i am a 63 year old woman with rheumatoid arthritus and who has suffered from major depresson for most of my life. i take tramadol. it helps with the arthritus pain and i have found that it has completely eliminated the depression. i fear these new regs
38
For those who suffer, dealing with chronic pain is a life draining, full time job. I'm paralyzed after being hit by a car. My back is a train wreck after many fusions and surgeries. Being in a wheelchair is tough enough, however, I consider my biggest disability to be my chronic back pain. The pain runs my entire day and life. Modest daily use of pain meds dulls the pain and allows me to be somewhat active and productive. I'm dead in the water without them. The most recent restrictions that went into effect have been one more hassle to deal with in this entire disability mess. These latest proposals would be a nightmare. What's the point of snatching someone from the jaws of death with state of the art medical expertise and technology only to have them waste away from chronic pain or face overly restrictive barriers to relief?
44
Big Pharma lobby makes it impossible to get sensible federal drug legislation: no surprise.
Big Pharma sends drug sales reps to our doctors' offices, pays doctors for "research" and for lectures promoting drugs.
Big Pharma advertises directly to customer (TV, etc)--which is not allowed in other countries.
F.D.A. now decides (with its new head and his ties to Big Pharma) to let drug company market drug off label (for other than F.D.A. approved uses) as long as the pharmaceutical company tells the truth about the benefit. What a joke.
Meantime, other drugs, such as statins in particular, are jammed down our throats--in spite of the fact that 1/4 of user complain of muscle pain. 32 million Americans take statins.
Muscle pain (and it can be neuromuscular diseases too) from statins. How to treat pain? Well, a pain caused by a drug can be dealt with via another drug, of course. And of the pain killers, morphine may be the most controllable and benign.
Taking an opioid for pain from adverse effects of statin?
See http://statinvictims.weebly.com/
Big Pharma sends drug sales reps to our doctors' offices, pays doctors for "research" and for lectures promoting drugs.
Big Pharma advertises directly to customer (TV, etc)--which is not allowed in other countries.
F.D.A. now decides (with its new head and his ties to Big Pharma) to let drug company market drug off label (for other than F.D.A. approved uses) as long as the pharmaceutical company tells the truth about the benefit. What a joke.
Meantime, other drugs, such as statins in particular, are jammed down our throats--in spite of the fact that 1/4 of user complain of muscle pain. 32 million Americans take statins.
Muscle pain (and it can be neuromuscular diseases too) from statins. How to treat pain? Well, a pain caused by a drug can be dealt with via another drug, of course. And of the pain killers, morphine may be the most controllable and benign.
Taking an opioid for pain from adverse effects of statin?
See http://statinvictims.weebly.com/
6
I recently had extensive knee surgery. From the beginning, I used NSAIDs in addition to prescribed opiods. The NSAIDs alone were not enough and without opiatess I would have been in agony. As my pain decreased, I decreased my use of opiates. I believe this is how most patients behave. Recovering from surgery in a country where sick time and in home care is limited is very difficult; adding more doctor's visits and additional trips to the pharmacy is prohibitive for the average working American.
This article states that restrictive measures have resulted in a decrease of the prescription of opiods in MA, but have they resulted in a decrease of opiod deaths in MA? Combining deaths from legitimately prescribed drugs with those caused by illegal street drugs (heroin or illegally obtained opiods) is deceptive and irresponsible. It's akin to combining accidental deaths with mass shootings when advocating for greater OSHA oversight.
Uncontrolled pain can make one desperate and patients may be forced to pursue solutions such as nostrums, untested remedies, and perhaps illegally obtained drugs - all of which will be outside of their physicians' supervision.
Severe pain is traumatic, and depriving people who have had surgical procedures, injuries, etc., of a way to deal with pain is torture. We need effective ways to address addiction and its causes, not needless harm inflicted on people suffering from real pain.
This article states that restrictive measures have resulted in a decrease of the prescription of opiods in MA, but have they resulted in a decrease of opiod deaths in MA? Combining deaths from legitimately prescribed drugs with those caused by illegal street drugs (heroin or illegally obtained opiods) is deceptive and irresponsible. It's akin to combining accidental deaths with mass shootings when advocating for greater OSHA oversight.
Uncontrolled pain can make one desperate and patients may be forced to pursue solutions such as nostrums, untested remedies, and perhaps illegally obtained drugs - all of which will be outside of their physicians' supervision.
Severe pain is traumatic, and depriving people who have had surgical procedures, injuries, etc., of a way to deal with pain is torture. We need effective ways to address addiction and its causes, not needless harm inflicted on people suffering from real pain.
29
It is a important public health issue and I hope states go about new rules with good input. As a provider in a level one Burn center , we have to make careful choices prescribing what others might consider high doses of narcotics, while we carefully monitor the patients and their condition. I am concerned about the regulatory impact on patient care when indiscriminate laws are generally applied.
24
In 2000 I was involved in a road accident, my acetabulum (right hip) was shattered, and the cartilage in the joint was destroyed so that I needed a hip replacement in addition to the repair of the pelvic girdle. The post-operative pain was extraordinary and I needed large doses of hydrocodone (vicodin) for over 4 months. My surgeon was located 130 miles from my home and under current rules in Illinois would not have been able to fax prescriptions for opioids to my local pharmacy. And so, if the 7 day rule had been in place he would have had to mail a prescription every 7 days for over 16 weeks! Real pain happens to real people and the medical community and the government should be able to devise a strategy that addresses addiction problems without punishing these people.
36
In my experience treating over 7000 alcoholics and addicts, it is drug abuse that leads to addiction. No one who uses opiate painkillers AS PRESCRIBED become addicted to them. Some may become physically habituated to certain drugs, but that is not addiction, which ALWAYS includes misuse and/or abuse of a drug. This is easily handled by tapering dosage before discontinuing a medication. Misuse and abuse lead to addiction. Some physicians facilitate this by overprescribing painkillers or "selling prescriptions", but in general those who have real pain use their medication as intended. Limiting all prescriptions to one week is very impractical for patients who suffer chronic pain and are on long term pain therapy. Those who want only a few pills on hand for emergencies can get them regardless of the size of the prescription by asking their pharmacist to give them only part of the prescription. The real problem is addressing the social and psychological issues that lead to misuse of drugs and providing sufficient and competent care for those who are addicted.
30
In its zeal to reduce the abuse of opioid painkillers, government is making it more difficult, if not impossible, for responsible people like me with severe, chronic pain to get relief from these pain killers. I evermore frequently consider suicide when the painkillers are not prescribed. It's another case of Big Daddy throwing out the baby with the bath.
37
I suffer from a brachial plexopathy. As a fireman, my company was called out to a boat fire. During the the course of fighting that fire, I suffered a traction injury to my brachial plexus. Every procedure the doctors have used to treat my injury, from nerve blocks to epidurals, spinal stimulators and something called P-STIM. Nothing worked to relieve my pain. The only thing that that has helped me at all is oral morphine. I know how dangerous this substance is and I know that I have a physical dependence to this drug. To avoid taking more and more of this medicine I need to wean myself off these drugs over the course of a month, then spend the next month with no pain management whatsoever. These are the worst months of my life, not only does the pain return, my sleep is affected by even more than usual. With my medicine, it takes me 12-14 hours to get 6-8 hours of sleep, waking up a half a dozen or more times throughout the night. Without, my sleep deteriorates and it takes me close to 20 hours of trying to get enough sleep just to function through the day. Basically, I take a series of naps throughout the day until I become so exhausted that I begin to hallucinate. Depression is another symptom of my condition and if not for my psychiatrist and my pain doctor I would not be able to survive the agony I endure. I feel for the victims of addiction and mourn their passing, but I'm terrified that the lawmakers will neglect those of us for whom these drugs are truly lifesaving.
41
Having had 5 major spine surgeries during the past 11 years, at age 63 now, and about to undergo my 6th, I have been taking pain medication after each surgery and as needed sporadically in between surgeries. Suffering from a few diseases of the spine, inherited from my father, is the hand I was dealt. I do my best to stay very thin, to exercise, to do my physical therapy, and to refrain from lifting heavy items and doing anything that might hurt my back. If I was going to become addicted to painkillers, surely I would be by now. I believe people are addictive types or not....and if you truly need painkillers for serious pain, you will not become abusive of pain medication. To deny a person such as myself, with a serious, painful spine condition pain medication when I need it because some abuse such medication seems unfair. I believe it should be on a case by case basis...not just cancer cases but those with debilitating and degenerative diseases as well. There are no hard and fast rules and it is not cut and dry. Only a patient's doctor or surgeon can truly judge their patient's need for pain medication. Following an 8 or 9 hour spinal fusion surgery, if you tell me I am only allowed 7 days worth of pain pills, what is next? Am I supposed to bite down hard on something and/or drink whiskey to dull the pain?
48
No one wants to keep you from your needed medicine. But, there's no way that we can continue to allow the rampant misuse and abuse of painkillers. It's killing us...and our children and the world for that matter.
4
These comments are from patients are compelling. I hope the NYT and lawmakers notice. However my hunch is that people who suffer or have suffered excruciating pain, or those who have witnessed loved ones who have suffered excruciating pain, need to speak up. Don't let the responsible be punished because of the problems of the abusers.
49
These rules paint in such broad strokes that those with legitimate need who use opioid analgesic medications appropriately are lumped with the addicts and drug-seekers.
One of my patients, who has agreed to let me share his story, suffered severe burns to over 80% of his body surface area and sustained traumatic amputation of all 4 limbs decades ago. He went on to independently maneuver a wheelchair, drive a vehicle, raise a family, and do handy man tasks around the house like putting down new tile in the kitchen. He says, and I agree, that he would not have been able to accomplish all this without fairly high doses of pain medications which make his severe nerve pain tolerable. He also uses non-opioid medications but they are not sufficient.
With the way things are going I will no longer be able to prescribe his pain medications despite the fact that I closely monitor him and his urine drug content to ensure compliance. He will be at the mercy of the system administrators. May God help him the rest of us should we ever find ourselves in anything even approaching his unfortunate position.
One of my patients, who has agreed to let me share his story, suffered severe burns to over 80% of his body surface area and sustained traumatic amputation of all 4 limbs decades ago. He went on to independently maneuver a wheelchair, drive a vehicle, raise a family, and do handy man tasks around the house like putting down new tile in the kitchen. He says, and I agree, that he would not have been able to accomplish all this without fairly high doses of pain medications which make his severe nerve pain tolerable. He also uses non-opioid medications but they are not sufficient.
With the way things are going I will no longer be able to prescribe his pain medications despite the fact that I closely monitor him and his urine drug content to ensure compliance. He will be at the mercy of the system administrators. May God help him the rest of us should we ever find ourselves in anything even approaching his unfortunate position.
54
Thank you for addressing patient needs. Now, how about you identify known misuses and post a solution here. Becuase, frankly, your post is meaningless. We all know that there are real patients...real needs...and certainly you should, if you're a real doctor, be able to treat your patients as you see fit.
As a real doctor, and insider, you undoubtedly have had conversations with your colleagues about painkiller misuse. Why don't you tell us about that?
No one wants to keep medication away from those who really need it.
As a real doctor, and insider, you undoubtedly have had conversations with your colleagues about painkiller misuse. Why don't you tell us about that?
No one wants to keep medication away from those who really need it.
6
Narcotic painkiller overdose deaths dropped sharply in CO after marijuana was legalized...
