Thoughts On the Opioid Crisis

Discussion in 'Off Topic' started by bellalou, Aug 11, 2017.

  1. bellalou

    bellalou Senior Member

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    I heard today that President Trump has referred to this as a state of emergency. Which is good. It's a huge issue and people are dropping like flies. But I'm concerned because the steps I've heard about that states and agencies are taking are not enough to solve the issue.

    The way I see it, this is a multi-level problem and needs to be addressed on all those levels. So -

    1. There are doctors who over-prescribe opioids.
    This is common knowledge and it's a big problem. One of the solutions talked about has to do with educating doctors. Which is good. Here's a true story. I once went to an Urgent Care facility because I'd fallen from a horse (natch) and had a huge bruise on my outer thigh that had swelled up and felt like a big bag of water. It was gross. It jiggled. I went in to see if they could drain it.

    The doctor who saw me examined it and told me it was not infected and asked if it was causing me pain. I said no, it was just annoying. She said it couldn't be drained and she prescribed me antibiotics and Vicodin. After telling me it wasn't infected and after I told her I wasn't in pain.

    This is a problem. The automatic dispensation of medications that are not suitable for the issue. In addition, a lot of patients specifically ask for narcotic pain relief and doctors just give it. Doctors need to learn to say no.

    2. BUT there are a lot of people who actually need major pain relief.
    One of the big causes of the opioid epidemic is that people actually have pain, are prescribed these highly potent and addictive painkillers and become addicted. One of the solutions to the epidemic has been to limit the number of pills that can be dispensed over a given period. That's fine, except it doesn't address either the pain or the addiction. So people look for other ways to relieve one or both and turn to drugs like heroin, which is now being laced with Fentanyl.

    Much of this could be avoided if other ways of managing pain was covered by insurance. Too often they are not, and too often doctors don't even consider them. For instance, my insurance that I had through my former job only covered a small fraction of physical therapy costs, and only for PT that was prescribed for surgical aftercare. It did not cover PT for routine pain management. Many if not most insurance plans don't cover massage, chiropractic, acupuncture or other forms of alternative pain management. But they cover drugs. That needs to change. If I hadn't discovered that Chinese herbal medicine reduces my pain level to almost nothing, I would probably be addicted to Norco. I was taking 5-6 a day. For years. I was terrified I was developing a habit; not only that, it didn't work anymore because I'd built up a tolerance. I'm lucky - I pay about $60 every 3 or 4 months for herbals and I live close enough to San Francisco to have access. Lots of people don't. (I haven't taken a narcotic pain pill in at least 6 months and I now take maybe a half a one every once in a blue moon)

    3. Insurance needs to pay for addiction treatment.
    It's ridiculous that insurance will pay for the drugs that one gets addicted to but won't pay for treatment. That needs to change too. It is frankly easier to scrape up the money to get today's fix than it is to scrape up the amount you need to enter a decent rehab. There's been some effort to address this but not enough. Kicking any kind of opiate is brutal and can be very dangerous to do cold turkey (not to mention nearly impossible). It's a medical emergency and should be covered.


    I don't know if anyone else has really paid a lot of attention to this but as someone who suffers from a chronic pain disorder, and who used to take a lot of opioids, and as someone who works with people affected by drug addiction on a regular basis, it's a big deal to me. I'd be interested in hearing other people's thoughts.
     
  2. manesntails

    manesntails Senior Member

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    I've had cronic back pain since 1992. If you have pain, you don't get high off pain killers when taking the correct dosage.

    It's like you say: taking pain killers when you don't have pain causes the person to get high and the body wants to feel that way again and sends signals to the brain to feed it more of that.

    It's not only the dooctors prescribing it when not necessary, it's also, IMHO, the patient using it irresponsibly. Then you have patients faking pain just so they can get high. The doctors can't definitively claim that someone who says they are in pain is not.
     
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  3. slc

    slc Senior Member

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    I don't believe that the prescribing of opiate drugs is how the majority of people who are heroin or crack addicts got started on the path to being addicts.

