१६ जून, २०१६
"More than half of patients who get a prescription for opioid painkillers have leftover pills and keep them to use later..."
More than half? Like 90%? No, just 61.3%. I'm surprised it's so few.
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The alternative is what, prescribing a patient too few pills and making him ask the doctor for a refill? The article said something absurd about needing to make it easier for patients to dispose of their leftover pills. What? These people don't know how to use toilets and trash cans?
I think they are way over prescribed. I got a two weeks prescription of Oxycontin for a root canal. My son got the same for minor foot surgery. I didn't take anything and didn't fill the prescription. He took a few Advil as needed. He did have a funny line "Now I know how I'm going to cover my deductible."
Worth nothing that 61.3% of people voluntarily stop taking them when they no longer need them. Which suggests, at least for that 61.3%, that there's nothing wrong with keeping the extras around just in case.
It's probably better to have extras around rather than not enough. There's nothing quite like being in serious pain late at night and unable to do anything about it.
And forget going to the emergency room--you have a better shot at seeing a doctor at McDonalds, because one might come in to buy some fries. I once took my wife in at 2:30, finally saw a doctor at 8 and they finally put her on a "painkiller" (that killed no pain, just my faith in the emergency room staff) a half hour later. What I would have given to have some painkillers in the house.
The vet recently prescribed Tramadol for my dog. Right! Like I'm going to waste them on him!
...a practice that could potentially...
Ha! Classic! Well, then, there oughta be a law, shouldn't there?
"I'm surprised it's so few."
Me too. I don't think I've *ever* finished out a prescription of painkillers. With antibiotics, it's important to finish them. With pain pills -- it's taper off, use as needed, and the less the better.
I'd bet the average reflects two populations: Those with chronic pain, who will keep refilling the prescription, and those with acute pain, who get a prescription after surgery or an injury and taper off, having some left over.
I'd bet the number is closer to 90% in the second group.
If your body feels pain, it is trying to tell you something.
Get that something fixed, or favor that bodypart and live with the pain.
Whatever you do, do not take known addictive drugs to mask the pain.
"Worth nothing that 61.3% of people voluntarily stop taking them when they no longer need them. Which suggests, at least for that 61.3%, that there's nothing wrong with keeping the extras around just in case."
I know you mean "Worth noting..."
I agree that it's good that people know they don't need to take them all (as with an anti-biotic) and that they voluntarily stop.
There is something wrong with keeping them around because it's a prescription drug and the case for using them for something new is supposed to be determined by someone licensed to make this decision. So it's not like your own decision to take an over-the-counter painkiller. But I can certainly see why many people think they'll just use one of these pills for their next headache or whatever.
It's a worse problem if people decide to use them recreationally or for some other reason that's outside of what a doctor would prescribe them for.
I think the important thing about the study is that it shows 61% of people don't feel totally bound to the authoritarian regime of prescription drug law.
Doctors have hooked more people on opiods than any other source. They willy nilly hand Percocet out like candy for pain that could be managed with Advil, without any regard for the history and psychology of the patient. Of course they are in denial about this.
Another big problem is the way the remaining pills are disposed of. Flushing them releases opiates into the water supply.
"it's a prescription drug and the case for using them for something new is supposed to be determined by someone licensed to make this decision."
A doctor gives me a pill when something hurts like hell. I am better qualified to determine if something hurts like hell than some doctor and have no problem self medicating at that point. I take perhaps one Tylenol with codeine every three months. If I was going to be taking them recreationally, they would already be gone.
There is something wrong with keeping them around because it's a prescription drug and the case for using them for something new is supposed to be determined by someone licensed to make this decision.
Thank you for correcting the typo. There's always one I miss until the moment after I hit post.
I don't see the prescription drug regime in that way. I will do what I want with what's in my medicine cabinet and I'm not going to let the FDA tell me otherwise. Besides, as has been pointed out, if aspirin were invented today, you'd need a prescription to get it. The FDA is just another bloated captured federal bureaucracy getting in the way of the nation's health and well being.
I disagree with 2 things said so far.
- It's not wrong to use "addictive" drugs to mask pain. that's what they're for.
- It's not wrong to keep the extra around when the pain stops. You've experienced pain in the past and that pill might be put to good use in the future.
As to the use of the drug to "feel good" when you don't have pain, I fall squarely in the libertarian camp, perhaps radically so. I believe people should be allowed to ingest whatever they want so long as they don't harm other people (and I'm not talking emotional harm to people who care about you). Now we fact the situation where people in chronic pain where painkillers are the only thing that helps them requires a stupid amount of hoops to jump through, exposing them to pain and distress.
We've gone way too far in trying to protect people from themselves, and as a result we've lost a great motivator for personal responsibility and education. Our species is poorer for it as certain recessive genes are being reinforced and kept in the pool when they would have been bred out.
