Did any one tell the Dotard that a significant part of the opioid problems

[malaise]

begin with prescriptions to ease pain after surgery. How the fuck do people just say no?

Damn he's a fucking idiot.

[Not Ruth]

1. I think that it is genetics combined with dumb doctors

Pain management should be a specialty, but any doc can prescribe pain meds. Makes no sense. We are all different and pain management for you is different than pain management for me. But to a doctor, we are the same.

[malaise]

3. True but telling young people to just say no is bullshit in this situation

I'm with you on the pain management problem but apparently the Con thinks this is about alcohol or ganja. He knows nothing about anything and believes he's an expert on all matters.

[KY_EnviroGuy]

11. Pain management is a specialty.

But pain management doctors can be very difficult to get in to see. IMO, there's far too few of those clinics.

For some friends I have that truly need regular pain meds to avoid living in misery every day, regular doctors are almost refusing to prescribe anything beyond extra-strength Tylenol with codeine (which most people hate), out of fear of getting in trouble with the authorities.

Much of the problem comes from a small percentage of doctors that are dishonest and greedy - many of which operate pill mills that don't do much beyond writing pain med scripts. Why it's so damn hard to put those guys and the pharmacies they work with out of business, I'll never understand.

[Glamrock]

17. This is why....

https://www.washingtonpost.com/graphics/2017/investigations/dea-drug-industry-congress/?utm_term=.d92601e3cf20

The pharmaceutical industry recruited people right out of the DEA that had knowledge of how the DEA worked. They then bought some congressmen and Senators who passed a bill written by one of these turncoats and Obama signed it into law. The law literally hamstrings the DEA's abilities to do anything about prescription drugs.

Ain't capitalism awesome! He with the most money wins!

[KY_EnviroGuy]

18. Another fine example of excess profits corrupting our government.

I'm astounded that they spent over $100 million to influence our lawmakers just for one bill. That process and outrageous sum should be illegal!

This was another surprise:
(snip)
Michael Botticelli, who led the White House Office of National Drug Control Policy at the time, said neither Justice nor the DEA objected to the bill, removing a major obstacle to the president’s approval. “We deferred to DEA, as is common practice,” he said.

The bill also was reviewed by the White House Office of Management and Budget. “Neither the DEA nor the Justice Department informed OMB about the policy change in the bill,” a former senior OMB official with knowledge of the issue said recently.

--------
Sounds like Obama's people are extremely embarrassed that this snuck by them. Hopefully, it can be repealed!

I don't find too much admirable about capitalism these days, see: https://www.theguardian.com/business/2017/oct/26/worlds-witnessing-a-new-gilded-age-as-billionaires-wealth-swells-to-6tn
(maybe someone can turn that into an OP)

[elias7]

22. Broad brushing highly intelligent and trained individuals is not helpful

First, pain management is a speciality. Second, docs do not see all patients as the same, and work very hard to address this complicated issue over many discussions and visits, often in light of extremely demanding and sometimes belligerent patients. Mostly, though, you see someone suffering and their non opiate options are not working. When someone comes to you, clearly in pain and at their wits end, it is very hard to say no, because, well, empathy. Rx use can be monitored through pharmacy screens across many states now to make sure you're not getting fleeced by a good actor. And you do get a good feel for patients over years of practice as you try to match up pain reported/experienced vs objective physical findings.

This is very complex and to pigeon hole doctors into an unthinking, uncaring or corrupted box is really failing to consider walking in my shoes for a day to see what I deal with in a busy ER.

[FakeNoose]

2. A related issue (but tricky to address)

...is the fact that Americans as a whole are the most over-prescribed nation in the world. Who writes prescriptions? Medical doctors (and dentists), who are overwhelmingly Republican.

So how will Trump or anyone in the GOP ever address this issue? Quick answer: they never will

I'm not saying that all medical professionals are over-prescribers. But the people who do contribute to the epidemic are licensed to practice medicine amd dentistry. The medical professionals of this country are not regulating themselves. Neither is anyone else, apparently.

Most of the opioid abusers of this country got started down that path by taking drugs prescribed by their doctors.

