The 60 Minutes piece on opioids was an eye opener for me

[KelleyKramer]

Last edited Mon Oct 16, 2017, 05:01 AM - Edit history (1)

The small town clinic ordering millions of pills, those places are nothing more than dope pushers

I only have a few personal experiences with those kind of drugs. A few years ago I had a bad work accident and ended up in ICU for three days.

When I went home they gave me a scrip for a full 30 days of really strong pills. There is no way I needed that many, I took maybe 4 in the first two days. I don't remember what they were but about 6 months later a friend saw them and said they sell on the street for about $8 to $10 a pill.

And a couple months after the accident I had to have surgery. And when I woke up in the OR, one of the first things they asked was if I wanted some oxicontin for the pain and I quickly said no. Then he asked if I wanted any dilaudid (sp?) and I emphatically said NO, that's even worse!

And he said.. well, you can take it just the one time. I told him that is EXACTLY what the heroin dealers on the street say!

He didn't ask me anything after that

Ever since then I have had a theory, with no proof, but a theory...

These dope companies are playing a numbers game. Sending me home with a big bottle of pills, they know a certain number of people will actually take them all, and many of those people will get addicted and become long term high paying 'customers'

Same thing with the strong stuff at the hospital. They know a certain number of people can take that stuff just a couple times and will become addicted to their high priced 'product'. So that one is literally a numbers game... the more people you give them to the more people you get addicted

Another interesting thing happened about a year before all that. My father had major back surgery. I was with him in the hospital room that first night and the doctor kept coming in and asking why my dad had not hit the button to use the heavy pain killers.
My dad kept telling him 'I don't need it'. The doctor came and asked that about 4 times, then the 5th time the doctor just leaned over my father and punched the button for him anyway.

I remember thinking what the hell was that all about, and immediately thought the doctor was getting something out of that, some kind of kick back. Maybe not cash, but some sort vacation trip or high value perk. The dope dealers were giving that doctor something, it was obvious from his persistence

And again, I have no proof, this is just my personal speculation

The whole damned thing is nothing but a dope pushing racket


=============

Edit to add....


Video of 60 Minutes segment


https://www.cbsnews.com/videos/the-whistleblower/


<iframe src="https://www.cbsnews.com/embed/videos/the-whistleblower/" id="cbsNewsVideo" frameborder="0" width="620" height="349"></iframe>


https://www.cbsnews.com/news/ex-dea-agent-opioid-crisis-fueled-by-drug-industry-and-congress/


Ex-DEA agent: Opioid crisis fueled by drug industry and Congress

Whistleblower Joe Rannazzisi says drug distributors pumped opioids into U.S. communities -- knowing that people were dying -- and says industry lobbyists and Congress derailed the DEA's efforts to stop it


In the midst of the worst drug epidemic in American history, the U.S. Drug Enforcement Administration's ability to keep addictive opioids off U.S. streets was derailed -- that according to Joe Rannazzisi, one of the most important whistleblowers ever interviewed by 60 Minutes. Rannazzisi ran the DEA's Office of Diversion Control, the division that regulates and investigates the pharmaceutical industry. Now in a joint investigation by 60 Minutes and The Washington Post, Rannazzisi tells the inside story of how, he says, the opioid crisis was allowed to spread -- aided by Congress, lobbyists, and a drug distribution industry that shipped, almost unchecked, hundreds of millions of pills to rogue pharmacies and pain clinics providing the rocket fuel for a crisis that, over the last two decades, has claimed 200,000 lives.



JOE RANNAZZISI: This is an industry that's out of control. What they wanna do, is do what they wanna do, and not worry about what the law is. And if they don't follow the law in drug supply, people die. That's just it. People die.

[gyroscope]

1. Surprised the network would run this story on Prime Time

or at all. Big Pharma is a huge source of their advertising income.

Why is it even legal for these companies to advertise powerful prescription drugs on television?
It's ridiculous.

Big pharma sees legal weed as a potential huge threat to their business so they want to go all out to get more people hooked which they know non-addictive weed cannot do, hence is not nearly as profitable as their highly addictive narcotics.

[Duppers]

14. Exactly right. I agree.

[jmowreader]

19. I think Big Beer sees legal weed as a worse threat

The pharmaceutical industry would probably LIKE legal weed...if you were John Average Consumer and you had a disease pot was good for, would you - remember, you are John Average Consumer, not John Jaded DUer - rather have Bayer weed, or Gecko Growers weed? The pharmaceutical industry doesn't give a fuck what it sells, so long as they make money. Come on...Baycol, Fen-Phen, Accutane, Elixir Sulfanilamide? (The last one is a special interest of mine...the crackhead who was running the research department at the drug company that made this shit decided the perfect thing to put in a medicine for children was diethylene glycol...and while it DID cure what ailed the kiddies, it did it by killing them.)

