Drug overdoses now kill more US citizen's than guns

[interchange]

I'd say that the docs who are likely to foster addiction without awareness are likely to be the ones who simply cut people off when they find it.

Part of this problem is that opioid withdrawal, while severely uncomfortable is not in itself medically dangerous. Personally, I think it ought to be taken more seriously medically, as lots of withdrawal gets unappreciated, and people who are otherwise medically complicated might be at risk if they have persistent nausea/vomiting added on.

 

[monkeydelmagico]

No one has mentioned the leading cause of heroin deaths: Fentanyl

When experienced users are OD'ing you know the greedy dealers are really messing up.

 

[hal2kilo]

No one has mentioned the leading cause of heroin deaths: Fentanyl

When experienced users are OD'ing you know the greedy dealers are really messing up.

I have really been wondering about that. Killing off your customers, when you should be cutting more doses. Oh, well, nobody ever said drug dealers were geniuses.

 

[momeNt]

I have really been wondering about that. Killing off your customers, when you should be cutting more doses. Oh, well, nobody ever said drug dealers were geniuses.

It's not about that. It's about the fact that it is so much more powerful, and thus, smaller quantities are needed to smuggle into the US from Mexico. It makes things much easier from a smuggling standpoint from Mexico to have a smaller more potent product.

 

[hal2kilo]

It's not about that. It's about the fact that it is so much more powerful, and thus, smaller quantities are needed to smuggle into the US from Mexico. It makes things much easier from a smuggling standpoint from Mexico to have a smaller more potent product.

Which obviously, needs to be cut more, so more doses, more money.

And yes, I've read about wooden lung syndrome with regard to fentanyl.

 

[interchange]

No one has mentioned the leading cause of heroin deaths: Fentanyl

When experienced users are OD'ing you know the greedy dealers are really messing up.

Uhm. Am I nobody?

 

[Darwin333]

I have really been wondering about that. Killing off your customers, when you should be cutting more doses. Oh, well, nobody ever said drug dealers were geniuses.

Actually in the crazy world of heroin when one of your customers OD's your sales skyrocket because everyone knows you have really strong product.

 

[IronWing]

Actually in the crazy world of heroin when one of your customers OD's your sales skyrocket because everyone knows you have really strong product.

NPR interviewed some addicts on this very topic. Yep, the addicts were saying, "It killed him? Hit me up!" Amazing what one can do to one's brain with a bit of effort.

 

[superstition]

NPR interviewed some addicts on this very topic. Yep, the addicts were saying, "It killed him? Hit me up!" Amazing what one can do to one's brain with a bit of effort.

If you believe NPR. I would take them with a big grain of salt if I were you.

Besides, anecdote does not define the norm.

 

[superstition]

No one has mentioned the leading cause of heroin deaths: Fentanyl

When experienced users are OD'ing you know the greedy dealers are really messing up.

I already discussed carfentanil. Maybe you should read the posts before making such claims.

 

[superstition]

I disagree. How is opioid prescription different than any other form of malpractice? If a physician is providing quantities which may be lethal, not providing informed consent, not reasonably attempting to identify abuse, and not treating abuse when it is found, on what basis is their liability absolved?

Medications have instructions about proper usage. Adults are able to read and follow those instructions. Not only are the instructions on the pill bottles, they are printed on paper with the medications.

Nanny states should, at the very least, not promote suffering with the excuse that it's protection. Idiots who abuse medications are not all of us nor do they negate the fact that adults actually exist.

 

[IronWing]

If you believe NPR. I would take them with a big grain of salt if I were you.

Besides, anecdote does not define the norm.

Having no experience with opioid abuse myself, though a close family member made himself dead via prescribed opioids, I have to defer to the addicts to explain their own thinking.

 

[superstition]

Hydrocodone typically have either 350 miligrams to 500 miligrams of acetaminophen.

That is after the recent change. Before it was usually 500–750 mg.

The FDA now says doses of acetaminophen above 325 can cause liver damage. That's right, just one dose.

And, even better is the research that found that doses higher than that are worthless for killing pain. That's right, anything past that level had no extra pain-killing effect.

 

[superstition]

Having no experience with opioid abuse myself, though a close family member made himself dead via prescribed opioids, I have to defer to the addicts to explain their own thinking.

1) Anecdote does not define the norm.

2) People with personalities that are prone to abuse can abuse all kinds of things, not just opioids.

