The Opioid Crisis

[Skeptical Greg]

I will bring my bottles of medicine to show the doctor how many are left.

There seems to be a loop-hole there...

 

[Trebuchet]

Opioids have been a daily part of my life for several years. Because of a degenerative spinal condition, I have had 4 spine surgeries and the last one contributed to permanent damage, resulting in CRPS.

Never, in the 20 years or so that they have been prescribed to me, did any doctor tell me it was the only thing that would work. Many other options were tried. Physical Therapy, other medicine, yes, even woo-ing off on my own with acupuncture. Bad, bad idea.

It is becoming much more difficult for people like me, who have no red flags in 20 years, to obtain them. In a way I have been lucky, in that my spinal issues are so easily identifiable on film, scans, reports. Yet now, there are new hoops to jump through.

To receive a prescription, I must sign a contract. They may urine test me at any time when I'm there. I will never take another - (sorry, the class that valium and zanax are in) - so I went cold-turkey, and I will bring my bottles of medicine to show the doctor how many are left.

That's fine. I receive no euphoria or shift of mood or sleep. It is simply a question of how well I need to function. My history shows that a one-month supply lasts me an average of 7 weeks. Yet, the manner of the doctors, in my experience, is insulting. It feels as if I am being reminded every few weeks that I am a potential criminal. A statistic.

It would be interesting to hear the experiences of others, because I only know the California experience.

My wife's experience in Washington, for the same medical problem, is pretty much identical, but she hasn't stopped and we aren't finding it so insulting as you appear to. In fact, I was somewhat amused and disgusted to find that the amount of red tape for buying some Sudafed is even more than to pick up her Rx.

Trump's solution, of course, is to execute drug dealers. That won't apply to doctors and Pharma CEO's, of course.

ETA: I think I may have misread your post. Is it just the valium/xanax you've stopped?

 

[luchog]

(sorry, the class that valium and zanax are in)

Benzodiazepines.

Yet, the manner of the doctors, in my experience, is insulting. It feels as if I am being reminded every few weeks that I am a potential criminal. A statistic.

Blaming it on the doctors is misguided at best. They are forced to comply with comply with increasingly restrictive, invasive, and complex regulations and monitoring, or risk losing their license to practice. This is entirely the fault of a whole lot of politicians who insist on treating addiction as a legal problem instead of a medical problem; and enacting high-profile legislation to make it appear as though they are doing something useful to combat the crisis, without actually doing anything useful. Image over utility.

 

[Tony99]

Solution: remove all government regulation on opiods and opiod treatment.

Agree with you Bob.

Also, it becomes a 'crisis' when white middle and upper class people start having a problem and dying.
I remember the heroin 'crisis' of the late 90's was in the daily news when suburban white kids in Texas and Florida started getting addicted and dying.
http://www.nytimes.com/1997/11/23/us/10-heroin-deaths-in-texas-reflect-rising-use-by-young.html

 

[CORed]

Benzodiazepines.




Blaming it on the doctors is misguided at best. They are forced to comply with comply with increasingly restrictive, invasive, and complex regulations and monitoring, or risk losing their license to practice. This is entirely the fault of a whole lot of politicians who insist on treating addiction as a legal problem instead of a medical problem; and enacting high-profile legislation to make it appear as though they are doing something useful to combat the crisis, without actually doing anything useful. Image over utility.

that's a good point. Also, a maintenance dose of opioids should be an option for addicts. It may not be the best option, but it's certainly better than cutting them off and sending them to their local drug dealer. In any case, addiction should be treated as a medical problem, not a moral or criminal problem.

 

[wasapi]

My wife's experience in Washington, for the same medical problem, is pretty much identical, but she hasn't stopped and we aren't finding it so insulting as you appear to. In fact, I was somewhat amused and disgusted to find that the amount of red tape for buying some Sudafed is even more than to pick up her Rx.

Trump's solution, of course, is to execute drug dealers. That won't apply to doctors and Pharma CEO's, of course.

ETA: I think I may have misread your post. Is it just the valium/xanax you've stopped?

Yes, those are the only ones I stopped. There was some withdrawal, but not terrible. They did, however, try to decrease the dose of the pain meds. A few months ago a Dr I no longer see, told me she was reducing it "a pinch", which turned out to be 50%. My pain increased, and the next Dr I saw put it back to the usual dose.

