First, there’s apparently little to no evidence that opioids are effective for long term pain:
Second, and anecdote alert!, it seems pretty obvious to me that opoids are over-prescribed. Two different times recently, I had something broken (toe, ankle), and neither time was I in much pain after a cast was applied. I told the doctors (different doctors, different hospitals) that I wasn’t in much pain, but they gave me a script for percocet anyway. The second time, I said that I really don’t need or want that prescription, but they said, here, take it anyway, just in case. I have two relatives who are former addicts, so there’s no way I was going to fill it – I just threw it away.
Anyway, I found it really odd that they would basically push the script on me, even when I clearly didn’t need it. I think some government regulation on these kinds of scripts probably makes sense (even though this proposed law doesn’t even go that far, according to DSeid.
On NJ Transit trains, there’s an ad that says something like, “You wouldn’t give your daughter heroin for a soccer injury,” implying that giving kids opiates for their injuries makes no sense. It wasn’t that long ago that people were expected to live with some amount of pain and discomfort – this flurry of opioids is a relatively new thing (last 20 years?).
I’m not saying it should be withheld from people in acute pain or who have terminal illnesses. But, pushing it on people who don’t want it and onto kids makes no sense to me.
Since obviously I support further restrictions on abortion there is no contradiction for me. But, yes, it seems clear to me that certain large pharmaceutical interests have been pushing painkillers on the American people through doctors that has led to large-scale addiction and rising death-rates. They should be glad we are doing this interesting of say having the top 200 drug executives in this country (starting with Martin Shkreli) summarily shot or deporting most of the upper management to corrective labour camps.
Yes to the government but I am skeptical of too much involvement by politicians…
Mt wife and daughter deal with opioid abusers on a daily basis and the little that they are able to share has opened my eyes to the severity of the problem. I think we need better guidelines on pain management, opiod prescriptions and better treatment for opioid dependency.
According to these guidelines from the CDC (an appropriate involvement) even primary care clinicians do not always feel well trained to deal with the issue of opiod use - and the CDC says they prescribe roughly half of the prescriptions.
Before you go around attacking politicians and CEOs, perhaps you should read up on the history of laudanum?
What we really need is a cure for addiction. And no, we haven’t got anything. Primarily because instead of looking to science for an answer we have for decades blamed addiction on “lack of willpower” and “immorality.”
As far as doctors prescribing “too much,” explain something to me. I’ve occasionally been in severe pain from something, and ask for one or two days worth of, say, Tylenol-3. That means 3-6 pills. More than one doctor has told me that pharmacists are suspicious of prescriptions for very small amounts, so they give me 10 instead.
Why are pharmacists suspicious of prescriptions for very small amounts of opioids?
I’ve never had the experience that they are Rivkah. On the rare occasions I prescribe T3 I have often done just the 5 to 7 to get through the day of two, and never had a pharmacist question it.
addie, I have no clue what that is “already going on” you want evidence of.
“Politicians” (i.e. elected representatives via delegated bodies) deciding that “doctors are doing their jobs right”? Yes, that is what the state medical boards are supposed to be doing. Or least protecting the public from those who are grossly doing their job wrong, such as by prescribing drugs in excess or without a legitimate reason. They also try to make sure we are continuing to be adequately trained.
The variety of involved parties, inclusive of state and Federal levels, are in process of impacting the public health problem that has emerged from the liberal prescribing of opioids. There has been impact but it is a moving target and a comprehensive approach is both required and not yet fully formulated let alone implemented. The Act of the op is part of that emerging comprehensive approach.
Heroin use though is up and it is not certain why.
The proposal discussed in the op (again, actual act linked to earlier) is an very thoughtful attempt to put all of the needed pieces in place. It in no way “puts the government between you and your doctor.” Again, read it.
I thought it maybe had something to do with drug-seekers going from doctor to doctor faking things like sprained ankles, which are easier to fake than being post-surgical, and a sprained ankle is something one might have a single day’s worth of an opioid for, as opposed to being post-surgical, where you’d get a week’s worth.
One time a did get a day’s worth was after having an injection in my wrist of a steroid for carpal tunnel syndrome. It would hurt like a bitch for a couple of days, with the second day being the worst-- it hurt too much to wear the brace I was supposed to wear-- but four Vicodin would get me through it. I would take Tylenol for a few more days after. The doctor did say that if there was any question to have the pharmacist call him, I guess to verify that I actually had had something done to me, and hadn’t walked in off the street with a complaint, asking for narcotics.
I don’t get high from narcotics, not even the fentanyl I had when I had my c-section, not even a little buzzed, although I do get sleepy if I’m already tired. I also get constipation, but I get pain control, so I want them when I’m in serious pain, but I don’t want them as long as something else will work.
