Call it marijuana....don't call it medicine

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Fair enough.

If we assume there will be some direct negative consequences of legalization, at what point are the positive consequences outweighing the bad? The massive influx of tax revenue to schools and other underfunded programs, decreased incarceration rates and the associated expenses, decreased opioid addictions/deaths (the studies are in on this one), the list goes on.

Let me pose it in another way... is it a bit disconcerting to know that two of the largest anti-legalization lobbyists are coming from Big Pharma, particularly those with a vested interest in opioid drugs... and the alcohol industry? Could it be they foresee their market share shrinking if MJ was made legal? If legal pot gets more people off pills and drinking less alcohol, I think this is a good thing and reason enough to deal with any negative consequences legal pot brings.

One last point. You make the assumption that an individual who refuses to use pot simply because it's illegal would then use the drug and... do what exactly? Break a different law, like drive intoxicated? I guess I'm not sure what you are assuming this person will do once she/he tries legal pot. He's already shown he won't break a law. So if we can safely assume this person will continue refraining from breaking laws, are you just afraid of him trying pot?

And FWIW, Portugal and some of the Northern European countries have seen a decrease in use after legalization/decriminalization efforts were made (this includes harder drugs too). They have a sound model which appears to be working...I wouldn't automatically assume legalization = free for all drug use.
we have a privileged nation of drug abusers period... MJ is just another illicit drug ripe for abuse. Most of us have written Marinol for dying cancer patients and AIDS wasting syndromes for years. Cachexia and wasting dying patients should have access to THC. A physician cannot translate this medicinal usage to the general population or bogus medical indications like ptsd. There are many neuropsychological consequences from MJ and more public health studies are necessary prior to wide spread use. As for assumed direct consequences, we know at "legal" levels of MJ Vs. etoh usage; the MJ patient causes 1.5 times more accidents as confirmed by the CO dept of transportation data.... Youre a doctor, stop listening to the liberal progressive nonsense and read the literature .

As for recreational use and jail time, give warnings, allow leniency at 2g or less like some states do. Don't allow serial violators.

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Marinol is lousy for pain, all THC and no CBD.
Sativex has a nice 50:50 ratio but is not available in the USA and will be very expensive when it is available.
 
Marinol is lousy for pain, all THC and no CBD.
Sativex has a nice 50:50 ratio but is not available in the USA and will be very expensive when it is available.
THC has been studied for wasting syndromes; AIDS and malignancy. Thus I use it. Never said its for pain. I believe opioids work much better than MJ for malignancy pain, including IT pumps(which I implant by the way). Although I would be likely to agree to CBDs for a dying patient, just not general non malignancy mediated pain. See my point , we are substituting MJ as the next paradigm/excuse for Non malignant pain... Let's review this thread in ten years time...we keep on repeating our societal mistakes.
 
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I'll agree with others here that marijuana does nothing for pain. It does wonders for muscle/GI spasms, tremors and seizure disorders. With everything else on the market, the utility is best in the right patient but greed has allowed significant abuse. I'm seeing medical marijuana being offered for anything and everything without any other management being offered.

For now I'm tired of the diffuse pain patients on disability. And forgodsake stop diagnosing 'migrating CRPS' and fibromyalgia on any patient who doesn't realize that weak muscles are supposed to ache after working/living life. Its getting difficult to sit there with a straight face while they tell me how everyone misdiagnosed them until one fine doctor told them that the cause of their pain was fibro/chronic pain syn/migrating crps.
 
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http://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.2016.303426

ABSTRACT


Objectives. To assess the association between medical marijuana laws (MMLs) and the odds of a positive opioid test, an indicator for prior use.

Methods. We analyzed 1999–2013 Fatality Analysis Reporting System (FARS) data from 18 states that tested for alcohol and other drugs in at least 80% of drivers who died within 1 hour of crashing (n = 68 394). Within-state and between-state comparisons assessed opioid positivity among drivers crashing in states with an operational MML (i.e., allowances for home cultivation or active dispensaries) versus drivers crashing in states before a future MML was operational.

Results. State-specific estimates indicated a reduction in opioid positivity for most states after implementation of an operational MML, although none of these estimates were significant. When we combined states, we observed no significant overall association (odds ratio [OR] = 0.79; 95% confidence interval [CI] = 0.61, 1.03). However, age-stratified analyses indicated a significant reduction in opioid positivity for drivers aged 21 to 40 years (OR = 0.50; 95% CI = 0.37, 0.67; interaction P < .001).

Conclusions. Operational MMLs are associated with reductions in opioid positivity among 21- to 40-year-old fatally injured drivers and may reduce opioid use and overdose. (Am J Public Health. Published online ahead of print September 15, 2016: e1–e6. doi:10.2105/AJPH.2016.303426)
 
http://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.2016.303426

ABSTRACT


Objectives. To assess the association between medical marijuana laws (MMLs) and the odds of a positive opioid test, an indicator for prior use.

Methods. We analyzed 1999–2013 Fatality Analysis Reporting System (FARS) data from 18 states that tested for alcohol and other drugs in at least 80% of drivers who died within 1 hour of crashing (n = 68 394). Within-state and between-state comparisons assessed opioid positivity among drivers crashing in states with an operational MML (i.e., allowances for home cultivation or active dispensaries) versus drivers crashing in states before a future MML was operational.

Results. State-specific estimates indicated a reduction in opioid positivity for most states after implementation of an operational MML, although none of these estimates were significant. When we combined states, we observed no significant overall association (odds ratio [OR] = 0.79; 95% confidence interval [CI] = 0.61, 1.03). However, age-stratified analyses indicated a significant reduction in opioid positivity for drivers aged 21 to 40 years (OR = 0.50; 95% CI = 0.37, 0.67; interaction P < .001).

