Why would anyone take a medication where you have a 6% chance of becoming addicted after using it for only one day??
Sometimes there’s no good alternative for effective pain relief. That’s been true for several members of my family and for me. We live with chronic pain and it impacts our quality of life. We only take pain meds when it becomes impossible to sleep otherwise and nothing else has helped.
It’s too frequently assumed that acetaminophen or an NSAID will be adequate. The former doesn’t do enough and the latter is contraindicated for those of us with a history of bleeding ulcers. One of my kids was told in the hospital to respond to the pain rating question with a 9 or 10 if pain relief was really needed and not to act stoic. I’ve been told the same thing.
To me these numbers look fishy. I am wondering whether 6% of one-day prescriptions for opioids are prescribed to people who are addicted, which is very different from 6% of people who take opioids for one day being addicted (for example people who are already addicted will be looking for more, and if doctors are skeptical about the need they might just prescribe one day’s worth in order to get the patient out of their office).
I have had opioids (codeine) after getting stitches and after getting a tooth worked on, and have had a different opioid (percoset) after surgery a couple of times. My wife has had these also, as have multiple friends (including every adult I ever asked, which isn’t very many people since the subject does not normally come up). We never had any trouble at all and neither of us ever finished the original prescription.
I understand that there is a problem here. If we lived in a fully rational world then there would be research going on to find alternatives (probably including research into derivatives of marijuana). However, I am highly skeptical that a one day supply of codeine really gets 6% of users addicted.
On the other hand two young sisters both became addicted after one of them was prescribed an opioid for her pain due to a sports injury. One of them died later of an overdose. Apparently the second sister wasn’t warned about the dangers of addiction and thought it was okay for her to try her sister’s painkiller. I can’t imagine what this family is going through now.
There is a need to develop good courses at the middle school, high school, and college levels to educate the young about this problem.
Thought I’d mention that this study didn’t even consider the thousands and thousands of other opioid addicts running around the streets and buying opioids illegally.
“It’s too frequently assumed that acetaminophen or an NSAID will be adequate. The former doesn’t do enough and the latter is contraindicated for those of us with a history of bleeding ulcers.”
I have a friend whose daughter does liver transplants in children. He told me that half of her patients are due to acetaminophen. For someone with chronic pain and a history of bleeding ulcers, it is not at all clear what they should do.
HOLD ON! That study is NOT about addiction. That wasn’t part of it.
It’s about “long term use” associated with the amount of drug that was initially prescribed. A nice and hopefully tidy statistical study from which you can’t draw any firm conclusions.
It included all sorts of people needing pain relief for long term pain which includes back problems, surgery which takes a long time to heal–all sorts of things. They did discount cancer prescriptions.
It only says sometimes they got pain meds up to a year (or some instances three). Which is perfectly fine if you have pain for a year or three or longer. That STILL does not mean addiction nor prove illegal use.
The study showed a correlation between how large the initial prescription versus how long the patient took it.
Think about that. Perfect sense. The doc hopefully won’t give you a one day supply knowing you’ll probably need it for the next 12 weeks.
If the doc gave a long-acting opiate vs something short-acting, he probably figured you needed something that lasted at least through the night without break-through pain at 2am. And that you’ll be needing it for at least a certain longer duration than 3 days.
And yes, all these people who were in pain more than the few weeks or months they needed pain relief had multiple prescriptions filled. Of course. That also is not an indication of addiction or illegal use. That sounds like pain management.
The doc who gives you a 6 month supply for a toothache is a problem. The patient who has 6 docs all giving them pain meds has a problem (or a business).
Something else that left a bad taste in my mouth reading this article…the use of the word stash.
.“For patients who get a 30 DAY STASH (my caps) of opioid all at once for their initial prescription, the chance of being on opioids for a year rose to 45 percent. But, Martin says, getting that much in one go is uncommon. Only about seven percent of patients get such long-duration prescriptions in the study. Most people get about a week’s worth at a time.”
I don’t think patients who need pain meds think of their pain relief medicine as a STASH. That’s for addicts waiting for their next fix who don’t know where it will come from. That’s the author of the article looking for an alarming story.
And if you follow the next line, Martin says that is uncommon for a supply. A week at a time is usual (which may lead more often to multiple scripts which tends to set off alarm bells in other studies).
The actual study is here: https://www.cdc.gov/mmwr/volumes/66/wr/mm6610a1.htm
As gouf78 said, they studied whether someone who got an initial prescription was still taking legally prescribed opioids a year later. They did not include people who had already been taking opioids, people who had previously taken some kind of drug that indicated addiction treatment, or people who had cancer.
The study was huge: 1.3 million people. Of the people who got even one single pill, 2.6% were still taking opioids legally a year later. Of the people who had at least one day of prescription (rather than just a single pill, I guess), 6% were still taking opioids legally a year later. Of the people who had more than 7 days in the initial prescription, 13.5% were still taking opioids a year later.
This study is underestimating the number of people still taking opioids a year later. It doesn’t include those who got addicted to legal drugs legally prescribed, were cut off, and then turned to illegally obtained prescription drugs or heroin.
