The Opioid Crisis

[crescent]

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 ' ?

I would assume quite a few want to kick the habit, possibly the majority. I can't find numbers on that, though.

One of the key features of the current wave is people who became addicted when opiates were prescribed to them for pain. The news has a number of stories of people who never used them in a truly recreational way, but instead went straight from "I need this for pain" to "I can't stop using this, even if I try". Getting high was never the goal for those people, it was instead "I feel like I'm going to die if I stop". Addiction is like that. That's what makes addiction a medical issue as much, or even more so, than a moral or behavioral issue.

 

[angrysoba]

This topic came up on a recent SGU episode. The study that Cara was talking about was this one, which reported as follows:

Question For patients with moderate to severe chronic back pain or hip or knee osteoarthritis pain despite analgesic use, does opioid medication compared with nonopioid medication result in better pain-related function?

Findings In this randomized clinical trial that included 240 patients, the use of opioid vs nonopioid medication therapy did not result in significantly better pain-related function over 12 months (3.4 vs 3.3 points on an 11-point scale at 12 months, respectively).

Meaning This study does not support initiation of opioid therapy for moderate to severe chronic back pain or hip or knee osteoarthritis pain.

Steve Novella also chimed in to give his opinions on the study and his own experiences of prescribing opioids and how they are often abused.

The discussion begins about half-way through the podcast.

https://www.theskepticsguide.org/podcast/sgu/661

 

[The Greater Fool]

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

I don't think you grasp the situation. It's not an extra trip to the Pharmacy (which, between my spouse and myself, I end up there at least once a week and am on a friendly, first name basis with all staff). It's an issue of my spouses pain meds being cut in more than half because of the new laws.

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

What is this 'extra trip'? And Pharmacies in the US can't deliver narcotics. Again, I have no issue with pharmacy trips, and my spouses pain meds being cut in half has no impact on pharmacy trips.

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.

Again, you don't grasp the situation. AZ Gov signed a law that reduces my spouses pain meds by half. This is not a medical decision, as it should be.

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

The harm is when my spouse is in constant pain, she has a tendency to want to die. This is a problem, as we're rather attached.

It's such uninformed opinions that are causing harm.

 

[kellyb]

Getting high was never the goal for those people, it was instead "I feel like I'm going to die if I stop". Addiction is like that. That's what makes addiction a medical issue as much, or even more so, than a moral or behavioral issue.

From what I understand, taking opiates for a while lowers your general pain threshold, too, and not just in some sub-conscious psychological "junkie" way.

 

[wasapi]

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 ' ?

The high? Perhaps I am doing something wrong. For 20 years I have heard about the euphoria, the high. It just hasn't happened. The pattern has existed for a long time for me. When the pain starts to become something that inhibits my ability to function and think clearly, I take a dose. Within an hour, the rough edges of the pain feels soothed.

 

[Skeptical Greg]

'High' was maybe poor choice of word..
I was addressing the use of a drug that makes users lose their craving, and counteracts the effects of other drugs..

Perhaps a lot of users don't want to give up their cravings, much less take a drug that neutralizes the effect of
their other drug/s of choice..

 

[Crawtator]

Two back surgeries here. I also come from a family filled with addicts. I was horrified to use Perc-10's but nothing else would stop the extreme pain that I was suffering for a long while consecutively and still suffer from, from time-to-time. A few points (I know....anecdote):

1. The combination of non-opioidal med compared to opioidal is not a good one, in some cases, mine in particular. A bottle of 30 percs would last me 8 months, but when I needed 1 or 2, the non-opiates wouldn't touch my problems.

2. Anyone who has taken suboxone can tell you that, at the least the first few times, you get high....I mean REALLY HIGH....on the sublinguals at least. I was taking 3 perc-10's a day and I left them home on a 8 hour road trip. A friend had suboxone and gave me one to lower the pain and I have never been that fried from any of the traditional opiates. It is my understanding that suboxone prices (on the street) are significantly higher that the other traditional opiates, but that may just related to location.

The opiate crisis sides need to understand that there is a portion of the population that really don't have good fall back options. How big or small is it? I don't really know. But I do know that, at some point and time, I fell in that group and was thankful that they were available. Without the availability of them, my standard of living, both physical and mental, would have been very compromised.

