Opioids

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tgb
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Opioids

Post by tgb »

As I've posted elsewhere, I have severe arthritis in my hip, and it's quite painful. A Cortisone shot back in May offered great relief for about 3 months, but right before I could get another, I ended up having to have surgery for (yet another) stomach ulcer. According to several of my doctors, an injection of a steroid is about the worst thing you can do following abdominal surgery, so I've had to put off the second injection for at least another couple of months.

Everyone is in such a tizzy about the so-called "opioid epidemic" that the strongest thing I could get my primary care dr. to prescribe for the pain was Tylenol 3, which did essentially nothing to help. Finally he washed his hands of the matter by referring me to a pain management specialist.

I saw the specialist yesterday, and while he agreed that holding off on another Cortisone shot was the best idea, at least he was willing to write me a script for Vicodin to tide me over.

Geebus, I couldn't believe the hoops I had to jump through from that point until I actually had it in my hand. I had to read and sign off on all kinds of releases absolving the clinic of responsibility if I happen to kill myself or someone else. I also had to read and sign that I understood the potential dangers and side effects, as well as swear on the eyes of my children that I wouldn't drive, drink alcohol, use other drugs, or operate a forklift while under the influence. I also had to pass a urine exam.

In 30 days when it comes time to renew, I have to come in and meet with a drug counselor, bringing my stash with me (I'm not sure what that's supposed to show). I'm sure I'll be piss-tested again at that time before I get the renewal.

I realize that some people go overboard with these things and move on to smack and fentenyl, but I can't help but think we might be over-reacting a bit.

Besides, while the Vicodin helps considerably with the pain, I can't even say that I get that much of a buzz off of it.
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Re: Opioids

Post by gameoverman »

This is typical when reactionary policies are implemented. In this case, people are abusing drugs, so they make rules to stop it. Except the only people following these rules are the people who need the drugs, the abusers have alternative methods of acquiring drugs. So the rules really only make things difficult for the people it needs to be easiest for, and does nothing to stop the abuse.

I'm sure the people who always say "We need to do something" feel better though. They can feel like we're doing something about the problem even if we aren't doing something that works.
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Re: Opioids

Post by Sectoid »

Following my 5th surgery on my femur, my Oncologist prescribed Oxycontin for the pain. With the considerable amount of pain I was in, it was appropriate. However, my insurance company at the time (Horizon BC/BS) would not approve the medication. After my oncologist called them, they still would not approve the oxy. They would however approve straight morphine. So, let me get this straight, it is better to be on a drug pretty much 1 step away from heroin, but not oxycontin? Good to know.
I was on morphine for a year and grew so dependent on it that when I went off, which I had to do gradually, I had chills, fever, insomnia (for 10 days straight), diarrhea, hallucinations, lack of appetite, and pain. After the withdrawl, I was put on gabapentin, which IMHO did nothing. I still have pain in my hip and leg, but it is manageable for the most part.
After my experience with morphine, I won't take opiates. I had shoulder surgery last year and refused the pain meds they gave me. I wound up getting through it with just Ibuprofen and other meds. On the positive side, my pain tolerance is sky high right now. I sat for a tattoo a couple weeks ago for over 3 hours, then went to the dentist who had to put in a temp crown (with 3 hours of drilling) with only a local for the dental work. It is really amazing what you can tolerate if you put your mind to it.
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Re: Opioids

Post by ImLawBoy »

tgb wrote:bringing my stash with me (I'm not sure what that's supposed to show).
I'd guess it's to show you're taking the appropriate amount. If you're supposed to have 30 pills left at that point, but you only show up with 5, they'll think you're abusing it by taking too much.
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Re: Opioids

Post by McNutt »

I've never needed opioids (thank God), but I've read so many stories of people who got addicted at the drop of a hat. From my little knowledge, lots of hoops seems appropriate.
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Re: Opioids

Post by Daehawk »

The shit the country and Gov put you through for something that isn't even what they make it out to be. the rules are placed by people who have never used the drugs and prescribed by mostly docs and NPs that have never used the drugs. Everyone reads off a sheet.

