New pain pill's approval: 'Genuinely frightening'

[Recursion]

I'm not sure what I think about this. We're already killing a lot more Americans with prescription drugs than illegal ones. And the US, UK, Australia, and Argentina together consume something like 90% of the world's pharmaceutical opioids (in Austria, even, my friends get acetaminophen after major surgery, let alone here in India...). Does "much stronger drug" mean "much greater risk of abuse; get rid of it", or does it mean "we can stop hogging the entire world's supply of painkillers"?

(The particular problem here seems to be that this can be easily crushed and snorted, like adderall used to be...)

http://edition.cnn.com/2014/02/26/health/zohydro-approval/

A coalition of more than 40 health care, consumer and addiction treatment groups is urging the Food and Drug Administration to revoke approval of the prescription drug Zohydro.

The hydrocodone-based drug is the latest in a long line of painkillers called opioid analgesics. The FDA approved the medication last fall to treat chronic pain, and it is set to become available to patients in March.

"In the midst of a severe drug epidemic fueled by overprescribing of opioids, the very last thing the country needs is a new, dangerous, high-dose opioid," the coalition wrote in a letter to FDA Commissioner Dr. Margaret Hamburg.

"Too many people have already become addicted to similar opioid medications, and too many lives have been lost."

[ZombieHorde]

1. Legalize all drugs. nt

[frwrfpos]

8. this

[TheFrenchRazor]

10. yes. nt

[nomorenomore08]

13. + 300,000

[reformist2]

36. Repeal the FDA!

[ZombieHorde]

38. Why? nt

[reformist2]

43. If we're going to legalize all drugs, why would we need an FDA?

[joshcryer]

44. So people can't sell arsnic as a cure for baldness?

So mad cow disease, avian flu, and the countless cases of food poisoning doesn't occur on a wider basis?

[reformist2]

46. I was trying to point out the stupidity of legalizing all drugs.

You want to make arsenic illegal? Good. I want to keep heroin illegal.

[joshcryer]

47. Arsenic as a cure for baldness, sure.

As a feed additive, maybe.

In car batteries and computer chips? Uh, no?

[ZombieHorde]

107. You've done a poor job pointing out

the stupidity of legalizing all drugs.

[ZombieHorde]

57. The "F" and the examination of drugs.

The FDA helps doctors and pharmacists gain (hopefully) unbiased information about drugs.

The FDA also helps consumers know which drugs actually do what they claim to do. For example, many herbs that are sold as cures say the claim isn't backed by the FDA, so then we know the claim probably isn't scientifically proven.

Then there is the "F," for food.

[HuckleB]

99. +1

[NaturalHigh]

63. I'm with you.

How many drug lords has our "war on drugs" created?

[nolkyz]

94. Love your signature, ZH!

How'd you do that?

[ZombieHorde]

100. Thank you.

I think I just did a copy paste.

[silverweb]

2. It's needed.

[font color="navy" face="Verdana"]For palliative care and hospice cases, concern for addiction is not a valid issue.

It's up to physicians to properly prescribe this medication and pharmacists to properly restrict its inappropriate use.

Terminally ill patients and those in severe chronic pain refractory to other medications should not be denied adequate relief because other people can't control themselves.

[libodem]

3. Thank you

[Ecumenist]

4. Absolutely, I agree...

[pacalo]

5. +1.

[Mz Pip]

6. I agree n/t

[TheFrenchRazor]

11. word. no more hysteria about pain pills. nt

[LuvNewcastle]

19. Exactly right.

[madfloridian]

22. I agree.

You said:

"Terminally ill patients and those in severe chronic pain refractory to other medications should not be denied adequate relief because other people can't control themselves. "

Amen.

[PasadenaTrudy]

25. Exactly

when the time comes, I hope I won't need it. But if I do, I'm sure as hell going to request the strongest meds as possible.

[La Lioness Priyanka]

26. this. our fear of addicts cannot make us ignore the reality of those with chronic/debilitating pain

addiction MAY occur. PAIN is currently occurring.

[magical thyme]

45. ^^^This. nt

[mrmpa]

76. Thank you for a very sane attitude &........

answer. I take 2 Vicodin a day (for the past 5 years). I never call the Doctor for an early refill or go to the pharmacy with some pathetic excuse. I hate the fact that the pharmacy wants my drivers license every time I pick up a refill. And it's all because of those who abuse it.

I honestly don't see why anyone would get a "high" or other feelings with pain killers.

[Boudica the Lyoness]

81. Right on Silverweb.

I agree with you 100%.

[HuckleB]

96. +1,000,000 ... 000 !!!!!

[Aristus]

103. Yeah, but actually behave like an ethical medical provider, and

people will hate you!

Certainly some people right here on this website will. I've been called names that would embarrass a sailor for mentioning the care with which I prescribe opioids, on the rare occasions when I prescribe them at all.

I've had people call me a horrible provider who hates his patients and wants them to suffer.

I've had people insist (just as they do in the exam room) that: "I gotta have Vicodin, man! It's the only thing that works! Nothing else WORKS!"

I've had people tell me: "My mother died a long, horrible, agonizing death because her doctors wouldn't prescribe narcotics. That probably makes you happy, doesn't it?"

