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legsdiamond
Member since May 05th 2011
79336 posts
Fri Aug-12-16 07:19 AM

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"DEA cracking down on Doctors who overprescribe pills"


          

it's about damn time.

http://www.post-gazette.com/news/overdosed/2016/08/12/Feds-have-taken-thousands-of-prescribing-licenses/stories/201608120095

Thousands of medical professionals have quietly signed away their rights to prescribe narcotics — and, in many cases, their careers — in recent years in a little-discussed part of the federal crackdown on prescribing that has some doctors’ advocates crying foul.

From 2011 to 2015, the Drug Enforcement Administration accepted the surrender of 3,679 prescribing licenses nationwide, and revoked another 99, according to the agency’s response this week to a Freedom of Information Act request from the Pittsburgh Post-Gazette. In Pennsylvania during that time, the DEA accepted the surrender of 148 prescribing licenses — typically held by doctors, dentists, veterinarians and nurse practitioners — and revoked one such license.


When federal agents rush into the office of a physician accused of prescribing too many pain pills, they often offer up a one-page form through which the doctor can surrender his right to prescribe many drugs. If the doctor signs?

“Kiss it goodbye. It’s never coming back,” said Dick Margarita, a former DEA agent who defends California doctors against prescribing-related charges. “One of the prerequisites for being employable is having a DEA license. You’ve basically written yourself out of employment.”

A lot of those license surrenders stem from the effort to combat the diversion to the streets of opioid painkillers, said Barbara Carreno, a DEA spokeswoman.

“DEA is working hard in all aspects of our regulatory authority to try and address the opioid epidemic,” she said. If the DEA sees “the number of schedule II OxyContins that they’ve dispensed in the last two years has gone up 200 times,” that can trigger an investigation and a license action, she said.

The surrender or revocation of a DEA prescribing license can spur state action against a doctor’s privilege to practice medicine — a one-two punch that some view as unfair.

Professor Leo Beletsky, a drug law expert at Northeastern University in Boston, pointed out that dual regulation by federal and state governments can cause frustration and confusion. Although state medical boards issue and regulate medical licenses, doctors must register for a DEA license to prescribe controlled substances.

State and federal authorities may disagree in some cases about how and whether a doctor should be disciplined. “Sometimes the state doesn’t really follow what the federal level is doing, and sometimes the federal level doesn’t fully appreciate the nuance of the situation,” he said.

Practices also seem to differ across states.


In Kentucky, where the regulator’s lash has hit rogue prescribers hardest, nearly 20 of every 1,000 prescribing licenses were surrendered or revoked over five years. In Pennsylvania and Ohio, by contrast, roughly five of every 1,000 prescribing licenses were surrendered or revoked.

In states that issue their own controlled substances licenses or have aggressively policed doctors, an action by the DEA almost always triggers a state action. In California, said Mr. Margarita, the DEA and the state medical regulators are “in cahoots,” coordinating their powers to exercise maximum leverage against an accused doctor.

In Pennsylvania, which doesn’t regulate prescribing, “A surrender to the DEA doesn’t automatically trigger revocation or some other discipline on the part of the board,” said Ian J. Harlow, the commissioner of Professional and Occupational Affairs. “These individuals are entitled to due process just like anyone else.”

Doctors are often frustrated that they are investigated by agents who don’t have medical degrees. “A lot of times providers complain that the people who are watching over them have no medical training and they’re not really qualified to make the decision,” Mr. Beletsky said.

DEA agents “indicate they’re there for possibly a routine DEA inspection,” said Detroit defense attorney Ron Chapman II, who works exclusively for accused doctors. “Then come the black SUVs and the DEA agents with jackets, and oftentimes they’ll raid the facility, start taking documents, and separate the physicians in the facility for interviews.”

Mr. Chapman said it would be fairer if the DEA would instead use its power to propose restrictions on a physicians’ prescribing, rather than asking immediately for surrender.

