The takeaway from this article is that you'd better hit the Internet before you take any drug at all, prescription or otherwise. If I had done this, I'd be able to hike, swim, travel, etc today, rather than having the neuromuscular disease triggered almost instantly by a "blockbuster" prescription drug.
Because of this disease, I got to learn firsthand about pain medication. In "Deadly Medicines and Organized Crime", Dr Peter C. Gotzsche estimates that Vioxx alone caused over 120,000 Americans deaths. He writes that Merck was aware from the beginning that Vioxx caused thrombosis. One chapter in the book is titled, "Merck, where the patients die first."
It's just coincidence that simvastatin is the generic of Zocor, which is Merk's blockbuster statin, and that simvastatin is the drug that did me in. The initial symptoms (foot cramps, Charlie horses in calves, connective tissue injuries) occurred within weeks of starting the drug. (see StatinVictims.com)
It's not only Merck, of course, and it's not just pain drugs and statins. America's system for adverse effects is self-reporting, and of course it doesn't work. Generic drug companies aren't required to stay current on warning labels, so forget about that.
In 2015, the F.D.A. took the unusual step of strengthening its warning about NSAIDs causing heart attack and stroke. But the shelves are still stacked, advertisements bombard us, and no one I know is even aware of the strong warning.
Aspirin?
1
This is a poorly written article. For many with chronic pain, opiates are the only thing that works and they are best for after surgery too. Just because someone shoots heroin, don't accuse everyone. And no one locks up medications.
1
Good article. As reported by The Cleveland Clinic, seniors as example, take on average 5 prescription medications a day. not including over the counter concoctions. Drugs of course all have side effects. We are a highly medicated society and a over tested society. If Doctors run enough test, they certainly will find something to treat. New Blood pressure reversed guidelines, will add scores taking BP pills, usually a cocktail of 3. Caution rise slowly and try to avoid falling it too will become more common now.
Cannabis resin, an edible which is not smoked, is a remarkable analgesic. With a doctor's prescription, one can treat pain without danger. As long as you're not driving etc. Worth a serious discussion. Come on Jane!
The author raises all the issues associated with all the pain killers, but doesn't make any useful recommendations. Pain is a real problem and people do suffer from it, and foregoing ALL of these medications is not a solution. Despite some side effects of NSAIDs which do need to be monitored, it would not be very helpful to tighten up their use when trying to limit the use and prescription of opioids for pain. And it doesn't seem like a legitimate criticism that a large fraction of surgery patients don't end up using their opioid prescriptions. These are given after surgery just in case they're needed to minimize post surgical suffering. The alternative would be to let everyone who has undergone surgery to suffer pain, since there would be no easy way to get the medications later.
3
JAMA published a study which indicated 4 ibuprofen provided virtually the same pain relief as a narcotic. I believed it until I needed dental surgery. The opioid helped far more. It is surprising to learn that NSAIDS can precipitate artery clogging.
2
A family member has had his antidepressant medication increased because a tolerance develops over time and lower doses stop working. No one suggests *he* is in an *addictive* pattern despite the fact that the drug make him feel better not increasing causes suffering,. Dosage increases are normal for nearly all medications for chronic conditions, including ones like blood pressure meds and statins No drug I have ever taken has worked the same over a long period of time.
I therefore find this mass attack on pain medication profoundly uninformed about how all medication actually works. A goal should be the most effective drug with the least side effects for the individual patient. For me and many other patients with severe chronic pain (including burn patients, former open heart and cancer surgery patients, people with chronic orthopedic degenerative diseases) opioids work best, often in combination with other kinds of drugs and therapies. Please stop spreading misinformation that only causes suffering. A vast majority of people use their pain medication properly - yet every poorly-sourced article leads to more post-surgical patients being mocked and under-medicated. chronic pain patients are criminalized into a state of high anxiety and terminal despair. I wish you would focus on this inhumane situation, and other more pressing issues, such as what can be done about the adulterated cheap heroin, which is by far responsible for the deaths.
9
neuromuscular disease will leave a person screaming for pain relief. the punks out for a high and escape from their mundane lives will fall into this addiction. it is not an addiction if it works to alleviate pain; it brings a sense and feeling normal. i have CIDP/diabetes and that combination will stop a man or woman their tracks. a smart person will use these drugs wisely, knowing they work too mediate [pain over time, however other drugs can be used to carry the pain lead: nortriptyline, gabapentin, Lyrica, etc. for real sufferers of pain there is NO drug epidemic, only a much larger knowledge of pain relievers. i'd like to take these addicted numbskulls and knock their heads together so I don't feel like a potential junkie every time I change opioid doses. and, btw, the body produces its own opioids, that is why we humans have opioid receptor. if we were hot such a gluttonous society common sense might prevail...and the PHARMACEUTICAL industry might stop trying to play us like greenhorn Las Vegas gamblers or rubes. OPIOIDS WORK FOR ME AND WILL FOR A LIFE TIME BECAUSE CIDP IS A CHRONIC DISEASE.
4
Gotta love the folks who pile on in any crisis to further the interests of their own narrow misbelief or the economic interests of big pharma and medicos. Let's make aspirin a controlled drug! That way her doc can charge $100 for writing a scrip and some drug company can charge $500 a bottle
3
An unanticipated side effect of the aca has been to increase opioid use. Because pts can now "rate" their care, doctors are under tremendous pressure not to be downgraded especially for things like pain control. If a pt is unhappy with their care, especially pain control, a doctor/Hosp/clinic can get a bad rating and it can negatively affect their practice. This comes from politicians, corporations, lawyers, and special interest groups like big pharma writing health care law. If you work in an ER and a pt comes in looking for pain meds, it's often easier to give them opioids than risk the wrath of the administrators and bad ratings. I wouldn't expect the repubs to do any better, but at least part of the current opioid mess is from a misguided attempt to have pts control their care, which at least in some instances amounts to addicts controlling access to the drugs.
1
I have endured chronic spinal pain for years and have been through the gauntlet of prescription pain meds, only to finally release myself from all of that medication. I have learned to manage my pain through appropriate physical exercise, massage therapy, limited amounts of Tylenol, and occasional sessions with a physical therapist. Even though I still have some pain to a certain degree, I am well in tune with my body and I no longer walk around in a stupor.
These powerful painkiller drugs should only be used when absolutely necessary. I am so grateful to have that burden off my shoulders.
3
Anyone who has worked in a hospital, and especially an ER, could tell you there was a serious problem with opioid addiction over a decade ago, if not before that. It is relatively easy to tell a person in real intense pain from one who is drug seeking. We call them our Frequent Flyers. Since the mid 1990's I have been made to take a educational module and then a test once a year written by the Pharmaceutical companies for my hospital for all their nurses. This "module" emphasizes the importance of the fifth vital sign of pain and actually still says that you cannot get addicted to opioids, we should call their habit a "pseudo" addiction. The medical field has been influenced by the drug companies in so many ways to push their products for them. It is a part of the problem as you mentioned. Opioids are given out to just about every person I care for for the smallest of surgeries. I now work in oncology and see the benefits of these opioids for those patients dealing with terminal cancer who need these drugs. However the addiction of our country is real.
Here is an example from my physician practice. We were getting about 2-3 calls a day from pharmacies about phoned in hydrocodone (when you still could phone this in) prescriptions that sounded fishy. And these calls were only the ones who questioned the RX. The DEA actually came in to see who was doing this. Turns out one of the MD's relatives had stolen his DEA number and was selling and or taking the meds herself.
3
okay, how do you tell?
My daughter had extensive bone surgery and required pain relief. Every opioid made her so nauseated even the most powerful anti-nausea drugs did not help. She couldn't keep the pain drug in her stomach long enough to get any relief. After trying several in increasing "severity," she was given one that got into her system fast enough to get a little relief before it inevitably came up like the rest. A year later a second surgery: despite informing the (different) surgeon of her past experience and requesting the drug that worked, she was made to endure two days of constant, "productive" nausea and intense pain while she AGAIN had to work through the different levels of drugs before she was given a prescription for the one that worked.
It's hard enough to endure such misery, but to be treated as a drug seeker made it even more difficult. Of course, these were "drive-by" surgeries with the messy recovery at home, and the ordeals entailed many phone calls and extra trips to the pharmacy.
I understand trying to balance the needs of people in pain and the public good. However, do we really have to make people want to die because of untreated pain? Sure, don't hand out opioids like candy, but don't withhold them from people in great need. My daughter ended up with a second two days of unnecessary torture and at least two bottles of opioids she didn't want and couldn't use. This, so we can reduce the amount of unused opioids in people's hands. Feh!
7
In the pain game there is no free lunch. If you are faced with a chronic pain syndrome that is not amenable to surgical intervention, your choices are stark, few and not great. You can live with the pain, which I have done, and is not fun. It affects your work, socializing and impacts every aspect other of your life. Behind door number two there are NSAIDs but thousands and thousands of patients present to the ER with GI bleeds that are caused by NSAID use every year. Behind door number 3 are opioids. They have high efficacy compared to the alternatives but tolerance is a significant issue and the doses tend to climb. Hyperalgesia contributes to this problem. Higher doses mean more pills and more potential for some one around the patient to access that medication.
While there are no easy answers here, I can definitely say that eliminating opioids from non-palliative care environments would be catastrophic. The human suffering caused by such a policy would raise suicide rates, divorce rates and cost billions in lost wages and productivity.
5
There's a little bit of false equivalence here. NSAIDs probably have dose-dependent problems—kidney injury, erosion of GI lining, cardiac. Acetaminophen has threshold-dependent liver problems. At recommended doses it doesn't cause toxicity, and probably still doesn't when used chronically. In overdose, it can be extremely deadly, far more so than NSAIDs.
3
I have chronic osteoarthritis which has destroyed a number of joints in my feet and hands. Until a couple of years ago, it was in the process of doing the same thing to the hand and foot joints. I had tried everything. NSAIDs, COX-2 inhibitors, diet, steroids to no avail. The disease kept progressing.
They I got a medical card two years ago. After trial and error I settled on a dose of a indica dominant medicinal brownie that I take each night before bed. Over the two years since, the pain in the joints that were just starting the disease process stopped completely. The joints no longer burn and the inflammation has dissipated. It does not help much with the joints that are too far gone and where bone is on bone, but even there it helps a bit. I also sleep better since the pain does not wake me anymore.
Yet, I have to deal with an attorney general who thinks I am nothing but an addled drug fiend and am either lying or delusional about the impact medical marijuana has had on me. He wants to close my dispensary I am sure.
9
I can understand that doctors and medical organizations oppose opiod and NSAID abuse. But I haven't heard one decent suggestion about pain alleviation for those who need these drugs. And please don't give me some mumbo-jumbo about exercise, Chinese medicine or psychotherapy. Give me a genuine alternative and I'll try it.
6
I'm an ER doctor in NYC. It's informative to read the perspectives of people living with chronic pain; I understand the defensiveness people may feel when they believe they're being accused of being drug addicts.
Nevertheless, there's an epidemic of addiction. Maybe it's not you and your doctor who are to blame, but we can't lose sight of the public health picture: there's an alarming correlation between doctors prescribing narcotics and our tragic overdose epidemic. It's a similar argument with gun rights. You, gentle reader with the gun, are law-abiding and not psychotic, but there's plenty of people out there who have powerful firearms and aren't as well socially adjusted. And our society suffers because of it. So, from a public health perspective, we have to make policy changes for the benefit of the greater population.
A couple of points: 1) little evidence that narcotics for chronic pain provide net benefit to patients - yes, extremely difficult to prove, but still...
2) also little evidence that taking NSAIDs with food will mitigate their side effects; that's conventional wisdom but not proven medicine.
3) I also question whether there's evidence that topical NSAIDs have less systemic side effects; perhaps the author could cite.
In my practice, I only give narcotics in the ED for painful emergencies (broken bones, intraabdominal infections, etc.), with no home prescriptions, with the exception for patients with painful terminal illness, usually metastatic cancer.
4
So much depends on language. Prescription opioids are "medicine," while heroin is a "drug." Does the benefit/detriment of something really depend on what it is called. "Doctors" and "drug dealers" are both trying to make a livelihood (profit motive). Only difference is rules of the game. Drugs, we are told, have no health benefits, but medicines do. Do I trust the government to make the decision of what will and won't benefit/hurt me? Let me make that call; it affects me the most after all.
Medicine is just as important as propaganda or police in controlling a population. CEOs of big pharma should either be in jail (to see the destruction they caused their clientele) or forced to fund rehabs (with their salaries). Our whole country is living in an abstraction. These problems build beyond the veil, eventually piercing it with their enormity. At that point, my father calls: "Your brother is addicted to heroin."
2
I am very concerned about the opioid epidemic. But I am also concerned that people in real pain are not always able to get the paid meds that they need. It seems to me that our current prescription-based model for dispensing drugs causes almost as many problems as it solves, often making it too difficult for people to get medication they really need. I'm not really sure what the answer is. I'm tempted to say just eliminate the prescription-based system and make all drugs available over the counter without a prescription. That's probably not the answer. At the very least, our current prescription model needs some kind of make-over.
2
I keep reading that our problem is unique, if not in kind then in degree. We consume most of the world's opioids, just as we consume more than our share of the oil and....
More detail on how other first world nations handle pain would help. We shouldn't be out here re-inventing a wheel.
Perhaps a bit off the main emphasis of the article but the statistic of 100 million persons in the US with chronic pain seemed suspicious. One in three, really? Yes, as cited in the National Institutes of Health source. But no, not really. After tracking down the original source (Tsang A et al, Journal of Pain, 2008:883-891) this number appears to be a spurious extrapolation from the data in a study looking at the association between pain and depression or anxiety. The criterion was a chronic condition (such as headache or back pain) in the past 12 months. No controlling for duration or intensity. A sample size of 85,052 across 17 countries. Hardly a basis from which to declare that 1 of 3 Americans live with chronic pain.
11
Who are these doctors who over prescribe opioids? When my husband shattered his leg in a fall, he was sent home from the hospital with one days supply of Percocet and it was close to impossible to get more even though he had a shattered leg. Then trying to fill his prescription was a challenge, I went from pharmacy to pharmacy trying to get his pain meds and half wouldn't fill and the other half made me feel like a criminal. In my experience, the pendulum has swung too far to undertreatment of pain he re in Florida.
10
Another case of damed if you do and damned if you don't.
When doctors did not prescribe narcotic meds readily, they were not being serious about patient pain, and the the agencies decided MDs had to make it a priority to measure it at every encounter and to treat it effectively.
Patients rated their MDs on the quality of the medical visit, and their degree of "satisfaction". Not prescribing opioids meant not taking their pain seriously.
Now that there is an "opioid epidemic" the pendulum is swinging the other way, with doctors so blamed for overprescribing opioids that they are reluctant to do so even when their indication makes this necessary.
The bottom line is that there is no perfection in life, and so in medicine.
Do no harm becomes, do the LEAST harm and help the patient stay well.
With every decision that is made, there is consideration of the benefits against the liabilities, and it is all tailored to that particular patient.
Doctors should follow certain criteria to prescribe ANY medication, and certainly opioids. HOWEVER, Intense pain is terrible suffering. Opiods should not be withheld when indicated and patients who need them should not be treated as drug seeking addicts.
15
Sorry to nit-pick, but the lyrics of "It Ain't Necessarily So" were written by Ira Gershwin, not George.
9
My liver specialist says NSAIDS are worse for the liver than Acetaminophen, which should be limited to no more than 2000mg per 24 hours if you have liver problems. He warned me about Cox2 inhibitors when they first came out! Diclofenex is bad news even as a gel if you have liver problems. Actual opiates (derived from opium) don't destroy your liver, heart or kidneys but docs are too afraid to prescribe, so push a variety of dangerous substitutes that do nothing but cause side-effects.
5
In principle, I agree with "ultimateliberal" but I hesitate to assume that I know how pain feels to anyone other than myself. I would support his or her comment fully if it was presented as a suggestion; for example, the Lamaze method of focused breathing, etc. has been very helpful to many people with pain so it's definitely worth trying. But in spite of good intentions it's wrong, and seems arrogant, to assume that something that works for me is going to work for you, let alone everyone.
My partner was given a prescription for 30 (thirty!) Norco following an uncomplicated tooth extraction. He never took even one, but he's a tough guy; I might have taken ONE. I jokingly said if he ever needs some quick cash he could sell them at $10 apiece.
I
2
The doctors were told pain is the 5th vital sign and must be treated. Then we were told it is illegal to keep a patient in pain. Add to that patient satisfaction scores (withhold narcotics from patients asking for pain relief and watch your satisfaction scores dive down). The government tried to legislate judgement and now we see the results of widespread addiction. Now I read the following from the NY times: "physicians and dentists who prescribe opioids with relative abandon, and patients and pharmacists who fill those prescriptions, lend a big helping hand" It is a frustrating situation. But to blame physicians when many of us opposed all of the pressure to prescribe more and more is ridiculous
3
Actually, George Gershwin DIDN’T write, “It Ain’t Necessarily So”. His brother Ira wrote that lyric. George wrote the music which accompanied it.
2
In the SF Bay Area were I live, my doctors are not handing out opioid pain relievers like candy. Maybe it is because they are more aware of the dangers of opioid addiction.
When they do hand out an opioid prescription, it is a small number of tablets and they monitor how much I am using. I have had them twice after two separate knee surgeries and I took them very rarely. NSAIDs work better than opioids for me, but after surgery, doctors worry about NSAIDs caused bleeding which could interfere with healing. Aspirin, Advil, and Aleve, when I am allowed to take them, are superior for me than hydrocodone/acetaminophen tablets. They also do not need a prescription.
2
People need to accept and adapt to the chronic pain they bear. It is fairly easy, with the proper mindset, to accept pain and move "around" it. The last time I had an acetominophen/codeine mix was about 30 years ago. My pain from arthritis is just that--arthritic; not life-threatening. Whenever pain arises in another part of my body, and the doctor says it's not a serious indication of illness, the pain becomes bearable.
To lessen acute pain, use the Lamaze Method of controlled, focused breathing, then get busy amusing yourself with a hobby or good old-fashioned busy work. Or take a nap.
I refuse opiods and NSAIDs whenever they are offered by my physician. And they should ask first, before prescribing. I was in the emergency room recently, following an accident. While waiting for x-rays, the nurse entered with both a pill and a hypodermic dose of opiods. He seemed taken aback when I refused both, then explained that they would ease the pain. My answer: "The pain is bearable, so long as a possible rib fracture is not slicing into my aorta. Opiods? I don't like what they do to me, and I refuse to have them in my body for any reason."
Maybe on my deathbed, but not while I'm still enjoying life--almost to the fullest, in spite of chronic pain.
What a trite and dismissive comment. Nerve pain so bad that it makes it impossible to sit down? Daily debilitating migraines that make it extremely difficult to function if not impossible? Both at the same time?
When these kinds of pain conditions go on for YEARS, it is enough to make one contemplate suicide to escape it. I know I did. Fortunately, I finally found a treatment that has been able to control the migraines thank god. But when every single day is an inescapable amount of pain that makes it impossible to "amuse yourself with a hobby" or engage in any other sort of distraction.
Pain conditions can be entirely debilitating, and while there are techniques that can help (meditation, yoga if you are able, Reiki) the sheer relentlessness of it can drive anyone to go to whatever lengths just to escape it. I'm glad that opioids have never really helped with any of my pain, because that would have been difficult to control. Xanax does help with my nerve pain, but I monitor my intake judiciously.
But sometimes "just getting used to it" isn't possible.
20
thank you I could not have said it better myself
5
Well good for you..
Some people have chronic pain, not from arthritis....
We can't have a quality life, which is what correct pain medication can provide?
But people can have guns &are dying daily...
You're busy messed up & so I'd this government
The negative press about opioids could lead one to think there is almost no legitimate use for them at all. While there can be little doubt about widespread abuse, no one seems to be thinking about the people who truly need them to recover from major surgery. How would you like to undergo emergency back surgery, be discharged from the hospital 3 days later just to find that almost no pharmacy will fill your prescription? This is what happened to me 3 years ago. Despite my condition, no pharmacy would dispense the medication to anyone else. Most would not reveal on the phone if they had enough in stock. If the script is for 28 pills and they only have 27 you get nothing. I spent two hours in the back of a cab, going to 6 different pharmacies before I found what I needed. The process aggravated my pain. No one was available to provide detailed counseling on how to taper. Fortunately I am a good researcher. I cobbled together a tapering plan and weaned myself off in 5 weeks, a week shorter than what the surgeon had advised. It was one of the most difficult things I have ever done. Most people do not have the resources or academic background to do that. Before any other policy changes, we need better or more easily available pain management counselors to advise and monitor patients. This can be the most challenging part of surgical recovery, but gets astonishingly little attention. People and time are expensive, however, and no one seems to want to pay for it.
12
Wouldn't taking aspirin with 12 oz. of fluid be a better idea.
The mantra that opioids have no place in chronic pain is true but only partially true. I will go out on a limb here and say that all properly diagnosed chronic pain patients will have occasional spikes of acute pain. These spikes are bouts of acute pain and are appropriate for the use of opiods.
The anxiety a chronic pain patient has when attempting to do something out of thier ordinary pain defensive life style is crippling without a dozen or so so opiods tablets in their pocket.
It's all a balance. MDs, PAs and NPs must listen to patients and prescribe appropriately. Statewide drug data bases must become proactive and send alerts to Drs when they prescribe to patients seen by multiple providers. Better their EMRs should alert them in real time so that they must manually override the information to prescribe.
The opiods epidemic as reported by the press is poorly done. Reporters report the scary stuff to sell copy. Education is important. Accurate information about how often illegal substances combine to produce the lethal punch is vitally important.
I'm old enough to remember when Drs were sued for not prescribing enough pain meds. The pendulum has swung to the opposite position. Technology is available to help providers. Pain is subjective and providers do not have a crystal ball to identify drug seekers.
4
I'm one of the people who have been prescriubed pain pills--usually by dentists--but dont use them. I hang on to them. They don't solve the underlying medical problems and make me sick. The reason I hang on to them is to be able to euthanize myself when the time comes. Sad that this is the option our horrendously expensive and bad medical care leaves us.
11
I am an MD and see that the LABELING of acetaminophen is wrong. The instructions say every 4 hours and this is why it is one or maybe the most common cause of acute liver failure in this country. Everywhere else in the world tylenol is given every 6 hours no more than 10 mg per kg for kids or no more than 500 mg in an adult. Here in the US the dosing is 15/kg for kids and 500-1000mg for adults. People abuse this medicines and also they polymedicate with cold and flu cocktails. Pharma wants people to get all this meds with no prescription, I think people should get some "education" when they get OTC drugs.
15
This is a pointless article comparing apples to oranges, (almost) any drug when taken in too large amounts will cause harm, but to somehow try to argue that NSAIDs and acetaminophen are even remotely similar to opoids in regards to the problems they cause and their destructive effects general, is ludicrous. Opoids create a chemical addiction and alters the brain (probably permanently), turning otherwise good people in to one minded zombies, willing to lie, steal and often worse to get their drugs and as noted by the author (in an apparent moment of lucid writing), drugs that will loose their efficacy treating pain very quickly, unfortunately by that time it is more often than not, too late and a permanent addiction has been created, courtesy the ignorance of US physicians, their trade groups and the despicable companies who market these drugs... Pablo Escobar is a saint compared to the executives of the companies that make opoids and he died in a shoot out on a Medellin rooftop...
7
As a physician who works with many patients with chronic pain, I'd like to point out that prescription NSAIDs are a very valuable and underutilized tool. There are six classes of NSAIDs and if one does not provide some benefit for a patient, it is very likely that one of the others will. Of course some patients are not able to take them or have to use them with warnings and close supervision, like all prescription drugs. While I appreciate articles that educate people about their medications, it is important not to scare patients and inexperienced providers away from using appropriate and helpful medications.
16
Why don't we make opioids OTC?
1
Because Dr.s would lose their control over you & cops couldn’t arrest you!
2
Target of acetaminophen damage is usually liver, not kidney. Article should be corrected.
http://emedicine.medscape.com/article/820200-overview
2
On closer reading, I see liver damage is mentioned. My bad.
1
I know someone with rhumatoid arthritis, which came on many years ago after a spinal surgery. RA is an autoimmune disease in which the immune system attacks the lining of the joints, causing extremely painful inflammation, joint deformity and bone erosion, among other things. She's unresponsive to the usual medications prescribed for RA patients. Last year her medical team tried a risky therapy that involved giving her chemo meds to shut down her immune response and relieve the constant pain; the first time they tried it, she had a bad reaction and almost died. The second time it worked, but only lasted a few months and put her at high risk of death from common infectious diseases. This therapy costs tens of thousands of dollars. Her other, more affordable option is fentanyl patches. They make her so tired she sleeps all day long, but they mostly stop the pain.
As long as our discussions of the opioid crisis focus on the drugs, we will get absolutely nowhere. The problem is the pain. Pain that can hit at any age, for no obvious reason, and from which you never recover. Pain that takes away everything in your life that gives you happiness, joy, and meaning. Pain that erases your identity. Pain no one else can see because you look "normal". Until doctors and researchers start taking it seriously, and until the general public demands that they do, opioids will continue to be among the best of all the poor options that are currently available. And the crisis will continue.
39
Thank you for posting this. A lot of people don't understand what intense, chronic, daily pain does to you. You can't just " breathe " it away.
7
Finally, someone taking note of the fact that the alternatives to opioids are dangerous. NSAIDS can exacerbate coronary artery disease and cause gastrointestinal problems. Acetominophen can cause liver damage.
Yet doctors, in their rush to avoid the current "bad drug of the day" will often just brush of pain complaints with "just take some Tylenol, or Motrin." That's best for them because they won't go on a DEA list for prescribing opioids, but is it best for the patient? I personally can't take NSAIDS and Tylenol is really not a good pain killer on it's own, so that leaves opioids, which in this current climate is a non-starter. I'd like to know where they're giving them out like Tic-Tacs, because I get NOTHING for chronic pain. And yes, I sometimes take way too much Tylenol, because that is all that is available to me.
Maybe this article will help people to realize that there are positive and negative aspects to every medication, and stop treating opioids like the bogey man. Used judiciously, they are excellent plain relievers, but the current climate is causing even those who need them to go without.
13
"used judiciously" as you mentioned, is the key here. there is a place in pain relief for opioids. The real as actual bogeyman isn't the opioids themselves, the bogeyman is manufacturers of opioids who would strenuously endeavor to have doctors and patients underestimate the potential for severe addiction. Equating taking too much Advil or Tylenol with the danger and societal impact directly caused by the very real opioid epidemic is minimizing the severity of the opioid problem.
Guns are more dangerous & kill more people daily...more than alcohol, pain medicine &car accidents &no one cares...
Why isn't the govt doing something to control guns instead of people who are in cronic pain?
I'm so outraged when yesterday in Walmart a man just walked in &started shooting killing 3people...but that's OK.
Hey people in pain, cheer up... we'll probably get shot in a grocery store & won't have to be in pain anymore...
2
The article incorrectly states at one point that taking large amounts of acetaminophen over a period of time could pose a threat to one’s kidneys. In fact, acetaminophen has far less of a deleterious affect on kidneys than other NSAIDS. Rather, it is acetaminophen’s affect on the liver that is worrisome. Large doses of acetaminophen (for whatever length of time) have been linked to severe liver problems - even complete liver failure in some cases. When it comes to kidney problems from pain medications, it is drugs such as ibuprofen and naproxen that one should be concerned about.
4
if you develop liver failure from acetaminophen toxicity then that may lead to an acute kidney injury.
During prohibition, patrons found a way to partake in alcohol, if that was to their choosing. It was a personal choice. Opioids are also a personal choice after your prescription runs out. It's hard to believe a dentist would prescribe more than 1 week of pain medicine for a tooth extraction. It's your responsibility to police yourself; you know right from wrong. Stop blaming others for your weakness.
1
Maybe you should learn more about addiction before you make ignorant statements which are not based on fact.The fact is that addiction is a disease.Those who are susceptible often take painkillers for an appropriate reason but then find themselves addicted. An addict, once he has become addicted to an opioid, HAS NO CHOICE. To an addict it feels like you are underwater and out of air, no matter what or how you do it you must get air. An addict needing another dose of medication can only focus on the next dose above and before family, friends and everything or anyone they hold dear to them.Once clean the actions an addict took to get drugs can be hard to face, but we can with courage and honesty face our past, deal with the consequences, make amends to those we can and move on to live a productive life once again.DON'T EVER TELL ME I DIDN'T HAVE THE WILLPOWER OR WANT TO STOP BAD ENOUGH TO STOP ON MY OWN - THAT'S WHAT ADDICTION REALLY IS.Obsessed with thoughts of using and compelled to use, there is no willpower involved at that point. Inpatient treatment with attention to outpatient aftercare and counseling start the long process of recovery. I won't use drugs today I am certain. I will always be an addict of that I am certain. I can never take opiods without "reactivating" my addiction back to where it was and not having control, of that I am certain. I struggle every day to stay clean and will do so every day for the rest of my life, of that I am certain.
