Mental health

Ted DuPuis said:
He also was very clear that in his mind, doctors were who were at fault for the prescription opioid epidemic by prescribing opioids too often and in too big of bottles.
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The flood of prescription opiates is the result of a deliberate decision by the AMA leadership to promote them as part of the 'pain as the fifth vital sign' campaign in the early 2000s. Up to that point, it was accepted that 'surgery hurts' and 'broken bones hurt'. Now suddenly it was malpractice to have a patient readmitted for pain control and all kinds of administrators got involved if it happened. The mantra recited repetitively was 'no patient in real pain will ever get addicted to opiates from treatment'. I had just moved here from europe where the opiate crisis of the 70s had never ended the way it had in the US. With my perspective of having seen opiate addicts throughout my medical training, that naivite of my US colleagues when it came to opiates was baffling. I came here with the understanding that to get opiates you were either on a surgery floor recovering from a major procedure, or you were in the process of being sent home to die from cancer. To send someone home with a weeks supply of opiates after a tooth extraction seemed lunacy to me. Two weeks ago, I had a molar out. Same thing, well meaning surgeon gave me a script for Norco. The stuff is dirt cheap to boot. I took one when I came home from the procedure and another one at bedtime.
 
weilke said:
The flood of prescription opiates is the result of a deliberate decision by the AMA leadership to promote them as part of the 'pain as the fifth vital sign' campaign in the early 2000s. Up to that point, it was accepted that 'surgery hurts' and 'broken bones hurt'. Now suddenly it was malpractice to have a patient readmitted for pain control and all kinds of administrators got involved if it happened. The mantra recited repetitively was 'no patient in real pain will ever get addicted to opiates from treatment'. I had just moved here from europe where the opiate crisis of the 70s had never ended the way it had in the US. With my perspective of having seen opiate addicts throughout my medical training, that naivite of my US colleagues when it came to opiates was baffling. I came here with the understanding that to get opiates you were either on a surgery floor recovering from a major procedure, or you were in the process of being sent home to die from cancer. To send someone home with a weeks supply of opiates after a tooth extraction seemed lunacy to me. Two weeks ago, I had a molar out. Same thing, well meaning surgeon gave me a script for Norco. The stuff is dirt cheap to boot. I took one when I came home from the procedure and another one at bedtime.
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Its amazing to me how different we all are. I haven’t had too many surgeries but the pain pills do very little for me. But sugar, by god, lights my brain up!
 
weilke said:
Doesn't mean he can't use the excuse to milk some cash from Grandma.
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Absolutely he did. Beg borrow steal - whatever. One thing that stands out to me is everything is always someone else’s faults. With both of them. They have a real problem admitting any mistakes or fault. I guess thats part of it.
 
Gerhardt said:
Ironically, my aversion to drugs isn't based or morals or laws, it's that I think I'd really, really like it and wouldn't be able to stop. Which is why I think once a person has an addiction it's no longer a binary "yes/no" behavioral choice.
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One of my best friends has said similar. It's important and good to have that level of introspection.
 
To the OP you have my absolute sympathy and understanding - as both a physician and a father who went through this. To the others, until you have been there you haven't a clue.
On the issue of who is at fault for the access to opioids, some of you might want to know what you are talking about before talking.
Back in the 70's the Fed-Gov and ATLA (not the AMA) made it clear to us docs that if you did not treat pain adequately you were going to be reprimanded, de-licensed AND sued - and the Courts smiled.
Some 20 years later the Fed-Gov and ATLA (not the AMA) made it clear to us docs that if we did not stop treating pain, yadda yadda, deja vue all over again (see above).
Some 20 years later again the Fed-gov, etc. etc. made it clear to us docs that if you were not treating pain adequately (see above, see above)
Now it's the 20'teens - What a surprise, here we go again (see above - well, you get the idea)
Those of us who have been there, done that just grimace with pain at the memory(s) - the courts are still smiling as they get to grind people into small bits.
 
Ted DuPuis said:
I think it's fair to say that the change of behavior is harder for them than for those of us deciding not to eat that doughnut or having a second cup of coffee, but the implication that comes with saying "it's a disease" is that it's something that the person doesn't have responsibility for getting. I think that's where people have a hard time finding much sympathy, not unlike when you have a life-long chain smoker who gets lung cancer.

I think I've told this story before, but can't recall for sure. When I was in college there was a kid who one of my friends introduced me to. Kid was smart, interested in cars, had his own computer business in high school and did well with it. Had a bright future.

He started volunteering at a drug rehab center to learn from the addicts about hard drugs, then proceeded to start with... I forget but pretty sure heroin and cocaine, probably 8-balls or whatever those combination shots are that kill so many people. I very quickly blocked him and I wrote him off as a person. Told the friend who introduced us that the kid would OD one day and die. My friend said he seemed to have all the amounts figured out so he didn't approve of the drug use but thought he'd be fine. I told my friend he was a fool.

