So... what? Bring back prescription opiods?
“We created a huge cohort of people dependent on opioid pills and when we pulled back on those, we created a heroin wave — and that quickly got replaced by fentanyl, and then people really started dying,” said Daniel Ciccarone, a researcher at the University of California at San Francisco School of Medicine who studies street drugs and overdose trends....
“Doctors are humans influenced by culture,” said Ciccarone, of the University of California at San Francisco. “I think the culture of medicine changed partly because of our feeling responsible, partly out of new regulations, partly out of zeitgeist. The pendulum has swung — we’re anti-opioid now.”
And later? Isn't this article arguing for a return to prescription painkillers, with their less devastating problems?
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54 comments:
(musingly) "Unexpectedly"...."Unexpectedly."
Stop. Using. Narcan.
At least it wasn't horse dewormer...
"If guns are outlawed, only outlaws will have guns." There is a pattern here.
Why not? People were taking those pills long before the "opioid crisis" and long before oxycontin was marketed.
After my 2006 surgery I got all the pills I wanted. And tapered off, no problem. In 2018 they got paranoid and stingy, husband had to go out and pick up new paper Rx for every refill, and the prescriber wanted pill counts.
And as I rapid tapered I felt dope sick for the first time ever. I wouldn't wish that on anyone.
People learn to handle these meds like they handle alcohol. Or they don't.
What to do, what to do???
How about summary execution of anyone trafficking in these hellish compounds?
Just a thought.
I don't get opioids. They make me sick, but I've known a few addicts. One thing that stands out is that an addict has some prior experience with drugs or pill popping before their addiction. And they'll move on to something else if their previous high dries up.
And yet, during the pandemic most governors shut down AA and NA.
And during the push for Obama care, Obama pushed for a culture where grandma gets the pill for pain instead of the surgery.
The people at the top make terrible decisions. They get money from The Saklers (and Bankman-Fried, and who knows who else) and they make life-altering, culture altering decisions. And nobody cares.
The way Purdue Pharma was able to push the idea that Oxycontin was not addictive through the FDA should have been a government-shaking expose. But we just continue on as if it couldn't happen again.
Wondery's American Scandal podcast season 51 is a great primer for anyone who wants to listen.
Historically, we have a limited ability to anticipate and avoid unintended consequences. This modern world gives humans more agency, and they use that agency in unexpected ways.
What a gift pain killers are to humankind, right? With something this powerful, the good is very good, but the bad is very bad. If only all humans had a set of values as unassailable as our own, but alas...
I remember sitting in the movie theater watching Traffic were the moral of the story was the 'war on drugs' was a colossal failure and the solution was rehab, twelve step, coddling of addicts. We're so fucked I recall thinking...
Like most things these days all the money and incentives are in the wrong place focused the wrong people. I think graduate schools have been teaching a generation to avoid the right answer at any and all costs. Especially if the costs are high. What comes after a trillion? they ask....
"normally used as an elephant tranquilizer"
I've heard that about almost every drug, ever, except for pot
And later? Isn't this article arguing for a return to prescription painkillers, with their less devastating problems?
Yes because the problem is they took away something that was effective and helpful and offered no replacement options. My wife has two conditions that cannot be fixed by surgery or therapy and cause debilitating pain, which also causes anxiety. They reduced the amount of prescribed drugs for both, drastically reduced them, which increased her anxiety and discomfort. Statistically, almost zero "overdose deaths" are from people on prescribed opiates and instead occur on people using street drugs, especially fake pharmaceuticals that are fentanyl impersonating other pills. So pretty much the only people hurt by this crackdown on "opiates" were patients who needed the medication they were prescribed and who were not inclined to buy and use street drugs. Sure a few doctors were running pill mills. So what? Go after them with the FDA and suspend their licenses. But no, every change in law and FDA guidance hurt ordinary patients with zero effect on the criminals and illegal drug sellers, and with disastrous effect on legit patients who regrettably turned to the street only to be killed by shitty counterfeit drugs.
I listened to a recent Triggernometry podcast interview of a former Old Bailey judge. It was, as they intend, honest and fascinating while touching on whether or not increased levels of punishment is actually doing anything to reduce crime. However, it was more focused on violent crime, and while they touched on what I think is critical societal issues (single parent homes particularly the effect of fatherless homes on children going through puberty); I think they didn't discuss enough about how other strategies have failed to deter crime.