4
Stop using the word 'fear' in the title of articles about health. What we need is to use all medications wisely, but fear is useless. I've met people who 'fear drugs' and could have better lives if they understood how to use drugs wisely.
8
When the article says of "810 patients...42 percent to 71 percent failed to use the opioids," does that mean they didn't use any (which certainly sounds like more were prescribed than needed) or that the patient's didn't use the entire quantity prescribed (which would it be expected.) In other words does "use" mean "use up" or "use any?"
4
There is no good data no matter what was really meant.
I do fear those who need to take strong narcotics for pain will once again be shut out of access to the only medicine that allows them life. Please read Dennis Prager's article in the 1-16 issue of National Review. He gives an account of a friends suicide due to inadequate pain treatment. There is a new consensus that treating non cancer pain caused our present crisis. If that is the case we must rehabilitate Dr Kevorkian. It is illegal to leave a dog in pain. Not so much for humans
10
Pain management? Again? When do we learn about pain prevention?
Runners taking pain medication? Is there then nobody who can draw the obvious conclusion?
If it hurst, stop doing it.
That's right. If it hurst, stop doing it.
If potatoes and Chardonnay give you arthritis, stop consuming them. If your posture makes your wrists hurt, find a better posture. If your legs get restless after too much sitting, get up and walk. If cornflakes give you high cholesterol, try oatmeal. And if too much running makes your muscles ache, run less.
Giving in to pharmaceuticals should be at the bottom of our option list.
12
You do know that many, many people who suffer from serious chronic pain haven't brought it on themselves with anything they've done, right? And that for certain people with repetative stress injuries, it might not be possible to stop what they're doing and still, for example, have a job.
Part of the reason the opioid epidemic exists is that chronic pain is not taken seriously, whether by doctors or researchers or random people on the internet. It's much easier to throw dangerous and ineffective medications at patients and hope they'll just go away, or insinuate that its their fault they're in pain and refuse to offer meaningful solutions (which may or may not help a given individual, but are at least something). Being in constant pain changes the way the nervous system functions over time, making the brain and spinal chord more sensitive to pain signals. There aren't a lot of helpful treatments available to deal with this problem. Warm water physical therapy, yoga, tai chi, massage and the like may temporarily soothe the nervous system and offer some relief. Eating oatmeal? No so much.
17
How do you treat old age?
4
Talk about “pie on the sky” idealism. Please! You sound like the Regan lady that said of drugs,”just say no.” Let’s see how well that worked out...it didn’t !
Another question I have to ask...how many of those 142 people that died every day were opioid deaths (i.e. prescribed Percocet, Vicodin,etc..as opposed to illegal use). I have a feeling this number also included many deaths from heroin, meth, etc.,etc. Not all those deaths were from opioid use. NYT needs to be more exacting in their listing of stats.
18
Author Sam Quinones book about this subject: Dreamland
2
Dreamland. Great book...there were two streams of access that came together: Mexican drug dealers and Big Pharma...which led to the current disaster.
1
And the author neglects to mention that acetaminophen used topically can damage your liver just as effectively as when taken orally.
3
What all the articles I search, none ever deal with intractable, unrelenting neuropathic pain.
All that is ever discussed is interventions which would not make a dent in it.
(The level of root canal without analgesics, major surgery with no medication pain.) It exists.
The patients who live without relent.
An alternative must be found. Otherwise, what IS the choice?
Invent an alternative. One that works.
and please please as I have, being a partner, learn that sometimes it is beyond quality of life, it is survival.
15
Gabapentin! Best for neuropathic pain. It is perscription so find a doctor who is familiar with diabetic pain, not necessarily your PCP.
1
Worst drug I ever took. Within a year to get the same, mild effect I went from 900 mg to over 3000 mg, The most common side effect is severe aphasia - your memory will be shot in other ways as well. It is also severely sedating. And, physically addicting, in the sense that your body becomes dependent on it - it took me over a year to be able to stop taking it even though I knew it had barely helped and wanted nothing more than to be free of it. It is an anti-seizure drug previously only given to severe epileptics. It is not surprising that it messes up so many higher functions. Meanwhile, no side effects whatsoever from any other drugs.
Hello! I am a pharmacist and would like to make a correction to the article. I believe the article meant to say that a high dose of acetaminophen can cause LIVER damage. This is also a risk because it is found in prescription medications, most commonly in Vicodin or Norco.
Please note the black box warning for acetaminophen Hepatotoxicity: Injection: [US Boxed Warning]. Acetaminophen has been associated with acute liver failure, at times resulting in liver transplant and death. Hepatotoxicity is usually associated with excessive acetaminophen: intake and often involves more than one product that contains acetaminophen. Do not exceed the maximum recommended daily dose (>4 g daily in adults). In addition, chronic daily dosing may also result in liver damage in some patients.
19
I am a former WebMD reporter and have continued on with my daily health site https://healthsass.blogspot.com, not because I make money (google keeps it somehow), but because I run across info others might be interested in. We also have opiate addiction issues in our family. Yet, I kept thinking acetaminophen was an anti-inflammatory as well as a painkiller--so I took two each AM to get my arthritic knees off to some sort of start. Now I know it is not cutting inflammation, so where from here? Just oooo and ahhh, I guess. Or as we say here in Phoenix, cowboy up.
3
Take Turmeric, active ingredient called curcumin. Also Ginger. Both are available in capsules over the counter.
3
Double blind studies?
5
I take Tylenol for osteoarthritis pain relief and I am concerned about the consequences for my liver. Oddly, Medicare does not cover routine (annual?) checks for elevated liver enzymes that would be a sign that the Tylenol is having a negative effect. This is crazy given the reported incidence of Tylenol related liver failure in the USA. Please note that I cannot take any aspirin or NSAID's due to a systemic Asthma allergic response to these drugs.
7
Actually, Ira Gershwin wrote "It Ain't Necessarily So." George wrote the tune Ira could add the lyric to.
6
The first medication my son abused was ADDERALL in high school.
His spiral through the disease of substance abuse went from there until his death from a methadone overdose while working hard to progress towards recovery at age 25.
So no, Opioids aren't the only drugs to fear, let alone pain drugs.
His spiral through the disease of substance abuse went from there until his death from a methadone overdose while working hard to progress towards recovery at age 25.
So no, Opioids aren't the only drugs to fear, let alone pain drugs.
11
My wife suffers from severe chronic pain resulting from 2 cancers and a trans-vaginal mesh that is now descending but inoperable. She takes morphine every day but that is not enough. She needs the help of Percoset for the “breakthrough” pain. She is not an abuser or an addict. In fact, she hates it when she takes too much and gets “high”, so she carefully regulates herself. In any event, the pain never goes away, just lessens with the Percoset. She has tried medical cannabis but that only serves to relax her, not diminish the pain. She couldn’t get by without the Percoset and now she is hampered by draconian restrictions because of the abuse by others. As a solution, people should be carefully screened by interviews to distinguish the truly suffering from those who do not really need it.
34
The people making these regulations really don't care. If you or someone you love has to suffer, so be it, so it might, maybe, perhaps save the very low number of actual addicts.
2
These comments are so ignorant&self rightious...so uncaring.
Why don't you campaign for gun control laws?
People are killed daily by guns &no ones concerned about that...
This govt is so messed up...wanting people who have cronic pain to not have a quality life& not care about the millions killed by guns a year...
Fear all drugs. Opioids, Cox-2 inhibitors, hormonal replacement therapy drugs, thalidomide, statins.
HRT: huge market (obviously), blockbuster drug, then turned out lethal. Next Vioxx and Celebrex, known to cause thrombosis (and thus heart attacks) even before released to the market. Death from Vioxx about 60,000; you can look up Celebrex deaths on your own.
Next the new and ongoing blockbuster: statins. With the advent of the vastly more expensive new cholesterol-lowering drugs, our research "scientists" and MDs are acknowledging the huge adverse effects from statins. You'd better read a lot about statins, especially if you're being put on one for primary prevention! Massive numbers take statins, but mark my words, that will soon stop. As with hormonal treatment, COX-2 inhibitors, opioids, and the other blockbusters, we'll be counting statin deaths and damages very soon.
We fully know that drug companies push their blockbusters. Drug companies illegally market drugs off-market, take massive fines (often acknowledging criminal violations) and count the resulting profits. Again and again and again, even though they sign forms promising not to repeat. No one loses (seriously, think about it) except the suckers who take the drugs.
You should look at the repetitive crimes and no-punishment of big pharma. You should NOT trust those who gets their "science" from the medical journals. You SHOULD first read "Overdo$ed America" and "Deadly Medicines": statinvictims.com
HRT: huge market (obviously), blockbuster drug, then turned out lethal. Next Vioxx and Celebrex, known to cause thrombosis (and thus heart attacks) even before released to the market. Death from Vioxx about 60,000; you can look up Celebrex deaths on your own.
Next the new and ongoing blockbuster: statins. With the advent of the vastly more expensive new cholesterol-lowering drugs, our research "scientists" and MDs are acknowledging the huge adverse effects from statins. You'd better read a lot about statins, especially if you're being put on one for primary prevention! Massive numbers take statins, but mark my words, that will soon stop. As with hormonal treatment, COX-2 inhibitors, opioids, and the other blockbusters, we'll be counting statin deaths and damages very soon.
We fully know that drug companies push their blockbusters. Drug companies illegally market drugs off-market, take massive fines (often acknowledging criminal violations) and count the resulting profits. Again and again and again, even though they sign forms promising not to repeat. No one loses (seriously, think about it) except the suckers who take the drugs.
You should look at the repetitive crimes and no-punishment of big pharma. You should NOT trust those who gets their "science" from the medical journals. You SHOULD first read "Overdo$ed America" and "Deadly Medicines": statinvictims.com
9
Listen to your doctor. Use common sense. Get regular blood tests and control your meds with preventive prescriptive protocols. No protocol works for every person. We are ALL different and no cookie cutter solution exists. Know your body and be aware. Due diligence if paramount. Assume nothing, question everything. You will be ok and have nothing to fear..
6
The NYTIMES has chosen to publish a number of articles on the "opioid epidemic". I worked with statistics; I see the numbers & understand it's a problem. HOWEVER, after 4 spine surgeries and possibly facing more I have been a through every stage and treatment since the 90s. I jump through hoops to get my pain PATCH (i.e. CAN'T BE ABUSED) and think attention is focused on the wrong end! Even the expert neurosurgeon/ pain management Dr from John Hopkins said only a small percentage became addicted. Only prescribe a few post-op with a refill if needed and then there won't be leftover!! One easy fix? Don't prevent chronic pain patients from getting help. (& yes, I do PT etc!).
29
That's always the way it is. Think meth and now we buy sudafed after signing away our first born. So, the majority of people never abuse the drugs or become addicted, so we have to make it extra, extra difficult for everyone to get pain meds. Isn't that the American way?
8
This doesn't compute with my experience or that of a family member. I had two knee replacements this summer and got by with Tylenol and Tramadol the first time. The pain was often brutal and I rarely slept. I asked for oxycodone for the second surgery because I had a good experience in Denver during orthopaedic surgeries.The hospital sought to comply but insurance wouldn't allow it. I got two Morphine pills a day that helped but wasn't ideal. I found the oxy cut the pain, didn't cloud my thoughts or disrupt sleep. I was denied because of the problems of others.
28
I will happily reply to your comment. I have been on a NSAID-Tylendo compound combo for 35+ years. I had spent over 2 years on oxycontin, oxycodone and everything in between down to Tylenol 650mg and my fav NSAID favorite, flurbiprofen 100mg (for 35 years). I have often questioned why I never became addicted to narcotics as I took so many for so long (every year was another surgery and my knees were tough, but so was the spinal surgery.) There were two reasons for this: 1) there are about 10% of the population that does not metabolize narcotics into morphine derivatives, thus the addiction, like the majority of the population. Genetic luck. but that is half the story (smaller half); a physician recently said to me I won't get addicted because you are 'strong'. So what is strong? Strong is feeling peace of mind' being comfortable about who you are, etc. People who are more likely to be effected by drugs and become addicted are in psychological need. Tough life, tough parents, seven generations of sin kind of stuff, whatever fits. . So what I know, along with some colleagues who do a lot of surgeries, is that we do not need to have narcotics to handle many pain situations. in my work I rarely do. Neither does my friend (35 years of surgeries and no narcotics0. So you are right in that you may be able to handle narcotics better than most but, in fact, likely never needed them as much as you originally thought. Doctors prescribe medications to avoid phone calls and law suits.Amen
It seems to me that your doctor's opinion was a personal one and not a medical one, as there is no scientific basis for it. We like to "other" the folks that become addicted as being "not like us", but there are as yet no clear cut reasons why some folks become addicted and others don't. There does seem to be some genetic basis, but that doesn't account for everyone.
3
Isn't this strong gambit sort of like Just Say No....?
2
What about aspirin?
3
Indeed, I take exception to Dr. Campbell's statement, "But for people with Alan history of coronary heart disease, even when taken short term, NSAIDS can precipitate clogging of the vessels". I feel that someone taking daily aspirin for prevention of secondary heart attack could misinterpret this statement to cause concern about the current therapy the person is and at worst being uniformed stop taking aspirin.
5
Acetaminophen (paracetamol) damages the liver, not the kidneys.
13
Julie, ibuprofen (Advil , Motrin) damage the kidneys.
3
yes, the quotation was "Nor is acetaminophen (Tylenol and its generic imitators) always safe. It can damage the kidneys when used in large doses, as might happen when taken for chronic arthritic pain."
This is not true, as acetaminophen damages the liver, not the kidneys.
This is not true, as acetaminophen damages the liver, not the kidneys.
15
We are taught to read.We are taught to write.We are taught to express ourselves.Our needs.Clearly and effectively, or not.We are taught interpersonal skills.We are taught to analyze.Correctly or not.We learn to move from "data," to some level and quality of knowledge.Knowing.We create understanding, with its implications and consequences.Immediate as well as in the future.All of this,and much more, in a range of ways which involve many others and systems.And all of this takes place within a reality of uncertainties,unpredictabilities, and randomness no matter what we do.
and within this daily framework, whatever our internal and external resources, their availability and accessibility there are many types of pains.Physical. Psychological.Spiritual.Others as well.Measurable ones as well as those which may not be.And somehow we have yet to be helped to learn pain management, however delineated, as a necessary. basic skill for daily coping, functioning and adapting to a range of physical, psychological, spiritual, environmental, visual, conflict-laden, dehumanizing, natural disaster, etc., and other type of stimuli, which challenge and effect us.At home.In our neighborhoods.Communities.Work and leisure places.And so many other environments.Safe and less than safe ones.And over time we have learned that there is a "pill," object and metaphor, for whatever ails us.We have also integrated willful blindness, deafness and ignorance to the pains of others. Is this of epidemic levels?
and within this daily framework, whatever our internal and external resources, their availability and accessibility there are many types of pains.Physical. Psychological.Spiritual.Others as well.Measurable ones as well as those which may not be.And somehow we have yet to be helped to learn pain management, however delineated, as a necessary. basic skill for daily coping, functioning and adapting to a range of physical, psychological, spiritual, environmental, visual, conflict-laden, dehumanizing, natural disaster, etc., and other type of stimuli, which challenge and effect us.At home.In our neighborhoods.Communities.Work and leisure places.And so many other environments.Safe and less than safe ones.And over time we have learned that there is a "pill," object and metaphor, for whatever ails us.We have also integrated willful blindness, deafness and ignorance to the pains of others. Is this of epidemic levels?
Sometimes it is useful to focus on a specific problem and possible solutions. Take them on one at a time. And yes, we need to understand that sometimes we will feel physical pain. Not a metaphor.
2
While I know this article is about other medications to fear, I see the same issues given no attention in most articles on medications and pain. Put big Pharma executives on paid salary so they don’t push their drugs to make more money and have doctors get a big bonus. The government has to look at the bigger picture. The social problems of unemployment need to be addressed so young people have something to look forward to in life instead of escaping. One thing that bugs me, people who run chronic pain groups haven’t experienced chronic pain. They don’t get it.. I met my best friend 20 years ago in a pain chat room. That friendship has saved my life. Pain patients are often so alone and isolated and have no hope. Get the chronic pain group leaders to deal with the emotional side affects of being in pain…the terror of having an acute pain attack while shopping, driving and more. Give pain patients some support and hope not a bunch of platitude. Give us hope instead of lumping us in. I now wear a Quell device that has changed my life. Will insurance ever cover it? NO. That would take away all their money. Had the drug companies and the doctors who took a large bonus not pushed all their drugs in the first place perhaps this epidemic could have possibly been avoided. If the bigger picture isn’t addressed nothing will change. Give all people hope for a possible better future and start to fix the bigger picture.
8
Most of these drugs are concerning, even in small doses. A friend sent me this article on how chronic pain is getting managed in a Medicaid population: http://www.outsourcestrategies.com/blog/2017/07/medicaid-pilot-project-e...
1
But people aren't committing crimes to get Ibuprofen!
4
I was SO disappointed in NYT when they ran this story Tuesday with headline about PAIN MANAGEMENT and it only focused on drugs.
There is so much more to real pain mgmt and Brody never mentioned any alternatives. Sad and outdated view of chronic pain.
There is so much more to real pain mgmt and Brody never mentioned any alternatives. Sad and outdated view of chronic pain.
8
"Nor is acetaminophen (Tylenol and its generic imitators) always safe. It can damage the kidneys when used in large doses."
This is wrong and needs a correction. It damages the liver as the next paragraph makes clear. It is safe for the kidneys.
This is wrong and needs a correction. It damages the liver as the next paragraph makes clear. It is safe for the kidneys.
5
All the campaigning to make it more dangerous for Drs to prescribe pain killers is extremely harmful to people suffering extreme pain over a long period. In addition, many drugs easily and inexpensively available in other countries cannot be bought here without prescriptions, the epitome of the nanny STATE. Last year I went to an ophthalmologist for an eye infection, causing a $500 bill . Later when I was in Thailand, I bought the same treatment from a pharmacy for $1.20.
5
Good info. The Fed Govt's war on drugs should be accompanied by a real information war on the misuse and overprescription of pharmaceuticals, especially when there are so many alternatives.
Unlike NSAIDs, Acupuncture, for example, is rich in secondary benefits. Besides relieving pain effectively, it also promotes relaxation and is an excellent for helping with stress management. The same is true of deep tissue massage.
The other problem with NSAIDs is that they are often used alongside myriad other drugs, especially in Seniors. You would be shocked to see how many drugs at once seniors are taking. Does anyone test safety of the drugs they take in combination? www.bodymindwellnesscenter.com
Unlike NSAIDs, Acupuncture, for example, is rich in secondary benefits. Besides relieving pain effectively, it also promotes relaxation and is an excellent for helping with stress management. The same is true of deep tissue massage.
The other problem with NSAIDs is that they are often used alongside myriad other drugs, especially in Seniors. You would be shocked to see how many drugs at once seniors are taking. Does anyone test safety of the drugs they take in combination? www.bodymindwellnesscenter.com
My father passed away from acute liver failure. At 79 years of age he was self medicating with Tylenol PM to help deaden the aches and pains of old age. In addition to his nightly ritual of Tylenol, his doctor had prescribed pain medication that included acetaminophen for a problem with his ankle and was also self medicating with a cough medicine to treat a cold. His dying was brutally difficult to witness. Neither the doctors or pharmaceutical companies were too blame, but in some degree culpable . His ignorance was the cause of his death. 10 years later, my family is now challenged with the rapid decline of my 90 year old mother from acute kidney failure brought on by the daily use of Advil PM. We need to do more to educate the public that these over the counter remedies have significant and sometimes fatal consequences.
4
If acetaminophen (APAP) came up for review today by the FDA for over the counter use, it would probably not be approved due to the potential for overdosing and acute liver damage. APAP is also not a non-steriodal anti-inflammatory drug (NSAID). I am trained as a pharmacologist and I have taught my elderly parents to stay away from APAP containing pain relievers and sleep aids. Of course, there is the potential for kidney damage from chronic use of ibuprofen and naproxen, but the overdose toxicity is not as severe. One of the top causes for acute liver failure in the United States is APAP overdose.
4
While while I agree that this article covers some very important points regarding responsible use of pain medications, I think it needs to be said that people with long-term chronic pain, requiring prescription medication from a Pain Clinic or Specialist, are not responsible for the "opioid crisis"
11
Narcotics have essential medical uses currently without effective substitutes. When has prohibition ever controlled a substence people want? All this hand wringing is going to allow congress to hand the "solution" over to big Pharma, and the result will be a new generation of much worse stuff. Narcotics are naturally occurring, low margin and don't make real money for the prescription drug business. The reality of this tragic epidemic is that, it is one of many; obesity, gun violence, entertainment hate news, all deadly, all profitable.
We have made it clear from our choice of leaders, in the USA money is more valuable than people, and the government is the enemy - which only leaves business. The ultimate products are controllably addictive and have good margins. Cigarette anyone?
We have made it clear from our choice of leaders, in the USA money is more valuable than people, and the government is the enemy - which only leaves business. The ultimate products are controllably addictive and have good margins. Cigarette anyone?
2
When? Never.
2
As a cannabis physician in western Colorado I wean many patients off narcotics with cannabis.
Those with more severe addiction to narcotics have been able to cut in half the amount of narcotics they use. They begin to feel empowered as they move from synthetic chemicals to a medicine provided by Nature. One of these patients said to me the other day, "the worst side effect of cannabis is a feeling of well-being and peace of mind. Time for all of us to wake up and listen to Nature's incredible wisdom.
Those with more severe addiction to narcotics have been able to cut in half the amount of narcotics they use. They begin to feel empowered as they move from synthetic chemicals to a medicine provided by Nature. One of these patients said to me the other day, "the worst side effect of cannabis is a feeling of well-being and peace of mind. Time for all of us to wake up and listen to Nature's incredible wisdom.
9
^^^ THIS ^^^. I noted the absence of cannabis in the article. Why not give people information about what is safe, not just what is potentially harmful?
4
If we are concerned with numbers, alcohol kills over 80,000 people annually in America, and preventable medical mistakes kill over 250,000 -- it's the third leading cause of death behind cancer and heart disease. Maybe we need an Alcohol Task Force, or to declare preventable medical mistakes a national emergency.
6
The truth is one can abuse many things and excessive anything can be bad for people. It is the right application, right amount at the right occasions. Thus you need competent doctors and pharmacists with good characters. And patients need to think for themselves too.
7
The federal government should ban mixing acetaminophen with other medications in a single pill or liquid. It should always be a stand-alone medication so people don't accidentally overdose. The other day I bought a cough syrup that looked identical to what I usually get, but had acetaminophen and other ingredients. It was only in the fine print.
13
While it's clear there are great risks associated with narcotics and particularly the longterm use of them, what I think is more important to point out is that when these medications, both opioids and anti-inflammatories, are prescribed appropriately and responsibly with close monitoring for necessity, safety, and effectiveness, it can mean the difference between living and dying for patients in regard to quality of life. I work at a large research and academic cancer institution as a Nurse Practitioner doing Palliative Care and pain management for individuals undergoing treatment or living with a terminal and often incredibly painful disease. While there are certainly people with histories of or active addictions who get cancer and vice versa, my job is to ensure I am fully educated about the risks, monitor for misuse, prescribe safely, and hold my patients accountable when problems arise which yes, has meant refusing to continue prescribing and helping them find a detox or treatment program.
It's not a perfect system and the rising numbers of deaths for opiate use and deaths from overdose IS staggering but much of that data comes from illegal use of the substances, such as street Fentanyl being imported from China and other overseas countries, not-regulated by the FDA, and entirely unpredictable which should be labeled a public-health crisis all on its own.
It's not a perfect system and the rising numbers of deaths for opiate use and deaths from overdose IS staggering but much of that data comes from illegal use of the substances, such as street Fentanyl being imported from China and other overseas countries, not-regulated by the FDA, and entirely unpredictable which should be labeled a public-health crisis all on its own.
25
This is so true. It is totally unfair to lump someone suffering with disabling pain for the past 7 years, in with addicts who illegally acquire and illegally abuse narcotics. Opioids are just as much of a life-line for people living with a history of chronic pain, every bit as much as triptans are a life-line for migraine suffers or calcium channel blockers are a lifeline for hypertension suffers.
14
Drugs?
The victory of Big Pharma is one rarely mentioned consequence of Obama's dismal failure to lead the nation as President, especially when the Democrats controlled both the House and Senate in 2009, his first year in office.
Tone deaf to pleas from people like Chuck Schumer, Obama arrogantly lectured everyone about the right thing, and "did it my way," in Frank Sinatra's words.
Instead of passing single-payer when he had a filibuster-proof Senate in 2009, Obama sold out to Big Pharma, the docs, the hospitals, and, most egregiously, to the insurance lobby in order to pass his dismal alternative.
And then he fought tooth and nail for the next eight years to preserve his "legacy."
Obama had a rude awakening in November 2016 when Trump clobbered him and his proxy, Hillary.
No wonder Obama is silent.
What legacy?
Obamacare is a paid for, and bought, subsidiary of Big Pharma, which controls the production and marketing of every single drug mentioned in this article.
The victory of Big Pharma is one rarely mentioned consequence of Obama's dismal failure to lead the nation as President, especially when the Democrats controlled both the House and Senate in 2009, his first year in office.
Tone deaf to pleas from people like Chuck Schumer, Obama arrogantly lectured everyone about the right thing, and "did it my way," in Frank Sinatra's words.
Instead of passing single-payer when he had a filibuster-proof Senate in 2009, Obama sold out to Big Pharma, the docs, the hospitals, and, most egregiously, to the insurance lobby in order to pass his dismal alternative.
And then he fought tooth and nail for the next eight years to preserve his "legacy."
Obama had a rude awakening in November 2016 when Trump clobbered him and his proxy, Hillary.
No wonder Obama is silent.
What legacy?
Obamacare is a paid for, and bought, subsidiary of Big Pharma, which controls the production and marketing of every single drug mentioned in this article.
4
YOU people can invade ANY discussion with your hatred and lies. Do you hunt for movie reviews where you can find an Obama angle and a way to promo Trump and attack Hillary too?? How about gardening stories -- you could attack Michelle.
FACTS; we did NOT EVER have votes for single payer -- Lieberman and a few others bailed. At least tell the truth.
FACTS; we did NOT EVER have votes for single payer -- Lieberman and a few others bailed. At least tell the truth.
12
If you don't treat pain effectively you can develop nerve damage and then it will hurt forever.
8
Where is the proof of that ridiculous statement?
1
Sarah,
Ever heard of Shingles?? In about 30% of patients the rash disappears but the pain never does. How about phantom leg pain in amputees??
Ever heard of Shingles?? In about 30% of patients the rash disappears but the pain never does. How about phantom leg pain in amputees??
1
Big problem is how to dispose safely of unused drugs. The local CVS pharmacies in NYC WON'T ACCEPT UNUSED PILLS. I don't want to throw the pills into the garbage or down the drain. Nor do I time to research and travel to designated pill disposal sites. HELP MAKE THIS EASIER!
9
Mix the pills with a cleaning agent, and put them in the trash.
1
As per the FDA, mix the medicines (do not crush tablets or capsules) with a substance such as dirt, kitty litter, or used coffee grounds. Place the mixture in a container such as a zip-top or sealable plastic bag, and throw the container away in your household trash.
1
I have an elderly friend who was given fentanyl without her consent after an operation. The side effects ruined her life. She didn't get addicted (she's not that kind of woman), and there are other cases of negative side effects.
2
What were the side effects that ruined your friend's life???
5
The diagnosis of the precise cause of any instance of chronic, intractable, pain is a complex matter, requiring specific expertise in a wide field of medicine. The determination of the optimum treatments to be applied, medical, surgical, and psychological, is equally complex. All require much time and persistent, repeated, followup in each and every case, to reassess diagnosis and to assess the course of treatment, as well as the issues of duplicated or pseudo treatment, and of patient intent and compliance.
Long-term prescription of opioids is a one of a number of evidence-based methods of pain control for situations of this type. Failure appropriately to treat chronic, intractable, pain leads to suicide.
Broad denigration of opioids, physicians prescribing them, and manufacturers making them available, is not helpful.
Attention must be paid to these issues. The cost of medical training and practice must be assumed and broadly shared, as for all of medicine, by patients and insurers, private, or government, or both.
This type of appropriate patient care is generally precluded or inhibited by current methods of payment of physicians for their efforts.
The fundamental problem now being faced in the "opioid epidemic" is the non-medical and lethal provision of imported fentanyl and its derivatives. This is a matter for enhanced border control and domestic law enforcement.
