Is it really just because of the fentanyl situation? I know there is a huge disagreement with how the strict rules for prescribing opioids are so tight even for chronic pain patients like myself who can’t participate in life without em struggle to find a provider who is willing to prescribe us them.
Because it’s low hanging fruit. Politicians can be “tough” on chronic pain patients and frame it as furthering the battle against the “opioid epidemic” without having to address the actual kraken in the bathtub, which is shady, Chinese bootleg fentanyl flooding the US through our leaky International mail system. The opioid crisis and epidemic of overdoses isn’t fueled by Grandma selling off her “extra” 5mg percosets, its coming from illegally smuggled fentanyl being sold illegally on the streets. Chronic pain patients are just a convenient sock puppet for the constant campaign mode our politicians are in, and they don’t care who they hurt to get elected or stay in power. Imho.
I agree with everything you said here, but just came by to say, “Kraken in the bathtub” is one of my favorite new idioms.
opioids were over prescribed for years and years with no thought to the consequences - mainly because the person writing the scrip was compensated for it by the drug manufacturers.
this led to tens of thousands of people who became addicted to opioids and lacked the willpower to fight being dope sick to get clean. even once you’re clean, relapse is common. the reality is that many people are weak willed - but no one wants to discuss that.
now cheap synthetic opioids are easily mass manufactured in China and Mexico and they are widely available & flood the streets. examples: https://www.youtube.com/@talesfromthestreets/videos & https://www.youtube.com/@examiningportland/videos (there are others but those are the ones I’ve seen recently).
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In my country you just tell the doc that you want opioids and you get them. What’s funny despite of that there is literally no problem with opioid addictions. It must be combination of other factors like poverty and lack of education etc. that combined with opioids cause the problem.
It’s always interconnected.
People do drugs in general more often when their life situations necessitate feeling like they need the help. It’s a coping mechanism. The only reason why we attack drug usage with such fervor compared to other, more socially acceptable things, is because they have a faster, more immediate, and more drastic effect.
When you feel your life is going well – work is good, you’re not crunched for money, your housing is stable, your diet is good, etc. you rarely feel the need for any kind of relief. When things start getting shaky or insecure, that kind of escapism can provide relief to people. The downside obviously is that a lot of things can be addiction-forming and cause a feedback loop where the drug use makes the overall situation worse, which feeds the drug use, which makes the overall situation worse, etc…
There are certainly people who kick off that cycle who weren’t necessarily doing so as some kind of escapism, but that brings us neatly back to the discussion about opioid abuse in general. You use them to solve a pain problem, you become addicted, and it snowballs.
So it’s easier to target the symptom of drug use than it is to address the underlying causes of financial, housing, food, and general life instability. Especially because in the US there is such a culture that’s perpetuated of people being wholly responsible for their own actions, and that we see any failings as failings of the individual. Meanwhile drug abuse numbers continue to grow, streets continue to get lined with tents, and people would rather write those things off as personal failings rather than indicators of systemic problems.
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It needs to be done with objective intelligence instead of arbitrary bureaucratic oversimplification. Someone that has had no criminal record and has been on any controlled substance for years should not get dragged through the mud over this issue. After a couple of years, they shouldn’t need to constantly see a doctor in person every few months or have pharmacies make their life any more difficult. These people should be the main priority of focus not some peripheral aspect of a 1% problem.
As far as I am concerned, the vast majority of fentanyl deaths are because it is the ideal suicide drug in a society that has an ineffective government that is bent on growing the poverty class.
I’m one of these chronically disabled people in constant pain. I choose not to take any pain meds because it doesn’t really change anything other than my mental sharpness. I’ve spent years on opioids, and can and have stopped at will. I despise the way I am treated and the nonsense it takes to get the meds. If I get sick of the struggle, an OD is less of a mess to clean up and I have every right to choose how I wish to exit. Fixing the real problem here involves changing society so that people feel they have options other than such an exit. Getting disability in the USA is difficult, expensive, and takes years. As of right now, when my folks die, that is my exit, and when I become this statistic too. You’re fighting the wrong problems here and inadvertantly making them worse.
It may be low, but it’s still thousands. I had knee surgery last year and didn’t take opiates because I’m at higher risk for addiction.
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Does overprescription just mean prescribed for people who don’t actually need it? And how would we know they don’t have the pain?
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I haven’t had any opioid since my last surgery several years ago but if I’m terminal I better hope they won’t restrict them to me. What a horrible death…
Because 1% of a few million people is still thousands of them.
Also, I’m not sure if the 1% figure is really that accurate, as it should become much higher when people are on them long term. The problem is that most opioids were prescribed to be safe for long-term use, which wasn’t true.
In this case it’s more that 1% of hundreds of millions is still millions. Opiates get prescribed to basically everyone at some point in their lives, so it’s basically just 1% of the population
Your 1% figure comes from misrepresentation of a ‘study’, pushed by Purdue and others for criminal gain.
