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Oxycontin - The Pill of Pain
January 23, 2012 8:53 PM   Subscribe

OxyContin: Purdue Pharma's painful medicine. Among the sellers of opioids, none has been more successful -- or controversial -- than Purdue Pharma, maker of the No. 1 drug in the class: OxyContin, which generated $3.1 billion in revenue in 2010. Purdue and its marketing prowess are the biggest reasons such drugs are now widely prescribed for all sorts of pain, says Dhalla: "Purdue played a very large role in making physicians feel comfortable about opioids." And as we'll see, Purdue's past and present go a long way toward explaining how so many Americans came to be in the grip of potent painkillers.
posted by storybored (63 comments total) 19 users marked this as a favorite

 
Heroin and Speed. The two addictions of the US public which are disguised by the pharmaceutical industry for their profit motives. It's sad. We should just take up allowing sales of laudanum and dextroamphetamine again like we did at various points in our history. It would be more honest.
posted by hippybear at 9:08 PM on January 23, 2012 [4 favorites]


I am trying very hard to give this article an honest reading. I really am. I am trying not to snark in the thread before I've read the whole thing. It is very difficult.

Ok, I've made it to the end.

Full disclosure: my boyfriend has a herniated disc in his back. This is an injury that heals slowly, if at all. Surgical intervention requires money and time spent not-working that we as a couple do not have.

Without some form of medication, the pain from his injury interferes with sleeping, eating, going to work, using the restroom, putting on his socks, taking off his socks: every aspect of his daily life.

The draconian regulations around the prescription painkiller that he takes - vicodin - are such that he typically goes a week or two between refills, so every time he gets, yes, physical withdrawal symptoms. Every time he has to suffer for no god damn reason. Every time he has to go back on vicodin, which makes it very difficult to get to sleep for a couple days on its own.

Not once - not ONCE - does the author of this article address the issue of pain and its relief.

If you're talking about abuse of pain meds, does it not behoove you to talk about motherfucking pain? If someone has a chronic condition, does this guy think "well, fuck them, if you're not suffering you're a junkie".

Arggdfsgdfgsdg.

I mean it's not like the vicodin (by the way, it's mixed with doses of acetaminophen hefty enough to kill someone that tries to take more than prescribed) even fixes the pain. It just dulls it some. It's still there, every second of every day.

So no, I'm not worried that the rich and famous are able to abuse the drug that my boyfriend needs to live a normal life. Really do not give a shit.

And sentences like this?
We have become a nation of pill poppers.
Rhetorical flourishes - brightly blazing little strawmen - are inexcusable. Shameful. Incendiary statements made without any empirical data to back them up - just GIT THEM JUNKIES fear-mongering.

Awful. Without redeeming merit of any sort. Truly and exhaustively lacking in any sort of worth. If the author got paid for this piece, she should be charged with theft.
posted by kavasa at 9:11 PM on January 23, 2012 [127 favorites]


Big Pharma sucks.

On the other hand, why can't people in pain have painkillers without calling them drug addicts?

Someone's dying of a horrible cancer, and the government's worried they're going to become addicted?

Americans have some weird ideas about drugs, fer shure. Can we all drink to that?
posted by BlueHorse at 9:14 PM on January 23, 2012 [5 favorites]


Yeah OxyContin is terrible! It would be so much better if people suffering chronic pain were forced to suffer as much as god intended. I mean just imagine someone with constant, debilitating pain might become addicted to drugs!!

Then how could they be productive members of society!
posted by delmoi at 9:15 PM on January 23, 2012 [8 favorites]


We have become a nation of pill poppers.

And thank God. If I had to live in a time before Excedrin Migraine I think I would have offed myself a while ago.
posted by drjimmy11 at 9:21 PM on January 23, 2012 [2 favorites]


making physicians feel comfortable about opioids

Doesn't use of opium/morphine as a painkiller date back at least to ancient Greece or Rome, or probably further back in China? Fail.
posted by drjimmy11 at 9:22 PM on January 23, 2012


DrJimmy: Surprise. Opium isn't from China. The British forced it upon them. It's actually a European plant. (I thought as you before I learned. It's what the Opium Wars were about).
posted by Goofyy at 9:29 PM on January 23, 2012 [1 favorite]


Pain Patient Advocate Siobhan Reynolds Dies in Plane Crash
posted by homunculus at 9:30 PM on January 23, 2012 [2 favorites]


Leaving people in pain to stop some people from getting high is unconscionable.

I think we need to accept that people want to get high. Recreational drug use dates back thousands of years. We need to stop trying to legislate what chemicals people can put in their own bodies.
posted by Ad hominem at 9:31 PM on January 23, 2012 [10 favorites]


Pain needs treatment. Addicts need treatment. Treatment makes jobs. Oxycontin for all!
posted by Goofyy at 9:36 PM on January 23, 2012 [1 favorite]


On the flip side-- it's a really good painkiller. I've been unlucky enough to have two serious cases of kidney stones, last year the doctor prescribed me oxycontin for when the pain started ramping up and the stones played their fun game of conga with my insides while I waited on my surgery date.

It's got pretty horrible side effects for me, after one dose I got sweaty, felt nauseous, but that easily beats having the feeling of a rusty knife in your back (to be replaced by a mere butter knife), and when the pain started kicking in on a transatlantic flight, that little capsule was worth more then it's weight in gold.

Pain. Sucks.

And for when the pain really let loose, thank the stars for Fentanyl. I discovered my rather crappy superpower of being able to metabolize morphine super-quick when I first went in for my kidney stones at age 16. After they injected me with Fentanyl was the the first time I could take a full breath of air and just feel human.