3) Crazy people are crazy. Therefore, we should look to their crazy behavior to determine how sane people should be treated.

I have experience with opioids including hydrocodone, codeine, and oxycodone.

Hydrocodone is an excellent medicine to have in one's cabinet in case one gets an infected tooth and needs a root canal. My dentist was not available for immediate surgery when my tooth failed and my face swelled up. I had to wait through the weekend. If I had not had leftover hydrocodone I would have never made it with that level of pulsating pain.

Hydrocodone is also rather weak as opioids go and doesn't even scratch acute severe back pain.

Codeine is utterly worthless, given its poor efficiency. It has a similar level of side effects to strong opioids and yet it's very weak. I don't see why it's on the market or prescribed at all — other than the fact that the obsession over restricting strong painkillers leads people to not only put toxic substances into the pills but also to prescribe people inefficient weak meds that generally don't do the job. If ibuprofen isn't strong enough to kill the pain then codeine isn't going to do the job.

Oxycodone is a great solution for acute chronic back pain and yet it's impossible to get a prescription for it now, thanks to the nanny state. I have expired oxy in my fridge that I had to save from my spouse's major surgery and despite having had to have three separate ER trips because of back flareups my doctor has danced around the problem with a lot of nonsense. Worthless Celebrex (weaker than ibuprofen). Worthless tramadol which I didn't even fill. I know from experience that oxycodone will cut the pain enough for me to sleep and heal. Something weaker is not going to cut it and I could do without a weaker seizure-inducer (tramadol).

This is the same physician that nearly cost my spouse a job by going crazy with Paxil and anti-psychotics after I complained about the symptoms the Paxil was causing, especially after he doubled the dosage from my first complaints. If a physician offers Paxil to you or anyone you know find a new doctor. If that doctor wants to double the dosage to counteract the side effects, find a new doctor. If the doctor wants to prescribe an anti-psychotic to hide the symptoms find a new doctor. The level of loopiness from this cocktail is well beyond the pale.

It's ridiculous that ER physicians actually will subject people to severe pain, refusing to prescribe anything while they're loaded into an ambulance on a stretcher, because of liability. Apparently, causing heart attacks isn't a problem. And, "family" doctors won't give you a backup for these random rare acute flareups. Medical care in this country is poor unless you're rich. It's really that simple.

It's fine to render people unemployable with unnecessary mind meds but apparently not okay to let people survive severe pain episodes. Anyone who hasn't experienced extreme back pain is in no position to pass judgement about whether or not effective opioids should be available to such a person. Unless there is solid evidence that the patient has a substance abuse problem there is no good justification for refusal.

I heard a doctor brag that if a patient asks for a specific painkiller he always says no to it. That is the sort of glib "zero tolerance" lack of thought and arrogance that typifies the elitist medical profession. Heaven forbid a patient might have taken the time to really investigate a medication. This is the same industry that bombards people with ads telling them to "ask their doctor about" everything else under the sun. The cognitive dissonance might be cute if not for the high level of unnecessary suffering it causes.

 

[interchange]

Medications have instructions about proper usage. Adults are able to read and follow those instructions. Not only are the instructions on the pill bottles, they are printed on paper with the medications.

Nanny states should, at the very least, not promote suffering with the excuse that it's protection. Idiots who abuse medications are not all of us nor do they negate the fact that adults actually exist.

So a doctor has no responsibility at all in weighing the benefits and risk for a patient? Their training and clinical experience with these medications and knowledge of a patient's specific history should not factor into their treatment decisions and monitoring?

Aside from this, you only talk about informed consent. There were quite a few other factors I pointed out that would constitute standard of care.

But, on the topic of informed consent, are you arguing that such a thing should not exist between physician/patient because they are provided a piece of paper upon receipt of their prescription?

The cases of physician criminal liability for opioids are few and involve an egregious disregard for standard of care.

If I followed your stance on how to treat patients, you would absolve a few people to harm millions.

Please note: you are talking to a physician who prescribes controlled substances who is arguing for a high standard of accountability in the law. I am the person whose livelihood your argument would protect, and I am telling you that you are wrong.

 

[interchange]

3) Crazy people are crazy. Therefore, we should look to their crazy behavior to determine how sane people should be treated.

This argument is exceedingly dangerous. Lifetime prevalence of substance use disorders is somewhere between 15 and 30 percent, and cumulative lifetime prevalence of substance use disorder or any mental illness approaches half of the population.

