New way for hospitals to get a facility fee...

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Insane. What is the hospital going to do when their patients complain that they can't afford heroin? Offer a prostitution room next to the safe-injection room? I'll say it again; insane.
 
Agree this is insane far left liberal nonsense.

People have to take personal responsibility, the state shouldn't do everything for them.
 
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bedrock said:
Agree this is insane far left liberal nonsense.

People have to take personal responsibility, the state shouldn't do everything for them.
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the state pays for their care once the complications occur.

when i was an intern literally half of my service were alcoholics that we were giving tapering doses of benzos to and then discharging, only to see them again in a week.

it does seem a bit strange to offer addiction services in the same room you are allowing addicts to inject an illegal drug while also providing them needles
 
They should also have nurses place the IVs and inject the medicines, so that the pts dont mess it up. Because you know, they are gonna shoot up anyway so might as well do it as safely as possible. And we are already giving them a warm place to sleep and food so why not, its just like charitable right?
And if the nurse or environmental services folks are exposing themselves to an elevated risk of HepC, that is really not on the patient in any way. I mean they are drug addicts after all, so endangering other people is really not something that they need to be held responsible for.
If they crap all over themselves when they are high out of their minds, and dont really clean it up even when asked or even own any other clothes to change into or anything, that is cool.
And all the heroin coming into the hospital from the street which is manufactured and distributed by murderous cartels and associated with prostitution, torture, and human trafficking is just a part of the deal, really in the end.
Maybe to avoid this hospitals should purchase the heroin directly from manufacturers, to avoid impurities or other health endangerments? I mean these people need HELP!
And we should all the taxpayers pay for all the health complications that occur from the injection of the heroin, because basically its not these people's fault.
And if there heart valves get all endocarditis'd out we should just have anesthesia and surgery come in stat at 2am to fix it STAT, instead of staying in bed and at home with their families.
And we should all pay for 1-2 months of futile end of life ICU care at a minimum if we are actually going to be compassionate about things.
And they shouldn't worry about paying any of the hospital bills, or taking care of their kids or families, or getting a job, or seeing a psychiatrist or getting sober. They should just be high 24/7 until they die with no obligation to make the world a better place, contribute to society or the economy, or even behave decently.

Because, you know, this is health care after all that we are talking about here. And getting people high is pretty much the Hippocratic Oath in its essence. Its not like we have any actual obligation to help anyones health here.
 
the otherspeak to what you are pontificating about is that safe injection practices and supervised injections would reduce the risk of endocarditis, reduce the risk of futile end of life ICU care (due to accidental OD), reduce the costs of Hep C amongst those who are still negative, and decrease overall costs of healthcare bills to the community. reduce the power of cartels, and decrease the "need" to get involved in prostitution, trafficking and torture because they will have a safer place to shoot up.

I don't agree with this, mind you. I think it is condoning the practice of illicit drugs

but they are actually using your "arguments" as grounds for setting up these safe injection sites - supervised injection sites may decrease certain societal burdens...
 
Yea but. God forbid it's your child that ends up with the addiction. THEN you'd feel differently. I think this is an acquiescence to a nasty reality of now.
 
I'd like to see the how the pro-forma for "safe injection sites" pencils out in HOPD's and what the site of service differential would be in a hospital, outpatient infusion center, versus MD office. Will Medicaid pay for it and will it be "any willing provider" or no-bid, behind-closed-door's, pubic-private cash transfers?
 
Ducttape said:
the otherspeak to what you are pontificating about is that safe injection practices and supervised injections would reduce the risk of endocarditis, reduce the risk of futile end of life ICU care (due to accidental OD), reduce the costs of Hep C amongst those who are still negative, and decrease overall costs of healthcare bills to the community. reduce the power of cartels, and decrease the "need" to get involved in prostitution, trafficking and torture because they will have a safer place to shoot up.

I don't agree with this, mind you. I think it is condoning the practice of illicit drugs

but they are actually using your "arguments" as grounds for setting up these safe injection sites - supervised injection sites may decrease certain societal burdens...
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my point is entirely different..
"Harm reduction" is not humane, it is profoundly dehumanizing. Completely giving up on these people and writing off any ability they might have to overcome or at least cope with these issues, is what this actually is in practice.

Sometimes people need to feel the icy and irrevocable consequences of their actions, or at least the threat of such, to actually change their behavior and thinking. Addictionology 101.

