Are we losing our minds regarding opioids?

isissxn said:
Do other countries really not prescribe opioids for right after surgeries? That is kind of crazy. Maybe I just have a really low pain tolerance, but it seems crazy to me!
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Of course they do, but those people would generally be recovering in hospital, and after discharge such drugs are tightly regulated (e.g. oxycodone is a Schedule 2 controlled drug). The vast majority of prescriptions are on the NHS, so tracked, and over-prescribing would be quickly spotted. Private prescriptions must also be notified to the local NHS authorities for the same reason. Pharmacists also have to report any problematic prescribing patterns they see.
 
Travis said:
Yes, the opioid crisis is bad. I've lost family members to overdoses. That said I think we are now terribly overreacting. Twice in the last few months I've had family members get surgery, back and heart, and get sent home with nothing but Tylenol. The hospital has a new policy to not allow any of its doctors with privileges to write any narcotic pain medication prescriptions. The only pain opioid pain meds one can get is by IV when you are actually in the hospital but since insurance companies are always pushing for people to be kicked out of the hospital as soon as possible it leaves us in this strange new place where people are being treated in ways unthinkable long before Oxycontin was even a thing.


Which is really what bothers me. We aren't just rolling back the really problematic meds we are rolling back everything even the ones that were used largely without incident for decades before Purdue sent out armies of leggy drug reps in short skirts to push Oxy on everyone.


There must be better ways to attack this problem. I already know of at least one person who is avoiding getting surgery for an ongoing problem precisely because they are terrified of being booted out of the hospital in unbearable pain with no way to treat it.


What in the hell are we doing?
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Wow it sounds almost like they are being treated like they are black. See wanda sykes talk about her double mastectomy.
 
Puppycow said:
Insisting that you take hydrocodone whether you think you need to or not sounds like a red flag to me.
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The arm surgery was done under very light anesthesia combined with a nerve block. When I left the hospital a few hours later, my right arm was still completely numb and in a sling - a weird feeling since I couldn’t even locate my arm in space without looking.

I think the instructions to take the hydrocodone regardless of pain level when I got home was to avoid the potential of extreme pain as the nerve block wore off, which could have been quite unpleasant in the half hour or so it took for the meds to “kick in”. I now recall the specific instruction was to take the dose as soon as I could move my fingers at all, and that’s what I did. I don’t see the instruction to take a single dose of opiates, and then only “as needed”, sends up any red flag at all.
 
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Fast Eddie B said:
The arm surgery was done under very light anesthesia combined with a nerve block. When I left the hospital a few hours later, my right arm was still completely numb and in a sling - a weird feeling since I couldn’t even locate my arm in space without looking.

I think the instructions to take the hydrocodone regardless of pain level when I got home was to avoid the potential of extreme pain as the nerve block wore off, which could have been quite unpleasant in the half hour or so it took for the meds to “kick in”. I now recall the specific instruction was to take the dose as soon as I could move my fingers at all, and that’s what I did. I don’t see the instruction to take a single dose of opiates, and then only “as needed”, sends up any red flag at all.
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Sounded like it is to avoid the issue caused by "breakthrough pain". Waiting until the pain gets to a degree you decide you need to medicate is often not the beat way to control pain, especially chronic pain.
 
Information Analyst said:
Of course they do, but those people would generally be recovering in hospital, and after discharge such drugs are tightly regulated (e.g. oxycodone is a Schedule 2 controlled drug). The vast majority of prescriptions are on the NHS, so tracked, and over-prescribing would be quickly spotted. Private prescriptions must also be notified to the local NHS authorities for the same reason. Pharmacists also have to report any problematic prescribing patterns they see.
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Anecdote/Old War Story Alert:


I am currently on 15/500 Co-codomol, reduced from 30/500 last week, for Temporomandibular Joint disorder. It was readily prescribed (the condition is a bit nippy) but renewal had to be done face-to-face and warnings were given about what even these mild opiods/opiates involved.


When I had my patial knee replacement a few years ago, I was given oral morphine of some description - the pain was excruitiating - but it didn't agree with me and I was taken off quickly. The guy in the next bed had a broken hip replacement (!) and was on morphine for several days until they operated.


I had a bad ear infection at one stage and was given a prescription of Tramadol. Took one, would never touch 'em again.



So yes, they are prescribed in the UK.
 
A few years ago I fell down the stairs at our house and landed awkwardly causing a distal radial fracture in my left wrist. Two days later I had surgery to repair the damage, which consisted of a metal plate and somewhere around 14 screws. Like above, I had the nerve block for my arm.

During recovery the surgeon advised me that this was going to be very painful and to "stay ahead of the pain" for a few days and sent me home with some Oxycodon or something similar. He was right, it hurt like hell once the block wore off but after a week or so I was able to control it with Extra Strength Tylenol. Problem was every visit they would ask about the pain and give me another script "just in case". I think I had one we never even filled.

My wife and I both commented on how odd that seemed for them to be handing out scripts for these like candy. My wife, a recovering addict btw, kept a very close eye on how much and how often i was dosing myself.

Therein lies the problem we have. It isn't that people are getting prescribed what they need when they need it, it is that they are getting over prescribed long after they aren't.

We also had a pharmacy right by my house that lost their license because the pharmacist was selling Oxy out the backdoor by the thousands to addicts.
 
Does anyone have any solid reference/site for opioid use outside of a hospital/clinic setting in other countries?

