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Here's the scuttlebutt I have heard on this question: the government paid Big Pharma off big time for not fighting them on the opioids. In exchange it would allow them to hold onto patents on profitable meds longer thus blocking generics, allow them to raise costs on their existing meds essentially as much as the market would bear, and promising them the gov't would never introduce price controls similar to what Europe and other nations have.
If thats accurate, that is absolutely amazing what the Govt was willing to do for them in exchange for the crackdown...all I can say is, the major drug cartels must have some serious ( and I mean SERIOUS) dirt on them and/or a whole lot of power! Since they have cracked down on opioid prescriptions, heroin use has skyrocketed, never before have we seen as many ODs and deaths...of course this benefits the cartels immensely.
Personally I do not see how they can keep the ENTIRE country fully supplied, enough for there to be epidemics in numerous cities, this would be tough for a legitimate company with a legal product! They must have 100s of 1000s of acres of poppies, and HUGE number of employees, this is something that is just not possible without some degree of cooperation/ collusion between US Govt and cartels.
If thats accurate, that is absolutely amazing what the Govt was willing to do for them in exchange for the crackdown...all I can say is, the major drug cartels must have some serious ( and I mean SERIOUS) dirt on them and/or a whole lot of power! Since they have cracked down on opioid prescriptions, heroin use has skyrocketed, never before have we seen as many ODs and deaths...of course this benefits the cartels immensely.
Personally I do not see how they can keep the ENTIRE country fully supplied, enough for there to be epidemics in numerous cities, this would be tough for a legitimate company with a legal product! They must have 100s of 1000s of acres of poppies, and HUGE number of employees, this is something that is just not possible without some degree of cooperation/ collusion between US Govt and cartels.
You make a lot of good points, rstevens. Here's what I have read: first of all this elimination of painkillers from the market simply is not for the purpose of saving the lives of a few useless junkie kids. The FDA couldn't care less about them. They do have a little concern about the fact the idiot news agencies like NBC are pumping this issue for ratings and causing a controversy.
So that leaves several possible suspects: the drug companies themselves receiving massive benefits from the FDA to forget about opioids and making up the losses on their other inventories. Or the prison industrial complex making huge donations to get legal opioids illegalized so more people will be sentenced to prison for buying heroin thus driving up stock in the PIC and making Wall Street and the economy happy. Or the heroin lords who maybe made big donations and are now making money hand over fist from a 100,000% rise in heroin use. Or the Drug Rehabilitation complex which is making huge profits from a flood of new patients cut off by their doctors from legal opioids. Or Medicare/SS which will be saving huge amounts of money as more and more old people in chronic unbearable pain commit suicide to escape it. Or the alcohol industry whose legal product kills 5 times the number of addicts on opioids who are seeing sales of their liquor skyrocket as more and more people who cannot get pain meds turn to alcohol to numb their pain and then die of liver disease.
On the downside chronic pain, alcohol, drug rehabilitation, prison, cost the economy a trillion dollars in medical costs and productivity so the profits in banning legal painkillers must be HUGE.
Here's a tragic story about Montana Dr. Mark Ibsen who was forced by the DEA to shut down his practice. I've read dozens of similar ones of pain doctors threatened by the FDA with loss of license and prison if they keep prescribing painkillers.
Quote:
In 2014, Ibsen said a DEA agent told him: “You are not only risking your license by prescribing to these folks, you are risking your freedom.”
Ibsen said he asked the agent what he could do to ensure that he was doing things right.
He said the agent replied: “I can’t tell you. We’re not doctors.”
After hearing about the charges against Christensen and reading a story from Florida where authorities are seeking the death penalty against a physician in a similar case, Ibsen said it was “too dangerous” for him to continue in this regulatory climate.
“That was pretty much it for me,” he said. “These guys are not going to stop.”
So anyway, folks, that's all I have to say on the matter. I have no proof of any of this. It's just what I read on other websites. Good luck to you folks in chronic pain. We're going to need it.
