Now the drugs don't work, they just make you worse

November 28, 2012 7:00 PM

Rapid Growth Seen in Addiction to Painkillers The escalating use and abuse of powerful painkillers can be found in rich societies from the UK, across Europe to the antipodes. But the country that really knows all about prescription pill excess, and the human toll it claims, is the US. Americans make up less than 5% of the global population but consume 80% of the world's supply of opioid prescription pills.

The more pills handed out, the more cases of addiction; the more cases of addiction, the more illegal street trafficking of the drugs; the more illegal street trafficking, the more snorting and injecting of the crushed pills; the more snorting and injecting, the more overdoses; the more overdoses, the more deaths. The result is that about 15,000 Americans are dying every year from prescription pill overdoses – triple the rate of a decade ago, according to the US government body the Centres for Disease Control, which has declared the problem an epidemic. The death toll exceeds that caused by heroin and cocaine combined, and in 17 states has become the No 1 killer, surpassing even car crashes.

posted by modernnomad (63 comments total)

Opium legalization would probably solve a lot of this insanity.
posted by humanfont at 7:04 PM on November 28, 2012 [3 favorites]

Sales of the drugs have increased more than fourfold in the past 10 years,

in 2010 enough of Geni's pills, or their brand-name equivalents, were handed out by doctors to medicate every American adult with a typical dose of hydro– codone, a pure opioid as powerful as morphine, every four hours for a month

about 15,000 Americans are dying every year from prescription pill overdoses – triple the rate of a decade ago,

I'm really struggling to see how a legalisation argument can be run through those facts (unless of course you failed to RTFA). Seems to me that legal drugs are your problem and tightening up prescription is the first thing you should be doing.

posted by wilful at 7:10 PM on November 28, 2012 [7 favorites]

Hmm. I'm gonna go way out on a limb here and speculate that, if this is not an artifact of an unusual prescription scheme, maybe people are unhappy.
posted by clockzero at 7:12 PM on November 28, 2012 [9 favorites]

Tightening up prescription runs into some other issues though. It makes it more difficult for people who actually need the drugs to get them.

Last week, U.S. Drug Czar Gil Kerlikowske testified before the House Energy and Commerce Committee during a hearing on prescription drug overdose deaths. Kerlikowske called for a prescription drug monitoring system, more education about the dangers of opioid painkillers, and more restrictions on how they're distributed and prescribed. The committee also heard from several state attorneys general, addiction experts, officials from the Drug Enforcement Administration, and representatives from pharmaceutical companies, drug stores, and distributors and wholesalers of prescriptions drugs.

All of the witnesses began their testimony on the assumption that there is a prescription drug abuse epidemic in the U.S., and that access to controlled drugs, benzodiazepines and especially opioid painkillers, needs to be restricted, or at least monitored.

Noticeably absent from the hearing, however, was anyone living with chronic pain, or anyone even to speak on behalf of pain patients. Patients and their advocates say last week's hearing is typical of the lack of balance in the public debate over painkillers.
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One Indiana pain patient who wrote to HuffPost tells a typical story. Faced with debilitating pain from spinal stenosis, she was told by local doctors she was displaying the drug seeking signs of an addict, and they refused to treat her. "I have never used an illegal substance, and seldom have a glass of wine- I've never had a beer in my life," she writes.
posted by Drinky Die at 7:14 PM on November 28, 2012 [19 favorites]

When they were marketing it, Purdue pharma claimed the incidence of addiction to OxyContin was 1%?!!

This is blatant, intentional deception. How is this any different than the guy on the corner telling me "this stuff is pure... Fresh off the boat, man."
posted by Bathtub Bobsled at 7:15 PM on November 28, 2012 [2 favorites]

i think making weed legal would actually fix a lot of this. the argument that marijuana is a gateway drug is dumb, except (save for a couple places) it's illegal so you have to go to a drug dealer to get it. i never considered myself the type of person who would be a pill popper, but because it was on offer when i would go pick up my sack, i tried it. and then 8 or 9 months disappeared. i really don't think i would have gone down that road if i could have gone to the corner store to buy a pack of joints.
posted by nadawi at 7:17 PM on November 28, 2012 [17 favorites]

This all sounds pretty scandalous: http://en.wikipedia.org/wiki/Oxycodone#Marketing_and_misbranding

Yay Big Pharma!
posted by wilful at 7:19 PM on November 28, 2012

Americans make up less than 5% of the global population but consume 80% of the world's supply of opioid prescription pills.

And 85% of the world's supply of Ritalin. It's not just opioids—we love our CIIs.
posted by dephlogisticated at 7:19 PM on November 28, 2012 [2 favorites]

Appalachia has long been accustomed to high levels of addiction to tobacco, alcohol and meths...

