Are the new opioid prescribing restrictions pushing innocent people to the streets to buy heroin? (lawyer, regular)

[KCZ]

Originally Posted by 2sleepy

Opioids never should have been prescribed long term for chronic pain, i.e. bad back or sciatica. Not only do you develop tolerance and need increasingly higher doses as time goes by, but at least some people become more sensitive to pain than they were before they started taking opioids. The good news is that even with chronic opioid use, only about 10% of users become addicted. The bad news is that most users will undergo physical withdrawals and they will have find an alternative means of living with pain.

If you know anyone who is in that situation you might suggest biofeedback. It worked for me, it basically teaches you how to compartmentalize pain and pretty much ignore it. Here's an explanation of how it works: https://www.practicalpainmanagement....ain-management

Originally Posted by 2sleepy

I don't know, it amazes me too. I can see taking them for a few days after surgery, but to take them every day for years because you have back pain? That's just nutty. Have you seen the commercial for some kind of laxative specifically for people who take opioids? I guess so many people take them now and have chronic constipation that some enterprising drug company came up with a special laxative for them

So where does this leave people with back pain, since you brought that up for example, who've had every other treatment for it, like PT, US, Estim, TENS, acupuncture, steroid injections, osteopathic manipulation, biofeedback, +/- a severe allergy to NSAID's, etc, etc, etc, culminating in a huge operation, that are left with pain so bad that they can't stand long enough to take a shower or fix a meal on some days?

Because there are plenty of patients out there just like this with chronic back pain, or post-traumatic pain, or whatever, who have been through every other type of treatment imaginable, who need judiciously-dosed opioids to function, and who don't abuse them, who've been caught in this web of DEA paranoia.

What all these restrictions on legit patient prescriptions haven't done is to cut down on the OD's by non-legit users. In fact, the OD problem is getting worse, at least in my state. IMHO, letting patients suffer to help addicts is unconscionable.

[thrillobyte]

Originally Posted by KCZ

So where does this leave people with back pain, since you brought that up for example, who've had every other treatment for it, like PT, US, Estim, TENS, acupuncture, steroid injections, osteopathic manipulation, biofeedback, +/- a severe allergy to NSAID's, etc, etc, etc, culminating in a huge operation, that are left with pain so bad that they can't stand long enough to take a shower or fix a meal on some days?

Because there are plenty of patients out there just like this with chronic back pain, or post-traumatic pain, or whatever, who have been through every other type of treatment imaginable, who need judiciously-dosed opioids to function, and who don't abuse them, who've been caught in this web of DEA paranoia.

What all these restrictions on legit patient prescriptions haven't done is to cut down on the OD's by non-legit users. In fact, the OD problem is getting worse, at least in my state. IMHO, letting patients suffer to help addicts is unconscionable.

One of the CDC recommendations to doctors is to teach people in extreme pain "to just suck it up and learn to live with it." According to them, opioid painkillers should not be given except for acute emergencies and even then only at most a week's supply. And news agencies trumping up a manufactured crisis by constantly blasting "deaths from opioid use have skyrocketed to 59,000 bla bla never separate heroin deaths (90%) from prescription painkillers deaths (10%) It's all orchestrated by government/media to make it sound like prescription painkillers are going to cause the USA to collapse. And for those who say, "Sure wish some of these FDA officials got severe pain. They' know what it feels like" let me tell you: they get all the pain pills they want so they're not worried in the slightest.

If your Dr. says they need to operate, make your decision wisely because from what i read many of these people in horrible pain got there because of botched operations on their backs that made moderate pain excruciating. Tread carefully. Dr's will tell you "We need to exhaust all possibilities before we can try pain pills" so they give you hope. Then when the operation gets botched and your pain doubles they say, "Sorry about that. But I can't give you pain pills. I thought I could but the FDA just told me I can't so you cannot be my patient anymore." All they wanted was the money from operating. They never had any intentions of giving you meds should the thing go south. Tread carefully.