12
These laws virtually guarantee heroin use will increase.
20
For the greater good, all clinicians and patients
need to truly evaluate the benefits and risks of
opioid therapy in chronic non-cancer pain.
As been the practice the last 15-20 years, most PCP's
have tried to "Do No Harm" in helping those with pain
however, not everyone responds to opioids in kind.
Each opioid has a different molecular structure, so what is
effective for one, isn't necessarily effective for another.
We each have different genetic expression and biology.
Side effects (constipation) need to be considered.
State Registries do help substantially as the article indicates
for the "shoppers".
That said,opioids could be beneficial in relieving acute and
chronic pain, however, attention and evaluation of a patient's
suitability for opioid treatment needs to be patient and dose
specific.
There are many alternative therapies for the management of
pain that should be explored before opioids are considered.
Relief, doesn't have to come only in pill form.
need to truly evaluate the benefits and risks of
opioid therapy in chronic non-cancer pain.
As been the practice the last 15-20 years, most PCP's
have tried to "Do No Harm" in helping those with pain
however, not everyone responds to opioids in kind.
Each opioid has a different molecular structure, so what is
effective for one, isn't necessarily effective for another.
We each have different genetic expression and biology.
Side effects (constipation) need to be considered.
State Registries do help substantially as the article indicates
for the "shoppers".
That said,opioids could be beneficial in relieving acute and
chronic pain, however, attention and evaluation of a patient's
suitability for opioid treatment needs to be patient and dose
specific.
There are many alternative therapies for the management of
pain that should be explored before opioids are considered.
Relief, doesn't have to come only in pill form.
1
Having recently suffered a five-year syndrome involving nerves and special connective tissue, that traveled from my face to my feet, then an arm and then hip, I can tell you that taking NSAIDS has its limits. And pain is not a straight arrow that can be treated with just any medicine. Aspirin is an NSAID but it is the least caustic on the stomach as compared to the heavier duty NSAIDs. Eventually, a patient will need to take a substitute for the pain, in my case codeine and then at times for very severe pain, oxycotin.
Now doctors and hospitals have become hostile and like suspicious police about prescribing pain medication, not the NSAIDs which can kill too, that they send pharmacuetical interns into my waiting room prior to seeing my doctor. There I read them the riot act on medical privacy. I would like to TRUMP the guy out of the hospital but that would not be wise. My present primary care physician has been scared into prescribing the opoids for me because of the Yellow Journalism about opiod abuse in the US. I don't believe it.
Constant pain leads to depression; I need the relief from the overall pain.
What might be beneficial for me is the meldonium the drug mentioned in an NYTIMES article which the FDA prohibits but circulates blood.
As the woman in the Times article "When Gene Tests for Breast Cancer Reveal Grim Data but No Guidance" who is confronted with divergent medical diagnoses and treatments, we all must be our own medical engineer.
Now doctors and hospitals have become hostile and like suspicious police about prescribing pain medication, not the NSAIDs which can kill too, that they send pharmacuetical interns into my waiting room prior to seeing my doctor. There I read them the riot act on medical privacy. I would like to TRUMP the guy out of the hospital but that would not be wise. My present primary care physician has been scared into prescribing the opoids for me because of the Yellow Journalism about opiod abuse in the US. I don't believe it.
Constant pain leads to depression; I need the relief from the overall pain.
What might be beneficial for me is the meldonium the drug mentioned in an NYTIMES article which the FDA prohibits but circulates blood.
As the woman in the Times article "When Gene Tests for Breast Cancer Reveal Grim Data but No Guidance" who is confronted with divergent medical diagnoses and treatments, we all must be our own medical engineer.
7
"...doctors are restricted from prescribing more than 30 days’ worth of the drugs over a two-month period."
OK, so what happens when you have a 60 day pain every two months -- or to be more exact, a 62-day pain...ah, heck, let's just be sensible about this.
What happens when you have everyday pain because you suffer from a chronic condition that is well-known to have pain as one of its symptoms?
After the 30-day supply runs out and you have at least a month to wait for a refill...are you supposed to rob pharmacies? Burglarize the houses of legislators, away voting to meddle in your medical care with no expertise to do so, hoping they have a stash in the medicine cabinet? Hit the local crack house, hoping someone will clue you in to where to find some H?
Seriously?
I halfway am, but it's obvious some people are clueless about suffering. Or just oblivious. It's like some weird Milford experiment, where lawmakers get to actually start hurting people, just to see how much they enjoy doing it.
What's worse is this is driven by the sham compassion of the war on drugs. Might be fewer people dying if government policy didn't create the incentives that keep an uncontrolled flow of drugs flowing, while politicians morally posture. Once they are no longer hooked on locking people up and pretending they control all human behavior, they may find that there are ways to keep people from dying...but cracking down on the sick isn't that.
OK, so what happens when you have a 60 day pain every two months -- or to be more exact, a 62-day pain...ah, heck, let's just be sensible about this.
What happens when you have everyday pain because you suffer from a chronic condition that is well-known to have pain as one of its symptoms?
After the 30-day supply runs out and you have at least a month to wait for a refill...are you supposed to rob pharmacies? Burglarize the houses of legislators, away voting to meddle in your medical care with no expertise to do so, hoping they have a stash in the medicine cabinet? Hit the local crack house, hoping someone will clue you in to where to find some H?
Seriously?
I halfway am, but it's obvious some people are clueless about suffering. Or just oblivious. It's like some weird Milford experiment, where lawmakers get to actually start hurting people, just to see how much they enjoy doing it.
What's worse is this is driven by the sham compassion of the war on drugs. Might be fewer people dying if government policy didn't create the incentives that keep an uncontrolled flow of drugs flowing, while politicians morally posture. Once they are no longer hooked on locking people up and pretending they control all human behavior, they may find that there are ways to keep people from dying...but cracking down on the sick isn't that.
27
The death toll was 40,000 in 2015
All this increasing 'regulation' ('Parole' would be a better term. With conditions growing more onerous by the day.) will guarantee one thing: A higher and higher death rate for those with the misfortune to be in severe chronic pain (Typically resulting from the kind of injuries that often made their treating physicians wonder if they'd WALK again), due to everything from infections related to stress-diminished immune function (Something EVERY responsible doctor in pain management has seen) to perhaps cancer and auto-immune conditions (See above) to almost CERTAINLY suicide. As well as overdoses for those who, in desperation, resort to that one 'pain medication' that no one prescribes but is widely available on the street - heroin. Doctors will be increasingly frightened to death of prescribing anything in the way of opioids beyond a short term. With good reason.
Well, I hope these politicians and elected prosecutors (Typically politicians themselves) who serve as their - er, 'hench-people'? - are proud of themselves. Just how they can look in a mirror is beyond me.
Well, I hope these politicians and elected prosecutors (Typically politicians themselves) who serve as their - er, 'hench-people'? - are proud of themselves. Just how they can look in a mirror is beyond me.
12
How absurd. As our population continues to age our great leaders decide to restrict pain relief? Can't catch the "bad guys" se let's go after the "good guys". Brilliant. Just brilliant.
27
Follow the $$$. Big PhRMA wasn't making anything off generic painkillers, hence this new "crisis".
Many doctors are falling for it too, most probably because they're afraid they'll lose their license.
Women get treated differently when in pain as well . I was told when I had a a couple few really bad back injuries that my spine was fine. I could tell the injury was recent from the MRIs but the "experts" couldn't. They just prescribed physical therapy. I asked for bit of relief with a steroid injection in one part of my back and was mocked out of the office for my troubles.
My excellent neurologist is getting ready to retire and I'm scared to death of what/who will take his place, if they can even find someone.
At least he listens, so few do anymore which I always thought was the basis of of good medicine.
A few years ago the gov was telling doctor tell weren't treating people's pain sufficiently and now this reversal. Anything to harm people I say
Anyway, now the FDA has this manufactured opiod "crisis and yet they are going to allow unlabeled GMOs into our food supply? Anybody really think the FDA is interested in protecting us from ourselves?
Oh and PhRMA has acted swiftly to patent a time-released opiod for people ho just have to have it. But the tweakers know all they have to do is crush it and snort it and get the same effect.
This is all about money, big government and an extension on the WAR on Drugs
Many doctors are falling for it too, most probably because they're afraid they'll lose their license.
Women get treated differently when in pain as well . I was told when I had a a couple few really bad back injuries that my spine was fine. I could tell the injury was recent from the MRIs but the "experts" couldn't. They just prescribed physical therapy. I asked for bit of relief with a steroid injection in one part of my back and was mocked out of the office for my troubles.
My excellent neurologist is getting ready to retire and I'm scared to death of what/who will take his place, if they can even find someone.
At least he listens, so few do anymore which I always thought was the basis of of good medicine.
A few years ago the gov was telling doctor tell weren't treating people's pain sufficiently and now this reversal. Anything to harm people I say
Anyway, now the FDA has this manufactured opiod "crisis and yet they are going to allow unlabeled GMOs into our food supply? Anybody really think the FDA is interested in protecting us from ourselves?
Oh and PhRMA has acted swiftly to patent a time-released opiod for people ho just have to have it. But the tweakers know all they have to do is crush it and snort it and get the same effect.
This is all about money, big government and an extension on the WAR on Drugs
9
This is a really stupid idea. Some people rely on hydrocodone for chronic pain Limiting the amount prescribed is foolish.
22
Most doctors try to help pain patients either chronic or acute ( short lasting) with the most cost effective methods available which based on their best medical judgement often is to prescribe opiates (in various forms. Opiates are even a normal human brain chemical.
The DEA (which is a federal police force operating in many cases using intimidating and/or extortionate laws-Google the phrase "21 CFR Section 842" and you will find that the Gestapo-like DEA and its USA deputized police "Task Forces" which number in the thousands nationally can bring US Government civil charges of $25,000.00 per medical prescription written for a patient for a single medical prescription that the DEA (a federal police force, again) and the law enforcement division of the US Gov Department of "In-Justice" as Sydney Powell refers to this Department of the US Judicial system in her superbly documented book, "Licensed to Lie" ...Subtitled "Corruption in the US Justice Department". Most doctors (I have been licensed 40+ years...unfortunately for pain patients...am afraid to prescribe any sort of pain relieving medications (of which opiods have been the mainstay of treatment of due to the civil lawsuits or criminal lawsuits that generate billions to pay police salaries from "Asset Confiscation" from private citizens by the US Gov.. Check the link :
http://www.aapsonline.org/index.php/site/article/actions_against_pain_ma... or read "The Criminalization of Medicine" by Ron Libby.
The DEA (which is a federal police force operating in many cases using intimidating and/or extortionate laws-Google the phrase "21 CFR Section 842" and you will find that the Gestapo-like DEA and its USA deputized police "Task Forces" which number in the thousands nationally can bring US Government civil charges of $25,000.00 per medical prescription written for a patient for a single medical prescription that the DEA (a federal police force, again) and the law enforcement division of the US Gov Department of "In-Justice" as Sydney Powell refers to this Department of the US Judicial system in her superbly documented book, "Licensed to Lie" ...Subtitled "Corruption in the US Justice Department". Most doctors (I have been licensed 40+ years...unfortunately for pain patients...am afraid to prescribe any sort of pain relieving medications (of which opiods have been the mainstay of treatment of due to the civil lawsuits or criminal lawsuits that generate billions to pay police salaries from "Asset Confiscation" from private citizens by the US Gov.. Check the link :
http://www.aapsonline.org/index.php/site/article/actions_against_pain_ma... or read "The Criminalization of Medicine" by Ron Libby.