"Meths"? Is this like "maths"? England is weird.
posted by nebulawindphone at 7:25 PM on November 28, 2012 [9 favorites]

The NFL's Secret Drug Problem
posted by telstar at 7:26 PM on November 28, 2012 [1 favorite]

These moral panic articles make me absolutely furious. I really don't know where to start in trying to refute all of the half-truths, outright lies, and hyperbole in this piece. The most obvious one is the "15,000 deaths" figure that people seem to be impressed by. That figure, if you read the actual CDC statistics it's derived from, is not the number people who died because they overdosed on a prescription painkiller. It's the number of overdoses in which a prescription painkiller was "involved." If you come into the emergency room with a heroin needle sticking out of your arm, but the doctors determine that you took a single Tylenol 3 pill that night along with your heroin, and you die of a heroin overdose, that will be marked as an overdose death in which prescription painkillers are "involved."

That statistic tells us absolutely nothing about the number of deaths caused by any alleged increase in abuse of prescription drugs. The article also doesn't tell us anything about the overall rate of drug-related deaths, which is, by and large, decreasing over time even as prescription drugs have become more available. And screaming about how Americans use a lot of these drugs as compared to people in other countries certainly doesn't tell us anything about whether the rate of use of these prescription drugs is too high in the US, or whether perhaps other countries could benefit from making them more available so that more of their citizens can be free from pain.
posted by decathecting at 7:27 PM on November 28, 2012 [40 favorites]

Patients and their advocates say last week's hearing is typical of the lack of balance in the public debate over painkillers.

Yeah seriously. Last time I hurt my back I had to wait in urgent care for hours before I could see a doctor and they could only give me a shot of something to relax the muscles-- they couldn't even give me any painkillers while I waited in the lobby, crying from pain. It was over an hour after I'd seen a doctor before I actually got the painkillers I needed, since I had to go to the pharmacy to pick them up. It was one of the worst experiences of my life. I only have occasional back pain and have always been able to get the prescriptions that I needed for them. I can't imagine what it would be like to live with that kind of regulation and the amount of suspicion and disdain that those who need hardcore painkillers because they live with chronic pain must have to go through.

I do, however, think marijuana might be a good alternative both for legal and illegal use of painkillers. It's certainly less addictive than most.
posted by NoraReed at 7:29 PM on November 28, 2012 [7 favorites]

Fortunate or unfortunate for me even the smallest amount an opiate makes me very ill
Half a hydrocodone and I am laying on the floor dry heaving and feeling as if I have been on the most violent amusement ride ever
posted by robbyrobs at 7:33 PM on November 28, 2012

CII's?
posted by Mei's lost sandal at 7:34 PM on November 28, 2012

Yay Big Pharma!

Given that I have more than enough money in my loose change jar to buy all the Purdue stock there is (Answer: None) this is hardly a Big Phama thing. This is more like gong out with a plan to buy locally but forgetting that you live in a neighborhood full of skeevy weasels.
posted by Kid Charlemagne at 7:36 PM on November 28, 2012

Opium legalization would probably solve a lot of this insanity.

"Why should I have to pay taxes to support these drug addicted bums?"

Average price of prisoner: ~$30,000 per year
Food stamps + TANF for single person household: ~$6,000 per year

How is this not a question of basic arithmetic? Are you seriously willing to spend $20K+ extra per year just to make some poor/minority person miserable in jail for possession instead of just letting them sit on the sofa stoned out of their brain?
posted by Talez at 7:37 PM on November 28, 2012 [13 favorites]

I'd sure love to know where all these doctors apparently are who just write up a prescription for anyone. I'm sick of seeing primary care doctors for my headaches who won't continue a prescription for Fioricet (which takes me 4-6 months to get through, so I'm not pounding a half dozen of these a day), a prescription I've had on and off for the better part of 20 years, having been the only effective medication for my headaches.

I finally stopped around 2004 going to a doctor who spent 3 years trying everything else (literally everything non-opioid and non-barbiturate) and refused to allow Fioricet but had no trouble trying to talk me into continuing to take an antidepressant off-label for the headaches that made me feel sick for a week, had no trouble prescribing a dose of a beta blocker that if I forgot to take it one day could cause a heart attack or stroke, and shrugged when I turned up covered in hives and angioedema because I finally kicked off an allergy to ibuprofen.

Fuck this moral panic about medication, I just want to be able to take something for my goddamn headaches that WORKS so I don't have to spend a few days every month in my bed.
posted by chimaera at 7:37 PM on November 28, 2012 [24 favorites]

Even Grandma is hooked. It's horrible, really.
posted by Chuffy at 7:43 PM on November 28, 2012 [1 favorite]

CII's?

