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Thread: Opioid epidemic

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    Insider Jim Wilke's Avatar
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    Opioid epidemic

    The US has 5% of the planet's population but uses 80% of the painkillers.

    Big Pharma is the issue, not the dude on the street corner.


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    Insider Frank Capua's Avatar
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    The neighbor lady who I take to her doctor appointments & Dialysis treatments gets Oxycon-something every time she gets surgery. Never takes more than a couple. When she got out of the hospital following her most recent visit I helped her get rid of 6 bottles of the crap out of her medicine cabinet. I told her that she probably had a couple hundred dollars of street value. I told her how dangerous this stuff was the last time she was prescribed it and this time they sent her home with tramadol. It's still a narcotic but it doesn't have any street value because there's no high.

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  3. #3
    Quote Originally Posted by Jim Wilke View Post
    The US has 5% of the planet's population but uses 80% of the painkillers.

    Big Pharma is the issue, not the dude on the street corner.
    The dude on the street corner can't entirely be separated by the prescriptions either. The table you cite appears in a JAMA article from last year which shows heroin users being far more likely to have abused prescription opiates in the year prior than any other form of drug. Only cocaine, another opiate, is in sums greater than single digits of likelihood, and is still nearly 3 times less likely to have been used than prescription opiates. Also, one of the key limitations of the manuscript is that the cited studies on the theorized shift of prescription drug users to heroin occurred prior to the crackdown on prescription opioids. While the correlation of crackdown in 2011/2012 and the hockey stick up can't automatically be claimed as being a true correlation (you need to look at other variables first, such as age, average income, education, individual debt, race/ethnicity, etc), it is certainly to be the target of a lot of research.

    Or, at least, it would be if the NIH wasn't possibly getting cut to shreds.

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    Insider Jim Wilke's Avatar
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    I'd like to see production and sales numbers for opioids. DEA is cutting back, should cut more:

    The U.S. Drug Enforcement Administration is moving to curb the national opioid epidemic by slashing the production of a number of popular prescription painkillers.

    In a notice published Wednesday in the federal register, the DEA finalized a previous order on 2017 production quotas for a variety of Schedule I and II drugs, including addictive narcotics like oxycodone, hydromorphone, codeine and fentanyl. The agency has the authority to set limits on manufacturing under the Controlled Substances Act.

    In a release, the DEA said it is reducing “the amount of almost every Schedule II opiate and opioid medication” by at least 25 percent. Some, like hydrocodone, commonly known by brand names like Vicodin or Lortab, will be cut by one-third.

    In 2013, doctors wrote nearly 207 million prescriptions for narcotic painkillers, up from around 76 million in 1991, according to the National Institute on Drug Abuse. Much of this was due to the pharmaceutical industry’s lobbying and PR campaign, led by Purdue Pharmaceutical, to boost the use of narcotics. (Purdue would ultimately plead guilty to misleading the public about the addiction risk posed by the painkiller OxyContin, which contains oxycodone, and pay a $634.5 million fine.)

    DEA quotas also played a role in empowering pharmaceutical companies to flood the market with pills. In 1993, three years before Purdue released OxyContin, the agency capped oxycodone manufacturing at just 3,520 kilograms, journalist John Temple writes in his book American Pain. But by 2007, this number had shot up to 70,000 kilograms, an almost twentyfold increase. Production peaked in 2013, with pharma companies churning out more than 150,000 kilograms of oxycodone. Next year, with the revised quotas in place, they’ll produce more than 108,000 kilograms.
    http://www.huffingtonpost.com/entry/...b03254526297bd

  5. #5
    Quote Originally Posted by Jim Wilke View Post
    The US has 5% of the planet's population but uses 80% of the painkillers.

    Big Pharma is the issue, not the dude on the street corner.
    By that logic, aren't Smith&Wesson et al responsible for gun deaths?

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    Insider Frank Capua's Avatar
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    Quote Originally Posted by Gary the Møøse View Post
    By that logic, aren't Smith&Wesson et al responsible for gun deaths?
    Hmmm.... A moderator openly campaigning to turn an Off-Topic forum thread political.

  7. #7
    It was just an analogy Let's see if it holds.

    Besides, it was political from.the start. And really, what isn't?

    The truth will come out eventually.

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    Insider goner's Avatar
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    Big Phella on the corner takes care of all your Smith & Wesson and junk needs.
    He cares not a bit about politics and takes no responsibility.

