Prescription drug deaths
January 1, 2013 3:39 AM   Subscribe

Dying for Relief, an LA Times investigative series about deaths from prescription drug deaths. Part 1, Nov. 11, 2012

Prescription overdoses kill more people than heroin and cocaine. An L.A. Times review of coroners’ records finds that drugs prescribed by a small number of doctors caused or contributed to a disproportionate number of deaths.

Part 2, Dec. 9, 2012
Part 3, Dec. 20, 2012
Part 4, Dec. 30, 2012
posted by OmieWise (25 comments total) 25 users marked this as a favorite
And the other side of this frequently told story from Metafilter's own maias.
posted by PeterMcDermott at 4:29 AM on January 1, 2013 [12 favorites]

"If you are an oncologist and you are taking care of people in cancer pain, that's one thing," said Wender, an anesthesiologist who oversees a large pain-management practice in Los Angeles. "But if you are a general practitioner and writing loads of opioid prescriptions, then something is wrong."

And yet another side. Pain management clinics don't like the competition either.
posted by three blind mice at 4:32 AM on January 1, 2013 [3 favorites]

They have a database that they don't have money to maintain. I know nothing of how much it costs to maintain such a database.

Can someone give me an idea of what is involved in terms of how many man hours (person hours?) it would take on a weekly basis? How much it would cost in terms of equipment and labor?
posted by sciencegeek at 4:57 AM on January 1, 2013

That really hurts to read. My mother is a person who takes far too high and frequent doses of prescription drugs, for legitimate hip and back pain issues. I am always worried. Before Christmas, we inherited some money and sent her for two weeks to a private hospital where she had daily physiotherapy and massage, and was taken down on the drugs. Just yesterday, I went to take her out for an event. She could walk! She was clear and relatively happy.
Always, her doctors have found it easier to drug her down, and she has preferred those doctors who prescribed pills.
posted by mumimor at 5:12 AM on January 1, 2013 [3 favorites]

So, it's currently nearly 8 am. I haven't slept since a nap that ended at midnight, because of pain in my face (Trigeminal Neuralgia) and an ache in my hip (juvenile rheumatoid) while my husband sleeps in. Have I taken one of my acetaminophen and hydrocodone 10/325s, or my oxycodone 10/325s?


Why? Because after counting them each out, and checking my refills, I've choses to hoard the pills I have for when I REALLY need them, like for days I need them to leave the house to go to work or school. The reason I have to hoard them, and count them out like Cratchit's office coal: all of the restrictions placed on where and when I can pick up a refill of them.

Maias' article is right on the money. People in legitimate pain are being hounded, treated like criminals, berated, and degraded by the very system that is supposed to help them. What would happen to me if my rheumatologist got marked as writing too many pain scripts of the wrong type? Or to my nearly 70 year old dad with RA and multiple injury induced neuropathies if his pain doc did? A database to save lives, but at the cost of the quality of living of how many?

Soon I'll be the one pissing in a cup every month and submitting myself to the indignities and abuses of a system designed to punish everyone equally. My husband - who has fibromyalgia and ostio-arthritis - will not submit to this shit. It was all I could do to get him to finally see a doctor about his pain 8 years ago, because of the shit he went through in terms of shaming and derision in getting an IBS diagnosis at 13! How many others will drop treatments that helped them out of shame at being treated like a criminal? How many people will turn to alcohol, street drugs, and even the fucking Hemingway Solution rather than be shamed as addicts and potential criminals every time?

At least in prison I'd get some pain medication a day...

I say this EVERY time an article like this gets posted on Metafilter, and I know it is fucking axe grindy and I honestly don't care. I'm in too much pain to care. That I have to choose between sleep on a holiday and going to work one day, that I have to not pick up my two pain meds less than a week apart, that I honestly had tears in my eyes when my Rheumatologist wrote me the 10/325s of the hydrocodone rather than the 10/500s so I could actually take enough to get through a 9am -8pm day on my worst mobile days, that I have to deal with the new pharmacy techs every few months eyeing my script file and my 30 year old face and writing down my drivers license number? I'll be rather up front about grinding my fucking axe. I'm tired, I'm sick, and all I have left is the ability to scream online over and voer again until my hands and mind give out.
posted by strixus at 5:14 AM on January 1, 2013 [54 favorites]

Why don't they name the other doctors whose prescriptions were involved in these deaths? Seems like the authors are just looking for a convenient scapegoat.
posted by gjc at 5:18 AM on January 1, 2013

I say this EVERY time an article like this gets posted on Metafilter, and I know it is fucking axe grindy and I honestly don't care. I'm in too much pain to care.

