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RoseRed135

The Opioid Crises - How do you believe it should be handled?

49 posts in this topic

DsD had her wisdom teeth extracted just after HS graduation...I had control of the pain meds, so they weren't misused or underused. She mostly used them at bedtime. Daytime we always did OTC before using the Vicodin and with good results along with ice packs and rest. Self care rules.

Imp makes a good point about the night time breakthrough pain. It can sneak up on you on a sudden & horrific scale. That is why you get the prescription. If you don't fill it immediately, you stand the chance of a really miserable night before you can get to the pharmacy to fill it.

The problem I see is that pain management is not sufficiently discussed before the procedure or when dispensing the medication. Pharmacists are able to have an in depth discussion on ANY and ALL meds they dispense and can be a great source of accurate information.  Refills should never be "offered". They should be allowed on a case by case basis only. 

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I live in an area with an opioid problem. Frequently, the "pain" to be managed is the pain that comes from being uneducated, poor, unhappy, making bad choices and generational abusive patterns.

The opioids are problems, but they're symptoms of larger, societal problems. It's like any other drug problem, really, but with ONE chief difference: Big Pharma is complicit in major ways, as are doctors who give them out like M&Ms.

I like BSW's take: Treat Big Pharma like Big Tobacco.

And for god's sakes, we need universal healthcare in America. Not yesterday, but 25 years ago.

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Imp, don't you live in Canada? It sounds like there are more controls on the drugs there than In the US, Here any doctor can prescribe opioids, any pharmacy can dispense them, pharmaceutic reps  meet doctors and push for doctors to prescribe. Maybe Canada has gone too far in regulating and there are probably better ways to make sure that chronic pain sufferers can get what they need, but think of all the suffering of individuals and their families and loss of life from drug overdoses happening here in the US. I'm not saying that there isn't a proper use for these drugs, I'm just saying that in the US these drugs are now a source of tragedy and suffering for far too many people.

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2 hours ago, oscarsmaman said:

I live in an area with an opioid problem. Frequently, the "pain" to be managed is the pain that comes from being uneducated, poor, unhappy, making bad choices and generational abusive patterns.

The opioids are problems, but they're symptoms of larger, societal problems. It's like any other drug problem, really, but with ONE chief difference: Big Pharma is complicit in major ways, as are doctors who give them out like M&Ms.

I like BSW's take: Treat Big Pharma like Big Tobacco.

And for god's sakes, we need universal healthcare in America. Not yesterday, but 25 years ago.

Addiction doesn't discriminate, happy or sad, rich or poor, educated or ignorant- Regardless of which one of those things a person may be, choosing to use is a bad decision-

The state I live in passed opioid prescription law/s that take into consideration those suffering from chronic pain but limit how much a doctor / dentist / nurse practitioner can prescribe to others- They also have to report every opioid prescription they write-

I also believe that societal problems are at the core of the issue- Most US citizens don't get to "live", they get to "cope" with governmental / corporate bs and as a result self-medicate- Just my take-

Also agree we needed universal healthcare since forever-

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Also agree with BSW, too ..

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I am fortunate in that I've never had pain that was severe enough to need an opioid, so my prescription did not have to be used following surgery or different injuries I have experienced.  Same with my DH who has had several painful surgeries/injuries.  DH and I have both had success with using Advil and adding Tylenol if the pain is bad enough, and just dosing aggressively 24/7 until the pain subsides.   Years ago, my doc recommended this Advil/Tylenol mix for severe pain, which is where I learned it.   I also like using these pain killers as they don't make me loopy or nauseated as some opioids are known to do.  Advil/Tylenol doesn't work for off the charts pain or some ongoing chronic pain, but it can be quite effective for a lot of other categories of pain. 

I did see this article in the headlines last week, and thought it was an interesting outcome to a study on opioids vs. over-the-counter pain meds:

http://www.latimes.com/science/sciencenow/la-sci-sn-pain-opioids-ibuprofen-20171107-story.html

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18 hours ago, Mame925 said:

DsD had her wisdom teeth extracted just after HS graduation...I had control of the pain meds, so they weren't misused or underused. She mostly used them at bedtime. Daytime we always did OTC before using the Vicodin and with good results along with ice packs and rest. Self care rules.

Imp makes a good point about the night time breakthrough pain. It can sneak up on you on a sudden & horrific scale. That is why you get the prescription. If you don't fill it immediately, you stand the chance of a really miserable night before you can get to the pharmacy to fill it.

