The king of all opiates, and a killer drug crisis
June 24, 2015 10:09 AM Subscribe
Dr. Woodall, the forensic toxicologist, says patches are sometimes peeled off dead bodies at funeral homes
What's the famous line from HST, that you can turn your back on a person, but you can never turn your back to the drug they're on. What we need is far more than just cradle to grave healthcare. We also need cradle to grave counseling. How many societal ills would dramatically improve if every kid had mandatory weekly sessions with a school counselor? The savings would far outweigh the cost.
posted by Beholder at 10:38 AM on June 24, 2015 [3 favorites]
What's the famous line from HST, that you can turn your back on a person, but you can never turn your back to the drug they're on. What we need is far more than just cradle to grave healthcare. We also need cradle to grave counseling. How many societal ills would dramatically improve if every kid had mandatory weekly sessions with a school counselor? The savings would far outweigh the cost.
posted by Beholder at 10:38 AM on June 24, 2015 [3 favorites]
We also need cradle to grave counseling . How many societal ills would dramatically improve if every kid had mandatory weekly sessions with a school counselor?
Really? Do you remember your school counselors?
posted by el io at 10:40 AM on June 24, 2015 [86 favorites]
Really? Do you remember your school counselors?
posted by el io at 10:40 AM on June 24, 2015 [86 favorites]
I don't know about everyone, but the bit at the end, where the guy recovering is described as living a lonely life, with no one to talk to, on welfare with his dad; that's somebody that could be reached with the right programs and organizations (and yeah, counseling). But I don't know how Canada deals with all of that. In the US, of course, we give no fucks about addicts or the mentally ill.
I first heard of fentanyl addiction in an Elmore Leonard novel, where one of the baddies would put on scrubs, go into random nursing homes, and peel patches off of old people who were too weak or out of it to stop him.
posted by emjaybee at 10:43 AM on June 24, 2015 [7 favorites]
I first heard of fentanyl addiction in an Elmore Leonard novel, where one of the baddies would put on scrubs, go into random nursing homes, and peel patches off of old people who were too weak or out of it to stop him.
posted by emjaybee at 10:43 AM on June 24, 2015 [7 favorites]
We also need cradle to grave counseling . How many societal ills would dramatically improve if every kid had mandatory weekly sessions with a school counselor?
Really? Do you remember your school counselors?
Yeah, actually. They were caring people who looked out for me and actually showed concern for my well being.
posted by NoxAeternum at 10:43 AM on June 24, 2015 [17 favorites]
Really? Do you remember your school counselors?
Yeah, actually. They were caring people who looked out for me and actually showed concern for my well being.
posted by NoxAeternum at 10:43 AM on June 24, 2015 [17 favorites]
How many societal ills would dramatically improve if every kid had mandatory weekly sessions with a school counselor?
I can't imagine an enforced hour of rote conversation with an overworked underpaid school counselor would have any demonstrable benefit in the majority of cases. I donate every year to local classrooms that can't even afford paper and crayons. Where do you think the money for all these new counselors is going to come from? As usual the more privileged districts will benefit and everyone else will continue to suffer.
posted by poffin boffin at 10:44 AM on June 24, 2015 [14 favorites]
I can't imagine an enforced hour of rote conversation with an overworked underpaid school counselor would have any demonstrable benefit in the majority of cases. I donate every year to local classrooms that can't even afford paper and crayons. Where do you think the money for all these new counselors is going to come from? As usual the more privileged districts will benefit and everyone else will continue to suffer.
posted by poffin boffin at 10:44 AM on June 24, 2015 [14 favorites]
drugs are not the problem. Boring, excruciating, meaningless, painful living situations are the problem to which drugs become the solution.
Also Rat Park
posted by philip-random at 10:47 AM on June 24, 2015 [38 favorites]
Also Rat Park
posted by philip-random at 10:47 AM on June 24, 2015 [38 favorites]
Yeah, actually. They were caring people who looked out for me and actually showed concern for my well being.
How people like that passed quality control at the school counselor factory I have no idea.
posted by Faint of Butt at 10:47 AM on June 24, 2015 [16 favorites]
How people like that passed quality control at the school counselor factory I have no idea.
posted by Faint of Butt at 10:47 AM on June 24, 2015 [16 favorites]
I first heard of fentanyl addiction in an Elmore Leonard novel, where one of the baddies would put on scrubs, go into random nursing homes, and peel patches off of old people who were too weak or out of it to stop him.
I think you mean Carl Hiassen.
posted by dortmunder at 10:51 AM on June 24, 2015 [5 favorites]
I think you mean Carl Hiassen.
posted by dortmunder at 10:51 AM on June 24, 2015 [5 favorites]
Boring, excruciating, meaningless, painful living situations are the problem to which drugs become the solution
Is that true, though? I mean, no doubt it is true for some people, but is that the strongest correlation with drug addiction? If you think of all the film stars, rock stars, high-paid lawyers, bankers etc. with drug addiction problems it's not clear to me that "self-medicating" in response to a life of tedious sameness is the main driver. Poor people are the most visible drug addicts, certainly, but I'm not sure if poverty and limited opportunities are actually major drivers of drug addiction. I know I've seen statistics that say that drug addiction is more common in the white US population than the black US population, which suggests that socio-economic status is at best complicatedly related to drug abuse.
posted by yoink at 10:54 AM on June 24, 2015 [7 favorites]
Is that true, though? I mean, no doubt it is true for some people, but is that the strongest correlation with drug addiction? If you think of all the film stars, rock stars, high-paid lawyers, bankers etc. with drug addiction problems it's not clear to me that "self-medicating" in response to a life of tedious sameness is the main driver. Poor people are the most visible drug addicts, certainly, but I'm not sure if poverty and limited opportunities are actually major drivers of drug addiction. I know I've seen statistics that say that drug addiction is more common in the white US population than the black US population, which suggests that socio-economic status is at best complicatedly related to drug abuse.
posted by yoink at 10:54 AM on June 24, 2015 [7 favorites]
Really? Do you remember your school counselors?
Never saw one or even knew they existed, but I attended public school in the early 70s bible belt.
Your up votes trouble me. I'm not sure you mean it to sound like "government can't help", but I pick up that vibe. I believe in government. I think proper funding, combined with ethical and motivated counselors, can make a difference. What we see in industrial society, with broken families and neighbors we never talk to, is a shattered myth that we can do it alone. We can't. Hillary Clinton is right, it really does take a village.
posted by Beholder at 11:01 AM on June 24, 2015 [9 favorites]
I would like to know what the social risk factors for opiate addiction are
Rich kids get addicted, kids with great parents get addicted, doctors and lawyers get addicted. Pain from a bad social environment might make someone more likely to seek solace in drugs, but don't kid yourself, addiction knows no social boundaries. Many people are just seeking to self medicate for depression and other mental illness, and these diseases know no social boundaries.
posted by caddis at 11:01 AM on June 24, 2015 [11 favorites]
Rich kids get addicted, kids with great parents get addicted, doctors and lawyers get addicted. Pain from a bad social environment might make someone more likely to seek solace in drugs, but don't kid yourself, addiction knows no social boundaries. Many people are just seeking to self medicate for depression and other mental illness, and these diseases know no social boundaries.
posted by caddis at 11:01 AM on June 24, 2015 [11 favorites]
I know these stories are true, but they always sound so weird to me. I've been prescribed both fentanyl and oxycontin, and not only did neither of them touch the pain they were prescribed for, they didn't produce anything remotely like a high. They just made me sleepy. I must have some kind of crazy massive natural tolerance.
posted by The Underpants Monster at 11:03 AM on June 24, 2015 [4 favorites]
posted by The Underpants Monster at 11:03 AM on June 24, 2015 [4 favorites]
Related: Addicts in Lab Coats (Newsweek).
posted by Sonny Jim at 11:04 AM on June 24, 2015 [2 favorites]
posted by Sonny Jim at 11:04 AM on June 24, 2015 [2 favorites]
A corrupt medical professional pleads guilty to prescribing fentanyl in exchange for kickbacks from an unnamed pharmaceutical company.
Meanwhile, a meta-study out of Yale finds cannabinoids successfully treat chronic pain and spacitity, conditions where opiates are commonly prescribed e.g. for MS patients.
Marijuana is still Schedule I (no currently accepted medical use in treatment in the United States).
posted by RobotVoodooPower at 11:06 AM on June 24, 2015 [11 favorites]
Meanwhile, a meta-study out of Yale finds cannabinoids successfully treat chronic pain and spacitity, conditions where opiates are commonly prescribed e.g. for MS patients.
Marijuana is still Schedule I (no currently accepted medical use in treatment in the United States).
posted by RobotVoodooPower at 11:06 AM on June 24, 2015 [11 favorites]
I start thinking "those people are probably mostly poor, they probably mostly work the kind of shitty working class jobs that break your body down, they probably face a lot of life problems that they really want to drift away from and solving some of the inequality/shitty job problems would probably solve 2/3 of the drug problem
Yes, that's an alternate model of addition that is gaining steam these days. The statistics on patients who use Fentanyl (or Oxy etc) for actual medical treatment and then cease use and go on with their lives when they don't need it anymore, if they are socially engaged and have support - a good life, basically - are very interesting. (There's an intersection there too about how the brain receives those kinds of opioids when you are actually in severe pain vs not, which is why the high is not especially interesting or chase-worthy if you're taking it for a reason.)
This article is a little whiffy because it's the author of the book writing an op-ed on their own book subject to sell their book, also it's HuffPo, but the rat study bit is interesting.
posted by Lyn Never at 11:10 AM on June 24, 2015 [4 favorites]
Yes, that's an alternate model of addition that is gaining steam these days. The statistics on patients who use Fentanyl (or Oxy etc) for actual medical treatment and then cease use and go on with their lives when they don't need it anymore, if they are socially engaged and have support - a good life, basically - are very interesting. (There's an intersection there too about how the brain receives those kinds of opioids when you are actually in severe pain vs not, which is why the high is not especially interesting or chase-worthy if you're taking it for a reason.)
This article is a little whiffy because it's the author of the book writing an op-ed on their own book subject to sell their book, also it's HuffPo, but the rat study bit is interesting.
posted by Lyn Never at 11:10 AM on June 24, 2015 [4 favorites]
I've been prescribed both fentanyl and oxycontin, and not only did neither of them touch the pain they were prescribed for, they didn't produce anything remotely like a high.
Was it for acute (postsurgical) pain or chronic pain? My experiences with both is that anything that will touch chronic pain can give me a high from the combo the actual drug itself and the unbelievably indescribably fantastic feeling of not being in constant grinding awful pain. Stuff I get for postsurgical pain, even if it's the same thing as for the chronic, just makes me want to rest and heal. but of course ymmv.
posted by poffin boffin at 11:11 AM on June 24, 2015 [4 favorites]
Was it for acute (postsurgical) pain or chronic pain? My experiences with both is that anything that will touch chronic pain can give me a high from the combo the actual drug itself and the unbelievably indescribably fantastic feeling of not being in constant grinding awful pain. Stuff I get for postsurgical pain, even if it's the same thing as for the chronic, just makes me want to rest and heal. but of course ymmv.
posted by poffin boffin at 11:11 AM on June 24, 2015 [4 favorites]
I've been prescribed both fentanyl and oxycontin, and not only did neither of them touch the pain they were prescribed for, they didn't produce anything remotely like a high.
