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Thread: Opioid epidemic

  1. #31
    Insider Jim Wilke's Avatar
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    More good news:

    US Customs and Border Protection is seizing pill presses at a rate 19 times higher than in 2011. That’s the year the synthetic drug fentanyl exploded in the US drug market, according to the American Association of Poison Control Centers.

    While the Justice Department’s Drug Enforcement Administration deals with a national problem of synthetic fentanyl overdoses, these machines are playing a critical role in getting deadly counterfeit drugs onto American streets.

    “To the naked eye, you can’t tell the difference,” said John Martin, special agent in charge of the DEA’s San Francisco division. “If you have counterfeit pills, you can’t make them without pill presses.”

    Counterfeit pills marketed as oxycodone or Xanax but made with fentanyl can be deadly. Fentanyl is 25 to 50 times stronger than heroin and up to 100 times more potent than morphine.

    The painkiller was once found only in pharmacies but is now manufactured in China in synthetic form and widely available on the American black market.

    Pill presses — which can easily be bought online — allow someone to take powder and press it into a pill that looks legitimate. “People have died from ingesting what they think is a legitimate painkiller, (really) it’s a counterfeit pill that contains fentanyl,” Martin said.

    Across the country, authorities have seen this play out.

    The death of pop icon Prince may turn out to be one of the most famous cases of counterfeit pills. Police reportedly found mislabeled pills laced with fentanyl in his home, and the drug was found in his system.
    http://fox6now.com/2017/03/17/pill-p...ecord-numbers/

  2. #32
    Insider Jim Wilke's Avatar
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    The longer a person uses opioids, the greater the risk of forming a deadly addiction. But just how long does*it take to switch from being a short-term user—say, while you’re dealing with pain after a surgery—to a long-term, potentially problematic user? A few weeks? A month?

    According to a new study, that transition could take just a matter of days.

    When patients get an initial opioid prescription that’s just a one-day supply, they have about a six-percent chance of being on opioids for a year or longer. But if that first prescription is for a three-day supply, the probability of long-term use starts inching up. With an initial five-day supply, the chance jumps to about 10 percent. With a six-day supply, the chance hits 12 percent. With 10-day’s worth, the odds of still being on opioids a year later hits roughly 20 percent.
    https://arstechnica.com/science/2017...ng-term-users/

  3. #33
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    Quote Originally Posted by Jim Wilke View Post

    Thanks to precursor chemicals from China, and the Mexican government's complicity in the drug trade, pure heroin is almost a thing of the past because fentanyl is 50x stronger by weight than pure heroin.
    In their eyes El Diablito is a gift from above because it gives their product that boost they've been searching for, and now they can smuggle less and make more money.

    Albeit Fentanyl production/smuggling/importation is but one of many reasons that we must absolutely secure our southern border, it's certainly one of the deadliest reasons.

  4. #34
    Giving 'em 4 good ones dalz's Avatar
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    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.
    About the same time I finally had my wisdom teeth taken out. One was a dry socket, literally could touch my jaw bone inside the hole. Got it packed and it slowly healed. No long-term affects other than I lost weight because I lived on smoothies and milkshakes for two weeks while my mouth was too sore to open wide enough to get an eating utensil in it. But my point--I was offered Oxy--, Vicodin, Codeine, really anything else I wanted. Said no thanks, I'll call you if it's too bad. Ended up taking a few Tylenol over that span. I don't particularly think I'm more pain-tolerant than the next guy. I don't know why doctors push this stuff like they're getting a kickback from the pharmacies. It's weird. I just hope to live most of my life not having to depend on this system.
    "It takes a good 4 laps at Michigan to get up to speed, to really get 'er whizzing."--Gordy, 1982]

  5. #35
    Quote Originally Posted by Jim Wilke View Post
    I'd like to see production and sales numbers for opioids. DEA is cutting back, should cut more...
    IMO, doctors should be the ones deciding what is right for their patients.

    I read somewhere that only 5% of the opioids sold illegally are diverted from legitimate prescriptions. I don't know if that was completely accurate but its probably a small percentage.

  6. #36
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  7. #37
    Insider Jim Wilke's Avatar
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    For two decades Andrew had suffered serial joint failures from a combination of arthritis, obesity and other factors. Each began as an achy pain and ended in a joint replacement.
    I'm not obese but I have chronic knee pain and I deal with it. I've had 5 surgeries and avoided a couple more. I'm not going to have a knee replacement, not as long as I can still walk and still get up the stairs. I take Motrin when I have to, suffer the rest of the time and keep going.