Arthur Taub, MD PhD
Clinical Professor (ret.), Yale University School of Medicine
Long-term prescription of opioids is a one of a number of evidence-based methods of pain control for situations of this type. Failure appropriately to treat chronic, intractable, pain leads to suicide.
Broad denigration of opioids, physicians prescribing them, and manufacturers making them available, is not helpful.
Attention must be paid to these issues. The cost of medical training and practice must be assumed and broadly shared, as for all of medicine, by patients and insurers, private, or government, or both.
This type of appropriate patient care is generally precluded or inhibited by current methods of payment of physicians for their efforts.
The fundamental problem now being faced in the "opioid epidemic" is the non-medical and lethal provision of imported fentanyl and its derivatives. This is a matter for enhanced border control and domestic law enforcement.
Arthur Taub, MD PhD
Clinical Professor (ret.), Yale University School of Medicine
67
Thank you. I tried to hit recommend fifty times. It did not work.
5
Where I live in the American South, there is no way you want to be anywhere near marijuana because, if caught, you will go to prison for decades. Talk about mean. Having had multiple surgeries and joint replacements, I refuse to engage in another opiate approach to manage chronic, perpetual, debilitating pain, in favor of medical, artificial marijuana cannabis that has shocked me with its ability to eliminate pain entirely. Even fentanyl cannot do that. Ignorance and stigma pervade how we see pain itself. The reason these kinds of addictions to opiates are so available to everyone who wants to take the addiction risks opiates provide, the question is who are we going to allow to die, we have already washed our hands of them; this population of patients has been seen for a long time as losers and disposables. The cracks one can now fall through are wide-open chasms. The culture at large is addicted to rendering us invisible and costly. Hardly worth changing anything about the status quo. The marijuana option addicts no one. It puts the previously disabled back into the mainstream. Isn't that what we seek.
No. What we seek is antediluvian punishment.
And that, too IS the status quo.
No. What we seek is antediluvian punishment.
And that, too IS the status quo.
20
Yes yes yes!!!! Tim you are right on point! I'm trying to get my chronic pain patients off of opiates by using medical cannabis, but the system here in NY is set up to fail... it is way too costly for most people. Why is it that insurance will cover oxycodone but not cannabis? We need federal legalization of medical cannabis, it is much safer than opiates... as well as alcohol and cigarettes.
7
Well said. I have a torn meniscus that cannot be operated on due to scheduling of the facilities, etc., all outside my control. Due to the new oversight and monitoring of opioid abuse, my doc claims his hands are tied and I have to live with this excruciating pain for weeks. I have no history of misuse, abuse or addiction. Who are they saving me from? This indeed is partial confirmation of your assessment of any one even asking for pain relief is now a loser or potential addict.
7
It is callous to compare addiction and abuse with side effects.
5
The war on opiods has left chronic pain patients with stigmatization and undue ridiculous hurdles to obtain treatment. In NJ, the new rules require pain patients to "fail" a drug test or they cannot get a renewed prescription or worse. I was talking to gentleman who had the passed drug test(tested clean) at his rheumatologist because he had been feeling better and not taking his opiod medicine and was fired as a patient. This also means that if a patient is on opiod medication for breakthrough pain and they have a doctor's appt. they must take a dose of the medicine regardless of the need just to fail the test. This is one lost or misused dose as well as someone likely driving under the influence on the way to their appt. The onerous paperwork for the doctors if a patient passes the drug test makes them refuse to continue to treat patients. It is assumed that patients who test clean are selling their medications even though they are using them judiciously and only as needed. You must see the doctor every 30 days for a renewed prescription...a lost day at work. Instead of cracking down on the doctors who abuse their oaths, they crack down on patients in need. It is nothing new. My mother was bedridden in excruciating pain. Her doctor said he was 'saving the good stuff' for when she was worse because she might get addicted. What would it matter if a bedridden woman gets addicted? She died before he deemed her sick enough for proper pain medication. She died in agony.
48
I've been taking a barbiturate/codeine/aspirin/caffeine based pain-killer for 33 years, for relief from wounds received in Vietnam. Until about 3 years ago, it was fine by me and my doctor for me to take 2 five times a day, on average. After my doctor retired the next cut my dose in half, with no help in adjustment. Then I got kicked to the curb when I tested clean. Went to the VA, got cut down some more, again with no help.
After months of having two good weeks followed by two of the sheer horrors of withdrawal, I was referred to an acupuncturist. With her help, and by turning my intense anger at the Feds, the State, and the health profession's lack of spine into a determination that I would no longer allow them to be able to torture me, I now am able to take this medication
only occasionally.
Rather than feel all sanctimonious about sobriety, it really is rotten. Senior now, I find I have a wide selection of pains I didn't feel before. My quality of live is poor - good days are as rare as a $2 bill. I, and many other seniors, are being lumped together statistically with those trying to use heroin, but od on a fentanyl/carfentanyl/? cocktail.
To really cut down the death rate, legalize and regulate heroin, so what the addict gets is what they expect, and they can get help if they want. To condemn seniors and others who need relief from chronic pain is misguided cruelty.
After months of having two good weeks followed by two of the sheer horrors of withdrawal, I was referred to an acupuncturist. With her help, and by turning my intense anger at the Feds, the State, and the health profession's lack of spine into a determination that I would no longer allow them to be able to torture me, I now am able to take this medication
only occasionally.
Rather than feel all sanctimonious about sobriety, it really is rotten. Senior now, I find I have a wide selection of pains I didn't feel before. My quality of live is poor - good days are as rare as a $2 bill. I, and many other seniors, are being lumped together statistically with those trying to use heroin, but od on a fentanyl/carfentanyl/? cocktail.
To really cut down the death rate, legalize and regulate heroin, so what the addict gets is what they expect, and they can get help if they want. To condemn seniors and others who need relief from chronic pain is misguided cruelty.
39
I work as a nurse in a small family practice office and I have seen this same situation happen a few times. Before we do a random drug screen we ask when was the last opioid dose taken, and document that information on the lab form. The newer tests show expected metabolites of specific opioids and if the metabolites are not present, the patient is not taking the medication. The problem happens when the patient claims to be taking the opioid and the test does not detect the expected metabolites. The patient needs to be honest about when they took the last dose because the newer test, example Toxisure, are very accurate.
1
There is a compact book on prescriptions available on Amazon for less that $10. I often hand them out to friends and family like candy.
Before I take ANY PILL AND POP IT INTO MY MOUTH I always look it up in the "P. Book" Where I can obtain much more comprehensive info than any and I man ANY M.D. would ever give me. Have avoided many dastardly side effect and dangers of these drugs AND THEY ARE DRUGS with may side-effects that can do you permanent damage. Word to the wise!
Before I take ANY PILL AND POP IT INTO MY MOUTH I always look it up in the "P. Book" Where I can obtain much more comprehensive info than any and I man ANY M.D. would ever give me. Have avoided many dastardly side effect and dangers of these drugs AND THEY ARE DRUGS with may side-effects that can do you permanent damage. Word to the wise!
2
It seems too many doctors automatically prescribe a powerful drug that can have significant side effects without first counseling patients to try lifestyle changes or other non-prescription approaches in a preliminary attempt to manage their condition to an acceptable level (assuming alternatives to address their conditions are known).
I had to have emergency surgery for a strangulated hernia and they set me up with a Fentanyl pump--never pressed it. They also offered me percs...I asked for two tylenol...I had an 8-inch incision--it was sore but no like it was being freshly sliced each time I moved. I know everyone's pain threshold differs...actually my knees hurt worse being straightened in the bed (arthritis). I wonder if sometimes people take post-op med before seeing how bad the pain is...I don't mean to judge asking that...
1
In the past, we as a nation have overreacted to undertreatment of pain, and now we are overreacting to excessive opiate use. For example, my mother's physicians want to cut off her opiates (for chronic pain) because she is mildly dependent on them. Her dose is laughably small. The drugs improve her quality of life immensely. She is also almost 90 years old, so who cares if she has a bit of dependence. The only reason they caved in is because I am a physician. Of course, there are physicians who over prescribe, but let's use common sense and evaluate each case individually, and stop the witch hunt by the feds.
60
Exactly.. common sense is essential, every patient's case is unique. As a palliative care physician I'm now seeing an influx of (responsible) chronic pain patients who are at a loss and don't know where to turn because their primary care docs will no longer prescribe them the small amount of opiates they occasionally require in order to function... as in a month's supply lasts half a year. There is no compassion anymore, just "policy."
5
With this many drug overdoses in today's society, it is imperative that this national public health emergency be more publicized and widely discussed. The issue is twofold, with more people using these drugs, but also a more relaxed distribution of the drugs to patients that "need" it. It could be very beneficial to create a requirement of Doctors to follow certain protocols in order to hand out medicines that could be addictive. It is also necessary to inform more adults about the issue at hand. Children and teenagers will search around their parents medicine cabinets, looking for anything that could give them a potential high. Before a parent can even realize anything is missing, their child is hooked on painkillers. It is absolutely vital that adults keep better track of how they store and dispose of the dangerous drugs they receive from Doctors. It is also very important that the public youth is educated on the dangers of these drugs, and the degree of seriousness that falls into place when just taking one of these addictive pills. It is important to solve all sides of the problem: educating Doctors, adults, and children of the dangers of this very serious pill problem.
1
While marijuana may not provide complete relief from pain, it certainly removes anxiety from most people who use it. Unfortunately, not enough studies have been done to prove the benefits of marijuana but I wonder how much less dangerous it is than opioids. I assume it is MUCH less dangerous and quite satisfying for a lot of people.
11
Some pain meds have zero effect on reducing pain for me. Percocet and Alleve to be specific. Luckily, Advil and Aspirin work. Other than dental pain and a site specific drip post surgery, I have had little occasion to use pain meds. What I and my physician do not know is what would work should I need one in the future. Much of the pain med prescription scenario including what dosage level cannot be generalized or predicted. Friends have shared that their unused prescriptions reflected the reality that the drug did not work for them either.
2
Lidocaine patches are also a safe alternative. They are seldom covered by insurance, which is criminal, I think.
11
Lidocaine is strictly topical.
2
Yes, Lidocaine patches work wonderfully for many types of pain!
3
My 15 year old took Motrin for four days after oral surgery and suffered a kidney injury. Drink lots of water with those medications. Dehydration plus Motrin was a disaster.
8
Motrin is a brand name for ibuprofen, which is just about harmless.
ibuprofen is not harmless as we found out. Our pediatric nephrologist sees damage to kidneys all the time. this was no surprise to him, Be careful with your children. Drink lots and lots of water.
4
Ibuprofen is definitely not harmless. There have been many articles in recent years. Google it. B
1
I am a retired physician, and serious music lover. While I agree with most of the information in this article, I must point out that Ira Gershwin, not George, wrote the music lyrics quoted in the article. George gets full credit for the wonderful music, but Ira, alas, is too often forgotten, as the author of virtually all the clever and interesting Gershwin lyrics.
24
A relative of mine had knee surgery a couple of years ago and was sent home with a prescription for one hundred Percocet. I thought the surgery was performed well. I also think that the surgeon who prescribed a hundred Percocets acted completely without rationality. About twelve would have sufficed for the acute phase of the postop period. As it turned out, my relative used none of them at all, and did well with Motrin and physical therapy. That leads to another question, which is how did they dispose of the hundred pills? I have no idea.
2
Disposal of unwanted or unused medications is a BIG issue, not just for opiods. We are told not to flush them as they wind up in the water supply. We can't throw them in the trash for a number of reasons. Pharmacies used to take them and return them to the manufacturers but they no longer do so. Police departments were accepting them in some localities but then it just meant they had a disposal problem.
1
Current Registered Nurse here: Take your bottle of unused narcotics to the closest pharmacy and explain to the pharmacist you wish to dispose of them. They will happily take them off your hands. In this way the pills neither pollute the water supply (by flushing them down the toilet) nor endanger your younger relatives - who statistically are known browse relatives' medicine cabinets for supplies to "party".
5
You throw them in the trash like other basic refuse.
1
I broke a couple of bones in a foot a few years ago and was surprised at the amount of pain pills prescribed to me, with offers of easy refills.
Yes, my foot hurt, but for the acute pain and then after surgery it seemed to me to be better with ice and elevation instead of being zoned out on drugs.
As I recall, the focus was more on the meds than alternatives.
Knowing the risk of the oxy- drugs I avoided using them unless I had to and then sparingly (no refills) - and the surplus is hidden away safely in my home, so I'm as guilty as some of the ones in the article. I will have to take my long-expired stash to the local police station where I can dispose of them safely.
I worry about getting a condition where I might need more in the way of pain management, but I'm disappointed in medical science for not doing a better job of this - I'd like pain relief but not at the cost of becoming a zombie.
Yes, my foot hurt, but for the acute pain and then after surgery it seemed to me to be better with ice and elevation instead of being zoned out on drugs.
As I recall, the focus was more on the meds than alternatives.
Knowing the risk of the oxy- drugs I avoided using them unless I had to and then sparingly (no refills) - and the surplus is hidden away safely in my home, so I'm as guilty as some of the ones in the article. I will have to take my long-expired stash to the local police station where I can dispose of them safely.
I worry about getting a condition where I might need more in the way of pain management, but I'm disappointed in medical science for not doing a better job of this - I'd like pain relief but not at the cost of becoming a zombie.
3
You take old meds to the police?? Huh? You can simply bag them & throw them out, unless you think you are being watched by eyes that can read a prescription bottle through your walls.
2
Many police stations have disposal boxes for drugs. They are in lobby areas. No questions asked, no identifiers, put them into baggies, mix them up. No one cares. there are designated days and drop off areas for the public to dispose of drugs in communities. These are posted. It is a national project. Or toss them in with the nasty kitty litter. Doubtful even the most desperate drug seeker would paw through it.
On another note, Gabapentin which is not a controlled drug is reportedly now #5 in consumer sales and folks it is new drug of abuse. (From the mouths of those who abuse, sorry...misuse...it.) It is being prescribed off label for anxiety, sleep and particularly after surgery. Inexpensive high on its own but also helps crash from crack/smack.
On another note, Gabapentin which is not a controlled drug is reportedly now #5 in consumer sales and folks it is new drug of abuse. (From the mouths of those who abuse, sorry...misuse...it.) It is being prescribed off label for anxiety, sleep and particularly after surgery. Inexpensive high on its own but also helps crash from crack/smack.
Correct about Gabapentin- I'm oncology research RN and dx'd with rheumatoid disease which places me solidly in the chronic pain category, I was prescribed gabapentin as an adjunct to current narcotic regimen. It caused me to feel so high, so out of my body, that I couldn't work safely with patients...told my pain specialist who reduced the dose and we tried again with same results. I told the doc of my experience and that I stopped taking it, I was labeled non compliant in my med records. I did research gabapentin, unfortunately after the fact and discovered the potential for addiction and abuse... I believe it!
The opioid addiction crisis leaves those with chronic pain feeling anxious, afraid...powerless.
Back to my meditation and yoga practice, now that my pain meds have started working for the day-Namaste!
The opioid addiction crisis leaves those with chronic pain feeling anxious, afraid...powerless.
Back to my meditation and yoga practice, now that my pain meds have started working for the day-Namaste!
What is the one required question the nurses ask you in the hospital? How would you rate your pain? Why do they do this? The federal government!!!!! Try to deny them any medication and find your institution or DR's office investigated for low patient ratings.
4
The Federal goverenment is following the World Health Organization recommendations for evaluating and treating pain. But it's true that subjective questionnaires after a patient is discharged (called Press-Ganey) is also tied to Medicare-Medicaid reimbursement rates. One of the questions asks the patient to rate how staff treatex pain complaints.
2
Acetaminophen is hepatoxic in large doses. Damage to the kidneys would typically be secondary to liver injury. NSAIDs, by contrast, are excreted renally. There is good reason to advise cautions with these meds, but please get the facts right!
13
Misuse of any drugs was never a problem in the small Ohio town I grew up in. Any drug use was illegal or severely frowned upon (as was sex) since either could lead to dancing...
17
I see what you're doing here...
(and I approve)
(and I approve)
Did you grow up in Zeeland MI? Dancing was prohibited, Calvanist values and all that. When I was growing up back in the 60's & 70's, they had about the highest teen pregnancy rate in Michigan. & birth control and abortion were also considered a sin.
3
Am I missing something? Is Jane Brody now a licensed physician? If she isn't one, why is the Times allowing her to dispense medical advice:
"When treating localized pain, a topical NSAID, like a gel of diclofenac or ibuprofen, is a much safer alternative. Unfortunately, currently these are only available by prescription in the United States, making them far more costly than in other countries, where a tube can be purchased over the counter for about $10. (My advice: bring some back when traveling abroad, or ask someone to get it for you.)
"Much safer" based on what studies? And Times readers should smuggle in from overseas drugs not approved by FDA for OTC use?
Come on, Gray Lady, let's have some standards.
"When treating localized pain, a topical NSAID, like a gel of diclofenac or ibuprofen, is a much safer alternative. Unfortunately, currently these are only available by prescription in the United States, making them far more costly than in other countries, where a tube can be purchased over the counter for about $10. (My advice: bring some back when traveling abroad, or ask someone to get it for you.)
"Much safer" based on what studies? And Times readers should smuggle in from overseas drugs not approved by FDA for OTC use?
Come on, Gray Lady, let's have some standards.
17
"Much safer" based on the context of the article, that NSAIDs have side effects related to INGESTING THEM. You don't have to be a doctor to understand that difference.
I think Brody is generally a wise Gray Lady but you have a point. The NYT often takes far too many liberties in dispensing advice about drugs, both prescriptive & non prescriptive.
3
not to mention that the article says tylenol damages kidneys, which is wrong.
Nor is acetaminophen (Tylenol and its generic imitators) always safe. It can damage the kidneys when used in large doses - sic
Nor is acetaminophen (Tylenol and its generic imitators) always safe. It can damage the kidneys when used in large doses - sic
As any other substance abuse, prevention should be a foundation guidelines to lessen the overdose epidemic. Efforts should be dedicated to primarily predicting opioid dependence and avoiding deadly overdoses in persons already addicted. The pain management physicians, should closely and thoroughly evaluate patients with possible abuse, and consider the several nonpharmacologic approaches to pain, including acupuncture, manual therapies, and physical therapy.
Changing the method of prescribing highly addictive opioid painkillers is a foremost prevention method. In the consideration of chronic pain patients, pain management physicians need to evaluate and determine how long a patient would be approximately receiving an opioid medicine. In the case of long term usage, physicians should refer patient to other health care specialties, which would possibly solve a chronic pain with a surgical intervention.
Moreover, the prescribing opioid issue arose with drug companies that stimulate physicians which prescribe opioid medications. With the trend of opioid abuse elevation, these financial transfers might be significant and prevalent next to growths in number and cost. The government and its agencies must execute investigations and evaluate financial gain from opioid recommendations in order to regulate the unwanted effect of overprescribing and unwanted overdoses, with the objective to end encouragement for prescribing opioids.
Changing the method of prescribing highly addictive opioid painkillers is a foremost prevention method. In the consideration of chronic pain patients, pain management physicians need to evaluate and determine how long a patient would be approximately receiving an opioid medicine. In the case of long term usage, physicians should refer patient to other health care specialties, which would possibly solve a chronic pain with a surgical intervention.
Moreover, the prescribing opioid issue arose with drug companies that stimulate physicians which prescribe opioid medications. With the trend of opioid abuse elevation, these financial transfers might be significant and prevalent next to growths in number and cost. The government and its agencies must execute investigations and evaluate financial gain from opioid recommendations in order to regulate the unwanted effect of overprescribing and unwanted overdoses, with the objective to end encouragement for prescribing opioids.
4
This article completely failed to mention that Naproxen Sodium (Alleve, etc) has an extremely dangerous allergy effect! Rashes, red/pink skin circles, internal bleeding, itching, skin eruptions, and more! These effects, according to Web MD, can last for 1 month to half a year! I hope not, as I presently am experiencing one (from four doses of one every 12 hours, over 48 hour period), from common over the counter, non prescript tabs: SIX WEEKS AGO! And: there is no cure for the reactions, as I've tried every single inflammation ointment and over the counter anti histamine out there. And NO> Not at the same time, and according to the directions! Caveat Emptor- BIG time!
4
This whole line that people go on heroin as a result of legitimately taking prescription painkillers is a bunch of nonsense. I was on heroin for 4 years, before that I had tried (and didn't like) oxy, codeine and hydrocodone. When I told my Suboxone doctor this, she was very surprised and said that is very uncommon nowadays. I think people are using the prescription for an injury angle to deflect blame away from themselves, and it's terrible that people with pain are having difficulty getting their medication now as a result. I know many who ABUSED these drugs and then abused heroin and that's hardly the same thing as an injury turning you into a criminal stealing etc.
Don't buy into the press coverage of "the opioid epidemic", it's a sympathy ploy without actually doing anything (methadone/buprenorphine is THE most proven effective treatment by science...the people pushing the epidemic angle tend to be 12steps/"abstinence" people)
The worst hit places they never show on TV eg North Philly, The Bronx, Baltimore.
Don't buy into the press coverage of "the opioid epidemic", it's a sympathy ploy without actually doing anything (methadone/buprenorphine is THE most proven effective treatment by science...the people pushing the epidemic angle tend to be 12steps/"abstinence" people)
The worst hit places they never show on TV eg North Philly, The Bronx, Baltimore.
14
Some leading addiction professionals ARE recommending medication-assisted treatment, though Secretary of HHS Price unfortunately is not one. He states it substitutes one opioid for another. http://www.npr.org/sections/health-shots/2017/05/16/528614422/prices-rem...
Buprnorphine is one approach but so is Campral, that has been shown to be effective for alcohol cravings, for example. Drugs like Campral are finding acceptance in 12 step programs. Burprenorphine is too. I speak from experience on Campral but I assume acceptance can vary by locale and meeting.
BUT unfortunately you are very wrong about there not being an opioid epidemic. Statistics on skyrocketing numbers of opioid overdoes deaths are not "fake news."
Sadly, one of the fastest growing groups with use issues is older adults. Many older adults do experience chronic pain. They have increasingly been treated with opioids. Seniors are particularly susceptible to abuse, or cumulative negative effects of drugs because of the number of chronic conditions they have treated simultaneously with numerous medications that interact or magnify effects of each other. Seniors' metabolisms slow down which increases the effect of meds.
One item not often mentioned by Brody or others is the non-narcotic pain meds, egCelebrex, pulled from market because of cardiac or other side effects. So alternative meds have become more limited for seniors and others with pain.
Buprnorphine is one approach but so is Campral, that has been shown to be effective for alcohol cravings, for example. Drugs like Campral are finding acceptance in 12 step programs. Burprenorphine is too. I speak from experience on Campral but I assume acceptance can vary by locale and meeting.
BUT unfortunately you are very wrong about there not being an opioid epidemic. Statistics on skyrocketing numbers of opioid overdoes deaths are not "fake news."
Sadly, one of the fastest growing groups with use issues is older adults. Many older adults do experience chronic pain. They have increasingly been treated with opioids. Seniors are particularly susceptible to abuse, or cumulative negative effects of drugs because of the number of chronic conditions they have treated simultaneously with numerous medications that interact or magnify effects of each other. Seniors' metabolisms slow down which increases the effect of meds.
One item not often mentioned by Brody or others is the non-narcotic pain meds, egCelebrex, pulled from market because of cardiac or other side effects. So alternative meds have become more limited for seniors and others with pain.
1
human being - Addicts ODing is tragic, but their lives are over anyway. The real crisis is new users ie a healthy functional person becoming an unhealthy dysfunctional addict creating cash flow for pushers who ruin other lives.
2
CK, that is just who many users are-older adults included. I am not talking solely of people who entered addiction through street drugs only--not even in 12 step rooms. You find plenty of people there, too, who started with prescription opioids--some for legitimate pain--who graduated to buying "extra" pills on the streets and then, perhaps to other street drugs, including heroin.
But leaving aside the many who were once healthy functional people who become addicted, as you say, remember that those we might see overdosing in the later stages of street drug addiction are someone's child, sister, brother, mom or dad... Sometime in the past they could have been a well-loved teen, a promising athlete or student or even a born kid "troublemaker"--in other words a functioning person. Just because they are "far gone" when we see them, their deaths are tragedies, too.
Many types of addicts or abusers create cash flows for dealers but dealers also come in many types--not all of whom are in open air drug markets in poor urban areas. Sad but true.
But leaving aside the many who were once healthy functional people who become addicted, as you say, remember that those we might see overdosing in the later stages of street drug addiction are someone's child, sister, brother, mom or dad... Sometime in the past they could have been a well-loved teen, a promising athlete or student or even a born kid "troublemaker"--in other words a functioning person. Just because they are "far gone" when we see them, their deaths are tragedies, too.
Many types of addicts or abusers create cash flows for dealers but dealers also come in many types--not all of whom are in open air drug markets in poor urban areas. Sad but true.
1
I see no reason to fear the pain medications under discussion in this article -- or for that matter any other drug that has clearly established benefits as well as adverse effects for some people -- but plenty of reasons to understand them and to prescribe and use them with care. Enough with fearing things and declaring war on them, almost always with dubious results.
15
two items; one "Dr. Campbell said. “But for people with a history of coronary artery disease, even when taken short term, NSAIDs can precipitate clogging of the vessels.”
say what? thats the OPPOSITE of their function. they REDUCE inflammation not exacerbate it.and I have some CAD. I've heard the malarky about their long term use and itrs just wrong. when I was a serious powerlifter, I lived on 12-16 naproxen a day til I figured out alot of what caused my issues. so I fixed it, dont use them much anymore, never ever had any problems stomach and my hsCRP is so low its almost off the charts, total cholesterol is <135 with a statin and I take care of myself mostly not eating junk esp sugar and get enough sleep. people who have trouble with them have inflammation issues most due to poor diets.
second, when appendix ruptured 18 mos ago, taking 3dr ER Dr 121hrs to figure it out had emer surgery. walked 3hrs afterward never taking pain meds even first day. had to fight off nurses and Drs who wanted to dope me up for "my pain" I told them was managable. got out 2d later with a scrip for 30 DAYS of pain meds shoved in my hand. I never filled it. did followup with surgeon 10d later got ANOTHER 14d scrip shoved at me. when I asked who the moron was that wrote it, said if I didnt need it in hospital, I sure didnt need it now, they looked at me like I was speaking Swahili. these people just dont get it. its pills, now, later and forever. and we wonder why our health care is a ripoff.
say what? thats the OPPOSITE of their function. they REDUCE inflammation not exacerbate it.and I have some CAD. I've heard the malarky about their long term use and itrs just wrong. when I was a serious powerlifter, I lived on 12-16 naproxen a day til I figured out alot of what caused my issues. so I fixed it, dont use them much anymore, never ever had any problems stomach and my hsCRP is so low its almost off the charts, total cholesterol is <135 with a statin and I take care of myself mostly not eating junk esp sugar and get enough sleep. people who have trouble with them have inflammation issues most due to poor diets.
second, when appendix ruptured 18 mos ago, taking 3dr ER Dr 121hrs to figure it out had emer surgery. walked 3hrs afterward never taking pain meds even first day. had to fight off nurses and Drs who wanted to dope me up for "my pain" I told them was managable. got out 2d later with a scrip for 30 DAYS of pain meds shoved in my hand. I never filled it. did followup with surgeon 10d later got ANOTHER 14d scrip shoved at me. when I asked who the moron was that wrote it, said if I didnt need it in hospital, I sure didnt need it now, they looked at me like I was speaking Swahili. these people just dont get it. its pills, now, later and forever. and we wonder why our health care is a ripoff.
4
Many of the commenters are leaving comments longer than the article itself. I love how everyone is an expert on everything. That is America now. Rampant racism is bad enough, but insufferable know it all types that type here are even worse.
9
my 90-year old father was prescribed a painkiller for a minor out-patient surgery. We came home; I encouraged him to take one because he was fairly stoic about pain; fell; and was back in the hospital. I later asked the doctor why he prescribed such a strong painkiller for an old man. He told me he did it because it was out-patient surgery. Had he been able to stay in the hospital, he wouldn't have given it to him.
4
Time to take a page from the military: Marine Corps, Army, Veteran's Administration all use acupuncturists for pain management. And have for at least ten years, I believe.
Inexpensive, effective, safe. A panacea: surely not. But in my 15 years of practice of acupuncture I've seen my geriatric and other pain patients benefit enormously from my treatments. And I am no master.
Inexpensive, effective, safe. A panacea: surely not. But in my 15 years of practice of acupuncture I've seen my geriatric and other pain patients benefit enormously from my treatments. And I am no master.
It amazes me how it has never come to public attention the role Social Security Disability (SSD) played in exacerbating the opioid crisis. In the 1990s and aughts I (as an SSD recipient) received God knows how many letters from SSD URGING me to go on opioids so I could reduce my chronic pudendal nerve pain and go back to work. I wish I had kept these many letters, which quoted from the science of the day as to how beneficial opioids would be for disabled people.
