But i think that’s what’s meant by “staying ahead of the pain”. Not dosing before there’s any twinge, but dosing before it gets bad.
It could be that your definition is what it’s intended to mean. But it’s often not how it’s used in practice, based on my and others’ experiences here. Each time I was hooked up to the pump, the nurse very earnestly told me to use it before the pain came. I guess that phrase (“stay ahead of the pain”) can be read both ways.
With my wife, it was the high dosages in pill form. She was so doped up she couldn’t stay awake for more than a couple minutes. And when I asked to reduce the dosage, I heard the “stay ahead of the pain” mantra and made to feel like I was an evil monster for wanting my wife in pain. She was there for recovery and it’s hard to recover when you sleep 24/7, but it is really easy to manage a patient when they are an inert blob versus someone that needs help up and down many times per day.
Yeah, that sounds horrible. I don’t know anyone who was doped that heavily. I know a lot of people whose pain medicine was adjusted down because they had negative reactions like that. I bet you are right about the motive.
My wife was difficult for a few days, but having numerous TBIs, along with severely injured limbs can do that to a person. It was a sad situation that I wish no one ever had to go through. Luckily, we made it through.
Purdue misrepresented a letter to the editor in the New England Journal of Medicine to push the lie and a lot of pills.
It was a study of people on pain meds in hospital under supervision:
But as it began to accrue citations, its findings also began to mutate. Porter and Jick had only looked at hospitalized patients in regimented settings, but that detail got lost in the push to prescribe opioids to patients at home—an entirely different scenario.
Oh wow.
My mother became clinically dependent (i think that’s the right term) to morphine in one or two days of treatment, under supervision, for post surgical pain. That is to say, she suffered very unpleasant withdrawal symptoms when they stopped giving it to her, and “cried all day”. By the time she was released she was fine, except for some lingering but manageable post-surgical pain, and I’m sure she would have counted as “not addicted” in that study. (In fact, given the timing and location, it’s possible she was included in that study. She was at a nearby hospital that might have shared data over the right time frame.)
I can’t find it now, but about 5 years ago i spent a lot of time reading medical studies about opioid use, and found an interesting letter from a heart surgeon on why he stopped using fentanyl during surgery. He found that people become tolerant of opiates so rapidly that by avoiding opiates during surgery itself, they needed lower doses of opiates for pain control after the anesthesia wore off.
Lies, damn lies, and statistics. Using a study that counted people who had a single dose and weren’t allowed more as evidence that it’s safe to take opiates for several days at home counts as a lie in my books.
What makes it even more outrageous is it was just a letter to the editor and Purdue presented it as a landmark study.
It’s the responsibility of doctors to make drug decisions based on the scientific literature, their personal experience, informed colleagues–and NOT on whatever drug salesmen tell them.
In 2014, when the first opioid lawsuits were filed against Purdue Pharma, Tiffinee Scott’s daughter was still years away from her fatal overdose from addictive prescription painkillers, including Purdue’s OxyContin, which she was taking to manage sickle cell pain. That year, Dede Yoder’s teenage son was struggling with an addiction that began with an OxyContin prescription for a sports injury. He would die from an overdose in 2017, after attempting rehab eight times. It would be years before Gary Carter’s son, who had been filching his grandparents’ OxyContin, would die from an overdose of fentanyl, an illicit opioid that many people who became addicted to prescription painkillers eventually turned to over the past decade.
The three families and others who have ended up suing Purdue shared their stories in letters to the Supreme Court, which will hear oral argument Monday on the remaining sticking point in the yearslong effort to settle litigation that has ballooned into nearly 3,000 cases. A multi-billion-dollar agreement is at stake.
The problem is the information in the scientific literature and from other doctors was polluted with lies spread and paid for by Purdue. This is not a matter of some doctors accepting golf lunches and prescribing against their patients’ interests, but rather a generation or more of doctors being taught things like opiates aren’t addictive if used to treat legitimate pain.
Which was a weird thing to teach, because it was well known during the civil war that opioids used for pain could addict.
But it was definitely something widely said by the makers of opioids and to many doctors believed it.
It’s hard for me to look at a complex system with any number of (sometimes, exceedingly malign) player$, and then $ingle out ju$t one kind of actor for the “per$onal re$pon$ibility” argument.
I feel like that’s the exact gambit that Purdue played in this whole saga, but their choice was … to blame the patient.
Yes……and this involved things like recruiting doctors to act as “thought leaders”, which involved having them put their names as authors of papers written by the drug company, which were then published in reputable medical journals, and giving technical speeches that advocated for those drugs at medical conferences.
The drug companies also oversaw the formation of astroturf “pain patient groups”, that advocated for effective pain medication and initiated lawsuits against doctors that refused to prescribe opiate pain medications.
Nasty business all around, but it’s unfair to put all the blame on the prescribing doctors.
It seems no one in this thread has mentioned Painkiller, a very powerful Netflix miniseries about how the Sacklers created and profited from the opioid crisis. It came out in August 2023.
The case against the Sacklers, and whether or not to uphold a settlement agreement, is still in the hands of the SCOTUS. A few of the justices – not entirely the Usual Suspects – are concerned that, in offshoring so much of their assets, the Sacklers may not have lived up to the spirit of bankruptcy laws (ie, let’s take what you do have left and divide it equitably among your creditors):
We recently watched it and learned so much about the Sacklers and the crisis they had a big part in bringing about. I have since also read the New Yorker article that was the basis for the show (there is also a book that I haven’t yet read):
Justice Neil Gorsuch, writing for the majority, said “nothing in present law authorizes the Sackler discharge.”…
“The Sacklers seek greater relief than a bankruptcy discharge normally affords, for they hope to extinguish even claims for wrongful death and fraud, and they seek to do so without putting anything close to all their assets on the table,” Gorsuch wrote. “Nor is what the Sacklers seek a traditional release, for they hope to have a court extinguish claims of opioid victims without their consent.”
Congress could write special rules for opioid-related bankruptcies, he wrote.
Interesting split decision, Jackson joined four conservative justices (including the far right Alito and Thomas) to make a decision that to my reading helps the little guy, while the other two liberals joined with the more moderate Roberts and Kavanaugh in opposition. Not what I would have expected.
The split definitely doesn’t seem based on political ideologies.
Wow – maybe they actually did their job?