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F.D.A. Moves To Rein In Pain Killers

The F.D.A. moves to rein in America’s huge usage of powerful painkillers. We’ll look at where they’re drawing the line.

In this Feb. 19, 2013 file photo, OxyContin pills are arranged for a photo at a pharmacy in Montpelier, Vt. The F.D.A. announced in Oct. 2013 that it would formally recommend a change in the classification of hydrocodone pain medications. (AP)

In this Feb. 19, 2013 file photo, OxyContin pills are arranged for a photo at a pharmacy in Montpelier, Vt. The F.D.A. announced in Oct. 2013 that it would formally recommend a change in the classification of hydrocodone pain medications. (AP)

It’s a familiar scenario: after a surgery or wisdom teeth extraction, the doctor writes a prescription for pain medication. A pill or two would do the trick, but the vial has 60 pills. And sometimes, those pills stick around. Abuse of high strength pain medication has reached a breaking point, we’re told, and the FDA is stepping up.  Last week, the FDA announced plans to make high-strength pain pills harder to prescribe, and harder to abuse or misuse. Many addiction experts cheered the decision, but some doctors have concerns. for. Up next, On Point: a plan to rein in  powerful pain meds.

Guests

Barry Meier, health policy and business reporter for the New York Times. Author of “A World of Hurt: Fixing Pain Medicine’s Biggest Mistake” and “Pain Killer: A ‘Wonder’ Drug’s Trail of Addiction and Death.” (@BarryMeier)

Dr. Josiah Rich, professor of medicine and epidemiology at the Brown University School of Medicine. Director and co-founder of the Center for Prisoner Health and Human Rights at the Miriam Hospital Immunology Center.

Dr. Brian Bruel, assistant professor, Department of Pain Medicine at The University of Texas MD Anderson Cancer Center.

From The Reading List

New York Times: F.D.A. Shift on Painkillers Was Years in the Making – “The F.D.A.’s long resistance to added restrictions on the drugs underscores what critics say is its continuing struggle to address the complexities of the painkiller problem in its often conflicting roles — one as a regulator that approves drugs and the other as a drug safety watchdog. On Friday, public health advocates who had cheered the agency’s decision the day before were dismayed when the F.D.A. approved a new, high-potency painkiller despite an 11-2 vote by an expert panel of its own advisers not to do so. The panel concluded in December that the long-acting opioid, called Zohydro, could lead to the same type of abuse and addiction as OxyContin.” — “The drugs at issue contain a combination of hydrocodone and an over-the-counter painkiller like acetaminophen or aspirin and are sold either as generics or under brand names like Vicodin or Lortab. Doctors use the medications to treat pain from injuries, arthritis, dental extractions and other problems. The change would reduce the number of refills patients could get before going back to see their doctor. Patients would also be required to take a prescription to a pharmacy, rather than have a doctor call it in.”

Wall Street Journal: FDA Recommends New Limits on Pain Drugs — “The decision by the federal agency follows a recommendation given to it by an advisory committee earlier this year, which voted 19-10 to limit the amount of such medicines that can be prescribed without a new prescription. The move covers pills containing hydrocodone. Hydrocodone is more widely dispensed in the U.S. than even cholesterol and blood pressure medications. But since it is commonly sold as a generic drug, hydrocodone makes up just a fraction of the fast-growing $7.3 billion pain market.”

The Post Game: Earl Campbell Opens Up About His Addiction To Painkillers And His Campaign To Help Others – “I had no clue my condition was becoming an issue until one morning in November 2009. My two sons, Tyler and Christian, sat me down and told me they were worried for my life and would be admitting me to a rehabilitation facility. I’ve had a lot of joyful and painful moments along the way, but hearing those words from my children whom I’ve always tried to set an example for was by far the lowest point in my life.”

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  • Wm_James_from_Missouri

    For a very long time I worked at a job where I managed to pinch my fingers between two pieces of heavy metal, quite often. For many years, I did the usual, “cuss, holler, scream”. Then one particular day I realized that I had been blaming, “him”, for something I did ! From then on, I started to think of “a point”, way out in space, somewhere. I would focus on this imaginary point, and keep my mouth shut. It was a significant breakthrough in managing my pain. Oh, I still knew that there was pain in my flesh, but this process of redirection helped minimize the fixation that comes with pain.

    • geraldfnord

      Gloves?

  • LinRP

    Best news ever for heroin dealers.

    • d clark

      Does it stop pain? Then you are right.

  • RolloMartins

    Pain is one of mankind’s greatest burdens. Those in pain deserve alleviating remedies. But Big Pharma is not out for the interests of others. They see a potential win-fall here, methinks. At the very least the FDA should have made them formulate the new hydrocodone in a tamper-proof way, such as in OxyContin. And forcing people to pick up a paper Rx is stupid. Why can’t the bureaucracy finalize the control e-prescribing regs? This would simplify Rx transfers for control drugs, AND make it safer and less likely for tampering. Duh.

    • Don_B1

      For some time, the big worry was that people in the last stages of life, particularly from chronic diseases and cancer, etc., had incentives to wish a quick death. Many rightfully pointed out that more pain medicine could relieve that and, at least from their perspective, the need for doctor-assisted suicide.

      But this epidemic does not appear to have much roots in the response to providing better pain relief in the elderly(?)

      • Stephen706

        Family/Friends Kids are stealing and diverting the pain meds meant for the eldrely…

        • Don_B1

          And people complain about the breakdown of the family!

          I guess the sickness in parts of this society knows no bounds.

  • Shag_Wevera

    I work in a hospital. Best of luck to anyone who tries to take away American’s pain meds.

  • Ray in VT

    Are such moves going to affect policies regarding these sort of opiate drugs in places such as Florida, where, it is my understanding based upon some reports over time, access is fairly easy, and people stock up and truck stashes of the pills to places like Kentucky.

    • TFRX

      Don’t get in the way of their entrepreneurism.

