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Unions didn't kill logging or fishing.
The prescription opioid epidemic in a nutshell
- Thread starter 101N
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Suffering isn't opioid responsive.
http://www.theguardian.com/us-news/2016/feb/07/suicide-rates-rise-butte-montana-princeton-study
Financial despair, addiction and the rise of suicide in white America
The death rate for white Americans aged 45 to 54 has risen sharply since 1999, but Montana officials wrestle to explain why the state has the highest rate of suicide in the US at nearly twice the national average – and it’s rising
Kevin Lowney lies awake some nights wondering if he should kill himself.
“I am in such pain every night, suicide has on a regular basis crossed my mind just simply to ease the pain. If I did not have responsibilities, especially for my youngest daughter who has problems,” he said.
The 56-year-old former salesman’s struggle with chronic pain is bound up with an array of other issues – medical debts, impoverishment and the prospect of a bleak retirement – contributing to growing numbers of suicides in the US and helping drive a sharp and unusual increase in the mortality rate for middle-aged white Americans in recent years alongside premature deaths from alcohol and drugs.
A study released late last year by two Princeton academics, Anne Case and Angus Deaton, who won the 2014 Nobel prize for economics, revealed that the death rate for white Americans aged 45 to 54 has risen sharply since 1999 after declining for decades. The increase, by 20% over the 14 years to 2013, represents about half a million lives cut short.
The uptick in the mortality rate is unique to that age and racial group. Death rates for African Americans of a similar age remain notably higher but continue to fall.
Neither was the increase seen in other developed countries. In the UK, the mortality rate for middle-aged people dropped by one third over the same period.
“This change reversed decades of progress in mortality and was unique to the United States; no other rich country saw a similar turnaround,” the study said.
Deaths from poisonings by drugs or alcohol have risen dramatically to push lung cancer into second place as the major killer with a sharp increase in suicides now a close third.
FacebookTwitterPinterest
‘I was a very hard-working American. Overly hard-working American. This is what brought down my health,’ Kevin Lowney said. Photograph: Walter Hinick for the Guardian
Lowney lives in Butte, Montana, where local officials see the Princeton study’s findings reflected in their community but struggle to explain them. The state has the highest rate of suicide in the US at nearly twice the national average and rising – up 7.3% in 2014. Those most likely to kill themselves are 45 to 65 years old.
“What’s been lacking in our town is an explanation for why this demographic in particular has been dying by suicide,” said Karen Sullivan, health director for Butte and the surrounding county, Silver Bow. “We want to take a look at what we’ve got going on in Butte. Is it economic in nature? Is it middle-aged white people discontented with where they landed in life? Is it isolation? A lack of a social network? Is it drug and alcohol issues? What do we have going on?”
Other officials see a number of interconnected forces at work and the rising rate of middle-aged deaths as indicative of crisis wider than those who kill themselves.
Growing economic inequality and increasing financial struggles are intertwined with other issues such as health and addiction. Some people living on low incomes hesitate to go to the doctor even if they have medical insurance because of the cost of out-of-pocket expenses. Chronic conditions can go untreated and become debilitating.
Pain is a driver of alcohol abuse and addiction to opioid painkillers, which in turn is feeding a growing heroin epidemic in the US. Stress and mental health issues are sometimes driven by constant worries about money and fear for the future as growing numbers of Americans look into a financial abyss at retirement.
What has changed?
Karl Rosston, Montana’s suicide prevention coordinator, said there are a number of constants that contribute to a historically high suicide rate throughout the Rocky Mountain region from social isolation to the availability of guns and a reluctance to seek mental health care.
But all of those are longstanding issues in Montana. So what’s changed to drive up the rate of people taking their own lives in recent years?
“Probably the biggest reason is socio-economic. We have about 150,000 people in our state that don’t have access to any type of healthcare, which is a major issue. We have a lot of people living in poverty. Wages are not going up at the same pace as rising health costs, rising cost of living and inflation,” Rosston said.
“Definitely you see a lot of people that all of a sudden they hit 45 or 50 and they don’t see retirement as a bonus. They see something that they’re going to have struggle with and they’re not going to be able to retire.”
