Maybe, maybe not. I was comparing that to the whole, “I’ve had broken fingers” as a measure of pain. For pain threshholds, I wouldn’t think a broken finger would rate all that high up there. I’m not saying it doesn’t hurt, but the idea that it’s the end all and be all, is pretty absurd.
This certainly makes sense and is in line with my migraine experiences.
All of my friends are like yours, but I am not. The closest thing I’ve ever taken to what’s been described in this thread was last year when I got some Codine cough syrup after being sick and unable to sleep for 2 weeks with the world’s worst cough. But my friends? Mention you have a migraine, get offered a Vicodin. Cramps? Take a Vicodin! Body aches? Vicodin! Uh, no thanks, guys. . . I’m going to take an Advil then lady down instead.
While I have no trouble believing there are lots of folks with lots of very real conditions that require these medications, I see plenty of people popping these pills left and right for the things I take two Advil for. Either my pain tolerance is absolutely out of this world amazing or my friends are over relying on these pills. Now, my friends are not addicts in any way, but my non medical opinion would be that they are using the meds a bit more frequently than they ought to be.
Fwiw, these are the same friends who are horrified that I don’t keep a stash of antibiotics around, too.
Huh - weird. I have a small stash of The Good Stuff left over from various things over the past 2 years, and while I don’t often have people over here, who happen to be experiencing pain at the time, I’m quite certain that my first thought would not be “Wanna vike?”. If it were someone I knew well, and I offered Tylenol or whatever and they whimpered “nope, that doesn’t touch it” I might, I suppose.
So I guess your experience of people offering these things does indeed show they view them as casual and harmless, and they may well use them more than strictly needed as a result.
Of course it also means you’re right about them not being addicts, or they wouldn’t have any to spare :).
A friend of mine had to call the doctor for a refill for her husband’s pain medication (he’d had heart surgery, involving cracked-open ribs etc.). They had people working in the house… and his bottle disappeared :mad:. IIRC, the doctor did phone in a single refill for them.
Thus speaks the person on probation for drug offenses.
StG
Mama Zappa, I think it may also be a result of the age group I’m in-- I suspect that as time goes on, prescription drug abuse is seen as less serious than “real” drugs. I’m 26 and while I was in college, I couldn’t walk 10 feet without bumping into somebody selling Adderall, Xanax, or Vicodin like it was nothing. It would have been slightly harder, but not not exactly difficult, to find someone who could get you some Oxy.
And I’m saying this as someone who has never taken one of those drugs in my life, but I hide my prudishness well, so people openly discussed and exchanged these things in front of me on the regular. These weren’t the crazy druggies, these were like the 4.0 physics students, taking a bunch of pills to stay awake and study, etc.
So yeah, I suspect the lax attitude about pills back in college colors their opinions about exchanging the pills now. To me, Adderall, Xanax, and Vicodin are very serious things. . . I can’t imagine just popping one like it was nothing.
What of it? I’ve never hidden it. Nor have I ever tried to scam a doctor, btw*. I do though think I have a unique insight into how people think and also into how underserved US chronic pain patients are cause I’ve “met” loads of them online and so many of them are having to go to seriously darastic measures. It’s absolutely disgraceful how your alphabet agencies are forcing people to suffer because of teh action of ANY NUMBER OF JUNKIES - it really doesn’t matter how many people are abusing the system, it is simply the duty of a civilised health system to releive the pain of those who have it, when they do. And that is even if we take the naive approach to junkies not having pain, which is nonsense. There’s a stonking great reason that you can give 50 people as much heorin as they want (or even more than they want) for months at a time and only ten of them will beomce addicts, you know…
P.S. I am not “on probation” at least as I understand the US meaning of that term. I don’t have to go meet a probabtion officer every week or something like you guys do. So long as I don’t do anything that can carry a prison sentence I can carry on as normal.
*Why would I? You would never get large amounts of opiates by trying to do so and you can buy 600mg of codeine over the counter at almost any UK chemist if you know what to ask for for less than $5 - and additionally, not that it’s any of your business, when I was busted I was on a waiting list to see a doctor and since I have done I am actually being prescribed extremely strong opioids, I take the equivlant of half a gram or so of oral morphine every day, perfectly legally…
That’s one part of who he is, and was upfront about it. And?
I have OA (osteoarthritis) and am really familiar with opioids. The good doctor is quite correct that there are other options.
But: Get the damned drugs (don’t go to Florida - they locked up one guy for 3 years because having a prescription for hydromorphone (Vicodin) was not a defense for possession.
There are doctors who refuse to prescribe narcotics - find one who will.
Hey Qadgop - I also have stage 4 Chronic Kidney Disease (aka Kidney Failure) - I can’t take NSAID’s - do I get an opioid? I sure hope so - I’m taking morphine. When the pain calls for it - I’m supposed to take it 3x daily. Sometimes I forget one dose. I’ve been on it for 2 years - does it sound like an addiction?
How about the hydromorphone I use for breakthrough?
Good grief, say it twice!
I’ve had a few occasions to have to use fairly strong opiates (morphine) and I don’t particularly care for it. I’m allergic to percocet (percoset?), which is a shame, because it works and it didn’t used to make me sick. Now it makes me throw up and gives me hives.