That's been my experience on opiates of various kinds, too. I think, though, that this is a well-understood part of the biology of addiction (well understood from the behavioral side, at least, if not necessarily from the biochemical side)--drugs just don't affect all people in the same ways. Some people try cocaine or opium or whatever and experience something that they feel a desperate urge to experience again while others experience something that might even seem pleasant or interesting, but just doesn't seem like such a big deal.
posted by yoink at 11:12 AM on June 24, 2015 [8 favorites]
That's been my experience on opiates of various kinds, too. I think, though, that this is a well-understood part of the biology of addiction (well understood from the behavioral side, at least, if not necessarily from the biochemical side)--drugs just don't affect all people in the same ways. Some people try cocaine or opium or whatever and experience something that they feel a desperate urge to experience again while others experience something that might even seem pleasant or interesting, but just doesn't seem like such a big deal.
posted by yoink at 11:12 AM on June 24, 2015 [8 favorites]
We had a nurse at the hospital I work at get busted for Fentanyl diversion for personal use. I felt bad for the guy; he was a widowed single dad, now forced to make his way after losing his nursing license, on top of whatever criminal stuff he got stuck with.
Everybody has pain. I have nothing but pity for people who get stuck on drugs.
posted by themanwho at 11:16 AM on June 24, 2015 [4 favorites]
Everybody has pain. I have nothing but pity for people who get stuck on drugs.
posted by themanwho at 11:16 AM on June 24, 2015 [4 favorites]
Yeah, actually. They were caring people who looked out for me and actually showed concern for my well being.
Lucky for you, then. My counselors throughout junior high and high school (circa the early '90s) were evenly split between clueless and actively harmful. When I entered 8th grade with a case of clinical depression caused by non-stop bullying and abuse from classmates in 7th grade, my counselor thought it would be a great idea to put me in a weekly "support" group filled with kids who all had severe behavior and substance abuse problems. After two sessions of basically allowing the nastier kids in the group to use me as an emotional chew toy, the counselor let me leave and never offered me any kind of help again.
Beholder, I get what you're saying. I agree, when correctly implemented government can and does make a positive difference in people's lives. But there do need to be some effective standards for what makes ethical and motivated counselors, as well as effective funding to make it happen. I don't think that was in play where I went to school as a kid, and I shudder to think what most public schools have to make do with now.
posted by Strange Interlude at 11:18 AM on June 24, 2015 [5 favorites]
Lucky for you, then. My counselors throughout junior high and high school (circa the early '90s) were evenly split between clueless and actively harmful. When I entered 8th grade with a case of clinical depression caused by non-stop bullying and abuse from classmates in 7th grade, my counselor thought it would be a great idea to put me in a weekly "support" group filled with kids who all had severe behavior and substance abuse problems. After two sessions of basically allowing the nastier kids in the group to use me as an emotional chew toy, the counselor let me leave and never offered me any kind of help again.
Beholder, I get what you're saying. I agree, when correctly implemented government can and does make a positive difference in people's lives. But there do need to be some effective standards for what makes ethical and motivated counselors, as well as effective funding to make it happen. I don't think that was in play where I went to school as a kid, and I shudder to think what most public schools have to make do with now.
posted by Strange Interlude at 11:18 AM on June 24, 2015 [5 favorites]
Oh wow. I just had a personal run in with this stuff. My mom called and was speaking normally. But in the conversation it seemed she was calling things "a laptop" or "the laptop". Like the mop? The laptop. A table? A laptop. At first I was confused. Then I realized she was the one confused. And I pointed this out to her. And she seemed non-plussed, like "Oh Mike of course I know the difference between a laptop and a laptop."
I began to be alarmed and expressed as much to her. She said one of her friends had just told her she was "talking funny", too. And no matter what I said or explained, she just kept on with the word soup-y talk.
So afraid she was having a stroke, I called a friend who knows my mom to stop in. (She lives 8 hours away by car.) He and his wife did. She welcomed them and offered them a laptop. He then explained to me that she had four patches on her arm. He also said my mom was walking. All over the place.
My mom hasn't "walked" in years. Her knees are shot. She can manage to get from her bed to her chair without assistance but that the extent of it. My mom couldn't walk to save her life. Worse, if she fell it would be an absolute disaster; my mom has the bone integrity like a saltine cracker. I called 911.
911 arrived, checked out my mom, and checked her into a hospital. The patches were fentanyl. They were old. My mom was having pain so she put one on, and it felt good, so she put another, and so on. A day later, my mom was in regular shape again, chatty and fully coherent. She went home.
Yes the patches are gone now. Gone gone gone. The doctors said they didn't know people could be alive with more than two. Life with grown-ups, I guess. You never know what's next. But yeah, Fentanyl is no joke.
posted by Mike Mongo at 11:23 AM on June 24, 2015 [79 favorites]
I began to be alarmed and expressed as much to her. She said one of her friends had just told her she was "talking funny", too. And no matter what I said or explained, she just kept on with the word soup-y talk.
So afraid she was having a stroke, I called a friend who knows my mom to stop in. (She lives 8 hours away by car.) He and his wife did. She welcomed them and offered them a laptop. He then explained to me that she had four patches on her arm. He also said my mom was walking. All over the place.
My mom hasn't "walked" in years. Her knees are shot. She can manage to get from her bed to her chair without assistance but that the extent of it. My mom couldn't walk to save her life. Worse, if she fell it would be an absolute disaster; my mom has the bone integrity like a saltine cracker. I called 911.
911 arrived, checked out my mom, and checked her into a hospital. The patches were fentanyl. They were old. My mom was having pain so she put one on, and it felt good, so she put another, and so on. A day later, my mom was in regular shape again, chatty and fully coherent. She went home.
Yes the patches are gone now. Gone gone gone. The doctors said they didn't know people could be alive with more than two. Life with grown-ups, I guess. You never know what's next. But yeah, Fentanyl is no joke.
posted by Mike Mongo at 11:23 AM on June 24, 2015 [79 favorites]
I'm just spit-balling here but could it be that more poor people are prescribed opiates in the first place, because poor people are more likely to be in situations where they are injured or in chronic pain? If you can afford a healthy diet and a gym membership, and you work at an office all day, needing opiates seems less likely, and thus getting addicted to them seems less likely. And of course, rehab is out of reach for most poor people so they are more likely to stay addicted.
posted by desjardins at 11:26 AM on June 24, 2015 [8 favorites]
posted by desjardins at 11:26 AM on June 24, 2015 [8 favorites]
Humans had opiate receptors long before humans started synthesizing opiates, we make our own. Fentanyl is a bad, bad drug created, knowing it would get out on the street. This is the anethesia component used to erase memory of what happens in the OR. Then as a short term memory eraser, it is put on elderly patients who already have some dementia and age related memory failure. It can also be a date rape drug.
I don't get opiates, the attraction, the addiction. I had an old orthopedic surgeon offer to addict me to lortab, with a ninety day prescription due to an injured shoulder. He said, "You're gonna love these, it's just like having a coctail!" I took two during one day and realized I wouldn't be able to work. I tossed the rest of the first month's worth.
All in all the pharmaceutical induatry, both legal and illegal is predatory, and so big it makes its own weather. Agencies have to be smarter than the dealers and more cunning than the addiction.
posted by Oyéah at 11:28 AM on June 24, 2015 [3 favorites]
I don't get opiates, the attraction, the addiction. I had an old orthopedic surgeon offer to addict me to lortab, with a ninety day prescription due to an injured shoulder. He said, "You're gonna love these, it's just like having a coctail!" I took two during one day and realized I wouldn't be able to work. I tossed the rest of the first month's worth.
All in all the pharmaceutical induatry, both legal and illegal is predatory, and so big it makes its own weather. Agencies have to be smarter than the dealers and more cunning than the addiction.
posted by Oyéah at 11:28 AM on June 24, 2015 [3 favorites]
"depression and other mental illness"- However when you start looking at the effects of poverty- maternal deprivation (which happens in wealthy homes)... child abuse and neglect (which happens in wealthy homes)...nutritional deficiencies (which happens in wealthy homes) you wind up getting a state where "depression" stops being a mysterious "disease" that magically appears to anyone at any time, and more like an inevitable sign of distress that the body as not met with adequate needs at critical periods of development- or that that has happened to the parents or grandparents at critical periods of development with effects being passed on.
If we ensure both that poverty and resources gaps to healthy living are addressed while also addressing education gaps about complex needs and how to help families with money but a lack of insight as to what their childrens (or their own) needs are; we may cause intergenerational healing we might be able to achieve not only for kids but their children and grandchildren (and beyond).
A lot of what we call "genetic disorders" are actually heritable epigenetic responses to stress, adversity and scarcity. Presenting even further medical cause to address social inequality and lack of access to the resources needed to address physical, emotional, and social needs.
posted by xarnop at 11:29 AM on June 24, 2015 [18 favorites]
If we ensure both that poverty and resources gaps to healthy living are addressed while also addressing education gaps about complex needs and how to help families with money but a lack of insight as to what their childrens (or their own) needs are; we may cause intergenerational healing we might be able to achieve not only for kids but their children and grandchildren (and beyond).
A lot of what we call "genetic disorders" are actually heritable epigenetic responses to stress, adversity and scarcity. Presenting even further medical cause to address social inequality and lack of access to the resources needed to address physical, emotional, and social needs.
posted by xarnop at 11:29 AM on June 24, 2015 [18 favorites]
Really? Do you remember your school counselors?
Yes! One of them suggested that I had brain damage and/or lyme disease because I 1) was acting out emotionally (fractious parental divorce) and 2) had knocked myself out by running into a low-hanging tree branch a couple of weeks prior. I was 9.
posted by grumpybear69 at 11:33 AM on June 24, 2015
Yes! One of them suggested that I had brain damage and/or lyme disease because I 1) was acting out emotionally (fractious parental divorce) and 2) had knocked myself out by running into a low-hanging tree branch a couple of weeks prior. I was 9.
posted by grumpybear69 at 11:33 AM on June 24, 2015
The women in my family all suffer from spinal stenosis, which just gets more painful as it goes. My mom, bless her heart, has had multiple surgeries, none of which have improved her prognosis. They recently prescribed both oxy and fentanyl patches. Neither seem to address her pain in any way that seems to improve her quality of life, and I'm worried that her drug regime has her closer to the overdose line every time she sees a pain doctor. But mostly I'm annoyed that pain doctors treat my 70 year old mom like she's a junkie there for drugs, rather than acknowledging that it's a miracle she can walk at all after those surgeons made their country club fees. American healthcare is crap.