      • Ray in VT

        Back when I was working at the gun factory a couple of us came up with a job description for a drug dealer that used all of the usual help wanted lingo that you see in the classified. Growth sector, work from home, set own hours, must be a people person, etc.

        • TFRX

          I haven’t really watched the show, but it wouldn’t surprise me if there were a whole page of “Breaking Bad” quotes about that.

          • Ray in VT

            I haven’t seen the show either, but one suspects that that could be the case.

          • hennorama

            Ray in VT — speaking of TV shows: your original post describes part of a plotline from the show ‘Justified,’ which is about a Deputy US Marshal based in Lexington, Kentucky.

          • Ray in VT

            Yet another show about which I have heard many great things but which I have never actually watched.

          • hennorama

            Ray in VT — like Breaking Bad, Justified is set in a part of the country that’s seldom depicted on TV. It’s based on an Elmore Leonard short story, and is now seen by some as an alternative high for Breaking Bad addicts.

          • Ray in VT

            I’m still in mourning for 30 Rock.

          • hennorama

            Ray in VT — I understand. Acceptance comes with time. Meanwhile, this may help you get through:

            http://30rocksupportgroup.tumblr.com/

          • Ray in VT

            Thank you. In time I think that I will be able to reach that stage, but until then I can continue to wallow. For now at least I have other favorites to turn to, such as Raising Hope or the new comedian game show @ Midnight, which I have enjoyed very much so far.

          • hennorama

            Ray in VT. YW, of course. As to the the shows one watches: à chacun son goût.

          • geraldfnord

            No, some shows (coincidentally, the ones I don’t watch) are ‘UNACCEPTABLE!!!’, as the Duke of Lemongrab had it about just about everything (except his brother/lover’s body used as food, quite the kids’ show we have here…).

          • hennorama

            My apologies, but your references escape me.

          • geraldfnord

            Addicts! Unclean!!

          • hennorama

            Ummm … alrighty then.

      • hennorama

        Yeah Ray … why do you hate small business owners?

        • Ray in VT

          Because if I can just undercut them, even to the point of selling below cost, and drive them out, then I can run the show and make a mint in part by paying my people so little that they can get government benefits, thereby pocketing more for myself.

          • hennorama

            Ray in VT — my apologies. I had forgotten that you had the peanut market cornered, pushing prices down about 7 percent YTD.

            Well done, sir.

  • fun bobby

    prohibition works so well lets have some more if it. we do not need the government to tell us what to put into our bodies

    • WorriedfortheCountry

      Let’s put government between you and your doctor.

      What a wonderful idea.

      • fun bobby

        big brother knows best and that’s why cannabis is schedule 1

  • Coastghost

    I guess this show is to be construed as “topical” because the New York Times editorial board says this is “topical”, and says that it’s topical now, today. Why look: they even assigned a reporter to take up the subject!
    (So much for simultaneity: because uncomplimentary hearings on the disastrous [Un]Affordable Care Tax Act are taking place down in DC, well, WBUR and “On Point” just can’t multi-task when it comes to broadcasting . . . .)

    • Don_B1

      The two biggest, most important stories for the future of this country are:

      1) Creating a strong economy to provide the job growth necessary to put the currently unemployed back to work, which will require increased short-term spending by the federal government.

      2) Creating economic incentives to decrease the burning of fossil fuels for energy generation so as to decrease the rate of increase of CO2 in the atmosphere, which is the major driver of climate change which will make the earth extremely inhospitable for human life in as little as a century or two and decidedly uncomfortable in a half century.

      But you are not choosing to learn more about those subjects; in fact, there is much to indicate you really don’t want to know about what really is happening on Obamacare. What Republicans want to do is get their false version of Obamacare indelibly planted in people’s minds before the truth dawns and it is shown to be a big improvement in healthcare delivery for millions of Americans.

      • Coastghost

        The truth that Obama lied through his teeth concerning provisions of the ACTA is only presently dawning, it may take months yet for the sunrise to occur fully.
        In the meantime ACTA “implementation” will only contribute to indefinite postponements concerning your 1) above. Concerning your 2): Obama’s growing ineptitude (he’s had a lousy 2013 thus far) gives him and the US little leverage when it comes to China, which seems only to be increasing the rate at which it burns coal. Obama and his Administration may well be at war with the economies of the states of West Virginia and Kentucky, but Obama’s domestic priorities still seem tied to fostering the perception of success with the Affordable Care Tax Act.

        • Don_B1

          His “lie” should be taken in the context of the radical right wing lies, such as those stating that the PPACA would bring “death panels,” etc.

          Was it oversimplification? A strong YES.

          The number of people who are “losing their policies” are in the group who are Individual Policy holders, half of whom annually had to choose a new policy often with premium jumps of 20% or more and then got policies with really poor coverage if they had a bad health even in their lives. Many thought they had decent policies until something bad happened.

          But their policies were “grandfathered” in, which means that they could retain them if their insurer would sell them to them. But the insurers have decided for reasons only they know to discontinue those types of policies. Most of these people will be pleased with the new insurance policies they can select from when the HealthCare.gov site is improved.

          The PPACA will give a lot of people who have held back from going out on their own because of the costs of individual health insurance plans will now be able to start a new company and hire people, which will begin to grow employment, but it is only a parallel track to what is needed to give an immediate push to the economy.

          It was not President Obama’s policies that led to the Snowden disclosures which is what is riling the waters internationally right now. The Middle East is riled up by the reverberations of the Arab Spring, which is not “controllable” by outside powers; what can be done is to provide some guidance, but that will take a lot longer than the couple years we have so far seen and good results will only be seen decades from now.

          As for China, the leadership there is quite willing to enter CO2 restriction agreements as soon as it sees the U.S. is able to commit and enforce internally its agreements. China knows and has admitted to huge downsides of its current increases in CO2 production, but its need for growth has put that priority above immediate implementation of CO2 restrictions without an equal commitment from the U.S. and the rest of the world.