Conclusions. Operational MMLs are associated with reductions in opioid positivity among 21- to 40-year-old fatally injured drivers and may reduce opioid use and overdose. (Am J Public Health. Published online ahead of print September 15, 2016: e1–e6. doi:10.2105/AJPH.2016.303426)
This study is nonsense.... Fatally injured? So if you're paralyze or you just maim others you wouldnt meet criteria. This antithecal to CO dept of transporting data
 
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http://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.2016.303426

ABSTRACT


Objectives. To assess the association between medical marijuana laws (MMLs) and the odds of a positive opioid test, an indicator for prior use.

Methods. We analyzed 1999–2013 Fatality Analysis Reporting System (FARS) data from 18 states that tested for alcohol and other drugs in at least 80% of drivers who died within 1 hour of crashing (n = 68 394). Within-state and between-state comparisons assessed opioid positivity among drivers crashing in states with an operational MML (i.e., allowances for home cultivation or active dispensaries) versus drivers crashing in states before a future MML was operational.

Results. State-specific estimates indicated a reduction in opioid positivity for most states after implementation of an operational MML, although none of these estimates were significant. When we combined states, we observed no significant overall association (odds ratio [OR] = 0.79; 95% confidence interval [CI] = 0.61, 1.03). However, age-stratified analyses indicated a significant reduction in opioid positivity for drivers aged 21 to 40 years (OR = 0.50; 95% CI = 0.37, 0.67; interaction P < .001).

Conclusions. Operational MMLs are associated with reductions in opioid positivity among 21- to 40-year-old fatally injured drivers and may reduce opioid use and overdose. (Am J Public Health. Published online ahead of print September 15, 2016: e1–e6. doi:10.2105/AJPH.2016.303426)

I was hoping legalized MJ for medical reasons would decrease narcotic usage. Haven't seen this in real life, just some fantasy journal articles.
 
Health Aff (Millwood). 2016 Jul 1;35(7):1230-6. doi: 10.1377/hlthaff.2015.1661.
Medical Marijuana Laws Reduce Prescription Medication Use In Medicare Part D.
Bradford AC1, Bradford WD2.
Author information

Abstract
Legalization of medical marijuana has been one of the most controversial areas of state policy change over the past twenty years. However, little is known about whether medical marijuana is being used clinically to any significant degree. Using data on all prescriptions filled by Medicare Part Denrollees from 2010 to 2013, we found that the use of prescription drugs for which marijuana could serve as a clinical alternative fell significantly, once a medical marijuana law was implemented. National overall reductions in Medicare program and enrollee spending when states implementedmedical marijuana laws were estimated to be $165.2 million per year in 2013. The availability of medical marijuana has a significant effect on prescribing patterns and spending in Medicare Part D.
 
Health Aff (Millwood). 2016 Jul 1;35(7):1230-6. doi: 10.1377/hlthaff.2015.1661.
Medical Marijuana Laws Reduce Prescription Medication Use In Medicare Part D.
Bradford AC1, Bradford WD2.
Author information

Abstract
Legalization of medical marijuana has been one of the most controversial areas of state policy change over the past twenty years. However, little is known about whether medical marijuana is being used clinically to any significant degree. Using data on all prescriptions filled by Medicare Part Denrollees from 2010 to 2013, we found that the use of prescription drugs for which marijuana could serve as a clinical alternative fell significantly, once a medical marijuana law was implemented. National overall reductions in Medicare program and enrollee spending when states implementedmedical marijuana laws were estimated to be $165.2 million per year in 2013. The availability of medical marijuana has a significant effect on prescribing patterns and spending in Medicare Part D.


"Using data on ALL prescriptions filled from MedicareD" doesn't really give me any information about effects on NARCOTIC usage.

Can you show me studies of patients showing a large decrease in narcotic usage in states with legal MJ?
 
Health Aff (Millwood). 2016 Jul 1;35(7):1230-6. doi: 10.1377/hlthaff.2015.1661.
Medical Marijuana Laws Reduce Prescription Medication Use In Medicare Part D.
Bradford AC1, Bradford WD2.
Author information

Abstract
Legalization of medical marijuana has been one of the most controversial areas of state policy change over the past twenty years. However, little is known about whether medical marijuana is being used clinically to any significant degree. Using data on all prescriptions filled by Medicare Part Denrollees from 2010 to 2013, we found that the use of prescription drugs for which marijuana could serve as a clinical alternative fell significantly, once a medical marijuana law was implemented. National overall reductions in Medicare program and enrollee spending when states implementedmedical marijuana laws were estimated to be $165.2 million per year in 2013. The availability of medical marijuana has a significant effect on prescribing patterns and spending in Medicare Part D.
Retrospective review study... Nonsense. Sounds like you want to advocate MJ based on limited data. Looks like another abuse epidemic on the horizon . ... Youre the next portnoy .
 
Retrospective review study... Nonsense. Sounds like you want to advocate MJ based on limited data. Looks like another abuse epidemic on the horizon . ... Youre the next portnoy .

LOL I notice 101N will use non level 1 evidence for things he likes like MJ.

Interesting how that works huh?

Got any level one evidence for MJ 101N?
 
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I don't have a dog in either the marijuana or procedure over-utilization fight:)
 
I don't have a dog in either the marijuana or procedure over-utilization fight:)

You claim that that you dont have a "dog in the fight" but your "evidence" demands prove otherwise.