And the other point that I was trying to make, is that "giving these people a safe place to shoot up" involves complicity in some profoundly horrible ways, e.g. the nightmare realities surrounding the entire world of illegal drugs. There is no moral justification for this, even if it were to theoretically make society safer (debatable). The line of reasoning is simply and literally logically incoherent. It is not OK to do bad things in order to make society safer. For instance, it is not OK to execute all criminals and troublemakers, as an example, even if it were to make society safer.

And in any case, I don't think anyone would deny that having people work in such a setting would be necessarily putting the staff in harms way. As I also mentioned. Is that fair or right?

The obvious implication here, is that the public in the form of the taxpayers really should not be paying for any of these complications from drug abuse. Think that might decrease the societal cost a little bit? Lol, for some reason it is just an unheard of solution!! This, despite the fact that there is not even enough money in this country to give non-drug abusing poor people the medical care that they need. If charitable people in the private sector desire to pay for some of the complications resulting from drug abuse, that is a different issue.

The reality is that many liberals just cannot cope with anything short of a theoretical perfect solution. The solutions are not viable, and are disastrous and counterproductive when implemented in the complex real world. They cannot just stand up and say "there is not enough money for all the stuff, so we are going to put on our big boy pants and start making some tough decisions here." Instead it is, increase taxes, increase the national debt, and any talk of cutting services to anyone ever is cruel and greedy.

And the end product of this type of delusional and nonsensical thinking, are ideas like carving out spots in hospitals were junkies can shoot up, on the public dime!

Just ask yourself what other ancient and medieval societies and thinkers would have to say about this type of proposal... oh how far we have come.
 
the point I am making is that there is a side that believes that these individuals are incorrigible and will never be cured, but this can prevent them from dying so frequently.

this concept contributed to the development of the drug policy in Portugal, that has been widely praised in some circles (possibly including these forums).

please take out the anti-liberal drivel from this argument. Please correct me if I am wrong, but isn't the conservative libertarian viewpoint that the government should not be in charge of prohibiting drug use?



if you are worried about how far we have come, answer this question.... how has "the War on Drugs" gone so far?
 
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Ducttape said:
the otherspeak to what you are pontificating about is that safe injection practices and supervised injections would reduce the risk of endocarditis, reduce the risk of futile end of life ICU care (due to accidental OD), reduce the costs of Hep C amongst those who are still negative, and decrease overall costs of healthcare bills to the community. reduce the power of cartels, and decrease the "need" to get involved in prostitution, trafficking and torture because they will have a safer place to shoot up.

I don't agree with this, mind you. I think it is condoning the practice of illicit drugs

but they are actually using your "arguments" as grounds for setting up these safe injection sites - supervised injection sites may decrease certain societal burdens...
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Why reduce any risks for them? This just allows them to further burden society. They want to die, why should we impede their life goal?
 
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how do you know they want to die? i thought they wanted to get high... im sure their family members don't want them to die.

and id hate to see what other populations can be "eliminated" if we argue burden on society.
 
bedrock said:
Agree this is insane far left liberal nonsense.

People have to take personal responsibility, the state shouldn't do everything for them.
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As has already been stated, it is the libertarian faction that supports this BS. Don't drag liberals into this
 
Ducttape said:
how do you know they want to die? i thought they wanted to get high... im sure their family members don't want them to die.

and id hate to see what other populations can be "eliminated" if we argue burden on society.
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What their family members want obviously means jack crap to the junkie.
 
PainDrain said:
As has already been stated, it is the libertarian faction that supports this BS. Don't drag liberals into this
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I disagree. Liberals want the government to take care of every single potential problem in life, no matter what the cost in taxes, and irrespective of whether or not the government is actually good at solving the problem.

there are a few libertarian socialists in Europe, however in America libertarians want minimal government and would rather that the individual be responsible for his/her successes and failures in life.

This proposed coddling of addicts, by the state paying for rooms for addicts to shoot up in hospitals is in direct opposition to the libertarian position of the majority of American Libertarians, and is much more in line with position of American liberals and the Democratic Party.
 
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Gauss said:
It will be interesting to see Vancouver's data tracking the rate of overdose deaths and detox utilization

http://www.theglobeandmail.com/news...re-overdose-prevention-sites/article33276659/

http://www.theglobeandmail.com/opin...ives-and-must-not-be-illegal/article33329479/
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Even more interesting is that lyrica and several other scheduled drugs are tested on these patients in Canada . Maybe some of the Canadian physicians can enlighten us on this governmental opioid project . Does it have any societal benefits that has been proven
 
bedrock said:
I disagree. Liberals want the government to take care of every single potential problem in life, no matter what the cost in taxes, and irrespective of whether or not the government is actually good at solving the problem.

there are a few libertarian socialists in Europe, however in America libertarians want minimal government and would rather that the individual be responsible for his/her successes and failures in life.

