The Opioid Crisis

JoeMorgue said:
Japanese doctors treated acute pain with opioids in 47% of cases - compared to 97% in the US.

Unless you can show me that 50% of Japanese pain sufferers are living in agony... what is even being argued?
Click to expand...

Acute pain and chronic pain are two different things.
You realize that, right?

Treatments are not necessarily the same. For example, with chronic pain that will last an entire life, dependency is not as much of a concern.
 
TomB said:
Acute pain and chronic pain are two different things.
You realize that, right?

Treatments are not necessarily the same. For example, with chronic pain that will last an entire life, dependency is not as much of a concern.
Click to expand...

Oh for the love of...

Unless someone can reasonably argue that other countries aren't meeting some legal, moral, ethical, or medical standard of treatment for their patients is some form of non-specific type of pain, so we don't have to hairsplit a difference that doesn't matter, the argument that current rate of opioid use in America is necessary for any such treatment here in America doesn't work.

Unless you want to argue that they don't have chronic pain or acute pain in Japan or Europe... what changes about my argument other than yet another "Well acsthually..."
 
I have diabetic neuropathy in my feet and lower legs. As I understand it, it's irreversible. I treat it with a combination of Gabapentin* and Tramadol. Without medication, my quality of life sucks, to the point that if I had to deal with that pain without the meds I'd opt for amputation; I wouldn't go as far as to say it makes me suicidal, but it is definitely depressing, not to mention exhausting. I'm sure another kind of opioid would work better than Tramadol - I've had my share of surgeries and injuries over the years, so I've got experience with how they effect me - but it doesn't get me high, and I prefer it that way.

All the same, there are days when the dosage I take isn't quite enough, since it wears off overnight and takes about 2 hours or more to kick in the next morning. My GP is reluctant to increase the dosage, so basically my situation is "you get X amount of pills per month, and if they're not enough for all day, every day relief, then it sucks to be you."

My situation is mostly under control at the moment. I don't expect it to improve, and it will probably get worse as I get older. So when I hear talk of the government - which I don't trust one goddamn bit to act with decency, humanity and intelligence when it comes to anything regarding drugs - talk of getting tough on opioids, it scares the hell out of me.


*Lyrica combined with Tramadol worked a helluva lot better, but then my wonderful insurance company stopped covering it, and out of pocket it's $750 a month - IOW 60% of my income.
 
Last edited:
I'm confused about those state by state numbers and maybe someone could help me, because I went to the CDC and the links provided, but couldn't find an answer...

Is the number of prescriptions really the most important number to look at? Because I know in the US, there are a lot of prescriptions written for smaller things such as tooth extraction that wouldn't be done on most of the rest of the planet, but these are extremely limited in magnitude and wouldn't really be indicative of abuse of these pain killers. Does the number of prescriptions tell you anything about the total amount of pills being dispensed? I really can't see that information, but maybe I just missed it. I think it could be important to seeing what percentage of the prescriptions are written to a small percentage of the population for chronic pain and what percentage are for acute pain, which would be a different matter all together. Heck if 2 people out of 100 get a monthly script of opiate medications, you are already at 24 prescriptions per 100, and I don't think that really is saying much.
 
Crawtator said:
Heck if 2 people out of 100 get a monthly script of opiate medications, you are already at 24 prescriptions per 100, and I don't think that really is saying much.
Click to expand...

I was wondering that, too.

Add to that the rare people (dealers?) who go see multiple doctors to get multiple monthly scrips, and it adds up quickly.
 
I just wonder what the tune would be of some of the critics when they are the ones suffering life shattering chronic pain.

As it is, it's hard to take seriously people that claim to have solved chronic pain issues though exercise, weight loss, good diet, vitamins, surgical intervention, hypnosis, message, chiropractic adjustment, meditation, marijuana, yoga, eliminating toxins, a good enema, Reiki, aromatherapy, faith in Jesus, Amway, or whatever their magic bullet is [Including cooking with the Magic Bullet].

Asking "How do other countries do it?" does little good until you answer the question.

It's pretty much a character flaw to treat chronic pain with narcotics. Do people really think chronic pain sufferers have not researched the possibilities?

Yes, I'm frustrated and honestly afraid.
 
Last edited:
The Greater Fool said:
I just wonder what the tune would be of some of the critics when they are the ones suffering life shattering chronic pain.

As it is, it's hard to take seriously people that claim to have solved chronic pain issues though exercise, weight loss, good diet, vitamins, surgical intervention, hypnosis, message, chiropractic adjustment, meditation, marijuana, yoga, eliminating toxins, a good enema, Reiki, aromatherapy, faith in Jesus, Amway, or whatever their magic bullet is [Including cooking with the Magic Bullet].