The vague impression I'm getting is that in other countries opioids are almost exclusively used for immediate post surgery care while you are still in the hospital or for end of life care.

The whole "Here's a 30 day supply of opioids to take home with you" seems to be an almost entirely American concept.
 
That may partly stem from insurance companies forcing patients to be sent home earlier and more procedures being done outpatient than inpatient. Also at the insistence of insurance companies.
 
I've read some accounts of opioid prescriptions being over-issued by dentists, with their patients subsequently getting hooked.
 
TragicMonkey said:
I've read some accounts of opioid prescriptions being over-issued by dentists, with their patients subsequently getting hooked.
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Dentist in America prescribe opioids at 37 times the rate of dentists in England.

22.6% of prescriptions from dentists in America are for opioids. In England that number is a mere .6%. Dentists in America also prescribe (to be fair very rarely) long lasting opioids which doesn't happen in England.

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2734067
 
I specifically have asked doctors not to prescribe opioids to me or my daughter.

A little pain is character-building.
 
As it happens, my friend who lives in New York (near Seneca Lake) had dental surgery last week. I asked, and he said he was given a prescription of Vicodin - hydrocodone - afterward. I don't believe it came with refills. Still, though, that seems normal to me. He was bitching up a storm about "it did nothing for the pain, waaaaah, I want oxy, the doctors are monsters," but I never got anything besides Vicodin after dental procedures in the past. And I've got an implant and all sorts of things from an incident where I had multiple teeth knocked out and others displaced.

I have no doubt that hospitals are rightfully cracking down on what's prescribed, but it still sounds as though Travis's hometown hospital is overdoing things maybe just a bit.
 
JoeMorgue said:
Dentist in America prescribe opioids at 37 times the rate of dentists in England.

22.6% of prescriptions from dentists in America are for opioids. In England that number is a mere .6%. Dentists in America also prescribe (to be fair very rarely) long lasting opioids which doesn't happen in England.

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2734067
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I'm sure that most pain from things like root canals could be handled with non-opioids or very weak ones. I have no doubt of that. My friend expecting oxy after some drilling may kind of prove the point you're making here.

It's the heart and back surgery mentioned in the OP that's blowing my mind. Surely there is certain pain that is just unbearable without a strong drug of some sort, at least for a few days. Though I wouldn't know. I've never had such serious surgery.
 
Drewbot said:
I specifically have asked doctors not to prescribe opioids to me or my daughter.

A little pain is character-building.
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When I broke my shoulder last year the doc didnt even mention pain meds, which was surprising. Here i thought hospitals were handing them out like candy. Not my experience.
 
HawksFan said:
Problem was every visit they would ask about the pain and give me another script "just in case". I think I had one we never even filled.
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I remember hearing that the two most sought after items after a Zombie Apocalypse will be...

1) Reading glasses, and...

2) Pain meds

As such, we always fill opioid prescriptions. Most often take one or two as needed, then put the rest in our safe. Can’t hurt.

As an aside, I find opioids very pleasurable. Good news is I don’t seem to have an addictive personality and know when to say “no”.
 
isissxn said:
I'm sure that most pain from things like root canals could be handled with non-opioids or very weak ones. I have no doubt of that. My friend expecting oxy after some drilling may kind of prove the point you're making here.

It's the heart and back surgery mentioned in the OP that's blowing my mind. Surely there is certain pain that is just unbearable without a strong drug of some sort, at least for a few days. Though I wouldn't know. I've never had such serious surgery.
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Well that's sort of the issue.

There's really not a lot of evidence that "opioids" specifically really are any better at treating pain at all, to say nothing of being effective enough to offset the risks.

But predatory and greedy insurance companies pushed them on patients as some new form of super pain killer.

But that's lead to the current mythology around them were... like a lot of people have convinced themselves that they have special pain that only opioids can treat. And that is going to be a very, very, very hard mentality to fight.

Now if you want to take Travis' story of being given nothing but OTC Tylenol at face value, sure that's a problem but even then it would be the exception, not the rule.

We're prescribing opioids at such a staggeringly rate we'd have to over-compensate pretty damn hard before the hand wringing over "But are we under prescribing them sometime?" would be necessary.
 
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HawksFan said:
That may partly stem from insurance companies forcing patients to be sent home earlier and more procedures being done outpatient than inpatient. Also at the insistence of insurance companies.
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I think there’s good evidence that, in general, outcomes are in fact better the sooner you can get the hell out of the hospital. Away from sick people and their associated microbes and away from possible medical errors. Certainly insurance companies may have a stake in that, but I’m not cynical enough to jump to that as a prime motivator.
 
isissxn said:
As it happens, my friend who lives in New York (near Seneca Lake) had dental surgery last week. I asked, and he said he was given a prescription of Vicodin - hydrocodone - afterward. I don't believe it came with refills. Still, though, that seems normal to me. He was bitching up a storm about "it did nothing for the pain, waaaaah, I want oxy, the doctors are monsters," but I never got anything besides Vicodin after dental procedures in the past. And I've got an implant and all sorts of things from an incident where I had multiple teeth knocked out and others displaced.
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Here in Sweden its pretty much unheard of for anyone to be given any strongly addictive pain medication for dental surgery, at least where the patient isn't hospitalized. For routine things like fixing teeth you'd pretty much have to survive on Ibuprofen, Asprin and Paracetamol.
 
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