The original link is simple and clear.
ucbalumnus–I know the guidelines say that and presently they are only guidelines but I also know that well-meaning guidelines (even if flawed in some way) have a way of expanding both by law and societal pressure. They already have. It’ll be a politician who has never been in pain or dealt with chronic pain who decides that the addiction issue is more important than pain management. I just happen to think that both issues are important and should be dealt with separately. When our society puts blanket taboos on drugs (marijuana for pain medication is a good example) the research slows or stops.
Addiction treatment is similar to mental health treatment in that society first views the problem as a personal failing by the individual rather than a possible medical condition that can possibly be treated. More could be done.
Yes, people do become addicted to prescription pain meds and it is bad. They can also become addicted to alcohol, other meds, gambling, sex. But the majority do not.
My wife started practicing as an NP in 1996, the same year that Purdue Pharma released OxyContin. It did not take long for drug users to realize they could get a euphoric high by crushing and snorting the pills. All the while, Purdue was advertising it as a time-released, non-addictive alternative to Percocet and Vicodin. It quickly became a problem; by 2001 Rush Limbaugh was deaf, a doctor she worked with was in rehab, and Oxy had become a multi-billion dollar street drug. My wife, for the most part, had stopped prescribing it. There were too many pill chasers: “I dropped the bottle in the toilet,” “My boyfriend stole them,”
It wasn’t until 2012 or 2013 (I think, too lazy to look it up) that Purdue was forced to discontinue all the pills that could be crushed and snorted or injected. At this point, the addicted doctor had lost his license for selling prescriptions and had died (“heart attack”). The old style Oxy (smallest) pills immediately jumped from $10 to $50 each on the streets. That’s when the addicts, many in HS, turned to heroin. About the same time, states had started to monitor pharmacy prescriptions to find and flag people filling prescriptions from multiple doctors and pharmacies. With the move to EMR, prescribers can now see the complete prescription history of their patients.
There are potent pain meds without the euphoria but, understandably, people don’t like them as much.
By the way, I had morphine after sinus surgery and a prescription for hydrocodone, and my brain/body chemistry LOVES opiates.
I think its a lot of doctors over prescribing. When my D2 had her wisdom teeth removed, the doc prescribed Ibupofen, and Hydrocodone! She was 13 at the time.
I agree. Even after broken bones, I’ve just used Tylenol or something similar. And even after major surgery, I’ve used Percocet for a few days and then switched to an over-the-counter. I only want to be prescribed oxycodone if I’m in severe pain from my end-stage cancer.
Isn’t the point that doctors need to deal with them together? Yes, we need pain relief. The oral surgeon prescribed vicodin for me after wisdom tooth removal. No one said a word about addiction or abuse. Same for my kids. I don’t see any real problem with prescribing it, but especially with minors a word to the parents about risks would be appropriate. In addition, if I had come back a couple of weeks later asking for more, wouldn’t that have been a medical issue the doctor should have been prepared to address?
Humans are complicated. Health care is complicated. I can see how people with chronic pain get nervous when this issue is raised, but not dealing with it up front is a problem, too.
We don’t seem to have the addict gene. Good for us. I know people who do, and have seen it ruin lives.
Oxycontin is oxycodone BTW.
But the story is the same. Drug companies add other meds like Tylenol to make a more soluble drug harder to use as an addict and discourage its use.
“There are potent pain meds without the euphoria but, understandably, people don’t like them as much”–
Fact: Addicts shun them but patients in pain don’t like them because they are less effective not because they don’t get high. A pain pill that doesn’t work is useless.
IF potent pain meds without addiction potential existed and severe pain was easily treatable using safe alternatives we would be using them and there would be no need for this discussion. The problem would already be solved.
Pain management isn’t black and white unfortunately. There are different types of pain–surgical pain, nerve pain, muscle pain are examples. They have different causes and different pathways in the body that cause the pain. And more than one type of pain can be present at a time. There are already pain management guidelines in place ( for years and years!!!) depending on type of pain, duration etc.
It doesn’t hurt less because she’s 13. So shouldn’t she have the same effective pain medicines that an older patient would receive?
I had hydrocodone after my gallbladder removal. It was a complicated surgery and I definitely needed the pain relief, but it made me so sick that I stopped taking it.
I’ve taken Vicodin, Oxycotin, Hydrocodone, Morphine, the list goes on. I don’t react well to most of them and they don’t work that well for me. So I haven’t found a combination that controls my chronic pain. It sucks.
Partyof5-- Your doctor did as he should. He followed standard practice. I’m sure he didn’t prescribe a month’s worth of pain meds for a 3 day stint (if he did that’s another story). If he had just said “take ibuprofen” and didn’t give an alternative if the pain got much worse (which it most often does) what would you say when your kid is up at 2 am in a lot of pain? And wisdom teeth removal is nerve pain (where narcotics are the answer in most cases). Wouldn’t you be calling him at 2am and say it isn’t working! Help me! ?