Sullivan sees that as tied up with “the expectation that as a middle-aged white person you would outdo your parents economically and socially, and that didn’t occur”.
Lowney is typical of those baby boomers who have seen expectations dashed. His grandfather immigrated from Ireland to work as a miner when Butte was renowned as “the richest hill on earth” for the copper beneath. His father, Jerry, was raised in impoverished conditions but by the 1950s had moved up the social scale working as a civil engineer in a Butte hospital. He owned a house and a car. He had eight children, of which Kevin was the youngest, and retired on a comfortable pension without debt.
Butte-Silver Bow Community Health Needs Assessment for 2014 23% of people in Montana have no health insurance.
But the report said that even among those with insurance, nearly 40% faced obstacles to receiving needed healthcare. About one-third said they could not afford the cost of the doctor or prescription. Nearly 8% said they lacked transport to get to a clinic. More than 11% said they skipped or reduced prescription doses in order to save money.
Kristen Ryan is among them. She works with children with disabilities in Butte. Her husband is a maintenance engineer at an elementary school but has two additional part-time jobs, including bar shifts, to bring in extra cash.
taken hold across the United States. That has contributed to a sharp rise in unintentional poisonings from drugs and alcohol which have risen by about 160% nationally since 1999. Montana has 82 painkiller prescriptions for every 100 people.
Case and Deaton say that “addictions are hard to treat and pain is hard to control, so those currently in midlife may be a ‘lost generation’ whose future is less bright than those who preceded them”.
Sullivan thinks it is less bright for other reasons. She said for many the prospect of retirement is a fresh crisis.
“Where people landed in life, expecting to exceed what their parents accomplished, really is at play in our country,” she said. “Once you retire, you’re on a fixed-income when life becomes more interesting and not in a good way. What do you do with your limited income?”
Lowney had to cash in his small pension of $17,500 to pay medical bills. Ryan sees no prospect of retiring.
“My job cut the employer contribution to my pension a couple of years ago. I prefer not to think about that because I know I don’t have anything. It’s very small. It’s not going to be enough to live on,” she said. “I think public housing or something like that might be in our future as we get older because I don’t know that we’re going to be able to do it on our own.
“We owe my mother-in-law quite a bit of money because sometimes more goes out than comes in. You don’t expect to have to borrow from your parents at this age. You would hope that they would be able to borrow from you if they needed to but that’s just not the way that it’s turned out.”
The Princeton study also notes that a higher proportion of middle-aged suicides are among people who have less than a university education, suggesting they are more likely to be in lower income jobs and more severely affected by growing economic inequality. Rosston sees that in Montana too.
“I actually review every single suicide that occurs in the state and we see that a very high percentage – about 80% – had less than a college degree. That may correlate with the type of jobs, the labour jobs, that they had because with only a high school education or maybe just a little bit of college you’re more likely to be in those labour intensive jobs,” he said.
Tracy Thompson heads the Laborers’ International Union of North America in Butte. She used to be a construction worker and then held a job at a pulp mill in Missoula, to the west of Butte, until it shut down in 2009.
“We lost four people to suicide when they closed their doors. These were individuals making $50,000 or $60,000 a year, maybe more. All of a sudden they’re forced into early retirement or to find employment elsewhere. One guy had worked there for 30 years. We were all shocked he took his life,” she said. “You see it all around. You see a guy dies at 53. What did he die of?”
According to the Butte-Silver Bow Community Health Needs Assessment for 2014, more than one-third of residents show symptoms of chronic depression.
“I grapple with depression,” said Ryan. “I take an anti-depressant. I find my situation very stressful. I find that I have trouble sleeping. I have to tell myself not to think about it so I can go to sleep. It’s hard not to be able to do for your kids what you want to be able to do.
“I’ve heard that the majority of Americans are afraid of even a $500 emergency. They’re one broken refrigerator away from not being able to make it. That’s us.”