14
I live in Cincinnati. Ten minutes on I-71 S puts me in Covington, Kentucky--the pill and heroin addiction hotspot of the nation from what I hear.
So let's say I am in horrible pain from an operation or injury or just what ever.
Instead of a responsible system where doctors are free to prescribe what is medically appropriate and trust me to be an adult and not suck the pills down to the point of addiction, we are now honestly proposing letting a middle man come in and further decide what's best for me?
When I can drive down the highway for a few minutes and buy real actual heroin? (You can too, in every city in America)
What is the wisdom of this action? Making it even harder for those in pain to get medication because people can't handle their medication?
So let's say I am in horrible pain from an operation or injury or just what ever.
Instead of a responsible system where doctors are free to prescribe what is medically appropriate and trust me to be an adult and not suck the pills down to the point of addiction, we are now honestly proposing letting a middle man come in and further decide what's best for me?
When I can drive down the highway for a few minutes and buy real actual heroin? (You can too, in every city in America)
What is the wisdom of this action? Making it even harder for those in pain to get medication because people can't handle their medication?
16
Look, this issue is not going to be fixed by legislation that restricts what a doctor can prescribe. What they need to do is recognize that opioids are not the only pain killers available. Legalize Cannabis, let people medicate themselves and let the doctors prescribe.
The stupids at the DEA tried to pull back prescription opioid use, and what happened? Heroin use spiraled up. It's cheaper, uncontrolled and available.
The stupids at the DEA tried to pull back prescription opioid use, and what happened? Heroin use spiraled up. It's cheaper, uncontrolled and available.
12
Again, the effect is to punish us all for the abuses of a few, as they have done with the pseudoephedrine restrictions.
16
Pain sufferers, place your blaim where is belongs - on drug marketers.
-Drug marketers spent a decade telling doctors and dentists that new opioid were perfectly safe to give to teens and healthy adults, with no addiction possibility. This prescribing produced an explosion of new addicts.
-Now we face the inevitable regulatory backlash, and you are the ones to suffer.
But remember, this opioid regulation is an effect, not a cause. If you want to prevent this from happening in the future, regulate drug company marketing.
-Drug marketers spent a decade telling doctors and dentists that new opioid were perfectly safe to give to teens and healthy adults, with no addiction possibility. This prescribing produced an explosion of new addicts.
-Now we face the inevitable regulatory backlash, and you are the ones to suffer.
But remember, this opioid regulation is an effect, not a cause. If you want to prevent this from happening in the future, regulate drug company marketing.
How does regulating drug company marketing resolve my chronic pain? The government needs to understand that making pain control more difficult is not an acceptable solution.
15
"The use of opioids began to skyrocket in the 1990s in the face of claims by pharmaceutical companies and medical experts that opioids could be used to treat conditions like back pain and arthritis without fear of addicting patients."
This single sentence concisely sums up the biggest cause of the current situation. I attended medical school during this time and I was taught to be aggressive with pain treatment to minimize the risk of the patient developing chronic pain. I was taught that addiction risk was minimal. It took me about ten years of practice to come to the conclusion this was entirely wrong. For the past decade I have been much more judicious in prescribing narcotics. However, I'm in the minority in my professional opinion among my peers.
This single sentence concisely sums up the biggest cause of the current situation. I attended medical school during this time and I was taught to be aggressive with pain treatment to minimize the risk of the patient developing chronic pain. I was taught that addiction risk was minimal. It took me about ten years of practice to come to the conclusion this was entirely wrong. For the past decade I have been much more judicious in prescribing narcotics. However, I'm in the minority in my professional opinion among my peers.
4
I am a Veteran with a service connected injury and I was prescribed Vicodin for pain resulting from my broken back in 1967 and two subsequent back surgeries. I have used them for over 10 years and now I am required to have a doctor visit and my blood checked every 90 days at the VA to insure that I am taking not selling these pills. I certainly wish that I could be Opioid free but the VA has offered no alternative except "just say no" to these pain killers that I rely on to ease the constant pain. Even though I live in a state that allows use of marijuana for medicinal purposes and studies have shown that MMJ works to relieve pain, the VA will not prescribe its use because it is still considered a narcotic. As a result, at 70 years of age I am being seen by the same government I served and was injured in so doing, as a risk of selling my drugs for profit. There truly is a crisis in over prescribing but the new laws do nothing to help me decrease my dependence on a drug that has taken its toll on my other bodily functions. Nothing would make me happier than to be offered a less addictive alternative to Vicodin to help me get on with my life.
If I use MMJ I then run the risk of losing my VA benefits that I rely on. Time to rethink the policy and drug scheduling of MMJ and to help all of us who the MD's initially hooked on Opioids. Now the already overburdened VA health system must use precious time and resources to insure that I continue to be hooked.
If I use MMJ I then run the risk of losing my VA benefits that I rely on. Time to rethink the policy and drug scheduling of MMJ and to help all of us who the MD's initially hooked on Opioids. Now the already overburdened VA health system must use precious time and resources to insure that I continue to be hooked.
7
Physicians did not "hook" you on Opioids. You needed them as the only medication that adequately relieved your pain. If you needed blood pressure or heart medication, would you say you were "hooked" on them. No, you have a medical condition for which that is the only adequate treatment. Unless you actually overuse and abuse them beyond what your pain requires for relief.
21
Making laws or having insurance company policies that restrict these drugs won't work. It will just send people in pain and people who want to get high to the street, and make these drugs more expensive on the street. When they become more expensive than heroin, people will use heroin on their dealer's advice.
We need to focus on treatment of addiction, especially drug treatment, which has been shown to save lives.
We need to focus on treatment of addiction, especially drug treatment, which has been shown to save lives.
13
Although I do not suffer from severe chronic pain myself, I have several friends who do. They use their pain meds responsibly and put off using them even when they are in pain. They are having an increasingly difficult time getting even a minimum of what they need. Meanwhile many of them could easily get their hands on opioid meds illegally but will not do so. They simply suffer. Some doctors and pharmacies are going beyond what the new laws require, presumably out of fear of liability.
There have to be better approaches to monitoring people that do not penalize everyone to the point of causing so much unnecessary suffering. This is not a one-size fits-all problem.
There have to be better approaches to monitoring people that do not penalize everyone to the point of causing so much unnecessary suffering. This is not a one-size fits-all problem.
21
After medical and dental procedures, I was always prescribed pain killers. I rarely needed them but was afraid not to get them and then find myself in pain after the nearby pharmacy had closed for the night. I also would have preferred some sort of low cost option of just a pill or two. Unfortunately that was never an option.
4
I am recovering from total knee replacement and nerve damage in my neck caused by pain. The only help was from opiod drugs. I tske them only as needed. The reported legislation puts everyone in the same category. As another writer stated, we should be offering regular help and programs for those addicted, not punishing those with post op or chronic pain.
24
My wife has been on a low dose of pain killers for years because of a head injury. She never asks for an increase in dosage and takes her medication as prescribed. I don't know if she is addicted. But I do know she is dependent. Without it her life would be miserable. Her doctor that has been helping her since her injury has dropped her. Not because he doesn't want to see her anymore but because of pressure from his partners. They don't want the attention it might bring. So now we are going to have to find someone else to treat her pain and of course we will look like pill seekers.
I'm sorry for all you people that have addiction problems, but my concern is for my wife and her quality of life and you have affected that with your problem. This reminds me of all the other stuff that the majority of society has to deal with because of a minority that has some problem they can't control. Sorry about your problem.
I'm sorry for all you people that have addiction problems, but my concern is for my wife and her quality of life and you have affected that with your problem. This reminds me of all the other stuff that the majority of society has to deal with because of a minority that has some problem they can't control. Sorry about your problem.
53
Your only alternative is a pain management clinic. They are trained to reject the seekers and provide discipline with surprise urine tests and pill counts.
DEA does inspect their records and as long as they are keeping control of flow of drugs they seem to be alright. I have a standing appointment every two months to get new prescriptions and never know if I am going to be tested.
No Poppy seeds a week before an appointment. They test as Morphine in your urine.
DEA does inspect their records and as long as they are keeping control of flow of drugs they seem to be alright. I have a standing appointment every two months to get new prescriptions and never know if I am going to be tested.
No Poppy seeds a week before an appointment. They test as Morphine in your urine.
1
Way too much use of healthcare in this country.How about some incentives to live healthier lifestyles and not need to visit doctors.Instead,we get Obamacare,which just incentivizes more use of healthcare.Exactly what we didn't need.
So we have primary care clinics which are so limited in their capabilities--hamstrung by bureaucratic meddling such as this--as to be almost useless to patients, and yet the cost of mandatory premiums keeps spirslling upward. It seems to me that the intensely regulated for profit health care modelis a moral and economic failure.
11
I think there should be a total review into all types of pain relief whether western medicines, Chinese or other eastern alternative treatments as acupuncture, herbal , meditation or whatever.
Modern drugs are known killers even those properly tested and prescribed. They all have side effects.
I was prescribed Tramadol, an opioid, but I did not know this until the effect of the drug had me breathless and dizzy plus spaced out.I stopped it immediately and went back to the traditional Naprosyn that works well. However, I now take Curcumin a derivative of Tumeric and that also works well for my sharp elbow pain.It is a herbal.
Herbals are now taking more space on the shelves of the pharmacies. Not all of them work but then none of them kill either.Homeopathics have found a place on my shelf as has Chinese gout herbals. Gout is one of the worst pains imaginable so if I can treat that with herbals with no side effects then that is what I am going to do and also carry on with acupuncture.
STAN CHUN
Wellington
New Zealand
12 March, 2016.
Modern drugs are known killers even those properly tested and prescribed. They all have side effects.
I was prescribed Tramadol, an opioid, but I did not know this until the effect of the drug had me breathless and dizzy plus spaced out.I stopped it immediately and went back to the traditional Naprosyn that works well. However, I now take Curcumin a derivative of Tumeric and that also works well for my sharp elbow pain.It is a herbal.
Herbals are now taking more space on the shelves of the pharmacies. Not all of them work but then none of them kill either.Homeopathics have found a place on my shelf as has Chinese gout herbals. Gout is one of the worst pains imaginable so if I can treat that with herbals with no side effects then that is what I am going to do and also carry on with acupuncture.
STAN CHUN
Wellington
New Zealand
12 March, 2016.
3
Good job on this article. Doctors have never had robust professional repertoires with opiates, and they still don't. The great help that opiates can be for chronic pain is being overwhelmed by excessive prescribing and associated mortality.
1
For Mr. Shumlin, Democrat: What does "big pharma" have to do with anything in this article?
Again we see the bean counters, most of whom could not even get through pre-med to be admitted to get into medical school, setting regulations for doctors who are using their best judgment and knowledge to help patients in pain...and that is a difficult problem for doctors, with some being attacked by the government if they are judged to be "overprescribing." This is not to excuse the behavior of a very few physicians who abuse this prescribing, but to defend doctors against yet another Mickey Mouse regulation which will, as the weight of so many other regulations, drive the best and brightest from providing medical care.
Again we see the bean counters, most of whom could not even get through pre-med to be admitted to get into medical school, setting regulations for doctors who are using their best judgment and knowledge to help patients in pain...and that is a difficult problem for doctors, with some being attacked by the government if they are judged to be "overprescribing." This is not to excuse the behavior of a very few physicians who abuse this prescribing, but to defend doctors against yet another Mickey Mouse regulation which will, as the weight of so many other regulations, drive the best and brightest from providing medical care.
