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re: Honest Question about the "Opioid Epidemic"
Posted on 11/28/17 at 10:27 am to RoosterCogburn585
Posted on 11/28/17 at 10:27 am to RoosterCogburn585
I work in healthcare and see addicts come in daily begging for pills. I don't like that doctors are lumped into some big, evil group who have perpetuated this. Should they actually need pain medicine, my doctor makes it clear how much they will get and that there won't be more after that. That doesn't stop them from coming back because the pain is "suddenly worse" or they "lost" their pills. My doctor is firm no matter what. And I know many doctors like that. But, he works in a specialty where this is common (all day, every day) and if he gave in, he'd never see the end of it. Junkies push to a certain point, and then they give up and go to the next doctor. So you can have 10 docs say no, but one guy who gives in, and suddenly doctors are the problem. No. The problem is those people make it their job to find pills. They don't go to work like you and I. They go to doctor appointments, all day if need be, until they get what they need.
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Posted on 11/28/17 at 10:59 am to mikelbr
I'm not the least bit ashamed of my "Coach Jones was not the problem" thread.
He had some issues, but when Wade starts losing game after game, we'll see that I was correct.
He had some issues, but when Wade starts losing game after game, we'll see that I was correct.
Posted on 11/28/17 at 11:05 am to RoosterCogburn585
“Pain is the fifth vital sign.”
“Pain is what the patient says it is.”
“Mrs Smith, you don’t have to hurt. We will make you completely comfortable.”
“There no danger of opiate addiction if the patient is really in pain.”
“Even if the patient is asleep you should wake them up and ask them if they’re hurting.”
These things didn’t come from a drug company. It’s what I? was taught in school 17 years ago and aggressively pushed by organizations like JACHO as recently as 5-8 years ago.
“Pain is what the patient says it is.”
“Mrs Smith, you don’t have to hurt. We will make you completely comfortable.”
“There no danger of opiate addiction if the patient is really in pain.”
“Even if the patient is asleep you should wake them up and ask them if they’re hurting.”
These things didn’t come from a drug company. It’s what I? was taught in school 17 years ago and aggressively pushed by organizations like JACHO as recently as 5-8 years ago.
This post was edited on 11/28/17 at 11:08 am
Posted on 11/28/17 at 11:23 am to Steadyhands
quote:
Treating pain is not a good solution, therefore it's not really effective. Opioids treat symptoms like most drugs. It's hard to find a root cause doctor that actually does good work...but you have to look out for yourself and your family and know that if a doc just prescribes medicine, and doesn't actually provide any other means to solve the problems, then you need a new doctor.
Very true, but not always possible. For example-patient aged 57 with shoulder pain diagnosed as needing total replacement, second opinions confirm, yet bcbs says no approval until age 60 due to limited lifespan of replacement (determined 20 years ago) bcbs insists on treating symptoms with physical therapy (but no more than 20 treatments per year) and pain meds until age of approval reached.
There are many issues to this problem and knee jerk solutions are not the answer.
Posted on 11/28/17 at 11:28 am to INFIDEL
quote:
These things didn’t come from a drug company
You sure?
Posted on 11/28/17 at 11:29 am to RoosterCogburn585
Personal responsibility is always front and center ahead of anything else with behavioral issues like opioid usage. That said, recognizing how many people don’t exercise personal responsibility might be a reason not to flood the market with opioids. The stuff was overprescribed for years because it was profitable. Not cool.
Posted on 11/28/17 at 11:44 am to RoosterCogburn585
My wife is going through some very painful treatment for Acanthamoeba keratitis and her doctor is very very hesitant on giving her any pain meds.
Posted on 11/28/17 at 11:44 am to majoredinwhitehorse
quote:
There are many issues to this problem and knee jerk solutions are not the answer.
Exactly. Like a security gate at an apartment complex. The only person it keeps outis the person living there.