 

[wasapi]

Luchog, you are absolutely right, and I apologize. In venting, I lost sight of that for a moment, so thank you. There was one Dr when my insurance changed to a new group, that treated me like an intelligent enough person to explain new and current CA law regarding opiode perscriptions.

 

[crescent]

that's a good point. Also, a maintenance dose of opioids should be an option for addicts. It may not be the best option, but it's certainly better than cutting them off and sending them to their local drug dealer. In any case, addiction should be treated as a medical problem, not a moral or criminal problem.

Suboxone (Buprenorphine/naloxone) is a better option. Kills the craving, prevents effects of any opiates they do take, doesn't get them high.

Buprenorphine/naloxone is used for the treatment of opioid use disorder.[9] Long term outcomes are generally better with use of buprenorphine/naloxone than attempts at stopping opioid use all together.[4] This includes a lower risk of overdose with medication use.[4] Due to the high binding affinity and low activation at the opioid receptor, cravings and withdrawal for opioids are decreased while preventing a patient from getting high and relapsing on another opioid. The combination of the two medications is preferred over buprenorphine alone for maintenance treatment due to the presence of naloxone in the formulation, which helps function as an abuse deterrent, especially against intravenous use.[9]

Buprenorphine/naloxone has been found to be effective for treating opioid dependence, and serves as a recommended first line medication according to the U.S. National Institute on Drug Abuse.[10] The medication is an effective maintenance therapy for opioid dependence and has generally similar efficacy to methadone, which are both substantially more effective than abstinence-based treatment.[4][11]

One current issue is that a lot of treatment places look at suboxone as a very temporary solution and push patients to get off of it pretty quickly. Given how messed up many addicts lives are, that seems to be counterproductive. They need time to put things together without having a constant craving nagging at them. Doctors and treatment professionals need to be open to keeping a person on suboxone for years, or even for life if that's what is needed to keep the person functional.

12 Step programs are one of the less effective treatment options, and many push too hard to get people completely off everything, including things like suboxone or methadone - that's bad. 12 step works great for a few, but it is no substitute for medical treatment and they need to allow the use of actual medicine to treat addiction.

 

[Giordano]

Suboxone (Buprenorphine/naloxone) is a better option. Kills the craving, prevents effects of any opiates they do take, doesn't get them high.



One current issue is that a lot of treatment places look at suboxone as a very temporary solution and push patients to get off of it pretty quickly. Given how messed up many addicts lives are, that seems to be counterproductive. They need time to put things together without having a constant craving nagging at them. Doctors and treatment professionals need to be open to keeping a person on suboxone for years, or even for life if that's what is needed to keep the person functional.

12 Step programs are one of the less effective treatment options, and many push too hard to get people completely off everything, including things like suboxone or methadone - that's bad. 12 step works great for a few, but it is no substitute for medical treatment and they need to allow the use of actual medicine to treat addiction.

Sorry- I was still composing my post when yours went up. I strongly agree with everything you stated!

The public understanding of the opioid crisis is incredibly muddled.

First, there are crucial roles for opioids for people in intense, unremitting pain, such as my father when he was dying of cancer. Tylenol and ibuprofen will simply not come close to substituting in this type of situation. Morphine-derivatives were a God-send to my dad in his last month of life, and he was able to have the dose adjusted to keep him in a relatively peaceful state in which he was still able to communicate with his family. Obviously risk of addition in the case of my father was zero but for those in chronic intense pain addiction is a risk, although I believe it is a much lower than many believe in this context. It would be a very cruel decision based on ignorance to further limit the access of these groups of people to necessary pain management through appropriate and legal opioid prescription.

The role of opioids in management of more moderate or time-limited pain, such as after a surgery, is less clear to me. It appears that in these situations Tylenol and ibuprofen can be very effective for many people. When one hears of the per-capita prescription rates for opioids it does appear that they are being prescribed far more in these types of situations than would be justified. Probably this is driven by doctors being encouraged to prescribed by the manufacturers of the newer opioids, who have often falsely indicated that they have less side effects and a lower chance of diversion and addiction than more traditional (and cheaper) opioids. I think more studies and a more cautious approach would be justified. And coming down hard on promotion of these drugs by their manufacturers.