          But China is doing more research in CO2 reduction per capita than any other country in the world. They will not have to be “beaten into the ground” to agree to and implement CO2 restrictions.

        • geraldfnord

          Amazing that you know his mental state—I am speaking as a Democrat and Bush-disliker who is fairly sure that Bush never ‘lied’ because he had the ability to make himself believe anything he needed to be true; I think Obama does that less, but it’s a problem that especially strikes the successful…though his assumption that the insurance companies would act decently, implicit in ‘your coverage won’t change’—the insurance companies were supposed to make up for their increased expences with the newly guarantied and subsidised customers’ monies, not with higher rates—does seem either stupid or willfully blind, or overly…hopeful.

          (Perhaps he could do only that, as his and everyone else of discenrment’s preferred alternative—destroying these creature of society and sowing their corporate charters with salt—was not on.)

    • hennorama

      Coastghost — perhaps you should start an alternative show that only discusses topics that YOU find interesting and topical.

      Otherwise, there is a very handy “Contact Us” link above, where you can register your complaints.

  • toc1234

    psst Tom… obama is being essentially called either a liar or incompetent by NBC (!) and you go with FDA story??? Even the NYT is running a front page piece today referring to Obama as the ‘bystander president’. but you go with an opiate story…
    keep up the mediocre/biased programming!

    • WorriedfortheCountry

      The Washington Post fact checker gave Obama 4 Pinocchios today on his promises.

      • toc1234

        TOm keeps deleting my post (and my original) here. the Stasi would be proud since it was up for only a couple minutes…

        psst Tom… obama is being essentially called either a liar or incompetent by NBC (!) and you go with FDA story??? Even the NYT (!!) is running a front page piece today referring to Obama as the ‘bystander president’. but you go with an opiate story…
        keep up the mediocre/biased programming!

        • nkandersen

          Tom and staff do not route through comments looking for posts to delete…our system makes choices based on repeat posts and key words. – Nick, On Point Web Producer

    • Coastghost

      Yet neither NBC nor NYT is crediting Rep. Joe Wilson with any sense of prescience, I’m sure . . . .

      • toc1234

        is it my browser or did Tom delete my post that you and WFMC replied to?

        psst Tom… obama is being essentially called either a liar or incompetent by NBC (!) and you go with FDA story??? Even the NYT (!!) is running a front page piece today referring to Obama as the ‘bystander president’. but you go with an opiate story…
        keep up the mediocre/biased programming!

      • toc1234

        TOm keeps deleting my post here. the Stasi would be proud since it was up for only a couple minutes…

        psst Tom… obama is being essentially called either a liar or incompetent by NBC (!) and you go with FDA story??? Even the NYT (!!) is running a front page piece today referring to Obama as the ‘bystander president’. but you go with an opiate story…
        keep up the mediocre/biased programming!

        • geraldfnord

          Yes, Tom cares enough, and you are important enough, that he is doing this to you _personally_.

          My guess: an off-topic comment with which they’re in more sympathy might have a better chance of not getting deleted, but an off-topic comment is still an off-topic comment, and liable to deletion.

  • Stephen706

    The number #1 killer of young women is currently Opioid medications (use, misuse, abuse)… these are way over prescribed and way overused. Ruining our country. Everyday in the ER I see the hazards and addiction.

    Use for legitimate pathology (real disease) is one thing–but for sinus headaches, ear aches, ovarian cysts, sprains, boo-boos and owies, migraines, back pain with no pathology (bulging disks and DDD is not real pathology)…

    We have gone way overboard and have created this mess–much like the creation of Superbugs from overuse and misuse of antibiotics.

    Fully support the move to Schedule 2 and for the love of God do not allow Noctors to prescribe at all. Am watching 3 more young women work they way to opioid death… RIP

    • hennorama

      Stephen706 — TY for bringing up the severity of this issue for women, and especially young women. Per the CDC:

      “Prescription painkiller deaths have skyrocketed in women (6,600 in 2010), four times as many as died from cocaine and heroin combined,” said CDC Director Tom Frieden, M.D., M.P.H. “Stopping this epidemic in women – and men – is everyone’s business. Doctors need to be cautious about prescribing and patients about using these drugs.”

      “The study includes emergency department visits and deaths related to drug misuse/abuse and overdose, as well as analyses specific to prescription painkillers. The key findings include:

      - About 42 women die every day from a drug overdose.
      - Since 2007, more women have died from drug overdoses than from motor vehicle crashes.
      - Drug overdose suicide deaths accounted for 34 percent of all suicides among women compared with 8 percent among men in 2010.
      - More than 940,000 women were seen in emergency departments for drug misuse or abuse in 2010.

      “Prescription painkillers have been a major contributor to increases in drug overdose deaths among women.

      - More than 6,600 women, or 18 women every day, died from a prescription painkiller overdose in 2010.
      - There were four times more deaths among women from prescription painkiller overdose than for cocaine and heroin deaths combined in 2010.
      - In 2010, there were more than 200,000 emergency department visits for opioid misuse or abuse among women; about one every three minutes.”

      Source:
      http://www.cdc.gov/media/releases/2013/p0702-drug-overdose.html

  • d clark

    For the doctor guest who is saying that patients may have more pain, but it is worth it to stop addiction, I find it difficult not to wish upon him some intense, intractable pain.

    • geraldfnord

      Don’t let them get to you; that’s the closest thing to victory anyone usually ever knows.

  • niceonegreg

    I would like to ask your guest about so called “pill mills” like they have down in Florida. How can these exist and how can they be reigned in?

    • geraldfnord

      Make a Mr Limbaugh move to Nevada.

    • Vigilarus

      They exist because pain and/ or the nucleus accumbins create a high level of demand for certain molecules that mimic endogenous endorphins.

      They can be reined in by acknowledging the simple fact just stated by creating legal, safe access to said molecules.