    China has taken steps recently to make fentanyl harder to import. Should see less at more cost.
    Cha Ching. Burglary increase maybe?

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    Registered User StandOnIt's Avatar
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    Quote Originally Posted by Frank Capua View Post
    The neighbor lady who I take to her doctor appointments & Dialysis treatments gets Oxycon-something every time she gets surgery. Never takes more than a couple. When she got out of the hospital following her most recent visit I helped her get rid of 6 bottles of the crap out of her medicine cabinet. I told her that she probably had a couple hundred dollars of street value. I told her how dangerous this stuff was the last time she was prescribed it and this time they sent her home with tramadol. It's still a narcotic but it doesn't have any street value because there's no high.

    Depending on the strength she could have had 3 or 4 thousand bucks worth easily.
    In many cases street heroin is cheaper. Those stats are undoubtedly blurred as many that have prescriptions sell their pills for extra income. A drug is a drug is a drug no matter who is selling it.


    The street prices of OxyContin are huge, and they range from $5 to $10 for a 10 mg pill, from $10 to $20 for a 20 mg pill, from $25 to $40 for a 40 mg pill and a 80 mg pill cost unbelievable $65 to $80
    http://www.steadyhealth.com/topics/t...e-of-oxycontin

  10. #10
    Quote Originally Posted by goner View Post
    Big Phella on the corner takes care of all your Smith & Wesson and junk needs.
    He cares not a bit about politics and takes no responsibility.

    China has taken steps recently to make fentanyl harder to import. Should see less at more cost.
    Cha Ching. Burglary increase maybe?
    Illegal fentanyl production is the new meth lab. Doesn't even create superfund level contamination or risk of explosion. Cities are pulling their vacants down, but rural america doesn't have the money, time, or ability.....

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    Insider Jim Wilke's Avatar
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    Quote Originally Posted by Gary the Møøse View Post
    By that logic, aren't Smith&Wesson et al responsible for gun deaths?
    Not the same. Just a guess but a large majority of guns are never or rarely fired. How much Oxy goes unused?

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    Insider Jim Wilke's Avatar
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    Quote Originally Posted by Frank Capua View Post
    The neighbor lady who I take to her doctor appointments & Dialysis treatments gets Oxycon-something every time she gets surgery.
    Two years ago, I had eyelid surgery - not for vanity, my upper lids were dropping into my eyes. I got a prescription for 30 Hydrocodone. Took two, flushed the rest. Last summer, I had cataract surgery. Prescribed 20, took 1.

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    It seems as the taxes and regulations on cigarettes increased, opioid use grew. I haven't seen anything connecting the two and having never really used either, I don't know if one could be a substitute for the other.

    I can't help but think there might be a correlation, though, admittedly I have no real info to back this up.
    I don't have a profile because I think profiling is wrong.

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    I had my wisdom teeth taken out a few years ago (in my mid 40s) and was prescribed Oxycodone (I think--it was the stronger one, if that makes any sense. I just know that when I told people what it was the all said it was strong and that I could have sold it in the streets for a lot of money.).

    Anyway, I had a lot of issues with my recovery and the pain killers certainly helped. I will admit that they made me feel pretty great and that I could see the temptation for people to take them illegally. I took the last two pills when I only had a little pain left but figured I might as well put them to use. I'll just go ahead and admit that. I was a recreational drug user for a day. Then they were gone and that was that. I think I'm lucky.
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    Insider Jim Wilke's Avatar
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    I know a very attractive woman who is the mother of 4; her husband is a well-paid executive in the air industry. She is small and trim, maybe 5'2" and 125. About 5 years ago, she had some trouble with her back and began seeing a doctor. He told her to exercise and prescribed a light dose of Oxy for the occasional pain. Within a few months, she was doctor shopping and eating them like candy. She eventually had to go to rehab in Oregon and recovered but it took work and a lot of family support and money.

    If she'd been single mom working in a bank or at Target, well ...

  16. #16
    A good share of the guile lies with Doctors who over-prescribe painkillers. Not sure of their motivation.
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    Quote Originally Posted by ventman View Post
    A good share of the guile lies with Doctors who over-prescribe painkillers. Not sure of their motivation.
    Not all of them.

