America's silent crisis...

[kapitalyst]

America has a major problem on its hands which many are unaware of. The problem directly effects tens of millions of people, as well as their families and friends. American citizens are being brutally tortured by their own government. These people typically cannot protest or stand up for themselves. They are essentially prisoners who don't face bars... they are imprisoned within their own bodies. The issue is chronic pain. Over 100,000,000 Americans suffer from it, and very few recieve adequate care for it.

Chronic pain is pain which lasts on a long-term basis. Many define the difference between acute and chronic pain as a span of over 30 days. But chronic pain is generally thought of as much longer term or even life-long pain. This is precisely what millions face. Chronic pain can range from being moderate, with little impact on quality of life, to severe and debhilitating, all but destroying one's life. There are many ways to treat chronic pain, some better than others. Over-the-counter pain remedies are helpful for some patients, and some find relief from physical therapy, stretching, chiropractic care, alternative medicine, etc. But for all too many pain sufferers, the pain is so severe and devastating that only narcotic/opioid medications can combat the pain and improve quality of life.

Throughout human history, opium and its derivatives have been used to treat pain. Sometimes too liberally, and sometimes far too conservatively. Opioids are highly effective pain relievers, and are considered a marvel of medical science. An opiate, like morphine, is powerful enough to bring relief and peace to one suffering the most severe pain -- even a soldier who's limb was blown or chopped off or a victim of a horrible car accident. In smaller, more controlled doses, these drugs can relieve moderate and severe severe aches and pain that stems from a myriad of causes. Opioids can relieve a migraine, tooth ache, broken bones, cancer pain, back and neck aches, sciatic pain and much more. Opioids work by binding to receptors in the brain and blocking pain signals. However, this has some side effects. Opioids can cause nausea, constipation, drowsiness, diziness, loss of appetite and loss of interest in sex. But one side effect has brought more attention to the drug than any other: euphoria. A large dose of opioids can put its user into a "blissful state" -- the user may feel sleepy/dreamy, extremely joyful, apathetic towards worries/troubles, etc. Some opioids greatly exaggerate this side-effect (e.g., heroin), while others cause very little of it (e.g., codeine).

Unsurprisingly, this quality has led to the abuse of opioids by those seeking a "high". For recreational users, opioids can be a fun way to spend a weekend, while for opioid addicts the drug can be a way of life and "escape" from his/her troubles and problems. With long-term use, opioids cause physical dependency. The body begins to depend on the drug to relieve pain, and the body does not produce enough natural endorphins to fight pain and discomfort. This is not a problem as long as the drug is taken, but when the drug is abruptly cut off the user will go into withdrawal. Opioid withdrawal can be mild for "light" users, or severe for high-dosage, long-term patients or "heavy" drug addicts. Withdrawal symptoms are similar to a bad case of flu. Among the symptoms of these withdrawals are nausea, increased pain/aches, "cold sweats", runny nose, watery eyes, a "crawling" sensation, restlessness, insomnia, etc. It is extremely uncomfortable but is rarely dangerous or life-threatening. Opioids can be quit, at any time, by a gradual tapering off of dosage, the use of certain treatments/drugs or even the "cold turkey" approach (though it is often unsuccessful for addicts and highly stressful or even downright torturous for patients).

It should be noted that there is a difference between physical dependency and drug addiction. The World Health Organization defines addiction as: continued, habitual use (for non-medical purposes) despite harm. Physical dependency is simply when the body needs a drug so as not to experience withdrawal and discomfort. Almost all drug addicts are physically dependent, but physical dependence is not addiction. For opioids, physical dependence is completely normal for long-term therapy, such that a cancer patient might recieve. Contrary to popular belief, the risk of addiction to opioids is very low within a medical context when the drugs are used properly under a physicians care. The risk is high, however, when large amounts of the drug are used for a "high" on a habitual basis. Even many recreational users avoid addiction by moderation. The risk of overdose is also extremely low for legitimate patients. It takes large doses of opioids, beyond the user's tolerance, to kill. However, the risk can be high for addicts who inject opioids into their blood stream in high doses -- where the line between a "good high" and overdose can be very thin. The majority of opioid-related deaths actually involve a bad combination of opioids and other drugs (especially alcohol, sedatives and benzos) and are not the result of lethal levels of opioids alone. In cases where a true overdose occurs, it is usually the result of intravaneous (IV) injection of the drug -- usually the street form of heroin which is of an unknown potency... the ignorant user unintentionally injects more heroin than they realized or intended.

Tolerance is another important aspect of opioid use. When using opioids for a long period of time, a person becomes tolerant to the effects of the drug -- meaning it takes a bigger dose to produce the desirable effect. This can result in a patient needing stronger medicine or higher doses, or an addict consuming bigger and bigger doses to "get high". However, tolerance does not increase indefinitely. At some point, each user of opioids will reach a "plateau" where consuming more of the drug is not necessary or tolerance grows very, very slowly. This level varies from individual to individual. Some individuals require doses which may seem extreme to another person, while some may attain the desired effect from a weaker opioid in much smaller doses. Typically, patients find a reasonable dosage which works well for them and stick to it -- the drug provides adequate pain relief and consuming more would just make them too drowsy for daily life. Addicts also can find equilibrium, but since their objective is to attain a "high", they may push the limits to increase the effect. The important thing to take away from this is that tolerance doens't go on forever and ever, but is an important consideration when dealing with opioids.

Opioids are generally very safe, extremely effective and relatively inexpensive for pain patients. The risk of addiction for medical usage is quite low, and tolerance reaches a "plateau" at some point. Opioids can be used to combat pain which, left untreated, destroys the lives of millions of otherwise ordinary people. The side effects are generally rather mild at proper doses. Opioids can be much safer than many non-narcotic drugs commonly prescribed or bought over-the-counter. NSAIDS, for instance, often cause internal/GI bleeding, coma and death. The main ingredient in Tylenol, acetominophen, can cause liver and kidney damage that results in death. Many other drugs for conditions like depression, ADD/ADHD, anxiety, etc can also be far more dangerous than opioids, though they are prescribed like candy.

