew Laudanum was an addictive drug, but it was legal then.

There was still a huge safe in one room that had a smaller safe inside of it. The smaller safe she said was very finicky, and had to opened with great care on the combination. That is where they kept the opioids.

[matthewb0051]

Originally Posted by pavulon

People who routinely deal with acute and chronic pain patients understand the pitfalls as well as the need for opiates in dealing with it. There simply is nothing else as effective and completely explains why opiates are still in use.

That about sums it up.

I have had chronic back pain for about 10 years. For a period of time I was taking opiates for the pain. But as Flatbutt says above, everyone gives you the third degree even if the need is legitimate and the script is too.

What's odd from the video is the guy describes 'off label' use. My docs were all about 'off label' use of anti depressants and psychotropics to treat pain rather than just using pain meds to treat pain. I even had one doc get pissy with me about how pain med use for non-cancer pain was 'off label'. They were so afraid of actual pain meds being abused even if there was no indication of such or much less even any evidence of such.

I used to say that the Docs would take me on a tour of the pharmacy just to keep me off of opioids for pain. Funny ain't it??? Stuff like Cymbalta, Elavil, Lyrica, all for depression and other mental stuff. All would just leave me comatose and unable to think whereas pain meds did not.

The absolute worst drug for pain is Tramadol, which is a synthetic. The docs liked it for a while because it was not on the Schedule of controlled substances. Its problem is that is has pain med like an opioid plus some anti depressant properties. When taking daily, the body (and more likely the brain) become dependent on it and if you miss a dose you will most definitely feel it. Miss two doses and bless your heart.

Message boards and forums all over the internet describe Tramadol as the spawn of Satan and most people's experience with it are horrible. It is now a controlled substance but still favored by some docs simply because it isn't Oxy or Vicodin or similar.

[matthewb0051]

Another thing without much elaboration:

I've seen the pay being raked in by the sales people and their supervisors in the sale of opioids. Absolutely shocking how much they were making. Plus the sales dynamic was not about letting the drug sell itself based on need in the market and the product filling that need.

[rattlsnak]

I obviously understand that addiction is a problem, but it’s hard for me to understand sometimes… I’ve had a few bad accidents in my life, like a broken shoulder, broken legs etc. where I was given OC for pain, and I took it when I had pain and when the pain went away, or got less, I simply stopped taking it. Lucky I guess..

[matthewb0051]

Originally Posted by Tobra

I shudder to think how many people with chronic pain issues have committed suicide in the last 5 years. I wonder what percentage of the suicides by our veterans are due to denial of medications.

Missed this part earlier. Spot on I'd say. The problem with veteran and active duty medical treatment is that it is institutionalized. Read my other post above. The docs on the treatment end are fed a 'best practices' idea or scheme from the higher echelon of management/chain of command and they follow it. It doesn't matter if it works or not for the individual patient, it is simply a treatment plan across the entire organization for a specific thing such as pain.

Opioids bad, get them off of it; doc says ok and does it. Or, Tramadol is not an opioid so use it; doc says ok and does it. Use anti-depressants 'off label' for pain; doc says ok.

[flatbutt]

Originally Posted by pavulon

People who routinely deal with acute and chronic pain patients understand the pitfalls as well as the need for opiates in dealing with it. There simply is nothing else as effective and completely explains why opiates are still in use. Until something else replaces opiates, the problems associated with addiction and abuse will persist and those with pain (especially severe chronic pain) will do whatever they can find to escape it.
......

Indeed. There are still a lot of people who don't / can't understand what it is like to live with this kind of pain. To put it mildly, it is exhausting.

[unclebilly]

I have some OxyContin from my knee reconstruction. I took 2-3 pills and then switched to Percocet which is less ‘torquey’ and then wiened myself off of that the next day.

I’ve taken the Percocet one or 2 times since but that’s it.

I probably have 50-60 pills of these and they will find their way into my backcountry first aid kit.

I really don’t want them in my house but know they could be useful for pain relief in the event of a backcountry injury.

[Tobra]

You can very easily kill someone putting them through opioid withdrawal.

Restrict the hell out of opioids, and give away Ambien and psychotropic drugs like they are GD Tic Tacs. That totally makes sense, if you are freakin' moron.

Originally Posted by matthewb0051

Message boards and forums all over the internet describe Tramadol as the spawn of Satan and most people's experience with it are horrible. It is now a controlled substance but still favored by some docs simply because it isn't Oxy or Vicodin or similar.

That is because they use morphine equivalent dosing. You can lose your license for stepping out of line on this. This is an online calculator that gives you the morphine equivalent dose for some narcotics.

I know what you're thinking, "that does not sound like such a bad idea." Yeah, well the execution is a problem. You would think that body weight would enter into this calculation, because practically ALL drugs are dosed by body weight. You would think it would make a difference if you are talking about the dose for a 110 pound woman, versus the dose for a 350 pro football player. You would be wrong, but you would think they would take that into consideration. They do not.


https://www.mdcalc.com/calc/10170/morphine-milligram-equivalents-mme-calculator

Too bad Dr Rose is dead. He is why there is a sign in the hospitals that states you have a right to having your pain addressed. That "Pain is the Fifth Vital Sign" jazz, Harvey Rose MD. His deal was that they are dying of cancer, why do you care how much I give them to alleviate their pain.

Retaliation Against Harvey L. Rose, MD

Dr. Rose was a leading medical advocate for using prescription drugs even strong narcotics to alleviate chronic pain when other forms of treatment fail. He challenged the thinking of many physicians, who often avoid painkillers for fear of patient addiction or being disciplined for over-prescribing drugs.

He was a sympathetic man who cared strongly about patients, his family and colleagues said, and he believed doctors could safely and effectively provide medicines to ease needless suffering and enable patients to lead productive lives.

"He was a pioneer because he was so outspoken about it," said Bill Sandberg, executive director of the Sierra Sacramento Valley Medical Society. "He was very tenacious on the whole pain thing and not afraid to prescribe."

His efforts almost cost Dr. Rose his medical license. In 1981, the California Medical Board brought charges accusing him of excessively prescribing pain drugs. He was found guilty, but the verdict was tossed out on appeal because part of the transcript was lost.

The case spurred Dr. Rose to push for legal protections for pain therapy. He helped state Sen. Leroy Greene draft the 1990 Intractable Pain Treatment Act, which shields doctors from discipline for prescribing potentially addictive drugs for serious cases. It was a key early measure in several steps California has taken toward greater pain management, including a 1997 Pain Patient's Bill of Rights. He lobbied for similar laws in Nevada and Oregon and appeared in a national news story on "48 Hours."

Meanwhile, a shift in attitude led the state medical board in 1995 to acknowledge that pain often is undertreated, and relief sometimes requires large drug doses. The same year, Dr. Rose was recognized as one of 10 "Heroes in Health Care" in a program sponsored by the Health Communication Research Institute.

"I don't think his contribution can be overstated," said Dr. Lee Snook, founder and president of Metropolitan Pain Management Consultants Inc. "He embraced the best tenets of being a physician to listen to patients and do whatever they have to do to alleviate their suffering. Harvey did that, even at his own risk."

Patients nationwide traveled to Dr. Rose for help. Besides his efforts to alleviate pain, he was renowned as a man of compassion, including footing the bill for those who could not afford to pay for prescriptions.

[red 928]

Oddly enough, people who don't take drugs
STILL won't get addicted to them

But it will also make it harder to blame
the entire world for their problems