Ms. Carreno said that before trying to take a license, the DEA almost always writes a “letter of admonition” saying something like: “It appears you’re not following the here, or you don’t understand the reg.” The agency seeks to suspend a prescribing license — a step toward revocation — only if “their continuing to practice is a public safety issue,” she said.

Doctors, she said, “don’t need to be afraid of the DEA, because only a small number of them are violating the controlled substances act.”

Pennsylvania has, from 2011 through 2015, disciplined relatively few doctors for their prescribing practices, compared with the other states that encompass opioid-plagued Appalachia, the Post-Gazette has reported.

Mr. Harlow noted that effective Aug. 25, Pennsylvania doctors will be able to check patient prescribing histories in an online database, allowing them to detect drug problems. Likewise, the state will be able to access data on any doctor’s prescribing tendencies.

“We now have another tool in the toolbox to look at when we’re opening the case” against a doctor viewed as prescribing unnecessary narcotics, he said.

****************
TBH the fact that you're even a mod here fits squarely within Jag's narrative of OK-sanctioned aggression, bullying, and toxicity. *shrug*

  

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Topic Outline
Subject Author Message Date ID
LOL. They lost a whole generation of kids to make big pharm rich
Aug 12th 2016
1
Appalachia was a damn pill party
Aug 12th 2016
2
huh. WOW at those stats.. 34%, 14%, etc.
Aug 14th 2016
19
Fuck the DEA on this one
Aug 12th 2016
3
Sorry about your mom, but there are non-narcotic options
Aug 12th 2016
6
First off - "addictive" doesn't come into play for everyone
Aug 12th 2016
7
      chronic pain is tough, my dad has been dealing w/similar issues
Aug 12th 2016
8
      Question. And I mean this with the utmost respect for your family's
Aug 12th 2016
9
           This is not an issue with my situation
Aug 12th 2016
11
Yeah, my mom's in the same boat
Aug 12th 2016
10
Its crazy how rules vary from state to state too. Florida sucked
Aug 12th 2016
12
The fact is....
Aug 13th 2016
13
      Trust me - I'd know if she was in danger of being an addict
Aug 13th 2016
14
           I'm not saying she is an addict.
Aug 13th 2016
15
                You are wrong
Aug 13th 2016
17
LOL, 10 years and a Heroin epidemic later NOW they want to do
Aug 12th 2016
4
Really interesting article. Good post.
Aug 12th 2016
5
RE: Really interesting article. Good post.
Aug 13th 2016
16
      Hmm.. iirc, the issue with Purdue's Oxycontin was less about
Aug 14th 2016
18

BigReg
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Fri Aug-12-16 08:06 AM

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1. "LOL. They lost a whole generation of kids to make big pharm rich"
In response to Reply # 0
Fri Aug-12-16 08:08 AM by BigReg

  

          

How many news stories on people robbing pharmacies, fake storefront doctors, etc...and the DEA just figured this shit out for the past few years. Shit, its over a decade since even RAPPERS switched to pills and codeine pushing in their raps.

There's a FUCKED UP article in the NYtimes this week that discusses why opiod use never took a real foothold in the hood (we stick to our coke heroin, and k2, thank you). Even doctors hate niggas


Dr. Meghani’s 2012 analysis of 20 years of published research found that blacks were 34 percent less likely than whites to be prescribed opioids for conditions such as backaches, abdominal pain and migraines, and 14 percent less likely to receive opioids for pain caused by traumatic injuries or surgery....that white children with appendicitis were almost three times as likely as black children to receive opioids in the emergency room...

Adam Hirsh, a pain researcher at Indiana University-Purdue University, Indianapolis, said he had often heard what might be called a silver-lining argument: that even if blacks have been unequally treated for pain, they have largely been spared from opioid addiction. That argument does not sit well with him.