A separate issue, at least theoretically, is the big increase in the illegal use of these drugs. But this involves human lives and human suffering just as much as the prescription use. I know addicts and former addicts- believe it or not they are human beings just like us, and the line that separates "them" and "us" is far thinner and less defined than the self-righteous would have us believe. Once addicted it is a medical problem, pure and simple, and should be treated as such. Drugs such as suboxone can be very effective at getting people off heroin and other pure opioid agonists and allowing them to become fully functional citizens with none of the behavior problems of addiction. They do remain physiologically dependent on access to a once a day dose of suboxone; unfortunately this seems to stick in the craw of many puritans because "they are still addicted so what's the point?" Well, aren't type I diabetes still dependent on insulin! In my experience it is no more possible to identify a person taking suboxone once a day than a diabetic taking insulin. And many people take suboxone until their lives are at a point when they have the support systems and the mental attitude necessary to drop the drug entirely and go through withdrawal. I have lots of hope that proper clinical use of suboxone and similar drugs will be a standard first-level intervention in addiction, which can be followed up once the addict's situation is stabilized.

Part of the current high rate of illegal use is that heroin and diverted "prescription" opioids have become quite cheap. Honestly I don't know how to reduce the number of people newly becoming addicts through experimentation with street opioids. But whatever we try to do about this we must not make it harder for people with legitimate needs for opioids to obtain them.

A final question is: are the newest opioids more effective, cheaper, run less risk of addiction, or less risk of diversion? From what I've read so far- possibly not, and claims to the contrary may be simply manufacturers hyping their products and their profits. I can see how patches are better forms of drug delivery than are injections. But I am uncertain of any other claimed benefits.

 

[luchog]

Counterpoint on blaming prescribed drugs:
Linky.
Linky.

Along with the other criticisms of this hit piece; over-prescription is definitely and absolutely the key motivator for the current crisis.

That's not strictly on the doctors, however, since too may of them fell for the lies put out by the drug manufacturers about how their lastest opiod medications were safe and non-addictive compared to older meds. If you poke around online a bit, you can find promo videos from the drug companies where their salespeople go through their spiels about how doctors should feel free to prescribe as much as they think the patient needs (or wants), and not ever have to worry about addiction problems.

 

[JoeMorgue]

Drug Manufacturers: Hey Docs it would be awesome if you would really prescribe a lot of these drugs, hint hint.
Doctors: I think Opioids will alleviate your pain.
Chronic Pain Sufferers: Opioids are the only drugs
Science: There is very little empirical evidence that Opioids are any better at controlling chronic pain than traditional pain killers.
Society: We're overprescribing Opioids!
Government: We need to restrict Opioids!
Chronic Pain Sufferers: But I need them!
Drug Manufacturers: But they need them!

I sort of see a feedback loop where one specific voice is getting ignored here.

 

[Distracted1]

I am terrified that we are about to experience another drug "crackdown".

I am not sure what the solution to this problem is ( I lean towards keeping it in the realm of public health instead of law enforcement) but I am sure that I want heroin to stay cheap.

As long as heroin is cheap junkies remain relatively harmless. If law enforcement starts up the war on drugs again the junkies' $20 per day fix that they can easily satisfy becomes a $400 per day fix that they must take drastic measures to satisfy. Does no one remember the horrors of city life in the seventies and eighties?

 

[CaptainHowdy]

Solution: remove all government regulation on opiods and opiod treatment.

That worked until 1906 or so in the United States.

 

[The Norseman]

I guess if everybody's dead, nobody can be addicted to opiods.

I'm shocked that you of all people would say something so breathtakingly idiotic. How did humanity possibly survive before all these drugs were classified as illegal to consume or produce?

The second link seems to be pushing a bit of a false dichotomy.

This seems to be ignoring the idea that, although these people are obtaining drugs from other than their regular doctors, the addiction itself started with prescribed medication.

The prescription gets people addicted. Then once they can't get the prescription filled, they get the drugs elsewhere.

And again, this ignores the initial formation of the addiction.

The (as you put it) initial formation is largely irrelevant. In other words, it doesn't have to take a lot to produce the euphoria or feelings of well-being or simply just being pain-free for people to wish to continue taking it. There are a tiny minority of doctors who are massively overprescribing but the vast majority of docs are able to prescribe narcotics within reasonable medical guidelines. More and more, however, are completely frightened at being investigated by the Feds, so they refuse to prescribe any narcotics at all these days.

You cannot really control who might become addicted by prescribing even fewer narcotic medications which means you cannot control who will go out seeking drugs after the docs stop prescribing, or develop other methods of getting their medications.

The availability of highly addictive substances certainly isn't helping things, but a worst-ever drug epidemic doesn't happen in a vacuum. Look at who we elected as President. That doesn't happen in a well-functioning society.