However, opioids are extremely under-prescribed in America and much of the western world, and pain is seriously and severely under-treated. Millions in America alone are denied access to these medications and left to suffer needlessly. For some, this becomes too much to take and they commit suicide to escape the pain forever. Others turn to the black market, paying absurd prices, and fall victim to violence and abuse on the streets. These people are not drug addicts looking for a "high". They are unfortunate human beings suffering from devastating pain, and they deserve to be treated like human beings. Many are also surprised by the racial disparity in pain management. Studies have concluded that black patients, for instance, are far less likely to recieve adequate treatment for pain or a prescription for opioids as whites or Asians. As we speak, real people are suffering all over the US and the world from severe pain. Some have lost their doctors to the "War on Drugs" and have nowhere to turn. Some of them will writhe in the agony of their pain and needless withdrawal. Some will turn to the streets to survive. Others, with more extreme pain, will take their own lives. And the question is WHY? Why are we doing this to people when the drug needed to relieve their misery is sitting on the shelf in a pharmacy. Not even a pocket full of money and premium health insurance can rescue them from the suffering, since obtaining a simple prescription can be all but impossible. The reason is public and government hysteria over drugs.

Sensational "journalism", government propaganda and myths have taken the US and the west by storm -- demonizing opioids that millions need. Governments began "cracking down" on what they deemed a problem and wildly exaggerated. Thousands of doctors have been forced or scared out of business by the DEA. Many have been arrested for simply treating their patients properly. The few cases where doctors were actually breaking the law and diverting drugs to the street intentionally recieve major attention from the press and are hyped up to epic proportions; only making the problem for too many Americans much worse. Medical students are being advised to completely avoid the practice of pain management. Doctors are being advised to NEVER prescribe opioids for any reason. The DEA uses threats and so-called "inquiries" to frighten doctors who prescribe pain medication. Most doctors tell their patients "I'm afraid to treat you because of the DEA and FDA". They have also placed arbitrary "quotas" on the amount of prescriptions pharmacies can fill, how much medication can be prescribed to a patient and/or how many patients a pain specialist may see. The results have been devastating...

There is now a major shortage of doctors who treat pain. Desperate patients find the few remaining doctors and flood into their doors. The DEA then deems it "suspicious" that these doctors write a lot of pain medication, and falsely label them "pill mills" for legitimately treating patients. Sometimes even patients get arrested for merely going to a "suspicious" doctor. This problem will only become worse as fewer and fewer medical students go into the field of pain management. Regulations on the remaining doctors have become more strict and assenine. Patients are now required to visit the doctor every 30 days, despite the fact that their pain is unchanging or life-long, and submit to a drug screening they must pay for. Many clinics have gone "cash only" as a result, and the cost can range between $300-$800 per visit. This expense can be financially devastating for many patients.

Furthermore, this has caused a supply/demand crisis for the drugs themselves. It has caused the street value of prescription opioids to skyrocket. A single 30mg oxycodone tablet, which costs as little as $0.70 from a pharmacy, sells for $30 on the street. Yes, $30 for a single pill... An 80mg tablet of the time-realeased drug Oxycontin (the brand-name of a time-release formulation containing oxycodone) can sell on the streets for up to $100. With the high, unsatisfied demand of legitimate patients turning to the streets (and actual drug addicts), and the huge street prices, it's not surprising at all that we now have a major problem on the streets. This has given rise to the practice of "doctor shopping" and "doctor hopping", where drug dealers visit multiple doctors to obtain multiple prescriptions -- the cost of travelling state to state and spending so much time on it becomes worth it for untold thousands of dollars in black market profits. Some legitimate patients have to sell some of their prescriptions to pay the extreme costs this problem has resulted in. With the huge profit potential on the street, violence will undoubtedly follow. A general rule of thumb is that where there is a highly profitable black market, regardless of the commodity, violence will result. Yet we continue the same failed government policy, and refuse to acknowledge reality. This problem has even started the phenomena of armed pharmacy robbery. Why rob a gas station when you can rob a pharmacy for thousands of pills worth $30 a piece? Even "big pharma" has felt the effects, as many of their shipments are stolen and trucks are hijacked.

Something must be done. This is one of America's biggest medical crises that is sadly unnoticed. Some commonsense must be restored in America, and our hysterical attitudes must be brought under control. I, for one, am personally a victim of this hytserical nonsense. As I'm writing this, a friend of mine, also a victim, is lying at home in bed, who just had her foot amputated, with no pain medication. The doctors simply would not give it to her. She's sick and miserable, and hurting worse than I can even imagine, and all I can do is pray for her and cry.

I hope that all of us can heighten our awareness of this issue and work towards spreading awareness and resolving the problem despite our political differences. Thank you for your time...

Regards,

[Revolution starts with U]

This is a very personal issue for me, so I will be getting to it when I get back. Some of it I agree with. Other parts I love, but my ego wants to punch the author in the face

Either way, I am on the side of the ending of the drug war and the treating of addicts like humans so... cheers

[ÑóẊîöʼn]

Crap like this would be a non-issue if opiates were available over the counter without a prescription, in measured doses, free of the contamination that characterises recreational street drugs.

Even if some people were to become addicted as a result, they would still be in a far better position than they would have been. They'd be able to get proper help for their problems or at the very least hold down a decent job without having to worry about getting fired thanks to some arbitrary drugs test (by the way, what is the logic behind drug testing people who don't operate heavy machinery daily?).

But nooooooooo, the US can't have sensible policies towards drugs of any kind, because then they wouldn't be able to carry on the proud Puritan tradition of punishing people for having fun.

[tfb]

I must be on opioids right now because it looks like Kapitalyst is doing something other than trolling...

[Lynx]

But nooooooooo, the US can't have sensible policies towards drugs of any kind, because then they wouldn't be able to carry on the proud Puritan tradition of punishing people for having fun.

