Does that have anything at all to do with what I wrote, or are you quoting random posts?
I keep running into this term, and google is not helpful.
In layman’s terms, what is the definition of “malignant pain” and “non-malignant pain”.
For those bored enough to want something to read:
Being a Medicare patient, I no longer have access to the quality of healthcare to which I became accustomed. I could just say “it hurts” and they’d take it from there.
My last three medication changes were:
Add magnesium to prevent muscle cramps caused by CKD (Stage II by a hair)
Use 300mg Gabapentin to control pruritus (CKD)
Both of these came from WebMD.
My “PCP” had no idea of these uses.
The third: I have been on Mirtazapine (45mg) for “suicidal ideation”.
I looked it up - Found it was a tricyclic anti-depressive.
Also found out the mechanism of anti-depressants.
This info was also from the web.
I decide that, whatever my future holds, I will deal with it with my synapses in full function.
So yes, I am in the market for a new PCP.
Malignant pain is pain from cancer.
Sent from my XT1585 using Tapatalk
Just out of curiosity, if you’d be kind enough to share:
Just what is this stuff and how many in a bottle?
Extended-play version:
I have been on opioids since 2005.
I have never had heroin (duh) or oxycodone, and the stuff I have been given are extended-release formulation of morphine.
I also have been on some benzodiazepine or another* since 10/2000.
The closets to “Nasty with a capital “N”” was having scripts for two benzos which made the Pharmacist blanch when reading them. “yes, I know, never use them at the same time”.
I can’t imagine getting nasty enough pills in a single month to kill an adult human.
-
- except for a brief use of Lunesta, which Blue Shield of CA will no longer pay for longer than 3 months/year.
So it was back to a benzo.
- except for a brief use of Lunesta, which Blue Shield of CA will no longer pay for longer than 3 months/year.
p.s. - what keeps them from OD’ing is the same thing which keeps heroin addicts from taking too much.
If you can get your sh*t together well enough and long enough to get the stuff, you probably still have the basic self-survival instinct with which you were born.
For people in certain conditions, handing them a bottle and saying “NEVER take X dosage - it would kill you” is how “Doctor-assisted suicide” has been practiced for years.
It puts the decision in the hands of the person suffering.
Paregoric was actually for diarrhea. It contained a very low dose of morphine (IIRC 2mg/5ml) in an alcohol-based vehicle that smelled a lot like licorice. Never tasted it, and it isn’t available in the U.S. any more.
Years ago, I worked with a woman who had graduated back when paregoric was available OTC with a signature, and she had a customer - an RN, no less - who was buying it semi-regularly. She asked the customer about it, and the customer said she would give her baby some paregoric every evening, so it would sleep all night, and an enema every morning.
:eek: :smack: :mad: :eek:
Among other things, that kid wasn’t going to develop normal bowel function.
Much more recently, I worked with a technician who had her kids back in that era, and she would rub it on their gums while they teethed, and then said she couldn’t get it any more. That’s because it had gone to RX status.
By the time it was removed from the market, it was C-III.
I know that “(at least some) pain caused by (some) cancers are termed malignant”.
My question: “is it possible to have ‘malignant pain’ without having cancer?”.
If not, why the redundancy of “malignant” meaning “cancerous”?
Some narcotics are also combined with ibuprofen. These products have not achieved wide use, and with one exception, I almost always saw them ordered by dentists, in very small quantities (10 or 20, that kind of thing).
Tylenol is a surprisingly effective pain reliever. I found that out even before I started pharmacy school, when I was working at a pizza place and burned my hand on the oven but not badly enough to require medical care. I had some Tylenol in my purse and took two, and was pleasantly surprised to realize a half-hour or so later that my hand no longer hurt. 
It sure did when they wore off, though.
I’m not sure what redundancy you’re taking about. It’s not redundant, it’s a synonym. Malignant pain means pain from a malignant tumor. Malignant means “a cancerous growth that invades surrounding tissues.”
It is distinct from chronic non-malignant pain because a) opioids tend to work better at treating malignant pain than noon-malignant pain on an extended basis and b) for many, but not all, cases of malignant pain we’re not so worried about hitting that threshold where effective dose is the same as respiratory failure dose, because chances are good the person will die of the malignancy first.