27
Friends in law enforcement all tell me the same thing: Government actions to limit the availability of opioids is the primary reason for the explosion of heroin use. Heroin is now cheaper on the streets than opioids, so that's where addicts go. And now, in a move that will do nothing to stop heroin abuse or, for that matter, opioid abuse, governments will simply make pain management that much more difficult for persons who genuinely need it.
I am not suggesting that we should throw opioids around so addictive persons will not use heroin. But the real problem is not easy availability of opioids, it is the totally ineffective and ultimately injurious "war on drugs" which keeps attention focused on trying to stop the flow of banned drugs--a futile exercise--instead of dealing with addiction and its causes and cures.
Forcing a post-op patient--or others who really need serious pain relief--to schlep to the pharmacy every three or seven days is a terrible, and utterly stupid, response to the abuse of opioids.
I am not suggesting that we should throw opioids around so addictive persons will not use heroin. But the real problem is not easy availability of opioids, it is the totally ineffective and ultimately injurious "war on drugs" which keeps attention focused on trying to stop the flow of banned drugs--a futile exercise--instead of dealing with addiction and its causes and cures.
Forcing a post-op patient--or others who really need serious pain relief--to schlep to the pharmacy every three or seven days is a terrible, and utterly stupid, response to the abuse of opioids.
41
I direct a brain research laboratory. We discovered recently that differences in patient's brains predict their ability to stay sober off drugs. Aside from our research, there is a lot of other work showing that differences in genetics, personality, family history, and many other factors can be used to predict a pattern of drug use, abuse and addiction. Not everyone is likely to become an addict. But, none of this is used to determine who should or should not be prescribed potentially addictive drugs. It leaves many people in pain who could have some relief, and others become addicts when they should have been using other options for pain control.
13
Why is it that we do not consider making help available for addicts? I wonder how it would affect the abuse of drugs and alcohol in this country if there were free, 24-hour clinics where anyone could go for help. Where does the addict turn when they have reached their bottom? There are 12 step programs and prayer-- woefully inadequate where medical intervention and intensive counseling is necessary. It's shocking to me that our answer, as a society, to addiction is to make the drug harder to get. As if that's going to help anyone.
2
Why is it that we don't consider making help available for addicts? I wonder how it would affect the abuse of drugs and alcohol in this country if there were free, 24-hour clinics where anyone could go for help. Where does the addict turn when they have reached their bottom? There are 12-step programs and prayer -- woefully inadequate where medical intervention and intensive counseling is necessary. It's shocking to me that our answer to addiction, as a society, is to make the drug harder to get. As if that's going to help anyone.
25
I hope every one of these medically uneducated persons who is defining how much pain meds a doctor can give a patient will soon have a heart or kidney transplant or hip or knee replacement or preferably a chronic pain condition like severe rheumatoid arthritis. And, I hope their respective surgeons give them a 7 day supply of very low dose pain meds so they get first hand experience dealing with their ignorant dictates. These people threaten our doctors who fear losing the license to practice, they threaten patients with chronic pain and treat them the same as addicts. How stupid can you get? Everyone is painted with the same broad brush dictate sans any consideration for pain. I'd say that is typical stupidity on the part of our government. But, the fact that the medical industry -- doctors, clinics, hospitals, etc -- is allowing this to happen is the most egregious behavior of all. This dictate solves nothing. It does not even define much less face the real issues involved with pain management.
61
Here, here!!! As a long time sufferer of severe osteoarthritis it is only through use of pain meds I can have even a semblance of a life. I would give those drugs up in a second if I didn't need them every day to function.
17
I agree! Recovering from knee replacement surgery and neck pain brought on by pain, I don't know how I would have survived without several weeks of opiod pain relief. We are all being punished by the few.
12
@Peg "But, the fact that the medical industry -- doctors, clinics, hospitals, etc -- is allowing this to happen is the most egregious behavior of all."
You are wrong. We physicians have ZERO control. We are at the mercy of the insurance companies. They say a patient can't have a medication or procedure? We can pay staff and take our time to write letters of appeal. Ins co still says no? Then the patient can't have it unless s/he wants to and is able to pay cash. Insurance company asks for money back a year later? We're required to give it back no questions asked or they'll take it out of future payments. Insurance company decides to not pay for a procedure they "pre-authorized" for the patient? No problem, "pre-authorization is not a guarantee of payment." The physician can eat the cost (supplies + time) of what was done.
Again, we have ZERO control. Folks should be very afraid of the severe limitations on allowable services and increasing insecurity that doctors will be reimbursed for provided services, but to blame the medical industry for allowing this to happen is ludicrous -- unless you're blaming the medical industry of ~30-40 years ago which accepted the HMOs and all the strings that came attached.
You are wrong. We physicians have ZERO control. We are at the mercy of the insurance companies. They say a patient can't have a medication or procedure? We can pay staff and take our time to write letters of appeal. Ins co still says no? Then the patient can't have it unless s/he wants to and is able to pay cash. Insurance company asks for money back a year later? We're required to give it back no questions asked or they'll take it out of future payments. Insurance company decides to not pay for a procedure they "pre-authorized" for the patient? No problem, "pre-authorization is not a guarantee of payment." The physician can eat the cost (supplies + time) of what was done.
Again, we have ZERO control. Folks should be very afraid of the severe limitations on allowable services and increasing insecurity that doctors will be reimbursed for provided services, but to blame the medical industry for allowing this to happen is ludicrous -- unless you're blaming the medical industry of ~30-40 years ago which accepted the HMOs and all the strings that came attached.
6
These laws will punish real people with real pain, not merely those who abuse the drugs. Those who abuse the drugs now already have methods of feeding their addictions illegally. This will push people who live with chronic pain to go to the black market.
Doctor's offices charge a copay determined by insurance companies every time we visit them. Insurance companies generally charge a copy every time we fill a prescription whether it is for use in 7, 10, 30, or 90 day supplies so this will also make some people choose between pain relief and food.
Brought to you by the people who wax eloquent about keeping government limited, of course... If a doctor is over-prescribing, this can be determined and disciplinary action taken. This new law in Massachusetts punishes patients instead.
Doctor's offices charge a copay determined by insurance companies every time we visit them. Insurance companies generally charge a copy every time we fill a prescription whether it is for use in 7, 10, 30, or 90 day supplies so this will also make some people choose between pain relief and food.
Brought to you by the people who wax eloquent about keeping government limited, of course... If a doctor is over-prescribing, this can be determined and disciplinary action taken. This new law in Massachusetts punishes patients instead.
48
The point of the regulation is to stop creating new addicts, not saving the existing ones.
I agree with you. I am a registered nurse and have worked managing clinics and hospitals in rural areas for more than 25 years. There are many people who are "drug seekers" but there are also people with legitimate pain. My 93 year old mother has osteoarthritis, degenerative disc disease and osteoporosis. She has been on pain medications for many, many years and it enables her to live her life more comfortably. Access to her prescriptions is getting more and more difficult and I hate to see what awaits her down the road. I hope that some reasonable medical people, including nurses address this bill as it progresses through the legislature. I am so tired of the pendulum swings from one extreme to another. Back in the 90's, a physician or hospital could get sued for not taking care of a patient's pain!!!
17
Doctors are too eager to prescribe these drugs! Two years ago, as I was leaving the office after having had a root canal, a prescription for hydrocodone was pressed into my hands. I protested that I was in no discomfort and didn't want it, I could use ibuprofen if I needed it. I was urged to get the prescription filled anyway, "just in case." So I did, and never used it. A month later, after having a mole removed, the doctor automatically send a prescription (also for hydrocodone) to the pharmacy, which sent me an email saying I had a prescription to pick up. Not knowing what it was, I went and picked it up, but also never used it (never had any pain at all from that procedure). So now I have 60 tablets of this stuff in the back of my medicine cabinet, which I can't throw away, and don't want to use. I paid a modest co-pay, but I have no idea what it actually cost my insurer.
I'm sure these drugs have legitimate uses, and the day may come when I'll be glad to be prescribed something appropriate. But why have pain killers thrust upon you when you are not complaining of any pain?
I'm sure these drugs have legitimate uses, and the day may come when I'll be glad to be prescribed something appropriate. But why have pain killers thrust upon you when you are not complaining of any pain?
5
Today you have the option of taking those drugs. (You could have refused the prescription at the pharmacy.) But the trend is looking more and more like that option won't be available to you in the future because the government and the media are promoting just one side of the issue.
11
It was your choice to fill the prescription the doctor pressed into your hand. If you really felt you didn't need it you could have just held onto it for a day or two in case you changed your mind and then taken it to the pharmacy or discarded it. Also, just because the pharmacy filled a prescription that had been sent electronically doesn't mean you have to accept it. If you didn't want or need it you could have just declined it and they would have put it back into stock. So take a little responsibility yourself.
5
This is EXACTLY the experience my husband and I have had. These drugs make us both sick so we don't take them. However, various docs keep prescribing them anyway, and like Joan, we picked them up without realizing what they were. Now we have a collection of dangerous drugs we can't throw away so don't know what to do with. One thing I know we need to do is have our medical records reflect we are "allergic" to opioids. Although not strictly true, this may stop some of the over-prescribing for us.
Legislators voting for such provisions -- and advocates of such controls -- should be forced to themselves experience untreated pain for extended periods of time. These could be measured to match the pain of untreated patients. Also, they should be force to brave the pain to walk two miles through snow and rain and mud to pick up renewals for sham prescriptions so as to understand what pain patients live through. If they are not themselves old they should be arrayed with varying constraints to simulate the experience of fighting pain and immobility in old age. This should go on for 6-12 months.
9
Of course prescribing will decrease if the amount that can be prescribed legally is decreased. Should use increase? No.
“If we could adopt policies regionally or nationally, we could make some real progress”
Yeah, progress decreasing reimbursement by the insurance companies for drugs insanely overpriced by drug companies.
Opioids are addictive and that's a risk that has to be weighed against the benefits to individual patients. Databases to cross check abusers obtaining multiple prescriptions are an excellent idea and I would venture have prevented a lot of drug diversion or dependency escalation.
The fear of prescribing opiates has unquestionably gotten to where those in legitimate need suffer for no reason. Our pediatrician's group office will not prescribe any opiates, not even codeine cough syrup for severe coughing. The Dr's know it's the right med and know it will calm a nasty cough in one or two doses but aren't allowed to prescribe it.
"Yeah, I know, nothing I can do" is the only thing our pediatrician had to offer when I tried to get help for my son who had been coughing around the clock for a week.
There's a h*ll of a lot more to the opioid saga than fragmented attempts at protecting innocent people from awful drugs. Meanwhile, even those who can truly benefit from a short course of mild opioids are getting the shaft.
“If we could adopt policies regionally or nationally, we could make some real progress”
Yeah, progress decreasing reimbursement by the insurance companies for drugs insanely overpriced by drug companies.
Opioids are addictive and that's a risk that has to be weighed against the benefits to individual patients. Databases to cross check abusers obtaining multiple prescriptions are an excellent idea and I would venture have prevented a lot of drug diversion or dependency escalation.
The fear of prescribing opiates has unquestionably gotten to where those in legitimate need suffer for no reason. Our pediatrician's group office will not prescribe any opiates, not even codeine cough syrup for severe coughing. The Dr's know it's the right med and know it will calm a nasty cough in one or two doses but aren't allowed to prescribe it.
