Oxycontin

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Oxycontin

Post by dualstow » Tue Jan 29, 2019 6:39 am

Jackson and Moda, if you want to get worked up about something, read the story of the Sackler family, the robber barons of Oxycontin. https://www.newyorker.com/magazine/2017 ... re-of-pain
Truly appalling.
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Re: Trump as tragicomedy

Post by WiseOne » Tue Jan 29, 2019 11:34 am

Fascinating article - thanks for posting!

As per usual though, there's an agenda here. Definitely pharmaceutical companies advertising tactics, influence on medical literature and research, and the revolving door with the FDA has played its part. I'd like nothing better than to see this reined in. I think the bigger problem, though, is that doctors have had progressively less and less time to spend with patients. This all got much worse under Obama...it's now about billing, ticking off checkboxes, etc, with maybe 30 seconds to spare for actual patients per visit. And we get rated now, so we have to make the customer - ahem, patient - happy. How do you that? Write a prescription of course!

In other words, if you address the problems outlined in the article, you may reduce opioid overdose deaths and addition somewhat, but I suspect you won't solve the problem. There are other factors too btw...like the "Doctor Google" and doctor shopping phenomenon, and ever increasing rates of psychiatric illness (which most of these prescriptions are written for). Sadly, I have a family member who is a poster child for exactly this, and I know it's not going to end well.
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Re: Trump as tragicomedy

Post by Kriegsspiel » Tue Jan 29, 2019 11:49 am

The 2019 Medscape survey confirms.

Image

Burnout defined as long term, unresolvable job stress that leads to exhaustion and feeling overwhelmed, cynical, detached from the job, and lacking a sense of personal accomplishment.

Image

Thread split?
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Re: Trump as tragicomedy

Post by dualstow » Tue Jan 29, 2019 12:20 pm

I hear you, WiseOne.

And yes, this would make a good thread of its own. My fault for derailing.
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Re: Oxycontin

Post by Xan » Tue Jan 29, 2019 1:26 pm

I've split off the new discussion.
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Re: Oxycontin

Post by Mountaineer » Tue Jan 29, 2019 3:14 pm

At the risk of derailing this new thread I offer that for Christians the subject of burnout (i.e. allowing yourself to become burned out) is not at the top of the list of things to think about. When one keeps focus on Jesus and His promises, temporal issues are much more manageable because of the hope that is within us. Hope, a big word with even bigger comforting results. Seriously.

1 Peter 3:13 Now who is there to harm you if you are zealous for what is good? 14 But even if you should suffer for righteousness' sake, you will be blessed. Have no fear of them, nor be troubled, 15 but in your hearts honor Christ the Lord as holy, always being prepared to make a defense to anyone who asks you for a reason for the hope that is in you; yet do it with gentleness and respect, 16 having a good conscience, so that, when you are slandered, those who revile your good behavior in Christ may be put to shame. 17 For it is better to suffer for doing good, if that should be God's will, than for doing evil.
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Re: Oxycontin

Post by ochotona » Tue Jan 29, 2019 3:15 pm

I had shoulder surgery in December, too much Aikido I suppose, and I found Oxycontin to be a rough and revolting drug with terrible side-effects. I never had an issue with codeine (Tylenol 3).
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Re: Oxycontin

Post by jacksonM » Tue Jan 29, 2019 4:28 pm

I think this spin-off thread is confusing two different stories in the news - one about Oxycontin and another about physician burnout.

