The Opioid Epidemic

Discussion in 'The Mainboard' started by steamengine, Jun 23, 2017.

  1. blotter

    blotter Aristocratic Bum
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    hmm I can go to a football game or paris with a relaxed mind, someone suffering from addiction is altering their behavior or mind because of a felling of dis-ease or stress, no? Stress is like top three causes for tons of diseases but not a disease in itself? not sure I can see his argument from that excerpt

    in terrible people news:

     
  2. ShuPoor

    ShuPoor My life for comrade Britney
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    That guy sucks
     
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  3. TDCD

    TDCD Handling the Fisher account
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    I like that idea.
     
  4. Tony Ray Bans

    Tony Ray Bans Most Overlooked. Most Overbooked.
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    No one has ever, in the history of drugs, stopped before doing a shot of heroin and thought "wait what if there isn't narcan?" That is not going to do anything but increase the number of deaths. By the time you get to the needle, using vs not using is not a choice in the sense that a normal person thinks of one. We need to seriously beef up the resources that exist to treat addiction so that we can get people into rehab/treatment and avoid multiple ODs. Removing the safety net will not decrease the number of people who OD, just the number of ODs total (obviously you can't OD twice if you die the first time). I know people that have OD'd multiple times and then gotten clean and I KNOW their parents/siblings/friends are pretty god damn happy the paramedics had narcan and didn't use their loved one's life to "teach people a lesson."

    If someone suggested that we don't give medical attention to long term smokers or people that eat themselves to death, it would be denounced as ridiculous and cold-hearted. People make bad choices and put themselves in bad situations but we have the technology and the resources to give them a chance to make it right. I cannot get on board with cutting off the use of a drug that could save the life of someone I love to prove a political point that will not help stop the epidemic in any way whatsoever.
     
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  5. TC

    TC Show me your portfolio, pussy
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    This isn't about stopping an epidemic Tony. It's about people getting what they deserve
     
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  6. BrickTamland

    BrickTamland You're not Ron...
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    Opioid epidemic, sure.

    Obesity and our inability to have any semblance of a fucking clue how to "eat healthy" is a much larger issue to America's health.

    Luckily food industry and pharma lobbyists will make sure both problems persist.

    Ultimately it falls back on the individual. Choice is a beautiful thing and is truly at the core of what makes us the best country in the world.
     
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  7. Hide&SeekChamp

    Hide&SeekChamp Well-Known Member
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    I am hesitant to post in this thread and hopefully this will be my only post, so please forgive me for the long post. I have worked with this issue in some capacity for 15 years and I have seen legit pain transform into death and destruction more than I would prefer.

    1. Opiod/heroin addiction almost always begins with a legitimate cause. Like the poster earlier that was talking about a tonsillectomy, most people that have an injury or a surgery have a need for pain medication. I had a pretty serious knee injury, took 3 tablets and threw the rest away. Had a tonsillectomy and took every dose. Unlike most people, I work in an field that makes me very familiar with addiction and I am terrified of the slippery slope that goes from legit pain med need to addiction. Practically none of the addicts that I see on a daily basis set out to be an addict. Most of them were not weaned off their pain medication properly and most of them have legitimate chronic pain, but also eventually developed dependence. Once dependence is present, everything else is secondary.

    2. Doctors are not lining their pockets from the drug companies to prescribe these meds. Overwhelmingly, pain medications are dispensed in their generic forms. There are a few exceptions that are prescribed that are branded still at this point (Hysingla, Zohydro), but oxycontin, Vicodin/Lortab/Lorcet, Roxicodone have all been generically available for quite a long time. The doctors that are prescribing to line their pockets are lining the pockets with money from patients with dependency issues as opposed to lining them through big pharma. Unless some of the branded pain meds gain popularity, big pharma will struggle to displace the generically available pain meds.

    3. The DEA has taken steps to try to curb the opiod issue. Basically every opiod is now a schedule 2 medication. In the past, many of these drugs were schedule 3 which allowed refills to be given to a patient without being seen. Ironically, when the DEA made this change, heroin use skyrocketed in my state. The DEA had cut the supply dramatically and had forced doctors to be more diligent, but did not account for the dependency issues of the people taking the medication legally or illegally. With the supply of prescription opiods being reduced, the street value increased. Guess what is still dirt cheap? Black tar heroin. Heroin use increased here as a result of the government and medical boards attempting to address the issue of overprescribing and misuse.