    I do believe that some people started that way, and I do believe that the prescribing of opiate drugs needs to be tightened up.

    But I don't believe the majority of addicts became addicts because of opiate prescriptions. I DO believe that many of them sought opiate prescription drugs at some point in their addiction, though.

    I think that with addiction to opiates you're dealing with several very distinct populations who have different reasons and pathways to addiction. And I think there is way, way too much emphasis on 'how this happened' and 'let's prevent it' instead of 'let's deal with the addicts we have right now' because we DO have a crisis on our hands and there is no avoiding that we have a great many addicts NOW. And the first priority is treating the people who are at greatest risk of - dying.

    The idea to ONLY think prevention falls right into line with the hatred people have for addicts, considering them less than human and a 'lost cause', largely because we believe it's simply a 'choice' someone freely makes. And it is not a freely made choice. It's far more complex than that.

    Who are addicts? Well, I can say what I've learned through study and volunteer work.

    I think one group is suffering from untreated mental illness. In some, this is very severe mental illness like schizophrenia or severe depression. About HALF of schizophrenics have an addiction problem (drugs, alcohol or both). That right there is a huge number of people.

    Addiction can, in that group, be 'self medicating' (an attempt to control symptoms of an illness). But also in this group is a bunch of people who became addicts due to much more minor problems like social anxiety, mild depression, etc. AND another group who became addicts because of PTSD, trauma or mistreatment.

    Another group has chronic pain. They may also have mental health issues. With chronic pain, depression is said by some to be inevitable if the pain goes on for six months or longer. That's a pretty scary idea right there.

    Another group simply get addicted easily. Some people say they have an 'addictive personality'. From an early age they've been fascinated with drugs and seem to have an almost unturnable path toward addiction. It doesn't much matter what serves as their 'gateway drug'.

    Each of these groups needs a unique AND DIFFERENT kind of help.

    We simply cannot treat all these people in the same way. And this is what too many programs try to do. And that will fail. While a certain number of 'slips' (falling back into addiction) isn't all that unusual for e recovering addict, it's also important to recognize that every failure leads to more discouragement and more loss of the community/family support for the person.

    The severely mentally ill person needs intensive intervention. He may not be in reality enough to ask for or even want help. His thinking processes may be severely impaired. Long neglected, his mental illness may not respond at all easily to treatment. These days, a 'dual diagnosis' team is the best approach, and treating the mental illness first, quite often is the only way the addiction has any chance of ending.

    Others won't need the same services this group needs. The person with chronic pain very often can be in far less pain with surgery or simply a pain management team addressing his problem, for example. You can't just ignore the chronic pain.

    But this is the problem with most attempts to treat addicts. Not recognizing how very different they are from each other.

    And many people have multiple problems. For example, in veterans, it's not unusual to find chronic pain, PTSD, mental illness and addiction.

    The key is that each addict needs a unique treatment plan tailored to his or her specific pattern of addiction.

    I often hear, in certain camps, that the cheap solution is the best solution: peer counselors. We're not going to lick this by just throwing volunteer peer counselors at it. The problem is much bigger than that.
     
  4. slc

    slc Senior Member

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    The history of America is also the history of no one wanting to pay for mental illness treatment or addiction treatment. Both have been a 'hot potato' that no one wants to catch. It's shifted from the federal to the state to the local government, with diminishing success at each shift.

    My take? You'll never get health insurance companies to pay for it. They are too powerful and they want too much, to hang onto every fraction of their profit.

    By too many readily available measures, mental health care and addiction care are 'failures'. There will always be people who can't be cured or can't recover (those two are very different things...). The benefit of as successful as possible a program is 'immeasurable', supposedly. But addiction and mental health actually cost billions of dollars in lost productivity, both in how the individual and how his family/community are affected.

    These are programs no one wants to afford, and that no one can afford to do without.
     
