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...The point I was trying to make is that if anyone takes opioids for a long period of time they will develop a tolerance to them and need more to kill the pain and most doctors at some point will just refuse to continue increasing the dose. Why it has upset people for me to say that is baffling
It upsets people because you are WRONG, and you are just repeating the knee-jerk "sound bite" that the media feeds us 1,000 times a day--as Government makes up yet another crisis that gives more money and power to politicians (and other wealthy interests). By the time you hit age 50, you've been through so many that you realize the world revolves around making money--and a crisis that you make up out of whole cloth is the easiest way to do that.
The vast majority of pain patients do NOT constantly ask for higher doses--they find the dose that controls the pain, and stay there until the pain level changes. And that's not my opinion: this is the direct response from the question I asked my relative to ask his Pain Management Doctor when he went to his appointment last week.
I also accompanied another relative with cancer to his Chemo treatment at Mass General Hospital, and asked that Oncologist (who has an incredible resume) how many of his cancer patients abused their pain medications. His answer: zero. Yes, even I was a bit surprised at that; I thought there would be a few.
Under-treatment of pain is the only "crisis" we are dealing with, and absolutely NONE of the ridiculous bureaucratic hoops that are constantly being added for legitimate pain patients to have to jump through do ANYTHING to stop those few people who are bored and desperate to feel "high."
BTW, Subutex is actually a powerful pain medication, and only ended up being approved by the FDA for treatment of drug abuse because that was the way to maximize profit. It doesn't mean using it for other problems is illegal, unethical, or uncommon. It is standard practice. I've never heard of an insurance company having a problem with it, though they make up endless excuses not to cover medications just to hike the profits a bit more.
Goodd Lord, the pretentiousness and self righteousness level in this thread is off the charts!
Many of you think "narcotics" are only "OK" for horrible, unbearable extreme pain.
What is WRONG with you??Really??
I have chronic shoulder pain from an unknown problem that mimics a serious trauma injury. I also have mid to severe arthritis.
The pain NEVER stops. I COULD live without painkillers, but why on earth should I?
WHY the damn do gooders seeming punishment for having pain? Am I being punished? How nice of you?
I have taken Tylenol #4 for years.YES! I have a tolerance! NO! I am not interested in Heroin (LOL) or stronger drugs, yet I am treated with disgust, suspicion and as a semi "weak" person criminal by others, INCLUDING pharmacy staff at CVS.
Again, how thoughtful.
Why am I expected to have no quality of life ( I'm 64 years old ) and just "deal" with "it"???
Not a long rant, but it's time for america to grow up regarding drugs in general, stop with the tough guy cops approach and stop FAILING over and over!
I DO NOT need your damn morality and judgement!
"Under-treatment of pain is the only "crisis" we are dealing with, and absolutely NONE of the ridiculous bureaucratic hoops that are constantly being added for legitimate pain patients to have to jump through do ANYTHING to stop those few people who are bored and desperate to feel "high."
TRUE! Totally TRUE!
In California you now have to show a drivers license when you pay for controlled substances at a drug store.
Wow. Because drug abusers can't get fake licenses you know.
I was ANGRILY grilled by a 20 something Walgreens pharmacy twerp as to WHY I wouldn't get my prescription at the closest Walgreens! How suspicious! He REFUSED to fill my LEGAL, verifiable Doctors prescription! Because his store was....more than a mile from my home!!!
WHY not the closest ( to my residence)?? BECAUSE the one I tried to use is next to the dry cleaners and grocery store I like to patronize, you little ****!!!!!!!!!
Gee, what an effective strategy for fighting the "Opioid Epidemic!!!
It upsets people because you are WRONG, and you are just repeating the knee-jerk "sound bite" that the media feeds us 1,000 times a day--as Government makes up yet another crisis that gives more money and power to politicians (and other wealthy interests). By the time you hit age 50, you've been through so many that you realize the world revolves around making money--and a crisis that you make up out of whole cloth is the easiest way to do that.
The vast majority of pain patients do NOT constantly ask for higher doses--they find the dose that controls the pain, and stay there until the pain level changes. And that's not my opinion: this is the direct response from the question I asked my relative to ask his Pain Management Doctor when he went to his appointment last week.
I also accompanied another relative with cancer to his Chemo treatment at Mass General Hospital, and asked that Oncologist (who has an incredible resume) how many of his cancer patients abused their pain medications. His answer: zero. Yes, even I was a bit surprised at that; I thought there would be a few.
Under-treatment of pain is the only "crisis" we are dealing with, and absolutely NONE of the ridiculous bureaucratic hoops that are constantly being added for legitimate pain patients to have to jump through do ANYTHING to stop those few people who are bored and desperate to feel "high."
