[quote=rivkahChaya}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?[/quote]
Researchers have been trying that for decades. Tweaking the opioid molecules, adding blockers/modifiers.
Heroin was developed and advertised as a non-addicting substitute for morphine when it came out; as was demerol. Stadol and nubain, with mixed agonist/antagonist properties were supposed to be the answer to the pain/addiction problem. So too was Talwin NX, and now the magical buprenorphine, ‘cure’ for addiction, is being abused too.
But researchers will persevere. Sadly, it seems that the relief of pain provided by opioids is so closely linked to its addictive nature that separating those two may not be possible.
I’m in favor of approaches/modifications that make the med safer to use and harder to divert, BUT am not really in favor of changes that add side-effects to misuse/overuse. Nor changes that dilute/alter the pharmacokinetics of the effect one is supposed to get from the drug.
In short: Safer but as effective is good. Forms that can’t be extracted or diverted to IV/nasal use, certainly. Forms that add acetaminophen to increase the risk of toxic overdose, or add decongestants to make the ‘high’ less pleasant, not so much.
The DEA is outright lying or deflecting responsibility. I’ve tried to get fentanyl patches for my wife. No one has them(even though they do carry them). So I ask, when will you have them? They’ll give me a date. I go in, and they say they didn’t get the shipment, they were denied. By who? “the government limits how much we can order.”
I believe 12 drug stores over the government any day.
Addie, ooookay. The DEA is lying. There is law and policy instructing pharmacies to limit how much they can order that the DEA denies exists and is distributed on cassette tapes that self-destruct 30 seconds after it is listened to.
I appreciate the frustration you have over getting your wife her medicine and how the go-to blame the government response that the pharma industry from the top down gives appeals to you. Obviously “blame Obama” sells well. And I have no understanding of a host of med shortages including regularly recurring vaccine shortages I have to deal with in my end of the business.
Ironically enough the act that you complain about in the op may help prevent some more intrusive efforts from passing. States have been passing laws on their own in the context of a lack of any meaningful action at the Federal level.
This belated bipatisan rational Federal Act may help reduce some of the pressure to just “do something” (and perhaps not always the most well thought out something) at individual state levels.
Let us be clear here: so there is no shipments being denied by the government. That is bullshit being fed you by multiple pharmacists.
There are instead, as per my cite, actions being taken against those who have “failed to maintain effective controls against the diversion” of controlled substances, an increased attention to enforcing extant laws. Your cite concurs, even as it argues that actually making serious concerted efforts to enforce long existing laws is somehow bad.
And some of the supply chain, conscious of the fact that they have indeed possibly been a bit lackadaisical and not taking the need to have those effective controls in place as seriously as they should, and as the law requires and has required, are like speeders who just noticed the cop on the side of the road, slowing down to below the speed limit because they are freaked out, backing up traffic.
Blaming the cop on the side of the road for the traffic jam though is silly. And the issue is not imagined new speed limit laws being passed.
And it has nothing to do with “politicians replacing doctors’ judgment with their own.”
Read what I wrote (and what you quoted me writing): " physicians have not been demonstrated to be the best judges of national policy on the topic". National policy, not individual patient care.
Frankly, it’s government’s role to determine what the national policy should be, with the input from physicians, pharmacists, drug manufacturers and other interested and knowledgeable parties. And I see them working to do just that.
I’m not a physician. But it seems to me that setting medical policies at a national level will most likely lead to a “one size fits all” policy. Or, worse yet, a “one size fits all” set of rules.
As an example, let’s say that it’s generally a bad idea for a patient to continue taking pain killers for more than thirty days. If a patient is taking pain killers on an ongoing basis, their doctor should discuss the issue with them and determine if they’re developing an addiction. In other words, sensible health management at the one-on-one level.
But the same principle applied by government standards is likely to result in a blanket law that prohibits any physician from prescribing pain killers for more than thirty days. Or, at best, requires some special waiver to be applied for.
Chronic pain sufferers can be on painkillers their whole lives. And yes, they do have a high death rate. The core problem isn’t the availability of painkillers, it’s PAIN. Deny painkillers, you just increase suicides or send them for other solutions that aren’t regulated by the FDA.
There is no question addie that chronic pain is a horrible thing. I am sorry that your wife, and by extension you as her loving partner, have to deal with it.
Chronic pain has been around for a long time. The newer generation of more potent opioids and the much wider prescribing of them has really taken off in the last 15 years. The prescribing is highest in certain regions and in certain demographics (rural South, White).
If opioids are the best and most effective long term approach to chronic pain and less effectively treated chronic pain would increase suicide rates, then one would expect to see decreasing suicide rates as these medicines became more available and physicians more willing to prescribe them.
Is that what we are seeing?
Um no. Suicide rates are increasing as opioid use has gone up and especially in the groups and regions that have seen opioid use go up the most.
Insert standard reminder about correlation and causation here but clearly more strong opioid availability and physicians willing to prescribe them in large amounts has not decreased suicide rates.
