The opioid crisis - an analogy

Remember the “pill mills,The OxyContin Express, Hillbilly Heroin, etc”, back in the 90’s, all over the news? As a result, they have since locked down the system so tight, its nearly impossible to Doctor shop, double or fake scripts, get more than one needs. It’s a national database, tracking all controlled substances.
What happened to the war on street drugs? The propaganda conveniently weaned the public from using the “H” word and replaced it with the “o” word. Insurance companies don’t have to cover the patients meds, because of a completely different problem. The “crises” is causing grief to patients and doctors, alike. It’s a “PC” win, for the insurance companies. Jeffrepubics comments, seen on other threads regarding this subject, were spot on! The domino effect, from the “war” on drugs is more crimes. Treatment or legalized drugs for the existing addicts stops them from committing crimes to prevent suffering, thus breaking the cycle of new addicts. Education, starting in the 4th grade, showing the REAL dangers of these drugs. Drilling it home, without worrying about TMI for your children.
Chronic pain patients can still (barely) get Rx for medication. The insurance just denies coverage. Can still be filled, just pay out of pocket. That’s going to stop the war on drugs?! Heroin? Meth? Nope...just going to hurt innocent folks who are legally prescribed these medications. Overload the doctors with so much paperwork, that some have to hire more help, just to fight for the right of their patients. The pharmacists, who have been helping the same pain patients, for years, are seeing the fallout, firsthand, as a result, also. They have to keep a headset going all day long, helping patients navigate the new laws.
This is one analogy to the “crises”:
https://pbs.twimg.com/media/DsItiDPUcAAeydB?format=jpg

Guilty-Remnant Guilty-Remnant
Nov '18

Opiate medications exist for one purpose. To treat severe, acute pain. That is... something like a broken leg, just got out of surgery, etc. All too often doctors prescribe these to chronic pain patients for long-term uses. Patients will sometimes take this pills for months - even years. These patients 100% become addicted and dependent to these substances. Doctors continue to prescribe them for long term pain... even though study after study has proven that they are not the answer to chronic pain.

I hate to break it to you but these innocent folks you mention who are legally prescribed this medication.... they are no different from the junkie on the street. The only difference is that their dealer is a doctor.

Chronic pain patients should not be taking opiates, and most will never admit it, but all it causes is addiction and physical dependency. Opiates should never have been used to treat chronic pain - but big pharma pushed them to docs and hospitals like wild back in the day.... and here we are.

I am speaking as a medical profession with experience in pharma research. These drugs should not be prescribed for chronic pain and that is where the problem started.


Your comment about the drug war is spot on - it has never done anything except further fuel the black market drug trade and marginalize addicts who become afraid to seek help.

Newburry Newburry
Nov '18

Glad to see the attention on this issue. Very pleased to see our president and first lady take a leadership role in addressing the tragic abuse and dependency/addiction of these powerfully addictive medications. It needs to stop.

GreyHawk GreyHawk
Nov '18

Oye, as is with many things in life, the pendulum swings too far.

Opioids are great for short term acute pain. Given the shortness of use, safer here too. And I’m sorry if I don’t want to tough it out or take a ineffective Motrin when in acute pain.

At palliative care there really is no issue.

With proper care and monitoring, according to CDC and other guidelines, and combined with non-pharmaceutical aids, they can be life giving for chronic pain sufferers.

They are also physically addictive and mentally too. Care is needed, extreme care and monitoring for chronic pain sufferers. For example, lowest possible dosage needs to be determined over time. The time release versions should not be used until dosage monitoring is complete. With proper dosage, monitoring, and non pharmacutical support, they can really help chronic pain sufferers.

Yes, drs were overusing them. That’s because they work. Yes, they are so addictive that monitoring, oversight, and other prevention techniques should be used. But to take them out of our medicine toolbox is a pendulum swung too far IMO.

Strangerdanger Strangerdanger
Nov '18

Thank you Newbury... you are spot on and I couldnt agree with you more. I am a recovering addict of 11 years now and I am stunned that those drugs can be prescribed EVEN when it's in your chart or when you have to be operated on, you must answer questions. yet they still prescribe those to you and you ask for something different other. Nope either this or tylenol. Really? It's all about Big Pharma and its supporters...perhaps if everyone could see exactly who are the supporters you might begin to understand the web that is woven. It's quite scary. I'm shocked and appalled at all of this. The best thing you could do is to educate and understand.