In the end I was right. The kid OD'd and died somewhere around age 20.

It was as stupid as it gets. The kid literally intentionally decided he wanted to go start doing hard drugs. He sought it out and went to lengths to research what and how to do. I have no sympathy.

But that's a very polarized example. I've talked to plenty of doctors who've seen heroin addictions start with an athlete getting a pain prescription after they have some injury and then get hooked. In that situation, it's more grey. Some people are more prone to becoming addicted than others and it's not intentional but something they fell into. I can have some sympathy there.

Regardless, it's a hard situation for the friends and family, and the parents most of all. Nobody wants to bury their children, and I'd have to imagine that death due to an addiction would be one of the hardest reasons.
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I went to a very small high school, and there are about 15 of us who use Facebook to keep up with each other. Of those 15, two have had children die of opioid overdoses. It's shockingly common.

On a slightly different tack, I don't understand how the hell anyone would be willing to use street drugs. For all anyone knows, that person could be selling you desiccated horse urine, and then you're going to put it in your body? What are you thinking?

Cooter said:
I’ve been curious to know what drives the attraction to pain pills. The times I’ve been on them following surgery or accidents, I’ve only taken them for about two days and stopped. I hated the grogginess (and other side effects). I understand pursuing euphoric or relaxing drugs, but not pain pills unless there’s chronic pain.
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You and are are among those blessed with a nonresponse to those sort of substances. I had surgery to repair a ruptured tendon in my left foot a number of years ago, and the doctor gave me Tylox, which is a combination of Tylenol and Oxycodone. Once I left the hospital I wasn't in much pain so I didn't take them at first, but I was having trouble sleeping with the cast on my foot so I tried taking them a couple of evenings. They didn't seem to have any effect, so I tossed the rest. It's not that I'm more strong willed, or better than someone who gets addicted to Oxycodone, it just doesn't register in my brain so I have no tendency to get addicted to these sort of things.

RJM62 said:
I'm the same way. I took one Vicodin after getting my gall bladder removed and decided I'd rather have the pain. Then I got a bottle when a tooth exploded and I needed a root canal, and never took a single one. I also declined the sedation when I got my colonoscopy. I guess I have a high pain tolerance and a low drooling tolerance. I'd make a terrible addict.

That being said, I think it's the height of idiocy and barbarism to restrict opioids from patients suffering from chronic pain for fear that they'll become dependent. Who cares? Opioids are cheap; so as long as they continue to have a safe, legal source, who cares if they become dependent? If their pain can eventually be relieved by surgery or some other method, titrate them off the drugs. But until then, I think it's sadistic to let people suffer excruciating pain every moment of every day of their lives for fear that they might become dependent on the thing that can relieve it.

Rich
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The trouble with opioids is that somewhere around five percent of the populate is subject to becoming addicted to them and it's dangerous to prescribe them. I can see the point of giving them to people with severe chronic pain, but even then you risk making someone a lifetime addict by starting them on such medication, and the medical community needs to make sure that the treatment is worse than the disease. Giving them out routinely for post surgery or dental work is asking for the 70,000 or so overdose deaths we are seeing per year. The other problem with them is that they stop working after a while. My father in law had severe chronic back pain when he was in his later years, and he had to rotate between two or three different medications as his body became accustomed to them.
 
Old97 said:
Absolutely he did. Beg borrow steal - whatever. One thing that stands out to me is everything is always someone else’s faults. With both of them. They have a real problem admitting any mistakes or fault. I guess thats part of it.
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How could any of this be his fault if it is already yours ?
 
FormerHangie said:
I went to a very small high school, and there are about 15 of us who use Facebook to keep up with each other. Of those 15, two have had children die of opioid overdoses. It's shockingly common.
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It is. That one instance is the only person I've personally known who died from a drug overdose (at least that I'm aware of) but there are others I've known of through friends of friends or the like.

On a slightly different tack, I don't understand how the hell anyone would be willing to use street drugs. For all anyone knows, that person could be selling you desiccated horse urine, and then you're going to put it in your body? What are you thinking?
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+1000. This is something I have never understood, especially when you're talking about something like combining uppers and downers so you can take more of both or whatever it is.

Yeah, this sounds like a great idea. Take a person who's probably high on whatever he/she's taking mixing a cocktail together that if the doses are wrong will absolutely kill you. Or he could just be putting in baby powder, horse urine, whatever. But that's part of the addiction and defies logic.
 