He and other researchers say the reasons may include false stereotypes, such as the assumption that blacks are more likely to abuse drugs, as well as a tendency for doctors to empathize less with patients whose race is different from their own — perhaps subconsciously — and to underestimate the severity of their pain. Only about 4 percent of the country’s practicing physicians are black.

http://www.nytimes.com/2016/08/10/us/how-race-plays-a-role-in-patients-pain-treatment.html?_r=0

  

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legsdiamond
Member since May 05th 2011
79336 posts
Fri Aug-12-16 08:30 AM

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2. "Appalachia was a damn pill party"
In response to Reply # 1


          

only reason they finally did something is because heroin started hitting the suburbs and fucking up good homes

slightly off topic, I met a woman who just quit the drug rep game because she was slinging the drug that killed MJ.

She told me doctors asked her how much they should give a patient. Do they get paid by the pound?

My boy used to be a GSK rep. Back when this was ramping up he said it got to a point to where the doctors office wasnt filled with patients... it was all reps.

****************
TBH the fact that you're even a mod here fits squarely within Jag's narrative of OK-sanctioned aggression, bullying, and toxicity. *shrug*

  

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kfine
Member since Jan 11th 2009
2218 posts
Sun Aug-14-16 01:45 PM

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19. "huh. WOW at those stats.. 34%, 14%, etc."
In response to Reply # 1
Sun Aug-14-16 01:52 PM by kfine

          

>
>He and other researchers say the reasons may include false
>stereotypes, such as the assumption that blacks are more
>likely to abuse drugs, as well as a tendency for doctors to
>empathize less with patients whose race is different from
>their own — perhaps subconsciously — and to underestimate
>the severity of their pain. Only about 4 percent of the
>country’s practicing physicians are black.
>
>http://www.nytimes.com/2016/08/10/us/how-race-plays-a-role-in-patients-pain-treatment.html?_r=0


I wonder if there's disparity by gender as well.

And I bet that 4% probably shrinks to <1% if they were to only count specialists/pain specialists, who black patients are already less likely to be referred to in the first place.


edit: On a side note, this phenomenon has taken some getting used to because I grew up in a predominantly white region where POC were a large proportion of the doctors and specialists. Not sure of the exact proportion, but it was definitely more than the 1% of POC in general the population. I'd guess it was probably around 30% for doctors in general, and inching up to 40%+ once you got to various specialties.

  

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handle
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Fri Aug-12-16 11:23 AM

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3. "Fuck the DEA on this one"
In response to Reply # 0


          

Yes, I will agree that their is a drug problem when people who don't need the drugs take them for "fun."

BUT the flipside is that people who *actually need* the medication for pain management are often in horrible, years long pain.

My mother injured her back in the military (Navy nurse, hut her back lifting patients and preventing falls) and has had several major back surgeries.

When her back pain kicks in (sometimes it goes away for months at a time, sometimes it stays for multiple months) she NEEDS pain medication - and in some cases an epidural.

Well it's difficult for her to get the drugs now, so she'll be in agonizing back pain for days sometimes.

Luckily as an ex-nurse she knows the words to say - and the poeple to talk to to get the medication she needs. But if her health declines - or if she starts to lose her mental capabilities a bit (people often do when they get older) it might be a lot worst for her.

Recently the pain management doctor she's been seeing has had his Medicare certification removed - because he's "over prescribing" pain medication.


She's almost 70. Retired military. Major back surgeries. Medically discharged from the service and has a handicap placard on the car. In no way could she be considered an addict.

But who cares if she became addicted anyways?
I'd rather have her on be "addicted" than to be in horrible pain for days/weeks on end.