We have in our home, in random used pharmacy bottles, Norco, Percocet, Oxycontin and multiple strings of Tylenol. Useful for pain almost anywhere in the body.
An earlier commenter mentioned the long wait at ER's. In Austin we have a variety of what I call the "Doc-In-A-Box", or urgent care clinics. Very handy, and almost all open till 11:00 pm. South Austin also has a stand-alone ER facility, and since they're stand-alone and not connected to a hospital they don't have to take Medicaid and don't have to wait on illegals for free. My wife used them once and was very impressed. Capitalism. Good stuff.
Here is part of the problem that is only touched upon. There are a number of people in this country who have chronic pain. And often it is not their fault. A car wreck where six disks were damaged. A fall at work. Etc. The pain doesn't go away - it just has to be managed. Opioids are often the only choice. This sort of drugs can only be legally prescribed 30 days at a time, and require a written prescription. If you lose medicine, or it is stolen, you are SOL. Your doctor can't help, if they want to keep their license to prescribe narcotics. If you throw up twice in a month, losing the meds you just took, and take them twice a day, the last day of the month, you are going to be in, often debilitating, pain. Or you may be traveling, and your doctor can't write that written script more than, say, a week in advance, again, without risking their license. Which is why, whenever I have excess pain meds, I save them for someone in my life who has chronic pain, and needs them to bridge to their next prescription.
"There is something wrong with keeping them around because it's a prescription drug and the case for using them for something new is supposed to be determined by someone licensed to make this decision. So it's not like your own decision to take an over-the-counter painkiller. But I can certainly see why many people think they'll just use one of these pills for their next headache or whatever."
So what if someone chooses to take a pill beyond what the doctor prescribed? Far as I see it, it's their own business. You can follow the doctor's instructions or go against them at your own risk. Obviously the doctor and pharmacist shouldn't be liable for your deciding to go rogue with your medicine.
This country has been far too nanny-state when it comes to drugs (among other things). We have to stop trying to force others into doing what's best for them. Let them make their own decisions, if that means smoking pot or taking more opioids than their doctor recommends.
I guess it never occurred to me that I was supposed to dispose of the leftovers. Never thought about it. There's just a handful of old pills in the back of the medicine cabinet that have been ignored. Seems wasteful to just pitch them.
And doctors these days are very gun-shy about prescribing painkillers because of all this fear that they'll get in trouble. We're going about it all wrong--let the doctor prescribe what they think is best, and anything you want beyond that you should be able to get with a knowing waiver, so that if you go home and zonk out and choke on your own vomit, it's your problem and the doctor warned you against it. Now, people suffering severe pain are lumped in with addicts and can't get enough of what they actually need.
"I guess it never occurred to me that I was supposed to dispose of the leftovers. Never thought about it. There's just a handful of old pills in the back of the medicine cabinet that have been ignored. Seems wasteful to just pitch them."
I never dispose--what I keep around are old prescribed allergy drugs, which still work long after expiration. I know, the government nannies may have a problem with my reign of allergy-drug taking terror, as I may overdose and be able to walk through a garden center at springtime with nary a sniffle.
I'm stocked up thanks to some horrible back spasms a month ago, like nothing I've ever experienced. Percocet can't compare to the Dilaudid they used on me in ER, but at least I have something now if the spasms come back.
Really, with all this media hysteria I'm afraid that soon the good stuff will be withheld when I really need it, for the sake of Society. We're lurching from one "epidemic" to another.
Gee, what's wrong with this country.
I wish that doctors could prescribe extras so that people in chronic pain could get relief when they inevitably turn up short some month, often through no fault of theirs. But opioids are so frequently misused these days that this is a vacant hope. Drug addicts will steal them from their own parents, even knowing the pain that that parent will be in, when they come up short at the end of the month. The Feds have to walk a fine line here, but the worse the abuse gets, the more they overreact, and the worse it gets for those with chronic pain who have no other alternatives. And it just keeps getting worse and worse.
"There is something wrong with keeping them around because it's a prescription drug and the case for using them for something new is supposed to be determined by someone licensed to make this decision."
This is the party line. That fact is that people wth acute pain, after surgery or an injury are virtually never addicted by taking appropriate opioids.
Chronic pain is a serious problem made worse by two factors. There is a subset of addiction types who use drug seeking behavior all the time. When I was in practice, I would get a call from one of them every month or so. They call the exchange and tell you they are your partner's patient who just had a flare up of pain and needs a prescription refill. They count on your not being able to check with the partner or the records. They come into ERs all the time and have inventive stories.
The other factor is that the DEA is determined to destroy doctors who prescribe pain medicine to people with chronic pain. A pain specialist in Virginia a few years ago went to prison, I believe (unless she got a judge with good sense) for treating people with real chronic pain. Unless you are dying of cancer, the DEA is convinced you do not deserve treatment for chronic pain.
