deadrose
Illuminator
The Opioid Crisis
- Thread starter JoeMorgue
- Start date
kellyb
Penultimate Amazing
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Thanks, and yeah, it looks like the IMF-caused deaths number inflates the real-opioid deaths number by about 100%.
Unfortunately the first page of the first article cut off just before it was about to talk about the change in overdose rates. But it appears that it was going to say that prescription related overdoses were either not increasing or not increasing at nearly the same rate. (It literally cuts off in the middle of the sentence.)
The inference is that prescriptions are not behind the epidemic. The real problem appears to be illicitly manufactured opioids.
A few years back, I was in Montreal on a work trip. On the news, they were talking about an epidemic of Fenatnyl overdoses in Canada. It caught my attention because my wife used to be treated with Fentanyl patches. I think it was the illicitly manufactured stuff they were talking about.
The inference is that prescriptions are not behind the epidemic. The real problem appears to be illicitly manufactured opioids.
A few years back, I was in Montreal on a work trip. On the news, they were talking about an epidemic of Fenatnyl overdoses in Canada. It caught my attention because my wife used to be treated with Fentanyl patches. I think it was the illicitly manufactured stuff they were talking about.
The Norseman
Meandering fecklessly
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The Greater Fool
Illuminator
I appreciate the understanding. I think (hope?) that just about anyone that have themselves experienced, or a loved one that experienced chronic pain understand the situation.
Coping with acute pain is quite different than chronic pain. I had a series of reconstructive surgeries when I was 12-15 that were quite painful in a sensitive area with no narcotics. I developed some decent coping tactics. I knew the major pain of now would be gone tomorrow. I knew the same thing the next day. I used to say I can deal with anything for [a day, a week, a month].
Knowing the pain today will be there tomorrow, and the next day, until you die is a horse of a different color.
Just a footnote, opioid induces hyperalgesia is not a given, and when it does happen is most often of short duration. Weening off narcotics reduces or eliminates the short term effects.
Another footnote. While developing a tolerance may be an issue, it (obviously) may not be an issue. My spouse has been on the same regimen (with temporary adjustments when we moved to a new area) for 15 years. I have been on my far lower level for 10 years.
One last footnote. Dependence and Addiction are two different things. My spouse and I are dependent on our narcotics. We have never experienced withdrawals when we've not taken them.
As has been mentioned before, chronic pain patients often react differently to narcotics than other folks. No high, no withdrawals, just a level of pain relief.
And yet they have patients on narcotics.
No one is arguing that narcotics are not over-prescribed and/or obtained illegally. As a society, we need to deal with this. But let's not throw the baby out with the bathwater. Chronic pain people the world round use narcotics when they are available. Don't make folks like my wife suffer and die because some other idiot likes the high.
I'll be looking at these links.
Couldn't agree more, and much of this is my spouses experience.
It's sad that some people say they get by with NSAIDs or Tylenol. For acute pain it's OK, and it often does work. But when you start taking them at maximum dosages for an extended period of time, Tylenol will destroy your liver, NSAIDs your digestive system, not to mention thinning your blood, which creates other problems.
It's now Carfentanil, which is being used to cut herion and other fun stuff. Carfentanil is 5000 times as powerful as heroin, 100 times more powerful than Fentanil.
The news has said one grain of Carfentanil can kill. It's also said in the reports that since these are obviously illegally obtained drugs, addicts are buying heroin that they don't know is cut with Carfentanil, and dying. In some places, groups are handing out testing kits, or doing the testing of the heroin to ensure it is 'safe'.
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Again unless someone wants to argue that other countries are just letting people live in pain, they have managed to maintain a proper baby/bathwater ratio.
All this hand wringing over "We have to make sure the actual people in need aren't unduly impacted by this" seems to be something that literally every other developed nation seems to have handled.
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The Greater Fool
Illuminator
Yes, by prescribing narcotics. Perhaps more appropriately.
I get that this doesn't impact you, so you can call it hand-wringing. It impacts my family directly and adversely, so it is a critical concern for me. I am not vexing about nothing.
And this "other country" trope of yours is nonsense. Other countries *DO* prescribe narcotics. Perhaps they do it better, perhaps they do it worse. Until you share how they do it better or worse, the fact that they do it less is meaningless. The links KatieG (I think) presented above may indicate other countries may NOT deal with chronic pain better. Some countries prescribe heroin more, so let's do that if what other countries do is to be our barometer.
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kellyb
Penultimate Amazing
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1) calling it "hand-wringing" is ridiculous in a dark, sheltered, and nasty way that makes you a lot less likely to be taken seriously on this topic.