I'm lucky enough that they can just cut me open and remove the boulders (great souvenirs), so the need of the drugs is gone, but someone living day in, day out with pain even a fifth what I went through, real chronic pain, my heart goes out to them and I hope they have every medical breakthrough at their fingertips to help them live their life in a comfortable manner.
posted by Static Vagabond at 9:45 PM on January 23, 2012


Oh, for fuck's sake:

"You could call it the invisible addiction: countless Americans -- including all manner of businesspeople -- taking medication prescribed to them who discover, months or years later, that they can't stop."

Being physically dependent is NOT synonymous with being addicted. (Numerous links rigorously explaining this are available and those interested might use Google Scholar—to find, for example, sources such as this one.)

The claim that physicians currently have an unprecedented level of comfort prescribing opioids is false. In truth, during this decade, primarily because of the explosion of OxyContin abuse, there has been a profound shift by practioners, especially primary care physicians, away from prescribing opioids for anything excepting cancer pain. It is the case that during the 90s there was a growing consensus that opioids were underprescribed. But that came to an end with the OxyContin abuse and the more reactionary Bush administration. Or, more specifically, with the vastly increased oversight and prosecution of physicians for alleged misprescribing of opioids. It is extremely common for primary care physicians today to either refuse to prescribe opioids out of principle, or simply for fear of running afoul with the DEA or a local prosecutor.

This article, like many others, conflates all opioid overdoses with prescribed opioid overdoses and ignores the vast trade in stolen and dishonestly acquired opioids which accounts for the overwhelming majority. That's not to say that opioid ODs don't happen among patients who legitimately are prescribed opioids, but then that's true of people who legitimately are prescribed acetaminophen and the triptyline antidepressants and the antianxieties and numerous other drugs. Any CNS depressant should be carefully prescribed and monitored with a large quantity of patient education. Those issues, by themselves, do not invalidate the rationale for opioid treatment for pain.

Chronic pain is best managed with a systematic, holistic treatment plan which includes things like diet and physical therapy and various other things besides medication that help alleviate chronic pain. Nevertheless, within the narrow context of pharmaceutical efficacy of pain treatment, there has never been, nor is there anything on the horizon, with the same ability to manage pain as the opioids.

Furthermore, anyone who lives with chronic pain and has been prescribed opioids can tell you that it's not even a little bit true that it is "easy" to acquire opioids, and that, in contrast, it's a never-ending set of hoops one must jump through, while constantly being scrutinized and suspected of being an addict. It's humiliating and, not coincidentally, it often perversely results in medication being unavailable once one has already become physically dependent, causing the entirely unnecessary misery of withdrawal.

That's why, and only why, I am no longer taking opioids. My previous doctor had worked out a comprehensive treatment plan that included both NSAIDs and opioids, as well as a lot of supervision. She was a pain specialist and the practice fired her and the other pain specialist because of budget cutting. Even with her, given the narrow constraints of my monthly renewal of my prescription, about once every three months there was a mistake made either in the doctor's office or the pharmacy and I would go into withdrawal because I wasn't able to get my refill in time. (I was taking oxycodone, which is what is used in OxyContin, and it has a short half-life, so the onset of withdrawal happens relatively quickly once the medication stops...in my case, with my dosage, within twelve hours.)

Now that the primary care physicians in the practice are left to handle the pain patients, many of us found ourselves SOL because, for example, my particular primary care doctor simply refuses to prescribe opioids on a chronic basis. Period. I could switch to another practice and/or a specialist, but I am extremely sick of this whole load of crap and would actually rather live with more pain instead of dealing with it. The medication mix my previous pain doctor had come up with managed my pain better than anything I've ever experienced. But, instead, I'm living in more pain than I need to simply because it's not true that it is "too easy" to get opioids.

Finally, the abuse of opioids has been driven, as this article describes (undercutting its argument, actually) by the explosion of OxyContin prescriptions, the subsequent abuse of it, and the expansion of opioid abuse in general that followed. And that's not the fault of opioids, or even of physicians which over-prescribed them. It's the fault of Purdue Pharma and the FDA, both of whom stupidly and suspiciously claimed/believed that the extended release formulation of OxyContin would prevent it from being prone to abuse because it wouldn't cause the quick-onset "high" that is very strongly linked to drug abuse and addiction.

And, taken properly, OxyContin doesn't cause a quick-onset high. But if you crush the pills...well, it does. This is mind-numbingly obvious, it should have been obvious in clinical trials, it should have been obvious to everyone, and most specifically the FDA. And yet, mysteriously, it was approved under a more flexible guideline because it was supposed to be not prone to abuse.

Instead, it became the single most abused opioid in modern history.

This isn't the fault of opioids. It's the fault of a corrupt pharmaceutical industry and a questionable FDA which has arguably been the victim of regulatory capture.
posted by Ivan Fyodorovich at 9:45 PM on January 23, 2012 [29 favorites]


Truly and exhaustively lacking in any sort of worth.

When I read articles like this on sites like CNN, I immediately discount the whole article. This writer is just hacking a piece with enough information to make it sound like it is worthwhile to read. In reality, it is just an apologist piece for a company that wants to spin their involvement in a problem that demonizes legit users.
posted by lampshade at 9:54 PM on January 23, 2012 [1 favorite]


If you're talking about abuse of pain meds, does it not behoove you to talk about motherfucking pain? If someone has a chronic condition, does this guy think "well, fuck them, if you're not suffering you're a junkie".