Asking "How do other countries do it?" does little good until you answer the question.

It's pretty much a character flaw to treat chronic pain with narcotics. Do people really think chronic pain sufferers have not researched the possibilities?

Yes, I'm frustrated and honestly afraid.
Click to expand...

I just needed to let you know: some of us here get it! Following this thread has repeatedly made me quite upset as some with little or no experience with truly intense chronic pain blithely make uninformed, pronouncements. "Oh, I had oral surgery once and I found that alternating Tylenol and Ibuprofen worked fine- why would anyone need opioids?" "My back pain was really bad until I changed my mattress and chair and it went away" "I had bad headaches and I simply thought them away- like Mr. Spock would have." "Clearly opioids are being over-prescribed, everyone tells me, so the idea of the State government cutting your spouse's dose by half is only reasonable." "What's the problem- the doctor only has to run a quick simple form past a pain management team and your spouse's problem will be fixed."

I am unbelievably lucky- I have never had the kind of intense, unrelenting pain that your spouse has. I've seen the edges of it: I've had oral surgery with pain intense enough for a day that I could not sleep or even think. I've had back problems where just turning around in bed sent waves of sharp pain that froze me in place. Etc. Probably not much different from what any poster here has personally experienced. Yet I never (and still do not) feel that any of these situations needed opioids. My gums got better within a day. Ibuprofen did help my back, and I learned what to do and not do to make my back better. But I have seen enough from family members and others to realize that my circumstances are not what we are discussing here as to your spouse, or the many other people who legitimately need opioids. I also learned enough to not base my understanding of opioids on TV cop shows or melodramatic, overwrought, puritanical headlines in the current "OPIOID CRISIS!" news cycle.

Folks- the Greater Fool has a lot more knowledge of what his (?) spouse is suffering, what has worked for her (?), and what their options now are, than we strangers do. Opioids have unpleasant side effects in addition to serious risks and I am certain that both the GF and the spouse would be thrilled if it was possible to reduce the dosage, or change to other forms of pain relief. And based on the GF's postings here and throughout the Forum he is clearly intelligent and well-informed. I would never dare to assume the he, immersed in this dreadful scenario of watching a loved one suffer day after day, would not have devoted far more research and thought to opioids, their use, and their alternatives than we have (having no such personal motivation).

Dear GF- I agree with you, more people than not see any need for narcotics as a deep character flaw (with the possible exception of the last few days of dying- during which time, BTW, my dad's narcotics were nonetheless severely limited so he wouldn't get addicted!!). And now the politicians and news reporters have further made a complete muddle of it all by mixing together concerns about over-prescription by legitimate doctors, over-prescription by sleazy doctors, over promotion by pharmaceutical firms, diversion of prescription drugs onto the streets, and the street corner availability of straight-up drug-ring manufactured heroin and its derivatives.

As I posted above, it is crucial to depend on facts and not rumor, stereotypes, or what we read in People magazine. Getting it right is important if we want to avoid torturing people already in pain. Getting it right is important if we what to reduce the number of new addicts and help those already addicted. And listening to people such as the GF and their spouse without presuming we know better is one beginning to getting it right.
 
Last edited:
Giordano said:
I just needed to let you know: some of us here get it!
Click to expand...

Seconded.

I've never experienced it, but I have a vivid imagination, and I know very well 2 people who became extremely suicidal from it.
 
JoeMorgue said:
Oh for the love of...

Unless someone can reasonably argue that other countries aren't meeting some legal, moral, ethical, or medical standard of treatment for their patients is some form of non-specific type of pain, so we don't have to hairsplit a difference that doesn't matter, the argument that current rate of opioid use in America is necessary for any such treatment here in America doesn't work.

Unless you want to argue that they don't have chronic pain or acute pain in Japan or Europe... what changes about my argument other than yet another "Well acsthually..."
Click to expand...

It's not hairsplitting. It's significantly different.

The main problem with narcotics is that they result in a physical dependence. That physical dependence is only a problem when you are trying to stop taking them. It's a non-issue for chronic pain because you aren't going to stop taking them.

Acute pain has different treatment objectives. It's short duration stuff that you need to get through until the body heals and the pain goes away. Mostly, this is going to be post-surgical or dental treatment, or injuries that will heal over time. Dependency is an issue with those because the pain will go away and you won't need the medication any longer.