BTW, Subutex is actually a powerful pain medication, and only ended up being approved by the FDA for treatment of drug abuse because that was the way to maximize profit. It doesn't mean using it for other problems is illegal, unethical, or uncommon. It is standard practice. I've never heard of an insurance company having a problem with it, though they make up endless excuses not to cover medications just to hike the profits a bit more.
I'm wrong because I said people who take opioids develop a tolerance?
As to the development of tolerance to side effects, we now know that not all opioid targets develop tolerance at the same rate and to the same degree. This differential tolerance can put patients at significant risk. In addition, recent studies have made it clear that continued exposure to opioids induces more than tolerance. It also induces a degree of hyperalgesia. Whereas, in principle, tolerance can be overcome by increasing opioid dose, hyperalgesia is made worse in the long run by increasing the opioid administration.Differential Opioid Tolerance and Opioid-induced Hyperalgesia:A Clinical Reality | Anesthesiology | ASA Publications
In summary, although opiate analgesics are potent for a variety of time limited painful conditions, the duration of their efficacy has only been established for up to two months. Animal studies indicate that tolerance and dependence are common with repeated opioid use and both animal and human studies indicate that long term administration of opiate analgesics can actually worsen pain. Because of this, significant caution should be exercised in initiating therapy for patients with chronic non-malignant pain. On the other hand, although the potential is there, addiction is actually quite rare in patients treated appropriately for pain https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3073133/
Or you disagree with me because I suggested that Physicians will not manage opioid tolerant patients by increasing their dosage?
Most healthcare providers acknowledge some upper limit for the safe consumption of opioids. Side effects such as sedation, cognitive dulling, and constipation become too great at high doses. More importantly, accidental overdose can occur with long-term use of high doses of opioids. We are currently witnessing epidemic levels of accidental overdose due to opioid use. For these reasons, most reputable healthcare providers set an upper limit to the amount of opioids when prescribing opioids for a condition, such as chronic pain.Tolerance to Opioid Pain Medications
And I never said that tolerance is the same as addiction, or that patients who develop a tolerance are addicted, did I?
As far as Subutex, I'm fully aware of what it is and I suggested to the OP that it sounded like they were lucky to have a doctor who would prescribe it for pain. WHAT I did say is that some insurance companies will not pay for off label use of drugs, the health plan I had before I went on medicare would not pay for off label use of any drug. I have Raynauds and was prescribed sildenafil (Viagra) by my Rheumatologist for it and I had to pay for it out of pocket, it's efficacy for treating Raynauds is established but it is still off label use.
I am not sure why you are so agitated about anything that I have said, I have not criticized or passed judgment on anyone here or anything that they have said. I offered my opinion and I have provided support for it. You are free to disagree but there's no need to get nasty about it.
I'm wrong because I said people who take opioids develop a tolerance?
As to the development of tolerance to side effects, we now know that not all opioid targets develop tolerance at the same rate and to the same degree. This differential tolerance can put patients at significant risk. In addition, recent studies have made it clear that continued exposure to opioids induces more than tolerance. It also induces a degree of hyperalgesia. Whereas, in principle, tolerance can be overcome by increasing opioid dose, hyperalgesia is made worse in the long run by increasing the opioid administration.Differential Opioid Tolerance and Opioid-induced Hyperalgesia:A Clinical Reality | Anesthesiology | ASA Publications
In summary, although opiate analgesics are potent for a variety of time limited painful conditions, the duration of their efficacy has only been established for up to two months. Animal studies indicate that tolerance and dependence are common with repeated opioid use and both animal and human studies indicate that long term administration of opiate analgesics can actually worsen pain. Because of this, significant caution should be exercised in initiating therapy for patients with chronic non-malignant pain. On the other hand, although the potential is there, addiction is actually quite rare in patients treated appropriately for pain https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3073133/
Or you disagree with me because I suggested that Physicians will not manage opioid tolerant patients by increasing their dosage?
Most healthcare providers acknowledge some upper limit for the safe consumption of opioids. Side effects such as sedation, cognitive dulling, and constipation become too great at high doses. More importantly, accidental overdose can occur with long-term use of high doses of opioids. We are currently witnessing epidemic levels of accidental overdose due to opioid use. For these reasons, most reputable healthcare providers set an upper limit to the amount of opioids when prescribing opioids for a condition, such as chronic pain.Tolerance to Opioid Pain Medications
And I never said that tolerance is the same as addiction, or that patients who develop a tolerance are addicted, did I?
As far as Subutex, I'm fully aware of what it is and I suggested to the OP that it sounded like they were lucky to have a doctor who would prescribe it for pain. WHAT I did say is that some insurance companies will not pay for off label use of drugs, the health plan I had before I went on medicare would not pay for off label use of any drug. I have Raynauds and was prescribed sildenafil (Viagra) by my Rheumatologist for it and I had to pay for it out of pocket, it's efficacy for treating Raynauds is established but it is still off label use.