By your definition, nearly half of us are crazy. All that your splitting narrative does is ostracize those who might otherwise be able to seek treatment.

 

[superstition]

So a doctor has no responsibility at all in weighing the benefits and risk for a patient? Their training and clinical experience with these medications and knowledge of a patient's specific history should not factor into their treatment decisions and monitoring?

If it's something that is directly life-threatening like monitoring the administration of Propofol then, yes, of course. If the doctor knows the patient has grand mal seizures then prescribing Tramadol is probably not the smartest move.

You're evading my point.

The point is that doctors don't force patients to abuse medications. Adults are fully capable of following the directions. If the doctor put the wrong dosage instructions on the bottles then they are liable. Otherwise they aren't, no matter how easy it is for someone to get the prescription.

Opioids like oxy are not particularly dangerous unless people choose to abuse them.

Please note: you are talking to a physician who prescribes controlled substances who is arguing for a high standard of accountability in the law. I am the person whose livelihood your argument would protect, and I am telling you that you are wrong.

You're likely arguing for it because you know it exists and don't want to get into trouble. It's easy to refer to the status quo when you're not the one who has to suffer.

 

[superstition]

This argument is exceedingly dangerous. Lifetime prevalence of substance use disorders is somewhere between 15 and 30 percent, and cumulative lifetime prevalence of substance use disorder or any mental illness approaches half of the population.

By your definition, nearly half of us are crazy. All that your splitting narrative does is ostracize those who might otherwise be able to seek treatment.

That's brilliant. Call everyone crazy.

Even if were to buy into your argument it still leaves ~50% of people who aren't crazy. They're supposed to suffer unnecessarily from extreme pain because there are a lot of crazy people?

That's called a fallacy.

 

[OverVolt]

1) Anecdote does not define the norm.

2) People with personalities that are prone to abuse can abuse all kinds of things, not just opioids.

3) Crazy people are crazy. Therefore, we should look to their crazy behavior to determine how sane people should be treated.

I have experience with opioids including hydrocodone, codeine, and oxycodone.

Hydrocodone is an excellent medicine to have in one's cabinet in case one gets an infected tooth and needs a root canal. My dentist was not available for immediate surgery when my tooth failed and my face swelled up. I had to wait through the weekend. If I had not had leftover hydrocodone I would have never made it with that level of pulsating pain.

Hydrocodone is also rather weak as opioids go and doesn't even scratch acute severe back pain.

Codeine is utterly worthless, given its poor efficiency. It has a similar level of side effects to strong opioids and yet it's very weak. I don't see why it's on the market or prescribed at all — other than the fact that the obsession over restricting strong painkillers leads people to not only put toxic substances into the pills but also to prescribe people inefficient weak meds that generally don't do the job. If ibuprofen isn't strong enough to kill the pain then codeine isn't going to do the job.

Oxycodone is a great solution for acute chronic back pain and yet it's impossible to get a prescription for it now, thanks to the nanny state. I have expired oxy in my fridge that I had to save from my spouse's major surgery and despite having had to have three separate ER trips because of back flareups my doctor has danced around the problem with a lot of nonsense. Worthless Celebrex (weaker than ibuprofen). Worthless tramadol which I didn't even fill. I know from experience that oxycodone will cut the pain enough for me to sleep and heal. Something weaker is not going to cut it and I could do without a weaker seizure-inducer (tramadol).

This is the same physician that nearly cost my spouse a job by going crazy with Paxil and anti-psychotics after I complained about the symptoms the Paxil was causing, especially after he doubled the dosage from my first complaints. If a physician offers Paxil to you or anyone you know find a new doctor. If that doctor wants to double the dosage to counteract the side effects, find a new doctor. If the doctor wants to prescribe an anti-psychotic to hide the symptoms find a new doctor. The level of loopiness from this cocktail is well beyond the pale.

It's ridiculous that ER physicians actually will subject people to severe pain, refusing to prescribe anything while they're loaded into an ambulance on a stretcher, because of liability. Apparently, causing heart attacks isn't a problem. And, "family" doctors won't give you a backup for these random rare acute flareups. Medical care in this country is poor unless you're rich. It's really that simple.

It's fine to render people unemployable with unnecessary mind meds but apparently not okay to let people survive severe pain episodes. Anyone who hasn't experienced extreme back pain is in no position to pass judgement about whether or not effective opioids should be available to such a person. Unless there is solid evidence that the patient has a substance abuse problem there is no good justification for refusal.