Schedule II controlled substances. Though, to be fair, we also love our CIIIs, CIVs, and CVs, in descending order of love.
posted by dephlogisticated at 7:44 PM on November 28, 2012

I'd also like to know whether, in determining that "Americans make up less than 5% of the global population but consume 80% of the world's supply of opioid prescription pills," they took into account differences in nonprescription availability internationally. My understanding is that in most of the world, at least some opioids are available without a prescription. In the US, codeine and other basic painkillers require a prescription, while in many other countries, they can be bought directly from a pharmacy without prior approval. In other words, if everyone in Europe were massively addicted to codeine and swallowed pills by the fistful, it would still be the case that the US would have a higher rate of codeine prescriptions, because everyone who takes it here needs a prescription for it, whereas most people there can get it without a prescription.
posted by decathecting at 7:44 PM on November 28, 2012 [15 favorites]

I'd sure love to know where all these doctors apparently are who just write up a prescription for anyone.

In my experience, they're everywhere. I was in an extremely minor car accident a couple years ago, went to an urgent care on the advice of my insurance company "just in case", and walked away with a prescription for Vicodin despite telling the doctor I wasn't even sure the neck discomfort I was experiencing was real or psychosomatic. The same thing happened a few years before when I had a dental infection - both my dentist and my primary care physician threw prescriptions at me even though I mentioned that Advil was actually more effective for my tooth pain than opiates. I live with a recovering addict, do not want those medicines in my house, and in all cases actually told the doctors I didn't think I really needed drugs of that strength. It was fascinating. I threw them away.
posted by something something at 7:44 PM on November 28, 2012 [1 favorite]

I just noticed the phrase "medically prescribed synthetic heroin". Seriously? I mean, I guess that is sort of true, but the connotations people associate with heroin makes that pretty, you know, editorializing. The drug they're talking about is percocet. I've taken that; I was prescribed it after a scooter accident made me wind up with a hole in my foot. I'm pretty sure it's, uh, different from heroin.

"In our pursuit of 'pain-free', that elusive modern goal, we have created a monumental problem of drug addiction, abuse, lost productivity, crime and death."

We also make the lives of people who live with pain bearable. The notes in this article about people feeling "entitled" to pain free lives reeks of the sort of privilege that you hear from people talking about how poor people shouldn't be "entitled" to healthcare, food or shelter. Painkiller addiction is a bad thing, yeah, but this dismissive attitude towards people living with pain feels to me like the same sort of dismissal you get of other medical conditions from people with no understanding of what it is like to live with them and no particular desire to attempt to develop sympathy: you don't need antidepressants, you just need to cheer up; why don't you just take an advil if your headaches are that bad, etc. It's like they think doctors just hand out hydrocodone, percocet and oxycodone for an occasional stress headache. What's the dude who fell off a roof supposed to do if he's not given decent painkillers, take an asprin and a hot bath?
posted by NoraReed at 7:46 PM on November 28, 2012 [17 favorites]

The same thing happened a few years before when I had a dental infection - both my dentist and my primary care physician threw prescriptions at me even though I mentioned that Advil was actually more effective for my tooth pain than opiates.

If we lived in the same region, I'd offer to give you a reference to my old doctor in exchange for one for yours.
posted by chimaera at 7:48 PM on November 28, 2012 [5 favorites]

From what I understand it's not just addiction and death you need to worry about, they also can damage your liver quite severely.
posted by Brocktoon at 7:54 PM on November 28, 2012 [1 favorite]

Like many people posting in this thread, I've had multiple experiences in which asking a doctor for something to help me not be in so much fucking pain resulted in them looking at me like I was asking if they'd hold the tourniquet while I shot up.

I understand that addiction is an awful thing for those experiencing it and for their friends and families but turning this into a moral panic is just going to stigmatize addicts more and also make it frustrating and humiliating for people already in a great deal of pain to get any relief. It really does feel awful when you basically have to beg a medical professional -- someone who is supposed to help you! -- to relieve your pain and to know that the more you beg and the most desperate you look the less likely they are to help you.
posted by Mrs. Pterodactyl at 7:57 PM on November 28, 2012 [13 favorites]

Soma.
posted by nathancaswell at 7:58 PM on November 28, 2012 [1 favorite]

So in my little rural county in Appalachia, the main drug problem has never been meth, but opiates - doesn't matter whether prescription or not. Heroin, morphine, oxycontin, vicodin - anything will do, and the supply comes in from the organizations in nearby big cities or in deliveries to the pharmacies.

