The Opioid Crisis

crescent said:
Did you know that acetaminophen/paracetomol/Tylenol and ibuprofen/Advil/Motrin are different enough to allow full doses of both to be taken at the same time? They can be more effective in combination than alone?
Click to expand...

In America you can find "Migraine Strength" pain relievers that contain Aspirin and Acetaminophen. I am not allowed to take either, but when I feel a migraine coming on I do take it, and it helps, sometimes avoiding a whole debilitating episode. The same doesn't do much for the back/joint pain that is nearly constant.

The narcotics have little to no impact on migraine onset.

Belz... said:
I think the question is in what way does this affect dosage? If it doesn't, then Sadhatter is asking what the problem is. I think you're talking past one another.
Click to expand...

The dosage, for my spouse, works out to slightly less that half what she was getting. I don't know how that could be missed in what I've posted.
 
The Greater Fool said:
In America you can find "Migraine Strength" pain relievers that contain Aspirin and Acetaminophen. I am not allowed to take either, but when I feel a migraine coming on I do take it, and it helps, sometimes avoiding a whole debilitating episode. The same doesn't do much for the back/joint pain that is nearly constant.

The narcotics have little to no impact on migraine onset.



The dosage, for my spouse, works out to slightly less that half what she was getting. I don't know how that could be missed in what I've posted.
Click to expand...

My wife's neurologist has told her the opioids tend to make the migraines worse. She's trying to cut back on them for that reason. But her back really doesn't want her to.

Pharma advertising has been mentioned a couple of times in the thread. While there's a whole lot wrong with it, I don't think the opioid crisis is one of them. Opioids are generic and cheap. And Pharma doesn't really need to advertise to sell them.

I personally avoid them strenuously because of what they do to my GI tract. When I got hurt five years ago I spent four or five extra days in the hospital because my intestines had flat shut down. They were sucking my stomach contents out through my nose. That was lovely.
 
Belz... said:
Ok so that was the claim. I was a bit confused as well. The issue is not the amount of medecine in the bottle but how much she can take daily.
Click to expand...
The claim is that my spouse will receive 1/2 of the active ingredients in her medicine for the same period of time the medicine is intended to be active.

Perhaps the problem is some people can't grasp how the Governor would sign a bill that, despite medical need, has limited what Doctors can prescribe their chronic pain patients. Not the number of pills or patches, the total dosage of those pills and patches.

I would not be complaining or worried if my spouse could get her medications in a different form or on a different schedule, as long as it handles the pain. It will not handle her pain, and I'm not going to sit by and allow her to suffer until she decides to end it.

Trebuchet said:
My wife's neurologist has told her the opioids tend to make the migraines worse. She's trying to cut back on them for that reason. But her back really doesn't want her to.
Click to expand...
It's hard to compare apples to apples on this. I've gotten migraines my entire adult life (I don't remember my childhood, so who knows there). They were more frequent when I was younger, perhaps one a month(ish). Now, one a year seems more like it.

I personally avoid them [opioids?] strenuously because of what they do to my GI tract. When I got hurt five years ago I spent four or five extra days in the hospital because my intestines had flat shut down. They were sucking my stomach contents out through my nose. That was lovely.[/QUOTE]
I don't find I have that issue (nor does my spouse).
 
What helped my bad back was not Oxycontin but dropping 50 lb and exercising and keeping the weight off my midsection
 
applecorped said:
What helped my bad back was not Oxycontin but dropping 50 lb and exercising and keeping the weight off my midsection
Click to expand...

Many people seem to underestimate the extra pounds that are making the pain worse. I started to think about having a 10 or 15 pound sack tied to my body 24/7.

So, watching my weight, trying to get exercise daily, 40 mgs of Oxycodone a day, while trying to maintain a sense of humor, seems to get me through chronic pain and help prevent it from becoming unbearable.
 
Fudbucker said:
Focusing on the drug of choice is not going to solve the problem. We have to understand why people in this society are self-medicating so much.
Click to expand...

How does America compare to other first world countries in drug use? Is there no prob in Germany, France, UK?
 
casebro said:
How does America compare to other first world countries in drug use? Is there no prob in Germany, France, UK?
Click to expand...

