A Strong Response to the Opioid Scourge

[iluvatar5150]

Those who take the government's side in this may find themselves one day thinking otherwise. An onset of a debilitating condition, a car accident, a fall, may thrust them into a nightmare existence of tortuous pain. Perhaps karma will provide a voice at that point to tell them that they've been conditioned to believe that life should be free of physical pain. One can hope.

It's pretty obvious that doctors have been screwing up recently and causing problems with their prescription of pain meds. Why do you trust the medical community to act appropriately in this situation, without oversight or guidance, when they've demonstrated so far that they won't/can't?

 

[nightflight]

It's pretty obvious that doctors have been screwing up recently and causing problems with their prescription of pain meds. Why do you trust the medical community to act appropriately in this situation, without oversight or guidance, when they've demonstrated so far that they won't/can't?

A better question is why do you trust the DEA to practice medicine?

 

[iluvatar5150]

A better question is why do you trust the DEA to practice medicine?

With no other context, I don't. But a couple things:

1.) As your article pointed out, these guidelines were published by the CDC and are voluntary.

2.) Why do you trust the doctors to get it right without additional oversight when it's clear that they are getting it wrong?

 

[ThatRobGuy]

Easy to say when you are not writhing in excruciating and/or chronic pain. "Just hang in there, grandpa; you have an appointment with the physical therapist next week. Until then here's some extra-strength acetaminophen."

The nerve, huh? Thinking people have the right to alleviate pain! Do you also object to pain control to women during childbirth?

Obviously there are times when there's so much pain, that strong pain killers are warranted and needed, however, the fact that we have bigger issues with prescription drug addition & overdose than a nation like Mexico (that can stroll into a pharmacy and buy prescription-grade drugs if they'd like without even seeing a doctor) is indicative of some sort of culture issue when it comes to Americans and prescription drugs...or with how our medical system over-prescribes them.

To put it in perspective, here's a little stat to consider:
The United States has 5% of the world’s population & consumes 75% of the world’s prescription drugs.

Another fun fact, the US is only 1 of 2 nations (in the first world) on the entire planet that allows total unrestricted Direct-to-consumer advertising for pharmaceuticals. ...and as no surprise, those two nations (US and New Zealand) are on the top of the list for prescription drug misuse.

...so like with many things, there's a happy medium somewhere...obviously the solution isn't to take all of these sorts of drugs off the market, there are times when they're needed. But, given the stats mentioned above, I feel quite confident in saying that we, as a country, are too far toward that other end of the spectrum (overuse).

 

[farout]

Those who take the government's side in this may find themselves one day thinking otherwise. An onset of a debilitating condition, a car accident, a fall, may thrust them into a nightmare existence of tortuous pain. Perhaps karma will provide a voice at that point to tell them that they've been conditioned to believe that life should be free of physical pain. One can hope.

I can tell you that in the VA system long term, serious pain medications prescribed by the doctors require a contract. Then a persons blood is monitored monthly to assure the medication is really being taken by the person with the pain medication.

Unless there is a caring pain management system to help patients manage their pain either for temporary or increasing chronic pain things will stay pretty much as it is now. Without serious pain medications, doctors will treat persons in serious pain with and Tylenol or Ibuprofen. That kind of treatment is like giving only Tylenol or aspirin for major surgery.

Simply put only by careful monitoring of patients like the VA does, will hopefully lessen the abuse of these pain reducing drugs

 

[nightflight]

Why do you trust the doctors to get it right without additional oversight when it's clear that they are getting it wrong?

I'd rather err on the side of helping people with excruciating and chronic pain; even it it means a few will abuse it. Who knows, before the week is out you or I might be in a situation where life only becomes bearable if we have adequate pain medication.

 

[cow451]

I'd rather err on the side of helping people with excruciating and chronic pain; even it it means a few will abuse it. Who knows, before the week is out you or I might be in a situation where life only becomes bearable if we have adequate pain medication.

We obviously struck a nightflight nerve. The simple fact is that people with pain that get addicted to opioids are suffering now from two serious problems rather than one. Addicts are not having a good life quality whether they are primary addicts or unfortunate people with real pain that happen to be susceptible to addiction. Some people can maintain on a consistent level of opiate medication but some cannot.

Nobody is suggesting we do nothing about severe pain. I am suggesting that simply allowing people to become addicts is not the answer. Every situation should be addressed based on the person's medical condition. Some people (remember I've worked in healthcare for decades) have been simply given medication without enough consideration for whether they can be better treated without or with less pharmaceuticals. That's why I noted the nerve blocks and other strategies.