The problem I see is that pain management is not sufficiently discussed before the procedure or when dispensing the medication. Pharmacists are able to have an in depth discussion on ANY and ALL meds they dispense and can be a great source of accurate information.  Refills should never be "offered". They should be allowed on a case by case basis only. 

Here, the pharmacists DO go into details of use before dispensing a narcotic. I'm able to skip through it b/c of my history, but when Wolf had some, it was a 15 minute discussion.

Personally, I hate the side effects of narcotics. Loathe them. BUT, if it's that bad that I'm close to the edge of breaking down from pain, I'll take them. It's better than the alternative.

For me, the alternative includes vomiting, passing out, and being trapped in a position where my brain is so clouded by pain that I can't think, let alone make sense to myself or anyone around me.

It's terrifying, for me, and especially my family, when things get that bad, so as a wife and mother, I do my best to ensure that it doesn't get that bad again, and head it off when it starts creeping to the edge of my ability to cope.

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19 minutes ago, ImpishMom said:

Here, the pharmacists DO go into details of use before dispensing a narcotic.

They do here as well, but you'd be amazed at the number of people who decline. I don't know if it's because they think they know everything or don't want to appear uninformed....

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43 minutes ago, Mame925 said:

They do here as well, but you'd be amazed at the number of people who decline. I don't know if it's because they think they know everything or don't want to appear uninformed....

The pharmacists we've dealt with don't hand the meds over until after their spiel. Even w/me, I get, "You've had these before, you're aware that...." and get a brief thumbnail description, and "Do you have any questions or concerns?" the first few times I've gone in, despite the clear history of having used them for years.

Now, of course, b/c they've gotten to know me, I just get, "These are still working okay for you? Any questions or concerns?"

But, again, history. They can see how many tablets I get, and how long it is btwn refills.

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2 minutes ago, ImpishMom said:

The pharmacists we've dealt with don't hand the meds over until after their spiel. Even w/me, I get, "You've had these before, you're aware that...." and get a brief thumbnail description, and "Do you have any questions or concerns?" the first few times I've gone in, despite the clear history of having used them for years.

Now, of course, b/c they've gotten to know me, I just get, "These are still working okay for you? Any questions or concerns?"

But, again, history. They can see how many tablets I get, and how long it is btwn refills.

That makes you a responsible consumer, not a drug seeker...DH took Narco by the handful for years...he used them responsibly despite the large dosage. 

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Just now, Mame925 said:

That makes you a responsible consumer, not a drug seeker...DH took Narco by the handful for years...he used them responsibly despite the large dosage. 

Exactly my point. Folks who want to use a broad brush to deal with the addiction issues are frightening to those who genuinely require the meds to be able to live their life with any semblance of quality and ease of pain.

I demanded that my pain specialist try every non narcotic med available to manage my condition. The result? I ended up sobbing on the phone with him, telling him that I gave up, that I would follow whatever he decided was best, b/c this wasn't working, this was hell, and I couldn't do it anymore. That was *months* into seeing him.

And it still took months after *that*, and being stranded while he was out of the country, to get breakthrough meds.

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@ImpishMom then that makes you the perfect example of participating in your own care....(a good example, BTW)

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13 hours ago, oscarsmaman said:

I live in an area with an opioid problem. Frequently, the "pain" to be managed is the pain that comes from being uneducated, poor, unhappy, making bad choices and generational abusive patterns.

Wait... Are you saying that most people  don't generally take the opioid for physical pain, even at first? Or that emotional pain causes them to overdose or keep taking the drug long after the physical need is gone (if it's temporary)?

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7 hours ago, Mame925 said:

@ImpishMom then that makes you the perfect example of participating in your own care....(a good example, BTW)

So, is it possible, people, that one way to combat the opioid problem would be to do more to educate the public to the value of "participating in (their) own care" and being a "responsible (medicine) consumer?"

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22 minutes ago, RoseRed135 said:

So, is it possible, people, that one way to combat the opioid problem would be to do more to educate the public to the value of "participating in (their) own care" and being a "responsible (medicine) consumer?"

In theory, sure...as a nation we I think we are woefully ignorant of our own health. Mass media suggests there is a drug for every situation. Medical schools in the US lean toward "better living through pharmaceuticals". And we're taught that doctors are "gods", whose authority is never to be questioned.

I call BS these these statements...we should each be responsible for our own health. Personally I think minor symptoms can managed and/or cured naturopathically rather than drowned in drugs. And this failure/fear to manage ourselves (by educating ourselves) leads to over dependence on medication.

This certainly isn't as simple as I make it sound, but it is doable. 

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13 hours ago, RoseRed135 said:

So, is it possible, people, that one way to combat the opioid problem would be to do more to educate the public to the value of "participating in (their) own care" and being a "responsible (medicine) consumer?"