[malaise]

5. I am always shocked at the advertisements telling people to tell their doctor

that they want certain drugs. It says big pharma rules. And we know doctors (and not just in America) love their cruises funded by the drug companies.

[Not Ruth]

9. Did you know that opiates are racist?

They work differently with a percentage of the population. This percentage varies by race.

http://www.worstpills.org/public/page.cfm?op_id=414

Codeine is routinely converted to morphine in the body in order for it to be an effective painkiller. The metabolism of codeine to morphine takes place in the liver through the actions of an enzyme called CYP2D6. Most people have normal CYP2D6 activity and their response to codeine is as expected. However, a substantial minority of people— differing by national origin and race (see below)—have CYP2D6 activity that is higher or lower than normal, potentially resulting in excessive (higher activity) or inadequate (lower activity) response to codeine.

What genetic factors are at work?

The effect of genetics on the CYP2D6 enzyme has been extensively studied, and we now know that total CYP2D6 deficiency occurs in about 6 to 10 percent of Caucasians, 3 to 6 percent of Mexican Americans, 2 to 5 percent of African Americans and about 1 percent of Asians Americans.

People deficient in CYP2D6, called “poor metabolizers” (PMs), have inherited a nonfunctional gene from each parent, and have no CYP2D6 activity.

The next group is called “intermediate metabolizers” (IMs) and they have inherited one nonfunctional gene; they have some CYP2D6 activity, but it is lower than normal.

Most people have at least one functional gene, and they have normal CYP2D6 activity. They are called “extensive metabolizers” (EMs).

Finally, there are some people who have higher than normal CYP2D6 activity, and they are called ultrarapid metabolizers (UMs). As with poor metabolizers, the likelihood of being an ultrarapid metabolizer depends on one’s ethnic background. Ultrarapid metabolizers are found in about 1 percent of people from Finland and Denmark, about 4 percent in Caucasian North Americans, about 10 percent of people from Greece and Portugal, about 20 percent in Saudi Arabia and almost 30 percent of people from Ethiopia.

How do these genetic differences affect codeine?

People who do not have any CYP2D6 activity (PMs) are not able to convert codeine to morphine; thus, codeine is unlikely to be an effective painkiller for these people. So if you have taken codeine for pain and it didn’t help, you may be in the PM category.

Intermediate metabolizers (IMs) who have some CYP2D6 activity may have some analgesic response to codeine, but it would probably be inadequate in most cases.

People with normal amounts of CYP2D6 (EMs) will generally have a normal response to codeine. Keep in mind that there is a substantial placebo effect when drugs are taken for mild to moderate pain, so it would be difficult to assess one’s CYP2D6 status based only on their response to codeine.

The potentially most dangerous situation is when codeine is used in ultrarapid metabolizers (UMs). Since UMs have increased amounts of CYP2D6—sometimes markedly increased amounts—they produce greater amounts of morphine. So UMs can have severe reactions to codeine with excessive sedation, severe constipation, and other side effects of excessive morphine levels in the blood.

[mopinko]

10. they are starting to do genetic testing for this.

my daughter had it, as she has long term chronic pain issues that she has a very hard time w it. she has been tagged as a drug seeker, tho she has never abused prescriptions in any way.
when they tested her they found out, lo and behold, that opioids have little effect on her.

red heads tend to need higher meds, too.

[Scruffy1]

15. That is why I love DU.

Peple that post here give me information I didn't know. Thank you.

[KY_EnviroGuy]

19. Thanks for that info and the link!

Quite informative for me, as codeine never did a damn thing for pain, but just made me goofy-headed for a couple of days. Used to be common in prescription cough syrups, too.

[smirkymonkey]

31. Thank you! Very interesting information.

I always wondered why opiates didn't really do anything for my pain when I have had surgeries. Not only that, but I have developed an allergy to them and break out in hives all over my body and become violently ill (projectile vomiting). I suppose that's a good thing in that I have never been in danger of becoming addicted to them, but then I am worried about what I would do if I was ever in serious, chronic pain. What else could I take?