Law enforcement shut down one doctor who was attracting patients from several counties around for his replacement therapy - prescription opiates instead of street opiates - his way of battling drug addiction, was his claim. So he's out of business, but now what? Anything will do, after all, and I'm sure the city dealers see this as a marketing opportunity, you might say...

Meanwhile the DA and his cohorts pose as heroes by getting confidential informants to set up little buys, and getting their busts in the local papers, a few stamp bags or a half dozen black market percocets at a time... that is, when they're not crowing about busting slackers for selling a couple grams of pot in the parking lot of the Dew Drop Inn.
posted by tommyD at 8:00 PM on November 28, 2012 [1 favorite]

So that's why there's no new cocaine addicts!
posted by Orange Pamplemousse at 8:00 PM on November 28, 2012

The Military's Billion-Dollar Pill Problem
posted by telstar at 8:01 PM on November 28, 2012

Fuck this moral panic. Some of us legitimately need painkillers to function day to day, and all this does is make it harder on us.

My fucking pharmacy - which I have been using for 8 years now - will no longer keep prescriptions of any pain medication "on file". That is, if you have a new prescription to drop off, but don't need it filled then, they will hold it for virtually any drug except painkillers.

So now, on top of only being able to get 3 months of refills on one of my meds, and only ONE month's supply on another one, if I happen to have my regular check in with my rheumatologist at any other time in the month from when my refills are able to be filled (28 day cycle, on my insurance) I have to keep track of the paper copies of the prescriptions until then, and hope they don't freak out over me bringing in one nearly 3 weeks after it was written. And I can only pick it up between 9am to 6pm most days, and I have to CALL to find out if someone is there who can fill them at all on weekends.

I mean, hell, the only reason they let my husband even pick up my pain meds (we have different last names) is because they've seen us together over the last 8 years, and he's been a patient longer.
posted by strixus at 8:01 PM on November 28, 2012 [8 favorites]

In my state, they're making people who need painkillers take piss tests to prove that they're actually taking their pills (not selling them) and that they aren't taking any other illegal drugs.

So that means that people who are in legitimate pain are being required to jump through another hoop just to get pain relief, and people who use illegal drugs CAN'T GET PAIN RELIEF.

I fucking hate this country.
posted by dunkadunc at 8:03 PM on November 28, 2012 [12 favorites]

Another thing I want to throw out there on Americans and drug abuse. I'm cribbing this from my athletes and Adderall post from earlier today because I think it applies here.

Adderall use is common performance enhancer among students: Even the phrase “the study drug” seems mildly contradictory, an oddly tame and constructive form of rebellion, a prescription drug abuse with a very modest, one could say almost praiseworthy goal: to concentrate a little better on a paper or test.

Similar stimulants are used to maintain alertness in battle: According to military sources, the use of such drugs (commonly Dexedrine) is part of a cycle that includes the amphetamines to fight fatigue, and then sedatives to induce sleep between missions. Pilots call them "go pills" and "no-go pills."

For Adderall or for painkillers, this is a question that goes way beyond your stereotypical drug user looking for a high. This isn't rebellion or fantasy DARE style peer pressure. We are using these drugs for functional purposes. We need to work long hours but we are too tired and we are in too much pain and we can't concentrate and we never have vacations and after a day of labor we need to go to sleep and we don't have time to figure out why we can't.

Methamphetamine use has traditionally been associated with white, rural, predominantly male blue-collar workers somewhere in their 20s or 30s.

Factory workers and lawyers and everyone need to "go" and "no-go" just as much as a pilot. We may think of Jesse Pinkman as a stereotypical meth user, but it's just as likely to be a guy who just needs to get through a third shift. And maybe he has back pain too. And probably he doesn't have the best medical care.

This is a situation where stopping use means getting to the root of the problem which is as usual more about economics than loose morals that need regulation via prohibition. Did Rush Limbaugh simply chase a high? No. He was in pain, he had a (let's not be politically judgmental) difficult and stressful job, and he pushed himself beyond what he could handle in a lot of ways and left himself open to addiction.

If we let ourselves live lives with more downtime, more economic security, and less stress...we aren't going to be turning to pills as much to help cope.
posted by Drinky Die at 8:05 PM on November 28, 2012 [20 favorites]

The obvious solution is to take all the painkillers away.
posted by clarknova at 8:08 PM on November 28, 2012

How is this not a question of basic arithmetic? Are you seriously willing to spend $20K+ extra per year just to make some poor/minority person miserable in jail for possession instead of just letting them sit on the sofa stoned out of their brain?