Bingo. Our entire approach to pain is shot through with this idea: opioids are "bad" (whereas NSAIDs and corticosteroids are acceptable even though they can be quite harmful, partly because they're not used for recreational purposes), and marijuana is so "bad" -- solely because it's used recreationally -- that it's still a Schedule I drug more than thirty years after modern studies suggested it was medically useful.

Would that we could confront our bizarre hang-up about drug use... until then, I guess we'll keep causing out-and-out suffering for many people, as serious physical harm and/or relative ineffectiveness as a painkiller are treated as less of a problem than simple dependence on safe, effective drugs.
posted by vorfeed at 9:58 PM on January 23, 2012 [3 favorites]


"I'm lucky enough that they can just cut me open and remove the boulders (great souvenirs), so the need of the drugs is gone, but someone living day in, day out with pain even a fifth what I went through, real chronic pain, my heart goes out to them and I hope they have every medical breakthrough at their fingertips to help them live their life in a comfortable manner."

Static Vagabond, for what it's worth, I've had five or so kidney stones. I have pretty severe chronic pain from extraordinarily severe osteoarthritis (like something you'd see in someone 80+ and I'm 47). "They" often say that kidney stones are just about the worst pain people commonly ever will experience; I've had women tell me that it's worse than what they've experienced with natural childbirth. In my experience, the only pain I've ever had that was comparable was an abdominal abscess, which I ironically thought was yet another kidney stone and so didn't bother going to the ER for three days expecting that I would pass it soon enough and it would be over. (Because I never had anything other than palliative treatment for my kidney stones—as you know, it's rare for the ultrasonic or surgical treatments to be performed because most people will pass the stones within some number of days.)

Anyway, I mention all this by way of explaining both how true it is what you say—that kidney stones are excruciatingly painful—and what it's like to experience that in the context of someone who has constant chronic pain.

And that is, yes, other than the abscess, they are easily the most severe pain I've experienced, and that includes post-surgical pain from a dual hip osteotomy when I was ten.

Yet, on the other hand, it wasn't really that big of a deal to me. I've lived with pain for much of my life. For those five kidney stones, and for the abdominal abscess, you wouldn't have known I was in as much pain as I was unless you examined me closely. I was sweating and my pulse and BP and respiration were all heightened. But otherwise I was always calm. When I went to the ER for the abscess, after it getting worse and worse over three days, I calmly walked up to the ER receptionist and told her that I had very severe abdominal pain, on a scale of one-to-ten, a nine. I had a friend who had a kidney stone and he was literally screaming while I sat with him in the ER.

And this has a lot to do with the fact that I live with chronic pain. That doesn't mean that I don't feel it. In one sense, I don't. But, really, I still do. It's just that unless it's particularly severe, I have to actually do a mental check to see how bad it is. It's always there, so I long ago learned to not notice it consciously. The thing is, though, is that it's still there and, as I've often explained to people, all the things that come along the ride with chronic pain are what really disable me. Such as being deeply exhausted all the time. Pain involves an inflammatory response, and it's not just pain. The inflammatory response is still there even when the pain is managed with opiates (thus why someone in my situation will also take NSAIDs) and the inflammatory response has all sorts of other effects.

In a way, I think that maybe I'd be more receptive to the suspicion against opioids if it were the case that chronic pain is just pain. That would be a mistake on my part, of course, because no one should be expected to simply live with pain. But, still, my own experience has been that pain itself is something I can mostly ignore. What I can't ignore is everything else. And, yeah, the opioids help with some of that and not with other parts of it. Like, for example, having to fight against being a jerk to other people because I'm in a lot of freaking pain. Opioids certainly do help with that.

Anyway, I think I'm rambing, so I'll shut up now. I've said my piece here before on this topic, so there's little point rehashing it all again.
posted by Ivan Fyodorovich at 10:05 PM on January 23, 2012 [5 favorites]


Wondering if anyone has any thoughts about synthetic opioids vs natural opiods.

I was recovering from a vehicle accident and was put onto a synthetic opioid for pain relief and I had a psychotic reaction where I removed my dressings for what were compelling reasons at the time. When I became cogent an hour later I consulted with the pain doctor and she switched me to a natural opioid but only after I explained what had happened and that I would not be taking the previously administered pain relief under any circumstances.

It was clear that there was a heavy reluctance to switch from a synthetic substance. I was wondering why this would be the case?
posted by vicx at 10:06 PM on January 23, 2012


Would that we could confront our bizarre hang-up about drug use... until then, I guess we'll keep causing out-and-out suffering for many people, as serious physical harm and/or relative ineffectiveness as a painkiller are treated as less of a problem than simple dependence on safe, effective drugs.

It's almost like we're a society that venerates Mother Teresa or something.
posted by rodgerd at 10:13 PM on January 23, 2012 [4 favorites]


Probably because the synthetic was much stronger and therefore more effective. And probably more typically clinically used in a hospital setting. Your reaction was probably not because it was synthetic, but more likely simply because you were heavily drugged and later, on the natural opiate, less heavily drugged.

Unless maybe it was some really weird and unusual synthetic. But it was probably just fentanyl.

People can have fairly idiosyncratic reactions to opioids. It's messing with pretty fundamental brain chemistry, and doing so in a pretty ham-handed fashion. That's why, really, they're so widely and unusually effective.
posted by Ivan Fyodorovich at 10:14 PM on January 23, 2012


kasava: [i](by the way, it's mixed with doses of acetaminophen hefty enough to kill someone that tries to take more than prescribed)[/i]

Is this a required ingredient of the medication, or is it introduced for the sole purpose of "discouraging" abuse? Sort of like the US government's Prohibition-era lacing of alcohol with fucking rat poison or whatever it was.
posted by Kandarp Von Bontee at 10:15 PM on January 23, 2012


Jesus, this article is horrible.

