"I knew I liked it too much."
April 4, 2017 6:15 AM Subscribe
I was a young ER doctor with a perfect life: gorgeous wife, three kids and a beautiful waterfront house. Then I got hooked on fentanyl and lost it all
Is there hope for non-addictive opioid painkillers?
Six pharmaceutical executives who worked for fentanyl company Insys Therapeutics, including a former CEO, were arrested on Thursday and charged with leading a nationwide conspiracy to defraud insurance companies and bribe doctors to prescribe their powerful and addictive opioid painkiller, according to an indictment from the U.S. Attorney’s Office in the District of Massachusetts.
Is there hope for non-addictive opioid painkillers?
Six pharmaceutical executives who worked for fentanyl company Insys Therapeutics, including a former CEO, were arrested on Thursday and charged with leading a nationwide conspiracy to defraud insurance companies and bribe doctors to prescribe their powerful and addictive opioid painkiller, according to an indictment from the U.S. Attorney’s Office in the District of Massachusetts.
I'm really grateful that my doctor prescribed only a small amount of Percocet after my oral surgery -I think 8 pills - which, along with the Tylenol 3 he also prescribed, carried me through the 2 or 3 days after, and that left me with none just about exactly when I did not truly need them anymore. Attempts at abuse would have required me to go back to the office and lie about my pain level, which I very much did not want to do. That was my first experience with oral narcotics, and I can see how seductive they could be. It wasn't like I felt really high, but everything was FINE. I didn't much mind that I couldn't eat and had a bunch of missing teeth and healing wounds.
posted by thelonius at 7:03 AM on April 4, 2017 [3 favorites]
posted by thelonius at 7:03 AM on April 4, 2017 [3 favorites]
He's able to be honest with himself about all those terrible details of his own addiction and the consequences that have destroyed his life, but dismisses out of hand the possibility that his mother might have been brought down by it as well.
He must have known, on some level, that something was wrong there...otherwise, why take the drastic measure of banning his parents from his family's house?
posted by tully_monster at 7:06 AM on April 4, 2017 [3 favorites]
He must have known, on some level, that something was wrong there...otherwise, why take the drastic measure of banning his parents from his family's house?
posted by tully_monster at 7:06 AM on April 4, 2017 [3 favorites]
My husband was given a huge amount of oxycodone for a variety of issues, but he has high pain tolerance and never used them. They accumulated until there were probably ~100 pills in the medicine cabinet that we never got around to taking to the local police department for disposal. This was about 15 years ago and we were selling our house. There were a lot of workers in and out and one day Mr. Carmicha thought something looked off about the medicine cabinet. Sure enough, all the oxycodone was gone. I've always felt bad about that, so now I'm super responsible about it. Just after my mother died, we had a lot of opioids to take to the PD disposal place. One of my relatives was especially insistent that we get rid of it as soon as possible; turns out they'd had an issue with opioids in the past and didn't want the temptation around. I had no idea. This article gave me the willies.
posted by carmicha at 7:16 AM on April 4, 2017 [7 favorites]
posted by carmicha at 7:16 AM on April 4, 2017 [7 favorites]
One of the things that I'm grateful for as a recovering alcoholic is that I've become aware of the potential to get addicted to other things such as opiates, both from people that I've known in the program who have struggled with it (including some who have died either from overdosing or from suicide after failing to get or stay clean), and from reflecting on the times when I'd use prescription painkillers recreationally (sometimes mixing them with alcohol, which is an extremely bad idea, but I had a lot of bad ideas). I also have a good sponsor. Once, I was prescribed Vicodin after treatment for a local infection, and even though I was allowed one every six hours, I only took one before going to bed. I was patting myself on the back for my restraint, and mentioned it to my sponsor, hoping for another back pat.
"So, you've got some left over?"
"Yeah."
"What are you going to do with them?"
"Save them in case I need them in the future."
"Well, if you need them in the future, won't they just prescribe you more?"
"Well, yeah... are you saying that I should dispose of them instead of having them around the house?"
"I don't think I need to tell you what to do."
I disposed of them.
posted by Halloween Jack at 7:34 AM on April 4, 2017 [52 favorites]
"So, you've got some left over?"
"Yeah."
"What are you going to do with them?"
"Save them in case I need them in the future."
"Well, if you need them in the future, won't they just prescribe you more?"
"Well, yeah... are you saying that I should dispose of them instead of having them around the house?"
"I don't think I need to tell you what to do."
I disposed of them.
posted by Halloween Jack at 7:34 AM on April 4, 2017 [52 favorites]
Yep...after a close family member's death from cancer, the first thing her oldest son did, right after the funeral, while we were all sitting at the kitchen table, was to pour all the liter bottles of liquid oxycontin straight down the sink. (Not the best way to dispose of the stuff, but certainly the most expedient). Yes, you heard me. Multiple liter bottles. (Fuck cancer.)
posted by tully_monster at 7:40 AM on April 4, 2017 [3 favorites]
posted by tully_monster at 7:40 AM on April 4, 2017 [3 favorites]
I was given a mess of Norco (which, near as I can tell, is basically another name for Vicodin) after my bike accident two years ago, and I remain thankful that, as it turns out, I don't like or tolerate opiates very well. It made me sweaty and queasy, and I was basically counting the days until I could stop taking it (having been counseled that keeping the pain away was WAY easier than making it go away again if you quit the painkillers too early).
posted by uberchet at 7:49 AM on April 4, 2017 [2 favorites]
posted by uberchet at 7:49 AM on April 4, 2017 [2 favorites]
As a recovered alcoholic and addict heavily involved in a 12-step program, it's always good to see someone in a well-respected field/position write openly about their experiences with addiction. Both in my white-collar corporate life and personally, I am forever dumbfounded and disappointed by the lack of insight and understanding into the disease of addiction. While the taboo has lifted to an extent, the ignorance is still very real. These days if you don't know someone who is in recovery (or more likely, should be) you're either very lucky or not looking closely enough at those around you. I'm lucky to have survived relatively intact and count myself grateful every day.
posted by eggman at 7:53 AM on April 4, 2017 [13 favorites]
posted by eggman at 7:53 AM on April 4, 2017 [13 favorites]
As a person with debilitating chronic pain, my inability to get even small amounts of narcotic pain relievers because of the increased concern about addiction is really frustrating. I recently switched to a new clinic that doesn't prescribe opiates at all. My old doctor would prescribe 8-10 pills per month, with instructions to use them no more than 3 days. Having those helped me get through some very rough times. Often it helped just knowing they were an option for really bad days, that at least two out of three days of the month I could get some real relief. It's very hard to do without them completely. Nothing else relieves my pain like those when it's extremely bad.
I know the risk of addiction is real. When I was in patient last summer at a clinic dedicated to my condition, the nurses told me that many, many people were admitted with Vicodin habits of 20, 30 pills per day. I thought my old doctor had found a good solution, though. It was certainly one that worked well for me, and having narcotics off the table has made pain management (ha! my pain is never managed) that much more of a challenge for me.
posted by Orlop at 7:56 AM on April 4, 2017 [50 favorites]
I know the risk of addiction is real. When I was in patient last summer at a clinic dedicated to my condition, the nurses told me that many, many people were admitted with Vicodin habits of 20, 30 pills per day. I thought my old doctor had found a good solution, though. It was certainly one that worked well for me, and having narcotics off the table has made pain management (ha! my pain is never managed) that much more of a challenge for me.
posted by Orlop at 7:56 AM on April 4, 2017 [50 favorites]
Interesting read. On the one hand, he experienced chronic pain (herniated disc) from an early age, and needed painkillers. On the other hand he says he has experienced anxiety from an early age. He also seems to have had difficult relationships with his parents and then his wife.
Victoria, BC, had the highest number of overdose deaths per capita of fentanyl in Canada last year. It's crazy.
posted by My Dad at 7:57 AM on April 4, 2017
Victoria, BC, had the highest number of overdose deaths per capita of fentanyl in Canada last year. It's crazy.
posted by My Dad at 7:57 AM on April 4, 2017
I'm wondering about how it works in Canada with opiate prescriptions: Isn't there just one provider of healthcare? So doesn't the medical record collate how many prescriptions you've had from various docs? I guess not if you're just writing a paper prescription and taking it to the pharmacy? It does seem like this is a thing where safety would be increased by better documentation systems..
I recognize this is a small part of the picture of addiction and so forth, but just curious about this small part.
posted by latkes at 8:01 AM on April 4, 2017
I recognize this is a small part of the picture of addiction and so forth, but just curious about this small part.
posted by latkes at 8:01 AM on April 4, 2017
Damn, so much to unravel with my own feelings about this. Super-interesting article overall.
Most addicts aren't this guy, and plenty of addicts who are mostly like him never have to truly confront the consequences of their addiction because of class/people who enable them to continue it until the grave. I try not to be frustrated with this kind of story--it is interesting and heartbreaking when anyone suffers from addiction--but it drives me nuts how even as the opioid crisis was clogging ERs in the midwestern US, needle exchanges, addiction centers, and education programs were being cut throughout the region.
Not sure how it was playing out in Canada, but stateside it apparently took a bunch of well-off white people dying to get law enforcement really paying attention. The uneven enforcement across borders is also striking. In the US I assume this guy would still be in jail.
There's a bunch of weird North American cultural stuff at work here too, in addition to race, but tied somewhat to class. Something encouraged this guy, who knew he'd always had a "difficult time coping with stress," to take on a really stressful job and just keep buying things. Gebien mostly describes accomplishments, relationships, etc. in terms of purchases and brand names.
posted by aspersioncast at 8:02 AM on April 4, 2017 [13 favorites]
Most addicts aren't this guy, and plenty of addicts who are mostly like him never have to truly confront the consequences of their addiction because of class/people who enable them to continue it until the grave. I try not to be frustrated with this kind of story--it is interesting and heartbreaking when anyone suffers from addiction--but it drives me nuts how even as the opioid crisis was clogging ERs in the midwestern US, needle exchanges, addiction centers, and education programs were being cut throughout the region.
Not sure how it was playing out in Canada, but stateside it apparently took a bunch of well-off white people dying to get law enforcement really paying attention. The uneven enforcement across borders is also striking. In the US I assume this guy would still be in jail.
There's a bunch of weird North American cultural stuff at work here too, in addition to race, but tied somewhat to class. Something encouraged this guy, who knew he'd always had a "difficult time coping with stress," to take on a really stressful job and just keep buying things. Gebien mostly describes accomplishments, relationships, etc. in terms of purchases and brand names.
posted by aspersioncast at 8:02 AM on April 4, 2017 [13 favorites]
Whenever I read these stories I remember something I read in Bruce Alexander's book (The Globalization of Addiction, which I recommend without reservation): that even with something as addictive as heroin, addiction is a person-to-person thing. Some people *dislike* the feeling of opiates in their system.
It's a reminder to me in two ways:
1. That I have to take on those troubles in my life that can make me susceptible
2. I will never know for sure if I'm susceptible until I take one of these drugs myself. So... I'd better have a good reason
posted by billjings at 8:09 AM on April 4, 2017 [3 favorites]
It's a reminder to me in two ways:
1. That I have to take on those troubles in my life that can make me susceptible
2. I will never know for sure if I'm susceptible until I take one of these drugs myself. So... I'd better have a good reason
posted by billjings at 8:09 AM on April 4, 2017 [3 favorites]
"Well, if you need them in the future, won't they just prescribe you more?"
Maybe not, if you're a woman. I can't tell you how hard it was for me to get the handful of percocets that my male colleagues got without asking (and with lots of sympathy!) for exactly the same back problem from exactly the same clinic (small university town). Although I had never abused opioids in my life (hadn't had them since my wisdom teeth surgery in tenth grade), at the time I was viewed as if I were a junkie trying to score a fix and informed that my pain wasn't that bad despite my not being able to stand for more than a few seconds at a time. (Just tell them you're in pain, my coworkers said. It's a perfectly reasonable request.)
So that may be one reason people hang onto them and self-medicate...unless they're white men (like the guy in the article), they can't trust the healthcare system to take them seriously and treat them fairly. And then guys like the author pull the kinds of stunts he did, making it even harder for the rest of us to effectively manage pain.
posted by tully_monster at 8:09 AM on April 4, 2017 [79 favorites]
Maybe not, if you're a woman. I can't tell you how hard it was for me to get the handful of percocets that my male colleagues got without asking (and with lots of sympathy!) for exactly the same back problem from exactly the same clinic (small university town). Although I had never abused opioids in my life (hadn't had them since my wisdom teeth surgery in tenth grade), at the time I was viewed as if I were a junkie trying to score a fix and informed that my pain wasn't that bad despite my not being able to stand for more than a few seconds at a time. (Just tell them you're in pain, my coworkers said. It's a perfectly reasonable request.)
So that may be one reason people hang onto them and self-medicate...unless they're white men (like the guy in the article), they can't trust the healthcare system to take them seriously and treat them fairly. And then guys like the author pull the kinds of stunts he did, making it even harder for the rest of us to effectively manage pain.
posted by tully_monster at 8:09 AM on April 4, 2017 [79 favorites]
Not sure how it was playing out in Canada
The writer doesn't really represent the full fentanyl crisis in Canada. On the street fentanyl has replaced heroin. Almost all of the overdose deaths are people injecting what they think is heroin, but it's really the much more potent fentanyl.
Opioids have been overprescribed in Canada. A crackdown on painkiller prescriptions has left many addicts struggling to get supplied. They turn to the street, they get uncut fentanyl, they die.
At my son's school, two kids have overdosed in the past year or so on fentanyl. People in the park a block from me here in Victoria have overdosed on fentanyl.
However, 90% of overdose deaths in British Columbia, which has the most overdose deaths per capita in Canada, occurred "inside", and therefore not on the street.
It's an epidemic.
posted by My Dad at 8:10 AM on April 4, 2017 [8 favorites]
The writer doesn't really represent the full fentanyl crisis in Canada. On the street fentanyl has replaced heroin. Almost all of the overdose deaths are people injecting what they think is heroin, but it's really the much more potent fentanyl.
Opioids have been overprescribed in Canada. A crackdown on painkiller prescriptions has left many addicts struggling to get supplied. They turn to the street, they get uncut fentanyl, they die.
At my son's school, two kids have overdosed in the past year or so on fentanyl. People in the park a block from me here in Victoria have overdosed on fentanyl.
However, 90% of overdose deaths in British Columbia, which has the most overdose deaths per capita in Canada, occurred "inside", and therefore not on the street.
It's an epidemic.
posted by My Dad at 8:10 AM on April 4, 2017 [8 favorites]
In Canada there's one payer of healthcare (per province, so actually a few but one where you live), not one provider. And for drugs we have private insurance too. That said, in Ontario they now track opioid prescriptions by doctor so they can see who is prescribing a lot.
posted by warriorqueen at 8:17 AM on April 4, 2017 [5 favorites]
posted by warriorqueen at 8:17 AM on April 4, 2017 [5 favorites]
I've also experienced chronic pain with no one willing to prescribe me anything stronger than Ibuprofen. It's like there are two different systems in place--one where people are given hundreds of percs any time they want, and another in which everyone must go teetotal, and there's nothing in between.
If me having to endure that pain for all those years is the price I had to pay so that one person could be free from addiction, I'm okay with that. I 100% understand the reluctance to prescribe, and even the refusal. But so many of these stories are just at complete odds with my experience in the medical system trying to get my pain managed.
posted by soren_lorensen at 8:22 AM on April 4, 2017 [22 favorites]
If me having to endure that pain for all those years is the price I had to pay so that one person could be free from addiction, I'm okay with that. I 100% understand the reluctance to prescribe, and even the refusal. But so many of these stories are just at complete odds with my experience in the medical system trying to get my pain managed.
posted by soren_lorensen at 8:22 AM on April 4, 2017 [22 favorites]
"If me having to endure that pain for all those years is the price I had to pay so that one person could be free from addiction, I'm okay with that."
I'm not. Fuck that shit. I go to you [pain doctor] and jump through all your stupid hoops so you can give me something that is the difference between functioning/holding down a job/not crying in bed all the time and being a completely useless lump of chronic pain. I don't want this pain. I'm not ok with being a martyr AND the actual causes of addiction not being treated because instead we can just say "oh don't prescribe to anyone."
posted by fiercecupcake at 8:34 AM on April 4, 2017 [76 favorites]
I'm not. Fuck that shit. I go to you [pain doctor] and jump through all your stupid hoops so you can give me something that is the difference between functioning/holding down a job/not crying in bed all the time and being a completely useless lump of chronic pain. I don't want this pain. I'm not ok with being a martyr AND the actual causes of addiction not being treated because instead we can just say "oh don't prescribe to anyone."
posted by fiercecupcake at 8:34 AM on April 4, 2017 [76 favorites]
I do not have a history of addiction to prescription opiates. This is almost entirely due to a chance remark a friend of mine with a loooooong personal addiction history made, about how one way addiction gets you is by suggesting that you take the pills even when you don't really need them. "Sure that headache would probably go away with ibuprofen," says addiction. "But you could also take Vicodin, and then it would definitely go away." I happened to remember that statement while I was idly wondering if there was some way I could process the Tylenol out of the AC&C I had picked up over the counter in Canada, so that I could get more than 8mg of codeine for my tension headache without risking Tylenol poisoning, and I had one of those psychological moments that feels like the zoom-in dolly-out camera shot in Vertigo.