And of course it's all bad-tempered ugliness.

My father died from pancreatic cancer, and his last few days were serene and pain-free due to appropriate palliative care. I appreciate the judicious use of these meds.

But I once reported on DU how I refused powerful narcotics to a brand-new patient in no visible distress but complaining of 10/10 pain and who declined a proper workup and evaluation of her pain, and the narco crowd lined up to spit in my face.

[silverweb]

104. I'm sorry for that unpleasant experience.

[font color="navy" face="Verdana"]People who would judge your professional assessment of a patient they know nothing about are ignorant and irresponsible.

Of course there are addicts and patients with drug-seeking behaviors who need to be carefully screened and evaluated. Determining the right course for each patient is your job as a physician. It's often not an easy call and objective detachment is required for each assessment of subjective complaints. All you can do is your best.

[Aristus]

105. Thank you.

I don't have as many drug-seekers as I used to. The word must be out on the street: my clinic is not a pill-mill.

Drug-seekers are a very small irritation in an otherwise very rewarding job.

[silverweb]

106. I'm glad to hear that.

[font color="navy" face="Verdana"]What is the primary focus of your practice?

[Aristus]

108. Healthcare for the homeless.

When I said 'the word is out on the street', I meant it literally.

I love my patients, and I'm very protective of them. My inside view of the homeless community would shock those 'why-don't-they-just-go-get-a-job?' types.

[silverweb]

109. That's wonderful!

[font color="navy" face="Verdana"]You are so very needed and appreciated.

I was in the hospital very recently for surgery myself and while everyone on staff was wonderful, one nurse did shock me by making a derogatory remark about the ACA. When I said that my family and I strongly support it and wish it would morph quickly into a universal single-payer system, she didn't say another word, but quickly finished her task and left the room. I just can't understand how any health care worker would be against universal access.

Thank you for all you're doing.

[Aristus]

110. Thank you.

The ACA has been a Godsend for my practice. As long as I've been doing this, about 1/3 of my patients have had some form of insurance, either state insurance, or private insurance still good from before they hit the streets. But for most of my patients, proper care has been a slog. Primary care here is covered under a grant - visits, labs, in-office procedures, and a small store of basic medications we could give out for free. But if an uninsured patient needed imaging, x-rays and so forth, or specialty care, or a medication that we didn't stock, they either had to pay out of pocket for care or meds, seek a charitable organization that would cover their care, or go without.

I just about jumped for joy when the first of the year rolled around, and all of my patients who had registered now had insurance. It's wonderful now to know I can get my patients exactly the care they need.

If those anti-ACA right-wingers would just slow down for a few minutes and think, they'd support a program that lowers the cost of medical care, even theirs. My patients are no longer going to the emergency rooms for primary care, which reduces tax write-offs for the hospitals, which reduces the tax burden on the rest of us.

[silverweb]

111. Absolutely right.

[font color="navy" face="Verdana"]Unfortunately, getting RWers to "slow down and think" seems to be the hardest part of that prescription. Hopefully, more and more will actually do it as time goes on and they see the results for themselves.

[Warren DeMontague]

7. Oh God, those Greedy pain patients demanding pain relief! Throw em all in prison, like Richard Paey.

http://www.nytimes.com/2005/07/19/opinion/19tierney.html

http://www.cbsnews.com/news/prisoner-of-pain/

Sorry, but if I have to choose between humane pain management policies combined with the risk that someone might get an unauthorized buzz, versus doctors terrified to prescribe adequately because of the DEA, I'll go with the former, thanks.

[TheFrenchRazor]

12. precisely. nt

[nomorenomore08]

14. That story is disgusting. I'm anti-death penalty, but the people who put him in prison

should be fucking hanged!

[Egalitarian Thug]

9. WTF? If you're in pain, here's a wonderful drug that will help.

Opium is a miracle, what makes it detrimental is the profound sickness that plagues us.

[Ghost in the Machine]

15. As a chronic pain sufferer for over 10 years, and a pain management patient for over 4 years now,

I can speak from experience. My neurosurgeon told me after my SECOND neck surgery in 2 months that he had done all he could, and all he could do now was refer me to pain management, and said I would be in it for the rest of my life.

I detested pills so much that I wouldn't even take an aspirin for a headache. I was always the "macho" type of "shake it off, man, you'll be ok". Couldn't tell you how many times I've cut myself bad enough to need stitches and did a few home made butterfly stitches and wrapped the cut up in duct tape or electrical tape. I worked a half a day on a rolled ankle, with torn ligaments, then drove myself home in my stick shift truck. I thought I was ok.. until I stepped out of bed in the middle of the night, screamed out in pain, and hit the floor! I had to be driven to the E.R., where I learned a rolled ankle was worse than a broken one. I spent 12 weeks on crutches. I fell off a roof in 2003 and broke my neck, but still had feeling and could walk. I sent the ambulance crew away, stating I was alright, but I was really in shock. This happened right after lunch, and I went back to work until 3:30, when the boss came with our paychecks. I drove myself home, over 40 miles. I relaxed all weekend, figuring I was just sore, and tried to drive to work Monday morning. I got half way there and was hurting so bad I pulled over, called the boss, told him I was trying to make it to work but I was just hurting too bad to come in. He was shocked and said he didn't even expect me to come in for a few days and to go back home and not to worry, he was going to pay me anyways. He said if I got worse and needed to go to the doctor just let him know and he would provide me a list of his approved workers comp doctors. Well, by Wednesday morning, 5 days later, I couldn't use my arms and was starting to stumble all over when I tried to walk. I wound up going to the doctor..