 

[dudalb]

The abuse of prescription drugs is notorious...partiuclary in Hollywood, where it is pretty well known there are doctors,who, if you pay them enough,will pretty much prescribe whatever you want. That is how Michael Jackson got the drugs that killed him.

 

[Giordano]

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 ' ?

I believe you are incorrect in both assumptions:

1.You refer to clear working options for those who want to kick the habit. I am unaware of anything that fits this description. What are the "working" options you cite and the statistics as to their success? As far as I am aware, the traditional approaches all have incredibly high failure/re-addiction rates. In contrast suboxone and similar antagonists appear to be relatively effective at allowing opioid addicts who wish to be able to function normally again to do so and to re-enter a normal life.

As I noted in my post, there are many who try to hand-wave away suboxone and similar medical interventions because "They don't cure addiction, they just substitute one drug for another." I think this objection comes from a subconscious puritanism that views any continued dependency as a sign of weakness and degeneration. People on heroin often ultimately find themselves alone, penniless, and in desperate conditions; they often cannot function at work or in relationships, and are at substantial risk of dying of an overdose. People on prescribed suboxone suffer none of these events and can lead fully normal lives. They are monthly prescribed strips of the drug that they can take orally at home once a day- they do not stand outside of wireless clinic windows shivering waiting for their dose in orange juice as you might be imagining. And as mentioned upthread, when they feel that their lives are stable enough to do so, they can (and do) reduce their dosage and a goodly number wean themselves off the suboxone too.

2. Many addicts do indeed no longer want to get high because they realize it ***** up their lives. These are the people the suboxone is designed for. Do you think that any program exists that can successfully convince addicts who wish to get high that they should stop? That would be impressive indeed!

 

[The Great Zaganza]

The first step is to avoid getting more people hooked on opiates: banning pharma from marketing to doctors and make advertisements would be a step in the right direction.

 

[Giordano]

'High' was maybe poor choice of word..
I was addressing the use of a drug that makes users lose their craving, and counteracts the effects of other drugs..

Perhaps a lot of users don't want to give up their cravings, much less take a drug that neutralizes the effect of
their other drug/s of choice..

And of course these are people for whom any intervention is likely to be unsuccessful. Incarceration or other imposed withdrawal programs can force them to go cold-turkey (assuming they can't find drugs in their particular prison or therapy unit) but the re-addiction rates on release in these situations are very high.

Helping addicts who want to stay addicts is a very difficult problem. Taking things more one at a time, I think there are some very valuable medical interventions for the addicts who do want to quit but who are... addicted.

 

[kellyb]

The high? Perhaps I am doing something wrong. For 20 years I have heard about the euphoria, the high. It just hasn't happened. The pattern has existed for a long time for me. When the pain starts to become something that inhibits my ability to function and think clearly, I take a dose. Within an hour, the rough edges of the pain feels soothed.

It sounds like you've been taking a fairly low dose, and maybe of ones that are relatively mild compared to Oxycontin and morphine, and only when in pretty extreme pain. My understanding is that they don't cause highs under those circumstances, but rather work more like aspirin or tylenol then.

 

[Giordano]

Two back surgeries here. I also come from a family filled with addicts. I was horrified to use Perc-10's but nothing else would stop the extreme pain that I was suffering for a long while consecutively and still suffer from, from time-to-time. A few points (I know....anecdote):

1. The combination of non-opioidal med compared to opioidal is not a good one, in some cases, mine in particular. A bottle of 30 percs would last me 8 months, but when I needed 1 or 2, the non-opiates wouldn't touch my problems.

2. Anyone who has taken suboxone can tell you that, at the least the first few times, you get high....I mean REALLY HIGH....on the sublinguals at least. I was taking 3 perc-10's a day and I left them home on a 8 hour road trip. A friend had suboxone and gave me one to lower the pain and I have never been that fried from any of the traditional opiates. It is my understanding that suboxone prices (on the street) are significantly higher that the other traditional opiates, but that may just related to location.
The opiate crisis sides need to understand that there is a portion of the population that really don't have good fall back options. How big or small is it? I don't really know. But I do know that, at some point and time, I fell in that group and was thankful that they were available. Without the availability of them, my standard of living, both physical and mental, would have been very compromised.