Then the drugs are always talked about as all powerful suicide pills. Far from it in my 7 years of using experience. My liver just does not convert them that well.

And just posted in the news yesterday new record numbers of deaths are now happening..but its street opiates ..fentynol, heroin , cocaine...because people can no longer get their meds they need and have no idea how to use street drugs plus the Fent one is totally a killer..just a little touch can kill you.

And ive driven for 7 years fine..though my new doc doesn't really want me to. Im not high or drunk or anything. I used to take Hydrocodone, Ultram, Opana, and Soma all together just fine. Now Im only on Hydro thanks to all the major BS in this country and in a lot more pain. Docs cant really treat patients any longer.

PS..Pill counts are so stupid. You could take and sell like all of them but 3 then take two the day before the doc visit and one that morn and its all good. No I dont but Ive took this stuff for 7 years so I have heard it all.
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Re: Opioids

Post by Smoove_B »

tgb wrote:Besides, while the Vicodin helps considerably with the pain, I can't even say that I get that much of a buzz off of it.
Here's the thing - pain meds are going to work differently for individuals. Some are able to take opiods as prescribed and there won't be any problems. Other people (for reasons we don't fully understand) are going to get addicted. Where it progresses from there (misuse, abuse, addiction, etc...) is also going to an individual path.

However, I do want to reiterate that we have crossed a line with opioid overdoses and overdose deaths (including those that have now switched over to heroin). There's absolutely a crisis unfolding nationwide and it's been something no one has wanted to talk about or address. The push-back you're experiencing and the resistance to prescribe them is coming from state and federal pressure in recognition of the problem. In short, it's a mess and if you start reading up on it, there are some real problem areas around the United States with disproportionately impacted communities. While it might not be something you're seeing locally, I can tell you it's a real problem around here. Back in December of 2016, I think NJ overdose deaths were up 22% - tied to increased use of heroin and fentanyl. And not surprisingly when you learn about these people, they didn't wake up one day and start shooting heroin. Usually it was a surgery or accident that had them hooked on pain pills and when the prescriptions ran out, they still needed relief. Make no mistake, there are problems.
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Re: Opioids

Post by Skinypupy »

When my gout flares up (usually once or twice a year), it's so painful I can barely function. I can't walk, can't sleep, and have a hard time focusing on anything but the pain. It usually takes a week to go away, but can sometimes take up to two.

I have to basically beg and plead with the docs to give me something I can take to manage the pain. Even though they can visibly see the effects (my entire foot gets massively swollen and red), they're still very reluctant to prescribe anything. I get why they're cautious, it's infuriating and feels ridiculous. As if I could somehow fake this to get access to painkillers.
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Re: Opioids

Post by Z-Corn »

I highly recommend to anybody that is interested in how we have come to this opioid crises in the US read Sam Quinones' book Dreamland.

And cocaine is not an opioid.
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Re: Opioids

Post by dbt1949 »

The VA entered their opioid tough stage about a year ago. Every time I go to the VA they test me for any kind of drugs other that what they prescribe. And they read me a riot act about the overuse of them.
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Re: Opioids

Post by gameoverman »

I was never into those kinds of drugs. Last time I was in the hospital for a really bad broken ankle, they gave me a drip for the pain. One of those deals where you can push a button when you need the pain relief(up to a point of course). A nurse came by early on and noticed I wasn't using it. She told me not to be afraid, I won't get addicted. I laughed and said "I don't care if I get addicted or not, I don't like the side effects". For one thing, that stuff gets me constipated. That by itself earns an automatic "no thanks" from me. I'll take some Advils or whatever if I need to, and otherwise just deal with it. I don't blame people who'd rather be pain free and will take the drugs that will allow that. I figure we all have to decide for ourselves what's 'worth it' and what isn't.
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Re: Opioids

Post by Kraken »

Wife got some vicodin for a recent minor surgery. She reports that it is a fine pain reliever, but that there's nothing euphoric about it. I don't understand the addiction potential unless one has severe and long-term pain and therefore legitimately needs them. Do addicts grind them up and snort them, or swallow them by the handful, or what? Or is vicodin just a junior member of that class?