Long story short, I fought against pain management for 7 years, because the 10mg oxycodones I was prescribed after surgery just knocked me out and I couldn't function. I was a single father, with two young kids depending on me. I weaned myself off of the pills in two weeks, and started using marijuana. When I went back for my two week check-up from the surgery, the doctor asked if I needed more pain meds? I tossed him half a bottle I had left and said "NO, these things just knock me out and I can't function on them. I've found a more "natural" way for pain relief. He looked at me ans smiled, with a knowing grin, and said "this is off the record, but THC is the BEST pain reliever known to man. I have no problem with you doing that, rather than getting hooked on what the "drug pushers" come around here with!" Yes, he actually referred to pharmaceutical reps as "drug pushers".

With a very sizable settlement from workers comp, because I was told I could never work again, I had plenty of money to buy weed... at least an ounce a week. Then I also got disability approved, and got even more money. I was spending $300 -$400/month on weed, and it was getting less effective, so I started thinking about the medicare card I had in my pocket. No co pays for doctors visits, and $2.10 co pay for meds. I found a pain clinic, and they prescribed me 6 oxycodone 30mg's per day. That's 180 mg's per day. They took my pain away, but I was still unable to work. I have graduate from the oxy 30's, to Opana 15's, then Opana 30's, and now on Opana 40 ERs, plus 2 oxycodone 15 mg IRs for break-through pain.

I am dependent on my meds, just like a diabetic or an AIDS patient or heart patient is dependent on their meds, except for the fact that I am also addicted to the opiods, even though I take them as directed and DO NOT abuse them. It's the people who get the pills just to sell, or to get high, that give us legitimate pain patients a bad name. I turned my own nephew in for doing that. He was getting pills because he said his back hurt, but all he was doing was snorting them and selling them. I have never gotten high from a pain pill, just stopped hurting. I guess I just don't understand how people use them recreationally like pot or cocaine, which I had a 13 year love affair with many years ago. I've been clean from coke for over 20 years. I had a $1,000/day habit and quit cold turkey. I never went through withdrawals or anything, but let me miss a dose of these fucking opioids and I start into withdrawals from hell! I couldn't afford the weed it would take to help my pain now, but it still only costs me $2.65/month for a bottle of medications.

Iwouldn't wish my pain on anyone, nor would I wish the withdrawals on them, but I *WOULD* wish the pain relief on anyone who needed it and knows what it's like to live in constant pain.

Peace,

Ghost

[JCMach1]

17. Exactly, until you need it, you have no idea about how this drug might help

[Ghost in the Machine]

37. Agreed! If some dumbass dies from an overdose because they CHOOSE to ignore instructions on

the proper way to use a certain medication (crushing and snorting/injecting or chewing a time released pill), that's on them and them alone. People such as myself and a million others, who do their medications properly, should not be punished because of the actions of a few junkies.

As I admitted, I was no angel in my younger days and sometimes *still* wonder how and why I lived through it, but here I sit still making it through life.... with a LOT of help from my medications. Without them, I'd be a bedridden lump of pain, unable to function at all.

Peace,

Ghost

[seaglass]

50. I have empathy for both those suffering from pain and those addicted to opioids/heroin.

I'm surprised that as a former recreational drug user you don't.

There ARE people who fake their pain to get opioids to get high and to sell to others. There is a direct line from FL pain clinics to the streets.

The FDA should require that any drug co. that develops new pain relief meds develop the abuse deterrent version first. Hopefully within the next few years this will be the case.

[Ghost in the Machine]

70. Oh, I *do* have empathy for addicts....

but there's a difference, to me anyways, between an addict and a dumbass. It's the dumbass who takes a fistful of xanax bars, or 3 - 4 oxy 30's at once, or crushes and snorts two extended release 40mg opanas, knowing full well it can, and most likeky will, cause you to OD and die.

I lost a friend 3 years ago.... 2 days after she got into a pain clinic. She had less than 50 pills left out of 120 oxy 30's she had just gotten, and less than 30 out of 90 2mg xanax bars.

I just have a very low tolerance for stupidity, and doing something like that is just plain stupid... even for an addict.

As I've said several times, I have never even gotten high from my pain meds, so I wouldn't even know what it's like. All I do is notice that I've stopped hurting and I'm able to enjoy a little 'quality of life' with my family and friends. When I'm in pain so bad I can barely get out of bed to make it to the bathroom, I don't want ANYONE around me. I know it tears my kids up to see me like that, and I don't want family and friends seeing me like that.

Peace,

Ghost

[dionysus]

64. while i believe in the pain relieving properties of THC, it didn't do anything for me.