  • Scott B

    Opiates (opioids) and I don’t get along, so taking one, for me, means a choice between pain and nausea. Do to some various issues (cancer, and various surgeries and procedures) I have been prescribed hyrdrocodone, and sometimes had to ask for a refill. The doctors have sometime looked at me like I just grew a third eye when I ask for a few, or lower dosed, pills, pills which I usually snap in half anyway because of my reaction to opiates. They seem to be in the habit of giving out the quart-sized bottle of pain-killers.

    • geraldfnord

      Just try to get codeine when they’re trying to prescribe you vicodin; my college’s drugs-dealers would never have acted so unprofessionally, if they had dealt in opiates at all.

  • James Pherris

    What does the panel think of using marijuana for long term pain management as a replacement for opioids?

    • geraldfnord

      I don’t know: I know that it’s probably a good replacement for some, a good adjunct that would allow for lower doses for many more, and useless for some—nothing is magical.

  • Paul Meade

    I have some familiarity wi

  • Stephen706

    What happened to my posting???

    The #1 cause of young American women dying is Opioid use, misue, and abuse–face it. The problem is real!

    It is one thing to use these powerful medicines for real pathology. The problem is they are being way too over-prescribed for non-pathologic conditions (sprains, aches, cysts) and they are being diverted–purposefully, accidentally, seruptiously, and unknowingly. Kids, family, friends, caretakers will steal these meds meant for the afflicted.

    We as a nation consume over 90% of the world’s opium based pain medications.

    Wisdom teeth–give #5-#10, not 20-30-60. That makes sense.

  • Stephen706

    And opiate addicts are like gambling addicts and alcoholics–no, you cannot always spot them. They put on the facade very well…

    • geraldfnord

      Some of them put on the façade so well that they are functionally indistinguishable from non-addicts; so long as they can keep them up, I see no point in bothering them.

  • Dana Ortegón

    My 70-year old aunt has severe arthritis in both knees. She attends a monthly pain clinic here in Boston, so her medications are closely supervised. Is she physically addicted to her painkillers? Yes. But until she undergoes knee replacement surgery, she suffers intense pain, every day. Because her medication is so closely monitored, if her pain is too intense and she doubles up on a dose, she runs out 2 days before her scrip is due to be filled. On one occasion, she ran out three days before and the pharmacy refused to refill her scrip. After three days of vomiting and withdrawal, she fainted from dehydration and had to go to the ER in an ambulance. How can this be an appropriate strategy for management long-term, chronic pain?

    • Stephen706

      Where is her pain management doc in the equation–this is appropriate use but there needs to be a 7/24/365 relationship with the prescribing physician. He should have been contacted so she didn’t go without. And agree–fix the knees

      Chronic Pain Meds due not get filled in the ER.

      • Dana Ortegón

        Her situation was/is definitely exacerbated by the fact that her physician is here in Boston, but she lives in New Jersey. When she moved three years ago, she didn’t want to switch doctors as she was nervous about having to “start over” with someone new. No matter what any of us told her about subjecting herself to the 8 hour drive and the danger of driving under the influence of opiates, she wouldn’t (couldn’t?) listen. And yes, the ER doc gave her three pills to carry her until we could get her scrip filled, which was an adventure in and of itself.

  • Ellen Dibble

    I missed the way profits figures into this, but I know my insurer paid a huge amount over a decade to chiropractors, pain management practitioners, for trigger point injections, physical therapy, massage, etc., etc., and after that decade I saw my neck and shoulder was not going to be cured by modern medicine. I had/have a bottle of hydrocodone, and I found that if I took three, I could actually work, so I would do that. I had to take coffee too. But that was no way to live. For one thing, it made me so constipated that I had to alternate days of eating with days of working while medicated. Then I bought everything on the shelf at the health food store, and discovered tourmaline, which is sold as “foot patches.” Now I use it for neck pain, shoulder pain, wrist tendonitis, etc. Once you learn how to locate them, they are very effective, though for something entrenched like my frozen shoulder, it took a few days to kick in, and had to be used for six years, day and night. Now only now and then. Right now, I have a tourmaline patch on my hand, because I felt hard on it yesterday, and couldn’t even hold a pencil or switch a light. By morning, after swapping out for a fresh patch a few times, that’s mostly better. What I use the hydrocodone for is if some pain seems to be getting entrenched. A toothache last week, I used one hydrocodone the night before I saw the dentist, and the dentist told me maybe the nerve would die. She was thinking she could kill the nerve. Oh, no, if it’s that aggravated, I told her, I’ll take another hydrocodone. It tried to act up again that night, but I sort of talked it down. You can’t put a foot patch over your upper lip.
    The solution seems to me to be that doctors can call in prescriptions for say three or four pills, and hopefully those can be delivered. The more miserable you are, the less you are interested in walking three or four miles to the doctor and three or four miles to the pharmacy. Oh, it can be very inconvenient.

    • geraldfnord

      The low-{called-in amount} solution you propose makes more sense than anything I’ve heard in the show…or that I’ve seen here, including mine own bloviations. If combined with an effective scheme against using multiple doctors, it should make this a less effective way of being an addict but deal with those who might run out when the doctor weren’t available.

  • Davesix6

    Pain management should be between an individual and their doctor.
    We don’t need some government bureaucrat deciding what medications we do or do not need!

    • Stephen706

      Yes we do–because we have totally screwed this up

      • Coastghost

        Agreed: it’s time to re-legalize raw opium and laudanum.

      • geraldfnord

        I don’t think we’ve totally screwed this up: most pain patients don’t go on to be recreational users, most recreational users don’t go on to become addicts. Late Victorian addiction rates were artifacts of massive advertising, lack of decent alternatives (calomel? colchicine?—I’d do less damage to myself, even just to my liver, as a legal junkie), and even more so of our society’s only recent acquaintance with those drugs…even crack, supposedly an ultimate addictor, stopped mattering so much once one generation had seen what it had done to their parents and siblings.