That may go some way to explain the differing middle aged death rate with other developed countries that have extensive welfare systems, free or cheap health care and greater support for pensioners. The proportion of US pensioners living in poverty is more than double that in Germany and nearly six times that of France. Few western Europeans are fearful of losing their homes to pay medical bills.
Sullivan also thinks there may be something else unusually American at work.
The power this traditional white male used to have is decreasing and they aren’t at the root of power anymore
Karen Sullivan, health director
“I’ve watched white males rule this country from the beginning. The power that this traditional white male used to have is decreasing. We’ve evolved and white males aren’t necessarily at the root of power anymore. Everything from the Oregon military takeover to the abuse people have hurled at our president, I think a lot of that is at play,” she said.
African Americans on the other hand have long struggled against inequality and have generally held fewer assumptions about social advancement, which may explain why the same increases in suicides and drug and alcohol deaths have not been seen among middle aged black people.
Rosston said that whatever the causes, the increased numbers of suicides reflects a mental health crisis that is not being addressed in part because of a lack of professionals but also because of a reluctance to seek their help.
“We have a very high shortage of mental health professionals in our state, specifically psychiatrists. About 80% of the people who take psychotropic medication in Montana have never even spoken to a psychiatrist,” he said. “Also, there’s a stigma when it comes to mental illness. We have that kinda cowboy mentality, frontier mentality of taking care of your own, and people see depression as a weakness.
“The words I often see when I review suicides is that the person thought they were a burden. That they weren’t serving a purpose anymore or they’re tired of dealing with things. When you feel that way, you’re not going to ask for help.”
• In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In the UK, the Samaritans can be contacted on 116 123. In Australia, the crisis support service Lifeline is on 13 11 14.
http://www.theguardian.com/us-news/2016/feb/07/suicide-rates-rise-butte-montana-princeton-study
Financial despair, addiction and the rise of suicide in white America
The death rate for white Americans aged 45 to 54 has risen sharply since 1999, but Montana officials wrestle to explain why the state has the highest rate of suicide in the US at nearly twice the national average – and it’s rising
Kevin Lowney lies awake some nights wondering if he should kill himself.
“I am in such pain every night, suicide has on a regular basis crossed my mind just simply to ease the pain. If I did not have responsibilities, especially for my youngest daughter who has problems,” he said.
The 56-year-old former salesman’s struggle with chronic pain is bound up with an array of other issues – medical debts, impoverishment and the prospect of a bleak retirement – contributing to growing numbers of suicides in the US and helping drive a sharp and unusual increase in the mortality rate for middle-aged white Americans in recent years alongside premature deaths from alcohol and drugs.
A study released late last year by two Princeton academics, Anne Case and Angus Deaton, who won the 2014 Nobel prize for economics, revealed that the death rate for white Americans aged 45 to 54 has risen sharply since 1999 after declining for decades. The increase, by 20% over the 14 years to 2013, represents about half a million lives cut short.
The uptick in the mortality rate is unique to that age and racial group. Death rates for African Americans of a similar age remain notably higher but continue to fall.
Neither was the increase seen in other developed countries. In the UK, the mortality rate for middle-aged people dropped by one third over the same period.
“This change reversed decades of progress in mortality and was unique to the United States; no other rich country saw a similar turnaround,” the study said.
Deaths from poisonings by drugs or alcohol have risen dramatically to push lung cancer into second place as the major killer with a sharp increase in suicides now a close third.
FacebookTwitterPinterest
‘I was a very hard-working American. Overly hard-working American. This is what brought down my health,’ Kevin Lowney said. Photograph: Walter Hinick for the Guardian
Lowney lives in Butte, Montana, where local officials see the Princeton study’s findings reflected in their community but struggle to explain them. The state has the highest rate of suicide in the US at nearly twice the national average and rising – up 7.3% in 2014. Those most likely to kill themselves are 45 to 65 years old.
“What’s been lacking in our town is an explanation for why this demographic in particular has been dying by suicide,” said Karen Sullivan, health director for Butte and the surrounding county, Silver Bow. “We want to take a look at what we’ve got going on in Butte. Is it economic in nature? Is it middle-aged white people discontented with where they landed in life? Is it isolation? A lack of a social network? Is it drug and alcohol issues? What do we have going on?”