The bad news is it looks like she'll have to have another surgery within the next year

------------


Gone: My Discogs collection for The Roots:
http://www.discogs.com/user/tomhayes-roots/collection

  

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bentagain
Member since Mar 19th 2008
16595 posts
Fri Aug-12-16 06:13 PM

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6. "Sorry about your mom, but there are non-narcotic options"
In response to Reply # 3


  

          

the opioids that are being prescribed were never intended for extended use

as they don't address the issue causing the pain

and are highly addictive

has your Mom considered an implant?

http://www.tamethepain.com/chronic-pain/spinal-cord-stimulation-neurostimulation/about/index.htm?loc=testa

---------------------------------------------------------------

If you can't understand it without an explanation

you can't understand it with an explanation

  

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handle
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Fri Aug-12-16 06:44 PM

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7. "First off - "addictive" doesn't come into play for everyone"
In response to Reply # 6


          

>the opioids that are being prescribed were never intended for
>extended use

Actually, they are. And when used in people with medium to severe pain addiction isn't a worry. Because if you're in pain and take a drug that greatly decrease your pain then it's effective - and physical depndcy , in my mind, is a lot better than being in severe pain for days/weeks/years on end.

>as they don't address the issue causing the pain

Well something like severe back pain because of disc herniation can't really be addressed in any other way.Surgery only helps so much.


>and are highly addictive

Again, not so if you take them only when you have pain. And , let's just say that they were addictive - who cares if a 70 year old woman who has chronic and agonizing back pain is addicted to pills?

>has your Mom considered an implant?
>
>http://www.tamethepain.com/chronic-pain/spinal-cord-stimulation-neurostimulation/about/index.htm?loc=testa

My understanding is that those don't really work as well. I could be wrong - but they're for more mild pain. I know my mother met with a lot of doctors to discuss her options as recently as a year ago.

Pain is just neurons in your brain firing and being received - opiods suppress those signals - and long term users of them actually think and function better than those with severe pain.

Drug addicts and drug dealers are fucking this up for everyone.

------------


Gone: My Discogs collection for The Roots:
http://www.discogs.com/user/tomhayes-roots/collection

  

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GOMEZ
Member since Feb 13th 2003
5613 posts
Fri Aug-12-16 06:54 PM

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8. "chronic pain is tough, my dad has been dealing w/similar issues"
In response to Reply # 7


  

          

but even if it is for the treatment of pain, the side effects of opioids and their addictive nature are still there. And no lie, it's caused some issues. It's a worthwhile trade off for a lot of people with severe chronic pain, though.

He ended up quitting the opioids and getting a green card and going that route in WA. He's a happier and healthier person for it. Every situation is different, so i'm not pretending like that's the solution for everyone, though.

Overall I agree that people like your mom need to have access when necessary, but even then it needs to be monitored and kept in check to a degree, because treatment of pain can escalate into abuse pretty easily.

Chronic pain is a real fucker of a problem.

In a generation of swine, the one-eyed pig is king.
-Hunter S. Thompson

  

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kfine
Member since Jan 11th 2009
2218 posts
Fri Aug-12-16 07:16 PM

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9. "Question. And I mean this with the utmost respect for your family's"
In response to Reply # 7
Fri Aug-12-16 07:33 PM by kfine

          

situation and what your mother is going through: But would you not prefer that your mother remain alive?

Because, from the government's perspective, it's my understanding that the most troubling outcome of this opioid issue is the staggering number of deaths resulting from "accidental" overdoses.

Clinician practices have been linked to the skyrocketing rise in accidental overdoses.. such as overprescribing, either by quantity or by dosage. Which makes sense... because pain is not a new phenomenon, and pain medication is not a new phenomenon.. but somehow, the rate of patients dying from accidental opioid overdose tripled in a decade. I'm not denying the involvememt of addiction, and pain as an experience is still an area of research with huge gaps that remain to be understood. But there are definitely systemic forces contributing to the problem, which I believe is what the government is trying to address with the type of intervention described in the article..

So just wondering if it is possible to consider the heightened regulation as a way of actually protecting your mother, too?

I understand how sensitive this topic must be for you, and I hope I haven't offended you by asking, for real

  

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handle
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Fri Aug-12-16 09:01 PM

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11. "This is not an issue with my situation"
In response to Reply # 9


          

>situation and what your mother is going through: But would
>you not prefer that your mother remain alive?

I want two things for my mom:
1)To be alive
2)To have a quality of life that does consist of agonizing to medium pain for every waking moment of every day.