Yeah, that sucks, and I know you're in pain, but I honestly can't quite tell what your axe is here. "Allow doctors to adequately prescribe pain meds to people in need" is not an axe. It would seem that the more time and attention given to illegitimate uses of the meds, the more of a chance that people in need will really get what they need. It would seem to help remove the moral panic about the meds per se.
posted by OmieWise at 6:32 AM on January 1, 2013 [5 favorites]

Well I think because there is some debate among different types of professionals about the legitimacy of diagnosis like fibromyalgia, IBS, and many other conditions of chronic pain that are said to be "psychosomatic" by many-- it does mean patients have limited tools to "prove" they are in pain and need real treatment.

Personally, I think emotional pain is also physically real (and involves biological processes) and physically damaging to the body and that it can't always be solved by CBT or telling yourself your life is ok when it's just really not.

My friend that was locked in basements and literally tortured his whole childhood? He's going to be on either heroin, methadone, or some sort of legally prescribed emotion blocker for the rest of his life. I personally think there are ways of supporting people in excruciating pain that we should be using as first line of treatment BEFORE resorting to drugs with a lot of side effects and many of those treatments are not available on insurance (and many people in chronic physical or emotional pain are unable to work or get insurance anyway).

But, yeah, there are some forms of pain that are literally so bad many people don't mind at all the risk of earlier death. Without the drugs they will have no moments of enjoyment or pleasure at all.

I think fears that tightening up access to painkillers will cause more suspicion and "debunking" of conditions like fibro are very well founded. People with chronic pain get enough suspicion for making it up or trying to get attention, or being hypochondriacs, or not dealing with their emotional issues "Right". I think pain medication is dangerous, and I think many pharmaceuticals commonly prescribed are outright toxic to the human body and affect our future children and grandchildren after taking them.

I'm all in favor of creating better solutions than pharmceuticals. But the key is actually HAVING better treatments. If the alternative to painkillers is living in chronic pain permanently, then I think it's only decent to let people decide for themselves what future health risks they are willing to deal with to escape the pain now. People who are worried about too much prescription pain use should take some time to learn about environmental, social, and familial factors that increase disease and conditions of chronic pain. And support research into non-pharmaceutical therapeutic interventions like physiotherapy, biofeedback, massage, bodywork, nutritional support, and getting those that provide clinically significant results available on insurance.
posted by xarnop at 6:49 AM on January 1, 2013 [11 favorites]

None of that is really counter to the fact that we should definately be concerned about doctors who are handing out painkillers without educating patients about their effects or seeking to solve the actual cause of the pain before resorting to dangerous drugs like oxycontin.
posted by xarnop at 6:52 AM on January 1, 2013 [1 favorite]

I have a client who was busted in a parking lot for selling hydrocodone pills. She had fifty or so on her, which makes it a trafficking amount. She is likely to get 10 to 20 years in prison. She was prescribed these drugs by a doctor who would have clients come in, give him 100 dollars in cash, and then he would prescribe them pain medication. He did this 30 to 50 times per day and it went on for quite some time. My client would get go to him several times a month to get more prescriptions. She estimated she had received prescriptions for thousands of pills overall.

My client is among many who were charged with felonies for selling or possessing large quantities of those pills. Many of those people have gone to prison or will be going to prison. Almost all of them were some combination of people suffering from chronic pain, drug addicts, or very poor. After all, prescription drug overdoses kill a lot of people. DA's and judges like to put people in prison because they feel like they might be stopping the next death.

What about the doctor who prescribed all that medication to all those people without diagnosing them in exchange for cash payouts? Well, he lost his license to practice medicine. He also pleaded guilty to misdemeanors and received probation. You see, since he only wrote the prescriptions, he was never in actual possession of the opiates and therefore could not be charged with trafficking them. Ah, here he is.
posted by flarbuse at 7:09 AM on January 1, 2013 [4 favorites]

Omiwise, it doesn't work that way. A person who is in pain only has so much energy, and the more hoops you make them jump through, the fewer will get treatment. To say nothing of the associated social stigma of addict, criminal, and faker that these stories apply to people who need these medications.

My husband refuses to take hydrocodone at all, and barely takes the pills he's been prescribed because he's afraid of being addicted to them. A co-worker of mine wouldn't take the prescription her dentist gave her after having major bridge work done because she didn't want to be labeled an addict. I've had family members lecture me about "all those pills you take" making me weak and dependent on them. And I've had people tell me that I clearly didn't deserve the things I'd worked for (in that one case, my masters degree) because I had the moral failing of showing my illness in public.