[elias7]

21. Doctors are most certainly not overwhelmingly Republican

If you do a little research, or look at this graphic.
?1424435860

[FakeNoose]

23. OK

So I guess the Democratic Party has a plan to address this issue?

What does it matter which party they belong to? They're over-prescribing and they've started an epidemic.

[EllieBC]

27. A friend of mine with a chronic pain condition said a very real and honest

discussion between patients and doctors needs to happen. She has ankylosing spondylitis. Basically her spine is fusing itself together. She's in a lot of pain much of the time. Her doctor was smart and so was she and they both understand that the goal isn't pain free but instead "functional". She said in her experience people want pain free no matter what. They won't accept just functional and often that's the best you can get without going to the heavy hitter medications.

[FakeNoose]

33. It sounds like a sensible solution

I'm sorry for your friend's problem, but it seems like she has reasonable expectations. Also it sounds like her doctor has been upfront and honest with her and is treating her fairly. I wish more doctors were able to have this kind of discussion with patients instead just writing the scripts that their patients ask for.

Doctors know that people shop around and go to the ones that write the scripts they want, from seeing some TV commercial. Doesn't that just make you cringe?

[EllieBC]

34. When I hear about people getting Percocet for wisdom teeth removal

I gasp and cringe at the same time. Know what helped me? Avoiding dry socket by following my dentist's instructions to the letter and Advil. And yes there was still some pain that was at times bad but I would have felt silly taking a narcotic painkiller for it.

My heart hurts for people with chronic illnesses or injuries who are constantly in pain. But I know from several people that things like physical therapy help too. Why just throw the pain pills at people first? They even do that here. I have herniated discs that occasionally act up and leave me nearly bed ridden. My doctor tried to give me hydromorphone. No thanks, I said. Can I have a referral to PT instead? She said the medical services plan only covers a handful of sessions. It's sad.

[Doreen]

4. I bet trumps idea of fighting the problem is putting

those who are addicted into prison and making them work to fight the addiction. I have a feeling the doctors and drug companies will not be questioned. Maybe I am wrong but it does sound like a trump way to handle it. You see, he needs to take more regulations off the drug companies so it is easier to hand opioids out like candy but blame the addicts.

[malaise]

6. He's an incompetent moron

Well said

[Glamrock]

16. I believe the correct term, malaise, is

"Fucking moron" - Rex Tillerson

[brewens]

7. I've had five knee surgeries, one was a total knee, and a hip replacement over the last

14 years. I've been on hydrocodone for all of those. I admit I love those things. The first thing I do is try and limit my use at night though. Partly because I really don't sleep so good on them. That leaves more for me to take during the days. I don't go over the max dose I'm supposed to have, but just that keeps me feeling pretty nice all day!

I'm glad they cut us off pretty quick now. It used to be routine that I would call and whine and get a refill. So I'd get another ten days worth or so anyway. Now in my area, they all have this med policy they make you sign. No refills, no way. They even warn you could be dismissed from the practice for drug seeking behavior.

Even on some of my longest stints on the stuff years ago, back when I knew where to get more illegally, I knew better and never did it. I know I was beginning to get addicted anyway. I felt like crap for a day or two after I ran out.

[Mariana]

28. I was on hyrocodone for about two years, pretty hefty dose.

I took them as prescribed. I loved not being in pain. I suppose they made me feel happy, but how much of that was just feeling the pain recede? Who knows. When my problem improved, we reduced the dose because I needed less. When my problem finally resolved, I stopped taking them. I felt like crap for a day or two when reducing the dose and when stopping, also. Fortunately, withdrawal from opioids is not dangerous, just miserable.

I think it's important to remember that the vast majority of people who take them never get addicted, just like most people who drink don't become alcoholics. Addicts certainly do cause a lot of grief, regardless of their drug of choice.

[KY_EnviroGuy]

8. tRump has no business even speaking on this subject.

This is why we have a Surgeon General and experts on addiction that he should defer to.

The man is so arrogant, elitist and narcissistic that he thinks he needs to appear an expert to his base on everything. I guess next, it will be the cure-all for cancer.

