Putting aside the thought that the only thing Christie should be advising on is the best way to cause gridlocks for fun and profit I noted the following:
Now I do not have the answer to the very real problems caused by addiction to opiates and other substances but is it really the place of the state to tell doctors what and how much medication they can prescribe? Sure, the state can reply that they have consulted medical professionals while framing the law but I guarantee that it is politicians with no medical expertise whatsoever who are driving these laws through and isn’t that dangerous? Basically the authorities are saying that they do not trust doctors to make these decisions and that they know better. With respect, they bloody well don’t.
I’ve heard stories of people being given ibuprofen for serious injuries because doctors are afraid to prescribe opiates.
Also I thought a major issue was that back alley chemists were synthesizing fentanyl or other similar compounds, or buying them from china and passing them off as heroin. If so, what difference would controlling Rx drugs make?
its tricky. i think the bill is not intended to replace the doctors judgement, but rather to force them to reevaluate the need sooner. alot of doctors already do this. as far as i can tell, its not just 5 or 7 days worth of pills total, but 5 or 7 days at a time. the idea is to reduce the number of unused pills lying around in addition to weaning the patient off the course of meds in a timely fashion.
The origin of the heroin epidemic is said to be people getting hooked on prescribed opiates like Oxycontin. Once people can’t get prescription drugs by legal or illegal means they turn to heroin.
Sorry, I know this is a bit of a mini-hijack but could I request that you capitalize when it’s needed? I don’t understand this, it seems like you have to go out of your way and intentionally not capitalize. My computer automatically capitalizes the first word in each sentence. I’d have to make an effort to un-capitalize. It’s annoying and it detracts from whatever point you’re trying to make, simply because it makes it harder to read.
Second, I’m not an expert on opioids at all, but I can relay my limited personal experience right here in NJ.
I broke my ankle (there is another thread around someplace on this). In the emergency room, the doctor asked how much pain I was in and I said, not too much. He then handed me a script for Oxycontin (or whichever has Tylenol plus hydrocodone). I didn’t fill it. A week later, I went to see the same doctor as a follow-up and he asked me how I’m holding up. I said, not bad, not much pain and I said that I never filled the script. So, he gives me another script and says I need surgery. I go get a second opinion on the surgery and she (the second surgeon) agrees that I need it and do I need a script for pain? I didn’t get one then, but I went to her for the surgery and she handed me another script, with the nurse telling me to definitely fill it and start taking it, to “stay ahead of the pain”. I filled it but didn’t take it right away. A day or two later, I decided to try one before bed, thinking it might help me sleep. It did, but I had strange dreams and didn’t take any more. So, that’s three scripts that I didn’t really need. Each one was for like 40 pills or something.
Later, my daughter had her wisdom teeth removed. She was in a fair amount of pain, so she tried one and didn’t like it and just dealt with the pain. So, another full script, with one pill used.
Needless to say, I think opioids are over-prescribed, so some kind of regular checkup makes tons of sense to me.
I know this is GD, but I don’t think anecdotes are disallowed, right?
Edited to add that I didn’t see the back and forth between Ambivalid and mikecurtis before posting my first line. Thanks mc!
My wife, who has chronic neurpathic pain and is on a high dose methadone regimen, has a panic attack every time she hears about potential opioid legislation on the news. Without Methadone my wife would spend her days in bed writhing in pain. As it is she can get up and around and do the dishes, some vacuuming some painting and have a life. Without pain medication she has told me specifically that she would kill herself in short order. Some might say she is addicted to opioids but she gets no high, takes it only as directed and has not increased her dosage in years. She addicted to opioids in the same way that a diabetic is addicted to insulin. We recently watched the movie Cake, which does a very good job of portraying the life of a woman with chronic pain (Including that sever pain can make you into somewhat of a bitch when you are under-medicated.) However, the movie lost realism points when the protagonist decides to simply stop taking her medication, and although clearly in pain is still able to walk around and watch a drive in movie etc… My wife explained that without her medication all she is capable of doing is lying in bed watching the clock tick by and wishing she were dead.
I agree with the idea that doctors shouldn’t be handing out Oxycodone like candy as it appears that they did in Rittersport’s case, we are deeply concerned that they will rush too far in the opposite direction. It is already pretty hard for her to get her medication as it stands. Right now she is allowed to get a two one month prescriptions when she visits him every two months, and her pain doctor is usually heavily booked. She is terrified that one day there will be a bad snowstorm the day of her appointment and she won’t be able to rebook until a after she runs out of her reserves, and so she will have to endure weeks of torture until they can fit her in. There are also mandatory drug tests every other visit which she always passes but which run $400 a pop after insurance. The pain management group that requires the tests is the same one that gets reimbursed for running them so we suspect that there might be a bit of a conflict of interest there.
Ironically the thing that scares us most of all is when pundits or politicians always make sure to say that opioids will be allowed for Cancer patients. This makes is sound as if Cancer is the only legitimate use of opioids, and that by allowing them for cancer patients they are taking into account both sides of the issue. In fact although they are often over-prescribed there are legitimate non-cancer cases where opioid treatment is the proper course.