I have had and do have an opioid Rx for chronic pain, with never any issue re filling a prescription. No one has said anything at all about any planned changes, none are expected.
My provider office has that sign on the door but they are warning drug abusers they don't play their game. Once they established the accuracy of my situation, they have been happy to prescribe for me.
BTW...as a med professional, I assure you no MD would "push" a pt off pain meds without a decreasing dose in increments where the pt would NOT be subject to withdrawal symptoms.
Then you are lucky. I have been fortunate for the past year or so (at CVS no less... see link below) but I have had the worst trouble when forced to change pharmacies. If one shuts down, or your insurance changes, you can be forced to go to another one.
Like I said in my previous post. The DEA already has a policy in place limiting pharmacies to a set amount of pain medication. That means that when they suddenly receive a patient that is taking a larger prescription of opiates, they will deny it. I have talked to at length to several chief pharmacists that were very humane and simply didn't have the supply given their current monthly limit to take on another high dose opiate patient
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Originally Posted by rruff
Control or self discipline? I don't think that's the problem. People are different. When it comes to strong chemical triggers like opiates, I don't think you can blame the person for being susceptible.
I fortunately don't get addicted to stuff; it just doesn't happen. It isn't because I have "control or discipline", it's just how I am. It's not a struggle. I also don't have a problem experiencing pain. Its just a sensation, not a big deal. I don't have issues with feeling anything. It's all fine with me. Let it in and let it go. But for most people it isn't that simple.
This is probably one of the worst misconceptions out there about opiates. The word "addicted" is misused both by the public but by doctors (many of which don't understand the difference either).
If you take opiates long enough you will form some sort of physical dependence on the drug. Everyone. However, the symptoms do completely depend on several variables including genetics, the type of opiate, the dose, the duration, how much pain they are truly in, other prescriptions they are taking, etc.
Addiction is a behavioral issue seeking pleasure or using drugs to cope with issues not requiring the medication. It's characterized by the not being able to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response.
Quote:
Originally Posted by Annie1004
I have probably taken a thousand Vicodins over the past 20 years (kidney stones and dental work), and have never been addicted nor abused the meds. I found them hard on the stomach and would only take if needed. Frankly, Vicodin barely touched the pain, especially kidney stones and their treatment.
As far as Level 10 pain, I trot myself to the ER where I receive intravenous pain medication.
It's a shame that so many have abused opioids in epidemic proportions because their actions have ruined it for those of us who take the drug as directed. I have always been aware that pain killers are addictive, so do not blame the doctors (except for pill mills). Patients need to take responsibility for their actions.
Quote:
Originally Posted by thrillobyte
How will this latest move affect legitimate pain patients who never abused their medications?
Likely all major pharmacy chains will follow suit. Starting Feb 2018 if you carry a script into a CVS pharmacy for more than a 7-day supply the pharmacy will either reject it outright or, if you're lucky, agree to fill the 7-days. On the report they had a guy with a sob story who started with a prescription for an injury and then turned to heroin. He gushes, "Thank God I found my way out. These dangerous substances should be banned." We have no idea whether he's referring to heroin or prescription opioids but naturally NBC as usual didn't bother to address this aspect, just lumped heroin in with all opioiod painkillers. They end the report with a statistic intended to raise eyebrows: that in 2015 opioid prescriptions were written for 71 of every 100 people in America--nothing about how in 2017 prescriptions for painkillers have been cut to near zero, or the tens of thousands of people trapped further in their suffering or how 20,000 people committed suicide from not being able to get anything for their intractable pain last year. Obviously yellow journalism from NBC. I'm telling you, folks, the FDA's intent is to make opioids obsolete in America.
Thank you for posting this link. I cried and then almost threw up when reading this. There are many diseases and injuries that are just as painful and more painful than many cancer patients.
Quote:
Originally Posted by elnina
Y
Opioids are highly addictive. Patients constantly taking them for long period of time WILL become addicts and they will seek higher dosage because their body get used to it.
