prescription drug addiction

[shedevilprincss]

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 say the increase coincides with the increase in opioid use in rural communities and rising prescription pill overdose rates.

Honestly, I would be happy if I never had to give IV dilaudid.

I have told all my docs and nurse friends, if I end up in the hospital, NO IV NARCS. I had auditory hallucinations when I had PO oxycodone after a knee surgery. I can only imagine that dilaudid would probably kill me.

[NCtoILrecoveringRN]

They should be in my opinion. I hurt my back severely at work and they put me on narcotics. I went on to become addicted and ended up "impaired on duty according to the Nurse Practice Act." I am struggling to get my license back now. Don't accept them just because the Dr. wants to prescribe them. They are highly addictive and there are other methods of pain control besides analgesics.

[Esme12, ASN, BSN, RN]

It is a really scary fact that incidence of NAS in the US has risen from 1.5/1000 to 6/1000 over just 10 years.

It is scary....but can all narcotic addiction be traced to prescription meds as a source? Do I need to be denied appropriate medical intervention and prescription meds simply because it is now not popular to treat patients with long term pain with pain meds?

Here is my problem. I have pain. Severe pain. My doctor admits I have severe pain but will remove pain relief for me because I have "been on the pain med a long time" even though it is clear the acute reason persists. I don't want to be pain free...I mean really why would anyone want to be, or have the expectation to be, pain free? Some of my issues are chronic. Most of the others are not, even though they have lasted more than 12 weeks. I still suffer from open healing stage 3 wounds (from the sepsis that I suffered because I was under treated and ignored), abdominal pain and persistent nausea from my internal dehiscence that contains my small/large bowel and stomach that can't be fixed yet...it doesn't make sense I will suffer because of others disease.

Some people can drink alcohol and not become and alcoholic just as some can take pain meds and not become a narcotic addict and shooting heroin.

[BostonFNP, APRN]

It is scary....but can all narcotic addiction be traced to prescription meds as a source? Do I need to be denied appropriate medical intervention and prescription meds simply because it is now not popular to treat patients with long term pain with pain meds?

No absolutely not.

Here is my problem. I have pain. Severe pain. My doctor admits I have severe pain but will remove pain relief for me because I have "been on the pain med a long time" even though it is clear the acute reason persists. I don't want to be pain free...I mean really why would anyone want to be, or have the expectation to be, pain free? Some of my issues are chronic. Most of the others are not, even though they have lasted more than 12 weeks. I still suffer from open healing stage 3 wounds (from the sepsis that I suffered because I was under treated and ignored), abdominal pain and persistent nausea from my internal dehiscence that contains my small/large bowel and stomach that can't be fixed yet...it doesn't make sense I will suffer because of others disease.

You have pain with a clear ongoing etiology. Your initial insult has not resolved. More-so, you have suffering due to the pain. You are an appropriate patient to be using narcotics. You are working toward an end-goal that does not include them; the ultimate solution for you is not (doesn't seem to be) long-term narcotics. Changes need to be made so patients like you don't have to suffer, don't have to be stigmatized.

Some people can drink alcohol and not become and alcoholic just as some can take pain meds and not become a narcotic addict and shooting heroin.

It is a comparison I have heard before, and my response always is: people use alcohol, alcoholic or not, for pleasure. You aren't using pain meds for pleasure; and I have always considered that people in pain taking narcotics to make pain manageable have significant reduced risk of becoming an addict. You will have physical dependence that will need to be managed just like someone on prednisone or a beta blocker but you won't have psychological dependence.

I don't like the comparison to alcohol for this reason. If you saw a patient that drank more than a pint of alcohol a day to "treat anxiety" that said "I'm not an alcoholic because I use it for a reason" what would you think? I think most HCP would consider them to have an alcohol problem. Pain meds shouldn't be like that.

Many of the patients I see with narcotic addiction don't shoot heroin. Heroin is a last resort; you can be a pill addict without ever picking up a needle.

[Jules A, MSN]

The big problem as I see it is that opiates are not effective long term for pain control of chronic conditions. They can result in adverse changes to brain chemistry making pain and mood worse. What I have seen happen with both prescribed meds as well as heroin is that over time the relief and euphoria diminish and it becomes about taking the pills or shooting up round the clock in an effort to either avoid being dope sick or possibly have a very brief period of relief from the increased pain they now feel due to long term opiate use.

[Aunt Slappy]

I haven't read every comment in this long thread, so this may have been addressed already. I love ZDogg and acknowledge that there is an opioid dependency crisis in this country, BUT......