The "pharm" parties where kids empty their parents' medicine cabinets, dump the haul into a bowl, and ingest random pills.

pharm parties, eh?

Might as well throw in something there about rainbow parties while you're at it. Maybe even that the kids are throwing combined pharm rainbow parties! That should rile up your scared old white audience some more!

There's more shit, but I don't even want to waste my time responding to it all.

We have become a nation of pill popperslazy hack journalists.
posted by formless at 10:25 PM on January 23, 2012 [11 favorites]


"Is this a required ingredient of the medication, or is it introduced for the sole purpose of 'discouraging' abuse? Sort of like the US government's Prohibition-era lacing of alcohol with fucking rat poison or whatever it was."

The latter in the case of the US. It's not just acetaminophen, although it's suspiciously the most common. ("Suspiciously" because of those it's often paired with, it's the most toxic.) It's not the case that there's never any clinical rationale for such a pairing. There often is. But it's also the case that there often is not; and, worse, there's a strong counter-rationale for the inclusion of acetaminophen given how widely it's used in OTC medications and how frequent there are fatal acetaminophen overdoses. And, it should be noted, outside of the US this is certainly not the universal or frequent norm.
posted by Ivan Fyodorovich at 10:32 PM on January 23, 2012


Is this a required ingredient of the medication, or is it introduced for the sole purpose of "discouraging" abuse? Sort of like the US government's Prohibition-era lacing of alcohol with fucking rat poison or whatever it was.

Hydrocodone and paracetamol/acetaminophen have a synergistic effect when used together, which allows for a lower dose of each.

That said, Vicodin and similar mixed-opioid drugs are classified as Schedule III drugs, whereas pure hydrocodone is on the much more restrictive Schedule II. It's hardly available in the US, even though it's much less likely to lead to harmful overdose... hmm.
posted by vorfeed at 10:36 PM on January 23, 2012 [1 favorite]


I was on Fentanyl (no problems) and then Oxy(problem) and then Morphine (no problems). Just did some reading about opioid receptors and it looks like Oxy works on the kappa receptors while the others don't however IANAD. I had no problems on Fentanyl and it is strong enough to take away a lot of pain.

On the abuse of pain relief maybe we need to focus on the sources of pain. No easy solutions there and none profitable. It is just a very big subject.
posted by vicx at 10:36 PM on January 23, 2012


homunculus: "Pain Patient Advocate Siobhan Reynolds Dies in Plane Crash"

Thank you for posting that. She is missed.
posted by gingerbeer at 10:44 PM on January 23, 2012 [2 favorites]


Arggdfsgdfgsdg.

Yes! Not that I wish real pain on anyone, but it might help give Katherine Eban some perspective. Before I broke my kneecap (hence the name) a few years back, I had no no no no no fucking clue what real pain might be. Passing out if your leg moves is the sort of pain that resets that scale of 1 to 10 on which docs ask you to indicate your discomfort. Once I thought I knew what 10 was, but after my accident I knew that I'd really only experienced a 4.

Thank god for morphine. And once the surgery was over and I was pinned and wired back together and released from hospital, oxycontin made life bearable and recovery successful. You can't get better if your body is screaming at you in pain. Oxycontin made it possible for me to sleep, and later to begin rehab. I felt no high during this time, I just felt a lot less pain.

I knew I didn't need it when it started to buzz. Then it was easy to stop. For me the pain was not chronic, and once it was done with me, I was done with oxy. But I will always be grateful for that wonder of pharmacy, and begrudge no one who needs it.
posted by kneecapped at 10:48 PM on January 23, 2012 [2 favorites]


Well, fentanyl is a synthetic, too. So, as you mention, it's probably some other distinction that caused the problem, then.

"No easy solutions there and none profitable. It is just a very big subject."

Well, yes. Ideally, you'd always eliminate whatever is causing the pain. In reality that's often not possible or even apparently nonsensical (when the pain is idiopathic). In my case, I have an extraordinarily rare genetic mutation that causes my collagen, and therefore cartilage, to be defective. Short of a non-existent (though perhaps soon otherwise) gene therapy, there's a very limited range of therapy to treat the underlying condition. Basically, for the worst joints, it's joint replacement. And that doesn't eliminate the osteoarthritis even in the replaced joints, and certainly not in all the others which haven't been replaced.

My father, for example, had both hips, both shoulders, and one knee replaced. My sister has had both hips replaced. I've not had any, but that's not because I don't need it done. It's because...well, I have no good explanation for that, really. It's a topic of some discussion among those who care about me. But, anyway, unless you can actually correct the mutated gene and therefore stop the production of the faulty collagen, there's a very limited amount of treatment possible for the underlying cause of the pain.

This is true for a very large number of diseases. And even when it is not, there's always going to be some interval before such treatment is performed but while the disease and consequent pain is present. Pain management will always necessarily be an important part of patient care. Not just because people shouldn't needlessly be in pain, but also, as I wrote, there are unhealthy ancillary effects that result from pain itself.
posted by Ivan Fyodorovich at 10:51 PM on January 23, 2012 [1 favorite]


I still haven't forgiven the ER doctor I saw after I was rear-ended. I was already crying in pain, and after she told me in great detail how the pain would get worse before it got better - gleefully advised me to take over the counter painkiller. Because a week's worth of muscle relaxer/pain relief may have been addictive.