I had the lowest disc in my back pretty much explode on me... the gel from the blown disc was enveloping my sciatic nerve. I was hunched over at a 45 degree angle for over 3 months.

whenever I blazed, it didn't touch the pain, I was just stoned off my ass *and* in excruciating pain.

in a way I got lucky when insurance wouldn't cover surgery; it got better on its own after a few years.

but when it was bad, only the prescription meds helped.

[Ghost in the Machine]

72. I know that what works for some people doesn't work for others... that's why we have so many

different medications out for the same conditions.

I blew out my back the first time when I was 23 years old. Ruptured 3 lumbar discs, and I know that pain also.

Surgery has no guarantees, and in many cases makes you worse, so I'm glad your insurance didn't cover it and glad you are doing better now. I wouldn't wish that pain on anyone!

Stay well, dionysis

Peace,

Ghost

[dionysus]

73. you stay well also! for me, nausea and headaches are helped by the kindly herb, but not different

types of pain.

yeah, I'm glad insurance didn't offer up surgery; at the time I'd have taken it, and it would most likely have been a big mistake!

[COLGATE4]

16. This hyper paranoid concern about keeping prescription

pain medications away from patients who legitimately need them is getting ridiculous. Due to a severe back injury I have (after exhausting all other options) been prescribed a schedule I drug by a major University Pain Clinic for several years. In December I went to my regular Walgreens to fill the usual monthly Rx, only to find that it was out of stock. But then things got strange. I asked if they knew when they would get more in, only to be told that "they didn't know and, if they knew, they couldn't tell me". Incredulously, I then asked if they could call one of the other Walgreens in the area to see if they could fill it for me - again, the answer was "no - we're not allowed to. You'll have to do it yourself". I asked if they could at least tell me which Walgreens had the drug in stock. As before, "we're not allowed to do that". In desperation, I asked if they would hold the Rx and fill it for me when the new stock arrived? Answer as before -"we can't do that".

More than a little pissed I then got on the phone to several of Walgreens' pharmacies relatively near me, only to be told that "they will not give out any information on whether they have the drug in stock over the phone". Instead, I was told I'd have to physically come in to each store to ask. At that point I contacted Walgreens Corporate Office and spoke with Customer Relations. The lady confirmed that Walgreens policy prohibits any pharmacy from 1) knowing when a given supply of the drug will be shipped, 2) telling a customer over the phone whether they have the drug in stock or not and 3) asking another Walgreens to fill the Rx. The solution she offered me was for me to drive to every Walgreens in the greater Tampa Bay area to see if someone could fill the Rx.

Pain patients are not addicts and they shouldn't have to jump through ridiculous hoops placed in the way of their obtaining needed medications due to paranoid concerns about potential addiction.

[LuvNewcastle]

21. I'd stop using Walgreens.

I use a locally-owned pharmacy, and they would have no problem telling me if they had a certain drug in stock. They know me well since I get all my meds filled there, so they know I'm not trying to get pills for illegitimate purposes. Those big chains have no personality. They have a bunch of stupid rules and they treat regular customers the same as people who have just walked in the door. My local pharmacy fills my scripts right away, too. I never have to wait more than 15 minutes. It costs a little more to use them instead of Walgreens and Walmart, but the personal attention I get is totally worth it.

[COLGATE4]

35. The problem (at least here in the Tampa Bay area)

is that the smaller local pharmacies don't stock Schedule I drugs. Only the bigger chains, and even then most of the stores don't carry them. So I'm stuck with Walgreens or CVS.

[LuvNewcastle]

40. That's awful!

My pharmacy can get me anything I need. They might not have it in stock right then, but they can always get what I need from one of their other pharmacies (they have 6) or even from a different pharmacy. That's outrageous that they don't carry all the drugs people need. No wonder the big chains are taking over in so many places.

[Digit]

39. I also had trouble with Walgreens

I had been using them for years for all my medications and also happen to be in a pain management program.

My doctor was changing one of my medications so I had some questions for my pharmacist but instead I was treated like a drug seeker and just told they did not carry it. While googling my questions, I discovered I was not the only one having difficulty with the pharmacy being a tad over zealous when it came to scheduled drugs.

When I called CVS, they provided me with the information I needed and I switched all my meds to them. I also ended up saving money!

[TheFrenchRazor]

41. wow. they make it hard for people to get their pain meds so they will give up. nt

[zabet]

42. I made the mistake of using Walgreens once

for filling my pain meds. Never again, I had to get the cops involved....I dropped my script off and sat down in the waiting area, an hour later I still had not been called. I asked the pharmacy tech I gave my script to how much longer and they looked me square in the eye and told me I had not given them a script to fill. I had to call police to review security camera footage to get my script ......same pharmacy tech had folded it up and hid it. (I get a large script of IR oxys that are high mg - a dealer/junkies dream). After a couple of hours I had my meds and parmacy tech was fired. Needless to say, I will never use the pharmacy at the Walgreens here again.

[Boudica the Lyoness]

83. wow..

In Walmart a month ago, my husband and I were refilling some of my meds, one was a narcotic.

The pharmacist talked to me about this new med I was taking and when he was done my husband looked at the paper bag the drugs were in told the pharmacist the pain meds were not in there. The pharmacist had a very concerned look on his face and he quickly found them.