In the US, and I suspect the UK as well, the sources of these drugs are external. Our disinterest in controlling borders is allowing a market to flourish with strong supply chains. This has led to increased levels of drug use not seen in many decades if ever before. I think that is a bigger issue (as well having stronger families), than anything to do with supply of prescription drugs. The increased violence is related to the increased drug use as suppliers literally fight for market capture on the streets and desperate users seek ways to survive and afford their next high.
Unfortunately, none of this will be resolved anytime soon, because nobody wants to seriously fix our border problem. If you want to argue that somebody, perhaps Trump, DeSantis or Abbott might be serious; who is serious about tackling the other family level societal problems? Not Trump and not Biden, yet they are begin framed as our next choice for President. We are more fucked than Susanna Gibson (our carnal knowledge of her is legal).
Cronic pain is depressing and debilitating.
In many states, the government effectively outlawed prescription opioids with onerous regulations backed by threats of loss of license if prescribers violated the regulations. Most doctors decide it isn’t worth the risk. And yes, that’s when heroin and fentanyl overdoses took off. The politicians were warned this would happen, but they didn’t care. They made the decision to cut off less dangerous forms of opioids, even from legitimate use. There’s no putting the heroin and fentanyl genies back in the bottle.
George "Fentanyl" Floyd syndrome. An empathetic handmade tale should not be interrupted by progress. Some, Select [Black] Lives Matter
My late sister suffered from extreme pain following a botched surgery for the second half of her life. Thinking back on what she went through I’d like to take those politicians and petty bureaucrats who think pain is a nothingburger and smash their kneecaps so they grasp the concept that pain is real and there are people who suffer extreme pain daily and will do so for the rest of their lives.
In California earlier this year, they killed a bill that would have added penalties for convicted Fentanyl dealers.
“Isn't this article arguing for a return to prescription painkillers, with their less devastating problems? “
There’s a practical problem: 4 pharmaceutical companies had to pay out $26 billion to settle opioid lawsuits, and distributors like CVS, Walgreens, and Kroger paid out billions more.
Who wants to get back into that business?
The problem is the drug culture that people insisted we had to have, which has led to skyrocketing dope overdoses, the stench of pot smoke everywhere, and government-become-drug dealer.
Yes. The answer is bring back opioids. There were many people getting prescription pain medicine for legitimate pain. The medication was what helped them lead a somewhat normal life. Suddenly doctors cut back or totally discontinued their prescription all because of the threats of the government.
Until you have experienced that non-stop excruciating pain, you can't understand the steps people will go through to get some relief (Think of a non-stop toothache times 10). Now in addition, many had to go through withdrawals since doctors didn't taper their prescription amount but cut them off altogether. Now the person can't sleep because of the pain, can't function during the day because of the pain, and is going through withdrawal symptoms. Not a fun place to be. I know a person who went through that for three months until a new doctor paid attention to his diagnosis and medical history and put him back on his former prescription. The government interference in his medical treatment nearly killed him but thank goodness he never looked for illegal drugs as a replacement.
The "war on opioids" didn't stop any of the illegal drug trafficking. However, it did destroy the pain management programs of many cancer patients and those suffering with a slipped disc, amputations, and other such injuries. They started looking elsewhere for relief and ended up getting pain drugs tainted with fentanyl thereby creating a whole new class of users and over-dose victims.
. Statistically, almost zero "overdose deaths" are from people on prescribed opiates and instead occur on people using street drugs,
Doctors- at least legitimate doctors - aren't going to prescribe enough to overdose. But that doesn't mean the addiction didn't start with prescribed opiates. And it isn't just people in pain who then turn to street drugs. It was people looking for the high they had gotten from the once-legitimate drugs.
The existence of the pill mills shows another failure of our whole system. People not in pain going after the high, and getting it because it was making a lot of people rich. Going after them with the FDA didn't happen, because the FDA was captured by Purdue at the very start.
wild chicken said...And as I rapid tapered I felt dope sick for the first time ever.
What does that feel like?
Are people in pain actually not able to get opioids? That doesn't ring true to me. My dad had surgery and was prescribed a very limited prescription for opioids. My sister who had cancer had opioids.
Or is it that people who are long-term on opioids are being directed to different medications?
Do we need to find alternatives that don't cause spiraling addictions?
I don't think we can say either "people should just live in debilitating pain" or "there were a few pill mills. So what?". Both are problems.
This drug control stuff has progressed from opiates; I've been on zolpidem (aka, Ambien) for over 10 years now, use it sparingly but effectively, and the last few years they've gotten really picky on it. I have to take a urine test twice a year now and sign something promising I'll never hoard them or sell them or anything. And ALL IT DOES IS MAKE YOU FALL ASLEEP.