The people who sell beer see legal cannabis as a significant threat - because every joint smoked is a beer not drunk, in their eyes. And the brewers and wine-makers have Congress' ear.

[HopeAgain]

29. The real problem is doctors are under trained in pain management.

Opiods can be the most complex medication to prescribe and yet physicians get barely any training in addiction and pain management.

[Hoyt]

2. The other side is that there are lots of people who will feel they are not getting the

pain relief they need if the doc doesn't write a script. It's complicated. I think I fall on your side, but I know people hurt and are scared they won't get the pain relief they need.

Truthfully, I doubt docs get many kickbacks, if any, on pain meds. In your case, they were probably trying to discharge you with enough meds that you won't come back in pain. I bet if it happened today, they wouldn't be so persistent.

[BigmanPigman]

3. That is the side of the issue that I am pissed off about.

Last edited Mon Oct 16, 2017, 02:06 AM - Edit history (1)

Last year I was in such terrible pain for months and my doctors couldn't diagnose it. I was taking handfuls of aspirin, ibuprofen and acetaminophen for months and it did no good. I suffered in agonizing pain in my back and abdomen and my own mother wouldn't even give me more than 3 of her Tylenol 3. I went to a neighbor who was on painkillers and got a codeine and something else and they had no effect. Finally I had to check myself into the hospital (it ended up costing me $1,000 a day WITH ACA). Since I had taken so many over the counter pills I almost killed my liver and stomach. It turned out that 3/4 of my pancreas is gone (scar tissue) and my symptoms that I had been reporting to two doctors were not properly diagnosed despite being classic textbook symptoms of my disease. The pain is so bad that 50% of the people with it kill themselves within 7 years of being diagnosed. Yet I could NOT get painkillers!!!!! This is fucked up!

[Ms. Toad]

5. Yup.

My story isn't as drastic -

But the gist of it is that the current rules are punitive and prevent access to appropriate pain relief. They have been implemented because it is easier just to treat everyone as a criminal - and there is no opposition from doctors who love it because you are reuqired to go visit them every 3 months (so they make more $ for doing pretty much nothing other than record keeping).

[Hoyt]

6. I get it. When you are in pain, and perhaps under-insured, it's tough going to

a bunch of docs trying to find someone that helps.

Not a doc or anything, but I've worked in emergency rooms and medical offices. There are a lot of people seeking drugs to take and sell. I've seen people get up and leave when a urine drug screen is ordered. Unfortunately, that makes life tough for people like you.

If I were diagnosed with terminal cancer, I think my only real question would be will the doc prescribe pain meds when I call up and say I need them, no matter if he/she thinks I ought to just suck it up a little longer?

I agree it's fucked up, but I'm not sure what the answer is.

[TheFrenchRazor]

9. well, some would say that it is better for 100 guilty people to go free, than for a single innocent

one to be imprisoned. i would rather that my "sin" (if there was one) would be one of omission (NOT stopping someone from OD'ing ), than one of commission (preventing a person in extreme suffering from having pain relief).

[Lee-Lee]

32. unfortunately it is not that simple.

Doctors, especially ER docs, have to be very guarded about it for many reasons, big picture and little picture.

First is that there are only so many beds and staff in an ER. If even a whiff gets out in that community of users that the doctor working that day is an easy mark to get some pills the ER will be flooded with "patients". I've seen it working off duty security in an ER, a temp doc was working and one of the regular seekers managed to get a script, within an hour a dozen more regulars were all in the waiting room all with the same symptoms that had just worked for the first one. This in a rural ER that only had 6 beds and had plenty of real patients that there people were now delaying from getting care.

That affects everyone. That means people with real issues wait hours more before being seen and get less time with the doctors and nurses. That reduces the quality of care for every tine.

On top of that your drug seekers are always uninsured or Medicaid patients, that means that your not only wasting your time and limited resources providing a totally unneeded service but the hospital is going to take a loss on it too. Add that up dozens or more times a day and it's a huge hit, especially in rural areas.

Then add in the personal frustration of overworked doctors who have legitimate patients in legitimate need waiting while they have to go through the paces with someone clearly lying to them.

Then add in that the DEA can and will revoke the certification to write prescriptions if they decide they have been providing too many drugs that end up for sale on the street, and a doc with no DEA number is unemployable.