"Yeah, I know, nothing I can do" is the only thing our pediatrician had to offer when I tried to get help for my son who had been coughing around the clock for a week.
There's a h*ll of a lot more to the opioid saga than fragmented attempts at protecting innocent people from awful drugs. Meanwhile, even those who can truly benefit from a short course of mild opioids are getting the shaft.
12
I didn't know that opioids work to suppress severe coughs. My daughter broke her collar bone in second grade (in a playground accident) -- and it was a bad fracture, with sharp pointy bone fragments jabbing at each other. She received a prescription for Tylenol with codeine, yet took only 2-3 doses (we had a one week supply, at several doses per day). What did work? A new Barbie doll!! (I should have known it would be anesthetizing!) Actually, it was the distraction. I tried her prescription some time later for a really bad headache -- no help at all. This bottle languished for a long time in our house, in the absence of a drug take-back program.
Do not understand the need for under-medicating post surgical patients. How
do we judge expert pain management & the cycle of persistent pain. Is a
medical doctor now obligated to evaluate pain in his or her patients now
in a judgment by judgment basis as each person has different tolerances
for true pain, thus being intimidated by state authorities & insurance companies for controlled substances becoming stricter. The cycle of pain
is real as is break thru pain. Believe me, orthopaedic surgery necessary
for hip and knee replacements is prolonged unnecessarily as injections no longer are effective. A medical doctor is burdened with denial of offering
any relief. It is a fact that the more affluent can persuade certain doctors to over prescribe e.g., the Michael Jackson situation. Many people respond v v differently to opiods with some meds not effective at all, e.g., morphine.
Experiencing pain is now stigmatized as is mental disease which is just plain offensive and degrading to the person experiencing it. I can foresee
surgery with use of Chinese medical practices now not offered as an alternative which would at least be a choice if covered by insurance
companies. Why not explore alternatives reimbursed by insurance. Are the pharmaceutical companies blocking such alternatives? Forget the abuser, who can be easily tracked & helped before those abusers turn to hard
drugs.
do we judge expert pain management & the cycle of persistent pain. Is a
medical doctor now obligated to evaluate pain in his or her patients now
in a judgment by judgment basis as each person has different tolerances
for true pain, thus being intimidated by state authorities & insurance companies for controlled substances becoming stricter. The cycle of pain
is real as is break thru pain. Believe me, orthopaedic surgery necessary
for hip and knee replacements is prolonged unnecessarily as injections no longer are effective. A medical doctor is burdened with denial of offering
any relief. It is a fact that the more affluent can persuade certain doctors to over prescribe e.g., the Michael Jackson situation. Many people respond v v differently to opiods with some meds not effective at all, e.g., morphine.
Experiencing pain is now stigmatized as is mental disease which is just plain offensive and degrading to the person experiencing it. I can foresee
surgery with use of Chinese medical practices now not offered as an alternative which would at least be a choice if covered by insurance
companies. Why not explore alternatives reimbursed by insurance. Are the pharmaceutical companies blocking such alternatives? Forget the abuser, who can be easily tracked & helped before those abusers turn to hard
drugs.
5
How is giving someone a week's worth of drugs under medicating? For many surgeries that is more than sufficient. If someone needs more after that amount runs out, they can be prescribed more. A 30-60 day supply should not be routine for everyone.
I can't take any of these drugs without a reaction, but was cleaning recently and still had the non-opioid pain meds I got after hand surgery. I took a total of four of them.
I can't take any of these drugs without a reaction, but was cleaning recently and still had the non-opioid pain meds I got after hand surgery. I took a total of four of them.
1
I suffer from chronic back and leg pain that kept me in a wheelchair for 10 weeks last year. Here in Georgia, recently enacted legislation meant that neither my primary care physician nor two other spinal specialists could prescribe medicine to give me pain relief - off the record, they rolled their eyes at the politicians responsible for interfering with the practice of good medicine.
In the meantime, the simple acts of showering or turning over in bed were so severe - with excruciating pain shooting down my right thigh and calf - that I was left only to try to hide my tears. Many other nights I lay awake in anguish, because the searing, stabbing pain was so unrelenting I couldn't even sleep enough to allow a healing process to start.
According to the new Georgia law, my doctors were helpless to treat me themselves; they were required instead to refer me to a pain management specialist. This legally mandated referral process took almost a month. Eventually and fortunately, my new pain management specialist - the fourth physician now working on my case - helped control my world of physical hurt with a combination of epidural steroid injections and - yes - opiate medication in the form of Oxycodone, 10 milligrams 3 times a day.
More and more, politicians are trying to play "doctor". If playing "doctor" causes undue pain and suffering for the public, maybe that is what ought to be criminalized, not the reverse. Perhaps they need to feel some pain in the voting booth.
In the meantime, the simple acts of showering or turning over in bed were so severe - with excruciating pain shooting down my right thigh and calf - that I was left only to try to hide my tears. Many other nights I lay awake in anguish, because the searing, stabbing pain was so unrelenting I couldn't even sleep enough to allow a healing process to start.
According to the new Georgia law, my doctors were helpless to treat me themselves; they were required instead to refer me to a pain management specialist. This legally mandated referral process took almost a month. Eventually and fortunately, my new pain management specialist - the fourth physician now working on my case - helped control my world of physical hurt with a combination of epidural steroid injections and - yes - opiate medication in the form of Oxycodone, 10 milligrams 3 times a day.
More and more, politicians are trying to play "doctor". If playing "doctor" causes undue pain and suffering for the public, maybe that is what ought to be criminalized, not the reverse. Perhaps they need to feel some pain in the voting booth.
13
Numerous times I have requested that one of these articles break out exactly who these overdose fatalities consist of. How many and what percentage are:
1. People who are deliberately committing suicide
2. People who illegally obtained these drugs
3. People who were legally prescribed the medication
I am amazed that Kentucky's prescription level fell only 8.6 percent, given the level of pressure physicians are feeling from the authorities. It apparently makes absolutely no difference to anyone that many people, particularly elderly, who suffer intractable pain will face insurmountable hurdles to getting relief because of this campaign. It would be different if there was something else equivalent available, but there is not.
1. People who are deliberately committing suicide
2. People who illegally obtained these drugs
3. People who were legally prescribed the medication
I am amazed that Kentucky's prescription level fell only 8.6 percent, given the level of pressure physicians are feeling from the authorities. It apparently makes absolutely no difference to anyone that many people, particularly elderly, who suffer intractable pain will face insurmountable hurdles to getting relief because of this campaign. It would be different if there was something else equivalent available, but there is not.
11
Like so many problems, education, appropriate and thorough education, of both physicians and patients, is what is needed. Rules and laws with both intended and unintended consequences, which put those patients who appropriately need opioids as a part of their pain management at risk of "pseudo addiction," or, seeking drugs for inadequately treated pain, are not the answer.
Those patients who require opioids as part of a multidisciplinary treatment plan, and those physicians who attempt to successfully treat those patients are done a tragic disservice, relegating the patient to be labeled as "drug seeking" while experiencing on-going and debilitating pain, and relegating the physician with the education to help such patients to worry that a bureaucrat will wreak havoc with his/her ability to help this patient. This is a "work-around" of a tremendous problem which will only result in further pain and suffering and the severe depression which accompanies this.
In addition, those with intractable pain will likely resort to illegal and dangerous remedies adding a further burden to the individual and to society.
There is no doubt an enormous problem, affecting life and death, due to the inappropriate use and prescribing of opioids. And, like many substances such as alcohol, opioids are significantly abused.
But the answer is not in legislation, but education.
And for the problem of opioid abuse, treatment, not legislation and criminalization, is the answer.
Those patients who require opioids as part of a multidisciplinary treatment plan, and those physicians who attempt to successfully treat those patients are done a tragic disservice, relegating the patient to be labeled as "drug seeking" while experiencing on-going and debilitating pain, and relegating the physician with the education to help such patients to worry that a bureaucrat will wreak havoc with his/her ability to help this patient. This is a "work-around" of a tremendous problem which will only result in further pain and suffering and the severe depression which accompanies this.
In addition, those with intractable pain will likely resort to illegal and dangerous remedies adding a further burden to the individual and to society.
There is no doubt an enormous problem, affecting life and death, due to the inappropriate use and prescribing of opioids. And, like many substances such as alcohol, opioids are significantly abused.
But the answer is not in legislation, but education.
And for the problem of opioid abuse, treatment, not legislation and criminalization, is the answer.
5
Let me get to the point, opiate based drugs are more effective than any other drugs for alleviating pain, but because they carry a high risk of addiction the government has decided my risk of addiction exceeds any beneficial effects this class of drugs may provide. Are proponents of this legislation the same people that believe in the sanctity of doctor/patient relationships, or are they simply the common stooges who claim to know what is best for me, and need to protect me from my base instincts?
If it is the former, it demonstrates their hypocrisy when arguing about government sponsored healthcare undermining the sanctity of doctor/patient relationships.
Unfortunately, the liberal position is not any better; they base their opposition to opiate based drug treatment on their sanctimonious attitude that they know what is best for me. In their holier than thou attitude, they believe it is their duty to protect me from myself, and the stigma of addiction, and I should utilize scientifically unsubstantiated alternative pain programs to cope with my pain.
The bottom line is that we have been here before; the number of returning drug addicted Vietnam vets led to the current War on Drugs policies that both parties are now railing against, yet, as the article demonstrates, they are quite content with initiating War on Drugs 2.0.
It's hard to believe congress once debated the idea that depriving individuals the right to use any drug was constitutional.
If it is the former, it demonstrates their hypocrisy when arguing about government sponsored healthcare undermining the sanctity of doctor/patient relationships.
Unfortunately, the liberal position is not any better; they base their opposition to opiate based drug treatment on their sanctimonious attitude that they know what is best for me. In their holier than thou attitude, they believe it is their duty to protect me from myself, and the stigma of addiction, and I should utilize scientifically unsubstantiated alternative pain programs to cope with my pain.
The bottom line is that we have been here before; the number of returning drug addicted Vietnam vets led to the current War on Drugs policies that both parties are now railing against, yet, as the article demonstrates, they are quite content with initiating War on Drugs 2.0.
It's hard to believe congress once debated the idea that depriving individuals the right to use any drug was constitutional.
9
I applaud government efforts to limit the availability of prescription opioids for short-term (and long-term in some cases) pain relief. The evidence for their efficacy, compared to alternatives, is much lower than the drug companies would let you know. Drug companies want one thing: to get as many drugs sold as possible by any means necessary. They cannot be trusted.
However, doctors need to take as much responsibility for prescribing this legal heroin as any one else. They can ask the question "there are alternative medications and treatments rather than opioids for pain, are you willing try one of these and come back if it doesn't work?" There are organizations such as Physicians for Responsible Opioid Prescribing and others to help.
We as parents and society are also responsible. Ask for alternative medications, deal with temporary pain like having wisdom teeth pulled or bone breaks with Advil, and when you are prescribed opioid medications, hide them from your children and dispose of them immediately. Just think to yourself, "if I had heroin in the house, what would I do with it?"
Drug companies need to be regulated because they care about profits more than anything else. However, we all can make a difference by putting a small amount of effort into stopping the availability of "legal heroin" - which is what need to call these drugs.