Seven days prescription is adequate for a start, then each patient case should be careful evaluated for other options first.
That's the plan.
Note: lots of patients take powerful pain medications for pain that doesn't require those.
Narcotics are prescribed just about to everyone who says: it hurts....
Doctors should find and try to cure the cause and not just go the easy way and prescribe pain meds, as they often do.
The prescription of powerful painkillers has to be evaluated and controlled in a more effective way.
Quote:
Originally Posted by elnina
Sorry to correct you, but I actually know more than "people not in the loop". I have postgraduate medical education and I WORK in that field.
No, Seven days is completely arbitrary and has no rational medical science behind it. It is a one size fits all solution so that a person running a cash register with little or no training can enforce it. It is punishing the people in pain for the actions of those that choose to take a drug unnecessarily.
On many of the things you are saying, I will agree the basis of your argument. I will completely admit that there are people out there in mild pain that I would agree do not require them. I'm sure many people on this forum know someone that was prescribed opiates when they didn't need them, the problem is that you are having two arbitrary entities with (government and pharmacy) now with absolutely zero knowledge about a patient except for a diagnosis and prescription, limiting medicine that is needed just as much as a diabetic needs insulin.
I will totally agree that it may be better for society as a whole, it may slow the spread of diseases like HIV or Hep C. Just as you should be able to admit that it will hurt some people. That a policy like this punish a portion of the population with what basically amounts to torture for the actions of a different population.
While well intentioned, your statement "Doctors should find and try to cure the cause and not just go the easy way and prescribe pain meds, as they often do." proves that whatever medical education you have you do not understand chronic pain or medicine in general. Doctors do not often "not try to find or cure the cause and just prescribe pain meds". It is like seeing the news and saying "Cops often just shoot the a suspect vs. arrest them".
Every doctor tries to find the cause, however, if you had any diagnostic education you would realize that many diagnosis are very difficult to find the cause. Many diagnosis involve multiple tests, possible consultation with specialists, and they have one week to do it. Simply ordering an X-ray and simple blood tests like CBC, CRP, Sed Rate, can take days to multiple weeks to get back to a doctor. Then the patient has to make a follow up appointment. If those tests are negative more tests are ordered perhaps waiting weeks or months for a CT Scan or MRI. Perhaps the patient sees a specialist taking months to make an appointment. A very substantial number of patients fall into this category and what this law is making them do is see their Dr. weekly for a new prescription. With limited Dr. resources, why would we do this now having the unintended consequence of limiting care to those in need of it and again lengthening the time for diagnosis.
Not to mention the patients that cannot be cured or have enormous amounts of pain without an obvious cause. I was one of those and I know plenty of people in similar situations.
And finally there are those that cannot be cured or require more pain meds to be bring their pain under control than the law provides for. What about them?
Quote:
Originally Posted by 2sleepy
They will do what they should have done before they started taking opioids, find alternatives to managing their pain. You'd be surprised how people can learn to cope with pain when they realize that they aren't getting any more percocets.
Quote:
Originally Posted by 2sleepy
I did not say they should have done something differently before they were in pain, I said they should have tried different approaches to pain management before they started taking opioids on a regular basis.
I won't deny there are tons of people that this is true for. Obviously, if a person can come off opiates, they should. A a doctor with a chronic pain patient should consistently be searching for alternative forms of treatment and/or therapy.
A general physician shouldn't be resupplying a patient with chronic pain when he cannot find a diagnosis in most cases. The patient should be sent to a pain management facility where they can be more closely supervised. But I would never even support this as a law because not everyone in the U.S. has access to a pain management facility or even the same physician regularly.