    4. The majority of high narcotic prescription writers in this area are known to be corrupt. I have helped with a few DEA investigations and in many of those cases the doctor was only accepting cash and running a pill mill. I asked the agents why they weren't pursuing more doctors and they said that the cost of investigating a doctor is astronomical. It is much less expensive to try to control the supply than to assess the prescribing patterns of every doctor. Pain management is inherently relative. A level 10/10 pain for one person might be level 2/10 for the next. The science is so inexact that treating the pain is literally completely subjective.

    5. Anesthesia has dramatically changed based on the rampant opiod tolerance in society. Doctors have told me that they frequently have to dose people at crazy levels because so many have a legal or illegal tolerance to the opiods used for anesthesia in many surgeries.

    6. Benzodiazepines are the next major issue. Taken alone, they are safe and useful for anxiety, nerves, etc. Taken with pain medication, they are potentially lethal. In this area, most of the OD issues have been a combination of either opiods (including methadone) and xanax. Steps are being taken to change the classification of xanax based on this. No matter the steps that are taken, addicts will find a way to abuse whatever is accessible.

    7. From extensive work in a methadone clinic, I actually feel that the patients that are in a legit treatment setting and are held to reasonable standards have successful outcomes in a methadone clinic setting, Unfortunately, some of the clinics are similar to the pill mills and do not really care about the outcome. They simply care about the income.
     
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  8. TDCD

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    Maybe so, but they had plenty of previous choices that they botched to get to a point of IV heroin use.
     
  9. Tony Ray Bans

    Tony Ray Bans Most Overlooked. Most Overbooked.
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    I completely agree. I just can't get behind the idea that those bad decisions make that person's life not worth saving
     
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  10. Mikelangelo

    Mikelangelo Nicking a living
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    Guy I've had thanksgiving with for the last 20 or so years just died, dad found him with a needle. Shit is terrible.
     
  11. Tony Ray Bans

    Tony Ray Bans Most Overlooked. Most Overbooked.
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    Sorry man, thats awful :embarrassed:
     
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  12. NoNatty

    NoNatty Keyboard Cowboy
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    Bullshit.
     
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  13. Tony Ray Bans

    Tony Ray Bans Most Overlooked. Most Overbooked.
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    I see the point this article is trying to make but 1) tons of people DO start using that way (myself included) and 2) there wouldnt be billions of pills sitting in medicine cabinets all over the country if they werent over prescribed. If we hadn't been handing people hundreds of percocets for wisdom teeth and other rather minor incidents, they wouldnt exist to be diverted into the recreational market.
     
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  14. WillieHuff

    WillieHuff RACKEM
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    That article isn't terribly off base but there are some things they neglected. Nowadays, you can look up and see exactly how many narcotics people have been prescribed, by who and when. In some states this is mandatory before writing a prescription because you can look at it and be like "Umm bullshit miss smith, you picked up 120 percocet 10/325's three days ago, sorry nope." As far as the overprescribing surgical patients more than they need, this is kind of done on the patient doctor convenience because we can't call in Narcotics; gotta have a physical script for that which means the patient has to drive back to the office or the ED. Usually you do this for people who you think are going to be responsible. A lot of attendings I work with refuse to give narcotics unless you have a broken bone or have surgery, anything else is tylenol #3 or tramadol and if you need something stronger, you need to go to chronic pain.
     
  15. Tony Ray Bans

    Tony Ray Bans Most Overlooked. Most Overbooked.
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    But arent a lot of those things responses to the epidemic? Florida didn't have a prescription monitoring program until 2011(?) before that you could go to 5 docs a day. Oxy came out in 1996. This problem didn't start last year. I certainly agree that we have made HUGE strides in limiting the number of narcotics prescribed but the problem now is that a huge population of addicts has been created. There is a reason heroin use is skyrocketing: oxy is either too expensive or not available to most of them. In 2004-5 you could get an oxy 30 for 8-10 dollars on the street. Certain regions (Appalachia, South Florida, etc) were awash in them. Now we have to figure out how to solve the problem of the huge number of people who became addicted to opiates when they WERE easy to get. Cutting off supply may help in some ways (its definitely better than the free for all we had in the early 2000's) but heroin is cheap and dangerous as hell especially with the rise of fent.
     
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  16. WillieHuff

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    Oh yeah its totally in response to the epidemic
     
  17. NoNatty

    NoNatty Keyboard Cowboy
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    I don't think the article and/or research on the topic says that overprescribing wasn't a real issue, but rather that the large majority of people who use opioids for pain will not end up developing an addiction.
     
  18. THF

    THF BITE THE NUTS, THUMB IN THE ASS!
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    No judging here at all I am honestly just really curious your opinion here, but how do you feel about alcoholics being denied liver transplant options?