That said, watching my mom navigate this nightmare has made me exercise more, and refuse moving into "real" drugs to deal with the pain if I can get by with itty bitty doses of hydrocodone, because I know me well enough to know that addiction would be an easy place to find myself.
posted by dejah420 at 11:39 AM on June 24, 2015 [6 favorites]
That said, watching my mom navigate this nightmare has made me exercise more, and refuse moving into "real" drugs to deal with the pain if I can get by with itty bitty doses of hydrocodone, because I know me well enough to know that addiction would be an easy place to find myself.
posted by dejah420 at 11:39 AM on June 24, 2015 [6 favorites]
Boring, excruciating, meaningless, painful living situations are the problem to which drugs become the solution
Is that true, though? I mean, no doubt it is true for some people, but is that the strongest correlation with drug addiction? If you think of all the film stars, rock stars, high-paid lawyers, bankers etc. with drug addiction problems
For clarity, let me rephrase that as "Boring and/or excruciating and/or meaningless and/or painful living situations are the problem to which drugs become the solution."
Certainly, in my experience, the people who have gone down the addiction hole (whether it be a legal or illegal drug, weird religion, weird politics, whatever) have all had a profound issue with pain (physical, emotional, social, existential, metaphysical). So any number of people can try something like heroin a few times, but only a few of them (15 percent, I heard once) will go on and get get married to the stuff.
So I can't help but come back to ... If You Want To Solve the Addiction Problem, Take on the Pain Problem.
posted by philip-random at 11:54 AM on June 24, 2015 [2 favorites]
Is that true, though? I mean, no doubt it is true for some people, but is that the strongest correlation with drug addiction? If you think of all the film stars, rock stars, high-paid lawyers, bankers etc. with drug addiction problems
For clarity, let me rephrase that as "Boring and/or excruciating and/or meaningless and/or painful living situations are the problem to which drugs become the solution."
Certainly, in my experience, the people who have gone down the addiction hole (whether it be a legal or illegal drug, weird religion, weird politics, whatever) have all had a profound issue with pain (physical, emotional, social, existential, metaphysical). So any number of people can try something like heroin a few times, but only a few of them (15 percent, I heard once) will go on and get get married to the stuff.
So I can't help but come back to ... If You Want To Solve the Addiction Problem, Take on the Pain Problem.
posted by philip-random at 11:54 AM on June 24, 2015 [2 favorites]
xarnop: A lot of what we call "genetic disorders" are actually heritable epigenetic responses to stress, adversity and scarcity.
I'm not so sure about this. Anything with an identified genotype or chromosomal abnormality is not epigenetic, Plus, epigenetic-related issues tend not to show genetic patterns of inheritance exactly, since they derive from ancestral events (so you can't track them back more then one or two generations). I'm not sure how many disorders have bee tied to stress or famine linked epigenetics - the studies I've seen usually link them to tendencies toward obesity or something similar.
posted by Mitrovarr at 11:56 AM on June 24, 2015
I'm not so sure about this. Anything with an identified genotype or chromosomal abnormality is not epigenetic, Plus, epigenetic-related issues tend not to show genetic patterns of inheritance exactly, since they derive from ancestral events (so you can't track them back more then one or two generations). I'm not sure how many disorders have bee tied to stress or famine linked epigenetics - the studies I've seen usually link them to tendencies toward obesity or something similar.
posted by Mitrovarr at 11:56 AM on June 24, 2015
I think you mean Carl Hiassen.
Always get them mixed up :(
My mom was addicted to painkillers in the last year of her life, and her doctors didn't seem to much care. She wasn't that old, only 68, and her mind was sharp before she went on them. She was in pain from lupus and other issues, and so we didn't know what to do when she became foggy, helpless and terribly depressed. She wanted to die, and I've often wondered about the "infection" that took her, and if that rural county hospital just wasn't concerned about what was really going on with one old lady with an addiction and COPD. But who knows.
Maybe if we could have just gotten her some pot, she'd have done a lot better. She could hardly have done worse.
posted by emjaybee at 12:02 PM on June 24, 2015 [3 favorites]
Always get them mixed up :(
My mom was addicted to painkillers in the last year of her life, and her doctors didn't seem to much care. She wasn't that old, only 68, and her mind was sharp before she went on them. She was in pain from lupus and other issues, and so we didn't know what to do when she became foggy, helpless and terribly depressed. She wanted to die, and I've often wondered about the "infection" that took her, and if that rural county hospital just wasn't concerned about what was really going on with one old lady with an addiction and COPD. But who knows.
Maybe if we could have just gotten her some pot, she'd have done a lot better. She could hardly have done worse.
posted by emjaybee at 12:02 PM on June 24, 2015 [3 favorites]
One great benefit from any strongly attractive drug is endless sensational headlines.
posted by telstar at 12:09 PM on June 24, 2015 [3 favorites]
posted by telstar at 12:09 PM on June 24, 2015 [3 favorites]
"Anything with an identified genotype or chromosomal abnormality is not epigenetic" SURE! But a lot of the mental health realm especially is claimed to be "genetic" but most of the proof of this is that it's heritable, not that they have very clear proof of actual genes associated with it. Even the copy varients and SNP's that are offered up as having "associations" have very loose associations.
My point is, people have accepted without founding the idea that heritability means genetic and gets used to talk about what mental health issues are (your brain spontaneously for no reason produces the "wrong" chemicals and there's no way we could ever figure out why! Rather than that the brain is actually producing the right chemicals for specific situations it has experienced or what it's coping with)-- and that thinking needs to be undone. Actual genetic problems with specific provable gene issues are a different matter.
posted by xarnop at 12:11 PM on June 24, 2015 [2 favorites]
My point is, people have accepted without founding the idea that heritability means genetic and gets used to talk about what mental health issues are (your brain spontaneously for no reason produces the "wrong" chemicals and there's no way we could ever figure out why! Rather than that the brain is actually producing the right chemicals for specific situations it has experienced or what it's coping with)-- and that thinking needs to be undone. Actual genetic problems with specific provable gene issues are a different matter.
posted by xarnop at 12:11 PM on June 24, 2015 [2 favorites]
We're so insane about pain management in this country. You don't want to look like an addict but you'd also like to be a functioning member of society. On the other hand, one of the most awkward conversations I've ever seen was a dude screaming at his pharmacist that he needed a refill of of his pain script immediately after it had already been refilled, trying to drag everyone in the building into shaming the guy for more drugs.
(Also, I think the medicinal use of oxycontin is different than the recreational use--if you strip out the buffers that deliver it over a period of time and take it all at once, the effect is different. I think.)
Maybe this would be different if we'd just acknowledge we've lost the War on Some Drugs and have adult conversations about these things. (Given the other conversations we've failed to have, this is probably not in the pipeline anytime soon.)
posted by fifteen schnitzengruben is my limit at 12:22 PM on June 24, 2015 [4 favorites]
(Also, I think the medicinal use of oxycontin is different than the recreational use--if you strip out the buffers that deliver it over a period of time and take it all at once, the effect is different. I think.)
Maybe this would be different if we'd just acknowledge we've lost the War on Some Drugs and have adult conversations about these things. (Given the other conversations we've failed to have, this is probably not in the pipeline anytime soon.)
posted by fifteen schnitzengruben is my limit at 12:22 PM on June 24, 2015 [4 favorites]
The article talks about using fentanyl to cut both opium and cocaine. The opium I get, but cocaine? How does that work? Aren't they completely opposite in effect?
posted by KGMoney at 12:28 PM on June 24, 2015
posted by KGMoney at 12:28 PM on June 24, 2015
-I've been prescribed both fentanyl and oxycontin, and not only did neither of them touch the pain they were prescribed for, they didn't produce anything remotely like a high.
--Was it for acute (postsurgical) pain or chronic pain?
The former for the latter, and the latter for the former.
posted by The Underpants Monster at 12:36 PM on June 24, 2015
--Was it for acute (postsurgical) pain or chronic pain?
The former for the latter, and the latter for the former.
posted by The Underpants Monster at 12:36 PM on June 24, 2015
I am a chronic pain patient. I am addicted to pain killers. I need them to function. I have Juvenile Rheumatoid Arthritis, Trigeminal Neuralgia, and various neuropathies of the hand and arm caused by my arthritis. I take hydrocodone 5/325 and 10/325 nearly daily. I take topiramate for chronic migraine like symptoms caused by vascular constriction. I take gabapentin in a dose high enough my neurologist wonders how I function as well as I do. I've been given higher dose pain killers on and off regularly, as my issues flare. I've had more benzodiazepines than I can count. Oxycoton I avoid because I know one day I'll have to step up to it rather than my hydrocodone. I've been on lidoderm patches. I've been given fentanyl, and have to say it was one of the best experiences of my life.
To suddenly not hurt and not care? It was wonderful. But I know how dangerous that can be. I dread the day I am finally bumped up to it full time, because it means that is the end. If the pain is that bad, then I really have nothing left but that.
posted by strixus at 12:37 PM on June 24, 2015 [25 favorites]
To suddenly not hurt and not care? It was wonderful. But I know how dangerous that can be. I dread the day I am finally bumped up to it full time, because it means that is the end. If the pain is that bad, then I really have nothing left but that.
posted by strixus at 12:37 PM on June 24, 2015 [25 favorites]
Aren't they completely opposite in effect?
Speedballs.
posted by Melismata at 12:39 PM on June 24, 2015 [3 favorites]
Speedballs.
posted by Melismata at 12:39 PM on June 24, 2015 [3 favorites]
Substance use counselor here. There is desperate need for funding and higher professional standards in the field. I work in one of the more progressive cities in the US and even here substance use programs are poorly funded (like, the walls in the clinic I work in haven't been painted in probably over ten years) and often staffed by folks who are poorly trained/educated and who cling to outdated non-evidenced based practices. There are some programs where the only requirement to become a counselor is a year of abstinence, a authoritarian approach and a working knowledge of the 12-steps! Even here, in one of the most progressive cities in the US, there is sometimes only begrudging acceptance that psychotherapy is useful in combating substance use problems. The city's stance towards treatment is supposedly harm reduction, but this unevenly (and sometimes not at all) practiced by city-funded clinics.
I could go on and on about my complaints of the field (like, the fact that I'm paid very little despite an advanced degree and registration with the State as an intern therapist), but to be more positive - there is a lot of good work being done by really good people, even in a broken system (and I can't imagine how bad it might be in rural/poor areas). Despite what many people might think, substance use treatment can be highly successful in greatly improving the quality of life for both users, their loved ones and society.
So, please give us more money. Human connection, whether it is through therapy, peer counseling, job training, housing advocacy or whatever is ultimately what helps people over come their problems with substances.
posted by the lake is above, the water below at 12:45 PM on June 24, 2015 [26 favorites]
I could go on and on about my complaints of the field (like, the fact that I'm paid very little despite an advanced degree and registration with the State as an intern therapist), but to be more positive - there is a lot of good work being done by really good people, even in a broken system (and I can't imagine how bad it might be in rural/poor areas). Despite what many people might think, substance use treatment can be highly successful in greatly improving the quality of life for both users, their loved ones and society.