[TheFrenchRazor]

7. i know exactly what you're talking about. most people here literally don't care who suffers agonizi

who suffers agonizing pain to the point that they would even consider suicide; the more important thing is to push useless regulations that do nothing to help the people who need it, and leave others in constant, severe pain. i've also been in the situation where doctors either couldn't find out what was wrong with me, or apparently didn't think it was "that bad." in situations like that, you are basically told to STFU and suffer until you die.

[Ms. Toad]

4. Staying ahead of the pain is critical to healing quickly

I always take the first dose of narcotics following surgery, because I don't know how bad the pain will be - and it is much easier to stave off intense pain than it is to stop it. Unless you are an addict (or other health-based contraindications), there is little danger in using opiods for intense pain in the critical healing period - and not being in pain allows faster healing.

Generally, I need it less than 24 hours.

That said, I will never refuse a prescription for opioids, always refill them even though I never take them past 24 hours, and I hoard them.

After the last surgery, I was sent home on a Friday night after outpatient surgery with a prescription for narcotic pain pills. My insurance company screwed up and had the wrong records for the doctor, and refused to fill the prescription (and because it was Friday night they could not do anything to correct their records). It was the insurance company screw-up.
The pharmacy was able to find the narcotic license - but the insurance company just wouldn't authorize payment because according to their records, the doctor didn't have the proper license. Thank goodness I had a stash of pain meds from the previous surgery or I would not have been able to sleep.

I have migraines - and occasionally need to be on blood thinners and cannot take the normal medication that is not a good mix with blood thinners. When I have one, I don't want to have to go to the emergency room to get a prescription for the only thing other than ordinary NSAIDS that can dull them.

My spouse also has frequent kidney stones. Because of the new, throw-the-baby-out-with-the-bathwater rules, her only options when she gets a kidney stone is to wait nearly a month for an appointment with her urologist OR a very costly trip to the ER - becasue her urologist can no longer call in a prescription for opioids for her to take while she waits the requisite period of time for the stone to not pass before she has surgery or lithotripsy (she has not yet passed one - and the pain is unbearable while she waits).

So no - it's not just a dope pushing racket, and it is hurting a lot of people financially - because the only access to pain meds when needed on a quick basis (my migraines or kidney stones) is to go to the emergency room. For chronic pain (like both of my grandmothers had - one osteoporosis with repeated compression fractures and the other metastatic bone cancer), the obnoxious rules require visits to the doctor every three months even when regular pain medication is appropriate and visits are not otherwise medically necessary.

Yes, there should be reasonable rules, but the current rules are punitive and costly for people who need access to narcotic pain relief either on a chronic or urgent basis.

[TheFrenchRazor]

8. agreed; many here do not realize how important pain control is to your overall health, and a lot

of other quality of life issues. i can not believe the thoughtlessness of so many people, when it comes to OTHER people's pain. on the bright side, a lot of the people here who are smugly pushing all these useless, intrusive rules will someday find themselves in extreme chronic pain and not be allowed to have any relief. this will end up just like the rest of the drug war; it does no good, but has all kinds of negative unintended consequences.

[Lucinda]

16. +1

[kcr]

10. Well. Good for you for being someone who can experience back surgery pain-free

Must be nice to be so lucky with such wonderful bionic superpowers. Kudos to you. Not everyone is so lucky, however. They aren't the same as heroin users.

[KelleyKramer]

11. So if some people need them, then they should be given to everyone?

And if someone says they don't need them and don't want them, then they should have to take them anyway?

And I didn't say anything about heroin users

[kcr]

12. For surgery?

Yeah. I think that's an opt-out kind of thing. Feel free to do you, but there's nothing wrong with doctors who give pain relief or the patients who receive it.

And you most certainly did too on the heroin thing:

"And he said.. well, you can take it just the one time. I told him that is EXACTLY what the heroin dealers on the street say! "

[KelleyKramer]

13. That says heroin DEALER, not user

It's clear you are not looking for an honest discussion, so I am done talking to you

Have a nice day

[kcr]

15. But you were declining the.. Oh, never mind.

Whatever, honest, strong and mighty one.

[Ms. Toad]

20. They should be made available to everyone post-surgery, by default.

I had surgery to remove a bone - pretty painful surgery. The anesthesiologist screwed up and had to use narcan on me, which wiped out the narcotic relief from fentanyl that should have carried me through the recovery room until I hit my room. (I have confirmed with the hospital that it was a screw-up).

Because of other crazy policies, I was not given pain relief in the recovery room (they wanted me alert when I was being transported) - so I was at least an hour without narcotics in my system before they rolled me through the halls, shooting pain spikes at every seam in the uneven floors. When I arrived in my room, they asked me to grab the rails and pull myself over from the cart to the bed - using the side from which the bone had just been removed. Movement was excruiating at that point. I asked them to let me slowly figure out how to move and they grabbed the sheets, folded me in on myself in the sheets, folding freshly cut flesh against the rough edges of bone remnant.

