Unintended Consequences

[charlie sherrill]

I read an article a few minutes ago that stated overdose deaths in the US have increased from about 70,000 in 2019 to about 90,000 last year. It will probably be more this year. Why the increase? Our government has seen fit to put severe restrictions on prescription opiate products. What has happened is opiate abusers have started using heroin and other illegal drugs laced with the very dangerous fentanyl. They're dropping like flies. There are five people on my road who have died from overdoses. All were over 40 and at one time were just average people. I'm sure most of you here know or are kin to someone who has died from drug abuse. Now "Holly Housewife" is a full blown junkie instead of just a pill head. I saw this happen to a good friend's daughter. An unscrupulous doctor put her on prescription painkillers that she didn't need and when the government mandated that the doctor take them away from her she started using heroin and other street drugs and the things she had to do to get them. She is no longer with us, leaving her Dad and twin sister to mourn. Is there a solution? I'm thinking go back to the prescription painkillers and monitor them closely. Computers are such that doctor shopping for more pills is getting harder. Other opinions are welcome.

 

[waffles]

This isn't a new thing at all. When I was working in an ER in 2012-2014 it was already that way. Generally the pattern was lower income worker, usually from a package delivery service or one of our waste/paper plants, gets a back injury, gets prescribed opiates, then feels the standard withdrawal back pains and stays on them.

His insurance stops covering them or the doc stops prescribing them, which, as an aside, happened way quicker if you're something other than a professional looking white guy, and gets them labeled as a "medication seeker" when they come in complaining of pain again.

Once that happens, treating the real pain becomes a non-starter, the patient tends to first buy pills on the street, but that gets expensive quick, someone tells them heroin is the same stuff but way cheaper, they start it, and that's that. Generally by this point if they're lucky they had some disability claim paying, but more likely they're broke, out of the workforce, and working on losing housing. It's an evil business, and while I knew some individuals who started heroin recreationally, it was waaaaay more often the result of that switch getting thrown during legit medical treatment.

 

[cmj8591]

If I had an answer to this question I would be living in Bill Gates' neighborhood. Where I am, the mental health system is broken beyond repair. Unless you are court committed, it is almost impossible to get a detox bed if you want help. I can't say, and I'm sure the political overtones will get me in trouble, but the problem seemed to really get bad around the time that Obamacare started. Also, heroin and fentanyl are extremely cheep and a move away from enforcement of the drug distribution laws has made them very available. Heroin is cheaper than Advil around where I live. There is also an issue with Narcan. Everyone has access to it. Some users overdose multiple times. Lots of times, they are out of the ER before the EMT's who brought them there and OD again the same day. So, many of those OD stats are people who OD over and over. I think that the biggest underlying cause, for drugs and many other societal issues, is that we have an adult population for whom self responsibility was never taught. In the end, a person makes a conscious decision to inject heroin. They can blame pain killers, doctors, absent parents, politicians, but it's their own bad choices that leads them down the road. No matter what the community does to try and help, until an addict takes responsibility for themself, nothing will change for them. It then becomes a race between getting clean and an OD death.

 

[lihpster]

When Oxycodone came out, it was touted by the drug company that it was a safe, non-addictive opiate. They pushed the idea that it was better than Vicodin as it wouldn't create dependency. Why the doctors believed that I don't know. Between that and the drug companies giving financial and other incentives for prescribing it and the docs started writing scrips like they were going out of style. At first I don't blame the docs. They were lied to and a safer, non-addicting powerful painkiller is a wonderful idea. But it was a lie. When the overdoses and addiction started, you'd think the docs would slow down on the scrips. But they didn't. Greed is a strong thing. When some found out they could sell scrips for big cash, they went from being poor docs to outlaws. I think I remember hearing about a county in KY that the docs prescribed enough oxy in one year to give every man, woman and child in the county 3 pills a day. That's alot of sore backs. Now when the street price of one of those pills can be $70, it becomes both big business and an expensive habit. A dime bag of heroin is much cheaper and gives you the high you're seeking. Not to mention you can get it 24/7 without a co-pay and without paperwork. Add in the lack of space in rehab facilities and you have the perfect recipe for disaster.

