It's about this "opiod crisis"

[Sam McGee]

I certainly do not want to belittle the severity and personal tragedies of the oipiod epidemic . . . however . . . let's point out a fact that's being overlooked: The "opiod epidemic" is NOT caused by drugs brought in by "Mexican drug dealers." No. Opiods are coming from US pharmaceutical manufacturers. Opiods are distributed by US physicians, nurse practitioners, physician's assistants, pharmacists and pharmacy technicians. Of course, you won't hear this from Trump.

[applegrove]

1. The fentanyl coming in is coming from the outside. And the heroin people

end up on because it is cheaper. The legal prescriptions are what starts the addiction. You are right about that.

[Stinky The Clown]

2. There is no one path to addiction

Youthful experimentation

Being part of the party crowd

Dealing with life and self medicating with illegal substances

Establishing dependency resulting from pain killers after an injury

Numbing chronic pain any way possible

Any and all of the above

Those are but a very few of the oh so many other ways.

[applegrove]

4. Of course. You are correct.

[lostnfound]

21. Kickbacks encouraging doctors to prescribe FENTANYL even for TONSILITIS

[ThatGuyJerome]

3. Opioids

Very true...the opioids initially come from the pharmacuticals but then the doctor's cut the drugs off and heroin is cheap and they need their fix....

The heroin crisis is serious...I've lost 6 people I know due to it...all under the age of 30!

I would like to consider this a topic everyone can equally debate about. What do y'all think? How do we solve this?

[tulipsandroses]

10. More money is needed for long term evidenced based treatment

Some things that I think need to change:

Detox is only the first step. There are not enough long term rehab facilities or effective outpatient long term out patient programs. Some of my patients relapse while waiting for weeks for a bed to open up. The time after detox can be extremely dangerous. The same amount of drugs you used before detox, may now be a lethal overdose.

More training for addiction professionals. Addiction falls under the umbrella of Psych/Mental Health. However, not all psych providers are trained to deal with addiction.

Get rid of the red tape so more providers can prescribe Suboxone. It is ridiculous that you need a certain certification to prescribe Suboxone and limited to how many patients you can treat. After all, you don't need a special certificate to prescribe opioids.

Don't think Detox and a script for Suboxone is the miracle cure. Suboxone should only be one tool in box of tools. There are other meds in our arsenal such as Vivitrol/Naltrexone as well as other meds that provide withdrawal symptom relief.


Treat people with underlying mental illness. Not all, but mental illness can make someone more susceptible to addiction.


Meet people where they are. 12 Step Recovery is not for everyone. Provide alternative to 12 step recovery programs.

Force insurance to pay for long term sober living/half way houses

Sometimes patients have burned bridges with families and friends due to years of addiction. I can't blame the family member that does not want an addict to return to their home. These families go through so much. Its exhausting dealing with addiction. Recovery takes time. We have to be thinking long term. There are no quick fixes. Addicts who are facing homelessness need safe sober spaces.

When I went to nursing school. From the first day, it was drilled into us by our nursing instructors, pain is whatever the patients says it is. Medicine's version of the customer is always right. I'm sure that advice came from pharmaceutical companies. As well as hospitals afraid of bad surveys. Some docs may give in for request pain meds to avoid getting bad reviews on the patient surveys. Sometimes insurance reimbursement is tied to provider performance tracked by these surveys. Doctors refusing to write for pain meds, sometimes get bad surveys.

[Motownman78]

11. Do what portugal does

Provide Heroin addicts with half a gram a day of pure-medical grade heroin. It is the fentanyl that heroin is cut with that killed the people you know.

[Doreen]

5. Yup, that is why the addicts are going to be punished for being addicted.

It will probably be made easier for the pharmaceutical companies to hand it out. Think about it. If more people are going to prison for addiction the private prisons will have more slaves to do the work that was being promised to the people.

[klook]

6. And...it wasnt seen as a huge deal until the numbers of white addicts reached epidemic levels (nt)

[JI7]

7. imagine how people would talk about it if it was black people or some other minority group

[BainsBane]

8. Yes

Last edited Fri Oct 27, 2017, 02:06 AM - Edit history (1)

Have you seen those aids for some drug for "opioid-induced constipation"? They act like that's a disease that requires special treatment. How about laying off the narcotics?

The crisis is real, but as you say it's the product of irresponsible and often criminal medical providers and pharmacists.

[Motownman78]

13. There wasn't a crisis when docs were giving

out hydrocodones like candy. The crisis began when the DEA decided to be puritan and cut-off the pills. A lot of people then switched to heroin and god knows what else. In Jamaica, you can by opioids like codeine over-the-counter. Why are people not dying in the streets there?

[BainsBane]

14. More people die from opioids and other prescription drugs than heroin

and there are clinics and pharmacies in states like W Virginia that dole out stupefying amounts of narcotics. They are drug dealers. Puritan is keeping pot illegal, not trying to keep people from slipping into opiod comas or die by age 25. The shit kills, and drug companies, and disreputable doctors and pharmacies profit
.

[Motownman78]

20. If it kills

Then why are people not dying in the streets of places like Jamaica where you can buy Codeine (An opioid) over-the-counter without a prescription?

[TheFrenchRazor]

18. yep; this stuff used to be sold over-the-counter right here in america, with nothing near the

problems we have now. prohibition has NEVER worked. i really wish that people who are trying to stop overdoses would find a better way than getting between doctors and their patients.

[Aristus]

9. You're right about that. It's unscrupulous medical providers who are the problem.

They make the rest of us, the responsible practitioners, look bad.