Later my husband told me that he watched the tech put the other meds in a plastic bag, then she put the pain meds on the counter...in a discreet place. That is why my husband looked in the bag while in the presence of the pharmacist. If we left the counter and noticed they were absent, we would not have been believed.

Mine is also a very large script. Needless to say, we are keeping a close eye on the meds now.

[zabet]

91. I don't normally

use Walgreens or any big chain pharmacy but was called to the next town over to help Mom take care of my 81 yr old father who had recently had a heart attack.
I am lucky enough to personally know my usual small-town pharmacists and NEVER in 30 years have I had a problem with him.

[gollygee]

18. There seems to be an assumption in the medical community

that dependency is worse than chronic severe pain.

[ScreamingMeemie]

20. I know, right?

Last edited Fri Feb 28, 2014, 04:05 PM - Edit history (1)

First there is this. I stopped filling my standing prescription for pain meds because I didn't like the way they made me feel and I was tired of the looks I received. Now, I rely on two ex-strength Excedrin to cut the pain at least in half so that I can function. I just noticed they would like to removed Extra-strength dosages from OTC. Honestly.

[ohheckyeah]

27. Excedrin Migraine

is what I take when I can't handle the pain any more. I got off all prescription pain pills just because I hate how they make me feel and I hate the hassle and being treated like a drug addict. I've been in pain since I was 16 and have metal rods and screws in my back...the hot tub helps some with that pain. I'd use marijuana if I could.

My mom's dentist told her the best pain relief you can get from non-prescription drugs is to take three 200 mgs of ibuprofen with one extra strength Tylenol.

[ScreamingMeemie]

28. It's what I take as well.

Did you notice they changed the recommended dose on the back?

[ohheckyeah]

29. No, I never even look at the recommended dose.

What was it changed from and to?

[ScreamingMeemie]

30. It was changed from "no more than 6 in any 24 hour period" to "no more than 2 in any 24 hour period"

I've been taking them every 6-8 hours as needed for pain for the past 4 years. I don't plan to change that. I do know the Acetaminophen/Hydro combos are now down to 350mg at the most (instead of the 5/500, 7/750, 10/1000 that they used to be).

[alarimer]

32. I just checked and you are correct.

I never noticed it before. I routinely exceed that because I take it every time I have a headache or cramps or whatever. It's about the only thing that works for my headaches, 2 of those and some caffeinated beverage.

If pot were legal everywhere, I think people would have a whole lot less pain, although I guess that people who have jobs that drug-test might not be able to use that option.

[ScreamingMeemie]

53. I would hope (I know, I know...hoping a corporation would be human haha)

drug testing would change to fit the laws... but I doubt that would happen.

The dosage on Excedrin/Tylenol is ridiculous now.

[Delphinus]

56. You're kidding!

When two don't even put a dent in the pain ...

Wow, I had not known they changed things like that. I'll remember what was said up-thread (one Ibuprofen and three of these).

[Boudica the Lyoness]

84. I wish OTC pain meds helped me.

The narcotics I take barely take the edge off my pain. I have no side effects from them at all......no dizziness ...nothing...just some pain relief.

I have never received any kinds of looks either. Who was giving you looks?

[Warren DeMontague]

31. I would agree except in this case I think the thinking comes less from the "medical community"

than it does from the "DEA Gravy Train/Law Enforcement" one.

I suspect most medical professionals who deal with pain patients trust their own and pharmacists' ability to correctly gauge and prescribe these things. Unfortunately you have a situation now where people suffer in agony because their doctors are afraid to adequately manage pain because they don't want to be sent to prison.

[Tom Ripley]

33. +1000! It is indeed medical professionals being held hostage by the Law Enforcement Industry

and it is disgusting

[gollygee]

51. Fair enough

[HuckleB]

97. Not in the community as a whole, no.

Sure, there are pockets, but let's not miss the whole picture.

[nilesobek]

23. Its a deeply rooted paranoia.

The fear being that a lot of Christians consider drugs of any kind to be a form of witchcraft. If you are feeling good because you took an opioid you might stop staring at temples & crosses and maybe even forget about Jesus.

[Warren Stupidity]

24. Other countries manage to prescribe opiates without civilization collapsing.

They think we are fucking nutz.

[Recursion]

34. Other countries also do so at about 1/10th the rate we do (nt)

[kcr]

54. Those countries have products available OTC that we don't

Like tylenol 3. That likely makes some difference.

[Comrade Grumpy]

58. Yes, and there are severe global problems with the undertreatment of pain.

How would you like to go to your death moaning in pain from terminal cancer? That's what's been happening in India, among other places. But now, the Indian parliament has just approved a law that should ease access to opioid pain medications. That's a good thing.

[Recursion]

59. If they can get them in the first place, but the US/UK/Argentina/Australia buy them all

I think that's the four at least. There's two problems: the protocols in the Single Convention that make opioids hard to transship in the first place, and the more prosaic fact that four of the richest markets are happily buying up basically all of them once you get the legalities worked out.

Meanwhile, as I said in the OP, prescription drugs are killing more Americans than illegal drugs...

[Comrade Grumpy]

61. Well, the INCB keeps saying there is enough opium to meet legitimate global demand.

But that seems divorced from reality.

Maybe the INCB needs to revise its estimates.

