There are many euphemisms commonly used in substance abuse - “self-medicating”, “scoring”, etc. Obtaining opiates from doctors for the purpose of abuse typically requires lying, malingering, and sometimes fraud. Obtaining them from the street requires lots of money, willingly breaking the law, stealing, prostitution, and so on. Those behaviors are no doubt “easy” for some types of people but an average decent person would consider those behaviors anything but easy.
“deliver a box of with donuts and other treats carefully arranged to spell out the word “OxyContin.” The surprise gift won over the doctor, who began prescribing OxyContin. “We are pleased that we have such a sweet start in developing a relationship with this ‘no-see’ physician,” the sales reps later wrote, “and we’re looking forward to sweet success with OxyContin!””
If someone who is on hospice services at their time of death, when whoever it is that comes out from hospice to pronounce the death and call the funeral home or crematory, they ‘waste’ any narcotics left in the house. It used to be done down the drain or toilet, but now they either dispose of them in cat litter they carry around in their car, or coffee grounds. And they have to document exactly how much was disposed of. I’d say 95% of narcotics leftover when someone dies are in liquid form as imminently dying patients can’t swallow pills. So it’s easy to waste the leftovers. In all the times I attended a death, only one time did we have a family member that we were concerned was going to try to use any of the leftovers, and it was a family member (actually, an ex-wife, who despite being an ex, stepped up to the plate and cared for her ex-husband because he had no one else to care for him) who was so distraught we almost called 911 for her. But yea, she asked another family member to ask us if she could use some of the leftovers. Of course we said no, and kept our eye on them until we could properly dispose of them. But we only were responsible for disposing of the narcotics our pharmacy provided, so if there were narcotic pills that had been prescribed before hospice got involved, and they hadn’t been thrown out, someone ‘could’ steal them.
Again, if they are on hospice, the patient’s nurse keeps tabs on how often narcotics are being refilled, and if it’s more often than could be justified based on how often it can be given because it’s possible someone is stealing them, then the clinical staff will have a serious confrontation with the patient and their caregiver. And they are typically only prescribed enough to get them through 3-4 days, so there are pharmacy deliveries usually twice a week. If a family is requesting refills more often, then it would require a nurse visit to determine whether the pain is being managed properly or not.
On the other hand, it was just absolutely disheartening to see people really in pain when they refused to take narcotics because they didn’t ‘want to get addicted’. I kid you not. My own grandmother was one who refused to take morphine because of this… at 101 1/2 years old, with metastasized ovarian cancer. Yes, this is the conundrum of our culture - we need to keep it away from those who could abuse it, yet make it crystal clear there are times when nothing else could be more appropriate.
My mother wouldn’t take narcotics because they made her so out of it and she didn’t want to spend her last days not even being cognizant.
It really varies - my dad had metastasized lung cancer, which had gone to his brain before they diagnosed it; the only reason they did the work up is because he was having seizures in his hand. Once they got him on appropriate anti-seizure medication, he had no pain issues, or breathing issues until the last 24-36 hours, at which point he had declined so much, being cognizant wasn’t going to be possible since he was sleeping so much. Once he was sleeping, yet showing non-verbal signs of pain and agitation, we started giving him the morphine and he was very comfortable.
There are strategic ways to administer pain meds and allow people to still be somewhat cognizant, and there are lots of pain meds to try - people react differently to different ones. I’m really talking about people who are in the final hours and days where the pain and anxiety are so great, there is no possibility of being cognizant. Why would someone worry about becoming addicted then? Obviously because of the stigma our culture has placed on narcotics across the board.
I have an aunt who died last year of metastasized ovarian cancer, who did not respond well to narcotics and did not like not feeling in control (she was a tough cookie- spent a couple of years in a TB sanitarium when she caught TB as an army nurse). However, when the aides came three days a week to give her a bed bath, or at times when she needed to be moved to minimize the risk of bed sores, she did agree to small doses so the pain of being moved wasn’t quite so intense. They don’t have to be given around the clock (some people choose to take them only at bedtime so they can sleep well), but mostly, this is the last time people should deny pain relief out of a fear of becoming addicted. If they don’t want it for other reasons, fine, but let’s not stigmatize treating dying people with dignity.
EDITED TO ADD:
Sometimes people’s pain levels are increased due to anxiety about dying, and just giving them something for their anxiety can help with pain, without resorting to the strongest narcotics.
Both of my children had surgery in the last year and I was kind of shocked at the level of pain killers that were prescribed.
My son’s lower arm got pretty mangled in a hockey game and he had to have plates put in. After surgery his surgeon told him he would be in a lot of pain and prescribed a 10 day supply of Oxycontin. He has a very high threshold for pain and didn’t take them – said Motrin did the trick. I was happy and tossed the Oxy.