There are also many people with chronic pain that either had or become depressed. Untreated depression makes pain worse and vice versa.

 

[iluvatar5150]

I'd rather err on the side of helping people with excruciating and chronic pain; even it it means a few will abuse it. Who knows, before the week is out you or I might be in a situation where life only becomes bearable if we have adequate pain medication.

It's not "a few." There are about 14,000 deaths by prescription opioid overdose in the US each year, while there are about 41,000 cases of suicide in all forms per year. (AFAIK, the accidental o/d stats are not included in the suicide stats) That's one o/d death for every three suicides. Heck, there are almost as many deaths by prescription opioid overdoses as there are murders (about 16,000).

http://www.cdc.gov/drugoverdose/data/overdose.html
http://www.cdc.gov/nchs/fastats/suicide.htm

 

[nightflight]

We obviously struck a nightflight nerve.

Good one!

It's not "a few." There are about 14,000 deaths by prescription opioid overdose in the US each year, while there are about 41,000 cases of suicide in all forms per year. (AFAIK, the accidental o/d stats are not included in the suicide stats) That's one o/d death for every three suicides. Heck, there are almost as many deaths by prescription opioid overdoses as there are murders (about 16,000).

http://www.cdc.gov/drugoverdose/data/overdose.html
http://www.cdc.gov/nchs/fastats/suicide.htm

The needs of the many outweigh the needs of the few. Having government make the decisions that doctors should is disastrous. I can't believe you people would rather have the DEA in charge of pain management rather than physicians.

Again, the time may come when you see things differently. In fact, the older you get the more likely that is to happen.

Again, read the comments in the linked article, especially the comments.

http://www.lynnwebstermd.com/dea-inflicts-harm-on-chronic-pain-patients/

 

[LaSorcia]

I'm implying chronic pain is worse than addiction. But thankfully, the government will look out for our interests.

I have very strong opinions and feelings about this issue. Thank GOD I do not live in chronic pain, but I know a significant number of people who unfortunately do. Every single one of them is under-medicated. God forbid a person should have an illness or injury comorbid with addiction problem. In my experience, the doctors (or their liability insurance) only sees the addiction and refuses to treat the pain. Ibuprofen for someone who has had multiple back surgeries and lives with pain that makes them cry is ludicrous.

 

[cow451]

I have very strong opinions and feelings about this issue. Thank GOD I do not live in chronic pain, but I know a significant number of people who unfortunately do. Every single one of them is under-medicated. God forbid a person should have an illness or injury comorbid with addiction problem. In my experience, the doctors (or their liability insurance) only sees the addiction and refuses to treat the pain. Ibuprofen for someone who has had multiple back surgeries and lives with pain that makes them cry is ludicrous.

One of the sad outcomes of the over prescribing is now the under prescribing. I also know many people struggling with chronic pain. But i also know people with loved ones trapped in opiate addiction and others that have lost loved ones to it. Our disjointed healthcare system makes getting proper care for pain difficult.

It's a complicated set of problems that requires a complicated approach. America has always had a "War on Drugs" rather than looking at addiction as a public health issue. So.... here we are.

 

[iluvatar5150]

The needs of the many outweigh the needs of the few. Having government make the decisions that doctors should is disastrous.

Letting the doctors do what they want is already proving to be disastrous.

I can't believe you people would rather have the DEA in charge of pain management rather than physicians.

You're not really that obtuse, are you?

Again, read the comments in the linked article, especially the comments.

http://www.lynnwebstermd.com/dea-inflicts-harm-on-chronic-pain-patients/

I read the article and I read the comments, including this one, which is at the very top:

Dr Webster – new studies show that long term opioids DO NOT work for most patients, and the conversations surrounding the up scheduling of hydrocodone (Vicodin, Percocet, etc) began long before the now pandemic of chronic pain patients in our country. This is a very misleading article. What we have in our country is >100 million narcotic dependents due to the false marketing of Purdue Pharma, and uneducated “pain management physicians”.
Up scheduling hydrocodone in fact, MAKES physicians be engaged in their patients “pain” complaints and multidiscipline treatment modalities with opioids as a LAST resort. This is in fact exactly what your are now publishing within the VA system. So, to blame the DEA for aligning with your now “new” platform of chronic pain treatment, is extremely short sighted and inaccurate.
Please do not mislead the public again. Our country is loosing 1 life every 19 minutes due to your previously boisterous education of the physician community that “opioids” are not addictive. They in fact are, and the cause of the CDC declared epidemic.
Very misleading article, and as a physician, you again are promoting false information with insufficient efficacy studies on long term use of narcotics.