It seems like we in the US need a better way of dealing with opiates. They are an essential medication for pain, but they can also kill or addict you. A Canadian researcher told me they did 90,000 injections of pharmaceutical heroin in one study, had 11 overdoses, none fatal.

Why are so many people overdosing here? Is it just a function of broader use of those drugs, i.e. "For every thousand opioid prescriptions, one person will die of an overdose"? Or are there things we're doing wrong? I suspect people are taking them for party purposes and doing stupid shit, like mixing with other drugs or alcohol.

There are harm reduction measures to take:
--Making the overdose reversal drug naloxone more widely available.
--Passing 911 Good Samaritan laws so people don't fear getting busted when seeking medical help for ODs.
--Decriminalizing drug possession.
--Making pharmaceutical quality heroin (diacetylmorphine) available, perhaps by prescription.

[Recursion]

62. Ooh! I actually know this one: There is, at *mean global use levels*

It was one of the most disingenuous things I'd ever read, once I finally parsed through the footnotes. The claim is perfectly accurate based on... wait for it... current global use levels. Which is to say, we make enough opioids to satisfy the people who currently use them. I banged my head on my desk for about an hour after I finally tracked the references down.

Why are so many people overdosing here? Is it just a function of broader use of those drugs, i.e. "For every thousand opioid prescriptions, one person will die of an overdose"? Or are there things we're doing wrong? I suspect people are taking them for party purposes and doing stupid shit, like mixing with other drugs or alcohol.

My limited experience based on "having grown up in the south" is that people like snorting. Is that more dangerous? I have no idea.

[muriel_volestrangler]

89. If Argentina, with its foreign currency problems, can get them, you'd think the richer countries

that find international trade easier would be able to buy them if they wanted.

[pipoman]

48. Yet the FDA refuses to approve

a natural, non-addictive pain killer, or even allow testing. Just more proof that health care is about money and not actual health care.

[Sunlei]

49. It is better for those who depend on the medicine for legit pain relief.

Any Doctor who writes scripts for the old (many times abused) same pain medication will switch legit patients over to the same medication. They can take less tablets per day because it's a stronger dose AND the new is time released (less tabs per day.)

" a severe drug epidemic fueled by over prescribing of opioids" This still is a problem, but it has gotten much better, doors have been closed .

. I remember early in President Os admin he mandated something about this RX problem? people can no longer go over state lines to multi-doctors or get multi scripts, started to track the VA hospitals who were huge buyers of much opioid medications.

Weren't opioids also recently moved up a step to schedule 2 ? where they have a much tighter rein on the actual medicine.

I do think people will continue to get addicted, just not from RX drugs, Opioids are easy to grow & process. Block doctor scripts, bad doctors, back door of wholesale supply and change the medicine dose,schedule - addiction will still continue to grow. Because the war on drugs is so profitable some just don't want to stop the stream of 'for profit' prisoners and 'for profit treatment' addicted customers.

[TM99]

52. I find myself torn on the matter.

I fully support any patient using what will work including these powerful opioid analgesics to manage severe and chronic pain. I suffer from pain, and while I have chosen other means of tolerating the daily pain, I do not think that others should be forced to make my choice.

But I have to admit that the coalition makes a valid point with regards to the epidemic of over-prescribed opioid analgesics. PCP's, who are not pain management specialists are over prescribing them much in the way that they do anti-depressants.

Ultimately then with such a new and more powerful drug, I say make it available but increase safeguards by limiting prescribing to specialists and more long-term follow-up studies on its effectiveness versus its addictiveness are warranted.

[gulliver]

55. Crushable opioids should be outlawed.

They are probably the true gateway drug to heroin abuse.

[TheFrenchRazor]

65. you're kidding, right? i guess you're volunteering to pay the living expenses of

those people who can not function due to people like you denying them medication to treat their pain?

[gulliver]

68. Why do we need crushable opioids?

Explain, please.

[moriah]

71. Your antibiotics are crushable, too.

It's not a capsule where all they have to do is pull the thing apart and viola, there's the powder. It's an extended release formulation. "Zohydro ER is available in 10 mg, 15 mg, 20 mg, 30 mg, 40 mg, and 50 mg hard gelatin capsules, containing white to off-white beads, roughly spherical in shape, and uniform in appearance."

The lowest dose is less than many immediate-release crushable opiates like Roxicodone (lowest dose there is 15 mg, and that one is just like an antibiotic or regular pill instead of this one). The 50 mg amount is less opiate than OxyContin, which goes up to 80 mg.

People are making huge mountains out of molehills IMHO (and I'm aware my opinion likely stinks).

[gulliver]

74. Crushable opioids are the issue.

Starting with heroin is going to be a lot harder than finding one or two diverted pills from the huge number of pain prescriptions out there. If they make the pills non-crushable, there is no easy first step to heroin.

http://www.popsci.com/science/article/2013-05/science-un-crushable-oxycontin

[moriah]

78. Crushable doesn't mean injectible always.

There are formulations to make the powder, when wet, get gummy and unable to dissolve in water. The newer form of Oxycontin is like that. In this pill's case, it's not even like a standard pill but a hard gelatin pill that is, as I indicated, far less crush-friendly than other pills out on the market.