And of course there is Mountaineer telling us that Jesus is the answer to everything if you want a three-way circus.
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Re: Oxycontin

Post by dualstow » Tue Jan 29, 2019 6:40 pm

jacksonM wrote:
Tue Jan 29, 2019 4:28 pm
I think this spin-off thread is confusing two different stories in the news - one about Oxycontin and another about physician burnout.
If burned out physicians are cynical about their work, they are probably more easily influenced by the marketers at Purdue Pharma.
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Re: Oxycontin

Post by Mountaineer » Tue Jan 29, 2019 6:46 pm

MangoMan wrote:
Tue Jan 29, 2019 5:24 pm
jacksonM wrote:
Tue Jan 29, 2019 4:28 pm
And of course there is Mountaineer telling us that Jesus is the answer to everything if you want a three-way circus.
+1
Mountaineer, please keep the religious diatribes to the religion thread. Thanks
Pug, with all due respect, and I mean that seriously because I enjoy your posts and insights, I think if you examine your request you will see the ill-logic and "conversation shutdown" aspects of it. Asking someone to not discuss something that they think is important just because another does not hold the same value for the subject (i.e. religion) is in my humble opinion very short sighted although typical of our increasingly divided nation. It is like asking someone to never mention gold outside of the Gold Forum, or asking a democrat never to mention the word democrat because it might offend a republican - or vice versa. Thus, I hear what you are asking, and I generally try to hold religion comments to the religion thread, but in this specific case, I think Christianity is a likely valuable solution to the burnout problem, and probablty the oxy problem - I fully understand that non-believers cannot see that and they have their own ideas. I also do not try to to have posts banned to some other thread just because it offends me. If I see something I don't like, I just move on to those posts I enjoy and do not try to take a specific and generalize it to shut down the conversation. If Xan wishes to ban me from the forum, so be it for speaking up, but I think one huge problem with our country is failure of the church to take a stand on issues and speak up when it needs to. Our country is in a huge mess, e.g. abortion of 61,000,000 human beings since Roe vs. Wade, and personally think a significant factor is people spending far too much time caring about themselves instead of caring for their friends and neighbors and other humans in general including the unborn. Obviously, I'm not accusing you of that as I don't know you other than through your posts. I do think you are quite smart. That is why I started my post the way I did. I doubt you want to be perceived as joining the lemmings of hating all things Christian and loving all things secular (or Buddhist or Muslim) while persecuting the Christians as my post of 1 Peter 3 indicates is completely expected for those who stand up for their belief in Christ, that He intersected time and space to provide the solution to the problem that man is incapable of solving on his own. Peace be with you, you are forgiven.
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Re: Oxycontin

Post by Kriegsspiel » Tue Jan 29, 2019 8:41 pm

dualstow wrote:
Tue Jan 29, 2019 6:40 pm
jacksonM wrote:
Tue Jan 29, 2019 4:28 pm
I think this spin-off thread is confusing two different stories in the news - one about Oxycontin and another about physician burnout.
If burned out physicians are cynical about their work, they are probably more easily influenced by the marketers at Purdue Pharma.
Right. I originally went back to that link (I had it open in another tab) was because WiseOne mentioned less time to deal with patients and I thought that was an interesting topic alongside the opiod one. But the slide that probably relates to the oxycontin overprescribing is this one:

Image

Of the 15% of doctors that are depressed, 91% say they do things that could reasonably lead to them overprescribing opiods.
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Re: Oxycontin

Post by jacksonM » Wed Jan 30, 2019 11:50 am

ochotona wrote:
Tue Jan 29, 2019 3:15 pm
I had shoulder surgery in December, too much Aikido I suppose, and I found Oxycontin to be a rough and revolting drug with terrible side-effects. I never had an issue with codeine (Tylenol 3).
Back to the original topic, I've never used Oxycontin but I had a doctor prescribe Tramadol for back pain which is another synthetic opioid drug. The bottle is still sitting unused on a shelf, not because of any bad reaction but because it didn't do anything at all, at least as far as I could tell. Maybe they gave me a placebo. Personally I prefer smoking pot. I think there is some evidence that there are fewer deaths from opioid addiction in places where it has been legalized.
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Re: Oxycontin