Frankly I can see how someone might want to be dead if their life is nothing but pain.

Note:My mother has months and even sometimes a year where she is largely pain free and she does not take the opioid drugs. Believe me - she stockpiles the unneeded/unused medication for the times when pain does hit because many times it can take days to see a pain specialist and have medication prescribed.


>Because, from the government's perspective, it's my
>understanding that the most troubling outcome of this opioid
>issue is the staggering number of deaths resulting from
>"accidental" overdoses.

I think these overdoses occur mainly for people without severe and chronic pain - plus my mother is a nurse.

So if the pain medication is not as effective she doesn't take MORE - she takes what she is prescribed and then calls the doctor to get other treatments.

One such treatment are epidurals - another is switching the type of opioid - she's been given a Fentanyl patch for time periods where the pain was unmanageable without it. And there's still a lot of other drugs in the opioid family that are still stronger - they're usually reserved for hospice care/cancer treatments.


>Clinician practices have been linked to the skyrocketing rise
>in accidental overdoses.. such as overprescribing, either by
>quantity or by dosage. Which makes sense... because pain is
>not a new phenomenon, and pain medication is not a new
>phenomenon.. but somehow, the rate of patients dying from
>accidental opioid overdose tripled in a decade. I'm not
>denying the involvememt of addiction, and pain as an
>experience is still an area of research with huge gaps that
>remain to be understood. But there are definitely systemic
>forces contributing to the problem, which I believe is what
>the government is trying to address with the type of
>intervention described in the article..

Yes, if you have a minor pain or a transient pain (break and arm and the pain goes away after a month) and take the stuff and keep taking it when the pain is gone and then keep taking it for fun then have to increase to get the same high then you'll probably overdose.

That is not the case for a lot of people with severe and chronic pain.

Now figuring out if the person is truly having severe chronic pain or just faking it to get high or to not start withdrawals is an issue. I'd error on the side of letting someone without pain get high - not by having someone in pain stay suffering.


>So just wondering if it is possible to consider the heightened
>regulation as a way of actually protecting your mother, too?

This all *depends*. If the regulation is from bureaucrats (and I'm not using that as a Republican swear word - I mean people in the FDA who do not practice medicine and have not treated real chronic pain patients) then I think they'll do a lot of harm.

if it means having protocols in for doctors and pharmacists to aid them in determining who needs pain medication and who might be abusing it then I'm all for it.

And prosecuting doctors who are overprescribing to get rich - lock them up too.

But I know , because I've had to drive my mother to appointments when the pain was too bad for her to drive, that what's really happening is the FDA is trying to have FEWER people given medication and it often affects those who actually need it.


>I understand how sensitive this topic must be for you, and I
>hope I haven't offended you by asking, for real


Drug addiction is a real problem - but so is pain management.

------------


Gone: My Discogs collection for The Roots:
http://www.discogs.com/user/tomhayes-roots/collection

  

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Mynoriti
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Fri Aug-12-16 08:46 PM

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10. "Yeah, my mom's in the same boat "
In response to Reply # 3
Fri Aug-12-16 08:50 PM by Mynoriti

  

          

She's disabled, has degenerative conditions, has had multiple surgeries.. certain painkillers and PT are the main things have helped her remain functional and have a decent quality of life (she's tried plenty of the alternatives) They're always adding new hoops for her to jump through though. Especially whenever she has to change doctors. Many docs in general have gone from over prescribing to the opposite extreme. Even though they know she's not BSing, they're paranoid of scrutiny now.

  

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GOMEZ
Member since Feb 13th 2003
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Fri Aug-12-16 10:46 PM

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12. "Its crazy how rules vary from state to state too. Florida sucked"
In response to Reply # 10


  

          

Shit was a beaurocratic nightmare. Washington was pretty fair, on the side of maybe too lenient. Too lenient at least lets good doctors do their thing. Florida just fucked addicts and legit patients alike.

It's a tough balance.