Once again, why are you promoting MJ without level one evidence? I notice you are willing to accept retrospective reviews for MJ though huh?
 
I'm only poking you and Stim:) You guys are lunatic fringe.
 
I know patients that were damn near unable to function in society with opiates that are fine utilizing medical marijuana. The results, for some, speak for themselves. Plus I've never known someone to die from medical marijuana, while opiates- well, ya know...

Plenty of people "die" from MJ over the longer term.

Your argument could be made that no one has ever overdosed on cigarettes either so no one ever "dies" from cigarettes right?
 
I'm only poking you and Stim:) You guys are lunatic fringe.

Are you though? I notice you continue to cite retrospective analyses for MJ and CBT or other things you seem to like.
 
Plenty of people "die" from MJ over the longer term.

Your argument could be made that no one has ever overdosed on cigarettes either so no one ever "dies" from cigarettes right?
[citation needed]

We have comprehensive studies proving cigarettes have a serious effect on morbidity and mortality. All studies to date have shown no link between marijuana consumption in non-cigarette smokers and cancer, despite several studies being done in this area. As to all-cause mortality, no data currently exists that I know of. Without data, it's hard to argue your point.
 
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Jack:
I'm glad you're here but it's clear you're slumming.
 
[citation needed]

We have comprehensive studies proving cigarettes have a serious effect on morbidity and mortality. All studies to date have shown no link between marijuana consumption in non-cigarette smokers and cancer, despite several studies being done in this area. As to all-cause mortality, no data currently exists that I know of. Without data, it's hard to argue your point.

The onus is on the MJ supporters to provide "level one" evidence that it actually works for chronic pain, back pain, etc compared to placebo/alternatives.

Also, the American Lung Association also believes MJ smoke is harmful on lungs: http://www.lung.org/stop-smoking/smoking-facts/marijuana-and-lung-health.html
 
The onus is on the MJ supporters to provide "level one" evidence that it actually works for chronic pain, back pain, etc compared to placebo/alternatives.

Also, the American Lung Association also believes MJ smoke is harmful on lungs: http://www.lung.org/stop-smoking/smoking-facts/marijuana-and-lung-health.html
I don't think it should fall under the same regulatory mechanisms as pharmaceuticals- I think it should be decriminalized and dealt with like any other plant or herbal supplement. The onus in that regard is for regulators to prove that it poses a substantial enough risk to public health to limit consumption, which would be difficult to establish if it were compared to alcohol or tobacco.

https://www.ncbi.nlm.nih.gov/pubmed/24947688
 
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I don't think it should fall under the same regulatory mechanisms as pharmaceuticals- I think it should be decriminalized and dealt with like any other plant or herbal supplement. The onus in that regard is for regulators to prove that it poses a substantial enough risk to public health to limit consumption, which would be difficult to establish if it were compared to alcohol or tobacco.

https://www.ncbi.nlm.nih.gov/pubmed/24947688

Yeah thats a different story.

People are talking about "medical MJ" and its benefits.

If you think legalization of all drugs that can be potentially harmful is fine under some liberal utopian ideal, that would be more honest.

Also your study you linked shows: "Compared to nonhabitual or never users, the summary OR was 0.88 (95%CI: 0.63-1.24) for individuals who smoked 1 or more joint-equivalents of cannabis per day and 0.94 (95%CI: 0.67-1.32) for those consumed at least 10 joint-years. For adenocarcinoma cases the ORs were 1.73 (95%CI: 0.75-4.00) and 1.74 (95%CI: 0.85-3.55), respectively."

Sounds like for a small amount of MJ for a short period of time (only 10 years at 1 joint), there was a big increase in adenoCA.

Also, the numbers in the study are extremely low with no control on the potency of the THC, higher dosages of THC for longer periods of time, etc.

Here's more literature on the subject:

http://www.cancerresearchuk.org/abo...-questions/does-smoking-cannabis-cause-cancer
 
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I don't think it should fall under the same regulatory mechanisms as pharmaceuticals- I think it should be decriminalized and dealt with like any other plant or herbal supplement. The onus in that regard is for regulators to prove that it poses a substantial enough risk to public health to limit consumption, which would be difficult to establish if it were compared to alcohol or tobacco.

https://www.ncbi.nlm.nih.gov/pubmed/24947688

Here's another article linked from New Zealand that suggests one joint can equal 20 cigs in terms of risk for Lung CA:

http://www.medpagetoday.com/psychiatry/addictions/8096
 
Here's another article linked from New Zealand that suggests one joint can equal 20 cigs in terms of risk for Lung CA:

http://www.medpagetoday.com/psychiatry/addictions/8096
Single study from 2008 versus my meta analysis from 2015, truly the evidence is on your side.

http://www.hhs.gov/sites/default/files/Factsheet-opioids-061516.pdf

Here's a good one- 78 people die of opiate overdoses each day, 60% of which are caused by prescription opioids. That adds up to 17,082 deaths directly caused by prescription opioids per year if we assume zero of the remaining forty percent initially got hooked on prescriptions, which is unlikely but I'm being kind. That's nearly as many people dying from these drugs as there are dying from esophageal cancer each year, and more than the number of people killed in intentional homicides each year by a good margin. So, while we don't have solid data on the deaths caused by marijuana, we do have it on opioids, yet people defend them to the death despite a lack of strong evidence for their use in many chronic pain conditions. It's almost as if there's some bias towards one and a stigma against the other being exhibited...
 