It was at least two hours after that before they got the orders for pain meds on the floor.

So yes, opioids should be immediately available by default post-surgery. It is far better to have them, than to be in the situation I was in when I needed them and they were unavailable for at least 3 hours.

And if you are under the illusion that you will become an addict by using narcotics in the immediate post-surgery pain, they should educate you enough to ensure that you are not choosing to endure pain (which is not healthy for healing) because irrational fear of opioids has convinced you that it is safer to endure pain than to take opioids to address accute pain. If you really have a clear and realistic understanding and then decline, that should be respected. But the default should be narcotic pain relief.

I'm not saying there are no dangers, but - absent some special circumstances you have not disclosed - your reaction to the thought of using narcotics is way out of proportion to any risk related to proper post-surgical use for pain relief.

[KelleyKramer]

21. I never said they should not be available, of course they should be available post-op

All I can tell you is what happened to me

He tried several times to talk me into taking them, and one of them was the exact same thing I have been told by dope dealers on the street

And I told him after that... I'm not in serious pain, if you don't mind I would like to start with something at a 'lower volume' and if that doesn't work out then will evaluate it

Keep in mind I had just woke up from surgery

Actually, when I woke up they asked me four questions..

What is your name?

What year is it?

Who is the president?

Can I give you some opioids?

I answered no to the last one

And I found it odd that he kept rephrasing that question over and over to see if he could get me to say yes

Just like the year before when the doctor kept asking my father over and over and over to try to get him to yes to taking opioids

[Ms. Toad]

22. You should be grateful you and your father had surgical teams

That understood the importance of staying ahead of the pain, even if they were apparently not communicating well about what they were doing.

It is challenging to try something else first for a variety of reasons. Other things do not work as quickly as opioids. If you try something else first you give the pain a longer time to dig in, and by the time you are willing to try opioids, you may need a much higher dose to take care of the pain than if you had taken something to prevent it from getting that high in the first place. In addition, the something else is usually tylenol-based - as are most opioids. Because even small Tylenol overdoses can destroy your liver, you may not be able to take the standard first line opioid, which is lower dose because of the Tylenol combo -so again, you may have to take a higher dose without Tylenol because you tried to avoid taking it at all.

Bottom line, you seem to be reading too much into what, in my experience is consistent with best practices for pain management, aside from, perhaps, clear communication about why they kept offering pain meds.

[KelleyKramer]

24. Oh I am very grateful, and thank you for reminding me

There was never any discussion to me after surgery or my father about why they insisted on dosing us.

And in my fathers case, he had another back surgery about a year and half before, so he knew what he was in for

There was never any medical discussion on any of the four tries by the doctor to get a yes

And my father said no he was fine four times in a row and the doctor came in the 5th time and dosed him anyway

[Ms. Toad]

37. Continuing to ask is appropriate -

Any good medical team will do that in order to make sure your pain hasn't dipped to a level at which you have decided you did that. I worry when they don't ask repeatedly.

As for dosing without his consent - that should never be done. Things like that are why no one in our family ever stays in a hospital alone unless they are fully capable of defending themselves (no meds on board, capable of communicating with the medical team, and capable of moving away from whatever threat there might be). The second criteria is why no one, other than me, ever stays alone in the hospital - regardless of whether they have meds on board or are capable of mving away from a threat.

[janterry]

28. That's so wrong

I'd be really upset with them. Your body, your choice. A doctor is supposed to respect that.

[KY_EnviroGuy]

17. Maybe someday a miracle will occur...

and some brilliant scientist will invent an instrument that accurately measures pain in humans real-time.

Used in the home, pain levels could be transmitted to an authorizing facility and pain meds dispensed from a machine, or authorization could be sent to a local pharmacy. Used in a hospital, ER or hospice facility, meds could then be accurately dispensed, and perhaps done automatically.

After that invention, there should be no more prescription pain drug crisis.

[area51]

18. This is something I heard, that insurance cos. are covering the highly addictive

opioids but not the less-addictive painkillers. Link

"According to a new joint report from ProPublica and the NY Times, a large number of insurance plans make it difficult or expensive for patients to acquire effective treatments that aren’t highly addictive opioids like oxycodone and morphine."

[elias7]

23. My experience has been just the opposite

As a physician, i have never been offered some kind of kick back, vacation, or high value perk for prescribing anything. Most, if not all physicians I have ever worked with strive to avoid prescribing narcotics, unless absolutely necessary. That is the rule, not the exception, which is emphasized he by 60 minutes in a somewhat slanted report.