“Generic for Norco”, a combo pill of 10 mg hydrocodone and 325 mg acetaminophen (yes, Tylenol really is an effective pain killer, so effective it is an integral part of his pain management for cancer). Quantity: 120 (a month’s supply at 4 per day). The lethal dose of hydrocodone is generally 90 mg (this is assuming no tolerance has built up). There are 1200 mg in that bottle when new. My bad, that’s enough to kill 13 people if you divy it up evenly and they take it all at once.
I suspect you’d get an acetaminophen OD, too, if you tried it for Extra Special Fun. That would be almost 3 grams of acetaminophen along with the hydrocodone.
Extended release morphine sulphate, 15 mg tablets, 90 in bottle (one month’s supply at 3 per day). Lethal dose around 200 mg, so with around 1350 mg in the bottle that’s enough to off 6 or 7 people.
Extended version:
I’ll also note that his pain was NOT controlled for awhile at those doses. He passed out several times from the pain. At one point they gave him a sort of cocktails that included valium as well as opiates and more or less knocked him out - but they also had him on medical monitoring when they did that and watched him carefully and closely (that was when fluid was backing up on his kidneys, once they got that problem dealt with the pain level dropped a lot). I don’t know what the hell people did before they had opiates - died literally screaming in agony, I guess. It took awhile and some expert care by experienced doctors to achieve a balance between pain control and side effects, although now that the chemotherapy is starting to show some signs of working he is experiencing less pain, sleeping better, and is taking less for “breakthrough” pain. Which is the difference between proper medication and addiction - he’s not seeking a high, he’s seeking pain relief, so stepping down the medications isn’t a huge issue. Assuming the chemo continues to work he’ll be making fewer requests for breakthrough pain and (ideally) be left with just the maintenance dose. We’re still going to have to taper him off the opiates when this is done, but without a psychological craving for the drug’s effect that’s likely to be done without a hitch. I’ve known several people who developed a physical dependence on opiates but not a psychological one and tapering off wasn’t a problem.
(He is bitching about the constipation, but unless you want to here details about my husband’s bowel habits let’s just say they’ve come up with a way to deal with the problem)
Anyhow - that’s a LOT of pills to be at a bedside. Because my husband does NOT want to die when things got really bad he had me control the dispensing because he was concerned his judgement and sense of time were being thrown off. It can be very easy, when extremely ill and in extreme pain, to take more than you should because your sense of time can get distorted and your judgement can take a hit. Ever forget if you took a pill? Ever not sure if you did or did? Haven’t we all thought that? Yeah, people really can accidentally take too much. That’s why elaborate pill boxes are hot sellers in drug stores, people on a lot of medications, or who are severely ill, use them as a tool to make sure they aren’t over or under medicated.
It’s also why I suspect some of those overdoses aren’t entirely accidental - someone suffering from a severe, life-threatening illness (like cancer) who wants to check out can do so if they aren’t completely helpless. Take a handful of pain pills, maybe wash them down with a beer or other alcohol, and lights out.
Three days worth of Norco is a lethal dose. But only giving out 2 days worth at a time is going to be problematic for someone seriously ill enough to warrant that level of pain medication. So we hand out significantly more than 3 days’ worth at a time so the ill person (or their caretaker) isn’t having to go to the pharmacy every other day. MOST of the time this is going to be OK, but we should have no illusions that we can prevent all accidents with this stuff. Powerful tools can do wonderful things, but they can also hurt you badly. In the context of legitimate medical use both OD’s and actual addiction are risks of using opiates, they’re side effects, just like vomiting or hair loss during chemotherapy are side effects. Or permanent organ or nerve damage are potential side effects of chemotherapy.
The reason some medications are restricted to trained personnel is because they are dangerous and can be harmful or lethal in untrained hands. It’s not about being mean or profit for big pharma, it’s about making sure people don’t accidentally harm themselves.
This is also, by the way, one reason why I am leery of letting strangers into the house - that sort of stash of opiates is a temptation and has significant street value. There ARE people who’d steal pain medication from someone with cancer or other painful condition. Happened at least once to my father-in-law while he was dying of bone cancer.