I've been extremely careful about prescription narcotics ever since. When I need them, I ask my providers to write me very small prescriptions, and if possible I give them to my husband to dole out to me. I discovered that Percocet puts me right to sleep and makes me depressed after I take it for a couple days while Vicodin feels like I'm getting a hug from God, so now I ask for Percocet as opposed to Vicodin. I ask my doctors to chart my potential tendency so that it's part of my medical records, in case my resolve ever wavers. Because things would not have to have gone so very differently in my life for this to have been me -- even with my precautions I've had a couple close calls -- and I really, really, really don't want that to happen.
posted by KathrynT at 8:36 AM on April 4, 2017 [14 favorites]
I've been extremely careful about prescription narcotics ever since. When I need them, I ask my providers to write me very small prescriptions, and if possible I give them to my husband to dole out to me. I discovered that Percocet puts me right to sleep and makes me depressed after I take it for a couple days while Vicodin feels like I'm getting a hug from God, so now I ask for Percocet as opposed to Vicodin. I ask my doctors to chart my potential tendency so that it's part of my medical records, in case my resolve ever wavers. Because things would not have to have gone so very differently in my life for this to have been me -- even with my precautions I've had a couple close calls -- and I really, really, really don't want that to happen.
posted by KathrynT at 8:36 AM on April 4, 2017 [14 favorites]
So that may be one reason people hang onto them and self-medicate...unless they're white men (like the guy in the article), they can't trust the healthcare system to take them seriously and treat them fairly.
Yeah, I have a chronic condition that has intense, unable to function, vomiting from the pain type pain, and it could crop up every six months, or once a year, or never again.
And even so, I get very nervous having my small amounts of prescribed Oxycodone on hand in case the pain hits. What if I suddenly lose all sense of proportion and take it recreationally? I don’t think I would (I’ve never even finished 1/3rd of a prescription), but that seems to be a common thread for a lot of people struggling with opioid addiction— they never thought it would be them until it was.
But the flip side is that as a woman, I can never be sure that doctors will trust me enough to prescribe the next time, so just throwing it all out and counting on a new prescription if I need one is by no means a guarantee.
The other flip side (which I guess makes it a facet instead) is that the last time I got this medicine prescribed, getting it filled was IMPOSSIBLE, because every pharmacy is completely out of it so much of the time. There’s nothing like a pharmacist telling you about the next oxy delivery drop in a “just-between-us” whisper to make you feel like you’re somehow asking for something illicit. What if I needed the pills right now? Too bad! Take your blinding pain and drive to another store, repeat until you find a place that has it in stock.
(Not to mention— when my mother was in hospice care, my father and I often had to go pick up her liquid morphine for her. There was literally no way she could have come with us, but I worry that increased restrictions will mean that picking up these prescriptions on behalf of another person becomes increasingly impossible.)
It’s all just—terrible.
posted by a fiendish thingy at 8:40 AM on April 4, 2017 [13 favorites]
Yeah, I have a chronic condition that has intense, unable to function, vomiting from the pain type pain, and it could crop up every six months, or once a year, or never again.
And even so, I get very nervous having my small amounts of prescribed Oxycodone on hand in case the pain hits. What if I suddenly lose all sense of proportion and take it recreationally? I don’t think I would (I’ve never even finished 1/3rd of a prescription), but that seems to be a common thread for a lot of people struggling with opioid addiction— they never thought it would be them until it was.
But the flip side is that as a woman, I can never be sure that doctors will trust me enough to prescribe the next time, so just throwing it all out and counting on a new prescription if I need one is by no means a guarantee.
The other flip side (which I guess makes it a facet instead) is that the last time I got this medicine prescribed, getting it filled was IMPOSSIBLE, because every pharmacy is completely out of it so much of the time. There’s nothing like a pharmacist telling you about the next oxy delivery drop in a “just-between-us” whisper to make you feel like you’re somehow asking for something illicit. What if I needed the pills right now? Too bad! Take your blinding pain and drive to another store, repeat until you find a place that has it in stock.
(Not to mention— when my mother was in hospice care, my father and I often had to go pick up her liquid morphine for her. There was literally no way she could have come with us, but I worry that increased restrictions will mean that picking up these prescriptions on behalf of another person becomes increasingly impossible.)
It’s all just—terrible.
posted by a fiendish thingy at 8:40 AM on April 4, 2017 [13 favorites]
I'm not. Fuck that shit.
Me, neither. The coalescence of an old-fashioned moral panic with an unquestionably real problem has had really horrible consequences for people with chronic pain. God forbid we try to figure out how most safely to prescribe these drugs to people who genuinely need them, much less sort out the underlying social problems that promote addiction. Nope, it's jump straight to "let's torture the drug-seekers!"
posted by praemunire at 8:53 AM on April 4, 2017 [37 favorites]
Me, neither. The coalescence of an old-fashioned moral panic with an unquestionably real problem has had really horrible consequences for people with chronic pain. God forbid we try to figure out how most safely to prescribe these drugs to people who genuinely need them, much less sort out the underlying social problems that promote addiction. Nope, it's jump straight to "let's torture the drug-seekers!"
posted by praemunire at 8:53 AM on April 4, 2017 [37 favorites]
I'm really frustrated with the binary narrative around pain medication and addiction - that it's either one or the other rather than the unfortunate fact that some people with pain are going to become dependent on the only imperfect options we have at this time.
Some people with high blood pressure are dependent on their medication. Some diabetics as well. My partner can function, at the moment, without his biweekly immunosuppressant, but without treatment his body is increasingly damaged by itself irreversibly. Some cancer patients are dependent on chemotherapy and others on frickin' lasers.
And that's all fine as long as none of it makes you feel good, because pleasure is a moral failure. If you could get high on insulin without pretty immediate ramifications, we'd make diabetics line up outside a clinic for half-doses of poor-quality insulin, just enough to stay out of a coma.
I know people who are literally being tortured to their slow deaths by pain that doctors refuse to manage because it might make them feel better, and there's a real strong wrapper of sexism there too. But telling someone with Ehlers-Danlos, or spinal damage, or eroding joints to just take ibuprofen is bullshit.
posted by Lyn Never at 8:56 AM on April 4, 2017 [65 favorites]
Some people with high blood pressure are dependent on their medication. Some diabetics as well. My partner can function, at the moment, without his biweekly immunosuppressant, but without treatment his body is increasingly damaged by itself irreversibly. Some cancer patients are dependent on chemotherapy and others on frickin' lasers.
And that's all fine as long as none of it makes you feel good, because pleasure is a moral failure. If you could get high on insulin without pretty immediate ramifications, we'd make diabetics line up outside a clinic for half-doses of poor-quality insulin, just enough to stay out of a coma.
I know people who are literally being tortured to their slow deaths by pain that doctors refuse to manage because it might make them feel better, and there's a real strong wrapper of sexism there too. But telling someone with Ehlers-Danlos, or spinal damage, or eroding joints to just take ibuprofen is bullshit.
posted by Lyn Never at 8:56 AM on April 4, 2017 [65 favorites]
If you want a full carefull study of how the pharmaceutical industry, doctors, pain clinics, Mexican heroin dealers, and govt disability programs all contributed to our present addiction problem with heroin and oxycontin, then this award winning book fully explains it
posted by Postroad at 8:57 AM on April 4, 2017 [3 favorites]
posted by Postroad at 8:57 AM on April 4, 2017 [3 favorites]
The blowback on chronic pain patients (or women in any kind of pain, as others have mentioned) can be frustrating and heartbreaking. I have a diagnosed condition (Ehlers-Danlos) that causes chronic pain and I'm worried that the medication that allows me to get out of bed will become difficult to get after almost ten years on the same dose. I'm extremely careful to get all of my medication from one doctor and be open with other doctors about it (e.g. I turned down pain medication after getting dental implants because I have pain medication from the doctor who manages all of my scripts). I know of several patients who've been stable on the same dose of the same opiate medication for years and suddenly have to get 7-day prescriptions, have their dosages halved, and take drug tests. I don't know what the answer is, but hassling pain patients isn't it.
posted by swerve at 9:03 AM on April 4, 2017 [15 favorites]
posted by swerve at 9:03 AM on April 4, 2017 [15 favorites]
If you want a full carefull study of how the pharmaceutical industry, doctors, pain clinics, Mexican heroin dealers, and govt disability programs all contributed to our present addiction problem with heroin and oxycontin, then this award winning book fully explains it
Hey! That's next on my To Read pile.
posted by thivaia at 9:06 AM on April 4, 2017
Two insights from the article that people seem to be ignoring:
1. The line between "sick person who actually needs opiates" and "drug abuser" is porous, as shown by the author's mother's OD death.
2. For those who suggest we focus on "social problems" instead of prescription control to stem the opiate epidemic --- did you read the article? Drug dependency is a problem that spans social strata.
posted by loquacious crouton at 9:08 AM on April 4, 2017 [5 favorites]
1. The line between "sick person who actually needs opiates" and "drug abuser" is porous, as shown by the author's mother's OD death.
2. For those who suggest we focus on "social problems" instead of prescription control to stem the opiate epidemic --- did you read the article? Drug dependency is a problem that spans social strata.
posted by loquacious crouton at 9:08 AM on April 4, 2017 [5 favorites]
instead of prescription control to stem the opiate epidemic
I don't disagree with your other point, but I would say that prescription control is what has turned the opioid epidemic in Canada into total carnage, particularly in British Columbia. But Ontario (where the writer of this article resides) is going to experience what BC has experienced next.
Restrict access to opioids, and people will find fentanyl on the streets. And then they will die. The only thing that has somewhat stopped the exponential increase in fentanyl OD's in British Columbia is making naloxone kits more available at the street level. So people are being revived after ODing. Some people have been revived multiple times. This has created a secondary problem: these people have been essentially brain dead for a few minutes at a time, so they all have, besides their addictions, various cognitive impairments. It's not a small problem.
The fentanyl, by the way, is popular because it is cheaper and easier to import (from China, by the way) into British Columbia than heroin.
Is the same thing happening in the States, I wonder?
I mean, there is just slaughter going on in British Columbia right now.
posted by My Dad at 9:26 AM on April 4, 2017 [8 favorites]
I don't disagree with your other point, but I would say that prescription control is what has turned the opioid epidemic in Canada into total carnage, particularly in British Columbia. But Ontario (where the writer of this article resides) is going to experience what BC has experienced next.
Restrict access to opioids, and people will find fentanyl on the streets. And then they will die. The only thing that has somewhat stopped the exponential increase in fentanyl OD's in British Columbia is making naloxone kits more available at the street level. So people are being revived after ODing. Some people have been revived multiple times. This has created a secondary problem: these people have been essentially brain dead for a few minutes at a time, so they all have, besides their addictions, various cognitive impairments. It's not a small problem.
The fentanyl, by the way, is popular because it is cheaper and easier to import (from China, by the way) into British Columbia than heroin.
Is the same thing happening in the States, I wonder?
I mean, there is just slaughter going on in British Columbia right now.
posted by My Dad at 9:26 AM on April 4, 2017 [8 favorites]
Wow. That was -- wow. Definitely makes me understand why painkillers for childbirth #3 last year were so much more stingily provided than for childbirth #1, 8 years ago.
I'm curious to read Katie's side of the story. Like she sounds NOT SO NICE in the early going with the undermining parenting and cutting off his parents. And yet, what the hell, doctor guy, that you thought you could still make a go of the marriage after using with three kids in the house and getting your wife arrested for your crimes! THAT SHIP SAILED WHEN YOU GOT YOUR WIFE CHARGED WITH A FELONY SHE DIDN'T COMMIT.
But geeeez, that was a harrowing story.
posted by Eyebrows McGee at 9:30 AM on April 4, 2017 [13 favorites]
I'm curious to read Katie's side of the story. Like she sounds NOT SO NICE in the early going with the undermining parenting and cutting off his parents. And yet, what the hell, doctor guy, that you thought you could still make a go of the marriage after using with three kids in the house and getting your wife arrested for your crimes! THAT SHIP SAILED WHEN YOU GOT YOUR WIFE CHARGED WITH A FELONY SHE DIDN'T COMMIT.
But geeeez, that was a harrowing story.
posted by Eyebrows McGee at 9:30 AM on April 4, 2017 [13 favorites]
On the one hand, he experienced chronic pain (herniated disc) from an early age, and needed painkillers. On the other hand he says he has experienced anxiety from an early age. He also seems to have had difficult relationships with his parents and then his wife.
Yes, chronic pain will do that to a person.
This may not be at all what you were getting at, but I have always wondered whether the people and doctors [1] who look out for a somatizing personality profile, detective-style, so as to deny such people pain drugs, have given any thought to what kind of effects on the personality being in pain all day most days might have. (For anyone who may not know, I can tell you: it makes you cranky, weepy, snappish, easily enraged, and generally unpleasant to be around. You can hold back the expression of those personality effects for the duration of a doctor visit or much of a workday if you have the will, but whether or not you have the will is not a function of how bad your pain is or what its origin might be or how helpful opiates might or might not be.
oho, but wait a second, isn't it possible that being a giant emotive asshole actually causes you to perceive pain, though the magic of the nervous system, and I have it all backwards? no. generally speaking, no. the universe does not punish people for being histrionic by blighting them with unresolvable chronic pain, because the universe does not have a quasi-human sense of vindictiveness and fairness.)
[1] I am aware that some individuals fall into both of these groups.
posted by queenofbithynia at 9:32 AM on April 4, 2017 [8 favorites]
Yes, chronic pain will do that to a person.
This may not be at all what you were getting at, but I have always wondered whether the people and doctors [1] who look out for a somatizing personality profile, detective-style, so as to deny such people pain drugs, have given any thought to what kind of effects on the personality being in pain all day most days might have. (For anyone who may not know, I can tell you: it makes you cranky, weepy, snappish, easily enraged, and generally unpleasant to be around. You can hold back the expression of those personality effects for the duration of a doctor visit or much of a workday if you have the will, but whether or not you have the will is not a function of how bad your pain is or what its origin might be or how helpful opiates might or might not be.
oho, but wait a second, isn't it possible that being a giant emotive asshole actually causes you to perceive pain, though the magic of the nervous system, and I have it all backwards? no. generally speaking, no. the universe does not punish people for being histrionic by blighting them with unresolvable chronic pain, because the universe does not have a quasi-human sense of vindictiveness and fairness.)
[1] I am aware that some individuals fall into both of these groups.
posted by queenofbithynia at 9:32 AM on April 4, 2017 [8 favorites]
The line between "sick person who actually needs opiates" and "drug abuser" is porous, as shown by the author's mother's OD death.
All the evidence I've read suggests exactly the opposite. Sick people who actually need opiates tend *not* to abuse them. Rather, the abusers are people like the doctor in this somewhat nauseating article -- people with a history of recreational drug use who develop a taste for opioids at some point.
I see no evidence that his mother was an abuser, despite her accidental death/possible suicide.
Why did I find the article nauseating? These doctors-cum-dopefiend drugalog stories are ten a penny now. There's always a subtext in there about how they aren't really deserving of the consequences most street addicts suffer because -- I dunno, because they have a medical degree?
The graceful thing to do would be to do your porridge in contemplative silence
posted by PeterMcDermott at 9:32 AM on April 4, 2017 [10 favorites]
All the evidence I've read suggests exactly the opposite. Sick people who actually need opiates tend *not* to abuse them. Rather, the abusers are people like the doctor in this somewhat nauseating article -- people with a history of recreational drug use who develop a taste for opioids at some point.
I see no evidence that his mother was an abuser, despite her accidental death/possible suicide.
Why did I find the article nauseating? These doctors-cum-dopefiend drugalog stories are ten a penny now. There's always a subtext in there about how they aren't really deserving of the consequences most street addicts suffer because -- I dunno, because they have a medical degree?
The graceful thing to do would be to do your porridge in contemplative silence
posted by PeterMcDermott at 9:32 AM on April 4, 2017 [10 favorites]
thelonius: " That was my first experience with oral narcotics, and I can see how seductive they could be. It wasn't like I felt really high, but everything was FINE. I didn't much mind that I couldn't eat and had a bunch of missing teeth and healing wounds."
There's very little I've been more casually thankful for than the fact that oral narcotics don't make me feel good. I mean they don't make me feel bad, but I certainly don't get any enjoyment from taking them. The accompanying guaranteed OIC is enough to make sure I don't take any of them a day longer than I have to. I was prescribed them for both a tooth extraction / replacement and gallbladder removal. In both cases I switched out to regular Tylenol at the first available opportunity.
Recently I had some fairly significant dermatological work done and in the consult before the surgery they mentioned painkillers. I said offhand, "Please don't prescribe any opioids" thinking to myself, "Why make this doctor write down a prescription I have no intention of even filling" and was just kind of absentmindedly expecting them to ask, "Are you sure?" but was met with zero resistance and they immediately moved on to the next bullet point on their sheet. It was only a minute or two later it occurred to me what it must have looked like from their end.
posted by komara at 9:33 AM on April 4, 2017 [1 favorite]
There's very little I've been more casually thankful for than the fact that oral narcotics don't make me feel good. I mean they don't make me feel bad, but I certainly don't get any enjoyment from taking them. The accompanying guaranteed OIC is enough to make sure I don't take any of them a day longer than I have to. I was prescribed them for both a tooth extraction / replacement and gallbladder removal. In both cases I switched out to regular Tylenol at the first available opportunity.
Recently I had some fairly significant dermatological work done and in the consult before the surgery they mentioned painkillers. I said offhand, "Please don't prescribe any opioids" thinking to myself, "Why make this doctor write down a prescription I have no intention of even filling" and was just kind of absentmindedly expecting them to ask, "Are you sure?" but was met with zero resistance and they immediately moved on to the next bullet point on their sheet. It was only a minute or two later it occurred to me what it must have looked like from their end.
posted by komara at 9:33 AM on April 4, 2017 [1 favorite]
The fentanyl, by the way, is popular because it is cheaper and easier to import (from China, by the way) into British Columbia than heroin.