This proposed coddling of addicts, by the state paying for rooms for addicts to shoot up in hospitals is in direct opposition to the libertarian position of the majority of American Libertarians, and is much more in line with position of American liberals and the Democratic Party.
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Correct.

Liberals also would like to blame doctors or some other force besides the JUNKIE themselves for the problem.

Ergo, even when prescription opioids decrease by 30%-40% with ZERO difference in overdose rates due to junkies going on the streets to get heroin/coke/etc, these liberals will continue to strawman the issue to blame someone else besides the junkie.

The next liberal argument will be the "doctors caused the junkies to get these drugs off the street, therefore, its their fault!". Just wait a few years and that will be the new mantra after rates of overdose don't decrease.

Reminds me of the Chicago murder rate situation with the police. If the police go into bad areas to crackdown hard, they are "racists" who are treating people like "animals" and therefore are causing hoodrats to murder each other because they are "dehumanizing them".

Yet when the police pull out and the murder rate goes UP, the police are GUILTY again for abandonment of the "vulnerable" populations.

Damned either way.
 
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A little off topic but I thought I would also make this known.

I have gone from a previous private practice to now hospital employed.
I see patients in a free standing outpatient clinic.

I was asked by the hospital admin about potentially seeing patients in a clinic on the second floor of the hospital.
I recently found out, that when other physicians see patients on hospital campus and not in the outpatient medical office building, hospital is charging a facility fee in addition to my usual 99xxx clinic codes.

They have apparently been doing this for several years to a couple of decades.
 
myrandom2003 said:
A little off topic but I thought I would also make this known.

I have gone from a previous private practice to now hospital employed.
I see patients in a free standing outpatient clinic.

I was asked by the hospital admin about potentially seeing patients in a clinic on the second floor of the hospital.
I recently found out, that when other physicians see patients on hospital campus and not in the outpatient medical office building, hospital is charging a facility fee in addition to my usual 99xxx clinic codes.

They have apparently been doing this for several years to a couple of decades.
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I would tell them that I couldn't live with myself if I knew that patients (or their health plans) were having to pay facility fees that didn't accurately reflect the actual level of intensity of resources provided to them.
 
DrCommonSense said:
Correct.

Liberals also would like to blame doctors or some other force besides the JUNKIE themselves for the problem.

Ergo, even when prescription opioids decrease by 30%-40% with ZERO difference in overdose rates due to junkies going on the streets to get heroin/coke/etc, these liberals will continue to strawman the issue to blame someone else besides the junkie.

The next liberal argument will be the "doctors caused the junkies to get these drugs off the street, therefore, its their fault!". Just wait a few years and that will be the new mantra after rates of overdose don't decrease.

Reminds me of the Chicago murder rate situation with the police. If the police go into bad areas to crackdown hard, they are "racists" who are treating people like "animals" and therefore are causing hoodrats to murder each other because they are "dehumanizing them".

Yet when the police pull out and the murder rate goes UP, the police are GUILTY again for abandonment of the "vulnerable" populations.

Damned either way.
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i understand you do not want physicians to shoulder any of the "blame" with regards to the opioid situation. think of it this way - Big Pharma and the desire to make $$$ lead to this problem. and I understand you don't want to affect potential livelihood in pain in any way.

but 2 points -
1. you use the argument that we should not do any procedural interventions due to the dearth of EBM. well, it is even worse for COT.
2. the problem with your argument is that the drugs already caused the junkies to exist. even if physicians do decrease opioid prescribing, I agree it will probably not affect the rate of the # of junkies OD'ing. they are a lost generation - Legacy patients. it may even be too late for their children, who see and become exposed via their parents.

opioid reduction is for the future, for the next generation to avoid the exposure.
 