However, doctors need to take as much responsibility for prescribing this legal heroin as any one else. They can ask the question "there are alternative medications and treatments rather than opioids for pain, are you willing try one of these and come back if it doesn't work?" There are organizations such as Physicians for Responsible Opioid Prescribing and others to help.
We as parents and society are also responsible. Ask for alternative medications, deal with temporary pain like having wisdom teeth pulled or bone breaks with Advil, and when you are prescribed opioid medications, hide them from your children and dispose of them immediately. Just think to yourself, "if I had heroin in the house, what would I do with it?"
Drug companies need to be regulated because they care about profits more than anything else. However, we all can make a difference by putting a small amount of effort into stopping the availability of "legal heroin" - which is what need to call these drugs.
1
Have we learned nothing from our decades-long "War On Drugs"?
These rather draconian measures will merely cause a slight ripple in illicit drug use, while causing extraordinary inconvenience -- and increased costs -- to patients who rely on opioid analgesics for relief of actual pain, especially chronic pain, and those who prescribe them.
It it patently obvious that these proposals are being made by those who have been fortunate enough never to have had serious injuries, nor chronic conditions that produce debilitating, even unbearable, pain.
These rather draconian measures will merely cause a slight ripple in illicit drug use, while causing extraordinary inconvenience -- and increased costs -- to patients who rely on opioid analgesics for relief of actual pain, especially chronic pain, and those who prescribe them.
It it patently obvious that these proposals are being made by those who have been fortunate enough never to have had serious injuries, nor chronic conditions that produce debilitating, even unbearable, pain.
18
the article states that prescriptions in massachusetts are down 20% after they enacted these tighter control measures. addicts won't bother faking symptoms if it's too difficult to get the pills. and you're reaching with the "extraordinary inconvenience". i think you added the adjective because you're ashamed that you put your convenience above a health crisis. these controls should've been put in at the beginning. It's like if there were never drunk driving roadblocks and after many deaths they decided to use them. it's "extraordinarily" inconvenient for legit drivers but probably saves thousands of lives by stopping people from drinking and driving in the first place.
Why does everyone who thinks the government is patently incompetent in all things but then in their little corner of the world asks that they can somehow perfectly make guidelines that don't inconvenience legitimate patients while also ensuring that drug addicts can't get it? kind of a perfect line in the sand you're asking them to find.
Why does everyone who thinks the government is patently incompetent in all things but then in their little corner of the world asks that they can somehow perfectly make guidelines that don't inconvenience legitimate patients while also ensuring that drug addicts can't get it? kind of a perfect line in the sand you're asking them to find.
I offer anecdotal evidence that doctors do overprescribe these painkillers. My medicine cabinet, which I will clean out today, is proof. Hand surgery for me - 50 oxycodone. I took 2. Husband's more painful surgery recovery - 48 prescribed, 24 remain. Son's wisdom teeth removal - 30 tablets prescribed. He took 1. Doctors write scrips for large amounts because they don't want to write a second one for need. Multiple prescriptions must get scrutinized more is my guess. But now I must go grind these suckers up and mix them with cat litter or sand, because you can't just dissolve them or trash them. I do empathize for chronic pain sufferers and the hurdles they must go through to obtain pain relief. On the other hand, I've seen the addictive effect of these drugs firsthand. All in all, we need more comprehensive pain management than handing out pills. Sadly, our healthcare system (if one could call it that) is not designed to provide this unless one seeks it out, if even available in one's locale or circumstances.
5
If you have a medicine cabinet full of these pills and didn't use them why did you keep getting new prescriptions filled? Just because a doctor prescribes the medication does not mean you have no choice in whether or not to fill the prescription. You were lucky that your pain was managed so easily so your complaint has no traction with me.
12
I don't have a solution for the problems of opioid abuse and addiction. I do wonder (and wish that the Times had thought it worth reporting) how many abusers/addicts started out with legitimate prescriptions, and how many are purely 'recreational' users. And I suspect that a more rational approach could be devised that appropriately differentiates between the two.
Instead, we're taking an all too typical, knee-jerk approach that throws the pendulum too far in the opposite direction and that will, inevitably, increase unnecessary suffering. Outpatient surgery centers already under-medicate for post procedural pain. People who need the medication to maintain a minimally acceptable quality of life will spend their days immobilized by, and trying to think about much beside the pain that dominates their lives.
Instead, we're taking an all too typical, knee-jerk approach that throws the pendulum too far in the opposite direction and that will, inevitably, increase unnecessary suffering. Outpatient surgery centers already under-medicate for post procedural pain. People who need the medication to maintain a minimally acceptable quality of life will spend their days immobilized by, and trying to think about much beside the pain that dominates their lives.
11
As someone who has used these drugs for chronic back pain for over ten years.
They still work and I still forget occasionally to take these "highly addictive" medications.
The endless demonization by government officials have made me afraid to discuss them with anyone. I go to great lengths to destroy the paperwork and bottles that come along with them every month each with my name and address on them.
Now I am drug tested bimonthly along with a procession of my aged crippled peers with walkers and bent spines and wheelchair bound possible addicts all at enormous cost.
The problem people are not in pain management programs.
Getting high and pain relief are not the same.
The folks who are problem drinkers are also problem addicts.
They still work and I still forget occasionally to take these "highly addictive" medications.
The endless demonization by government officials have made me afraid to discuss them with anyone. I go to great lengths to destroy the paperwork and bottles that come along with them every month each with my name and address on them.
Now I am drug tested bimonthly along with a procession of my aged crippled peers with walkers and bent spines and wheelchair bound possible addicts all at enormous cost.
The problem people are not in pain management programs.
Getting high and pain relief are not the same.
The folks who are problem drinkers are also problem addicts.
23
most addicts buy their pills from people with legit prescriptions. they pay a lot.
I don't dare tell anyone what narcotics are in my home. You are right to destroy the drugstore invoices. We are always in danger of someone burglarizing our homes or worse.
5
A certain percentage of the population is pre-disposed to addiction due to genetic or other reasons. As long as we continue to treat addiction as a crime or moral failing, the elicit underground economy for opioids will continue be it prescription pain medications or heroin. The only rational response is a "harm reduction" based model that limits the destruction opioids cause (including overdose) on both the user and society (crime) until the patient is ready to deal with their addiction. Keeping pain medications away from people who really need them could be the true harm that efforts to limit prescribing risks.
11
A model approach to minimize the harm from common addicting drugs should include removing profit, decriminalization of users, and appropriate use guidelines.
We have a National Institute on Drug Abuse to coordinate and support the development of such a model, to the be available to states and physicians.
We have a National Institute on Drug Abuse to coordinate and support the development of such a model, to the be available to states and physicians.
1
A lot of people are beginning to understand that human brains are very susceptible to addictions to chemicals that give it shots of dopamine. It doesn't matter if it is Salt, Sugar, Fat or OxyCodone and American Greed has used it to make billions for Corporations. This is particularly effective in creating addicts when our brains are still forming, which is the reason it is not legal to give alcohol and tobacco to kids. Tobacco kills half a million people a year in the US and now Big Pharma is providing extremely addictive medication to kids. It is necessary that we begin to control the damage Greed is doing, it is almost too late.
1
Have we learned nothing from years of anti-drug legislation? It does not work. People will take drugs. Encouraging the drug companies to manufacture drugs that are "better" than natural substances has made drug abuse more rampant. Just back off and let doctors and patients decide what is best for individuals and spend money on treatment and education, not enforcement. How many 80 years olds are going to be jailed now for drug abuse?
18
they sell their pain meds. i live in a halfway house - im alcoholic not an opioid user- and most heroin users i live with started with a legit prescription for oxycodone/oxycontin/percocet after surgery/accident/wisdom teeth whatever. then when it ran out after exhausting every avenue to fake symptoms for more pills because they were now addicted, got people who have prescriptions to sell their pills. then they turned to heroin.
3
As a chronic migraine sufferer who uses my prescription painkillers responsibly and when needed for severe pain, I am outraged at the States and insurance companies for interfering in the medical care that has been established between my doctor and myself for the past 15 years. The medication is already monitored and recorded to the government and I have to sign a pain contract agreement annually. The most recent increase in regulations means that instead of having refills available as needed that I have to go in each time for an appointment which the government doesn't pay for (I do). I'm tired of people who abuse drugs making regulations worse for people like me who suffer from chronic pain and are responsible. The regulations will not make a difference to those who are already abuse the system, they simply create more hoops for law abiding citizens to jump through.
28
Kind of like the gun control argument.
4
I recently had a total hip replacement. My pain was not managed well while I was in the hospital and had two episodes of what I later learned from hospital staff were panic attacks that they alleviated with morphine. After returning home, the pain medication was woefully insufficient. The rehabilitation nurse that visited every other day agreed and called my orthopedic surgeon refused to increase the dosage or allow a few additional days worth of medication. Consequently, my rehabilitation required more than two additional weeks because it was too painful to complete the exercises I needed to. I had complicated, extensive cancer surgery 12 years ago and my pain was well managed so healed quite quickly. Soon I will Ned to have my right hip done and it honestly terrifies me.
30
This will start happening more and more. Doubting a doctor's judgment, esp in light of he or she having a good record of prescribing in the past.
Patients will suffer needlessly, doctors will be subject to even more redundant rules, and the "solution" will end up making the heroin problem much worse.
Politicians will now make medical decisions for you and your physician. And they're just worsening the heroin issues, these state legislators with SO much medical knowledge of you as a patient.
Patients will suffer needlessly, doctors will be subject to even more redundant rules, and the "solution" will end up making the heroin problem much worse.
Politicians will now make medical decisions for you and your physician. And they're just worsening the heroin issues, these state legislators with SO much medical knowledge of you as a patient.
16
Unfortunately health care providers are inadequately trained on non-narcotic methods from reducing pain for patients. Chronic pain requires a comprehensive treatment plan which includes psychiatric, psychological, and specialty coordination. It is easier and faster just to write a prescription.
Couple this with the barriers to access to disability insurance and assistance for workers when they are injured- and you have desperate people, struggling through the pain to stay employed, with overwhelmed health care providers who have to make decisions in short periods of time and without access to or knowledge about available the physiatry services the patient truly needs for long term management.
Then with the stigma of addiction and the shortage of available treatment programs and any adequate way for patients to afford treatment, no wonder we are in a pickle.
Unfortunately these legislative actions do nothing to address any of these other factors.
Couple this with the barriers to access to disability insurance and assistance for workers when they are injured- and you have desperate people, struggling through the pain to stay employed, with overwhelmed health care providers who have to make decisions in short periods of time and without access to or knowledge about available the physiatry services the patient truly needs for long term management.
Then with the stigma of addiction and the shortage of available treatment programs and any adequate way for patients to afford treatment, no wonder we are in a pickle.
Unfortunately these legislative actions do nothing to address any of these other factors.
11
Legislation should not interfere with decisions between doctors and their patients. Teach more medical ethics classes in medical school, open more substance abuse treatment programs, and send illegal users to them first before jailing them. Don't punish the patients who legitimately need these medications for daily pain management for severe chronic conditions.
23
Two months ago, I became a registered cardholder under the Montana Marijuana Act. Montana voters approved the use of medical marijuana in 2004. After a boom in the number of cardholders and businesses serving them in 2009 (following the DOJ memo indicating a policy shift on enforcement), the Act was reformed in 2011. The new law prohibited medical marijuana providers from exchanging anything of value for the drug, and limited them to assisting three people. A court blocked implementation of these changes, and years of litigation ensued. Two weeks ago, the Montana Supreme Court upheld the prohibition on providers serving more than three people. That leaves approximately 12,000 people suddenly without access to medical marijuana. Meanwhile, I could get synthetic heroin at the grocery store a few blocks away if I had a tooth pulled. Wake up people! We are not facing an epidemic of medical marijuana use.
