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Wednesday, April 12, 2017

Recommended Reading

See How Bad is the Opioid Epidemic? (dated Feburary 23, 2016) and Trump’s FDA Chief Cites Opioid Epidemic As Top Priority (dated April 7, 2017). Apparently, the use of opioids is so prevalent that Colleges can get free doses of naloxone for students overdosing on opioids (dated April 10, 2017):
The Clinton Foundation and Adapt Pharma are working together to give colleges 40,000 doses of NARCAN nasal spray, which is the only FDA-approved nasal spray and is designed to be simple enough to administer that people without medical training can provide a potentially lifesaving dose.
According to the first link: Twelve states have more opioid prescriptions than people, and there are urgent calls for action. What should that action entail?

At this point, opioids are the most effective pain killers known, and doctors with integrity wish to help patients suffering from debilitating pain syndromes, which are often mysterious in origin. On the other hand, some doctors are nothing better than legal drug dealers.

What should be the government's role in ameliorating the opioid epidemic?

And how did we get to this sorry point?

44 comments:

  1. What should be the government's role in ameliorating the opioid epidemic?

    Stop "helping". More of the problem's "cause" is no "cure".

    ReplyDelete
    Replies
    1. Legalize all drugs. Make it a capital crime punishable by death to provide medical assistance to drug ovwrdoses.

      Delete
    2. People tend to be victims of their own mental and physical laziness –– the desire always to take the paths of least resistance

      People are always looking for an Easy Way Out –– Something Outside Themselves –– to rescue them from Pain, from Duty, from Boredom, from Perplexity, –– from Challenges of ANY Kind.

      That is why we've become virtual SLAVES to MACHINES, –– Movies, –– Radio, –– Television, –– Canned Music, –– Computers, –– Cell Phones, –– Fast Food, –– Pornography, –– Drugs, –– Plastic Surgery, –– and now ROBOTS and SELF-DRIVING CARS!

      We tend to MISUSE all of these things to AVOID making EFFORT. In so doing we also avoid BUILDING CHARACTER, which means we FAIL to FULFILL OUR POTENTIAL thus dooming ourselves to more or less permanent feelings of EMPTINESS, ANXIETY, HOSTILITY, and DEEP DISSATISFACTION.

      Modern "PSYCHOLOGY," –––– which in essence is ANTI-CHRISTIAN, ANTI-COMMON SENSE, and ANTI-SELF-DISCIPLINE ––––, has given us the PERVERSE NOTION that we are all VICTIMS of CIRCUMSTANCE and therefore, NOT RESPONSIBLE for OURSELVES, that –– to use Anna Russell's comic phrase –– EVERYTHING WE DO THAT'S WRONG is SOMEONE ELSE'S FAULT, and that SELFISHNESS is GOOD.

      All these things have combined to make us into a race of beings who barely tap into their potential, barely develop their humanity, who tend to be petulant, demanding, and therefore, continually criticize and lash out at others for not automatically anticipating and fulfilling their every need, whim and fancy.

      We have become a race that gets old without ever having matured, –– a race who never can know the meaning of Inner Peace, Joy, and Contentment.

      Is it any wonder so many of us have become SLAVES to SUBSTANCE ABUSE?

      "The fault ... is not in our stars, but in ourselves."

      As usual, Shakespeare said it best, and most succinctly.

      HAPPY EASTER, EVERYONE!

      Delete
  2. "And how did we get to this sorry point?"

    Big Pharma greed and physicians naivety.

    ReplyDelete
    Replies
    1. Jon,
      Physicians naivety?

      Do you mean that they are taken in by false studies and Big Pharma? Or the slyness of those seeking drugs?

      Delete
    2. "Do you mean that they are taken in by false studies and Big Pharma? Or the slyness of those seeking drugs?"

      What I mean is that the drug companies reported that much of this $#!t wasn't addictive or not a problem. I thought that has already been acknowledge here. Physicians depend upon what they are informed by Big Pharama. If you ask me Physicians are not God-like and can be scammed and even be on-the-take! Some times it goes like this: prescribe lots, get recognized, give favorable speeches about the medication, in question, then receive a fat honorarium. This was exposed in the DENVER POST, awhile back.