Ducttape said:
i understand you do not want physicians to shoulder any of the "blame" with regards to the opioid situation. think of it this way - Big Pharma and the desire to make $$$ lead to this problem. and I understand you don't want to affect potential livelihood in pain in any way.

but 2 points -
1. you use the argument that we should not do any procedural interventions due to the dearth of EBM. well, it is even worse for COT.
2. the problem with your argument is that the drugs already caused the junkies to exist. even if physicians do decrease opioid prescribing, I agree it will probably not affect the rate of the # of junkies OD'ing. they are a lost generation - Legacy patients. it may even be too late for their children, who see and become exposed via their parents.

opioid reduction is for the future, for the next generation to avoid the exposure.
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Yeah, the data regarding long term opioid therapy is flat out ridiculous--VERY poor data to support long term use. If anything, the pendulum is swinging in the opposite direction now (thank god), with a fairly clear trend in the literature--i.e., that the long term effects of systemic opioid therapy involve more adverse effects than benefit. Hopefully this translates into a dramatic reduction in COT for non-malignant pain. Unfortunately, in my neck of the woods, this trend in the literature seems to be ignored for the most part. Opioids are just bad news all around for non-malignant pain in the long term. No question about it.
 
I'm so confused. Are cops still gonna arrest people for possession? Are these places like embassies, where you can deal and use right outside and run inside if a cop is after you? I picture the "guards" at these places suddenly having a lot of spare cash...
 
Ligament said:
Lets make it safer and more convenient so we can foster an even larger junkie population. The liberal mindset is an offense to logic.

Have any of you guys been to Vancouver, BC? It is flush with junkies and ever expanding. What a great objective to have as a city.
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No offense lig, but I found Vancouver to be a sister city to Seattle in most ways. Both cities are extremely liberal, and hippie central.
 
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Ducttape said:
i understand you do not want physicians to shoulder any of the "blame" with regards to the opioid situation. think of it this way - Big Pharma and the desire to make $$$ lead to this problem. and I understand you don't want to affect potential livelihood in pain in any way.

but 2 points -
1. you use the argument that we should not do any procedural interventions due to the dearth of EBM. well, it is even worse for COT.
2. the problem with your argument is that the drugs already caused the junkies to exist. even if physicians do decrease opioid prescribing, I agree it will probably not affect the rate of the # of junkies OD'ing. they are a lost generation - Legacy patients. it may even be too late for their children, who see and become exposed via their parents.

opioid reduction is for the future, for the next generation to avoid the exposure.
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I used the argument that we shouldn't do procedures? Wait what?

Maybe you should go back and read what I have written.

Number 2 is just speculation that is the chicken and egg problem. Clearly, in areas where opioid prescriptions have gone down the most, there has been no mortality decrease from drug abuse. These people just get on other drugs.
 
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and aren't you the one who rails against cardiac caths, fusions, C-sections, etc.? or is there another drcommonsense?
is there level 1 evidence for ESI? even RFA has some equivocal level evidence...

Clearly, in areas where opioid prescriptions have gone down the most, there has been no morality decrease. These people just get on other drugs.
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no, you miss the point entirely. the opioid epidemic primed the pump. reducing the opioid prescribing rate will not touch the overdose rate, not til the at risk portion of this generation is gone - either dead, or rehabbed.

as an example, we are making progress in reducing the rate of smoking. that rate is going down much faster than the rate of developing cancer, but smoking related cancer is still high.
 
Ducttape said:
and aren't you the one who rails against cardiac caths, fusions, C-sections, etc.? or is there another drcommonsense?
is there level 1 evidence for ESI? even RFA has some equivocal level evidence...



no, you miss the point entirely. the opioid epidemic primed the pump. reducing the opioid prescribing rate will not touch the overdose rate, not til the at risk portion of this generation is gone - either dead, or rehabbed.

as an example, we are making progress in reducing the rate of smoking. that rate is going down much faster than the rate of developing cancer, but smoking related cancer is still high.
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I have "railed" against basically all of procedural medicine when looking at it being Level 1 to prove a point when discussing IPM. If you can disprove anything I have written about the most common procedures used in medicine having no level one evidence for the vast majority of patients they are used on, refute that instead of going on childish tantrums.

I can promise it won't happen.


So by the logic concerning the opioid epidemic with a large decrease in opioid prescriptions with very few being given to patients in the 18-25 age range, then we should see a subsequent decrease in heroin overdoses from this population.

We shall see. Im very skeptical about that.

There should be AMPLE evidence that states with far higher restriction of narcotic meds should have far lower overdose rates considering the huge variances in prescribing patterns between states. My premise is there will be zero change with restriction but we will see.