Other officials see a number of interconnected forces at work and the rising rate of middle-aged deaths as indicative of crisis wider than those who kill themselves.
Growing economic inequality and increasing financial struggles are intertwined with other issues such as health and addiction. Some people living on low incomes hesitate to go to the doctor even if they have medical insurance because of the cost of out-of-pocket expenses. Chronic conditions can go untreated and become debilitating.
Pain is a driver of alcohol abuse and addiction to opioid painkillers, which in turn is feeding a growing heroin epidemic in the US. Stress and mental health issues are sometimes driven by constant worries about money and fear for the future as growing numbers of Americans look into a financial abyss at retirement.
What has changed?
Karl Rosston, Montana’s suicide prevention coordinator, said there are a number of constants that contribute to a historically high suicide rate throughout the Rocky Mountain region from social isolation to the availability of guns and a reluctance to seek mental health care.
But all of those are longstanding issues in Montana. So what’s changed to drive up the rate of people taking their own lives in recent years?
“Probably the biggest reason is socio-economic. We have about 150,000 people in our state that don’t have access to any type of healthcare, which is a major issue. We have a lot of people living in poverty. Wages are not going up at the same pace as rising health costs, rising cost of living and inflation,” Rosston said.
“Definitely you see a lot of people that all of a sudden they hit 45 or 50 and they don’t see retirement as a bonus. They see something that they’re going to have struggle with and they’re not going to be able to retire.”
Sullivan sees that as tied up with “the expectation that as a middle-aged white person you would outdo your parents economically and socially, and that didn’t occur”.
Lowney is typical of those baby boomers who have seen expectations dashed. His grandfather immigrated from Ireland to work as a miner when Butte was renowned as “the richest hill on earth” for the copper beneath. His father, Jerry, was raised in impoverished conditions but by the 1950s had moved up the social scale working as a civil engineer in a Butte hospital. He owned a house and a car. He had eight children, of which Kevin was the youngest, and retired on a comfortable pension without debt.
Butte-Silver Bow Community Health Needs Assessment for 2014 23% of people in Montana have no health insurance.
But the report said that even among those with insurance, nearly 40% faced obstacles to receiving needed healthcare. About one-third said they could not afford the cost of the doctor or prescription. Nearly 8% said they lacked transport to get to a clinic. More than 11% said they skipped or reduced prescription doses in order to save money.
Kristen Ryan is among them. She works with children with disabilities in Butte. Her husband is a maintenance engineer at an elementary school but has two additional part-time jobs, including bar shifts, to bring in extra cash.
taken hold across the United States. That has contributed to a sharp rise in unintentional poisonings from drugs and alcohol which have risen by about 160% nationally since 1999. Montana has 82 painkiller prescriptions for every 100 people.
Case and Deaton say that “addictions are hard to treat and pain is hard to control, so those currently in midlife may be a ‘lost generation’ whose future is less bright than those who preceded them”.
Sullivan thinks it is less bright for other reasons. She said for many the prospect of retirement is a fresh crisis.
“Where people landed in life, expecting to exceed what their parents accomplished, really is at play in our country,” she said. “Once you retire, you’re on a fixed-income when life becomes more interesting and not in a good way. What do you do with your limited income?”
Lowney had to cash in his small pension of $17,500 to pay medical bills. Ryan sees no prospect of retiring.
“My job cut the employer contribution to my pension a couple of years ago. I prefer not to think about that because I know I don’t have anything. It’s very small. It’s not going to be enough to live on,” she said. “I think public housing or something like that might be in our future as we get older because I don’t know that we’re going to be able to do it on our own.
“We owe my mother-in-law quite a bit of money because sometimes more goes out than comes in. You don’t expect to have to borrow from your parents at this age. You would hope that they would be able to borrow from you if they needed to but that’s just not the way that it’s turned out.”
The Princeton study also notes that a higher proportion of middle-aged suicides are among people who have less than a university education, suggesting they are more likely to be in lower income jobs and more severely affected by growing economic inequality. Rosston sees that in Montana too.