The internet, being helpful as always, says I should take six of them with six beers.
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Re: Opioids

Post by Smoove_B »

Kraken wrote:Do addicts grind them up and snort them, or swallow them by the handful, or what? Or is vicodin just a junior member of that class?
Is it extended release? Then yes, split it open or grind it up and take it all at once. That's why they were working on crush-resistant pills a few years ago, which then helped spark an HIV outbreak. Again, the whole thing is an f-ing mess.
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Re: Opioids

Post by Daehawk »

Everything they do to try and help ends up hurting.

As for addicts...I take 4 a day. To some that would be silly excessive. Ive read online of people who have built up a tolerance to them and are super addicted eating 50 a day. I have no idea how they breath or shit. Ive been on these things 7 years.

I once told the doc Im not sure how well they help me these days. he said if I was without them id know. I did run out right before a time he upped my amount because i took extra. Stuff hurt I didn't know would hurt...like my bad knee and my hands and fingers which must have some arthritis in them now.
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Re: Opioids

Post by tgb »

Kraken wrote:Wife got some vicodin for a recent minor surgery. She reports that it is a fine pain reliever, but that there's nothing euphoric about it.
That pretty much sums up my experience, other than they also help me sleep.
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Re: Opioids

Post by gilraen »

gameoverman wrote:I was never into those kinds of drugs. Last time I was in the hospital for a really bad broken ankle, they gave me a drip for the pain. One of those deals where you can push a button when you need the pain relief(up to a point of course). A nurse came by early on and noticed I wasn't using it. She told me not to be afraid, I won't get addicted. I laughed and said "I don't care if I get addicted or not, I don't like the side effects". .
I had procedure about 6 months ago, where I was in the hospital overnight, and they put me on one of those PCA drips, where I was supposed to push the button for the extra painkillers. Well, first of all, all that stuff makes me really nauseous. I was already dehydrated, and I threw up from the drugs they pumped into me during the procedure (it wasn't general anesthesia, but I was out for most of it anyway, that stuff really works a number on me). Last thing I needed was the extra nasty chemicals in my system. I mean, I was plenty uncomfortable, but it was also because the protocol for the PCA drip was to check my vitals every hour for the first 8 hours and every 2 hours after that. If they had just LET ME SLEEP - I would have been fine. I ended up pushing the button twice - once in the evening and once early in the morning. The pain wasn't unbearable, I could have dealt with it, but I was so annoyed and I had trouble going back to sleep, and I figured - oh, may as well.

They gave me an Oxy script for after the procedure - I took it for about 36 hours (7 or 8 pills total, I think), and then I woke up in the morning and I was feeling much better and I didn't need it anymore.

There's a chance I may need to repeat the procedure, and I think I'll ask my attending if she can just leave out the PCA drip (I'll sign whatever waiver they want me to sign) - and they just leave me alone.

I had sinus surgery a few years ago, and the surgeon gave me a script for Vicodin, to fill beforehand. I filled it, but I didn't need it, I didn't take a single pill. In both cases, though, the pharmacy never gave me any trouble about filling any one of those scripts (nor did the insurance company). Maybe they can see in their database that I have no history of taking those meds, and they are pretty much a one-time thing.
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Re: Opioids

Post by Hipolito »

McNutt wrote:I've never needed opioids (thank God), but I've read so many stories of people who got addicted at the drop of a hat. From my little knowledge, lots of hoops seems appropriate.
This nearly happened to me. I took a Vicodin once. I don't remember why, maybe back pain. Just that one pill made me understand why so many people get hooked to it and die. I really wanted to take a another one, but I knew if I did, I'd be doomed to addiction. I fought the urge hard. It took about a month for the craving to completely disappear.
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Re: Opioids

Post by Daehawk »

If I ever could quit...which I never will be able to.....Id have to very slowly and carefully reduce my intake over the course of months and months. If they took me right off of them Id most likely die from stuff it can do.
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Re: Opioids

Post by Lorini »

I vomit every hour on the hour with Vicodin and Codeine makes me sick as well. I hope I never ever have to take opiates. I have Etodolac for hip pain and it's been fine.
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Re: Opioids

Post by Grifman »

gameoverman wrote:This is typical when reactionary policies are implemented. In this case, people are abusing drugs, so they make rules to stop it. Except the only people following these rules are the people who need the drugs, the abusers have alternative methods of acquiring drugs. So the rules really only make things difficult for the people it needs to be easiest for, and does nothing to stop the abuse.