I think it's the only way that things will improve, is if folks start taking personal responsibility.

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This was in my Sunday paper this week:

HEALTHY LIVING

Handling chronic pain without relying on opioids

Mayo Clinic program helps patients learn strategies to manage their pain by addressing emotional, social and psychological aspects

By Michelle Andrews

Kaiser Health Network

Each year, more than 300 people take part in a program at the Pain Rehabilitation Center at the Mayo Clinic in Rochester, Minnesota. Their complaints range widely, from specific problems such as low-back pain to systemic issues such as fibromyalgia. By the time patients enroll, many have tried just about everything to get their chronic pain under control. Half are taking opioids.

Continuing to do so is a dealbreaker. To qualify for treatment, participants must agree to taper off pain medications during the three-week program.

More than 80 percent of those who enroll complete the entire program, says Wesley Gilliam, the center’s clinical director, and many previous opioid users who finish the treatment report six months later that they have been able to stay off opioids. Just as important, he adds, they have learned strategies to deal with their pain.

Mayo’s 40-year-old program isn’t the only one to address the emotional, social and psychological aspects of pain, and to focus on reducing patients’ reliance on addictive medications to manage their pain. But as the nationweathers an opioid epidemic, there are too few programs to address the need, Gilliam says.

Gilliam, a clinical psychologist with a specialty in behavioral pain management, talked

with me about the program. The transcript has been condensed and edited for clarity: Q How do pain medications work — by blunting the pain?

A They blunt some of the pain. Opioids are very effective for acute problems, but they were never designed to be used chronically. They’re not effective in the long term.

Opioids are central nervous system depressants. They soothe people who are in distress. Many people aren’t demonstrating improved functioning when they take opioids; it’s calmingtheir nerves. It’s chemical coping.

Q In treating pain, does it matter what’s causing it or how severe it is?

A Pain is pain. The fundamental approach to self-managing it doesn’t change based on the cause or severity of the pain.

Image_7.jpg

The Mayo Clinic’s Pain Rehabilitation Center aims to help patients manage pain without the use of opioid medications such as OxyContin.

ASSOCIATED PRESS ARCHIVES


 

Opioids

Q How does someone wind up at a program like yours?

A Virtually all of our patients have tried and exhausted primary and secondary treatment options for pain. In primary care, a patient comes in with a complaint, and a treatment plan is developed. It generally involves encouraging the patient to be active, to stretch. Maybe the doctor initiates a non-opioid medication like a nonsteroidal anti-inflammatory or an antidepressant. If the patient continues to complain of chronic pain, the primary care provider will step up to level two and refer someone to a neurologist or maybe a pain psychologist or pain anesthesiologist.

If patients don’t respond, they start to think about Step 3, which is a pain program like Mayo.

Q How does the Mayo program work?

A People come to us every weekday from 8 a.m. to 4 p.m. for three weeks.

We don’t take a medical approach. It’s a biopsychosocial approach that acknowledges not only the biological aspect of pain but also recognizes that psychological and social variables contribute to how people experience pain.

That is not to say that pain is imagined, but rather how people experience pain is influenced by mood, anxiety and howthat person’s environment responds to the person’s symptoms.

A more medical approach tends to focus on targeting and eliminating symptoms at the expense of the recognition of individual differences.

Q What does that mean for the patientwho’s in pain?

A People need to accept that they have pain and focus on their quality

of life. Some approaches reinforce in patients that the only way you can function is if you reduce your pain, as measured on a pain scale from zero to 10.

We focus on how to get you back into your life by focusing on function, instead of eliminating symptoms and pain. When I refer to functioning, I mean getting back into important areas of your life such as work, social activities and recreation. If you’re waiting for pain to go away, you’re never going to get back into your life.

When that happens, people get despondent; they get depressed.

Q So how do you help people manage it?

A When you’re in chronic pain and it’s poorly managed, the nervous system can get out of whack. Your body behaves as if it’s under stress all the time, even when it’s not. Your muscles may be tense and your heart and breathing rates elevated, among other things.

With meditation and relaxation exercises, we’re trying to teach people to learn to relax their bodies and hopefully kick in a relaxation response.

If I have low-back pain, for example, during periods of stress, muscular tension is going to exacerbate the pain in my back.

By learning to relax in response to stress, muscular tension can be diminished and the experience of pain eased. This doesn’t require a medication or a procedure — just insight and implementation of a relaxation skill.

Kaiser Health News is an editorially independent news service supported by Kaiser Family Foundation.