There is a recent best seller book that addresses this issue and it's worth reading if you're interested in this epidemic. It's called "Dope Sick". I got it from the library and it's written by a journalist who did extensive research on opioid addiction. I highly recommend it.

P.S. Thanks for the topic. It really needs all our attention.

Joyce Polack Joyce Polack
Nov '18

"These patients 100% become addicted and dependent to these substances. Doctors continue to prescribe them for long term pain... even though study after study has proven that they are not the answer to chronic pain."

Only problem is that sometimes they ARE the only answer to chronic pain.
And this is something that there is not an easy answer for.
And to deny painkilling medication to someone who really needs it because you are afraid that someone is going to become a drug addict is not the answer.

callitlikeIseeit callitlikeIseeit
Nov '18

"It's all about Big Pharma and its supporters."
Sure it is. All doctors are drug pushers.
Not.
Anyone who wants to be operated on without painkillers go right ahead. I guess we could go back to shots of whiskey. A little fentanyl or dilauded after major surgery given in the recovery room does not make patients addicts.

And yes, there are alternatives that work well on many people, but certainly not all.

callitlikeIseeit callitlikeIseeit
Nov '18

And by the way, take the xanax away from the mommies as well. The rage at the shopping malls will be out of hand.

Women were also much more likely than men to report taking psychiatric drugs.

“I was particularly surprised to discover that about one out of five adult women are taking a psychiatric drug and that that rate was double that of men,” Moore said. “That is a very high exposure rate.”

Mothers Little Helper.


https://www.cbsnews.com/news/psychiatric-drugs-study-reveals-widespread-use-women-men/

callitlikeIseeit callitlikeIseeit
Nov '18

Newburry pretty much summed it up.

The FDA can parse the hell, scientifically, out of anything within their purview.

Still, they are a bureaucracy subject to all sorts of special interests.

Guess this " medical science" charade didn't work out well....though it made tons of money for interested parties (the "Two Choice" party option in Uh'Merica included.)

jjmonth4 jjmonth4
Nov '18

Forget about all of that, here is the real problem, getting the price of prescription drugs lowered to a reasonable amount.

"Pfizer will raise prices on 41 of its prescription drugs in January after initially putting off those plans this summer amid pressure from President Trump.

The drug giant will increase the list price of about 10 percent of its drugs Jan. 15, the company announced Friday. Most of the increases will be 5 percent, though Pfizer will raise three drugs' list prices by 3 percent and one drug's by 9 percent."

Dodgebaal Dodgebaal
Nov '18

I think if you look at the drug trade from an economic view of supply and demand, you must lessen demand. Anything else is just playing with the numbers; less supply creates more demand that increases the price, price increase brings in more supply because it’s profitable so there’s more dealers, more supply lowers the price which increases demand because more users can afford it, and so it goes round and round. If nobody wanted it, then there would be nothing to sell.


Dodgebaal

Yes, I guess the bonus payments to management and dividends going to stockholders weren't quite high enough this year with the tightening of opioid distribution and the high profits from those sales.

They'd make a heck of a lot more money if they weren't spending so much on advertising to tell us all what medications we direly need. Is that better and cheaper than marketing directly to Physicians, as they always had done in the past until the Clinton Administration & the FDA allowed it? I don't know, but it definitely caused more complications in physician/patient interactions and the prices seem to have gone up faster after the change that was forced on us. Canada still does not allow direct marketing of drugs to patients via TV advertising, etc.

Phil D. Phil D.
Nov '18

Blame it on your politicians and America's love of unfettered capitalism.
"Greed is good." Gordon Gekko.

" Canada still does not allow direct marketing of drugs to patients via TV advertising, etc."

Pennsylvania man drives to Canada for son's $15K medication. The US price? $50K.

Xeljanz, made by Pfizer and used to treat the disease, would cost the Yeagley family $50,000 a year, as the medication is not covered by their health insurance plan. So the family uses a $15,000 Pfizer rebate to get three months of the treatment in the U.S., and then travels to Canada three times a year to get the rest of the treatment, costing $3,700 for a three-month supply.