I would describe the medical establishment as being arrogant, and slow to adopt change. Which is typical of elitist institutions.

I have suffered needlessly from tooth abscesses thanks to dentists who prescribed painkillers that were insufficiently strong or did not cover the period until my next visit.

About the only time you can obtain effective pain relief is when you are terminal. There remain problems with palliative care as well.

[Judicator]

Portugal is an excellent example of the minimal impact decriminalization has on drug abuse:

http://www.time.com/time/health/arti...893946,00.html

[Dean]

You wanna know why I do dope? I'm interested in why you don't when our whole world is children drenched in their parents own blood.

[kapitalyst]

I totally agree with you guys. Complete decriminalization, I think, should be the ultimate goal. And the abolition of drug prohibition and the DEA. We talk a lot about creating jobs, but some jobs need to be destroyed... jobs that involved the persecution of our own people. There should also be a massive class action lawsuit against those who have created this crisis.

I think that we should be able to just buy the opioids at a pharmacy if we want to. A prescription shouldn't be mandatory... merely desirable as sound medical advice. The fact is, drug addicts are, well... drug addicts! They're already using opioids despite them being tightly controlled. Therefore prohibition accomplishes nothing... it only creates and exacerbates problems. They're all over the streets. And besides, addicts are human beings too. Using a drug, even if it makes your life miserable, is not a crime. It's a health issue. And prohibition has turned a health issue into a criminal justice disaster... over 1,000,000 non-violent "drug offenders" in prison. And America has more people in prison, total, than any other country on earth (making me wonder how we can talk about Iran and other countries and call them "oppressive regimes" -- do we not see ourselves?).

However, we aren't going to get there overnight. I think we have to work towards this goal by taking some logical steps. At the bare minimum, we need to reign in the DEA and pass legislation to protect doctors from prosecution for merely treating patients properly. Obviously, "drug diversion" to the streets would still be illegal, but we'll eventually make that obsolete. We also need a commonsense approach to dealing with drug addiction. Instead of treating addicts like animals and criminals, we need to treat them like human beings who have a health problem. I like what Canada and some European countries have done: the "Insite and Onsite" clinics. These are harm-reduction facilities that ensure addicts use the drugs safely, use sterile needles and do not overdose... and upstairs, the Onsite clinic offers full drug rehabilitation. It has been highly successful, and why we haven't adopted similar policies is simply beyond me... There hasn't been a single fatality among their patients, they've put a major dent in the AIDs and STD problem, crime has been reduced and more addicts are recovering. We need to wake the fuck up, America...

Unlike many problems in America, this one doesn't discriminate between rich and poor. The poor are effected worse, of course, due to the huge expenses. But being rich doesn't stop you being a victim here. And you'd be surprised how miserable you can be from chronic pain, especially when you're withdrawing at the same time, even with $1M in your bank account. Sometimes I wish I could trade everything that I have for a normal, healthy, pain-free body. I couldn't put a price tag on that. I think about all the poor people who've been forced onto the street because of this... if they need 5x Roxicodone a day and are lucky enough to get them for just $20 a piece, that's $100 a day... $36,500 a year. No one can afford that... This is just totally fucked up beyond belief...

I thank you all for your time, concern and support. And I sincerely hope we can accomplish something on this front not only in America but worldwide.

[Skooma Addict]

doesn't weed solve chronic pain?

[Revolution starts with U]

Ok I didn't get back early enough to respond. And I have to get up early tommorow to go to a... wait for it... opiate addiction seminar.

I will respond then. But suffice it to say, the gist of my argument was going to be that I have found "chronic pain" to often be a subconscious rationalization of the need for more drugs.
This is not to say some people do not have chronic pain. But some of them dont need opiate strength relief, and others are not, in my opinion, really in pain that their brain is not creating. I would say 10-20% of the people supposedly in chronic pain are nothing more than drug addicts.
I have been in some serious pain; kidney stones, 3rd degree burns on my face, and a filling way too large for my tooth (that was the worst. worse than kidney stones). I got by with Ibuprofen. Opiates should mostly be reserved for severe cases, and, in my opinion, should never be prescribed for a prolonged period. Nobody should live on a narcotic every day of their lives.
Doctors.... doctors are some of, if not the worst drug dealers in our society. They kill millions of children and get away with it. Not only do they get away with it, but are treated as heros. I cannot tell you of one person who doesn't sell a large chunk of their percriptions the moment they get them. Doctors are both too willing to prescribe opiates for just about anything (they tried to give me vicaden for a toothache... seriously? What next, stubbed toe?), and to refill perscriptions for patients they know could not have taken that much of the drug that fast without killing themselves.
This is not to place all the blame on doctors. In some ways they must do this. Everybody knows about doctor shopping, where people will shop around til they find a doctor more willing to perscribe them opiates. This isn't just your normal junkies doing this, but soccer moms and football dads. If a doctor wants to remain in business, in many ways he must become a petty drug dealer. Big pharma has also been very aggressive in trying to get doctors to perscribe this more.
... and then these soccer moms and football dads give their prescription strength opiates to their teenagers for minor pains (like PMS cramps, etc) and wonder why their children grow up to become drug addicts....
And i haven't even gotten onto the government yet... the whole situation is entirely fucked. Garbage in, garbage out. We need a complete 180 degree shift in the way we approach drugs in America. The drug war obviously is making things worse. So is the medical industry.

[kapitalyst]

@ RSWU:

I would have to largely disagree with that take on things. I don't know what state you're living in, but it's not like that in most of the country. In my state (Louisiana) everyone from cancer patients (like my late grandmother) to amputees (like my friend) are going totally untreated. Practically every doctor says, sometimes with tears in their eyes, "I'm sorry, but I can't do it under any circumstances... the DEA will come down on me." They're totally unwilling and/or terrified to write opioids for anyone in any case. And the few that still do will often write some of the strongest ones like Opana and morphine for severe cases, but will not write oxycodone just because of the media stigma associated with the name. The only state I know of that has many "pill mills" is Florida. And the problem there is highly sensationalized and exaggerated to epic proportions.