Would you tell your kid to “suck it up”? Real pain meds are only for grown-ups? I doubt it.
Nothing is black and white.
I don’t do well with narcotics, nauseated & asleep is how i am. I have had serious surgery and chosen to only take Ibuprofin to avoid the nausea. But many years ago I had severe cluster headaches & I would not want anyone in that kind of pain not to be able to get the medicine they need because the pendulum has swung the other way, though narcotics don’t work for me, they work for many. I have seen our society allow people to die in pain, then be free flowing with the meds, then back again.
My brother was a recovering alcoholic/drug addict. He was clean for many years. Then he was in a car accident &, had shoulder surgery, and was given opioids for pain. In the end, he was getting multiple prescriptions from multiple doctors. He tried really hard to stop using, even going to residential rehab twice in a very short period of time … and then he OD’d (and died).
1: Doctors should try less addictive methods of pain management for all patients before going to opioids.
2: Insurance companies should track opioid usage by a single patient (computers are a wonderful invention). It is possible my brother might have found other ways to get his drugs if the insurance company called him out, of course ... I don't blame them ... but it might help.
Romani–part of my concern is that media focus on "prescription pain use and we need all these guidelines to get rid of drug addicts! ( that we’ve already had for at least 30 years) is that it curtails pain management and research to an extent that patients suffer.
“So I haven’t found a combination that controls my chronic pain. It sucks.”–I wou
Yep, 30 days for each of us after wisdom tooth removal. We only got one of the prescriptions filled, used about 5-6 pills total among the 3 of us, and eventually dropped the rest off at a local drug drop-off event. So it was a non-issue for us, but it was very casual. DH got a 30 day prescription after an injury but never filled it, I think he had some previous bad experience with pain pills (nausea).
MomofJandL–well, that’s a problem then! But fortunately not for you.
And now guidelines for pharmacists might prohibit the filling of that Rx.
The cracking down on addiction and prescribers and limits on medication is NOT limited to “guidelines”. Nor is it something new. It is an on-going continuing education (and law) that spans physicians, pharmacy, and nursing.
Rest of the story–post 32
“So I haven’t found a combination that controls my chronic pain. It sucks.”–
I would maintain that you shouldn’t have to do your own research. It should already be part of a very large body of studies. And apparently it is not.
kelsmom–I’m really sorry about your brother. Truly.
I think addiction research would be more beneficial to more people than restricting pain meds.
And I’ll have to disagree on one point–computers are great but I don’t think insurance companies should be in charge of anything. They are the “black and white” companies and medicine is gray. They are not there to be your friend and save you–they are there as a business entity and make money.
A 30 day Rx is simply too much for oral surgery and something the new guidelines reflect. But, as ever, we need to watch the anecdotes because they can mislead. Of course there are people who abuse. And people who need relief. As someone mentioned (a few times,) this isn’t meant to block palliative. I think we need to recognize that palliative is a rather new subset of medicine.
If nothing is working for you, Romani, maybe you need a pain specialist. Sometimes, it can be a matter of when, with or without foods, or in combo with other things, on a cycle. I’m sure you know that. And, wish you the best.
But with the right attention, these meds aren’t being denied for legit use.
Because of someone near to me who abused, I’m generally medication averse. But I had oxy-something after major surgery and it was only a 7 day Rx. I did need an addl 7 days. But, even though the recovery was considered at least 4 weeks, like hell they were going to prescribe that much from the get-go.
ps. why would we assume the new discussion will prevent pharmacists from filling a needed Rx? My reading of the guidelines does not lead me there.
I read the comment to mean that the new guidelines would prevent pharmacists from filling my 30 day Rxs, which were probably inappropriate. I’m not sure they would, I thought they would just remind the oral surgeon that 30 days was too much.
And that’s the hard part here. Some physicians are way to free with the Rx pad. And some see us all as pill-seeking junkies faking our pain. Continuing education seems like a good thing here, but I’m not sure that the pendulum is in the same place everywhere we look, so it’s hard to figure out which direction to move it.
This is more as a guideline, a heads-up to clinicians. This concept is repeated throughout that they should start with a low dosage, having evaluated (or considered) the effectivity of non-opiods first. and start with a minimal time period.
“This guideline is intended for primary care clinicians.” “Prescriptions by primary care clinicians account for nearly half of all dispensed opioid prescriptions, and the growth in prescribing rates among these clinicians has been above average,”
Pharmacists can also prescribe, in some settings. I don’t see anything that sets limits on filling an Rx, though where I am, if a pharmacist disagrees, he or she will consult back with the doc or make a different suggestion.
I don’t see anything to be afraid of, in the CDC link. It’s a discussion of sorts.