That makes sense; I had been wondering why fentanyl was becoming so popular as a street drug lately. I assume the same holds true for the even more potent carfentanil. I deal with fentanyl and similar drugs in the OR on a daily basis and the thought of drugs like that, of uncertain purity, in untrained hands is really scary. I have known physicians who overdosed on fentanyl straight from the pharmacy; I am surprised it doesn't happen more often in other scenarios.
posted by TedW at 9:35 AM on April 4, 2017 [3 favorites]
That makes sense; I had been wondering why fentanyl was becoming so popular as a street drug lately. I assume the same holds true for the even more potent carfentanil. I deal with fentanyl and similar drugs in the OR on a daily basis and the thought of drugs like that, of uncertain purity, in untrained hands is really scary. I have known physicians who overdosed on fentanyl straight from the pharmacy; I am surprised it doesn't happen more often in other scenarios.
posted by TedW at 9:35 AM on April 4, 2017 [3 favorites]
This may not be at all what you were getting at
As the epidemic has become evermore worse in my community, and as my son's classmates die, I often wonder how people get addicted in the first place. To anything. This article provides a few answers. It could be any one of us. But there are other "somatic" reasons, I think.
Just an FYI, but our family lives with chronic pain. My wife has a severely herniated disc that at one point kept her bedridden for four months. So I'm not just some clueless, insensitive white middle-aged guy or whatever. I'm just someone who is curious and happens to wonder why so many people in my community are dying.
posted by My Dad at 9:37 AM on April 4, 2017 [1 favorite]
As the epidemic has become evermore worse in my community, and as my son's classmates die, I often wonder how people get addicted in the first place. To anything. This article provides a few answers. It could be any one of us. But there are other "somatic" reasons, I think.
Just an FYI, but our family lives with chronic pain. My wife has a severely herniated disc that at one point kept her bedridden for four months. So I'm not just some clueless, insensitive white middle-aged guy or whatever. I'm just someone who is curious and happens to wonder why so many people in my community are dying.
posted by My Dad at 9:37 AM on April 4, 2017 [1 favorite]
I wish that maias were still around. there has been this spike in moral panic / Lost Weekend flavored horrorterror stories of the OPIOID EPIDEMIC. stories about individual people's pain, addictions, difficulty coping are not at all the same thing as examinations of addiction across the population, and i have noticed a whole shitload of the former standing in for the latter lately. this is a public health problem, it's not a moral panic, and framing it as a moral panic keeps people from getting the help they need.
posted by nixon's meatloaf at 9:38 AM on April 4, 2017 [9 favorites]
posted by nixon's meatloaf at 9:38 AM on April 4, 2017 [9 favorites]
Two insights from the article that people seem to be ignoring:
No, they're just really basic ground-level observations that have already been considered and responded to if you've thought about this problem at all before.
1. The line between "sick person who actually needs opiates" and "drug abuser" is porous, as shown by the author's mother's OD death.
There is not a single person (not being paid by a pharma) who will not tell you that, as with many other powerful drugs, the prescription of opiates carries risks. This doesn't mean we can't prescribe them. This means two things. First, we need to actually try to determine what patient populations are most vulnerable to these risks, and what treatment practices are most effective in minimizing them, so that we can prescribe them as safely as possible. Second, we need to understand that, humans being humans, addiction is going to happen for some percentage of the population (whether they start with prescriptions or not--there is astonishingly little actual data, as opposed to anecdotage, on how many addicts' problems began with their own prescriptions, and not with street drugs or drugs prescribed for others), and learn how to respond to it in a way that does not produce the unnecessary carnage strewn on our streets every day.
For those who suggest we focus on "social problems" instead of prescription control to stem the opiate epidemic --- did you read the article? Drug dependency is a problem that spans social strata.
No kidding?
It's almost as if social problems do, too!
The addict I know best is not poor. Because he's white, has a college education, and knows how to work the system, if you saw him on the street, you would probably think of him as a vaguely respectable middle-class person. But he had an abusive childhood to which everyone turned a blind eye at the time and later and then suffered from decades of untreated and severe depression. I feel strongly that these two circumstances contributed powerfully to his addiction. Neither had to happen, in a society that took proper care of its people.
posted by praemunire at 9:40 AM on April 4, 2017 [16 favorites]
No, they're just really basic ground-level observations that have already been considered and responded to if you've thought about this problem at all before.
1. The line between "sick person who actually needs opiates" and "drug abuser" is porous, as shown by the author's mother's OD death.
There is not a single person (not being paid by a pharma) who will not tell you that, as with many other powerful drugs, the prescription of opiates carries risks. This doesn't mean we can't prescribe them. This means two things. First, we need to actually try to determine what patient populations are most vulnerable to these risks, and what treatment practices are most effective in minimizing them, so that we can prescribe them as safely as possible. Second, we need to understand that, humans being humans, addiction is going to happen for some percentage of the population (whether they start with prescriptions or not--there is astonishingly little actual data, as opposed to anecdotage, on how many addicts' problems began with their own prescriptions, and not with street drugs or drugs prescribed for others), and learn how to respond to it in a way that does not produce the unnecessary carnage strewn on our streets every day.
For those who suggest we focus on "social problems" instead of prescription control to stem the opiate epidemic --- did you read the article? Drug dependency is a problem that spans social strata.
No kidding?
It's almost as if social problems do, too!
The addict I know best is not poor. Because he's white, has a college education, and knows how to work the system, if you saw him on the street, you would probably think of him as a vaguely respectable middle-class person. But he had an abusive childhood to which everyone turned a blind eye at the time and later and then suffered from decades of untreated and severe depression. I feel strongly that these two circumstances contributed powerfully to his addiction. Neither had to happen, in a society that took proper care of its people.
posted by praemunire at 9:40 AM on April 4, 2017 [16 favorites]
If you found the idea that doctors get addicted to heavy drugs fairly frequently "nauseating", maybe you should go read that doctor suicide thread from a few days ago.
My Dad it seems like you are suggesting that restriction after providing opiates doesn't work, which makes sense and is inhumane. But how did those people get addicted in the first place?
posted by loquacious crouton at 9:41 AM on April 4, 2017 [2 favorites]
My Dad it seems like you are suggesting that restriction after providing opiates doesn't work, which makes sense and is inhumane. But how did those people get addicted in the first place?
posted by loquacious crouton at 9:41 AM on April 4, 2017 [2 favorites]
One summer I lived on Crystal Cove, one of the nicest little places on the north shore of Lake Tahoe. I met a woman who took her little kids to the beach there, she was a neighbor, and the daughter of an orthopedic surgeon. She told me about her addiction. It was a tale I never forgot. She had a bad back, and finally had surgery to repair it. In the course of recovery she was prescribed codeine for the pain. So she recovered, and recovered, and recovered, but could not recover. The surgery had been unsuccessful, or so it seemed, and she relied on the codeine to treat her symptoms. This was in individual who was not prone to an addictive frame of mind, and finally after yet another examination, it was determined the back surgery had been successful, but an addiction to codeine was manifesting as back pain at the surgical site. She went through recovery and went back to her regular life, with no back pain and no opiates. I was amazed at how sneaky addiction can be.
posted by Oyéah at 9:41 AM on April 4, 2017 [4 favorites]
posted by Oyéah at 9:41 AM on April 4, 2017 [4 favorites]
My Dad it seems like you are suggesting that restriction after providing opiates doesn't work, which makes sense and is inhumane. But how did those people get addicted in the first place?
It's not only inhumane, it appears to be deadly. It seems that one path to addiction is receiving pain medication in the first place. In Canada it is easy to "shop around" for prescriptions. Just go to different walk-in clinics and see different doctors, go to different pharmacies. There may be single-payer in Canada, but health records are fragmented.
This is a pretty typical (and heartbreaking) scenario of overdose and death in British Columbia.
posted by My Dad at 9:45 AM on April 4, 2017
It's not only inhumane, it appears to be deadly. It seems that one path to addiction is receiving pain medication in the first place. In Canada it is easy to "shop around" for prescriptions. Just go to different walk-in clinics and see different doctors, go to different pharmacies. There may be single-payer in Canada, but health records are fragmented.
This is a pretty typical (and heartbreaking) scenario of overdose and death in British Columbia.
posted by My Dad at 9:45 AM on April 4, 2017
getting your wife arrested for your crimes
He's indeed got some heavy bad karma to bear from this; he also says that several people who he used in his drug diversion schemes were fired.
posted by thelonius at 9:47 AM on April 4, 2017 [5 favorites]
He's indeed got some heavy bad karma to bear from this; he also says that several people who he used in his drug diversion schemes were fired.
posted by thelonius at 9:47 AM on April 4, 2017 [5 favorites]
I guess that I'm happy that opioids don't seem to do much for me. I was given a prescription for Vicodin after back surgery a few years ago and it did nothing but give me a splitting headache without helping the pain all that much. Aleve is the only the drug that seems to help my back pain.
posted by octothorpe at 9:54 AM on April 4, 2017 [1 favorite]
posted by octothorpe at 9:54 AM on April 4, 2017 [1 favorite]
One more thing about all this. I had a shoulder injury, a bad one, but the organization I worked for sent me to an Ortho who gave me steroid shots, and then a ninety day prescription for Lortabs. He said that I was going to love it, it was just like having a cocktail. I took one and realized I could not work while taking these, and I didn't want them around the house, so I threw out the first month's supply and never refilled. In retrospect, an addict gave me an addictive prescription. I don't seem to have an opoid receptor that functions also as a source of pleasure.
posted by Oyéah at 10:04 AM on April 4, 2017
posted by Oyéah at 10:04 AM on April 4, 2017
I often wonder how people get addicted in the first place. To anything. This article provides a few answers. It could be any one of us.
I don't know what does it, but I know a couple of things that don't reliably do it: chronic pain for which opiates provide some relief, general neuroticism, and a basic ability to feel pleasure from opiate operation. (I know because I enjoy all of these qualities and have never been addicted or habituated enough to suffer withdrawal or have any physical cravings.) It is absolutely not the case that liking the way opiates feel requires you to lose your grasp on the basic fact that if you take too many, you'll get tolerant and they won't feel good anymore.
I know there is something, some group of factors that makes the difference to people, something about the brain and the body and lifestyle and life situation, but whatever it is, it does not express itself well through warning checklists for harried and hurried doctors.
general miserabilism and hypochondria make it extraordinarily difficult to get doctors to give you drugs when you need them, but they, too, do not make it difficult to stop taking the pills when they no longer help or are no longer needed. not automatically. On paper I make a fantastic addict candidate and I really couldn't say why I'm not one. but I cannot stress enough that it was never a danger to me that pain pills made me feel good. If they were the only thing that made me feel good, that might have made everything different. that, I can see as a valuable distinction.
posted by queenofbithynia at 10:05 AM on April 4, 2017 [8 favorites]
I don't know what does it, but I know a couple of things that don't reliably do it: chronic pain for which opiates provide some relief, general neuroticism, and a basic ability to feel pleasure from opiate operation. (I know because I enjoy all of these qualities and have never been addicted or habituated enough to suffer withdrawal or have any physical cravings.) It is absolutely not the case that liking the way opiates feel requires you to lose your grasp on the basic fact that if you take too many, you'll get tolerant and they won't feel good anymore.
I know there is something, some group of factors that makes the difference to people, something about the brain and the body and lifestyle and life situation, but whatever it is, it does not express itself well through warning checklists for harried and hurried doctors.
general miserabilism and hypochondria make it extraordinarily difficult to get doctors to give you drugs when you need them, but they, too, do not make it difficult to stop taking the pills when they no longer help or are no longer needed. not automatically. On paper I make a fantastic addict candidate and I really couldn't say why I'm not one. but I cannot stress enough that it was never a danger to me that pain pills made me feel good. If they were the only thing that made me feel good, that might have made everything different. that, I can see as a valuable distinction.
posted by queenofbithynia at 10:05 AM on April 4, 2017 [8 favorites]
I am glad that I don't respond well to pain medication, it makes me feel ill and a little goes a long way. Apparently it is common among redheads to be sensitive to opiates but resistant to other pain medications and anesthesia. While I am a brunette, I do have redheads in my family. Conversely, I wonder if there is a way to see who might be at risk by looking at genetics. Like estimating risk of breast cancer or heart disease, it could help patients make informed decisions. Or it could lead to patients being refused much-needed relief. It's a mixed bag.
posted by domo at 10:12 AM on April 4, 2017
posted by domo at 10:12 AM on April 4, 2017
queenofbithynia -- what makes people predisposed to addiction, what keeps people addicted, and how people stop being addicted to various kinds of things are super loaded questions. there's so much stuff in these ZOMG OPIOID EPIDEMIC articles that doesn't get touched on -- underlying socioeconomic / psychological factors ( ie rat park consideration: if your life is shit and drugs are fun, it's likely you will slam that fun button harder) as well as the tendency for large numbers of people to age out of addiction
but like the problem the states has with affordable housing, there's a tendency in the discourse to reduce the situation to a lot of anecdotes and, i notice, a tendency to ignore conclusions that go against our notions of "responsibility" and "punishment"
if you want more boring information about wherefores i will be very happy to dig it up
posted by nixon's meatloaf at 10:24 AM on April 4, 2017 [7 favorites]
but like the problem the states has with affordable housing, there's a tendency in the discourse to reduce the situation to a lot of anecdotes and, i notice, a tendency to ignore conclusions that go against our notions of "responsibility" and "punishment"
if you want more boring information about wherefores i will be very happy to dig it up
posted by nixon's meatloaf at 10:24 AM on April 4, 2017 [7 favorites]
I'm not queenofbithynia, but I'd be interested in that information! I'm definitely no expert on this and I've never before heard anything about addicts aging out, so thank you for that.
posted by R a c h e l at 10:27 AM on April 4, 2017
posted by R a c h e l at 10:27 AM on April 4, 2017
> There's always a subtext in there about how they aren't really deserving of the consequences most street addicts suffer because -- I dunno, because they have a medical degree?
Jesus christ. Because nobody deserves those consequences. No matter how gross or nauseating you find them, or their stories, or what you perceive to be "the cause" of their addiction.
posted by rtha at 10:30 AM on April 4, 2017 [11 favorites]
Jesus christ. Because nobody deserves those consequences. No matter how gross or nauseating you find them, or their stories, or what you perceive to be "the cause" of their addiction.
posted by rtha at 10:30 AM on April 4, 2017 [11 favorites]
I regularly take opioids for severe chronic pain caused by several incurable health problems. I'm prescribed under close supervision by the Pain Management Center at our local hospital.
I wish I didn't need the medication; the side effects like grogginess, dizziness, intense itching, and dry mouth (which contributes to dental problems) are bad enough without all the hoops that our current moral panic requires me to jump through (random pill counts and urine tests, having to wait 3 or 4 days to get my scripts filled because no local pharmacy will keep the medication in stock, being threatened with having to go back to the beginning of a step-up plan if I change insurance companies, etc.).
I think if we moved more toward a model of offering sympathy and help to those with an actual opioid *problem* instead of demonizing and punishing them, there would be a lot less spillover of assuming the worst and causing trouble for people who are being treated with these medications in a responsible manner.
Trouble is, I don't know if there's a simple, easy way to do that. I guess you could require extra training for practitioners who prescribe certain classes of drugs, but it's already so difficult and expensive to become a doctor in the first place that you'd probably just have fewer doctors getting into the pain management field, in the same way that you have fewer pharmacies willing to keep opioids in stock.
posted by The Underpants Monster at 10:34 AM on April 4, 2017 [7 favorites]
I wish I didn't need the medication; the side effects like grogginess, dizziness, intense itching, and dry mouth (which contributes to dental problems) are bad enough without all the hoops that our current moral panic requires me to jump through (random pill counts and urine tests, having to wait 3 or 4 days to get my scripts filled because no local pharmacy will keep the medication in stock, being threatened with having to go back to the beginning of a step-up plan if I change insurance companies, etc.).
I think if we moved more toward a model of offering sympathy and help to those with an actual opioid *problem* instead of demonizing and punishing them, there would be a lot less spillover of assuming the worst and causing trouble for people who are being treated with these medications in a responsible manner.
Trouble is, I don't know if there's a simple, easy way to do that. I guess you could require extra training for practitioners who prescribe certain classes of drugs, but it's already so difficult and expensive to become a doctor in the first place that you'd probably just have fewer doctors getting into the pain management field, in the same way that you have fewer pharmacies willing to keep opioids in stock.
posted by The Underpants Monster at 10:34 AM on April 4, 2017 [7 favorites]
I've had chronic pain since a couple of surgeries for herniated discs in college, the first of which got me a nice MRSA infection. When the disc problem first became impossible to ignore anymore, I was given a shot of Demerol, and honestly it was probably one of the best things I've ever experienced, and I'm quite happy never to have another shot of it again, it was terrifying how good everything was.
After the surgery to clean out the infection and give me a shunt, I woke up with a morphine drip, and having heard how wonderful it was, I pushed the button and felt nauseous almost immediately. A bit later, the pain came back, and I pushed the button, and then started pushing the nurse call button because that was it, I was going to be sick, and was, and that was the end of morphine.
After I was released from the hospital, I was given a prescription for Vicodin. They did very little to help with the pain, and although I honestly didn't notice it, my family said they knew it was working because I'd become animated and start talking a lot, and they knew it was wearing off when I got quiet and less animated. I took it, hoping it would help with the pain, but it never really did, but then when the month was up, and I had no more pills to take, I got to enjoy (very minor, obviously) withdrawal, which makes me happy to avoid Vicodin for the rest of my life.
