As someone who has been taking opiods for chronic pain for several years, I find the direction this issue is going to be very disturbing.
I would much prefer to be both pain and drug free. However, the reality is that without my daily doses, I am in too much pain to get out of bed. Taking the opiods leaves me realatively pain free, and functional. I can even put in most of a day’s work.
I have seen several pain specialists, and have found them to be patronising, condescending and useless. They have said I need to get off the opiods “in case you get addicted”. When I ask them what is their alternative, they tell me they don’t have one.
So, I am supposed to spend my days in bed, in extreme pain, because some moralistic idiot thinks I may become an addict?
Incidentally, despite the fact I take large quantities of opiods, I have never experienced a “high”.
I guess the government should get between patients and their doctors. Seriously, commanding lower doses? That’s a terrible idea and the article explains why it’s a terrible idea.
You see, some people have this condition that is known as “pain”, and if their pain is chronic then they may be taking high doses because they have built up a tolerance and nothing else has been effective for their cases. Now the government is saying, “Just go get street drugs or commit suicide or live with the pain.”
You see, some people have this condition that is known as “pain”, and if their pain is chronic then they may be taking high doses because they have built up a tolerance and nothing else has been effective for their cases, *and so they are addicted to the opioids without them doing much good. *
You’d be surprised by the number of people taking opioids for their pain, where the acetaminophen is doing the pain relief and the codeine is feeding the addiction and causing painful unhealthful constipation. Too many good MD’s are overworked and just give their patients what the patients want… or that their addiction wants. It’s a LOT of work for wean someone off prescription painkillers.
I am not saying this law is a great idea, but something needs to be done.
I want to interject once again that the best objective scientific evidence presently available shows that opioids are not safe or effective for the treatment of chronic, non-malignant pain. MOST especially if the dosages are higher than 90 morphine milligram equivalents per day. Which is where most of the inadvertent drug overdose deaths occur also. Far, far too many people died after the medical profession began its push to treat ‘pain as the 5th vital sign’. And while we are now finally dialing back on that death rate, far too many folks are still dying because of that error.
So it’s a real problem. And one without a simple solution, unfortunately.
I’ve been out there in the trenches in the war against opioid addiction since 1980, when I encountered my first patient on methadone to treat heroin addiction. Along the way I studied directly under the man who won the Lasker award for discovering the opioid receptor, got addicted to opioids myself (and had a LOT of fun with the DEA over that), got clean in 1990, studied addiction, treated addicts, prescribed methadone for chronic pain, treated patients with malignant pain with enough opioids to control their pain, prescribed naltrexone and buprenorphine to manage addictions, got reported to the Medical Board for both not prescribing enough opioids AND too many opioids (MB ruled the complaint was unfounded), taught physicians when to prescribe opioids and when not to, got fooled by patients who diverted their drug supplies to someone else, got to review opioid overdose deaths, got to testify in federal court on the proper way to take someone off opioids, etc. etc. ad nauseum until I despair that there is a decent answer to the problem.
Frankly, I think the best approach is to decriminalize opioid use, educate the public, provide lots of accessible treatment for addiction on a community level, make sure emergency overdose meds like naloxone are readily available, provide clean needles and syringes for all who want them, and just let the chips fall where they may. Addicts will feed their addiction and either succumb or eventually burn out and decide to recover, patients who actually benefit from opioids won’t have to jump through so many hoops to get their meds, and we won’t have to incarcerate so damn many people for having the disease of addiction (yes, they’ll still be punished for actual crimes but not for being addicts who use drugs).
But what do I know?
A lot. All this sounds good Doc!
I oversimplified a bit in my post there, but the Good Doctor has made it quite clear.
Who would that be?
Doesn’t long term acetaminophen use cause liver damage, especially in high does?
People with significant acute pain after injury or surgery.
People with malignant pain from progressive destructive disease processes.
People with specific focal chronic pain due to known etiologies such as spinal cord trauma, particular compression radiculopathies, demonstrated regional neuropathies or post-arachnoiditis pain syndromes, to name some of the most common.