They are very effective at relieving pain or just making you feel good. I think that's a pretty good reason to use them, and have them around. Obviously, they can be very addictive, which ruins their value on both counts if you allow that to happen. Control yourself, and they can be a very nice thing. And yes, do not throw them down the toilet. Send them to me and I'll do it properly. I have a special method. Self control is almost like magic that allows you to use dangerous things in useful ways: Money, credit, drugs, alcohol, sex, exercise, compassion, the internet, all kinds of things, that if over-used become bad things. Even self-control is one. Balance, my friends.
@Michael K:
I used to suffer from kidney stones, and when a stone would move from the kidney to the bladder, the pain was intense and unremitting. In ER, the personnel there would put me through all kinds of nonsense, even though it was plain what the deal was. I knew they had to do it to screen out the junkies, but that knowledge wasn't too soothing when you're thrashing around in agony on a gurney for an hour.
Then, finally, blessedly, came the shot of morphine. In 15 minutes the world was a beautiful place.
Life hurts and eventually it is fatal. Just deal with it.
I'm one of them. I suppose you could say that I did a great job of getting off the pills and that's why I have extras, but that would be a less alarming story. I was taking Oxycodine and I hated it. The pain was bad but the drug was worse. Then I quit too fast and boom major insomnia. But who knows when I might need it. Bad me.
Hospice uses morphine to ease people into the grave.
My father died at 4AM in a nursing home. My mother was there as he passed. She then gathered up his belongings, and the remaining morphine. She said "We paid for the pills, and we can save them for a rainy day."
" Unless you are dying of cancer, the DEA is convinced you do not deserve treatment for chronic pain."
True enough.
That's why I kept the extras.
It's funny, my dentist is all concerned about acetaminophen (Tylenol) and its damage to the kidneys and liver, but she has no problem giving me an 20 extra Norco (reduced amount of Tylenol).
Pain is inherently subjective and, although there are physicians who over-prescribe opiods, there are also those who under-prescribe.
So, the pattern seen here is: many people stop taking prescribed opiods when they no longer need them (i.e., responsible behavior). And then they keep the extras "just in case" a day comes when they're in pain and run into a physician who won't prescribe adequate pain relief.
And that, too, is responsible behavior. So, what's the problem here?
You're suppose to destroy them? Really? Didn't know that. Nor am I going to do it. It's ridiculous.
"Peter said...
So, what's the problem here?"
The level of opioid, and subsequent heroin addiction. And it's a huge problem.
"There is something wrong with keeping them around because it's a prescription drug and the case for using them for something new is supposed to be determined by someone licensed to make this decision. So it's not like your own decision to take an over-the-counter painkiller."
My prescription for Oxycodone, 90 pille in the bottle, says "use as needed". Filled last Seeptember, 9 months ago. I opened the bottle up and used one pill 2 nights in a row last week for recurring lower back pain. 88 left.
I know when I hurt, and why I hurt. I don't need to see "professional" each time I get a pain. I need something that targets that pain and makes it go away.
Doctors are gatekeepers for pain relief because of the government in collusion with the doctors union, the AMA. And in my experience, most doctors know diddlysquat about pain relievers and their side effects, including the ones listed on the PDR. My son ended up in the psychiactric ER with acute feelings of paranoia after taking one prescription drug for headaches. With the first listed side effect being "May induce feelings of paranoia." My family doctor agreed with me- the ER doctors and the prescribing doctor who wanted him admitted and pumped full of other drugs were idiots with MD degrees. Professionals, painkiller gatekeepers, and idiots.
"No, just 61.3%. I'm surprised it's so few."
I'm surprised you think the number may be credible. How could they possibly know?
" knew they had to do it to screen out the junkies, but that knowledge wasn't too soothing when you're thrashing around in agony on a gurney for an hour."
Yes and they are inventive. For example, they will prick a finger for a drop of blood and put it in their urine sample.
I don't know the solution but it is not to harass pain specialists who are trying to do the right thing.
The kidney stone scenario is quite common for junkies.
Having reached the age of 60 without ever abusing prescription drugs I think I can be trusted with a few extra pills left over to use at my discretion. I am well aware of the hazards. It would frustrate the hell out of me if a doctor said "I can only give you five of these because the regulators are afraid you'll become a junkie or sell them the extras on the street, even though that means you may have to make another appointment and then sit around my office for 90 minutes so that I can whisk into the examining room for 2 minutes to write a script for another five." A practitioner with common sense would be more cautious with a young person making exaggerated complaint of pain from a minor injury. Isn't that what the professional judgment should be about?
tim maguire said...