(And if you've ever had insomnia, it's maddening)
I have written it before- it is too easy to synthesize fentanyl and its even more potent analogs. There is no way to control the materials from which they can be made since the materials themselves have multiple easy paths to preparation from even more basic materials. It is a drug enforcement agency's worst nightmare.
What about all the bullshit news stories we saw about fentanyl being so powerful, that if a cop touched it or even breathed it, he could die?
Remember that?
One ounce could kill a city of a million people or some such nonsense.
Now it's 100 times more powerful?
Shouldn't we all be living on the moon to avoid its noxious properties?
I recently was searching for a primary care physician, and visited several offices looking for one that could get me in before next years- in every single one the most highlighted thing, on posters and verbally relayed was this- "the doctors of this office do not prescribe pain killers for any reason."
So, yes, it is apparently getting harder for people with chronic pain to get prescription opioids.
In California earlier this year, they killed a bill that would have added penalties for convicted Fentanyl dealers.
Too hard to get fentanyl dealers to pay the penalties, yet much easier to get pharmaceutical companies to do so. Funny that California's government acts noble on this issue while also providing free syringes to drug users. Shame on those for providing the drugs that go into the syringes provided for the safe delivery of the drugs.
The government's response to bad behavior is to punish everybody, but not the bad behavior. I don't know any addicts, as far as I know, but I do know several people with chronic pain conditions. When the attack on prescription pain killers got up its head of steam, they were in a bad way. They're still in a bad way, because it's become impossible for them to get the drugs they need. The corrupted medical practices that schemed to get these on the street, the prescription mills, and the addicts that gamed the system have all moved on to more dangerous and unregulated things. The patients meanwhile, are left to suffer and abide. The Feds think the suffering is OK, as long as they're abiding.
You get more of what you incentivize. Close the border, death penalty for traffickers, institutionalize the addicts and make'em work it off - if you want the problem to become smaller.
I've always wanted to tranquilize an elephant. It's on my bucket list.
Bob Boyd said...
I've always wanted to tranquilize an elephant. It's on my bucket list.
As a young child I watched Marlin Perkins and Jim. I thought it was a career opportunity like fireman...
So, yes, it is apparently getting harder for people with chronic pain to get prescription opioids.
Thanks Yancy That is interesting. I haven't seen those signs in my area.
I do wonder if the primary care doctor would refer someone in chronic pain to a specialist. I understand the desire for doctors to let people who are doctor shopping to not bother with their practice.
In the early 2000s I had a ruptured disc and I was in pain for about 3 years. Excruciating pain for long periods of time. But I thank God I wasn't given a prescription for opioids. I eventually got the physical therapy I needed to get my back right again. It was a painful 3 years, but being a young opiod addicted mother would have been much worse. And my family has a history of addiction, so I really do think that would have been my fate.
Obviously, there's a problem on both ends of the spectrum. There's been little accountability for all the actions that helped kill so many people. Our government just sits in the middle like a big, unaccountable blurb.
"Go after them with the FDA and suspend their licenses. But no, every change in law and FDA guidance hurt ordinary patients with zero effect on the criminals and illegal drug sellers, and with disastrous effect on legit patients who regrettably turned to the street only to be killed by shitty counterfeit drugs."
A stunning parallel to "common sense" gun control.
You'd think the problem could be solved with common sense regulation.
Perhaps there could be drug buybacks and drug-free zones to get these harmful drugs off the streets.
Local drug show loopholes should also be closed.
Finally, permission to carry concealed drugs should be strictly limited by local law enforcement on a as-needed basis.
Are people in pain actually not able to get opioids?
They make it extremely hard for legit patients. As noted above by others, we had options in the past. Aetna RX would ship 3-month supplies. Six month frequency to see doctor for refills, but here in California it had to be a pain specialist (plus psyche consult for every benzo refill). Then only 30-day supplies on a 3-month script, and no more by mail; hello CVS. Then only 30-day supply AND new script every month as well (tripled co-pays in that move). Then CVS/Walgreens pharmacies started running OUT of Percocet and Oxycontin, with the caveat they could not say when the new stock comes in (for security reasons). So hello local independent pharmacy, since the huge Loma Linda Healthcare system pharmacies, which never run out because they supply their own hospitals, only fills opioids when prescribed by their doctors. Independent is friendly and efficient but closed weekends. Of course the new rules are no early fills even if the fill date falls on a Sunday. Suck it up. Go without the 1/4th supply you used to take for two whole days and maybe we'll have it ready Monday.