Sorry for getting on my soap box but this is a really bid deal in my household.
I agree it’s a tricky issue. Most doctors didn’t get training in pain management in medical school until recently.
So my understanding is we went through three phases:
Almost total ignorance about pain. Care to guess when scientists/doctors believed animals experienced pain?
You’d think like 1630, but no -it was like the 1980s/90s - and some still don’t believe it.
With the advent of OxyContin (the exact same thing as Oxycodone - with a time release mechanism- designed to emulate two doses four hours apart). Can you believe that they (the manufacturers) - promoted this as non addictive?
Let’s see - would anyone believe if you knew alcohol could cause some people problems - that having them take a beer that automatically redid itself four hours later - that that would be a good idea?
Whole campaigns were run with pain being considered the 5th vital sign (or fourth - or I don’t remember)
People started crushing the OxyContin pills to make it effectively into Oxycodone. That way a 20mg OxyContin would be effectively a 40mg Oxycodone.
If you aren’t IVing - heroin is pretty much the same experience as Oxycodone (snort vs snort).
So this generation of doctors believed we finally had an opiate that wouldn’t be addictive (I believe they were talking less than 1%).
They changed the formulation of OxyContin to make it almost impossible to break down, but now their street price has fallen in half. So you can get close to the same experience now - for the same amount of money (but for those that smoked or snorted OxyContin- they needed to go to another opiate - usually heroin or Oxycodone).
Most enthusiastic users end up getting kicked off by the doctors eventually - and Oxy is way more expensive than heroin. So eventually - many turn to heroin.
Opiate epidemic - I believe most young adults are more likely to die from opiates than any other cause of death.
The bad thing is that this has lead to a rise in heroin - so much so that other opiates stronger than heroin (on a mg/mg basis) - that entrepreneurial drug dealers started importing fentanyl. The reason is money. I might not be comparing same time periods, but I believe the same amount of fentanyl that will net you $60k - will net you a cool $1,000,000.
The main problem with fentanyl is that due to its extremely light weight - it is hard for your dealer to insure an accurate mixture - that and the amount to get you high is very close to the amount that will kill you. I believe the example I heard was fentanyl the size of two grains of salt - will get many people high - bump that to four grains - they can die.
I heard of two cops that passed out from opening a bag of fentanyl- they didn’t drop it or anything - just the normal air currents was enough.
The cancer thing is due to the fact that last time I checked - it’s the only disease proven to be most effectively treated with opiates.
It’s only recently that we are beginning to understand some of the side effects of opiates - like increased unemployment, loss of hearing, lowering your testosterone levels, and most interesting to me is opiate induced Algesia.
This means that opiates can CAUSE pain. When you stop taking them - you feel like your in pain (well you are), but it isn’t (always) due to external factors. It’s extremely tricky - cause there are tons of people that are convinced they need the opiates - cause when they stop taking them - they are in pain. Pretty rational conclusion, but many times wrong.
Two good things though:
Narcan - many states now allow people to get Narcan which helps to reverse an overdose. One minute they aren’t breathing - a couple minutes later they are up and about (and usually pissed cause they go through the normal 3-4 day withdrawal process in minutes.). If you get to them in time - very, very high success rate (not so much so with fentanyl - but still can work - might need more than one dose)
Suboxone/buprenorphine - this is good for two things - it allows an opiate dependent individual to lead a relatively normal live - and for many people - almost entirely reduces physical withdrawal symptoms.
Stupidly - it is the only drug available in a pharmacy that most doctors (post residency) can’t prescribe - you need to take a special class. I get the reasons, but there are other stupid rules - you need to be high to get it (Suboxone) - doctors will tell you to go get high and come back so they can give it to you. If they don’t outright tell you that - they will strongly imply it.
It’s a schedule III drug - so less controls than the schedule II - except for the doctor requirements.
Also - it isn’t used for it much, but I’ve recommended two friends that swear their back pain only will respond to something strong like Oxycodone- to try buprenorphine- a doctor doesn’t have to have special training to give you that. They can’t give it to you for treating addiction. They are the same drug, but packaged differently.
Suboxone could be a godsend for millions - but it’s really being under sold.
Just my 2 cents.
Some of the rules for pain management contracts - only really filter out the stupid people. If you want to divert - keep enough on hand to pass your drug test silly!
I get that politicians want to do something about it - I just wish they’d rely on science and not knee jerk reactions - and consider the full costs to society.
Keep in mind - for almost everyone - opiates stop working the way they did at the beginning- it’s a subtle menace - cause despite what you see in the movies - many people when the first do opiates - actually it energizes them. Heck - it used to be used as an antidepressant - That doesn’t last.
Oh and Suboxone is a partial agonist - not full - most people don’t get the dose escalation - and it has a ceiling effect - you almost can’t OD (not that I’d recommend trying)
I have been on opioids for osteoarthritis pain since 2005.
