prescription drug addiction - page 13
Noticed a Facebook "trending topic" this evening (early morning?) about neonatal abstinence syndrome and it talked about prescription drug abuse. Thought it was an interesting article. Researchers... Read More
Dec 29, '16 by David40836You figure that one out you will own my soul. Current medication and limits of treatment as far as I can tell are no where close to coming to that realization. An addiction zero med to treat pain would be a miracle......meds aren't the issue its the human brain. I'm no doctor but as I understand we create the chemicals for pain/pleasure already so influencing those circuit leads either to dependence on the foreign substance or the chemical centers to shut down. We all know opiates make the pain go away but also make the mind and body happy...bad combo and no matter what will lead to dependence in some way with repeated or lengthy use.
Quite honestly you hit the nail on the head and that should be the topic of every and all discussions vs. how to we stop something which is already known to be addictive. I would compare it to talking about gasoline being flammable and how to stop fires from it while being used near open flames when its inherent to the chemical vs. talking about an alternative fuel with those requirements stated before development.
We all know opiates are a godsend, the poppy was treated as a gift from the gods for thousands of years. We took it and modified it to be 1000's of times more potent then it is without knowledge of the impacts. Yes it has served us well but for nearly 150 years we've become dependent on those chemicals. Which in turn stopped us from pursuing other methods or chemicals to relieve pain. We are way behind the 8 ball on this and the talk of addiction is a bit redundant considering its the negative of the current solution and there are no other solutions right now. So do you cure the headache by cutting off the head? Or do you treat the symptoms? It should be an automatic known that if someone is extensively on opiates then there should also be a requirement for therapy/treatment either during or after conclusion of the need. It is inevitable to become addicted as a chronic pain sufferer. So is that truly an issue? If under the care of a doctor being addicted to a needed substance? Even if it isn't needed it may keep a person off the streets and much safer then banging H up their veins. Denmark practices dispensaries for heroin addicts free of charge and nearly 100% of them are as normal as anyone, working living and dealing with it on their terms.
I believe the focus and tactics of the current policies are wrong. Its incorrect and does not work with the human brain. Harm reduction vs. restrictions in effect today....which is less harmful to the people and to the society? Addiction is life limiting in terms of what the person needs to do to maintain that addiction. Is it robbing banks or prostitution? Something has to give of course to maintain so if it was properly monitored by a medical professional would that addiction truly be life limiting? I would think not as your time isn't devoted to finding either your next fix or the bones to pay for it. To have a truly honest discussion, then all parties should be voiced. The police, politicians, doctors, nurses, patients and even addicts. Demonizing it only pushes it underground. That was my reason for ever posting is those views are never discussed which causes the wrong decisions to be made and end up biting everyone in the butt.
Dec 29, '16 by David40836I addressed that below...well above. The issue of if the person was an addict or a person in need wasn't an issue until recently. Mainly the Florida and Coal Belt states pill mills. Used to be a direct flight folks called the Oxy express down to Florida. Everyone knew it, everyone used it. Folks would fly down to Miami or other cities and come back the next day with 1000's of 80mg Oxycodone tablets. Florida was one of the last states to adopt a prescription database but before putting in the changes it had already swept the nation. Before all of that blew up along with the Purdue lawsuit, doctors treated everyone as patients. Back then it wasn't bad to tell your doc you hungered for them or they were running out to fast and they would get you the help you needed. Now your reported to registries and all other sorts.
So who best to treat either your pain or your addiction? Your PCP in my opinion. I have seen mine since I was 8 and he knows me better then I do but he is now unable to treat me effectively due to regulations and fear. With these new regulations, databases, requirements and limitations everyone feels paranoid about saying anything. That is my point. In attempting to fix a problem it was made worse. Its horrible going to a doctor and before even being told hello your herded into a bathroom from a waiting room with a pee cup in your hand. Think anyone will speak about addiction in a situation like that? No way. My last pain mang doc told me if I came in without the right number of pills he would report me to a database in Tennessee as a pain pill abuser and doc shopper and I am supposed to speak with him with trust? I am supposed to trust doctors who expect me to stop what I am doing at anytime during the day to come to their office with my pills so they can count and if not I am reported or kicked out? Try all that out and see how you feel, either talking to the doctor or just your self esteem as you feel like a damn criminal.
So yes you are probably right about doctors or nurses not knowing what they are/were treating but I believe now it is a million times worse then before. I beg of you to go hang out at a pain clinic for a day and see what folks ask you or you hear. Asking who was doing the pee tests, if they can borrow 1 pill because they had a bad day or dropped one down the sink. People in absolute fear of consequence and not because they are bad people.