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  5. Kappa

    Kappa Senior Member

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    I had an interesting conversation with one of our prison doctors. She was a Czeck woman, in her 70's, brilliant, and had seen it all before. She said, "we have non-narcotic pain killers, in a lot of cases ibuprofen will work. If I offer non-narcotic, tell them it's all they're getting, and they turn it down then I understand more about their level of pain." And yet my dentist prescribed me Lortab after getting a temporary filling. Totally unnecessarily.
    Opioids are a HUGE issue. I've known, and know, many people hooked on them and I see inmates every day who are in prison because of their addiction, in one way or another. I think very strict restrictions, finding a way to stop doctor shopping, and greater availability of rehab and mental health resources is a great start.

    Something has to be done.
     
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  6. equineeventer33

    equineeventer33 Senior Member

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    One thing that needs to be done (and healthcare industry is working towards this), is a national controlled substance database. In South Carolina, every controlled substance prescription written and filled goes into a database, called the Scripts program or the Prescription Monitoring Program. There are huge penalties to the pharmacy for not reporting what they fill. Pharmacies, when they receive a new script for a controlled substance, can look up the patient and see how often they are getting controlled substances/opioids. If something seems off, like they regularly get opioids filled from different pharmacies and/or different doctors, they can refuse to fill. Every pharmacy needs to be doing this. Recently it was just changed that doctors will now get fined if they don't check the program before writing a controlled substance prescription. If everyone does their part, this will help. But the problem is, it's state by state. South Carolina can't see neighboring states NC and GA. So, especially if you're near a border, drug shoppers can just go to a different state. Some pharmacists I know are now starting to refuse to fill controlled substance prescriptions from out of state or from patients that live in one state but use a doctor in a different state, etc. It was recently brought up in SC to make a law where if a person overdoses and dies from an opioid, the pharmacist that filled it could be held liable for manslaughter. This is way too extreme, and would just make pharmacists refuse to fill any opioid (I know I wouldn't fill one) but I agree something needs to be done. In SC, we've recently given EMS and police officers Narcan, the opioid reversal medication, to help prevent opioid deaths, but this has opened more problems because now people think they can just do a lot of drugs and then have it "reversed".
     
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  7. Kappa

    Kappa Senior Member

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    I was listening to NPR the other day and Narcan was being discussed in relation to the EMS system in Minnesota, though I can't really remember if that was the place (though that is neither here nor there). The price of Narcan is going up and they are having to use so much of it, a firefighter/paramedic reported that they use it at least once a day. With the addition of extremely powerful Fentanyl this is going to grow into a larger problem before it is fixed. Our government simply does not move fast enough, and has waited around long enough, that what is now an epidemic may become a massacre.
     
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  8. slc

    slc Senior Member

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    Very few people are in favor of stopping addicts from dying. Some are willing to allow it once, but not multiple times for the same person.

    And in fact, that's probably not realistic. Most addicts have a few lapses on their way to recovery. That's no reason to get mad at the person or refuse to help them.

    Once the person is addicted, chemistry has the upper hand and the addiction isn't going to vanish after a 3 day detox. The individual's mental health and eventual re-entering of the employment market are complex issues as well as the addiction being challenging.

    Even on the crassest level, the gained productivity of the individual and his loved ones over their lifetime, is worth far more than a couple syringes of narcan.

    The lost productivity of the family, the depression, anxiety and even suicide that happens in the people around the addict...these are 'expensive' to the country.

    There is movement to lessen its price (It's extremely cheap to make, the company is just capitalizing on the need for it.) and that I think would help.
     
    Last edited: Aug 12, 2017
  9. bellalou

    bellalou Senior Member

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    Excellent and easy idea. And if there's a central database it would show if people are pharmacy shopping.

    I'm actually sitting in the herb store in SF waiting for my herbal prescription to be filled. :D
     
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  10. Compadre

    Compadre Senior Member

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    I think part of the blame can be laid squarely on the cluster bomb that is called HCAHPS.

    For those who don't know, HCAHPS is a way of grading a hospital based on patient satisfaction. It is part of what determines a hospitals reimbursement. After a hospital stay, a certain number of random patients are called afterward and surveyed specific questions about their stay.

    Which is fine I suppose, if you prefer to have your healthcare graded not on how well they treat your ailments, but how happy they made you.
     
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