It was around that time that I found out a family member had a long running issue with heroin, and having gotten sober, refused any form of opioid even after a knee replacement just to avoid going through withdrawal again. With that sort of family background, yeah, I think I'll continue to avoid them as long as I can.
posted by Ghidorah at 10:35 AM on April 4, 2017 [1 favorite]
After the surgery to clean out the infection and give me a shunt, I woke up with a morphine drip, and having heard how wonderful it was, I pushed the button and felt nauseous almost immediately. A bit later, the pain came back, and I pushed the button, and then started pushing the nurse call button because that was it, I was going to be sick, and was, and that was the end of morphine.
After I was released from the hospital, I was given a prescription for Vicodin. They did very little to help with the pain, and although I honestly didn't notice it, my family said they knew it was working because I'd become animated and start talking a lot, and they knew it was wearing off when I got quiet and less animated. I took it, hoping it would help with the pain, but it never really did, but then when the month was up, and I had no more pills to take, I got to enjoy (very minor, obviously) withdrawal, which makes me happy to avoid Vicodin for the rest of my life.
It was around that time that I found out a family member had a long running issue with heroin, and having gotten sober, refused any form of opioid even after a knee replacement just to avoid going through withdrawal again. With that sort of family background, yeah, I think I'll continue to avoid them as long as I can.
posted by Ghidorah at 10:35 AM on April 4, 2017 [1 favorite]
So I'm personally stumped by what kinds of policies we should enact to a) allow people to receive adequate pain management and b) prevent overdose deaths.
There is a huge overlap between chronic pain and addiction - lots of people have both.
Giving lots of leeway to providers makes them even more susceptable to their implicit biases, which is going to make them even worse re: under prescribing African Americans and women and over prescribing rich white dudes.
Giving less leeway to providers seems to lock out the option of making a plan tailored to an individual.
For many people, even without the risk of overdose, living life in an opiate fog becomes an unacceptable outcome, one they find hard to assess meaningfully while in it. For others, opiates are a key component of making life manageable, if not pain free.
I'm seriously wondering what policy we should be pushing for here: the things that seem the most clear to me are those that are way upstream: addressing income inequality, physical inactivity, the collapsed welfare state, and other factors that contribute to despair which clearly has some role in the opiate death epidemic. Recruiting more women and African Americans to medicine and training all providers about implicit bias. Giving providers more time to get to know patients and expanding pain management programs that also include exercise, physical therapy and cognitive interventions.
But in terms of actual opiate prescribing policy for clinics and providers and pharmacies, what should the rules be?
posted by latkes at 10:42 AM on April 4, 2017 [4 favorites]
There is a huge overlap between chronic pain and addiction - lots of people have both.
Giving lots of leeway to providers makes them even more susceptable to their implicit biases, which is going to make them even worse re: under prescribing African Americans and women and over prescribing rich white dudes.
Giving less leeway to providers seems to lock out the option of making a plan tailored to an individual.
For many people, even without the risk of overdose, living life in an opiate fog becomes an unacceptable outcome, one they find hard to assess meaningfully while in it. For others, opiates are a key component of making life manageable, if not pain free.
I'm seriously wondering what policy we should be pushing for here: the things that seem the most clear to me are those that are way upstream: addressing income inequality, physical inactivity, the collapsed welfare state, and other factors that contribute to despair which clearly has some role in the opiate death epidemic. Recruiting more women and African Americans to medicine and training all providers about implicit bias. Giving providers more time to get to know patients and expanding pain management programs that also include exercise, physical therapy and cognitive interventions.
But in terms of actual opiate prescribing policy for clinics and providers and pharmacies, what should the rules be?
posted by latkes at 10:42 AM on April 4, 2017 [4 favorites]
And that's all fine as long as none of it makes you feel good, because pleasure is a moral failure. If you could get high on insulin without pretty immediate ramifications, we'd make diabetics line up outside a clinic for half-doses of poor-quality insulin, just enough to stay out of a coma.
I take your point but these are totally different things. Doctors aren't hesitant to prescribe pain killers because of moral panic. People will die without chemo or insulin. People are dying at incredible rates because of opioid addiction. Pain killer prescriptions are leading to addiction, overdose, and the spread of HIV. The do no harm principle becomes much more complicated when the risk of iatrogenic fallout is so high, as it is with opioids, which is why so many doctors get skittish. If anything, doctors recognize that the problems with pain killers are not moral problems - these are powerful drugs that can addict anyone, even strong-willed people who have a genuine need for them and don't want to be addicted. Dangerous addiction and medical need are not necessarily separate things, and it's almost impossible to predict who will become addicted and who will not. This is why this issue is impossibly complicated.
My sister lives in West Virginia, where this problem is notoriously absurdly large. This past weekend her whole family had been suffering an intense flu, and the toddler especially was in a bad way. They took him in to urgent care, where they said he needed immediate IV fluids and sent them to the ER. At the ER they waited 6 hours (6 hours) to be seen. My sister, a headstrong person who takes no bullshit, continually pressed the staff, who repeatedly told her that they were swamped with OD patients and that they had to triage them first. This is in a town with a clinic dedicated to weening infants born addicted to opioids off of them before they are sent home. Many, many of these folk's first pill was prescribed for a medical need.
It's a problem caused by a perfect storm of huge factors: the desire of the medical community to treat pain, the desire of the pharma community to make bank, the biology of people to want to feel good, the biology of people to get addicted, the vast economic disparity in rural America, the fear of medical malpractice lawsuits, the failure of medicine to treat addiction, underlying pain causes, or to provide well for preventative care, the overwhelming caseloads of doctors particularly in ERs and in rural areas, the lack of motivation for pharma to create better pain drugs that aren't so addictive, on and on. It's just an impossible situation.
posted by Lutoslawski at 10:47 AM on April 4, 2017 [19 favorites]
I take your point but these are totally different things. Doctors aren't hesitant to prescribe pain killers because of moral panic. People will die without chemo or insulin. People are dying at incredible rates because of opioid addiction. Pain killer prescriptions are leading to addiction, overdose, and the spread of HIV. The do no harm principle becomes much more complicated when the risk of iatrogenic fallout is so high, as it is with opioids, which is why so many doctors get skittish. If anything, doctors recognize that the problems with pain killers are not moral problems - these are powerful drugs that can addict anyone, even strong-willed people who have a genuine need for them and don't want to be addicted. Dangerous addiction and medical need are not necessarily separate things, and it's almost impossible to predict who will become addicted and who will not. This is why this issue is impossibly complicated.
My sister lives in West Virginia, where this problem is notoriously absurdly large. This past weekend her whole family had been suffering an intense flu, and the toddler especially was in a bad way. They took him in to urgent care, where they said he needed immediate IV fluids and sent them to the ER. At the ER they waited 6 hours (6 hours) to be seen. My sister, a headstrong person who takes no bullshit, continually pressed the staff, who repeatedly told her that they were swamped with OD patients and that they had to triage them first. This is in a town with a clinic dedicated to weening infants born addicted to opioids off of them before they are sent home. Many, many of these folk's first pill was prescribed for a medical need.
It's a problem caused by a perfect storm of huge factors: the desire of the medical community to treat pain, the desire of the pharma community to make bank, the biology of people to want to feel good, the biology of people to get addicted, the vast economic disparity in rural America, the fear of medical malpractice lawsuits, the failure of medicine to treat addiction, underlying pain causes, or to provide well for preventative care, the overwhelming caseloads of doctors particularly in ERs and in rural areas, the lack of motivation for pharma to create better pain drugs that aren't so addictive, on and on. It's just an impossible situation.
posted by Lutoslawski at 10:47 AM on April 4, 2017 [19 favorites]
Remember the friend I mentioned in my comment above, the one who had the casual comment about addiction? She once told me a series of harrowing stories about her worst experiences with LSD, a drug she took upwards of a hundred times despite never having an experience any better than "terrible" while she was on it.
I finally asked her "if it was so awful, why did you keep taking it?" and she shrugged and said "it was better than being sober."
posted by KathrynT at 11:09 AM on April 4, 2017 [12 favorites]
I finally asked her "if it was so awful, why did you keep taking it?" and she shrugged and said "it was better than being sober."
posted by KathrynT at 11:09 AM on April 4, 2017 [12 favorites]
I doubt I'll ever see my theory tested, but I strongly suspect that the rates of addiction (and tobacco use, and alcohol abuse) would plummet with Basic Income and strong comprehensive accessible mental health treatment as a matter of course (as in, everybody learns anxiety management, everybody gets communication skills coaching, everybody has access to additional treatment). West Virginia's problem isn't opiates, that's just what's available as a coping mechanism for entire economies disappearing under multiple generations' feet.
There'll always be somebody who manages it anyway, and people with difficult-to-treat impulse control or novelty-seeking behaviors, but I believe the numbers would be minimal. And there'd be a lot less of all this bragging about not taking/tolerating properly prescribed pain medication so that people who overhear it don't feel so much shame for using it, or be forced to forego it and suffer to be considered a good person.
posted by Lyn Never at 11:37 AM on April 4, 2017 [25 favorites]
There'll always be somebody who manages it anyway, and people with difficult-to-treat impulse control or novelty-seeking behaviors, but I believe the numbers would be minimal. And there'd be a lot less of all this bragging about not taking/tolerating properly prescribed pain medication so that people who overhear it don't feel so much shame for using it, or be forced to forego it and suffer to be considered a good person.
posted by Lyn Never at 11:37 AM on April 4, 2017 [25 favorites]
I wish that maias were still around.
She was here yesterday!
The addict I know best is not poor. Because he's white, has a college education, and knows how to work the system, if you saw him on the street, you would probably think of him as a vaguely respectable middle-class person. But he had an abusive childhood to which everyone turned a blind eye at the time and later and then suffered from decades of untreated and severe depression. I feel strongly that these two circumstances contributed powerfully to his addiction. Neither had to happen, in a society that took proper care of its people.
I don't think it's necessarily great to frame addiction as something that always indicates a trauma history or inadequately treated mental illness either, though those are frequently contributing factors. Not that I'm implying that was your intention. There are a lot of ways people get into drugs. It's definitely a lot easier to get out if you have more support and more positive shit going on in your life though.
posted by atoxyl at 11:40 AM on April 4, 2017 [1 favorite]
She was here yesterday!
The addict I know best is not poor. Because he's white, has a college education, and knows how to work the system, if you saw him on the street, you would probably think of him as a vaguely respectable middle-class person. But he had an abusive childhood to which everyone turned a blind eye at the time and later and then suffered from decades of untreated and severe depression. I feel strongly that these two circumstances contributed powerfully to his addiction. Neither had to happen, in a society that took proper care of its people.
I don't think it's necessarily great to frame addiction as something that always indicates a trauma history or inadequately treated mental illness either, though those are frequently contributing factors. Not that I'm implying that was your intention. There are a lot of ways people get into drugs. It's definitely a lot easier to get out if you have more support and more positive shit going on in your life though.
posted by atoxyl at 11:40 AM on April 4, 2017 [1 favorite]
latkes, the New Yorker had a recent article on incremental medical care that might interest you:
posted by clew at 12:36 PM on April 4, 2017 [6 favorites]
We devote vast resources to intensive, one-off procedures, while starving the kind of steady, intimate care that often helps people more.It starts with a chronic-pain example.
posted by clew at 12:36 PM on April 4, 2017 [6 favorites]
I have to admit, as an adult ADD sufferer (so bad it is a running, albeit goodnatured, joke between people that know me), I can't get a prescription for anything to help with it, as the vast majority of adult ADD meds have recreational uses and it is really frustrating.
Of course, part of that may be that I make no bones about having had a crystal meth addiction in my past, so... Yeah.
posted by Samizdata at 12:41 PM on April 4, 2017
Of course, part of that may be that I make no bones about having had a crystal meth addiction in my past, so... Yeah.
posted by Samizdata at 12:41 PM on April 4, 2017
R a c h e l - here is a little stuff i dug up about aging out.
aeon co article is an anecdote but includes bunch of links to studies within body of article
nationwide drug abuse trends ofc this is self-reported so ymmv but notice the big spike at people in their 20s reporting recent drug use and subsequent decrease
mefi's own maias on aging out
posted by nixon's meatloaf at 1:07 PM on April 4, 2017 [1 favorite]
aeon co article is an anecdote but includes bunch of links to studies within body of article
nationwide drug abuse trends ofc this is self-reported so ymmv but notice the big spike at people in their 20s reporting recent drug use and subsequent decrease
mefi's own maias on aging out
posted by nixon's meatloaf at 1:07 PM on April 4, 2017 [1 favorite]
"Well, if you need them in the future, won't they just prescribe you more?"
Been touched on before, but these days you can't assume that. I've been on the same low dose of hydrocodone for 10 years or so now, but recently its gotten extremely difficult to actually get. In my case I have a doctor who will prescribe, but I can only get 30 days at a time and have to go back to her to get a paper prescription that I have to take to the pharmacy (which often doesn't have it, for some reason). In addition to all sorts of other mandatory tests/etc that were not there before. And there's all sorts of talk of additional restrictions.
I also am still seeing my doctor in another city because I'm worried a new doctor will be too afraid to prescribe it for me. I guess there are doctors who hand this out like candy, but my experience has been the opposite.
Having tried all the other alternatives, I'm down to "take hydrocodone" or "stop working" which is a fairly easy choice.
posted by thefoxgod at 1:29 PM on April 4, 2017 [5 favorites]
Been touched on before, but these days you can't assume that. I've been on the same low dose of hydrocodone for 10 years or so now, but recently its gotten extremely difficult to actually get. In my case I have a doctor who will prescribe, but I can only get 30 days at a time and have to go back to her to get a paper prescription that I have to take to the pharmacy (which often doesn't have it, for some reason). In addition to all sorts of other mandatory tests/etc that were not there before. And there's all sorts of talk of additional restrictions.
I also am still seeing my doctor in another city because I'm worried a new doctor will be too afraid to prescribe it for me. I guess there are doctors who hand this out like candy, but my experience has been the opposite.
Having tried all the other alternatives, I'm down to "take hydrocodone" or "stop working" which is a fairly easy choice.
posted by thefoxgod at 1:29 PM on April 4, 2017 [5 favorites]
I can say having been a white-collar drug addict, while I have some family history of addiction and a personal history of depression, I started getting into opioids at the same time I was "retiring" from most other drugs (which I tried initially because I had set out to try everything on purpose) which were starting to seem too taxing or time-consuming. Opioids were one thing I knew I liked, and which seemed relatively physically benign and minimally impairing, but I never had more than occasional access. And then I met some people who had their little secret heroin circle and I started to buy shit from them occasionally (marked up 200 percent) and from there it was a slooooow ratchet over a year or even two smoking it on the weekends, making the plunge into IV (but still strenuously avoiding using for more than a couple days without a break), working up the nerve to go out on the street and find my own dealer. And then I hit a convergence of factors where I found myself a much cheaper connection, a new, higher-paying job, and a partner in crime, and somehow just said "fuck it, might as well do this every day now" - which is one thing I'll never completely understand - and then I was just spending money faster and faster for less effect until I ran out of money.
One thing I can say for sure is that having a supportive family who trusted in my exit plan - just getting on Suboxone, no taking my life apart for expensive rehab bullshit - and still having a job to pay for that plan even though I'd burned my savings made a tremendous difference.
posted by atoxyl at 2:12 PM on April 4, 2017 [5 favorites]
One thing I can say for sure is that having a supportive family who trusted in my exit plan - just getting on Suboxone, no taking my life apart for expensive rehab bullshit - and still having a job to pay for that plan even though I'd burned my savings made a tremendous difference.
posted by atoxyl at 2:12 PM on April 4, 2017 [5 favorites]
His family life sounds complicated. My family can be a bit of a pain in the ass, though. The fact that his own mother introduced him to fentanyl is disturbing and does seem like part of the pathology of his addiction. In terms of his ex-wife, it doesn't sound like the greatest relationship, but a lot of people have difficult relationships with a spouse. His ex-wife also had to somehow deal with his addiction.
posted by My Dad at 2:21 PM on April 4, 2017
posted by My Dad at 2:21 PM on April 4, 2017
Opioid dependency and the treatment of acute and chronic pain are challenging, non-binary issues: people aren't simply addicts or resistant to addiction, and response to narcotics vary. It's challenging to treat because of this and reasons such as concerns for abuse and dependency.
The pharmaceutical industry much share some of the blame (see this article for an idea of how crazy things were. In medical school, the idea of pain being a vital sign was drilled into our head, bearing as much important as a patient's temperature, heart rate, blood pressure, and respiratory rate. We were given those charts that had scale of 1-10 and their correlating emoticon. Treat pain. Ease suffering. And look into long-acting narcotics.
These days, thankfully, such a notion as been dispelled and with all the media coverage of late, such as this bit on a VA hospital, and state medical boards have been issuing guidelines on prescribing narcotics. Pain clinics perform urine drug screens to ensure that their patients are indeed positive for opioids, as testing negative for them suggests that they may be selling their meds. Some hospitals, such as this one in New Jersey are turning to non-narcotic treatments for pain.
And yet there's a legitimate concern for undertreating pain-- swinging the pendulum so far back that we may not be treating people's pain as well as we could. I've seen countless patients who've been on multiple medicines for pain. Some people really do need multiple medications to tackle their pain issues, and it would be wrong to NOT treat them. Many people do a fine job with judiciously taking their meds. I'm not a pain specialist, but I've encountered plenty of people who have great relationships with their physicians, and while the spectre of abuse always looms large, I don't have any reason to fault them.