I'm a hospice nurse. The hue and cry about narcotics the last few years is causing a major problem in that I regularly get family members who do not want to allow their loved ones with cancer to have narcotics. Basically, they expect me to medicate cancer pain with Tylenol. While Tylenol may be part of an effective pain regimen, when your abdomen is being devoured from the inside out by tumors, you're going to need narcs for pain control. This is uncharitable, I know, but I can't help hoping there is a special ring of Hell for people who want to deny narcs to cancer patients because they saw 20/20 last night.

[heron, ASN, RN]

I want to say once again that ignorant, lazy or venal prescribers and people with unrealistic expectations are certainly factors in the current opioid problem. But defining the problem solely in terms of "bad" consumers and incompetent providers is what leads to people like Esme being scapegoated for problems they do not have and did not create.

What's not being mentioned is the colossal amounts of money involved. Consider this:

The Gazette-Mail obtained previously confidential drug shipping sales records sent by the U.S. Drug Enforcement Administration to West Virginia Attorney General Patrick Morrisey's office. The records disclose the number of pills sold to every pharmacy in the state and the drug companies' shipments to all 55 counties in West Virginia between 2007 and 2012.

...The wholesalers and their lawyers fought to keep the sales numbers secret in previous court actions brought by the newspaper.

The state's southern counties have been ravaged by a disproportionate number of pain pills and fatal drug overdoses, records show.

The region includes the top four counties — Wyoming, McDowell, Boone and Mingo — for fatal overdoses caused by pain pills in the U.S., according to CDC data analyzed by the Gazette-Mail.

Another two Southern West Virginia counties — Mercer and Raleigh — rank in the top 10. And Logan, Lincoln, Fayette and Monroe fall among the top 20 counties for fatal overdoses involving prescription opioids.

... Mingo, Logan and Boone counties received the most doses of hydrocodone — sold under brand names such as Lortab, Vicodin and Norco — on a per-person basis in West Virginia. Wyoming and Raleigh counties scooped up OxyContin pills by the tens of millions.

The nation's three largest prescription drug wholesalers — McKesson Corp., Cardinal Health and AmerisourceBergen Drug Co. — supplied more than half of all pain pills statewide.

... For more than a decade, the same distributors disregarded rules to report suspicious orders for controlled substances in West Virginia to the state Board of Pharmacy, the Gazette-Mail found. And the board failed to enforce the same regulations that were on the books since 2001, while giving spotless inspection reviews to small-town pharmacies in the southern counties that ordered more pills than could possibly be taken by people who really needed medicine for pain.

As the fatalities mounted — hydrocodone and oxycodone overdose deaths increased 67 percent in West Virginia between 2007 and 2012 — the drug shippers' CEOs collected salaries and bonuses in the tens of millions of dollars. Their companies made billions. McKesson has grown into the fifth-largest corporation in America. The drug distributor's CEO was the nation's highest-paid executive in 2012, according to Forbes.

It starts with the doctor writing, the pharmacist filling and the wholesaler distributing. They're all three in bed together,” said Sam Suppa, a retired Charleston pharmacist who spent 60 years working at retail pharmacies in West Virginia. The distributors knew what was going on. They just didn't care.”

Charleston Gazette-Mail | Drug firms poured 780M painkillers into WV amid rise of overdoses

And this:

More than a half dozen pharmaceutical executives and managers were taken into custody by federal officials this month on charges that they "led a nationwide conspiracy to bribe medical practitioners to unnecessarily prescribe a fentanyl-based pain medication and defraud healthcare insurers," federal prosecutors based in Massachusetts said in a statement.

U.S. Attorney for the District of Massachusetts Carmen Ortiz alleges that several former employees of Insys Therapeutics, Inc. - including the once CEO and president of the company - conspired to bribe medical staff in several states to get them to prescribe a specific pain medication.

The medication, "Subsys," is a sublingual spray intended to treat cancer patients experiencing intense moments of pain. The powerful narcotic is a highly addictive substance that can cause respiratory distress and death when taken in high doses or when combined with other substances.

Federal officials allege doctors prescribed the drug to many patients - the majority of whom were not diagnosed with cancer - in exchange for bribes and kickbacks.

Pharmaceutical executives accused of bribing doctors to 'unnecessarily prescribe' fentanyl | masslive.com

It's admittedly much more difficult to hold large multinational corporations responsible for their behavior. Much easier to dictate abstinence to people who are in pain regardless of their individual situations and call it a solution.