I have never encountered surgical patients or people on short term pain relief who have become addicted.
They take the meds because they hurt. And then stop. Normally, they don’t even get a high (some just feel sick)–guess the pain keeps them grounded. They get sleepy --but they need the sleep. Chronic pain works similarly–nobody cares about a “high” they are happy to be out (or at least tolerate) the pain. The body adjusts to side effects and builds tolerance. The pain relief is needed for daily functioning.
A person on long term opiate use will have withdrawal (at least physical symptoms) if they need to get off them which will have to be dealt with. It is a major concern that needs to be dealt with. Physical symptoms are short term, psychological addiction is harder. Everyone is different.
But long term pain WITHOUT relief has major problems also. Long term untreated pain leads to low levels of serotonin in the brain. That causes major depression and can lead eventually to suicide.
Cardinal–I’m not even looking back–even at the worst none of your stats is 20 per cent.
Of the people whose first prescription was >10 days, ~20% were still using a year later.
“I have a friend whose daughter does liver transplants in children. He told me that half of her patients are due to acetaminophen”
It’s so true which is one reason they don’t make acetaminophen infant drops anymore. No more liquid acetaminophen in children’s formulations because it was a major problem in overdose situations.
Toxic doses of acetaminophen lead to irreversible liver failure. There are some drugs as an antidote but they aren’t that great and require immediate treatment (and awful). I don’t wish it on anybody.
Even as an adult watch drinking alcohol (which affects liver pathways–don’t combine with acetaminophen) or combining cold medications (many have acetaminophen as a component which can lead to high doses).
All these drugs (aspirin, ibuprofen, acetaminophen) have different ways that the body filters them. NONE are good in an overdose situation but acetaminophen is a major culprit for liver failure.
“Of the people whose first prescription was >10 days, ~20% were still using a year later.”
So?
It means EIGHTY per cent did NOT use it over a year. (good news!)
And having the Rx for more than 10 days initially most likely meant they had a medical condition which warranted it. It has nothing to do with addiction rates–it’s just numbers.
Just because you use pain medication for a certain number of days doesn’t mean the pain disappears on a permanent basis. Not for chronic pain.
It’s not an antibiotic that you take 14 days until the disease goes away and you should feel better.
So 30,000 people died in the US last year from opioid overdoses. Many more are addicted to opioids.
This is destroying people’s lives, and we need to maker sure that the people who are being prescribed opioids are people who need opioids. In the past, some emergency room doctors were handing out opioid prescriptions like candy. People on this board have reported receiving opioid prescriptions or having their kids receive opioid prescriptions that either seemed unnecessary, or seemed to be for a longer duration than necessary.
I might be misinterpreting, gouf78, but it sounds to me like you do not think overprescription of opioids is a problem we should be concerned about. I think it IS a problem we should be concerned about.
Three sides to every coin.
Addicts.
Patients who need pain meds.
Patients who get helped through research for something other than pain.
I am not about to lobby to restrict the rightful need to pain medication for anybody because somebody else decides to abuse it or make an extra buck (or millions). I’ll leave that to the feds. That’s what they do.
But? I’m mad. I’m upset Israel has been studying marijuana for 30-40+ years (not just Israel–there are other countries but NOT the US) while we spend high tax dollars not in medicinal research but how to stop anybody from “getting high” and worrying about addiction. I see it as 40 -50 years of lost research. On a ton of fronts. Both medicinal use AND addiction. You can’t study EITHER without approval.
The US is sitting in a position that the people with the MOST research experience in opiates are those selling it for profit in an illegal drug market. I’m sure there are some “approved studies” somewhere but not nearly enough to make a true dent in the social landscape.
I now read how marijuana (oils and derivatives) are very promising in studies for autistic kids, how it decreases multiple seizures, etc. etc. and (surprise?) all the research is from other countries. That’s a travesty. The US moral compass prohibits science in these areas.
"In the past, some emergency room doctors were handing out opioid prescriptions like candy. "
And now you have our current local scenario from about four years ago…news reporter (well-known, about 50 years of age and father of three) sat in the ER untreated for about 4-6 hours for kidney stones at 2 AM because they thought he was a drug addict.
At the time all he knew was they weren’t helping and didn’t know what to do…
Bumping this for this: http://www.cnn.com/2017/07/06/health/opioid-prescriptions-cdc/index.html
Opioid prescriptions dropped but remain high, CDC says
quoteOpioids continue to be prescribed at high rates, a new report from the US Centers for Disease Control and Prevention finds, even as drug overdoses remain the leading cause of accidental death in the country, killing more people than guns or car accidents.
The report found that opioid prescriptions overall decreased 18% from 2010 to 2015. However, the number of prescriptions in 2015 was three times higher than in 1999 and four times higher than opioid prescription rates in Europe.