 

[Onomea]

Do all oxycodone addicts start off using oxycodone for pain? And is the reason they are addicted, the reason that they are driven to keep taking the stuff, that it continues to alleviate their chronic pain?

I ask this because I had oxycodone for pain relief after a knee operation. It does alleviate pain, but other than that was not enhancing my mood insofar as I could tell, so I was mystified as to why people get addicted to it. In my case, the pain lessened with time. But yeah, if someone has chronic pain, I can see why they'd keep taking it.

 

[waffles]

Do all oxycodone addicts start off using oxycodone for pain? And is the reason they are addicted, the reason that they are driven to keep taking the stuff, that it continues to alleviate their chronic pain?

I ask this because I had oxycodone for pain relief after a knee operation. It does alleviate pain, but other than that was not enhancing my mood insofar as I could tell, so I was mystified as to why people get addicted to it. In my case, the pain lessened with time. But yeah, if someone has chronic pain, I can see why they'd keep taking it.

Some people get into it recreationally for sure. Never did much pleasant for me, but to some it does, and I found out that having a few beers watching football after taking a couple post root canal felt reaaaally good. That's about when I said I'll deal with with toothache to not get that ball rolling.

Opiates are great pain killers, and many do need them for chronic pains, but even those whose pain would have otherwise subsided can feel a resurgence in their specific pain or other aches while they are going through opiate withdrawals, which is often interpreted as oh **** I still hurt , I need to keep this going.

 

[Rodan]

I think that the biggest underlying cause, for drugs and many other societal issues, is that we have an adult population for whom self responsibility was never taught. In the end, a person makes a conscious decision to inject heroin. They can blame pain killers, doctors, absent parents, politicians, but it's their own bad choices that leads them down the road. No matter what the community does to try and help, until an addict takes responsibility for themself, nothing will change for them.

QFT.

Narcan is great for bringing people back, but it's just one more consequence for bad behavior that's been eliminated. No consequences = more bad behavior.

 

[lihpster]

Do all oxycodone addicts start off using oxycodone for pain? And is the reason they are addicted, the reason that they are driven to keep taking the stuff, that it continues to alleviate their chronic pain?

I ask this because I had oxycodone for pain relief after a knee operation. It does alleviate pain, but other than that was not enhancing my mood insofar as I could tell, so I was mystified as to why people get addicted to it. In my case, the pain lessened with time. But yeah, if someone has chronic pain, I can see why they'd keep taking it.

It's not the chronic pain so much as the chemical addiction. just like heroin oxy is an opiate. Take 4 oxys and I'll guarantee you'll feel something. Stop taking those oxys and you'll feel something else. Opiate withdrawals are terrible. You go from being high and feeling the best you ever felt to being in pain, sick and half crazy. that's why junkies do the things they do to get their drugs. Whether it's a pill or a needle, the active drug is the same and has the same effects.

 

[waffles]

QFT.

Narcan is great for bringing people back, but it's just one more consequence for bad behavior that's been eliminated. No consequences = more bad behavior.

The lack of availability of a means to save OD victims didn't deter all the users before, why do you think this is going to change someone's mind? It's the same argument as harsh sentencing laws, bumping a mandatory sentence from five years to ten doesn't do anything preventative, because I'll never get caught, I'll never OD, so of course it doesn't matter. These aren't all homeless junkies shooting up on the sidewalk after robbing a little old lady to get their fix, and I can't think of any reason to argue against having better outcomes for ODs readily available.