Clearly, this is working.
posted by strixus at 7:31 AM on January 1, 2013 [11 favorites]

My husband is 33. He had a total hip replacement just over a year ago. He had a congenital defect that was ignored, misdiagnosed, and then ignored some more, so by the time he got treatment in his early teens, things were really bad. The end result of his first round of surgeries was a leg two inches shorter than other, which, over nearly twenty years, caused four discs in his back to herniate.

He has been in pain literally his entire life. We had to doctor shop a lot to get someone to treat him properly.

He hates his pills. They make his stomach hurt. They affect his sex drive and his sleep schedule. He can't drink at all anymore, even just a nip on holidays. He has to get drug tests that our insurance won't pay for. Every time he gets a refill, regardless of who picks it up, we get treated like drug addicts.

I live in a place where there is a lot of prescription drug abuse and illicit sales. People are poor, so they get Medicaid and food stamps, but precious little money. They hoard their pain pills, cut their script in half, sell whatever they can. They can pay for their phone this way, and buy toilet paper. They sell pills without instructions, without caution. People who buy them this way take them by the fistful, or with alcohol. They get sick and often die.

The place where I grew up, about ten years ago, Oxy moved in a big way. When the bottom dropped out of the economy, people turned to heroin because it was cheaper. My cousin got caught up in this. He's been in and out of jail a few times and has taken three cracks at rehab. He's 29 years old now. I wonder what will become of him.

I see both sides of this issue, and I have no answers. Should it become more difficult for my husband to get pain meds, I'll track them down and buy them online. It's something I've looked into already. Legit pharmacies don't usually sell narcotics anymore, so you are basically dealing with high tech drug dealers out of the southwest, who have mules and truckers that move the pills in from Mexico. GreenDot, MoneyPack... they all have some "untraceable" way they want to get paid. This makes my stomach hurt to think about. I don't want to have to do this. But I see it coming, and I won't watch my husband suffer.
posted by Athene at 8:10 AM on January 1, 2013 [11 favorites]

Given my history of back issues and surgeries, the idea of a future without proper pain meds is scary beyond belief. I've already trained myself to ignore and live with all but the worst of the daily pains, but there are always days where I absolutely need my hydrocodone just to be a semi-functional person for most of the day.
posted by Thorzdad at 9:19 AM on January 1, 2013 [1 favorite]

I could probably write much, much more but I'm trying to get two kids on an international flight this morning and probably shouldn't have opened this thread.

Chronic pain management is the number one reason cited for why primary care physicians leave the practice of medicine. For more than ten years, we have been told by the American Pain Society (whose president-elect is laughably quoted in this article about the danger of addiction) that "Pain is the fifth vital sign" and "It is a moral travesty to abandon your patients in pain." And for more than ten years no infrastructure has been developed to treat co-occuring mental illness, no infrastructure to better assess for or treat chemical dependency. The Affordable Care Act still hasn't been implemented and we still have 45 million uninsured patients for whom rehab and surgery and job retraining are expensive, and a bottle of Vicodin is ten bucks.

And so began 12 years ago, the uncontrolled experiment that has given us the clear, predictable results today. If you give large populations prescriptions for opiate medications a small, known percentage of patients will die taking their medication as prescribed. (Notwithstanding the clear increase in abuse -- people faking illnesses and selling their prescriptions on playgrounds, stolen medications, unscrupulous doctors acting as dealers)

This has happened to a patient of mine at least once that I know of, and probably more that I don't know of. A 45 year old woman, with big time PTSD, intermittent homelessness, poverty, and extremely poor ability to cope with pain and stress. She also a herniated disk in her neck which contributed to intractable chronic pain. She was on Medicaid, had been to 2 spine surgeons neither of which thought they should operate on her. I sent her to a pain clinic who made the recommendation to start her on long acting morphine (all of the pain clinics in Washington state are eager to recommend opiates but none of them actually prescribe them, because you know, that's hard and requires work). As part of her treatment, like all of my patients, she was required to sign a pain contract, provide urine specimens regularly to screen for other drug use, and participate in mental health treatment. She was on a stable dose of her med for about a year before she was found dead on her toilet at home. The coroner suspected she forgot she had taken her morning medication and doubled up and took one of her muscle relaxers and she simply stopped breathing.