I'm sure the people who always say "We need to do something" feel better though. They can feel like we're doing something about the problem even if we aren't doing something that works.
No, this is about stopping addiction from starting, not stopping someone who is already addicted. Too many people (led by their doctors) fell into addiction totally by accident. Like the OP, they had a pain problem and doctors too willingly prescribed opiods and people too willingly took them, not realizing the risks. Now opiods overdose is one of the leading causes of death. Given that last year there were over 60,000 drug overose deaths (more than died in the entire Vietnam War) and about half were due to opiods, I'd say caution and management are well warrented.
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Re: Opioids

Post by Jeff V »

Lorini wrote:I vomit every hour on the hour with Vicodin and Codeine makes me sick as well. I hope I never ever have to take opiates. I have Etodolac for hip pain and it's been fine.
I vomited once after taking Codeine (I don't think the drug was the problem though) and my dentist has refused to proscribe it since. He will give me Vicodin, but I'd rarely use it for whatever dental tortures led to it being prescribed. It's awesome fighting migraines, but I've not had one of those in years.

I think if I ever suffered chronic pain that needed treatment I'd likely lobby for weed. I think. It's been a few decades since I partook.
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Re: Opioids

Post by Isgrimnur »

Morphine drip made my nose itch.
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Re: Opioids

Post by Kraken »

I do like codeine for the entertaining dreams and deep restful sleep it gives me. I can see getting addicted to that if it were OTC (as it is, or used to be, in Canada; we always used to pick some up when we were passing through).

A friend gave me an oxycontin once because I was curious about it. Just one pill. It wasn't euphoric, but it did feel good when all my little aches and pains went away for a few hours.

Apart from that I have no experience with opioids, and I'm happy to leave it that way.
Jeff V wrote: I think if I ever suffered chronic pain that needed treatment I'd likely lobby for weed. I think. It's been a few decades since I partook.
States with legal medical cannabis have lower rates of opioid abuse. It has limited effectiveness against severe pain, but it certainly helps with lesser complaints and can keep some people from needing the hard stuff, or needing as much of it.
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Re: Opioids

Post by tgb »

The last two occasions on which I was given morphine in the hospital, I suffered frightening hallucinations and nightmares. I much prefer dilaudid.

I was a little concerned seeing that I have an addictive personality and a history of pretty heavy substance abuse, but as already noted, I'm not exactly getting high - just some relief from the pain and a little drowsiness.

I would gladly drop this tomorrow in exchange for a Cortisone shot if I could.
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Re: Opioids

Post by Anonymous Bosch »

In related news...

CVS to Limit Opioid Prescriptions to 7-Day Supply
NBCNews.com wrote: CVS Pharmacy will limit opioid prescriptions to a seven-day supply for certain conditions, becoming the first national retail chain to restrict how many pain pills doctors can give patients.

When filling prescription for opioid pills, pharmacists will also be required to talk to patients about the risks of addiction, secure storage of medications in the home and proper disposal, the retail pharmacy chain said Thursday.