Dr. O said:
To the OP you have my absolute sympathy and understanding - as both a physician and a father who went through this. To the others, until you have been there you haven't a clue.
On the issue of who is at fault for the access to opioids, some of you might want to know what you are talking about before talking.
Back in the 70's the Fed-Gov and ATLA (not the AMA) made it clear to us docs that if you did not treat pain adequately you were going to be reprimanded, de-licensed AND sued - and the Courts smiled.
Some 20 years later the Fed-Gov and ATLA (not the AMA) made it clear to us docs that if we did not stop treating pain, yadda yadda, deja vue all over again (see above).
Some 20 years later again the Fed-gov, etc. etc. made it clear to us docs that if you were not treating pain adequately (see above, see above)
Now it's the 20'teens - What a surprise, here we go again (see above - well, you get the idea)
Those of us who have been there, done that just grimace with pain at the memory(s) - the courts are still smiling as they get to grind people into small bits.
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You are 100% correct.
This "opioid crisis" is not 100% due to over prescribing as some have been lead to believe. The overwhelming majority or OD's are not related to prescribed meds but opioids found on the street.
 
Dr. O said:
To the OP you have my absolute sympathy and understanding - as both a physician and a father who went through this. To the others, until you have been there you haven't a clue.
On the issue of who is at fault for the access to opioids, some of you might want to know what you are talking about before talking.
Back in the 70's the Fed-Gov and ATLA (not the AMA) made it clear to us docs that if you did not treat pain adequately you were going to be reprimanded, de-licensed AND sued - and the Courts smiled.
Some 20 years later the Fed-Gov and ATLA (not the AMA) made it clear to us docs that if we did not stop treating pain, yadda yadda, deja vue all over again (see above).
Some 20 years later again the Fed-gov, etc. etc. made it clear to us docs that if you were not treating pain adequately (see above, see above)
Now it's the 20'teens - What a surprise, here we go again (see above - well, you get the idea)
Those of us who have been there, done that just grimace with pain at the memory(s) - the courts are still smiling as they get to grind people into small bits.
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What, say it isn't so, the government dabbling in healthcare caused this issue? So many lessons to be learned, thanks for posting.
 
They are excellent pain killers, and the backlash has left a lot of people in agony - if a patient with long-term, terrible pain, gets addicted, so what? But the "overflow" effects, when prescribed for marginal cases, get the attention. And the preponderance of availability gets tens of thousands treated for overdose, addiction, etc.

I have a bit of a social Darwinist attitude - some folks have a propensity to addiction. It's sad, it's grim, but I'm good with them going under, if it keeps others from living in agony. Being part of the problem (a Fed worker) I am mortal-lock certain the Feds should be involved to the absolute minimum degree possible in any aspect of daily life. Can't avoid some gov't functions, of course, but the level of competence, integrity, "big picture" understanding, and accountability just isn't there.
 
1RTK1 said:
You are 100% correct.
This "opioid crisis" is not 100% due to over prescribing as some have been lead to believe. The overwhelming majority or OD's are not related to prescribed meds but opioids found on the street.
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There is a subset of addicts who started their 'opioid career' as the result of ill advised opioid prescriptions. The fact that they may die from a batch of fentanyl laced heroin doesn't negate that.
 
Sundancer said:
I have a bit of a social Darwinist attitude - some folks have a propensity to addiction. It's sad, it's grim, but I'm good with them going under, if it keeps others from living in agony.
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What does this mean?
 
weilke said:
There is a subset of addicts who started their 'opioid career' as the result of ill advised opioid prescriptions. The fact that they may die from a batch of fentanyl laced heroin doesn't negate that.
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I am in the medical profession, of all doc's I know and work with there has not been one single OD of due to pain meds, and none that I know of have gone to street opioids either. Ethical doc's aren't making people addicts which end up on street drugs.
We all have free will, some people make bad choices and that lies on the individual person and no one else. It is a sad state though.
The feds have complete records of every narcotic prescription written by every doc which includes all patient information.
The problem with over prescribing (candy man docs) could very easily be taken care of.............. If the powers that be wanted to.
 
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1RTK1 said:
I am in the medical profession, of all doc's I know and work with there has not been one single OD of due to pain meds, and none that I know of have gone to street opioids either. Ethical doc's aren't making people addicts which end up on street drugs.
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I dont think that opinion is supported by data.

https://www.cdc.gov/drugoverdose/data/prescribing.html

35% of overdose deaths are due to prescription opioids, mostly due to oxycontin, methadone and hydrocodone. I have encountered a couple of cases involving fentanyl patches (none of them prescribed by me, in fact I haven't filled out a triplicate since internship).