3
This is such a great point.
Back around June 12 or so (2017) the NYT published a letter co-signed by Pamela T.M. Leung, Erin M. Macdonald and Matthew B. Stanbrook, all Canadian medical researchers, about the origins of the opioid epidemic.
All of the various "endorsements" of opioids and the claims that they are not addictive (like the one you mention) were traced back to a single one-paragraph letter published in the New England Journal of Medicine in 1980. That 1980 letter was quoted out of context hundreds of times over the next two decades.
Back around June 12 or so (2017) the NYT published a letter co-signed by Pamela T.M. Leung, Erin M. Macdonald and Matthew B. Stanbrook, all Canadian medical researchers, about the origins of the opioid epidemic.
All of the various "endorsements" of opioids and the claims that they are not addictive (like the one you mention) were traced back to a single one-paragraph letter published in the New England Journal of Medicine in 1980. That 1980 letter was quoted out of context hundreds of times over the next two decades.
6
I have suffered from chronic pain, traumatic in origin, for about 35 years now. Opiates became a part of my treatment regimen pretty early on. Every five years or so, always under a physician's supervision, I have tapered off the opiates and stayed off them long enough to return to square one. Each time my doctors and I have experimented with different medications (and non-pharmaceutical treatments as well) to try to deal with the pain and each time I have ended up back on opiates. Sometimes they really are the best class of medications and most of us struggling with life-changing chronic pain do not abuse them.
This article, like many others recently, makes sweeping generalizations about the chronic pain community that only add to the stigma we already bear. I note that this is the first of two columns to deal with chronic pain; I hope the second is less alarmist and more constructive in both its tone and content.
This article, like many others recently, makes sweeping generalizations about the chronic pain community that only add to the stigma we already bear. I note that this is the first of two columns to deal with chronic pain; I hope the second is less alarmist and more constructive in both its tone and content.
19
Michael, I agree with you and understand. I was an exceptionally healthy young adult when I was hit with what became a life-altering pneumonia in my 30's and I have suffered from chronic pain ever since. I had never taken any medication besides Excedrin before, so being put on so many meds was terrible for me, except for the salient fact that they made it possible for me to get out of bed, eat, even walk outside with my dogs again. I have gone off of them a couple of times, but never for more than a couple of months because the pain is just too hard to take for very long. I would be so happy to never swallow another pill if there were just something else that worked as reliably. (Yes, I know the meds aren't healing anything or getting to the root cause of anything, and I have gone through months of PT, seen chiropractors, kinesiologists, herbalists, homeopaths, naturopaths, osteopaths, rheumatologists, massage therapists, personal trainers, etc. I'm still open to ideas, though, if anyone out there knows of anything.)
I do hope we don't all get thrown into the same group and made to feel worse than we already do for taking these medications, though. It's already difficult enough.
I do hope we don't all get thrown into the same group and made to feel worse than we already do for taking these medications, though. It's already difficult enough.
14
I forget the name of the movie, but it has an American Indian actor stating that it is "a good day to die". I would imagine that there are thousands, perhaps millions, of old folks in America who consider that quite often as they are bed-bound and waiting for the only joy they have during the day, night when the bed pan arrives. So let us consider that perhaps instead of praising life, let's set an annual Good Day to Die day, when those of us who are tied of the pain and grief of living are given some of these lethal drugs that we keep reading about. It would be a great day to honor funerals with flags and music and to say goodbye to our seniors as the friends of Socrates did when he decided to go. Why do we treat death as something strange and awful when life can be just as bad? Adios.
12
The movie is "Smoke Signals," based on Sherman Alexie's book "The Lone Ranger and Tonto Fistfight in Heaven." It's a great one! I'm glad you saw it.
1
The movie is "Little Big Man," and the words are spoken by Old Lodge Skins, Jack Crabb's adopted grandfather: "It is a good day to die!" As he climbs on and lies on his funeral bier. He closes his eyes, but nothing happens. "Oh, well," he says, "sometimes the magic works; sometimes it doesn't. Let's get something to eat."
Why this myth that heroin/fentanyl addicts started out with "pain" medication? They're addicts! Period! If they were black instead of white, there wouldn't be all this sympathy for them.
It's not a myth. 75% of heroin addicts who enter treatment started with prescription opioids - not street drugs. I know formerly middle class people who are now addicts; one's addiction began when he was prescribed fentanyl for a broken leg, the other started when she was prescribed opiods for migraine headaches. They turned to street drugs when their MDs refused to renew the opioid scripts.
Also, Ohio's opioid epidemic can be traced directly to pill mills billing themselves as "pain clinics," where MDs will write a script for anyone with $150 in cash. In 2011, prescriptions were written for 9.7 million doses of opioids in Scioto county alone - an area with a total population of 76,000 people.
http://www.cincinnatimagazine.com/features/pill-mill-portsmouth/
Also, Ohio's opioid epidemic can be traced directly to pill mills billing themselves as "pain clinics," where MDs will write a script for anyone with $150 in cash. In 2011, prescriptions were written for 9.7 million doses of opioids in Scioto county alone - an area with a total population of 76,000 people.
http://www.cincinnatimagazine.com/features/pill-mill-portsmouth/
10
One of the stupidest things you see in American medicine is the combining of hydrocodone and acetaminophen. Guess what that does when people take too much. Apparently the doctors or whoever it was who came up with that bright idea don't have a clue, but the answer is: liver damage. Not from the dope, but from the acetaminophen. Nice work.
9
The acetaminophen is to keep the addicts off it. AIUI that’s the rational.
Though I do believe it is important to for the people in America to be safe with the medication provided for them, I fear the things that these opioids can do to the people taking it. There are way to many stories of people becoming addicted to drugs, easily ruining their lives. I believe it all starts with a simple reasoning like this. Drugs left around and not cared for when they are not needed anymore can lead to a big problem.
Not to mention, all the health problems that come with taking these drugs. I was unaware that the drugs could actually harm others while taking them as prescribed rather than helping the person taking it. People believe that even for the smallest amount of pain, it is necessary to take 2 tablets of their prescription drug whenever they feel it. But as seen in the article, this is not the smartest decision.The article mentions many risks that come with taking prescription drugs that no one has really mentioned before. It also mentions safer alternates and the ways to prevent yourself from further injury.
I find this new information interesting because it is ironic that the thing that is supposed to help you can actually cause more damage in the process. I am left with a curious notion wondering why so many people are allowed to obtain these drugs, if they are only really harming and not helping?
Not to mention, all the health problems that come with taking these drugs. I was unaware that the drugs could actually harm others while taking them as prescribed rather than helping the person taking it. People believe that even for the smallest amount of pain, it is necessary to take 2 tablets of their prescription drug whenever they feel it. But as seen in the article, this is not the smartest decision.The article mentions many risks that come with taking prescription drugs that no one has really mentioned before. It also mentions safer alternates and the ways to prevent yourself from further injury.
I find this new information interesting because it is ironic that the thing that is supposed to help you can actually cause more damage in the process. I am left with a curious notion wondering why so many people are allowed to obtain these drugs, if they are only really harming and not helping?
"Nor is acetaminophen (Tylenol and its generic imitators) always safe. It can damage the kidneys when used in large doses"
It's the liver that is usually at risk with acetaminophen, not so much the kidneys.
And Ms. Brody's statement about NSAIDs causing liver failure--they are much more likely to damage the kidneys.
I think she's got the two types of pills and the two vital organs reversed.
It's the liver that is usually at risk with acetaminophen, not so much the kidneys.
And Ms. Brody's statement about NSAIDs causing liver failure--they are much more likely to damage the kidneys.
I think she's got the two types of pills and the two vital organs reversed.
19
Agreed. And I'm a nephrologist who routinely reminds my patients to use Tylenol and avoid ibuprofen and other NSAIDs. Please consider correcting this or providing your sources.
4
I was just going to comment on this: NSAIDs can be risky for kidneys and acetaminophen for liver.
1
I noted these errors immediately
All drugs have side effects.
Prescribed at the recommended dosage -- before the opioid scare -- a very small percentage become "addicted" whatever that means. Does it mean people who like the reduction in anxiety and so wanted to continue taking opioids are addicted Not wanting to stop feeling good is not addiction. It's no different than not wanting to come home from a vacation. Not coming home is a decision. Putting a pill in your mouth is a decision. Going for more drugs is a decision. Going out and scoring street drugs is a decision. There is no "addiction" here. It's a preference for a feeling.
True it's a preference that eventually can lead to death, but that an individual choice. It is not the government's responsibility to keep people from making stupid decisions.
People who get real pain relief have no responsibility to suffer because some other people make stupid decisions. Letting those who actively seek drugs that can kill them limit prescriptions to those who need them is the tail wagging the dog.
What if these people suffer physically if they stop? How long? A few days of feeling sick verses the risk of dying. Choosing to risk death rather than feeling very sick is a decision. One doesn't need an expensive drug program to make a decision to not go out on the street and score drugs. The idea people are so dumb they don't know what they are doing and what they are risking is making adults into children.
Yes many are dying. Engaging in risky behavior is risky.
Prescribed at the recommended dosage -- before the opioid scare -- a very small percentage become "addicted" whatever that means. Does it mean people who like the reduction in anxiety and so wanted to continue taking opioids are addicted Not wanting to stop feeling good is not addiction. It's no different than not wanting to come home from a vacation. Not coming home is a decision. Putting a pill in your mouth is a decision. Going for more drugs is a decision. Going out and scoring street drugs is a decision. There is no "addiction" here. It's a preference for a feeling.
True it's a preference that eventually can lead to death, but that an individual choice. It is not the government's responsibility to keep people from making stupid decisions.
People who get real pain relief have no responsibility to suffer because some other people make stupid decisions. Letting those who actively seek drugs that can kill them limit prescriptions to those who need them is the tail wagging the dog.
What if these people suffer physically if they stop? How long? A few days of feeling sick verses the risk of dying. Choosing to risk death rather than feeling very sick is a decision. One doesn't need an expensive drug program to make a decision to not go out on the street and score drugs. The idea people are so dumb they don't know what they are doing and what they are risking is making adults into children.
Yes many are dying. Engaging in risky behavior is risky.
1
Drug abuse has been in a problem around the world for a long time. Typically, the abuser is the one being blamed. However, many forget that there are more people involved.
The article states “the number of prescriptions for opioids jumped from 76 million in 1991 to 219 million two decades later”. It makes me wonder what has changed during this time. Have doctors changed their method of figuring out which medicine to prescribe? Has the population declined in health over time which causes them to use opioids?
Unfortunately, the answer is not that simple. I think the government and the medical industry (including both doctors and pharmacists) should work together to monitor the amount of opioid prescriptions distributed. This could be done by making the laws stricter on opioid use, by only letting people with certain illnesses/medical procedures use them. Also, physicians or pharmacists that abuse their power should have a significant punishment. As they say, with great power comes great responsibility, and affecting someone’s health gives you a power not many people have.
Also, the size and strength of a dose should be regulated as well. The smaller the dose, the less medicine people will have to abuse when their medication cycle is over. A doctor should not be afraid to say no to his patient if the pain they are feeling is not significant enough for a medicine of that strength. This will ensure that the only the people who truly need these drugs will receive them.
The article states “the number of prescriptions for opioids jumped from 76 million in 1991 to 219 million two decades later”. It makes me wonder what has changed during this time. Have doctors changed their method of figuring out which medicine to prescribe? Has the population declined in health over time which causes them to use opioids?
Unfortunately, the answer is not that simple. I think the government and the medical industry (including both doctors and pharmacists) should work together to monitor the amount of opioid prescriptions distributed. This could be done by making the laws stricter on opioid use, by only letting people with certain illnesses/medical procedures use them. Also, physicians or pharmacists that abuse their power should have a significant punishment. As they say, with great power comes great responsibility, and affecting someone’s health gives you a power not many people have.
Also, the size and strength of a dose should be regulated as well. The smaller the dose, the less medicine people will have to abuse when their medication cycle is over. A doctor should not be afraid to say no to his patient if the pain they are feeling is not significant enough for a medicine of that strength. This will ensure that the only the people who truly need these drugs will receive them.
Credit where credit is due: It was IRA Gershwin who wrote "It ain't necessarily so." George wrote the music that goes with the words.
6
The title of this story is "Finding Better Ways to Manage Pain." Yet at no point in the story are there any serious suggestions on what to do to manage chronic pain. Why no mention of medical marijuana? The only medicine mentioned without negative remarks is diclofenac, and that advice, to me, is dangerous. This medicine carries the same warnings as any other NSAID. Additionally, there is a warning which you probably wouldn't see if it were over the counter. It interacts with some blood pressure medicines.
I also have to take issue with the statement that doctors and dentists prescribe opioids with reckless abandon. This sounds like what a talk show with no real value would say about this issue. Until science, or our stodgy legislature, comes up with a better alternative there are millions who have a need for this medicine you are so quick to demonize.
I also have to take issue with the statement that doctors and dentists prescribe opioids with reckless abandon. This sounds like what a talk show with no real value would say about this issue. Until science, or our stodgy legislature, comes up with a better alternative there are millions who have a need for this medicine you are so quick to demonize.
18
Funny, the title is different now.
I'm one of the 100 million on an opiate pain killer. I also had perforated ulcers, so I can never have anti-inflammatory drugs. And, thanks to breast cancer, I can never use anti-inflammatory drugs, These articles anger me. They imply that every patient is a drug addict, or will be a drug addict, which means they are a danger to everyone. But, I don't have many options, especially since any pain killers mus be in liquid form. If I am given the solid form, I regurgitate the pills within a minute.
I go out of my way to avoid medical discussions because people don't understand, and this article is one of the reasons why. The attitude is that everyone on an opioid is an addict. Of course, people are reluctant to use them. A PSA in our area implies that using them for the right reasons still makes people an addict, emphasizing that it is "so easy" to become addicted.
So, what is the option for those of us with chronic pain, which is not a fabricated condition. I have rheumatoid disease, as well as other medical conditions. What of is for whom there is no other option? I'm open to any drug that relieves my pain, and causes no additional harm, to my tendons, muscles, etc. I'm not opposed to other drugs, but none seem to exist.
I go out of my way to avoid medical discussions because people don't understand, and this article is one of the reasons why. The attitude is that everyone on an opioid is an addict. Of course, people are reluctant to use them. A PSA in our area implies that using them for the right reasons still makes people an addict, emphasizing that it is "so easy" to become addicted.
So, what is the option for those of us with chronic pain, which is not a fabricated condition. I have rheumatoid disease, as well as other medical conditions. What of is for whom there is no other option? I'm open to any drug that relieves my pain, and causes no additional harm, to my tendons, muscles, etc. I'm not opposed to other drugs, but none seem to exist.
84
There are patients who do require long term opioid use for various reasons as you described.When used in the right way for the right patient they are necessary.However physicians are being pressured and intimidated by state authorities to avoid them,so people who are non abusers may be denied these medications.Not to mention state attorney generals now see a financial bonanza by suing the manufacturers of these drugs,the end result will be people with legitimate needs for these drugs will not get them.
3
Both my internist and neurologist are intimidated and would not prescribe an opiod for the pain I suffer from an autoimmune disease. They referred me to pain specialists. One pain specialist pushed spinal injections (unsuccessful), and the other was obnoxious and made me feel like an addict. So I suffer while my search continues for a good, caring, independent doctor.
1
In the nineties when I was Director of a Pain Management Program our patients were a lot of times the results of poor management of acute pain.
About the same time my son had his wisdom teeth extracted and four days post procedure he asked me where those pain pills. His swelling had subsided so I told him he didn't need them and to take Tylenol. He replayed ,"I know but I like the feeling they give me " I responded " that is precisely why you do not need them".
Now at 77 and dealing with the chronic pain of osteoarthritis , I'm told that I should not take Alive because it's bad for my kidneys and liver. Well I'm hedonistic enough to tell my kidneys and liver they are on their own.
About the same time my son had his wisdom teeth extracted and four days post procedure he asked me where those pain pills. His swelling had subsided so I told him he didn't need them and to take Tylenol. He replayed ,"I know but I like the feeling they give me " I responded " that is precisely why you do not need them".
Now at 77 and dealing with the chronic pain of osteoarthritis , I'm told that I should not take Alive because it's bad for my kidneys and liver. Well I'm hedonistic enough to tell my kidneys and liver they are on their own.
3
As a Medical Toxicologist and one interested in Preventive Medicine, I have been deeply concerned about the US citizen's interest in taking a pill for whatever ails you. I started my academic career as a general pediatrician and often had to "argue" with mother's who demanded antibiotics for their children's colds, decongestants for runny noses, etc. When in the Navy, mothers would complain that I Navy doctors were not as good as Army or Air Force ones, because we didn't give them enough medication!
We train our children to take medication for whatever ails them. On TV we are garaged by advertisement for diseases that didn't really even exist before a treatment was invented. Why then should we be surprised when we see the overuse and abuse of opioid? How many people take sleep aids, anti-anxiety meds? How often were other treatments tried? What about sleep hygiene.
The tv ad that really offends me is The construction worker complaining about his opioid-induced constipation from the opiods he takes for back pain, a condition that is really not an indication for opioid use. The medication He is touting was invented to treat the side effect of a drug that is misused and is not indicated for most of those using it who develop the constipation. The drug was FDA approved for non-cancer used opioid induced constipation, another odd situation!
We train our children to take medication for whatever ails them. On TV we are garaged by advertisement for diseases that didn't really even exist before a treatment was invented. Why then should we be surprised when we see the overuse and abuse of opioid? How many people take sleep aids, anti-anxiety meds? How often were other treatments tried? What about sleep hygiene.
The tv ad that really offends me is The construction worker complaining about his opioid-induced constipation from the opiods he takes for back pain, a condition that is really not an indication for opioid use. The medication He is touting was invented to treat the side effect of a drug that is misused and is not indicated for most of those using it who develop the constipation. The drug was FDA approved for non-cancer used opioid induced constipation, another odd situation!
11
Taking an antibiotic for a cold, and comparing it to chronic pain which can be debilitating and never goes away, is a poor analysis. People are living longer, and therefore liable to have injuries and illnesses. I hope you don't have the problems that others do, or may I hope you do, so you can experience what many others are going through .
10
Use of any drug leads to tolerance. Antidepressant dosages are adjusted as the lower dose stops working, blood pressure medication, cancer drugs. A 15 mg pill becomes a 30 mg pill of drugs that keep people alive, living, and sane. Pain medication of any kind is no different - why treat it this way? One pill might lead to two, but in my experience, it's taken a decade for any increase in dosage. In addition the doctors cited in your article sell expensive surgical procedures for pain that also have a sell-by date. The second epidural works less well than the first, and so on, until your insurance company is paying tens of thousands of dollars for something that might give two weeks of relief. Follow the money Mrs. Brody. I think you are a good reporter and columnist. You have written with tremendous compassion - please give chronic pain patients who are now living under severe stress from doctors, government, family members, and press, a better-rounded view. The suffering incomplete reporting and dishonest editing causes is never brought into consideration.
14
The attention given the opioid crisis is appropriate. But let's not forget that tobacco kills 480,000 people a year (Center for Disease Control data). That's over 1300 people a day. These deaths aren't as dramatic as the sudden deaths that occur from opioid overdoses but they're just as real and tragic.
16
The article assumes a quite a bit about medication use and storage. My wife and I have prescriptions to use in third world countries; we;re not going to dispose of them. There are no family children within 1000 miles, so drugs are not locked up. My primary care physician and cardiologist are informed of the OTC drugs use. So the article seems narrow without defining who were being studied and why?
5
Doctors should discuss these drugs with patients before prescribing them. Even if it's just a limited prescription for, say, post-surgery pain. Because doctors don't know if their patients or their family have a history of problems with the drugs. And there should be clear guidance on getting rid of unused mess.
Basically, tell patients what the drug is and tell them to take as little as possible and tell them where to dispose of leftovers.
This seems like common sense, but where I live, doctors don't do it. They give you a scrip after your surgery, don't warn you it's an opiod, and if you have a family member who wants you to give them the leftovers, it's Katie bar the door. Also... it's tempting to keep the leftovers, in case you ever have bad pain again and no access to care because you lost your health insurance or can't afford the deductible.
Basically, tell patients what the drug is and tell them to take as little as possible and tell them where to dispose of leftovers.
This seems like common sense, but where I live, doctors don't do it. They give you a scrip after your surgery, don't warn you it's an opiod, and if you have a family member who wants you to give them the leftovers, it's Katie bar the door. Also... it's tempting to keep the leftovers, in case you ever have bad pain again and no access to care because you lost your health insurance or can't afford the deductible.
3
Am a bit disappointed that Jane quoted Dr Campbell as an expert without noting his having been paid by pharma, defending Sacklers/Purdue pharma, coining the "fifth vital sign" in his now infamous lecture and his role in creating this crisis. Most of us addiction physicians view that as the launchpad for this crisis. To be sure, NSAIDS can have serious risks in the wrong patient, but this was a bad choice of expert and a major miss to not call out his obvious bias. Would rather hear from experts not co-opted by opioid pharma.
24
I itch when I take hydrocodone and related drugs. That means that I ONLY take what is necessary--and when the pain relief outweighs the side effects. I am very grateful for this.
1
So if you take Aleve twice daily to totally control osteoarthritis what are you supposed to do. With it I am pain free and the deformation and the Heberden’s nodes have stopped happening to my joints. I will take whatever risk this drug brings as it enables me to function normally and pain free. As an RN, I think it is worth it. There is living and there is existing.
22
You always have to carefully compare the risk:benefit of the use of any therapy!
3
I also was prescribed 96 Percocet after a spinal angiogram. I was shocked. My symptoms were numbness not pain. I accepted only a few but did not take them. A simple short conversation with a nurse or doctor would have prevented this inappropriate prescription. A doctor saving time and money was the cause of this sloppy practice that could have set off an addiction. Cymbalta also can raise coronary artery plaque, I discovered after researching it when my plaque numbers increased as discovered by a functional medicine doctor. Taking it, which I've now stopped, was my only lifestyle change. One neurosurgeon I saw, to his credit, said to stay off cymbalta, neurontin, and lyrica as much as possible. He also said not to take osteoporosis drugs, to wait until they've found something better, as the current drug is too risky. The functional medicine doctor I've consulted said he's been saying this for the last ten years. Keep searching until you find doctors who speak to you respectfully, who really listen to your issues(present them as clearly and succinctly as possible of course), and who show intelligence in their thinking and explaining of your case to you. It is hard to be a doctor, but harder to be a suffering patient. Take care of yourself, and require the best care fAnd communication skills from doctors.
10
I am very fortunate to have only one addiction: My nightly glass of rosé wine, sometimes before, sometimes during, sometime after, dinner. I tried a lot of things over the years, mostly just for fun or due to social pressures. But even though I have my aches and pains, I am okay with them. Nothing more than an very occasional ibuprofen.
1
Many commenters on this article have smugly asserted that chronic pain issues are the result of a lack of discipline or control on the part of the sufferer -- if only they hadn't let themselves get obese and out of shape they wouldn't have painful knees and backs. This view is small-minded and WRONG! I am, and have always been, slender and reasonably fit, and I have severe, painful arthritis in both knees. Pain problems arise for many reasons, regardless of body type, and all deserve thoughtful treatment, not condemnation.
132
The stereotype of chronic pain being the patient's fault is so unfair, especially to those of us who are suffering because of a loss in the genetic lottery or an accident. I have a hereditary version of spondylolisthesis, for which I have had three back surgeries -- including a spinal fusion.
My last two surgeons have been very careful about the dangers of addiction. The provision of self-administered IV opiates for me while I was in the hospital, kept pain at bay following the last two surgeries -- not least because of feeling "in control" instead of having to wait for what seemed like eternity to get help in the old system. Back then, patients had to ask (or plead) for more medication. With the pain IV in place, I knew I could "push the button" whenever I needed to and the pain would recede.
My first surgeon, however, in the 1970's either didn't know or didn't care about the risks of pain management. He gave me a prescription for 90 valium tablets. Taking them almost killed me because of their addictive potential and the depression which developed.
I am so grateful for the surgeries I had, without which I would be in a wheelchair. But pain management needs to be addressed with caution and intelligence.
My last two surgeons have been very careful about the dangers of addiction. The provision of self-administered IV opiates for me while I was in the hospital, kept pain at bay following the last two surgeries -- not least because of feeling "in control" instead of having to wait for what seemed like eternity to get help in the old system. Back then, patients had to ask (or plead) for more medication. With the pain IV in place, I knew I could "push the button" whenever I needed to and the pain would recede.
My first surgeon, however, in the 1970's either didn't know or didn't care about the risks of pain management. He gave me a prescription for 90 valium tablets. Taking them almost killed me because of their addictive potential and the depression which developed.
I am so grateful for the surgeries I had, without which I would be in a wheelchair. But pain management needs to be addressed with caution and intelligence.
3
Absolutely, I too have severe pain. Broken neck in past and back surgeries. My Dr. is feeling pressured by the recent tear of Opiates. I understand but guess that after 5 years of a regimine, yes we are or most are more than used to the drugs. Addicted with A prescription. I have gotten off the opiate solution and I hurt but its better than being in the opiate haze I was in. For many its intolerable and may be for me later. I hope not. At any rate its A Dr. Patient decision not A commercial issue or Insurance company decision...
We like to think that we are in control of everything, including how much pain we feel. Makes us feel safer, I guess, but doesn't do much for compassion for others.
We had an unusual freeze in Pasadena a few years ago and I actually slipped on ice (we forgot to turn our sprinklers off) and broke my wrist. Needed surgery. They gave me lots of opioids. I felt tolerance already happening after four days. The prescribed dose was wearing off an hour before the next prescribed dose. I'd have to increase my dose to remain pain-free. That taught me a huge lesson about opioids. Since I was being tempted to go up to five a day, I cut back to three per day instead, and filled in the gap with marijuana. Worked fine. I was off the opioids entirely after a few more days.
21
Part of your problem was the expectation/desire to be pain free. Rather the goal should be to make the pain tolerable. Fact is that after an accident like that it's probably good to retain a certain amount of discomfort just to remind you that you're still healing and need to be cautious regarding your injury.
I find that I'm better able to tolerate the pain when I know that I have a solution for it if it becomes too much. The reduction in stress that I get from having a pain killer on hand strengthens my ability to bear the pain without having to actually take the pain killer. On the other hand, if I do need that pain killer I'm not at all shy about taking it. Fortunately I am one of the people, so far, who has never had a problem regulating my use of these drugs. I understand that for other people it's not so simple.
I find that I'm better able to tolerate the pain when I know that I have a solution for it if it becomes too much. The reduction in stress that I get from having a pain killer on hand strengthens my ability to bear the pain without having to actually take the pain killer. On the other hand, if I do need that pain killer I'm not at all shy about taking it. Fortunately I am one of the people, so far, who has never had a problem regulating my use of these drugs. I understand that for other people it's not so simple.
8
Tolerance does not begin that quickly. The healing process is ups and downs, and I am glad marijuana worked for you. It does not work for everyone.
1
The pills never work for the entire length of time before your next dose. It was your error to not follow the instructions. Forty years ago I had knee surgery. Lifting the sheet on my bed caused agony. I was given a shot every three hours, but in between each one I had to suffer for thirty to forty minutes. This was the first day. Don't blame the drug, blame the user.
1
I was caught up in the trials of pain control using western medicine at the end of it I barely felt human. Marijuana is the gateway drug to movement and pain control- shame on the medical establishment and government for keeping this miraculous plant away from people in need.
42
Although marijuana has some uses, it is not a panacea. It does not help for many types of pain, and in fact some patients have a worsening of pain when using it. It certainly should be legal, but don't over estimate its worth.
Stop using the word FEAR in your health headlines. It is beneath the NYT standards.
24
Two Words..... Medical Marijuana.
22
I confess. I keep some opioids prescribed for previous surgeries just in case I need them and can't get them. I use ibuprofen on a daily basis. I started before anyone said there was permanent damage to the kidneys from it. Now I am wondering how I can replace ibuprofen which kills the arthritic pain enough that I can sleep. Guess I can switch to Tylanol. I have switched to Tylenol for nights when I wake up in pain in the middle of the night.
So, am I supposed to give up sleep now so as to avoid opioids and nsiads? I think I would rather not live without sleep and therefore must pay the price for taking Nsaids. Bummer.
So, am I supposed to give up sleep now so as to avoid opioids and nsiads? I think I would rather not live without sleep and therefore must pay the price for taking Nsaids. Bummer.
3
You might try topical DMSO on affected areas. OR you could try Aspercreme - NOT the maximum strength with Capsaicin - that can severely burn your skin if you use too much.
2
I'm confused about something. Many of the comments state that opioids work for chronic pain. Many also blame big pharma for the opioid crisis.