The move by CVS to limit prescription opioids like OxyContin or Vicodin to a seven-day supply is a significant restriction for patients — the average pill supply given by doctors in the U.S. increased from 13 days in 2006 to 18 days 2015, according to a recent report from the Centers for Disease Control and Prevention.
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Re: Opioids

Post by Daehawk »

Ya thats just a damn stupid thing to do. These folks on pain meds need to get their meds and go home .Having to go to town every 7 days is hard as hell on them. I know. I hate having to go every 30.
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Re: Opioids

Post by dbt1949 »

I would drop CVS if I were using them.
The VA cracked down on opioids about a year back. Anytime I go to the VA now I get tested for drugs.
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Re: Opioids

Post by Punisher »

dbt1949 wrote:I would drop CVS if I were using them.
Depending on your insurance you might not be able to. My current insurance requires me to go to CVS for certain meds.
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Re: Opioids

Post by Jeff V »

My current insurance requires me to go to CVS for ALL meds.
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Re: Opioids

Post by AWS260 »

The Cincinnati Inquirer ran a lengthy story documenting a week in the opioid epidemic in central Ohio. It was published last September, but I wasn't aware of it until it won a Pulitzer last week.

It's devastating and eye-opening and well worth the read. For me, the part that struck hardest wasn't the description of an overdose, but a report from a well-baby visit by a new mom who quit cold turkey when she found out she was pregnant. Her baby is healthy, she's doing well, and in the accompanying video she and the baby are just joyful.
After years of addiction, Gaffney’s goals are modest. She wants to raise her child in a normal home. She wants a normal life.

Uebel finishes the examination. “She looks real, real good,” she says.

Gaffney is relieved. She scoops Elliana into her arms and takes her appointment card for her next visit to the clinic in December.

“See you then,” she says.

(Ten days later, Gaffney is dead from a heroin overdose.)
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Re: Opioids

Post by tjg_marantz »

Definitely more and more calls coming in up here. Cross section of ages, genders, possible income due to location. It's everywhere.
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Re: Opioids

Post by Skinypupy »

AWS260 wrote: Mon Apr 23, 2018 2:33 pm The Cincinnati Inquirer ran a lengthy story documenting a week in the opioid epidemic in central Ohio. It was published last September, but I wasn't aware of it until it won a Pulitzer last week.

It's devastating and eye-opening and well worth the read. For me, the part that struck hardest wasn't the description of an overdose, but a report from a well-baby visit by a new mom who quit cold turkey when she found out she was pregnant. Her baby is healthy, she's doing well, and in the accompanying video she and the baby are just joyful.
After years of addiction, Gaffney’s goals are modest. She wants to raise her child in a normal home. She wants a normal life.

Uebel finishes the examination. “She looks real, real good,” she says.

Gaffney is relieved. She scoops Elliana into her arms and takes her appointment card for her next visit to the clinic in December.

“See you then,” she says.

(Ten days later, Gaffney is dead from a heroin overdose.)
Wow, that's a seriously tough read.
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Re: Opioids

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I punched out early. Mainly for lack of a narrative.
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Re: Opioids

Post by Daehawk »

Premature ejectalati....ejac.....damnit. Theres a joke there somewhere I just cant find it.
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Re: Opioids

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Daehawk wrote: Mon Apr 23, 2018 6:27 pm Premature ejectalati....ejac.....damnit. Theres a joke there somewhere I just cant find it.
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Opioids

Post by Chrisoc13 »

Honestly the crisis is not fabricated, it's certainly real. On the prescriber side I can say the awareness has increased dramatically as have the hoops we have to jump through to prescribe. But along with this there has been a significant amount of research into opioid usage and requirements. In my field (urology) we are actively moving away from narcotics completely for many procedures. The research conducted has shown that the risks outweigh the benefits for much of what we do.

The entire shift requires a huge culture change and a change in mentality, as well as a lot of education. When we initially started drastically cutting back on narcotics prescriptions we would routinely get called by the post operative nurses who were incredulous that we weren't giving narcotics and this not adequately managing the patient's pain after surgery. But now they have seen that the vast majority of our patients have their pain managed by non-narcotic means and have bought in largely as well.

Another compounding issue is that the average lay person has many misconceptions and a general lack of knowledge of what narcotics actually do, what they are good for, and the differences between various narcotics. Most people are completely ignorant about narcotics. We need a much better education strategy aimed at patients. I tend to have to spend a fair amount of time educating patients about why narcotics won't actually solve their problem. Like I said it's a dramatic shift in mentality and culture going on.

