Are we losing our minds regarding opioids?

Having had 4 spine surgeries, creating more problems then I had prior, and having CRPS for the past 18 years, I have taken opioid based medicine every day since. All that I have experienced is based on living in a county in Northern Calif.

I must jump through hoops for the prescription. Constant urine and blood work. A strict contract must be signed. No early refill. Ever. Monthly evaluation in a doctors office. My doctors goal was to wean me off. Then she saw the results of my recent MRI and changed her mind, however she still reduced my already low dose.


If there are doctors who "hand them out like candy", I haven't a clue who they are.
 
One problem is that it's difficult to really understand how much pain someone else is or isn't in. It's a difficult thing to communicate, even when we assume complete honesty and good faith. And it may be at least partly subjective. My kidney stones hurt, but much less than everyone says they would. I had three wisdom teeth out and three dental implants put in at the same time, and despite a prescription for oxycodone I didn't even need Advil afterwards. Yet a single root canal years earlier left me in so much pain I spent hours rocking back and forth in bed, literally unable to see straight. My tattoo was mildly irritating, but I've had a bug bite that hurt so bad I couldn't sleep. The human body is bizarre.
 
isissxn said:
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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I had back surgery and needed opioids prior to the surgery, but not after the surgery. Didn't need any pain killers since the surgery resolved the pain issue and the surgical site was very small. Actually, I only took the muscle relaxants* because the doctor said it would help with the healing process.

A family member just had knee surgery and their doctor prescribed ten days worth of opioids at three doses a day. Apparently the pharmacy would only fill a script for something less than that, I want to say 7 days, so they had to get the doctor to re-write the script. Kind of a pain in ass at a time when they really didn't want to be making a bunch of phone calls.


*They are serious about not mixing muscle relaxants and alcohol. I remember waking up one morning unable to move for what seemed like an eternity. Probably just 30 minutes, by paralysis is horrifying in even very small doses. I almost gave up drinking that day. Instead I gave up the muscle relaxants.
 
Arcade22 said:
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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Yeah, that sounds fine to me. My dental trauma incident was kind of a long time ago now, so I can't remember a great deal in detail. I know the pain was pretty bad at first, but I'm sure I'd have lived if I'd just taken Tylenol.

As I recall, they gave me about 2 weeks' worth of the hydrocodone pills back then, not 30 days. I took them for 3-4 days before deciding I was fine. (Sidenote - the remainder of the pills later disappeared, owing to the fact that I had a shady roommate at the time. So point even further proven!)
 
wasapi said:
Having had 4 spine surgeries, creating more problems then I had prior, and having CRPS for the past 18 years, I have taken opioid based medicine every day since. All that I have experienced is based on living in a county in Northern Calif.

I must jump through hoops for the prescription. Constant urine and blood work. A strict contract must be signed. No early refill. Ever. Monthly evaluation in a doctors office. My doctors goal was to wean me off. Then she saw the results of my recent MRI and changed her mind, however she still reduced my already low dose.


If there are doctors who "hand them out like candy", I haven't a clue who they are.
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I have tremendous sympathy for people who actually need these drugs, because the backlash almost certainly means that their lives are going to get more difficult. I would expect that it is going to be harder and harder to get and fill longer term scripts for these drugs.

An anecdote that I feel shows the aversion docs now have to these types of patients. I injured my back while exercising with weights. I had pulled my back with varying severity several times in the past, but this time was by far the worst. I was genuinely concerned that I had done something pretty severe, such as herniating a disc in my back.

I didn't have a primary care doctor at the time, so I called one up to make an appointment. I barely begin to explain my situation when the receptionist interrupts me to say "we aren't accepting new pain management patients at this time". She wouldn't schedule me until I explained that I wasn't looking for script but just wanted a physical exam to ensure my back wasn't seriously injured.

God forbid I actually had been someone who needed a pain management doctor. They wouldn't have seen me.
 
As mentioned above, the problem is not people who need pain medication. The problem is the scamming that is being done, like that town in Tennessee.
 
isissxn said:
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.
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Either that or else a serial yarn spinner is spinning yarn -- a far more likely probability.
 
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.

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.
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I don't think doctors can offer refills for any controlled substance in NY. I know they can't for ritalin.
 
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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Trying to stop tens of thousands of deaths and vast amounts of addictions and misery caused by drug profiteers.