    It's s tricky question and I struggle on both sides of the argument. I have a history in my family and have ended up in relationships with dependents on alcohol. I go a week without touching alcohol but drink more than I should often. So I am curious how you feel and see the issues.
     
  19. Can I Spliff it

    Can I Spliff it Is Butterbean okay?
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    We could save a shitload of money if we refuse help to overweight-and-heavier people having heart attacks or drunk drivers
     
  20. Redav

    Redav My favorite meat is hotdog
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    Start making it where you have to pass a morality test to receive medical care
     
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  21. AlternativeFactsRule

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    A liver transplant is different. It's like an adoption and you have to assess the patient's ability to care for that donor organ.
     
  22. THF

    THF BITE THE NUTS, THUMB IN THE ASS!
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    See I disagree that there is a difference. It's health care in my eyes. It's simply providing an option for someone with a disease to replace a damaged organ.

    No issue. Just wanted to clarify I have a different opinion of the situation
     
  23. AlternativeFactsRule

    AlternativeFactsRule Mmm ... Coconuts
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    Alcoholics will continue to receive the best care possible for their failing livers, they simply will not get transplants until they are clean. This is how limited resources are managed. If we had excess livers just going to waste, your argument might make sense, but that isn't the case.
     
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  24. Tony Ray Bans

    Tony Ray Bans Most Overlooked. Most Overbooked.
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    If we had the ability to create transplantable livers for the couple hundred dollars max that a dose of narcan costs, I don't think it would even be a question that we would give one to anyone who needed it. Giving a liver to an alcoholic could potentially deprive another person of that particular liver, which is why the question becomes difficult (I honestly don't feel qualified to make that call). That said, we don't have precious few doses of narcan. And if we are weighing the few hundred bucks in resources it costs against a human life, I personally have been close enough to those situations to know I think that is not even a question in my mind.
     
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  25. Tony Ray Bans

    Tony Ray Bans Most Overlooked. Most Overbooked.
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    Well that argument is exactly what pharmaceutical companies used when they pushed the drugs initially and is the exact claim that they were taken to court for. They lost the largest class action lawsuit in their industry's history behind claiming that the drugs aren't addictive. I mean, we know that oxy is literally identical to heroin. If I told you that if you use heroin long term to treat a medical condition, you won't get addicted, would you believe that?
     
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  26. TC

    TC Show me your portfolio, pussy
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    Not to mention the shady stuff oxy pulled with how they mandated their drug be prescribed...their whole selling point was the one pill for eight hours. Except it started wearing off before 8 hours, causing the person to cycle from withdrawal symptoms to feelings of relief at the next dose. Studies show this cycling leads to addictive behavior. Docs wanted to write scripts that allowed for redosing but the manufacturer blocked it through lobbyists
     
  27. TC

    TC Show me your portfolio, pussy
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    Same manufacturer is now on record basically saying their next goal is to get the entire world addicted and they're expanding aggressively internationally
     
  28. TDCD

    TDCD Handling the Fisher account
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    Alcoholics should absolutely not be put on liver transplant lists. Should be for those with cancer/other uncontrollable diseases, not those who destroyed their liver themselves.
     
  29. AlternativeFactsRule

    AlternativeFactsRule Mmm ... Coconuts
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    You might want to read up some more on liver cancer.
    https://en.m.wikipedia.org/wiki/Hepatocellular_carcinoma
     
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  30. TDCD

    TDCD Handling the Fisher account
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  31. NoNatty

    NoNatty Keyboard Cowboy
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    They didn't say it wasn't addictive, they just significantly downplayed the risk of addiction citing one study in short term opioid use and applied it to chronic pain.

    Long term use of opioids is going to lead to dependence, but dependence doesn't always equal addiction. I'm not advocating for opioid use, but even the high side of things you see rates at like 8% of people prescribed will become addicted. The idea that most people who are prescribed opioids develop addictions is false.
     
  32. M'ark Pepperonio

    M'ark Pepperonio Free mahi mahi! Free mahi mahi!
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    A half-assed, ill-informed, and misleading piece of journalism from that shit factory called vice? Color me shocked. What an awful organization. Fuck vice.
     
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  33. NoNatty

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    Maia Szalavitz has gotten awards from the APA. If that still doesn't mean anything to you look at the research, even NIDA acknowledges the risk of developing addiction in short term opioid use is low.
     
  34. Pharm

    Pharm Right Handed
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    Yeah it the shooting up the pill and snorthign that would be the problem, eating a fentanyl pill wouldnt do much, very low bioavailability.
     