I wonder how common it is to get significantly high on prescription suboxone. Most notably you were not an opioid addict when you took the suboxone- your response was therefore very different from that of an individual whose body was already physiologically adapted and addicted to opioids. Buprenorphine (one component of suboxone) can produce what is described as a mild euphoria, but this appears to plateau and additional dosage does not yield a greater high. Furthermore suboxone as prescribed mixes buprenorphine with naloxone, a opioid antagonist, that makes it nearly impossible to get truly high from the combo.

Suboxone is indeed traded on the streets, but it is more often used between doses of a pure opioid to delay the withdrawal symptoms until the next big high. Why buy a mild euphoria when for less money you can get the real thing?

https://americanaddictioncenters.org/suboxone/get-high/

 

[Giordano]

I don't think you grasp the situation. It's not an extra trip to the Pharmacy (which, between my spouse and myself, I end up there at least once a week and am on a friendly, first name basis with all staff). It's an issue of my spouses pain meds being cut in more than half because of the new laws.


What is this 'extra trip'? And Pharmacies in the US can't deliver narcotics. Again, I have no issue with pharmacy trips, and my spouses pain meds being cut in half has no impact on pharmacy trips.


Again, you don't grasp the situation. AZ Gov signed a law that reduces my spouses pain meds by half. This is not a medical decision, as it should be.


The harm is when my spouse is in constant pain, she has a tendency to want to die. This is a problem, as we're rather attached.

It's such uninformed opinions that are causing harm.

Absolutely, and this is what terrifies me about the loose and ignorant talk of the "opioid crisis." Most news articles conflate all types of opioid abuse, average person pictures some low life murderous addict in a made-for-TV movie, and the current wave of conservative politics seems likely to impose a puritanical approach to any drug than might actually allow someone to feel better. Just look at how upset Sessions is by pot!

Again- I saw how important opioids were for my dying father. I see how their use is hospice has allowed people to die with dignity (and others to live in dignity). For many people in intense pain, the ability to find some relief in opioids is perhaps the only thing that prevents them from considering suicide. Any uninformed and ideologically motivated restriction on opioids that keeps them from the people who desperately need pain relief is evil at a very fundamental level.

 

[sadhatter]

I don't think you grasp the situation. It's not an extra trip to the Pharmacy (which, between my spouse and myself, I end up there at least once a week and am on a friendly, first name basis with all staff). It's an issue of my spouses pain meds being cut in more than half because of the new laws.


What is this 'extra trip'? And Pharmacies in the US can't deliver narcotics. Again, I have no issue with pharmacy trips, and my spouses pain meds being cut in half has no impact on pharmacy trips.


Again, you don't grasp the situation. AZ Gov signed a law that reduces my spouses pain meds by half. This is not a medical decision, as it should be.


The harm is when my spouse is in constant pain, she has a tendency to want to die. This is a problem, as we're rather attached.

It's such uninformed opinions that are causing harm.

Define cut in half.

In Canada we are doing similar things in which narcotics are prescribed in shorter intervals. So instead of getting 3 months worth people get 1 month worth before having to refill.

Are you saying that there is a law that is getting made that says your dosage is to be halved? For example is a 20 mg dose being brought down to a 10 mg dose. Or are you recieve only half the days of medication.

I'd be astonished at any law that says to lower dosages by any specific amount. But id love to see it, and if it is written as "patients must have medication doses halved" there is very justified outrage.

 

[The Greater Fool]

Define cut in half.

In Canada we are doing similar things in which narcotics are prescribed in shorter intervals. So instead of getting 3 months worth people get 1 month worth before having to refill.

Are you saying that there is a law that is getting made that says your dosage is to be halved? For example is a 20 mg dose being brought down to a 10 mg dose. Or are you recieve only half the days of medication.

I'd be astonished at any law that says to lower dosages by any specific amount. But id love to see it, and if it is written as "patients must have medication doses halved" there is very justified outrage.

Then be astonished.