We all have free will, some people make bad choices and that lies on the individual person and no one else. It is a sad state though.
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I dont think its that simple. There are genetic and social factors that play into an individuals vulnerability to develop an addiction to opioids after they receive them for a legitimate therapeutic purpose. The great majority of patients take a couple of doses and toss the rest. A few seem to get a 'high' from therapeutic doses and get hooked on the stuff after a few doses. It's a bit more complicated than the 'just dont do it' ideology tells you.

The feds have complete records of every narcotic prescription written by every doc which includes all patient information.
The problem with over prescribing (candy man docs) could very easily be taken care of.............. If the powers that be wanted to.
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The problem is bigger than the 'candyman' practices that specialize on the drug-seekers. Those are the target of both the feds and state regulators, but it's a game of 'whack-a-mole' with the pillheads just moving on to the next unethical provider.

The wider problem are primary care providers who hand out monthlong supplies for 'back pain', the orthopedic surgeons who have standing orders to send folks home with 10 day courses after arthroscopies or pin removals, ER docs who reflectively give opioids for complaints of 'headache', oral surgeons who prescribe more than a few doses for an extraction or implant etc.

The US accounts for 5% of the worlds population and 99.7% of all hydrocodone prescriptions. Something is off here.

And no, its not the Sakler family either that singlehandedly created this mess. They are just a convenient scapegoat because they are rich and ignorant.
 
weilke said:
I dont think that opinion is supported by data.

https://www.cdc.gov/drugoverdose/data/prescribing.html

35% of overdose deaths are due to prescription opioids, mostly due to oxycontin, methadone and hydrocodone. I have encountered a couple of cases involving fentanyl patches (none of them prescribed by me, in fact I haven't filled out a triplicate since internship).



I dont think its that simple. There are genetic and social factors that play into an individuals vulnerability to develop an addiction to opioids after they receive them for a legitimate therapeutic purpose. The great majority of patients take a couple of doses and toss the rest. A few seem to get a 'high' from therapeutic doses and get hooked on the stuff after a few doses. It's a bit more complicated than the 'just dont do it' ideology tells you.



The problem is bigger than the 'candyman' practices that specialize on the drug-seekers. Those are the target of both the feds and state regulators, but it's a game of 'whack-a-mole' with the pillheads just moving on to the next unethical provider.

The wider problem are primary care providers who hand out monthlong supplies for 'back pain', the orthopedic surgeons who have standing orders to send folks home with 10 day courses after arthroscopies or pin removals, ER docs who reflectively give opioids for complaints of 'headache', oral surgeons who prescribe more than a few doses for an extraction or implant etc.

The US accounts for 5% of the worlds population and 99.7% of all hydrocodone prescriptions. Something is off here.

And no, its not the Sakler family either that singlehandedly created this mess. They are just a convenient scapegoat because they are rich and ignorant.
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Thank you for this.
 
If 35% of OD’s are due to prescription meds, then the overwhelming majority, 65% are due to non prescription drugs.
America does use the majority of opioids, though some countries use basically none, India being one example.
I’m not saying this isn’t a problem, unfortunately you are going to have a hard time stamping out addiction when the availability of street drug of any kind are available to any one that wants them.
When society condones drug use by putting nurses in shootings galleries for heroin addicts you might be sending the wrong message.
Legalizing pot and soon to be magic mushrooms also seems to be a bad idea for people with addiction problems. The problem with and cause of prescription meds fail in comparison.
 
We found out yesterday that he survived an overdose on Thursday. Heroin and fentanyl. His buddy called the ambulance for him.

He sounds the same on the phone. He will never get past this without psychiatric care. Its torture to be on this ride for all of us.
 
Old97 said:
We found out yesterday that he survived an overdose on Thursday. Heroin and fentanyl. His buddy called the ambulance for him.

He sounds the same on the phone. He will never get past this without psychiatric care. Its torture to be on this ride for all of us.
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Damn, sorry you are going through this, there is no way to get him involuntarily committed?
 
PaulS said:
Damn, sorry you are going through this, there is no way to get him involuntarily committed?
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Its very difficult in situations like this. He is sane enough to know how to act normal for the cops and the doctors if it gets that far. Then he tells us about his delusions. Nike wants to sponsor his clothing line - that kind of thing.

The system just isn’t set up to help people in his position.
 
Old97 said:
Its very difficult in situations like this. He is sane enough to know how to act normal for the cops and the doctors if it gets that far. Then he tells us about his delusions. Nike wants to sponsor his clothing line - that kind of thing.

The system just isn’t set up to help people in his position.
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Sorry to hear this. It's an impossible position to be in, and I think it's tougher on the family than the patient. I hope he seeks out help.
 
Sorry for the situation your family is in, it is hard on all.
You could try an intervention with the family and have him put into a 30 day rehab. We did this for a friend of mine and he has been clean and sober for 30 years.
 
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