So, please give us more money. Human connection, whether it is through therapy, peer counseling, job training, housing advocacy or whatever is ultimately what helps people over come their problems with substances.
posted by the lake is above, the water below at 12:45 PM on June 24, 2015 [26 favorites]
I was given IV fentanyl for a colonoscopy. It made me feel really relaxed and happy through the whole thing, but not drunk or weird at all. It was just the perfect drug in that context.
posted by w0mbat at 12:59 PM on June 24, 2015 [1 favorite]
posted by w0mbat at 12:59 PM on June 24, 2015 [1 favorite]
Oh, re-reading the thread, I'm sorry that so many here have had terrible experiences with their school (or other) counselors. However, that should be even more reason to better fund mental health and substance use treatment! You can't go to, say, Cameroon (sorry any Cameroonians reading this) for cheap cancer treatment and then complain when it was ineffective or even exacerbated the condition. I mean, I guess you can, but you look foolish. Similarly, we can't staff our treatment programs (or school counseling positions) with cheap labor and expect the same results as well-funded medical centers.
posted by the lake is above, the water below at 1:04 PM on June 24, 2015 [6 favorites]
posted by the lake is above, the water below at 1:04 PM on June 24, 2015 [6 favorites]
w0mbat, are you sure you're not confusing it with propofol?
posted by gaspode at 1:05 PM on June 24, 2015
posted by gaspode at 1:05 PM on June 24, 2015
This is the anethesia component used to erase memory of what happens in the OR.
Are you referring to the urban myth (please let it be a myth, please) that people being operated on feel everything and would be traumatized for life if they remembered the pain of surgery? That's a myth, right? Right?
posted by Beholder at 1:16 PM on June 24, 2015
Are you referring to the urban myth (please let it be a myth, please) that people being operated on feel everything and would be traumatized for life if they remembered the pain of surgery? That's a myth, right? Right?
posted by Beholder at 1:16 PM on June 24, 2015
This seems to be an evergreen story, I have an issue of Discover magazine from 30 years ago where it is the cover story, and remember it coming up previously in the past 5 or so years.
posted by rhizome at 1:17 PM on June 24, 2015 [2 favorites]
posted by rhizome at 1:17 PM on June 24, 2015 [2 favorites]
This is the anethesia component used to erase memory of what happens in the OR.
In the OR opiates and opioids in general have a reputation for being pretty bad at inducing amnesia in patients. If given enough fentanyl to induce general anesthesia (50 mcg/kg in most people) you will probably not remember anything, but we generally rely on benzodiazepines, propofol, and volatile anesthetics (among others) to more reliably produce amnesia.
Fentanyl has long been a drug of choice among those who have access to it, but until the patches came out that was limited to people who work in operating rooms and other places that have need for strong IV narcotics. It's power lies not just in its potency but in its relative affinity for the various subtypes of opioid receptor (alpha, kappa, mu) and lipid solubility. What is really scary is that there are far more potent derivatives out there. Some have been developed as possible chemical warfare agents; it may have been one or more of these that were used in the Russian theater fiasco. (I made a more detailed comment in the thread on that event when it happened but my search and link abilities are limited right now). The bottom line is that fentanyl is a useful drug in the proper setting, but it is scary to think of it out on the streets.
posted by TedW at 1:24 PM on June 24, 2015 [19 favorites]
In the OR opiates and opioids in general have a reputation for being pretty bad at inducing amnesia in patients. If given enough fentanyl to induce general anesthesia (50 mcg/kg in most people) you will probably not remember anything, but we generally rely on benzodiazepines, propofol, and volatile anesthetics (among others) to more reliably produce amnesia.
Fentanyl has long been a drug of choice among those who have access to it, but until the patches came out that was limited to people who work in operating rooms and other places that have need for strong IV narcotics. It's power lies not just in its potency but in its relative affinity for the various subtypes of opioid receptor (alpha, kappa, mu) and lipid solubility. What is really scary is that there are far more potent derivatives out there. Some have been developed as possible chemical warfare agents; it may have been one or more of these that were used in the Russian theater fiasco. (I made a more detailed comment in the thread on that event when it happened but my search and link abilities are limited right now). The bottom line is that fentanyl is a useful drug in the proper setting, but it is scary to think of it out on the streets.
posted by TedW at 1:24 PM on June 24, 2015 [19 favorites]
My mother got hooked on medical demerol very many years ago after an ectopic pregnancy. It wasn't a huge deal for her - I didn't hear about it till much later - she had complications, she ended up in hospital for quite a while longer and then the doctor told her, "It's likely you'll be getting withdrawal symptoms when we take you off it."
My mother was a very compassionate and also insightful person. She said the withdrawal symptoms weren't much fun, but just weren't significant as part of the whole thing - but she also said that she didn't like any of the drugs in the first place because she didn't want to be in the hospital, and she wondered how very different it would have been if she had an emotional attachment (and shuddered and said, "I'd rather not think about it.")
Pain management is hard. Life is painful. I'm over 50, I'm generally very healthy, and yet I have minor and middling pain far too often (I lost a week of work to nerve pains in my hands last month.) If you gave me a drug that made pain go away - and I didn't know better - I'd be all over it. Who wouldn't? And yet my pains are less than many people I know. And yet pain medication is dangerous and I think even before I take an aspirin (which I did in the middle of writing this).
We fragile humans.
posted by lupus_yonderboy at 1:36 PM on June 24, 2015 [1 favorite]
My mother was a very compassionate and also insightful person. She said the withdrawal symptoms weren't much fun, but just weren't significant as part of the whole thing - but she also said that she didn't like any of the drugs in the first place because she didn't want to be in the hospital, and she wondered how very different it would have been if she had an emotional attachment (and shuddered and said, "I'd rather not think about it.")
Pain management is hard. Life is painful. I'm over 50, I'm generally very healthy, and yet I have minor and middling pain far too often (I lost a week of work to nerve pains in my hands last month.) If you gave me a drug that made pain go away - and I didn't know better - I'd be all over it. Who wouldn't? And yet my pains are less than many people I know. And yet pain medication is dangerous and I think even before I take an aspirin (which I did in the middle of writing this).
We fragile humans.
posted by lupus_yonderboy at 1:36 PM on June 24, 2015 [1 favorite]
Humans had opiate receptors long before humans started synthesizing opiates, we make our own. Fentanyl is a bad, bad drug created, knowing it would get out on the street. This is the anethesia component used to erase memory of what happens in the OR. Then as a short term memory eraser, it is put on elderly patients who already have some dementia and age related memory failure. It can also be a date rape drug.
TedW got there already but fentanyl is used as a painkiller to supplement better general anesthetics. If you wanted to (sort of) safely induce amnesia while minimizing the effect on breathing you'd want benzos. An amnesiac dose of opioids is generally pretty close to the line of mortal danger. I see how you get to "date rape drug" from its potency, especially combined with alcohol, but if anything that's a good way to be an accidental murderer.
The reason it exists in patches and lollipops is that opioid tolerance can get extremely high in patients with chronic pain or terminal illness. That's a good reason but it's dangerous stuff for sure. As TedW also mentioned, there are related compounds that are equipotent to hundreds (thousands?) of times as potent. Few of these are used in medicine but occasionally they are synthesized clandestinely to spice up street drugs, which usually kills a bunch of people.
posted by atoxyl at 2:03 PM on June 24, 2015 [3 favorites]
TedW got there already but fentanyl is used as a painkiller to supplement better general anesthetics. If you wanted to (sort of) safely induce amnesia while minimizing the effect on breathing you'd want benzos. An amnesiac dose of opioids is generally pretty close to the line of mortal danger. I see how you get to "date rape drug" from its potency, especially combined with alcohol, but if anything that's a good way to be an accidental murderer.
The reason it exists in patches and lollipops is that opioid tolerance can get extremely high in patients with chronic pain or terminal illness. That's a good reason but it's dangerous stuff for sure. As TedW also mentioned, there are related compounds that are equipotent to hundreds (thousands?) of times as potent. Few of these are used in medicine but occasionally they are synthesized clandestinely to spice up street drugs, which usually kills a bunch of people.
posted by atoxyl at 2:03 PM on June 24, 2015 [3 favorites]
I took two during one day and realized I wouldn't be able to work.
Well different drugs for different folks. For a lot of people I know who got into opioids part of the appeal is that they don't impair cognition too much compared to, say, alcohol. Why not get high then?
posted by atoxyl at 2:08 PM on June 24, 2015
Well different drugs for different folks. For a lot of people I know who got into opioids part of the appeal is that they don't impair cognition too much compared to, say, alcohol. Why not get high then?
posted by atoxyl at 2:08 PM on June 24, 2015
here's the comment TedW recalls making (13 years ago!)
posted by p3on at 2:16 PM on June 24, 2015 [5 favorites]
posted by p3on at 2:16 PM on June 24, 2015 [5 favorites]
The differences between dependence and addiction are important to know, so that you don't end up insulting someone (or yourself, strixus) who is in pain and using pain relief medicine appropriately.
Misunderstanding of these differences often results in un- or under-treated pain (or fear of taking an aspirin), which is a sad, cruel state of human affairs.
posted by Dashy at 2:23 PM on June 24, 2015 [11 favorites]
Misunderstanding of these differences often results in un- or under-treated pain (or fear of taking an aspirin), which is a sad, cruel state of human affairs.
posted by Dashy at 2:23 PM on June 24, 2015 [11 favorites]
I don't know what I would do without weed and acupuncture; I was dysfunctional to begin with and put opioids (including fentanyl) on top of that, and I was basically an overdose waiting to happen and not much else.
It kind of pisses me off that my choices to treat my chronic pain are between that shit and what my insurance won't cover, namely, acupuncture and weed.
posted by angrycat at 2:32 PM on June 24, 2015 [3 favorites]
It kind of pisses me off that my choices to treat my chronic pain are between that shit and what my insurance won't cover, namely, acupuncture and weed.
posted by angrycat at 2:32 PM on June 24, 2015 [3 favorites]
My dentist told me that opiates don't actually address pain directly, they just make you not care about it.
posted by Brocktoon at 2:42 PM on June 24, 2015 [2 favorites]
posted by Brocktoon at 2:42 PM on June 24, 2015 [2 favorites]
TedW got there already but fentanyl is used as a painkiller to supplement better general anesthetics. If you wanted to (sort of) safely induce amnesia while minimizing the effect on breathing you'd want benzos. An amnesiac dose of opioids is generally pretty close to the line of mortal danger. I see how you get to "date rape drug" from its potency, especially combined with alcohol, but if anything that's a good way to be an accidental murderer.
I shouldn't really make strong assertions about how they're used in anesthesia because I'm not an anesthesiologist. But this is what seems logical from what I know about the pharmacology. It's usually GABA drugs and NMDA antagonists that make you lose time.
posted by atoxyl at 2:47 PM on June 24, 2015 [1 favorite]
I shouldn't really make strong assertions about how they're used in anesthesia because I'm not an anesthesiologist. But this is what seems logical from what I know about the pharmacology. It's usually GABA drugs and NMDA antagonists that make you lose time.
posted by atoxyl at 2:47 PM on June 24, 2015 [1 favorite]
Mr. Strong was my school counselor when I was a little kid dealing with being bullied and molested. He accused me of making up stories for attention. He told me I could get in a lot of trouble with the police for telling terrible lies about people. Fuck you, Mr. Strong. I hope you burn in Hell.