We have no studies supporting the use of opioids for chronic pain. Now if big pharma believed these drugs actually worked for this and was trying to make as much money out of them as they could, then why haven't they funded research to demonstrate that they are beneficial for chronic pain? I would assume they would love to be able to legally promote them for the management of chronic pain.
I can only be led to believe that either they have done such studies and have never published them because they didn't support the use of opioids or believe that such studies wouldn't support their use.
We have no studies supporting the use of opioids for chronic pain. Now if big pharma believed these drugs actually worked for this and was trying to make as much money out of them as they could, then why haven't they funded research to demonstrate that they are beneficial for chronic pain? I would assume they would love to be able to legally promote them for the management of chronic pain.
I can only be led to believe that either they have done such studies and have never published them because they didn't support the use of opioids or believe that such studies wouldn't support their use.
8
Sorry to disappoint you, but millions of people use opioids for chronic pain. Until marijuana is legalized there really isn't an alternative.
4
Keep your unused meds in a freezer. For every 10 deg drop (in deg C), the drug will last roughly twice as long. Read the insert that comes with your prescription to see what the recommended safe storage is at room temperature, then you do the math.
I can anecdotally report that a small piece of zucchini bread made with canna butter, about 2 x 2 in, is a great sleep aid. Dose depends on the recipe and the strength of the butter. Don't mix with alcohol.
Here in Colorado, many people who have pain in their joints from arthritis, age, injury or muscle pain from overindulging in our many outdoor activities, a product bought in marijuana shops called "Angel Cream" works well. Some compound their own from other local ingredients. Come visit Colorado, and take home some of that in your luggage. No carry on, though.
I can anecdotally report that a small piece of zucchini bread made with canna butter, about 2 x 2 in, is a great sleep aid. Dose depends on the recipe and the strength of the butter. Don't mix with alcohol.
Here in Colorado, many people who have pain in their joints from arthritis, age, injury or muscle pain from overindulging in our many outdoor activities, a product bought in marijuana shops called "Angel Cream" works well. Some compound their own from other local ingredients. Come visit Colorado, and take home some of that in your luggage. No carry on, though.
11
Ordinary medicines in the freezer? Bad idea. The expiration dates on most prescription medications are ridiculously conservative. (Wonder why?) Studies have found little decrease in potency after DECADES of storage at room temperature.
http://www.usmedicine.com/agencies/department-of-defense-dod/dodfda-prog...
Over the counter aspirin and acetaminophen are conspicuous exceptions.
http://www.usmedicine.com/agencies/department-of-defense-dod/dodfda-prog...
Over the counter aspirin and acetaminophen are conspicuous exceptions.
2
As a college student pursuing a career in health care, I feel that the issue discussed in this article, which is that while the opioid epidemic is a major issue, a problem less known, but equally as important, is that over-the-counter medication can harm one’s body when taken in excess and like opioids, can be abused. I agree with George Gershwin’s comment in the article that medication that doesn’t require prescription doesn’t always mean that it is safe, as it is stated in the article that NSAID can cause cardiovascular and gastrointestinal problems. The article also said that topical NSAID is a safer alternative, but it was not explained how that is. It is disheartening to learn that topical NSAID requires prescription in the United States, but the pill form doesn’t. If topical NSAID truly is safer, then this should be changed. Another issue discussed in the article was how the general public doesn’t know how to safely dispose of medications they are not using anymore. As the article stated, 42 percent to 71 percent didn’t use the opioids they were prescribed and 67 to 92 percent still have them at home. Personally, I don’t know how to safely dispose medication. Perhaps an improvement that can be made to the article is how to do this and resources for help for those dealing with addiction. Education about this issue, especially at a young age, is very important because knowing about tolerance can prevent someone from getting addicted to any form of drugs.
7
Was George Gershwin commenting on the 2017 opioid crisis when he wrote "It Ain't Necessarily So"?
2
In the village where I live, there is a drop-off box in the police station to dispose of any medication. You might find a service like that in the Boston area where you reside. Whatever you do, be kind to your municipal water works and don't even think about flushing pills down the toilet.
Great information from the Food and Drug Administration on how to dispose of unused drugs if you cannot put them in a collection container sponsored by your police dept. etc.
https://www.fda.gov/drugs/resourcesforyou/consumers/buyingusingmedicines...
https://www.fda.gov/drugs/resourcesforyou/consumers/buyingusingmedicines...
There is no reason to fear any pain medication. The suggestion is wrong-headed.
Medications are one of the great modern miracles that own generations have been blessed with.
Opioids allow trauma victims surgery patients to recover in safe relative comfort. "As with alcohol, opioids are not a problem for most people...." they are a miracle.
NSAIDs (aspirin, ibu, acetamin) are virtual miracle drugs -- especially aspirin -- fighting fever and inflammation - -literally life-saving in may cases.
It is only the misuse of these miracle medications that is a problem. All medications come with risk -- with side effects. Literally all substances in the world have bad effects if used to excess, even plain water.
Education is the cure for unintentional misuse or over-use of OTC medications. The watchcare of a personal physician is the remedy for overuse or misuse of prescription drugs -- including opioids. Draconian law enforcement is the cure for illegal importation and sale of addictive substances. Drug rehabilitation and mental health programs, enforced by law if necessary, are the cures for the addicted.
Promoting fear of good things is a bad thing.
Medications are one of the great modern miracles that own generations have been blessed with.
Opioids allow trauma victims surgery patients to recover in safe relative comfort. "As with alcohol, opioids are not a problem for most people...." they are a miracle.
NSAIDs (aspirin, ibu, acetamin) are virtual miracle drugs -- especially aspirin -- fighting fever and inflammation - -literally life-saving in may cases.
It is only the misuse of these miracle medications that is a problem. All medications come with risk -- with side effects. Literally all substances in the world have bad effects if used to excess, even plain water.
Education is the cure for unintentional misuse or over-use of OTC medications. The watchcare of a personal physician is the remedy for overuse or misuse of prescription drugs -- including opioids. Draconian law enforcement is the cure for illegal importation and sale of addictive substances. Drug rehabilitation and mental health programs, enforced by law if necessary, are the cures for the addicted.
Promoting fear of good things is a bad thing.
45
Literally all substances in the world have bad effects if used to excess, even plain water.
Water use of any kind does not kill 147 Americans DAILY , anything that kills thousands a month , creates debilitating addiction in thousands of others , with the associated crime , violence , and social dysfunction MUST be feared if a person is sane - what other "substance" has such an effect except other neurological drugs also to be feared ? The logical inference of the above quote that we should not fear any substance including apparently cyanide anthrax and plutonium - so in fact we must fear toxic substances that can readily destroy healthy tissue etc opioids are one of them FEAR them
Water use of any kind does not kill 147 Americans DAILY , anything that kills thousands a month , creates debilitating addiction in thousands of others , with the associated crime , violence , and social dysfunction MUST be feared if a person is sane - what other "substance" has such an effect except other neurological drugs also to be feared ? The logical inference of the above quote that we should not fear any substance including apparently cyanide anthrax and plutonium - so in fact we must fear toxic substances that can readily destroy healthy tissue etc opioids are one of them FEAR them
1
Trust me...when you break your ankle and dislocate it...you're not going to fear any opiod when the ER doc twists it back into place just an hour after breaking it! Most of the people who have abused these drugs and overdosed took up to 50 pills a day, crushed them so they could snort them or melted them down to inject them. That does not sound like someone carefully taking them for chronic pain. These are people with addiction problems.. not pain problems. How can you fear a pill?..if you don't think you can control yourself around pills that make you feel high if you just add a few more every day THEN you should fear them and fear YOUR self control too!
1
Here in Germany, ibuprofen and acetaminophen are not sold in big bottles like we have in the US, but rather there are about 10 per strip, each one protected by a folio. A few times after surgery here I was "given something strong", which when I looked at it was about 600mg of ibuprofen. (Needless to see, this didn't cut it after my c-section and I finally got something very strong to help with the pain). I was ordering some meds for my son, and because I ordered more than one package of each one, I got a detailed paper printout of the dangers of overusing pain medications and the recommendation to limit as much as possible. This coming from the company that sold me the medications.
Can you imagine this happening in the US?
Can you imagine this happening in the US?
7
The limit of acetaminophen to no more than 10, 325 mg tabs was done to limit the liver damage from overdose from a single ingestion, aka suicide.
This is a pretty lame article. Sure there are risks from NSAIDS and acetaminophen but they are scarcely comparable to the addictive dangers of opioids. Used sensibly, the OTCs offer a very low risk alternative to opioids for minor to moderate pain.
I don't think the NYT is serving its readers well with articles such as this.
I don't think the NYT is serving its readers well with articles such as this.
7
That's not actually true. The most dangerous ingredient in Vicodin is not the opioid. It's the acetaminophen. Opioids cause addiction, but they do not cause cirrhosis of the liver like acetaminophen can. People recover from addiction every day. But once acetaminophen scars your liver, you're toast. There is nothing that can restore your liver to perfect health after that. Except maybe a transplant.
And from what I have read, all you have to do to achieve this permanent liver damage is to take acetaminophen one time on an empty stomach the day after over-indulging on alcohol.
And from what I have read, all you have to do to achieve this permanent liver damage is to take acetaminophen one time on an empty stomach the day after over-indulging on alcohol.
1
Opiods do not lead to abuse or addiction for recipients of 95% of the prescriptions written. Of that 5% abuse their prescription, fewer than half will develop an addiction, and it will be to a crushed, snorted, shot, or smoked pill -- the opioid addicted individual is overwhelmingly subject to multiple addictions already, primarily alcohol. Of that very small number that abused opioids in this way, fewer than half will go on to heroin. Heroin is, and has been for years, cheap, available, and increasingly deadly because it is mixed with powerful drugs imported primarily from China. So, to get back to your point, I think to this extent, for that very small percentage of the multiple addiction population that uses heroin, opioids are deadly. But not for the other 95%, who never abused anything at all.
5
You are mistaken. Acetaminophen is quite safe if taken at doses up to 2 grams a day. Your last sentence is pure urban myth.
1
1 in 3 Americans suffer chronic pain? I think falling out of bed after binge drinking is considered self induced.
Now we understand why all those old, white dudes are no longer looking for jobs.
Now we understand why all those old, white dudes are no longer looking for jobs.
2
Wow--that's pretty unsubstantiated....
1
'You have no Vitamin D', what does that mean when the professional calls with the results. We never took vitamins in France, Ireland or Spain in my youth, and my American parents long divorced, never did either. My mother went into a decline in Paris with dementia, and lived until 92, from a blocked artery in her hip. Perhaps she needed more vitamin D.
Checked with American friends, one from Jamaica, the other Austrian, they recommend a multi-vitamin once a day and rarely take an aspirin, unless if badly needed. Some of us are living to great ages, but even children are now being given sedatives for some emotional disorder or biological imbalance.
The only remedy for a fierce tick bite is an antibiotic? Well, it seems to be working but there is probably a side effect to be expected. 100 Million Americans are in chronic pain? I believe it, and the lines at the large convenience store are increasing.
Doctors are now being given added but necessary responsibility, thanking Jane Brody. Our constitution is different, and we are not guinea-pigs. Yet doctors are obliged by law to give the same recovery dosage to each and every one.
It takes patience, but the patient has a responsibility as well. How to gauge the individual make-up for the stabilizing amount required is a migraine. Let us try to find the right set of shoes when an Apple-a-Day is not enough.
Checked with American friends, one from Jamaica, the other Austrian, they recommend a multi-vitamin once a day and rarely take an aspirin, unless if badly needed. Some of us are living to great ages, but even children are now being given sedatives for some emotional disorder or biological imbalance.
The only remedy for a fierce tick bite is an antibiotic? Well, it seems to be working but there is probably a side effect to be expected. 100 Million Americans are in chronic pain? I believe it, and the lines at the large convenience store are increasing.
Doctors are now being given added but necessary responsibility, thanking Jane Brody. Our constitution is different, and we are not guinea-pigs. Yet doctors are obliged by law to give the same recovery dosage to each and every one.
It takes patience, but the patient has a responsibility as well. How to gauge the individual make-up for the stabilizing amount required is a migraine. Let us try to find the right set of shoes when an Apple-a-Day is not enough.
Pretty much a worthless article. It is just a rehash of what people already know and doesn't provide any guidance for what to do if you have chronic pain. People with chronic pain know the downsides of the medications available but they don't have a lot of choice. Tell people what they are supposed to do instead of just limiting their options.
73
Your comments on the usage of topical NSAIDs like gel of diclofenac / Voltaren are misleading. They cause the same side-effects as the oral version, such as ulcers, intestinal bleeding and cardiovascular problems. Here is the monograph from NIH's MedlinePlus:
https://medlineplus.gov/druginfo/meds/a611002.html
https://medlineplus.gov/druginfo/meds/a611002.html
13
And:
http://www.pharmacytimes.com/contributor/jeffrey-fudin/2015/07/should-to...
provides an alternative view. Systemic levels of the drug are way, way, way, way lower with the use of topical applications of NSAIDs
http://www.pharmacytimes.com/contributor/jeffrey-fudin/2015/07/should-to...
provides an alternative view. Systemic levels of the drug are way, way, way, way lower with the use of topical applications of NSAIDs
What I get concerned about with topical meds is how to know the correct dose has been applied and how long the gel or cream should remain on the skin. Very hard to know that.
This is why so many people take a dim view of politicians legislating medicine. And frankly, our medical researchers aren't much better with their recommendations. Do you *read* your own stuff? You say 1% of Americans use opioids for non-pain-treatment reasons in a month. But you also say 30% of Americans are enduring chronic pain. 30%! Perhaps the doctors who are prescribing pain meds have a little compassion for the millions of Americans in constant pain. Perhaps we should make easing the suffering of 1 in 3 Americans a priority, rather than spending all our energy judging the 1 in 100 who abuse pain meds.
58
Well said, Nancy. Add to that the very recent curtailing of dosage for those enrolled in legitimate pain management programs. These people are following all the rules, are closely monitored, agree to tracking, random urine tests and the costs of seeing a specialist on monthly basis. Most take only a modest amount of medication. But, hey, the governments knows better than the doctor. I understand the need to limit use, but those in intractable chronic pain should be cared for. I fear for those who will now be faced with the prospect of un or under-addressed pain relief, including some in my family due to hereditary spinal issues. This is a scorched earth response to the problem.
2
i am sure that there are other people like myself who save unused medication ,in my case at least knowing that it will save me a trip to the ER at some point where after hours of waiting i will be promptly treated like i am drug addict in search of a fix rather then someone living with herniated disks and degenerative disk disease
38
Did you mean to say that prolonged or excessive use of tylenol can damage the liver (rather than the kidneys)?
8
And it doesn't have to be prolonged or excessive use. I've read that one can cause liver scarring by taking acetaminophen on an empty stomach after a night of drinking. The liver has already been challenged severely by the alcohol and by the empty stomach. Adding acetaminophen to that mix is just too much.
People take that stuff as a hangover medicine and it's the absolute worst and most damaging way to take it.
People take that stuff as a hangover medicine and it's the absolute worst and most damaging way to take it.
1
As a medical toxicologist, I have treated, conservatively, hundreds of cases of acetaminophen overdose. A single large overdose of acetaminophen can damage both the liver and kidneys. But, it is not related to cirrhosis though. If one survives the liver damage, the liver returns to its pre-exposure state.
2
Then why are we hearing that Vicodin accounts for a high percentage of liver transplants? It's not the hydrocdone that is sending Vicodin addicts into the transplant programs. It's the acetaminophen.
I hope the second column actually offers advice on treating chronic pain without opioids and OTC analgesics. As a chronic pain patient for 30+ years, I could use some new ideas.
Things I've tried that haven't worked: Physical therapy, therapeutic massage, TENS therapy, gabapentin, antidepressants, steroid injections, yoga, biofeedback, Flexeril, and on and on.
So before you come to take away my meds, please do me a favor and offer me something that works as well. Something that works better would be really great.
Things I've tried that haven't worked: Physical therapy, therapeutic massage, TENS therapy, gabapentin, antidepressants, steroid injections, yoga, biofeedback, Flexeril, and on and on.
So before you come to take away my meds, please do me a favor and offer me something that works as well. Something that works better would be really great.
104
Every single pill has a side affect in some cases.This another scare story from jane brody who is not even a doctor.I'm sick of her negative articles about all times of mediacal stories for 20 years.My doctor who studied medicine for 8 years ,tells me all the time to ignore the times.The point is How can someone with no medial degree continue to write this colunm!
16
First this column complains about over-prescription, then it complains that people don't take all the drugs they have been prescribed. Which is it?
If the drugs are dangerous, as they are, then it's better when people think them unnecessary and don't take them.
Does the writer really think that dopers break into houses and ransack medicine cabinets in the hope of finding a bottle of some opiod with three unused pills left?
If the drugs are dangerous, as they are, then it's better when people think them unnecessary and don't take them.
Does the writer really think that dopers break into houses and ransack medicine cabinets in the hope of finding a bottle of some opiod with three unused pills left?
5
Some dopers do, but there is little call for it now that (as in the rustbelt) heroin is cheaper than a six-pack and much more potent.
It is presented oddly in the article. It helps to know that only 5% of opioid prescriptions are abused. That means 92% can easily have not used their entire prescription. Mrs. Brody is confronted with contradictory statistics, but is either editorially or otherwise compelled not to explain them because it speaks the truth - that an overwhelming percentage of people prescribed opioid or opiates do not become addicted to anything. They don't even finish their prescriptions. Now addicts, during the period (which ended variously around the country 2007-2011) did, during the pill mill period, feign pain, if they had to, to get prescription drugs, which they abused in the same way as heroin to get a rush (smoked, snorted, shot). But they don't do that anymore. It is much, much easier to get heroin.
Meanwhile, the 95% that did not abuse anything, especially the perhaps 3 percent or so with persistent, severe chronic pain that responds very well to opioid/opiates, are suffering horribly due to the extent of this misinformation. Parents deny their post-surgical kids pain meds and brag about it. The elderly and disabled are left to slowly go mad with pain, or due to mind-scrambling drugs like the Gabapentin or Cymbalta families. I have seen this. It is repulsive and terrifying - but there is no place like America for a moralistic crusade
It is presented oddly in the article. It helps to know that only 5% of opioid prescriptions are abused. That means 92% can easily have not used their entire prescription. Mrs. Brody is confronted with contradictory statistics, but is either editorially or otherwise compelled not to explain them because it speaks the truth - that an overwhelming percentage of people prescribed opioid or opiates do not become addicted to anything. They don't even finish their prescriptions. Now addicts, during the period (which ended variously around the country 2007-2011) did, during the pill mill period, feign pain, if they had to, to get prescription drugs, which they abused in the same way as heroin to get a rush (smoked, snorted, shot). But they don't do that anymore. It is much, much easier to get heroin.
Meanwhile, the 95% that did not abuse anything, especially the perhaps 3 percent or so with persistent, severe chronic pain that responds very well to opioid/opiates, are suffering horribly due to the extent of this misinformation. Parents deny their post-surgical kids pain meds and brag about it. The elderly and disabled are left to slowly go mad with pain, or due to mind-scrambling drugs like the Gabapentin or Cymbalta families. I have seen this. It is repulsive and terrifying - but there is no place like America for a moralistic crusade
7
Sorry Maureen...heroin is cheaper but is not covered by insurance. Opiates are. Drug seekers are part of your 95% who misuse/abuse. They go to EDs, dentists, self-injure, feign conditions and score meds people with legitimate complaints need for comfort and quality of life. They know what works. With opiates being monitored more closely, Gabapentin is now sought and misused. It enhances illicit street drugs, helps with crashing, provides a cheap high itself and reportedly interferes with meds that counteract opiate cravings so an addict can partake w/o becoming sick. (Word from the street.) There is a population who would no more think of usiing heroin than giving up their first born. The Stepford Wives Club's drugs of choice comes in prescribed pharmaceutical packaging whether they be uppers or downers. Pls cite your data source.
Pain Prevention. Why are so many people in pain in the first place? Victims of Crimes that have not been stopped by the Law Enforcement? A different approach to Medicine that decreases Pain Infliction?
100 Million people in the US suffer from chronic pain????!!!! That is One in Three. There is something seriously, seriously wrong here.
3
Accidents aside, I suspect this is due in part to overuse injuries and is a side effect of living in a technologically advanced society where most people are less active than our ancestors were.
I suffer from a pinched nerve in my neck from poor posture, and a strained bicep and shoulder from decades of working at a computer. I am in a least some pain every day and though it is tolerable, it is no less annoying. I do physical therapy, acupuncture, and try to stay active, but I don't take NSAIDS often because I find they don't help much. I think it's a slippery slope to start depending on medication and I'm hoping to push that off as long as possible.
I suffer from a pinched nerve in my neck from poor posture, and a strained bicep and shoulder from decades of working at a computer. I am in a least some pain every day and though it is tolerable, it is no less annoying. I do physical therapy, acupuncture, and try to stay active, but I don't take NSAIDS often because I find they don't help much. I think it's a slippery slope to start depending on medication and I'm hoping to push that off as long as possible.
2
Old people get arthritis, both rheumatoid and osteoarthritis. Cancer treatments, even when they work, can leave you in chronic pain. People with Type II diabetes can suffer chronic nerve pain. Athletes suffer chronic pain. Especially football and hockey players of all ages. Pain-inducing sports are very popular in America. That accounts for a lot of chronic pain. And sitting at a desk all day can cause a lot of pain problems, as well as high blood pressure and poor circulation.
5
I don't understand. Opioids and other pain killers do exactly that -- "kill" pain. Who would not want their pain to stop?
I've been taking an opioid (Vicodin) every day for years for my chronic pain. The doses give me freedom to live life fully, without pain limits. I have never wanted to up the dose, one pill a day is enough to relieve my pain.
I do understand why people want to go beyond just relieving pain. The various opioids make your body "disappear." That means you cannot feel any of the emotions (well or ill) signaled by your muscles. To be free of not only the routine discomforts of life, enough opioids help free you from any physical response to the numerous slings and arrows of normal living.
That effect is what so many Americans are seeking. Do we have to let them overdose and die, or be cast into a prison for that? Why? Can't modern medicine or pharmacology find a better, non-toxic way to escape?
I wouldn't mind occasionally taking a pill to escape the normal pain associated with having friends and relatives whose travails tug at one's heartstrings. But because I personally have developed ways to anesthetize myself from that source of pain doesn't mean others can or would be able to choose my path. I can understand their fall-back reliance on today's very effective numbing drugs.
Is it a mystery why such a blessing - drugs that kill pain - have become a scourge, a fatal plague? What if it is perfectly understandable but too many refuse to understand?
I've been taking an opioid (Vicodin) every day for years for my chronic pain. The doses give me freedom to live life fully, without pain limits. I have never wanted to up the dose, one pill a day is enough to relieve my pain.
I do understand why people want to go beyond just relieving pain. The various opioids make your body "disappear." That means you cannot feel any of the emotions (well or ill) signaled by your muscles. To be free of not only the routine discomforts of life, enough opioids help free you from any physical response to the numerous slings and arrows of normal living.
That effect is what so many Americans are seeking. Do we have to let them overdose and die, or be cast into a prison for that? Why? Can't modern medicine or pharmacology find a better, non-toxic way to escape?
I wouldn't mind occasionally taking a pill to escape the normal pain associated with having friends and relatives whose travails tug at one's heartstrings. But because I personally have developed ways to anesthetize myself from that source of pain doesn't mean others can or would be able to choose my path. I can understand their fall-back reliance on today's very effective numbing drugs.
Is it a mystery why such a blessing - drugs that kill pain - have become a scourge, a fatal plague? What if it is perfectly understandable but too many refuse to understand?
13
Thank you for this wise and compassionate observation. It cut through all the noise. It's the truth.
I've taken narcotic pain meds for more than twenty years after a couple of botched back surgeries. That being said, the only time I got into trouble with pain medication was when I took more Tylenol than I should have. Not a lot more. Just a couple of pills over the daily maximum. I thought I was going to die.
I understand the concern over the opioid epidemic. It is obviously a huge problem. But there are plenty of people for whom living would be unbearable without the help of these medications.
I worry, as do others, that Chis Christie & Jared Kushner are going to lump everyone into the abuser/addict category and that some day soon the medicines we need will no longer be available. Not everyone becomes an addict. Not everyone turns to heroin. There are those who take their meds in much the same manner as someone with any other medical condition: Just as prescribed.
Personally, there is no high, no euphoria. I'm lucky if the medicine takes the edge off. And, yes, I have tried other, non-narcotic remedies, everything from acupuncture and yoga to hypnotism and alternative or holistic compounds.
There's a reason these opioids are still around: THEY WORK. I see my primary once a month, have a complete physical yearly and, other than chronic pain, I am relatively healthy.
If the government thinks they have a problem with overdoses and suicides now, just wait and see what happens if they snatch the life preserver from millions of Americans. Sad!
I understand the concern over the opioid epidemic. It is obviously a huge problem. But there are plenty of people for whom living would be unbearable without the help of these medications.
I worry, as do others, that Chis Christie & Jared Kushner are going to lump everyone into the abuser/addict category and that some day soon the medicines we need will no longer be available. Not everyone becomes an addict. Not everyone turns to heroin. There are those who take their meds in much the same manner as someone with any other medical condition: Just as prescribed.
Personally, there is no high, no euphoria. I'm lucky if the medicine takes the edge off. And, yes, I have tried other, non-narcotic remedies, everything from acupuncture and yoga to hypnotism and alternative or holistic compounds.
There's a reason these opioids are still around: THEY WORK. I see my primary once a month, have a complete physical yearly and, other than chronic pain, I am relatively healthy.
If the government thinks they have a problem with overdoses and suicides now, just wait and see what happens if they snatch the life preserver from millions of Americans. Sad!
76
Maurice: Exactly! I am in almost the exact same position as you, and I am living with the same fears caused by the reactions to the opioid problems in this country. I would have No quality of life without my Rx.
I, too, had failed back surgeries, after a nasty fall at work. After much trial and error with my PCP, we found one med that really works for me, and it is an opioid. I also went through months and months of grueling physical therapy, etc., that didn't help.
I have never felt high from my medication, and have never felt any urge to take it other than prescribed. I have been on the same dosage for a few years, and haven't had any need to have it increased. Even so, I am treated as a possible drug abuser by my doctor's office, because that is "policy."
I suggest that there is something Behind this opioid crisis that is not just the drugs themselves. We have gone through phases of so many different drugs being abused by people: cocaine, heroine, crack, ecstasy, meth-amphetamine, etc.
The bigger question is Why do so many people have a need to escape reality, to the point that they will sell their souls to do so? That is the true crux of the problem with drug abuse, getting to the Why.
Unfortunately, this nation seems to only see drug use through the lens of criminal activity. We need to seek the solution as to why so many have a need to over-medicate, self-medicate and abuse, only then will we actually be able to prevent overdose.
I, too, had failed back surgeries, after a nasty fall at work. After much trial and error with my PCP, we found one med that really works for me, and it is an opioid. I also went through months and months of grueling physical therapy, etc., that didn't help.
I have never felt high from my medication, and have never felt any urge to take it other than prescribed. I have been on the same dosage for a few years, and haven't had any need to have it increased. Even so, I am treated as a possible drug abuser by my doctor's office, because that is "policy."
I suggest that there is something Behind this opioid crisis that is not just the drugs themselves. We have gone through phases of so many different drugs being abused by people: cocaine, heroine, crack, ecstasy, meth-amphetamine, etc.
The bigger question is Why do so many people have a need to escape reality, to the point that they will sell their souls to do so? That is the true crux of the problem with drug abuse, getting to the Why.
Unfortunately, this nation seems to only see drug use through the lens of criminal activity. We need to seek the solution as to why so many have a need to over-medicate, self-medicate and abuse, only then will we actually be able to prevent overdose.
8
People pop Advil and other nsaids like candy and commercials on tv and magazines encourage it; what does one expect. People should consult physicians, only use medication when absolutely necessary and safely dispose of them. It is not to be taken lightly.
Do not punish pain patients for opioid use, and do not punish physicians who prescribe painkillers, by withdrawing medications from the market. This is another example of prudish legislators imposing moral judgement.
it is infuriating as making cold sufferers sign for Sudafed, which is truly the only decongestant that actually works. American Puritanism still rules despite all the silly noise about big/small government.
it is infuriating as making cold sufferers sign for Sudafed, which is truly the only decongestant that actually works. American Puritanism still rules despite all the silly noise about big/small government.
51
Although acetaminophen can damage the kidneys, this is quite rare and usually only in acute overdoses - I think you meant so say that it can damage the liver, which is a far more common risk
10
Maybe the answer is to prescribe fewer pills to people after surgery. Both my kids were prescribed opiods after having their wisdom teeth out ( 2 different dentists in different states). Neither used a single pill. We never picked up my son's prescription, we still have the 20 or so pills from my daughter's surgery.