  8. #38
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    Please let reiterate....doctors are NOT getting kickbacks from pharma companies. A lot of shady stuff used to happen, that's for sure. Trips, big meals for offices, dinners at fancy restaurants, gas and go (reps would put their company card in a gas pump and docs would drive up and fill their tanks while the rep gave them a quick sales pitch about their drug), tickets to sporting events and big name concerts....yes that all happened. 20 years ago. Today, if a rep so much as gives out too many samples they can get fired. The FDA cracked down hard on all this bs and I'm glad I entered the industry after it happened bc I wouldn't have felt right doing any of that stuff. Besides, a majority of my time has been spent with a company that never did anything like that. Nuts and bolts, education, expanding addictions treatment. No fancy dinners, our physician speakers get paid a penance (they do it out of passion for getting others involved in treating addiction, not the money), and we keep our medication prices relatively low. Sadly our docs get put under more scrutiny than the ones passing out the Vicodin like it's candy....very ironic.

    That being said, old habits die hard. And a lot of these doctors are still in the routine of giving out painkillers for the slightest of injuries. Luckily the newer, younger docs are coming out with a bit more education around how addictive they are, and most are pretty tight with the prescription pad when it comes to painkillers.

    Just my observations from someone who has been in pharma for 14 years...
    "We named the dog Indiana"

  9. #39
    Insider Jim Wilke's Avatar
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    Pharm rep is a tough job, docs get hounded by them and every drug company hires them by the boatload. Young little cutie pies think it will be easy, never get past the gate keeper. They starve to death and get out.

  10. #40
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    Quote Originally Posted by Jim Wilke View Post
    I'm not obese but I have chronic knee pain and I deal with it. I've had 5 surgeries and avoided a couple more. I'm not going to have a knee replacement, not as long as I can still walk and still get up the stairs. I take Motrin when I have to, suffer the rest of the time and keep going.
    Ever try Celebrex? I have one of those worn out knees and Celebrex beats Motrin six ways to Sunday, at least for me. Non-narcotic but pricey.

    I've taken hydrocodone a few times post-surgery and while it was very effective for pain control I really didn't think much of the "high". I guess you could get addicted to feeling sleepy.

  11. #41
    "Big Pharma" is no more the problem than "big autos" are the cause of DUIs, as both make a legal product. Any product can be misued by those without personal responsibility.

    Sorry, policially incorrect, but addiction is a lifestyle choice, not a disease. Be that alcohol, illegal drugs, or prescription drugs. It is a personal choice to put your own recreational desires above those who depend upon you (and, personally, if you really have no one depending upon you and want to live a stoned out lifestyle, who am I to care, as long as you get your hands out of my pockets).

    The simple fact is, divorced for the day to day need to feed and clothe oneself, a certain %age will CHOOSE to live stoned.

    What to solve this "crisis" ? 30 seconds of moral courage is all that is needed. Dear _____ : You are between 18 and 65 years old and not disabled. You have been getting free food, free phones, free housing, free health care, free, blah, blah, blah. Starting next Tuesday, you will no longer received ONE cent of other people's money. Get a job and go to work. Since you have never worked, understand that employers have no use for dopers. So you have a choice. Dry up or starve to death. I really don't care which you do.

    Problem 95% solved. And, as I said, if somebody actually can live independently and stoned, why do I care? So problem 100% solved.

  12. #42
    Insider Jim Wilke's Avatar
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    Quote Originally Posted by Sleepcheap View Post
    Ever try Celebrex? I have one of those worn out knees and Celebrex beats Motrin six ways to Sunday, at least for me. Non-narcotic but pricey.
    Bechtra worked the best but got taken off rthe market, Vioxx helped some. My ortho doc smiled and he said he kept all the Bechtra that was left for himself. I tried Celebrex but, you're right, it was pretty pricey. IIRC, I was spending $200 a month and still had a lot of pain at times.

    I learned to live with it. I can't run any more. I walk as much as I can, though, and that seems to help. Try to do an hour a day, more when the weather warms up. Take 4-5 Motrin on the bad days and deal. 3 years ago, I was convinced I would have to have a knee replacement, probably 2. Now, things are stable and my knees aren't getting any worse. There are limits to what I can do but I can live with this.