My father is an alcoholic and was an emotionally absent parent. He joined AA when I was a teenager and stayed sober for maybe 20 years. Over the years, we forged a reasonably emotionally healthy father-adult son relationship given the circumstances. It was pretty good. He was good with my boys.
Then he got hooked on opiates. It's worse than when he was drinking. I suspect he's playing three pain clinics in three different states off of each other. He got really nasty with my son on the phone one day when he was high. It's destroyed the trust in him that I worked so hard to build. I'm glad he lives far away. It makes it easier for me to protect myself and my sons from his emotional drama bullshit.
(After re-reading this, I should make it clear that he wasn't the one who molested me. He broke my heart by ignoring me.)
posted by double block and bleed at 2:48 PM on June 24, 2015 [2 favorites]
My father is an alcoholic and was an emotionally absent parent. He joined AA when I was a teenager and stayed sober for maybe 20 years. Over the years, we forged a reasonably emotionally healthy father-adult son relationship given the circumstances. It was pretty good. He was good with my boys.
Then he got hooked on opiates. It's worse than when he was drinking. I suspect he's playing three pain clinics in three different states off of each other. He got really nasty with my son on the phone one day when he was high. It's destroyed the trust in him that I worked so hard to build. I'm glad he lives far away. It makes it easier for me to protect myself and my sons from his emotional drama bullshit.
(After re-reading this, I should make it clear that he wasn't the one who molested me. He broke my heart by ignoring me.)
posted by double block and bleed at 2:48 PM on June 24, 2015 [2 favorites]
rhizome: "I have an issue of Discover magazine from 30 years ago where it is the cover story"
August 1986
posted by rhizome at 2:55 PM on June 24, 2015
August 1986
posted by rhizome at 2:55 PM on June 24, 2015
I encouraged my mom to try pain patches when opiates weren't touching her pain. Almost immediately she was having problems talking, like mentioned up thread, and frequently felt like she couldn't breathe. So she pretty quickly ditched it and lives with the pain, even though it affects things like her ability to sleep.
I really wish we had better pain management available more readily. It seems like better addiction treatment would have to go hand-in-hand with that, because it seems like a lot of the reluctance to ameliorate pain comes from fear of addiction (and yet it clearly isn't working to treat pain Or prevent addiction).
posted by ldthomps at 2:59 PM on June 24, 2015 [4 favorites]
I really wish we had better pain management available more readily. It seems like better addiction treatment would have to go hand-in-hand with that, because it seems like a lot of the reluctance to ameliorate pain comes from fear of addiction (and yet it clearly isn't working to treat pain Or prevent addiction).
posted by ldthomps at 2:59 PM on June 24, 2015 [4 favorites]
Two good previously's that address addictions and overdoses in blue-collar Staten Island:
Staten Island’s Pill Problem: [The New Yorker]
Heroin’s New Hometown: [New York Times]
posted by Drab_Parts at 3:02 PM on June 24, 2015 [1 favorite]
Staten Island’s Pill Problem: [The New Yorker]
Heroin’s New Hometown: [New York Times]
posted by Drab_Parts at 3:02 PM on June 24, 2015 [1 favorite]
I don't get opiates, the attraction, the addiction.
well then it sounds like you're lucky enough not to be suffering from chronic pain that will never go away.
posted by poffin boffin at 6:19 PM on June 24, 2015 [5 favorites]
well then it sounds like you're lucky enough not to be suffering from chronic pain that will never go away.
posted by poffin boffin at 6:19 PM on June 24, 2015 [5 favorites]
atoxyl, I think you're right. I had a colonoscopy last year and they told me it was Valium. Sure was weird when 40 minutes just disappeared except for a couple of vague recollections of discomfort.
posted by sneebler at 6:35 PM on June 24, 2015
posted by sneebler at 6:35 PM on June 24, 2015
Heroin’s New Hometown: [New York Times]
Previous thread.
MeFi's own Maias wrote a good critique of that and a later piece by the same two NY Times journalists:
The 'New York Times' Is Hooked on Drug du Jour Journalism
posted by homunculus at 7:34 PM on June 24, 2015 [2 favorites]
Previous thread.
MeFi's own Maias wrote a good critique of that and a later piece by the same two NY Times journalists:
The 'New York Times' Is Hooked on Drug du Jour Journalism
posted by homunculus at 7:34 PM on June 24, 2015 [2 favorites]
Boring, excruciating, meaningless, painful living situations are the problem to which drugs become the solution
Is that true, though? I mean, no doubt it is true for some people, but is that the strongest correlation with drug addiction? If you think of all the film stars, rock stars, high-paid lawyers, bankers etc. with drug addiction problems it's not clear to me that "self-medicating" in response to a life of tedious sameness is the main driver. Poor people are the most visible drug addicts, certainly, but I'm not sure if poverty and limited opportunities are actually major drivers of drug addiction. I know I've seen statistics that say that drug addiction is more common in the white US population than the black US population, which suggests that socio-economic status is at best complicatedly related to drug abuse.
I read through the entire thread just to see if somebody would catch the assumption that a life with wealth and power is incompatible with suffering boring, excruciating, meaningless, and painful living situations.
I think the closest I saw was a belief that rich people must not be eating very well.
posted by effugas at 7:53 PM on June 24, 2015 [4 favorites]
Is that true, though? I mean, no doubt it is true for some people, but is that the strongest correlation with drug addiction? If you think of all the film stars, rock stars, high-paid lawyers, bankers etc. with drug addiction problems it's not clear to me that "self-medicating" in response to a life of tedious sameness is the main driver. Poor people are the most visible drug addicts, certainly, but I'm not sure if poverty and limited opportunities are actually major drivers of drug addiction. I know I've seen statistics that say that drug addiction is more common in the white US population than the black US population, which suggests that socio-economic status is at best complicatedly related to drug abuse.
I read through the entire thread just to see if somebody would catch the assumption that a life with wealth and power is incompatible with suffering boring, excruciating, meaningless, and painful living situations.
I think the closest I saw was a belief that rich people must not be eating very well.
posted by effugas at 7:53 PM on June 24, 2015 [4 favorites]
atoxyl, I think you're right. I had a colonoscopy last year and they told me it was Valium. Sure was weird when 40 minutes just disappeared except for a couple of vague recollections of discomfort.
For "conscious sedation" like you might have for that or for dental procedures I think midazolam is the most popular but diazepam (Valium) is plausible. Add just local anesthetic or some amount of opioids depending on how much pain can be expected.
posted by atoxyl at 8:16 PM on June 24, 2015
For "conscious sedation" like you might have for that or for dental procedures I think midazolam is the most popular but diazepam (Valium) is plausible. Add just local anesthetic or some amount of opioids depending on how much pain can be expected.
posted by atoxyl at 8:16 PM on June 24, 2015
I read an article regarding memory of surgery, causing post traumatic stress. They were adding an extra medication to block memory formation. When I had a gruesome shoulder surgery in May of 2012, it took until December of 2012, to throw off the fog from the anaesthesia. My two hour surgery started at 7:00 AM, and I was out until 2:00 PM. Whatever combo they used worked for months. I have heard others talk of how long it takes the fog to lift, months. I will try to find the.article that mentioned fentanyl as the memory blocker, maybe I remembered it wrong. I wouldn't put it past me.
posted by Oyéah at 8:59 PM on June 24, 2015
posted by Oyéah at 8:59 PM on June 24, 2015
I've cancelled out of at least three responses to "those people are probably mostly poor, they probably mostly work the kind of shitty working class jobs that break your body down, they probably face a lot of life problems that they really want to drift away from and solving some of the inequality/shitty job problems would probably solve 2/3 of the drug problem" because I am finding it very hard to contain the anger such ignorance is bringing out in me. But I'll be sure to tell the two middle-class nurses I know currently in treatment for opiate addiction that they are special flowers.
posted by old_growler at 9:06 PM on June 24, 2015 [3 favorites]
posted by old_growler at 9:06 PM on June 24, 2015 [3 favorites]
Opiates are for pain relief as meth is for ADHD and college students. I self medicated because I couldn't legally get the drugs I felt I needed. All the drug "addicts" I know/knew were bored or curious, or just generally LIKED the feeling of the drug. Dependance/tolerance is different, as has been mentioned. If someone were to offer me shrooms right now I'd really have trouble turning them down because I had so much FUN on them 20 years ago.
posted by Hazelsmrf at 9:10 PM on June 24, 2015
posted by Hazelsmrf at 9:10 PM on June 24, 2015
For "conscious sedation" like you might have for that or for dental procedures I think midazolam is the most popular but diazepam (Valium) is plausible. Add just local anesthetic or some amount of opioids depending on how much pain can be expected.
Lorazepam and midazolam are what have been used for me to induce the surgery amnesia, they work pretty well. Ambien also makes me forget everything that happened between when I took it and morning. Kind of strange to wake up to a clean house or to realize you ate two bags of cookies.
posted by Hazelsmrf at 9:13 PM on June 24, 2015
Lorazepam and midazolam are what have been used for me to induce the surgery amnesia, they work pretty well. Ambien also makes me forget everything that happened between when I took it and morning. Kind of strange to wake up to a clean house or to realize you ate two bags of cookies.
posted by Hazelsmrf at 9:13 PM on June 24, 2015
FIRST thing Hospice did once my dad died (brain tumor) was mix the pain meds + water in kitty litter. THEN they turned to his body and us. Despite utter exhaustion from weeks of 24/7 caring, and our grief, I recall thinking that seemed strange. I guess it was actually a good call on their part after all.
posted by beckybakeroo at 10:21 PM on June 24, 2015
posted by beckybakeroo at 10:21 PM on June 24, 2015
I read an article regarding memory of surgery, causing post traumatic stress. They were adding an extra medication to block memory formation. When I had a gruesome shoulder surgery in May of 2012, it took until December of 2012, to throw off the fog from the anaesthesia. My two hour surgery started at 7:00 AM, and I was out until 2:00 PM. Whatever combo they used worked for months. I have heard others talk of how long it takes the fog to lift, months. I will try to find the.article that mentioned fentanyl as the memory blocker, maybe I remembered it wrong. I wouldn't put it past me.
This?
This?
Or Ketamine, maybe?
posted by atoxyl at 11:00 PM on June 24, 2015
This?
This?
Or Ketamine, maybe?
posted by atoxyl at 11:00 PM on June 24, 2015
Oops sorry that's not specifically about surgery but other studies of intentional blocking of memory to treat PTSD.
I think most general anesthetics have the potential to cause persistent effects. Some once widely used inhalational anesthetics are being phased out because of neurotoxic reactions.
posted by atoxyl at 11:09 PM on June 24, 2015
I think most general anesthetics have the potential to cause persistent effects. Some once widely used inhalational anesthetics are being phased out because of neurotoxic reactions.
posted by atoxyl at 11:09 PM on June 24, 2015
FWIW I had arthroscopic knee surgery yesterday afternoon and the doctor gave me a mix of a benzodiazepine (midazolam?) and fentanyl, IV, to 'reduce anxiety' and, I think, to induce amnesia. This was in addition to a spinal anaesthetic injection that numbed me from the ribs down.