The problem is lack of job opportunities, general depression, hopelessness, etc in a large segment of the society. These people won't all of a sudden become normal with restrictions of prescription meds.

http://www.clinicaladvisor.com/the-...d-prescription-rates-progress/article/485154/
 
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bedrock said:
No offense lig, but I found Vancouver to be a sister city to Seattle in most ways. Both cities are extremely liberal, and hippie central.
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no offense taken...just that van had a much larger (yet somehow better isolated) junkie population until recently, until Seattle thought it would be a good idea to attract junkies by offering free campgrounds and housing and food. Now Seattle has homeless encampments spread throughout the city, and it is growing. How about we attract working folk with skills only, as opposed to homeless? WTH?
 
oh that's an easy one commonsense. and the article notes it too. its about availability.

first, you can clearly see that there is an upward trend of opioid painkiller OD and a downward trend in heroin OD. that in itself should be easy to understand. take whats available, and "safer" or "cheaper" or "doctors orders"...

in 2010, Purdue reformulated oxycontin so it was more difficult to crush and more tamper resistant. it took about 4-5 months before someone figured out how to break through. even then, apparently not worth the effort, according to SWIM on opioiphile.org forums.

your article states: "people who were pill users in 2013 were much more likely to be heroin users in 2106, but were no longer pill users. In other words, drug abusers switched from pills to injectable narcotics during a time when the pills were becoming more difficult to obtain."

and yes, that suggests that opioid restricting will not affect these victims.

but my point all along is that a main reason to decrease prescribing is so that fewer people will start using pills - and subsequently get addicted - in the first place. those who have started are already a lost generation.
that's why a snapshot of heroin OD rates will not significantly change, until the current patients that got addicted to prescription opioids die or learn to manage their addiction.
 
Each state has its own unique drug overdose problem: synthetic opioids vs non synthetics vs heroin overdoses. Each state has its own overdose story . That is, some states have low prescription OD rates but high heroin OD rates and vice versa. We cannot generalize this drug epidemic since there are regional subtleties. However, The common theme is an underlying societal drug entitlement...
 
Ducttape said:
oh that's an easy one commonsense. and the article notes it too. its about availability.

first, you can clearly see that there is an upward trend of opioid painkiller OD and a downward trend in heroin OD. that in itself should be easy to understand. take whats available, and "safer" or "cheaper" or "doctors orders"...

in 2010, Purdue reformulated oxycontin so it was more difficult to crush and more tamper resistant. it took about 4-5 months before someone figured out how to break through. even then, apparently not worth the effort, according to SWIM on opioiphile.org forums.

your article states: "people who were pill users in 2013 were much more likely to be heroin users in 2106, but were no longer pill users. In other words, drug abusers switched from pills to injectable narcotics during a time when the pills were becoming more difficult to obtain."

and yes, that suggests that opioid restricting will not affect these victims.

but my point all along is that a main reason to decrease prescribing is so that fewer people will start using pills - and subsequently get addicted - in the first place. those who have started are already a lost generation.
that's why a snapshot of heroin OD rates will not significantly change, until the current patients that got addicted to prescription opioids die or learn to manage their addiction.
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The term "victim" is amusing to me. That implies there is this horde of perfectly normal, innocent people who were prescribed Oxycontin for no reason by bad physicians.

When there is zero difference in OD rates for drugs overall in the 18-25 group, where the vast majority have never been prescribed legal narcotics from physicians, how will you explain this?

That being said, I have zero problems with restricting narcotic medication usage through aggressive urine screens, drug monitoring programs, limitations on morphine equivalents for good majority of patients and avoiding narcotics as much as possible (especially in the younger populations with low morbidity).

I just don't believe it will change anything overall. Millenials will be still be OD'ing off heroin, carfentanil, coke, etc at the same rates as ever before. The only thing that will change is the addicts will go from prescription pills to street drugs.


I heard the same nonsense liberal arguments when it came to police and violence in Chicago.

My position is that the DEMAND for drugs will REMAIN THE SAME and HIGH. The only change will be the usage of prescription drugs to abuse vs others will shift. The same dysfunctional people will REMAIN dysfunctional with just different drugs.

You seem to think magically that restriction of prescription narcotics to the addict population will magically transform this population into productive and functional people.

No amount of Suboxone pimping will change anything much on the macro level either.

Neither will nonsense addiction psychiatry. Trust me, I've tried to send COUNTLESS medicaid addict types for this treatment.

In fact, I will probably get on the Suboxone racket (like 101N and PROP) but I'm under no illusion there is not going to be much of a change in terms of recidivism rates.
 
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I hate to say this, but you don't seem to remember when opioid prescribing was not the norm.

The current generation got addicted because they were given opioids or stole them from people who were given them.

There is no debating the fact that the majority of patients now using heroin started with non heroin opioids.

I agree the majority of these people will never get better.

As I stated before, a primary reason to decrease prescribing is so the the next generation doesn't get addicted too. There's still hope for the kids...