It's maddening. As with many medical issues, it can be very difficult to practice population-centered medicine when treating an individual. But the studies and statistics are sobering.
I've had patients come in with sickle cell crises, who require relatively high doses of narcotics and PCA pumps to get their pain under control. I can hardly imagine what they're going through. I can recall several specific patients who have multiple allergies to narcotics, who come in and tell me exactly what they need to get their pain under control. I don't blindly write for these drugs, and of course they're monitored closely for any signs of overdose. But they know themselves better than I ever could.
I've also had patients who come in and are clearly abusing the system to obtain more narcotics: the state's prescription monitoring program lists what they've filled, when, in what quantity, and with the prescriber identified. And a lot of these sorts of patients are demonized or looked down upon as addicts, which is dehumanizing.
It's not fair because in many cases, we in the medical community may indeed have played a part in the development of their dependency. It's not fair because addiction and dependency are real phenomena. We've done a really shitty job in managing pain (see all links above). And these days, I've come to the realization that we've probably done a really shitty job in outlining the risks of dependency whenever we do prescribe opioids.
How do I know this? Because when I started counseling people in earnest about the risks of taking narcotics, it felt new. I mean, shouldn't have I been doing this already? Don't I do this for any medication I prescribe? Sure, but not so much, or as much as is warranted for this class of meds. How fucked up is it that this far out from residency I'm only realizing this? How humbling it is to be reminded that, while I thought I was doing a good job doing my job, I could've been doing a lot better for something that the whole country is waking up to?
And how terrible is it that, even while we've become more aware of the lack of mental health support and services, we continue to see people with dependency issues as pariahs? We say: "get help." They ask: "where? how?" And we have few, if any, answers.
Physicians aren't exempt from this. Clearly. I'm glad that the author had colleagues who called him out for it, and I hope he's able to get his life together. I remember seeing a broken ampule of Fentanyl in the bottom of a toilet in the MD bathroom for the OR, while I was in medical school. I'd asked my senior resident about it, and whether it should be reported. He said he'd take care of it, but I doubt anything was said or done. Sure, maybe it was there because an anesthesiologist just dumped his pockets after the legitimate administration of the drug, in which case he might be scolded for trying to flush down things that shouldn't be flushed down toilets. But shouldn't we be doing a better job not just at identifying potential issues, but trying to help the people from harming other people or at least themselves vis-a-vis their own health, lives and careers?
For my part and my experience with narcotics: I've an allergy to morphine. Now, I've been told that I look young for my age, but let me tell you: whenever I go to a health screening, or see any health care provider for whatever reason, I always answer that morphine causes itching. I don't have any other allergies, but I can see that sometimes people wonder why I would know this. Why, for someone who looks relatively young and healthy, would I have an allergy to morphine?
(Side note: the "triple cocktail" that a lot of drug-seeking patients ask for includes IV Dilaudid, IV Benadryl, and IV Phenergan. They claim to be allergic to all narcotics apart from Dilaudid, and claim to have itching and nausea with its administration. Supposedly, these three drugs produce a very, very desirable high. I wouldn't know, but I include this aside because when people start naming their allergies to the point where things are being funneled down to IV Dilaudid, suspicions for abuse are raised.)
Anyway, I had crazy surgery for sleep apnea. Cored out my sinuses, cut out my tonsils. It was terrible. They'd apparently given me morphine post-op, which I wasn't aware of, but after I got home I woke up one morning to find deep scratch marks all over my body. They have me some Lortab, which is essentially liquid Vicodin, for pain. I poo-pooed the idea of taking it, because I didn't want to take narcotics. A couple days post-op, I felt like I was dying. Fever, pain, tunnel vision, etc. I was worried about some infectious process or something. Called the on-call resident otolaryngolist, who called their attending, who called me and said:
"Are you taking your Lortab?"
No.
"You're not dying. Take your fucking Lortab."
(It should be noted that I knew the attending, and he's not an ass who curses at all his patients.)
So I did. And I stopped feeling like I was dying. However, it made me super nauseated, and not acting like myself. I'd be gardening half naked in front of my house. I'd claim I was hungry, then not, then change my mind and said I wanted a smoothie, then changed my mind again. I'd sweep my walkway and sidewalk in the middle of the night. Half naked.
Anyway, the point is that I've seen first hand the very mildest case of judgement from other medical professionals when I mention I'm allergic to morphine (a cocked eyebrow, for instance, until I explain my surgical history). And it makes me angry to think about people who are suffering from pain and are judged for it and don't have their pain addressed adequately. But things have taken a 180° turn from the days of "pain is a vital sign," to the hopeful benefit of patients, to the hopeful non-exclusion and treatment of those with pain.
posted by herrdoktor at 2:44 PM on April 4, 2017 [21 favorites]
The pharmaceutical industry much share some of the blame (see this article for an idea of how crazy things were. In medical school, the idea of pain being a vital sign was drilled into our head, bearing as much important as a patient's temperature, heart rate, blood pressure, and respiratory rate. We were given those charts that had scale of 1-10 and their correlating emoticon. Treat pain. Ease suffering. And look into long-acting narcotics.
These days, thankfully, such a notion as been dispelled and with all the media coverage of late, such as this bit on a VA hospital, and state medical boards have been issuing guidelines on prescribing narcotics. Pain clinics perform urine drug screens to ensure that their patients are indeed positive for opioids, as testing negative for them suggests that they may be selling their meds. Some hospitals, such as this one in New Jersey are turning to non-narcotic treatments for pain.
And yet there's a legitimate concern for undertreating pain-- swinging the pendulum so far back that we may not be treating people's pain as well as we could. I've seen countless patients who've been on multiple medicines for pain. Some people really do need multiple medications to tackle their pain issues, and it would be wrong to NOT treat them. Many people do a fine job with judiciously taking their meds. I'm not a pain specialist, but I've encountered plenty of people who have great relationships with their physicians, and while the spectre of abuse always looms large, I don't have any reason to fault them.
It's maddening. As with many medical issues, it can be very difficult to practice population-centered medicine when treating an individual. But the studies and statistics are sobering.
I've had patients come in with sickle cell crises, who require relatively high doses of narcotics and PCA pumps to get their pain under control. I can hardly imagine what they're going through. I can recall several specific patients who have multiple allergies to narcotics, who come in and tell me exactly what they need to get their pain under control. I don't blindly write for these drugs, and of course they're monitored closely for any signs of overdose. But they know themselves better than I ever could.
I've also had patients who come in and are clearly abusing the system to obtain more narcotics: the state's prescription monitoring program lists what they've filled, when, in what quantity, and with the prescriber identified. And a lot of these sorts of patients are demonized or looked down upon as addicts, which is dehumanizing.
It's not fair because in many cases, we in the medical community may indeed have played a part in the development of their dependency. It's not fair because addiction and dependency are real phenomena. We've done a really shitty job in managing pain (see all links above). And these days, I've come to the realization that we've probably done a really shitty job in outlining the risks of dependency whenever we do prescribe opioids.
How do I know this? Because when I started counseling people in earnest about the risks of taking narcotics, it felt new. I mean, shouldn't have I been doing this already? Don't I do this for any medication I prescribe? Sure, but not so much, or as much as is warranted for this class of meds. How fucked up is it that this far out from residency I'm only realizing this? How humbling it is to be reminded that, while I thought I was doing a good job doing my job, I could've been doing a lot better for something that the whole country is waking up to?
And how terrible is it that, even while we've become more aware of the lack of mental health support and services, we continue to see people with dependency issues as pariahs? We say: "get help." They ask: "where? how?" And we have few, if any, answers.
Physicians aren't exempt from this. Clearly. I'm glad that the author had colleagues who called him out for it, and I hope he's able to get his life together. I remember seeing a broken ampule of Fentanyl in the bottom of a toilet in the MD bathroom for the OR, while I was in medical school. I'd asked my senior resident about it, and whether it should be reported. He said he'd take care of it, but I doubt anything was said or done. Sure, maybe it was there because an anesthesiologist just dumped his pockets after the legitimate administration of the drug, in which case he might be scolded for trying to flush down things that shouldn't be flushed down toilets. But shouldn't we be doing a better job not just at identifying potential issues, but trying to help the people from harming other people or at least themselves vis-a-vis their own health, lives and careers?
For my part and my experience with narcotics: I've an allergy to morphine. Now, I've been told that I look young for my age, but let me tell you: whenever I go to a health screening, or see any health care provider for whatever reason, I always answer that morphine causes itching. I don't have any other allergies, but I can see that sometimes people wonder why I would know this. Why, for someone who looks relatively young and healthy, would I have an allergy to morphine?
(Side note: the "triple cocktail" that a lot of drug-seeking patients ask for includes IV Dilaudid, IV Benadryl, and IV Phenergan. They claim to be allergic to all narcotics apart from Dilaudid, and claim to have itching and nausea with its administration. Supposedly, these three drugs produce a very, very desirable high. I wouldn't know, but I include this aside because when people start naming their allergies to the point where things are being funneled down to IV Dilaudid, suspicions for abuse are raised.)
Anyway, I had crazy surgery for sleep apnea. Cored out my sinuses, cut out my tonsils. It was terrible. They'd apparently given me morphine post-op, which I wasn't aware of, but after I got home I woke up one morning to find deep scratch marks all over my body. They have me some Lortab, which is essentially liquid Vicodin, for pain. I poo-pooed the idea of taking it, because I didn't want to take narcotics. A couple days post-op, I felt like I was dying. Fever, pain, tunnel vision, etc. I was worried about some infectious process or something. Called the on-call resident otolaryngolist, who called their attending, who called me and said:
"Are you taking your Lortab?"
No.
"You're not dying. Take your fucking Lortab."
(It should be noted that I knew the attending, and he's not an ass who curses at all his patients.)
So I did. And I stopped feeling like I was dying. However, it made me super nauseated, and not acting like myself. I'd be gardening half naked in front of my house. I'd claim I was hungry, then not, then change my mind and said I wanted a smoothie, then changed my mind again. I'd sweep my walkway and sidewalk in the middle of the night. Half naked.
Anyway, the point is that I've seen first hand the very mildest case of judgement from other medical professionals when I mention I'm allergic to morphine (a cocked eyebrow, for instance, until I explain my surgical history). And it makes me angry to think about people who are suffering from pain and are judged for it and don't have their pain addressed adequately. But things have taken a 180° turn from the days of "pain is a vital sign," to the hopeful benefit of patients, to the hopeful non-exclusion and treatment of those with pain.
posted by herrdoktor at 2:44 PM on April 4, 2017 [21 favorites]
atoxyl: thanks for sharing your story.
My sense which I believe is supported by data but not totally sure on this: lots of people can become dependent on opiates and other drugs, to a dangerous, debilitating, or life-threatening degree. But people who stay in this state of life-threatening, family-destroying, economically devastating addiction for years and years are much more likely to have had intense and lasting childhood trauma or other crushing social factors.
In other words, we can't remove the risk of dangerous substance use, but we can make it much more possible for people to recover sooner, by addressing poverty, childhood abuse and so forth.
posted by latkes at 2:45 PM on April 4, 2017 [1 favorite]
My sense which I believe is supported by data but not totally sure on this: lots of people can become dependent on opiates and other drugs, to a dangerous, debilitating, or life-threatening degree. But people who stay in this state of life-threatening, family-destroying, economically devastating addiction for years and years are much more likely to have had intense and lasting childhood trauma or other crushing social factors.
In other words, we can't remove the risk of dangerous substance use, but we can make it much more possible for people to recover sooner, by addressing poverty, childhood abuse and so forth.
posted by latkes at 2:45 PM on April 4, 2017 [1 favorite]
It's so interesting reading about the ease with which these drugs can be prescribed, because my experience, like others, has been the opposite.
When I asked for something to help with the pain when I'm having an episode, my former GP reacted like I had asked to shoot up in the practice waiting room. I had been seeing her for this same condition for over ten years at this point, and had never asked for anything before.
Lack of effective pain medication put me in the emergency room on Christmas day with my ulcer. I felt terribly guilty, hogging resources on a busy day for a non lethal condition, but in my defense the pain was unprecedented. Got some morphine for the first time, was actually disappointed. Thought I would be high AF but barely felt anything and was still in pain albeit reduced.
The result of this stigma is that I periodically push the dosage the limit of our over the counter Tylenol/codeine equivalent. Great news, they're talking about banning that now, too, because of people with opiate addictions killing their livers. And I'm thinking about stockpiling. How sad is that?
posted by smoke at 3:01 PM on April 4, 2017 [4 favorites]
When I asked for something to help with the pain when I'm having an episode, my former GP reacted like I had asked to shoot up in the practice waiting room. I had been seeing her for this same condition for over ten years at this point, and had never asked for anything before.
Lack of effective pain medication put me in the emergency room on Christmas day with my ulcer. I felt terribly guilty, hogging resources on a busy day for a non lethal condition, but in my defense the pain was unprecedented. Got some morphine for the first time, was actually disappointed. Thought I would be high AF but barely felt anything and was still in pain albeit reduced.
The result of this stigma is that I periodically push the dosage the limit of our over the counter Tylenol/codeine equivalent. Great news, they're talking about banning that now, too, because of people with opiate addictions killing their livers. And I'm thinking about stockpiling. How sad is that?
posted by smoke at 3:01 PM on April 4, 2017 [4 favorites]
Building off of Lyn Never's comment, I agree that in addition to pharma misbehavior, and a high potential for addiction, that conditions such as:
- the pressure of bad health care (pervasive pain without physical or occupational therapy available)
- unforgiving work environments (little or no sick leave, and insecure employment)
- economic stress, uncertainty, and anxiety (constant mental health struggle, no available care)
All act as a bridge from first prescription, to ameliorative "self-prescribing" of leftover pills, to full-fledged addiction.
This extensive Washington Post article "Disabled, or just Desperate" and the letters that followed it, highlight how hard people are squeezed. Health care is hard to access, stress about employment, success, and a lack of control grind people down.
And for those not on the edge of poverty, there is the stress of a never-disconnected world, and pervasive anxiety.
When people are being squeezed from all directions it's unsurprising that willpower and resilience are low, and that addiction to an escape from all that is easy to fall into.
posted by mercredi at 3:20 PM on April 4, 2017 [3 favorites]
- the pressure of bad health care (pervasive pain without physical or occupational therapy available)
- unforgiving work environments (little or no sick leave, and insecure employment)
- economic stress, uncertainty, and anxiety (constant mental health struggle, no available care)
All act as a bridge from first prescription, to ameliorative "self-prescribing" of leftover pills, to full-fledged addiction.
This extensive Washington Post article "Disabled, or just Desperate" and the letters that followed it, highlight how hard people are squeezed. Health care is hard to access, stress about employment, success, and a lack of control grind people down.
And for those not on the edge of poverty, there is the stress of a never-disconnected world, and pervasive anxiety.
When people are being squeezed from all directions it's unsurprising that willpower and resilience are low, and that addiction to an escape from all that is easy to fall into.
posted by mercredi at 3:20 PM on April 4, 2017 [3 favorites]
Opioids do a lot more than simply alleviate pain:
Add to this the fact that endogenous opioids also have immunosuppressive effects (see link), and that we might expect at least any autoimmune condition triggered by a pathogen or foreign substance to also down regulate endogenous opioids so that the immune system can more effectively cope with the invader, and we have a perfect set-up for additional drug abuse as unwitting self-medication for autoimmune problems.
posted by jamjam at 4:07 PM on April 4, 2017 [3 favorites]
Opioids are the most potent analgesics and widely used for the treatment of severe pain such as cancer pain. However, a great number of studies have convincingly demonstrated that opioids, in particular morphine and derivatives, are immunosuppressive.And we are currently at least knee deep in a rising tide of autoimmune disease -- from celiac to childhood asthma, to peanut and other allergies, to Hashimoto's, to type 2 diabetes, to COPD, to psoriasis, to irritable bowel, and so on.
Add to this the fact that endogenous opioids also have immunosuppressive effects (see link), and that we might expect at least any autoimmune condition triggered by a pathogen or foreign substance to also down regulate endogenous opioids so that the immune system can more effectively cope with the invader, and we have a perfect set-up for additional drug abuse as unwitting self-medication for autoimmune problems.
posted by jamjam at 4:07 PM on April 4, 2017 [3 favorites]
I was hospitalized in February and after surgery (at 11:30 PM on a saturday, which should give you an idea about the severity), they offered me pain meds, and I didn't take anything but ibuprofin. I have a bottle with some oxycontin here (and considering my financial status if I knew where I'd consider trying to make some spare cash selling it) untouched.
I'm terrified of the addiction possibilities. Ten years ago I had my gall bladder out due to gallstones and an obstructed vent, and they gave me morphine and I loved it (also, the lack of sleep didn't help as I was at 40 hours awake at the time I got in the ER), and that scared me.
I feel sorry for him, because of how much he found it relieved his pains (physical and mental), but I think he needs a lot of therapy to get to why he hated himself like that.
posted by mephron at 5:02 PM on April 4, 2017 [1 favorite]
I'm terrified of the addiction possibilities. Ten years ago I had my gall bladder out due to gallstones and an obstructed vent, and they gave me morphine and I loved it (also, the lack of sleep didn't help as I was at 40 hours awake at the time I got in the ER), and that scared me.
I feel sorry for him, because of how much he found it relieved his pains (physical and mental), but I think he needs a lot of therapy to get to why he hated himself like that.
posted by mephron at 5:02 PM on April 4, 2017 [1 favorite]
So doesn't the [Canadian] medical record collate how many prescriptions you've had from various docs?
