The Opioid Epidemic

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Maddy
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The Opioid Epidemic

Post by Maddy » Tue Jun 06, 2017 4:13 pm

Quite a number of news articles have come out in recent weeks regarding the "opioid epidemic." As with most news these days, the reporters rarely bother to cover the "who, what, when, where, and why," leaving the reader to divine most of the essential facts. In this instance, one particular detail that seems to always get omitted is how it is that scheduled prescription drugs can be abused to any significant extent given (1) the need for a prescription and (2) the various external controls (inter-pharmacy computer networks, professional licensure boards, etc.) over the dispensing of narcotics.

Back when I was doing law, we had a client who had been caught forging prescriptions for narcotics. She had been getting away with it for years. Strange thing was, she didn't venture far from her own upscale neighborhood when filling her bogus scripts, and in one instance had filled something like 40 prescriptions at the very same pharmacy over a ridiculously short period of time. That was in the early '90s, but still. . .

Last year, when I visited a doctor for the first time in many years, I was surprised to learn that a prescription (any kind of prescription) is no longer written out on a little pad, but rather called in directly to the pharmacy. That appears to be the new way of doing things--pretty much everywhere, I'm told.

So you've got to wonder how people are even getting a hold of these drugs to which they're become addicted. It's hard to believe that there would be physicians and pharmacists stupid enough to risk their licenses for these people. If there are, what motivates them?

Just curious.
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Re: The Opioid Epidemic

Post by farjean2 » Thu Jun 08, 2017 10:35 pm

Maddy wrote:Last year, when I visited a doctor for the first time in many years, I was surprised to learn that a prescription (any kind of prescription) is no longer written out on a little pad, but rather called in directly to the pharmacy. That appears to be the new way of doing things--pretty much everywhere, I'm told.
I got a prescription for a synthetic opioid last month along with two others and the opioid prescription was the only one that couldn't be phoned in directly to the pharmacy. I had to hand carry it. I asked why and was told that's just the way it is.

Haven't tried them yet because I'm not in that much pain and I'm afraid I might get addicted if I do.
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Re: The Opioid Epidemic

Post by WiseOne » Fri Jun 09, 2017 7:38 am

Yes, electronic prescriptions are increasingly common. They're mandatory in New York and I assume other states will do the same. It makes centralized prescription tracking possible, so there's another piece of data about you being collected. The purpose, though, is to catch situations like what MangoMan described.

The "epidemic" idea is a bit overblown though. Opioids are great for acute pain situations and you shouldn't be afraid of using them for that, as needed. Addiction doesn't happen after just a few doses, unless you're talking about heroin. For chronic pain, almost any pain medication, opioid or not, is going to cause problems. Even taking NSAIDs chronically is a really bad idea. People end up with upper GI bleeding, kidney/liver damage, and rebound headaches among other issues. I spent a lot of my general neurology time getting people off medications with brutal side effects given in an attempt to deal with things like chronic back pain that should properly be addressed with lifestyle changes - and almost none of them were opiates.
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Re: The Opioid Epidemic

Post by clacy » Fri Jun 09, 2017 3:55 pm

Not unexpected. The CIA was heavily involved in Central/South America in the 80's and a huge cocaine epidemic ensues.

Now that we've been operating Afghanistan, oddly enough we have a huge opioid epidemic.

The CIA is the largest drug operator in the world for anyone that hasn't done research into it.
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Re: The Opioid Epidemic

Post by Maddy » Fri Jun 09, 2017 4:01 pm

WiseOne, is there some reason why opioids would be singled out for attention? [Edit: Clacy, I hadn't thought of that aspect.]

Around here, the drug of choice seems to be methamphetamine. You can spot 'em a mile away: Emaciated, bad skin, tucked into a hoodie, rattling around Walmart in flip-flops in the wee hours of the morning. You've got to wonder what the appeal is. They always look like they're about ready to crawl out of their skin.
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Re: The Opioid Epidemic

Post by Libertarian666 » Sat Jun 10, 2017 2:33 am

WiseOne wrote:Yes, electronic prescriptions are increasingly common. They're mandatory in New York and I assume other states will do the same. It makes centralized prescription tracking possible, so there's another piece of data about you being collected. The purpose, though, is to catch situations like what MangoMan described.