 

[Rodan]

The lack of availability of a means to save OD victims didn't deter all the users before, why do you think this is going to change someone's mind? It's the same argument as harsh sentencing laws, bumping a mandatory sentence from five years to ten doesn't do anything preventative, because I'll never get caught, I'll never OD, so of course it doesn't matter. These aren't all homeless junkies shooting up on the sidewalk after robbing a little old lady to get their fix, and I can't think of any reason to argue against having better outcomes for ODs readily available.

The biggest increase in ODs we're seeing is with teenagers. Fear of death used to be a motivator, and we didn't see a lot of heroin and other opiates in this demographic. Now it's "don't worry, Narcan will bring you back"... no consequence. So the kids are using it more.

25 years in LE... the only result I've observed from relaxed sentencing, and emphasis on 'treatment', is more drugs and more drug users.

 

[ameridaddy]

I guess I'm lucky in that I can't wait to get off prescribed opiates just as soon as I can. They do ease pain, but also make me want to sleep most of the day. As soon as the discomfort they were prescribed for abates to a level I can stand, I stop taking them. I hate the loggy, disconnected way they make me feel.

 

[waffles]

The biggest increase in ODs we're seeing is with teenagers. Fear of death used to be a motivator, and we didn't see a lot of heroin and other opiates in this demographic. Now it's "don't worry, Narcan will bring you back"... no consequence. So the kids are using it more.

25 years in LE... the only result I've observed from relaxed sentencing, and emphasis on 'treatment', is more drugs and more drug users.

I'd love to see any data on that, that's the first time I've heard fear of death being cited as a reason teens, the age group notoriously confident in their own immortality, hadn't previously been doing a drug. I'm open to being wrong on that, but I'd imagine it's tied into the increase of synthetic opiate availability and increasing combinations with other drugs (meth being the most often cited) as is cited in all the other studies on this.

 

[SMSgt]

I've been on Oxy and Vicodin on and off for years for various reasons. Other than some drowsiness, they have little effect on me and certainly are not addictive as many suggest--when taken as prescribed. Most of those who die of overdoses of whatever drug of choice are getting what they sought.

 

[waffles]

I've been on Oxy and Vicodin on and off for years for various reasons. Other than some drowsiness, they have little effect on me and certainly are not addictive as many suggest--when taken as prescribed. Most of those who die of overdoses of whatever drug of choice are getting what they sought.

This is just absolutely wrong. You personally may have less predisposition to addiction, and I'm glad you're able to use them for years, but prescription opiates, even when it starts with someone taking them as prescribed for a legit problem, are incredibly addictive to a wide number of people.

(bolding mine)

 

[Rustyt1953]

My life is a daily exercise in pain management. I get 120 NORCO 7.5's a month. I keep them in my gun safe and extract 4 daily.

Few people outside of my immediate family know I have them. I wish I didn't need them but I do. They are a blessing to me.

 

[Racer X]

This is just absolutely wrong. You personally may have less predisposition to addiction, and I'm glad you're able to use them for years, but prescription opiates, even when it starts with someone taking them as prescribed for a legit problem, are incredibly addictive to a wide number of people.

(bolding mine)

The CDC statistics are less than 8% of long term users become addicted. Opioid Overdose Crisis | National Institute on Drug Abuse (NIDA) Can't find the direct CDC link where it was a solid 8%

So, those of us who need them, can't get them.

 

[waffles]

The CDC statistics are less than 8% of long term users become addicted. Opioid Overdose Crisis | National Institute on Drug Abuse (NIDA) Can't find the direct CDC link where it was a solid 8%

So, those of us who need them, can't get them.

Sorry, is 8% of long term users not a massive number? Even leaving out unreported instances, and their own data of much higher instances of misuse, that is an absolute ton of people. Arguing opiates are not addictive is so out there I'm almost not sure where to go with it.

 

[Rodan]

I'd love to see any data on that, that's the first time I've heard fear of death being cited as a reason teens, the age group notoriously confident in their own immortality, hadn't previously been doing a drug. I'm open to being wrong on that, but I'd imagine it's tied into the increase of synthetic opiate availability and increasing combinations with other drugs (meth being the most often cited) as is cited in all the other studies on this.