It might be something like the examples of prolific homophobes who end up being revealed as gay. They think everyone will sit on the couch getting stoned all day if we let them because...that's what they would do.
posted by Drinky Die at 8:12 PM on November 28, 2012 [4 favorites]

the "i can't get the drugs i legitimately need" vs "i can't get doctors to stop giving hardcore opiates" is a discussion i've been in before.

i have crooked teeth, adult acne, and live in one of those flyover meth capital type of states. i've been broke enough that i've had to go to the ER for relief for impacted tooth pain. i have doctor related anxiety. my attire is also more grunge-ish than professional. i just tick all the boxes of drug seeker. i'm not. except for that 9 month period i talk about upthread, i've never taken pills in ways they aren't prescribed.

i basically can't get appropriate drugs to relieve legitimate pain. when i try to get something for cramps, my gyn tries to get me on birth control. i refuse because i'm super sensitive to hormones and suffer from depression, and the conversation ends. she suggests doubling the dose on OTC pain killers. i've had the cops called on me for buying under the legal amount of allergy meds. i hurt my back at work a few years ago and i was given a muscle relaxer and told to take OTC meds. i asked if there was any way they could prescribe something stronger and the doctor looked at me like i just asked him to shoot me up. my brother on the other hand gets handed piles of drugs by just being like "oh, i have anxiety and knee pain."

it sucks and it's a shitty way to decide who gets help and who gets hassled.
posted by nadawi at 8:14 PM on November 28, 2012 [11 favorites]

I'd sure love to know where all these doctors apparently are who just write up a prescription for anyone.

Yeah, they're around. I had a friend who used to say, jokingly, "Okay, I'm off to my appointment with Dr. X. You want anything?"
posted by ODiV at 8:17 PM on November 28, 2012

You know what stresses me out? Being in terrible pain. That's really what stresses me out.
posted by Sidhedevil at 8:18 PM on November 28, 2012 [11 favorites]

1. The Guardian very much likes printing stories about the US being in the middle of a crisis of epic proportions, mixing a couple anecdotes with scary statistics that read like they've been cribbed from an advocacy group (ie spun/inflated for maximum impact).

2. Stories about the problem of prescribed painkillers and the number of deaths never seem to distinguish between fatal overdoses of actual opiates vs combinations (opiates & other prescribed drugs or opiates and alcohol or all three) vs fatal liver damage from too much acetaminophen/paracetamol.

3. It's often mentioned prescriptions for opiate painkillers (and addiction rates and deaths) are rising, but rarely how much of this might be naturally expected from the Baby Boomers (26% of the population of the US) moving into retirement age when people genuinely need that sort of medicine more and more.
posted by K.P. at 8:19 PM on November 28, 2012 [12 favorites]

From what I understand it's not just addiction and death you need to worry about, they also can damage your liver quite severely.

Hydrocodone is offered in several combination products with acetaminophen, and these are prescribed much more frequently than pure hydrocodone. The problem is that acetaminophen is horribly toxic to the liver in high doses—it's actually the leading cause of liver failure in the US and UK. So you can imagine what happens to people after a heavy hydrocodone/APAP binge.

Opioids on their own aren't particularly hepatotoxic. Their main problem, aside from addiction, is respiratory depression. They basically inhibit the part of your brain that keeps you breathing while you're unconscious, which is why they cause so many deaths.
posted by dephlogisticated at 8:19 PM on November 28, 2012 [10 favorites]

Pain can also be a consequence of obesity. It ain't easy being heavy.
posted by srboisvert at 8:24 PM on November 28, 2012 [2 favorites]

The obvious solution is to take all the painkillers away.

Well, I dunno. They don't play together that often anymore, anyway.
posted by flapjax at midnite at 8:31 PM on November 28, 2012

Morphine - Cure for Pain
posted by telstar at 8:34 PM on November 28, 2012

Pain can also be a consequence of obesity.

And also a cause.
posted by Drinky Die at 8:44 PM on November 28, 2012 [2 favorites]

I had a friend with a wicked opiate addiction once. She was a classic case - bought pills off the street, went in to the ER to try to get drugs, etc.

You know why? Because she was a bouncer at a bar, paid under the table and sure as shit had no insurance, so when she blew out her knee hucking a keg up a flight of stairs, she had no options. She bought a brace from Walgreens, got some oxycontin, and went back to work, because if she didn't work, she couldn't eat.

Three years later, she was finally making little enough money that she could get the meniscus repair she needed under a state program. By that point, her other knee was screwed up too, because she'd been limping so long. And she couldn't take any extra time off work to dry out, because opiate withdrawal at that level is not a matter of drinking extra water and coping with a headache.

The last time I saw her, she looked terrible and was barely holding down a job, still trying to figure out how to get clean. That was four years ago.

I'm pretty sure she's not dead.
posted by restless_nomad at 8:52 PM on November 28, 2012 [12 favorites]

Patients and their advocates say last week's hearing is typical of the lack of balance in the public debate over painkillers.