Why would we lock up the leftover pills? We have no drug addicts in the family and if some guest or worker turns thief, I'd rather they take pills of no use to me than my jewelry.
Why would we lock up the leftover pills? We have no drug addicts in the family and if some guest or worker turns thief, I'd rather they take pills of no use to me than my jewelry.
2
Another topical that's great for pain is Alocane - it's a 4% Lidocane gel that's marketed for burn victims and used in ER's to treat burns. It's a fantastic topical pain reliever with no side effects. I've used it for migraines joint pain and a severely sprained ankle.
1
Is the brand name ALEVE an NSAID? This is so confusing...
Yes, Aleve is an NSAID. It is the over-the-counter brand name; the generic OTC name is naproxen sodium. The prescription form is naprosyn.
Motrin and Advil are brand names for ibuprofen, also an NSAID.
Aspirin is also an NSAID, but though it also presents bleeding risks, it has cardio benefits.
Tylenol is the brand name for acetaminophen, which is NOT an NSAID, because it is not classed as an anti-inflammatory drug.
Motrin and Advil are brand names for ibuprofen, also an NSAID.
Aspirin is also an NSAID, but though it also presents bleeding risks, it has cardio benefits.
Tylenol is the brand name for acetaminophen, which is NOT an NSAID, because it is not classed as an anti-inflammatory drug.
2
Yes, and that information is readily available across any search engine on your computer.
3
Sorry, but you seem to have an error in this article. Acetaminophen is far more likely to damage the liver than the kidneys - it's metabolic pathway produces a hepatotoxic metabolite that is safe in normal use, but dangerous when overused.
4
And also dangerous on an empty stomach after a night of alcohol abuse.
An important topic in light of the ongoing and worsening overdose death epidemic related to opioids. You should have noted the criminal role of drug companies like Purdue who promoted the overuse of drugs like Oxycontin to a generation of doctors. They claimed that Oxycontin was an abuse proof way to treat conditions like chronic back pain and faked the medical literature by bribing academic researchers. They were never really held to account for their role in precipitating this public health crisis.
4
Oxycontin was abuse-free if you were of a mind to abuse it orally. As an extended release medication, you'd have to take thirty a day to get a buzz that way. But that was not how it was abused! Addicts, often those who had had exposure to heroin before, crushed them and shot them, or snorted them, or smoked them. This gives you a heroin-like rush from just one pill. As heroin became very cheap and available, roughly the same class of addicts - rush addicts - went over to heroin. Now none of the extended release drugs can be crushed. They are no longer abusable. The non-extended release ones can be, but do not provide anything comparable in a high. I wish the NYT would clarify this at some point.
2
It seems to me that there is a marked willingness to blame medical professionals--doctors, dentists, pharmacists and so on--for the opiod death problem, while ignoring the culpability of street dealers, foreign producers of illegal drugs (hello, China!) and drug cartels. The vast majority of people we see in news stories being given Narcan on the streets and in ERs are those who purchase their supplies on the street, not people in medically supervised pain management.
It is unfair to those suffering from chronic pain and their medical providers to cast them in the role of the villain. When will we lay at least some of the blame where it largely lies--at the doorstep of our trading partner, China, and the rapacious street capitalists, drug cartels?
It is unfair to those suffering from chronic pain and their medical providers to cast them in the role of the villain. When will we lay at least some of the blame where it largely lies--at the doorstep of our trading partner, China, and the rapacious street capitalists, drug cartels?
All of these drugs are potentially dangerous but living in pain is not worth living at all. So, what are people, especially older adults who are only concerned about quality of life and not how many years they have left, supposed to do?
Since most people don't get addicted and since most people only want relief from the terrible discomfort in their lives, why not be reasonable and offer them the choice of taking opiates, which are often much safer than NSAIDS?
Imo, these new laws concerning Rx. narcotics are cruel, judgmental, or one could simply say draconian.
Since most people don't get addicted and since most people only want relief from the terrible discomfort in their lives, why not be reasonable and offer them the choice of taking opiates, which are often much safer than NSAIDS?
Imo, these new laws concerning Rx. narcotics are cruel, judgmental, or one could simply say draconian.
13
I thought large quantities of acetaminophen caused damage to the liver rather than the kidneys as stated in the article. Any comments or clarification on this?
1
Jane, Ira wrote the lyric, George the music.
2
There's no need to fear medication, prescription or over-the-counter. They are perfectly safe for most people when taken properly. Caution and good sense and only when absolutely necessary, yes; fear, no.
The opioid panic is a fraud. Politicians, with an assist from the media, are conflating heroin and Percocet, replacing their names with the spooky sounding "opioids." Boo! They are conflating drug addicts and the drugs they take to get high, with patients taking prescribed mediation when needed for pain. They're making doctors afraid to prescribe pain medication, and patients afraid to take it. Caution and good sense also come in handy when taking in the daily drip of the "opioid" panic.
The goal seems to be to eventually make pain medication unavailable to most people. When it's gone, the anti-opioid crusaders may one day experience pain themselves, and they they'll know what we know, but it will be too late. It's too bad there's not a pill to fix empathy deficits.
The opioid panic is a fraud. Politicians, with an assist from the media, are conflating heroin and Percocet, replacing their names with the spooky sounding "opioids." Boo! They are conflating drug addicts and the drugs they take to get high, with patients taking prescribed mediation when needed for pain. They're making doctors afraid to prescribe pain medication, and patients afraid to take it. Caution and good sense also come in handy when taking in the daily drip of the "opioid" panic.
The goal seems to be to eventually make pain medication unavailable to most people. When it's gone, the anti-opioid crusaders may one day experience pain themselves, and they they'll know what we know, but it will be too late. It's too bad there's not a pill to fix empathy deficits.
39
Yes! Also, don't physicians understand that if they don't treat people's pain, then many will go out and search for something, anything to give them relief? Wouldn't doctors rather prescribe than have their patients go to the street corner?
After I broke my foot a month ago, I reacted to the meds prescribed for pain, hydrocodone-acetaminophen and an NSAID. I self-dosed OTC naproxin to control pain without the sharp stomach pain caused by the Rx NSAID and started taking extended relief acetaminophen instead of the Rx opioid--worked well. However, after a couple of days, the naproxin caused a dull ache in my abdomen that spread to my chest and, after a few more days, my BP jumped to 150/120 on a home monitor! So, I had two trips to the ER in two weeks! I agree with Cheryl's comments. Don't take these useful drugs off the market, but do give adequate warning of their dangers. And not in lawyerly language that patients will just ignore.
1
You were lucky. I was prescribed Naprosyn some years ago, before it was an OTC drug...took exactly one dose, and immediately develop severe acid reflux that did not dissipate for 3 days. Two regular strength ibuprofen is as much as my stomach can tolerate in an NSAID, and thanks to kidney damage, can't even take that anymore.
1
One thing that the article remarks about is the fact that many people who are prescribed opioids after surgery fail to dispose of the residue of pills on hand when they have stopped taking the drug. Some while ago I underwent spinal surgery. In the aftermath I was prescribed strong opioids, which I took, all the while fearing the danger of getting addicted. I quickly came to deal with that by taking the minimum prescribed dosage. After a while my doctors switched me to a less powerful opioid, and ultimately switched me to Vicodin. When I had successfully weaned myself off that I still had a remaining residue of pills. I then sought to find a suitable to dispose of that residue. It is improper to put them in the garbage. Our county landfill has a hazardous waste disposal program two days per week, but they are not permitted to accept controlled substances such as any opioids. I was told that one can dispose of them by taking them to the local police station. When I went there I was told that they only accept controlled substances one day each year. So what is a person to do to get rid of these dangerous drugs?
1
Not sure pharmacists should be included in the blame net. Unless I'm mistaken, aren't pharmacists bound to fulfill physicians' lawful prescriptions? Also, these same pharmacists get severely criticized by the left for, say, refusing to fill other prescriptions, i.e., birth control pills. Let's try to minimize the hypocrisy. (Disclosure: I am NOT a pharmacist!)
2
I am one and I found the author judgmental. If it's a lawful prescription with no red flags, the dosing is correct, the doctor and patient's profile is not suspicious, what reason do I have not to fill this? I go over potential side effects and risks for new prescriptions and answer those with concerns. Not sure what Ms. Brody would want me to do more short of refusing legal prescriptions.
I wouldn't compare this to the birth control issue. If I decide to turn down an opioid prescription (and I have) because it doesn't check out for the reasons I listed, it is within my professional judgment which the law grants me. If I decide to turn down a birth control script, it is within my religious judgment which a few states allow (hypothetical, as I myself do not support this). One is essential for my job. The other...it's just not the same situation.
Also don't think Ms. Brody should be blaming patients in this as well. If she wants to call out abusers, go ahead. But don't lump in well intending patients who legitimately seek medical treatment.
I wouldn't compare this to the birth control issue. If I decide to turn down an opioid prescription (and I have) because it doesn't check out for the reasons I listed, it is within my professional judgment which the law grants me. If I decide to turn down a birth control script, it is within my religious judgment which a few states allow (hypothetical, as I myself do not support this). One is essential for my job. The other...it's just not the same situation.
Also don't think Ms. Brody should be blaming patients in this as well. If she wants to call out abusers, go ahead. But don't lump in well intending patients who legitimately seek medical treatment.
1
In the last five years both my daughter and I had wisdom teeth removed. In both cases we were given a prescription for Vicodin and *required* to fill it before they would perform the surgery. Neither of us used any of it, and the full bottles sat in our medicine closet until we threw them out. Ibuprofen was plenty.
I've had doctors refuse to write a pain med prescription before surgery, which in one case led to a post-surgical scavenger hunt trying to find a pharmacy that had the drug in stock before the local anesthesia wore off. Most annoying was Walgreens, which refused to fill my script on the spot, even though there was literally nobody else in the store. But they had prescriptions in the queue ahead of mine, and didn't think anything of letting a woman with an increasingly bloody bandage on her foot sit in their waiting area for over an hour. Rules are rules, after all.
1
" When treating localized pain, a topical NSAID, like a gel of diclofenac or ibuprofen, is a much safer alternative. Unfortunately, currently these are only available by prescription in the United States, making them far more costly than in other countries, where a tube can be purchased over-the-counter for about $10"
So why are they over the counter in Europe and Canada but only available by prescription in the U.S.? You can buy Ibuprofen to swallow OTC but rubbing the same drug on your skin takes a prescription? Maybe now with the opioid epidemic we can look at helping people relieve pain in other ways by making this readily available.
So why are they over the counter in Europe and Canada but only available by prescription in the U.S.? You can buy Ibuprofen to swallow OTC but rubbing the same drug on your skin takes a prescription? Maybe now with the opioid epidemic we can look at helping people relieve pain in other ways by making this readily available.
3
You really have to wonder why drugs cost so much more in this country? Ask big pharma. Better yet, ask their shareholders and executives, and even the employees getting big bonuses every year. Ask them if they wouldn't mind reducing their obscene profits by lowering prices, or why they been the law and make uncompetitive agreements that allow monopolistic pricing on generics as well as brand-name drugs.
The problem with the cost of medications in this country is due to a lack of regulation in this area, because we are taught to worship capitalism and find it hard to admit when the system fails to work for anyone but the already wealthy.
The problem with the cost of medications in this country is due to a lack of regulation in this area, because we are taught to worship capitalism and find it hard to admit when the system fails to work for anyone but the already wealthy.
3
It's not clear to me why a topical pain reliever, which is specifically formulated to penetrate the usually impenetrable skin barrier, would still not become diffused throughout the entire body? Is it just the gastrointestinal damage that is being avoided?
1
That's exactly it, at least according to my former nephrologist, who freaked when my rheumatologist at the time gave me some Voltaren gel without considering its effects on my kidneys.
The systemic levels from topical applications are much, much lower than from oral administration ( and avoiding GI damage is a pretty big deal). if you have heart or kidney disease, using them should be discussed with your Dr. But for most people topical applications are very safe, so far as has been seen.
Another side effect of some NSAIDs, specifically ibuprofen, is an allergic rash. After routinely taking ibuprofen for years, my wife suddenly developed full body hives after a routine dose. I can still take it but I use it with caution. The biggest problem with acetaminophen, not an anti-inflammatory, is that it's so many medications. It is a liver toxin and the safety level is only 8 times (or less) of the typical dose.
after surgery one will usually get a script for an opioid. If you go to the doc and complain about pain, you will probably get an nsaid. The pain that doesn't require surgery may be worse than pain following surgery so the protocol makes no sense. Actually for surgical pain you usually get something like percoset which is an opioid combined with an nsaid. The theory is that addressing pain with both kinds of drugs may be more effective but it is also more dangerous.
In most cases prescribed meds are not likely to induce euphoria as the dose Is just not high enough. It is more likely that people become tolerant and need higher doses for pain control. Patients in this predicament may then be labelled as addicts. This is unfortunate. They are opioid dependent but not addicted.
In most cases prescribed meds are not likely to induce euphoria as the dose Is just not high enough. It is more likely that people become tolerant and need higher doses for pain control. Patients in this predicament may then be labelled as addicts. This is unfortunate. They are opioid dependent but not addicted.
No opioids, no NSAIDS, no acetaminophen. Just what is someone with chronic pain supposed to take (or do) to be able to function? There is very little helpful information for someone like me with disabling arthritis pain or others with severe chronic pain issues.
13
Funny Lyrica wasn't mentioned in this article, which has been helpful in treating my chronic back pain, but has enough side effects to make me limit my dose to the bare minimum. At the dose my doctor prefers, I can barely hear people talking above the whooshing noise in my ears.
Just a note on accuracy. Acetaminophen in large doses can be fatal because of liver, not kidney damage.
4
People today would far rather take a pill than try something else for chronic pain. Many people I know who have chronic joint or back pain are also grossly obese. Their poor old backs, knees and hips can no longer support their huge bodies. But they prefer pain meds and surgery to the idea of actually losing weight and doing some resistance training.
I had back pain for years, caused by scoliosis and some disc problems. My doctor prescribed Tramadol - told me it was non-addictive and harmless. I took one pill three times WEEKLY (NOT daily!) for many years - I took it prior to going to pulmonary rehab to exercise. It allowed me to do far more vigorous exercise than I would have been able to do without it.
After a few years, I realized that on the days I wasn't going to rehab, I "crashed" - I felt awful all day - truly ill. After this went on for a few months, I wondered if it were possible for me to have become addicted to such a low dosage of this drug. All I read made it seem unlikely - THREE pills a week? But I decided to not take them and see what happened. I spent two pretty miserable weeks = clearly I was in some sort of withdrawal from this drug. After that, I was fine, but I was never again to exercise quite as vigorously. When I told my doctor about this, he thought I was lying - that I was taking far more of the drug. I assured him I was not.
I will never again take an opiod and I avoid OTC drugs as well. I just exercise more and it works.
I had back pain for years, caused by scoliosis and some disc problems. My doctor prescribed Tramadol - told me it was non-addictive and harmless. I took one pill three times WEEKLY (NOT daily!) for many years - I took it prior to going to pulmonary rehab to exercise. It allowed me to do far more vigorous exercise than I would have been able to do without it.
After a few years, I realized that on the days I wasn't going to rehab, I "crashed" - I felt awful all day - truly ill. After this went on for a few months, I wondered if it were possible for me to have become addicted to such a low dosage of this drug. All I read made it seem unlikely - THREE pills a week? But I decided to not take them and see what happened. I spent two pretty miserable weeks = clearly I was in some sort of withdrawal from this drug. After that, I was fine, but I was never again to exercise quite as vigorously. When I told my doctor about this, he thought I was lying - that I was taking far more of the drug. I assured him I was not.
I will never again take an opiod and I avoid OTC drugs as well. I just exercise more and it works.
1
Please be careful where you position the cart, as it might not be obvious that it's in front of the horse. For a good dose of empathy, I strongly suggest acquiring an autoimmune disease like lupus, which destroys your joints, causes massive fatigue, and most often requires you to take prednisone for the rest of your life.
And when that steroid medication is at a high dose, and your appetite is such that after you've eaten a full meal, you want to eat another full meal, and another after that, and you're drowning in manic, incoherent, steroid-induced thoughts that make willpower fly in the wind...and you can't do any useful exercises because every time you do you end up injuring yourself or in such pain that you can't even get out of bed...then maybe you'll consider that being fat can actually be an effect and not a cause. In the meantime, thanks for the anecdotal advice, and spare me the crass judgment.
And when that steroid medication is at a high dose, and your appetite is such that after you've eaten a full meal, you want to eat another full meal, and another after that, and you're drowning in manic, incoherent, steroid-induced thoughts that make willpower fly in the wind...and you can't do any useful exercises because every time you do you end up injuring yourself or in such pain that you can't even get out of bed...then maybe you'll consider that being fat can actually be an effect and not a cause. In the meantime, thanks for the anecdotal advice, and spare me the crass judgment.
8
I was extremely fit and thin when I had an accident at work which left me with chronic pain, which was not helped thru 2 surgeries or the plethora of PT modalities I endured.
Since that time, I have gained some weight because it can be difficult for me to exercise as regularly as I used to do. Yes, exercise can help with pain, but sometimes it also exacerbates it. I have had both happen.
I have done exercise, regularly, after my accident and surgeries, but without having pain medications I would not even be able to stand up, let alone do Zumba.
Everyone's pain is not the same, and everyone's bodies are not the same.
Since that time, I have gained some weight because it can be difficult for me to exercise as regularly as I used to do. Yes, exercise can help with pain, but sometimes it also exacerbates it. I have had both happen.
I have done exercise, regularly, after my accident and surgeries, but without having pain medications I would not even be able to stand up, let alone do Zumba.
Everyone's pain is not the same, and everyone's bodies are not the same.
3
But I don't care if you never take an opioid again.
I care about the people who aren't tough as nails, like you, and can't get the relief they desperately need.
I care about the people who aren't tough as nails, like you, and can't get the relief they desperately need.
The article mixes up the risks in relationship to Tylenol versus nonsteroidal anti-inflammatories. High-dose Tylenol risks burning out your liver, high-dose nonsteroidals, your kidneys as prostaglandins regulate blood flow there. There is fundamental ignorance about analgesics not just in terms of what the public knows but even in terms of what physicians typically know. For example, opioids have differential effects on other receptor systems besides the mu opioid receptor system that are undesirable: receptors modulating inflammation (TLR-4), those involved in pain plasticity (NMDA) and even in translating stress into depression (Kappa opioids). Many opioids have promoting effects on TLR4, particularly at higher doses, a system that is part of the inflammasome, and upregulating this leads to opioid tolerance and declining effectiveness. When you give opioids that promote NMDA (fentanyl), you're actually amplifying pain plasticity issues in chronic pain. When you give opioids that remote the kappa opioid system to someone who's already stressed-out, there is an increased risk of precipitating a depression, and possible slide into addiction. This knowledge is not well disseminated. Pain has to be approached with a clearer knowledge of its mostly inflammatory origins, and oftentimes ice, nonsteroidal anti-inflammatories, better sleep, even dietary adjustments can knock down inflammatory tone and thus pain level so that opiate dosing can be much lower – or nonexistent.
Pain itself can also cause depression and other marked differences in the brain if left untreated.
I do agree that ice, NSAIDS, sleep, etc., can help with pain management, but the results differ from person to person.
I do agree that ice, NSAIDS, sleep, etc., can help with pain management, but the results differ from person to person.
2
I was diagnosed with facet joint disease in 2009. Everytime it flared up I would get a wrenching muscle spasm in my lower back that could literally knock me off my feet. Rather than prescribe an opioid, my primary care doctor put me on 7.5 mg meloxicam, a prescription NSAID, once daily to stave off the pain that sent the muscles into spasms. By 2014 my kidney function had declined to a threshold that alarmed my new primary care doctor. I had to see a nephrologist for a year so my kidney function could be monitored, and of course, no more meloxicam. I was in Stage 3A kidney failure when I first saw the nephrologist!! Thankfully, it is now three years later and my kidney function is normal. I lost some weight and exercise regularly,which has helped my back. I can never take NSAIDS again, and I take flexeril and tramadol when I have spasms, which are infrequent. I am very careful about what medications I take, even OTC. Lesson learned...
The problem with treatment of chronic pain is here to stay .
With an aging population affected by every kind of aches and pains , especially arthritis associated with chronic pain , it's quite difficult to find pain relief without side effects .
Moderation in using NSAID could be the answer , together with light exercise, walking , yoga etc...
Pain doctors might offer temporary relief , often followed by worse relapses .
It is easy to recommend to use NSAID for a short period of time , unfortunately pain will not disappear.
Many prescription anti inflammatory drugs are extremely expensive in the USA , as well as topic anti inflammatory creams or gels .
In Europe they are much cheaper , or one can order them from Canada .
Why is this Great Country allowing Big Pharma to behave like a predator , vulture or vampire towards the sick , when we all know that the well being of a country is based on the general health of its citizens ???
With an aging population affected by every kind of aches and pains , especially arthritis associated with chronic pain , it's quite difficult to find pain relief without side effects .
Moderation in using NSAID could be the answer , together with light exercise, walking , yoga etc...
Pain doctors might offer temporary relief , often followed by worse relapses .
It is easy to recommend to use NSAID for a short period of time , unfortunately pain will not disappear.
Many prescription anti inflammatory drugs are extremely expensive in the USA , as well as topic anti inflammatory creams or gels .
In Europe they are much cheaper , or one can order them from Canada .
Why is this Great Country allowing Big Pharma to behave like a predator , vulture or vampire towards the sick , when we all know that the well being of a country is based on the general health of its citizens ???
1
No mention of marijuana as a way to get people off these other damaging drugs? Its efficacy in a host of pain problems has been demonstrated over and over. There has never been one, ONE, reported and documented death caused by an overdose of marijuana. People are using it as a way of weaning off opioids. THC, the active ingredient in marijuana, has some very interesting medicinal uses from seizure control, treatment for PTSD, headaches, and a broad range of chronic pain problems. It should be offered as an option when dealing with these issues.
1
Doctors used to prescribe drugs only to patients who needed them. There was always a few who became rich by selling prescriptions.
With Medicare Part D, the US established prescription drugs as a sheltered economic cartel, turned all doctors into drug distributors, and captured a market that would infect the rest of the population for eternity.
Reliance on pills has become a national religion. The automated distribution system via doctors and pharmacies takes attendance regularly, while the annual Medicare Wellness Visit operates as a heresy-prevention check. People should break the circuit: get a paper prescription, and research the drug, the quantity, and the price before you get it filled.
With Medicare Part D, the US established prescription drugs as a sheltered economic cartel, turned all doctors into drug distributors, and captured a market that would infect the rest of the population for eternity.
Reliance on pills has become a national religion. The automated distribution system via doctors and pharmacies takes attendance regularly, while the annual Medicare Wellness Visit operates as a heresy-prevention check. People should break the circuit: get a paper prescription, and research the drug, the quantity, and the price before you get it filled.
"A new review of six studies by Dr. Mark C. Bicket and colleagues at Johns Hopkins University School of Medicine found that among 810 patients who underwent seven different kinds of operations, 42 percent to 71 percent failed to use the opioids they received, and 67 percent to 92 percent still had the unused drugs at home.
Six studies revealed that patients had no plans for safely disposing of the pills they no longer needed.”
Now why on earth would people keep narcotics they no longer need? I know as I am an MD at a free clinic in Georgia. They are afraid with the current “opioid crisis” that they won’t be able to get any more narcotics if they do get severe pain! Until these “experts” understand what pain does to themselves, they won’t understand that desperation of what if I run out of opioids I NEED to live a normal life.
The author wails over the fact that THREE times the opioids were prescribed in 2011 as in 1991. We ALSO know that MDs were under treating pain in 1991.
Yes. Fentanyl and its analogues are killing people at extraordinary rates. And heroin consumption/ODs are on the rise. HOWEVER patients with legitimate prescriptions are NOT the folks dying of overdoses.
It’s too easy right now to make this simplistic. It isn’t. Until we find out WHY people use drugs for reasons other than physical pain, all of this is a fool’s errand.
Six studies revealed that patients had no plans for safely disposing of the pills they no longer needed.”
Now why on earth would people keep narcotics they no longer need? I know as I am an MD at a free clinic in Georgia. They are afraid with the current “opioid crisis” that they won’t be able to get any more narcotics if they do get severe pain! Until these “experts” understand what pain does to themselves, they won’t understand that desperation of what if I run out of opioids I NEED to live a normal life.
The author wails over the fact that THREE times the opioids were prescribed in 2011 as in 1991. We ALSO know that MDs were under treating pain in 1991.
Yes. Fentanyl and its analogues are killing people at extraordinary rates. And heroin consumption/ODs are on the rise. HOWEVER patients with legitimate prescriptions are NOT the folks dying of overdoses.
It’s too easy right now to make this simplistic. It isn’t. Until we find out WHY people use drugs for reasons other than physical pain, all of this is a fool’s errand.
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Nuschler: Thank You! I am a chronic pain patient, and when it wasn't being managed well enough I was extremely depressed and almost suicidal. I am very concerned right now about the hysteria of the opioid crisis, because without my opioid medication I will have NO quality of life.
Yes, I do understand the horrific result of people overdoing that is going on in this country, but I have also been saying for a long time, as you have, that we need to investigate Why some people need to misuse and abuse drugs to the point that they can die. This didn't start with opioids and heroine, either. We have seen cocaine, crack, meth-amphetamies, etc., taken in mass amounts in previous times. There is something with some people who are going to abuse whatever drug is "in fashion." Until we know why that is, we will always have a drug (and alcohol!) problem in this country.
Yes, I do understand the horrific result of people overdoing that is going on in this country, but I have also been saying for a long time, as you have, that we need to investigate Why some people need to misuse and abuse drugs to the point that they can die. This didn't start with opioids and heroine, either. We have seen cocaine, crack, meth-amphetamies, etc., taken in mass amounts in previous times. There is something with some people who are going to abuse whatever drug is "in fashion." Until we know why that is, we will always have a drug (and alcohol!) problem in this country.
1
Thank you for covering that over the counter NSAIDS and acetaminophen are not benign and have serious side effects. However, these are very different from opioids - do not have tolerance and dependence issues that opioids have.
With our obese society with their worn out knees and spines - if they do not take OTC meds within safe dosages - what are they going to do? This is where I disagree with this article. People need to chose their poison - if they do not take anything - they live with pain which is their side effect. They can use OTC meds and their side effects. Ideally people should not be obese and active - that is not done by most people - life gets in the way.
Spine issues do not have surgical options. Surgery for worn out knees (total knee replacement) is actually more risky than taking tylenol and/or ibuprofen within safe dosages. Total knee is a good deal more expensive as well.
So it is good to know side effects but OTC meds within safe dosages for managing day to day pain of aging bodies is not the evil you have made it to be.
With our obese society with their worn out knees and spines - if they do not take OTC meds within safe dosages - what are they going to do? This is where I disagree with this article. People need to chose their poison - if they do not take anything - they live with pain which is their side effect. They can use OTC meds and their side effects. Ideally people should not be obese and active - that is not done by most people - life gets in the way.
Spine issues do not have surgical options. Surgery for worn out knees (total knee replacement) is actually more risky than taking tylenol and/or ibuprofen within safe dosages. Total knee is a good deal more expensive as well.
So it is good to know side effects but OTC meds within safe dosages for managing day to day pain of aging bodies is not the evil you have made it to be.
1
The important sentence here is "with 142 Americans dying daily from drug overdoses, a fourfold increase since 1999, more than the number of people killed by gun homicides and vehicular crashes combined." I was prescribed & have taken Nsaids (Motrin) since 1992 because I could not walk or move before taking them & will not go on prescriptions for any opioids!!! I take the Nsaids after eating & within the prescription limits, they are a lifesaver compaired to opiods or surgery, doctors today want to do surgery so they make their paychecks..
1
Acetominophen is liver toxic, not kidney toxic in overdose.
1
You got it backwards - Tylenol is metabolized by the liver, NSAIDs by the kidneys.
3
You got that backwards. Acetimenophen can damage the liver, even fatally when overdosed. NSAIDs are the ones that have cardiac and definitely kidney risks.
1
We go after drug dealers who ply their trade on street corners, what about the professional's who are over prescribing these very dangerous drugs?
1
From a prescriber's point of view, I have multiple patients that are on longterm opiates for pain. Some are cancer patients or have nerve pain from injuries and are in wheelchairs. Some have come back from the pain specialists on these medicatons. Some have insidiously gone from a few, intermittent doses of opiates that were started by surgeons or ER docs to daily use at gradually increasing doses. Most have tried all other pain meds and feel opiates help them the most. I have recommended drug holidays, but none ever do this (too much rebound pain and withdrawal symptoms). I am as succesful at getting patients to stop opiates, as I am succesful at getting smokers to quit smoking. A few do, but just a few. The path of least resistance is continuing to write the prescription and to go through all the hoops this involves. I had one chronic opiate patient in his 50s die, but I do not think it was an overdose. He was a smoker and lived a very stressful life, so, a heart attack in his sleep may have been the cause. Any suggestions on how I can get these patients to want to stop the opiates? Why not just keep them on a stable dose, like a methadone or suboxone patient?