The USA now has a (relatively) centralised controlled substance prescription database called "CURES" that breaks out by State and recent regulation changes have made it part of a standard of care for every doc who gets a patient on a controlled substance or is going to prescribe one to check their local CURES database to review prescription patterns. Covers opioids, stimulants and benzos/barbs. Basically, if you prescribe controlled substances for someone and don't document you checked CURES or explain your reasoning based on a deviation from standard of care, and an adverse event happens and/or they sue you, you are much more liable.
It's not perfect, since there are some omissions. If properly registered, you can message other docs through an alert system to ask questions about how/why something was prescribed, or to alert for unusual patterns. But many Docs are not properly registered.
posted by meehawl at 5:19 PM on April 4, 2017 [2 favorites]
The USA now has a (relatively) centralised controlled substance prescription database called "CURES" that breaks out by State and recent regulation changes have made it part of a standard of care for every doc who gets a patient on a controlled substance or is going to prescribe one to check their local CURES database to review prescription patterns. Covers opioids, stimulants and benzos/barbs. Basically, if you prescribe controlled substances for someone and don't document you checked CURES or explain your reasoning based on a deviation from standard of care, and an adverse event happens and/or they sue you, you are much more liable.
It's not perfect, since there are some omissions. If properly registered, you can message other docs through an alert system to ask questions about how/why something was prescribed, or to alert for unusual patterns. But many Docs are not properly registered.
posted by meehawl at 5:19 PM on April 4, 2017 [2 favorites]
I too had emergency surgery on a Saturday night, followed by an all-day surgery on a Monday, and I was on morphine when I came home a month later, because I needed it. I was in dire pain. I was in that much pain for most off the year and seven follow-up surgeries that followed. I used pain meds as directed. I did not get addicted, nor was I irrationally afraid of pain meds.
And most of all, I absolutely avoid preaching that fear, or judging people who used pain meds appropriately because they need it.
I really, really resent stories about getting an appendix out and then only taking a single aspirin delivered on the wings of pure angels.
posted by Dashy at 5:31 PM on April 4, 2017 [11 favorites]
And most of all, I absolutely avoid preaching that fear, or judging people who used pain meds appropriately because they need it.
I really, really resent stories about getting an appendix out and then only taking a single aspirin delivered on the wings of pure angels.
posted by Dashy at 5:31 PM on April 4, 2017 [11 favorites]
Yeah. Pain meds fill a real need, because some people's pain won't go away with a single aspirin. There's So Much Baggage about it, culturally. It's a distillation of all of the bullshit around who gets to be vulnerable and who gets to be listened to and whose needs are 'more valid' than others.
I will say that the shot of Demerol I got in ER after I'd been in pain for a day and a half (due to an ovary and its associated ginormous cysts twisting itself in knots) was pretty fucking epic.
I have a definite tendency towards addiction. I keep an eye on my drinking (as I explained to a friend, "I enjoy drinking, so I'd hate to have to give it up..."), and I try to stay very aware, when I have industrial strength pain meds, as to whether I'm taking the drugs because I'm in pain if I don't or just because it's time to take another one.
When I had a patient controlled dosage thing in the hospital after a surgery once, I remember I figured out how long I had to wait between button pushes and would start pushing the button about 5 seconds before the timer was up not because of pain but because I could. Normally I have more awareness and can ask myself "self, really?", but I was running at diminished capacity. And the button was so very easy.
posted by rmd1023 at 6:31 PM on April 4, 2017
I will say that the shot of Demerol I got in ER after I'd been in pain for a day and a half (due to an ovary and its associated ginormous cysts twisting itself in knots) was pretty fucking epic.
I have a definite tendency towards addiction. I keep an eye on my drinking (as I explained to a friend, "I enjoy drinking, so I'd hate to have to give it up..."), and I try to stay very aware, when I have industrial strength pain meds, as to whether I'm taking the drugs because I'm in pain if I don't or just because it's time to take another one.
When I had a patient controlled dosage thing in the hospital after a surgery once, I remember I figured out how long I had to wait between button pushes and would start pushing the button about 5 seconds before the timer was up not because of pain but because I could. Normally I have more awareness and can ask myself "self, really?", but I was running at diminished capacity. And the button was so very easy.
posted by rmd1023 at 6:31 PM on April 4, 2017
So doesn't the [Canadian] medical record collate how many prescriptions you've had from various docs?
For one thing, there is no "Canadian medical record", since healthcare is administered at the provincial (state) level. So you get a provincial health care card.
In British Columbia, there are multiple regional health authorities, which all manage their own medical records. Alberta next door has just one health authority province-wide.
In British Columbia, healthcare is actually performed in part by private contractors, such as general practitioners (family doctors) and neighborhood clinics.
I'm not sure about the details, but, because of this patchwork, I do know that it has been very challenging to manage health records in British Columba (let alone across Canada). If you phone the 811 nursing hotline (as we do from time to time), they will have a unified record of your interactions with the hotline. But they have no access to the visits to our family doctor, where any online information might simply be billing. And, there won't be any information in a unified place about what prescriptions I have purchased. You would have to contact the pharmacy for that.
As a result, it has not even been a year since B.C. doctors became the first in Canada to face mandatory prescribing standards for opioids and other addictive drugs.
posted by My Dad at 6:34 PM on April 4, 2017 [1 favorite]
For one thing, there is no "Canadian medical record", since healthcare is administered at the provincial (state) level. So you get a provincial health care card.
In British Columbia, there are multiple regional health authorities, which all manage their own medical records. Alberta next door has just one health authority province-wide.
In British Columbia, healthcare is actually performed in part by private contractors, such as general practitioners (family doctors) and neighborhood clinics.
I'm not sure about the details, but, because of this patchwork, I do know that it has been very challenging to manage health records in British Columba (let alone across Canada). If you phone the 811 nursing hotline (as we do from time to time), they will have a unified record of your interactions with the hotline. But they have no access to the visits to our family doctor, where any online information might simply be billing. And, there won't be any information in a unified place about what prescriptions I have purchased. You would have to contact the pharmacy for that.
As a result, it has not even been a year since B.C. doctors became the first in Canada to face mandatory prescribing standards for opioids and other addictive drugs.
posted by My Dad at 6:34 PM on April 4, 2017 [1 favorite]
I've been on morphine drips a few times, and they just did the job of lessening the pain. The horrible constipation side-effect, I could do without.
I don't think I have much of an addictive personality, but... several years ago, I was in the ER for something that ended up needing emergency surgery. I remember the doctor telling a nurse to "give her something for the pain," and then the nurse telling me she was going to give me a shot of dilaudid, that I would feel a chill and then it should start working. In that moment as she gave me the shot, I realized exactly how much pain I had actually been suffering (and had been for weeks before my dad made me go to the ER) because suddenly the pain was completely 100% gone.
I still think about that shot sometimes.
posted by lovecrafty at 6:57 PM on April 4, 2017 [3 favorites]
I don't think I have much of an addictive personality, but... several years ago, I was in the ER for something that ended up needing emergency surgery. I remember the doctor telling a nurse to "give her something for the pain," and then the nurse telling me she was going to give me a shot of dilaudid, that I would feel a chill and then it should start working. In that moment as she gave me the shot, I realized exactly how much pain I had actually been suffering (and had been for weeks before my dad made me go to the ER) because suddenly the pain was completely 100% gone.
I still think about that shot sometimes.
posted by lovecrafty at 6:57 PM on April 4, 2017 [3 favorites]
So doesn't the [Canadian] medical record collate how many prescriptions you've had from various docs?
Ontario has had a narcotics monitoring system since about 2010 that alerts pharmacists to double doctoring and other potential issues, but prescribers have not had access to it (this is beginning to change through provincial EHR initiatives).
posted by sevenyearlurk at 7:51 PM on April 4, 2017
It's so interesting reading about the ease with which these drugs can be prescribed, because my experience, like others, has been the opposite.
I think it is dependent on the pharmacy and doctor. The unscrupulous ones pass them out like candy. Periodically you'll get an expose of one doctor or another where a reporter finds out they've been doling out 80% of the pain meds in their area or something crazy like that.
posted by Anonymous at 8:15 PM on April 4, 2017
I think it is dependent on the pharmacy and doctor. The unscrupulous ones pass them out like candy. Periodically you'll get an expose of one doctor or another where a reporter finds out they've been doling out 80% of the pain meds in their area or something crazy like that.
posted by Anonymous at 8:15 PM on April 4, 2017
Lovecrafty was the only one to mention the wonderful side-effect of opiates: constipation. How do people doing drugs as recreation deal with that?
A friend of mine just had a kidney removed. Of course he had pain killers. (Which didn't affect his appetite.) And he took those drugs at first, because they made his surgical site stop hurting. And because they gave him a whole bottle and said take it every 4 hours. Until his gut got a bit full after a couple days, and then he was taking the drugs because his belly hurt. So TEN DAYS later, he heads to the doc-in-a-box, then immediately is shipped to the ER. According to his doc, it is possible to rupture a gut.
Funnily enough, I'm a female that doesn't have any problem getting drugs.
At the last checkup, I had asked the doc for something to relieve back spasms, maybe three or four tabs. I told him if it didn't resolve, which often it does after a couple tabs and some ice/heat/rest, then it would be time to make an appointment anyway. So he gives me a script for a month's worth! And the pharmacy would prefer to fill the whole thing! And it won't cost me any extra! It's a darn good thing that I hate taking drugs, because I could have a hellofa house party.
Last fall, I cleared out the medicine box and tossed Norco and Oxycontin and Valium and Percoset and Fentanyl and several different types of sleeping pills. It's getting to the point, on the forms where surgeries and major wrecks are listed, there's not enough space.
There are three drugs that I do appreciate. One is the morphine drip you get after a knee replacement, a horse wreck, or lumbar disk surgery. When ya need it, it's the soothing balm from heaven. After it stops hurting though, it's like being wrapped up in a rug and duck taped down. Not fun.
The second drug is the IV Dilaudid they gave me when I fell 3 weeks after surgery, smack down on the knee that was replaced, and opened the incision site wide open. ER Doc asked me how bad it was. "Eh, ouch, but I'll live." He felt it would probably would be wise to get on top of it before it got worse. Sure, why not? Holy kaleidoscopes! When they wheeled me into surgery, I think I was levitating off the gurney. Fun at the time, but I need a bit more focus to function.
The one drug I do miss is Terpin hydrate with codeine. Used to be over the counter till the '90s, and it was the one thing that would clear my chest and keep me from coughing my lungs up when I had bronchitis or pneumonia. It was like taking a big ol' swig of gasoline. Nasty stuff! But by Ringo, that crap worked for me. You can't get it at all now. I think drug companies couldn't make any money on it out of patent. Robitussin with guaifenesin is about as effective as corn syrup. IMO.
posted by BlueHorse at 9:02 PM on April 4, 2017
A friend of mine just had a kidney removed. Of course he had pain killers. (Which didn't affect his appetite.) And he took those drugs at first, because they made his surgical site stop hurting. And because they gave him a whole bottle and said take it every 4 hours. Until his gut got a bit full after a couple days, and then he was taking the drugs because his belly hurt. So TEN DAYS later, he heads to the doc-in-a-box, then immediately is shipped to the ER. According to his doc, it is possible to rupture a gut.
Funnily enough, I'm a female that doesn't have any problem getting drugs.
At the last checkup, I had asked the doc for something to relieve back spasms, maybe three or four tabs. I told him if it didn't resolve, which often it does after a couple tabs and some ice/heat/rest, then it would be time to make an appointment anyway. So he gives me a script for a month's worth! And the pharmacy would prefer to fill the whole thing! And it won't cost me any extra! It's a darn good thing that I hate taking drugs, because I could have a hellofa house party.
Last fall, I cleared out the medicine box and tossed Norco and Oxycontin and Valium and Percoset and Fentanyl and several different types of sleeping pills. It's getting to the point, on the forms where surgeries and major wrecks are listed, there's not enough space.
There are three drugs that I do appreciate. One is the morphine drip you get after a knee replacement, a horse wreck, or lumbar disk surgery. When ya need it, it's the soothing balm from heaven. After it stops hurting though, it's like being wrapped up in a rug and duck taped down. Not fun.
The second drug is the IV Dilaudid they gave me when I fell 3 weeks after surgery, smack down on the knee that was replaced, and opened the incision site wide open. ER Doc asked me how bad it was. "Eh, ouch, but I'll live." He felt it would probably would be wise to get on top of it before it got worse. Sure, why not? Holy kaleidoscopes! When they wheeled me into surgery, I think I was levitating off the gurney. Fun at the time, but I need a bit more focus to function.
The one drug I do miss is Terpin hydrate with codeine. Used to be over the counter till the '90s, and it was the one thing that would clear my chest and keep me from coughing my lungs up when I had bronchitis or pneumonia. It was like taking a big ol' swig of gasoline. Nasty stuff! But by Ringo, that crap worked for me. You can't get it at all now. I think drug companies couldn't make any money on it out of patent. Robitussin with guaifenesin is about as effective as corn syrup. IMO.
posted by BlueHorse at 9:02 PM on April 4, 2017
The one drug I do miss is Terpin hydrate with codeine. Used to be over the counter till the '90s, and it was the one thing that would clear my chest and keep me from coughing my lungs up when I had bronchitis or pneumonia.
That's something I could have used just this past couple of months (assuming it worked for me). What they did end up giving me (after the previous cough suppressant prescription that may or may not have been responsible for me breaking out in hives--EPIC FAIL) was Robitussin with codeine. I had to hand-carry the prescription (printed on special paper) over to the pharmacy, and then the dosage was 10 ml at bedtime only. And still, no matter whom I told (other than Dr. TM, who is a sensible person and had been watching me suffer), the response was always the same: "Ohhh! Pour that stuff right down the sink! You shouldn't mess with anything involving codeine! You'll get addicted!" As if 10 ml at bedtime was going to turn me into a raving codeine fiend, or something. (It had no effect, as it turned out. But the massive prescription for antibiotics I finally broke down and got filled? That has been working, to my everlasting relief.)
At least a few people upthread are saying that if a painkiller feels too good, they won't take it--instead, they'll make themselves miserable with some other alternative, because they're that afraid of addiction. I don't think I've ever had a euphoric reaction to a painkiller, so I don't know quite what that's like. But I do know what it's like to experience all-consuming pain and then to experience the absence of that pain, which is a kind of overwhelming relief, especially after one has begun to wonder if one will ever be pain-free again and able to concentrate and engage in normal daily activities. (Maybe that's what euphoria is. I don't know.)
So to me, this fear of addiction seems just a bit overwrought--and even a bit counterproductive, because that painkiller-induced sense of well-being should be helping one to rest and reducing pain-induced stress and anxiety, both of which can mess with recovery. You might feel virtuous about avoiding addiction, but you might also not be doing your body any favors. I can't imagine what it would be like to have more than a three-day supply of an opioid-based painkiller, but in the past, I've focused entirely on the question "What would be more effective in helping me to recover and get back to normal?" and not on the question "How high will I get when I take the little white pill?" But then, I was never much interested in that sort of experimentation to begin with.
posted by tully_monster at 10:03 PM on April 4, 2017 [10 favorites]
That's something I could have used just this past couple of months (assuming it worked for me). What they did end up giving me (after the previous cough suppressant prescription that may or may not have been responsible for me breaking out in hives--EPIC FAIL) was Robitussin with codeine. I had to hand-carry the prescription (printed on special paper) over to the pharmacy, and then the dosage was 10 ml at bedtime only. And still, no matter whom I told (other than Dr. TM, who is a sensible person and had been watching me suffer), the response was always the same: "Ohhh! Pour that stuff right down the sink! You shouldn't mess with anything involving codeine! You'll get addicted!" As if 10 ml at bedtime was going to turn me into a raving codeine fiend, or something. (It had no effect, as it turned out. But the massive prescription for antibiotics I finally broke down and got filled? That has been working, to my everlasting relief.)
At least a few people upthread are saying that if a painkiller feels too good, they won't take it--instead, they'll make themselves miserable with some other alternative, because they're that afraid of addiction. I don't think I've ever had a euphoric reaction to a painkiller, so I don't know quite what that's like. But I do know what it's like to experience all-consuming pain and then to experience the absence of that pain, which is a kind of overwhelming relief, especially after one has begun to wonder if one will ever be pain-free again and able to concentrate and engage in normal daily activities. (Maybe that's what euphoria is. I don't know.)
So to me, this fear of addiction seems just a bit overwrought--and even a bit counterproductive, because that painkiller-induced sense of well-being should be helping one to rest and reducing pain-induced stress and anxiety, both of which can mess with recovery. You might feel virtuous about avoiding addiction, but you might also not be doing your body any favors. I can't imagine what it would be like to have more than a three-day supply of an opioid-based painkiller, but in the past, I've focused entirely on the question "What would be more effective in helping me to recover and get back to normal?" and not on the question "How high will I get when I take the little white pill?" But then, I was never much interested in that sort of experimentation to begin with.
posted by tully_monster at 10:03 PM on April 4, 2017 [10 favorites]
These stories kind of fascinate me. As someone who got hurt a lot in the freewheeling days of the 1990s and early 2000s I've been prescribed opiates more times than I can remember. And I took most of them I'm sure, probably not exactly as prescribed either, I definitely remember that saving them for when you felt better was a thing in college. They're great: nothing hurts and you feel groovy as hell. I totally get the feeling of no-more-anxiety and I'm-finally-happy now that all these people describe but what I can't grok the complete lack of self awareness. It's a drug, messing with your brain- you are not really happy or awesome just like you're not the good singer you think you are when you're drunk and you don't love everyone when the X wears off. I guess I'm not an addictive person but I don't get how people can't go- OK that was a totally false and short lived feeling of euphoria! Neat! and then move on with their lives. I'd think it was because their lives are so unbearably shitty that they can't face them but they're clearly not in many cases. It's like getting the spinnies from twirling in circles and just deciding to twirl in circles for the rest of your life because it feels cool. I read a lot of articles like this that try to justify it and it all falls flat to me- I just don't get it and probably won't ever I guess. Total self destruction I can understand, nihilism I can understand, peer pressure I get etc but this? Wtf?