14
MRIs show I have no discs left. My single pain doctor prescribes one codeine per day, which I take only when I leave the house. Yet, I'm to be treated the same as my heroin addicted classmate?
Fine. I can fill prescriptions more often. But will Congress reimburse me for the extra specialist co-pay, or the lost productivity to my employer?
My classmate wanted to die and knowing her well, it was a rational choice: this world disappointed and she faced a bleak future. The War on Drugs didn't discourage her and nothing stops someone with contempt for the law.
Fine. I can fill prescriptions more often. But will Congress reimburse me for the extra specialist co-pay, or the lost productivity to my employer?
My classmate wanted to die and knowing her well, it was a rational choice: this world disappointed and she faced a bleak future. The War on Drugs didn't discourage her and nothing stops someone with contempt for the law.
19
Between '09 and '13 I had my spine fully fused - S1 thru T10 - in spine surgeries #6 thru 11. The daily 120 mg of hydrocodone, mixed with post op morphine and oxycodone was all that kept me able to cope with the pain.
I've recently had electrodes and a med pump put in that delivers 0.08mg medication into my spine, eliminating need for opioid pain tablets.
I am so glad to have found a competent pain management dr who, thru insight and vision, was able to effectively treat my 'chronic intractable' pain.
Yes, there is much abuse, but then medicine is called a practice, letting insurance and politicians set rules?!? No.
I've recently had electrodes and a med pump put in that delivers 0.08mg medication into my spine, eliminating need for opioid pain tablets.
I am so glad to have found a competent pain management dr who, thru insight and vision, was able to effectively treat my 'chronic intractable' pain.
Yes, there is much abuse, but then medicine is called a practice, letting insurance and politicians set rules?!? No.
32
Most of the patients I treated for either chronic (long term) or acute pain (short term) with opiods or other pain medications (before I left the field because of threats of imprisonment and/or confiscation of my savings and another other assets I had earned in 40 years of medical practice under the US Government euphemism of "Asset Forfeiture" (a cover legal term for US Government asset confiscation from private American citizens (plus a Veteran of US Air Force Military Service in my case) would agree with the gentleman from Middleton as he has so well expressed himself above.
6
This article states, "In 2014, the death toll from overdoses involving prescription painkillers or heroin reached 28,647"
I notice HEROIN was included in that deadly statistic. WHY ? I am not aware that Doctors commonly prescribe that drug and do not understand its significance here.
Something is very unclear. How many of these tragic deaths were due to Prescription Drugs illegally obtained, i.e., opioids siphoned off somehow from legal suppliers and then sold on the 'street' ? Or stolen from a medicine cabinet ?
And, how many of these deaths are of people under the 'care' of a physician, with a legal prescription?
How many might be intentional suicides of people with chronic, poorly treated pain?
Aren't we mixing up 2 different problems - illegal drug use and the 'legal' drug abuse due to the over-prescribing of drugs due to poor judgement of the physician or of the patient's misuse of the medication?
Tighter prescribing rules based on shallow statistics are likely to penalize patients who need pain medications. Are we really concerned about that ?
We need to be aware that all modern medical treatments and surgeries have some level of risk. For example, deaths from hospital infections are at least 103,000 (!) , according to the Committee to Reduce Infection Deaths (RID) .
@ http://hospitalinfection.org/about/our-mission
That problem certainly deserves at least as much awareness as the concern shown about prescription drug abuse.
I notice HEROIN was included in that deadly statistic. WHY ? I am not aware that Doctors commonly prescribe that drug and do not understand its significance here.
Something is very unclear. How many of these tragic deaths were due to Prescription Drugs illegally obtained, i.e., opioids siphoned off somehow from legal suppliers and then sold on the 'street' ? Or stolen from a medicine cabinet ?
And, how many of these deaths are of people under the 'care' of a physician, with a legal prescription?
How many might be intentional suicides of people with chronic, poorly treated pain?
Aren't we mixing up 2 different problems - illegal drug use and the 'legal' drug abuse due to the over-prescribing of drugs due to poor judgement of the physician or of the patient's misuse of the medication?
Tighter prescribing rules based on shallow statistics are likely to penalize patients who need pain medications. Are we really concerned about that ?
We need to be aware that all modern medical treatments and surgeries have some level of risk. For example, deaths from hospital infections are at least 103,000 (!) , according to the Committee to Reduce Infection Deaths (RID) .
@ http://hospitalinfection.org/about/our-mission
That problem certainly deserves at least as much awareness as the concern shown about prescription drug abuse.
43
Oh, great. Just when we were getting some sense about marijuana and realizing that the consequences of the war on drugs were worse than pot itself, here we go again. You know, there's a reason the opium poppy is one of the oldest domestic plants. People in pain have been using it for 50,000 years because nothing else does the job. And as for the belief that the Bible requires suffering without drugs - sorry, neither the Bible nor the Koran mentions opium, and Christian doctors used it just as did Jewish and Islamic physicians, right up to the twentieth century. Society did not collapse. Punishing the most vulnerable members of our society, the elderly and disabled, when they are most desperately in need, is a vile thing to do.
55
This article infuriates me. Addicts have royally screwed up pain management for millions of law-abiding citizens with pain that interferes with their activities of daily life. Insurance companies and pharmacies already keep track of every pill that is prescribed, and responsible doctors are already terrified of writing prescriptions for painkillers. Suggesting that patients be given only enough pain medication for three days is absurd, punitive, and and guarantees epic amounts of record keeping. Why are we expending so much energy trying to protect self-destructive, devious, and determined addicts from themselves - while punishing the unfortunate patients who live in constant pain? We are looking through the wrong end of the telescope at criminals instead of focusing on decent people who are suffering and just want to function without their constant battle against pain from illness or accidents. They are being victimized twice, first by their disorder and second by this kind of legislation - while addicts thumb their noses at everyone and do whatever they want. For the love of God talk to the patients who live in constant pain and find out what that's like before making their lives even worse.
73
I attempted suicide twice due to severe excruciating pain because I did not have enough pain medication for my broken back in 2009; I was plowed into by a car which broke my back, crushed my left foot, and stopped just inches before almost running over my head. My neurosurgeon said I was 1 hair away from being a paraplegic. I spent over 1 year in bed, 4 months immobilized in an "iron man" back brace, 2 years in P.T., & I had to learn to walk again. I also suffer from severe migraines from a brain injury over 2 years ago, & I just got another 30-shot Botox treatment from my neurologist 3 days ago. In the past 2 months, I've had a migraine once to twice a day, & my medication was not always working. I had 2 IV infusions, missed work, & had to use extra Vicodin, Tramadol, & Relpax. Insurance covers Botox once every 3 months, so when it wears off, I have to have IV infusions & pain meds. It's HELL! Today, I had to drive 70 miles to my doctor's office to pick up my Vicodin prescription; in the past, she could send it electronically. If I ever suffer such severe pain again, & my doctor is NOT ALLOWED to prescribe me enough pain medication, I will definitely commit suicide, & next time I will not fail. Excruciating chronic pain 27/7 is 1 reason many people kill themselves. Even my doctors agree that this new law will not keep the drugs out of people's hands who will abuse them & then get them illegally; it only punishes those of us who need the medications and can't get them.
59
This article infuriates me. Addicts have royally screwed up pain management for millions of law-abiding citizens with chronic pain that interferes with their activities of daily life. Insurance companies and pharmacies already keep track of every pill that is prescribed, and responsible doctors are already terrified of writing prescriptions for painkillers. Suggesting that post-operative or migraine or stenosis patients be given only enough pain medication for three days is absurd, punitive, and and guarantees epic amounts of record keeping. Why are we expending so much energy on trying to protect self-destructive, devious, and determined addicts from themselves - while punishing the unfortunate patients who live in constant pain? We are looking through the wrong end of the telescope at criminals instead of focusing on decent people who are suffering and just want to function without their constant battle against chronic pain from illness or accidents. They are being victimized twice, first by their disorder and second by this kind of legislation - while addicts thumb their noses at everyone and do whatever they want. The drug manufacturer already changed the formula for Oxy, and within ten minutes the addicts found ways around it. For the love of God talk to the patients who live in constant pain and find out what that's like before making their lives even worse.
36
To tell you the truth, I am not sure why doctors would want to go through this kind of scrutiny. My son runs pain clinics and is already overcome with audits and oversight that is stifling...
4
The insurance companies have a hand in this mess too.
In January 2015 BCBS made me change the regimen on my Oxycontin which I'd used for years. That reduced their cost from $380 a month to $260. To compensate my pain doctor added Generic Percoset to my regimen which added an addition $6.00 to my monthly cost.
In January they took the Oxycontin off the formulary and I am now using Morphine. The copay is now $80 and BCBS's cost is $8.92. The Percoset is costing me $40 copay and BCBS's cost is $.66. That's right. 60 tablets for 66 cents.
Chronic pain pain are being killed with pricing. BCBS has lost $500 million treating Obamacare people who aren't paying premiums and signing up when they need medical care. The Feds say BCBS is supposed to "pay and chase" these people but it's a lot easier to just take it from those who are paying.
In January 2015 BCBS made me change the regimen on my Oxycontin which I'd used for years. That reduced their cost from $380 a month to $260. To compensate my pain doctor added Generic Percoset to my regimen which added an addition $6.00 to my monthly cost.
In January they took the Oxycontin off the formulary and I am now using Morphine. The copay is now $80 and BCBS's cost is $8.92. The Percoset is costing me $40 copay and BCBS's cost is $.66. That's right. 60 tablets for 66 cents.
Chronic pain pain are being killed with pricing. BCBS has lost $500 million treating Obamacare people who aren't paying premiums and signing up when they need medical care. The Feds say BCBS is supposed to "pay and chase" these people but it's a lot easier to just take it from those who are paying.
4
The times has been pushing opioid limits for years, while arguing that no one should get between a person and their doctor, especially in the abortion context, and drug legalization in other areas. I am at a loss to understand why it is necessary to limit the availability of drugs for pain to an amount lower than a doctor might otherwise prescribe. Given that this is 2016, and an ample supply of such things is available across the Rio Grande (I suspect that the Internet provides, as well), I'm wondering why it feels the need for such onerous regulation?
20
I have severe endometriosis and the Vicodin I take allows me to function. However, I am conflicted about it and worried about physical dependence and the physical and psychological withdrawal after the surgery. I think that physicians have to be more up front about the potential issues involved with long term use and prepare patients for the possibility of withdrawal. SAMSHA has some interesting guidelines for physicians. These include a very carefully spelled contract between patient and doctor a plan for stepping down the dosage and referrals to treatment as necessary.
5
Every state except MO has a registry system... And PA where I practice. We have a registry on the books but no funding to implement it. Meanwhile, Western PA is in the middle of an opioid epidemic. And the state legislature can't even pass a budget due July 1, 2015.
4
I just love the politico's reference to the "Big Pharma" boogey man and the NYTs willingness to repeat it. This issue has NOTHING to do with "Big Pharma" as virtually all of these medicines that are regularly abused are generic and cheap.