Post by ochotona » Wed Jan 30, 2019 12:01 pm

jacksonM wrote:
Wed Jan 30, 2019 11:50 am
ochotona wrote:
Tue Jan 29, 2019 3:15 pm
I had shoulder surgery in December, too much Aikido I suppose, and I found Oxycontin to be a rough and revolting drug with terrible side-effects. I never had an issue with codeine (Tylenol 3).
Back to the original topic, I've never used Oxycontin but I had a doctor prescribe Tramadol for back pain which is another synthetic opioid drug. The bottle is still sitting unused on a shelf, not because of any bad reaction but because it didn't do anything at all, at least as far as I could tell. Maybe they gave me a placebo. Personally I prefer smoking pot. I think there is some evidence that there are fewer deaths from opioid addiction in places where it has been legalized.
Oxy didn't relieve my pain either, and it made me sick.
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Re: Oxycontin

Post by dualstow » Wed Jan 30, 2019 3:04 pm

Interesting, I've never taken it. Dentist gave me endocet after wisdom tooth extraction and it was fantas- I mean, it worked. I can see why people get hooked on those, and hopefully I'll never have the need to take one again.
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Re: Oxycontin

Post by Kriegsspiel » Wed Jan 30, 2019 4:05 pm

I got some codeine after I had my appendix removed. It was alright. Nothing to get addicted over.
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Re: Oxycontin

Post by jacksonM » Wed Jan 30, 2019 4:44 pm

PBS recently did a documentary on opioid addiction. One thing it showed was that when someone checks into a hospital for a heart attack they are treated and then referred to specialists for further treatment. If you overdose on opioids you are treated and then, if you manage to survive, you are discharged and then left to fend for yourself.

Also, it showed that there is encouraging treatment available but it's hard to get.

Until we start treating it as a medical condition instead of a crime to be punished I think all the talk of solving the problem will be just as meaningless and unsuccessful as the rest of the "war on drugs" has been.
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Re: Oxycontin

Post by Libertarian666 » Wed Jan 30, 2019 4:55 pm

The war on drugs is over.
Drugs won.

Time to declare defeat and get out.
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Re: Oxycontin

Post by jacksonM » Wed Jan 30, 2019 4:57 pm

Libertarian666 wrote:
Wed Jan 30, 2019 4:55 pm
The war on drugs is over.
Drugs won.

Time to declare defeat and get out.
Amen!
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Re: Oxycontin

Post by Kriegsspiel » Wed Jan 30, 2019 5:11 pm

A witness has testified that an ex-stripper-turned-drug company executive gave a doctor a lap dance as part of a sales pitch for an addictive fentanyl spray.

Holly Brown, a former sales representative at Insys Therapeutics, said in federal court on Tuesday that her then-boss, Sunrise Lee, had been rewarding the Illinois doctor, identified as Paul Madison, who received the alleged dance for prescribing the powerful product to patients and paying him to speak at events, Reuters reported. link
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Re: Oxycontin

Post by Xan » Wed Jan 30, 2019 6:28 pm

jacksonM wrote:
Wed Jan 30, 2019 4:44 pm
PBS recently did a documentary on opioid addiction. One thing it showed was that when someone checks into a hospital for a heart attack they are treated and then referred to specialists for further treatment. If you overdose on opioids you are treated and then, if you manage to survive, you are discharged and then left to fend for yourself.

Also, it showed that there is encouraging treatment available but it's hard to get.

Until we start treating it as a medical condition instead of a crime to be punished I think all the talk of solving the problem will be just as meaningless and unsuccessful as the rest of the "war on drugs" has been.
That was a fascinating documentary and I highly recommend it. Very scary stuff.
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Re: Oxycontin

Post by WiseOne » Thu Jan 31, 2019 8:04 am

jacksonM wrote:
Wed Jan 30, 2019 4:44 pm
PBS recently did a documentary on opioid addiction. One thing it showed was that when someone checks into a hospital for a heart attack they are treated and then referred to specialists for further treatment. If you overdose on opioids you are treated and then, if you manage to survive, you are discharged and then left to fend for yourself.
That should not ever be true. I suspect that it's a case of something treated in the emergency department that's supposed to be followed up by a primary care physician, except we all know what the barriers are there. Also, there is no mechanism for an emergency MD or dept to follow up with the patient to make sure the care transition took place.