And I think it's kind of a travesty that people in real pain have to suffer because otherwise smart people refuse to face reality.
posted by fshgrl at 10:41 PM on April 4, 2017
And I think it's kind of a travesty that people in real pain have to suffer because otherwise smart people refuse to face reality.
posted by fshgrl at 10:41 PM on April 4, 2017
There are three drugs that I do appreciate. One is the morphine drip you get after a knee replacement, a horse wreck, or lumbar disk surgery.
I also ride and I think there might be different rules for horse people, because they are idiots who will pretend they are fine when they are dying.
posted by fshgrl at 11:47 PM on April 4, 2017 [4 favorites]
I also ride and I think there might be different rules for horse people, because they are idiots who will pretend they are fine when they are dying.
posted by fshgrl at 11:47 PM on April 4, 2017 [4 favorites]
I quit drinking and drugging a long time ago because reasons hint hint. And those reasons have kept me keeping a close eye on myself.
About seven years ago I re-arranged my shoulder and some other shit in my back and I'm on a massage table literally crying, and crying out, also, as this great massage therapist tried to help me. Next day I'm in my MD's office and he knows me and trusts me completely and he wrote me for norco 10/325s and lo, it was good.
I treated the stuff like a sacrament. It helped me so. fkn. much. and goddamned if it didn't make me feel great, and not just because of the relief/release of the pain. I loved it. Disneyland. I'm lying in my bed, on ice then heat, ice then heat on my shoulder, I'm looking up at the ceiling and it's so pretty, it was sortof like shallow water waving.
Disneyland.
I am not afraid to ask others to keep a close eye on me also. My doc. My mentor. Guys that I mentor. I kept all of my cards face up on the table because addiction thrives in the dark, grows best in the dark. Every pill I took, I literally would ask myself if I could take 1/4 less of a tablet, or even 1/8 less. When I felt that maybe I could step down, I tried it. (Usually I was able to step down if that was the answer that came back to me.)
I got onto a chiropractors table and he was a magician but still, it took a long time for that pain to get down to ibuprofen level.
A year later I tore the shoulder again. Unreal. Same deal, except I skipped the massage therapist. Chiropractor. MD. Norcos. Ice / Heat. Cards face up on the table, keeping myself accountable, and friends keeping me accountable.
Four years ago my front wheel slid into a rain grate, stopped the bike immediately. I was looking behind me, didn't know it was happening until I came to, laying in the street, unable to move, and clocked out again. Came to again, could move, unclipped myself from the bike (the great thing about wearing clips is that you get 40% more power, the not great thing about clips is that if you go down and don't kick free you're married to the bike and you're totally screwed), tried to get my bearings, wtf had happened.
Same shoulder but this time I tore the rotator cuff right off the bone -- cool. Broke a bunch of bones in my face, I got this dent in my high left cheek now -- cool. Maybe the best concussion I've ever had, and I've had plenty.
I called a kid I mentor and had him pick me up, take me to the ER. (I couldn't even tell him where I was, though I was on a street I've traveled daily since 1992; he had to ask me questions, what did I see, etc and etc. It really rang my bell.) It was really great -- this kid is a neat freak, and I got blood on some paperwork in his car, I was so happy.
Checked out of the hospital next day AMA because norcos, heat/ice, bed, wavy ceiling, Disneyland. They wrote me for 10/325s, a lot of them, and I needed them. I *really* needed to be held to account, by myself and by my team. I hurt like a bastard on Fathers Day for a few weeks, could scarce eat anything for a month or more except avocado sandwiches. Which aren't bad but still. I think that the first thing that I ate was a sub sandwich, cut into smaller pieces with my pocketknife...
~~~~~
So many people upthread have written that they like this stuff. Not me. No, I don't like it -- I love it. I lurve it. I want to marry the shit. I want to rub it all over my head. I needed it, for the pain -- no way 'round that -- but I've never met a down that I don't just love and this stuff is so fine. It was so damn scary. Truly, I had to take this stuff as a sacrament, and that maybe sounds wacky and maybe it is but it isn't to me. It's life and death to me.
~~~~~
How can anyone read that account and then hold that man in contempt? So much lack of understanding and compassion -- it's like they can't understand that it's an addiction. An addiction. An addiction is way, way bigger than the addict that's suffering it. And that's the right word, too -- suffering. It's like getting hit by a bus. It's like getting run down by a train. It takes over your life. It takes over your life. It. owns. you. Maybe people think that the addict set out one day "Hey, I think I'll burn my life down! I wanna lose everything! I want to hurt those I love most! I want to be held to scorn and shame! I want to be covered in my very own puke and piss and shit, shaking down in DTs -- I can scarce wait! Sign me up!"
~~~~~
Following is a comment by rtha that I'd favorite seventeen thousand times if I could:
There's always a subtext in there about how they aren't really deserving of the consequences most street addicts suffer because -- I dunno, because they have a medical degree?
Jesus christ. Because nobody deserves those consequences. No matter how gross or nauseating you find them, or their stories, or what you perceive to be "the cause" of their addiction.
posted by rtha at 12:30 PM on April 4
posted by dancestoblue at 2:56 AM on April 5, 2017 [12 favorites]
About seven years ago I re-arranged my shoulder and some other shit in my back and I'm on a massage table literally crying, and crying out, also, as this great massage therapist tried to help me. Next day I'm in my MD's office and he knows me and trusts me completely and he wrote me for norco 10/325s and lo, it was good.
I treated the stuff like a sacrament. It helped me so. fkn. much. and goddamned if it didn't make me feel great, and not just because of the relief/release of the pain. I loved it. Disneyland. I'm lying in my bed, on ice then heat, ice then heat on my shoulder, I'm looking up at the ceiling and it's so pretty, it was sortof like shallow water waving.
Disneyland.
I am not afraid to ask others to keep a close eye on me also. My doc. My mentor. Guys that I mentor. I kept all of my cards face up on the table because addiction thrives in the dark, grows best in the dark. Every pill I took, I literally would ask myself if I could take 1/4 less of a tablet, or even 1/8 less. When I felt that maybe I could step down, I tried it. (Usually I was able to step down if that was the answer that came back to me.)
I got onto a chiropractors table and he was a magician but still, it took a long time for that pain to get down to ibuprofen level.
A year later I tore the shoulder again. Unreal. Same deal, except I skipped the massage therapist. Chiropractor. MD. Norcos. Ice / Heat. Cards face up on the table, keeping myself accountable, and friends keeping me accountable.
Four years ago my front wheel slid into a rain grate, stopped the bike immediately. I was looking behind me, didn't know it was happening until I came to, laying in the street, unable to move, and clocked out again. Came to again, could move, unclipped myself from the bike (the great thing about wearing clips is that you get 40% more power, the not great thing about clips is that if you go down and don't kick free you're married to the bike and you're totally screwed), tried to get my bearings, wtf had happened.
Same shoulder but this time I tore the rotator cuff right off the bone -- cool. Broke a bunch of bones in my face, I got this dent in my high left cheek now -- cool. Maybe the best concussion I've ever had, and I've had plenty.
I called a kid I mentor and had him pick me up, take me to the ER. (I couldn't even tell him where I was, though I was on a street I've traveled daily since 1992; he had to ask me questions, what did I see, etc and etc. It really rang my bell.) It was really great -- this kid is a neat freak, and I got blood on some paperwork in his car, I was so happy.
Checked out of the hospital next day AMA because norcos, heat/ice, bed, wavy ceiling, Disneyland. They wrote me for 10/325s, a lot of them, and I needed them. I *really* needed to be held to account, by myself and by my team. I hurt like a bastard on Fathers Day for a few weeks, could scarce eat anything for a month or more except avocado sandwiches. Which aren't bad but still. I think that the first thing that I ate was a sub sandwich, cut into smaller pieces with my pocketknife...
~~~~~
So many people upthread have written that they like this stuff. Not me. No, I don't like it -- I love it. I lurve it. I want to marry the shit. I want to rub it all over my head. I needed it, for the pain -- no way 'round that -- but I've never met a down that I don't just love and this stuff is so fine. It was so damn scary. Truly, I had to take this stuff as a sacrament, and that maybe sounds wacky and maybe it is but it isn't to me. It's life and death to me.
~~~~~
How can anyone read that account and then hold that man in contempt? So much lack of understanding and compassion -- it's like they can't understand that it's an addiction. An addiction. An addiction is way, way bigger than the addict that's suffering it. And that's the right word, too -- suffering. It's like getting hit by a bus. It's like getting run down by a train. It takes over your life. It takes over your life. It. owns. you. Maybe people think that the addict set out one day "Hey, I think I'll burn my life down! I wanna lose everything! I want to hurt those I love most! I want to be held to scorn and shame! I want to be covered in my very own puke and piss and shit, shaking down in DTs -- I can scarce wait! Sign me up!"
~~~~~
Following is a comment by rtha that I'd favorite seventeen thousand times if I could:
There's always a subtext in there about how they aren't really deserving of the consequences most street addicts suffer because -- I dunno, because they have a medical degree?
Jesus christ. Because nobody deserves those consequences. No matter how gross or nauseating you find them, or their stories, or what you perceive to be "the cause" of their addiction.
posted by rtha at 12:30 PM on April 4
posted by dancestoblue at 2:56 AM on April 5, 2017 [12 favorites]
I want to be covered in my very own puke and piss and shit
People always say this like it would be better if it were someone else's.
posted by thelonius at 3:19 AM on April 5, 2017 [4 favorites]
People always say this like it would be better if it were someone else's.
posted by thelonius at 3:19 AM on April 5, 2017 [4 favorites]
How can anyone read that account and then hold that man in contempt? So much lack of understanding and compassion -- it's like they can't understand that it's an addiction.
How can anyone do that to the people he supposedly loves most? What about them? Why does all the compassion on this thread have to be for the addicts? Why is it always about them?
posted by tully_monster at 5:53 AM on April 5, 2017 [1 favorite]
How can anyone do that to the people he supposedly loves most? What about them? Why does all the compassion on this thread have to be for the addicts? Why is it always about them?
posted by tully_monster at 5:53 AM on April 5, 2017 [1 favorite]
How can anyone do that to the people he supposedly loves most?
Addiction.
posted by Room 641-A at 6:46 AM on April 5, 2017 [1 favorite]
Addiction.
posted by Room 641-A at 6:46 AM on April 5, 2017 [1 favorite]
The family can leave. The addict is stuck with himself.
posted by Made of Star Stuff at 6:49 AM on April 5, 2017 [1 favorite]
posted by Made of Star Stuff at 6:49 AM on April 5, 2017 [1 favorite]
I would like to know about whether they managed to find any work in the medical field after that, how long the subsequent job search was, and what the financial and personal repercussions were for them after that firing.
This. For every "Million Little Pieces" there are a bunch of incidental casualties whose self-harm was limited to caring about an addict.
Why is their story less compelling/publishable than the addict's?
posted by aspersioncast at 7:15 AM on April 5, 2017 [2 favorites]
This. For every "Million Little Pieces" there are a bunch of incidental casualties whose self-harm was limited to caring about an addict.
Why is their story less compelling/publishable than the addict's?
posted by aspersioncast at 7:15 AM on April 5, 2017 [2 favorites]
Why not tell both? As a Canadian (this fellow is from Ontario) I'm curious about almost everything about the opioid crisis here in Canada. Until the last couple of years, the crisis has been presented as being part of an "other" community -- the homeless and so on.
Any information helps.
I think any reasonable, thinking person reading the article will be able to form their own opinions about this guy, and all the lives he has impacted. It would also be good to hear from the people he has hurt, but I wonder if they might also want to just get on with their lives.
posted by My Dad at 7:29 AM on April 5, 2017 [1 favorite]
Any information helps.
I think any reasonable, thinking person reading the article will be able to form their own opinions about this guy, and all the lives he has impacted. It would also be good to hear from the people he has hurt, but I wonder if they might also want to just get on with their lives.
posted by My Dad at 7:29 AM on April 5, 2017 [1 favorite]
How can anyone do that to the people he supposedly loves most?
You know, I think a lot of family members struggle with this feeling, watching someone close to them do this kind of stuff. For me, the big lightbulb moment came in a conversation with my husband a few months into his (now long-term) sobriety. I said, "if you relapse, it will be just as bad for me as for you," and he said, "What are you talking about? You'll still have your friends, your family, your home, your job, your money, your pets. I'll lose everything." And I was like OH. Right. It really, really isn't about me. The addict's problems are their own, and they're damaging their own psyche and their own life far, far more than anyone else's. When you approach it from that perspective, it's hard to feel anything other than compassion. They aren't choosing it. Nobody would choose that.
posted by something something at 7:37 AM on April 5, 2017 [3 favorites]
You know, I think a lot of family members struggle with this feeling, watching someone close to them do this kind of stuff. For me, the big lightbulb moment came in a conversation with my husband a few months into his (now long-term) sobriety. I said, "if you relapse, it will be just as bad for me as for you," and he said, "What are you talking about? You'll still have your friends, your family, your home, your job, your money, your pets. I'll lose everything." And I was like OH. Right. It really, really isn't about me. The addict's problems are their own, and they're damaging their own psyche and their own life far, far more than anyone else's. When you approach it from that perspective, it's hard to feel anything other than compassion. They aren't choosing it. Nobody would choose that.
posted by something something at 7:37 AM on April 5, 2017 [3 favorites]
Addiction is a disease. And yes, caring for and loving someone with a chronic illness can be exhausting and terrible, particularly if the person who has the disease is resistant to getting it treated or if the available treatment isn't very effective.
"How can anyone do that to the people he loves the most?" Do you say that about people with schizophrenia, or PTSD, or who have a TBI from an accident? Addiction is not a moral problem.
posted by KathrynT at 8:39 AM on April 5, 2017 [4 favorites]
"How can anyone do that to the people he loves the most?" Do you say that about people with schizophrenia, or PTSD, or who have a TBI from an accident? Addiction is not a moral problem.
posted by KathrynT at 8:39 AM on April 5, 2017 [4 favorites]
> Why is their story less compelling/publishable than the addict's?
We used to see a lot more of these, back when addicts were of course poor/homeless/otherwise undeserving (except, perhaps, of the most dehumanizing pity) immoral fuckups. Then lots of "nice" people who didn't "deserve" to become addicted started dying of overdoses and now they are the frames for these stories.
posted by rtha at 9:13 AM on April 5, 2017 [1 favorite]
We used to see a lot more of these, back when addicts were of course poor/homeless/otherwise undeserving (except, perhaps, of the most dehumanizing pity) immoral fuckups. Then lots of "nice" people who didn't "deserve" to become addicted started dying of overdoses and now they are the frames for these stories.
posted by rtha at 9:13 AM on April 5, 2017 [1 favorite]
The addict's problems are their own, and they're damaging their own psyche and their own life far, far more than anyone else's.
Not necessarily. I guess the conscientious addict makes sure that all the bad things they do only affect them. Addicts drive while stoned and cause serious accidents, cheat on spouses (and maybe spread diseases to those spouses), neglect their children, steal things, etc. Not all addicts do all those things all the time, but that "rock-bottom" place that lots of addicts say you have to get to before you're ready to get better is usually something the above and it causes serious emotion and physical harm to those around them.
Is it worse to be cut off by your parents or have to cut off your own child? Addiction does serious everlasting damage to families and relationships. I have so much sympathy for addicts, they are sick and need all the help they can get, but do I have more sympathy for them than I do the people around them who are trying to cope and take care of them? No.
posted by LizBoBiz at 10:53 AM on April 5, 2017 [3 favorites]
Not necessarily. I guess the conscientious addict makes sure that all the bad things they do only affect them. Addicts drive while stoned and cause serious accidents, cheat on spouses (and maybe spread diseases to those spouses), neglect their children, steal things, etc. Not all addicts do all those things all the time, but that "rock-bottom" place that lots of addicts say you have to get to before you're ready to get better is usually something the above and it causes serious emotion and physical harm to those around them.
Is it worse to be cut off by your parents or have to cut off your own child? Addiction does serious everlasting damage to families and relationships. I have so much sympathy for addicts, they are sick and need all the help they can get, but do I have more sympathy for them than I do the people around them who are trying to cope and take care of them? No.
posted by LizBoBiz at 10:53 AM on April 5, 2017 [3 favorites]
Oh, absolutely. The fact that addiction isn't a moral problem doesn't mean that nobody needs to set boundaries around it. I guess I just reject the framing that addiction is about the addict "doing this to" anyone -- the harm that addiction does to the communities around the addict is real, but it isn't volitional.
But it doesn't have to be volitional in order to be horrifyingly toxic and bad for the most innocent of bystanders. Of course you have to protect yourself and the people you love from that harm. But it's not something that the addict is doing to you, it's something that is happening to the addict and is catching you in the backdraft.
posted by KathrynT at 11:12 AM on April 5, 2017 [5 favorites]
But it doesn't have to be volitional in order to be horrifyingly toxic and bad for the most innocent of bystanders. Of course you have to protect yourself and the people you love from that harm. But it's not something that the addict is doing to you, it's something that is happening to the addict and is catching you in the backdraft.
posted by KathrynT at 11:12 AM on April 5, 2017 [5 favorites]
My favorite family member, of all of the members of my family, was my nephew. Like me, he suffered manic depression. Like me, he suffered alcoholism. Unlike me, he was not given the gift of a clean and sober life, though he sure did put his all into it. This past Sunday would have been his 46th birthday. He died -- alcoholism -- a few days before Thanksgiving, this past November. Three days before his sons 4th birthday.