"Opiates should mostly be reserved for severe cases, and, in my opinion, should never be prescribed for a prolonged period." -- RSWU

This is the attitude of someone who hasn't experienced debilitating chronic pain... the type of pain that leaves you trapped in the bed and your home, hardly able to use the bathroom. The type of pain that makes you consider suicide. Some of us are stuck with such a condition for a life sentence. It's not an injury that will heal, or acute pain that will just go away. How could you speak for something you haven't experienced? Consider my case...

I was born with an unusual case of scoliosis which progressively worsened as I grew and aged. My spine has three opposing curvatures... not a typical "C" or "S" curve. It was 38-degrees by last measurement. Fortunately, since there are three opposing curves I am upright and not awkwardly tilted to one side. But on the unfortunate side, this "cosmetic advantage" causes some serious issues. On the right side of my back, beneath the shoulder blade, there is a huge knot of muscle which is constantly tight and tense -- caused by the muscles being pushed up and trying to fight the curvature and right the spine. Not only is the spine curved, but it is twisting. I have 9 disks along the spine which have been crushed flat and are, for all practical purposes, dead. Others are bulging and herniated. There is severe nerve damage, and nerves occasionally become pinched. To add insult to injury, the curve of the lower spine causes my hips to sit a bit tilted... thus one leg is slightly longer than the other. This has caused me a limp for years, and puts severe stress on the socket and joints. This pain radiates down the sciatic nerve, and added stress makes my knees hurt badly. Even my feet, sometimes, give me serious trouble.

Besides the pain, I also have to deal with weird nerve quirks. Sometimes I turn my head and feel/hear a "snap" and it suddenly feels like ice water has been poured over my head and runs down to my feet -- accompanied by a blackout and an excruciating pain. Sometimes I wake up and my left arm, hand and fingers are almost totally paralyzed -- no feeling and unable to move. When that happens, it can take half an hour of stretching and wiggling my fingers to regain control. From time to time, I experience one of the worst things... my neck will suddenly grow extremely tense, causing burning hot pain and a mind-numbing migraine, and I become so dizzy I cannot stand. When this happens, if I turn my head to the side or look down and then look back forward, it feels like the entire world does a somersault and I fall flat on my face. I've had this happen while driving too, which scares the crap out of me. The doctors aren't exactly sure what causes all of this other than the fact that it's obviously problems with my nerves. If I have stable opioid therapy, physical therapy and chiropractic care, these symptoms almost totally disappear.

Without opiates, I simply cannot function. I cannot walk, drive, go anywhere, have normal relationships with friends and family, have a girlfriend, work or do anything other people take for granted. Opioid therapy was a miracle for me. It totally gave me back my life and let me live again. Combined with physical therapy and chiropractic care, it gave me the ability to live like a relatively normal person and once again find joy in life. This all got disrupted a little over a year ago. Since then, I've had to change doctors several times as they quit/retire, change their practice or get scared/shook out of pain management by the state. They didn't even have the decency or humanity to taper off the dosage to help me avoid withdrawal... Nope, you were just kicked onto the street. Not only to be sick with withdrawals but also deal with the excruciating pain. I had these disruptions in my care several times in the last couple years... each time causing a devastating impact on my life (especially a financial impact from my inability to work). Once I spent 4 entire months confined to my bed; I had to withdraw from the meds cold turkey (horrible symptoms for over two weeks straight) then waste away for months before I found a pain specialist. Now this has happened to me yet again. My meds are running out and I'm not sure I'll be able to find another pain and spine specialist at all now... and I'm supposed to be packing up to close the sale of my home and move. Doesn't look like that's gonna happen now...

It wouldn't surprise me if, like you said, 10% (give or take) of the people in the clinics are junkies or dealers. These drugs are more valuable than gold per weight (literally) on the streets... a milligram of oxycodone is worth up to $1, and a mg of gold is worth only 5-cents -- thus it's about 20x's more valuable than gold (approx. $1650-oz / 31100mg = $0.053-mg). Therefore it's no shock to me that junkies and dealers try to slip in the clinics and blend in with legit patients to get these valuable drugs. But that's not the fault of doctors or the drugs themselves... it's a symptom of drug prohibition. It's also not true that virtually everyone is selling pills. I dunno who you've been hanging out with, but that's not the norm. However, it is the norm for many poor people who otherwise couldn't afford their own medical care. I can't blame them one bit for it. They're doing what they have to do to get through life and take care of themselves. Again, this is the result of prohibition.

"I have been in some serious pain; kidney stones, 3rd degree burns on my face, and a filling way too large for my tooth (that was the worst. worse than kidney stones)." -- RSWU

While I'm sure that was very painful, that was acute pain. The people I'm talking about are people who have cancer, have been shot, got into horrific accidents, had botched surgeries, amputated limbs, birth defects, MS, fibromyalgia, crippling migraines and arthritis, etc, etc... There's a big difference. I've had broken bones and also shattered teeth and third degree burns. I'd trade my chronic pain for any of those any time, any day. Vicodin for a tooth ache is actually totally appropriate -- if anything, too little. Besides, it's only for a few weeks tops -- you won't get addicted if you follow the directions. Maybe you are one of the few who copes well with acute pain and responds well to OTC remedies, but most people don't. Vicodin is one of the weakest opioid analgesics available and can be safely prescribed to anyone but very small children or people with an allergy. I broke my wrist when I was 13, and was prescribed Lortab 10mg... and it did virtually nothing for me -- didn't even make me drowsy or have noticeable side-effects.

I once analyzed the statistics of the "War on Drugs" on the government's own propaganda websites. I compared their numbers and percentages to the entire US population. The so-called "epidemic" really involves only a sliver of the US population. I could do the number-crunching again if anyone's interested. It made it obvious that the statistics, while likely to be relatively true, were presented in a way to play off the average person's ignorance and create the impressive of this huge problem that "threatens society and civilization", as they claim. It's total nonsense when you do the math...