Three years later, and I'm still in pain from my fucked up neck. No job, no medical insurance, no physical therapy, no treatment plan - but at least I'm not a pill popper!

Yay.
posted by Space Kitty at 12:45 AM on January 24, 2012 [7 favorites]


Honest question here, why aren't more people growing opium in their backyards, like we do with ganja? It is a pretty hardy plant and the process of harvesting isn't really that complicated. When I have some land, I'm gonna grow poppies so that I can take care of my own pain problems when I get older.
posted by Meatbomb at 1:53 AM on January 24, 2012


My front garden is overrun with the damn things. Plant just a couple and they rapidly take over anywhere anywhere they've been allowed to go to seed -- no cultivation necessary.
posted by PeterMcDermott at 1:58 AM on January 24, 2012


I think the reason why people don't grow opium poppies seriously is because the yield is piss poor compared to ganga. Which isn't to say that it never happens. I remember reading in a police publication about a man who'd been arrested for having a quarter acre of papaver somniforum under cultivation here in the UK. When they'd arrested him, they also found a couple of ounces of his own home-grown opium.

Until very recently though, it made more sense just to buy your opiates on the black market. The persistent drought we've seen in the UK of late (with concomitant reduction in purity levels) might be changing that though.
posted by PeterMcDermott at 2:06 AM on January 24, 2012


Yeah, it takes a lot of plants to produce much opium and to do it where you're not wasting it, that is, how it's normally done by slitting the plants and harvesting the sap, is really darn obvious to anyone who looks at the plants and is cause to be arrested in the US, as I understand it.

It's kind of funny given how common the plant is. It's amazing that it's as successfully controlled to the degree that it is.
posted by Ivan Fyodorovich at 2:32 AM on January 24, 2012


I'm also addicted to air and water... unable to stop.
posted by blue_beetle at 5:02 AM on January 24, 2012


And this has a lot to do with the fact that I live with chronic pain. That doesn't mean that I don't feel it. In one sense, I don't. But, really, I still do. It's just that unless it's particularly severe, I have to actually do a mental check to see how bad it is.

This.

My wife was the same, having had to live with chronic pain for decades, ever since she had survived a bout of the kind of cancer you usually don't survive from, which left her with loads and loads of neat little side effects, including almost dead kidneys. She could live with pain that would've left me crippled in bed howling unable to do anything but that.

Of course, being so stoical in the face of pain also meant she was not as likely to actually get the painkillers she needed because she wasn't obviously suffering. Even more ironically, having had to use extremely serious opiod painkillers when she had cancer as well as having had to take things like morphine sulfate to regulate her insides and deal with the chronic pains she had als left her with a quite high opiod tolerance, which meant that when she did get more serious painkillers, they never worked as well as they should've.

One thing that did help a lot in making life bearable was able to smoke weed, which didn't so much make the pain go away as to put it in a place where it didn't bother her so much. We spent a lot of afternoons the last two years in quiet corners of the hospital grounds smoking dope. Nobody ever said anything about this; her doctors all knew and if not approved, at least tolerated it, while the only time somebody else said anything about it it was a polite request by a bored security guy to please do it outside the designated smoking huts as the smell might bother regular smokers.

Three guesses which country this was in.
posted by MartinWisse at 5:22 AM on January 24, 2012


These medicines are very effective at low doses and significantly fuck people up at high doses. It would be very easy for as elf medicating individual to cross the threshold. I think medical supervision and control of access is a good thing. The real problem isn't access to drugs, it's access to good doctors.
posted by humanfont at 5:34 AM on January 24, 2012 [2 favorites]


Wondering if anyone has any thoughts about synthetic opioids vs natural opiods.

yes, almost constantly.
posted by quonsar II: smock fishpants and the temple of foon at 6:03 AM on January 24, 2012 [1 favorite]


The draconian regulations around the prescription painkiller that he takes - vicodin - are such that he typically goes a week or two between refills, so every time he gets, yes, physical withdrawal symptoms. Every time he has to suffer for no god damn reason. Every time he has to go back on vicodin, which makes it very difficult to get to sleep for a couple days on its own.

This kind of thing, yes. I am far, far more worried that I'll get cancer or some other grave illness and die in screaming agony because the doctors won't medicate me than anything else about drug use.
posted by Frowner at 6:24 AM on January 24, 2012 [1 favorite]


Chronic pain sucks! I don't know what it is like *NOT* to be in pain. I've had this curse for a decade now and I am in my mid twenties. Every morning I wake up after about 4 to 5 hours of sleep feeling as if I've been assaulted in my sleep. I have nerve pain that radiates down my leg in a variety of different ways, shooting, burning, and my left leg feels as if it is always asleep. Seriously, it drives one mad.

If it wasn't for drugs, anything that will take some edge off... I don't want to think of what I'd do. It is a sad place to be, but walking in my shoes is nothing short of a nightmare or a punishment.

Getting opiate medication is like pulling teeth. I've had the same doctor for years, and she is always concerned about "going down that rabbit hole". Little does she seem to comprehend I am already in a dark hole, one of constant.fucking.pain.

I wouldn't wish having arthritis of the spine on anyone. The chronic lower backpain, the muscle spasms brought on by bulged discs in my neck pressing on my nerve sheath, and the nerver pain down my leg are a constant reminder, always on the forefront of my mind.

Anything that will numb or quiet that noise is helpful. I've used legally/illegally most opiate medications, including oxys and percs, and when I've had the chance opium. These medications are a double edge sword, but a godsend when it comes to quiet the never ending screaming pain from within.