I believe this is a consensus throughout the US now, at least the people I have talked to at pain clinic waiting rooms. Its horrible but as long as one bad dude doesn't get 30 tablets while the 900 good folks others go through that its ok right?
It is all interlinked and connected....just adding my opinion. No one person is right nor wrong its just a very large onion with a ton of layers. Not often that I can remember has there been a similar situation. Most drug issues were always illegal or became illegal but nothing so absolutely needed by real people in really bad situations as this.
Dec 29, '16 by LadysSoloI am sorry it makes you feel like a criminal David40836, but when I was doing primary care, I had pain med contracts with ALL my chronic pain patients. I explained to them at the start that this is the way it has to be, and if they want/need the meds, they need to comply with the contract. The ones NOT selling their meds had no issue with it, the others (and I heard all the stories, "my child dumped my pills in the toilet," "I had company and someone stole all my pills," "I had them in the glove box of my car and my car was stolen," etc.) left. I was already nearly 100% certain who would be okay with the contract and who wouldn't. I always tried to work with the patients as to need, but I often required physical therapy as part of the contract. I understand chronic and acute pain (I worked in oncology for 23 years) but I also am not a fool and have no desire to have my compassion taken advantage of. And I totally agree we need non-addictive pain meds.
Dec 29, '16 by BostonFNP GuideQuote from David40836I am unsure how a provider being honest and direct with patients about the expectations that are put in place to ensure safe use of these medications is cause for patients to not "trust" them?My last pain mang doc told me if I came in without the right number of pills he would report me to a database in Tennessee as a pain pill abuser and doc shopper and I am supposed to speak with him with trust? I am supposed to trust doctors who expect me to stop what I am doing at anytime during the day to come to their office with my pills so they can count and if not I am reported or kicked out?
Quote from David40836Do you honestly think most of the people sitting in the waiting room trying to "borrow" a controlled substance to pass a urine screen are doing so because they "had a bad day" or "dropped one down the sink"? Leave alone the fact that these "good people" are trying to circumvent the safeguards for whatever reason (all the while not "trusting" the provider), I am willing to bet the vast majority of them didn't just have a bad day or drop a pill down the sink (though to be honest this is the most common used excuse and every person that uses it seems to the flabbergasted anyone had ever used that excuse before, and interestingly enough never seems to happen with BP meds or statins), they are trying to bum a pill because they deviated from safe usage (took too many, sold them, etc).I beg of you to go hang out at a pain clinic for a day and see what folks ask you or you hear. Asking who was doing the pee tests, if they can borrow 1 pill because they had a bad day or dropped one down the sink.
Quote from David40836Talking to people at pain clinic waiting rooms gets you one side of the story; many of us here are prescribers dealing with the other side of the story. I do feel bad that legitimate patients need to be subjected to this stigmatizing set of rules (especially because it is not their fault), but I also feel that these rules are important for fair and safe prescribing right now.I believe this is a consensus throughout the US now, at least the people I have talked to at pain clinic waiting rooms. Its horrible but as long as one bad dude doesn't get 30 tablets while the 900 good folks others go through that its ok right?
Dec 29, '16 by BostonFNP GuideQuote from David40836Can you cite your source for this? I have read several studies that all all showed significant decline in scripts, volume, and MME following implementation of prescription opioid legislation. I have no idea what the prices are on the street and if they have changed. Unfortunately, while prescription opioids have plateaued in 2011, heroin abuse has increased and with that has followed overdoses. The problem is not fixed, it has transitioned, and probably to a more deadly medium.But I will tell ya what....it has done nothing. The numbers of prescriptions hasn't fallen, overdoses hasn't changed, people selling prescriptions hasn't changed nor the price of them or quantities.
Quote from David40836David, from what you have presented here about your case, I think we can all understand what a difficult place you are in. There are numerous red flags that have popped up even in your own narrative of your care and you face a hearty uphill battle to find care that you will consider satisfactory, especially now that your script history follows you every where you go now (even across state lines). You are between a rock and a hard place and I think we can all appreciate how hard that must be.The only thing that has, is people with real problems are being left in the void or have gone to use illegal drugs. [I] have been to nearly every pain management center within 400 miles....
On the other side, as upset as your are about not being able to get your pain/addiction managed, there are others here that struggle with pain issues and access to care that don't have your high-risk factors. I feel for them too.