I hate vicoden, it makes me extremely nauseated and doesn’t touch the pain, in fact, it doesn’t do anything at all but give me a headache and make me throw up.
Morphine does work (several days after surgery on shattered leg, two weeks in the hospital for gall bladder surgery that ended up having tons of complications, thus keeping me there, tubal ligation in the early 90s, same thing, complications).
When I broke my leg and got out of surgery, they gave me a shot of morphine. I woke up at night in pain and asked the nurse to give me another shot and unlike the other nurses, she gave me the third degree and was quite upfront about “well we have to be careful, some people use this as an excuse for getting drugs”.
Seriously lady? My leg bone disintegrated, and then they cut into it and put in an 8 inch plate and several bolts to hold things into place. A mere 10 hours ago. Um yeah, I destroyed my leg on purpose because (at 43 after a lifetime of being a normal working citizen with no history of drug abuse), I decided “you know what? the hell with it, I’m going on morphine”!
Yeesh. What I actually told her was “look, sweetie, I’m 43, I’ve gone this long without being an addict, I think I’m okay, not to mention, you do know I JUST got out of pretty intense surgery right”? I’m not sure if she had me confused with a different patient or what, because she went and checked and was back PDQ with a nice shot. After that one, I was okay with tylenol and an occasional percocet (before I developed an allergy to them). The darned leg hurt for two years before it finally started to feel normal, so if I were going to annoy my doctor for a constant supply of pain pills that would have been the time.
When I was in for the gall bladder surgery a few years later, they’d changed to this self-medicate pump thing. I loved the pain relief, but really disliked the feeling of the drug itself. Blech! Luckily morphine only makes me feel a little nauseated, but again, after too much, I feel like “I’m done, ugh”.
I cannot understand people who seek out how narcotics make you feel. Either they affect me differently than other people, or addicts have really bad taste in what they consider pleasure.
Anyway, long story longer, what broomstick said, not all of us become drug addicts. I mean, if that were the case, what with all the booze available for purchase, wouldn’t we ALL just become alcoholics?
Good points. Actually, the Codeine in Vicodin is a pretty crappy pain reliever for most people, you’re not alone. The Tylenol does the heavy lifting pain-relief wise. What is does do is let you fall asleep and give you a mild feeling of euphoria. It’s also very habit forming.
Now, sure, everyone is different as far as pain goes, but since Codeine is generally such a crappy pain reliever, this is why MD’s are usually quite skeptical when dudes insist they want the Vicodin “for the pain”. Of course, the euphoria does make the pain more endurable and of course feeding a addiction does make your body happy*, so it’s not crazy.
- this is why even tho nicotine causes elevated stress levels, smokers feel stress relief when they light up.
I’m going to hazard a guess that the reluctance to prescribe (especially in quantity) has as much or more to do with liability as it does with US drug enforcement policy. In America it is all too likely that a junkie’s family would sue the physician that prescribed him Vicodin even if said junkie OD’d on back alley smack. MD’s malpractice insurer has to pay a big settlement to avoid going to trial and losing even bigger to a sympathetic jury that thinks insurance money is magic money that grows on trees.
All in all, don’t underestimate how much the insurers in America influence policy and behavior in order to limit their exposure to liability claims.
Here is a case of a DEA investigation into a Dr for over-prescribing. He’s also being looked at for three deaths. I’m sure he isn’t the norm, but this is probably what many doctors are afraid of being accused of. From the article ( Seizure of 39 horses in Graham reveals massive DEA drug investigation | The Mountain News – WA ) :
As for those who say something to the effect of err on the side of the patient, even if that means excess prescriptions for addicts or those who are selling the drugs. How do you deal with the fact that many of those people are using insurance to pay for it? Wouldn’t that be insurance fraud of they are reselling it? Do you really want your prescription drug coverage rates to be increased to cover the costs of those who are re-selling the drugs?
It’s actually hydrocodone, not codeine, and do you have a site for some of these claims? E.g. that hydrocodone is a “pretty crappy pain reliever for most people,” that the “Tylenol does the heavy lifting pain-relief wise,” and that its primary mechanism is to “let you fall asleep and give you a mild feeling of euphoria.”
Hydrocodone (and opiates in general) isn’t the best choice for some types of pain, but you seem to be implying that it’s basically a placebo, and that doesn’t jibe with my own experience being prescribed hydrocodone post-surgery or anything I’ve ever read. I do recall the efficacy of Darvon/Darvocet (containing dextropropxyphene) being questioned in the past, but it was a weaker opioid that was withdrawn from the market in the U.S. when it was shown to cause (or correlate with) heart arrhythmias.
First, Vicodin *is *a codeine derivative, and that’s an important fact for lay-people to know.
Next- here in this thread, we’re talking about *long term/chronic *pain treatment, not short term. Sure, when your Doc or dentist gives you a weeks supply for post-operative pain relief, it’s fine.
But I agree with my good friend (or is that fiend?) and good Doctor **Qadgop the Mercotan *** in that Vicodin is a very poor choice for long term/chronic pain treatment:
1.It’s addictive.