Most of the rest are incoherent, but I get the overall point - people live in chronic pain. I get that. Really, I do. But the medical establishment as a whole has shown itself ineffective at responsibly policing itself and its prescription-writing practices.

I'd be happy to entertain alternative ways of dealing with this, but the status quo is not working and it's harming and killing a LOT of people.

 

[Rick Otto]

I'm implying chronic pain is worse than addiction. But thankfully, the government will look out for our interests.

I agree with your first sentence, but I've seen both poor, excellent and good service at three different VA hospitals, two in this area, the excellent one in southern Georgia.

 

[Rick Otto]

One of the sad outcomes of the over prescribing is now the under prescribing. I also know many people struggling with chronic pain. But i also know people with loved ones trapped in opiate addiction and others that have lost loved ones to it. Our disjointed healthcare system makes getting proper care for pain difficult.

It's a complicated set of problems that requires a complicated approach. America has always had a "War on Drugs" rather than looking at addiction as a public health issue. So.... here we are.

Yep, I've seen this pendulum swing. Codeine was more common when I was a kid in the sixties, but new stuff was starting to come out of labs by the 70s. I think personal supervision, as labor intensive as it may be, is the way to go. It could involve multiple approaches designed to meet people's needs where they are at.
Sorry if I wax Socialist Dictator on this one, but I admit when it comes to pain, I am a hater.

 

[Rick Otto]

Letting the doctors do what they want is already proving to be disastrous...
I'd be happy to entertain alternative ways of dealing with this, but the status quo is not working and it's harming and killing a LOT of people.

Yep, disastrous. I have heard the conversations between vets and accident victims, etc. in the ghetto. Red tape and long waits are disincentive to seek help, especially when your addiction has been morally condemned, and affordable, available alternatives have been criminalized.I

I've heard mixed reports on hospice care, but my mother's was excellent, in Tucson.
My wife is an RN and has worked gerontology, substance abuse, adult and adolescents went psych units,...of course I had to hear the horror reports. I worked in an old folks home for a season.

 

[nightflight]

I read the article and I read the comments, including this one, which is at the very top:

Yes, the comment that got well deserved rebuke.

Most of the rest are incoherent, but I get the overall point - people live in chronic pain. I get that. Really, I do. But the medical establishment as a whole has shown itself ineffective at responsibly policing itself and its prescription-writing practices.

So well turn it over to faceless bureaucrats. When your kid, or your spouse, parent, etc. is screaming through the night, remember that.

 

[iluvatar5150]

So well turn it over to faceless bureaucrats. When your kid, or your spouse, parent, etc. is screaming through the night, remember that.

1 in 550. Remember that.

 

[JustOneWay]

Why not throw in transcendental meditation? But sell that to someone who was ripped up in a car accident. smh

Why do TM when simple praying will do the trick?

 

[trunks2k]

Easy to say when you are not writhing in excruciating and/or chronic pain. "Just hang in there, grandpa; you have an appointment with the physical therapist next week. Until then here's some extra-strength acetaminophen."

Who is saying we should just let people suffer in pain? You're acting like we're suggesting that people never get prescribed opiates for pain. The new guidelines are issued by the CDC and are intended to get doctors to not just go and prescribe opiates as a first option for chronic pain, which is much too common. Instead, doctors should try non-opiate options first, and prescribe opiates only when really necessary. Opiates should not be a first line of defense.

Here is some information on the CDC guidelines for opiod prescription for chronic pain:

http://www.cdc.gov/media/dpk/2016/dpk-opioid-prescription-guidelines.html
http://www.cdc.gov/drugoverdose/pdf/PDO_Checklist-a.pdf
http://www.cdc.gov/media/modules/dpk/2016/dpk-pod/rr6501e1er-ebook.pdf

What, precisely do you object to? So far you seem to be objecting to the idea that the CDC is saying "Hey, opiod addiction is a problem. Studies show there's probably some more effective means of treating chronic pain that don't risk people getting addicted to opiods. Here's some guidelines on how to deal with chronic pain without jumping to long term opiod scripts"

 

[nightflight]

What, precisely do you object to? So far you seem to be objecting to the idea that the CDC is saying "Hey, opiod addiction is a problem. Studies show there's probably some more effective means of treating chronic pain that don't risk people getting addicted to opiods. Here's some guidelines on how to deal with chronic pain without jumping to long term opiod scripts"

Yes, because a government agency knows better than my doctor.