The opiod epidemic....

[smadsen]

I am a fan of irony. A few years ago, the L.A. Times ran two headlines on the front page. One to congratulate the legalize marijuana crowd on their success, the other to castigate Percocet users. I find it amusing, if not amazing, none of the "take away everyone's access to opioids" crowd seems to know the difference between 325/5 and 325/80.

[Jeff Higgins]

Originally Posted by Noah930

Agreed. Super irritating. And also reflective that the people forcing these rules on us are totally out-of-touch with and/or don't GAF about how things work in the real world.

There's supposed to be some sort of 6-month grace period, but tell that to the patient with a narcotic prescription for post-op pain who is standing in front of a pharmacist who refuses to fill the prescription because it's not on one of the new scripts.

I've been seeing a lot of stories in our local news lately about these "totally out-of-touch with and/or don't GAF about how things work in the real world" sorts. It seems real-world doctors, hospitals, clinics, pharmacists and such are starting to push back against them regarding what they say is a largely manufactured "crisis", at least with respect to prescription pain killers.

The real-world practitioners are starting to call "bullschitt" on the accusations being leveled against them by government regulators, pointing to statistics that still show the vast majority of this "opioid crisis" lies with illegal street drugs like heroin and fentanyl. They point to statistics that highlight the extremely minuscule percentage of legal prescription users that ever abuse or become addicted to opioids, much less die from overdoses. That remains almost the sole province of the street drug abusers.

Of course government regulators and overseers cannot sue illegal drug dealers. It actually costs real money to pursue them, with no payout at the end. Maybe the law enforcement agency that busts them gets to confiscate some cash, but it's nowhere near the pot of gold awaiting the government at the end of a big pharma lawsuit rainbow. And what an easy, popular target - evil big pharma. Grotesque profits, deep pockets, and now the perfect conspiracy theory. It simply behooves our government to shift the blame to those with the deepest pockets of legal money, money for which they can sue. They sure as hell cannot sue El Chappo and expect anything.

The end result is now an entire class of people - chronic pain sufferers, post surgery patients, and others who do not have access to our very best pain meds. There was a story a month or so ago about a middle aged couple where the husband had some debilitating degenerative spinal condition of some kind. The guy was taking morphine, or demerol, or some other high horsepower opioid daily. The doc cut him off under the new "guidelines". He wrote a long, very thoughtful note, him and his wife went to their favorite park, and he took his own life rather than face the rest of his life in the kind of pain he was facing. I'm sure there are many, many similar stories, not quite as extreme, but nonetheless impacting the lives of people who are now needlessly suffering.

This got pretty personal for me about a month ago, so maybe that's why I'm ranting on so. My wife had surgery in her throat, removing a (thankfully benign) cyst from her vocal chords. Pretty damned invasive stuff, wherein they cut a pretty good chunk out of her vocal chords. They sent her home telling her to alternate Tylenol and Advil. They "no longer prescribed" opioids, even for post surgery recovery. I watched that poor girl suffer for days, unable to sleep, in immense pain. I was ready to drive back to the hospital and introduce a good bit of that into that righteous little prick of a so-called doctor's life. His overly scrutinized prescribing practices had overtaken his concern for his surgery patients' pain during recovery. So that's what it has come to, has it? Really?

[Noah930]

The reason why it is a bit of a manufactured crisis dates back about 15 years ago when "they" (some bureaucrat or committee) decided that pain was Uber important. So "they" decreed pain as "the 5th vital sign." Elevated in importance to the same level as heart rate, blood pressure, respiratory rate, and temperature. Pain became ranked on a scale of 1-10.

The federal government added to this more recently by suggesting that provider reimbursement will be linked to patient outcomes. Not just on things like do your patients live or die, or infection rates, but also by patient satisfaction ratings. Was your doctor nice to you? Warm bedside manner? Pain control? (Remember, it's that 5th vital sign.). Not only will providers be paid for what they do, but how much they get paid gets modified by their patient outcome/satisfaction rate!

Of course, we live in America, too, the land of customer satisfaction. The customer is always right. (Let me tell you something--in the world of medicine where frequently the decision-making is based on pretty complicated variables, the customer/patient is often not right, because they don't have the knowledge and experience to truly understand their own big picture.). Combine that with a society that pushed (and still does) for patient advocacy (you know your own body--don't listen to what someone else is telling you). Also add in society's expectation for life to be pain and suffering free. And don't forget about social media/Yelp scores. It's a disaster for complicated issues like pain and pain control.

No surprise that we have an opioid epidemic now. The federal government and bureaucrats have been unwittingly setting the stage for it for the last 10-15 years. And now these same factions think they know best on how to fix it? Good freaking luck.

[daepp]

Not to be flip, but if someone wants to get loaded, they’ll get loaded - one way or another:

https://kfiam640.iheart.com/content/2019-01-25-woman-drunk-on-vanilla-extract-charged-with-dui/

[wdfifteen]

We went looking for new doctors when we moved. The first three we talked to would not prescribe ANY schedule II drugs. There are schedule II drugs used for other purposes that are not strong enough for pain relief, but they are schedule II so you can't get them. Our friend has epileptic seizures and takes a schedule II drug to help control them. She has to travel over 100 miles to find a doctor who will still prescribe the drug.