Here, in AZ and in most states, you can only get a 1 month supply of narcotics. That has not changed. What has changed that in my spouse's case, the new Law allows her only half of what she's had for 20 years. That's 50%. That's how I define 1/2.

 

[kellyb]

One key provision of the measure limits initial prescriptions to no more than five days — of 14 days for post-surgical patients — with an absolute dosage of no more than 90 “morphine milligram equivalents” unless they fall into certain excepted categories like burn victims, cancer patients and those in hospice.

The good news, TGF:

Doctors who say their patients need more must first get approval from a board-certified pain management specialist.

http://tucson.com/news/local/arizon...cle_8c5fb239-64f9-59b8-b209-fd8adceb5db3.html

 

[TragicMonkey]

Absolutely, and this is what terrifies me about the loose and ignorant talk of the "opioid crisis." Most news articles conflate all types of opioid abuse, average person pictures some low life murderous addict in a made-for-TV movie, and the current wave of conservative politics seems likely to impose a puritanical approach to any drug than might actually allow someone to feel better. Just look at how upset Sessions is by pot!

Again- I saw how important opioids were for my dying father. I see how their use is hospice has allowed people to die with dignity (and others to live in dignity). For many people in intense pain, the ability to find some relief in opioids is perhaps the only thing that prevents them from considering suicide. Any uninformed and ideologically motivated restriction on opioids that keeps them from the people who desperately need pain relief is evil at a very fundamental level.

Whatever happens, it will happen in a way to preserve (or increase) the profits of large pharmaceutical corporations. The puritanical element will act as if they'd preferred millions to suffer horribly rather than risk a single person having illicit pleasure, and perhaps they even believe that, but ultimately it's all down to money.

 

[TomB]

It sounds like you've been taking a fairly low dose, and maybe of ones that are relatively mild compared to Oxycontin and morphine, and only when in pretty extreme pain. My understanding is that they don't cause highs under those circumstances, but rather work more like aspirin or tylenol then.

My wife has been taking Morphine ER twice a day for the past ten years or so for her chronic pancreatitis. A pretty high dose, actually, which has not changed in ten years. She has never gotten a high from it, even on day one.

Over the years I've done a lot of research on pancreatitis and treatments. There are a few alternatives: nerve blocks, for example work about half the time (not for my wife). But really the only reliable treatment for the pain is opioids.

Opioids allow chronic pain patients to function normally like everyone else. They don't usually get high. They don't get cravings. They aren't vegetables lying in bed all day. They aren't watching the clock anticipating their next fix. (Hell, my wife forgets a dose a couple times a month.) They lead normal active lives, which they wouldn't be able to do without the medication.

The worst part is not the morphine. (Actually, the only bad effect of the morphine is constipation.)

The worst part is other people and their ignorant preconceived ideas about the medication. (This includes a lot of medical professionals as well.)

 

[Wolrab]

I have several stories to tell and will split them up so they won't be TL/DR material.

I am a registered nurse and many of my patient's have either Norco (hydrocodone/acetaminophen), Percocet (oxycodone/APAP), or just oxycodone immediate release prescribed after knee, hip, or back surgeries. I always teach them to wean off the narcotics ASAP.

My dead brother was prescribed 300 5mg oxycodone IR tabs a month, 80 mg oxycontin twice a day by a VA MD. He was part of what I jokingly called The Greater Finger Lakes Prescription Narcotic Exchange Program. Him and the other members would buy, trade, and steal their pills from one another.

My brother was even able to convince his doctor to prescribe him a 150mcg fentanyl patch.

My dead friend was taking care of his sister (also now dead) with terminal lung cancer. They had to fight to get a 25mcg fentanyl patch for her even though she was terminal and had obvious extremely high pain.

The VA check my brother's blood once and found no opioids in his system so they cut him off. He went through withdrawal (or at least pretended he did) and amazingly he was dead broke financially by the middle of the month as he had nothing to sell. The MD did put him back on the pills but took him off the fentanyl patch after he nodded out and crashed his car.

Once we got a call from the FDA. It seems my brother had called and lodged a complaint that Big Pharma was reducing the amount of active drug in his oxycontin. He had explained that he had to take 3 tabs a day- 240mg in addition to the oxycodones he ate like candy. Talk about building a tolerance.