It's the kind of stuff that's happening more and more in our dysfunctional medical system. Followup appointments pay squat and barely break even with expenses (due to high overhead more than low fees), if that. New patient appointments and procedures is how an office practice makes money. If you don't have either of those to offer, you're basically a drag on the practice. There are trends now to shift most followups to telemedicine calls or to clinics run by nurse practitioners, both of which help reduce costs and will hopefully at least partially address the problem.
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Re: Oxycontin

Post by sweetbthescrivener » Thu Jan 31, 2019 2:11 pm

I had a somewhat hellacious fall in December of last year, but no broken bones, very limited movement in my arm, and tons of pain if I moved it out of a very narrow window of motion.

I could handle the pain and was mostly relieved nothing was broken, though it was hard to find a a good sleeping position so I asked the emergency room doc if I could have some higher dose ibuprofen in case I needed it.

She came in after the X Rays, said nothing was broken and left, and the nurse told me the doctor had prescribed 5 days of Hydrocodone for me, which seemed odd at the time, and made me wonder if it was just what they did automatically for pain.

With the opioid crisis so much in the news, I was both relieved about pain relief and feeling some trepidation at all the stories we hear all the time.

But I figured ten pills couldn't get me in trouble so I took them before bed or if I was getting a bunch of pain during the day.

What I noticed on the first day was that they didn't really make the pain go away, they just made me feel pretty good until they wore off. It wasn't the messy pretty good feeling of having some drinks, it was a very clean but weird feeling. I guess I can say it felt medicinal or chemical, and unnatural.

It was kind of like a first cigarette, where the good feeling was weighed against the chemical/unnatural feeling (Hard to describe. Like the difference between taking mushrooms and taking LSD. The pain pills felt somehow accelerated or unnatural, like LSD rather than the mellower mushrooms) and then there was a letdown phase of poor energy when the effects faded, so, like that first cigarette, there were positives and negatives, but no real reason to continue.

Taking it a few nights in a row, it was a comfort to know that I could roll on my side in the middle of the night without waking up feeling like Charles Barkley had hauled off and given me a charley horse in the middle of the night.

Took them for most of the early days too though, and what started off as weird was normal pretty soon, and ultimately, who wouldn't want a pill that side stepped anxiety, depression, worry and just made you feel 'all right' without any observable loss of cognition or motor skills?

(Unless like a lot of us, you are also aware of tolerance and declining potency of the drug, not to mention physical dependence. Besides those two, it was a pretty spiffy little pill to take, and it is not surprising that people, especially the frustrated or depressed, take to it pretty quickly.)

My experiment ended after 7 days and to be honest, I missed it on the 8th and 9th day, and if someone had offered me one, I would at very least been tempted to toss it down my throat.

An enlightening and a little scary experiment all things considered. Talked about it with my therapist and he said that for some people, five days, ten pills that is, is enough to get them hooked and he has seen it in his own practice.

Despite the fact that on the 8th day, another little pill was a mild temptation, the mental image of becoming a burglar and fencing hot tvs and computers in exchange for pills was a much more vivid and stark image, and ultimately it was no contest.

Still, it made me understand and have some compassion for people who get sucked into this life, and that aspect was at least worthwhile, although next time I will insist on the ibuprofen or nothing at all.

I found it very odd that the emergency doc automatically prescribed it when I had asked for something else and that all she and the pharmacist seemed concerned about was that I wouldn't operate heavy machinery.

Cool if you get addicted, but not if you are stocking Amazon shelves.

Man, I wonder how many pills I could have got if I had jacked a forklift and gave it to the dude on the corner.
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Re: Oxycontin

Post by Libertarian666 » Thu Jan 31, 2019 3:06 pm

sweetbthescrivener wrote:
Thu Jan 31, 2019 2:11 pm
I had a somewhat hellacious fall in December of last year, but no broken bones, very limited movement in my arm, and tons of pain if I moved it out of a very narrow window of motion.

I could handle the pain and was mostly relieved nothing was broken, though it was hard to find a a good sleeping position so I asked the emergency room doc if I could have some higher dose ibuprofen in case I needed it.