Exactly this. It's the exact same concept as gun-control: too often the focus is in the wrong place. Here, the focus is on coming down on doctors and dealers rather than trying to fix the society that makes it so people are so desperate to escape their lives to do whatever they can to get the drugs they know will solve their problems (at least for a few minutes/hours). Or emotionally dealing with chronic pain: with very few services available, little emotional support, little counseling or adequate medical care for the working poor or indigent, people are desperate enough to try and DO SOMETHING to get some relief, even if that SOMETHING is in the long-term, harmful.

Blaming it on the doctors is misguided at best. They are forced to comply with comply with increasingly restrictive, invasive, and complex regulations and monitoring, or risk losing their license to practice. This is entirely the fault of a whole lot of politicians who insist on treating addiction as a legal problem instead of a medical problem; and enacting high-profile legislation to make it appear as though they are doing something useful to combat the crisis, without actually doing anything useful. Image over utility.

Again, exactly this. Everything you post on this subject is worthwhile, thank you!

Sorry- I was still composing my post when yours went up. I strongly agree with everything you stated!

The public understanding of the opioid crisis is incredibly muddled.

First, there are crucial roles for opioids for people in intense, unremitting pain, such as my father when he was dying of cancer. Tylenol and ibuprofen will simply not come close to substituting in this type of situation. Morphine-derivatives were a God-send to my dad in his last month of life, and he was able to have the dose adjusted to keep him in a relatively peaceful state in which he was still able to communicate with his family. Obviously risk of addition in the case of my father was zero but for those in chronic intense pain addiction is a risk, although I believe it is a much lower than many believe in this context. It would be a very cruel decision based on ignorance to further limit the access of these groups of people to necessary pain management through appropriate and legal opioid prescription.

The role of opioids in management of more moderate or time-limited pain, such as after a surgery, is less clear to me. It appears that in these situations Tylenol and ibuprofen can be very effective for many people. When one hears of the per-capita prescription rates for opioids it does appear that they are being prescribed far more in these types of situations than would be justified. Probably this is driven by doctors being encouraged to prescribed by the manufacturers of the newer opioids, who have often falsely indicated that they have less side effects and a lower chance of diversion and addiction than more traditional (and cheaper) opioids. I think more studies and a more cautious approach would be justified. And coming down hard on promotion of these drugs by their manufacturers.

A separate issue, at least theoretically, is the big increase in the illegal use of these drugs. But this involves human lives and human suffering just as much as the prescription use. I know addicts and former addicts- believe it or not they are human beings just like us, and the line that separates "them" and "us" is far thinner and less defined than the self-righteous would have us believe. Once addicted it is a medical problem, pure and simple, and should be treated as such. Drugs such as suboxone can be very effective at getting people off heroin and other pure opioid agonists and allowing them to become fully functional citizens with none of the behavior problems of addiction. They do remain physiologically dependent on access to a once a day dose of suboxone; unfortunately this seems to stick in the craw of many puritans because "they are still addicted so what's the point?" Well, aren't type I diabetes still dependent on insulin! In my experience it is no more possible to identify a person taking suboxone once a day than a diabetic taking insulin. And many people take suboxone until their lives are at a point when they have the support systems and the mental attitude necessary to drop the drug entirely and go through withdrawal. I have lots of hope that proper clinical use of suboxone and similar drugs will be a standard first-level intervention in addiction, which can be followed up once the addict's situation is stabilized.

Part of the current high rate of illegal use is that heroin and diverted "prescription" opioids have become quite cheap. Honestly I don't know how to reduce the number of people newly becoming addicts through experimentation with street opioids. But whatever we try to do about this we must not make it harder for people with legitimate needs for opioids to obtain them.

A final question is: are the newest opioids more effective, cheaper, run less risk of addiction, or less risk of diversion? From what I've read so far- possibly not, and claims to the contrary may be simply manufacturers hyping their products and their profits. I can see how patches are better forms of drug delivery than are injections. But I am uncertain of any other claimed benefits.

The sad thing is that the FDA does not yet allow docs to prescribe Suboxone and related medications for chronic pain. It's technically allowed only for chemical dependency clients. Yes, some docs (especially in California) are prescribing Suboxone off-label for chronic pain, but apparently the Feds are keeping those docs under close scrutiny. From what I understand, Suboxone is practically a miracle drug and its use needs to be more wide-spread. At least in conjunction with other society-improving measures.

