We are a commune of inquiring, skeptical, politically centrist, capitalist, anglophile, traditionalist New England Yankee humans, humanoids, and animals with many interests beyond and above politics. Each of us has had a high-school education (or GED), but all had ADD so didn't pay attention very well, especially the dogs. Each one of us does "try my best to be just like I am," and none of us enjoys working for others, including for Maggie, from whom we receive neither a nickel nor a dime. Freedom from nags, cranks, government, do-gooders, control-freaks and idiots is all that we ask for.
Our Recent Essays Behind the Front Page
Friday, September 13. 2013
Here's what I have learned, over time:
- Abusers of precribed narcotics are a trivial social problem
What are you views?
Display comments as (Linear | Threaded)
Thank you doctor Joy. Many people are worried about their loved ones drug habits, which they would like to control. We are currently going thru end of life issues with a senior parent snd I am so glad these resources are available.
I live in a rural area and see a lot of abuse of pain medications, with a few well known script doctors profiting from weak individuals seeking pills not for real pain relief, but for the drug effects, and the aftermath of bad behaviors, impaired driving, and downward spirals. Lazy folks who feign back pain to get more pills, which further reduces their ambition, as they try to get on SS disability income programs so they never have to work again. Lots of petty crime in areas that used to be safe, folks looking for more pills.
The medications are needed for patients with post-surgical pain, and debilitating conditions or cancer or similar illnesses. The abusers put pressure on docs to limit the distribution, and sometimes some of the folks who should have pain relief don't get it. But there are probably more people getting meds they don't need than there are patients being denied for a legitimate need.
People with terminal conditions should not be denied pain relief, and our family's experience has been that doctors aren't shy about using it in those circumstances. Mercy dosages aren't unheard of in some cases, though the doctors and nurses don't talk about it directly outside the hospital.
My mother had some difficulty getting her pain-killers while she died in hospice. Luckily we ahd a cousin working there who saw to it that she got them in a timely fashion and "as needed' while she was on duty. Evidently the owners were afraid she'd either get hooked or die a few hours early and we'd sue.
There needs to be a better way.
This was exactly my experience with my 96-year-old aunt, who spent her last years in great pain, especially in the very last year after an inoperable hip fracture catapulted her chronic arthritic pain into something even more excruciating. After the hip fracture, she was bed-bound and in very serious pain that become agonizing when they had to move her (several times a day). It was terribly difficult to get even the hospice-care staff to ramp up her opioid dose to an effective level. Only in her last few days did they finally move to fentanyl patches, which I had been asking for from the start. I believe my cousins, with the power of attorney, were afraid of addiction problems, though what the point is of worrying about such a thing with such a patient I cannot understand. The nursing facility was worrying about the same thing, presumably from past legal experience.
Make sure you give your medical power of attorney to people without psychological hangups about opioids. And if you break your hip, DO NOT refuse surgery. There is no way to control the pain without it. A doctor friend later told me they surgically repair broken hips even in short-term terminal patients, just because there is no other way to make them comfortable. My aunt was a terrible surgical candidate, but her last nine months didn't need to be such a nightmare.
I think doctors/pharmacists are completely disbelieving of how easy it is to get hooked on pain meds even after a very short period of time. I was given a common prescription pain med after minor surgery. I took half the dose recommend the first couple of days. Then took a half a pill. This was only for 4 or 5 days. After I decided I no longer needed pain relief I went through 24 hours+ of pretty awful withdrawal symptoms...extreme tiredness, cold sweats, headache.
I called the pharmacy to see if this was normal. They were mystified and claimed you had to be on these drugs several months before you actually had any kind of risk of withdrawal symptoms. In other words, they did NOT believe me.
This tells me that there is no real understanding of how these drugs affect the body and how quickly they do it. To feel like I was going through withdrawal after such a short period of time, tells me doctors are overprescribing pain medications and NOT giving people ample warning about side effects and withdrawal symptoms.
I think that the government is the worst arbiter of what drugs and what medical treatment a doctor and patient should be allowed to pursue. What's next, SWAT teams to enforce government medical decisions.