[rruff]

Originally Posted by thrillobyte

It can't be, nina, because Big Pharma stands to lose billions in profits from painkillers and they did nothing to lobby Congress to stop the de facto banning of painkillers. So why did they not put up a fight? Use of narcotics in the US may have been 80% of world supply before but now it's dropping like a stone and Dr.'s refuse to prescribe them for fear of being busted by the FDA. Plus the industry has been ordered this year and next to cut production of opioids by 40%. It sounds conspiratorial but there is something BIG going on behind the scenes to orchestrate this whole ban because none of it adds up. .

Who benefits from getting lots of people hooked and then pulling the plug? The illegal drug trade, organized crime, the chaos and fear mongers. Could it be a response to MJ legalization?

Maybe it isn't that big of a deal, and will settle out pretty quickly. I'm not in favor of overprescribing meds.

[2sleepy]

Originally Posted by KCZ

So where does this leave people with back pain, since you brought that up for example, who've had every other treatment for it, like PT, US, Estim, TENS, acupuncture, steroid injections, osteopathic manipulation, biofeedback, +/- a severe allergy to NSAID's, etc, etc, etc, culminating in a huge operation, that are left with pain so bad that they can't stand long enough to take a shower or fix a meal on some days?

Because there are plenty of patients out there just like this with chronic back pain, or post-traumatic pain, or whatever, who have been through every other type of treatment imaginable, who need judiciously-dosed opioids to function, and who don't abuse them, who've been caught in this web of DEA paranoia.

What all these restrictions on legit patient prescriptions haven't done is to cut down on the OD's by non-legit users. In fact, the OD problem is getting worse, at least in my state. IMHO, letting patients suffer to help addicts is unconscionable.

My personal philosophy is that for adults all drugs should be decriminalized. The only activity that should be criminalized is if a person's drug/alcohol use harms others, i.e. drunk driving. But I'm sure that won't happen, so my recommendation to you if you are suffering with chronic pain and can't get opioids is to try biofeedback and find a source for high cannabidiol (CBD) marijuana

[coschristi]

Every time this topic comes up (which has been frequently) I comment. Yet I've yet to actually SAY much of anything because I know my real opinion is confrontational. And I'm not a confrontational person. I have enough difficult, long-term issues IRL: I never log on here to pick a fight.

So I pussyfoot around it every time I comment & I'm really pretty disgusted with myself at this point for being such a wimp! So I'm just going to say it cause somebody needs to:

"Are the new opioid prescribing restrictions pushing innocent people to the streets to buy heroin?"

Well, buying Heroin on the street is illegal here. So by definition of the law; once you have purchased Heroin you are no longer innocent.

Default answer to that question is: No.

Are you implying (as is acceptable by public opinion) that chronic pain patients are innocent users of opiates while Heroin users are guilt-worthy users? Obviously; public opinion demands the answer to that be : No. It seems counter-intuitive to imply anything close to that assertion.

That's the wrong question ... they both are. "Are the new opioid prescribing restrictions pushing people to the streets to buy heroin?"

Yes. So did the old prescribing restrictions. People aren't dropping like flies from overdoses & tainted drugs because they all had insurance & an appropriate diagnosis & prescribed opiates. Only the one's who don't are. But one is a "Patient" & the other is a "Criminal".

Guess what? If the current status quo of stigmatization of addicts continues; there won't be any distinction in the very near future. Not by the medical community, at least. Sure "we" will all be empathetic to the plight of the chronic pain patient, & for good reason too. But "we" don't have prescribing authority. Nobody cares what we think & nobody is going to ask us, either.

If they did; this is what I would say: The pain of a person with a 12 year long history of chronic pain is no more, nor less; legitimate than the pain of the person with a 12 year long history of addiction.

Without the opiate, both will experience a debilitating resurgence of the pain experienced when opiate use was initiated. There are imaging studies that can validate a crushed vertebra, for instance, as a "valid" source of pain. Luck you; there are no such diagnostics to validate PTSD.

Without the opiate, both will experience pain specific to long term opiate use that is NOT related to the original source of pain. This pain is caused from long term opiate use that damages the nervous system; it does not distinguish who had a prescription from who was a junkie. The chronic pain patientonly appears to have a legitimate & "from the original source of" pain because this pain manifests as nerve/skeletal/muscle pain.