Chris and I were so, so much alike. We felt the same, felt as much as the other did. You know how young ppl today say "Yeah, he's my brother from another mother." Chris used to tell me that "You're my brother from my mothers mother." And that was the dead-on truth.
Is it nature? Nurture? Some combination? Or nothing to do with that at all? Lots of people with this manic depression thing, we can and do get close to alcohol because it's an effective if very inelegant anti psychotic, and will soothe the burn of the manic beast. Except "Whoops!" it turns loose another beast, and now you've got manic depression *and* alcoholism. Sweet. In any case, best I can see is that it doesn't matter who/what/when/where/how/why. What matters is that Chris had it. And alcoholism had Chris.
I've been given this huge gift -- a clean and sober life. So far. Chris and I would talk, I'd tell him, again and yet again these past two or three years "Chris, this is killing you. You're dying. It's just a matter of when, though as far as you've progressed, your when likely won't be too far off in the future." He understood all of that. He wanted to stop. He loved his son with all of his huge heart. Chris had so much to live for. He didn't want to die. He blew his liver apart last November.
If you want to hear about family members who are broken and broken down and co-workers -- co-workers who, btw, signed their own warrant, by doing what they knew to be against their professional rules and ethics -- if you want to read about any of them, or all of them, it's not hard to find first person accounts, all over the place. But it just so happens that this thread is about a piece written from the perspective of the addict.
Or, if you want to see it a bit closer to the bone, to any Al Anon meeting. Or ask me. Or ask my sister, or my brother-in-law. Or ask Noah, that son of his. You could have called me, this past Sunday, and if I felt that I wasn't going to be judged, and/or that my nephew wasn't going to be judged, I'd have laid my heart wide open to you, and told you exactly what it is you seem to want to hear, ie how addiction and/or alcoholism is devastating to anyone in it's sphere. Just be careful, you'd have wanted to try to get lucky, try to catch me when I wasn't crying Sunday.
I didn't write that we're not to have compassion for those whose lives are impacted by an addicts devastating illness. What I wrote -- and will hold to, regardless the squeals and moans and finger-wavings of self-righteous, contemptuous, sanctimonious people who cannot understand, or will not understand -- is that the man who wrote this, and lived this, and is living this, this man is suffering also.
posted by dancestoblue at 12:29 PM on April 5, 2017 [7 favorites]
Chris and I were so, so much alike. We felt the same, felt as much as the other did. You know how young ppl today say "Yeah, he's my brother from another mother." Chris used to tell me that "You're my brother from my mothers mother." And that was the dead-on truth.
Is it nature? Nurture? Some combination? Or nothing to do with that at all? Lots of people with this manic depression thing, we can and do get close to alcohol because it's an effective if very inelegant anti psychotic, and will soothe the burn of the manic beast. Except "Whoops!" it turns loose another beast, and now you've got manic depression *and* alcoholism. Sweet. In any case, best I can see is that it doesn't matter who/what/when/where/how/why. What matters is that Chris had it. And alcoholism had Chris.
I've been given this huge gift -- a clean and sober life. So far. Chris and I would talk, I'd tell him, again and yet again these past two or three years "Chris, this is killing you. You're dying. It's just a matter of when, though as far as you've progressed, your when likely won't be too far off in the future." He understood all of that. He wanted to stop. He loved his son with all of his huge heart. Chris had so much to live for. He didn't want to die. He blew his liver apart last November.
If you want to hear about family members who are broken and broken down and co-workers -- co-workers who, btw, signed their own warrant, by doing what they knew to be against their professional rules and ethics -- if you want to read about any of them, or all of them, it's not hard to find first person accounts, all over the place. But it just so happens that this thread is about a piece written from the perspective of the addict.
Or, if you want to see it a bit closer to the bone, to any Al Anon meeting. Or ask me. Or ask my sister, or my brother-in-law. Or ask Noah, that son of his. You could have called me, this past Sunday, and if I felt that I wasn't going to be judged, and/or that my nephew wasn't going to be judged, I'd have laid my heart wide open to you, and told you exactly what it is you seem to want to hear, ie how addiction and/or alcoholism is devastating to anyone in it's sphere. Just be careful, you'd have wanted to try to get lucky, try to catch me when I wasn't crying Sunday.
I didn't write that we're not to have compassion for those whose lives are impacted by an addicts devastating illness. What I wrote -- and will hold to, regardless the squeals and moans and finger-wavings of self-righteous, contemptuous, sanctimonious people who cannot understand, or will not understand -- is that the man who wrote this, and lived this, and is living this, this man is suffering also.
posted by dancestoblue at 12:29 PM on April 5, 2017 [7 favorites]
What I wrote -- and will hold to, regardless the squeals and moans and finger-wavings of self-righteous, contemptuous, sanctimonious people who cannot understand, or will not understand -- is that the man who wrote this, and lived this, and is living this, this man is suffering also.
Oh, please. No one here is saying we shouldn't have compassion for him. But perhaps I'm alone here and some kind of psychopathic freak in my not being able to devote all, or even most of my compassion to a man whose innocent wife was carted off to jail because of his addiction (please tell me more about how just "leaving" will somehow magically erase the scars both for her and for their children!).
"How can anyone do that to the people he loves the most?" Do you say that about people with schizophrenia, or PTSD, or who have a TBI from an accident? Addiction is not a moral problem.
Hi! Lifelong sufferer of clinical depression here! You know when I realized I needed treatment? When I saw the effect my depression was having on my husband and knew there was a very real possibility I might lose him if I didn't get it together and do something!
I'm still struggling with depression. I will always be struggling with depression. But I work on it constantly, even when it drains me, even--especially--when I think the best thing for everyone would be for me to slip over the side of my kayak without a PFD or step in front of a bus, because I know that depression affects not just the depressive but everyone with whom he or she interacts closely--and, of course, even innocent bystanders. I am an intelligent, high-functioning mental illness patient, and I consider it my responsibility to shield those I love from my illness. No, my illness is not my fault, but I try my damnedest not to let it affect others. That isn't to say that I don't fail sometimes, but when I do, I don't expect other people to have compassion for me when I've burned bridges and pushed people away, and no one does, except for the only one who matters.
Is my clinical depression less of an illness than the others you've listed above? Is that it? Because it can be and has been just as debilitating. I'm not arguing that everyone with these disorders (including major depression) is completely capable of protecting others from their effects, but many do so to the very best of their ability, especially those with the intelligence, experience, and resources to do so. Which is what this man had, and what he failed to use to protect his family. And his lack of genuine introspection shines forth from every paragraph.
Depression is hard to battle because it colors everything. It's insidious; it creeps up on you from behind; it disguises itself as "realistic thinking" and "shattering self-delusions." If I wanted to be grandiose, I too could say that depression is far, far bigger than the depressive (whatever that actually means). I could answer questions about why untreated depressives--including those who willfully refuse to seek treatment because of the stigma--make their families' lives a living hell and their children more susceptible to depression themselves with a shrug and "That's depression." But I don't, because I don't see depression in quasi-evangelical terms, as an all-powerful monolithic juggernaut of an evil that can never be overcome and against which we are all powerless.
And I don't see addiction that way, either, and neither do a whole lot of scientists and doctors and people who have gone through Rational Recovery and other non-quasi-religious movements that rely on evidence-based substance abuse treatment. I'm not trying to be cruel or offensive here. I'm actually hopeful. I want to see people like this guy get the evidence-based opportunity to clean up their acts before it's too late--for them, for their families, for all the other people they manage to hurt along the way. But frankly, I don't think kneejerk "compassion"--which comes with its own self-righteous, contemptuous, sanctimonious finger-wagging and squealing--is any more helpful here than kneejerk judgmentalism.
posted by tully_monster at 2:05 PM on April 5, 2017 [5 favorites]
Oh, please. No one here is saying we shouldn't have compassion for him. But perhaps I'm alone here and some kind of psychopathic freak in my not being able to devote all, or even most of my compassion to a man whose innocent wife was carted off to jail because of his addiction (please tell me more about how just "leaving" will somehow magically erase the scars both for her and for their children!).
"How can anyone do that to the people he loves the most?" Do you say that about people with schizophrenia, or PTSD, or who have a TBI from an accident? Addiction is not a moral problem.
Hi! Lifelong sufferer of clinical depression here! You know when I realized I needed treatment? When I saw the effect my depression was having on my husband and knew there was a very real possibility I might lose him if I didn't get it together and do something!
I'm still struggling with depression. I will always be struggling with depression. But I work on it constantly, even when it drains me, even--especially--when I think the best thing for everyone would be for me to slip over the side of my kayak without a PFD or step in front of a bus, because I know that depression affects not just the depressive but everyone with whom he or she interacts closely--and, of course, even innocent bystanders. I am an intelligent, high-functioning mental illness patient, and I consider it my responsibility to shield those I love from my illness. No, my illness is not my fault, but I try my damnedest not to let it affect others. That isn't to say that I don't fail sometimes, but when I do, I don't expect other people to have compassion for me when I've burned bridges and pushed people away, and no one does, except for the only one who matters.
Is my clinical depression less of an illness than the others you've listed above? Is that it? Because it can be and has been just as debilitating. I'm not arguing that everyone with these disorders (including major depression) is completely capable of protecting others from their effects, but many do so to the very best of their ability, especially those with the intelligence, experience, and resources to do so. Which is what this man had, and what he failed to use to protect his family. And his lack of genuine introspection shines forth from every paragraph.
Depression is hard to battle because it colors everything. It's insidious; it creeps up on you from behind; it disguises itself as "realistic thinking" and "shattering self-delusions." If I wanted to be grandiose, I too could say that depression is far, far bigger than the depressive (whatever that actually means). I could answer questions about why untreated depressives--including those who willfully refuse to seek treatment because of the stigma--make their families' lives a living hell and their children more susceptible to depression themselves with a shrug and "That's depression." But I don't, because I don't see depression in quasi-evangelical terms, as an all-powerful monolithic juggernaut of an evil that can never be overcome and against which we are all powerless.
And I don't see addiction that way, either, and neither do a whole lot of scientists and doctors and people who have gone through Rational Recovery and other non-quasi-religious movements that rely on evidence-based substance abuse treatment. I'm not trying to be cruel or offensive here. I'm actually hopeful. I want to see people like this guy get the evidence-based opportunity to clean up their acts before it's too late--for them, for their families, for all the other people they manage to hurt along the way. But frankly, I don't think kneejerk "compassion"--which comes with its own self-righteous, contemptuous, sanctimonious finger-wagging and squealing--is any more helpful here than kneejerk judgmentalism.
posted by tully_monster at 2:05 PM on April 5, 2017 [5 favorites]
My supervisor and the hospital’s chief of staff called me into a meeting and asked me if I had any problems they should be aware of. I lied... They gave me pamphlets on addiction and mental health, and I went back to work.Jezum crow, this. I've received these sorts of things -- typically useless -- for routine things all the time. They're always poorly photocopied like they came out of a poorly-funded school and smell of a rote application, a token gesture. Horrifying to see them applied this deeply.
posted by Ogre Lawless at 2:30 PM on April 5, 2017 [1 favorite]
I'll admit I'm a little judgmental of people who cause serious material problems for others in the course of addiction - at least when they don't have to, I have a way higher standard for a guy with a six figure job than a petty thief or scammer - more or less because it makes the rest of us look bad? I guess this is kinda the inverse of the recovered addict who feels so guilty about something he did back in the day that he goes around telling everybody that junkies are pieces of shit and should be locked up. I've met a few of that guy (that guy is not very likable).
If his co-workers were really fired over breaking the rules for this one dude and nothing else though I'm inclined to blame that as much on an overzealous crackdown on prescribers as on his manipulation.
posted by atoxyl at 2:35 PM on April 5, 2017 [1 favorite]
If his co-workers were really fired over breaking the rules for this one dude and nothing else though I'm inclined to blame that as much on an overzealous crackdown on prescribers as on his manipulation.
posted by atoxyl at 2:35 PM on April 5, 2017 [1 favorite]
I think it's important to have empathy for both the "addict" and the people he or she has harmed. I think it's important to hold people accountable for their actions, and also hold them account to a commitment to get well again. But it's important for me at least to not use these people as a proxy to express whatever anger I have bottled up inside of me.
posted by My Dad at 3:46 PM on April 5, 2017 [2 favorites]
posted by My Dad at 3:46 PM on April 5, 2017 [2 favorites]
How can anyone read that account and then hold that man in contempt?
Because he was an ER doctor who treated god knows how many people while high as fuck? How many people died or are living lives of pain or disability because of this guy? He never even addresses it. Because he let his wife get charged with a felony? Because he got people fired by bullying them into giving him drugs? He's a terrible fucking person and I definitely feel contempt for him.
the harm that addiction does to the communities around the addict is real, but it isn't volitional.
I would argue very strongly that it is entirely voltiional. Addicts know what they are doing.
All the talk of addiction as a sin or a disease or a community problem or any of the other mythos or stories we tell about it doesn't help. People nervously declaring they flushed their prescribed vicodin rather than risk the horror of enjoying the side effects are being ridiculous. There is noting extraordinary or brave about being either an addict or an ex-addict and conflating the decision and steps taken to quit with a bunch of psychobabble helps no-one in the long term. All these things just help addicts justify their behavior which is uniformly pretty shitty.
People need to have good facts and be rational and unemotional about it if they want the situation to get better. Addicts get high first because they want to and later on because they are physically addicted. That's it- no mas. There is no particular value in anecdote to understanding addiction any more than there is to understanding farming or investment banking. It's not apart from real life, or mysterious to be an addict, we all get the appeal just fine. The question is how to motivate people not to make that decisions.
posted by fshgrl at 9:23 PM on April 5, 2017 [2 favorites]
Because he was an ER doctor who treated god knows how many people while high as fuck? How many people died or are living lives of pain or disability because of this guy? He never even addresses it. Because he let his wife get charged with a felony? Because he got people fired by bullying them into giving him drugs? He's a terrible fucking person and I definitely feel contempt for him.
the harm that addiction does to the communities around the addict is real, but it isn't volitional.
I would argue very strongly that it is entirely voltiional. Addicts know what they are doing.
All the talk of addiction as a sin or a disease or a community problem or any of the other mythos or stories we tell about it doesn't help. People nervously declaring they flushed their prescribed vicodin rather than risk the horror of enjoying the side effects are being ridiculous. There is noting extraordinary or brave about being either an addict or an ex-addict and conflating the decision and steps taken to quit with a bunch of psychobabble helps no-one in the long term. All these things just help addicts justify their behavior which is uniformly pretty shitty.
People need to have good facts and be rational and unemotional about it if they want the situation to get better. Addicts get high first because they want to and later on because they are physically addicted. That's it- no mas. There is no particular value in anecdote to understanding addiction any more than there is to understanding farming or investment banking. It's not apart from real life, or mysterious to be an addict, we all get the appeal just fine. The question is how to motivate people not to make that decisions.
posted by fshgrl at 9:23 PM on April 5, 2017 [2 favorites]
Okay, let me add this since my point was not quite clear: I have an addictive personality and I know I'd go down that track if I had the opportunity.
That's what scares me: knowing I'd dance down that path given an opportunity. So that bottle is hidden away.
If knowing that about myself is sanctimonious so be it.
posted by mephron at 9:24 PM on April 5, 2017
That's what scares me: knowing I'd dance down that path given an opportunity. So that bottle is hidden away.
If knowing that about myself is sanctimonious so be it.
posted by mephron at 9:24 PM on April 5, 2017
But you do have the opportunity! Drugs are so easy to get even teenagers and morons can do it. Saying you don't have the opportunity is a story you are telling yourself. And you aren't doing it so don't kid yourself and don't feel a sense of kinship or false sympathy, you are not the same as this guy,
posted by fshgrl at 9:42 PM on April 5, 2017 [3 favorites]
posted by fshgrl at 9:42 PM on April 5, 2017 [3 favorites]
Thing I learned last month: It takes a tiny amount of THC for pain management. According to Dr. Mark Ware, McGill U., it's 25 milligrams of herbal cannabis for pain relief -- and his tiny sample of participants mostly did not get the euphoric "high" on that single dose.
Go to about the 27 minute mark in this video of his lecture.
Not nearly enough research being done on cannabis and pain relief, just lots of anecdata.
posted by wenat at 1:13 PM on April 8, 2017
Go to about the 27 minute mark in this video of his lecture.
Not nearly enough research being done on cannabis and pain relief, just lots of anecdata.
posted by wenat at 1:13 PM on April 8, 2017
Addicts Who Can't Get Painkillers Turn To Anti-Diarrhea Drugs, nytimes
I knew Immodium had an opioid, but I thought it wouldn't cross the blood - brain barrier.
posted by the man of twists and turns at 2:23 PM on April 11, 2017
I knew Immodium had an opioid, but I thought it wouldn't cross the blood - brain barrier.
posted by the man of twists and turns at 2:23 PM on April 11, 2017
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One of the most interesting things to me in the entire article, though, is that his mother, the original source of his fentanyl, died of an overdose of patches "we think she applied by accident." He's able to be honest with himself about all those terrible details of his own addiction and the consequences that have destroyed his life, but dismisses out of hand the possibility that his mother might have been brought down by it as well.
posted by something something at 6:47 AM on April 4, 2017 [10 favorites]