“I actually review every single suicide that occurs in the state and we see that a very high percentage – about 80% – had less than a college degree. That may correlate with the type of jobs, the labour jobs, that they had because with only a high school education or maybe just a little bit of college you’re more likely to be in those labour intensive jobs,” he said.
Tracy Thompson heads the Laborers’ International Union of North America in Butte. She used to be a construction worker and then held a job at a pulp mill in Missoula, to the west of Butte, until it shut down in 2009.
“We lost four people to suicide when they closed their doors. These were individuals making $50,000 or $60,000 a year, maybe more. All of a sudden they’re forced into early retirement or to find employment elsewhere. One guy had worked there for 30 years. We were all shocked he took his life,” she said. “You see it all around. You see a guy dies at 53. What did he die of?”
According to the Butte-Silver Bow Community Health Needs Assessment for 2014, more than one-third of residents show symptoms of chronic depression.
“I grapple with depression,” said Ryan. “I take an anti-depressant. I find my situation very stressful. I find that I have trouble sleeping. I have to tell myself not to think about it so I can go to sleep. It’s hard not to be able to do for your kids what you want to be able to do.
“I’ve heard that the majority of Americans are afraid of even a $500 emergency. They’re one broken refrigerator away from not being able to make it. That’s us.”
That may go some way to explain the differing middle aged death rate with other developed countries that have extensive welfare systems, free or cheap health care and greater support for pensioners. The proportion of US pensioners living in poverty is more than double that in Germany and nearly six times that of France. Few western Europeans are fearful of losing their homes to pay medical bills.
Sullivan also thinks there may be something else unusually American at work.
The power this traditional white male used to have is decreasing and they aren’t at the root of power anymore
Karen Sullivan, health director
“I’ve watched white males rule this country from the beginning. The power that this traditional white male used to have is decreasing. We’ve evolved and white males aren’t necessarily at the root of power anymore. Everything from the Oregon military takeover to the abuse people have hurled at our president, I think a lot of that is at play,” she said.
African Americans on the other hand have long struggled against inequality and have generally held fewer assumptions about social advancement, which may explain why the same increases in suicides and drug and alcohol deaths have not been seen among middle aged black people.
Rosston said that whatever the causes, the increased numbers of suicides reflects a mental health crisis that is not being addressed in part because of a lack of professionals but also because of a reluctance to seek their help.
“We have a very high shortage of mental health professionals in our state, specifically psychiatrists. About 80% of the people who take psychotropic medication in Montana have never even spoken to a psychiatrist,” he said. “Also, there’s a stigma when it comes to mental illness. We have that kinda cowboy mentality, frontier mentality of taking care of your own, and people see depression as a weakness.
“The words I often see when I review suicides is that the person thought they were a burden. That they weren’t serving a purpose anymore or they’re tired of dealing with things. When you feel that way, you’re not going to ask for help.”
• In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In the UK, the Samaritans can be contacted on 116 123. In Australia, the crisis support service Lifeline is on 13 11 14.
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Suffering isn't opioid responsive.
http://www.theguardian.com/us-news/2016/feb/07/suicide-rates-rise-butte-montana-princeton-study
Financial despair, addiction and the rise of suicide in white America
The death rate for white Americans aged 45 to 54 has risen sharply since 1999, but Montana officials wrestle to explain why the state has the highest rate of suicide in the US at nearly twice the national average – and it’s rising
Kevin Lowney lies awake some nights wondering if he should kill himself.
“I am in such pain every night, suicide has on a regular basis crossed my mind just simply to ease the pain. If I did not have responsibilities, especially for my youngest daughter who has problems,” he said.
The 56-year-old former salesman’s struggle with chronic pain is bound up with an array of other issues – medical debts, impoverishment and the prospect of a bleak retirement – contributing to growing numbers of suicides in the US and helping drive a sharp and unusual increase in the mortality rate for middle-aged white Americans in recent years alongside premature deaths from alcohol and drugs.