I get that pain is important. I get that people cannot work because of pain. I get that it ruins lives, that it makes people miserable. I get that there are many things in medicine that are not fixable. Opiate medication works. The problem is that the infrastructure to treat pain properly does not exist. It is extremely time consuming to do it right with appropriate precautions, and even when it is done safely following all guidelines, as with my lady above, it's still hazardous and typically provides a small benefit. Few of these people go back to work. Over the long haul (years), the emerging medical literature is clear that people who take chronic opiates rate their pain and disability similarly to those who didn't take the opiates.

On top of all this, there is a constant flood of healthy twenty somethings with a sore back after a weekend of raking leaves who've somehow gotten the message that this deserves 100 Percocet tablets.

So from, the primary care perspective, chronic opiates are an intervention that A. clearly carries hazard. B. is extremely time consuming, taking energy away from other sick patients (there still is a primary care shortage you know) C. lacks financial and infrastructure support D. has the potential to get the prescribing doctor in trouble with the law E. according to the literature that guides our practice, isn't very effective over the long term and F. once you start investing the energy in treating those who really need it, word gets out and you'll get innundated with nothing but requests for pain meds.

Is it at least understandable that no legitimate primary care doctor wants to deal with this?

My current practice, a federally funded community health center which sees almost entirely Medicaid and uninsured patients, ie pretty sick needy patients who have nowhere else to go, made the decision two years ago that this problem was interfering with our primary mission to such a degree that we have a published policy, complete with glossy pamphlets, that we do not prescribe chronic opiates. Period. Like brain surgery or angioplasty, it's just not a medical service that we are trained or have the infrastructure to perform.

I currently have 59 chronic pain patients who were grandfathered in from before, and who I haven't found a reason yet to stop prescribing (every month I shed a couple -- "You're telling me cocaine is in your urine from second-hand crack at a party you were at? Sorry, the rules are the rules, here's your last tapering prescription. Would you like a referral to a drug treatment program?"). These people take up a full half of my practice time, and it's a pretty frustrating, unrewarding part of my practice, full of people who see their treatment as ineffective, angling for early refills, "lost" prescriptions, and dealing with the side effects and toxicities of their meds.

I wish I wish the DEA had a registration that would allow you to opt out of opiate prescribing, then I would just be absolved of this whole problem and it would be for someone else to deal with. I did not sign up for this.

At least in prison I'd get some pain medication a day...

No, at least in Washington, prisons stopped dealing with this bullshit years ago.

Listen, I am really sorry about your trigeminal neuralgia. (Presumably you've tried other non-opiate drugs that have been shown to treat this condition effectively. And presumably you understand by now the unconscious reaction that a patient insisting that opiates are the only thing that works for them, even when non-opiate options exist provokes from physicians. I always try to accept what patients say as truth, but I'm just sayin'.) I really am sorry. I hate seeing my patients in pain and I hate saying "no" to patients. But I've been struggling with this for 15 years and I'm like a couple steps away from throwing my career away over this issue. 2000 uninsured patients will be without a doctor. I've got babies with cancer and shit to deal with.

By all means, do something to change the system to make chronic opiates a safe and sustainable part of my practice. But I, like many other primary care docs, am done trying to make it work. It's an utterly no win situation. We are pushing back -- crafting legislation, working with the DEA, and in many cases just refusing. I'd rather have a few people call me a selfish uncaring prick than be a Dr. Vu.
posted by Slarty Bartfast at 9:41 AM on January 1, 2013 [44 favorites]

Not to make things more depressing, but yet another factor is the rising number of publicly reported patient satisfaction scores for hospitals and physicians. I know of one doctor who has discreetly inquired as to whether anyone has done a study on the correlation between emergency room doctor approval ratings and the number and type of painkiller prescriptions that they write.
posted by Halloween Jack at 9:45 AM on January 1, 2013

I know it sounds strange but ultimately I fall on what it sounds like both Omiewise and Slarty Bartfast feel about this. I absolutely think that most pharmaceuticals have consequences in the body and are not good solutions to maintain human health.

But when you have people who can't even afford a decent diet, or are too fatigued and in pain to take proper care of their bodies and health-- they will continually feel pain and discomfort until the environment becomes more suitable for human inhabitance. And that's not to mention people who's immune system and nervous system didn't form right to begin with or have been coping with extremely unhealthy circumstances in critical periods of development that have left the system crippled in coping with even an overall healthy environment for the average person.