You asked if there was more info on my statement that over half of opioid OD’s are from prescribed drugs as opposed to illegally produced opioids. On the HHS page I cited it says:
I never said anything about whether those deaths were intentional. Outside of a suicide note there is no way to know for sure whether it was accidental or not and, if intentional, whether the decision was made under the influence of the drugs and would not have been otherwise (see Broomstick’s post just above for anecdotal evidence showing that is a real possibility).
The only “argument” I have is that opioids are demonstrably dangerous drugs that are causing deaths in record numbers and there exists no evidence that making them more easily available will lower the death rate.
What about the evidence that making them more "in"accessible is "in"creasing the death rate?
Through what mechanism? Suicide from pain? While not impossible, I doubt many are in such pain AND have been denied opiates that they needed.
There’s a great deal of evidence that pain patients denied pain medications are turning to heroin, much of which is laced with fentanyl and other even nastier things, and causing an epidemic of overdoses.
I’m treating a LOT of patients who turned to heroin because they couldn’t get their oxycodone or hydrocodone or morphine.
And I’m finding that while many of them do have underlying chronic pain, their pain is rarely of the type for which chronic opioid use is recommended. What they have in common is that they have the disease of opioid addiction, got hooked on opioids when availability was widespread then went jonesing when the available legit supply dried up. Lacking resources to get treated for that, they fell afoul of the law in their pursuit of opioids.
Most of these folks eventually detox just fine off the opioids, get placed on non-narcotic therapies for their pain, and while not pain free, become pretty functional: Able to work, sleep, go to recreation, live their lives. And if lucky, get treated for the hepatitis C they acquired while sharing needles for IV heroin. 
May we assume your question has been answered yet? If not, simply refer to commonly available CDC stats showing the opiate OD numbers climbing at even higher rates AFTER the OCT 2014 DEA action to re-schedule them, making it much more time-consuming, costly and difficult for doctors to get even legitimate prescriptions to their patients. Addicts not being served in the increasingly difficult to navigate healthcare industry are now looking for heroin on the streets.
Broomstick -
Thanks for the details.
My info on LD 50’s for hydrocodone and hydromorphone are at odds with yours.
I was given Vicodin 10/325 (when it was still Sch II). Didn’t work for me.
To say I have “tolerance” the understatement of both this century and the last.
Until I developed OA, I had found exactly TWO drugs for pain: Vicodin and Demerol.
While I am a long way from addiction to any opioid, I am quite dependent on one of about 3 drugs just to get to sleep. Yes, I have tried to sleep without my benzo or Z drug.
One time I went 3 days before popping a pill, the other 4 days.
THAT is an experience I would wish on my worst enemy, but nobody else.
At one time, my bedtime cocktail was:
temazepam (sleeper)
morphine ER 75 mg
(bunch not relevant)
Washed down with 250-300 ml 100 proof vodka.
I suspect your resources would have me dead long ago.
But I did not wake in pain, as I did before and after the great DEA “People can’t possible know what they are doing! Take away anything resembling useful for this one!”.
I am now down to 15mg time-release morphine.
I can go days without needing the morphine - if I just lie in bed all day and do nothing to cause pain.
Result: I found drilling a hole in the ceiling now requires both hands to just hold the drill.
It’s called “atrophy”.
I need to save at least 2 day’s worth of morphine before I do anything more on that project.
Kids: never be an “outlier” - this culture hasn’t a clue on what to do with you.
Hydrocodone and morphine sulphate, not “hydromorphone”, not sure if that’s a significant difference.
Anyhow - “lethal dose” is going to vary by body weight as well. Is the person giving the information using 150 lbs as “standard human” or 200 lbs? Is it an LD50 or LD100? My figures were not intended as hard and fast, it’s just what googliing got me.
A lot depends on your tolerance - when I worked at a methadone clinic we had some people needing twice what would kill a person without tolerance just to function. If you’ve been taking these medications a long time you have more tolerance for them than someone who has never taken them. This can definitely complicate a discussion such as this.
again. As long as we’re playing “what about…”, what about reading reliable sources?
From the CDC:
And again from the CDC:
(footnote indicators removed from both quotes for reading clarity)
How, exactly, is that making these drugs more inaccessible?
You must be the most confused doctor I’ve ever heard of. And/or not write opiate prescriptions - If you really are a doctor.