One thing I feel duty-bound to correct, however, is the use of the term Physician's Assistant. The correct term is Physician Assistant, no apostrophe.

Every day in our practices, we are confronted with decisions that can affect our patients, and cost us our medical licenses if we make the wrong one. Hell, every time I stick my head in the lion's mouth over the issue of opioid prescribing, it gets bitten off by an entire legion of people who assure me that they really need these medications, and it's everyone else who is obtaining and taking them inappropriately.

I'm accused of sadism; of prolonging and enjoying the pain that patients suffer by denying them narcotic medications. I'm accused of being a poor medical provider. (I can't blame the people making the accusations; it's not like they've read the accolades I get from the doctors who audit my charts.) I'm even accused of not being a medical provider at all. (Which is understandable; the anonymous nature of DU means it's not a good idea to post my medical license for all to see.)

Occasionally, I just get someone who is behind the times. I was engaged in a discussion once over appropriate prescribing and clinical management, and someone else warned the other posters on the thread that I wasn't a medical provider, but a Medical Assistant. I had been a Medical Assistant prior to my training at P.A. School. But at the time this happened, I hadn't been an MA for some four years.

Regardless, the quacks at the pill-mills are just making things difficult, and even deadly as we have seen, for people in need.

[TheFrenchRazor]

19. what gives you the right to decide who will or won't be allowed to stop their own suffering?

serious question, and i'm not talking about "legal authority;" i'm talking about moral authority. what gives you the right to force someone to suffer, sometimes for years on end, due to severe chronic pain? do you pay that person's bills, so they won't have to work or function at all? i doubt it, but you arrogate to yourself the authority to stop them from obtaining medication that could reduce their suffering and allow them to have some reasonable quality of life. i'm not a believer, but there has got to be a special place in hell for anybody who would do that. if you are trying to help people, prohibitionist hysteria is probably not the way to do it.

[Aristus]

23. First of all, thank you for proving the point I made above.

Second, it's called clinical judgement, and it's informed by training and experience.

If someone is in genuine pain, I do everything medically necessary and appropriate to ameliorate that pain. But if someone is blatantly trying to hit me up for a bottle of six-hour vacations, I send them packing. The opioid addiction crisis exists because not every medical provider is that scrupulous.

When we have to visit with 25-30 patients a day, and our face time with patients is extremely limited, we can't always go eighteen rounds with a drug-seeker. Some medical providers write a scrip just to get a trouble-maker out of their hair and out of the clinic. And they are the ones causing or worsening the opioid epidemic. But I don't know a single medical provider colleague, whether doctor, Physician Assistant, or Nurse Practitioner, who doesn't do everything they can to ease the suffering of a patient. It's what we signed up for.

It's worth pointing out that if someone becomes combative, insulting, and insisting that 'nothing else works!', we take that as a warning sign.

[Nevernose]

12. Something like 90% of US heroin is fentanyl-adulterated now

In some places it’s 100%. Some of that fentanyl is coming from quasi-illicit Asian labs, some is diverted from legit sources, some is skimmed off the top from the US labs. I was also told that it wasn’t terribly difficult to make, so an unscrupulous chemistry PhD with a full lab and an adjunct’s salary...

It’s the fentanyl that’s caused the uptick in death (though probably the pharmaceutical industry caused the rise in addiction).

It’s also kind of hypocritical. Alcohol kills 100,000 people a year in America — and that’s not including drunk driving, falls, fights, etc. Prohibition of an addictive drug simply doesn’t work. Prohibition works well for other things, but not so much for neurochemistry.

[SeattlePop]

15. After Cutting Taxes For Billionaires And The Corporations They Own There Will Be No Treatment Money

Sorry folks.

Trump agenda.

[Dotarded]

16. Where is one supposed to stand on this

I have for long thought that anyone should able to do whatever it is they so desire to their own bodies. I know people that I have lived with that have died OD'ing on whatever street heroin concoction they got. But it was their choice no one stuck a needle in their arm and killed them. If it was impossible to not OD after ever having a prescription for those drugs or a hospital visit on those drugs most people in the country would be dropping dead left and right. It is still a smaller level of death in this country. Not to far off from suicide which is what I consider that action to be.

The entire drug war that I am pretty sure most on this board are against loves this though. Cant wait to find the next powder in someones car to pin felony charges on. What a pleasant existence where crumbs from a donut leads to a battle with the state because they have to pursue life ruining charges. Look it up. Someone just won tens of thousands of dollars for that scenario.

But what would your answer be to this problem?

We will never get out of this circular logic of prison is overpopulated but this one thing I care about needs to see everyone in prison because reasons

[TheFrenchRazor]

17. right on; i can't believe the # of people here who think the War on Drugs is great; they

seem to think that if you make it more difficult for doctors to prescribe these meds to people who legitimately need them, this will somehow stop people from using/abusing them recreationally. when has prohibition EVER stopped people from using/abusing drugs???!!! all it does in the case of pain meds is cause people who are already suffering to suffer more.

even if every single legal pharmaceutical company stopped producing these drugs entirely tomorrow, they would simply be produced in illegal, off-shore factories, basements, garages, etc. just like every other illegal drug; there would be even more deaths due to adulterated, non-standardized products, made with absolutely no safety regulations or oversight. is this really what the bleeding hearts trying to protect people from themselves want?? if somebody wants to stop people from ODing, there has got to be a better way than to have politicians and busy-bodies making medical decisions, instead of doctors and their patients.

[dchill]

22. What we need is a big, beautiful wall...

Between big business and government.