      Delete
    3. Jon,
      the drug companies reported that much of this $#!t wasn't addictive or not a problem. I thought that has already been acknowledge here.

      Please forgive me if I missed that information having been posted here in a comment. I wasn't online as much as usual yesterday.

      It's important to reiterate that information:

      the drug companies reported that much of this $#!t wasn't addictive or not a problem

      You are spot on as to how the relationship between physicians and Big Pharma works!

      Delete
    4. Naiveté, please. I don't believe "naivety" is a legitimate part of the language.

      Naiveté, Naiveté, Naiveté, Naiveté, Naiveté
      Naiveté, Naiveté, Naiveté, Naiveté, Naiveté
      Naiveté, Naiveté, Naiveté, Naiveté, Naiveté
      Naiveté, Naiveté, Naiveté, Naiveté, Naiveté
      Naiveté, Naiveté, Naiveté, Naiveté, Naiveté


      Please try to remember it.

      As a former teacher I can tell you on good authority that an ERROR UNCORRECTED soon becomes an ERROR COMPOUNDED.

      };^)>

      Delete
    5. FT,
      Actually, naivety appears in the dictionary. See THIS. It seems that naivety is now accepted.

      Delete
    6. That's DEPRESSING, DISGUSTING, and DEGENERATE..

      Delete
    7. The British, whom I generally admire greatly, are known for ANGLICIZING terms and proper names that come to them from foreign languages, "ANGLICIZATION" is a polite term for DELIBERATE MISPRONUNCIATION.

      [A brief study of The Hobson-Jobson Syndrome might prove revealing in this area. https://en.wikipedia.org/wiki/Hobson-Jobson]

      Americans too are well known for MISPRONUNCIATION –– particularly of non-English, Scottish or Irish names, –– but EDUCATED Americans at least TRY to pronounce words that enter the language from foreign cultures CORRECTLY –– too often with limited success.

      You and I have clashed several times over words now deemed acceptable –– such TO FACT CHECK instead of TO VERIFY –– and now TO SURVEIL (:-o [a backformation from the French SURVEILLANCE, I would presume], instead of to MONITOR, to SUPERVISE, to AUDIT, to DRECT, or to OVERSEE.

      These graceless, completely unnecessary terms are the products of Ignorance and Laziness. People just do not bother either to LEARN –– or in most instances to TEACH –– proper English anymore.

      At age 76 I know I'm on my way out, and realize I have no influence, because in typical churlish fashion, which is The Modern Way, my studiously, assiduously acquired KNOWLEDGE and level of TASTE and EXPERTISE tend these days to be IGNORED, DISMISSED, RIDICULED or callously OVERRIDDEN.

      Sic transit gloria mundi!

      Nevertheless, I shall continue to maintain the very high standards by which I was fortunate to be raised as long as I breath in my body.

      I CAN accept "change," as long as it is CONSTRUCTIVE and LIFE-ENHANCING, but I can NOT –– and WILL not –– accept DEGENERACY.

      There IS a difference, believe it or not.

      Delete
    8. FT,
      These graceless, completely unnecessary terms are the products of Ignorance and Laziness.

      Surely you do not mean to imply that JonBerg is ignorant or lazy! Jon is a friend to this blog, you know. I value his commentary.

      Delete
    9. FT,
      People just do not bother either to LEARN –– or in most instances to TEACH –– proper English anymore.

      In fact, teachers today are specifically instructed to undermine the English language. Are you familiar with the term "creative spelling"?

      Delete
    10. FT,
      You know that I'm a stickler with regard to the English language. But to a certain extent, I simply have to accept authorized changes to our language Otherwise, I'm stuck with the equivalent of debating how many angels can dance on the point of a pin. What futility that debate was!

      Please understand that this comment to you is not dismissive of your concerns. I'm just pointing out the different sides of this argument about changes in language.

      I daresay that the opioid epidemic is of greater consequence -- particularly to the families so afflicted. I grieved to say that three members of my family are caught up in this epidemic -- not that they needed these medications for pain, but rather chose to use them for recreation because doing so was what nearly all their peers were doing. Two of these young people had such bright futures ahead of them. It's a heart breaker for those of us watching their self-destruction!