I felt no pain and have only hazy (and now fading) memories of the surgery itself.
posted by jpziller at 12:08 AM on June 25, 2015
I felt no pain and have only hazy (and now fading) memories of the surgery itself.
posted by jpziller at 12:08 AM on June 25, 2015
These articles focus on the poor end of addiction because of how lurid it is - stealing patches off corpses is gruesome stuff, poor people selling their offcuts to people willing to chew them with the hair on is just as bad.
Rich people have these sorts of addictions too. They just have less indelicate ways of servicing them. And they generally have better access good pain management practices in the first place.
There is a link between poor people working manual labour that destroys their bodies and subsequent addiction. It doesn't mean that rich people can't get addiction too, it's just that their pathways are different and so treatment is going to be different too.
I'd cite that but ironically I'm full of painkillers myself at the moment myself and haven't the spoons to spare. I had my gall bladder out Tuesday morning and am still in a lot of pain from it. The Oxy (Endone here in Oz, I believe) isn't a high, it just stops me hurting, and it's a very different sort of feeling than when I have taken it without being in sufficient pain. If I'm not in sufficient pain I do get a kind of pleasant, floaty problems-over-there sort of feeling. Right now it just allows me to sit upright and write this for you all.
posted by Jilder at 12:41 AM on June 25, 2015 [1 favorite]
Rich people have these sorts of addictions too. They just have less indelicate ways of servicing them. And they generally have better access good pain management practices in the first place.
There is a link between poor people working manual labour that destroys their bodies and subsequent addiction. It doesn't mean that rich people can't get addiction too, it's just that their pathways are different and so treatment is going to be different too.
I'd cite that but ironically I'm full of painkillers myself at the moment myself and haven't the spoons to spare. I had my gall bladder out Tuesday morning and am still in a lot of pain from it. The Oxy (Endone here in Oz, I believe) isn't a high, it just stops me hurting, and it's a very different sort of feeling than when I have taken it without being in sufficient pain. If I'm not in sufficient pain I do get a kind of pleasant, floaty problems-over-there sort of feeling. Right now it just allows me to sit upright and write this for you all.
posted by Jilder at 12:41 AM on June 25, 2015 [1 favorite]
On a related note, the state of Washington recently enacted very restrictive guidelines for prescribing opiates, and other states are considering similar restrictions. That's fine for people who are NOT in chronic pain, but for those who are, and who have developed a high tolerance for opiates, it's just bad. Here's a article from the Seattle Times which talks about the problem.
My wife has a chronic pain condition that keeps her mostly in bed, and is on relatively high doses of fentanyl (plus a host of other meds), so this is bad news for her. There is no associated "high", but there is a relief from the otherwise constant pain when she's adequately medicated. With proper pain management, she can move around the house a little bit, and do a few exercises, and try to help heal her body. If the pain management isn't working, she's not even close to functional - she can't get out of bed, can't sleep, and can barely think. With no meds at all, she's screaming and in tears from the pain. With low meds, she's whimpering with pain and trying to escape into a book.
In the course of trying to treat her pain, we went to one "pain clinic" where the staff treated everyone like drug addicts, and their goal was to get people off drugs, instead of trying to manage their pain. I don't doubt that there are people like that, but that's not my wife's situation, and some of these new laws/guidelines don't seem to respect situations like hers.
posted by Jefffurry at 1:14 AM on June 25, 2015 [5 favorites]
My wife has a chronic pain condition that keeps her mostly in bed, and is on relatively high doses of fentanyl (plus a host of other meds), so this is bad news for her. There is no associated "high", but there is a relief from the otherwise constant pain when she's adequately medicated. With proper pain management, she can move around the house a little bit, and do a few exercises, and try to help heal her body. If the pain management isn't working, she's not even close to functional - she can't get out of bed, can't sleep, and can barely think. With no meds at all, she's screaming and in tears from the pain. With low meds, she's whimpering with pain and trying to escape into a book.
In the course of trying to treat her pain, we went to one "pain clinic" where the staff treated everyone like drug addicts, and their goal was to get people off drugs, instead of trying to manage their pain. I don't doubt that there are people like that, but that's not my wife's situation, and some of these new laws/guidelines don't seem to respect situations like hers.
posted by Jefffurry at 1:14 AM on June 25, 2015 [5 favorites]
Also, it seems to be popular to prescribe Methadone in place of other opiates, because of it's low cost. Because Methadone stays in the body longer than Oxy or Fentanyl or other opiates, the danger of overdose is much higher.
posted by Jefffurry at 1:45 AM on June 25, 2015
posted by Jefffurry at 1:45 AM on June 25, 2015
I've cancelled out of at least three responses to "those people are probably mostly poor, they probably mostly work the kind of shitty working class jobs that break your body down, they probably face a lot of life problems that they really want to drift away from and solving some of the inequality/shitty job problems would probably solve 2/3 of the drug problem" because I am finding it very hard to contain the anger such ignorance is bringing out in me. But I'll be sure to tell the two middle-class nurses I know currently in treatment for opiate addiction that they are special flowers.
First, that isn't what "mostly" means.
Second, even though nursing (at the qualified, permanent job end of the spectrum) is relatively well paid, it can still be a physical job with all the long-term physical wear and tear that leads to. Nurses I know have to move or help move people multiple times a week, that gives a lot of opportunities for musculo-skeletal injuries that can lead to chronic pain problems.
Third, medical professionals are much more likely to end up with painkiller addictions. Although I don't know if this was a factor with the people you know, it's a known problems for people who work in ERs or ORs because the access is just so easy.
Fourth, "middle-class nurses...in treatment for opiate addiction" aren't the ones dying from chewing used fentanyl patches. That's something that people who can't afford legally prescribed or diverted narcotics do.
posted by atrazine at 2:37 AM on June 25, 2015 [2 favorites]
First, that isn't what "mostly" means.
Second, even though nursing (at the qualified, permanent job end of the spectrum) is relatively well paid, it can still be a physical job with all the long-term physical wear and tear that leads to. Nurses I know have to move or help move people multiple times a week, that gives a lot of opportunities for musculo-skeletal injuries that can lead to chronic pain problems.
Third, medical professionals are much more likely to end up with painkiller addictions. Although I don't know if this was a factor with the people you know, it's a known problems for people who work in ERs or ORs because the access is just so easy.
Fourth, "middle-class nurses...in treatment for opiate addiction" aren't the ones dying from chewing used fentanyl patches. That's something that people who can't afford legally prescribed or diverted narcotics do.
posted by atrazine at 2:37 AM on June 25, 2015 [2 favorites]
In response to Beholder who felt that the high response to negative attitudes towards school counselors meant people did not care, that is not always the case. I favorited the person who said "have you ever talked to a school counselor?" because I had, when severely bullied in Jr. High and suffering depression in high school, and the counselors were worse than useless. They blamed me, and said that the boys who were bullying me with obscenities and threats to kill my pets "really liked me" and that I should be nicer to them! Nothing like "blame the victim". Also no counselor even mentioned depression, it was assumed I was just lazy because my marks were so erratic, including a learning disability that was not diagnosed until I went back and finished college as an older adult. The counselors I saw made me feel worse and did nothing to help. My friends had similar experiences, we called our high school counselor "Smiley" because she had a horrid grin and gave only bad advice.
I also had no good experiences with school counselors with my children, one even showed me the wrong drawings saying my son had done them, when they were clearly the work of some other child. That son was always a skilled artist, now works in the field, and the disturbing stuff the counselor showed us was clearly the work of some kid who could not draw! The counselor could not even keep straight which kid he was talking about!
So my cynicism about mandatory counseling for all students comes from experience. I would love to see GOOD counseling that actually sees the child and actually helps them given through the schools, but given the low pay and low standards and cutting funds for everything in education today, I am not hopeful that it will get better.
posted by mermayd at 3:49 AM on June 25, 2015 [3 favorites]
I also had no good experiences with school counselors with my children, one even showed me the wrong drawings saying my son had done them, when they were clearly the work of some other child. That son was always a skilled artist, now works in the field, and the disturbing stuff the counselor showed us was clearly the work of some kid who could not draw! The counselor could not even keep straight which kid he was talking about!
So my cynicism about mandatory counseling for all students comes from experience. I would love to see GOOD counseling that actually sees the child and actually helps them given through the schools, but given the low pay and low standards and cutting funds for everything in education today, I am not hopeful that it will get better.
posted by mermayd at 3:49 AM on June 25, 2015 [3 favorites]
Can I just clarify here, and maybe ask that people read somewhat carefully?
Having read the first article, I would like to know what the social risk factors for opiate addiction are - almost everyone in the story seems to come from a pretty messed up (and mostly poverty-stricken) situation. That's not to say that no one from happy, well-off situations ever gets addicted to opiates, but when I start hearing about how there's a lot of prescriptions floating around for chronic pain conditions and how people are selling their used fentanyl patches, I start thinking "those people are probably mostly poor, they probably mostly work the kind of shitty working class jobs that break your body down, they probably face a lot of life problems that they really want to drift away from and solving some of the inequality/shitty job problems would probably solve 2/3 of the drug problem".
Please note that my whole comment starts "I would like to know what the social risk factors...." That's a question, even though the emphasis presumes an answer. And the rest of my comment speculates that social factors - primarily poverty - cause a large percentage (spitballing 2/3!) of the opiate addiction problem. That's not nearly the same as "the poors are addicted to opiates, look at their shameful lives, and in any case no one well-off gets addicted".
From an anecdata standpoint - the vast majority of people I know who have chronic pain, particularly at younger ages, are working class - people who were bartenders or nurses or factory workers or worked in similar occupations that just chew your body up and don't give you time off to recover from injury. The majority of people I know who have been motivated to sell drugs were doing it for the money, because they were poor. Especially people who were doing low-level stuff, and "here is my used fenatyl patch" is the very definition of low-level.
Again, I'm totally open to "oh here is a study about class and chronic pain that disproves you", but my first response when I start hearing a lot about chronic pain and addiction and people for whom selling a used fenatyl patch is economically worthwhile is to think of the many , many people I've met who've been fucked over and crippled by blue collar work.
posted by Frowner at 5:40 AM on June 25, 2015 [4 favorites]
Having read the first article, I would like to know what the social risk factors for opiate addiction are - almost everyone in the story seems to come from a pretty messed up (and mostly poverty-stricken) situation. That's not to say that no one from happy, well-off situations ever gets addicted to opiates, but when I start hearing about how there's a lot of prescriptions floating around for chronic pain conditions and how people are selling their used fentanyl patches, I start thinking "those people are probably mostly poor, they probably mostly work the kind of shitty working class jobs that break your body down, they probably face a lot of life problems that they really want to drift away from and solving some of the inequality/shitty job problems would probably solve 2/3 of the drug problem".
Please note that my whole comment starts "I would like to know what the social risk factors...." That's a question, even though the emphasis presumes an answer. And the rest of my comment speculates that social factors - primarily poverty - cause a large percentage (spitballing 2/3!) of the opiate addiction problem. That's not nearly the same as "the poors are addicted to opiates, look at their shameful lives, and in any case no one well-off gets addicted".