The "epidemic" idea is a bit overblown though. Opioids are great for acute pain situations and you shouldn't be afraid of using them for that, as needed. Addiction doesn't happen after just a few doses, unless you're talking about heroin. For chronic pain, almost any pain medication, opioid or not, is going to cause problems. Even taking NSAIDs chronically is a really bad idea. People end up with upper GI bleeding, kidney/liver damage, and rebound headaches among other issues. I spent a lot of my general neurology time getting people off medications with brutal side effects given in an attempt to deal with things like chronic back pain that should properly be addressed with lifestyle changes - and almost none of them were opiates.
Yes, NSAIDs are quite dangerous. The real crime is that the only pain medication that has no serious side-effects when used long-term is outlawed federally.
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Re: The Opioid Epidemic

Post by WiseOne » Sat Jun 10, 2017 7:42 am

Maddy wrote:WiseOne, is there some reason why opioids would be singled out for attention?
They're not. The term "narcotic" (or opioid) is still used correctly by the DEA, but state legislators and governors, nursing organizations, hospital administrators, journalists and others with more influence than pharmacology expertise use it loosely to describe anything on the DEA schedules. That includes everything from benzodiazepines to drugs that no one would ever be interested in for recreational use, but are listed because a couple of people checked the "euphoria" box in the clinical trials.

I think the problem is being pinned wrongly on the drugs. All drugs are useful in the correct setting- even cocaine has a legitimate medical use. The issue is that it's too easy for doctors to fall into the role of candy store supplier. Medicine has become a "the customer is always right" atmosphere, and when the customer wants a prescription, that's exactly what they get. Not to mention that it's about all you have time to do in a typical outpatient visit.
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Re: The Opioid Epidemic

Post by moda0306 » Sun Jun 11, 2017 8:12 am

MangoMan wrote:
Libertarian666 wrote:The real crime is that the only pain medication that has no serious side-effects when used long-term is outlawed federally.
Could you clarify what exactly you are referring to?
Marijuana.
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Re: The Opioid Epidemic

Post by Maddy » Sun Jun 11, 2017 1:41 pm

WiseOne wrote: The issue is that it's too easy for doctors to fall into the role of candy store supplier. Medicine has become a "the customer is always right" atmosphere, and when the customer wants a prescription, that's exactly what they get. Not to mention that it's about all you have time to do in a typical outpatient visit.
I know I owe you a "How the Practice of Law Has Changed" essay before I get the details on this one. Guess I'd better get on the stick. This time my procrastination has everything to do with the fact that I don't want to think about it.
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Re: The Opioid Epidemic

Post by Libertarian666 » Sun Jun 11, 2017 5:47 pm

moda0306 wrote:
MangoMan wrote:
Libertarian666 wrote:The real crime is that the only pain medication that has no serious side-effects when used long-term is outlawed federally.
Could you clarify what exactly you are referring to?
Marijuana.
Yep. I thought everyone knew that, but I guess not. :P
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Re: The Opioid Epidemic

Post by farjean2 » Sun Jun 11, 2017 6:30 pm

Maddy wrote:
WiseOne wrote: The issue is that it's too easy for doctors to fall into the role of candy store supplier. Medicine has become a "the customer is always right" atmosphere, and when the customer wants a prescription, that's exactly what they get. Not to mention that it's about all you have time to do in a typical outpatient visit.
This is very true. My opioid prescription came from a group of doctors calling themselves the " ? Spine Institute" (substitute name of my home state for ?). When I called to make the appointment I was asked if I wanted to see a doctor specializing in "pain management" or some other kind of doctor. I thought to myself WTF and said I just wanted to see a doctor who could help me with my neck and back pain. I like the doctor I was assigned to but he asked me on the first visit if I wanted to try a strong painkiller and I said yes. All those opioid pills are still in the bottle, reserved for when I actually might need them.

In the meantime I've had two EMG's and an MRI ($$$) - bulging disks in my spine and ulnar nerve entrapment in both arms, not to mention that I broke my tailbone at same time according to X-Rays, unbeknownst to me.

Despite describing opioids on my first visit, the doctor does seem to prefer conservative approaches. He prescribed physical therapy and I had several sessions wherein I was taught something called "myofascial" release. I've been working at it but not yet convinced of any benefit.

The bottom line is that every time I visit the "? Spine Institute" they want to hear that it's working and that I'm getting better and aren't happy if I state otherwise. I have no doubt they will eventually write me a prescription for whatever kind of legal painkillers I want as long as all other treatment options have been explored ($$$).

Is there such a thing as a double placebo effect?