In a generation of swine, the one-eyed pig is king.
-Hunter S. Thompson

  

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denny
Member since Apr 11th 2008
11281 posts
Sat Aug-13-16 03:26 AM

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13. "The fact is...."
In response to Reply # 3


          

It is easier to get opiates in the US than any other country in the world a few times over. And that's AFTER the recent crackdowns.

Also....addiction is not related to pain. You could take the pills for fun and not get addicted. You could take the pills because you had surgery and get addicted. There has been some studies that suggest some people may be genetically pre-disposed for addiction. But we really don't know why some get addicted and not others. There's no evidence that shows the amount of pain you are in decreases the likelihood of addiction.

There's been alot of newer studies that show opiate treatment actually INCREASES the amount of pain you are in. The scientific explanation is readily available via google....but the basic premise is that someone who has a back pain to a level of 5....then might use opiates to decrease that level to 2. But when they come off the opiates the pain level will be 7. So the base level of pain experienced without treatment actually INCREASES temporarily after prolonged opiate use.

"She's almost 70. Retired military. Major back surgeries. Medically discharged from the service and has a handicap placard on the car. In no way could she be considered an addict."

I'm certainly not referring to your mom specifically. But the last line of this quote is a huge red flag. You're falling into the trap of only seeing addiction where it fits the stereotype of what we think addicts are like. But that's the exact problem with this epidemic. People think there's no problem cause someone doesn't look like a street heroin user with no career credentials and bags under their eyes.

I completely agree with this though:

"I'd error on the side of letting someone without pain get high - not by having someone in pain stay suffering."

Amen to that.

  

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handle
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Sat Aug-13-16 11:10 AM

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14. "Trust me - I'd know if she was in danger of being an addict"
In response to Reply # 13


          


>"She's almost 70. Retired military. Major back surgeries.
>Medically discharged from the service and has a handicap
>placard on the car. In no way could she be considered an
>addict.">
>I'm certainly not referring to your mom specifically. But the
>last line of this quote is a huge red flag. You're falling
>into the trap of only seeing addiction where it fits the
>stereotype of what we think addicts are like. But that's the
>exact problem with this epidemic. People think there's no
>problem cause someone doesn't look like a street heroin user
>with no career credentials and bags under their eyes.

I know her particular situation and that's why I don't think she's anywhere near or in danger of being an addict. In her case I know she does not take the pills unless/until there is significant pain - and when there is pain that isn't severe she has other - non opioid drugs that she takes.

She also isn't prone to addiction - she pretty much stopped drinking once she got in her mid 30's and she doesn't seek those kind of thrills.

Also she had her first major back surgery in 1983 and I would have noticed if there is a proble over the past 33 years.

Unless she's so high functioning that it doesn't matter if she is an addict (she is not.)



>I completely agree with this though:
>
>"I'd error on the side of letting someone without pain get
>high - not by having someone in pain stay suffering."
>
>Amen to that.

------------


Gone: My Discogs collection for The Roots:
http://www.discogs.com/user/tomhayes-roots/collection

  

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denny
Member since Apr 11th 2008
11281 posts
Sat Aug-13-16 09:10 PM

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15. "I'm not saying she is an addict."
In response to Reply # 14
Sat Aug-13-16 09:14 PM by denny

          

But ask ANY addiction councillor and none of that would hold water in claiming that there is absolutely no danger of her being or becoming an addict.

1. You can't verify that she is in pain.

2. Addicts lie about being in pain....both to themselves and other people.

3. Opiate withdrawal IS painful. And if you have an injury...the pain you feel from that injury is increased during opiate withdrawal. So even when someone is not consciously lying about their pain....they may not know that the pain is a result of the combination of the injury AND the withdrawal. Opiate withdrawal makes unrelated pain more acute.

4. If your mother has been using opiates on and off for 33 years than she is addicted to them. She will experience withdrawals when coming off them and that is a medical fact. Some people (usually ones that are well-adjusted and happy) are able to cope with withdrawals without much difficulty.