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Single study from 2008 versus my meta analysis from 2015, truly the evidence is on your side.

http://www.hhs.gov/sites/default/files/Factsheet-opioids-061516.pdf

Here's a good one- 78 people die of opiate overdoses each day, 60% of which are caused by prescription opioids. That adds up to 17,082 deaths directly caused by prescription opioids per year if we assume zero of the remaining forty percent initially got hooked on prescriptions, which is unlikely but I'm being kind. That's nearly as many people dying from these drugs as there are dying from esophageal cancer each year, and more than the number of people killed in intentional homicides each year by a good margin. So, while we don't have solid data on the deaths caused by marijuana, we do have it on opioids, yet people defend them to the death despite a lack of strong evidence for their use in many chronic pain conditions. It's almost as if there's some bias towards one and a stigma against the other being exhibited...

Your "meta analysis" had very few patients in total with an accumulation of LESS patients than the ONE study I cited.

Why are no major cancer associations confident in your assessment that MJ is harmless in causing lung CA?

It is VERY possible that you are trading overdose deaths from opioids to CA deaths later with MJ. Also, I have no evidence that people won't want opioids, MJ, benzos, etc. either, so I am not even confident they will decrease their opioid usage.

We don't have "solid" numbers on opioid deaths either. Most of these "overdoses" have multiple medications in their system including benzos, possible illegal heroin, cocaine, THC, alcohol, etc. People are said to have died of opioids if they mix them with alcohol, THC, benzos, potentiating their response.


The bottom line. MJ (similar to opioids) have NO LEVEL ONE EVIDENCE to support their usage for "chronic pain, back pain, noncancer pain, etc"

I notice 101N still likes MJ though despite lack of any evidence for its benefit for pain. Interesting how that his standards of "evidence" appear to be very malleable huh?
 
Your "meta analysis" had very few patients in total with an accumulation of LESS patients than the ONE study I cited.

Why are no major cancer associations confident in your assessment that MJ is harmless in causing lung CA?

It is VERY possible that you are trading overdose deaths from opioids to CA deaths later with MJ. Also, I have no evidence that people won't want opioids, MJ, benzos, etc. either, so I am not even confident they will decrease their opioid usage.

We don't have "solid" numbers on opioid deaths either. Most of these "overdoses" have multiple medications in their system including benzos, possible illegal heroin, cocaine, THC, alcohol, etc. People are said to have died of opioids if they mix them with alcohol, THC, benzos, potentiating their response.


The bottom line. MJ (similar to opioids) have NO LEVEL ONE EVIDENCE to support their usage for "chronic pain, back pain, noncancer pain, etc"

I notice 101N still likes MJ though despite lack of any evidence for its benefit for pain. Interesting how that his standards of "evidence" appear to be very malleable huh?
It's impossible to collect level 1 evidence on a schedule 1 substance. You should be smart enough to get that.
 
Your "meta analysis" had very few patients in total with an accumulation of LESS patients than the ONE study I cited.

Why are no major cancer associations confident in your assessment that MJ is harmless in causing lung CA?

It is VERY possible that you are trading overdose deaths from opioids to CA deaths later with MJ. Also, I have no evidence that people won't want opioids, MJ, benzos, etc. either, so I am not even confident they will decrease their opioid usage.

We don't have "solid" numbers on opioid deaths either. Most of these "overdoses" have multiple medications in their system including benzos, possible illegal heroin, cocaine, THC, alcohol, etc. People are said to have died of opioids if they mix them with alcohol, THC, benzos, potentiating their response.


The bottom line. MJ (similar to opioids) have NO LEVEL ONE EVIDENCE to support their usage for "chronic pain, back pain, noncancer pain, etc"

I notice 101N still likes MJ though despite lack of any evidence for its benefit for pain. Interesting how that his standards of "evidence" appear to be very malleable huh?
Oh, and as to opioid deaths- I'm going by the numbers the CDC states. You can confound all you want, but in most of these cases the primary mechanism of death is respiratory depression secondary to opioids. I've seen enough of these deaths personally- we had a rash of people in my state die to heroin that was cut with fentanyl involving ODs in the three figures. Most of those people are like the people I've personally known that passed from opioid use- normal people that got hooked after surgery or a major accident that lost access to their scripts or the money to afford them. Can't count the number of families I know in my community with kids missing fathers and mothers from opioids- certainly can't say that about marijuana. We don't need level 1 evidence (and honestly, EBM is kind of oversold anyway, but let's not get into that) to tell us that 17,082 people a year dying of respiratory depression with opioids in their system in an openly declared epidemic is something that needs to be dealt with.

Anyway, I say bring on the trials with marijuana- drop the schedule down so we can study it, and I guarantee the evidence speaks for itself. Can't say "you have no evidence" when the catch 22 is that it's largely impossible to gather evidence for legal reasons.
 
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Single study from 2008 versus my meta analysis from 2015, truly the evidence is on your side.

http://www.hhs.gov/sites/default/files/Factsheet-opioids-061516.pdf

Here's a good one- 78 people die of opiate overdoses each day, 60% of which are caused by prescription opioids. That adds up to 17,082 deaths directly caused by prescription opioids per year if we assume zero of the remaining forty percent initially got hooked on prescriptions, which is unlikely but I'm being kind. That's nearly as many people dying from these drugs as there are dying from esophageal cancer each year, and more than the number of people killed in intentional homicides each year by a good margin. So, while we don't have solid data on the deaths caused by marijuana, we do have it on opioids, yet people defend them to the death despite a lack of strong evidence for their use in many chronic pain conditions. It's almost as if there's some bias towards one and a stigma against the other being exhibited...

