Spooky experience cleaning the attic

That is spooky.

There isn't a day that goes by now that I don't have to deal with issue on one side or the other. I practice in one of the worst affected regions and it is taking it's toll on the community from all angles: it seems like I don't have a single patient that hasn't been impacted by this via friends or family. It sure has a nasty way of destroying not only individual lives but whole family and community groups.

From a clinicians perspective we have a huge problem and no resources, and it seems many clinicians also have no real plan to deal with the problem. On one hand I see young people being put on opioids for minor problems and on the other I see chronic pain patients being rapidly tapered off medications they have depended on for years without any long-term plan.

Ditto... home health care nurse in a county that had more opiod prescriptions than people. I have an 84 year old patient that finally said "yes, I'm an addict. I've been taking these pills for over 20 years. What do you want me to do?"

I have no answers

If they are 84 and have been taking the pills for 20 years they absolutely have physical dependence and perhaps psychological dependence as well, but if they are not falling and they are not diverting them, are we doing them any favors trying to taper that patient off them? I'm not so sure.

I have had good success dose-reducing chronic patients to a tolerable/functional pain level. Chronic pain patients will always have some degree of pain, and while that is a crappy thing to tell them (and a crappy thing to live with too), I have found that most patients can have a similar level of pain with less medication (and sometimes no medications) if slowly tapered. The problem is that some can't and trying to paint everyone with the same brush never works out well.