  13. #43
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    "Big Pharma" is no more the problem than "big autos" are the cause of DUIs, as both make a legal product. Any product can be misued by those without personal responsibility.
    That's true but production of opiates is dramatically increasing and drug OD deaths now outstrip deaths in motor vehicles. Something is wrong:



    Drug companies are making tons of this stuff:


  14. #44
    Quote Originally Posted by SamC View Post
    Sorry, policially incorrect :SNIPPED NONSENSE:
    In all seriousness, you must have lived quite the life to still be under the impression that all people with addiction problems are jobless welfare seekers/queens. It isn't about being "politically correct," it's about actually reviewing real science done by real scientists, actual statistics reviewed by real statisticians, and reviewing the actual ways in which pharmaceutical companies operated in order to promote their drugs. By what rationale do you believe heroin, amphetamines, barbiturates, and cocaine not be available by prescription (or over the counter!) as they once were? Or do you think they should be?

  15. #45
    Quote Originally Posted by SamC View Post
    "Big Pharma" is no more the problem than "big autos" are the cause of DUIs, as both make a legal product. Any product can be misued by those without personal responsibility.

    Sorry, policially incorrect, but addiction is a lifestyle choice, not a disease. Be that alcohol, illegal drugs, or prescription drugs. It is a personal choice to put your own recreational desires above those who depend upon you (and, personally, if you really have no one depending upon you and want to live a stoned out lifestyle, who am I to care, as long as you get your hands out of my pockets).

    The simple fact is, divorced for the day to day need to feed and clothe oneself, a certain %age will CHOOSE to live stoned.

    What to solve this "crisis" ? 30 seconds of moral courage is all that is needed. Dear _____ : You are between 18 and 65 years old and not disabled. You have been getting free food, free phones, free housing, free health care, free, blah, blah, blah. Starting next Tuesday, you will no longer received ONE cent of other people's money. Get a job and go to work. Since you have never worked, understand that employers have no use for dopers. So you have a choice. Dry up or starve to death. I really don't care which you do.

    Problem 95% solved. And, as I said, if somebody actually can live independently and stoned, why do I care? So problem 100% solved.
    Good points.

  16. #46
    Quote Originally Posted by VirtualBalboa View Post
    In all seriousness, you must have lived quite the life to still be under the impression that all people with addiction problems are jobless welfare seekers/queens. It isn't about being "politically correct," it's about actually reviewing real science done by real scientists, actual statistics reviewed by real statisticians
    Missed those links.

    "Big Pharma" can "promote" its poison to me however it wants. I have no use for it, nor the time to take it. I have a J O B . I cannot take drugs and keep my job, because I would get hurt or hurt someone else.

    Fact is, if a person can support him (or her)self and take drugs, it is none of my business. If they cannot (and that is the 95%) the the solution is really pretty simple. 30 seconds of moral courage.

  17. #47
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    Quote Originally Posted by SamC View Post
    Missed those links.

    "Big Pharma" can "promote" its poison to me however it wants. I have no use for it, nor the time to take it. I have a J O B . I cannot take drugs and keep my job, because I would get hurt or hurt someone else.
    Like a lot of things in life, reality is not that simple. You would be surprised at the number of folks who take drugs legally and keep their jobs. When the readings come back on a drug screen, the Medical Review Officer asks for a prescription and that takes care of that.

  18. #48
    Quote Originally Posted by SamC View Post
    Missed those links.
    I'm feeling nice enough to do your homework for you, so here's some light reading:

    http://onlinelibrary.wiley.com/doi/1...g.b.30742/full
    http://www.sciencedirect.com/science...06899311009814
    http://onlinelibrary.wiley.com/doi/1...g.b.30004/full
    http://www.jneurosci.org/content/34/33/11048.short
    http://www.sciencedirect.com/science...91305709001038

    This is just a handful of the results provided by searching one database (PubMed) for two terms in manuscript titles - "polymorphism" and "addiction". There is a mountain of this stuff. If you printed out the datasets being mined, you could sled down it.


    "Big Pharma" can "promote" its poison to me however it wants. I have no use for it, nor the time to take it. I have a J O B . I cannot take drugs and keep my job, because I would get hurt or hurt someone else.
    https://link.springer.com/article/10...-6#enumeration

    Table 1 is pretty clear that statistically the majority of opioid and stimulant users are employed full time. There is a strong statistical correlation between unemployment and use, but it does not mean they are all/most of the user base.