I think that in order to make meaningful comparisons you need to account for "denominator data" comparing rates, length of exposure, etc not just "numerator data." And, while there may be more data on the harms versus benefits of long-term opioid use for managing persistent pain, there is virtually *NO* data on long-term harms or benefits of cannabis (nor its major components) use for persistent pain. FDA is asleep at the wheel on this one.
 
Oh, and as to opioid deaths- I'm going by the numbers the CDC states. You can confound all you want, but in most of these cases the primary mechanism of death is respiratory depression secondary to opioids. I've seen enough of these deaths personally- we had a rash of people in my state die to heroin that was cut with fentanyl involving ODs in the three figures. Most of those people are like the people I've personally known that passed from opioid use- normal people that got hooked after surgery or a major accident that lost access to their scripts or the money to afford them. Can't count the number of families I know in my community with kids missing fathers and mothers from opioids- certainly can't say that about marijuana. We don't need level 1 evidence (and honestly, EBM is kind of oversold anyway, but let's not get into that) to tell us that 17,082 people a year dying of respiratory depression with opioids in their system in an openly declared epidemic is something that needs to be dealt with.

Anyway, I say bring on the trials with marijuana- drop the schedule down so we can study it, and I guarantee the evidence speaks for itself. Can't say "you have no evidence" when the catch 22 is that it's largely impossible to gather evidence for legal reasons.

I agree with your argument about EBM being "overrated", however, your colleague 101N appears to believe only level 1 evidence "proves" anything. Therefore, I must use his level of criteria on all options including MJ, since he set that bar for us all.

Most of the people I know that have problem with narcotics are already addictive personalities that are like alcoholics. They lose meds, constantly need escalation of dosages, fail UDS findings, etc.

These people would become drug addicts ANYWAY. I have plenty of 60s to 70s patients that take a few Norcos a day without problems for literally YEARS. Funny how these people don't all of a sudden start going on the street to shoot up heroin right?

Amazing how its the "trouble" patients from day one that are 99.9% of the problems that I see "overdosing".

Also, just because you believe MJ would have evidence doesn't make it so. I agree they should legally study the drug though.
 
Amazing how its the "trouble" patients from day one that are 99.9% of the problems that I see "overdosing".
that implies that you can identify these "trouble" patients prior to initiation of therapy. and that you are wise enough to be able to spot the ones having problems when they are occurring.

if that is truly the case, you are in a significant minority. and many patients with SUD have coping skills that will elude your best detecting abilities...
 
I agree with your argument about EBM being "overrated", however, your colleague 101N appears to believe only level 1 evidence "proves" anything. Therefore, I must use his level of criteria on all options including MJ, since he set that bar for us all.

Most of the people I know that have problem with narcotics are already addictive personalities that are like alcoholics. They lose meds, constantly need escalation of dosages, fail UDS findings, etc.

These people would become drug addicts ANYWAY. I have plenty of 60s to 70s patients that take a few Norcos a day without problems for literally YEARS. Funny how these people don't all of a sudden start going on the street to shoot up heroin right?

Amazing how its the "trouble" patients from day one that are 99.9% of the problems that I see "overdosing".

Also, just because you believe MJ would have evidence doesn't make it so. I agree they should legally study the drug though.
Not so for many of the dead people I've known. You're making the argument that because a person uses one drug they're automatically going to be an addict going down a slippery slope, which just isn't the case. A lot if these people are law abiding until they get hooked on opiates they can no longer afford- I've seen grandmothers, teachers, cops, literally any sort of person you can imagine get hooked on this stuff. They may have been wired for it, but until they had that first pill they didn't know what they were missing. Hell, my ex wife ended up going from a horrible but otherwise normal human being to a drug addict that lost her three kids to DCF that was shooting up heroin regularly after she had her third kid and was given a script for oxy. She just couldn't get enough of the stuff when they prescribed it after her C/S, then she couldn't afford it. And heroin is basically everywhere in the Northeast, it's literally both easier and cheaper to get than marijuana (and twenty times cheaper than oxy) so she went to heroin the day her meds ran out rather than go into detox. This is a person I loathe more than damn near anything in the world, but hearing how dark a path she went on after she got remarried was a bit of an eye opener. I just thank God all of her kids were with husband number 2, because oxy destroyed her life. A similar fate took the lives of several co-workers and their spouses at the large medical center I used to work at- good, normal people with lives and no history of drug abuse. Can't count on both my hands the number of kids I personally know that are missing parents today because of the opioid epidemic. But let's not use anecdotes, let's use one of the journals out there like professionals.

http://archpsyc.jamanetwork.com/mobile/article.aspx?articleid=1874575

Your typical idea of an addict isn't the new reality.
 
that implies that you can identify these "trouble" patients prior to initiation of therapy. and that you are wise enough to be able to spot the ones having problems when they are occurring.

if that is truly the case, you are in a significant minority. and many patients with SUD have coping skills that will elude your best detecting abilities...


I haven't had ANY overdose deaths in literally thousands of patients due to narcotic usage. Granted, I am moderate on my doses, UDS screen aggressively and watch for doctor shopping, screen for mental/psychological issues, etc.
 