The One-Paragraph Letter From 1980 That Fueled the Opioid Crisis
Purdue Pharma, which makes OxyContin, starting using the letter’s data to say that less than one percent of patients treated with opioids became addicted. Pain specialists routinely cited it in their lectures. Porter and Jick’s letter is not the only study whose findings on opioid addiction became taken out of context, but it was one of the most prominent. Jick recently told the AP, “I’m essentially mortified that that letter to the editor was used as an excuse to do what these drug companies did.”
Don’t get me wrong, pain is miserable and treatment needs to be better. But around 80% of opioid addictions start with prescriptions for people in genuine pain. What percentage of prescriptees that is, I don’t know. But it’s not a trivial issue, and it is a very difficult problem to solve.
I have a friend who is in school for being a nurse and she had an exam and one of the questions was about this percentage which is why I brought this up because less than 1% was the correct answer. She told me this figure since she knows I’m on em. Is this school just completely in the wrong then for teaching this to nursing students and I’m sure doctors etc?
I linked an article about how that stat became widely cited, based on almost nothing. It’s not uncommon in medicine, especially when it suits Pharma. I teach medical students and the first thing we teach them is that half the course will be out of date by the time they graduate and the other half is already out of date.
That’s not to say that addiction rates can’t be kept very low with responsible prescribing and there’s nothing wrong with reassuring patients who may be concerned about swapping one problem for another. But this particular factoid was cultivated by drug companies wanting to encourage irresponsible prescribing. And they succeeded.
There’s a brilliant drama on Disney/Hulu called Dopesick which tells the story (including of this statistic). It’s an excellent, and enraging, watch.
Thanks for your input, appreciate it
I’d also imagine at least part of it is the same as how normal people seem to think ADHD people with amphetamine prescriptions are just constantly high.
They don’t realize that whatever good feelings they’re getting from taking 100mg of amphetamines at once don’t apply at all to people chronically on small extended doses.
Yeah I’m not aware of any studies that link stimulant-based ADHD medication with abuse of street meth. But it’s a pretty common meme amongst doctors for some reason.
I think it’s because of rampant Adderall abuse among university students. However, many doctors will prescribe something other than Adderall now like concerta or Vyvanse because they are harder to abuse.
I’m on a pain management plan that includes an opioid. It requires mandatory 3 month check-ins with my doctor, and my previous pharmacy had a pharmacist that would ask me if I “really needed it”. That pharmacy delayed my refills so much sometimes that I would go into withdrawal. And if I called to ask what was going on, they would start asking me why I was so concerned and if I was actually using them.
New pharmacy only has an issue if I pre-emptively request a refill, but even then I just explain my work schedule and issues with remembering to submit the refill and they just hold it until the normal refill date.
I finally found a pain management clinic that will work with me and prescribe me opiates but it’s gonna take a bit of trial and error to find the right pill and dosage. She requires monthly check ins. I’m currently on tramadol 300mg but it isn’t enough so I got an apt july 10th to go to stronger stuff.
I’m sorry about your pharmacy that gave you issues. I’ve read so many stories about that and I can’t believe that happens. I’m glad you found a better one
So I don’t know if you’ve read about all of the lawsuits against pharmacies in the news. Basically, court found that pharmacy companies gave out prescriptions they should t have. And these are all scripts prescribed by the doctor. This changed the whole retail pharmacy policy. Pharmacies are actively pushing pharmacists to find any reason to deny the script so as to not get sued again.
Each pharmacist still is able to give their own judgement, but now has guidelines from their company that they should follow.
How exactly do they count addictions when someone has an ongoing prescription?
I’m not sure if this answers your question but this is what was explained to me when I worked in retail pharmacy.
Patient has opioid addiction from being on painkillers too long/too high a dose/abusing script. The patient has multiple doctors and specialists and requests painkillers from as many as they can get.
Doctors then become wise to the situation. Set the patient up on a “pain plan.” Now the patient can only fill opioid scripts from one doctor at one pharmacy.
Good question. I’d be interested in seeing an answer
It’s fentanyl
It’s not just fentanyl. I remember a lot of news about the “opioid epidemic” before fentanyl was a story.
fentanyl was on the streets long before it was a story
Illicit fentanyl that did not come from a prescription, to be precise. Fentanyl can be an important and helpful medication when used correctly.
New doc here; its a confusing conversation all around. In training management of controlled meds is often an elephant in the room topic with no one really wanting to address it in too much detail. That’s mostly because everyone has a different view on it as the powers that be (mostly use state board of pharmacy as guideline) are pretty vague. Most can agree that regular visits (every 3 months at least), drug screens at least yearly, and a controlled use agreement contact between provider and patient is the standard of care. Everything in between that is subject to vary. To further complicate matters medical literature on these meds consistently finds them ineffective for chronic management many disorders including back pain which is in contrast to conventional opinion. Many providers see this as reason enough to sparingly use them. Regardless, in my experience so far whether they truly work or not most patient are very reluctant to stop these medications once started.
Do the patients say they help? I can see them being reluctant if it does help. But there is always the question of if the patients are lying or not if they are still in pain.