[KFC911]

What you docs are describing is totally messed up too imo . But the pills are out there....prescribed, distributed, and many are abused. Don't know what the actual #s are, but 20-25k people will die this year....just from the pills. The "system" is broken....that's for sure...because "some" people are broken....but which ones? I dunno....

[Sooner or later]

Originally Posted by wdfifteen

We went looking for new doctors when we moved. The first three we talked to would not prescribe ANY schedule II drugs. There are schedule II drugs used for other purposes that are not strong enough for pain relief, but they are schedule II so you can't get them. Our friend has epileptic seizures and takes a schedule II drug to help control them. She has to travel over 100 miles to find a doctor who will still prescribe the drug.

Your friend needs to move up to a schedule 1 drug, Read up on Alexis Bortell. She had dozens of seizures a day until. ..good old pot extracts.

She has quite a story. A good friend of mine knows the family. It is heart breaking what the family has gone through. They ended up moving from texas to Colo to get "legal" treatment.

[Tobra]

Originally Posted by Noah930

The reason why it is a bit of a manufactured crisis dates back about 15 years ago when "they" (some bureaucrat or committee) decided that pain was Uber important. So "they" decreed pain as "the 5th vital sign." Elevated in importance to the same level as heart rate, blood pressure, respiratory rate, and temperature. Pain became ranked on a scale of 1-10.

See post 171

They profiled Dr Rose like they did our friend with the 944 turbo that is marking its territory with oil.

It is not because they are anti-dentites.

They tell Harvey he is writing for too many strong narcotics. He says look at my patient population. Half of them are hospice patients and will be dead inside a year. If I can prevent them from spending their remaining, brief lives in misery, does it really matter if they die habituated to opiods. Initial response was yes, it looks like you need to lose your license. Period of intense Lawyering ensued, he keeps his license and dies of cancer himself at 75.

End result was the sign on the ED wall where you walk in that assures you that you have a Right to have your pain addressed. Now the pendulum is swinging the other way, and it is hitting everyone in the head. When do are the grownups going to take over this deal?

[berettafan]

the medicinal portion of cannabis is something like .000xx of the chemicals found within. How is it drug companies are not already able to produce these in some fashion? and if they were truly so effective do we really believe they have just been ignored? or do we believe drug co's have just been unable to convince Congress to allow them to generate these chemicals?

I've seen the inside of the pot business and the term 'medical' is a crock of ****. it is NOT based on helping people. this is just what politicians use for cover when they support it while they actually are just thinking about tax revenues.

[Sooner or later]

Originally Posted by berettafan

the medicinal portion of cannabis is something like .000xx of the chemicals found within. How is it drug companies are not already able to produce these in some fashion? and if they were truly so effective do we really believe they have just been ignored? or do we believe drug co's have just been unable to convince Congress to allow them to generate these chemicals?

I've seen the inside of the pot business and the term 'medical' is a crock of ****. it is NOT based on helping people. this is just what politicians use for cover when they support it while they actually are just thinking about tax revenues.

Tell that to Alexis

I guess she should go back to dozens of seizures a day. Last I heard she has had one seizure in two years simce starting treatment.

[Sooner or later]

Also. There has been liitle testing throughout the world since it is basically banned worldwide due to the 1961 Convention of Narcotic Drugs treaty.

[kach22i]

Originally Posted by Noah930

The reason why it is a bit of a manufactured crisis dates back about 15 years ago when "they" (some bureaucrat or committee) decided that pain was Uber important. So "they" decreed pain as "the 5th vital sign." Elevated in importance to the same level as heart rate, blood pressure, respiratory rate, and temperature. Pain became ranked on a scale of 1-10.

Thank you for the interesting retrospective.

If pain makes you want to die or is so bad that the symptoms of extreme blood pressure lead to other health emergencies including death, then yea, I'd kind of want to call it a 5th vita sign.

But I'm not in the medical profession, just an opinion.

Originally Posted by Tobra

Now the pendulum is swinging the other way..........

I agree, and it is a painful course correction.

[kach22i]

Originally Posted by berettafan

the medicinal portion of cannabis is something like .000xx of the chemicals found within. How is it drug companies are not already able to produce these in some fashion? and if they were truly so effective do we really believe they have just been ignored? or do we believe drug co's have just been unable to convince Congress to allow them to generate these chemicals?

I've seen the inside of the pot business and the term 'medical' is a crock of ****. it is NOT based on helping people. this is just what politicians use for cover when they support it while they actually are just thinking about tax revenues.

I've read several versions of history that suggest racism more than Big Pharma in the 1930's or Nixon's DEA in the 1970's put cannabis where it is.

The Science behind the DEA's Long War on Marijuana
https://www.scientificamerican.com/article/the-science-behind-the-dea-s-long-war-on-marijuana/

The good part of pot that can be extracted out for medical purposes is losing out to the bad part and making some very unstable smoking blends. So in that sense then yes there is little medical application to a blend tilted towards THC V's CBD.