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Not so for many of the dead people I've known. You're making the argument that because a person uses one drug they're automatically going to be an addict going down a slippery slope, which just isn't the case. A lot if these people are law abiding until they get hooked on opiates they can no longer afford- I've seen grandmothers, teachers, cops, literally any sort of person you can imagine get hooked on this stuff. They may have been wired for it, but until they had that first pill they didn't know what they were missing. Hell, my ex wife ended up going from a horrible but otherwise normal human being to a drug addict that lost her three kids to DCF that was shooting up heroin regularly after she had her third kid and was given a script for oxy. She just couldn't get enough of the stuff when they prescribed it after her C/S, then she couldn't afford it. And heroin is basically everywhere in the Northeast, it's literally both easier and cheaper to get than marijuana (and twenty times cheaper than oxy) so she went to heroin the day her meds ran out rather than go into detox. This is a person I loathe more than damn near anything in the world, but hearing how dark a path she went on after she got remarried was a bit of an eye opener. I just thank God all of her kids were with husband number 2, because oxy destroyed her life. A similar fate took the lives of several co-workers and their spouses at the large medical center I used to work at- good, normal people with lives and no history of drug abuse. Can't count on both my hands the number of kids I personally know that are missing parents today because of the opioid epidemic. But let's not use anecdotes, let's use one of the journals out there like professionals.

http://archpsyc.jamanetwork.com/mobile/article.aspx?articleid=1874575

Your typical idea of an addict isn't the new reality.


I've literally never seen someone become an "addict" after taking 2 or 3 Norcos a day and stable for years.

Its ALWAYS the ones with need to "escalate", "lose their meds", have no meds in their UDS, doctor shop, etc.

Is your argument that your "ex wife" was perfectly normal on no anti depressants, benzos, etc without any mental/psychological issues and took a few Norcos and bam she was on the street getting heroin? I have literally NEVER seen this out of thousands of patients.

I can almost promise that your "ex wife" had many red flags before she even took her first Norco.


I've seen plenty of these "addicts" come in as new patients (usually after PCPs get bullied into escalating their dosages) pretty quickly. They always have personality/mental disorders, often have drug usage issues before taking Norco (often taking MJ, cocaine, benzos, illegally taking meds from friends, etc), etc.

Funny how its never my 65 year old lady that has been married for 40 years with no personality/legal/drug issues beforehand taking 2 Norcos a day that go out on the street to get heroin.

Also, I've seen plenty of people take MJ and then escalate to cocaine, heroin, etc as well.

My personal opinion is that the new CDC guidelines will NOT decrease opioid deaths because these people who are addicts will just go on the street.

Florida had a 30-40% decrease in prescriptions for opioids but not corresponding deaths due to addicts just going onto the streets.

With open borders, black tar all over the place, etc. these addicts will find a way.
 
I continue to be appalled at the attitudes about marijuana use and its perception as a legitimate form of medicine. I have read the "studies" and to say this is a proven therapy that is more effective than conventional treatments is laughable. I cannot believe some medical societies have endorsed this and I feel it has only clouded the publics' perception of marijuana as a true drug of abuse. If you look at the history of the medical marijuana movement it has a foundation in the libertarian movement, whose goal is legalization of all drugs. The goal of groups like NORML is legalization for recreational and they saw "medicalization" as a means to an end.

Lastly, if this is a legitimate form of medicine and I, as a physician use marijuana for medical purpose, why is it that my state license is at risk? This is a drug legalized in my state and I am licensed by a state board. So what's the problem?

OP, stop posting. You lower the IQ of the entire forum.
 
I've literally never seen someone become an "addict" after taking 2 or 3 Norcos a day and stable for years.

Its ALWAYS the ones with need to "escalate", "lose their meds", have no meds in their UDS, doctor shop, etc.

Is your argument that your "ex wife" was perfectly normal on no anti depressants, benzos, etc without any mental/psychological issues and took a few Norcos and bam she was on the street getting heroin? I have literally NEVER seen this out of thousands of patients.

I can almost promise that your "ex wife" had many red flags before she even took her first Norco.


I've seen plenty of these "addicts" come in as new patients (usually after PCPs get bullied into escalating their dosages) pretty quickly. They always have personality/mental disorders, often have drug usage issues before taking Norco (often taking MJ, cocaine, benzos, illegally taking meds from friends, etc), etc.

Funny how its never my 65 year old lady that has been married for 40 years with no personality/legal/drug issues beforehand taking 2 Norcos a day that go out on the street to get heroin.

Also, I've seen plenty of people take MJ and then escalate to cocaine, heroin, etc as well.

My personal opinion is that the new CDC guidelines will NOT decrease opioid deaths because these people who are addicts will just go on the street.

Florida had a 30-40% decrease in prescriptions for opioids but not corresponding deaths due to addicts just going onto the streets.

With open borders, black tar all over the place, etc. these addicts will find a way.
Your lack of understanding of how addiction happens is pretty appalling, given your field. Your patients that are on narcotics for years won't suddenly become addicts because they aren't wired for it- everyone isn't equally susceptible to addiction. The ones who have that proper set of genetic and environmental factors will become addicted very early on, and those narcotics will feel like the thing that's been missing their entire life. They didn't know it was missing until you gave it to them, and now they just can't get enough. We have no way of screening for who is highly prone to addiction and who isn't, so every time you give those pills to someone you're kind of rolling the dice as to whether their reward pathways are appropriately wired or not. And if they get addicted, you no longer prescribing isn't going to temper their need for a fix- they're going to hit the streets, and they're probably going to end up dead or in prison.

Addiction is a disease process that is the result of genetic and environmental factors, yet you, a physician, talk of addicts as if it is merely some personality flaw, a personal weakness of character. This isn't the 1950s dude. Get up with the times. I also love how you threw my ex wife in quotes, as if many people on this site and I don't know each other and of the tumultuous train wreck that is my ex lol. Does my readily available divirce record count as level 1 evidence, or do you need her post-addiction arrest record for narcotic possession as well? Because they're both a matter of public record and just a Google search away! The magic of the internet!
 