A study released late last year by two Princeton academics, Anne Case and Angus Deaton, who won the 2014 Nobel prize for economics, revealed that the death rate for white Americans aged 45 to 54 has risen sharply since 1999 after declining for decades. The increase, by 20% over the 14 years to 2013, represents about half a million lives cut short.
The uptick in the mortality rate is unique to that age and racial group. Death rates for African Americans of a similar age remain notably higher but continue to fall.
Neither was the increase seen in other developed countries. In the UK, the mortality rate for middle-aged people dropped by one third over the same period.
“This change reversed decades of progress in mortality and was unique to the United States; no other rich country saw a similar turnaround,” the study said.
Deaths from poisonings by drugs or alcohol have risen dramatically to push lung cancer into second place as the major killer with a sharp increase in suicides now a close third.
FacebookTwitterPinterest
‘I was a very hard-working American. Overly hard-working American. This is what brought down my health,’ Kevin Lowney said. Photograph: Walter Hinick for the Guardian
Lowney lives in Butte, Montana, where local officials see the Princeton study’s findings reflected in their community but struggle to explain them. The state has the highest rate of suicide in the US at nearly twice the national average and rising – up 7.3% in 2014. Those most likely to kill themselves are 45 to 65 years old.
“What’s been lacking in our town is an explanation for why this demographic in particular has been dying by suicide,” said Karen Sullivan, health director for Butte and the surrounding county, Silver Bow. “We want to take a look at what we’ve got going on in Butte. Is it economic in nature? Is it middle-aged white people discontented with where they landed in life? Is it isolation? A lack of a social network? Is it drug and alcohol issues? What do we have going on?”
Other officials see a number of interconnected forces at work and the rising rate of middle-aged deaths as indicative of crisis wider than those who kill themselves.
Growing economic inequality and increasing financial struggles are intertwined with other issues such as health and addiction. Some people living on low incomes hesitate to go to the doctor even if they have medical insurance because of the cost of out-of-pocket expenses. Chronic conditions can go untreated and become debilitating.
Pain is a driver of alcohol abuse and addiction to opioid painkillers, which in turn is feeding a growing heroin epidemic in the US. Stress and mental health issues are sometimes driven by constant worries about money and fear for the future as growing numbers of Americans look into a financial abyss at retirement.
What has changed?
Karl Rosston, Montana’s suicide prevention coordinator, said there are a number of constants that contribute to a historically high suicide rate throughout the Rocky Mountain region from social isolation to the availability of guns and a reluctance to seek mental health care.
But all of those are longstanding issues in Montana. So what’s changed to drive up the rate of people taking their own lives in recent years?
“Probably the biggest reason is socio-economic. We have about 150,000 people in our state that don’t have access to any type of healthcare, which is a major issue. We have a lot of people living in poverty. Wages are not going up at the same pace as rising health costs, rising cost of living and inflation,” Rosston said.
“Definitely you see a lot of people that all of a sudden they hit 45 or 50 and they don’t see retirement as a bonus. They see something that they’re going to have struggle with and they’re not going to be able to retire.”
Sullivan sees that as tied up with “the expectation that as a middle-aged white person you would outdo your parents economically and socially, and that didn’t occur”.
Lowney is typical of those baby boomers who have seen expectations dashed. His grandfather immigrated from Ireland to work as a miner when Butte was renowned as “the richest hill on earth” for the copper beneath. His father, Jerry, was raised in impoverished conditions but by the 1950s had moved up the social scale working as a civil engineer in a Butte hospital. He owned a house and a car. He had eight children, of which Kevin was the youngest, and retired on a comfortable pension without debt.
Butte-Silver Bow Community Health Needs Assessment for 2014 23% of people in Montana have no health insurance.
But the report said that even among those with insurance, nearly 40% faced obstacles to receiving needed healthcare. About one-third said they could not afford the cost of the doctor or prescription. Nearly 8% said they lacked transport to get to a clinic. More than 11% said they skipped or reduced prescription doses in order to save money.