    When I treat acute pain I "might" give a 5 day course of a Vicodan. I figure if when they come back and are still in pain enough to need a refill I start looking for a different source of the pain. If I can't find it then its NSAID and Tylenol. Still I see patients who have been on these drugs for years. Vicodan, Percocet, Morphine, Fentanyl you name it they have been on it for years. All still complain of pain. The prescriber is not doing the patient any favors by not forcing the patient to face what the actual problem is. At my place of employment we have instituted monthly drug screens. If you are negative for the med you are prescribed or have other substances in your system that you are not suppose to have then the medication is discontinued.

    The bottom line is that it is a huge problem that the medical industry has created and is now trying to control. You will see a increase in heroin deaths as a result of these measures.

    TD

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    Insider Jim Wilke's Avatar
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    Quote Originally Posted by ventman View Post
    A good share of the guile lies with Doctors who over-prescribe painkillers. Not sure of their motivation.
    That's easy, they want patients to be comfortable. Pain medication eases pain, that's what it is for. Very, very few doctors are getting rich selling pills.

    That said, where the problems come is when patients see multiple doctors or keep coming back for continued meds. It is ugly business .... I take Lipitor because I'm in my 60s and that's the law. I've been in line behind a couple of these snaked out oxy freaks at Walgreens and it is not pretty. I've seen pharmacists turn them away and it gets bad.

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    Quote Originally Posted by ventman View Post
    A good share of the guile lies with Doctors who over-prescribe painkillers. Not sure of their motivation.
    There are some shady Pharmaceutical reps out there who may have something to do with some of these prescriptions.

    As for the epidemic, the problem that's really been on the rise up here has been black market Fentanyl that contains god knows what and is killing a lot of recreational users who don't know what they are actually getting. There is certainly also the problem of addicts who started on prescription opioids and have moved on to whatever they can get but the bootleg stuff that contains all sorts of **** is currently in the headlines up here.

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    Quote Originally Posted by senorsoupe View Post
    There are some shady Pharmaceutical reps out there who may have something to do with some of these prescriptions.

    As for the epidemic, the problem that's really been on the rise up here has been black market Fentanyl that contains god knows what and is killing a lot of recreational users who don't know what they are actually getting. There is certainly also the problem of addicts who started on prescription opioids and have moved on to whatever they can get but the bootleg stuff that contains all sorts of **** is currently in the headlines up here.
    And the craziest part is that the dealers selling the crap that ends up killing people use it as a selling point... Apparently that just shows how strong their stuff is.

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    Quote Originally Posted by TDIndy500 View Post
    Not all of them.

    When I treat acute pain I "might" give a 5 day course of a Vicodan. I figure if when they come back and are still in pain enough to need a refill I start looking for a different source of the pain. If I can't find it then its NSAID and Tylenol. Still I see patients who have been on these drugs for years. Vicodan, Percocet, Morphine, Fentanyl you name it they have been on it for years. All still complain of pain. The prescriber is not doing the patient any favors by not forcing the patient to face what the actual problem is. At my place of employment we have instituted monthly drug screens. If you are negative for the med you are prescribed or have other substances in your system that you are not suppose to have then the medication is discontinued.

    The bottom line is that it is a huge problem that the medical industry has created and is now trying to control. You will see a increase in heroin deaths as a result of these measures.

    TD
    That's great to hear.

    My family doctor has a horrible reputation amongst users because he is very strict about how he prescribes opioids and all habit forming medications, and that's one of the reasons I like him.

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    Quote Originally Posted by Jim Wilke View Post
    Not the same. Just a guess but a large majority of guns are never or rarely fired. How much Oxy goes unused?
    In your case, 95%:

    Quote Originally Posted by Jim Wilke View Post
    Two years ago, I had eyelid surgery - not for vanity, my upper lids were dropping into my eyes. I got a prescription for 30 Hydrocodone. Took two, flushed the rest. Last summer, I had cataract surgery. Prescribed 20, took 1.
    Same with us - I kept some from a surgery, in case I ever had another one of those migraines. Never have remembered it when I did, or decided to use it if I did remember. After a few years, I figured they were no longer chemically stable and dumped them. Ditto when the spouse had a kidney stone, which passed the same day.
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    I had a herniated disk and went through the entire routine before having surgery.
    I was eating Vicodin like candy during the process.

    After the surgery I took maybe one or two. I was worried I'd end up like Favre but did not.
    I talked with the Dr. about it and he told me that when you are in serious pain, it's okay to
    take more than the prescribed dose and when you get fixed up, it wouldn't be a problem.

    It was never a problem for me.
    ...---...