Opiates have their place. They are a very simple medication. They only do one thing. Make pain less or go away. Only a couple of side effects. Read a list of side effects on a prednisone dose pack. Or Celebrex. Everyone will point to other countries. We do use the most prescription narcotics. By far. But it’s not a knee jerk fix. We aren’t suddenly going to become Europe or Asia. It will take generations to get people to stop looking to opiates. Not a year. In the meantime people here today have pain
Posted on 11/28/17 at 11:47 am to olgoi khorkhoi
quote:
I had a scrip for 4 lortab 10s per day and I took them whether I needed to or not.
quote:
I did everything right and still became an addict.
This doesn’t add up.
Posted on 11/28/17 at 11:52 am to RoosterCogburn585
As a board certified addiction medicine physician, I'll give you my answer- the vast majority of this problem exists because of the desire by my physician colleagues to have the "happy patient experience".
In the 90's many hospitals and medical groups started with the 'patient as customer' model where physicians are graded by patient surveys. This unfortunately has led to the easing of controlled substance prescribing so that the physician gets a good survey result.
Case in point, I had a local ER in 1997 start associating 10% of the ER docs salaries to a certain level of success on post-visit surveys. What do you think happened next? Now matter what you went to the ER for, you walked out with a vicodin rx for "any pain that may occur". After a few years they changed this policy and the number of opiate scripts went way down. But did this create some addicts in the meantime? Of course.
This notion that the customer is always right may work for a restaurant but has been shown to have worse outcomes in medicine.
In the 90's many hospitals and medical groups started with the 'patient as customer' model where physicians are graded by patient surveys. This unfortunately has led to the easing of controlled substance prescribing so that the physician gets a good survey result.
Case in point, I had a local ER in 1997 start associating 10% of the ER docs salaries to a certain level of success on post-visit surveys. What do you think happened next? Now matter what you went to the ER for, you walked out with a vicodin rx for "any pain that may occur". After a few years they changed this policy and the number of opiate scripts went way down. But did this create some addicts in the meantime? Of course.
This notion that the customer is always right may work for a restaurant but has been shown to have worse outcomes in medicine.
Posted on 11/28/17 at 11:57 am to RoosterCogburn585
I'm only half-kidding when I say that I'd like someone to investigate whether there is some conspiracy ongoing between doctors and dentists and the manufacturer of Norco, which seems, now, to be the "go to" prescribed "pain killer" when someone presents in discomfort.
In my opinion, Norco is barely more effective than over the counter analgesics. I'm guessing that it's hailed as something which is less susceptible to addiction.
In my opinion, Norco is barely more effective than over the counter analgesics. I'm guessing that it's hailed as something which is less susceptible to addiction.
Posted on 11/28/17 at 12:54 pm to Eternally Undefeated
Norco is hydrocodone. Still powerful but not on the same level as oxycodone. My favorite is when a patient tells me “nothing works on me but Percocet 10” like someone else said, with drug seakers you just have to stand your ground. They’ll give up and go somewhere else.
Also the article I posted basically goes into detail about how one member of the family changed the way drug makers advertised to doctors and pushed doctors with false information.
Also the article I posted basically goes into detail about how one member of the family changed the way drug makers advertised to doctors and pushed doctors with false information.
This post was edited on 11/28/17 at 12:56 pm
Posted on 11/28/17 at 12:57 pm to nvcowboyfan
quote:
As a board certified addiction medicine physician, I'll give you my answer- the vast majority of this problem exists because of the desire by my physician colleagues to have the "happy patient experience". In the 90's many hospitals and medical groups started with the 'patient as customer' model where physicians are graded by patient surveys. This unfortunately has led to the easing of controlled substance prescribing so that the physician gets a good survey result. Case in point, I had a local ER in 1997 start associating 10% of the ER docs salaries to a certain level of success on post-visit surveys. What do you think happened next? Now matter what you went to the ER for, you walked out with a vicodin rx for "any pain that may occur". After a few years they changed this policy and the number of opiate scripts went way down. But did this create some addicts in the meantime? Of course. This notion that the customer is always right may work for a restaurant but has been shown to have worse outcomes in medicine.
exactly.