[ComradeMan]

sensible policies towards drugs of any kind, because then they wouldn't be able to carry on the proud Puritan tradition of punishing people for having fun.

and, it has been said, it might hurt certain "business" interests.

[kapitalyst]

and, it has been said, it might hurt certain "business" interests.

Yes, it would. And we don't support anyone's "business interests" which come from a position they've used the state and laws to create and enforce. Cronyism and state-backed business is completely anti-market.

I can point out a few of them... For starters, a lot of prominent doctors supported the regulations that requires patients to visit every single month instead of once every three to six months.

AR = (nPatients * ((12 / f) * p))

Where "AR" is annual revenue, "nPatients" is number of patients, "f" is frequency of visits and "p" is price. If you have 10 patients who have to come in once every three months for a price of $300/visit:

AR = (10 * ((12 / 3) * $300)) = $12,000

Change the frequency to every month:

AR = (10 * ((12 / 1) * 300)) = $36,000

Triple revenue... Going "cash-only" eliminates all the paperwork for insurance and Medicaid, eliminates the need for extra employees and saves money... thus boosting margins. Now imagine this in the context of a real clinic that sees some 100 to 300 patients!

It's complete bullshit... No other patients are treated like this. Only chronic pain patients. Imagine if we did this sort of shit to diabetics or cancer patients. I like the way one of my former doctors put it: "If you treat diabetes or the heart, you're a 'good doctor'... if you treat children you're a 'hero'... you treat pain and you're a criminal..."

[ComradeMan]

Yes, it would. And we don't support anyone's "business interests" which come from a position they've used the state and laws to create and enforce. Cronyism and state-backed business is completely anti-market....

I wasn't talking about that kind of "business"....

[ÑóẊîöʼn]

and, it has been said, it might hurt certain "business" interests.

What are you referring to exactly?

[kapitalyst]

I wasn't talking about that kind of "business"....

Please elaborate...?

[ComradeMan]

What are you referring to exactly?

Please elaborate...?

Illegal business.

[Revolution starts with U]

RSWU:

I would have to largely disagree with that take on things. I don't know what state you're living in, but it's not like that in most of the country. In my state (Louisiana) everyone from cancer patients (like my late grandmother) to amputees (like my friend) are going totally untreated. Practically every doctor says, sometimes with tears in their eyes, "I'm sorry, but I can't do it under any circumstances... the DEA will come down on me." They're totally unwilling and/or terrified to write opioids for anyone in any case. And the few that still do will often write some of the strongest ones like Opana and morphine for severe cases, but will not write oxycodone just because of the media stigma associated with the name. The only state I know of that has many "pill mills" is Florida. And the problem there is highly sensationalized and exaggerated to epic proportions.

I live in a state where dr's are perscribing 63 opoids per capita, per month in my county its 79, in another its 113. And that is not, per capita of drug users, but every man woman and child. I come from a state where some counties have as high as 63% opiate addiciton rates. In my state unintentional drug poisoning kills more people than car accidents, largely because of prescription drugs.

"Opiates should mostly be reserved for severe cases, and, in my opinion, should never be prescribed for a prolonged period." -- RSWU

This is the attitude of someone who hasn't experienced debilitating chronic pain...

This is the attitude of someone who has watched countless people ruin their lives becuase they claimed to be in chronic pain and shopped around until they found a doctor that agreed with them.
If you are in such sever pain you cannot concentrate, I have no problem taking a drug. But I have been in that pain and Ibuprofen worked perfectly fine for me.
If you are in such dehibillitating pain at all times, than permanent opiation is fine. But if it comes and goes, I would have to say the dangers far outweigh the costs.
You think it cannot ruin your life? I just learned of a doctor that became addicted to them, lost his practice, and ruined his life. It can happen to anyone, and most likely will.

the type of pain that leaves you trapped in the bed and your home, hardly able to use the bathroom. The type of pain that makes you consider suicide. Some of us are stuck with such a condition for a life sentence. It's not an injury that will heal, or acute pain that will just go away. How could you speak for something you haven't experienced? Consider my case...

Again, if you read my post I said the most severe cases could be treated with it. But, I think if you can still function, you don't need an opiate. Again, I have been in such pain, and Ibuprofen worked fine.

I was born with an unusual case of scoliosis which progressively worsened as I grew and aged. My spine has three opposing curvatures... not a typical "C" or "S" curve. It was 38-degrees by last measurement. Fortunately, since there are three opposing curves I am upright and not awkwardly tilted to one side. But on the unfortunate side, this "cosmetic advantage" causes some serious issues. On the right side of my back, beneath the shoulder blade, there is a huge knot of muscle which is constantly tight and tense -- caused by the muscles being pushed up and trying to fight the curvature and right the spine. Not only is the spine curved, but it is twisting. I have 9 disks along the spine which have been crushed flat and are, for all practical purposes, dead. Others are bulging and herniated. There is severe nerve damage, and nerves occasionally become pinched. To add insult to injury, the curve of the lower spine causes my hips to sit a bit tilted... thus one leg is slightly longer than the other. This has caused me a limp for years, and puts severe stress on the socket and joints. This pain radiates down the sciatic nerve, and added stress makes my knees hurt badly. Even my feet, sometimes, give me serious trouble.

But you can still function. Why would you need to permanently be on an opiate? Why couldn't you take the opiate during the extremes, and rely on something a little less dangerous on your good days?
And again, I doubt I was considering you, with your situation, as on the list of people who shouldn't be taking opiates.