When you say that one of the first thing they asked you after you woke up from surgery was if you wanted OxyContin, I hear a very pejorative framing of a physician responding to a perceived need. is if your opinion that you would have preferred not being asked about your pain control needs after surgery?

Part of the opiate problem is that some assholes have taken to lacing heroin with fentanyl and carfentanyl, leading to an epidemic of inadvertent overdoses, thus pushing the issue to the forefront. Lawmakers have tried to tie these deaths to the prescribing of narcotics, which is a very complicated issue and not a simple cause and effect.

Opiates kill pain. Physical pain, psychic pain. Like alcohol. Like marijuana. Like any other drug of abuse. Yet, there is a role in treating acute and chronic pain for narcotics. It's commendable that you and your father have such a high tolerance for pain, and I suspect you're not the ones writing those scathing letters to hospital administration about my failure to adequately address your pain needs.

I feel you need to consider all sides of this issue, not rely on an emotional response to a one sided report that seems to support your limited experience. We, whoever we are, have not been instructed to create addicts, have no conspiracy to get kick backs, vacations or other perks that you have already concluded I must be doing.

[safeinOhio]

25. If anyone feels their doctor is writing to many scripts,

you can go to ProPublica and check how much they get from drug companies.

[janterry]

27. I agree, but

If his/her patient is medicated for pain - while in recovery - or when they leave the hospital - then the transition will be 'smoother.'

I suppose there are two ways of looking at it. One is they are making sure their patients are comfortable. The other way to imagine it is that they know, through experience, that some patients will call back in pain. They want to avoid the calls.

I think that MD's are anticipating an (unbearable?) pain reaction and that's a mistake.

Some of this might fall on the MD's who - understandably - leave the surgery tired and order the meds (and I hate to say it, but we're all human) so they don't get an emergency call from the charge RN saying they need a script stat. Or that they discharge a patient whose primary will be dumped with a 'potential emergency' (and no one wants that, either).

[safeinOhio]

26. Why aren't the cops taking ever cent these companies have under

the Civil forfeiture laws. No conviction needed and the cops can buy brand new tanks, machine guns and the latest spy stuff.

[underpants]

30. Interesting. Haven't seen the piece yet. Here's a very weird element -PETS

Yes the doggies and kitties. It's we'll know in the prepper world that antibiotics and other needed drugs are available at pet stores. It has also become sort of a thing to use animals to get pain meds. From just calling in for a refill to actually harming the pets to get the next fix of what the owner needs. They literally take the same pet around to several vets and get what they need. I've heard about this from several people in the medical and addiction fields.

[ileus]

31. When pain management become a right Dr's had no choice.

My wife inservices her Docs, sends memo's and dismisses patients constantly.


What are you gonna do? Every other patient is a pillhead of some type...Some drive for 2 hours to find a new clinic that doesn't know them.

[madokie]

33. What about those of us who don't abuse our meds

I never take more than what is prescribed, in fact I take less most days. Its a have to now because the doctor and the pharmacy drags their feet in filling my script.

What about me, am I to suffer pain 24/7? Who did I cross? What part of I have no choice in the fact my feet feel like they're burning off 24/7 or that if feels like someone is sticking needles in the soles of my feet

What about ME?

About 3 or 4 years ago myself and three of my brothers, I'm the youngest at 69, were piddling with a power chair of my oldest brothers and I noticed my brother that is 8 years older than me was hurting, he recently had broken and had his left hip replaced. A guy who still works today btw. Anyways I ask him if his doctor gave him any pain meds and he said something to the effect that I don't want to take them and get addicted or some such shit. I say to him that I've been on pain meds for 10 years or so now. Well when the three of them pick their jaws up off the shop floor and in unison as if choreographed they say I would never have guessed you take pain meds. My answer was because I don't abuse them. I take them as prescribed.


Edit to change their to they're

[madokie]

34. Pardon me

But I have a hard time believing what you're saying about this

[RobinA]

35. It Strikes Me

that a reasonable approach might be to teach people how to manage, both use and tapering off, narcotic pain relievers. That plus, dare I say it, controlled use situations for people who do become addicted for whatever reason, seems to me to be the path to significantly lowering the death toll. That would give people an option to rolling the dice with Fentanyl and provide them with exposure to education about how to handle their particular pattern of use.

And included would be cut-the-crap treatment/education modalities. We don't treat all people with a given physical illness the same, let's stop treating everybody with problematic narcotic use the same.

[Tavarious Jackson]

36. I have to disagree

most DR's are not trying to push you to use pain meds. Not at all. Not where I am from