  • JonieCans

    How about acupuncture? Used in conjunction with western pain meds, it can be really effective in transitioning off of powerful opiates.

    • Stephen706

      YES!!!

    • Stephen706

      And hypnosis!!!

      • geraldfnord

        I’ve tried both for a bad back; perhaps my hypnosis were bad at it, but it was hard not to laugh. Acupuncture did nowt. Two days’ bed/floor rest with 14mg codeine b.i.d., followed by three days’ 14mg q.i.d. with increasing, moderate, levels of exercise actually works, dependably and repeatedly, every few years…and I don’t go throwing out my back to get some opiates (see: W.C. Fields’ notional uncle who only drank whisky as a snake-bite remedy…and made sure always to have a snake handy just in case.)

        (A G.I. bleeding problem makes N.S.A.I.D.s a bad idea for me…I’d be better-off in Canada, where 2-2-2s basically do the low-dose trick.)

  • Stephen706

    Pain is a perception. pain is a physical state as well as a psychological state. Pain meds may start with treating the physical but then the problem is the psychological issues.

    Most chronic non-pathologic pain patients I have seen have a common set of themes. They are overweight, out of shape, with poor lifestyle habits and smoke. So the first things are

    1. quit smoking,
    2. quit drinking,
    3. exercise to improve core strength and tone
    4. lose weight,
    5. proper diet/nutrition
    6. proper hydration with adequate intake of water
    7. proper sleep habits
    8. get/seek counseling for psychological factors
    9. expectation management–got to allow yourself time to heal

    Nine steps that ought to be done on every patient before resorting to such powerful meds.

    • Don_B1

      I agree with everything except the “before.” And that is because at least two (#3 and #4) cannot be instantaneous and adequate pain relief needs to be provided while waiting for the benefits of those alternate steps to “kick in.”

      Actually, items #5 through #9 are not instantaneous either.

      • Stephen706

        Nothing is instantaneous… pain develops often over time and will go away… non-pathologic pain in itself will not kill anyone… it can be managed without resorting to such meds…

        • Texas Star

          Some pain is so severe in people that they would prefer suicide to living with pain, so I would contend that you are wrong. There is the potential for serious harm and death. Not to mention interruption in activities of life, etc. Some people cannot be managed with non-opioids because of allergies, other concomitant disease states, etc, and other folks use them in conjunction with many other medications.

          • Stephen706

            True, and that as you are describing is pathologic pain, which is managed between patient and physician. No denying that. My reference above is focused for NON-pathologic pain which has and is mismanaged so badly that we are where we are. See the difference?

          • geraldfnord

            Pardon, but it looks to me that you’re using ‘pathologic pain’ in an idiosyncratic way—I take it to mean ‘pain not relatable to damage or inflammation’, which two sorts can’t to my knowledge ‘always’ be managed without opiates…and which can in fact kill someone (by inducing suicide or depressing immune response) or take away all rewarding activities in their lives, which is a form of living death.

            I agree with a more general version of your point, that management of non-pathologic pain is performed with an extreme lack of imagination, but I think that were better addressed by training and allowing patients more time to talk with their physicians, rather than new rules.

  • Stephen706

    Want a real eye opening experience–go to Topix.com and do a search for how to score Lortab or Vicodin and read the comments and well as deals being done… Or the websites dedicated to how to cheat on drug tests…

    Addiction is real and powerful and way out of control.
    Diversion and dealing is out of control.

  • https://www.facebook.com/kyle.rose Kyle Rose

    The supposed benefits of drug interdiction are not worth the loss of our civil liberties. Having known several people in my own family who deal with drug abuse, I sympathize with the friends and family members of those who have been impacted by abuse of opioids; but the alternative is pushing opioids further underground and combating it with an expanded Drug War, further eroding our rights against unreasonable search and seizure. Think of all the things that the drug war has wrought: civil forfeiture, police militarization, the greatest rate of imprisonment in the world, etc. That tradeoff is *not* worth it.

    • geraldfnord

      Well, some people believe that government were about maintaining ritual purity, not about some utilitarian goal of maximising pleasure or freedom, or minimising pain and the use of Authority (which is force veiled…still.better than naked force).

  • TVPC58

    Here in rural, Appalachian, Wilkes County, NC (also famous for its moonshine heritage ) there is an epidemic of prescription drug overdose deaths. Please comment on Project Lazarus as outlined in the following article. http://www.newsobserver.com/2013/04/26/2853232/nc-program-aims-to-stem-tide-of.html

    I believe that prescription opiate pain medications have more negative consequences for society than benefits for pain patients. These opiates are being over-prescribed and this is causing a public health hazard not limited to overdose deaths. Patients should not get more pills than they would use on a very short-term basis. This would prevent large inventories of these drugs easily available in homes so that unauthorized individuals cannot get at them for personal use or sale. The public safety concerns include increased robberies, burglaries, and traffic accidents. The addicted individuals become a burden to themselves, their families, and the community.

  • Judy Foreman

    I am a nationally syndicated health columnist with a new book, “A Nation in Pain – Healing Our Biggest Health Problem,” coming out in January. I am very concerned about the FDA’s action to restrict access to hydrocodone-containing drugs like Vicodin. That decision may or may not reduce the prescription drug abuse problem but it almost certainly will hurt legitimate pain patients who need the drugs and do not abuse them. Abuse is driving our whole thinking on this problem. It’s true that some people do die in opioid-related deaths – 16,651 people, in 2010, according to the federal Centers for Disease Control and Prevention. That’s too many, obviously. But only 29% of those deaths involved opioids alone – the rest also involved alcohol, benzodiazepines and other drugs. Yet opioids – and the patients who need them – get vilified. That is a shame.

    • Texas Star

      Ms Judy – I wholeheartedly agree with you. I think education of prescribers and intermediaries (eg pharmacists) should be more relevant and required. Also there should be more team based approaches because our fragmented health care system is also driving a great deal of this.