Besides the pain, I also have to deal with weird nerve quirks. Sometimes I turn my head and feel/hear a "snap" and it suddenly feels like ice water has been poured over my head and runs down to my feet -- accompanied by a blackout and an excruciating pain. Sometimes I wake up and my left arm, hand and fingers are almost totally paralyzed -- no feeling and unable to move. When that happens, it can take half an hour of stretching and wiggling my fingers to regain control. From time to time, I experience one of the worst things... my neck will suddenly grow extremely tense, causing burning hot pain and a mind-numbing migraine, and I become so dizzy I cannot stand. When this happens, if I turn my head to the side or look down and then look back forward, it feels like the entire world does a somersault and I fall flat on my face. I've had this happen while driving too, which scares the crap out of me. The doctors aren't exactly sure what causes all of this other than the fact that it's obviously problems with my nerves. If I have stable opioid therapy, physical therapy and chiropractic care, these symptoms almost totally disappear.

I feel for you, I really do. But you cannot deny that there is a massive opiate problem in this country right now. It is literally an epidemic. You probably need it. Most people don't, in my humble opinion... the opinion of a man who just buried his love because she became addicted to opiates and heroin was easier to get than pills... only because the pill problem here was so bad they HAD to shut down the pill mills.

It wouldn't surprise me if, like you said, 10% (give or take) of the people in the clinics are junkies or dealers. These drugs are more valuable than gold per weight (literally) on the streets... a milligram of oxycodone is worth up to $1, and a mg of gold is worth only 5-cents -- thus it's about 20x's more valuable than gold (approx. $1650-oz / 31100mg = $0.053-mg). Therefore it's no shock to me that junkies and dealers try to slip in the clinics and blend in with legit patients to get these valuable drugs. But that's not the fault of doctors or the drugs themselves... it's a symptom of drug prohibition. It's also not true that virtually everyone is selling pills. I dunno who you've been hanging out with, but that's not the norm. However, it is the norm for many poor people who otherwise couldn't afford their own medical care. I can't blame them one bit for it. They're doing what they have to do to get through life and take care of themselves. Again, this is the result of prohibition.

No, it is soccer moms and football dads. One of the major minor pushers a while ago, who is in jail now, was a cop's wife. I agree that drug prohibition plays a major role in the regressiveness... I still don't think opiates should be widely prescribed.
Doing what they have to do? They're dying! These are my best friends! And most of them, despite their excuses (I know somoene who takes vicadin daily becuase of his arthritis...) are just drug addicts who need help, not more drugs.

"I have been in some serious pain; kidney stones, 3rd degree burns on my face, and a filling way too large for my tooth (that was the worst. worse than kidney stones)." -- RSWU

While I'm sure that was very painful, that was acute pain. The people I'm talking about are people who have cancer, have been shot, got into horrific accidents, had botched surgeries, amputated limbs, birth defects, MS, fibromyalgia, crippling migraines and arthritis, etc, etc...

I specifically provided that role in needing at least a certain amount of opiates. I am not totally against it. I just think people are blinding themselves to the serious problem we face in society.
Some people could get by perfectly fine taking Ibuprofen on the weak days/times, and save the opiates for when they are needed.
And this was pain so bad I could not add 2 + 2. It was not chronic. But it was severe, and Ibuprofen worked fine.

There's a big difference. I've had broken bones and also shattered teeth and third degree burns. I'd trade my chronic pain for any of those any time, any day.

So would I, but not for their severity, but their chronic nature.

Vicodin for a tooth ache is actually totally appropriate -- if anything, too little.

Besides, it's only for a few weeks tops -- you won't get addicted if you follow the directions.

How many of your best friends have you had to bury because "it's just a little vicadin, you can handle it." Im sorry Kapitalyst, but you are fooling yourself.

Maybe you are one of the few who copes well with acute pain and responds well to OTC remedies, but most people don't.

Most people choose not to. (Again, some people need these. I am not including them. But they are a very small minority of the people actually being prescribed them.

Vicodin is one of the weakest opioid analgesics available and can be safely prescribed to anyone but very small children or people with an allergy.

I am starting a chapter of the support group SOLACE (Survivng Our Loss And Continuing Everyday) in my county. One of the ladies who spoke on their behalf told the story of how her daughter was in an accident at 8 yrs old and they prescribed her opiates. The mother thought she was doing the right thing. The pain kept getting worse, they prescribed her more opiates. She started going to pill mills, and doing anything she could to obtain the drugs. The mother kept trying to do the right thing up until the day she had to lower her daughter's 21 year old body into a casket and a gravesite because of an overdose.
It started at 8! We should NEVER be prescribing opiates to people who have not developed the mental capacity to overcome it (except in very severe cases).

I broke my wrist when I was 13, and was prescribed Lortab 10mg... and it did virtually nothing for me -- didn't even make me drowsy or have noticeable side-effects.

I plead the fifth on this comment as I do not want to make it personal.
But if you need any help, Kap, I love you, care for you, and will do anything I can.

I once analyzed the statistics of the "War on Drugs" on the government's own propaganda websites. I compared their numbers and percentages to the entire US population. The so-called "epidemic" really involves only a sliver of the US population. I could do the number-crunching again if anyone's interested. It made it obvious that the statistics, while likely to be relatively true, were presented in a way to play off the average person's ignorance and create the impressive of this huge problem that "threatens society and civilization", as they claim. It's total nonsense when you do the math...

The math is that in the last 5 months I have buried 3 people because of opiates, and it didnt start with heroin. 2 of them were very close friends from childhood, one I loved with all my heart. That is all the math I need.

[Robert]

But on the unfortunate side, this "cosmetic advantage" causes some serious issues. On the right side of my back, beneath the shoulder blade, there is a huge knot of muscle which is constantly tight and tense -- caused by the muscles being pushed up and trying to fight the curvature and right the spine. Not only is the spine curved, but it is twisting. I have 9 disks along the spine which have been crushed flat and are, for all practical purposes, dead.

Please find an experienced acupuncturist, trained in China or Taiwan, and give it a try.

Relief can be immediate, if not complete.

Sorry that you are hurting.

[kapitalyst]

I live in a state where dr's are perscribing 63 opoids per capita, per month in my county its 79, in another its 113. And that is not, per capita of drug users, but every man woman and child. I come from a state where some counties have as high as 63% opiate addiciton rates. In my state unintentional drug poisoning kills more people than car accidents, largely because of prescription drugs.