[Progressive dog]

12. This link is to an article from Scientific American

about data on opioid addiction in USA.
https://blogs.scientificamerican.com/mind-guest-blog/opioid-addiction-is-a-huge-problem-but-pain-prescriptions-are-not-the-cause/

[Stonepounder]

13. Seems to me that there is a fairly simple solution, as mentioned above.

1. Trust but verify doctors. I suspect that the vast majority of doctors do not over prescribe opiates or other pain killing drugs. Some patients need more, some have chronic pain and will need pain-killers until the day they die. Other patients go pill shopping. Trust the doctor to know the difference, but check his records.

2. Go after the pharmaceutical companies. When you see a company who is shipping 50,000 hydrocodone a month to a tiny pharmacy in the middle of nowhere, they have to know that something fishy is going on.

When I had open heart surgery I actually asked my doctor for a lower strength pain pill because I didn't need the heavy duty one I was taking. (I will admit that he told me that was the first time he had ever gotten a request like that!) The recuperation wasn't a whole lot of fun, but after the first month it wasn't particularly painful. Yeah, I needed the pills at night, but that was about it.

A few years later I broke my ankle. Sheared all 3 bones right straight across. Needed a pin, a plate, and a plaster cast. The pain was a whole lot worse than the heart surgery. The cast kept pressing on the incisions where they had to put in the pin and plate. My doctor was getting concerned about how many pills I was taking, but as soon as the cast came off I went off the pills.

Doctor's got to know his patients. I never would have made it through the surgery or the ankle with pain pills.

Now the Feds come in and audit how many opioid prescriptions a doctor has written and he/she can get in trouble if they write too many, regardless of whether it is warranted or not. Personally, I find I trust my doctor a lot more than I trust my Senators.

[Mariana]

29. You went of the pills when the cast came off.

Most people do stop taking them when they don't need them anymore.

[Motownman78]

14. The Pills are not what is killing everyone

It is the lack of access to pills and therefore people turn to heroin cut with fentynal that is killing everyone. Opioid deaths were not that high when doctors were handing them out like candy.

[elias7]

20. Makes you wonder if this an intentional genocide

Fentanyl and carfentanyl are what's killing heroin users. Rx opiates are abused by the overdose rates have not really changed. Why wouldn't dealers want to stop killing off customers? Why continue to cut product with such potent opiates?

BTW, I appreciate some of the posters here understanding the difficult role doctors are in. Damned if they do, damned if they don't, but readily accused of liking their free cruises and kickbacks, of being dumb, or some combination of stupidity and corruptness.

[Mariana]

30. They're also drinking along with pills to "stretch" them

or using other depressant drugs, because the painkillers are harder to get. Alcohol and painkillers make a very deadly combination. And of course there is the acetominophen in most pain pills, very toxic especially when mixed with alcohol. I think it's interesting that we're not being told how many of the opioid overdoses also involve alcohol. I bet it's a pretty high percentage. It would also be helpful if they wouldn't lump heroin/fentanyl overdoses with pain pill overdoses. Is that being done to inflate the numbers and make people afraid of legitimate pain medication?

[GoCubsGo]

24. He was probably told.

But, since there is nothing in between his ears to collect that information, it went in one ear and out the other. And, do doubt, he just doesn't give a shit about the facts.

[WhiskeyGrinder]

25. It's also tied in with our lack of paid sick/recovery time. People need to get back to work quickly,

so they rely on pills to keep working. You see it all the time in the trades, transportation, other work that's hard on your body. You take Thursday and Friday off to clean out some cartilage in your knee, get a big bottle of pills, go back to work on Monday, because if you don't work, you don't get paid.

[malaise]

26. Excellent point

Should be an OP

[elehhhhna]

32. It's much cheaper for your health insurance company of someone just hand you some pills

It's much cheaper for your health insurance company of someone just hand you some pills versus finding the source of the pain and actually treating it

[raven mad]

35. Had major surgery on my wrist last year.

"Take two aspirin and see how it goes".

Yeah, right.

I'm glad pot is legal here.