2.As with other opiates, it has a threshold. Thus, the dose which works fine for a week or even a month does little to nothing for you after a year. This forces you to seek out more drugs.
- It has Tylenol, which is extremely safe when taken as directed, but deadly when taken at larger doses. This takes us back to point two. Now you’re addicted to Hydrocodone/etc, and thus you begin to do typical drug seeking behaviors, such as thinking that “they” are trying to withhold the drug you need (’for the pain’ ) from you. Thus you get another ‘script or two or three, buy it on the street, or steal it from your friends medicine cabinet. BUT, once you get enough Hydrocodone to get you past your threshold into real pain relief (not to mention feeding your burgeoning addiction) , you are now taking whaaaaay too much Tylenol. Which brings you to the ER with liver failure.
- who is likely the SDMB’s biggest expert on this subject.
That is more to do with the silly US system of super expensive drugs in most cases. They don’t have to be given all these proprietary oxycontin type things, generic morphine or whatever is extremely cheap and I would excpect that’s the same for fentanyl patches.
It’s probably the case that anyone whose pain can be solved with codeine alone is not in that much pain.
Realistically, wherever we choose to set the threshold, there will be some chronic pain sufferers who can’t get what they need and some people who abuse the system. Rather than trying to choose one over the other as a priority, individual measures should be taken on their own merits.
What seems to be a big problem for people in this thread is the capriciousness and inconsistency. It doesn’t seem like standards are being set or, if they are, they don’t seem to make sense. Asking for help with pain relief shouldn’t be taken (without other context) as drug-seeking.
Here’s one experience I had just this year. I’ve been struggling with mysterious symptoms affecting my muscles and joints particularly. Here’s how things went with my GP.
(January) Doc: “Feeling weak eh? Okay, let’s try treating a couple of vitamin deficiencies you have. Come back in April.”
(March) Me: “I can’t make it to April, feeling weaker and terrible fatigue.”
Doc: “Any pain? We can medicate for pain.”
Me: “Not really.”
(April) Me: “Still having problems.”
Doc: “Any pain now?”
Me: “It’s not bad, I just want to deal with the other stuff.”
(May) Me: “Okay, still having problems.”
Doc: “How’s the pain?”
Me: “It’s okay, a little worse, but really mostly struggling with the weakness and stiffness.”
(June) Me: “Okay, things are getting worse. My joints have gotten really painful, especially in the hips, and it’s making it hard for me to function. I think it might be time to consider pain medication.”
Doc <pained face>: “Well, I can’t give you any narcotics. You should probably just use Tylenol.”
(Yes, the doctor really did say that last part verbatim even though I never mentioned narcotics or any specific drug other than ‘pain medication’! And I’ve never gotten a narcotics script from them or anyone other than an unrequested one from a dentist years ago.)
After being asked multiple times if I wanted pain medication, all of a sudden I’m treated like I’m a drug addict for finally bringing it up once I actually had enough pain to ask for treatment. She wouldn’t consider giving me anything and just kept telling me to take more Tylenol. It wasn’t until finally going to a rheumatologist that I got any pain medication. It was non-narcotic (Tramadol) and it has been really great at improving my overall functioning. I just got that script last week – and keep in mind, I’m at the point where, unmedicated, my hips hurt so bad and are so weak that I have to drag my legs into the bed with straps and can barely move under a comforter because it’s too heavy to do so without incredible pain. That’s how long I went without, because apparently asking for help with pain when you’re in pain is wrong – apparently even considering non-narcotic prescriptions at that point is too risky for my GP.
Surely there has got to be a better system. I would have totally been fine with taking drug tests to make sure I’m actually taking the drug, if it’s something that is easily abused. I had clearly observable symptoms, not just difficulty with mobility but objective measures like having visible inflammation and severe edema throughout my legs, there was obviously no reason to suspect that I was faking anything. I had repeatedly declined offers to discuss pain management! I don’t know how I could have seemed like less of a drug seeker.
I’ve said my piece in earlier pages about accepted principles of chronic pain management and the benefits/problems with using opioids for that diagnosis. I’m a big advocate for early and frequent use of opioids for significant acute pain, and of course for malignant pain.
But now the question has arisen about how pain-relieving tylenol and ibuprofen are compared to codeine.
Here’s a nice little study demonstrating that ibuprofen relieves pain just as well as Tylenol with Codeine for kids with significant extremity injuries.
As for tylenol (aka APAP, paracetamol), well from this study:
This indicates that tylenol plus codeine gave additional relief to slightly fewer patients than tylenol plus placebo did. One needed to treat 9.1 patients with tylenol plus codeine to give one patient more pain relief than they’d get with just tylenol alone. And it’s interesting to calculate that one would only need to treat about 8.7 patients with tylenol plus placebo to give one patient more pain relief than they’d get from tylenol without placebo. 
So we see some evidence that codeine isn’t necessarily better than ibuprofen or tylenol for typical patients.
Thanks, doc!
I’m just highlighting this bit of your post so Qadgop can see it and tell you what’s what, he’ll do it much better than I can 