From an anecdata standpoint - the vast majority of people I know who have chronic pain, particularly at younger ages, are working class - people who were bartenders or nurses or factory workers or worked in similar occupations that just chew your body up and don't give you time off to recover from injury. The majority of people I know who have been motivated to sell drugs were doing it for the money, because they were poor. Especially people who were doing low-level stuff, and "here is my used fenatyl patch" is the very definition of low-level.
Again, I'm totally open to "oh here is a study about class and chronic pain that disproves you", but my first response when I start hearing a lot about chronic pain and addiction and people for whom selling a used fenatyl patch is economically worthwhile is to think of the many , many people I've met who've been fucked over and crippled by blue collar work.
posted by Frowner at 5:40 AM on June 25, 2015 [4 favorites]
I have always felt as though I was most decidedly not an addiction risk. In my life I have done drugs recreationally and have never had an issue with wanting to do more of them, abuse them or make them part of any routine. That said, I put my back out about 2 years ago and was completely unable to move. In the ER, they gave me IV dilaudid, at which point I realized how addiction happens. It was delicious. When, a few days later, I went back to the ER and they gave me IM dilaudid, I was genuinely angry that they didn't do IV. I, apparently, should NEVER use heroin.
posted by Sophie1 at 6:43 AM on June 25, 2015
posted by Sophie1 at 6:43 AM on June 25, 2015
Trauma and effects of early life adversity can affect anyone in any class or pay scale. Not to mention many high paying jobs are themselves traumatic and bad for mental health- night shift work, facing a heavy load of other people's suffering- these can all cause poor mental health or damage to the bodies health.
Money does not mean the person has access to what they need--- rest, a day schedule, distance from human suffering, less physical labor, less mentally exhausting labor.
Money might mean you can access healing services and enrichment services (healthy prepared meals, cleaning services, physical therapy, therapy to address past traumas/adversity, yoga classes, gym etc) but it doesn't mean you have time or energy left to even use those things.
I think part time work should be a goal for a LOT of people recovering or healing from mental or physical health issues-- but it's only helpful if there is still access to housing, food, financial stability, long term job security (i.e. it's not knocking someone down from later opportunities), and money for the healing or supportive services the person needs. For most people that is not an option, no matter how damaging your work is causing you. For too many, there is no hope of ever having a needed break without the risk of your life literally going to the shitter and never being able to get it back together.
And even if you have loads of money, the damage to your social life-- you are now distanced from most of the population, you can feel hated and unworthy of all you have, you can feel a deeper burden to help everyone but still functionally powerless to actually effect meaningful change with your funds. A lot of people HATE rich people--- that level of hate can do real damage to souls who actually want to have meaningful connection to their community. You're often exposed to a culture of very damaging and harmful excess with less access to grounded people living simpler and possibly healthier lives. You're seeing this excess that innately is disrespectful to those who are starving or suffering with heavy loads that could be alleviated with income inequality and you can either face that or stuff it or take a lot of drugs to forget but I think many wealthy feel it. It can be, genuinely, a burden, a load that some can not handle or that actively hurts for many different reasons.
posted by xarnop at 6:54 AM on June 25, 2015 [1 favorite]
Money does not mean the person has access to what they need--- rest, a day schedule, distance from human suffering, less physical labor, less mentally exhausting labor.
Money might mean you can access healing services and enrichment services (healthy prepared meals, cleaning services, physical therapy, therapy to address past traumas/adversity, yoga classes, gym etc) but it doesn't mean you have time or energy left to even use those things.
I think part time work should be a goal for a LOT of people recovering or healing from mental or physical health issues-- but it's only helpful if there is still access to housing, food, financial stability, long term job security (i.e. it's not knocking someone down from later opportunities), and money for the healing or supportive services the person needs. For most people that is not an option, no matter how damaging your work is causing you. For too many, there is no hope of ever having a needed break without the risk of your life literally going to the shitter and never being able to get it back together.
And even if you have loads of money, the damage to your social life-- you are now distanced from most of the population, you can feel hated and unworthy of all you have, you can feel a deeper burden to help everyone but still functionally powerless to actually effect meaningful change with your funds. A lot of people HATE rich people--- that level of hate can do real damage to souls who actually want to have meaningful connection to their community. You're often exposed to a culture of very damaging and harmful excess with less access to grounded people living simpler and possibly healthier lives. You're seeing this excess that innately is disrespectful to those who are starving or suffering with heavy loads that could be alleviated with income inequality and you can either face that or stuff it or take a lot of drugs to forget but I think many wealthy feel it. It can be, genuinely, a burden, a load that some can not handle or that actively hurts for many different reasons.
posted by xarnop at 6:54 AM on June 25, 2015 [1 favorite]
"Fewer than five percent of patients prescribed narcotics to treat chronic pain become addicted to the drugs, according to a new analysis of past research.
The finding suggests that concerns about the risk of becoming addicted to prescription painkillers might be "overblown," said addiction specialist Dr. Michael Fleming at Northwestern University's Feinberg School of Medicine."
So 95% of people in pain are treated, in various ways, like societal dirt via new "protective" laws and restrictions on pain meds, for sake of the 5% who are problematic. And all of the Buzzworthy headlines screaming "Addition! Hooked on Teh Drugzzzz! The king of all opiates! A killer drug problem!" (and the journalists who write to the headline, not the story) are directly compounding theproblem pain of those 95%.
posted by Dashy at 7:50 AM on June 25, 2015 [13 favorites]
The finding suggests that concerns about the risk of becoming addicted to prescription painkillers might be "overblown," said addiction specialist Dr. Michael Fleming at Northwestern University's Feinberg School of Medicine."
So 95% of people in pain are treated, in various ways, like societal dirt via new "protective" laws and restrictions on pain meds, for sake of the 5% who are problematic. And all of the Buzzworthy headlines screaming "Addition! Hooked on Teh Drugzzzz! The king of all opiates! A killer drug problem!" (and the journalists who write to the headline, not the story) are directly compounding the
posted by Dashy at 7:50 AM on June 25, 2015 [13 favorites]
I met a well to do daughter of a physician, Lake Tahoe, expensive home on a choice cove, two little kids. She told me the story of her addiction, and recovery. This is how I learned about the cunning nature of opiate addiction. She had a back problem, for which she was prescribed codeine. She had a surgical repair. In spite of the successful surgery, the back pain persisted. She had PT, she exercised, until they finally realized she had an addiction to codeine that manifested as back pain. The codeine took away the pain, she experienced no high.
She had to go through treatment, and experience withdrawal from narcotics to get her life back. She did this, and had a tale to tell about the subtle and serpentine nature of the nervous system's ability to deceive as a basic function of addiction.
I know my wiring is different with regard to pain, I have a very high pain threshold, I don't bother with anesthetic when I see the dentist, etc.
There is some interesting work underway using vagal nerve stimulation to mitigate immune response in Rheumatoid Arthritis, by product of which is pain reduction.
posted by Oyéah at 8:42 AM on June 25, 2015 [3 favorites]
She had to go through treatment, and experience withdrawal from narcotics to get her life back. She did this, and had a tale to tell about the subtle and serpentine nature of the nervous system's ability to deceive as a basic function of addiction.
I know my wiring is different with regard to pain, I have a very high pain threshold, I don't bother with anesthetic when I see the dentist, etc.
There is some interesting work underway using vagal nerve stimulation to mitigate immune response in Rheumatoid Arthritis, by product of which is pain reduction.
posted by Oyéah at 8:42 AM on June 25, 2015 [3 favorites]
Oyeah, perhaps you meant to describe a dependence instead of addiction? What you describe falls squarely in the camp of physical dependence, but I didn't hear compulsive drug use and destructive behaviors in the woman you describe. The fact that she was treated during withdrawal does not indicate addiction, either.
Perhaps she doesn't deserve to be called an addict.
posted by Dashy at 8:58 AM on June 25, 2015 [3 favorites]
Perhaps she doesn't deserve to be called an addict.
posted by Dashy at 8:58 AM on June 25, 2015 [3 favorites]
Now that people mention it, I also have a lot of memories from during surgery under heavy sedation that I'm told I shouldn't remember. I know they're not imagined because they're confirmed by nurses.
I also have a crazy stupid high tolerance for pain. Its not that I don't feel it, but that I'm able to walk around and function with high levels of it.
posted by The Underpants Monster at 12:11 PM on June 25, 2015
I also have a crazy stupid high tolerance for pain. Its not that I don't feel it, but that I'm able to walk around and function with high levels of it.
posted by The Underpants Monster at 12:11 PM on June 25, 2015
Fourth, "middle-class nurses...in treatment for opiate addiction" aren't the ones dying from chewing used fentanyl patches. That's something that people who can't afford legally prescribed or diverted narcotics do.
Look, the "drug epidemics" definitely tend to hit places where lots of people aren't doing too good. And the work/chronic pain connection is a particular, significant path to opioid addiction. But there are a lot of those paths and let me point out that people who can afford narcotics tend to become people who can't afford narcotics as tolerance escalates, and people who divert narcotics tend to become people who can't afford narcotics when they get fired.
The majority of people I know who have been motivated to sell drugs were doing it for the money, because they were poor.
The majority of people I know who have been motivated to sell this kind of drugs were doing it for the money, because they were drug addicts.
posted by atoxyl at 1:03 PM on June 25, 2015 [1 favorite]
Look, the "drug epidemics" definitely tend to hit places where lots of people aren't doing too good. And the work/chronic pain connection is a particular, significant path to opioid addiction. But there are a lot of those paths and let me point out that people who can afford narcotics tend to become people who can't afford narcotics as tolerance escalates, and people who divert narcotics tend to become people who can't afford narcotics when they get fired.
The majority of people I know who have been motivated to sell drugs were doing it for the money, because they were poor.
The majority of people I know who have been motivated to sell this kind of drugs were doing it for the money, because they were drug addicts.
posted by atoxyl at 1:03 PM on June 25, 2015 [1 favorite]
This woman was deceived by her body, the body addiction to codeine made her back ache, until it got codeine. It took her and her doctor a while to understand it. She didn't get euphoria, she got pain relief, but the pain was created by her very cunning and subtle addiction, that even she was unaware of.
This might be the only warning you are going to get about the cunning of the nervous system's relationship with opiates. I just read a study of sedation in the OR, where patients received fentanyl alone, or with three different drugs, propofol, and two other drugs in that class, to be clear there were four sets, of fentanyl with one other drug or no accompanying drug. Anyway, the patients who had no OR memory, only got the fentanyl. I know I should cite but this phone makes that difficult.
posted by Oyéah at 7:12 PM on June 25, 2015
This might be the only warning you are going to get about the cunning of the nervous system's relationship with opiates. I just read a study of sedation in the OR, where patients received fentanyl alone, or with three different drugs, propofol, and two other drugs in that class, to be clear there were four sets, of fentanyl with one other drug or no accompanying drug. Anyway, the patients who had no OR memory, only got the fentanyl. I know I should cite but this phone makes that difficult.
posted by Oyéah at 7:12 PM on June 25, 2015
I had an ask me about this, but to recap: my chronic pain has been worse these days, or maybe I'm more often in situations these days where I would rather not be reduced to writhing around and moaning.
So I went to my GP about this, and I was like, I'm on tramadol, but it doesn't really seem to be doing much. Would a higher dose help? And what about the side effects? And btw as I've told you several times before, I smoke weed to manage pain.