So if you've read this far you probably already see what an enormous logistical hassle this is for diminished returns, higher costs (specialists are $40 co-pay not $25 like regular GP) more often, and we have the Obamacare mandated 10-minute visit with at least 5 spent watching the doctor enter data in his laptop. Local (D) congresscritter doesn't give a shit. Office gives you boilerplate "there's an opioid crisis" bullshit that of course doesn't really apply to legit pain patients. My wife isn't in danger of Fentanyl poisoning, she's in danger of bureaucratic death by chronic pain. And of course now zero benzos because after years of high doses, someone decided it's too dangerous to mix tiny amounts of benzos with the ever-tinier amounts of opioids. Fuck.
Used to have an earthquake stash. Can't have that either anymore. I love all those "plan for it" lists that still say you should ask for extra pills in case of a disaster. Yeah, now that would get you flagged as a "drug seeking patient" and you won't get it anyway. Thanks, Obama.
BC started giving away "dillies", dilaudid pills in an attempt to pull fentanyl addicts back to something safer.
Disastrous results.
1. Fentanyl addicts sold the free dillies to people lower down the addiction chain, so that they could buy fentanyl.
2. Dilly addicts quickly advanced up the addiction chain, joining the fentanyl addicts.
3. for this and other related reasons, fentanyl ODs skyrocketed
W.T.F.
"I've always wanted to tranquilize an elephant. It's on my bucket list."
In Soviet Russia, elephant tranquilize you!
Yes, provide prescription opioids to those who got hooked, or just shoot them.
“After my 2006 surgery I got all the pills I wanted. And tapered off, no problem. In 2018 they got paranoid and stingy, husband had to go out and pick up new paper Rx for every refill, and the prescriber wanted pill counts.”
Try 2023. Shopping your paper prescriptions around town no longer works. Electronic prescriptions for opioids are now mandatory. Walk into a pharmacy anymore with a paper prescription for opioids, and they can’t fill it. Ok, pick a pharmacy, and have them send it there electronically. Fine. What happens if they don’t have it? They can order it in. Maybe. Walgreens has centralized supplying, and their stores get in two shipments a week. Krogers gets in shipments daily, Mon-Fri, but you typically need to have your order in by late morning the day before. That means that it can take most of a week sometimes. So, you call around town, to various pharmacies, to see in advance, who has your prescribed opioids. Except that many chains have internal limitations on telling you over the phone if they have specific opioids in specific dosages. Walgreens typically are constrained from searching for specific meds at other Walgreens. At least you can’t many Krogers into checking their database for inventory at other stores in the chain. But, say, you find it at another store - can you just transfer the prescription to another store in the same chain? Nope. That’s not the way that electronic prescriptions work. They are point to point - between one doctor and one pharmacy. You need the doctor to cancel the prescription at the first pharmacy, and transfer a band new one to another pharmacy. Fine - except that the FDA counts their cancellations, and audits prescribers, if they have too many cancellations in a month. Can they dispense it then? Maybe not. Pharmacies have quotas on how many pain med patients they can service. Here in Las Vegas, by the Strip, you probably have to drive at least 5 miles to find a pharmacy that can dispense opioids to new opioid patients. This is a problem, because that covers most of the hotels in town, as well as ER rooms. And, of course, if your new pharmacy doesn’t have the prescribed med, you have to rinse the above and repeat. Compounding the problem of timing, the FDA doesn’t want prescriptions filled before one day before the previous prescription is supposed to be done. Thus, a 30 day prescription can be refilled on the 29th day (except, of course, you need a new electronic script every time). And most pharmacies won’t order meds, until they get the prescription (unless it’s something that they routinely dispense). They want to see the prescription before they order, but the prescriber can’t send them the electronic prescription until a day or two of when the refill is due.
It’s the FDA and their War on (Legal) Opioids all the way down. They screw things up, coming, going, and sidewalk, with their regulations and policies.
The good news is that this isn’t nearly as bad with post surgical prescriptions of opioids. We have had good luck with the pharmacies in hospitals where surgery was performed. The pharmacy in the hospital where my partner had surgery a year ago was willing and able to dispense the medications they gave her in the hospital, as long as the surgeon continues proscribing them.
"Are people in pain actually not able to get opioids?"
Over the last few years many doctors, including spinal surgeons and my GP have stopped prescribing opioids. Period. An ER doctor will give you a two day supply of a low level Norco. Two of the ones I saw cited cite the DEA as the primary cause. The puritans in the medical establishment use them as their enforcers.
After a week or two wait you eventually will end up at a pain management clinic which will test and monitor you while offering enough of a mild painkiller (Tramadol) to stop the screaming.