[/quote]
A real question is what percentage of people end up with chronic pain where they would need opiods for pain management (and personally, I sympathize with people with chronic pain conditions, from what I have seen medicine is still in the equivalent of the stone age when it comes to pain management, they don’t understand the causes and haven’t worked out anything but the blunt force trauma of doping someone with heavy duty painkillers that hasn’t changed much in the last 100 years…). About 11% of adults suffer with chronic pain conditions according to one NIH study and of that, roughly a third of that 11% had severe chronic pain. I don’t think anyone is advocating cutting off pain medication like Opiods to those who need it, someone with chronic, hard pain deserves relief,
That said, though, the numbers don’t tally, if you look at the kinds of cases where opiods are being prescribed that I think tells the story. Do some people who need it get denied it, like the guy in the ER with kidney stones? I have no doubt that goes on, but tracking of opiod prescriptions, the sheer numbers, say that it is being overprescribed. I hear stories like ‘I was prescribed opiods, took them, never got hooked’ but those are like the stories of grandpa that smoked 3 packs of luckies a day and died at 92, it is trying to use on case to prove the many, with addictions people have different levels of getting addicted. It is going to be interesting to see what happens with the many states that are now suing the pharmaceutical companies who produce these drugs, states AG’s are saying that the drug companies claims on safe levels of usage were way higher than the data indicated and were telling doctors basically there was no problem using higher dosages for longer and this has led to a lot of the people who become addicted. And a key thing those citing long term usage of legal prescription opiods (which show low numbers with continuing use) is that many of those who get addicted through legal use often end up switching to illegal sources when they no longer can get prescriptions, whether it is street selling of opiods, like synthetic versions of fentanyl that until recently was coming from China, or drugs like heroin. What makes it worse is that heroin these days is a lot more potent and cheap then it was 40 years ago which makes it easy for someone hooked on legal opiods to ‘switch’ to fill their needs.
And yes, I have seen doctors giving out prescriptions for opiods like candy, I have had routine ,medical procedures done where they prescribed things like Oxycontin (talking things like laparoscopic gall bladder surgery, sinus surgery to clean out an infected sinus), and both times they gave me prescriptions for it (I took advil for both and was fine). The parm companies have pushed these as miracle pain relievers, and basically there have been little to no control over the way they were prescribed it looks like, which given the nature of these drugs. One kind of control that would work is if prescriptions for these kinds of drugs have to be processed electronically and state health authorities can look at how many prescriptions doctors are writing, so they can spot people like the doctor here in NYC who is credited with having put like 6 million doses in the black market, or doctors who simply are freely writing these because of their ties to the pharm reps and the like.
A new federal study indicates 142 Americans die from opioid misuse every day. In 2015, 1 out of 3 Americans were prescribed or used them. 11.5 million misused them, and almost 2 million became addicted to them.
Two doctors on television indicated we can’t always predict who will become addicted to them. One suggests stopping using them after three days when prescribed, while the other one indicated seven days. It’s a long difficult journey back to good health once you cross the line. Now synthetic fentanyl is coming here from Mexico and China.
What, if anything, are we doing about this epidemic?
@tonyk:
I hear a lot of hot air, I see public service messages where some young woman is talking about her descent into hell of opiod addiction and then gives a phone number someone can call for help. I also have heard the typical law and order types saying we have to declare a new war on drugs which basically includes arresting abusers and putting them in jail, the same tired policy we have had for so many decades, and it failed then and it will fail now. One of the things that I see is that tracking of legal use of opiods is lacking, for example there isn’t a universal requirement that with these drugs prescriptions have to be done electronically and copies of the prescriptions be submitted to government regulatory agencies to be able to see, for example, if doctors are in fact writing these too often or worse, as seems to happen quite frequently in the NYC area, health practicioners busted for writing prescriptions for millions of doses of these in a given year that basically are being sold to drug dealers to fill and sell on the streets. Legal opiods seem to be the gateway to heroin and other illegal forms of these. That alone won’t stop it, but it is something.
We also need a heck of a lot more treatment centers and options, there are a lot of places in this country where there is basically no treatment available to people who have gotten hooked, and between the financial cost and also, quite sadly, politicians and people who basically are saying “they chose to become addicts, let them face the consequences”, the answer is little is being done.
There are also things like requiring that international packages, which have been used by drug gangs buying from places overseas things like synthetic fentanyl (the Chinese have cracked down on this supposedly), the worse offender apparently is USPS which does not check packages for illegal drugs, UPS and Fedex supposedly do. Pressure pointing drug gangs might help a bit, if they can get the street price up (one of the big problems is heroin is these days is not only cheap, but a lot stronger than it was back in the day), but it likely won’t change the dynamics, it needs to be on the demand side, and that takes preventing people from getting hooked and then in getting them off of it, going after only the source is likely to fail, but images of swat teams taking down drug gangs, undercover drug teams busting up a drug ring and the like looks great on the news as proof we are ‘doing something’, treatment and the demand side is not.
https://fivethirtyeight.com/features/opioid-prescriptions-across-the-u-s/ shows a map of opioid prescriptions per capita in 2015 and change over 2010-2015 by county.