Thomas G. Smith MD, Family Physician
Thomas G. Smith MD, Family Physician
5
"Nor is acetaminophen (Tylenol and its generic imitators) always safe. It can damage the kidneys when used in large doses, as might happen when taken for chronic arthritic pain."
Typically it's NSAIDs that damage kidneys; acetaminophen/paracetamol can cause liver damage.
Typically it's NSAIDs that damage kidneys; acetaminophen/paracetamol can cause liver damage.
1
Great article. Europe has it so right when it comes to simple / safe(r) OTC remedies for the maladies of everyday life.
When we traveled there many years ago, I could count on a whammy of a sinus infection by time of arrival, or some other ailment, am not an 'easy' traveler ... thank goodness for local apothecaries, and their helpful staffs. They saved, or at least, made endurable, more than one trip.
I can only guess big Pharma, the FDA and insurers are all to blame for the difficulties and obscene expense in getting something as basic, really, as a topical NSAID gel.
When we traveled there many years ago, I could count on a whammy of a sinus infection by time of arrival, or some other ailment, am not an 'easy' traveler ... thank goodness for local apothecaries, and their helpful staffs. They saved, or at least, made endurable, more than one trip.
I can only guess big Pharma, the FDA and insurers are all to blame for the difficulties and obscene expense in getting something as basic, really, as a topical NSAID gel.
1
The article cites a report which says 100 million Americans are living with chronic pain. That's almost one-third of the population. Is that accurate?
In our household we also have the occasional painkiller in quantities that far surpass what is needed at the time of prescription.
Some years ago our local firefighters organized a drive to get rid of expired drugs. Until that time these opioids remained at home, stored away, as we had no easy way to destroy them. Our health care provider, Kaiser, was no help at all: the pharmacy told us to call a number which would then bill us to mail the drugs to them....instead of having a system that responsibly safeguards not only dispensing these drugs in reasonable quantities but also removing them from circulation, the onus is on the patient to find (and pay for) ways to safely destroy any left overs without considering what a hindrance it is to not provide easy access to such methods.
Some years ago our local firefighters organized a drive to get rid of expired drugs. Until that time these opioids remained at home, stored away, as we had no easy way to destroy them. Our health care provider, Kaiser, was no help at all: the pharmacy told us to call a number which would then bill us to mail the drugs to them....instead of having a system that responsibly safeguards not only dispensing these drugs in reasonable quantities but also removing them from circulation, the onus is on the patient to find (and pay for) ways to safely destroy any left overs without considering what a hindrance it is to not provide easy access to such methods.
1
We must have better ways of safely disposing meds.
My late Mother was provided many controlled substance 'scripts from hospice in her two residences in NoVA; I was fortunate to be able to share care with my sister-in-law and family in nearby brother's house. We never needed the morphine thank goodness, but were given no way to dispose of it.
Hospice would not take it back and after tons of research I put both our med piles, controlled or not, into a CVS pharmacy bin (inside store by pharmacy counter). It was like a mailbox and only took small bottles so I needed help.
I had boxes, all kine stuff. Sounded like I was playing a slot machine.
CA does drive-through drop offs at police stations a few times a year. Getting rid of excess meds more easily would help stem abuse.
My late Mother was provided many controlled substance 'scripts from hospice in her two residences in NoVA; I was fortunate to be able to share care with my sister-in-law and family in nearby brother's house. We never needed the morphine thank goodness, but were given no way to dispose of it.
Hospice would not take it back and after tons of research I put both our med piles, controlled or not, into a CVS pharmacy bin (inside store by pharmacy counter). It was like a mailbox and only took small bottles so I needed help.
I had boxes, all kine stuff. Sounded like I was playing a slot machine.
CA does drive-through drop offs at police stations a few times a year. Getting rid of excess meds more easily would help stem abuse.
1
It is not credible to make such blanket statements regarding pain medications in the US. Physicians were told to treat pain as "a vital sign" and not undertreat it by our former Surgeon General. Now they are told there is an epidemic of overuse (which is, of course, true). Physicians and patients with pain needs cannot be swept into a media frenzy with extremes. There are not black and white answers to these problems, and physicians and patients still need to address patient needs individually. We, in the US, could do that more efficaciously if big business pharmaceutical lobbies didn't control the pricing and availability of common sense information, cost, and availabiility of all our medications.
Please, Ms Brody, address this complex problem with more nuance and less hype.
Please, Ms Brody, address this complex problem with more nuance and less hype.
3
Blaming the patients.... when so many are to blame? Clearly, it is the medication and the medical care that needs to improve. Defective products on the Market. Less than Brilliant well-educated Doctors still licensed to see patients. Those are just two reasons why this article should have a different emphasis/angle.
9
Diclofenac gel is highly efficacious, and it's patently absurd that a prescription is required in this country. Canada, too, sells diclofenac gel over the counter for about 1/10th the price in the US, where the medical professions seems in thrall to the pharmaceutical industry.
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agreed - I resorted to it when I had a broken wrist - in conjunction with NSAIDs or acetaminophen, it was helpful in rehab. I happened to have a tube of it - but there is no reason it should not be OTC. It is safer - from reports that exist - than taking NSAIDs orally in high doses.
It's not the physicians who want pharmaceuticals to be expensive. We want the opposite, as a matter of fact.
Ever try to get insurance coverage for diclofenac gel? It's almost impossible to get it approved for chronic back pain. There is also a patch version which is longer-lasting. I asked for it when I injured my shoulder. It would have cost me over $200 per month. These medications work well and safely, but insurance refuses to pay. Opioids are cheap.
The geriatric and gerontological communities have warned about overuse and misuse of drugs - both prescription and OTC - for decades. Indeed, the most common aphorism in geriatrics addresses this: "Whenever the patient has a new problem, first suspect the drugs." As a geriatrician, I find it disheartening to hear that this well researched problem is only now being discovered by other medical specialists and the lay public.
I encourage all patients to take the "brown bag" challenge, that is, throw all their drugs, whether prescribed or not, into a paper bag and take it to all their doctors' appointments. This likely will result in some unhappy surprises for both doctors and patients, but this approach may save some patients a hospitalization and some even their lives.
I encourage all patients to take the "brown bag" challenge, that is, throw all their drugs, whether prescribed or not, into a paper bag and take it to all their doctors' appointments. This likely will result in some unhappy surprises for both doctors and patients, but this approach may save some patients a hospitalization and some even their lives.
12
There have been several studies recently, reported in this paper, about the link between NSAIDs and increased risk of heart attack. How was this not mentioned in this article?
1
The article does, in fact, describe the increased risk for cardiovascular problems associated with NSAID usage.
Cardiovascular risk IS mentioned.
1
Actually it was. "Clogging of the coronary arteries" is what causes a heart attack.
I'm one of millions of Americans with QT Interval Prolongation - a propensity to ventricular tachyarrhythmias, which may lead to syncope (fainting), cardiac arrest, or sudden death. No physical symptoms at all except what's found on an EKG. I rely on sites that tell me what prescription and OTC medications contribute to QTIP. Alas, ibuprofen is one of the OTC no-nos. Even our beloved NSAIDs aren't good for some of us. Also, many antibiotics and other drugs are on the QTIP list.
If you know you have a medical condition, read the package inserts carefully. And even those don't tell the whole story. I use a site called CredibleMeds.org run by a physician and colleagues to check on my meds and QTIP. MDs have access to other physician-only sites to check on your medications for interactions or direct impact on a specific medical condition.
It's worth doing for a host of medical problems; with QTIP it's critical to stop using meds that contribute to this condition. I switched to acetaminophen for occasional - and I mean occasional - use even though it doesn't help me as well with pain, fever and inflammation as did ibuprofen. I miss my ibuprofen but I'd miss my life a lot more.
If you know you have a medical condition, read the package inserts carefully. And even those don't tell the whole story. I use a site called CredibleMeds.org run by a physician and colleagues to check on my meds and QTIP. MDs have access to other physician-only sites to check on your medications for interactions or direct impact on a specific medical condition.
It's worth doing for a host of medical problems; with QTIP it's critical to stop using meds that contribute to this condition. I switched to acetaminophen for occasional - and I mean occasional - use even though it doesn't help me as well with pain, fever and inflammation as did ibuprofen. I miss my ibuprofen but I'd miss my life a lot more.
14
@Janet: I understand your point of view, but I have the opposite point of view. I take generic Celebrex (celecoxib) for the arthritis that is not just in one place in my body, but everywhere from my feet & ankles to my knees, wrists and fingers.
I have clearly told my spouse that, if I happen to die as a result of a celecoxib-related coronary "event," I do NOT want anyone sued. Rather, my spouse and friends should know that I far prefer feeling well enough to live a full life every day - and to me, THAT is worth the risk that my life may be shorter.
I am grateful for pain medicine - both acetaminophen and celecoxib - that allows me to get through the day as fully functional as possible.
I find it interesting that as the population ages in this country, and therefore far more senior citizens nay be in pain, there is suddenly this push to keep people AWAY from pain-relief, and to discourage the use of pain relievers. It seems very punitive, even Puritan, to my mind.
I have clearly told my spouse that, if I happen to die as a result of a celecoxib-related coronary "event," I do NOT want anyone sued. Rather, my spouse and friends should know that I far prefer feeling well enough to live a full life every day - and to me, THAT is worth the risk that my life may be shorter.
I am grateful for pain medicine - both acetaminophen and celecoxib - that allows me to get through the day as fully functional as possible.
I find it interesting that as the population ages in this country, and therefore far more senior citizens nay be in pain, there is suddenly this push to keep people AWAY from pain-relief, and to discourage the use of pain relievers. It seems very punitive, even Puritan, to my mind.
20
QT medication issues are vert common-you may enjoy this:
Macrolide and fluoroquinolone mediated cardiac arrhythmias: clinical considerations and comprehensive review, has now been published on Taylor & Francis Online and is in the latest issue of Postgraduate Medicine, Issue 7.
http://www.tandfonline.com/eprint/THNT6YN2dTeNmSRRfvGH/full
Macrolide and fluoroquinolone mediated cardiac arrhythmias: clinical considerations and comprehensive review, has now been published on Taylor & Francis Online and is in the latest issue of Postgraduate Medicine, Issue 7.
http://www.tandfonline.com/eprint/THNT6YN2dTeNmSRRfvGH/full
Actually Ira Gershwin wrote the lyric to "It Ain't Necessarily So".
4
But music by George.
1
I have no pain and no pills or conditions at 62 which would require any but since I've lived in this country for nearly 3 decades, there is something which they do here with ALL medications given, even beauty creams come with them. They have a 2 to 3 page information sheet included in the box. They are very long indeed and cover every imaginable situation including breastfeeding mothers. This goes for vitimans as well. My husband has taken some things for headaches and I've also seen these in every drug package for my mother-in-law who takes several things. All possible situations and research results, along with warnings, are inside any box you would get and everyone is advised to read them before taking anything!
I asked my GP two months after 9/11 if he would give me "something" to help calm me because I was very upset being a former NYC woman. He flatly denied me anything saying I was a strong woman who would process my pain and that no pill would help me do so--would only make things worse. He knew me well. They do not give pills out like they do in the USA.
I asked my GP two months after 9/11 if he would give me "something" to help calm me because I was very upset being a former NYC woman. He flatly denied me anything saying I was a strong woman who would process my pain and that no pill would help me do so--would only make things worse. He knew me well. They do not give pills out like they do in the USA.
5
A gp who "flatly " denies help strikes me as rigid and cruel. A responsible doctor would discuss a variety of possible approaches to your difficulty. It obviously meant a great deal to you, as you went so far as to attend the appointmentment.
2
I don't know what Ms. Brody will cover in part 2 but a couple of comments on this part.
She notes that over time patients' bodies may get used to opioids requiring higher doses to achieve the same effect. This is called tolerance. There is also a condition called hyperalgesia where there is a lowering of the pain threshold. This gradually occurs so patients and physicians may think this indicates tolerance and increase the dose. This just ends up making the hyperalgesia worse. The real way to treat to it is get the patient off the opioid.
Also, with regard to opioids, it is true that as with alcohol, patients started on opioids can wind up abusing and becoming addicted to them. However, research indicates that this occurs in up to 24% of patients taking opioids for chronic pain. No where near that many people who drink alcohol regularly become alcoholics.
Finally, and perhaps this will be covered in part 2, an additional drug that is frequently prescribed to patients with chronic pain is one of the benzodiazepines. Not only can these also cause hyperalgesia like the opioids but they also actually interfere with the analgesic effects of opioids so patients will require a higher dose of the opioid if they are also taking a benzodiazepine. And benzodiazepines are also present in 30% of opioid overdose deaths.
She notes that over time patients' bodies may get used to opioids requiring higher doses to achieve the same effect. This is called tolerance. There is also a condition called hyperalgesia where there is a lowering of the pain threshold. This gradually occurs so patients and physicians may think this indicates tolerance and increase the dose. This just ends up making the hyperalgesia worse. The real way to treat to it is get the patient off the opioid.
Also, with regard to opioids, it is true that as with alcohol, patients started on opioids can wind up abusing and becoming addicted to them. However, research indicates that this occurs in up to 24% of patients taking opioids for chronic pain. No where near that many people who drink alcohol regularly become alcoholics.
Finally, and perhaps this will be covered in part 2, an additional drug that is frequently prescribed to patients with chronic pain is one of the benzodiazepines. Not only can these also cause hyperalgesia like the opioids but they also actually interfere with the analgesic effects of opioids so patients will require a higher dose of the opioid if they are also taking a benzodiazepine. And benzodiazepines are also present in 30% of opioid overdose deaths.
1
More like one in ten or so have receptor types conducive to addiction.
1
the reasons for the overuse, overprescribing and over-marketing are myriad and your warnings are certainly merited, but some of your information is simply incorrect and bears mentioning. NSAIDS like ibuprofren (advil) and naproxen (aleve) work in the kidneys and are meant to be used in specific doses for a prescribed amount of time (generally no more than two consecutive weeks). When these medications are taken in high dosage or for too long they can do irrepairable damage to the kidneys and can, in fact, cause immediate kidney failure in extreme circumstances. They pose no harm to the liver, however, as they are not absorbed or stored in the liver. acetaminophen, (tylenol), on the other hand works exclusively in the liver and can cause severe irreversible liver damage when taken in high dosages or in combination with alcohol. Acetaminophen, however, cannot harm the kidneys as it is not processed by them nor is it absorbed by the kidneys. so, in review -- nsaids can be harmful to the kidneys and acetaminophen can harm the liver, not vice versa. some doctors even go as far as recommending that patients rotate the two types of pain reliever as a way to mitigate the risk of organ damage.
10
Points well taken.
1
For me, both topical diclofenac and oral ibuprofen trigger episodes of atrial fibrillation (an irregular heartbeat, which risks stroke). A large study has shown that this also happens to others (http://www.bmj.com/content/343/bmj.d3450).
Perhaps this only happens to those whose genetics or medical history make them susceptible. But people using NSAIDs other than aspirin should get their GPs to check their pulse, or learn to take their own.
Perhaps this only happens to those whose genetics or medical history make them susceptible. But people using NSAIDs other than aspirin should get their GPs to check their pulse, or learn to take their own.
Unless things have really changed since I had a shoulder replacement three years ago, shoulder patients still leave the hospital with a three-month prescription for Percocet. I took about three pills and that was that; it seems to me that if significant pain remains that long after surgery the physician should address it by other means than Percocet. And as Cheryl points out in her comment, NSAIDs and acetaminophen are just as dangerous. Particularly acetaminophen; in addition to the OTC brands, Percocet and the Oxys are loaded with it, and each pill delivers a potentially lethal dose to the liver. BTW, I wrote the orthopod who did my shoulder about this problem and never got a response.
1
Most states (and insurances) limit controlled substances to a 30 day supply only. That seems lazy on the doctor's part considering (I would hope) the patient would have to go see him again for a follow up before 3 months. My state has cut down new prescriptions to 7 days for acute pain and doctors would need documentation of a medical diagnosis if it's for longer. It depends on the state though. Some are even stricter and, unfortunately, others haven't updated their laws to reflect this issue.
Btw, OxyContin and oxycodone do not contain acetaminophen. Percocet (which contains oxycodone) and Vicodin contain acetaminophen. Each pill contains 325 mg of acetaminophen. That is regular strength Tylenol. It is not a lethal dose (3000 mg+) if taken as directed and not combined with other acetaminophen containing products.
Btw, OxyContin and oxycodone do not contain acetaminophen. Percocet (which contains oxycodone) and Vicodin contain acetaminophen. Each pill contains 325 mg of acetaminophen. That is regular strength Tylenol. It is not a lethal dose (3000 mg+) if taken as directed and not combined with other acetaminophen containing products.
2
In New York after back surgery 7 years ago you would have left the hospital with nothing but a paper subsription for something like percocet for perhaps a week. You will need a determined friend to get it filled as many pharmacies -- CVS In my experience -- don't wish to be bothered with carrying such troublesome items, preferring low labour cost high margin high volume non prescrption items.
1
30 years ago my house burned down when my husband and I were away, left a friend house sitting.
The message was garbled, we arrived thing there had maybe been a kitchen fire, but no, when the cab left us at the address of our home on Tampa Bay, at night,there was no home there , we could see out over the dock from the road, the foundation was smoldering - our home gone - gone.
We spent the night there crying and holding each other and excavating the remains - finding a few treasures. A single disaster, no FEMA or press or cops or helicopters or Presidents.
A year before the insurance company settled - the wind people said it was water and fire people that made the the roof fall on the car in the garage and the car could not be totaled until moved and the home insurance people said the car could not be moved until the house was totaled...
I stood in the smoldering remains of the ashes of my home when the mailman delivered a Notice from the City - not for assistance, but of a Codes Violation of having a Burned Structure in my property.
Hurray! Disasters natural and human lie ahead. Best wishes.
The message was garbled, we arrived thing there had maybe been a kitchen fire, but no, when the cab left us at the address of our home on Tampa Bay, at night,there was no home there , we could see out over the dock from the road, the foundation was smoldering - our home gone - gone.
We spent the night there crying and holding each other and excavating the remains - finding a few treasures. A single disaster, no FEMA or press or cops or helicopters or Presidents.
A year before the insurance company settled - the wind people said it was water and fire people that made the the roof fall on the car in the garage and the car could not be totaled until moved and the home insurance people said the car could not be moved until the house was totaled...
I stood in the smoldering remains of the ashes of my home when the mailman delivered a Notice from the City - not for assistance, but of a Codes Violation of having a Burned Structure in my property.
Hurray! Disasters natural and human lie ahead. Best wishes.
4
I am about to have surgery. I have requested no opioids because they make me depressed -- like in the last time I stopped after three days following gallbladder surgery, I cried for a whole day. But doctors raise their eye brows when I say no opioids. We have no real alternatives? I don't know? I haven't experienced the pain yet, but I think I would rather experience some pain than spend a day crying. Guess I'll find out.
Opiates are the best thing we have for acute pain in cases of severe physical trauma and surgery. The problem is that opiates started being used to treat chronic pain and this is not what they're indicated for. For chronic pain ppl would be better off with SSRIs and certain other antidepressants.
It depends on the surgery but i would definitely want them available post-op with the intention of
stopping as soon as the pain was tolerable. Talk to your doctors about your concerns
It depends on the surgery but i would definitely want them available post-op with the intention of
stopping as soon as the pain was tolerable. Talk to your doctors about your concerns
The most striking thing about this article is that 100 million Americans are dealing with chronic pain! How is it that nearly a third of our population is dealing with this! With the way our medical system works it does not surprise me that pain medicines are over consumed. There is often no better option offered.
I have struggled with chronic migraine. My doctor told me to take more ibuprofen. That worked for awhile. Until I ended up with gastritis. After trying a new PCP who wanted me to take more drugs - I tried them but the insomnia was a side effect I could not tolerate. I finally knew I had found a good PCP when the next one said - I think you need to address the underlying condition which is stress. This is not easy and I can't say I have figured it out but at least I now feel I have an ally.
I have struggled with chronic migraine. My doctor told me to take more ibuprofen. That worked for awhile. Until I ended up with gastritis. After trying a new PCP who wanted me to take more drugs - I tried them but the insomnia was a side effect I could not tolerate. I finally knew I had found a good PCP when the next one said - I think you need to address the underlying condition which is stress. This is not easy and I can't say I have figured it out but at least I now feel I have an ally.
5
Apples and oranges. Comparing potential side effects from OTC drugs to the growing addiction from opioids is not helpful at all...it's also confusing..... should we switch from Tylenol to Tramadol to avoid potential liver damage but risk addiction?
2
I heard a radio interview with a physician who treats people with chronic pain who have become addicted, mostly to opioids. She spoke of many who abuse opioids, but none who use them responsibly to control long-term pain. The interviewer asked if she had ever suffered protracted pain. The answer, of course, was no. I find it interesting that "experts," many of them physicians, will blithely tell others they "should" live with their pain simply because thousands of "other people" have abused pain medications and, besides, those medications are being too widely prescribed. I expect my physicians to treat me as an individual, not a statistic. And I won't tolerate being told that I have to bear my pain with fortitude in order to solve a social problem or do penance for the missteps of a profession or an industry. It's MY pain, doctor, not yours; let me at least share the responsibility for managing it responsibly.
186
I am seventy and can't take NSAIDS after they caused diminished kidney function. At the same time, my new doctor doesn't prescribe opioids. I have noticed that in the past two years, since stopping these drugs, my headaches are MUCH less frequent and severe. They were causing them!
I need pain medicine for rotator cuff syndrome, and my doctor prescribed an NSAID gel, like you describe. Medicare turned it down, and I can't afford it. (They would pay for all the opioids and NSAIDS I could take and more.) The response to the appeal said it was not because of lack of medical necessity. This safe medicine was simply not in their "formulary" for rotator cuff syndrome.
I need pain medicine for rotator cuff syndrome, and my doctor prescribed an NSAID gel, like you describe. Medicare turned it down, and I can't afford it. (They would pay for all the opioids and NSAIDS I could take and more.) The response to the appeal said it was not because of lack of medical necessity. This safe medicine was simply not in their "formulary" for rotator cuff syndrome.
40
Diclofenic Gel (AKA Voltaren gel)
A) you need a different drug plan;
B) you can get it in Canada ( or Europe) Even Costco Canada has it. Never shopped for it online, but if you lived close enough to the border that's an option. Or since you already have an actual prescription, perhaps that's sufficient to order online.
C) it's pretty cheap as a generic.
A) you need a different drug plan;
B) you can get it in Canada ( or Europe) Even Costco Canada has it. Never shopped for it online, but if you lived close enough to the border that's an option. Or since you already have an actual prescription, perhaps that's sufficient to order online.
C) it's pretty cheap as a generic.
1
Drive to Canada and stock up in NSAID gels, you know, a Real Health System instead of a Business of Sickness where the goal is to make a buck. Sickness should not be a business model for profit.
1
Why would a patient take an excess of acetaminophen when the above article states increased dosing does not reduce pain more than lower doses?
1
Thank you for reporting that over-the-counter drugs can also be a problem. I had never heard of the gel NSAID option (for localized use) until having an accident while visiting Italy. A pharmacist there recommended "Voltaren" gel. I did bring it home, and have since asked my doctor to prescribe it. It is a very beneficial alternative to ingesting ibuprofen pills because it works on the specific site of pain, rather than circulating throughout the entire body. I wonder why it is not more frequently prescribed in the US, or made available without a prescription.
3
@Jessica: I have limited experience using Voltaren, but I found it messy to use, difficult to apply, easy to overdose on accidentally - AND that was after I had to fight my insurance company to get it approved!
4
That may be so; topical application can be a bit messier than popping pills. But the pills can cause more internal damage . . . to kidneys, liver, etc.
2
Follow the money.
I am not convinced that the evocation of "fear" is the way to handle this, but acknowledge that there is room argument. Putting things in perspective, understanding that all meds have have adverse reactions and can kill, I'd favor a more moderate outlook. All this inadequate for the current opioid epidemic, enhanced by the severe recession and rising economic inequality. To get a handle of some modern problems of addiction means addressing core economic imbalances,--not so easy to do.
Direct-to-consumer advertising is a massive concern, and I think more important than generating fear about pain meds: http://www.latimes.com/business/la-fi-lazarus-drugadvertising-20170215-s... . From that LA Times piece:
"Direct-to-consumer, or DTC, drug ads on TV became a thing in 1997, when the Food and Drug Administration greenlighted such marketing. ... The impact was immediate. Spending by drug companies on TV ads hit $664 million within a year. By 2005, the industry was spending more than $3 billion annually on televised DTC ads. The figure nowadays tops $5 billion."
No doubt the pharmaceutical companies love this. The AMA and other physician groups would like to see the practice severely curtailed. The pharmaceutical firms want to expand. Only the US and New Zealand allow DTC ads: most others are more sensible. Most others nations want the conversations more focused between physicians and their patients.
Direct-to-consumer advertising is a massive concern, and I think more important than generating fear about pain meds: http://www.latimes.com/business/la-fi-lazarus-drugadvertising-20170215-s... . From that LA Times piece:
"Direct-to-consumer, or DTC, drug ads on TV became a thing in 1997, when the Food and Drug Administration greenlighted such marketing. ... The impact was immediate. Spending by drug companies on TV ads hit $664 million within a year. By 2005, the industry was spending more than $3 billion annually on televised DTC ads. The figure nowadays tops $5 billion."
No doubt the pharmaceutical companies love this. The AMA and other physician groups would like to see the practice severely curtailed. The pharmaceutical firms want to expand. Only the US and New Zealand allow DTC ads: most others are more sensible. Most others nations want the conversations more focused between physicians and their patients.
6
in seattle you can change the channel from a commercial recruiting people for a class action suit against a drug to the next channel extolling the wonderful benefits of the same product
2
This article would have been more to the point if it cut the first half about opioids.
I take a baby aspirin every day for instance, I've been told it's good for my cardiovascular health; I would have liked the throwaway sentence about NSAIDs being bad for cardiovascular health to have been expanded upon.
But, yes, Tylenol is dangerous, lots of people hurt themselves taking too much because of combination OTC drugs and not being aware that acetaminophen is the generic name for it. That's a good warning to have repeated regularly.
I take a baby aspirin every day for instance, I've been told it's good for my cardiovascular health; I would have liked the throwaway sentence about NSAIDs being bad for cardiovascular health to have been expanded upon.
But, yes, Tylenol is dangerous, lots of people hurt themselves taking too much because of combination OTC drugs and not being aware that acetaminophen is the generic name for it. That's a good warning to have repeated regularly.
2
" opioids are often — probably too often — prescribed for people with chronic pain. Although these potent drugs may offer temporary relief, “they tend to lose their effectiveness over time, and one pill today can become three later,” said Dr. James Campbell, a neurosurgeon who specializes in pain management."
Persons in a pain management program are routinely subjected to urine tests and pill counts-always by surprise. This testing determines whether a person is supplementing their prescriptions from the street markets or not taking them completely and selling the remainder. All chronic pain patients should be in a program that provides accountability for the person's usage of these drugs. This can be a difficult program to follow outside of the cities but there's no reason why a local physician cannot be contracted to provide the testing to the pain clinic before issuance of prescriptions which would be controlled by the pain clinic. There may be some increased cost to this type of program but the alternative of denying alleviation of pain to a legitimate patient can be rationalized since many general physicians don't have the training or do not want to be involved in writing prescriptions for opiates and the responsibility for oversight.
Many patients live in fear of losing their participation in a program so compliance is actually very good. Those who don't end up street buying and face the danger of OD'ing
Persons in a pain management program are routinely subjected to urine tests and pill counts-always by surprise. This testing determines whether a person is supplementing their prescriptions from the street markets or not taking them completely and selling the remainder. All chronic pain patients should be in a program that provides accountability for the person's usage of these drugs. This can be a difficult program to follow outside of the cities but there's no reason why a local physician cannot be contracted to provide the testing to the pain clinic before issuance of prescriptions which would be controlled by the pain clinic. There may be some increased cost to this type of program but the alternative of denying alleviation of pain to a legitimate patient can be rationalized since many general physicians don't have the training or do not want to be involved in writing prescriptions for opiates and the responsibility for oversight.
Many patients live in fear of losing their participation in a program so compliance is actually very good. Those who don't end up street buying and face the danger of OD'ing
3
Aspirin is an NSAID linked with reduced cardiovascular mortality. The liver dangers from acetaminophen outweigh the kidney ones so drastically that I'm stunned the author didn't put that first. Ulcers and bleeding from ulcers associated with NSAIDs occur in the GI tract, so that duo of sentences is simultaneously redundant and vague: a wonderous feat! Also, massive duodenal bleeds are seen with diclofenac and ketorolac primarily.