I am not sure why you are so agitated about anything that I have said, I have not criticized or passed judgment on anyone here or anything that they have said. I offered my opinion and I have provided support for it. You are free to disagree but there's no need to get nasty about it.
Well said. As far as getting nasty about it, "nasty" is some posters' permanent posting style, year after year after year.
Well said. As far as getting nasty about it, "nasty" is some posters' permanent posting style, year after year after year.
Sure, let's argue and get huffy.That helps.
People don't care, UNLESS they too are in pain.
AND frankly, unless you do suffer from chronic pain, I have no interest in what you are saying.
Goes for all of you.
I recently tore a muscle in my back pretty badly. It was evident on the X-ray the ER doctor ordered and I was in a lot of pain--more pain than I can remember experiencing in 20 years. After consulting with the Dr I asked for some prescription pain pills to hold me over for a week or so while I recovered. He refused to give me anything prescription and told me to take NSAIDS. I told him I couldn't take Non-steroids because of an ulcer I'd had a few years ago. Still he was adamant. No pain pills.
What is happening in America when a doctor cannot prescribe even a few pain pills to help with a retiree's pain. I know there's a drug epidemic out there involving young kids abusing prescription pain meds but old people with chronic conditions are being cut off without even being weaned. All they hear from their Dr is "Sorry. I won't write any more prescription painkillers for you. Yes, I know you're in a lot of pain but I have the FDA and my license to worry about."
I cannot fathom what is becoming of America, I cannot begin to imagine the horror if I got cancer. Many terminally ill patients are being refused their pain meds right at the pharmacy by pharmacists who say, "I know it's a legitimate prescription but I just cannot fill it for you. I'm sorry." Anybody else having this kind of problem?
Yes, it's bad like that for chronic legitimate pain patients just about everywhere. It's causing a LOT of very serious issues for people in genuine need of pain control. I have a pain specialist doctor. I have to use a pain specialist for my chronic degenerative bone disease. Diagnose and documentation of the condition by another specialist was required to be accepted as a patient. It's more the DEA than the FDA causing all the wacked out arbitrary regulations that have doctors so scared. Family/primary doctors here , most won't write any Rx's for narcotic pain medicine at all any more. And all this draconian getting between patients and their doctors isn't effecting the abusers at all. Just people in genuine need.
For long term pain control, it's required that you get into a pain specialist, which can be quite difficult. Even when all the gaps are plugged, pharmacies can indeed be an issue. I've seen pharmacists play deliberate games to keep peoples pain scrips away from them. Many treat any and all pain medication Rx's as if the patients is an abuser just out of hand. It has gotten quite bad. When a long term narcotic pain patient is suddenly just cut off the effects can be fatal. In my case it would be. I've been there done that. An insurance FUBAR saw me chopped off at the knees with a 90 wait to get it hammered out. I made it not quite three before I was in the hospital with renal failure from dehydration caused by the nausea , vomiting and dysenteric level diarrhea. I nearly died. Came VERY close.
The hospital did help me though. I was admitted for ten days with that incident, but my new pain specialist had me in his office getting new Rx's the day after I was discharged. It took little effort to prove I was legitimate and not an abuser, and both the specialist and the hospital doctors told me with the medication I am on there is NO WAY I should have been just chopped off that way. The withdrawal effects as I found out will be fatal. Had I just continued to try and gut it out, I would have died from kidney failure, and I was close when I got in to the hospital.
This happens a lot. People are dieing because of these stupid laws and regulations. People with legitimate conditions, in genuine need. Everybody is treated like an abuser/drug seeker.
This happens a lot. People are dieing because of these stupid laws and regulations. People with legitimate conditions, in genuine need. Everybody is treated like an abuser/drug seeker.
I'm sorry you are going through this. It's truly awful but it is the way we do things in this Country, we overreact to everything that is perceived to be a crisis. Look at our history of dealing with crime, if there is an indication that crime is increasing we pass idiotic 3 strike laws that keep non-violent offenders in prison until their 80's, long after the time when they would be able to successfully steal a car. When law enforcement started freaking out about people making meth they put such severe restrictions on pseudoephedrine that you darn near need a prescription to get cold medicine, but all that did was increase the demand for a much stronger and addictive meth that comes from Mexican drug cartels. You cut off people from prescription drugs and some of them will turn to heroin, that's inevitable, and those people are pushed underground and will ultimately have to steal and sell drugs themselves just to avoid getting sick because once addicted, heroin isn't about getting high it's about avoiding getting sick.
I think the only chance to turn this around is for people have who have a legitimate need for these drugs to start writing and calling your legislators and recruit others to do the same.
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