And what state is this, might I ask?

I don't deny there are real "pill mills". They just busted up one in Florida... the owner of this one, little clinic had a collection of Ferraris, Mercedes, Porsche and other fine cars, a yacht, two "vacation homes" and a mansion. He was writing illegitimate Rx's for non-existent people, then passing the pills on to dealers and collecting his "dividend" payments. But without the strict prohibition of drugs and over-regulation of pain management, there would be no market for this sort of thing.

This is the attitude of someone who has watched countless people ruin their lives becuase they claimed to be in chronic pain and shopped around until they found a doctor that agreed with them.

I know a couple people who got fucked up on drugs, and even opioids. My brother, actually, got addicted and has recently recovered. This is, however, a small segment of the US population. However, the drugs are gaining street popularity and becoming somewhat of a "street fad", just like ecstasy in the 90s. Just like the so-called "ecstasy epidemic", it corresponds precisely to government "crackdowns" and rising drug prices. If you want to make a drug popular on the streets, ramp up enforcement and do a "crackdown".

Again, I don't deny addiction is a problem. It most certainly is. It is a very exaggerated problem, however. The impact is biggest in lower-class neighborhoods and inner cities... no surprise to me when the profit potential for pushing the drugs is huge and people are hungry for money... they're poor. The biggest problem, however, is the under-treatment and even outright lack of treatment for people who legitimately need these drugs. I've already watched two family members die an agonizing death while doctors looked on with stoic faces -- and outright refused to give them pain relief.

If you are in such sever pain you cannot concentrate, I have no problem taking a drug. But I have been in that pain and Ibuprofen worked perfectly fine for me.

Your body and your pain is not a way to measure that of other people, my friend.

If you are in such dehibillitating pain at all times, than permanent opiation is fine. But if it comes and goes, I would have to say the dangers far outweigh the costs.

You think it cannot ruin your life? I just learned of a doctor that became addicted to them, lost his practice, and ruined his life. It can happen to anyone, and most likely will.

Of course drugs can ruin someone's life. Didn't say they couldn't. I'm an advocate for sufficient treatment of pain and sensible drug policy... I'm not a drug use or addiction advocate.

Again, if you read my post I said the most severe cases could be treated with it. But, I think if you can still function, you don't need an opiate. Again, I have been in such pain, and Ibuprofen worked fine.

I think Ibuprofen working for you is nothing short of a miracle. Ibuprofen is an NSAID, primarily intended to treat inflammation and pain caused by it. It's effective for minor cases of arthritis, sprains, joint pain, muscle aches, etc. It can be of some use to treat the inflammation caused by things such as a broken bone. But it's not a cure-all pain reliever... it's for light pain related to inflammation. It won't even relieve a mild headache for me -- I have to take Tylenol (acetaminophen). I don't think it really helped your burns, and likely did you no good for your over-sized filling or kidney stone... it probably had more to do with high pain tolerance and placebo. And even you say the whole time you were in serious pain.

But you can still function. Why would you need to permanently be on an opiate? Why couldn't you take the opiate during the extremes, and rely on something a little less dangerous on your good days?

What?!

No, I can't function... I would never have taken any opiates if I could have gotten by through another means. Once I turned 17, my quality of life began to fall off a cliff. I was miserable 24/7. I tried everything... every non-narcotic, physical therapy and chiropractic, stretching, praying, meditation, healthy eating, applying heat/ice, massage therapy, homeopathic "remedies" (which I now know are nonsense), you name it... I was spending my life in two places: bed and my sofa. My mother had to care for me like a nursing home patient. No going out with friends to have a good time, no vacations, not even a trip to the store. My doctor and I exhausted every effort before opiates were ever tried.

I feel for you, I really do. But you cannot deny that there is a massive opiate problem in this country right now. It is literally an epidemic. You probably need it. Most people don't, in my humble opinion... the opinion of a man who just buried his love because she became addicted to opiates and heroin was easier to get than pills... only because the pill problem here was so bad they HAD to shut down the pill mills.

There is a problem... again, I don't deny it. But calling it "massive" or "epidemic" is sensationalism. The problem for the vast majority of Americans involved in this situation is gross and neglectful under-treatment of all pain. It's despicable that someone like my grandmother had to die a miserable, painful death from cancer because of this drug hysteria and paranoia.

No, most people don't need opiates. Of course not. But most of the people who do are getting none or far too little, and they are miserable. That is the whole point here...

No, it is soccer moms and football dads. One of the major minor pushers a while ago, who is in jail now, was a cop's wife. I agree that drug prohibition plays a major role in the regressiveness... I still don't think opiates should be widely prescribed.

You're speaking from your personal experience, so I'll speak from mine... I know and have been acquainted with several thousand people in my life. About twenty are on opioids... only two, I think, probably shouldn't be on them. And every one of the ones who are legitimately taking opioids are also under-treated and abused by the system.

Doing what they have to do? They're dying! These are my best friends! And most of them, despite their excuses (I know somoene who takes vicadin daily becuase of his arthritis...) are just drug addicts who need help, not more drugs.

Well, it sounds like you've been hanging out in a clique of opiate abusers... who know the other local drug abusers. So I think your anecdotal accounts are very skewed by the subculture you've been in (you said, I think, that you're recovering from addiction).

Drug users typically are friends with other users... just like skateboarders are friends with other skateboarders. I used to be a total pot head in high school, and I knew all the other pot heads and had connections to their connections' connections. From my standpoint, it seemed like everyone in the world smoked pot back then. But they don't... and pot is the most popular illicit drug by a huge margin. If you judge the popularity of political viewpoints by these forums and the people you know here, you might think nearly the entire world is communist.

Yes, if you have a lot of friends who are addicts they do need help. Help is hard to get (especially good help) in our paranoid nation. The state doesn't want to help your friends... they'd rather them be in prison. And the fact is, your friends are finding the drugs and abusing them... so what has prohibition and insane over-regulation done in fighting addiction? NOTHING. It's only hurting people who legitimately need the drugs and don't want to break the law.