    Fact is, if a person can support him (or her)self and take drugs, it is none of my business.
    You're good with truck drivers, airplane pilots, cabbies, and police officers using heroin or methamphetamine as long as they aren't caught?

  19. #49
    Quote Originally Posted by Jim Wilke View Post
    That's true but production of opiates is dramatically increasing and drug OD deaths now outstrip deaths in motor vehicles. Something is wrong:]
    Cars are getting too safe?

    What petcentage of the deaths in that stat are legally obtained precriptions?

  20. #50
    Quote Originally Posted by Jim Wilke View Post
    Like a lot of things in life, reality is not that simple. You would be surprised at the number of folks who take drugs legally and keep their jobs. When the readings come back on a drug screen, the Medical Review Officer asks for a prescription and that takes care of that.
    Even if you don't have a prescription and a urine sample is demanded by an employer (which assumes your employment contract gives them the right to demand it), you can beat drug tests in a hundred different ways. Taking SamC's analysis of drug users being welfare recipients and statistics indicating that a disproportionate number of unemployed use drugs, there shouldn't be any reason that drug testing of welfare recipients in actual practice should lead to positive results being well below expected rates of use. But that is precisely what has happened time and time again.

  21. #51
    Quote Originally Posted by Gary the Møøse View Post
    Cars are getting too safe?

    What petcentage of the deaths in that stat are legally obtained precriptions?
    The data that exists is from the National Vital Statistics System, for which registered deaths and births are input but not medical records information. Trying to cross the two isn't possible because the information is deidentified and lacks any geodata more specific than county. In order to see that info, you'd likely be better off with insurance records which are unfortunately a bit lacking for individuals who are uninsured but still employed and also are made functional less for data analysis by researchers, but rather for billing. That too may be lacking because you'd never see prescriptions which might be paid for cash or via supplementary drug plans.

  22. #52
    Insider Jim Wilke's Avatar
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    Quote Originally Posted by VirtualBalboa View Post
    Even if you don't have a prescription and a urine sample is demanded by an employer (which assumes your employment contract gives them the right to demand it), you can beat drug tests in a hundred different ways.
    Not as easy as you might think. Use the Internet and the test will come back 'not consistent with human urine.' Drink a bunch of water and the test will read, 'dilute sample, test again.' Labs test for temperature and foreign substances so if you dump in bleach or soap, it will get kicked back.

  23. #53
    Quote Originally Posted by Jim Wilke View Post
    Not as easy as you might think. Use the Internet and the test will come back 'not consistent with human urine.' Drink a bunch of water and the test will read, 'dilute sample, test again.' Labs test for temperature and foreign substances so if you dump in bleach or soap, it will get kicked back.
    Opioids and meth are non-fat soluble, so if you manage to go just a couple of days without them prior to a test, they won't show up. Diluted samples also aren't automatically failures, and while a retest might come back with a positive, it might also come back with a negative (see prior statement) or diluted again. You could also spend more money on a different type of test, but some companies aren't quick to do that for financial reasons.

    And of course, there is always the "get other people's pee" method which many a pro athlete has done. For those too broke to buy a fake penis to pee from online, one often discussed method on just about every bodybuilding forum in history is the use of a small squeeze bottle (visine is usually the suggested option) slung in the underwear.

  24. #54
    Insider Jim Wilke's Avatar
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    The problem with other people's pee is that it is almost always too cool. Lab techs can sense that and then check the temp.

  25. #55
    Quote Originally Posted by Jim Wilke View Post
    The problem with other people's pee is that it is almost always too cool. Lab techs can sense that and then check the temp.
    Very true; at this point we're heading towards this topic entering the Erowid zone though. Probably best to leave it there.

  26. #56
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    Quote Originally Posted by Jim Wilke View Post
    Pharm rep is a tough job, docs get hounded by them and every drug company hires them by the boatload. Young little cutie pies think it will be easy, never get past the gate keeper. They starve to death and get out.
    Yep. "Detail men" as they were called in the old days were a trusted source for doctors to get information on new drugs. Then, the big pharma companies decided that massive bombardment was the way to go. This was around the time that the government allowed DTC (direct to consumer) advertising of prescription drugs (1996). So, they hired a ton of reps, sometimes 4-5 for a given territory. And it became a marketing game. There were sometimes 3 reps calling on the same doctor representing the same drug! The offices responded by limiting access or eliminating it altogether. IU Health, for example, has a "no-rep" policy. A lot of their doctors hate it bc they don't get info on new drugs.....but a lot are happy there aren't 5 Pfizer reps in their offices daily.