Also, I will second how much rationing and withdrawing sucks (have never had it too bad, but certainly mild case, its not fun).
posted by handbanana at 6:39 AM on January 24, 2012 [1 favorite]


Haven't read the article yet (the reviews in the other comments aren't encouraging:P), but I have lived in two regions where oxycontin abuse has been a significant social problem. The history here is really interesting (if you don't mind being depressed and aggravated by the sheer amoral greed of large drug companies). If anyone's interested in learning more about the issue of oxycontin abuse from a more neutral, non-judgemental perspective than the linked article seems to be, I highly recommend the film Cottonland.

Oxycontin was first marketed heavily in the Appalachia region, where a lot of former coal miners had real issues with chronic pain 'cause that's what coal mining does to bodies. It was marketed as being completely safe and not prone to abuse unlike other opioid pain medications, due to the particular time-release formulation. But as Ivan points out, that's only if you take the pills as prescribed. Combine a significant population of people dealing with chronic pain with depressed economy due to coal mines getting automated or shutting down and significant proportion of young people with no job prospects to speak of and no other opportunities 'cause it's a poor rural area and a lot of free time, and you end up with a pretty significant drug abuse problem, increased levels of violent crime, etc. These problems were reported to the drug company that produced oxycontin, local pharmacists and medical professionals set up programs to monitor prescribing of oxy more carefully, invested more heavily in security and not keeping large supplies of drugs on hand measures to help prevent violent robberies at pharmacies, etc. Big drug company sees reduced profits as its market for the drug decreases due to these measures.

Fast forward about ten years and head up the Appalachians toward Downeast Maine. Here there are a lot of former lobsterman and people who have worked on other sorts of fishing boats for all their lives who have real issues with chronic pain 'cause thats what fishing does to bodies. Oxycontin was marketed as being completely safe and not prone to abuse unlike other opioid pain medications, due to the particular time-release formulation. But as Ivan points out, that's only if you take the pills as prescribed. Combine a significant population of people with chronic pain with a depressed economy due to reduced fish stocks and competition pressures from offshore factory fishing that smaller fishing communities can't keep up with and significant proportion of young people with no job prospects to speak of and no other opportunities 'cause it's a poor rural area and a lot of free time, and you end up with a pretty significant drug abuse problem, increased levels of violent crime, etc. These problems were reported to the drug company that produced oxycontin, local pharmacists and medical professionals set up programs to monitor prescribing of oxy more carefully, invested more heavily in security and not keeping large supplies of drugs on hand measures to help prevent violent robberies at pharmacies, etc. Big drug company sees another dip in profits as its market for the drug decreases due to these measures.

Fast forward another ten years and head down the coast to northern Nova Scotia and Cape Breton. Here there are a lot of former coal miners who have real issues with chronic pain 'cause that's what coal mining does to bodies. Oxycontin was marketed as being completely safe and not prone to abuse unlike other opioid pain medications, due to the particular time-release formulation. But as Ivan points out, that's only if you take the pills as prescribed. Combine a significant population of people dealing with chronic pain with depressed economy due to coal mines largely getting shut down and significant proportion of young people with no job prospects to speak of and no other opportunities 'cause it's a poor rural area and a lot of free time, and you end up with a pretty significant drug abuse problem, increased levels of violent crime, etc. These problems were reported to the drug company that produced oxycontin, local pharmacists and medical professionals set up programs to monitor prescribing of oxy more carefully, invested more heavily in security and not keeping large supplies of drugs on hand measures to help prevent violent robberies at pharmacies, etc.

... I hear somewhere out west is having problems with oxycontin abuse now?

The problem with oxycontin is that, from what I hear, it is a great drug for pain management when used appropriately, which is part of why it became so popular. But it's also been marketed in a very exploitative way, in particular to poor rural communities where you don't hear when there is a major social problem, because nobody cares about those communities. So we combine major structural issues around rural poverty with unethical marketing practices of drug companies with plain old classism on the part of the broader society and media, and what might have been a small problem easily prevented has become much larger and harder to solve.

The article, which I have just now browsed, seems to obscure the fact that the problem is not so much people who are actually in pain abusing their pain medication, but that people who are in chronic pain but also seriously poor will sell some of their pills to other people who are not in pain who then use oxy recreationally, or people who are not in chronic pain will obtain oxy prescriptions under false pretenses from naive or unethical medical practicioners or through less legal means. Selling pills provides income for people who have limited other options to make money, and can you blame people with few options or prospects in life if they want a bit of recreational release and provide the market? Also, when injected rather than taken in the carefully measured time-release pills, oxycontin is highly addictive.
posted by eviemath at 6:47 AM on January 24, 2012 [2 favorites]


Agreed: terrible article. The problem with drugs is that they are metabolized at different rates by different people, to a far greater extent than (it seems) anyone is willing to recognize. Yes, for medications that cause physical damage like liver or kidney function, they mandate regular testing. But for drugs that simply don't work well enough when there is a big enough difference in metabolism, the standard procedure seems to be just to "suck it up" or give up and try something different. Titrating doses is labor intensive and difficult, and Oxycontin was developed to try to help with that. I don't see where that's a bad thing. Maybe they didn't get it quite right, but I just don't see the malice and greed that others do. Maybe their marketing was over-optimistic, but that seems like the FDA's failure. It still, as far as I can tell, is a *better* option than handing a patient a bottle of 180 small doses and saying "make it last a month".