And, to be clear, I include addicts in that "people in pain". There certainly seems to be a physical, possibly genetic component to addiction, but there is also considerable reason to believe that the original motivation is often self-medication for emotional or psychic pain. Many of my addicted HIV patients, once they were too sick to continue their illicit drug habits, turned out to have bipolar, severe depression and/or histories of severe abuse. Anecdotal, sure, and impossible to say which came first (except in the case of childhood abuse), but not suggestive of the wild-eyed degenerate hedonists we think of when we hear "addict", either.

This is, after all, an epidemic of pain-relief abuse ... doesn't that suggest a co-existing epidemic of pain?

[BostonFNP, APRN]

There is some data out now on the changes made in Florida to curb their opioid problem (and for reference, a DEA report up here in MA determined that a considerable amount of the pills on our streets originated in FL):

Chang, H. Y., Lyapustina, T., Rutkow, L., Daubresse, M., Richey, M., Faul, M., ... & Alexander, G. C. (2016). Impact of prescription drug monitoring programs and pill mill laws on high-risk opioid prescribers: A comparative interrupted time series analysis. Drug and Alcohol Dependence.

[BostonFNP, APRN]

It makes me sick that legitimate patients can't get the medication they need, however, we know there is a fairly strong correlation between the availability of legimate prescription opioids and opioid abuse. So what do we do about it as health care professionals, on a population basis not an individual basis?

[NotAllWhoWandeRN, ASN, RN]

Obligatory not a nurse yet.

I have Chiari Malformation. I always have a headache - usually I can handle them with zero meds, but sometimes I can't. I can't get my PCP to give me a prescription for pain meds to have on hand for the bad days to save my life. He thinks that Advil or Aleve should be sufficient. It's not, not on the bad days - I can't move, speak or see on the bad days - and that lasts about three days at a time. A 'script for 30 vicodin would last me at least a year and give me some of my life back, but I'm refused that comfort and control over my own pain. And it makes me feel like I'm a drug seeker, which is a really, really bad feeling.

It sucks.

I understand and respect the need to be cautious, but I think sometimes that caution negatively impacts patients.

I'm sorry you have to deal with that. I have also been undertreated for severe pain. I was denied any pain control besides NSAIDS for the better part of 3 months after an acute injury that made even breathing severely painful. I eventually lost my job because it was ruled that the injury left me permanently disabled.

I've treated seekers and it's frustrating as heck, but refusing to treat someone's acute pain (even your own) is a great way to set them up for chronic pain.

[Esme12, ASN, BSN, RN]

You have pain with a clear ongoing etiology. Your initial insult has not resolved. More-so, you have suffering due to the pain. You are an appropriate patient to be using narcotics. You are working toward an end-goal that does not include them; the ultimate solution for you is not (doesn't seem to be) long-term narcotics. Changes need to be made so patients like you don't have to suffer, don't have to be stigmatized.

Thank you. We are stigmatized and as a nurse it's tough to know what providers and nurses are saying.....whether they believe it or not patients can hear what is being said.

It is a comparison I have heard before, and my response always is: people use alcohol, alcoholic or not, for pleasure. You aren't using pain meds for pleasure; and I have always considered that people in pain taking narcotics to make pain manageable have significant reduced risk of becoming an addict. You will have physical dependence that will need to be managed just like someone on prednisone or a beta blocker but you won't have psychological dependence.

I don't like the comparison to alcohol for this reason. If you saw a patient that drank more than a pint of alcohol a day to "treat anxiety" that said "I'm not an alcoholic because I use it for a reason" what would you think? I think most HCP would consider them to have an alcohol problem. Pain meds shouldn't be like that.

Many of the patients I see with narcotic addiction don't shoot heroin. Heroin is a last resort; you can be a pill addict without ever picking up a needle.

I agree that there are pill addicts. I also agree there can be physical dependence but are not addicts. Addicts are those looking for a physical high....I am not.

[Esme12, ASN, BSN, RN]

It makes me sick that legitimate patients can't get the medication they need, however, we know there is a fairly strong correlation between the availability of legitimate prescription opioids and opioid abuse. So what do we do about it as health care professionals, on a population basis not an individual basis?

I don't know...I am still researching.....sigh

[Jules A, MSN]

I agree that there are pill addicts. I also agree there can be physical dependence but are not addicts. Addicts are those looking for a physical high....I am not.

And the truth is no matter what the variety they are all in legitimate pain. Addicts often get to the point where they are not getting high any longer or if they are its for very brief periods of time and therefore are also trying to avoid being in excruciating pain. There are real no easy answers and my focus and goal remains: primum non nocere