Dodgebaal Dodgebaal
Nov '18

How much do they(we) spend on those non-sensical names? Wanna bet up to a million a piece..."Melding the words "vigorous" and "Niagara," Teck came up with "Viagra."" Go figure. Now I feel better: https://www.cnn.com/2016/11/25/health/art-of-drug-naming/index.html

All I know is when I am in acute pain, and I know that it might last one or two days, like I need 2-4 pills, but it is so acute I run to ER, I feel really, really bad when you withhold the oxy and suggest a Motrin; matter of fact you're willing to sell me one...

I had a DR. suggest Whiskey the other day. Real improvement from these masters of medicine.

Control and monitor; don't completely shut down the application.

Pharma and most of HealthCare do not operate under normal supply and demand curves. When you are sick, you will do anything, pay anything, to get well. When you're finger is cut off and in the bag, you are not comparison shopping for your best value.

strangerdanger strangerdanger
Nov '18

SD...”Pharma and most of HealthCare do not operate under normal supply and demand curves. When you are sick, you will do anything, pay anything, to get well. When you're finger is cut off and in the bag, you are not comparison shopping for your best value.”

True that! This is one of the major reasons people are losing everything! More money shifts to the already top %1. The money has got to come from somewhere. Pain and suffering are great ways to extort money. The more they merge (Atlantic, for example), the bigger they get, the greedier they get. Goodbye, stocks, savings and home....hello, medical bills. Not a vacation home, a fancy car, expensive jewelry...just medical bills...a REAL luxury, for a change, huh?

Guilty-Remnant Guilty-Remnant
Nov '18

GR -- very hard to follow the money trail in your rant but yes, prices are out of hand in the medical field. Biggest culprits, or low hanging fruit, depending how you look at it are ER/Hospital, specialists, and pharma.

Whether ObamaCare reduced the growth rate of healthcare pricing is a mixed bag. Given the current state of affairs with Ocare not only being on hold since 2010 and under sabotage since 2017, I think one would say current trends are pretty amazing. In that, it should be dead by now, not only sleeping. IMO, it's our best best to lower the rate of price increase. Fix it.

Second, open drug market to international suppliers; that will put instant price pressure on US suppliers. End the domestic protections offered to these companies.

Third, open the public option and let everyone who wants to, take the Congressional plan; that will put competitive price pressure on insurers.

strangerdanger strangerdanger
Nov '18

Now that the ACA mandate is gone, funding for healthcare is going to be worse. People forget, part of the ACA was to prevent folks from getting charged extra for pre-existing conditions. For 2019, now have a choice of “use more or use less plans”. Similar to last year, but it’s the wording that gives me pause. I don’t have a crystal ball. That’s how it starts...slowly weaning into charging/denying more for pre-existing conditions. I paid into premiums, my whole life. Never a gap, for a reason. I should’ve pocketed the money, when I was healthy, if I knew this type of thinking would take hold. People think the latter is a way to handle the costs?! SMH

Guilty-Remnant Guilty-Remnant
Nov '18

How about congress letting CMS negotiate for drug prices directly with manufacturers - what would be a big start

Skippy Skippy
Nov '18

"That’s how it starts...slowly weaning into charging/denying more for pre-existing conditions. I paid into premiums, my whole life. Never a gap, for a reason. I should’ve pocketed the money, when I was healthy, if I knew this type of thinking would take hold"

You were not "grandfathered" , that is the problem. Grandfathered individuals love talking about "phased in" as they like their grandfathered bennies, but could care less about those that come after them. Retirees want their pensions, want you phased out, want Medicare to stay for them, you "phased out", this is what RomneyCare was all about, phasing out the younger crowd, keeping themselves phased in.


It's going to get much worse after the ACA mandate is gone. Employers are giving worse benefits each year, more cost passed on to you, more out of pocket, less coverage. Own a home, they will slap a lien on it as soon as you don't pay.