I think addiction is an over used term and excuse. I can't speak to individual cases, but I know how many people in my family, myself included, who quit tobacco cold turkey to accept the characteristic of it as diabolically addicting. As far as addition to opiates, I find Theodore Dalrymple's book "Romancing the Opiates" provides a well argued, from his experience with British addicts, contrarian opinion to how powerful the addictive properties of opiates are. He point out that no one dies from opium withdrawal, but delirium tremens are a very real and potentially fatal reaction to being deprived of alcohol on a cold turkey basis.
And, I agree with each and everyone of Dr. Bliss1 bullet points.
I know a retired lumberjack in Alaska that only can function due to his use of opiates, so I understand what your saying there. However I also a handful of fellow tradesmen and one ex-girlfriend who have flushed there careers, marriages and in one case their life, due in part, to addictions to narcotics. I think its an error to say,
"Abusers of precribed narcotics are a trivial social problem" or- "The biggest social problems with narcotics are their illegality"
I believe that pain relief is one of the best things doctors have to offer the suffering, so I believe in generous opioid use when needed.
The highlighted words are the critical ones, IMHO. "Need" varies from case to case. Myself, I won't have addictive drugs in the house unless the need is real and immediate. When I sprained an ankle a while ago and the doctor gave me a prescription for a synthetic opioid, I didn't even get it filled. I didn't need it. The pain disappeared as the injury healed -- it was halved in two days and effectively gone in a week.
One of the dirty secrets of medicine is that every individual is just that: an individual who responds differently to every drug on the market, whether it's OTC or prescription. Person A needs an opioid painkiller for problem X; person B can get by with hi-test aspirin for the same problem. Person C takes that same opioid for a month and can stop cold turkey with no problem; person D takes it for three days and has bad withdrawal symptoms. Means nothing about either the efficacy or the addictiveness of the drug in question.
Did you know that there is a statistically significant correlation between having red hair and being resistant to standard surgical anaesthetics? (See http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1362956/ if you don't believe me) Living organisms are a weird wonderland of insanely complex inter-related systems, and general conclusions are very, very dangerous.
Painkillers have there place (try going through lung cancer without them). Families should monitor and control use of prescribed and other drugs (including alcohol). Addiction is real and happens. Addiction cannot be controlled by an agency of government. Physicians who over prescribe medications should be identified by family members (other than patient) and investigated by State licensing authority.
One problem with allowing the government the power in any sphere of action is that there is always an element of society that profits from the exercise of that power, even when the exercise is to the detriment of society as a whole.
They will have lobbyists, and they will have the government's propagandists on their side.
Pain killers should be a last resort after a reasonable period of wincing, cringing, muscle clenching, teeth gritting.... I had lower back surgery and a pacemaker implant in the last five years, and in both cases, woke up with a drip inserted. No one asked me if I wanted or needed it. I don't know if I would have or not, but if asked, would have tried to get along without it. Also in both cases, at hospital discharge I was handed prescriptions for opiate painkillers. No one asked if I wanted or needed them. After a couple of days of wincing, cringing etc, the pain diminished and I threw away the prescriptions. The point is, try to endure the pain before resorting to opiates.
My daughter-in-law is hooked on hard drugs. Meth seems to be her drug of choice. She has abandoned her four children and my wife and I are caring for them. I understand that she has to trade sex for drugs everyday and she hangs out with some pretty sleazy druggies and pushers. She lives in a crack house and gives it up to whomever is in the house that day. What a great life drugs has brought her! Meanwhile we are left dealing with the traumatized children. They have seen her arrested, accosted, try to commit suicide and passed out (over dosed). I don't understand those who speak glowingly about drugs and believe the problem is that the mean old government makes these happy drugs illegal. Maybe they are the ones taking advantage of these young girls.
The movement to effectively treat pain in the past 15 years has been accompanied by an explosion in deaths from opiate overdose and in the illegal use/diversion of opiates. While there are indeed people who are helped by opiates, there are many others who pester physicians for them without evidence of serious pathology that ought to be present to warrant their use. And the evidence for efficacy for many forms of chronic pain is scanty. See, for instance, Manchikanti et al, "The Opioid Epidemic in the United States" Pain Physician 2012: es9-38.
i do not believe it is responsible to suggest that opiate abuse is a "trivial social problem". While the movement to increase opiate use has helped some it has a lot of social harm to answer for.