Sent from my iPhone using SDN mobile
 
Ducttape said:
I hate to say this, but you don't seem to remember when opioid prescribing was not the norm.

The current generation got addicted because they were given opioids or stole them from people who were given them.

There is no debating the fact that the majority of patients now using heroin started with non heroin opioids.

I agree the majority of these people will never get better.

As I stated before, a primary reason to decrease prescribing is so the the next generation doesn't get addicted too. There's still hope for the kids...


Sent from my iPhone using SDN mobile
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You have no evidence the current generation got "addicted" due to prescription opioids in a fashion they wouldn't if they just got heroin or carfentanil off the street.

There is a HUGE difference between totally normal, non depressed/mental disease/addict patients who were totally functional becoming addicted to narcotics in droves due to LEGAL sources compared to some addict that steals pills from someone in a nonlegal manner.

I am strongly unconvinced that such addicts will stop having these issues with 100% restriction of prescription narcotics.

Your argument is basically that the crackhead 18 year old kid that robbed 70 y/o grandma's Norco pills wouldn't be an addict if grandma didn't have Norco pills.

So since some scumbag 18 y/o addict kid steals from the 65 y/o grandfather who had two fusion surgeries his prescriptions of Percocet, we should just restrict all narcotics to that grandfather type person to prevent the 18 y/o old addict from stealing the meds.

If the 18 y/o addict didn't have grandma or grandpa to rob, he would've been an upstanding citizen of the society right?

Next up, all rapists and murderers are victims too. I mean if some law abiding citizen didn't have a gun for the murderer to rob, there would be no murders either! We should hold off all gun rights for citizens!

If the rapist dude didn't have women walking around in short skirts, he wouldn't be tempted to rape those women. We should restrict short skirts on women!

So the liberal solution is such:

1) Restrict all legitimate narcotics to law abiding older citizens with legit pain problems, clean UDS, no doc shopping, no early refills, etc due to some scumbag addict stealing meds from such a person.

2) Give the addict access to Methadone and Suboxone clinics forever while restricting meds for legit patients

3) Blame all physicians who prescribed medications for all the problems of the addicts and pretend they would be high functioning normal citizens without such bad docs.

Reminds me of Chicago crime and police.

Wow makes sense in liberal land.
 
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omg. where have you been hiding these past 15 years?
and making multiple assumptions about what I want.

who is at fault is Big Pharma and the desire of some doctors to put profit over patient care.

before I post probably 30 some odd articles clearly linking the current opioid epidemic and heroin use increase, let me be point blank in that your "liberal" solution is not anywhere close to what would be "my" solution.

first, you define what are "legitimate narcotics".
I will discuss "appropriate opioid" medications. "Narcotics" are a legal term. we (at least I) am a physician. (your elderly patient needs to know how to safely store his/her opioid medications with a lock box and be told that under no circumstance

second, addicts should have access to addiction treatment. this may include a short course of suboxone.

third, there are bad seeds that are doctors. the DEA and state DOH is responsible for finding out who they are. most doctors are not bad seeds, but some get duped by money grubbing pharmaceutical companies advertising false lies all for more and more money.
 
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Ducttape said:
omg. where have you been hiding these past 15 years?
and making multiple assumptions about what I want.

who is at fault is Big Pharma and the desire of some doctors to put profit over patient care.

before I post probably 30 some odd articles clearly linking the current opioid epidemic and heroin use increase, let me be point blank in that your "liberal" solution is not anywhere close to what would be "my" solution.

first, you define what are "legitimate narcotics".
I will discuss "appropriate opioid" medications. "Narcotics" are a legal term. we (at least I) am a physician. (your elderly patient needs to know how to safely store his/her opioid medications with a lock box and be told that under no circumstance

second, addicts should have access to addiction treatment. this may include a short course of suboxone.

third, there are bad seeds that are doctors. the DEA and state DOH is responsible for finding out who they are. most doctors are not bad seeds, but some get duped by money grubbing pharmaceutical companies advertising false lies all for more and more money.
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I never said there weren't "bad docs", I am just strongly unconvinced there is a large segment of non-mentally ill/depressed/addict personality patients that are getting addicted to opioids randomly.
 
DrCommonSense said:
I never said there weren't "bad docs", I am just strongly unconvinced there is a large segment of non-mentally ill/depressed/addict personality patients that are getting addicted to opioids randomly.
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I agree. Docs have been complicit but, unless you are a pediatrician, I don't think you "make" an addict out of an emotionally healthy individual. Except maybe the very rare case.
 
hyperalgesia said:
I agree. Docs have been complicit but, unless you are a pediatrician, I don't think you "make" an addict out of an emotionally healthy individual. Except maybe the very rare case.
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Correct, I have rotated through psychiatry and "addiction" medicine before for months at a time.