    The industry pulled back and laid off a lot of reps. I'm very lucky to be in a niche field, actually one that is expanding (sadly bc of the epidemic). My company focuses solely on addictions medicine. We have about 200 reps nationwide with no plans to get any bigger. Contrast that to the thousands employed by Pfizer, Lilly, Merck, etc. If I ever lose this job I'll never go back to Big Pharma. I'd sell cars before I did that. Bc of the unique nature of our medication, our doctors treat us differently and actually want our advice and education....addictions medicine isn't easy for one, most docs get very little training on it in med school. So we're valuable to them. Which is nice.

  27. #57
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    Quote Originally Posted by Jim Wilke View Post
    The problem with other people's pee is that it is almost always too cool. Lab techs can sense that and then check the temp.
    That's what the $0.99 disposable hand warmers are for.

  28. #58
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    Quote Originally Posted by mattbholland View Post
    Yep. "Detail men" as they were called in the old days were a trusted source for doctors to get information on new drugs. Then, the big pharma companies decided that massive bombardment was the way to go. This was around the time that the government allowed DTC (direct to consumer) advertising of prescription drugs (1996). So, they hired a ton of reps, sometimes 4-5 for a given territory. And it became a marketing game. There were sometimes 3 reps calling on the same doctor representing the same drug! The offices responded by limiting access or eliminating it altogether. IU Health, for example, has a "no-rep" policy. A lot of their doctors hate it bc they don't get info on new drugs.....but a lot are happy there aren't 5 Pfizer reps in their offices daily.

    The industry pulled back and laid off a lot of reps. I'm very lucky to be in a niche field, actually one that is expanding (sadly bc of the epidemic). My company focuses solely on addictions medicine. We have about 200 reps nationwide with no plans to get any bigger. Contrast that to the thousands employed by Pfizer, Lilly, Merck, etc. If I ever lose this job I'll never go back to Big Pharma. I'd sell cars before I did that. Bc of the unique nature of our medication, our doctors treat us differently and actually want our advice and education....addictions medicine isn't easy for one, most docs get very little training on it in med school. So we're valuable to them. Which is nice.
    What are your thoughts on suboxone, if you don't mind? Thanks.

  29. #59
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    Quote Originally Posted by SamC View Post
    "Big Pharma" is no more the problem than "big autos" are the cause of DUIs, as both make a legal product. Any product can be misued by those without personal responsibility.

    Sorry, policially incorrect, but addiction is a lifestyle choice, not a disease. Be that alcohol, illegal drugs, or prescription drugs. It is a personal choice to put your own recreational desires above those who depend upon you (and, personally, if you really have no one depending upon you and want to live a stoned out lifestyle, who am I to care, as long as you get your hands out of my pockets).

    The simple fact is, divorced for the day to day need to feed and clothe oneself, a certain %age will CHOOSE to live stoned.

    What to solve this "crisis" ? 30 seconds of moral courage is all that is needed. Dear _____ : You are between 18 and 65 years old and not disabled. You have been getting free food, free phones, free housing, free health care, free, blah, blah, blah. Starting next Tuesday, you will no longer received ONE cent of other people's money. Get a job and go to work. Since you have never worked, understand that employers have no use for dopers. So you have a choice. Dry up or starve to death. I really don't care which you do.

    Problem 95% solved. And, as I said, if somebody actually can live independently and stoned, why do I care? So problem 100% solved.
    Quote Originally Posted by SamC View Post
    Missed those links.

    "Big Pharma" can "promote" its poison to me however it wants. I have no use for it, nor the time to take it. I have a J O B . I cannot take drugs and keep my job, because I would get hurt or hurt someone else.

    Fact is, if a person can support him (or her)self and take drugs, it is none of my business. If they cannot (and that is the 95%) the the solution is really pretty simple. 30 seconds of moral courage.
    The medical community disagrees with everything you've posted there, and the first thing they would tell you is that it has absolutely nothing to do with willpower.

  30. #60
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    I can agree with that. I have very little willpower, but have been relatively drug free for 40 years out of fear, mainly.
    "Each day well lived makes every yesterday a dream of happiness and every tomorrow a vision of hope. Look well therefore to this one day for it, and it alone, is life"
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