Edited by Mame925

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I see that, and I kinda laugh.

I went through a similar program. Biofeedback, group therapy, individualized therapy, the whole shebang, coupled with every non narcotic treatment my pain specialist had to offer (including a stellate ganglion block, which is putting a needle through the hollow in my throat to hit the nerve that runs into my arm and numbing it...now that was LOADS of fun, but unfortunately, ineffective. Only worked 1/3 times, and the one time left me unable to swallow for over 8 hrs. And I had a seizure another time.) I also had lidocaine infusions, which worked for a while (most effective thing ever for me) but then the side effects got so bad that I had to stop.

And started narcotics after being released from the program.

Can it work? Yes, for *some* people. Not for all. That's why neuralgia (nerve pain) is such a horrendous issue. What works for one doesn't for another.

For what *I* deal with, it's a dysfunction of the sympathetic nervous system. It literally rewires my brain. It doesn't matter how much I mediate, or do anything else, the pain WILL bring me to my knees (literally) and leave me unable to cope. That's where the narcotics come in. So that I get some slight relief (nothing actually leaves me pain free, *ever*) and dance away from the edge of wishing I were dead.

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I know Imp's case/care is the exception...and not as uncommon as we'd like to think and you did everything you could before accepting the narcarotics. I think this article is directed at those who are uninformed about their choices moving forward...and that you don't just jump to narcotics as a first choice, a practice far too common in our society. 

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5 minutes ago, Mame925 said:

I know Imp's case/care is the exception...and not as uncommon as we'd like to think and you did everything you could before accepting the narcarotics. I think this article is directed at those who are uninformed about their choices moving forward...and that you don't just jump to narcotics as a first choice, a practice far too common in our society. 

The reason I comment is b/c some folks really don't realize that chronic pain is a very individualized situation. There genuinely isn't a one size fits all.

Giving a voice to those like me, who often aren't heard, is one aspect of dealing w/my health that I think is important.

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My older sister tried all the other options her many specialist have suggested over the years and started on morphine as a last resort to keep her sanity.  Over the years after "they" got a handle on her chronic pain so she can at least sleep a couple of hours at night, they started backing off each couple of months so they can just maintain a handle on it.

She only gets a 60 day prescription at a time and if it runs out even in 59 days, she has to wait.  She has a very solid personality and doesn't stray from the doctors orders.  She has a lot of medical issues and a lot of drug allergies, and it is what it is.  She hasn't driver for years, not due to doctors orders, but she would never want there to be a question about whether or not she could possibly be DUI.

For some people, there really isn't a working alternative and even then, they settle for a 7 or 8 pain level on any given day.  Sister says she simply can't remember the last time she even woke up with a "5".

Edited by SueSTx

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@SueSTx - That's so sad...

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On 11/15/2017 at 8:43 PM, RoseRed135 said:

Wait... Are you saying that most people  don't generally take the opioid for physical pain, even at first? Or that emotional pain causes them to overdose or keep taking the drug long after the physical need is gone (if it's temporary)?

I am saying that frequently (not most), there are people who abuse the meds they or others are given. Meth is still a problem where I live, but opioids, because of their accessibility, are often taking the place of meth. 

My heart breaks for those who become addicted because the pain has passed but the addiction has developed. My heart breaks for those who rely on them (like Imp) to manage chronic pain (although I'm glad they have some respite-- I'm so sorry, Imp). But there is a large number of people who abuse opioids because it's like any other drug, they are looking for an "escape" from their desperate conditions.

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6 minutes ago, oscarsmaman said:

I am saying that frequently (not most), there are people who abuse the meds they or others are given. Meth is still a problem where I live, but opioids, because of their accessibility, are often taking the place of meth. 

My heart breaks for those who become addicted because the pain has passed but the addiction has developed. My heart breaks for those who rely on them (like Imp) to manage chronic pain (although I'm glad they have some respite-- I'm so sorry, Imp). But there is a large number of people who abuse opioids because it's like any other drug, they are looking for an "escape" from their desperate conditions.

I think part of my problem with the 'ban opiods' train is that it's often a comorbid addiction with alcohol. More folks are alcoholics than addicted to opiods. 

But we saw how well the Prohibition went.

Unfortunately, there have always been folks who have addiction issues. There always will be. The big piece of this puzzle, imo, is how to balance folks who genuinely need and use opiods as they are meant to be used, vs those who abuse them. There's not a 'blanket' solution to it, and too often, folks focus on one aspect of the situation (addiction) and forget about the other aspect (genuine medical need). Banning chronic pain patients from being helped in the ER was a step in the wrong direction, imo.

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