Out of literally thousands of patients I have seen, not one didn't have preexisting mental health/cocaine/alcohol/heroin/etc usage prior to their problems with prescription medications.

I remember when we used to treat sex offenders in the psych unit as well. All we basically did was put them on psychotic drugs and did "group" discussions. Never seen anyone ever get better, just numbed up with a basic pharma straight jacket where they were zonked out.
 
odd.

isn't that what Passik reported back in 1980?

and again as late as 2000:
https://www.ncbi.nlm.nih.gov/pubmed/11010058
Managing chronic nonmalignant pain: overcoming obstacles to the use of opioids.
Passik SD1, Weinreb HJ.
Author information
  • 1Oncology Symptom Control Research, Community Cancer Care, Inc., Indianapolis, IN 46202, USA.
Abstract
Physicians involved in cancer pain management treat thousands of patients with opioids, whose effective analgesia improves overall functioning. Side effects generally are tolerable, and treatment can be maintained with stable doses for long periods. Problems with addiction are infrequent. Many physicians, however, assume that opioids should be used only for chronic malignant pain. Research and clinical experience have demonstrated that opioids can safely and effectively relieve most chronic moderate to severe nonmalignant pain. Fears of addiction, disciplinary action, and adverse effects result in ineffective pain management. With current information on the use of opioids in chronic nonmalignant pain, primary care physicians can overcome these obstacles. Guidelines must clearly define the role of the primary care physician in the proper management of pain and the integration of opioid therapy. Used appropriately, opioids may represent the only source of relief for many patients.
Click to expand...
over 100,000 people dead from prescription opioid overdoses.
we really haven't learned a thing.
 
heroin abuse rates, when you look historically, are relatively unchanged from 1980s to present. 500,00 - 600,000 Americans.

what is different:
the rate of prescription opioid abuse and death.
MAPdeathRates.jpg

1_6.jpg

PainGraph.gif


take home message - the druggies have always been out there. making changes towards appropriate opioid prescribing will not affect them, I agree.

but everyone else...
 
Ducttape said:
heroin abuse rates, when you look historically, are relatively unchanged from 1980s to present. 500,00 - 600,000 Americans.

what is different:
the rate of prescription opioid abuse and death.
MAPdeathRates.jpg

1_6.jpg

PainGraph.gif


take home message - the druggies have always been out there. making changes towards appropriate opioid prescribing will not affect them, I agree.

but everyone else...
Click to expand...

Where did that graph come from that showed opioid analgesic deaths increased dramatically over last 10 years but heroin deaths have been the same?

Surely not the CDC.

https://fee.org/articles/the-dea-is-to-blame-for-america-s-opioid-overdose-epidemic/
 
Ducttape said:
heroin abuse rates, when you look historically, are relatively unchanged from 1980s to present. 500,00 - 600,000 Americans.

what is different:
the rate of prescription opioid abuse and death.


take home message - the druggies have always been out there. making changes towards appropriate opioid prescribing will not affect them, I agree.

but everyone else...
Click to expand...


This article ultimately answers this question beautifully:

https://www.theguardian.com/comment...ion-drug-abuse-addiction-treatment-painkiller


"The National Survey on Drug Use and Health consistently shows that 75% or more of those who start taking opioid medications for non-medical reasons obtain them not from their own prescription, but from friends, family members, dealers or other illicit sources.

Moreover, studies have found that the majority of people who misuse prescription opioids take other recreational drugs, too: for example, one study of over 1,000 people tracked from grade school into their 20s found that 75% of regular prescription opioid misusers had also taken cocaine, and two-thirds had taken psychedelics; earlier research on adults with Oxycontin addictions found similarly high proportions of other illegal drug use. The same research also showed that nearly 80% had previously been in addiction treatment. This suggests immersion in a drug-using subculture, not a life of doctor’s appointments and pain management."

So like I said, these people were ALREADY like that before seeing a doctor. Most of them are not even legally getting the medications but stealing them/using them from others as well.
 