  • Tom

    Not everyone who takes Opiates are taking them for
    pain. I am an individual with a form of Parkinson
    disease and Opiates are part of my daily management to stop muscle cramps, electrical
    shocks and involuntary muscle movements.
    As we move to ban Opiates what will happen to us with neurological
    deseases?

    • Stephen706

      Not to ban but more strictly control prescribing and use… you have a real legit issue and reason and probably working well with your doctor. Not much will change.

  • lilybeth12

    I think the point just raised is one that deserves more attention in this discussion. Many of these drugs are poor ways to treat certain kinds of pain. More research needs to be done to find alternatives to opiates.
    My situation is somewhat of a case in point. I suffer from chronic migraines. If i were to use opiate based pain relief I would experience MORE pain due to rebound and alteration of the receptors in my brain. I’m lucky to have a doc who is up on current research, and has managed my issues with non-narcotic alternatives available.
    I also come from the viewpoint of having an uncle and a great-aunt (at 79) who had to go into treatment for opiate addiction after chronic pain therapy.

  • Davesix6

    Alcohol is by far the most abused drug available today.
    Yet the FDA doesn’t even regulate alcohol.
    Why, because regulation does nothing to stem demand, and in fact punishes the innocent.

    • geraldfnord

      I’d say that it’s more because Prohibition pointed-out the problems with regulating alcohol, and the cost thereof, so blatantly that all but the stupid and the ideologically blinkered could see them. Use of other drugs is associated with the dregs of society—dark people and loser white people, drugs are tabu-tabu, their merest touch defiles, and you can’t argue rationally with ‘Unclean!’.

      (It is in this way that medical marijuana was a beautiful stalking-horse for its total decriminalisation: when it can no longer be thought of as simply a defiling bit of filth, people can begin to think rationally on it.)

  • Deborah Holmes

    I believe that opiates should not be prescribed to developing brains. I lost my son a year ago at age 24 to a heroin overdose that began as a prescription for hydrocodone (Lortab) prescribed at 17 for a broken leg and subsequent bone graft surgery. With an IQ of 125, an amazing personality and intellect, an ability to pull others from the depths of their addictions and troubles, he could not, even with rehab, recover from his.

    • Dana Ortegón

      I feel helpless when my children are in any kind of pain.A s the mother of a 12 year old son, I can only begin to imagine the nightmare you must have gone through. I’m so sorry for your loss.

      • Deborah Holmes

        Thank you Dana.

  • http://www.myadvocates.com/ MyAdvocates.com

    The DEA just had it’s 7th Annual National Take Back Day on October 26th. Here’s the info on drug disposal: http://www.deadiversion.usdoj.gov/drug_disposal/takeback/index.html

  • Linda

    I am a pharmacist, and a chronic pain patient. There is a huge problem with individuals abusing substances, yes, however I believe both personally and professionally that restricting pain meds is only going to worsen the problem.

    Most folks who need the pain meds really need them and with tighter restrictions prescribers are less likely to prescribe. Most people who doctor shop and fraudulently fill prescriptions do so because they do not get sufficient pain relief.

    Making hydrocodone based products more difficult to get for patients with pain disorders is going to increase pharmacy robberies, black market sales, etc.

    I know there is diversion. But I think education is a better tool than further restrictions. As it is now my peers and I all basically consider ourselves quasi law enforcement because of how stringently we have to enforce the controlled Substances Act.

    Really better education for everyone is key. I always convert patients daily dose equivalents of opiates when they are transitioning to long acting opioids because often prescribers don’t. It is crucial to ensure that patients have proper dosing and monitoring, and prescribers and pharmacists have adequate training as well.

    This is a highly complex issue and a blanket Class change will be more harmful than beneficial. Perhaps implementation of more R.E.M.S. Program participation?

    • geraldfnord

      You fail to see that the pain and suffering induced by this change is meaningless when compared to the horrible alternative: many people will enjoy themselves in a way of which we disapprove, and some will become addicted to substances of which we disapprove (as opposed to caffeine, sugar, shopping, television).

      Permitting unlicenced pleasures and allowing Authority to be contravened is much more important than preventing mere suffering, which is probably _good_ for people. (For one thing, people who suffer tend to end up feeling that they deserve to suffer, and so are best led by people better than they, like the ones who yearn to lead us—pleasure and comfort make people act as if they had _rights_. For another, many of us believe that intense suffering of a perfect being is the only reason we won’t be tortured forever.)

      • Guest

        I’m sorry but I don’t understand what you are conveying. Are you saying that people who are in chronic unremitting pain, who cannot function because of it deserve this? And because they deserve this then the government should come in and regulate?

        • geraldfnord

          I am mocking the tendency of some to act as if this were the case—they might not _think_ that they agree that it were better that ten pain patients suffer than one person use them recreationally, or (with a chance of 10-20%) become addicted, but they reason as if this were the case. I was trying to make fun of an hysterical fear of addiction and recreation’s supervening basic human decency.

      • Texas Star

        geraldfnord
        • a few seconds ago • 0 0

        +

        Delete
        Flag as inappropriate
        I’m sorry but I don’t understand what you are trying to convey. Is it your position that people in chronic unremitting pain, often unable function because of it deserve this pain so should not be treated? And because they deserve this then the government should come in and regulate?

  • geraldfnord

    I’m concerned that Puritanism—a major component of our culture, along with its secret ally consumerist libertinism—is making people believe that addiction, for all its problems, and pleasurable use without addiction, which is more common, were evils at all morally comparable to forcing people to endure pain they would not otherwise face.

    The problems of addiction are very real, but many of them stem from illegality—my powerful caffeine addiction does me nowt harm, and for all the damage my sugar addiction has done me, prison would have done worse—and the ones that aren’t were best handled by social services. (Example: helping the addicted as we find them seems to work better at getting them off drugs than waiting for them to get sober-er [we've all suffered from a 'dry drunk' in office] before we help them…public housing for alcoholics seems to be doing well in Seattle.)