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    This happened yesterday morning in Centerville, OH, a mostly upper middle-class suburb of Dayton. I have removed the names of the parents. They have 4 children. Note the Father's occupation.

    Overdose possible cause of death of Centerville couple

    A couple identified as XXXXXXX, 36, and XXXXXXX, 34, were found dead in their Centerville home after two children in the home called 9-1-1 saying their parents were unresponsive Thursday morning.

    The county coroner says deaths appear to be fentanyl-related
    XXXXXX was a Spirit Airlines pilot
    Two children in the home called 9-1-1 and reported their parents wouldn’t wake up

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    Quote Originally Posted by ventman View Post
    A good share of the guile lies with Doctors who over-prescribe painkillers. Not sure of their motivation.
    I disagree, people should take responsibility for what they put in their body. I was given Oxy after my shoulder surgeries, and took as few as I could get away with. I was well aware of how addictive they are, and had no intention of getting caught in that trap.

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    Quote Originally Posted by Baulz View Post
    I disagree, people should take responsibility for what they put in their body. I was given Oxy after my shoulder surgeries, and took as few as I could get away with. I was well aware of how addictive they are, and had no intention of getting caught in that trap.
    Problem is that not everyone is aware of how addictive these can be and not every doctor is educating their patients about it. Oxy was marketed as being not addictive (the same way that Heroin was originally marketed as a less addictive alternative to Morphine) and so a lot of people who got hooked to these pain killers were taking them while not aware of how addictive they can be.

  27. #27
    Quote Originally Posted by senorsoupe View Post
    Problem is that not everyone is aware of how addictive these can be and not every doctor is educating their patients about it. Oxy was marketed as being not addictive (the same way that Heroin was originally marketed as a less addictive alternative to Morphine) and so a lot of people who got hooked to these pain killers were taking them while not aware of how addictive they can be.
    It also happens that actual science has determined that individual susceptibility to addiction is hereditary, with even individual genes being identified as providing susceptibility to specific substances. But blanket moral stances are easy and reading for comprehension is hard.

  28. #28
    Quote Originally Posted by mikesorg View Post
    It seems as the taxes and regulations on cigarettes increased, opioid use grew. I haven't seen anything connecting the two and having never really used either, I don't know if one could be a substitute for the other.

    I can't help but think there might be a correlation, though, admittedly I have no real info to back this up.
    You don't have to look further than Canada, taxes on Cigarettes up here are insane ($16.00 for a pack of 25), and I don't think our numbers on opioids differ much from yours.
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    Spirit Airlines Pilot, Wife Found Dead From Apparent Fentanyl Overdose

    http://pittsburgh.cbslocal.com/2017/...anyl-overdose/

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    Quote Originally Posted by VirtualBalboa View Post
    It also happens that actual science has determined that individual susceptibility to addiction is hereditary, with even individual genes being identified as providing susceptibility to specific substances. But blanket moral stances are easy and reading for comprehension is hard.
    This^^^^^
    It's why a lot of you on here have taken opioid painkillers and been able to come off of them with no issues. But others cannot. It's a combination of heredity, the amount of endogenous (naturally occurring) opioids in our brains, length of exposure to the drug, the type of drug (fentanyl is more more potent than hydrocodone for example), etc etc. There is no cookie cutter way to tell who will become addicted and who will not. Though I will say, working with the top addiction doctor in Indianapolis if not the Midwest....I've learned from him this: someone that is a smoker throws up huge red flags for addiction potential to opioids. It isn't always the case, but recent studies have shown that upwards of 90% of opioid use disorder patients (addicts) are current or former smokers. I know correlation doesn't equal causation, but I'll take the experience of a top level addictions doctor who has been working 35+ years in addictions medicine (and is highly regarded in his field) as a guide.

    As for pharma, yes they were complicit. I've my mentioned it in another thread, but Purdue pharma, makers of OxyContin, paid out a huge settlement for false and misleading sales and marketing practices. Now the industry's much more highly regulated. The days of sending doctors to the Bahamas for "educational trips" ended 15 years ago. Pharma companies can't even give out pens anymore. Compliance is the name of the game now. But it's like putting toothpaste back in the tube, at least with regards to painkillers. The governments have cracked down on prescribing but that sent the patients to the streets....thus the drastic increase in heroin use in the past 5 years. It's not the only factor, but I've seen it myself enough to know it's a big part of why...
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