I heard a doctor brag that if a patient asks for a specific painkiller he always says no to it. That is the sort of glib "zero tolerance" lack of thought and arrogance that typifies the elitist medical profession. Heaven forbid a patient might have taken the time to really investigate a medication. This is the same industry that bombards people with ads telling them to "ask their doctor about" everything else under the sun. The cognitive dissonance might be cute if not for the high level of unnecessary suffering it causes.

Sorry your SO was on antidepressants, they kill most relationships IMO.

My mom is on them and if you give her an inch she will take a mile so I ultimately just don't really listen to her.

 

[MrSquished]

The point is that doctors don't force patients to abuse medications. Adults are fully capable of following the directions. If the doctor put the wrong dosage instructions on the bottles then they are liable. Otherwise they aren't, no matter how easy it is for someone to get the prescription.

Opioids like oxy are not particularly dangerous unless people choose to abuse them.

Americans are the most medicated nation on the planet by far, and in regards to pain medications and opiods, we lead by an even larger massive margin. And you think we live in a nanny state in regards to prescription meds?

http://webmarksonline.com/what-country-is-the-most-medicated-country-in-the-world/

You think doctors can prescribe whatever they want, give the usual 'you'll be fine', and as long as there are some printed words on paper in the bag with the meds it's all good.

Let me put it to you this way - do you think there are any drugs that shouldn't be prescribed? Or prescribed with special conditions to get off of them? Is there anything doctors can be held accountable for in regards to prescribing medicines, in particular narcotics, even if there is a note on the medication? So you think all patients who get hooked on prescription drugs are crazy. That's interesting. I kinda think it makes you rather nuts. You state that oxycodone is impossible to get. I did a little bit of searching and found the restrictions placed on it were things like the doctor could not prescribe a 6 month auto-refill schedule. That now you have to see the doctor every three months to get that refilled. That doesn't sound so bad. Perhaps I didn't find these mega ultra-restrictions on it, please link something up.

and what's super ironic is you state:

"This is the same physician that nearly cost my spouse a job by going crazy with Paxil and anti-psychotics after I complained about the symptoms the Paxil was causing, especially after he doubled the dosage from my first complaints. If a physician offers Paxil to you or anyone you know find a new doctor. If that doctor wants to double the dosage to counteract the side effects, find a new doctor. If the doctor wants to prescribe an anti-psychotic to hide the symptoms find a new doctor. The level of loopiness from this cocktail is well beyond the pale."

You blame the physician for almost costing your spouse a job. Basically everything you have stated before states that it's the patient's fault for any fuck ups with these medications. And just like you said, you both had the medication info placed into the bag with you with all the written info you claim we need to make smart decisions. Plus you have the internet. But you clearly weren't smart enough. You merely made some complaints and then let the guy double the dose. You should have practiced what you preached and figured out immediately whether weaning her off the meds was the best call or finding another physician immediately - or really if you are as smart as you claimed about this stuff, whether to put her on the damn pill in the first place. Instead you let it get way way too far, to the point her job was at stake. Thankfully it sounds like things are better now, but I thought only the other crazy people had issues with prescription drugs. Eh?

 

[OverVolt]

On a large scale, as prescriptions for opoids went up, so did overdoses.

Overmedicated, IMO.

I don't think its a healthcare problem its a cultural pill popping problem. Doctors and pharmacists should be able to exercise their judgment in prescribing and dispensing. Healthcare system itself is fine.

There are so many drug seekers out there, people have no respect for the side effects, its a mess.

 

[interchange]

@superstition I am sorry to hear of your experiences with our medical system. There are many things I could say, but I don't feel it would be appropriate to do so. I do want to clarify my stance:
1. I do not wish to restrict opioids to those patients for whom the treatment benefits outweigh the risks and for which the prescribing practices have appropriate informed consent, monitoring, and without abandoning patients when abuse is suspected
2. I am nonplussed by the off the cuff comments you've overheard by physicians. I hope to provide care and thoughts without resorting to such attitudes. This particular issue is charged with lots of emotions on both sides, and it shows.
3. I would like to hear more about your attitude toward calling people who might become addicted to substances "crazy" and different from the rest of humanity. I don't personally find much difference in the humanity between people with addiction problems and people without. Sometimes biology overwhelms a person's capacity to remain vigilant in making good decisions and sometimes the support is lacking. In my experience, this is simply a tipping of a scale rather than a wholly different kind of person.