Ever seen opiate withdrawal? Leg muscle spasms so violent it can put a bedridden patient on the floor? That's called "KICKING" the habit.

The only reason the patient is less likely to develop a rapid tolerance than the junkie is because their baseline started at lower than normal due to injury or degenerative conditions. They call it "relief" A junkie calls it "high".

Look; I don't use nor abuse opiates. I have no skin in this game. It doesn't mean I can't see a benefit to the reconciliation of bias directed towards people who are suffering. Because if it continues? It's just going to get worse. It's going to affect "you" & "us". And it's going to happen really fast.

It's called: The Opioid Abuse Prevention & Treatment Act of 2017. But that's Federal. Individual states are already adopting even more restrictive policy.

It's not a "no opiate" mandate; it calls for documented, mandatory screening of patients for potential factors of abuse; both prior to prescribing & for the duration of currently prescribed treatment. It's designed to discourage the physician from prescribing, or continuing to prescribe opiates.

You haven't seen bias & stigma until you have seen the criteria physicians are being educated to use! From
The American College of Preventive Medicine (http://www.acpm.org/?UseAbuseRxClinRef):

High risk groups; meaning "worthy of suspicion" include:

"Pain Patients" ... Because "The prevalence of lifetime substance use disorders ranges from 36% to 56% in patients treated with opioids for chronic back pain; 43% of this population has current substance use disorder (SUD) and 5% to 24% have aberrant medication-taking behaviors."

"Women" Because: "Women have a higher risk than men based on biological differences, more psychiatric problems (depression, anxiety), and higher rates of physical, emotional or sexual abuse."

"Those on Medicaid": "Patients covered by Medicaid are more likely to receive prescription drugs for low back pain" and: " This population also visits the emergency department more often than non-Medicaid patients."

"Be white" : Not even kidding. Also included are Teens & the Elderly. Basically; only a middle aged black man with acute pain will be above question.

This is the way our doctor is being told to "educate" us: "Stress that "doing prescription drugs” is the same as "using street drugs” ".

These are "warning signs". God help you if you are travelling. Hurting & tired. Detail oriented or knowledgeable about your care:

- " wanting an appointment toward the end of office hours"
- "...is travelling through, visiting friends or relatives"
- "Providing clinical reports and/or x-ray ... in support of their request"
- "lost a prescription, or forgotten to pack their medication, or saying their medication was stolen or damaged'
- "an unusual knowledge about opioid medications"
- "Stating that a specific non-opioid medication does not work. Stating an allergy to a non-opiod medication"
- "family history of drug abuse"

And here are some screening "tools":

- "saliva drug testing"
- "hair drug testing"
- "background checks"
- "random pill-counts"
- "Universal precautions (drawn from the infectious disease discipline) regards all pain patients as having the potential to get addicted to their medication."

And finally, physicians are instructed to lie:

- "Tell the patient that: The licensing board and federal government does not allow us to prescribe scheduled drugs (This is deemed "borrowed protection”)"

Other "good" verbal responses are:

- "I’ll give you 3 pills, but you will have to come back so we can set up a treatment plan” (Sidestep the urgency, but limit the amount prescribed)"

- "It is clinic policy to not prescribe these types of drugs for patients that may be developing or have a dependence problem, I can refer you to someone who can work with you both for pain and possible addiction.” (Chose language so the patient has no room to maneuver)".

Great guidelines. Can you "pass"? Because I don't! Screw "screening" if that's the best they can do; I'd rather work on compassion & understanding of the pathology of pain. Whether it's a 12 yr history of chronic pain or a 12 year history of Heroin addiction; it's not like prescribing the opiate is going to create an addict. But it might prevent a death, or at least get people out of bed & into the world.

If a patient starts "abusing" there is a whole other type of doctor, an addiction specialist, that can be consulted. Or better yet; require that all doctors receive addiction education.