Worth nothing that 61.3% of people voluntarily stop taking them when they no longer need them. Which suggests, at least for that 61.3%, that there's nothing wrong with keeping the extras around just in case.
6/16/16, 7:21 AM
This! Most of us are [you know] grown ups and we generally act that way. We always have a few extra around in the case of a sprain or muscle pull.
Ann Althouse said...
There is something wrong with keeping them around because it's a prescription drug and the case for using them for something new is supposed to be determined by someone licensed to make this decision. So it's not like your own decision to take an over-the-counter painkiller. But I can certainly see why many people think they'll just use one of these pills for their next headache or whatever.
6/16/16, 7:34 AM
It is a prescription drug [like most strong pain relievers] because someone somewhere decided that you as an independent adult are not properly "credentialed" do manage this on your own. Politics has gotten involved and so scared doctors from assigning them as needed that too many go without proper pain medication.
Of course we "horde" the extras. Its too damn inconvenient to get them as needed.
As usual, because some people have a problem with something, everyone has to pay the price...
Bagoh20: Your line about self control is a gem. That's going right into my arsenal.
Doctors, and dentists should have extreme pain induced during their training. Not momentarily, but for hours, daily for a few weeks. I recommend cluster headaches. Give them a little bit of common knowledge about what some of us go thru.
Pain is not "discomfort".
And, anybody who has never suffered extreme pain has no business assuming they understand what it is like.
Into each life a little pain must fall. I keep the extras, but I can't recall ever using them. I can, however, recall the time I had an abscessed tooth and no pain killer. If you look into the abscess long enough, it looks back at you.......I have been on strong pain medication. It helps with the pain, but that fuzzy, stuporous feeling is uncomfortable and not something that most people would want to entertain for a prolonged period. Miles Davis sounds a lot better when you're on OxyContin, but I see no other perceptual advantages. Most sane people don't want to be on drugs. Those people who welcome a drugged state would find other paths to oblivion if drugs did not exist.
Ann Althouse said...
"There is something wrong with keeping them around because it's a prescription drug and the case for using them for something new is supposed to be determined by someone licensed to make this decision."
Your unthinking faith in government licensing as a source of infallibility would be touching, were it not for the fact that you have frequent contact with impressionable young people.
FullMoon said...
Doctors, and dentists should have extreme pain induced during their training.
That'd be pretty easy to do, but I think a great medical advance would be some mechanism which let one person feel what another is feeling, whether pain, nausea, whatever, or at least a way of measuring them more accurately and consistently than asking "On a scale of 1 to 10...".
I recommend cluster headaches.
I had a textbook case of those suckers and the official "medical community" was worse than useless, couldn't even ID them (it was pre-Internet, or I'd have ID'd them myself - pretty trivial given the weird symptoms) and mostly interested in making sure I didn't want pain pills (which I didn't). But easily cured, not just treated, at a headache clinic run by a physiologist (a month of a beta blocker + a week of prednisone). The place was full of Asians for some reason.
Maybe the other 38.7% sold them.
I have painkillers in the back of the closet that are so old I imagine they are no good anymore. OTOH, when my wife had a cough after a cold that would not go away (and which kept her, and me, from getting any sleep) the cough syrup with codeine I had squirreled away fixed her up almost immediately. The stuff they sell over the counter, which she had been taking for 2 or 3 weeks to no effect, is colored water.
The morale of the story is that the criminalization of degenerative pleasure seeking behavior creates more problems and solves almost none.
Hmm, so let's see if we can rephrase this finding:
Vast majority of Americans show good sense, and lack of addiction, by halting their prescription pain pill usage when teh pain drops, rather than mindlessly using the whole prescription.
Or
Study shows it's safe to "overprescribe" pain pills, because Americans will stop taking them when the pain goes down, even if they have more left.
Ann Althouse writes: "There is something wrong with keeping them around because it's a prescription drug and the case for using them for something new is supposed to be determined by someone licensed to make this decision."
The idea that some random individual, who happens to have a degree, knows more about my pain level than I do is ludicrous.
In a world where abortion is a holy sacrament because "my body, my choice", the idea that I need a blessing from a gov't approved dolt before I can get pain relief is insane.
My body, my choice. The DEA, the FDA, and the crowd that believe that nothing should be done w/o the proper gov't approved piece of paper, can and should all get stuffed
I have a never-opened bottle squirreled away. I've never been tempted to share, maybe because someone else always offers up a pill or two when a loved one is in pain. And here I've felt guilty for not sharing.
I was once so straight-arrow that I refused a friend's offer of Motrin after a skiing accident because it wasn't over-then-counter yet. Maybe an opioid would cure crazy dash-happiness.
I, for one, intend to always have a revolver and some ammo around, in case the pain of life becomes really unbearable. But the opiods might be a better choice, so if you want them, keep them.
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