Yeah, I had surgery and got a script for The Good Stuff. The wife went to fill it at our usual pharmacy and because the doctor had left a letter out of my name they went all WHOA WHOA WHOA JUNKIE PILL SEEKING BEHAVIOR and were extremely rude to her despite the fact it was on hospital letterhead and we had a ton of prescriptions there, so she wound up having to drive all the way back to the hospital and wait for him to come out of surgery to re-issue the script and even when she went back, they were giving her the mean mug because WE FOUND THE JUNKIE TRYING TO SCORE and hassled her and busted out a magnifying glass to scrutinize it before finally, begrudgingly giving her my pills. And yet they were extremely upset when we moved all our prescriptions to another pharmacy. And I totally get if they couldn't fill it because he got the name wrong, it's the PILLHEAD ALERT treatment that annoyed me. When I explained that I was lying in bed alone at home in considerable pain wondering where the hell my wife was while they were playing Sherlock Holmes, the manager got all, "But what if someone was trying to get painkillers they didn't need?" and seemed horrified when I said, "Frankly I don't give a shit because I WAS IN A WORLD OF PAIN".

Likewise, she went to the ER for double-you-over-bad-crying pain and after a few thousand dollars worth of tests they decided "We don't know" and gave her Advil. When I asked if maybe there was something a bit stronger she could get, they started giving me the eye like I'd said "Yo doc, where can I score some rock?" A simple "No" would've been fine.

On the other hand, I have a doctor now that is entirely focused on patient comfort for surgeries and procedures and will write you the scripts for The Good Stuff without hesitation if you need it and that's part of the reason I'm reluctant to move because my god, I have a treasure.
posted by Ghostride The Whip at 8:55 PM on November 28, 2012 [14 favorites]

It's not a moral panic.

It's a financial panic. These pills cost money, and as long as they're prescribed, insurance has to pay for them.

The pharmaceutical load on the economy has exploded.
posted by effugas at 10:02 PM on November 28, 2012 [1 favorite]

The manager got all, "But what if someone was trying to get painkillers they didn't need?" and seemed horrified when I said, "Frankly I don't give a shit because I WAS IN A WORLD OF PAIN".

To be a bit fair, that manager is under a lot of pressure from the other direction -- he may get fired, lose his license, or even be imprisoned, for "supplying a junkie". That he did the "right thing" by one metric, and still lost business for the pharmacy, means he had no good action.
posted by effugas at 10:05 PM on November 28, 2012 [1 favorite]

When I explained that I was lying in bed alone at home in considerable pain wondering where the hell my wife was while they were playing Sherlock Holmes, the manager got all, "But what if someone was trying to get painkillers they didn't need?" and seemed horrified when I said, "Frankly I don't give a shit because I WAS IN A WORLD OF PAIN".

I have to admit this is my attitude despite the fact that just this week I wrote off a former friend who has managed to get herself addicted to both painkillers and anti-anxiety medications. I have hurt my back, had major surgeries and been in a few car wrecks and I want to be able to take painkillers when I need them to make a shitty situation less shitty and it's not my problem that some adults can't handle it. And trust me, I get why people get addicted, I'm totally one of those people that takes a Vicodin and goes and hangs out with the Bluebird of Happiness for a while. No puking, no bad side effects that stuff is magic as far as I'm concerned. Which is exactly why I want to be able to take it next time I break something and don't want to have to jump through 1,000 hoops because some people decided it was more fun than going to work. Painkillers are no different than wine or liquor or anything else that makes you feel a bit wheee! for a while. People who are unhappy or anxious are more prone to getting addicted, I get it and I sympathize but that's no reason the rest of us can't have nice things when we need them.

Says the women who was totally going to go to the gym but stayed home to watch Jusitifed and drink a glass of wine instead. Then had another. And on a school night!
posted by fshgrl at 10:19 PM on November 28, 2012 [1 favorite]

A couple of people mentioned MaryJ and it brought back my episode with chronic pain. Was in a car accident and messed up my back. I could barely sit up for more then 20 mins when it first happened. My doctor prescribed me vicodin and some sort of muscle relaxant. They worked to a point but screwed up my head up so bad it was awful. So yeah there I was still with pain and practically a drooling idiot if I took the recommended dosage. Even with those drugs in me I was still uncomfortable.

Then one evening a friend came over and we smoked a joint. Man it was bliss. My back muscles actually relaxed in a way that was different then the drugs and although I would still feel the pain there it didn't bother me. Yes I was stoned but I wasn't loopy.