I can accept the concept that chronic pain is a public health problem and that chronic pain diagnosis and treatment (with opioids), depression, and suicide are all increasing and increasing most in the same regions and in the same demographics. I do not understand the nature of those relationships, don’t pretend to. Lots of possibilities exist. I suspect they are complex. For example current major depression is predictive of future chronic pain and chronic pain can trigger depression; opioids are an effective means of killing oneself; opioids increase the risk of developing depression beyond the presence of pain (likely by brain mechanisms such as "opioid-induced resetting of the brain’s ‘reward pathway’ to a higher level; and on.
Is the increase of depression causing more chronic pain? Is the increase of opioid use causing more depression? Does opioid availability increase suicide completion rates? Is chronic pain increasing for other reasons specifically in certain regions and in certain demographics? If so what are those other reasons?
Can’t say I know but clearly more opioids availability has correlated with more suicide not less.
As I cited above, it’s not at all clear that opioids are safe and effective for chronic pain. If further studies confirm that opioids are not useful for long-term pain management, I definitely want the government to let doctors know that and recommend against using those types of drugs for that type of patient.
I’m not sure what your point is about abortion, but, yes, I do want the feds to make sure that abortion medications and methods are safe and effective, using science-based reasoning. In fact, the FDA recently lowered the recommended dosage and extended the period into a pregnancy that a certain abortion drug is safe and effective for, based on doctor’s real life experiences (certain states are over-riding that finding and requiring more medicine than necessary, but that’s not science based).
If the FDA makes the determination that opiods are not effective for chronic pain, then I can accept regulations in that vein. What i can’t accept is the DEA limiting access to an FDA-approved drug because a minority is acting with criminal intent.
The enforcement of existing regs that deter diversion of controlled substances to the illegal market is limiting access? Sorry, I don’t think so.
The conjoined problems of chronic pain, opioid overuse/abuse, and increased suicide rates are major public health problems. Public health problems are only potentially fixed by taking systems levels approaches.
There are key questions that must be answered. The following are just a few. Those who want some details can read here and here to start.
Does the long term use of opioids, while effective in the short term, actually increase the risk of chronic pain persisting? The circumstantial evidence is that it does and there is, OTOH, no evidence that it is effective in the management of chronic pain. There is meanwhile solid and growing evidence of both individual and population level serious harms.
Is there a true increase in chronic pain in particular subpopulations? If so, what else might be driving that increase other than the increased use of opioids? Are any of those potential root causes able to be addressed by society at large?
How are those overusing and abusing opioids getting on it in the first place? For those using diverted prescription medicine where does it come from? Well we actually do have moderately good information on this. Lots of those started are started by transfer of legitimately but excessively prescribed medication from patients to friends and family members wanting to self-medicate more generic pain. Some are hooked after use from an acute pain event with medicine legitimately but excessively prescribed. Some smaller number are those who feign pain to score scripts. Some is diverted directly from the supply chain by lackadaisical monitoring allowing for theft. What can be done to impact those issues?
How can addiction be better avoided and addressed once present? How can those prescribing opioids be brought up to speed about current best practice pain control guidelines? How can those guidelines be improved upon such that nothing is done that has more risk of causing harms than good? Are there other options that actually can have more goods than harms that can be developed? How can the system be set up to facilitate the following of what is determined by experts to be best practices?
The issues of harms to society as whole and the structural root contributors and potential root cause solutions of a public health problem are not best addressed by PCPs dealing with patients begging for pain relief. Nor are they best dealt with by ill thought out well intended “do-something” state laws that themselves do more harms than goods.
CARA though? Is not one of those. The DEA addressing diversion in the supply chain? Appropriate. Actual studies determine whether or not chronic opioid use causes more and more persistent chronic pain or effectively treats it? Needed. Designing prescription systems to maximize the benefits/risks equation? Should be done.
I hold that adult individuals should be permitted to govern their own lives.
As such I am in favor of no control over any recreational substances, including opiates.
If you hold that position with me, then the government should not intervene; in fact the government should not even make narcotics available only by prescription. An adult should be allowed to buy them as if they were a candy bar.
The idiotic war on drugs is…well; idiotic.
However if you hold that government should protect individuals from bad decisions that affect their health, then government should intervene. The medical profession is loaded with folks who will prescribe narcotics “inappropriately.”
(For those of you who do want government control, good news: There is no end to your do-goodism. Start next with government control over diet and exercise. Put some fatties in jail, along with their enabling mothers, and we’ll get this weight problem under control in no time. Surely it is time to end the tragedy that overeaters inflict upon themselves and their loved ones–not to mention the medical cost to society.
The original intent of the FDA was to ensure that foods and drugs were what the manufacturers claimed they were-presumably so that the consumer could make informed decisions about what to take and eat, rather than just hoping that those pills weren’t full of rat poison and might instead be helpful for condition X. It wasn’t to limit access to drugs and food that were properly manufactured and labeled.
Of course, if we let consumers decide what to take, we do run into societal problems such as antibiotics-for example, we know that letting consumers freely access antibiotics is going to cause some serious society-level problems.