      Delete
    11. FT,
      "These graceless, completely unnecessary terms are the products of Ignorance and Laziness."

      Do you want me to remember this the next time I catch one of your typos?

      Delete
    12. I'm 76-years-old, legally blind and arthritic, Jon. As a result, typing has become extremely difficult for me, so frequent typos have become almost inevitable.

      I'm sorry if my correction offended you. I didn't mean it as a personal insult to you at all, but more as a well-deserved criticism of the way our CULTURE has degenerated since I was of school age.

      I assume you are a good deal younger than I, and therefore realize that whatever deficiencies yoinger people show in the use of our precious language must be the result of perverse cultural conditioning and lackadaisical teaching NOT any willful determination on your part –– or anyone else's –– to break the rules.

      When I was in my formative years, EVERY ADULT around me, constantly corrected any mispronunciation, grammatical error, factual errr, or less-than-graceful syntax. They did it NOT to punish or humiliate me, but because they loved and cared about me, and wanted to give me the best possible chance fto have a good future.

      You and I normally see eye to eye on most issues. I thought we were good enough friends by now for me to be able to do what I did without your feeling "wounded."

      Delete
  3. How did people used to suffer through pain, chronic or not chronic, before these really strong drugs?
    There's no magic bullet and this one docs thought was so effective is killing too many.
    Also, when opioids are no longer given but the patient is hooked, heroin is often turned to, by people who'd no sooner have shot heroin than jump off a building.

    ReplyDelete
    Replies
    1. Z,
      How did people used to suffer through pain, chronic or not chronic, before these really strong drugs?

      You might want to read this brief history of opiates.

      Delete
    2. This comment has been removed by the author.

      Delete
    3. Z,
      heroin is often turned to

      Because it's cheaper and more easily accessed than prescription narcotics.

      Delete
  4. I have been organizing my thoughts on this... My premise is that Alcohol still kills as many if not more---more disease, more deaths than drugs. traffic accidents.That it is the tendency for addiction that is the problem. Either drugs or alcohol. That in the end, people who are in chronic exquisite pain, especially older people will be sentenced to live with a poor quality of life. I have pulled the numbers together and as far as I am concerned, we are back to prohibition. Yes, drugs need to be more controlled from illegal sources but beware of the end result of this.
    As far as the government, they are complicit in this. That survey that you receive after you get home from the hospital? One of the questions is was your pain controlled. These surveys are mandatory. If you don't answer All the time... which is unlikely if you had surgery, the hospital is docked from their reimbursement. If you were the hospital, what would you do??

    ReplyDelete
    Replies
    1. Bunkerville,
      it is the tendency for addiction that is the problem. Either drugs or alcohol.

      And, too often, doctors don't know in advance who has the gene for addiction and who does not.

      people who are in chronic exquisite pain, especially older people will be sentenced to live with a poor quality of life

      It seems to me that people in chronic exquisite pain should be allowed the medications that help them to have decent quality of life.

      Delete
  5. The problem is massive in New England.
    It's been greatly aggravated by the introduction of fentanyl which is thought to be involved in a large percentage of overdoses.

    There are multiple user profiles and it's in all strata.
    How to stop it?
    Interdiction has been an abject failure and the "war on drugs" has done more harm than good.
    Treatment is expensive and limited.
    Drug companies aren't going to stop pushing opiates and any attempts to limit prescribing is going to be resisted.

    It's a horrible complex problem.

    ReplyDelete
    Replies
    1. Duck,
      Isn't fentanyl supposed to be only after other pain-control medications have been tried according to a protocol?

      Or is it that people are stealing the fentanyl from those who have the medication properly subscribed?

      Apparently, fentanyl has become a recreation drug. Or so indicated the Google search I just did.

      I read somewhere that pain specialists who are not "legal drug dealers" prescribe a fentanyl transdermal patch instead of the other forms?

      The only person I've ever known who was prescribed fentanyl was my aunt, who had pancreas cancer. In a few weeks, though, the patch caused such severe skin breakdown that oral pain killers and IV pain killers had to be prescribed. The hospice nurse kept close track of the amount used and the amount remaining -- the latter after my aunt died, of course. And I mean a close watch! As soon as my aunt passed, the hospice nurse was notified and came to the house at midnight, shortly after my aunt was pronounced.