    Children suffering from their parents’ addictions? That’s bad, that’s hard, and I don’t wish to seem at all as snarkily self-confident in my views as in the above. I do have the reflex that when their welfare were used as a main argument (as in “The Simpsons”‘ famous ‘Think of the children!’, or the now-laughable ‘crack baby’ panic, poorly researched back then but very well-hyped, and in the end signifying nearly nothing) to be on my guard, as someone might be trying to hack my in-built protection and danger-awareness routines, but I think there is a actually real problem there, though I don’t notice its extent. My crude, preliminary, answer is to notice that we permit all sorts of inadequate people to be parents, and we should do what we can to make up for it in all cases…and if a parent leaves their [sic] pills where her kids can get them, they should be informed that very soon either their pills will be around the house or their children, but not both.

  • Stephen706

    we hold no one to personal responsibility… have you been to the ER (Free Care Center) lately??? No one accepts responsibility for their own actions and want a magic pill to fix it all!!!

    • geraldfnord

      We want it both ways: we want to believe that we aren’t at all socialist (a word that works better as an adjective than as a noun), but we don’t want the natural consequences of a market (that some will die, many will suffer, and even more get obviously substandard care, even if the standard of care does improve year-by-year, because they can’t afford otherwise).

      So we set up a semi-faux market in which our insurers can play-compete, and we can feel like virtuous capitalists….

  • truegangsteroflove

    This is a perfect topic to mention alternatives to pharmaceuticals. Three years ago I came down with a condition that was diagnosed as polymyalgia rheumatica, a version of rheumatoid arthritis. It came on suddenly after five days of taking Simvastatin, a medicine for cholesterol (beware). I was in intense pain from head to toe, joint and muscle.

    I was given Hydrocodone, which worked, but basically ruined my day, making me so wiped out I couldn’t do much except sleep. Prednisone, a steroid, was tried and it worked, but was deemed too harmful for long-term use. The doctors I saw at the VA gave up, recommending maximum strength Tylenol.

    I went to a naturopath, who put me on a cleansing diet, which mostly was removal of gluten, soy, dairy, sugar, and nightshades like tomatoes and potatoes. The pain gradually got better, but never went away completely.

    What made the biggest difference was the result of a simple Google search. I put in “natural treatments for pain,” and one of the recommendations that consistently was mentioned is turmeric. I bought some at the local food coop, and it had immediate effects, removing almost all of my pain. What remains is tolerable and sometimes is gone completely.

    Turmeric is a safe, non-addictive anti-inflammatory. In large doses it can be harmful, but there is no need to take large doses.

    Ask just about ANY standard practice medical doctor about alternatives and they will INVARIABLY either smirk, ignore, get irritated, or patronize. They have no training in herbs or other alternative practices, and their profession for some reason, likely money, is paranoid about lower-tech alternatives.

    So if you want to pursue natural treatments for pain or any other medical condition, you can, but it takes effort, and sometimes ridicule from orthodox practitioners. Turmeric is something you can try on your own. If you can’t find it locally, you can order it online. It may not “cure” your pain, but will likely reduce most pain significantly.

    Many also have been helped by yoga, tai chi, acupuncture, mindfulness meditation, Reiki, qi gong and chiropractic. I’m no expert on this. I’ve tried a lot of things, with mixed results. For pain, at least, I found something that works.

    • brettearle

      Statins did a number on me, too.

    • fun bobby

      plus obamacare won’t pay for any of that more effective less expensive stuff and the cheapest safest most effective drug remains banned

  • Dana Ortegón

    There were two factors to the delay. Initially, she was hesitant to undergo surgery and feared limited mobility. And then, a few weeks after she scheduled her first surgery, she was diagnosed with leukemia. They’ve postponed the surgery until her chemo is over.

  • Texas Star

    There was just a drug disposal day, yes. but other ways to dispose are to put a bit of liquid in the bottle with the pills to make them dissolve, then pour them into a sealable baggie with used cat litter, then put in your regular trash. this way they don’t get in the water supply and should not be able to be identified, picked out and taken/used

  • Texas Star

    As far as I am concerned there is no justifiable use for oxycontin in an opiate naïve person. The surgeon probably thought s/he was doing you a favor, but there really is no indication for a long-acting opioid pain medication for acute & limited post-op pain. Now Percocet, on the other hand, which is a combination of oxycodone and Tylenol, is frequently used.

  • http://www.myadvocates.com/ MyAdvocates.com

    The FDA’s priority is to protect the people, so yes, tougher regulation on highly-addictive prescription painkillers is necessary. While there are patients who need these medications, we also cannot let physicians abuse their prescription abilities and risk injuring patients.

    • brettearle

      And so a young man with a beard and tattoos–who doesn’t abuse drugs and walks into his doctor’s office with a fractured femur and it is especially painful–should be turned down for pain killers, simply because he looks like an addict?

      Because that is what is going to happen, more and more (I use the extreme case, above, to illustrate a more universal point)…..

      People are going to NEEDLESSLY suffer, simply because of the perceived biases of the providers/practitioners/

      caregivers who will be even more parsimonious in their disbursements of narcotics….due to blatant and unfair IGNORANCE.

      • Stephen706

        No this won’t. A fractured femur is a fractured femur. Now in a few months it should be healed and no longer necessary.

      • Stephen706

        Even if you were clean cut and Mr. All American, treatment for the acute injury and then wean off.

      • geraldfnord

        Sorry to be a broken wax cylinder, but you must admit that it were far better that a tattooed young person suffer than that anyone enjoyed themselves unacceptably (or, to be fair, coped with their addiction without bothering to get rid of it).

      • http://www.myadvocates.com/ MyAdvocates.com

        Doctors are human and do profile based on appearances, just like anyone else would. We hope this is uncommon. As you mentioned, your example is an extreme. The big question remains, where should the line be drawn on overprescribing these highly addictive drugs? Should we leave the system as-is and continue to see number of addicted patients go up?