Last edited:
the problem is that you are relying on an article that is in itself is primarily focused on recommending increased substance abuse treatment - ie more suboxone, which a few here have derided as a money making scam.

for example, the article states "In addition, looked at from the chronic pain treatment perspective, studies find that very low percentages of people who do not have previous drug abuse histories become addicted during pain care."

if you review the link, however, you find this: "Signs of opioid addiction were reported in 0.27% of participants in the studies that reported that outcome. All three modes of administration were associated with clinically significant reductions in pain, but the amount of pain relief varied among studies. Findings regarding quality of life and functional status were inconclusive due to an insufficient quantity of evidence for oral administration studies and inconclusive statistical findings for transdermal and intrathecal administration studies."

and you did not post the take home message on that article, which i agree with wholeheartedly:


"Up to 8 million chronic pain patients are estimated to currently receive opioid prescriptions; the vast majority of them do not have addiction problems. Certainly better oversight to ensure appropriate prescribing is needed to prevent future addictions and to target opioid treatment to those who will benefit. But today, simply reducing the legal supply will only increase the illegal market.

In order to really address the opioid problem, we need to rapidly expand evidence-based maintenance treatment – and figure out why so many Americans are turning to the most dangerous drugs to self-medicate."

(bold emphasis is mine)

im sorry you fail to see the logic in limiting supply so that addicts cannot steal their fix from family and friends, if the family/friends do not have opioid medication lying around.
https://www.drugabuse.gov/publicati...vailability-associated-increased-use-overdose
 
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Ducttape said:
the problem is that you are relying on an article that is in itself is primarily focused on recommending increased substance abuse treatment - ie more suboxone, which a few here have derided as a money making scam.

for example, the article states "In addition, looked at from the chronic pain treatment perspective, studies find that very low percentages of people who do not have previous drug abuse histories become addicted during pain care."

if you review the link, however, you find this: "Signs of opioid addiction were reported in 0.27% of participants in the studies that reported that outcome. All three modes of administration were associated with clinically significant reductions in pain, but the amount of pain relief varied among studies. Findings regarding quality of life and functional status were inconclusive due to an insufficient quantity of evidence for oral administration studies and inconclusive statistical findings for transdermal and intrathecal administration studies."

and you did not post the take home message on that article, which i agree with wholeheartedly:


"Up to 8 million chronic pain patients are estimated to currently receive opioid prescriptions; the vast majority of them do not have addiction problems. Certainly better oversight to ensure appropriate prescribing is needed to prevent future addictions and to target opioid treatment to those who will benefit. But today, simply reducing the legal supply will only increase the illegal market.

In order to really address the opioid problem, we need to rapidly expand evidence-based maintenance treatment – and figure out why so many Americans are turning to the most dangerous drugs to self-medicate."

(bold emphasis is mine)

im sorry you fail to see the logic in limiting supply so that addicts cannot steal their fix from family and friends, if the family/friends do not have opioid medication lying around.
https://www.drugabuse.gov/publicati...vailability-associated-increased-use-overdose
Click to expand...


Who said I was against giving Suboxone treatment? I said I was going to get into that racket but I doubt it will change things much at a population level.

From my experience with both Suboxone and Methadone clinics, patients just basically remain on the medication forever and have to be closely monitored with UDS testing. Very few seem to every get off Suboxone and Methadone while becoming productive citizens with a lack of substance abuse problems in the future.

However, I believe Suboxone would be a good ancillary service to offer and can provide another revenue stream, so since it is being pushed hard, I will not fight against this "tide" of Suboxone.

The rest of your post I agree with.
 
"and figure out why so many Americans are turning to the most dangerous drugs to self-medicate."

That, IMO, is the 64K question. I think there are two cohorts. Young people using illicits who are seeking euphoria,
and older people with miserable lives without hope who come to see us. Most of the latter aren't coming to us to see us
seeking euphoria but it's there when we Rx. I think they come to hear the lie.

“In a morbid society the belief prevails that defined and diagnosed ill-health is infinitely preferable to any other form of negative label or to no label at all. It is better than criminal or political deviance, better than laziness, better than self-chosen absence from work. More and more people subconsciously know that they are sick and tired of their jobs and of their leisure passivities, but they want to hear the lie that physical illness relieves them of social and political responsibilities. They want their doctor to act as lawyer and priest. As a lawyer, the doctor exempts the patient from his normal duties and enables him to cash in on the insurance fund he was forced to build. As a priest, he becomes the patient's accomplice in creating the myth that he is an innocent victim of biological mechanisms rather than lazy, greedy, or envious deserter of a social struggle over the tools of production. Social life becomes a giving and receiving of therapy: medical, psychiatric, pedagogic, or geriatric. Claiming access to treatment becomes a political duty, and medical certification a powerful device for social control.”
 
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