re: I keep hearing there is an opiod epidemic happening?

Democrats like to call it the crack of the suburbs, except doctors don’t prescribe crack, so the analogy doesn’t really hold up.

I was hunting not to long ago with one of my anesthesiologist friends. We were talking about the opioid crisis. We both remember getting a letter from the DEA or some other federal agency but we were pretty sure it was from the DEA. We both distinctly remembered discussing this letter during one of my cases. The letter was probably written 20 to 25 years ago. The essence of the letter was that with “ modern pain control drug regimens” there was no need for any of our patients to feel pain, intraoperatively or postoperatively. Funny how things change.
One of my fellow residents was from the Philippines she had incredibly different cultural ideas about pain. She basically felt Americans were wimps when it came to pain preception. From working in several foreign countries I now tend to agree with her.

Need more of them ODing

It's serious enough that Purdue Pharma will no longer market OxyContin, and other opioids, to doctors and is laying off half its sales force.

quote:

---

Purdue Pharma, maker of OxyContin, backs off aggressive marketing amid lawsuits

NEW YORK -- Monday marked a change of culture for Purdue Pharma, the drug company that makes OxyContin and other opioids. The company will no longer market those drugs to doctors and is laying off half its sales force.

After years of marketing testimonial videos and handing doctor's pamphlets claiming only about 1 percent of opioid users become addicted, Purdue Pharma -- the nation's largest opioid manufacturer -- now says it will back off aggressive marketing techniques, no longer sending sales representatives to doctors offices to push opioids.

While these techniques helped opioid sales spike in the last two decades, so too did the number of opioid overdose deaths. In 1999, there were 4,000 deaths, a number that spiked to 32,000 in 2016 -- an increase of more than 700 percent. OxyContin, the brand name version of the drug oxycodone, made the company billions of dollars and was at the heart of the crisis. ...

---

Of course this action comes after several hundred lawsuits were filed against the company.

quote:

---

...Purdue is currently facing multiple lawsuits filed by more than 400 cities and states alleging the drug maker misrepresented OxyContin's risks, creating an expensive public health crisis taxpayers had to handle. Late last year, they were asked to end their aggressive push with OxyContin and refused. ...

---

CBS News article and video.

quote:

---

i know four or so that have OD'd. all were upper middle class, but they were burn out losers. i have yet to see a decent person go down in my personal life.

eta: not saying that doesn't happen, of course.

---

Of the five from my graduating class, one was an attorney, one was a writer and journalist, one was a bartender, one had a regular working class job, and one was a deadbeat loser in and out of trouble since he was about 16.

The one who was an attorney was the one that really hit. He ran with a wild crowd in high school (lots of those cats have had problems of some sort or the other), but he was brilliant, driven, and seemed to have his shite together. He died in a hotel room the night before he was supposed to be a groomsman in one of his close friend's weddings in a very nice part of the world.

quote:

---

Automatic constipation.

---

Not if you drink copious amounts of whiskey with them.

It's definitely a thing, largely a combination of blue collar workers getting hooked after work-related injuries and the over-diagnosis of conditions like fibromyalgia being used a crutch.

As a physician, I can say there is NOTHING more frustrating than dealing with a drug seeking patient. Regardless of whether or not they actually believe they need the medication, it's just intolerable. It brings out the absolute worst side of people. And as a profession we bear much of the responsibility for over-prescribing medications meant and approved for cancer pain and end of life management and not much else.

Personally, I never prescribe or renew opiates medications except for metastatic cancer patients and certain types of end of life care like management of end state lung disease with severe air hunger. Any other instance they generally do more harm than good. Pain contracts are largely a way to make physicians feel better about using dangerous medications off label and I don't mess with them.

The most common reason they are prescribed in this country is back pain, and all the evidence shows they not only are less effective than other therapies but they actually have poorer outcomes.

quote:

---

I'll get crucified on here, but it is worth noting that most of the health problems with opioids arise from (1) the acetaminophen which is bonded to most prescription narcotics causing liver toxicity/failure and (2) government constricting access to legal meds forcing addicts to illegal drugs.

---

Generally the chronic use of Tylenol below 3 grams a day isn't an issue unless you already have underlying liver disease or are ingesting other hepatotoxic medications. And most chronic opiate abusers are adept at using various methods like cold water distillation to separate the Tylenol from the opiate and avoid ingesting much if any at all.

The majority of deaths from opiate use are caused by 1) acute overdose and 2) traumatic falls and auto accidents. Liver diease occurs chronically and is almost always multifactorial when Tylenol is involved unless you injest a huge quantity in a short period of time (at least 6-8 grams in 24 hours but usually more). The narcotic will kill you long before the liver failure though because Tylenol related hepatotoxicity kills over about 72-96 hours unless you have an incredibly high opiate tolerance. 8 grams of Tylenol is about 24 tabs of Norco for instance, which for the 10-325 dose is 240 milligrams of hydrocodone. That will kill most people.

quote:

---

is that we've developed this mindset in America that the only acceptable level of pain is no pain. We believe that if we're in ANY pain we are not being adequately treated.

---

Agree. No one needs 30 Percocet after getting their wisdom teeth taken out