The good news is that as science progresses, we ought to be seeing more and more drugs available in patch form, which should help in being better able to manage symptoms.
posted by gjc at 6:59 AM on January 24, 2012


gjc, the marketing greed comes in where the drug company made the exact same claims about the safety of the drug to different communities, over the span of a couple decades, despite knowing the potential for recreational abuse and the social cost to other communities when the drug was not used as prescribed.
posted by eviemath at 7:09 AM on January 24, 2012


I've had fentanyl as well, downside is the time it takes to kick in and doesn't address breakthrough pain which once it starts its hard to get under control. And fuck acetometaphen. It is worthless and liver damaging. Particularly for us who take pain medication regularly.
posted by handbanana at 7:11 AM on January 24, 2012


Wondering if anyone has any thoughts about synthetic opioids vs natural opiods.

This is a artificial distinction.
posted by Kid Charlemagne at 7:19 AM on January 24, 2012 [1 favorite]


The good news is that as science progresses, we ought to be seeing more and more drugs available in patch form, which should help in being better able to manage symptoms.

Patches really come into their own for materials with a small dose and a short half life. For something where dosing is as variable as pain medication, patches are going to have issues. And if people will crush up and inject Oxycontin, they'll learn how to do solvent extraction on drug patches, so it really won't accomplish much in the long run except to drive up the cost of pain management because those patches have to be developed and tested and will have a reduced shelf life.
posted by Kid Charlemagne at 7:34 AM on January 24, 2012


Probably a national, non-profit system to provide complete medical care as needed rather than as people are able to afford it would go a lot farther toward helping people in the U.S. (and even in Canada, where provincial health insurance often doesn't cover drugs, dental care, or other "extras") manage chronic pain.
posted by eviemath at 7:42 AM on January 24, 2012 [1 favorite]


As background, I have long-term issues with my back, including a 4-hour surgery a couple of years ago for a ruptured T-11/12 disc. I always have a small supply of hydrocodone on-hand in case of flair-ups.

I think doctors are timid about prescribing opioids is because their prescibing histories are reviewed by authorities. If my doc suddenly started writing me Avinza scripts every month, he'd be red-flagged like a May Day parade. Their skittishness is a CYA reflex. I really can't blame them.
posted by Thorzdad at 7:48 AM on January 24, 2012


We should just take up allowing sales of laudanum and dextroamphetamine again like we did at various points in our history. It would be more honest.

Indeed, it would! In fact, we still do allow sales of dextroamphetamine, though its not marketed as broadly as it used to be. I take it for ADHD, I've found it to be less physically strenuous than Adderall, plus it's dirt cheap because it's way out of patent and it has a well-known clinical profile. I also haven't (luckily) been affected by the recent Adderall shortages. I do, however, need to see the psychiatrist for each prescription, I've had to have 5 different pharmacies checked for stock one time and they won't tell me over the phone whether it's in stock - I have to go to a store and then have them call around if it's not in. This is ostensibly to prevent robberies (wherein someone who has been coming to the same pharmacy for the same prescription over 4 years suddenly decides to start robbing it?).

I've got to say, laudanum is pretty nice as far as opoids go. Though there might not be a clear chemical or pharmacological distinction between synthetic and natural opoids, there are certainly differences in opoids. Things that are more quick up are more quick down - at the extreme end of this would be shooting heroin/dilaudid/oxycodone (seconds to up, hours to down). Things that are more slowly up are more slowly down - at the extreme end of this, laudanum/poppy tea (takes 2-3 hours to fully kick in, over 24 to fully come down). My experience has been that the quicker the rise, the greater the "jones" and compulsive behavior. I wouldn't think "oh, man, I gotta do some more tea" every couple hours because it won't start doing anything for a while and it'll last a long time. That does not mean it does not have withdrawals, though. After using it every other day for a few weeks once, I ran out and decided to take a break. I thought that since I could go a full day without it I wasn't physically dependent. 2 days later, oh shit...not feeling good.... Had to take off work, get some drop-shipped, and taper slowly for a month of low-grade feeling crappy. That's still a lot better than what I've seen from friends that have had serious habits with stuff, though.
posted by nTeleKy at 8:22 AM on January 24, 2012 [3 favorites]


I had a friend who spent a month in the hospital in excrutiating pain, then had oxy to manage it on release. 2 months later, she was totally addicted and spending $80/day (street price) to just ward off the horrible withdrawl symptoms.
I wish there were more public clinics to help people regulate and deal with withdrawl. I wish the pharmaceuticals would reinvest some of that $3.1 billion in to alleviating the shame of painkiller addiction, and helping people step back from that often-hidden trap.

My friend is in treatment, she's getting better. She's now on a far lesser dose than when she started.
But she was recently diagnosed with a spinal problem, which will bring on bouts of major chronic pain, which will mean more exposure painkillers...
posted by Theta States at 8:38 AM on January 24, 2012


Is this a required ingredient of the medication, or is it introduced for the sole purpose of "discouraging" abuse? Sort of like the US government's Prohibition-era lacing of alcohol with fucking rat poison or whatever it was.
It's a combination of things. The doctor informs him that tylenol increases the efficacy of the hydrocodone, but there are also a variety of ranges of pills, with more or less tylenol. This is so that doctors can prescribe increased doses of the drug without killing their patients. There are also European countries where you can get unmixed prescriptions of the drug.

So there's a legit reason for the mixing (making the drug work better) that is then exploited to provide an excuse for an illegit reason (poisoning people that regulatory bodies think are junkies).

Ivan - thank you very much for your posts in the thread! I think you said everything very well. I'm very sorry to hear that you're in a lot of pain, all the time. =(
posted by kavasa at 9:31 AM on January 24, 2012


America has the best medical care in the world!