Pretty bad overall. Our numbers both for opioid use and opioid overdoses are substantially higher than in other comparable countries.

But those countries, in general, don't have drug advertising (or at least anything resembling it's form in the US) and have much higher restrictions on opioids, doctors don't prescribe them nearly as much and insurance doesn't cover them nearly as much but that's the thing we're being told we can't do because it will be a burden on chronic pain suffers.

https://www.vox.com/policy-and-politics/2017/8/8/16049952/opioid-prescription-us-europe-japan
 
wasapi said:
Many people seem to underestimate the extra pounds that are making the pain worse. I started to think about having a 10 or 15 pound sack tied to my body 24/7.

So, watching my weight, trying to get exercise daily, 40 mgs of Oxycodone a day, while trying to maintain a sense of humor, seems to get me through chronic pain and help prevent it from becoming unbearable.
Click to expand...

Exactly. There are a number of methods of helping to diminish pain. For mild to medium level pain these, plus perhaps taking Tylenol and ibuprofen may be enough. But for truly intense pain, such as that experienced by my Dad, or by you, dropping one's weight, exercising more, and taking an over-the-counter analgesic are not going to eliminate the need for opioids. I fear that too many people do not truly understand this and that together with their misperceptions about the risks of opioids when used under medical supervision, these misunderstandings will result in some horrendous laws.
 
The Greater Fool said:
Then be astonished.

Here, in AZ and in most states, you can only get a 1 month supply of narcotics. That has not changed. What has changed that in my spouse's case, the new Law allows her only half of what she's had for 20 years. That's 50%. That's how I define 1/2.
Click to expand...

Please post a link to the law as you are being very obtuse.
 
sadhatter said:
Please post a link to the law as you are being very obtuse.
Click to expand...
Obtuse?
Klimax said:
Direct link to law would be better. Reporters damn too often get things wrong.
Click to expand...
I was unable to find the text of the actual law. However, this PDF from the AZ Governor website should do you the trick. Page 14 is the one that clobbers my spouse, who was at about 180 MME. The exemptions spoken of are for cancer or dying patients. Basic Chronic Pain folks don't qualify.

The new max = 90 MME. As I said, and no I have no documentation, the 2 certified Pain Specialists (my spouses and mine) both are not inclined to go over that value as they don't want AZ and DEA in their lives. My spouses Doc is already acting on this max, reducing my spouses meds.

This law is virtually forcing me to get the illegal drugs they are trying to limit, if I can't move to a more enlightened state.

Yeah, you're right, I'm being obtuse. :rolleyes:
 
The Greater Fool said:
Obtuse?

I was unable to find the text of the actual law. However, this PDF from the AZ Governor website should do you the trick. Page 14 is the one that clobbers my spouse, who was at about 180 MME. The exemptions spoken of are for cancer or dying patients. Basic Chronic Pain folks don't qualify.

The new max = 90 MME. As I said, and no I have no documentation, the 2 certified Pain Specialists (my spouses and mine) both are not inclined to go over that value as they don't want AZ and DEA in their lives. My spouses Doc is already acting on this max, reducing my spouses meds.

This law is virtually forcing me to get the illegal drugs they are trying to limit, if I can't move to a more enlightened state.

Yeah, you're right, I'm being obtuse. :rolleyes:
Click to expand...

So your doctor was prescribing X, until the rule Rule changed and the doctor switched it to Y rather than make the effort to jump through the hoops for X?

Regardless of the law, I would seriously question that doctor's judgement, even around the original prescription.
 
BobTheCoward said:
So your doctor was prescribing X, until the rule Rule changed and the doctor switched it to Y rather than make the effort to jump through the hoops for X?

Regardless of the law, I would seriously question that doctor's judgement, even around the original prescription.
Click to expand...

The article I read said there are a whole, whole, whole lot of doctors in the same boat. The hoops are numerous and apparently very onerous (and legally intimidating) by design, it appears.
 
This is essentially an uncontrolled mass medical experiment being thrust upon chronic pain patients in AZ. It doesn't even seem medically sound to reduce the max dosage by half all at once. At least tapering over 6 months or more combined with mandatory opioid rotation would maybe make sense biologically, from what I understand.
 