      Delete
    2. It's easy to manufacture for no more than an equivalent volume of heroin.

      However, it is so potent that it can be cut many more times than an equivalent amount of heroin. Naturally with that potency comes the increased overdoses.

      My town just made it mandatory for police to carry Narcan things are so bad.

      Delete
    3. Ducky & AOW,

      I agree that Big Pharma shares blame. Oxycontin should be outlawed, and we need to crack down on prescription practices.

      My son had his wisdom teeth out last year on a Friday before spring break. Monday he was still staggering around in a fog, so I asked to see his meds. They had given him a week's worth of narcotics with no instructions to only use for severe pain, etc. I took immediately to the pharmacy disposal.

      When I left the hospital many years ago after getting my appendix out, they sent me home with one narcotic-based pain killer to get me through the first night. After that, it was some kind of powerful Tylenol equivalent.

      On a more metaphysical level, are we hollow people leading hollow lives, and looking for external things to fill us up? Paging C.S. Lewis.

      Delete
    4. SF,
      I'm certain that OxyContin is warranted in certain medical situations. But not until AFTER less dangerous pain killers have been tried and found wanting. Terminal patients -- those with cancers and end-stage kidney failure -- should have access to pain relief, IMO.

      OxyContin after a dental procedure? REALLY?

      It seems to me that only pain specialists who are anesthesiologists AND being properly monitored. should be prescribing narcotics. Other physicians simply don't have enough training to dish out such powerful medications.

      Delete
    5. It seems to me that only pain specialists who are anesthesiologists AND being properly monitored. should be prescribing narcotics.

      -------
      That's been my feeling.

      Delete
    6. Duck,
      "Doctor shopping" and "pharmacy shopping" are also major factors in all this. Are you familiar with those aspects and how they contribute to addiction?

      Yet another factor: using the ER to get narcotics. Apparently, faking kidney stone pain is a major way of getting IV Dilaudid, which is immediately provided so as to do an immediate CT scan or MRI. When I was in the ER on December 25 and March 30, I saw some addicts attempting that strategy. To the ER's credit, the medical personnel there didn't fall for that particular scam and sent the addicts on their way. Not that sending these addicts on their way addresses the problem, though.

      Delete
  6. What is the cause? Ultimately, life without meaning. Yes, I understand an aging population more prone to injury and surgery that truly require opioids for pain, addiction that may follow. But I doubt THIS is the epidemic.

    Government agencies are looking hard at how doctors use these meds. I had a physician client who led the Pain Management Clinic at a major institution. They trolled through his patient records and singled out several they demanded he answer for why he'd prescribed for them. I helped him sort out data on these to present his case. It was interesting to get his take - why they picked some (that made no sense) and ignored others that might have flagged. It sounded more like a hunt to fire a warning shot to others than truly investigating anything to me.

    It makes you go hmm. And good point about the reimbursements, Bunkerville!

    ReplyDelete
    Replies
    1. Baysider,
      I understand an aging population more prone to injury and surgery that truly require opioids for pain, addiction that may follow. But I doubt THIS is the epidemic.

      I have read that younger family members steal their grandparents' pain medications. I've also read that some senior citizens actually sell part of the supply of their prescription medications.

      Government agencies are looking hard at how doctors use these meds.

      A licensed pain-management doctor makes his patients pee in a cup to make sure that their patients are actually taking the medications. Furthermore, the patients have to sign an agreement to be monitored. I've heard that it's a multi-page document. It's come to that!

      Delete
    2. @ Baysider: "Ultimately, life without meaning"

      Bingo

      Delete
  7. When I was in the hospital last year, my surgeon told me a few days after major surgery: "You are extremely sensitive to IV narcotics. You need a much lower dose than is normally prescribed. Remember that!"

    He then asked: "Did you do any recreational drugs when you were younger?"

    I answered in the negative.

    "No wonder, then!" my surgeon exclaimed.

    ReplyDelete
  8. Informative article, dated March 4, 2015:

    How the American opiate epidemic was started by one pharmaceutical company.