Any way, I used up all of our spending account getting the diagnosis so don't have anything left for the treatment until next year unless I pay it out of pocket. Which I'm probably not going to do.
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Re: The Opioid Epidemic

Post by Maddy » Sun Jun 11, 2017 6:43 pm

farjean2 wrote:The bottom line is that every time I visit the "? Spine Institute" they want to hear that it's working and that I'm getting better and aren't happy if I state otherwise.
Sounds suspiciously like an outcome-based reimbursement scheme. I guess if you're a bean counter, a patient who stays at home stoned out of his gourd, rather than utilizing additional services, is a grand success.
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Re: The Opioid Epidemic

Post by farjean2 » Sun Jun 11, 2017 6:56 pm

Libertarian666 wrote:
moda0306 wrote:
MangoMan wrote: Could you clarify what exactly you are referring to?
Marijuana.
Yep. I thought everyone knew that, but I guess not. :P
I owe my life to marijuana. I was looking for the best way to commit suicide when I was in Vietnam when somebody turned me on to it.
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Re: The Opioid Epidemic

Post by Libertarian666 » Sun Jun 11, 2017 8:08 pm

farjean2 wrote:
Libertarian666 wrote:
moda0306 wrote:
Marijuana.
Yep. I thought everyone knew that, but I guess not. :P
I owe my life to marijuana. I was looking for the best way to commit suicide when I was in Vietnam when somebody turned me on to it.
Well, pot is the worst way to commit suicide, so I guess you never got what you were looking for. :P
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Re: The Opioid Epidemic

Post by Maddy » Sun Jun 11, 2017 8:19 pm

Just curious, Farjean, what exactly did marijuana do for you? I would have assumed that a depressed state would simply be made worse by something that loosens your thinking and gets you rolling around inside your own head.
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Re: The Opioid Epidemic

Post by Libertarian666 » Sun Jun 11, 2017 9:40 pm

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Re: The Opioid Epidemic

Post by Libertarian666 » Mon Jun 12, 2017 9:03 am

Desert wrote:
farjean2 wrote: I owe my life to marijuana. I was looking for the best way to commit suicide when I was in Vietnam when somebody turned me on to it.
Wow. That's a pretty amazing statement.

By the way, it sounds as if ingesting, rather than smoking, is the preferred administration method these days ... is that true?
Vaping is probably the most controllable and safest method. Ingesting can be tricky for relative newbies who don't know how much they actually want or need.
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Re: The Opioid Epidemic

Post by farjean2 » Thu Jun 15, 2017 8:09 pm

Maddy wrote:Just curious, Farjean, what exactly did marijuana do for you? I would have assumed that a depressed state would simply be made worse by something that loosens your thinking and gets you rolling around inside your own head.
I wouldn't say that I was depressed. Traumatized is more like it.

It puts you in a detached state of mind and everything just seems to slow down for me. I've never had the opportunity to use it for pain but I doubt that it actually relieves the pain like other medicines do. It's probably like "I have pain in my right arm. Oh that's really cool. Look at those clouds".
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Re: The Opioid Epidemic

Post by Libertarian666 » Thu Jun 15, 2017 8:21 pm

farjean2 wrote:
Maddy wrote:Just curious, Farjean, what exactly did marijuana do for you? I would have assumed that a depressed state would simply be made worse by something that loosens your thinking and gets you rolling around inside your own head.
I wouldn't say that I was depressed. Traumatized is more like it.

It puts you in a detached state of mind and everything just seems to slow down for me. I've never had the opportunity to use it for pain but I doubt that it actually relieves the pain like other medicines do. It's probably like "I have pain in my right arm. Oh that's really cool. Look at those clouds".
Correct. It makes pain more interesting and less painful, if that makes any sense.
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Re: The Opioid Epidemic

Post by Maddy » Thu Jun 15, 2017 8:32 pm

I know some of you are going to snicker when I confess that I listen to Coast to Coast. (Many nights, it's the only thing that puts me to sleep, and George Noory has aired some pretty intriguing interviews of geopolitical figures lately.) Anyway, I noticed this preview of tonight's show (Thursday, June 15), which could turn out to be interesting:
Investigative journalist Cathryn Jakobson Ramin suffered back pain for decades and spent a small fortune on a panoply of treatments. When her discomfort only intensified, she searched for better solutions and eventually exposed a much bigger problem. She'll reveal how a $100 billion-a-year industry, spine medicine, is often ineffective and sometimes harmful and exemplifies the worst aspects of the US health care system. Followed by Open Lines in the latter half.