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Addiction is a legal issue when it comes to prescribing opioids or patients taking other drugs. The real issue for pain physicians is dealing with the continuum of aberrant behavior that occurs that may be less than addiction but still just as fatal. Overuse of opioids, giving away or receiving opioids from non-medical sources, use of prescribed or unprescribed synergistic sedative medications or alcohol, trading opioids for favors or for illicit drugs/pot/heroin, are all just as problematic as addiction even though the definitions of addiction in some (or many) of these cases are not met.
What we don't know: how deleterious is the synergy between acute phase or chronic phase marijuana use in synergy with prescribed opioids or sedating meds.
What we do know: marijuana is a useful pain reducing medication only in very selected subsets of neuropathic pain. Otherwise it works by simply sedating the patients to the point they do not care about the pain.
 
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OP, stop posting. You lower the IQ of the entire forum.

Oh really, how so? Is it because I see through a sham perpetrated by a group of non-medical folks who want to expand the use of a currently uncontrolled (i.e. Not dose regulated) illicit substance with no medical benefit?
 
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Oh really, how so? Is it because I see through a sham perpetrated by a group of non-medical folks who want to expand the use of a currently uncontrolled (i.e. Not dose regulated) illicit substance with no medical benefit?
Progressive are immune to facts. Don't engage
 
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Your lack of understanding of how addiction happens is pretty appalling, given your field. Your patients that are on narcotics for years won't suddenly become addicts because they aren't wired for it- everyone isn't equally susceptible to addiction. The ones who have that proper set of genetic and environmental factors will become addicted very early on, and those narcotics will feel like the thing that's been missing their entire life. They didn't know it was missing until you gave it to them, and now they just can't get enough. We have no way of screening for who is highly prone to addiction and who isn't, so every time you give those pills to someone you're kind of rolling the dice as to whether their reward pathways are appropriately wired or not. And if they get addicted, you no longer prescribing isn't going to temper their need for a fix- they're going to hit the streets, and they're probably going to end up dead or in prison.

Addiction is a disease process that is the result of genetic and environmental factors, yet you, a physician, talk of addicts as if it is merely some personality flaw, a personal weakness of character. This isn't the 1950s dude. Get up with the times. I also love how you threw my ex wife in quotes, as if many people on this site and I don't know each other and of the tumultuous train wreck that is my ex lol. Does my readily available divirce record count as level 1 evidence, or do you need her post-addiction arrest record for narcotic possession as well? Because they're both a matter of public record and just a Google search away! The magic of the internet!

Yeah cool story bro except you can't account for the fact that heroin overdoses haven't gone down in areas that have cut narcotic medications by 40-50%. The drug addict personalities will just get fentanyl/carfentanil/heroin off the streets. Do you know how many I try to send to "addiction" treatment when I see them coming in with a SELF induced problem to my office? Almost no patients go. They just shop around for other physicians and attempt to bully one to give them high dosages of narcotics. If this is unsucessful after going to every ER/PCP/Pain Doc in the area, they then use street drugs due to difficult in obtaining them.

The PCPs that get in trouble are mostly weaker people that are literally bullied/manipulated by addictive personalities in almost every instance I see a problem.

How come the overdose rate isn't decreasing in states that have significantly reduced narcotic usage?

Also, if you believe a person who takes 30 Norcos after a surgery becomes "addicted" without preexisting mental/psychological/addiction problems already, I would suggest you have no common sense on the issue.

Please show me the areas that have had success in decreasing heroin overdoses

https://www.drugabuse.gov/publicati...caine/what-scope-cocaine-use-in-united-states

Apparently, cocaine usage is more prevalent than heroin usage by a factor of 2 among the younger cohorts. Did writing a few Tramadols for the younger cohorts cause them to get on cocaine too? I guess it was all the cocaine prescriptions by physicians that caused this "epidemic" as well right?

Sometimes people need to stop making excuses for their bad behavior.

Are you seriously trying to pretend your ex wife went on the street for heroin after some OB/GYN doc gave her a few oxycodones after a C/S? She was a perfectly functional person on no antidepressants/addiction/mental issues beforehand while working a full time job and taking care of kids but then had been prescribed 20 Percocets and BAM goes on the street for heroin? Please don't kid yourself despite your denial. I promise she was red flag city before getting those Percocets.

Here is a recent study with over 39K "opioid naive" senior patients that were given opioids after surgery. Amazingly, about 99% were off narcotics after 1 year. How come they didn't all go on the street to get heroin after their surgeries in the vast vast vast majority of cases for opioid naive/non addicted patients?

http://www.painnewsnetwork.org/stories/2016/8/12/study-long-term-opioid-use-rare-after-surgery
 
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Yeah cool story bro except you can't account for the fact that heroin overdoses haven't gone down in areas that have cut narcotic medications by 40-50%. The drug addict personalities will just get fentanyl/carfentanil/heroin off the streets. Do you know how many I try to send to "addiction" treatment when I see them coming in with a SELF induced problem to my office? Almost no patients go. They just shop around for other physicians and attempt to bully one to give them high dosages of narcotics. If this is unsucessful after going to every ER/PCP/Pain Doc in the area, they then use street drugs due to difficult in obtaining them.

The PCPs that get in trouble are mostly weaker people that are literally bullied/manipulated by addictive personalities in almost every instance I see a problem.

How come the overdose rate isn't decreasing in states that have significantly reduced narcotic usage?

Also, if you believe a person who takes 30 Norcos after a surgery becomes "addicted" without preexisting mental/psychological/addiction problems already, I would suggest you have no common sense on the issue.