BobTheCoward said:
So your doctor was prescribing X, until the rule Rule changed and the doctor switched it to Y rather than make the effort to jump through the hoops for X?
Click to expand...
Sure.

BobTheCoward said:
Regardless of the law, I would seriously question that doctor's judgement, even around the original prescription.
Click to expand...
It's really not about jumping through hoops, as they are used to doing that.

The two separate and unrelated doctors said that they don't want go over because AZ and DEU would be up their arses looking into EVERY patient. This would be an invasive time and resource drain, and frankly they should not be a party to my spouse's medical care.

[Edit: Hopefully more readable:]We've talked to several PCP (Primary Care Physicians) and to a person they recommended my spouse's Pain Doctor as the one to go to, which is why my spouse goes there.[ee] So they know their ****.

Additionally, "Doctor Shopping" is frowned on as it is a drug seeking behavior, and oddly in this case it would be drug seeking behavior. Further, no NEW doctor is going to prescribe double what the law indicates out of the gate. Imagine the initial conversion:

"So Doc, may I call you 'Doc'? So, Doc, I need 180+ MME for my four crushed vertebrae, and my old Doc reduced me to 90. Will you do the 180+ MME today?"

I'm told it's easier to find a drug dealer that will do it, and we won't need 10 years of medical records and current imaging to get it.
 
Last edited:
BobTheCoward said:
So your doctor was prescribing X, until the rule Rule changed and the doctor switched it to Y rather than make the effort to jump through the hoops for X?

Regardless of the law, I would seriously question that doctor's judgement, even around the original prescription.
Click to expand...

Doctors who prescribe opioids at all already feel the hot breathe of both governmental and professional organizations peering closely and very suspiciously over their shoulders. To ask for exemptions to the new limits is not just filling out some forms or jumping through some hoops. It generates suspicion, and is asking for one's entire practice to be reviewed in minute detail by people looking for violations of any kind. It is asking for detailed audits of your finances and patient paperwork, the unannounced arrival of auditors, the questioning of you, your personnel, and your patients, etc. etc. I believe that in many states undercover investigators may arrive at the medical office, possess as patients, and try to convince one or more of your staff to knowingly or unknowingly violate the rules. They will often choose the least experienced to target as the most vulnerable. And if you are found to have tripped over some aspect of the complex rules regulating opioid dispensing, or it can be made to look that way, your practice and your career may be over. Even if you avoid jail.

Most doctors will just say- forget it. No way I'm going to go down that road.
 
The Greater Fool said:
Obtuse?

I was unable to find the text of the actual law. However, this PDF from the AZ Governor website should do you the trick. Page 14 is the one that clobbers my spouse, who was at about 180 MME. The exemptions spoken of are for cancer or dying patients. Basic Chronic Pain folks don't qualify.

The new max = 90 MME. As I said, and no I have no documentation, the 2 certified Pain Specialists (my spouses and mine) both are not inclined to go over that value as they don't want AZ and DEA in their lives. My spouses Doc is already acting on this max, reducing my spouses meds.

This law is virtually forcing me to get the illegal drugs they are trying to limit, if I can't move to a more enlightened state.

Yeah, you're right, I'm being obtuse. :rolleyes:
Click to expand...

Why doesn't first exception apply to you?
This does not apply to a continuation of a prior prescription order that was issued
within the previous 60 days. The limit also would not apply to cancer patients, trauma
patients, burn patients, hospice, end-of-life care, or medication-assisted treatment for
substance use disorder.
Click to expand...

ETA:
9.) What if I am on a dose higher than 90 MME now? Will I have to taper down?
The law does not require you to reduce your dose, but health officials recommend you
proceed with caution and consider keeping Naloxone on hand in case of an overdose
Click to expand...

You shouldn't be affected.
 
Last edited:
Giordano said:
Most doctors will just say- forget it. No way I'm going to go down that road.
Click to expand...

Which calls into question their entire methodology for treating you. They are not acting as a fiduciary, so to speak.

I guess it is more accurate to say to have a healthy understanding that your treatment by your doctor is currently limited by time and resources.
 
Last edited:
The Greater Fool said:
Obtuse?