In other words, pull this article down and clean it. It's an inaccurate mess.
In other words, pull this article down and clean it. It's an inaccurate mess.
43
Very frequently seen in the hospital- acute renal failure from taking NSAIDS- as directed on the label or not. These medications were previously by prescription only, made OTC 1990s. People assume they are not that strong since they don't need a prescription. As the article says if one is pretty good then 4 should do the trick. NSAIDS likely contribute a pretty penny to the coffers of GI and renal docs. Job security as the cigarette is to the pulmonologist and oncologist.
2
Two decades ago we physicians were correctly criticized for under treating pain. Now we are castigated for treating it at all.
People do have severe pain that needs to be treated. Regrettably there are rarely any objective manifestations to independently assess the severity of discomfort.
As in most things medical, you, the public, are going to have to make up your minds about whether you are going to trust the majority of us to make the best decisions possible in this matter.
People do have severe pain that needs to be treated. Regrettably there are rarely any objective manifestations to independently assess the severity of discomfort.
As in most things medical, you, the public, are going to have to make up your minds about whether you are going to trust the majority of us to make the best decisions possible in this matter.
59
As stated in thr article, a large percentage of patients prescribed opiates don't even take them. The rise in presciptions is emphasized, making it seem that we are creating new addicts. I work as a physical therapist and about 7-8/10 of my patients took thier pain meds for a couple of days, then stopped because they didn't like the way they made them feel. My concern is for those patients for whom painkilers make life tolerable. I now see people who are in severe pain being given large doses of ibuprofen and acetaminophen, which as the author stated, can cause serious health issues. Physicians should not be afraid to prescribe pain meds when they see fit.
3
i am afraid too many doctors cower in fear of the dea for me to trust their opinions on pain medication ..so rather then endure the indignity of being treated like a drug addict if needed i will resort to picking up the small amount i need on the street corner before trusting your best decisions with that sword over your head
1
Fear of certain medications is the current narrative, rather than fear of our dysfunctional healthcare system. The system is set up to make $ by doing things to people, and this includes filling more prescriptions. The system is not set up to spend more time educating patients about how to properly use the dangerous drugs that are prescribed for them, nor to follow-up with patients receiving dangerous medications. In particular, pharmacists are not rewarded for spending time educating patients, even though they are well trained to do so. The recent Chicago Tribune investigation even showed that pharmacists failed to warn patients regarding serious drug interactions. Beyond analgesics, there is ample data demonstrating many severe preventable adverse events with other low therapeutic index drugs, including anti-diabetic medications, anti-coagulants, digoxin, etc. When used inappropriately, these drugs often cause mortality or land patients in emergency rooms or hospitals - perhaps more so than opioids? Lack of large epidemiologic studies with actual examination of causality precludes essential information on the overall scope of preventable adverse events from these drugs. The solutions (and only for the 'opioid problem') are framed in terms of restricting the medications, training prescribers and providing naloxone rather than patient education and follow-up.
11
Our healthcare system does need to change but is society willing to change with it? I'm lucky enough to work for a smaller chain where I can spend time counseling and going out to the aisle for OTC recommendations. My friends over at the big chains? They're lucky if they won't be reprimanded for not filling, verifying and getting their patients out the door fast enough. You're right, the system sets it up this way but we also influence what the system views as important. What do you think corporate hears when patients complain "What's taking so long? Don't you just put the pills in the bottle?" That society values pharmacists' clinical skills? Only until that dialogue (and with a little kick in reimbursement) changes will pharmacists be able to practice at the top of their license.
Just focusing on pharmacists here since you brought it up and it's my profession but our current system doesn't allow HCPs across the board to practice to their full abilities.
Just focusing on pharmacists here since you brought it up and it's my profession but our current system doesn't allow HCPs across the board to practice to their full abilities.
1
“As with alcohol, opioids are not a problem for most people,” according to a neurosurgeon specializing in pain management. Then why are most people living with chronic pain being punished by the Center for Disease Control recommendations for reduced opiate prescriptions in ALL cases? Chronic pain causes physical changes in the brain, often leading to depression and occasionally suicide. While opioid use for chronic pain does create drug dependency, it does not cause addiction – chasing the delicious “high” that comes from drug abuse.
The vast majority of opiate overdoses are due to illegally obtained drugs. Apparently it's much easier for the government to take pain medication away from those using it responsibly rather than provide education and treatment for abusers. We tried prohibition almost 100 years ago; instead of fewer drunks we got bootleggers and organized crime.
What America will get from this new attempt at prohibition is yet to be determined. Undoubtedly, it will create even more disrespect for misguided laws by honest citizens determined to find a way to reduce their suffering.
The vast majority of opiate overdoses are due to illegally obtained drugs. Apparently it's much easier for the government to take pain medication away from those using it responsibly rather than provide education and treatment for abusers. We tried prohibition almost 100 years ago; instead of fewer drunks we got bootleggers and organized crime.
What America will get from this new attempt at prohibition is yet to be determined. Undoubtedly, it will create even more disrespect for misguided laws by honest citizens determined to find a way to reduce their suffering.
89
Kris, extreme messages from CDC mid 2017 were designed to assure career and grants for Tom Frieden after prior 7 years of doing little as agency director. Also persons on CDC study
committee (non disclosed) believed in businesses and careers to profit. Surely these people have the right to harm others when necessary to advance their interests. Isn't that the American way?
committee (non disclosed) believed in businesses and careers to profit. Surely these people have the right to harm others when necessary to advance their interests. Isn't that the American way?
4
Kris: Yes, and thank you.
3
That's an interesting take on dependency and addiction, and I'd love to see some evidence to back that up. Most (granted, not all) people with a dependence on a substance experience two key features: increased tolerance - the dose going from one pill per day to three pills per day - and withdrawal - as the drug clears the body, the physical and mental effects become painful and unbearable. This is corroborated by the DSM and the SCID-SUD
I'd love to see evidence that only people who are "chasing the delicious high" are the ones who get addicted. Don't think the brain can distinguish between the motivations for taking the drug.
I'd love to see evidence that only people who are "chasing the delicious high" are the ones who get addicted. Don't think the brain can distinguish between the motivations for taking the drug.
As usual, a thorough cautionary overview from Ms Brody laying out how complicated medical issues can be, in this case the risks of pain treatment, particularly chronic pain. The array of prescription and over-the-counter drugs available is quite limited, all of them have been on the market for many, many decades, with plant derived 'natural' acetylsalacylic acid (aspirin - ASA) and opiates used by humankind for millenia. Acetaminophen, a synthetic (APAP), was branded and marketed by prescription only as Tylenol in 1953. The non-steroidal anti-inflammatory drugs (NSAIDs, ibuprofen, naproxen etc) also first came on the scene in the '50s. Nothing truly new since, with the main innovations being the panoply of formulations/preparations of narcotics.
While it is probably true that anyone can become addicted to narcotics (or any substance of potential abuse), the risks for it vary considerably among individuals. Genetic vulnerability, age at first exposure (< age 30; before brain maturation), personality type, psychosocial circumstances and availability are all involved to varying degrees, with genes and age probably the most important.
Sadly, we treat the adverse effects of non-narcotics as the medical emergencies that they are while drug addiction in all its' forms is regarded as a character flaw and moral failing.
While it is probably true that anyone can become addicted to narcotics (or any substance of potential abuse), the risks for it vary considerably among individuals. Genetic vulnerability, age at first exposure (< age 30; before brain maturation), personality type, psychosocial circumstances and availability are all involved to varying degrees, with genes and age probably the most important.
Sadly, we treat the adverse effects of non-narcotics as the medical emergencies that they are while drug addiction in all its' forms is regarded as a character flaw and moral failing.
22
There are actually quite a few new drugs for pain control, most in the categories of antidepressants and antiepileptics. Gabapentin, Lyrica, and Topiramate are effective for some. Effexor, Cymbalta, and Pristiq are effective for others. As with every drug, there are potential serious side effects.
1
I feel that to some degree, the euphoria-inducing "side effect" of pain killers like opioids (as opposed to NSAIDS) are a vain attempt by some of us to deal with the pressures and complexities of modern day living. NSAIDS have always been superior to opioids acute post surgery pain or for chronic pain. Still dangerous if too much is consumed but that is the nature of all analgesics.
What we are left with are the practices that tackle self-control of pain through mindfulness meditation, exercise, physical therapy, acupuncture and other non-chemical approaches. But they all require commitment and practice, not an option for many when taking a pill or a patch is so much easier and often cheaper.
Also, for certain chronic pains, Cannabis, particularly the cannabinoids with no euphoric effects, needs more attention but the data are showing promise.
What we are left with are the practices that tackle self-control of pain through mindfulness meditation, exercise, physical therapy, acupuncture and other non-chemical approaches. But they all require commitment and practice, not an option for many when taking a pill or a patch is so much easier and often cheaper.
Also, for certain chronic pains, Cannabis, particularly the cannabinoids with no euphoric effects, needs more attention but the data are showing promise.
5
Major umbrella review demonstrates mindfulness,etc treatments for pain are ineffective, have been introduced to practice by undersized studies with poor analytical methods. "Commitment" useless in view of ineffectiveness.
NSAIDS almost no use for post surgical pain except that due to inflammation. Hope you are not a surgeon.
NSAIDS almost no use for post surgical pain except that due to inflammation. Hope you are not a surgeon.
4
All medications need to be studied for potential side effects and and contraindications. Aspirin and NSAIDs can offer much benefit but consideration has to be taken for gastritis, internal bleeding and metabolic acidosis. Acetaminophen (Tylenol) should be limited to at most 4000mg/day in healthy adults. The doses need to be significantly decreased in children, the elderly and those with sensitive livers and kidneys.
NEVER CONSUME ANY ACETAMINOPHEN WITH ALCOHOL. The results can be deadly with potential for fulminant liver.
Frankly, we Americans are prescribed way too many pain medications of all types. It is considered by some to be the fifth vital sign (after blood pressure, pulse, respiratory rate and temperature). Hospital survey questions typically ask patients if their pain was treated adequately but leaves no room for physicians to explain conservative (and appropriate) pain management. Negative surveys impacts a physician's review and many feel compelled to over-treat pain. As a result, many physicians find themselves between strong mandates against overprescribing opioids (and other pain medications) and patient surveys that negatively impact their careers. Let's figure out why we are in this sorry state.
NEVER CONSUME ANY ACETAMINOPHEN WITH ALCOHOL. The results can be deadly with potential for fulminant liver.
Frankly, we Americans are prescribed way too many pain medications of all types. It is considered by some to be the fifth vital sign (after blood pressure, pulse, respiratory rate and temperature). Hospital survey questions typically ask patients if their pain was treated adequately but leaves no room for physicians to explain conservative (and appropriate) pain management. Negative surveys impacts a physician's review and many feel compelled to over-treat pain. As a result, many physicians find themselves between strong mandates against overprescribing opioids (and other pain medications) and patient surveys that negatively impact their careers. Let's figure out why we are in this sorry state.
4
I can only speak for myself, but learning to live with a certain amount of pain is a healthy thing. The attempt to banish all pain was the slippery slope for me.
I recently ended up in the emergency room with a suspicion of blood clots in my leg after an injury. The admitting nurse asked me where my pain lay on a scale of 1-10 and I said 1 because I knew what I had to do to avoid the pain. The doctor asked me again later after the ultrasound had ruled out blood clots and I said 1 again. He nodded judiciously and wrote me a prescription for percocet which I asked the nurse to throw away. I was amazed at the difficulty this simple request seemed to engender. My best guess is that health care professionals don't want to err on the side of allowing unnecessary pain, but maybe the question we should all be asking is whether we've become intolerant of an ordinary and necessary part of human experience. There is a saying often heard at the gym, "Pain is the sensation of weakness leaving the body." It's worth considering.
I recently ended up in the emergency room with a suspicion of blood clots in my leg after an injury. The admitting nurse asked me where my pain lay on a scale of 1-10 and I said 1 because I knew what I had to do to avoid the pain. The doctor asked me again later after the ultrasound had ruled out blood clots and I said 1 again. He nodded judiciously and wrote me a prescription for percocet which I asked the nurse to throw away. I was amazed at the difficulty this simple request seemed to engender. My best guess is that health care professionals don't want to err on the side of allowing unnecessary pain, but maybe the question we should all be asking is whether we've become intolerant of an ordinary and necessary part of human experience. There is a saying often heard at the gym, "Pain is the sensation of weakness leaving the body." It's worth considering.
4
Pain is an important diagnostic tool.
Living with pain though can make one miserable and not to mention very poor company. It can also greatly limit one's ability to function in a professional capacity.
There are no easy solutions and more and more it seems to be clear that there are no solutions.
Living with pain though can make one miserable and not to mention very poor company. It can also greatly limit one's ability to function in a professional capacity.
There are no easy solutions and more and more it seems to be clear that there are no solutions.
7
Wow, I never knew I had so much weakness in my body. 17 years worth!
1
There's also some worth to discussing Gabapentin a leading treatment for pain due to homeopathy, and a go to medication for people experiencing pain from diabetes, MS, and other conditions. It also makes one crave sugar and binds with calcium weakening bones and teeth over time.
1
Why no mention of aspirin? Aspirin has been around for 120 years. There is a chance of it harming children (Reye's Syndrome) but for adults, unless the individual has a contraindication, aspirin in a great solution. Yet for decades now, doctors, dentists and nurses have not offered it to me on occasions where it might be helpful; they always advise other drugs like acetaminophen and I have to ask them if aspirin is OK instead. They always look a little surprised, and then say, sure. Why has this simple painkiller fallen out of favor? In addition to being a painkiller, it can also play a role in cardiovascular health and a preventative to colon cancer (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3354696/).
15
Aspirin is cheap, safe and very effective if taken with a full glass of water!
2
Not a lot of profit in aspirin.
2
In my state, we can check out cannabis in various forms, and that's on my to-do list to explore as the aches and pains increase with age. In the meantime, how the local dispensary can help with various health problems is becoming a more common topic of conversation among my peers.
6
Excellent article, Ms. Brody.
We take pills as if they are candy Sweethearts, and rely too much on a chemical instead of looking for additional solutions -- meditation, rest, nutrition.
Any medicine, whether OTC or script, can help but can also harm. We live in a drug-infused culture, and we need to stop doing that.
Some 25 years ago I had a skull fracture that left a permanent dent in the top of my skull, and doctors had believed it was 'only a concussion' and not much to worry about. They didn't realize it was a skull fracture. They gave me acetaminophen and told me to rest. The only time I felt not under crushing pain, was when I was sleeping, because lying down reduced the bleeding and swelling in my brain, which was caused because cervical vertebrae had been damaged, thus damaging the circulation.
These days doctors would diagnose the fall correctly, and wouldn't assume that every 'fall' is a slip but could be a fall that can leave a permanent dent in the skull, with bleeding and swelling throughout the brain, risking the patient's life.
I'm thankful that my doctor did not give me opioids, even though I begged, because, as he said, this would be a long-term problem.
He was correct. I spent 18 hours a day in bed for several years, getting up to get the kids to school, watch a movie with them or heat prepared mac n' cheese.
I made do with then-prescription Alleve, sleep and living in constant pain.
Medication is not candy. Help the whole person.
We take pills as if they are candy Sweethearts, and rely too much on a chemical instead of looking for additional solutions -- meditation, rest, nutrition.
Any medicine, whether OTC or script, can help but can also harm. We live in a drug-infused culture, and we need to stop doing that.
Some 25 years ago I had a skull fracture that left a permanent dent in the top of my skull, and doctors had believed it was 'only a concussion' and not much to worry about. They didn't realize it was a skull fracture. They gave me acetaminophen and told me to rest. The only time I felt not under crushing pain, was when I was sleeping, because lying down reduced the bleeding and swelling in my brain, which was caused because cervical vertebrae had been damaged, thus damaging the circulation.
These days doctors would diagnose the fall correctly, and wouldn't assume that every 'fall' is a slip but could be a fall that can leave a permanent dent in the skull, with bleeding and swelling throughout the brain, risking the patient's life.
I'm thankful that my doctor did not give me opioids, even though I begged, because, as he said, this would be a long-term problem.
He was correct. I spent 18 hours a day in bed for several years, getting up to get the kids to school, watch a movie with them or heat prepared mac n' cheese.
I made do with then-prescription Alleve, sleep and living in constant pain.
Medication is not candy. Help the whole person.
2
@Kathryn: Can you explain why you don't consider spending TWO YEARS of your life in bed, in constant pain, barely functioning, to also fall into the category of "a long-term problem"?
7
It was for most of 10 years --a long-term problem, a problem of the times -- from an era that believed that non-motor vehicle accidents such as a 'fall'' were not serious. That belief has gone by the wayside, because others have also suffered long-term sequelae after slip/falls. Had I gotten the surgery I should have had I would have recovered much faster. It took days to read two or three articles about Princess Diana's death; my cognition was slow. I subscribed to the National Head Injury Association magazine, which included an article in the early 90s of a high school football player in Colorado, who had received what seemed like a light touch on the head during a game. The next day he was dead.. My sister suffered 10 years of crushing headaches after a fall on her bicycle during a mountain group-cycling trip in the 70s. She had fallen off her bike. Nobody did any scans for her crushing headaches that lasted 10 years. Cycling can be dangerous. A cousin passed away recently after a 2015 fall from her bicycle on a group cycling trip. When I came down with pneumonia four months after my fall, tests revealed I was down two pints of blood, had anoxia, Strep group F and legionella. I was hospitalized for pneumonia for two weeks, and on antibiotics for months. The doctors couldn't figure out how I had lost two pints of blood. Had I not suffered the brain injury from the fall in a grocery store, I might have come down with pneumonia, but it wouldn't have been as bad.
1
It was for most of 10 years --a long-term problem, a problem of the times -- from an era that believed that non-motor vehicle accidents such as a 'fall'' were not serious. That belief has gone by the wayside, because others have also suffered long-term sequelae after slip/falls.
Had I gotten the surgery I should have had I would have recovered much faster. It took days to read two or three articles about Princess Diana's death; my cognition was slow. I subscribed to the National Head Injury Association magazine, which included an article in the early 90s of a high school football player in Colorado, who had received what seemed like a light touch on the head during a game. The next day he was dead.
My sister suffered 10 years of crushing headaches after a fall on her bicycle during a mountain group-cycling trip in the 70s. She had fallen off her bike. Nobody did any scans for her crushing headaches that lasted 10 years.
Cycling can be dangerous. A cousin passed away recently after a 2015 fall from her bicycle on a group cycling trip.
When I came down with pneumonia four months after my fall, tests revealed I was down two pints of blood, had anoxia, Strep group F and legionella. I was hospitalized for pneumonia for two weeks, and on antibiotics for months.
The doctors couldn't figure out how I had lost two pints of blood. Had I not suffered the brain injury from the fall in a grocery store, I might have come down with pneumonia, but it wouldn't have been as bad.
Had I gotten the surgery I should have had I would have recovered much faster. It took days to read two or three articles about Princess Diana's death; my cognition was slow. I subscribed to the National Head Injury Association magazine, which included an article in the early 90s of a high school football player in Colorado, who had received what seemed like a light touch on the head during a game. The next day he was dead.
My sister suffered 10 years of crushing headaches after a fall on her bicycle during a mountain group-cycling trip in the 70s. She had fallen off her bike. Nobody did any scans for her crushing headaches that lasted 10 years.
Cycling can be dangerous. A cousin passed away recently after a 2015 fall from her bicycle on a group cycling trip.
When I came down with pneumonia four months after my fall, tests revealed I was down two pints of blood, had anoxia, Strep group F and legionella. I was hospitalized for pneumonia for two weeks, and on antibiotics for months.
The doctors couldn't figure out how I had lost two pints of blood. Had I not suffered the brain injury from the fall in a grocery store, I might have come down with pneumonia, but it wouldn't have been as bad.
1
"The number of prescriptions for opioids jumped from 76 million in 1991 to 219 million two decades later."
Ms. Brody states "The number of prescriptions for opioids jumped from 76 million in 1991 to 219 million two decades later." But raw numbers don't tell the story. How much of the increase can be explained by 1) increase in population 2) aging of the population due to the Baby Boomer generation and 3) increase in stress on joints and spine due to obesity epidemic, resulting in increased pain?
And how much of the increase is due to a change in prescribing practices by health care providers, secondary to a change in cultural ideas about pain management ("pain as the fifth vital sign") and sophisticated marketing on the part of opiate manufacturers?
These distinctions are important and I believe should have been addressed in Ms. Brody in her reporting.
Ms. Brody states "The number of prescriptions for opioids jumped from 76 million in 1991 to 219 million two decades later." But raw numbers don't tell the story. How much of the increase can be explained by 1) increase in population 2) aging of the population due to the Baby Boomer generation and 3) increase in stress on joints and spine due to obesity epidemic, resulting in increased pain?
And how much of the increase is due to a change in prescribing practices by health care providers, secondary to a change in cultural ideas about pain management ("pain as the fifth vital sign") and sophisticated marketing on the part of opiate manufacturers?
These distinctions are important and I believe should have been addressed in Ms. Brody in her reporting.
28
The number of prescriptions is higher because they can only write for 7-30 days and then must write a brand new one, according to new regulations. Hence, the rise in prescriptions.
I occasionally take acetaminophen with codeine in it for severe headaches. When I asked for this a number of years ago the doctor acted as if I was a budding drug addict. Her solution was to tell me that there was a medication I could take every day that would help me to avoid ever getting these headaches. My answer was that I didn't need that. I reiterated my need for the codeine and the acetaminophen and she grudgingly prescribed it. I didn't want to add another expensive medication with side effects to the pills I was already taking at that time.
We live in an environment that is noisy, has many artificial scents in it, is poorly lit. We don't need to remove pain medications from the market. We need to improve our living and working environments. And we need to improve our "health care" system so that patients have relationships with their physicians which will enable the latter to deal more constructively with the former. A 7 minute audience with the doctor is not sufficient for either to develop trust in the other. However, making it much harder to get pain medications, OTC or otherwise won't solve the problem.
For people who do not suffer with chronic or severe pain it's understandable for them to believe that severe restrictions are the way to go. My feeling is that we need to have better relations with our health care providers, a less stress filled environment (sights, smells, and sounds and less artificial food) as well.
We live in an environment that is noisy, has many artificial scents in it, is poorly lit. We don't need to remove pain medications from the market. We need to improve our living and working environments. And we need to improve our "health care" system so that patients have relationships with their physicians which will enable the latter to deal more constructively with the former. A 7 minute audience with the doctor is not sufficient for either to develop trust in the other. However, making it much harder to get pain medications, OTC or otherwise won't solve the problem.
For people who do not suffer with chronic or severe pain it's understandable for them to believe that severe restrictions are the way to go. My feeling is that we need to have better relations with our health care providers, a less stress filled environment (sights, smells, and sounds and less artificial food) as well.
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Agree with the better relationship with the health care provider. There is a huge difference between pain treatment and drug abuse and that begins with a proper diagnosis and a plan of management.
14
If you had not written this commentary, I would have written a nearly identical one. Thanks for sparing my arthritic typing fingers.
2
What you're describing sounds like migraines. If you have chronic migraines (15 days a month with headache lasting 4 hours or more), it's a good idea to try the preventatives to stop them before they start. As it is, if you take an OTC med for each of those migraines, you could be triggering rebound headaches from the medication itself.
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Overuse of OTC drugs - NSAIDs and acetaminophen - is due to decades of marketing by drug manufacturers. I do not want them taken off the market- thus increasing costs multiple times over- But the warnings should be clear, and any ads f should carry big black boxes. I have tinnitus, probably from overuse of ibuprofen - for major headaches - when it carried no indication that it could carry permanent adverse effects.
In describing the increase in use of opioid prescriptions, you say that there are "physicians and dentists who prescribe [them] "with relative abandon" are partly to blame. Of course there are some, but does any evidence support the idea that a substantial number of professionals do this? Are the same Drs. who under treated pain a decade ago now over treating it?
Also - the "alarming" fact that patients do not keep their meds in a locked container - right, WHO do YOU know who keeps meds in a locked container?
The hysteria over this one issue gnaws at me. Millions of children in the US are malnourished, and will suffer the effects of this for their lives. We have a low level of education and literacy. If we made the first 16 years healthier, imagine the future gains
Worry about opioids HAS led to effective multimodal, but labor intensive, strategies to mitigate pain. But grand pronouncements on this new offshoot of the war on drugs evade facing more basic problems affecting health - from access and coverage, to poverty and marketing of non-food to children
In describing the increase in use of opioid prescriptions, you say that there are "physicians and dentists who prescribe [them] "with relative abandon" are partly to blame. Of course there are some, but does any evidence support the idea that a substantial number of professionals do this? Are the same Drs. who under treated pain a decade ago now over treating it?
Also - the "alarming" fact that patients do not keep their meds in a locked container - right, WHO do YOU know who keeps meds in a locked container?
The hysteria over this one issue gnaws at me. Millions of children in the US are malnourished, and will suffer the effects of this for their lives. We have a low level of education and literacy. If we made the first 16 years healthier, imagine the future gains
Worry about opioids HAS led to effective multimodal, but labor intensive, strategies to mitigate pain. But grand pronouncements on this new offshoot of the war on drugs evade facing more basic problems affecting health - from access and coverage, to poverty and marketing of non-food to children
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The article does not claim to describe the most serious health problem that the country faces.
It addresses one problem. Let us not neglect any problem just because there is a bigger one.
It addresses one problem. Let us not neglect any problem just because there is a bigger one.
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Cheryl,
To answer a few of your questions.
1. During the past 5 years, the number of opioid prescriptions have declined but it is still 3x what it was in 1999. There is nothing to indicate that there has been a 3 fold increase in the number of people suffering pain or that the increased prescriptions resulted in a concomitant reduction in pain.
Furthermore, we still prescribe 4x the amount of opioids prescribed in the European countries.
2. With regard to a locked box, it probably would have little effect. Most people who take prescription medications for non-medical reasons are given them by family members and friends and aren't stealing them. They are useful if people have family members who abuse opioids and wish to ensure they don't have access to the drugs.
3. I agree that there are many other health problems that should be attracting increased attention. Even with regard to medications, there is little coverage of other medications implicated in the increase in opioid overdose deaths, i.e., the benzodiazepines. The reporters and editors at The Times seem either to be unaware of this or are so enthralled about covering opioids that they choose to ignore this. For example, go back and read The Times coverage of the death of Prince. It barely mentioned that in addition to the opioids he was also taking anti-anxiety medications that were no doubt benzodiazepines that would have markedly increased the risk of his dying from opioid overdose.
To answer a few of your questions.
1. During the past 5 years, the number of opioid prescriptions have declined but it is still 3x what it was in 1999. There is nothing to indicate that there has been a 3 fold increase in the number of people suffering pain or that the increased prescriptions resulted in a concomitant reduction in pain.
Furthermore, we still prescribe 4x the amount of opioids prescribed in the European countries.
2. With regard to a locked box, it probably would have little effect. Most people who take prescription medications for non-medical reasons are given them by family members and friends and aren't stealing them. They are useful if people have family members who abuse opioids and wish to ensure they don't have access to the drugs.
3. I agree that there are many other health problems that should be attracting increased attention. Even with regard to medications, there is little coverage of other medications implicated in the increase in opioid overdose deaths, i.e., the benzodiazepines. The reporters and editors at The Times seem either to be unaware of this or are so enthralled about covering opioids that they choose to ignore this. For example, go back and read The Times coverage of the death of Prince. It barely mentioned that in addition to the opioids he was also taking anti-anxiety medications that were no doubt benzodiazepines that would have markedly increased the risk of his dying from opioid overdose.
6
agree with everything you said. common sense would tend to indicate use of chronic pain medicine would increase with the aging baby boom generation who work now until 65. Big Pharma can be called out on many things, but not this. I know of no doctor that prescribes opioids with abandon. prescribing pain meds after surgery when people are now sent home immediately after surgery makes complete sense. The percentage of people that say they didn't use them all, or still have them, would tend to indicate responsible use by the patient i.e taken when necessary. My 83 year old mother, who is now in a wheelchair, wakes up crying every morning in pain and her doctor is so afraid of being criminally charged he won't prescribe a pain med. She cannot get out every month to go in for a drug test to make sure she is not addicted and get her next 30 day prescription. Sometimes I think this country has lost its mind. Virginia law now allows a person to be arrested and charged with Possession of a narcotic, and it is the citizen's responsibility to prove they have a prescription. So if you put your pills in a weekly sorting container ostensibly you could be arrested and charged. The drug addiction battle in this country has been going on since the 1800's. Perhaps we should have put as much effort into the things that might lead to drug addiction, ie no job, uneducated, untreated mental health issues such as depression etc.
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