The USA is now seeing nearly fifty thousand deaths due to opoids each year. That's a six-fold increase in twenty years. A 11SEP2001 level fatality event every three weeks.
It is now the leading cause of death for men aged over fifty in the USA.
Opioid deaths are measurably decreasing average US life expectancy.
 
ponderingturtle said:
I don't think doctors can offer refills for any controlled substance in NY. I know they can't for ritalin.
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I have to have a light dose of Ambien before I can sleep. My doctor can't give me a prescription with refills or do it electronically. I have to see him face-to-face every three months and get a physical prescription. He said that was going to be true for any level of controlled substance starting the first of next year.

I nearly lost a lower leg and foot to sepsis about two years ago and, while they loaded me up with all kinds of good stuff during my 23-day hospital stay, I went home with instructions to load up on Tylenol.
 
wasapi said:
Having had 4 spine surgeries, creating more problems then I had prior, and having CRPS for the past 18 years, I have taken opioid based medicine every day since. All that I have experienced is based on living in a county in Northern Calif.

I must jump through hoops for the prescription. Constant urine and blood work. A strict contract must be signed. No early refill. Ever. Monthly evaluation in a doctors office. My doctors goal was to wean me off. Then she saw the results of my recent MRI and changed her mind, however she still reduced my already low dose.


If there are doctors who "hand them out like candy", I haven't a clue who they are.
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Hopefully in prison soon.
 
I just had a broken molar drilled out piece by piece yesterday, and the only pain relief offered was to take acetaminophen or ibuprofen, preferably the latter at up to 600 mg per dose. It relieves most of the dental pain, but replaces it with stomach pain so I'm more or less stuck with normal doses of acetaminophen.

So dentists aren't handing out the goodies any more either.
 
deadrose said:
I just had a broken molar drilled out piece by piece yesterday, and the only pain relief offered was to take acetaminophen or ibuprofen, preferably the latter at up to 600 mg per dose. It relieves most of the dental pain, but replaces it with stomach pain so I'm more or less stuck with normal doses of acetaminophen.

So dentists aren't handing out the goodies any more either.
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You can alternate ibuprofen and acetaminophen so long as you don't exceed the total recommended dosage of either (especially the acetaminophen). For most people this works better than using just one or the other.
 
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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There is more to pain relief these days than opoids.
 
TragicMonkey said:
You can alternate ibuprofen and acetaminophen so long as you don't exceed the total recommended dosage of either (especially the acetaminophen). For most people this works better than using just one or the other.
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Yep, I'm aware of that. It still doesn't help with the problem that anti-inflammatories chew up my stomach painfully and quickly.
 
Skeptic Ginger said:
Travis is right. The medical community is ridiculously over-reacting to make up for their apathy in past years.
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Correct. Hospitals' and doctors' refusal to write narcotic prescriptions of any kind now out of a claimed "fear" of accidentally overprescribing is purely a passive-aggressive protest against heightened regulator attention.
 
Skeptic Ginger said:
I believe that's been challenged though I know from experience providers are being pressured not to prescribe much.
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I think this pressure is a problem. The message should not be "prescribe less" but "prescribe appropriately." Not every pain needs opioids, but NSAIDs aren't exactly wonderful either:
Every year, some 100,000 people are hospitalized in the United States with gastrointestinal bleeding from taking NSAIDs, and 16,500 of them die.
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https://experiencelife.com/article/this-is-your-body-on-ibuprofen/
 
TomB said:
I think this pressure is a problem. The message should not be "prescribe less" but "prescribe appropriately." Not every pain needs opioids, but NSAIDs aren't exactly wonderful either:

https://experiencelife.com/article/this-is-your-body-on-ibuprofen/
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One thing that horrifies me watching American TV is the constant reference to "Aspirin". I know it's easier to say than paracetamol here or acetaminophen there, but it's much more dangerous.
 
catsmate said:
The USA is now seeing nearly fifty thousand deaths due to opoids each year. That's a six-fold increase in twenty years. A 11SEP2001 level fatality event every three weeks.
It is now the leading cause of death for men aged over fifty in the USA.
Opioid deaths are measurably decreasing average US life expectancy.
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For a comparison, in 2018 there were 2,208 deaths due to opioids in England & Wales (population 58.7 million), although 79% of those were "traditional" heroin, morphine, or methadone.

https://www.ons.gov.uk/peoplepopula...thsrelatedtodrugpoisoningbyselectedsubstances
 
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