If you were arguing that maybe something else would be better for pain after your wisdom teeth are pulled, you might have a point. But to say that chronic pain is the same thing is just plain ignorance.

As to the weight loss thing...
If your pain is muscular or skeletal, there is some truth to that in some cases. But if you pain is from something like, say pancreatitis, then no.

I have done a lot of research on pain alternatives for pancreatitis, because if there were an alternative that actually worked as well as the morphine that would be great. Not because there is a problem with the morphine, but because ignorant people have attached a BS stigma onto it. If tylenol/naproxen/ibuprofen etc. worked, by golly that would be great. But it doesn't. Not in any combination. There are things that assist the morphine: Cymbalta, for example, but nothing else works as well to control the pain.

Again, chronic and acute pain have completely different considerations.
 
TomB said:
The main problem with narcotics is that they result in a physical dependence. That physical dependence is only a problem when you are trying to stop taking them. It's a non-issue for chronic pain because you aren't going to stop taking them.
Click to expand...

I disagree. Opioid-induced hyperalgesia is, IMO, possibly of equal importance to dependence. Also, with dependence comes tolerance, requiring ever larger doses, which leads to overdose deaths.
 
TomB said:
Again, chronic and acute pain have completely different considerations.
Click to expand...

*Very slowly* But the other countries that don't have the same degree of opioid problems also have to deal with both chronic and acute pain and they seem to do it without prescribing so many opioids.
 
JoeMorgue said:
*Very slowly* But the other countries that don't have the same degree of opioid problems also have to deal with both chronic and acute pain and they seem to do it without prescribing so many opioids.
Click to expand...

I'd really be curious to see the percentage of people in those other countries who report that their severe chronic pain is well managed with the non-opioid meds.
 
Europe:
http://www.nascholingnoord.nl/prese..._et_al___Survey_of_chronic_pain_in_Europe.pdf
In-depth interviews with 4839 respondents with
chronic pain (about 300 per country) showed: 66% had moderate pain (NRS = 5–7), 34% had severe pain (NRS = 8–10), 46% had
constant pain, 54% had intermittent pain. 59% had suffered with pain for two to 15 years, 21% had been diagnosed with depression
because of their pain, 61% were less able or unable to work outside the home, 19% had lost their job and 13% had changed jobs
because of their pain.
Click to expand...

US:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4545568/
Among female COT patients, 15% (vs. 26% of males) had favorable global pain status and 59% (vs. 42% of males) had unfavorable status.
Click to expand...

eta:
Look at this chart for the US: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4545568/table/T2/ exactly 34% with severe pain - which happens to be exactly the rate for Europe, too.
 
Last edited:
kellyb said:
I disagree. Opioid-induced hyperalgesia is, IMO, possibly of equal importance to dependence. Also, with dependence comes tolerance, requiring ever larger doses, which leads to overdose deaths.
Click to expand...

That's not our experience. My wife has been on the same dose for ten years with no decrease in effectiveness.

But yes, tolerance is a limitation of opioids. This is something we encountered 20 years ago with vicodin. It became less effective over time. Her doctor at the time saw this and switcher her to Fantanyl patches. She never developed tolerance to the Fentanyl, but a new doctor switcher her to morphine, which she has also never developed a tolerance for.

Different medications are appropriate for different patients. It's not one size fits all. For many long-term chronic pain patients, narcotics are the best choice.
 
TomB said:
That's not our experience. My wife has been on the same dose for ten years with no decrease in effectiveness.

But yes, tolerance is a limitation of opioids. This is something we encountered 20 years ago with vicodin. It became less effective over time. Her doctor at the time saw this and switcher her to Fantanyl patches. She never developed tolerance to the Fentanyl, but a new doctor switcher her to morphine, which she has also never developed a tolerance for.

Different medications are appropriate for different patients. It's not one size fits all. For many long-term chronic pain patients, narcotics are the best choice.
Click to expand...

I don't disagree with that. :)
 
I just ran into something rather interesting. Apparently the way the CDC sorts drug death categories has led to a huge overstatement in the number of prescription opioid deaths. Here's the article.

And I know that cheap Chinese fentanyl is causing problems all over the place, even in non-opioid street drugs like cocaine. So if those deaths are being listed as prescription overdoses, that explains why they claim such overdoses are skyrocketing.
 
deadrose said:
I just ran into something rather interesting. Apparently the way the CDC sorts drug death categories has led to a huge overstatement in the number of prescription opioid deaths. Here's the article.
Click to expand...

I don't have access to the full text. Can you quote the relevant parts?
 
You must log in or register to reply here.

Back
Top Bottom