Drugs cost so much here, so much cheaper in every other country. Lobbyists have their tentacles into our greedy politicians-don't expect a change here, Trump said he was going to do something, but nothing happens. And Skippy, you are right, that should happen with CMS, but what would be great as well would be if the DEA would allow Americans to buy medications from Canada- they stop this, claiming it is unsafe, but we all know what the real reason is...

Dodgebaal Dodgebaal
Nov '18

When you use opiates to treat chronic pain, you are introducing the drug into the individual's system every day, oftentimes multiple times per day. Because of the nature of opiates, the person will develop a physical dependency (aka... addiction) 100% the time. It is literally impossible to take an opiate every single day and not be addicted to it... whether you'd like to admit it or not, all those who use opiates to treat chronic pain become addicted to the drug. Some more so than others due to psychological factors... but physically, all it takes is a week or two of straight opioid use and your body is hooked. Don't believe me? Try asking a long-term prescription opiate user to quit cold turkey and see what happens to them.

With acute pain, you're taking it over the course of days, MAYBE a week or two... and the chances of you becoming addicted are much lower... simply due to the duration of the therapy.

Without going into the specifics (unless anyone is interested), long-term opiate use also damages our body's ability to feel and perceive pain, often making the disorder being treated worse, and keeping patients on a cycle of needing higher, and higher dosages.

It's all a sham. And for those saying it's the best option we have..... it's the only option we have because big pharma makes trillions off of opiate drugs and keeping people hooked on them. They actually lobby to make sure that up and coming opiate alternatives are shut down at the early stages of research and trials.

I'll end on this.
CBD oil. Research it, form your own opinion, try it... especially if you're a pain patient.

Newburry Newburry
Nov '18

Really interesting responses, here. Thank you. People, like Newburry, know the logistics of addiction. Addiction to potato chips, (psychological) can NO WAY compare to opiate addiction (physical dependency). I wish people would stop throwing the word “addiction” around, every time they crave something. It desensitizes the public towards a deadly problem. Yes, withdrawals can be deadly to the elderly or to folks who are in frail condition. That’s why they don’t “rapid detox” older patients.
The poppy was created by “God”.We were “made” in his likeness along with opiate receptors in our brains, spine and intestines. Coincidence? If humans didn’t “F” with the poppy milk, changing the molecules over the years, it probably would’ve worked out better. May be the fountain of youth, hence the historical opiate wars.

Guilty-Remnant Guilty-Remnant
Nov '18

"Because of the nature of opiates, the person will develop a physical dependency (aka... addiction) 100% the time."

1) Dependency and addiction are two different things.

2) Please provide a link to peer-reviewed studies which show the percentage of 100% addiction rate in subjects who take opiates for longer than a short duration to treat acute pain.

Points are always better made when one does so with a solid grasp of the subject, using facts instead of fantasies or hyperbole.

Rebecka Rebecka
Nov '18

Don’t matter to me; just open it up for acute short interval pain.

Reminds me when they pulled psuedefed (sp) and you had to go to pharmacy counter, show drivers license which somehow proved you weren’t a crack head. Meanwhile they created all these bs shelf remedies just like the new wave of bs shelf pain killers coming out.

So when Im in acute pain, short interval, dont tell me load up on the motrin, drink, etc. just give me some oxy. I dont care if pharma is getting rich. It works and its cheap to me. Last thing I would do is get hooked; rather do H if I was going that route.

Create registry, monitor and control. But please feel the pain, stop the pain.

Strangerdanger Strangerdanger
Nov '18

Taking opiates every day of your life will inevitably lead to a physical dependency, which leads to addiction. It's a fact. You can research the nature of addiction yourself.

Newburry Newburry
Nov '18

While I understand you are passionate about the opioid/opiate crisis, it's best to get your facts straight to make your point. That's all.

FYI: 100% of people who take opioids for longer than to treat acute pain will not become dependent/addicted, and dependence is not the same thing as addiction. One can be dependent without being addicted, and addicted without being dependent. The finer points are actually quite important to grasp.

Rebecka Rebecka
Nov '18

Rebecca - exactly! I remember when my then 78 year old mother-in-law was in hospital after horrible accident with broken legs and a shoulder, doctors didn't want to give her pain killers constantly because they didn't want her to become an addict. The same situation was when she was 89 and undergone her cancer treatment. We had to insist that painkillers have to be administered every and any time she was in pain. It was unbelievable to see this old lady being really uncomfortable (and she was a fighter all her life) and doctors worrying about her becoming an addict.