5. Highly functional addicts are also at risk. I agree with what I think you're suggesting....that drug USE is not really the problem. The problem is what results from the use regarding behavior, lifestyle and well-being. I was a functioning addict so I understand that viewpoint. But there is ALWAYS a degree of risk...albeit minimized by someone's ability to maintain responsibilities and well-being. The majority of addicts can be described as 'functioning'. That doesn't mean there's no risk.

  

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handle
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Sat Aug-13-16 09:34 PM

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17. "You are wrong"
In response to Reply # 15


          

Believe what you want - I know *this* situation and she is not ADDICTED to pills.

She does use them when the pain gets severe - which sometimes is not at all, and sometimes for weeks at a time - and then she discontinues use of them.

Just because you can't believe it doesn't mean it's not true.

It's not they had them out easily - they give her a very small supply and when she needs it for more than a few weeks she has to go into the office and they run her through a protocol to make sure she's not abusing the medication.

>1. You can't verify that she is in pain.

Jesus Christ, if you think someone who was medically discharged from the military (she retired at 20 years but gets a higher rate) has a handicap placard, has had several surgeries, who is claustrophobic so she has to drive 2 hours to an open-MRI machine (which she did last week) is faking it, then I'd like to see your medical credentials and your experience in diagnosing chronic pain patients.

I think I'm done with you on this - you're exhibiting the belief that THE ONLY REASON someone would use pain medication is because they're addicted to it. And that using pain pills to manage pain means that you are an addict.

Some people actually have medical conditions that will cause them to be in agonizing pain for long periods of times - and these drugs are exactly what they need to be able to live a life that isn't ONLY being in pain.

Now, I agree that more people are probably abusing drugs than actually need it - but frankly denying people who need the MEDICATION is not the answer.

We can increase rehab funding and drug education to help lessen that problem - but these drugs work well and have very little long term side effects of the people who need them.

I'd trade you all the opium in the world if you could find a fix for my mother's pain. So would she. So would the millions of people in chronic pain.

And the people who just want to get high will find other ways to do it.



------------


Gone: My Discogs collection for The Roots:
http://www.discogs.com/user/tomhayes-roots/collection

  

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Mignight Maruder
Member since Nov 30th 2003
7706 posts
Fri Aug-12-16 12:26 PM

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4. "LOL, 10 years and a Heroin epidemic later NOW they want to do "
In response to Reply # 0


  

          

something. I called this shit well over a decade ago. It seems my community got the brunt of it early - it's still horrible in the York, PA area. My little brother lost several of his childhood friends to Heroin in the mid to late 2000s. All of them got hooked on painkillers first and then graduated to H when the pills dried up or became too expensive.

I knew something was up when I got prescribed Codeine for a basic ass cough at some point in the early 2000s when I was away at college. My mom broke her ankle the year before and was prescribed a shit ton of oxy's for pain relief. I broke my ankle no less then 3 years prior to that and was never given pain pills. There's no reason she needed that many oxy's. Thankfully she didn't get hooked like so many others.

But yeah, Big Pharma has a shit ton of blood on their hands.

  

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kfine
Member since Jan 11th 2009
2218 posts
Fri Aug-12-16 06:07 PM

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5. "Really interesting article. Good post."
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I have to agree with most of the other thoughts shared in here about the response to the opioid issue. For a problem with so many actors involved (patients, clinicians, industry/Pharma, insurance companies), and at such scale? Strategy, coordinatian, enforcement was definitely weak out the gate.

I do understand how this must frustrate lawmakers (judging from the appropriation hearings, anyway) because theyve been throwing money at this shit.

But honestly there probably should have been some kind of joint public-private task force set up from jump, to make sure all the different sub-problems would be addressed appropriately and synchronized in the right fashion. Like any related government agency, any related medical association, pharmaceutical industry representation, insurance industry representation, patient groups, etc.