And thus I entered this new regime where if you are taking any pain medication -- gabepentin seems to be not one of these, for the moment, thank God -- you are required to take piss tests and if these test positive for weed, no more tramadol for you.
Now, I've since stopped tramadol, because it wasn't really helping anyway, and I know that weed helps. But I wanted to explore other pain management techniques, like acupuncture and God knows what. Anything but opiates.
But the doctor said that no pain management clinic she could refer me to would work with me if I was smoking weed.
Now, maybe this is really poor communication on my doctor's part, and there's some marijuana and tramadol conflict I'm not aware of. But my doctor's reaction really was off-putting: I was explaining that I needed something more for pain and as you know I smoke weed. First, she acted like the weed was news to her. Second, the whole contract and piss thing and the way it was offered to me was terribly off-putting.
One thing I love about acupuncture is that pain is explicitly discussed, and it's not something that I feel is some guilty secret. I know doctors have liability concerns, but it would be really great if I'm not treated as I've come to cop dope when I explain to a medical professional that I've been in excruciating pain.
posted by angrycat at 6:30 AM on June 26, 2015 [1 favorite]
So I went to my GP about this, and I was like, I'm on tramadol, but it doesn't really seem to be doing much. Would a higher dose help? And what about the side effects? And btw as I've told you several times before, I smoke weed to manage pain.
And thus I entered this new regime where if you are taking any pain medication -- gabepentin seems to be not one of these, for the moment, thank God -- you are required to take piss tests and if these test positive for weed, no more tramadol for you.
Now, I've since stopped tramadol, because it wasn't really helping anyway, and I know that weed helps. But I wanted to explore other pain management techniques, like acupuncture and God knows what. Anything but opiates.
But the doctor said that no pain management clinic she could refer me to would work with me if I was smoking weed.
Now, maybe this is really poor communication on my doctor's part, and there's some marijuana and tramadol conflict I'm not aware of. But my doctor's reaction really was off-putting: I was explaining that I needed something more for pain and as you know I smoke weed. First, she acted like the weed was news to her. Second, the whole contract and piss thing and the way it was offered to me was terribly off-putting.
One thing I love about acupuncture is that pain is explicitly discussed, and it's not something that I feel is some guilty secret. I know doctors have liability concerns, but it would be really great if I'm not treated as I've come to cop dope when I explain to a medical professional that I've been in excruciating pain.
posted by angrycat at 6:30 AM on June 26, 2015 [1 favorite]
Oyéah, you've been told this, but I'll say it again: you are describing dependence. Not addiction. Actual MeFites in this very thread who have working experience with addiction are telling you this, and you are ignoring it, and your axe-grindy argument is only serving to make those of us who depend on opiates to live a somewhat normal life feel even more put-upon.
angrycat: "Now, maybe this is really poor communication on my doctor's part, and there's some marijuana and tramadol conflict I'm not aware of." Nope. It's just the bullshit pain management clinic thing. And yeah, they're all like this. And it blows. I have made the opposite choice from you, since tramadol helps my chronic pain a lot and weed not as much. But it still feels just as crappy to have to piss in a cup to get my pain meds refilled every three months.
Dashy is 100% right on with this:
angrycat: "Now, maybe this is really poor communication on my doctor's part, and there's some marijuana and tramadol conflict I'm not aware of." Nope. It's just the bullshit pain management clinic thing. And yeah, they're all like this. And it blows. I have made the opposite choice from you, since tramadol helps my chronic pain a lot and weed not as much. But it still feels just as crappy to have to piss in a cup to get my pain meds refilled every three months.
Dashy is 100% right on with this:
So 95% of people in pain are treated, in various ways, like societal dirt via new "protective" laws and restrictions on pain meds, for sake of the 5% who are problematic. And all of the Buzzworthy headlines screaming "Addition! Hooked on Teh Drugzzzz! The king of all opiates! A killer drug problem!" (and the journalists who write to the headline, not the story) are directly compounding the problem pain of those 95%.posted by fiercecupcake at 7:12 AM on June 26, 2015 [3 favorites]
To suddenly not hurt and not care? It was wonderful. But I know how dangerous that can be. I dread the day I am finally bumped up to it full time, because it means that is the end. If the pain is that bad, then I really have nothing left but that.
That was so well-put and heart-breakingly straightforward, and you're just talking about your reality, not trying to make some profound philosophical point, but it resonates. I hope you extract every bit of happiness you can out life possible and wish you well.
posted by aydeejones at 7:01 PM on June 28, 2015
That was so well-put and heart-breakingly straightforward, and you're just talking about your reality, not trying to make some profound philosophical point, but it resonates. I hope you extract every bit of happiness you can out life possible and wish you well.
posted by aydeejones at 7:01 PM on June 28, 2015
w0mbat, are you sure you're not confusing it with propofol?
Doubtful, but it may have been cocktail. Fentanyl is also very often combined with versed for in-office relatively quick procedures like wisdom teeth extraction, termination of early pregnancy, colonoscopy, etc. For most people it's very much a "when I count to 10, you will..." *fade to black* kind of experience where you barely remember anything except for being very giddy (or weepy) and dreamy coming out of it.
Some people recall the entire experience fondly, but the inhibition of memory formation is part of the desired effect in combining the opiod (fentanyl) with a benzo (versed).
posted by aydeejones at 7:06 PM on June 28, 2015
Doubtful, but it may have been cocktail. Fentanyl is also very often combined with versed for in-office relatively quick procedures like wisdom teeth extraction, termination of early pregnancy, colonoscopy, etc. For most people it's very much a "when I count to 10, you will..." *fade to black* kind of experience where you barely remember anything except for being very giddy (or weepy) and dreamy coming out of it.
Some people recall the entire experience fondly, but the inhibition of memory formation is part of the desired effect in combining the opiod (fentanyl) with a benzo (versed).
posted by aydeejones at 7:06 PM on June 28, 2015
My dentist told me that opiates don't actually address pain directly, they just make you not care about it.
No...dentists don't always make the best pharmacists / pharmacologists / psychopharmacologists but it is in their interests to discourage patient fascination with painkillers.
Opiates and the greater category of opioids are essentially the de facto pain killing drugs. Unlike anti-inflammatory drugs that may treat the underlying inflammation that causes your body to trigger pain signals, opioids directly turn them off and create euphoria in the process, but the euphoria itself is not the primary mechanism of action. It's more of a side effect that implies you got too large of a dose for your pain level (though it's often overstated how little enjoyment a dependent / addicted person experiences through satiety, some of it is related to dopamine).
Endogenous morphine-like compounds (endorphins) are the system your body uses to specifically turn off pain signals regardless of the level of localized inflammation or tissue damage. Other drugs like gabapentin may more interact with the underlying messaging system. Alcohol is a notorious one because it causes strong obliviousness to pain (often to the point of pretty-darn-strong subjective analgesia) but is a potent inflammatory substance, so the next day is always much worse as a result (see: walking the strip in Vegas for several nights after destroying your feet stumbling around the first night).
What you're talking about is often attributed to other substances like THC and CBD, but is a general catch all for "we don't exactly understand what it does for pain, we just happen to notice some bliss or euphoria so that might be it." Cannabinoids are heavily marginalized into the "just makes you not care about pain" realm just as research is starting to reveal powerful anti-inflammatory effects especially when THC and CBD are combined.
posted by aydeejones at 7:18 PM on June 28, 2015 [3 favorites]
No...dentists don't always make the best pharmacists / pharmacologists / psychopharmacologists but it is in their interests to discourage patient fascination with painkillers.
Opiates and the greater category of opioids are essentially the de facto pain killing drugs. Unlike anti-inflammatory drugs that may treat the underlying inflammation that causes your body to trigger pain signals, opioids directly turn them off and create euphoria in the process, but the euphoria itself is not the primary mechanism of action. It's more of a side effect that implies you got too large of a dose for your pain level (though it's often overstated how little enjoyment a dependent / addicted person experiences through satiety, some of it is related to dopamine).
Endogenous morphine-like compounds (endorphins) are the system your body uses to specifically turn off pain signals regardless of the level of localized inflammation or tissue damage. Other drugs like gabapentin may more interact with the underlying messaging system. Alcohol is a notorious one because it causes strong obliviousness to pain (often to the point of pretty-darn-strong subjective analgesia) but is a potent inflammatory substance, so the next day is always much worse as a result (see: walking the strip in Vegas for several nights after destroying your feet stumbling around the first night).
What you're talking about is often attributed to other substances like THC and CBD, but is a general catch all for "we don't exactly understand what it does for pain, we just happen to notice some bliss or euphoria so that might be it." Cannabinoids are heavily marginalized into the "just makes you not care about pain" realm just as research is starting to reveal powerful anti-inflammatory effects especially when THC and CBD are combined.
posted by aydeejones at 7:18 PM on June 28, 2015 [3 favorites]
Opiates are for pain relief as meth is for ADHD and college students. I self medicated because I couldn't legally get the drugs I felt I needed. All the drug "addicts" I know/knew were bored or curious, or just generally LIKED the feeling of the drug.
Someone has pain privilege. You gotta be kiddin' me.
posted by aydeejones at 7:25 PM on June 28, 2015 [3 favorites]
Someone has pain privilege. You gotta be kiddin' me.
posted by aydeejones at 7:25 PM on June 28, 2015 [3 favorites]
That said, I put my back out about 2 years ago and was completely unable to move. In the ER, they gave me IV dilaudid, at which point I realized how addiction happens. It was delicious. When, a few days later, I went back to the ER and they gave me IM dilaudid, I was genuinely angry that they didn't do IV. I, apparently, should NEVER use heroin.
Many ER doctors are completely opposed to the "IV push" in all but the most traumatic cases (where a syringe is directly injected into your IV) because it's such a formative experience for many future addicts, and the "very curious" patients who keep asking for something like that weeks later.
My wife had one after delivering our firstborn son and it was almost cruel how effective it was, because it had a tiny half-life, and she was in severe pain due to tearing and could only take propoxyphene (Darvocet) afterwards (in theory better for the baby, but really just giving her way too much acetaminophen and useless toxic opiate metabolites), which is a hideously ineffective opiate that was taken off the market essentially because such high, toxic doses (i.e. 20X more than you would take in hydrocodone) are needed to get any analgesic effect from it.
posted by aydeejones at 7:33 PM on June 28, 2015
Many ER doctors are completely opposed to the "IV push" in all but the most traumatic cases (where a syringe is directly injected into your IV) because it's such a formative experience for many future addicts, and the "very curious" patients who keep asking for something like that weeks later.
My wife had one after delivering our firstborn son and it was almost cruel how effective it was, because it had a tiny half-life, and she was in severe pain due to tearing and could only take propoxyphene (Darvocet) afterwards (in theory better for the baby, but really just giving her way too much acetaminophen and useless toxic opiate metabolites), which is a hideously ineffective opiate that was taken off the market essentially because such high, toxic doses (i.e. 20X more than you would take in hydrocodone) are needed to get any analgesic effect from it.
posted by aydeejones at 7:33 PM on June 28, 2015
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