Drug Manufacturers: Hey Docs it would be awesome if you would really prescribe a lot of these drugs, hint hint.
Doctors: I think Opioids will alleviate your pain.
Chronic Pain Sufferers: Opioids are the only drugs
Science: There is very little empirical evidence that Opioids are any better at controlling chronic pain than traditional pain killers.
Society: We're overprescribing Opioids!
Government: We need to restrict Opioids!
Chronic Pain Sufferers: But I need them!
Drug Manufacturers: But they need them!

I sort of see a feedback loop where one specific voice is getting ignored here.

Long-term chronic pain patients who take opioids are the least likely group to abuse their medications than any other group of opioid users.

So while you're insinuating (like a sledgehammer) that science is the ignored group, it's actually the legitimate chronic pain sufferers who are being ignored. Mainly because people love to treat these sufferers as mere drug addicts who are over-emphasizing their pain levels in order to get high. Just as you're implying here, especially with your "society" false claims. Or at least, people claim this, but it's simply incorrect as a general thing. In certain areas there are handfuls of doctors out of tens of thousands who are over prescribing, but when these studies and papers and news articles are examined, they nearly all lump heroin overdoses in with prescription drug overdoses.

Separate those numbers then get back to us.

 

[The Norseman]

nm.

 

[This is The End]

Drug Manufacturers: Hey Docs it would be awesome if you would really prescribe a lot of these drugs, hint hint.
Doctors: I think Opioids will alleviate your pain.
Chronic Pain Sufferers: Opioids are the only drugs
Science: There is very little empirical evidence that Opioids are any better at controlling chronic pain than traditional pain killers.
Society: We're overprescribing Opioids!
Government: We need to restrict Opioids!
Chronic Pain Sufferers: But I need them!
Drug Manufacturers: But they need them!

I sort of see a feedback loop where one specific voice is getting ignored here.

Don't forget the insurance companies. They are the cause of a large percentage of this.

There are several situations where the patient needs extended physical rehabilitation by a trained physical therapist.

That costs an order of magnitude more than just turning the patient into an opiate addict. Guess which one the insurance companies fight tooth and nail for?


As for the opiates themselves. I'm not saying Marijuana has no downsides but the quality of life on opiates is absolutely horrible. It's so sad how backwards we are on those two substances.

If anyone reading this has an elderly loved one slowly dying on opiates I strongly recommend inquiring about having them switched to marijauana. If you are not in one of the 30 states that allow it, either move or take the risk of acquiring it yourself. (If it can cut off their opiate addiction it just might be worth the risk.)

You might be surprised in seeing your loved one turn from a zombie back into a somewhat normal human being for the last few years of their life.

 

[The Greater Fool]

Counterpoint on blaming prescribed drugs:

Linky.

Linky.

Good links.

Opioids have been a daily part of my life for several years. Because of a degenerative spinal condition, I have had 4 spine surgeries and the last one contributed to permanent damage, resulting in CRPS.

Never, in the 20 years or so that they have been prescribed to me, did any doctor tell me it was the only thing that would work. Many other options were tried. Physical Therapy, other medicine, yes, even woo-ing off on my own with acupuncture. Bad, bad idea.

It is becoming much more difficult for people like me, who have no red flags in 20 years, to obtain them. In a way I have been lucky, in that my spinal issues are so easily identifiable on film, scans, reports. Yet now, there are new hoops to jump through.

To receive a prescription, I must sign a contract. They may urine test me at any time when I'm there. I will never take another - (sorry, the class that valium and zanax are in) - so I went cold-turkey, and I will bring my bottles of medicine to show the doctor how many are left.

That's fine. I receive no euphoria or shift of mood or sleep. It is simply a question of how well I need to function. My history shows that a one-month supply lasts me an average of 7 weeks. Yet, the manner of the doctors, in my experience, is insulting. It feels as if I am being reminded every few weeks that I am a potential criminal. A statistic.

It would be interesting to hear the experiences of others, because I only know the California experience.

The Arizona experience is currently worse. A new law is going into effect that reduces what non-dying chronic pain sufferers can receive. We are contemplating leaving Arizona because of it.

I'm shocked that you of all people would say something so breathtakingly idiotic. How did humanity possibly survive before all these drugs were classified as illegal to consume or produce?