She came in after the X Rays, said nothing was broken and left, and the nurse told me the doctor had prescribed 5 days of Hydrocodone for me, which seemed odd at the time, and made me wonder if it was just what they did automatically for pain.

With the opioid crisis so much in the news, I was both relieved about pain relief and feeling some trepidation at all the stories we hear all the time.

But I figured ten pills couldn't get me in trouble so I took them before bed or if I was getting a bunch of pain during the day.

What I noticed on the first day was that they didn't really make the pain go away, they just made me feel pretty good until they wore off. It wasn't the messy pretty good feeling of having some drinks, it was a very clean but weird feeling. I guess I can say it felt medicinal or chemical, and unnatural.

It was kind of like a first cigarette, where the good feeling was weighed against the chemical/unnatural feeling (Hard to describe. Like the difference between taking mushrooms and taking LSD. The pain pills felt somehow accelerated or unnatural, like LSD rather than the mellower mushrooms) and then there was a letdown phase of poor energy when the effects faded, so, like that first cigarette, there were positives and negatives, but no real reason to continue.

Taking it a few nights in a row, it was a comfort to know that I could roll on my side in the middle of the night without waking up feeling like Charles Barkley had hauled off and given me a charley horse in the middle of the night.

Took them for most of the early days too though, and what started off as weird was normal pretty soon, and ultimately, who wouldn't want a pill that side stepped anxiety, depression, worry and just made you feel 'all right' without any observable loss of cognition or motor skills?

(Unless like a lot of us, you are also aware of tolerance and declining potency of the drug, not to mention physical dependence. Besides those two, it was a pretty spiffy little pill to take, and it is not surprising that people, especially the frustrated or depressed, take to it pretty quickly.)

My experiment ended after 7 days and to be honest, I missed it on the 8th and 9th day, and if someone had offered me one, I would at very least been tempted to toss it down my throat.

An enlightening and a little scary experiment all things considered. Talked about it with my therapist and he said that for some people, five days, ten pills that is, is enough to get them hooked and he has seen it in his own practice.

Despite the fact that on the 8th day, another little pill was a mild temptation, the mental image of becoming a burglar and fencing hot tvs and computers in exchange for pills was a much more vivid and stark image, and ultimately it was no contest.

Still, it made me understand and have some compassion for people who get sucked into this life, and that aspect was at least worthwhile, although next time I will insist on the ibuprofen or nothing at all.

I found it very odd that the emergency doc automatically prescribed it when I had asked for something else and that all she and the pharmacist seemed concerned about was that I wouldn't operate heavy machinery.

Cool if you get addicted, but not if you are stocking Amazon shelves.

Man, I wonder how many pills I could have got if I had jacked a forklift and gave it to the dude on the corner.
I have been prescribed hydrocodone a number of times and have taken it as needed. I haven't felt any desire to continue after the pain was more tolerable.

I don't seem to be an addiction-prone type, but of course I know I'm not necessarily representative of the general public.
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Re: Oxycontin

Post by jacksonM » Thu Jan 31, 2019 6:29 pm

I see some evidence of an addictive personality in myself. When I find a song I really like I will sometimes find myself playing it over and over again to keep the feeling going. Also, I have a hard time keeping a six-pack of beer in the refrigerator with the intention of having it last for several days. It's almost always gone the same night. I also posted something along these lines over on the religion thread.

I think this is probably different than people dealing with serious addiction problems however. That PBS documentary showed me that to them it's not so much enjoying the high as it is needing it. Most of them had low levels of dopamine to begin with so it becomes a choice between feeling good or feeling horrible all the time. I've never had a long lasting episode of depression but I've felt it enough on occasion, as we probably all have, to understand what they are probably dealing with.
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Re: Oxycontin

Post by boglerdude » Fri Feb 01, 2019 12:38 am

Low dopamine folks will do anything to feel normal/good and you cant "blame" them. Drugs, gambling...most of society's bad behaviors
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