The reason opioids WERE so oft prescribed is that they work. Billions of Americans could have less pain.

We have a problem, people are getting addicted or physically dependent or both.

Solve the problem but end the pain. Create registry, monitor and control. If people turn to the illegal markets, well, weren't they gonna end up there anyways? Does forcing everyone else to suck up the pain really help that?

Again, short term acute pain --- much less an issue. Chronic pain --- certainly have to monitor and control and a national registry will help that. Palliative and elder care: give me a break.

I mean I smash my toe. I am in ER and tomorrow's a pretty obvious snow day, no one will be moving. I am looking for 24-48 hours relief to just get me over the throbbing, swollen, part of the ordeal. Nope, can't have it, you must suffer with Advil OR up your dosage beyond what the bottle says because the ER guy said, "sure, you can go with up to xx pills." Liver be damned. Now, unless it's broken or cut off, I guess it's Jim Beam and Tylenol. No thought of dependency or addiction there.

The pendulum has swung too far and now we fix the problem by ignoring the pain. Hey, those DRs ain't hurting: I am.

strangerdanger strangerdanger
Nov '18

The registry has already been created and has been up and running for quite some time now, SD. Just google PMP Aware. All prescriptions of narcotics and certain other drugs are tracked in this State via PMP Aware. Other States also do this.

Pharmacies and medical professionals just need your name and date of birth to see all the tracked drugs you've picked up in the past 2 years.

The tracked drugs include those you would suspect, like narcotic pain killers, but also other drugs of potential abuse, such as Ambien, gabapentin (recently added), drugs for ADHD, subutex and suboxone, testosterone replacement drugs, etc.

Rebecka Rebecka
Nov '18

The drugs that are not tracked at all are the ones put into a drug drop off box, you know, when you are told not to flush them down the toilet(don't want any addicted fish or salamanders) but to conveniently drop them off in a safe place.

No copay required.

Dodgebaal Dodgebaal
Nov '18

Also, SD - if you are in pain and cannot get relief now because the "pendulum has swung too far the other way," I am so sorry to hear this.

Lena, the situation your mother-in-law dealt with is a perfect example of the pendulum having swung too far the other way.

So sad that many people see things only in black and white. Everything is grey, and on a spectrum. We must strive not paint with such broad brushes (but I understand that not everyone has the capacity to paint in fine detail).

"I hate to break it to you but these innocent folks you mention who are legally prescribed this medication.... they are no different from the junkie on the street."
-Newburry

That is correct. The junkies on the street are also innocent.

May I humbly suggest that you consider not calling those who struggle with addiction "junkies." They are humans like you and me, and labeling is nothing more than a sad attempt to dismiss a category of people. It's exactly the same as using derogatory terms to refer to a race, people of a different sexual orientation than you, etc. All these derogatory terms are attempts to dismiss a group of people. Have we not as a species evolved further than this?

When we realize that those who struggle with addiction are but a consequence of the society and culture we have all created together as a people, then and only then will we solve the issue.

Rebecka Rebecka
Nov '18

Dodgeball- don’t think that the drugs flushed down the toilet do not find their way into the public water supply.

Stymie Stymie
Nov '18

Spot On Rebecka!

Walking Girl Walking Girl
Nov '18

It was locked down for good reason! if you have seen the result of the Meth addicts in the Midwest you would know that it destroys lives, lives that albeit were often troubled but drugs like Meth nailed the coffin shut...


Thanks Rebecka and no I am fine. Its just that hurting yourself hurts worse tiday than it used to :-)

I just don’t get it. They have the registry, it can be multi-state, why can’t they use all these tooks to provide better care than “just say no.” Didn’t they get advanced degrees, take an oath, and make big bucks?

Like you said, black and white, so bring the hammer down, Katy lock the door.

Strangerdanger Strangerdanger
Nov '18

The registry is multi-State. When a healthcare provider or pharmacist logs in to PMP Aware, he/she has the option of searching for what prescriptions an individual may have filled in the neighboring States, as well as NJ.