Please show me the areas that have had success in decreasing heroin overdoses

https://www.drugabuse.gov/publicati...caine/what-scope-cocaine-use-in-united-states

Apparently, cocaine usage is more prevalent than heroin usage by a factor of 2 among the younger cohorts. Did writing a few Tramadols for the younger cohorts cause them to get on cocaine too? I guess it was all the cocaine prescriptions by physicians that caused this "epidemic" as well right?

Sometimes people need to stop making excuses for their bad behavior.

Are you seriously trying to pretend your ex wife went on the street for heroin after some OB/GYN doc gave her a few oxycodones after a C/S? She was a perfectly functional person on no antidepressants/addiction/mental issues beforehand while working a full time job and taking care of kids but then had been prescribed 20 Percocets and BAM goes on the street for heroin? Please don't kid yourself despite your denial. I promise she was red flag city before getting those Percocets.

Here is a recent study with over 39K "opioid naive" senior patients that were given opioids after surgery. Amazingly, about 99% were off narcotics after 1 year. How come they didn't all go on the street to get heroin after their surgeries in the vast vast vast majority of cases for opioid naive/non addicted patients?

http://www.painnewsnetwork.org/stories/2016/8/12/study-long-term-opioid-use-rare-after-surgery
I think I'll trust the CDC's analysis over your opinion, thanks.
 
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Gary Franklin has published a bunch of papers based on Washington State data showing that a flurry of new legislation and policy there has had an effect, I copy the abstract of one article below.

Re: Medical marijuana, The trend in the USA is for more and more places to legalize medical and even recreational marijuana, so I think it makes more sense for pain docs to discuss how we should approach these very numerous patients, rather than complaining about a trend we have no control over.

Bending the prescription opioid dosing and mortality curves: Impact of the Washington State opioid dosing guideline

Abstract
Background
Opioid use and dosing for patients with chronic non-cancer pain have dramatically increased over the past decade, resulting in a national epidemic of mortality associated with unintentional overdose, and increased risk of disability among injured workers. We assessed changes in opioid dosing patterns and opioid-related mortality in the Washington State (WA) workers' compensation system following implementation of a specific WA opioid dosing guideline in April, 2007.

Methods
Using detailed computerized billing data from WA workers' compensation, we report overall prevalence of opioid prescriptions, average morphine-equivalent dose (MED)/day, and proportion of workers on disability compensation receiving opioids and high-dose (≥120 mg/day MED) opioids over the past decade. We also report the trend of unintentional opioid deaths during the same time period.

Results
Compared to before 2007, there has been a substantial decline in both the MED/day of long-acting DEA Schedule II opioids (by 27%) and the proportion of workers on doses ≥120 md/day MED (by 35%). There was a 50% decrease from 2009 to 2010 in the number of deaths.

Conclusions
The introduction in WA of an opioid dosing guideline appears to be associated temporally with a decline in the mean dose for long-acting opioids, percent of claimants receiving opioid doses ≥120 mg MED per day, and number of opioid-related deaths among injured workers. Am. J. Ind. Med. 55:325–331, 2012. © 2011 Wiley Periodicals, Inc.
 
I think I'll trust the CDC's analysis over your opinion, thanks.

The CDC "guidelines" dont really change the surgeons giving out a few Tylenol 3s or Norcos after surgery. Also, notice how that huge study of 39K patients clearly show very very very low rate of problems with narcotic medications among "opioid naive" older patients with no addiction issues.

The CDC has a study larger than the one I quoted with 39K people who get a short term prescription of narcotics after surgery? Yeah didn't think so.
 
The CDC "guidelines" dont really change the surgeons giving out a few Tylenol 3s or Norcos after surgery. Also, notice how that huge study of 39K patients clearly show very very very low rate of problems with narcotic medications among "opioid naive" older patients with no addiction issues.

The CDC has a study larger than the one I quoted with 39K people who get a short term prescription of narcotics after surgery? Yeah didn't think so.
I'm referring to their expert opinion release on opioids causing the increase in deaths and heroin abuse from 2014.
 
I'm referring to their expert opinion release on opioids causing the increase in deaths and heroin abuse from 2014.

Their "expert" opinion is about people with >90 Morphine Equivalents per day not a few Norcos/Percs after surgery.

Also, studies with 39K patients >>>>> "expert" opinion from PROP that owns addiction clinics
 
Their "expert" opinion is about people with >90 Morphine Equivalents per day not a few Norcos/Percs after surgery.

Also, studies with 39K patients >>>>> "expert" opinion from PROP that owns addiction clinics
Elderly patients on short courses of opioids are not even close to a good indicator of general addictive potential. Addiction requires neuroplasticity, something elderly patients have the lowest degree of. Furthermore, getting your hands on heroin is a process- if you're young and you get hooked, it's pretty damn easy, because you probably know somebody down the line somewhere with a drug problem that can point you in the right direction. How the hell is an elderly person going to just go out and get themselves a stack? They're terrified of the sort of people that deal drugs, they have no connection to the sort of people that could deal to them, and they have no idea where to begin in the acquisition of heroin. These are people that struggle to do things in their daily routines, doing something as difficult as acquiring illicit substances may as well be asking them to walk on the moon. Finally, addiction generally requires time. These were short courses of meds, given to people that are both psychologically and neuropsychologically the hardest group to convert to addicts, who wouldn't even know where to begin to start their addiction- basically you couldn't develop a more biased study to get a desired outcome if you tried.

Guarantee if you did it on 25-39 year olds, you'd have drastically different results.

As to the CDC, they analyzed data from dozens of studies into the epidemiology of the heroin and opioid epidemic. They have no vested interest in the topic aside from their mission to save lives, unlike a study churned out by people in the field that have a vested interest in keeping practices within their field stable.
 
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