[gulliver]

92. It looks like Zohydro is crushable, and therefore snortable.

The kids crushed old formula Oxycontin to bypass it's slow-release design. It could be snorted or dissolved in water and then injected. That gave them a huge surge of opioid all at once and got them addicted. Then once addicted they found out that heroin is the same high for less money. But they would not have gotten to heroin if their first opioid experience hadn't been so easy.

The numbers are against us. Heroin has relatively few dealers and a terrible reputation. Crushable opioids create multiple sources (anyone with a prescription) of "pharmaceutical" heroin-style highs. Pharmaceutical opioids are easier to get and seem less dangerous and sleazy than heroin. That makes them a gateway waiting to happen.

The new Oxycontin isn't crushable and therefore can't be snorted or injected. When drug companies tried to make generic Oxycontin using the old crushable formulation, the FDA prohibited it.

Everything I am reading says Zohydro is crushable and snortable.

[moriah]

95. Even if it is, compared to what's already on the market....

... a 30 mg IR oxycodone is equivalent to a 50 mg Zohydro. IR meaning it's easily snortable, etc. http://www.globalrph.com/narcotic.cgi This is a pill that's harder to defeat than what's already on the market at this equivalent dose. It's not like this is any worse if diverted than what's already out there. I'm really shocked at the amount of panic I'm seeing.

Abuse of drugs should not be the primary focus of our policy IMHO when it comes to treating chronic pain patients. I'm glad that my condition doesn't require opiates. I'm very sympathetic to those who do require them to manage their pain, having witnessed the effects of chronic pain on my loved ones. I've also witnessed addiction first hand in loved ones as well. For the target chronic pain population, this is an excellent drug to avoid those exact highs and lows that can cause addiction. The market for this drug are patients who are currently managed on instant-release hydrocodone. If they are able to stop taking painkillers 4-6 times a day and instead take a pill twice a day, they're less likely to have psychological addiction to the substance. They'll also get better pain relief, leading to a better quality of life.

I don't think it's fair to delay relief for millions of chronic pain patients because of the actions of a few. There are ways to prevent diversion. Most people who are prescribed opiates do not divert them but take them as prescribed. Untreated and undertreated chronic pain is a problem that is strongly correlated with suicide, both with and without prescription drugs as the method. It's a serious problem, at least as serious and more widespread than abuse of drugs in my (likely stinky as I've said before) opinion based on what I've read and seen.

[TheFrenchRazor]

75. by "crushable," you mean pills? what is the other option? injectables? please explain. nt

[Recursion]

86. Look at Adderol

The chemistry of it eludes me, but the XR version doesn't "work" if you crush and snort it.

[Warpy]

80. The only true gateway drug is TOBACCO

which lights up those addictive pathways in the brain like a strip mall on Xmas eve.

However, some idiots are going to abuse anything, including air conditioner refrigerant. Yes, we're going to see a few drug addicts on this stuff. However, it will also help thousands of people who can't take other opioid drugs and whose kidneys have already been wiped out by Tylenol and NSAID additives.

Untreated pain is fatal. People isolate, get depressed and commit suicide to make it stop. This preparation of an old drug was necessary.

[hunter]

60. I have strong opinions about this.

Those puritanical religions that think suffering is "good for the soul" or a consequence of "God's Will" or some kind of fate, they all blow big kitty-litter-eating-and-money-grubbing chunks.

We have drugs that can help people, we ought to use them.

The corruption of "drug wars' and all the other rat-spawn preying on the small population of people who become addicts is utterly disgusting.

Addiction is a public health problem.

Drug gangsters, drug "warriors," corrupt prescription authorities, corrupt politicians, corrupt pharmaceutical corporations, corrupt bankers, they all make the problem far, far worse, and they increase human suffering.

Treat addiction as purely a public health problem and most of the rot will go away. But that would be bad for big money and the authoritarians, so here we are in HELL, allowing innocent people to suffer, casualties of senseless war and profiteering.

[Warren DeMontague]

66. I'll tell you what the real "crisis" is- a $60B/yr DEA gravy train seriously threatened by movement

towards widespread pot legalization, and searching desperately to justify itself.

[Ruby the Liberal]

67. Just free the weed already.

Crickets on a cracker - reschedule it to a III or IV so that (royal) we can research CBDs. Pharma is poison.

[moriah]

69. Why should pain patients suffer for the acts of abusers?

My grandfather was in chronic pain for the majority of his life. One time he had to be admitted to the hospital for his heart and his doctors there didn't know all the things he was on so weren't giving him his pain pills and Valium. Within two days he was hallucinating -- obviously he was physically dependent. But he kept them up on a high shelf. When he passed away, my grandmother took them to the doctor to have them destroyed. I was a child in that house and didn't die from finding a pill. Yes, I could have climbed on the counter to get them, and when I was old enough to understand they would be poison to me but would help him I was allowed to get them for him, but I remember the dire warnings if I *ever* got into that cabinet when I was a youngster.

There may be some people who are over-prescribed them, but they made my grandfather's quality of life better, not worse. That should always be the measure of the success of a medication IMHO. (For me, they make me violently ill to my stomach -- that doesn't really enhance quality of life.)