Some people could get by perfectly fine taking Ibuprofen on the weak days/times, and save the opiates for when they are needed.
And this was pain so bad I could not add 2 + 2. It was not chronic. But it was severe, and Ibuprofen worked fine.

Some people, maybe... No two people have the same body, the same pain, the same tolerance to it or the same tolerance to opioids. I don't approve of a "one-size-fits-all" approach to prescribing opioids, or some black and white dividing line between "yay" and "nay".

How exactly did Ibuprofen work fine if your pain was that severe -- that you couldn't "add 2 + 2"? Sounds to me like you were absolutely miserable and now you're looking at it through the rose tint of hindsight.

So would I, but not for their severity, but their chronic nature.

I would choose it for the severity and the chronic nature. If I had to choose between spending a week with:

A) dental pain, broken arm and a third degree burn
B) my chronic pain

The clear choice is A... Trauma and acute (localized) pain pales in comparison to what I've got to live with. I'd only choose my chronic condition if the alternative trauma/acute pain was extreme trauma, like getting run over by a car and having all your bones broken. That's about the only sort of thing that could be worse and more devastating.

How many of your best friends have you had to bury because "it's just a little vicadin, you can handle it." Im sorry Kapitalyst, but you are fooling yourself.

None... I've only known one person who died from opioids because he was shooting up methadone. I've heard of other cases, and practically all of them are A) combination of other drugs and alcohol B) IV use of opioids and other drugs C) suicide, esp. by the terminally ill.

Again, Vicodin? That's one of the weakest opioids available. You're not going to die from taking it correctly. If you took too many it wouldn't even be the hydrocodone that killed you... you'd overdose and die first from the acetaminophen (Tylenol) in the pills, because it would shut down your liver and kidneys. Some have even questioned the reason they put the acetaminophen in those things... because if you need it, you could take a Tylenol with the opiate and get the same effect. It seems like the intent is to kill (or make very ill) anyone who tries to "get high" off the Vicodin... really fucked up...

I have, however, known far too many people who have needlessly suffered from under-treatment of pain. That was a major contributing factor in the premature deaths of both my grandparents. Too much pain, especially when the body is weak from injury or illness, can cause shock, weaken the immune system and contribute to or directly cause death. My grandmother had breast cancer and had a good chance of survival. But they refused to give her anything but tiny doses of morphine orally (morphine is extremely weak orally). She moaned and screamed and cried, and even told the doctors that her dosage of morphine was so low that two Lortab did a better job (she was right...morphine's bioavailability orally is pathetic, and it was only 20mg every 6 hours). They didn't want to hear it -- they had to "protect" her from addiction. The pain got really bad, and she went into shock... she had seizures as a result, and slipped into a coma and died. The coroner and the doctors said "her pain was just too bad, causing shock, and she was weak and couldn't handle it". My grandfather's death, though it was inevitable, was accelerated by similar causes. A friend of mine got into a horrible car accident when he was 17. He was still conscious when they picked him up, and they brought him to our local hospital -- notorious for neglect and under-treatment. They gave him good odds of living. He had some broken bones, tissue damage, serious trauma, etc... but he was expected to live. But they wouldn't treat his pain, despite his screaming and pleading. They would give him a baby's dosage of hydrocodone every 12 hours. The stress lead to shock, and he also slipped into a coma and died. I know two other car accident victims who died of virtually identical causes and should have survived. Another friend of mine got into the worst car accident I've ever seen... I've never seen a human being so twisted and shredded before. That hospital treated him the same way, and he was on the brink of death... they even encouraged the family to "pull the plug". They knew better, however, and had him med-evaced to the hospital in New Orleans. They immediately put him on an adequate dosage of morphine and oxycodone for discomfort/breakthrough pain. He returned to full consciousness in three days and his immune system beat the infection that had set in within a week. They also gave him compassionate physical therapy and pain management throughout his long recovery. Today he is in great health, and walks, works and lives like a normal person.

I am starting a chapter of the support group SOLACE (Survivng Our Loss And Continuing Everyday) in my county. One of the ladies who spoke on their behalf told the story of how her daughter was in an accident at 8 yrs old and they prescribed her opiates. The mother thought she was doing the right thing. The pain kept getting worse, they prescribed her more opiates. She started going to pill mills, and doing anything she could to obtain the drugs. The mother kept trying to do the right thing up until the day she had to lower her daughter's 21 year old body into a casket and a gravesite because of an overdose.
It started at 8! We should NEVER be prescribing opiates to people who have not developed the mental capacity to overcome it (except in very severe cases).

I also know the story of a little boy who was born with severe back trouble, sort of like me. By age 6 he was in a wheelchair, and couldn't attend school. They put him on low dosage of Oxycontin. He was able to walk again, with limitations, and return to school. He has grown up and had a whole new lease on life. He should be in his first year of college now. The moral of the story is that these drugs can save lives and be a miracle for the people who need them. And for the people who don't... we're failing at stopping them from obtaining them (in fact, we're making it easier on the streets) through prohibition and draconian over-regulation. We need education, sensible policies and widely available help and treatment... not more police, "crackdowns", stricter regulations and more nonsense.

I plead the fifth on this comment as I do not want to make it personal.
But if you need any help, Kap, I love you, care for you, and will do anything I can.

Erm, what? No, do go on...

The math is that in the last 5 months I have buried 3 people because of opiates, and it didnt start with heroin. 2 of them were very close friends from childhood, one I loved with all my heart. That is all the math I need.

I'm deeply sorry for your loss. But I hope you realize that the draconian, authoritative approach to drug addiction (which I agree is a problem) only makes matters worse. Not only for the addicts who need help, but the legitimate patients whose lives can be restored by opioid therapy and compassionate treatment. The more they try to "crackdown", the higher the prices get and the more the drugs are pushed from the "pill mills" and dealers.