But it’s much easier to pin it on the evil drug companies in a conspiracy theory instead of saying “you know what, we fricked up.”
This post was edited on 11/28/17 at 1:00 pm
Posted on 11/28/17 at 1:03 pm to Vinny V
At least you get Percocet from your patients.
Here it has gotten to the point where "nothing works on me but Dilaudid"
Here it has gotten to the point where "nothing works on me but Dilaudid"
This post was edited on 11/28/17 at 1:05 pm
Posted on 11/28/17 at 1:06 pm to JetFuelTyga
I was given IV dilaudid once and it made me understand for the first time how people get addicted. But while coming down from it, I had the absolute worst panic attack of my life. No thanks!
Posted on 11/28/17 at 1:09 pm to Howyouluhdat
quote:
Junkies continue to abuse knowing the outcome.
that's because they have a dependency on said drug and after quite some time of abuse, that dependency is physical in nature.
This thread is full of idiots who clearly don't know anything about addiction, but somehow feel as though they are capable of speaking on the matter.
Pick up a book, or read a study (or even just the fricking abstract). Good lord.
Posted on 11/28/17 at 1:14 pm to RoosterCogburn585
a very large percent. People who don't need them are put on them just long enough to get hooked. Pharmaceutical companies are pushing them like candies. I'm not saying that people aren't responsible for their own actions but when you're being told you need these drugs and are given them freely it's easy for someone to get addicted without realizing it.
Posted on 11/28/17 at 1:19 pm to MLCLyons
It's not high blood pressure medicine or insulin. Nobody is prescribing pain medicine that is not requested and telling a patient they need them. Nobody dies from pain. People taking pain medicine when they aren't in pain or an Advil would do, prescribed or not, are at fault.
Posted on 11/28/17 at 1:22 pm to drunkenpunkin
quote:
Nobody is prescribing pain medicine that is not requested and telling a patient they need them. Nobody dies from pain. People taking pain medicine when they aren't in pain or an Advil would do, prescribed or not, are at fault.
Then why do opioids exist, period? Everyone should suck it up & take some Advil.
Posted on 11/28/17 at 1:25 pm to RoosterCogburn585
I have some experence with this subject as someone who was medicated with opioids for several months. I'd say there is a bit of blame on both patients and doctors.
I think doctors are too quick to turn to opioids. It was my experence that anytime I'd go for a follow up visit to my surgeon, the first question the nurse would ask me is if I needed a refill of Oxy even before my doctor came into the exam room. All I had to do was say I was hurting (which I actually was) and they'd hand me a refill prescription.
But on the other hand, I think people tend to abuse opioids. The temptation to not follow your doctors instructions is very real. Personally i was paranoid of becoming addicted to them so after I started to heal after surgery I'd actually hurt during most of the day and only take one right before going to bed. And even with that self restriction on my intake I could still tell my body craved the Oxy once I let my prescription run out. But notice I said I "let" it run out. I say that because had I wanted, all I'd have had to do was call the nurse and she'd have renewed the prescription over and over.
I think doctors are too quick to turn to opioids. It was my experence that anytime I'd go for a follow up visit to my surgeon, the first question the nurse would ask me is if I needed a refill of Oxy even before my doctor came into the exam room. All I had to do was say I was hurting (which I actually was) and they'd hand me a refill prescription.
But on the other hand, I think people tend to abuse opioids. The temptation to not follow your doctors instructions is very real. Personally i was paranoid of becoming addicted to them so after I started to heal after surgery I'd actually hurt during most of the day and only take one right before going to bed. And even with that self restriction on my intake I could still tell my body craved the Oxy once I let my prescription run out. But notice I said I "let" it run out. I say that because had I wanted, all I'd have had to do was call the nurse and she'd have renewed the prescription over and over.
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