But there are many people out there that do not have another solution. The human body is amazing in its ability to create continually higher levels of pain without end 24/7. Imagine hitting yourself with a hammer or being severely burned every minute or so 24 hours a day seven days a week. There are lots of people with this level of pain, and unfortunately it is not just cancer patients who usually get the exemption. This is what I live with daily.l
The news about CVS is so disheartening. I would ask everyone to write their Congressmen to put into place laws demanding pharmacies fill properly filled prescriptions. Having a pharmacy limit your treatment when you have just spent time with a physician that has access to your entire history, your physical exam, your lab-work, etc is ridiculous. I guarantee if anyone has had a relative that has had genuine severe chronic pain would not want to see them suffer. There are smarter ways to deal with the addiction problem than cutting the supply to those that need it.
I have RSD from a botched procedure on my left arm. I use zero narcs. I have pain every single day.
But maybe you missed the part where I said they were people in legitimate pain. And they are the vast minority of patients I see demanding narcotic pain medicines.
If you're functioning, you are not in pain to the point where you need the strong stuff. The people in pain who need the strong stuff aren't able to function due to the pain.
I have arthritis. It's usu. mild. I take nothing for it. But recently I hurt my back doing something. That's unusual for me. I was in such pain when doing just about anything, that I was not able to function. Getting up was very painful, walking was painful (unusual for arthritis...walking is usu. helpful), sitting down was painful, opening hte fridge door was painful. I took Aleve several times for it, because it was necessary. Things like that give me an idea of what real pain is. You can't function, and you suffer the whole time. And it's not going to end, like I knew mine would.
Well, if you thought the CVS 7 day limit was bad....
"Gov. Rick Scott announced today that he will push for a 3-day limit on prescription opioids during the upcoming legislative session. At a press conference in Bradenton this morning, Scott also announced $50 million will be dedicated to combating the opioid crisis." Gov. Scott to push for 3-day limit on opioid prescriptions
I won't deny there are tons of people that this is true for. Obviously, if a person can come off opiates, they should. A a doctor with a chronic pain patient should consistently be searching for alternative forms of treatment and/or therapy. .
This is not "obvious" to me at all.
Tylenol and Aspirin are real killers. So is suicide and not being able to go to work or do a particular job. They say a watched pot never boils - well, pain slows down life so you feel much more of it. Every second.
A Holistic approach doesn't mean using magnets, crystals or prayer. It means the person should eat well, sleep well, lower stress levels, make sure they are getting the proper nutrients...exercising properly and, maybe most importantly, enjoying life!
If opiates are a part of the overall plan, so be it.
I wouldn't call getting off opiates "obvious" any more than I'd call for someone to stop drinking wine or coffee or having recreational sex. That is - unless one is an ascetic and wants to go live in a cave.
There are lots of legal or quasi legal and even OTC pain relief substances...but I suspect many are more dangerous than light opiates. Heck, the tylenol in some opiates is more dangerous than the opiate itself.
Opiates have been one of God's gifts to mankind...they have relieved suffering on the battlefield, in early surgeries, for those who are terminal AND even for everyday people with chronic problems.
It seems so simple. Unless your "drug of choice" is harming your body permanently or making it so you can't function on a day to day level, it's "all good". That is for "regular" people.
For those in chronic pain, even the everyday functioning is not important since they can't handle that anyway.
We have so many "Victorian" ideas....ridiculous. The Forbidden Fruit syndrome....always tends to make things worse.
If you take opiates long enough you will form some sort of physical dependence on the drug. Everyone. However, the symptoms do completely depend on several variables including genetics, the type of opiate, the dose, the duration, how much pain they are truly in, other prescriptions they are taking, etc.
Addiction is a behavioral issue seeking pleasure or using drugs to cope with issues not requiring the medication. It's characterized by the not being able to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response.
Funny you said my post was the worst misconception. Then you basically agreed with me, even though you don't believe so.
Your response is a long and involved why of saying that people respond differently to drugs. Some want/need them, and some don't. Some get addicted and some don't. Some who are addicted can get off them, and some can't. Whether it is psychological or physical is not particularly meaningful. One is about as intractable as the other.
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