Posted on 08/26/2019 4:17:24 PM PDT by grumpygresh
Thanks for the research.
The use of the VAS is not very useful to assess pain especially chronic pain, functional assessments are of course much better.
However, most of these studies involve hospital based treatment, post op care, cancer, hospital stays for various illnesses.
The claim the government has made for a while is that the increased opioid overdose rate and death rate correlates with the increased total mg opioids prescribed which mostly comprises outpatient prescriptions for chronic pain. The dogma is that correlation equals causation. But recent analysis of CDC data indicates that the increased overdose rate is due to illicit drugs. There has been some slight recent improvement in overdose deaths (but not overdose attempts) because of narcan. However, with the sharp reduction in prescription opiates of more than 30% we should have seen a greater reduction in overdose deaths and overdose attempts and we have not.
The anti-opioid faction counters by saying that more exposure to opioids causes more addiction. But even that is likely not true becuse addiction rates for opiates and other substances have been essentially stable for years. Trying to completely eliminate exposure to opiates, which is the only way to avoid addiction, is nearly impossible. Even banning its use for cancer and postoperative pain would not likely eliminate exposure in the illicit market.
The same thing was tried 100 years ago with alcohol prohibition and there was very little decrease in alcoholism at the time.
I think the problem here is that suicide rates are up. Opioids are one means of accomplishing that act. However, everyone knows that there are many ways to commit suicide.
So based on this experience, the government should force people to abstain from alcohol and ban opiates. People should convert to Mormon, Islam or Amish, and we need to strengthen families by forbidding divorce.
As they say, abstinence is a virtue, but prohibition is a tyranny.
Exactly
Duragesic is a fentanyl patch.
Actually, there was a dramatic decrease in overall alcoholism rates(in terms of dysfunctional persons and shattered families) with prohibition but over all use remained unchanged.
Many got off the booze and stayed off after the restrictions were lifted.
Percodan is oxycodone and aspirin, percocette is oxy with Tylenol, Oxycontin is oxycodone in a slow release form. Oxycodone is also sold as fast relief without above additives. Perkies have been around for nearly 40 years now so why are they such a problem in the last 5 years....hmmmm.(?)
During this hospital stay, did you need medicinefor pain?
During this hospital stay, how often was your pain well controlled?
During this hospital stay, how often did the hospital staff do everything they could to help you with your pain?
1978 Bad Motorcycle accident, major roadrash,raw flesh,bones,...
1. NO I had Surgery the very next Morning and when I woke up All the Pain was GONE! I had a little stinging on my thigh where they skinned me alive to do the skin grafting,(1’x2’) but Not Pain.
2. for the first 2 days they gave me a shot of demeral once each day, mostly to calm me down. then another week and I was clean
My pain was the “Go Directly into Shock” and hit the ground wherever you are as soon as the meds wore off. I knew what to expect going in to this and would absolutely do it again, withdrawls sucked, and I would do it again, but so what the Percodan SAVED MY LIFE!!!
There’s absolutely a need for pain control. Through the 90s there was a notable lack of understanding in handling pain as part of treatment (and of the difference in OD tolerance between someone in mild pain and someone in extreme pain). That said, leaving the judgement after a point in the hand of the patient there is problematic.
Really, it’s a combination of that third question, and the compensation being tied to pain control that’s the main issue.
Pain killers, properly used, are a medical miracle. Improperly used, they can wreck your life, potentially worse than your accident - or end it.
I’m glad you were well cared for.
But recent analysis of CDC data indicates that the increased overdose rate is due to illicit drugs.
But you’re right, a lot is probably related to suicide (some certainly is). I suspect more is just related to a greater supply-chain making it more available.
Regardless, unless the drug companies are selling off-book, I don’t see that this is their responsibility.
Yeah, not saying it isn’t an opioid...it is just that I haven’t seen/read about an addict using a patch.
“Yeah, not saying it isn’t an opioid...it is just that I haven’t seen/read about an addict using a patch.”
One of our regulars used to chew his fentanyl patches. When we would show up, he would barely be breathing. He finally chewed one too many.
Exactly! Government is going after prescription opiates because they can’t/won’t go after drug cartels -— too much graft at stake. It burns me up! Then, to put the icing on the cake, they loudly crow about their “successful” efforts against opioid “abuse”. If J&J stopped making opioids tomorrow, it wouldn’t put the slightest dent in the problem. It would (will), however, drive the price of prescription opioids through the roof -— another “win” in the opioid wars.
FYI, duragesic IS fentanyl. :)
I believe the patches, when available on the street, are chewed. A very stupid way to die, if a person chews more than a small section of a fentanyl patch.
Sorry. Didn’t see your post til after I posted mine. :)
The question of addiction is really up for debate here. The new category is opioid use disorder which is not the same as addiction. Use disorder involves some type of noncompliance and in some cases it could represent under treatment (what was known as pseudo addiction) or use of opiates for a non indicated use such as anxiety. Addiction means that the user gets a high that creates a dysfunctional need to obtain more medication. Typically, we see this develop as a result of genetic predispositon or environmental factors that are manifested in the person by the time they are in their 20s.
So, the people getting hooked are usually less than 30. They are also the ones that have had the greatest increase in overdoses. Middle age overdoses have risen somewhat per the past 10 years, but OD for those over 51 are flat.
Those that say “anyone can become addicted” are not really looking at the data. People generally don’t become addicted at older ages. When people take medications for pain, it gives them some analgesia and sedation in most circumstances, not a high.
At our hospital we’ve had addicts come in who OD’ed by chewing om stolen fentanyl patches.
Yet don’t confuse me with an extremist anti opiate anti pain med luddite. I think a lot of legitimate pain sufferers are getting the shaft and in enough numbers that it could start affecting vote numbers if an organized effort were started. Addicts, we will always have but chronic pain sufferers should not be lumped in with them.
Hey, I’m a pro-pain med guy and understand these meds need to be tapered down to avoid the bad withdrawal symptoms. The bureaucrats are nuts! I think pain sufferers exist in sufficient numbers that they could put some politicians’ seats in jeopardy if it becomes an issue.
Thanks for the info...guess I am on the naive side...chewing patches...shaking my head.
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