Unless you're in pain or lack money.
posted by Goofyy at 9:33 AM on January 24, 2012 [4 favorites]


Honest question here, why aren't more people growing opium in their backyards, like we do with ganja? It is a pretty hardy plant and the process of harvesting isn't really that complicated. When I have some land, I'm gonna grow poppies so that I can take care of my own pain problems when I get older.

Poppies are actually illegal to grow in [some|many] parts of the western world, for one thing. The drug panic is at the point than when my wife was editing a children's book years ago, one of the things she had to do was re-shoot all the pictures of poppies in it, because they wouldn't be able to sell into the Californian market with pictures of opium poppies, so they had to go find a bunch of Icelandic poppies instead.
posted by rodgerd at 10:21 AM on January 24, 2012


On the abuse of pain relief maybe we need to focus on the sources of pain.

You were right that there are no easy answers in this area.

Sometimes the source of pain cannot be cured - or can only be cured with time. Sometimes the source of pain is not even known. We don't actually understand pain all that well.

People are going to be in pain for the forseeable future. Even were we to pour all of the money patients currently spend on painkillers in the US into pain research, it is unlikely that we would have a pain-free future anytime soon.

In the meantime, people will need pain relief. Focusing on the source of pain is not an alternative to allowing them the drugs that they need.
posted by Kutsuwamushi at 10:41 AM on January 24, 2012


I just got a scrip for Vicodin yesterday for severe neck pain that has interfered with my work, sleep, and personal life. And I was scared to ask for painkillers lest I be pegged as an addict. I space out my doses as much as I can stand so I don't become dependent, but I wonder how many people suffer because they're afraid to ask for what they need.
posted by desjardins at 11:09 AM on January 24, 2012


Oxycontin Blues
posted by Blazecock Pileon at 12:42 PM on January 24, 2012


That's what happens when a "war on drugs" goes unchecked for 30 years.

Also, you may want to consider avoiding acetaminophen unless you don't drink, have an ulcerated stomach or otherwise like having an inflamed liver.
posted by onesidys at 1:45 PM on January 24, 2012


rodgerd, I'm not sure it's so cut and dried. This (US) article IIRC says something like "poppies themselves aren't illegal, unless you're growing them to make opiates". But the idea that "opium poppies" are illegal to grow has certainly been promoted by law enforcement groups here in Canada and in the US.
posted by sneebler at 9:30 PM on January 24, 2012 [1 favorite]


Yeah, they say that as a kind of propaganda to discourage it even though poppies which can produce opium are not some rare variety that law enforcement is out scouting for. They're everywhere. So, no, it's not illegal to grow them.

But, as I wrote earlier, as I understand it, you can be arrested for harvesting the latex and doing so in a conventional manner leaves pretty unmistakable evidence.
posted by Ivan Fyodorovich at 10:37 PM on January 24, 2012


sneebler, that article was an excellent read, thank you.
posted by Meatbomb at 1:18 AM on January 25, 2012


These medicines are very effective at low doses and significantly fuck people up at high doses.

But the upfucking is completely reversable with a safe and inexpensive drug called naloxone.

It would be very easy for as elf medicating individual to cross the threshold. I think medical supervision and control of access is a good thing. The real problem isn't access to drugs, it's access to good doctors.

Actually, if you live in the USA and suffer from intractable pain, there's no shortage of doctors prepared to take your money. There is a major shortage of doctors willing or able to prescribe adequate pain control in large parts of the country.

People are attesting to their experience of that all through this thread.
posted by PeterMcDermott at 11:00 AM on January 25, 2012


Being physically dependent is NOT synonymous with being addicted.

In all the wacky medical tomfoolery on the show House, this bit made the least sense to me. Here's cranky Dr. House, who walks with a cane because he has chronic leg pain! He's so out of control, popping pain pills all the time to numb his feelings (and his constant leg pain)! Drugs are bad, so have a few seasons of junkie House going to rehab/jail/etc. for stealing pills to treat his chronic pain, pills that the people he asked for drugs would have totally given him if he weren't a drug-seeking junkie. Maybe someday House will discover the inner strength to finally kick drugs for life...which he'll spend curled in a ball whimpering from the undulled sensation of leg muscle death.
posted by nicebookrack at 8:35 PM on January 25, 2012 [3 favorites]


Actually, if you live in the USA and suffer from intractable pain, there's no shortage of doctors prepared to take your money. There is a major shortage of doctors willing or able to prescribe adequate pain control in large parts of the country.
And if you try to actually find one you're obviously a Doctor shopping junkie!
posted by delmoi at 10:14 PM on January 26, 2012


These medicines are very effective at low doses and significantly fuck people up at high doses.

People say that like it's a bad thing. Aside from driving, or working, or whatever... why is being pleasantly fucked up seen as a terrible side effect of pain medication?
posted by Meatbomb at 8:05 AM on January 27, 2012 [1 favorite]


People say that like it's a bad thing. Aside from driving, or working, or whatever... why is being pleasantly fucked up seen as a terrible side effect of pain medication?
Because any pleasure that's not the result of hard work is morally wrong, duh. If people could have pleasure and happiness without working hard, then they would stop working hard and capitalism would fail. So clearly, allowing people with chronic and debilitating pain to feel happiness and pleasure would mean that they wouldn't need to get jobs and work all day in order to feel satisfaction.
posted by delmoi at 9:06 AM on January 27, 2012


The War Over Prescription Painkillers

The New Panic Over Prescription Painkillers
posted by homunculus at 5:06 PM on February 12, 2012


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