The (as you put it) initial formation is largely irrelevant. In other words, it doesn't have to take a lot to produce the euphoria or feelings of well-being or simply just being pain-free for people to wish to continue taking it. There are a tiny minority of doctors who are massively overprescribing but the vast majority of docs are able to prescribe narcotics within reasonable medical guidelines. More and more, however, are completely frightened at being investigated by the Feds, so they refuse to prescribe any narcotics at all these days.

You cannot really control who might become addicted by prescribing even fewer narcotic medications which means you cannot control who will go out seeking drugs after the docs stop prescribing, or develop other methods of getting their medications.

Exactly this. It's the exact same concept as gun-control: too often the focus is in the wrong place. Here, the focus is on coming down on doctors and dealers rather than trying to fix the society that makes it so people are so desperate to escape their lives to do whatever they can to get the drugs they know will solve their problems (at least for a few minutes/hours). Or emotionally dealing with chronic pain: with very few services available, little emotional support, little counseling or adequate medical care for the working poor or indigent, people are desperate enough to try and DO SOMETHING to get some relief, even if that SOMETHING is in the long-term, harmful.

Again, exactly this. Everything you post on this subject is worthwhile, thank you!

The sad thing is that the FDA does not yet allow docs to prescribe Suboxone and related medications for chronic pain. It's technically allowed only for chemical dependency clients. Yes, some docs (especially in California) are prescribing Suboxone off-label for chronic pain, but apparently the Feds are keeping those docs under close scrutiny. From what I understand, Suboxone is practically a miracle drug and its use needs to be more wide-spread. At least in conjunction with other society-improving measures.

Long-term chronic pain patients who take opioids are the least likely group to abuse their medications than any other group of opioid users.

So while you're insinuating (like a sledgehammer) that science is the ignored group, it's actually the legitimate chronic pain sufferers who are being ignored. Mainly because people love to treat these sufferers as mere drug addicts who are over-emphasizing their pain levels in order to get high. Just as you're implying here, especially with your "society" false claims. Or at least, people claim this, but it's simply incorrect as a general thing. In certain areas there are handfuls of doctors out of tens of thousands who are over prescribing, but when these studies and papers and news articles are examined, they nearly all lump heroin overdoses in with prescription drug overdoses.

Separate those numbers then get back to us.

Chronic pain folks ARE being lumped in with addicts. It's a crime. When I can't get my spouse legal pain relief, I will do it illegally.

 

[JoeMorgue]

Long-term chronic pain patients who take opioids are the least likely group to abuse their medications than any other group of opioid users.

So while you're insinuating (like a sledgehammer) that science is the ignored group, it's actually the legitimate chronic pain sufferers who are being ignored. Mainly because people love to treat these sufferers as mere drug addicts who are over-emphasizing their pain levels in order to get high. Just as you're implying here, especially with your "society" false claims. Or at least, people claim this, but it's simply incorrect as a general thing. In certain areas there are handfuls of doctors out of tens of thousands who are over prescribing, but when these studies and papers and news articles are examined, they nearly all lump heroin overdoses in with prescription drug overdoses.

Separate those numbers then get back to us.

Yes I'm "insinuating" that if the science says that these particular class of drugs are not really any effective at treating chronic pain conditions than other classes of drugs which don't carry the same risks that's a pretty big factor in all this.

Not exactly sure why that's some crazy position I'm getting so much vitriol over.

 

[sadhatter]

Good links.



The Arizona experience is currently worse. A new law is going into effect that reduces what non-dying chronic pain sufferers can receive. We are contemplating leaving Arizona because of it.


Chronic pain folks ARE being lumped in with addicts. It's a crime. When I can't get my spouse legal pain relief, I will do it illegally.

Other than an extra trip to the pharmacy how would reducing quantity (is not a quality reduction) harm you?

And is an extra trip not worth combating a very serious problem? (As well most pharmacies deliver for free)

Keep in mind you atr talking to someone in the field not someone who thinks that "reducing the amount you can get" means that your pain meds are changed in any way other than amount you can keep on hand. And as a bonus unless your local area is very non standard, your limited supply is between 1 and three months.

So again please explain what is being done to you that is causing real harm. And being annoyed doesn't count.

 

[Skeptical Greg]

Suboxone (Buprenorphine/naloxone) is a better option. Kills the craving, prevents effects of any opiates they do take, doesn't get them high.

.....

Not much of a solution for the ' epidemic ' ...
There are clearly working options for those who want to ' kick ' the habit.

What percentage of opioid users would you think really want to give up the ' high ' ?