    Excerpt:

    [T]the story of the painkiller epidemic can really be reduced to the story of one powerful, highly addictive drug and its small but ruthlessly enterprising manufacturer.

    On December 12, 1995, the Food and Drug Administration approved the opioid analgesic OxyContin. It hit the market in 1996. In its first year, OxyContin accounted for $45 million in sales for its manufacturer, Stamford, Connecticut-based pharmaceutical company Purdue Pharma. By 2000 that number would balloon to $1.1 billion, an increase of well over 2,000 percent in a span of just four years. Ten years later, the profits would inflate still further, to $3.1 billion. By then the potent opioid accounted for about 30 percent of the painkiller market. What's more, Purdue Pharma's patent for the original OxyContin formula didn't expire until 2013. This meant that a single private, family-owned pharmaceutical company with non-descript headquarters in the Northeast controlled nearly a third of the entire United States market for pain pills.

    OxyContin's ball-of-lightning emergence in the health care marketplace was close to unprecedented for a new painkiller in an age where synthetic opiates like Vicodin, Percocet, and Fentanyl had already been competing for decades in doctors' offices and pharmacies for their piece of the market share of pain-relieving drugs. In retrospect, it almost didn't make sense. Why was OxyContin so much more popular? Had it been approved for a wider range of ailments than its opioid cousins? Did doctors prefer prescribing it to their patients?

    During its rise in popularity, there was a suspicious undercurrent to the drug's spectrum of approved uses and Purdue Pharma's relationship to the physicians that were suddenly privileging OxyContin over other meds to combat everything from back pain to arthritis to post-operative discomfort. It would take years to discover that there was much more to the story than the benign introduction of a new, highly effective painkiller.

    [...]

    Beginning around 1980, one of the more significant trends in pain pharmacology was the increased use of opioids for chronic non-cancer pain. Like other pharmaceutical companies, Purdue likely sought to capitalize on the abundant financial opportunities of this trend. The logic was simple: While the number of cancer patients was not likely to increase drastically from one year to the next, if a company could expand the indications for use of a particular drug, then it could boost sales exponentially without any real change in the country's health demography.

    This was indeed one of OxyContin’s greatest tactical successes. According to "The Promotion and Marketing of OxyContin," from 1997 to 2002 prescriptions of OxyContin for non-cancer pain increased almost tenfold. Meanwhile, in 1996 the FDA approved an 80mg version of the pill; four years later it approved a 160mg tablet. According to the FDA’s “History of OxyContin: Labeling and Risk Management Program,” higher dosages were approved specifically for opioid-tolerant patients.

    These high-milligram pills were probably one of biggest reasons that OxyContin became such a popular street drug. Recreational users and addicts could crush, sniff, and inject the pill for a powerful high that, as promised, lasted over eight hours. The euphoric effects and potential for abuse were comparable to heroin. But clearly doctors and pharmacies never drew the ghastly parallel. Why?...


    Read the rest HERE.

    ReplyDelete
  9. I was recently told by a doctor: "The more they mess with you [operate on you], the greater the risk of triggering neurogenic pain [neuropathy]."

    Nerves get nicked, severed, etc. And once nerves start firing, they keep on firing. Cymbalta and Lyrica work for some people who have that kind of pain, but those medications can have severe side effects, such that some individuals cannot tolerate those medications.

    I was prescribed Lyrica a few years after my 2005 car accident. Things went along okay for about two years. Then the side effects set in! One of the side effects was tardive dyskinesia:

    Grimacing
    Tongue movements
    Lip smacking
    Lip puckering
    Pursing of the lips
    Excessive eye blinking

    Rapid, involuntary movements of the limbs, torso, and fingers may also occur. In some cases, an individual's legs can be so affected that walking becomes difficult or impossible.

    These symptoms are the opposite of patients who are diagnosed with Parkinson's disease. Parkinson's patients have difficulty moving, whereas tardive dyskinesia patients have difficulty not moving.


    I was lucky in that once I stopped taking Lyrica, the above craziness disappeared.

    Nothing else has helped me as much as Lyrica did. But long term? A no-go, especially if I was to continue teaching in the classroom. The sciatica medication I take now (not a controlled substance) barely controls the pain, despite the recent increase in dosage -- that's one reason that readers here notice I disappear for a while. The pain is surreal at times! I become non-functional.