'Fear of death' is just short hand for an obvious, and severe potential consequence. Teens do stupid stuff, no question, but there used to be a hesitation regarding "hard" drugs among that demographic that seems to be gone now.

Certainly, there's more than a single factor involved, but the use of heroin and fentanyl outside the usual 'doper' demographic spiked right after Narcan became readily available. I'm not going to say it's 'causation', but the 'correlation' is there.

The amount of public resources used on drug related problems is staggering. And that's not going to change until people are forced to face the consequences of their choices.

 

[LVSteve]

Yeah, like any part of big pharma is going to let on that 8% of the folk that use their drugs may become addicted. Trouble with pain is that pain is just that, a pain. Whether it is the result of the injury or withdrawal is hard to judge for both patient and doctor.

Oh, and what is the half-life of a doctor who says to a patient "Hmm, your pain may well be the result of withdrawal". He or she has as good as said the patient is an addict. Now, educated folks know that certain people have a biochemical and/or psychological disposition to addiction, but how many want it shoved in their face when they're hurting, regardless of the truth of the matter.

Do some pain management doctors do a better job of recognizing addiction over need? Sure, but if it were that easy we could all do it. Are there some who keep writing the scripts regardless? Absolutely, and the consequence is that the those really in need often suffer because of the fixes for that abuse.

 

[boykinlp]

Do all oxycodone addicts start off using oxycodone for pain? And is the reason they are addicted, the reason that they are driven to keep taking the stuff, that it continues to alleviate their chronic pain?

I ask this because I had oxycodone for pain relief after a knee operation. It does alleviate pain, but other than that was not enhancing my mood insofar as I could tell, so I was mystified as to why people get addicted to it. In my case, the pain lessened with time. But yeah, if someone has chronic pain, I can see why they'd keep taking it.

My belief is that some people just have an addictive personality. If it is not one thing, it will be something else. Onomea, you probably don't have the addictive personality trait. Radiation treatments for my cancer cracked my sacrum bone. It is porous and has many nerves running through it. When it cracked, nerves were destroyed. I will have to live with these results from now on. But, it is better than the other choice which would have been a dirt nap. The treatments also caused me to have hammer toes on both feet. For those that don't know what that is, your toes actually curl under and you continuously walk on them. It is a pretty painful situation.

Because of these two painful problems, I have been on morphine for four years now. In September and, again in November of last year, I had surgery on each foot. They put pins through the end of each toe (the big toe has a large screw) that runs fairly deep into your foot. The pins are left sticking out the end of your foot for 6-7 weeks. That means no socks or shoes, no great showers, and you better not bump your toes into anything!! By the middle of December, my toes were much better, and it did not hurt to walk anymore. When I went to my next scheduled visit to the pain management doctor, I told him I was going to tell him something that he probably did not hear very much. I said that I wanted to DECREASE my pain medicine dosage. We have actually cut it in half now! I still take some everyday for my sacrum bone problem, but not as much. I know this is a long story, but like I told Onomea, I don't think I have an addictive personality.....except maybe food.

QFT.

Narcan is great for bringing people back, but it's just one more consequence for bad behavior that's been eliminated. No consequences = more bad behavior.

Let me tell you my Narcan story. Pain management doctors are required to prescribe Narcan to everyone that takes pain medication. I live alone, and if someone had to give Narcan to me, I would be in trouble. I know me, and know that I won't need Narcan, but I figured I would get the prescription filled anyway. My pharmacist told me it would cost around $150 (if I remember correctly) and I have insurance! I politely declined to have it filled. They give Narcan to tons of people on the street, because they believe it saves lives, but insurance doesn't cover it for me.

Rant over. Thought I would show you a picture, but don't click on it if you are squeamish!
Larry