I was unable to find the text of the actual law. However, this PDF from the AZ Governor website should do you the trick. Page 14 is the one that clobbers my spouse, who was at about 180 MME. The exemptions spoken of are for cancer or dying patients. Basic Chronic Pain folks don't qualify.

The new max = 90 MME. As I said, and no I have no documentation, the 2 certified Pain Specialists (my spouses and mine) both are not inclined to go over that value as they don't want AZ and DEA in their lives. My spouses Doc is already acting on this max, reducing my spouses meds.

This law is virtually forcing me to get the illegal drugs they are trying to limit, if I can't move to a more enlightened state.

Yeah, you're right, I'm being obtuse. :rolleyes:
Click to expand...


Read your pdf and you are severely misrepresenting the situation.

First this wasnt just pulled out of a politicians ass. Second it is seeing guidelines and review based on real scientific evidence not telling doctors they can't prescribe.

A doctor can prescribe over the guidelines but must consult with a group of pain specialists. This is to prevent doctors who just write prescriptions to shut people up or the shadier guys who are operating pill Mills.

If you expect to convince me you are right, you are saying you know more about pain management that not only 1 doctor but an entire group of specialists. Feel free to show your credentials.

But you are going to sassy how you know your love one so that doesn't matter.

Let's de personalize this.

You are essentially saying pain management should be loved one managed. Let's say I agree you are the one person who can do this without any issue.

How do you think things would go for other people if love ones managed pain medication? Do you think people would get better care? Do you think there would be any abuse?
 
Klimax said:
You shouldn't be affected.
Click to expand...
The Docs think otherwise. All that we've talked to. I'll let them know they are wrong.

I'm sure knowing knowing this will help my spouse when she is writhing in pain because the Docs don't know how the law affects them.

sadhatter said:
Read your pdf and you are severely misrepresenting the situation.

First this wasnt just pulled out of a politicians ass. Second it is seeing guidelines and review based on real scientific evidence not telling doctors they can't prescribe.

A doctor can prescribe over the guidelines but must consult with a group of pain specialists. This is to prevent doctors who just write prescriptions to shut people up or the shadier guys who are operating pill Mills.

If you expect to convince me you are right, you are saying you know more about pain management that not only 1 doctor but an entire group of specialists. Feel free to show your credentials.
Click to expand...
Feel free to provide your credentials. :rolleyes:

I am representing what the Docs have told my spouse. They recognize she needs the meds, but "can't" prescribe them. I've pointed out the document above, and they explained what happens when they want to do it. As they are the Professionals, I have to accept their word rather than yours.

This is not a unique story with my spouse. There are many reported in news stories, but the vast majority must suffer quietly, or get relief elsewhere.

sadhatter said:
But you are going to sassy how you know your love one so that doesn't matter.

Let's de personalize this.

You are essentially saying pain management should be loved one managed. Let's say I agree you are the one person who can do this without any issue.

How do you think things would go for other people if love ones managed pain medication? Do you think people would get better care? Do you think there would be any abuse?
Click to expand...
You've really gone down the rabbit hole here. Where did I say it should be loved one managed?

I said the Doctors acknowledge she needs the meds, but they can't or won't expose themselves to having the DEA up their collective asses.

I'm not saying "loved one managed" I'm saying let it be "Doctor Managed" without obstructive and intrusive legislative control of medical decissions.

Sure, I am just a voice on the internet. But my spouse isn't. I will do what I must to help, and the law is my obstacle one way or t'other. I can bang my head against the legal wall, or go around it.
 
Last edited:
The Greater Fool said:
The Docs think otherwise. All that we've talked to. I'll let them know they are wrong.

I'm sure knowing knowing this will help my spouse when she is writhing in pain because the Docs don't know how the law affects them.
...
Click to expand...

Yes, they are wrong. Alternatively, their hands are dirty and are guilty of over prescription or at best strongly problematic/questionable and thus want to fly as low under radar as they can or their deeds would be uncovered.

And cut that sympathy BS. Doesn't help your argument one iota. makes you look suspect in case of opioid abuse epidemic.
 