For example.. The CDC issued prescription guidelines earlier this year, but it's like..shouldn't tighter oversight over the prescription of highly addictive/potent patient drugs be a mandate all the time,across the board, not just after millions of Americans have died?? Or, congress pumping money into R&D, funding development of timed-release pain med formulations..only to find out that doctors were still prescribing regular old opioid formulations at similar rates as before. Why? Well because it turns out pharmaceutical companies like to make fancy new drug formulations expensive lol (them having a bottom line to consider and all), and insurance companies were deciding not to cover fancy safer pain meds when they could just cover older cheaper formulations that produce the same patient outcome (them having a bottom line to consider and all).

Nonsensical roundabout stuff like that kind of suggests a full gamut of stakeholders wasn't involved in strategizing a response from the beginning. And now the government is frustrated by what patients have known for a long time - that the health system has way too many loopholes for private interests to be put first instead of patients.

  

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denny
Member since Apr 11th 2008
11281 posts
Sat Aug-13-16 09:34 PM

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16. "RE: Really interesting article. Good post."
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The funding of time-released medication technology is what STARTED the epidemic. Specifically, Purdue's Oxycontin. The initial justification for wide-spread prescription of oxy was that it was not addictive BECAUSE it was designed for time-delayed release. Which, of course, was a HUGE lie and they fucking knew it.

Time-delayed opiates (the best example is methadone) are actually the worst imo. The longer the time-delay....the longer the withdrawal period. So something like heroin or percocet are immediate release. They hit the brain as soon as you take it but the effects don't last as long. Withdrawals mirror the time release....so when you're coming off an opiate with a short time release (intense high, short time period of effects)....the withdrawals coincide (highly intense withdrawal, short time period). So withdrawing from heroin could be estimated around 7 to 10 days with high intensity of symptoms. Withdrawing from methadone could be estimated at around 6 to 8 weeks with a low intensity of withdrawal symptoms. Not everyone agrees...but I'd take the fast, intense withdrawal over the long one ten times over.

  

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kfine
Member since Jan 11th 2009
2218 posts
Sun Aug-14-16 01:19 PM

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18. "Hmm.. iirc, the issue with Purdue's Oxycontin was less about"
In response to Reply # 16
Sun Aug-14-16 01:33 PM by kfine

          

the timed-release formulation (though still a part of it, due to the timed-release effect being inactivated depending how pills were ingested), and more about overzealous marketing (which we all know is/was a problem across the pharmaceutical and nutraceutical domain in general, not just pertaining to pain medications).

But regarding their utility... I think the continued support for timed-release/abuse-deterrent formulations hinges on them specifically targeting acute mortality risk. Meaning... with so many people dying due to accidental overdose, why not try to literally prevent (or at least delay) the timepoint of 'fatal' toxicity, starting from the moment one ingests the medicine.

Perhaps such formulations should really be referred to as overdose-deterrent though, not abuse-deterrent, because they only address a small proportion of mortality risk and do so "pharmacokinetically." And evidently, while the medical community was so focused on the alleged benefits of timed-release opioids, little was done to address the subjective pain experience, patient behaviors, clinician behaviors, accessibility etc.... which feeds into some of the criticisms you and Handle have shared.

That said, I still think it's dangerous to view the opioid issue through one lens (be it patient, provider, marketplace, legislative), since the problem is multifactorial.

It's kind of scary how clumsy the response has been, though. Tampering with the levels of pain experienced by individuals is such an extraordinarily delicate endeavor, and it tip-toes on multiple ethical concerns. Then, add in the market effects at play such as the marketing --> overprescription dynamic, and insurance companies manipulating prescription opioid coverage in a way that also shapes prescription practices, etc.? This whole thing's a mess.

But some effort is better than none.

You're probably familiar with some of the articles below, but just posting since relevant to the topic in general:


http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3411218/

http://painmedicine.oxfordjournals.org/content/12/suppl_2/S26.long

http://www.annualreviews.org/doi/pdf/10.1146/annurev-publhealth-031914-122957

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4370920/

http://painmedicine.oxfordjournals.org/content/12/3/415.long

  

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