The problem with using opioids for typical generalized chronic pain is that in the usual case, the patient gets used to the analgesic effect after a time, and the dose required to achieve the same pain relief goes up higher and higher. Until the patient is on enough opioid to sedate a T. Rex, and he eventually reports his pain is pretty much the same as it was before he got on opioids. Except he’s groggy all the time and can’t poop. And his life revolves around getting the next prescription filled.
Long term acetaminophen use doesn’t cause liver damage. Overdosing on acetaminophen causes liver damage. Most people with healthy livers can easily handle up to 4 grams of acetaminophen a day. Even people with hepatitis can generally handle up to 2 grams of acetaminophen a day. Avoid alcohol and the risk of inadvertent liver damage is reduced further. Also be sure to check your other OTC meds to ensure they’re not slipping acetaminophen into your cough suppressant, sleeping pill, and allergy/headache medicine too.
Older people can and do get addicted, regardless of how they get started.
For my own part;
I have chronic pain issues. Diabetic Neuropathy, five herniated disks, the whole ball of wax. Have an electronic massager on my spine right now because my left arm keeps going completely dead - pins and needles. The massager is relieving this without drugs, which wouldn’t help as it is a physical issue causing the blood to be cut off.
I hate taking opioids. Yeah, they cause uncomfortable constipation that I’m quite sure contributed to the navel-area hernia I had two years ago. Also don’t like the way it makes me feel. Of course, I’m not a big fan of alcohol either.
CBD on the other hand, gives me some relief from the pain.
As far as the opioid crisis goes, I think the DEA shares a great deal of the responsibility, as they were the ones who approved massive increases in opioid production.
Oh yeah.
I’ve treated a lot of geriatric addicts. And been delighted by the honesty of a few of them. One told me: “I take narcotics because I like the way they make me feel. And I don’t mean the pain relief either. For a little bit I can feel like a happy, hopeful man again.” And he wasn’t even an inmate!
As a recovering addict, I know what he means, too.
I can qualify as a geriatric addict myself, albeit a clean one. And I’ve had opioids for MI pain, post-op pain, and for fractured rib pain. And it helped me with the pain. But that old ‘happy hopeful’ feeling was lurking in the background too.
I really like my opioids.
Because I really dislike pain.
Aside from the post-op Demerol at age 21, I have had exactly 9 occasions of a psychotropic effect from my 11 years of osteoarthritis.
In that time, I have used:
Vicodin (hydrocodone)
Hydromorphone
Morphine
I must admit that I DO feel cheated - if I have to take the damned stuff, I should at least get a buzz from them.
It would be a great policy IF they could offer something, , anything to relive chronic pain. It’s easy to say that a person is getting too many pills, but had anyone thought about tolerance that a chronic pain patient has built up? I’ve been on opiods for over ten years now because I suffer from FBSS (Failed Back Surgery Syndrome). In the beginning I would take two or three vicodins a day and they would control the pain. Ten years later I receive a prescription a each month for 60 morphine extended release pills and 120 oxycodone pika for breakthrough pain.
120 pills sounds like a lot, but they only one pill every six hours. Without them I’m in unbelievable pain. So, do you think that some lawmaker who’s not in pain should be able to control how much pain relief in allowed to have? How about they leave it between myself and my doctor.
And I realize how dangerous these medications are. I NEVER take more than prescribed, even though at times the dosage doesn’t even touch the pain. Do I feel I’m addicted? No, I don’t get a high from the pills and would gladly never touch another one of the doctors could find some other way to control the pain.
Most overdoses are from recreational or unauthorized use. Going after patients is exactly the wrong approach. That’s government for you. Deal with criminals by targeting the law abiding.
You and I are in the same boat; I agree with every thing you have said.
The thing that really infuriates me is the superior moralistic attitude taken by some doctors, particularly the pain specialists I have seen.
One of them wanted me to sign a “contract” in which I was supposed to agree not to do a whole list of things; or else! The “else” was that I would be cut off cold turkey.
What? Am I five years old and mentally challenged?
Do I need a patronising over educated fool to tell me when I am in pain? Do I care that I might become addicted?
My dealings with the medical profession have given me a new appreciation for the corner dope dealer. The proposed directon this issue is going can only benefit the corner entrepreneur.