Klimax said:
Yes, they are wrong. Alternatively, their hands are dirty and are guilty of over prescription or at best strongly problematic/questionable and thus want to fly as low under radar as they can or their deeds would be uncovered.

And cut that sympathy BS. Doesn't help your argument one iota. makes you look suspect in case of opioid abuse epidemic.
Click to expand...
Thank you, I could not have demonstrated my point better.
 
I think The Greater Fool's point is that while there may be a way to continue the medication his wife needs, it puts the doctor on a government list he doesn't want to be on. The response for some seems to be: "If they aren't doing anything wrong they don't need to worry." That's the same argument used in support of warrant-less wiretaps and the like.

Doctors who are not doing anything wrong don't want the government poking around, not because of what might be found, but because justifying treatments when being second guessed (by those who have never met the patient) costs time and money.

Also, the starting point in these discussions is not "What is the best way to manage pain for this patient?" It's "What is your justification for using a treatment that we have decided is bad?" That's backwards.
 
So do people just honestly think there's a statistically significant population of chronic pain suffers living agony in Europe and Japan and other countries that are more restrictive of opioid use?

In Alabama, Arkansas, Tennessee, West Virginia, Mississippi, Oklahoma, Kentucky, and Louisiana there are literally more opioid prescriptions than they are people in the state. That's insane.

Japanese doctors treated acute pain with opioids in 47% of cases - compared to 97% in the US.

Unless you can show me that 50% of Japanese pain sufferers are living in agony... what is even being argued?

Links:
https://www.vox.com/policy-and-politics/2017/8/8/16049952/opioid-prescription-us-europe-japan
https://qz.com/1198965/the-surprising-geography-of-opioid-use-around-the-world/
http://www.politifact.com/new-york/...e-states-have-more-opioid-prescriptions-resi/
 
JoeMorgue said:
So do people just honestly think there's a statistically significant population of chronic pain suffers living agony in Europe and Japan and other countries that are more restrictive of opioid use?
Click to expand...

Yes

ETA: though I'm wondering if you mean something other than "statistically significant". Because a small number can be statistically significant.
 
Last edited:
That's crazy about the "more opioid rx's than residents" states.
 
BobTheCoward said:
Yes

ETA: though I'm wondering if you mean something other than "statistically significant". Because a small number can be statistically significant.
Click to expand...

That's true. Just 1% (or less) can be "statistically significant".
 
- I put terms like "statistically significant" in my posts whenever figures, stats, or numbers come up in a hopeless attempt to the pedantics from demanding we stop to discuss meaningless exceptions that don't matter.

- If the argument is going to turn to "Other countries have more chronic users in pain" even if true that raises its own fair share of questions.
 
kellyb said:
That's crazy about the "more opioid rx's than residents" states.
Click to expand...

It has to do that opiods can get you high, and many wealthy patients basically "bribe" their doctors to prescribe opiods for that reason.
Particualry bad in California. Most notorious case was Michael Jackson. Socal has along history of "Doctor Feel Good" abusing their licence.
I think there has to be a sane middle point between the Government sticking it nose where it does not belong and allowing greedy MD's to abuse their power for the sake of making a buck.
 
JoeMorgue said:
- I put terms like "statistically significant" in my posts whenever figures, stats, or numbers come up in a hopeless attempt to the pedantics from demanding we stop to discuss meaningless exceptions that don't matter.

- If the argument is going to turn to "Other countries have more chronic users in pain" even if true that raises its own fair share of questions.
Click to expand...

Whether it raises its own fair share of questions or not, my answer is still yes.
 
dudalb said:
It has to do that opiods can get you high, and many wealthy patients basically "bribe" their doctors to prescribe opiods for that reason.
Particualry bad in California. Most notorious case was Michael Jackson. Socal has along history of "Doctor Feel Good" abusing their licence.
I think there has to be a sane middle point between the Government sticking it nose where it does not belong and allowing greedy MD's to abuse their power for the sake of making a buck.
Click to expand...

I don't think the rich bribing their doctors can account for more opioid prescriptions than residents, can it?

I'd guess the primary cause is people (of all social classes) seeing multiple doctors for multiple prescriptions, as well as ER "frequent flyers", primarily.
 
You must log in or register to reply here.

Back
Top Bottom