        • brettearle

          First do no harm.

          To me that means first do no harm, to the RAW-PAIN SUFFERER.

          If MDs profile, because of appearances, THEN THEY ARE IGNORING THEIR BASIC COMMITMENTS AND ETHICS to the patient.

          And, if you pass this off, as incidental, then it is nearly as much of an OUTRAGE as the MD doing it him/herself.

    • fun bobby

      are you a krokadil dealer or something?

  • Tapdancer

    I am a 76 year old with diabetes and many other conditions that require medications that can cause liver damage. Because of this, my physician has determined that Hydrocodone is the safest pain medication for me. I cannot take any of the NSIDS. I have been taking Vicodin (now Norco with less acetaminophen) for about 10 years, averaging 1-2 pills/day and skipping days as often as possible to keep it effective. I need to stay as active as possible to improve my heart health and a lot of other health factors. I couldn’t do it without the pain medication.

    • Stephen706

      This won’t change things for you. You and your doc will continue onward.

      • geraldfnord

        Unfortunately, not: it will be much easier for her to run out on a week-end or holiday, and increased scrutiny of doctors might result in their [sic] being called-in and grilled as to why he’s ‘maintaining an addict’ in contravention of the law against that.

  • hennorama

    Open question:

    Will the provisions of the PPACA, making “mental health and substance use disorder services, including behavioral health treatment” part of the list of “”Essential health benefits” do much to reduce the dependency issues surrounding these drugs?

    • fun bobby

      no it will cause people to be given far more mind altering drugs

  • toc1234

    Hey Tom, just a heads up that due to the Sox playing tonight you may want to leave a little early for Obama’s fundraiser in Weston. Let us know tmrrw if it was more or less fabulous than the cash-grab party your colleague (Melissa block?) threw for him on the vineyard last year. and don’t forget to carpool w all the other NPR people! keep it green, you know.

    • geraldfnord

      Thanks for the mention—our daily orders from Soros and the Space Masons failed to make note of it.

  • http://www.drugpossessionlaws.com/ Drug Possession Laws

    Great subject! People in pain deserve relief, without question. But terrible addiction problems have resulted from easy access and abuse of these opiate prescriptions. And as law enforcement cracks down on the illicit prescription drug trade, we’ve seen addicts move to street drugs like heroin to feed a habit started with pills.
    Easier access to medical marijuana can help many people with chronic pain AND relief from quitting opiates, so it all comes full circle. But ultimately, it should be up to doctors and patients to figure out what is right for their needs.
    http://www.drugpossessionlaws.com/marijuana-treat-drug-addiction/

  • Stephen706

    How are you a recovering addict yet still on the pain medications

  • Stephen706

    You have real pathology. And there are many treatments available between you and your rheumatologist. Not denying that.

    But when you talk about chicken and egg– you start rationalizing deconditioning and deterioration. Yes, it may not be easy for you, but lifestyle changes will help your RA and Fibro and more. Won’t be easy but all the more reason why it needs to be firstline and not an afterthought. Get in a warm pool and exercise if need be, but exercising, losing weight and getting better sleep is the mainstay for Fibromyalgia–not opioids.

  • geraldfnord

    Potentially tl;dr:

    Shorter: Being inaccurate about drugs is the Prohibitionists’ job, not ours.

    I think that those of us who believe in less regulation of these have an obligation not to ignore the very real problems their use can induce, even in the absence of punishment.

    Cigarettes, and for that matter caffeine, became popular drugs partially because they were consonant with, or even assisted, ‘acting normal’—working for someone else, obeying other people, strangling your desires in their cribs, assuaging the pain that induces by shopping and by taking small pleasures (you may assert your quashed will in taking your coffee or cigarette), driving an automobile…I’m being snarky and prolix about it, but the point is simple: opiates, and hallucinogens, and cannabinoids, make it harder for many to Do What Were Expected of Them.

    Again, I think we’re probably in agreement as to what should be done with these laws, but I think too many of us too readily assume that _everything_ the gov’t or mainstream experts tells us were wrong. (Think of the anarchist saint who refused to pick some flowers in a public park despite the sign forbidding such, or those citizens of Russia astute enough to realise in the 1990s that ‘…everything They told us about Communism was a lie, but everything they told us about Capitalism was true.’)

  • geraldfnord

    They will be happy to help you; salaries are never high enough to make up for the danger they face on our behalf, and the evidence locker is not, regardless of what you might have heard, an endless fount of salable goods.

  • fun bobby

    and a great one against the medical device tax

  • ThisOldMan

    Given the medically incontrovertible facts that tobacco is as addictive as opiates, far more widely used, has no medical uses to speak of and ultimately kills a much greater fraction of its users, I find the FDA’s words and actions to be unbelievably hypocritical.

  • myblusky

    Wouldn’t it be better to come up with more effective treatments for pain instead of trying to fix this problem? Sure doctors shouldn’t be handing out drugs like candy, but pain sucks and it slows healing. And yes the current drugs are easy to get hooked on because that euphoria they produce is pretty sweet. I’m not even close to being a drug user, but I’ve been on scripted pain meds a few times and I can definitely see how someone would get addicted.

    It seems money would be better spent trying to understand pain – especially chronic pain – and come up with better treatments, especially ones that don’t ruin your kidneys and liver in the process.

  • Sy2502

    I have several friends whose Oxy prescription is still getting filled years after whatever it was prescribed for. One had an operation to fix a broken leg more than 10 years ago, and still gets refills. He’s completely addicted to it, and all he has to do is tell the doc his leg still hurts. To some of my friends it gets refilled automatically and mail delivered to their homes, to the point they have more than they can use, and just give their left overs around to whoever wants it. It’s turned into a complete joke, mediated by doctors that practice lazy medicine.

  • brettearle

    Your story is VERY significant.

    I am sorry for your loss.

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