Good pain management doctors don't "Just say no." They give their patients the most appropriate medicine(s) for their conditions, including treating some with chronic pain, end-stage cancer, etc., with opioids, if that is the most suitable option, in their professional medical opinion.

The trick is finding a good pain management doctor!

Rebecka Rebecka
Nov '18

Absolutely correct Rebecka on all of your points.

countryside
Nov '18

Both of these articles disgust me.

Three innocent people killed in Wayne yesterday due to an overdosing driver.

https://www.northjersey.com/story/news/passaic/wayne/2019/02/19/route-23-crash-wayne-nj-delta-gas-station/2913705002/

School bus driver revived with Narcan after crashing bus carrying students in Newark.

https://abc7ny.com/school-bus-driver-revived-with-narcan-after-crashing-in-nj/5147244/

Calico696 Calico696
Feb '19

Don’t forget to put down all the alcohol, gun and cell phone related deaths. Narcan wouldn’t help any of the latter. Like I said, the wrong folks are taking the hit, for others irresponsibility. Kind of like the “illegals” argument. There’s legal and illegal prescription medication. Most folks on legal prescriptions know better..... to be responsible and careful.

Guilty-Remnant Guilty-Remnant
Feb '19

Last bus driver was not high on anything. Just thought it was a bright idea to take a 40 ft school bus and drive it diagonally across Rt 80.

You will never solve these problems. Just wait till the MaryJane is out.
Some want that money so bad for tax relief, then will whine when someone kills an innocent in an automobile accident while high.
It's blood money.

dodgebaal dodgebaal
Feb '19

Meth, heroin and the other garbage brought in shipping containers is blood money. Weed? I wouldn’t call it blood money.Well, same rules will apply. Under the influence while driving should be dealt with....regardless of what the substance is. Alcohol was blood money...so much so, they finally just legalized it. Alcohol is more addictive, nasty drunks get violent, kids die from alcohol poisoning, hazings, etc.
Legalized weed should be held to the same rules as legalized alcohol. There’s no way that weed is more dangerous than %100 grain alcohol. No one has ever o.d.’d on pot. In fact I know some older folks who actually tossed most of their pills and booze because the pot helped them more. So...legalizing it could prevent death, rather than increase it.

Guilty-Remnant Guilty-Remnant
Feb '19

If you are high and have kids, and they get hurt, or need to go to the ER, the state will remove them from you if you are high. Even if pot is legalized.
And yes, pot is a gateway drug.
And opioids were too readily available.
My BFF used to drop one of Grampa's pills into her beer.
Why is Heroin so easy to get?
Ask your RICH congressman....


Same for alcohol. Alcohol is readily available in most homes. THATs the gateway drug. I know plenty of parents (who also happen to be police officers, teachers, doctors and church goers) who have been getting socially stoned...like a social drinker....and have been the best parents. Their children turned out fine. I know all mind altering chemicals can have an adverse effect, however reality has proven that’s the exception rather than the rule, in this case. It’s about personal responsibility. Like booze. BTW the puking parents really pissed off their kids.....so...legalize pot. Make alcohol illegal.

Guilty-Remnant Guilty-Remnant
Feb '19

I’ll just leave this here. Interesting reading.

https://www.politico.com/story/2018/08/28/how-the-opioid-crackdown-is-backfiring-752183

Guilty-Remnant Guilty-Remnant
Apr '19

Unfortunately some people need to learn to deal with some pain. You can't be completely numb. My dad is in rough shape for his age of 62. He's in pain all the time. He's had multiple hip, knee, and shoulder surgeries. He takes medication but some of it he just sucks it up. Tries to stay as active as he can. He tries to keep a positive outlook.

Metsman Metsman
Apr '19

In my life I have had a few major surgeries and broken bones. When I think back all I can say is thank God for opiates. I was lucky and never developed a dependence on them but they did the trick when I needed them. Unless they come up with a better method for extreme pain relief opiates are here to stay. We shouldn't make the people who need them pay the price for the people who abuse them. By people who abuse them I mean the people who drive the sales and over prescribe. There needs to be a solution to this epidemic but let's not lose our heads and cause suffering where it doesn't need to be.

Buster05 Buster05
Apr '19

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