But even in the face of this rather difficult and multifaceted dilemma, why not take a shot at the drug companies? There is always an appetite, apparently , among the NYT's readership, for conspiracy theories and bashing capitalism.
But even in the face of this rather difficult and multifaceted dilemma, why not take a shot at the drug companies? There is always an appetite, apparently , among the NYT's readership, for conspiracy theories and bashing capitalism.
5
Do you actually deny that pharmaceutical companies have fought the implementation of the prescription monitoring programs tooth-and-nail? If so, then you don't know what's actually been happening.
People only getting narcotics from one doctor means less profit for the manufacturers of the medications. Therefore they have fought against it as hard as possible.
People only getting narcotics from one doctor means less profit for the manufacturers of the medications. Therefore they have fought against it as hard as possible.
Since the drug cartels are losing money due to cannabis legalization they are going to flourish with underground opioid sales. People who need this type of medication and are desperate to stop their pain will get these pills one way or another and the governments, state and federal, will have no way to stop it. The heroin market is growing by leaps and bounds thanks to government nannyism. As for suicides there are other ways people will end their lives without drugs and governments will not be able to stop that either.
15
Twice in my life I had extreme, constant pain from herniate discs (L5 and L1/L2. Even with narcotics, I was in intense pain. Each episode lasted about two months and then I was pain free and medication free. Had I not been properly medicated, I know I would have killed myself. Yes, the pain was that intense and unrelenting. Even with the medication I got very little sleep and could barely function. We've seen these trends before i.e. the pendulum swings from one extreme to another without any consideration for those with genuine need.
34
They should act on Pharma advertising. Ban all pain-killer ads as first step, moving quickly to bans on sexual, beauty, incontinence/bowel/bladder/gas control treatments. Yes you Advil, Viagra, Moventik, Xifaxan, weight watchers and your lot. Take your attention-grabbing loud talk somewhere else.
9
I wonder how much individual physical and/or psychological reaction to the drugs plays a role? How much research is being done. I had a prescription for OxyCodone when I broke my wrist over 10 years ago - got pain relief, but no buzz at all. I only took a few pills, but it didn't do anything that would make someone want to keep taking it.
41
Interesting. I was prescribed OxyCodone for a herniated disk some eight years ago and it did nothing for the pain. I might as well have had a glass of water instead. I did have rapid heart beat, cold sweat and nausea though and I stopped taking it after a day because I absolutely hated that feeling.
1
Exactly! I was given a prescription for 90 tablets for my chronic hip and back pain and used themn sparingly. They lasted for 22 months, but now I'm having difficulty getting a refill. Why punish an aging population?
6
Yes, if you take the pills the way they are prescribed you won't get addicted. I took Vicodin for 2 weeks after having 4 wisdom teeth removed. It puts your brain in a fog (called euphoria by some and disconnected by others). I ran out and stopped with no problem. The addicts are crushing up the pills and injecting them to get high...not just taking 2 pills twice a day per the instructions.
4
I would be cautious about allowing insurance companies to dictate opioid policies. Their bottom line is about money. While I believe that controls and standards would be a good move, those are not the people to make the decisions.
73
Why not have a program like the TSA "trusted traveler" system where patients can be vetted and if approved, don't have to face jittery pharmacists and worried doctors afraid to write or process legitimate prescriptions because some state or federal agency is going to question why they performed one of the bedrock purposes of medicine:To relieve suffering. In America it easier to buy six gallon bottles of 80 proof hard liquor or a gun designed for the sole purpose of killing a lot of people quickly than to get a chain pharmacy to fill an Rx for 60 vicodin. Shame on doctors for ceding control of patient care. Shame on pharmacies for hoarding their DEA mandated monthly supplies for their best customers (just like a street corner Crack dealer), shame on hypocritical politicians and Shame on the NY Times for failing to report this story instead of being a megaphone for those who would deny the people with deformed spines or continuing pain from traumatic physical injuries under the guise that these people are all potential junkies.
121
I am waiting for my back surgery to be scheduled. I have 2 compression fractures and I face a six hour surgery to bring me some relief. I realize some people abuse opioids, but I don't. Anyone who has not yet lived with chronic pain has no idea how much constant pain can wear you out emotionally and physically. There must be a better plan than limiting dosages to 7 days. I like the idea of the TSA pre-approved list.
19
Thank you, Mr. Warner. Well said.
1
Because if you have no check on such things, then you have people going to CVS, the Walgreens down the street, Pop's Main Street Pharmacy, and then the supermarket drug counters ... the government runs a registry for Claritin D purchases, I think it should do for serious pain pills
My mother has terrible side effects from aspirin type meds. At 82 w/chronic pain from arthritis & stenosis, 4 artificial joints, difficulty walking &discomfort from dentures how is she supposed to function on a daily basis w/her, pain? Her state does not recognize medical marijuana....
67
Pain medication provides relief. Cannaboids are not pain killers.
7
From past articles in the times on the subject, she is supposed to learn to increase her tolerance to pain, which I gather means grin and bear it. Shameful.
20
Cannaboids, while not a pain killer per se, have been shown to help many people cope with pain. Opioid and heroin use and deaths from same are down in States that have legalized medical marijuana.
4
What ever happens, we will relearn the lesson that drug addiction cannot be legislated away, or legislatively ameliorated. It is a clinical, social and psychological problem, not a legal one.
66
Well, the illicit drug market will see a booming business because of this.
69
More than it already is?! What do you think happens to the extra pills when teens/young adults get these large prescriptions? As for the overall issue, the fact that Marijuana remains a schedule 1 drug tells you all you need to know about the little progress possible with big pharma in charge. The number of people quitting prescription drugs in states where pot is legal says it all and yet we've wasted decades and decades when we could have been conducting health-changing research. What a sad joke.
2
What do you think happens to most of the extra pills prescribed to late teens and young adults?
The fact that Marijuana remains a schedule 1 drug tells you about all the success this issue will have in defeating big pharma.
The fact that Marijuana remains a schedule 1 drug tells you about all the success this issue will have in defeating big pharma.
What needs to be recognized is that there is a huge group of folks, many who are elderly, who are already being burdened by the new restrictions already being implemented. And they are being penalized because of those who abuse. Shame on the abusers. I hope that those who are crafting the new regulations, realize you are creating a huge new group of folks who will now be incapacitated, because of the abusers. Sort of like the abortion debate, you deny abortion, do you take care of the babies?
86
I'm sorry, puarau, could you please define an "abuser" as distinct from other users who are just "folks"? Because both set of people are taking what they think they need to function.
This opioid prohibition drive is wildly out of touch with the general societal drive to end the war on drugs and empty the prisons of drug offenders. And inconsistent with the times' positions on many other issues. It's their own body, why are you getting between a person and their physician ... except on the question of opioids.
This opioid prohibition drive is wildly out of touch with the general societal drive to end the war on drugs and empty the prisons of drug offenders. And inconsistent with the times' positions on many other issues. It's their own body, why are you getting between a person and their physician ... except on the question of opioids.
11
No one is advocating that chronic pain patients be left to suffer or denied all treatment. The legislation in question is designed to reduce the doctor's reliance on opioids as the first line of treatment and decrease the likelihood that a patient may become addicted. There are many chronic pain sufferers who have become addicted over the course of their treatment, making it difficult for the clinician to determine whether the opioid is helpful or harmful. The elderly of whom you speak are not immune to addiction. Addiction is a chronic, life-threatening disease with physical, emotional and psychological components. It is also accompanied by a social stigma, which can perhaps be attributed to a lack of knowledge regarding the actual disease process. Statements such as "shame on the abuser" are offensive to those who have experience with or have attempted to understand the complexity of addiction. In general, addicts are unfailingly harsh critics of themselves. Societal judgment, whether the result of ignorance or a lack of empathy, only compounds the burden carried by the addict. We must educate, listen, and embrace a multitude of ideas if we are to find a solution for this problem. Judgment serves no purpose in the equation.
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Unfortunately, it is impossible to distinguish a patient's reaction to under-treatment of pain from drug-seeking behavior: they arrive asking for more medication. These rules make it more likely doctors will refuse them.
Thanks to breathless reporting from the NY Times, and others, we're now making it harder to obtain pain medication, which will result in *more* people dying from heroin overdoses, not fewer. When you make it harder for people in pain to find relief, they aren't simply going to suffer quietly, they're going to start taking risks (or they kill themselves). And because buying this drugs without a prescription is a crime, they are going to buy the strongest drugs available to reduce the risk of arrest. But, hey, the important thing is that people get to express their moral indignation at people in pain taking the "wrong kind" of drugs.
Lest you want to claim that opioids aren't useful for pain, witness the exception for "cancer pain", which is, apparently, the only kind people are willing to accept as legitimate.
Thanks to breathless reporting from the NY Times, and others, we're now making it harder to obtain pain medication, which will result in *more* people dying from heroin overdoses, not fewer. When you make it harder for people in pain to find relief, they aren't simply going to suffer quietly, they're going to start taking risks (or they kill themselves). And because buying this drugs without a prescription is a crime, they are going to buy the strongest drugs available to reduce the risk of arrest. But, hey, the important thing is that people get to express their moral indignation at people in pain taking the "wrong kind" of drugs.
Lest you want to claim that opioids aren't useful for pain, witness the exception for "cancer pain", which is, apparently, the only kind people are willing to accept as legitimate.
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Of course opioids are useful for pain management. That is not the issue at hand. For terminal cancer patients, dependency, withdrawal, abuse, addiction and sedation are not critical issues. Nor are they issues for those who use them for a few days post op or for a sprained ankle.
The issue is physicians prescribing opioids for chronic back pain, fibromyalgia chronic headaches, etc. This is were the vast supply for the illicit market comes from. Not cancer patients. And for patients with chronic pain there has been experiential and anecdotal evidence for decades that opioids increase chronic pain perception if for no other reason than to rationalize the need for the medication the patient is addicted to. Recent studies are confirming this as well.
So there is no real need to question the efficacy of opioids for short term pain management or the treatment of cancer pain. There is every reason to question the efficacy of opioids in the management of chronic pain. There is every reason now to admit that they do more harm than good.
The issue is physicians prescribing opioids for chronic back pain, fibromyalgia chronic headaches, etc. This is were the vast supply for the illicit market comes from. Not cancer patients. And for patients with chronic pain there has been experiential and anecdotal evidence for decades that opioids increase chronic pain perception if for no other reason than to rationalize the need for the medication the patient is addicted to. Recent studies are confirming this as well.
So there is no real need to question the efficacy of opioids for short term pain management or the treatment of cancer pain. There is every reason to question the efficacy of opioids in the management of chronic pain. There is every reason now to admit that they do more harm than good.
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You're wrong about doctors not having concern about the use of morphine as a pain killer for advanced cancer sufferers.
There is a threshold by which an opiod will work. No one can take it endlessly without consequences. Patients do go into withdrawal. Morphine is administered very carefully in any patient. If you ever have had an artery cut during surgery, and were given morphine after surgery and during surgery - you will know that the doctors wait to give it to you until you scream in pain.
There is a threshold by which an opiod will work. No one can take it endlessly without consequences. Patients do go into withdrawal. Morphine is administered very carefully in any patient. If you ever have had an artery cut during surgery, and were given morphine after surgery and during surgery - you will know that the doctors wait to give it to you until you scream in pain.
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I suppose from a purely intellectual standpoint, your comments are correct. So what would you suggest? Live with the pain? Because you seem to be suggesting that addiction is purely the problem, not the pain itself.
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