Is it possible it’s a genetic thing? there are no drug users in my family, and Jews in general tend not to be narcotics addicts. I’m not saying NO Jews are ever addicts, and we certainly have our own problems-- benzodiazepine abuse is pretty common among Jews, and there are Jews who abuse cocaine, but rates of narcotics and alcohol abuse are really low.
Are they? Or is theState Medical Boardsupposed to do that? The Medical Board is the agency who “reviews complaints against Illinois physicians for violations of the Medical Practice Act” and “conducts hearings and may recommend probation, suspension, revocation or other action of license.”
If the medical board (made up of, in our state: “- 5 Illinois licensed physicians licensed to practice medicine in all of its branches and possessing the degree of doctor of medicine. - 1 Illinois physician licensed to practice medicine in all its branches possessing the degree of doctor of osteopathy - 1 Illinois chiroptratic [sic] physician possessing the degree of doctor of chiropractic - Four members of the public who are not engaged in any way, directly or indirectly, as providers of health care”) finds that a doctor has been inappropriately prescribing or not adequately following their cases, then that would be reason for them to sanction that doctor. And that’s a good thing.
But, just like abortions, your average politician don’t know jack about opiate prescribing. To answer the question in the OP (rather than to address the specific, poor, example): No, I don’t think the government should get between you and your doctor by making legislation directing patient care. And that includes laws limiting prescription amounts or duration or numbers of refills and mandating whether a prescription is written on paper or faxed in. These are all roundabout ways to try to fix a problem that aren’t fixing the problem. If the doctor’s actions in prescribing are the problem, then that individual doctor needs to be guided and fixed. That’s what professional organizations and medical boards are for.
Pretty much all the horror stories I read on this subject (e.g., all the threads on this board, like Ambivalid’s recent one) seem to result from zero-tolerance paranoia originating with the DEA, and the pressure they put on doctors and pharmacists.
The DEA should have no business regulating medical drugs prescribed by doctors, dispensed by pharmacists, and used by patients. Leave all that to the FDA where it belongs. The DEA’s business is controlling illegal drugs, from the drug lords of the cartels down to the front-end retailers on the street corners. It’s a whole different arena than the opious problems between doctors and patients, out of which the DEA should butt.
There is probably a genetic factor or factors, but it’s not the whole story. Genetics might make you more or less susceptible, but it’s far from the whole story.
Unfortunately, there’s overlap. At least to the DEA. Rx drugs being sold on the street, whether legit scripts or stolen in some way, become their jurisdiction.
Granted, they should stay out of the prescribing end of things.
Elected representatives are entrusted to create their states’ Medical Practice Acts that regulate physician behavior and have created their State Medical Boards to implement those regulations, as their enforcement arm.
As far as the contention that the problem is one of individual doctors that need to be guided and fixed - no question there are individuals who do. But the problem is a systemic one, not just a few bad apples, and the path to improved quality is iess identifying and fixing the individual bad apples than it is a multi-faceted systems approach.
That’s far more intelligent than what politicians actually do. What they want to do is reduce deaths and they don’t particularly concern themselves with the means to that end. “Multi faceted” has included some good things, such as closing down the pill mills and dealing with doctor shopping, but it’s also included some dumb ideas, like limiting supply to pharmacies and making it harder for people to get access by making them get new prescriptions every 30 days. It’s kinda the way that politicians used to approach guns. “Gun violence is a crisis!” so they pass laws that affect the law abiding more than they do the criminal element. But it drops gun deaths a little bit, so they declare that it’s working.
It’s not Obama. Gun control laws have happened under a number of presidents, plus, they vary greatly by state.
ETA: When I bought a gun for target shooting, I needed a permit, and there were a lot of things, like I couldn’t have ever have a mental illness diagnosis, or been treated for substance abuse, and this was in Indiana, a red state with lots of hunters.
When I had a baby, I got rid of the gun, if anyone is curious.
I must agree with DSeid here. The government in the US has been regulating opioids in the US for over a century. And frankly physicians have not been demonstrated to be the best judges of national policy on the topic. Just look at the disastrous “pain as the 5th vital sign” movement of the late 1990’s, which frankly resulted in a horrific rise in unintended deaths from opioid use.
The measures as cited in this thread are pretty responsible attempts to get a handle on the problem. And I speak as a physician who treats opioid addiction, prescribes opioids at least weekly at work, and treats all types of pain including end of life pain. AND as a recovering opioid addict.
So, ignoring the ‘straw man’ issues raised in the media (by a lot of people who should know better, including physicians and pharmacists), I’m actually pleased (and surprised) that rationality seems to be ruling the day in legislative circles.
How about the government funding research to develop some better pain medication? Is it possible to tweak opioids somehow to make them either less addictive, or get you less high, but still provide pain relief? Is there something else out there that has potential to relieve pain without making you high? Is it worth looking at the brains of people who don’t experience opioid highs to figure out why, and see if there’s something going on, some brain chemical they have more, or less or, and it, or a blocker for it, could be added to opioids?