I have serious CNS Depressant tolerance - most “downer” drugs have no effect.
A MD changed me from hydromorphone to morphine.
Even though I am a kidney failure patient.
When discharged from hospital (the morphine eventually attacked my kidneys. Kidneys lost), I was prescribed:
Fentanyl trans-dermal
Hydromorphone
Acetaminophen - Yes, really.
Ummm, docs - if Tylenol had worked, I don’t think I would have been jumping through the hoops required to get an opioid script filled.
I keep getting told I am addicted to opioids.
If so, why do I not take them on days when the pain is minimal?
And yes, even if I do become addicted: So What? If these drugs are the only way to control the pain, I am going to use them - addicted or not.
Politicians should go find a Sunday School which teaches the Bible incorrectly - they should not tell MD’s how to treat patients.
If you have an MD who abuses the prescribing privilege, they can have the ability to prescribe controlled drugs taken away.
Until it is, leave the MD/patient relationship alone.
Your quote says it limits the initial prescription, not any subsequent ones. So the state isn’t mandating a change in treatment, just a change in supply timing. Which may have it’s own problems, but doesn’t seem to be what you’re going for here.
I believe lawmakers passing legislation to restrict doctors ability to hand out prescriptions is an overreach. Every person is different, as noted above, some people truly need pain meds to function every day, and other gets prescribed oxycodone for a hangnail.
What I haven’t seen discussed here is the TREATMENT doctors, the doctors that treat peoples addictions with suboxone (buprenorphine) for yeaarrsss. I am from an area of Greater Boston, Malden MA, and there is a huge opioid issue here. I know several people who have OD, my cousin included. I know tons of people addicted. I know tons of people who have been in and out of rehab and on suboxone for years and use it basically as a substitute for heroine until their dealer comes through.
Of all the people I know who have been addicted to heroine, there is only one that is clean and has been clean for years without any relapses. He did WITHOUT the help of suboxone. His brother has been on Suboxone for seven years now. While he doesn’t use Heroine, suboxone effects physically aren’t much better and I feel doctos are truly leading people out of one addiction in which they don’t benefit, and to another in which the DO benefit from pharmaceutical companies.
If they aim to regulate how much pain killers someone can be prescribed, that may lead to an addiction, I truly believe they should also focus on the amount of medication prescribed to addicts in recovery, otherwise it is a never ending cycle.
The last couple of years of my Dad’s life he was in a lot of pain, and we had to explain this to his doctor. “Who cares if he gets addicted? Christ, let him be a drug addict for a few years. At least it won’t hurt”
WE finally got hima referral to a pain management expert, who saw his health and said “yeah here’s the morphine.”
But the concern really isn’t people like my Dad. That’s not the issue. It’s people like my buddy T., who was severely addicted to opioids and spent years and a lot of NA meetings kicking it. Or the kids who are getting hold of it and dying; in Kanata, a pleasant suburb of Ottawa where by nephews live, there has been a spike id kids dying or being carted off to the hospital because they overdosed on oxy, Fetanyl, or what have you. An overabundance of prescribed drugs cascades downwards into
It being prescribed to people susceptible to addiction (this proclivity is very, very different from person to person) and
It being available to people who will use it for fun.
Rug rats finding a dropped pill. Result: VERY dead rug rat.
Teens getting into parent’s script drugs for fun and experimentation.
Neither of those has anything to do with the prescribing doctor. It is about in-home control of the drugs.
I saw an article (I think I posted a link a few months ago) about the unemployed coal miners in Appalachia - any the MD’s who were handing out Oxycontin like candy.
I wonder if the DEA has found the resources to track “White People’s Heroin”?
But the good self-serving politicians are going to make a sick person go to the drug store every 7 days.
Fentanyl is available in both oral and injectable forms. IM shots are simple - find a muscle close to the surface (remember the scar on your shoulder?) and stick in the needle, push plunger.
I get the transdermal form because I have a history of using opioids. I have a history of bone-on-bone pain. That history goes back to 2005. I also have a history of immune-to-CNS-depressants (including ‘pain pills’) that goes back to approx. 1957 when the aspirin my mother gave me failed to work. So did Tylenol, Tylenol with Codeine, and just about every other “pain med”. Vicodin (an opioid) was the only drug I knew that could take out pain.
I despise people who use these drugs for fun - they are the ones who have made them almost impossible to get.
There are anecdotes galore about this stuff. I could relate one myself (not me, someone I know).
Bottom line is there are plenty of cases where people need aggressive and continuous pain management.
Unfortunately these meds are either over prescribed or too casually prescribed which causes a raft of bad issues.
Laws like the one in the OP are too ham-handed to really address the issue. They may decrease the number of people who get addicted to the stuff but at the cost of people who absolutely, without a doubt, need the stuff to avoid excruciating pain.
It is a difficult problem. I am not sure of a good fix to it. Mostly we need to rely on doctors to be the gate keepers here and it seems they are abetting the problem more than fixing it.
It’s a very small, trivial matter.