  35. TC

    TC Show me your portfolio, pussy
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    Do they sell it in pills? Thought it was only patches etc
     
  36. Pharm

    Pharm Right Handed
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    Also on the subject of suboxone, Are people technically sober while on it? I actually dont think they are, however if you look at its intended purpose it works. Its there to prevent death. Im sure i will get crucified for this, sobriety cant be achieved for most people. Whether you consider it a disease, poor life choices, lack of will power etc, its goal is to prevent someone from ODing. I dont care if the person claims sobriety, but many people can return to normal lives while on suboxone, yet they were doing nothing while on heroin. I would consider addiction a disease similarly to the way type 2 diabetes is, yes genetics come into a part, but you have the ability to control some aspects of the disease.
     
  37. Pharm

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    It comes in buccal tablets for cancer pain. But tony raybans is saying oxy is getting counterfeited and laced with fentanyl. Which is scary as many people are too afraid to shoot heroin but are more than willing to shoot oxy pills. Just another way to accidentally OD.
     
  38. TC

    TC Show me your portfolio, pussy
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    My understanding is suboxone doesn't get you high at all. It's not like methadone. There may be a very small good feeling right when it kicks but mostly it's just neutral and it keeps them from taking anything else bc it wouldn't work while they're on subs anyway
     
  39. TC

    TC Show me your portfolio, pussy
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    True. If you're gonna abuse it I guess pills are superior to heroin bc at least you know exactly what's in it and exactly how much. I think people that shoot pills develop some fucked up stuff with their veins after a while though bc of the little chunks and powder :ohdear:

    Also true OCs can't be shot anymore bc they made them into the gel things but there are off brands that still can be I think
     
  40. Pharm

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    It can get you high no doubt. people will still shoot it. It is not as intense. Yes it mainly works to keep the person from withdrawing and does have a high affinity for the opioid receptors preventing many opioids from binding. However, if you really wanted to prevent any opioids from working you would use naltrexone.
     
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  41. Pharm

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    Not true, it is much tougher to shoot, but people have found a way around it. Yeah, the gel polymer does some shit to the veins of people that shoot it.

    I would much prefer the the way that emebeda(morphine capsule) does things, they included naltrexone mixed in with the morphine. It is at a ratio that allows certain amount of morphine to bind but any more its just wasted as the naltrexone is bound to opioid receptors. Now obviously it has it drawbacks, if a person needs any extra opiates for surgery etc, but you can overcome it with stronger opioids if need be, similar to if someone with vivatrol needed pain management.
     
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  42. TC

    TC Show me your portfolio, pussy
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    ITT TC gets schooled by an actual pharmacist
     
  43. NoNatty

    NoNatty Keyboard Cowboy
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    "Sobriety" is a really poorly defined term. I think that you have people argue both ways about whether maintenance therapies are considered sober. In the end maintenance treatments work from a quality of life of perspective, and I'm in the boat that it is the only thing that matters.

    Since you're the pharmacist, will buprenorphine bind before the naloxone or can you only shoot subutex?
     
  44. Pharm

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    It can be shoot, however the naloxone has poor sublingual bioavailability so shooting it will just increase the amount of nalxone that is available to bind to the receptors thus decreasing the high in theory. Im sure that people have found away to get the naloxone out of the tablet though
     
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  45. Chicago Seminole

    Chicago Seminole Well-Known Member

    Non sequitur?

    You admit the ability of lobbyists to create/manipulate "choices", then say Well individuals have complete autonomy in their actions.

    Don't make no sense.
     
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  46. Chicago Seminole

    Chicago Seminole Well-Known Member

  47. BrickTamland

    BrickTamland You're not Ron...
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    Sure it does.

    As individuals, we can educate ourselves on biological processes, nutrition, and exercise while developing diet and fitness routines that work for us.

    My point was that you can sit back and eat what companies and our government feeds you (remember the grain-heavy food pyramid, sugary cereals being part of a balanced breakfast, yogurt and granola bars as healthy snacks, low fat "diet" foods, fortified white bread, etc) or you can accept responsibility for your well being and chose to take care of yourself.

    It's irresponsible of our government and these companies, sure. But we're a capitalistic society and money drives everything. So is life.
     
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  48. Redav

    Redav My favorite meat is hotdog
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    Choose to lead a better life. I wonder if people have thought of that.
     
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  49. Arkadin

    Arkadin inefficiently efficent and unclearly clear
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    Not everyone has the same access to information. You're showing your fairy tale privilege
     
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