[tar21]

Originally Posted by elnina

According to medical survey more than 100M Americans is diagnosed with chronic pain. Is that possible that one in three people (incl.kids) are suffering pain, or are we a nation of fragile sissies and hipochondriacs?
None of my family or friends experience chronic pain nor take opioids. Sure, they get occasional headache, or other minor or temporary pain that is resolved with ORC medication, but no one takes opioids. Maybe they are just a bit more resistant to pain? Why so many people claim to have pain that could be only resolved by opioids. Or perhaps doctors used to prescribe opioids to whoever ask for it - justified or not?
Something is not right here: Approximately 80% of the global opioid supply is consumed in the United States. The US represents only 5% of the global population ....
In most countries, the use of opioid prescriptions is limited to acute hospitalization and trauma, such as burns, surgery, childbirth and end-of-life care, including patients with cancer and terminal illnesses. But in the United States, everybody can have "a bottle of pills and then some," U.S. Surgeon General Vivek Murthy has said publicly.
Are they really so sick or made dependant to opioid by their doctors, and why???

I think that "80% of the global opioid supply is consumed in the United States" is misleading. That is for prescription opioids prescribed by a doctor. In many 2nd and 3rd world counties you can buy them at a pharmacy with no prescription, and usage is not monitored. In many 1st world countries like Canada, the UK and France you can buy tylenol with codeine over the counter or even pure codeine or dihydrocodene (equivalent to Vicodin) in the UK over the counter. These countries don't have massive opioid problems despite easy availability.

[tar21]

Originally Posted by klaucka

I am hearing about this no opiod policy ss well. A friend recently had knee replacememt surgery and they sent her home with tylenol. I had both knees replaced two years ago and cannot imagine recovering from that surgery without vicodin. I was on a pretty high dose for five weeks and honestly did suffer from withdrawal when I stopped taking them to go back to work. Not prescribing for people in real pain is not the answer, however I do think we could have pain management specialists involved in these cases where rhey closely monitor the patient for abuse and work with them to wean you off the drugs when it is time. I was pretty much in my own with large dose prescriptions and zero guidance on using them from my doctors. If I wasnt si aware of the addiction issues and was on top of it all the time I was taking them, I could have easily developed a problem.

Are surgeons actually doing this? That seems like obvious malpractice. I had ankle surgery last year and even with 2 percocets and ice all over my leg I was in incredible throbbing pain 24/7 for weeks. I can't even imagine doing it with only tylenol. Are you sure it wasn't tylenol with codeine?

[LLCNYC]

Originally Posted by tar21

Are surgeons actually doing this? That seems like obvious malpractice. I had ankle surgery last year and even with 2 percocets and ice all over my leg I was in incredible throbbing pain 24/7 for weeks. I can't even imagine doing it with only tylenol. Are you sure it wasn't tylenol with codeine?

+1.

Tylenol for post op??? The hell?

NEVER heard of such a thing.

[rruff]

Originally Posted by coschristi

Every time this topic comes up (which has been frequently) I comment. Yet I've yet to actually SAY much of anything because I know my real opinion is confrontational.

Really? Based on this one post I think CD should pay you to write on whatever topic you wish.

Whether it's a 12 yr history of chronic pain or a 12 year history of Heroin addiction; it's not like prescribing the opiate is going to create an addict. But it might prevent a death, or at least get people out of bed & into the world.

If a patient starts "abusing" there is a whole other type of doctor, an addiction specialist, that can be consulted. Or better yet; require that all doctors receive addiction education.

Sadly our society trains people to be addicts. Consumer addicts. It's good for business! It's all "fine" until someone acquires a dysfunctional or debilitating addiction.

Docs pushing drugs or criminals pushing drugs, neither is the answer. Adults should have the freedom to buy whatever they want from the local licensed dispensary, subject to documentation and limits, with heavy taxes levied to pay for addiction counseling, rehab, and law enforcement. That's what would make sense in a semi-free society.

[rruff]

Originally Posted by tar21

Are surgeons actually doing this? That seems like obvious malpractice. I had ankle surgery last year and even with 2 percocets and ice all over my leg I was in incredible throbbing pain 24/7 for weeks. I can't even imagine doing it with only tylenol. Are you sure it wasn't tylenol with codeine?

I've never even gotten tylenol post surgery. Never any pain meds whatsoever. Maybe if I'd asked for them? Now that I think about it, I have gotten prescriptions that I never filled.