I was on hydrocodone for six years as treatment for arthritis, stenosis, and chronic pain (basically I am in waiting for a fourth spinal operation). Through self medication, I was able to identify a minimum dose that would give me enough relief to have relatively good days. Then Florida passed more restrictive laws on controlled drugs as a result of the “pill factories” that had sprung up. First, prescriptions were cut from a 90 day supply to 30 days and they could no longer be called in. In essence this tripled the cost to Medicare for getting a prescription. Next, my doctor decided I needed to be off all controlled substances. To show him I was not an addict, I went cold turkey with the result of increasing my use of naproxen. This led to my developing gerd and prescription stomach medicine. Next, I was given non addictive medicines, costing much more than opioids and frankly less effective. My following courses of treatment have been physical therapy (helps but allowed sessions are too few), nerve ablation (basically a temporary and partial relief), Botox injections (very expensive), trigger point injections and epidurals. All of this has greatly increased the cost of my treatment to the point that I’m embarrassed. The cost savings of opioids over my subsequent treatment is huge!
I firmly believe there are a large number of people who can be effectively and cheaply treated with opioids without being a threat to society. Because of the negative publicity, lawmakers made a knee jerk reaction to limit the use of opioids. I concede that the potential for abuse exists but think that more research and treatment for addictive personalities is the answer, not limiting a cheap and effective form of treatment.
Amen. The current policies punish the innocent and do not deter the guilty. My wife is in desperate, intractable neck and back pain. She has had four operations and is fused from C-2 to T-2. She cannot get the relief that would allow her to do physical therapy and begin to return her to functionality.
I did just read about some promising approaches to this. There is a trial on rats using a fentanyl derivative NFEPP. For fentanyl to work it must be protonated. Fentanyl is protonated everywhere int he body (pKa over 8). This derivative is only protonated at sites of inflammation (where pH is lower, NFEPP is pKa 6.8). Thus it hits opiate receptors at an injury and not in the brain. Trials on rats are good, but who knows where we will wind up.
My BIL deals with the back issue. His drug of choice is weed. He swears it reduces the pain. But there isn’t a 1 size fits all. You have to find the type that works for you. My sister smokes one type and he smokes another type.