Damn the people responsible. Damn them to Hell.
Blogger Bob Boyd said...
"I've always wanted to tranquilize an elephant. It's on my bucket list."
I really enjoyed this comment. Who among us has not dreamed of tranquilizing an elephant?
Yes, bring them back. People in genuine in genuine pain with no history of abuse are being denied relief because of the irresponsible behavior of others. This is like banning cars because some people drive drunk.
Humanity had made huge strides alleviating the suffering that comes from physical pain, only to backtrack because of the irresponsible abuses by bad actors. Reverse this over reaction and give assistance to those with serious pain.
I like my elephants like I like my women. Tranquilized. - Danny Masterson
"Walk into a pharmacy anymore with a paper prescription for opioids, and they can’t fill it."
I'd just go to the ER and let them give a shot of Morphine, or a drip, and they'll leave you with a take-home stash (I'd make a good junkie). ER isn't going to turn way, or turn down a request for pain.
IMO, the problem isn't overdoses, it's the off-label uses. Prior to regulation, Doctors seemed all too willing to wrongfully prescribe Oxycontin for everything from anxiety and depression, mood disorders etc. Just tossing it around.
The best painkiller is still aspirin, no prescription needed. Again, want something stronger? Head to the ER and put on an act.
Who among us has not dreamed of tranquilizing an elephant?
I imagine it’s challenging because if you tranquilize them out in the open I assume they’d risk injury falling down. Need to tranquilize them where they’ll pass out leaning against trees. Or so I would guess.
Yes, we should loosen up on prescribing pain pills. The percentage of opioid abuse that began as a result of people having drugs duly prescribed for actual pain is very small.
I would say that this post is too large a subject to be contained in one comment thread.
as RideSpaceMountain said...
Stop. Using. Narcan.
this is a problem, that would pretty much solve itself, if we just Stop. Using. Narcan.
"Yes, bring them back. People in genuine in genuine pain with no history of abuse are being denied relief because of the irresponsible behavior of others."
Yes, then the people in pain will be told that they better damn sign the euthanising papers and die if they are in so much pain, dammit. That will create a new stalwart breed that trusts no one over 30, by God. (Known as the Children of the Corn, right?) Or the Winter Garten of the "Stern de Ungeboren", a now unknown SF book from pre-Nazi Germany.)
Best way to get the drugs is having a surgical procedure. That's good for a one or two week supply (usually, weak-ass 5 mg tablets).
About the only other way is going to the ER, where you can polish your bullshitting and begging skills. I think some people working in the ER get-off on seeing the degree to which you'll debase yourself to get some relief.
Some of the pain's pysical and some might be described as "other". "Other" will earn you contempt and no small amount of humiliation. But, a few hours in Pleasantville is sometimes all it takes to make you a functional human being for another few days. Spending too much time thinking about suicide is not good for a person. Sadly, too many of our progressive leaders would congratulate a person of my age for "getting it" and ask what's holding me up.
Just think of the crap a person endures if they trigger some anxiety or degree of "discomfort" in another by an insensitive word or gesture. And yet, if you can benefit from controlled, prescribed opiod use, it's perfectly OK to shame the living sh** out of you.
Is there any such thing as a "doctor/patient relationship" anymore? I think those have largely been replaced by "doctor/administrator relationships" and "doctor/protocol relationships".
Mark said...
"The problem is the drug culture that people insisted we had to have, which has led to skyrocketing dope overdoses, the stench of pot smoke everywhere, and government-become-drug dealer."
You're a leftist. You voted for this. You made this market.
“I'd just go to the ER and let them give a shot of Morphine, or a drip, and they'll leave you with a take-home stash (I'd make a good junkie). ER isn't going to turn way, or turn down a request for pain.”
Better not have real back issues then. ER Doc, trying to determine whether a patient was faking it for the pain meds, tried to lift her leg too high. She ended up back at her spine surgeon’s office as a result. Another ER visit, and half a week in the hospital, and a prescription for Neurontin, for the next year or so. So, yes, if you don’t have real chronic pain issues, getting pain meds in the ER is fine.
On the flip side, her next ER visit went sideways when they mistakenly administered Ativan, so couldn’t dispense narcotics, and she couldn’t take her own, because she was in the hospital. Only relief to chronic pain offered was Tylenol in tablets, which she can’t swallow, because the same hospital flat lined her a decade earlier, and damaged her throat with an emergency reintubation. No surprise, the Tylenol tablets in her damaged throat burned it worse.
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