Then 8 months later he was hit against the boards so hard in another game that 2 screws in the plates came loose and were lodged in his bone. He was in excruciating pain and had to be taken immediately to the ER. They needed time to prep him for the surgery so they gave him a huge dose of liquid Oxy on arrival which he promptly threw up. They then put him on a morphine drip. After the surgery they again prescribed the Oxy. He only took it for 2 days and said it made his brain feel “weird.” Switched him over to Motrin again and he was fine.
D had her tonsils removed last May and she was also prescribed Oxy for recovery. After the 3rd day on it she said her body felt “polluted.” She stopped taking it but I think she suffered a bit.
I guess the good news is that neither of my children liked the way they felt on the drug.
When D1 had surgery for a broken ankle, I tried to explain as best I could what to expect in the hospital. Shortly after coming back to her room, she began to sob. I said, “Honey, what’s wrong? Are you in pain?” She said, “No. But I’m so confused…did I have a stroke or something?” I had forgotten to tell her that the pain meds would make her feel strange and disoriented. Once she understood it was the medication, and not something wrong, she calmed down and went to sleep. You’d think being a nurse, I would have thought to tell her that, but I guess I just figured everyone knew that anesthesia and narcotics can cause that woozy, foggy feeling.
I’m sorry, am I missing something here? EMTs should not revive a 50-year-old addict? What can you possibly be saying here? Many addicts recover from their addiction and go on to lead productive lives. Recovery is not rare, not a once-in-a-blue-moon kind of thing. I am unable to fathom anyone saying that we should let overdosing addicts die.
It is rampant here, and apparently there they are lacing the heroin with carfentanil(an elephant tranquilizer). Last month there were 174 overdoses in 6 days. It is out of control. So many folks are shooting up, and driving. There was a couple that od’d in their childs room at the Childrens Hospital. Apparently with them lacing the heroin with other things one shot of Narcan isnt doing the trick, it takes multiple doses. Narcan is now available in our area without a prescription.
Narcan and clean needles should be available freely and anonymously. It’s way cheaper than keeping them from people.
I don’t know about free Narcan being cheaper - and even if it is whether it is desirable or where it ends. Free needles, free Narcan, free HIV and Hep C testing, free treatment of Hep C ($60,000+), free drug treatment, free second third fourth nth round of drug treatment… Somehow, the drugs are always without fail 100% affordable to the user but absolutely none of the rest of it is affordable - yet affordable to the rest of us.
With these things, you reduce the rates of HIV, Hep C, etc. That’s the whole point.
Will you eliminate these things? No. Will you reduce the rates? Yes.
The cost to society of drug addicted newborns (among other things) is more costly than the stuff mentioned in post #49. It’s important not to be penny wise and pound foolish. It’s going to cost society whether or not we deal with it or not. What I do know is that the current and past protocols have been very useless.
Kind of. Drug treatment does not reduce the incidence of drug addiction. It helps reduce the impact. Treatment of Hep C does not reduce the incidence - it occurs after the fact. Narcan does not reduce the incidence of opiate overdoses - it forestalls death. Free needles might reduce the incidence of infectious disease in drug addicts and those they infect - but it also facilitates addiction. There is no free lunch in dealing with drug abusers - society I guess determines how much it is willing to pay to tolerate, mitigate, litigate, and treat drug addiction.
It does if it works. One successful drug treatment = one less addict. Of course, drug treatment doesn’t always work, but it sometimes works.
You are talking about the prevalence of drug addiction, not the incidence as I mentioned.
As an addiction physician and an anesthesiologist, I’ve found myself on both ends of the spectrum. I am the opioid administrator in chief and the opioid rehabilitator in general. So many of my deeply held beliefs have been shattered the moment I started caring for opioid addicts. These individuals are not weak minded and the majority became addicted through their good intentioned physicians. In addition, many have psychological and psychiatric diseases. There are a few things I can advise based on what I’ve seen:
- Minimize the use of narcotics after surgery or injury. I would say 1 - 3 days if best and definitely try not to exceed a week. The longer you are on opioids the higher the risk of addiction
- Addiction is subtle. If you suspect it, treat it.
- Addiction is a lifelong disease. The brain changes and don't ever think for one second that a successful drug treatment means that the person is cured.
- Treat the psychiatric and psychological disorders to make rehabilitation successful. I have found that anxiety disorder to be the worse co-morbid disease to have along with addiction. Managing the opioid addiction has been easy but successfully treating anxiety disorder has been very difficult in the majority of my patients. That disorder causes frequent relapses.
That sent me off to Google.
Incidence is the number of people who have ever had the condition.
Prevalence is the number of people who have the active condition now.
We care about both of these things. We don’t want people to become addicts. If people are addicts, we want to enable them to stop using.
I think it’s easy for people to talk about “addicts” as though they are a monolithic group of “weak” people.
These are people who have, generally, never actually been around/worked with people with addictions.
I assume you are referring to me for using the term “addicts.” You assume too much. I work with them every day. They are certainly not weak people. They are among the most strong willed, creative, clever, cunning, relentless people around.