2) you need to let this sink in a little more deeply:
http://www.latimes.com/opinion/op-ed/la-oe-hari-prescription-drug-crisis-cause-20170112-story.html
kellyb
Penultimate Amazing
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Well, we're certainly different in terms of lack of access to white-market healthcare. That's US-style capitalism, not magic. We're also unique in our lack of a solid economic safety net, which will exacerbate "social" predispositions to addiction.
I'm not sure we're all that different from Canada in terms of illegal fentanyl overdoses contributing to the opioid deaths.
My own sense is that N American doctors being fast and loose with opioid rx's in the 90's to early-to-mid 2000's created a culture where words like "lortab" and "percocet" are damn near household names now, and the market for pill-form opioids became a new niche drug market that's become mega-deadly now that illegally manufactured fentanyl is everywhere (they're even finding it being used to "cut" cocaine and in fake xanax!)
It's a lot more complicated than the single, overly simplified narrative of bad doctors.
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wasapi
Penultimate Amazing
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A few years ago, a friend who had serious spinal damage after being thrown from her horse. Kaiser prescribed fentanyl patches. Once, they accidentally sent her another patients patch. It was for a large man, over 300 lbs. She had gotten down to 90 lbs. She died of an overdose, one she was assumed was for her.
Statistically, I wonder if medical malpractice (Kaiser gave a large settlement to her mother.) is just counted as an opiode overdose?
Statistically, I wonder if medical malpractice (Kaiser gave a large settlement to her mother.) is just counted as an opiode overdose?
Posters in this thread are simply trying to explain that opioid use is a multi-facitated issue, that many of the popular stereotypes and mass media viewpoints are distorted or completely incorrect, and that you should rethink several of your assumptions because they do not always reflect the documented facts. Further, people who have real experience in how opioids are actually used in the treatment of severe chronic pain have important insights into the need for and risks of these drugs. They not only know the reality of what it is really like for the patients, their doctors, and their care givers (unlike the often fictional illusions of People Magazine or of the puritanical politicians), they typically have also devoted a substantial effort to researching the facts. I would listen very carefully to them.
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The Greater Fool
Illuminator
Well, aside from that being true...
You repeatedly state that other countries prescribe fewer narcotics than the USA. In so doing, you imply that other countries are handling narcotics and chronic pain better. Yet, the statistics provided by kellyb [sorry for the previous misattribution] that those other countries perform worse in the management of chronic pain.
Earlier in the thread, some one asked how people handled chronic pain issues before narcotics. The question was not really addressed directly, but my thought is that it was probably how people handled a plethora of maladies before modern medicine. They suffered until they died younger.
But OK, in spite of the evidence, let's grant that the countries prescribing fewer narcotics ARE doing better than the USA. Let's grant that those countries are prescribing fewer narcotics, more conservatively, more rationally, with better control of chronic pain. Those other countries are STILL prescribing narcotics for acute and chronic pain.
I advocate evidence based medicine. Our Pain Specialists are trained and board certified to practice pain management after studying for years, passing board exams proving their knowledge, then providing evidence based therapies to patients with whom they've developed a relationship over years of consultations. Until recently, this was the case.
Now, politicians who do not have this specialized knowledge and experience, are trying to solve the tangentially related problem of people overdosing on illegally produced and acquired narcotics by restricting legally prescribed and carefully monitored medications to patients that receive actual and demonstrable benefits therefrom.
Personally, I prefer my doctors doing the doctorin' and my politicians doing the politickin'.
kellyb
Penultimate Amazing
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They're actually exactly the same for severe pain. Not sure what the severe pain patients in the UK/Europe are being prescribed, tho.
The Greater Fool
Illuminator
Thanks for the correction.
The Greater Fool
Illuminator
Proof positive that admitting a flaw can have devastating effect. Here, it killed a thread.
Craig4
Penultimate Amazing
I until recently lived in Tampa Florida, hard hit by the opioid epidemic. I doubt any of my neighbors would have a hard time identifying the outrage. It was a constant thing. Kids stopped using libraries because people went to them to shoot up. There was plenty of outrage and not hard to find. Maybe there's something else you want to deflect attention from?
Skeptical Greg
Agave Wine Connoisseur
Not going to the libraries? Oh my, the outrage..
I guess I missed the marches, walkouts and oratory from the embattled teens, who can't wait to vote the heel dragging politicians out of office..
( Thanks for responding to my comment. It went largely ignored until now. )
I guess I missed the marches, walkouts and oratory from the embattled teens, who can't wait to vote the heel dragging politicians out of office..
( Thanks for responding to my comment. It went largely ignored until now. )
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Hlafordlaes
Disorder of Kilopi
Bringing the full weight of the vacuum to bear, I see. Hadn't seen that done before; kudos.
***
Just to remain topical: If the topic of drugs has you itching for some virile police work, I say, line them suspect assumptions up and throw books at them.