    ReplyDelete
  10. People tend to be victims of their own mental and physical laziness –– the desire always to take the paths of least resistance

    People are always looking for an Easy Way Out –– Something Outside Themselves –– to rescue them from Pain, from Duty, from Boredom, from Perplexity, from Challenges of ANY Kind.

    That is why we've become virtual SLAVES to Machines, –– Movies, –– Radio, –– Television, –– Canned Music, –– Computers, –– Cell Phones, –– Fast Food, –– Drugs, –– Plastic Surgery, –– and now ROBOTS and SELF-DRIVING CARS!

    We tend to MISUSE all of these things to AVOID making EFFORT. In so doing we also avoid BUILDING CHARACTER, which means we FAIL to FULFILL OUR POTENTIAL thus dooming ourselves to more or less permanent feelings of EMPTINESS, ANXIETY, HOSTILITY, and DEEP DISSATISFACTION.

    Modern "PSYCHOLOGY," –––– which in essence is ANTI-CHRISTIAN, ANTI-COMMON SENSE, and ANTI-SELF-DISCIPLINE ––––, has given us the PERVERSE NOTION that we are all VICTIMS of CIRCUMSTANCE and therefore, NOT RESPONSIBLE for OURSELVES, that –– to use Anna Russell's comic phrase –– EVERYTHING WE DO THAT'S WRONG is SOMEONE ELSE'S FAULT, and that SELFISHNESS is GOOD.

    All these things have combined to make us into a race of beings who barely tap into their potential, barely develop their humanity, who tend to be petulant, demanding, and thereofeore, lash out at others for not automatically anticipating and fulfilling their every need, whim and fancy.

    We have become a race that gets old without ever having matured, –– a race who never can know the meaning of Inner Peace, Joy, and Contentment.

    Is it any wonder so many of us have become SLAVES to SUBSTANCE ABUSE?

    ReplyDelete
  11. The TRAGIC STORY of GIFTED POET SYVIA PLATH is a GOOD CASE in POINT as to WHAT WENT WRONG in the MODERN ERA. To wit:

    _________ A CRITIQUE _________



    A rebarbative poet named Plath, 

    Who was filled with revulsion and wrath,

    Was best known not for smiling

    But rage and reviling ––

    The mark of a true psychopath.



    She worked herself into a lather

    In an orgy of hate for her father.

    The poor creature was doomed

    As vile passion consumed

    Her whole life, which seemed not worth the bother.



    So, she stuck her poor head in the oven,

    Because she knew nothing of lovin.’

    If she’d been more Bourgeois,

    She’d have gone to a Spa,

    Forgotten her Pa, and got movin.’



    The sad saga of Sylvia Plath.

    For whom much distaste I do hath.

    Might have ended more merrily;

    I asseverate verily,

    If her soul had been giv’n a hot bath!



    And a diet of rich chocolate malts

    Along with a good dose of salts

    Administered gaily

    On schedule daily

    To purge her of her grievous faults!




    ~ FreeThinke

    ReplyDelete
    Replies
    1. FT,
      Was Sylvia Plath addicted to narcotics? If so, I was unaware of that detail about her life.

      Delete
    2. The drug she was addicted to was Ted Hughes.

      Delete
  12. _________Death to Defeatism ________

    Has life defeated you? I rather hope
    Defeatist rhetoric will die aborning,
    Though seen by many merely as a warning,
    Each bitter word will serve to weave a rope
    By which we’ll hang ourselves when the despair
    We manufacture with denunciation
    Of all the grievous faults that plague the nation
    Convinces us our world’s beyond repair.
    What good could we expect to come from that?
    Affirmation is the only answer
    To the questions posed by social cancer.
    Get up and dance –– don’t bellow through your hat.
    Although The Axe inevitably must fall,
    Cringing will produce no good at all.

    ~ FreeThinke

    ReplyDelete
  13. Talk health!
    There's nothing that can either charm or please
    By harping on the minor chord
    Disease! Disease! Disease!


    "Laugh, and the world laughs with you; weep, and you weep alone."

    ~ Ella Wheeler Wilcox (1850-1919)

    ReplyDelete

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