Long story short I ditched the pills and used joints instead. (It was easy and no problem to get where I lived). Then it was check up time and I debated what to tell my doctor. I had no idea what his stance was. When he asked how things were I told him that I had stopped using the pills and...um....well... I made a smoking motion with my hand. He grinned slightly and nodded.

"Officially I cannot recomend that but unofficially...."

I got it and after an 'unofficial' conversation about how if it was working then it was okay and that he would actually prefer it as a course of treatment because of issue with possible addiction with the pills and the ability to control exactly the amount I needed for relief I went home with my unofficial prescription and doctors blessing.

I loved that doctor and am so grateful that I discovered this supposedly horrible illegal substance that helped my get through the first four months of my recovery with my life and sanity relatively intact. On the pills working was hard. With pot I would only smoke at night when I got home and it was enough to get me through the next day. Psychologically it helped because when I was lying on the office floor at lunch in excruciating pain I knew that in only a few hours from now it would be okay. With the pills regardless of when I took them I felt doped up and in a haze during the day which affected my ability to do my job.

I smoked it regularly for about a year but needed less and less as that year went on. I adjusted it myself. After about 15 months my back thankfully healed to a pain free state.
It was no problem stopping smoking. Would it have been that easy if I had been on addictive pain meds for that long? I dunno. I'm glad I didn't need to find out.

Since then I have related my story to other people experiencing chronic pain. Several of them tried it and had similar experience in terms of relief and love it. Criminals, all of us.

Yes this is all anecdotal but I really wish that our society would ditch the fear of maryJ and approach it more sanely. The stuff can be pretty damn useful and for some cases a good alternative to managing pain as far as I'm concerned.
posted by Jalliah at 10:19 PM on November 28, 2012 [10 favorites]

Also good for people who just want to get high with a minimum of side effects compared to most other recreational drugs and alcohol.
posted by Drinky Die at 10:27 PM on November 28, 2012 [1 favorite]

NoraReed: "I just noticed the phrase "medically prescribed synthetic heroin". "

I googled to see if maybe it might have been a reference to something like Fentanyl... (I haven't read the OP's article) "New Synthetic Heroin called 'Pump It' Gaining Popularity" (and then the little preview blurb on google "According to the DEA it's a synthetic drug that acts like speed.")

DEAR NEWS MEDIA - YOU ARE PART OF THE PROBLEM. Fuck off and die already you useless pieces of shit.
posted by symbioid at 10:33 PM on November 28, 2012 [3 favorites]

Drinky Die: "Also good for people who just want to get high with a minimum of side effects compared to most other recreational drugs and alcohol."

Eponysterical.
posted by symbioid at 10:33 PM on November 28, 2012 [1 favorite]

This is something I know about:

Two important factors:

1. The kind of doctor: Medicaid/Medicare docs are far more likely to give you narcs than Blue Cross doctors. Private insurance doctors are terrified of lawsuits, and Medicaid docs are mostly numb to them. Also, Medicaid docs are used to being asked constantly for narcs.

2. The kind of patient: Paradoxically, but very importantly, doctors make a judgment based on............... how far you may fall. A math professor with back pain, no history of addiction, may indeed get fewer narcs than a homeless guy with the same complaint. Not only does the math professor have more to lose, he and his phone calley- spouse is more likely to sue. "But I'm in pain!" You must think you're in Sweden, over here in the U.S. doctors treat patients based on avoiding liability. "That's idiotic, whatever happened to human compassion and duty?" And etc, expect no change in the coming decades.
posted by TheLastPsychiatrist at 10:50 PM on November 28, 2012 [5 favorites]

It's a financial panic. These pills cost money, and as long as they're prescribed, insurance has to pay for them.

The cost burden of pharmaceuticals is real, but if you want to name a cause, it's not opiates, it's cheeseburgers. Take a look at this chart. The top drugs by total cost are mostly for cholesterol, heart disease, diabetes, and psych disorders.

Now compare it to this chart, which ranks drugs by prescription volume. Hydrocodone/APAP claims three spots in the top 15, including the top two. If you count all the hydrocodone/APAP brands as a single product, that's almost three times as many scripts being written for it than the next highest drug on the list. But since it's generic and dirt-cheap, it's barely in the top 200 in terms of revenue.

Oxycontin, the hard-to-crush reformulation of oxycodone, is on patent and brings in a healthy chunk of change, but generic oxycodone is still available and gets prescribed far more often. So the problem is really more about use than cost.
posted by dephlogisticated at 11:56 PM on November 28, 2012 [1 favorite]

K.P.:

The Guardian very much likes printing stories about the US being in the middle of a crisis of epic proportions, mixing a couple anecdotes with scary statistics that read like they've been cribbed from an advocacy group (ie spun/inflated for maximum impact).