In Maine (and most States I presume) all narcotic prescriptions are carefully tracked and we have access to the state database where we can see what people have been prescribed before. With this tracking now mandatory (as of the last couple years) there have been lots of meetings in conferences educating prescribers. One in particular was interesting because the high volume prescribers in Maine were largely dentists. It's a problem they are trying to tackle from multiple fronts, and honestly it's a worthwhile and worthy cause.
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Re: Opioids

Post by tgb »

The surgeon who performed my hip replacement is very anti-opioid. His feeling is that in the next 2-3 years they won't even be prescribed outside of hospitals. OTOH he's a huge proponent of cannabis as an alternative.
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LawBeefaroni
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Re: Opioids

Post by LawBeefaroni »

There are a lot of alternatives out there. And with ouctomes and patient welfare finally starting to overpower big pharma's stranglehold, those alternatives are starting to be explored.
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Re: Opioids

Post by stessier »

Chrisoc13 wrote: Tue Apr 24, 2018 9:50 am Honestly the crisis is not fabricated, it's certainly real. On the prescriber side I can say the awareness has increased dramatically as have the hoops we have to jump through to prescribe. But along with this there has been a significant amount of research into opioid usage and requirements. In my field (urology) we are actively moving away from narcotics completely for many procedures. The research conducted has shown that the risks outweigh the benefits for much of what we do.

The entire shift requires a huge culture change and a change in mentality, as well as a lot of education. When we initially started drastically cutting back on narcotics prescriptions we would routinely get called by the post operative nurses who were incredulous that we weren't giving narcotics and this not adequately managing the patient's pain after surgery. But now they have seen that the vast majority of our patients have their pain managed by non-narcotic means and have bought in largely as well.

Another compounding issue is that the average lay person has many misconceptions and a general lack of knowledge of what narcotics actually do, what they are good for, and the differences between various narcotics. Most people are completely ignorant about narcotics. We need a much better education strategy aimed at patients. I tend to have to spend a fair amount of time educating patients about why narcotics won't actually solve their problem. Like I said it's a dramatic shift in mentality and culture going on.

In Maine (and most States I presume) all narcotic prescriptions are carefully tracked and we have access to the state database where we can see what people have been prescribed before. With this tracking now mandatory (as of the last couple years) there have been lots of meetings in conferences educating prescribers. One in particular was interesting because the high volume prescribers in Maine were largely dentists. It's a problem they are trying to tackle from multiple fronts, and honestly it's a worthwhile and worthy cause.
So what are opioids good at compared to other options? Are there some cases where they are the drug of choice?

I had oral surgery twice and both times I got vicodin that they wanted me on for 24 hours, although it seemed like the Advil/Tylenol alternating schedule was just as good at controlling the pain (granted, I only started that 24 hours after the surgery).
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Re: Opioids

Post by gilraen »

I had an IR procedure that required me to stay overnight at the hospital, and they put me on a PCA pump (one of those med-dispensing things where you push the button yourself when you want a dose of pain meds). I wasn't going to use it at all (opioids make me nauseous), but because I was hooked up to it, they had to check my vitals every hour. I ended up pushing the button a couple of times throughout the night just to be able to go back to sleep, but if they just removed the stupid thing and stopped waking me up, I wouldn't have needed it at all. I would have been fine with just some other "lighter" pain meds they were manually injecting every few hours.

I went home with an Oxy prescription, which I definitely needed for about 36 hours to manage the pain - I was also taking Ibuprofen, and it did nothing. Could I have managed without it? Yes, but I would have been really miserable.

I had sinus surgery a few years back, and they happily sent me home with a month's supply of Vicodin (which I didn't take, since I felt fine). But it didn't seem like they were particularly worried about giving me so many drugs for a fairly minor concern.

Last month I injured my Achilles tendon, and it was hurting bad enough that I went to urgent care to get some x-rays, to make sure I didn't also crack a bone. The doctor there asked me if I wanted a script for the pain - I don't know what she would have prescribed, I'm kinda curious, I said no because I didn't think I needed it. She then suggested taking naproxen (Aleve) to help with the swelling and bruising, and it upset my stomach so much, I had to stop taking it after 3 days.
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