The pain and discomfort are real, and painkillers, and many pharmaceuticals in general, are often not even remotely rebuilding the immune and nervous system to a point of real health. I think we need to be doing much more, from a public policy perspective and general education perspective to help people both understanding what their bodies needs in terms of care and how that literally translates to the diseases they're coping with-- and how to get help in making that care happen because some people who are ill/fatigued/in chronic pain can barely get out of bed let alone create a feast of organic veggies and then clean it all up three times a day. (Even in good health most people will avoid this level of self care because it's not energy efficient in terms of cost/reward for daily life in our culture. We just don't have that much energy or time.)

What's more when people are experiencing muscle weakness and other physiological conditions that come with conditions of chronic pain and mobility impairment, it may be necessary to do physical and occupational therapy just to get a person back to basic functioning to move around their home and cook food and do daily activities. These are services that are underfunded on medicaid and low income people and often underprescribed among people with the money to just find a pain-doctor and get a fast fix.

All of these things are problems that don't deminish the fact that people in pain really do need solutions and if you want to nix their painkillers, you need to make sure you have a realistic treatment plan that actually repairs their health and ability to feel good and function in daily life in place of those painkillers. If you're asking someone to essentially lose their job or fail at caring for themselves and their families because they can't make it through the day without pain pills, you damn well better be willing to help them financially in the aftermath of that or else let them use the crutches they're hobbling along with without shaming them for the fact that there are serious side effects of their chosen crutch.
posted by xarnop at 10:32 AM on January 1, 2013 [9 favorites]

Excellent comment, Slarty Bartfast. As a resident physician training in an city hospital I share your frustrations daily.
posted by i less than three nsima at 10:41 AM on January 1, 2013 [1 favorite]

What's more when people are experiencing muscle weakness and other physiological conditions that come with conditions of chronic pain and mobility impairment, it may be necessary to do physical and occupational therapy just to get a person back to basic functioning to move around their home and cook food and do daily activities. These are services that are underfunded on medicaid and low income people and often underprescribed among people with the money to just find a pain-doctor and get a fast fix.

The understanding that physical therapy is as much about neurological as it is about biomechanical dysfunction has only begun to start gaining ground in the PT community (at least in the US). Too often PTs or doctors look at a person's herniated disc and say "Well, that's your problem, until you get surgery here's pain meds" without paying attention to the numerous studies that indicate the high number of people with the exact same herniated disc walking around without any pain problems, and the number of people who receive no pain relief from surgery or "fixing" the biomechanical issue. Which indicates that there's something going on in the nervous system where one's CNS has got itself stuck in a pain signal loop, freaking out about problems that aren't necessarily there.

From what I've been reading approaching pain and chronic pain therapy from this standpoint--that it's a matter of fixing the signals--is more effective than surgery, pills, or more back exercises. Which, when effective, are generally just different ways of trying to fix the signals themselves. Maximally effective chronic pain management often involves this mix of neurodynamics-based physiotherapy (basically taking principles of neuro-orthopedics and using it to treat pain), psychological therapy, and judicious use of pharmacology in order to facilitate the progress of the first two. The problem is people look at the "psychological therapy" part or hear "nervous system" and the patients cry "I'm not crazy!" and their critics cry "See, they're fakers!"

That approach is a lot more complex, and costs a lot more money, and it's much cheaper and easier to throw a bunch of pills at someone (from an insurance company's standpoint). Not to mention the chronic pain patient is so sick and tired of being in pain that they desperately just want to stick with what works and are terrified of being in a situation where that pain is worse. And so the cycle continues.
posted by schroedinger at 11:01 AM on January 1, 2013 [3 favorites]

Well when nerves get tortured there are affects whether that came from psychological or biological trauma to the body (which in many cases can produce some similar responses in the body). Feeling psychologically well can certainly be part of that repair process as can biological remedies. From my perspective, if the trauma was well beyond what a persons immediate ancestors had coped and repaired before reproducing, the system might need a large quanitiy of social nurturing and security to feel safe again and physically rebuild.

I think the cells have "emotional" responses that don't logically make sense the same as the human psyche does. It makes perfect sense that a cell could literally be trained to have an excessive conditioned fear response that is "maladaptive" due to repeated pain signals in which the cell has zero power to address the problem. The solution for the tortured organism is to shut down as much as possible which impairs basic functioning and worsens health in other ways, or to remain sensing which leaves entity raw and frazzled and hypersensitive.