CBD vs. THC: What’s the Difference?
https://www.healthline.com/health/cbd-vs-thc

As the legal use of marijuana and other cannabis products grows, consumers are becoming more curious about their options. This includes cannabidiol (CBD) and tetrahydrocannabinol (THC), two natural compounds found in plants of the Cannabis genus.

CBD is found primarily in extractions from the hemp plant. It’s sold in gels, gummies, oils, supplements, extracts, and more.

THC is the main psychoactive compound in marijuana. It can be consumed by smoking marijuana. It’s also available in oils, edibles, tinctures, capsules, and more.

Both compounds interact with your body’s endocannabinoid system but they have very different effects.

[Sooner or later]

The US has convoluted pot laws due to our signing on the 1961 treaty. Read up on it.

Canada, with their new pot policy, is in direct violation of the treaty they signed and are a current member.

1961 Convention on Narcotic Drugs

[pavulon]

While well-intended, this JCAHO idea-turned-mandate was quickly seized upon by people in less than legitimate pain... because that’s what people do. That the morons of JCAHO contributed so heavily to the opioid mess only to go bipolar on it is emblematic of that organization’s dysfunction. In short, the Joint Comimission is a punchline in way too many jokes.

Originally Posted by kach22i

Thank you for the interesting retrospective.

If pain makes you want to die or is so bad that the symptoms of extreme blood pressure lead to other health emergencies including death, then yea, I'd kind of want to call it a 5th vita sign.

But I'm not in the medical profession, just an opinion.



I agree, and it is a painful course correction.

[kach22i]

Originally Posted by pavulon

While well-intended, this JCAHO idea-turned-mandate was quickly seized upon by people in less than legitimate pain... because that’s what people do.

Give them a little credit for acknowledging that they are a part of the problem.

2014
Joint Commission Cites Itself as a Major Hindrance to Medical Care
https://gomerblog.com/2014/09/joint-commission-2/

CHICAGO, IL – This past Thursday, the Joint Commission officially cited itself as a major obstacle for patient care and safety. The Joint Commission released in a statement Monday, “If we truly are trying to improve healthcare we had to write ourselves up for making it difficult and dangerous to take care of patients.”

Maybe that statement was taken out of context.

Just the mere presence of the Joint Commission is a safety hazard, the report clearly states. “When [the Joint Commission] is surveying a hospital, all personnel from the physicians to the janitors are under fear that the surveyor, who has been out of practice for quite some time, will see something done that is not a ‘best practice’ and cite the institution. This increased stress causes medical errors and poor performance during procedures, i.e. surgery.”

In fact, a recent survey demonstrated an increase in medical errors of 238% at a hospital during the days the Joint Commission is present. Surgical complications in surveyed rooms jump a staggering 430% likely due to the multiple distractions and questioning.

[ckelly78z]

A niece of some friends of ours just the other night had to be NARCANed by the responding police officer, and then again at the hospital (her third intervention over the last 2 years). There was no trace of opioids in her system, she had taken pure fentanyl (horse tranquilizer) for the second time. She has 3 kids from 3 dads, that won't step up, and be men, so the family has to pick up the pieces, and attempt to keep the kids out of the system.

This girl's sister, ODd last year, died at a friend's house, and was dumped on a local county road by 3 other addict "friends" who are now in jail on felony charges, which is a big, local story, and going through withdrawl on the taxpayer's dime.

My question is, WHY DO WE SAVE THESE PEOPLE ?

[Seahawk]

So I sat with Steve for almost two hours this morning, wide ranging discussions about many things. He shares some amazing stories I had not heard before (I think he is emptying the tank). We may have a plan.

However: You guys want Centralized Health Care?

Of course you do. Never mind.

He shared a story about David Yuengling (Steve is from Pennsylvania) and a letter that may be the coolest thing I have ever read.

More later.

[Jeff Higgins]

Here is a good read that explores the situation I alluded to above:

https://www.acsh.org/news/2018/11/05/who-telling-truth-about-prescription-opioid-deaths-dea-cdc-neither-13569

[daepp]

I have never believed in the whole pot panacea trend that’s been going on for about as long as I can remember - certainly the 1980s.

Then a 74-year-old friend of mine - 6’3” broad shouldered, hard-working, Irishman - was diagnosed with stomach and esophageal cancer. He declined his chemo and surgery - too few guarantees, other than a most certain miserable remaining time on earth.

To deal with the nausea and lack of appetite he has resorted to (with the help of others) distilling his own cannabis oil from 2lbs or pot at a time (and not the kind a void of THC.) I cannot tell you how tremendous the relief has been for him, and he has lived roughly 6 months longer than expected. But beyond that, his quality of life has been mostly bearable for nearly 9 months. And I saw him on a family campout where, for some reason, he neglected to bring his cannabis-oil capsules, and I saw firsthand how sick he was without them. It is been a serious game changer for him, and it has opened my mind to the notion that cannabis oil can at least, help with the symptoms.