But many people, even in this country, cannot get prescribed them when they legitimately suffer from chronic pain, and not everyone can tolerate oxycodone or other stronger pain relievers that are given for chronic pain. Extended release medications allow the patient to have fewer "ups" and "downs" -- those highs and lows make dependence and addiction more likely, as does a shorter time of taking the pill to getting the effects. This medication is far safer for patients who have been on Vicodin for their pain relief for many years, because of the lack of acetaminophen.

Overall, it's a great drug for the target patient population, who are suffering enough already.

[Warren DeMontague]

101. That's the bottom line. And that's what's happening.

I think we need to decide whether it's more important to humanely alleviate suffering, or to keep people who are determined to get an unauthorized, unpermitted buzz, from getting one.

[aquart]

77. I will now start screeching.

I am the sister of a chronic pain patient. A good day is one where she doesn't have to take morphine in addition to the oxy.

STOP WORRYING ABOUT FUCKING MYTHICAL ADDICTS AND DO SOMETHING FOR CHRONIC PAIN!

Pain management in this country borders on deliberately sadistic. No professional who has seen my sister's x-rays or read her history denies for one second how much pain she is in and how much pain she will always be in. Not one.

Stop nattering about the fools who might misuse this painkiller and start thinking about THE PEOPLE WHO NEED IT.

[Recursion]

82. Are you actually calling prescription opioid addicts "mythical"?

You know these painkillers are killing more Americans than heroin, cocaine, and meth combined, right?

[TheFrenchRazor]

85. i've never been harmed by an opioid addict; i have been harmed by the deliberate effort

by some to deny pain medication to those in pain.

[aquart]

87. So prevent the drug from reaching the people who NEED it?

Let's abolish painkillers, shall we? Like we so successfully banned the murderous alcohol.

Obviously, addicts aren't having much trouble getting their pills. My sister, however, has to take urine tests and sign oaths never to share before she is allowed the pills every fucking doctor admits she needs to even minimally function.

But all you can think about are the bloody addicts! Maybe they wouldn't die in such numbers if they could get what they need legally.

TRY, just try, to think about the people in pain. Maybe once a year or once a lifetime if that's all you can manage.

[Savannahmann]

88. Well considering that drug overdose is a fraction of a percentage of all deaths

I'm not sure we should be all wound up about it. I mean if heart disease was ranked number two and overdosing on pain meds was number one, I could see the reasons to get upset. But when we're talking about all overdoses and it still makes up about .2% of all deaths, I'm not so sure that the hysteria isn't a bit out of proportion to the results.

While I did not use Mythical, I can see the applicability. We want Doctors to have the freedom to treat the patients to the best of their ability. Then we tell the Doctors not to proscribe medication that may help the patients because a tiny fraction of the patients have been known to get addicted and abuse the drug. This tiny fraction is hardly worth the hoops those who need the medication to alleviate chronic pain go through.

FWIW, my opinion is pretty obvious. The use of any prescription drug is between the doctor, and the patient, and everyone else can go fuck themselves sideways. It's none of their business.

So forgive me if I refuse to get upset at the idea that .2% of all deaths are drug overdose related. I've got to be thinking those people who are wound around the axle about it could find something more constructive to get involved in, like Alcohol. Two and a half times as many people died from Alcohol poisoning as Drug Use and I don't see anyone demanding we remove a brand of booze because more people die from Everclear than Gray Goose. Yes I made that up.

BTW, total number dead from Drug Overdose is 573 according to this site. http://www.worldlifeexpectancy.com/usa-cause-of-death-by-age-and-gender

Drug use is number 55 of the list, and I'm thinking we can probably have a bigger effect by focusing on some of those other causes, like Falls in which 12k lost their lives. So make sure you're wearing your helmet. You are almost twenty times more likely to die from a fall than drug overdose.

[TheFrenchRazor]

98. word. it's nothing but "war on drugs" hysteria. nt

[moriah]

90. It's a more complicated picture than just number of deaths from opiate overdose.

Chronic pain is strongly correlated with suicide risk, and people whose pain is untreated or undertreated have a higher likelihood of suicide than patients who have their pain under control.

http://www.psychiatrictimes.com/suicide/pain-and-suicide

"In most cases of overdose deaths, we have no way of knowing with any degree of certainty whether they were accidental deaths or intentional suicides."

http://www.timesfreepress.com/news/2013/apr/14/chronic-pain-difficult-to-treat-hard-to/

"According to several large-scale studies, at least 10 percent of suicides -- and maybe as many as 70 percent -- are linked to chronic pain or unrelenting illness."

------

I don't think policies that have the unintended effect of making it harder for chronic pain patients to get adequate, appropriate treatment is going to lower these deaths.

[napi21]

79. I'm sorry there are many people abusing drugs, but if a patient is in severe pain, it wrong

to let them suffer if there is a drug that can reduce or eliminate their pain. All the Docs I know are VERY hesitant to prescribe any opioid, and even Pain clinics are hesitant.

[nolkyz]

93. At first, I thought the headline sain "Palin Pill"

Now that would be frightening!

[winter is coming]

102. No. Sadly, research has still not found anything to make Palin better. n/t