http://www.coasttocoastam.com/
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Re: The Opioid Epidemic

Post by Maddy » Fri Jun 16, 2017 9:36 am

Maddy wrote:I know some of you are going to snicker when I confess that I listen to Coast to Coast. (Many nights, it's the only thing that puts me to sleep, and George Noory has aired some pretty intriguing interviews of geopolitical figures lately.) Anyway, I noticed this preview of tonight's show (Thursday, June 15), which could turn out to be interesting:
Investigative journalist Cathryn Jakobson Ramin suffered back pain for decades and spent a small fortune on a panoply of treatments. When her discomfort only intensified, she searched for better solutions and eventually exposed a much bigger problem. She'll reveal how a $100 billion-a-year industry, spine medicine, is often ineffective and sometimes harmful and exemplifies the worst aspects of the US health care system. Followed by Open Lines in the latter half.

http://www.coasttocoastam.com/
Total waste of time.
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Re: The Opioid Epidemic

Post by WiseOne » Fri Jun 16, 2017 8:19 pm

Ya, back pain is one of those things that make surgeons wealthy and drive everyone else nuts. In most cases, it's a lifestyle issue. Bulging discs etc that get detected by back MRIs are just as common in people without back pain as with back pain, i.e. they're most likely unrelated.

The problem is that if you have back pain I won't tell you not to see a physician about it - because there are several serious things that can manifest as back pain. But for sure do not go anywhere with the label of "Spine Center". That's like going to a barber and asking if you need a haircut. Go to a good, competent general neurologist.
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Re: The Opioid Epidemic

Post by farjean2 » Sat Jun 17, 2017 12:46 am

WiseOne wrote: But for sure do not go anywhere with the label of "Spine Center".
Geesh, I wish you had posted this before I made an appointment with the "Florida Spine Institute". With an MRI, two EMG's, and a session with an electrical stimulation machine called a BioWave they used up all the money for the year in our spending account on the diagnosis and now there's nothing left for any kind of treatment unless I pay for it myself.

Ultimately they decided that all I needed for now was physical therapy and after a few sessions I'm pretty well convinced that this is another medical scam. For the "manipulation" part I think you could just get a simple massage and it would be just as effective. And then there was the "exercise specialist" who taught me something called "myofascial release". It consists of pressing tennis balls against my pectoral muscles to release "trigger points" to help with my neck pain. Based on what I read online the science behind this is questionable but I'm still doing it even though I'm not sure it's doing me any good beyond a placebo effect.

One of the EMG's that cost over $500 apiece did reveal that I have something called "cubital tunnel syndrome" which I had never heard of but I wasn't surprised since my arm and elbow have been hurting like hell and I read a website where it was called "The Programmer's Nightmare". As for how to treat it, the physical therapist had never heard of it so I went on Youtube and found lots of suggestions for what to do and the exercises seem to be working.
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Re: The Opioid Epidemic

Post by farjean2 » Sat Jun 17, 2017 1:13 am

Desert wrote:
farjean2 wrote: I owe my life to marijuana. I was looking for the best way to commit suicide when I was in Vietnam when somebody turned me on to it.
Wow. That's a pretty amazing statement.
And it's absolutely true. If it wasn't for marijuana I really don't think I would be alive today.

(And BTW, "Last Dance with Mary Jane" by Tom Petty is my favorite song of all time - https://www.youtube.com/watch?v=aowSGxim_O8. I wonder how many of you get the reference to the "Indiana Boys".)
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Re: The Opioid Epidemic

Post by WiseOne » Sat Jun 17, 2017 7:40 am

farjean2 wrote:
WiseOne wrote:And then there was the "exercise specialist" who taught me something called "myofascial release". It consists of pressing tennis balls against my pectoral muscles to release "trigger points" to help with my neck pain.
Use cold apples instead of tennis balls - even better! I did this for a couple of years after I injured my shoulder trying to open a stuck window. I went through the whole physical therapy rigmarole which did nothing, except annoy me because they guy tried to blame the injury on my cell phone use. After two years of constant pain and quite a bit of time combing the literature, I hit on a very simple solution that applies only to women - message me if you want to hear about it. The pain went away and I've not been bothered since. And I'm still using cell phones :-)

Which is to say, for most of these things figuring it out for yourself is the best and likely only solution. Also, a really good massage or physical therapist can sometimes give you very useful info (not the one I went to unfortunately).
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