I can't emphasise that point enough - articles about how the US is completely doomed because Americans are ebil, often with stats from activist groups, are the lifeblood of the Guardian's US coverage. The phrase "medically prescribed synthetic heroin" rings all sorts of press-release alarm bells, as NoraReed points out. Not to say that untreated pain and painkiller abuse aren't both problems, but the Guardian is a bad place to get levelheaded analysis of the US news.
posted by Wylla at 3:18 AM on November 29, 2012 [1 favorite]

I'd like to see a list of all the things that America consumes 80% or more of. That would be an interesting list.
posted by stavrosthewonderchicken at 3:24 AM on November 29, 2012 [6 favorites]

Their main problem, aside from addiction, is respiratory depression

Two or so years ago I had a cold that cleared up but left me with a hacking cough that wouldn't go away. Three nights in a row, maybe more, I didn't sleep, I kept my wife up, and then I started coughing up blood. Urgent care was shocked that a non-smoker might cough blood, and gave me a bottle of hydrocodone syrup.

I don't really dig on opiates in general, but I took the recommended dose to get some sleep and hopefully give my coughing parts a rest, but all it did was make me wake up every ten minutes because I wasn't breathing. What a freaking night.

Anyway, addiction stinks, but pain stinks too. Freedom from pain is one of the greatest things that modern medicine can give us, and to deny it in some half-assed Calvinist moral outrage is criminal. Real, single-payer healthcare in the US--where restless_nomad's friend probably doesn't wind up addicted--would probably go a long way in curbing addiction. Legalizing cannabis certainly wouldn't hurt, either.
posted by uncleozzy at 5:33 AM on November 29, 2012 [1 favorite]

nebulawindphone: "Meths"? Is this like "maths"? England is weird.

No, meths is methylated spirits, or denatured alcohol. Meth is meth. Don't know why the wikipedia only has one disambiguation page, I've only ever heard the terms with these distinct meanings.

we're still weird though.
posted by doiheartwentyone at 8:31 AM on November 29, 2012

Oh! Awesome. I'd parsed it as an extra-posh abbreviation of "methamphetamines" and then couldn't figure out why the world needed an extra-posh abbreviation of "methamphetamines." That makes way more sense.
posted by nebulawindphone at 8:36 AM on November 29, 2012

Pain is a bitch and I have totally experienced the "if you were older I'd give you something stronger" schtik. It. Is completely irresponsible and dismissive to me as a patient. Yes express concerns about addicition but doctors seem spooked about these scripts from Government pressures. Besides addicition and dependency are two different things. Ive been seeing the same damn doctor for years, and have the tests to prove that my back is fucked. Being treated like an addict or drug seeker simply pisses me off.

I've pretty much had every opiate under the sun minus heroin. Yes there are risks but minimizing pain should not be this difficult. Ironically if you are rich getting prescription medications is rather easy. with no one giving you a hassle for refills even allowing they're admins to pick up the medications.

Cannabis does work to help minimize pain. I find when I'm using cannabis I use much less of my medications. Last night alone I didn't even need to take muscle relaxers to help me get comfortable to fall asleep. A good indica did the job just fine. It's a shame that for the most part the government haven't caught up to what the people have already found out.
posted by handbanana at 8:47 AM on November 29, 2012 [1 favorite]

Oh, so that's where all the coke and meth addicts are headed. Kind of correlates with the "televisioning" of the American mind. Back in the 70s, everyone was fucking on cocaine. Now they're popping oxy and watching Animal Hoarders.

Cannabis does work to help minimize pain.

Absolutely, especially the high CBD strains (which also minimize the effects of the THC). The purple indica--Trident, Grape Ape, Urkle--all work well

Personally (I have a foot-long titanium plate and 7 screws in my hip that tend to be a bitch when it starts raining here), I like a blend for a nice head trip too, and just got some God's Gift from the Green Door that (like most of their stuff) is pretty darn effective.

I was on Morphine, Percocet, Dilaudid, then Norco (generic Vicodin) for a while, then ibuprofen for too long. Cannabis doesn't take all the pain away like opiates do, but (imo) it is far far better for me.
posted by mrgrimm at 12:24 PM on November 29, 2012 [1 favorite]

I don't have personal experience here but I've read that Cannabis is particularly good for nerve pain, with which many opiates have a difficult time.
posted by Justinian at 11:31 AM on November 30, 2012

Very late to this thread, but I just wanted to post a link to the Magnolia pharmacy scene because it encapsulates everything you feel dealing with all the dirty, suspicious looks and comments from pharmacists when picking up strong painkillers for your severely ill mate. I've had slightly less intense versions of the exchange in this scene a few times.
posted by Devils Slide at 7:58 PM on November 30, 2012