The idea that human emotions exist in some metaphysical "non-real" realm is very unproven and supersitious. The human psyche is a physical entity and subject to laws of the physical reality. Unless there is a magical spirit that operates outside of physics, in which case, who the shit knows.
posted by xarnop at 11:16 AM on January 1, 2013 [1 favorite]

Ugh. Until any of these articles manage to actually mention the word "naloxone", they aren't worth much. All the prescription drug databases in the country haven't reversed any opiate overdoses; naloxone does every day. Where doctors are being irresponsible is in not prescribing naloxone to people at risk of an opiate overdose. That quote from Dr. Vu in the first article pissed me off so much when it first came out -- where he's asked if there was anything he could have done differently and he says no -- he could've fucking handed out some naloxone with those pills.

On a more optimistic note, I will say that today in California, our 911 Good Samaritan law goes into effect, providing legal protections for people who call 911 when they witness an overdose, to encourage people to do the right thing and get medical assistance.
posted by gingerbeer at 12:50 PM on January 1, 2013 [4 favorites]

Sure you don't mean naltrexone?
posted by gjc at 2:58 PM on January 1, 2013

From the article in the first post: "Even if you did, in a worst-case scenario, join the tiny percentage of patients who develop a new addiction and became obsessed with using opioids, would this really be worse, especially if you had safe and legal access to them?"

As somebody who works in the addictions field and witnesses every day the devastating psychological, physiological, and social effects of active addiction I can firmly attest that yes, it would be worse. To minimize the very real negative implications of living with an addiction is ignorant, irresponsible, and disrespectful to the individuals suffering with chemical dependency, as well as the family and friends who are affected.

Edited to add: An opiate addiction isn't something that spontaneously resolves. It results in very real biological changes to the brain and usually ends with a fatal overdose or rehab.
posted by pugh at 3:13 PM on January 1, 2013

gjc: yup, naltrexone is used as a type of aversive medication to deter people from drinking; naloxone essentially reverses the effects of narcotics, sending an individual into immediate withdrawal if they abuse opiates (often used in conjunction with some kind of medication management such as methadone or suboxone to make sure that individuals take their medication as prescribed).
posted by pugh at 3:18 PM on January 1, 2013

Doctors and patients are both in a tough spot, but it's possible to do this right. My wife sees an excellent physical medicine and rehabilitation doctor who prescribes her opioid pain relief when other treatments don't work. Over the last year, the practice, which already had pretty stringent controls in place to prevent and identify abuse, has tightened things even more.

She already had to submit to random tests, go to one and only one pharmacy for her meds, and obtain a paper prescription to take to the pharmacy directly, but in the last year, they would no longer issue a prescription unless she came in for a normal visit each month (she's unable to drive, so I or her parents have to take her.) This wouldn't normally be a problem, except sometimes the 30 day window for the medicine and the 30-ish day window between appointments don't line up, and if the doctor's calendar is really busy, it's easy to get off schedule, blowing up six months of advance appointments in the process. When this happened before, they would let me pick up the scrip at the office as long as she had an appointment scheduled in the next week or two, but they stopped allowing even that. And since they don't want you to hoard an extra couple weeks worth of pills to bridge the gap, you don't end up with many options.

All of these hoops we jump through are a pain in the ass, and at first we were angry about the changes, but what we figured out is that they're not designed for us, they're designed for doctors who aren't as thorough in their evaluations, and patients who aren't as in control of their usage. My wife has certainly maxed out her usage during peak pain times, and has gone from low dosages of tramadol and percoset through oxycodone and extended release morphine all the way up to fentanyl patches, but she's always been able to stop when she hit the dosage limit, and when a treatment was working, she's always tried to jump back down to the next lowest rung on the ladder to see if a lower dose can work. I know some other patients aren't as fortunate, and it seems to me controls like this being applied universally could help keep a lot of doctors out of jail and a lot of patients from abusing the medication.
posted by tonycpsu at 4:58 PM on January 1, 2013 [1 favorite]

+1 for Kratom, my under-the-radar, legal-in-the-US painkiller. It got my wife thru 6+ months of excruciating back injury, which vicodin and muscle relaxants couldn't touch. What a magically fan-fucking-tastic plant.

I now have 2 very real fears:

1. it will be made illegal outright before real legitimate study can be done to show its benefits which seem super obvious to me

2. the pharmaceutical industry will get a hold of this and subject it to the same ridonkulous restrictions as other pain meds, and concentrate it into dangerously potent and abusable forms that nature never EVAR intended us to fuck with.
posted by cbecker333 at 6:07 PM on January 1, 2013 [1 favorite]

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