Kristen Ryan is among them. She works with children with disabilities in Butte. Her husband is a maintenance engineer at an elementary school but has two additional part-time jobs, including bar shifts, to bring in extra cash.
taken hold across the United States. That has contributed to a sharp rise in unintentional poisonings from drugs and alcohol which have risen by about 160% nationally since 1999. Montana has 82 painkiller prescriptions for every 100 people.
Case and Deaton say that “addictions are hard to treat and pain is hard to control, so those currently in midlife may be a ‘lost generation’ whose future is less bright than those who preceded them”.
Sullivan thinks it is less bright for other reasons. She said for many the prospect of retirement is a fresh crisis.
“Where people landed in life, expecting to exceed what their parents accomplished, really is at play in our country,” she said. “Once you retire, you’re on a fixed-income when life becomes more interesting and not in a good way. What do you do with your limited income?”
Lowney had to cash in his small pension of $17,500 to pay medical bills. Ryan sees no prospect of retiring.
“My job cut the employer contribution to my pension a couple of years ago. I prefer not to think about that because I know I don’t have anything. It’s very small. It’s not going to be enough to live on,” she said. “I think public housing or something like that might be in our future as we get older because I don’t know that we’re going to be able to do it on our own.
“We owe my mother-in-law quite a bit of money because sometimes more goes out than comes in. You don’t expect to have to borrow from your parents at this age. You would hope that they would be able to borrow from you if they needed to but that’s just not the way that it’s turned out.”
The Princeton study also notes that a higher proportion of middle-aged suicides are among people who have less than a university education, suggesting they are more likely to be in lower income jobs and more severely affected by growing economic inequality. Rosston sees that in Montana too.
“I actually review every single suicide that occurs in the state and we see that a very high percentage – about 80% – had less than a college degree. That may correlate with the type of jobs, the labour jobs, that they had because with only a high school education or maybe just a little bit of college you’re more likely to be in those labour intensive jobs,” he said.
Tracy Thompson heads the Laborers’ International Union of North America in Butte. She used to be a construction worker and then held a job at a pulp mill in Missoula, to the west of Butte, until it shut down in 2009.
“We lost four people to suicide when they closed their doors. These were individuals making $50,000 or $60,000 a year, maybe more. All of a sudden they’re forced into early retirement or to find employment elsewhere. One guy had worked there for 30 years. We were all shocked he took his life,” she said. “You see it all around. You see a guy dies at 53. What did he die of?”
According to the Butte-Silver Bow Community Health Needs Assessment for 2014, more than one-third of residents show symptoms of chronic depression.
“I grapple with depression,” said Ryan. “I take an anti-depressant. I find my situation very stressful. I find that I have trouble sleeping. I have to tell myself not to think about it so I can go to sleep. It’s hard not to be able to do for your kids what you want to be able to do.
“I’ve heard that the majority of Americans are afraid of even a $500 emergency. They’re one broken refrigerator away from not being able to make it. That’s us.”
That may go some way to explain the differing middle aged death rate with other developed countries that have extensive welfare systems, free or cheap health care and greater support for pensioners. The proportion of US pensioners living in poverty is more than double that in Germany and nearly six times that of France. Few western Europeans are fearful of losing their homes to pay medical bills.
Sullivan also thinks there may be something else unusually American at work.
The power this traditional white male used to have is decreasing and they aren’t at the root of power anymore
Karen Sullivan, health director
“I’ve watched white males rule this country from the beginning. The power that this traditional white male used to have is decreasing. We’ve evolved and white males aren’t necessarily at the root of power anymore. Everything from the Oregon military takeover to the abuse people have hurled at our president, I think a lot of that is at play,” she said.
African Americans on the other hand have long struggled against inequality and have generally held fewer assumptions about social advancement, which may explain why the same increases in suicides and drug and alcohol deaths have not been seen among middle aged black people.
Rosston said that whatever the causes, the increased numbers of suicides reflects a mental health crisis that is not being addressed in part because of a lack of professionals but also because of a reluctance to seek their help.
“We have a very high shortage of mental health professionals in our state, specifically psychiatrists. About 80% of the people who take psychotropic medication in Montana have never even spoken to a psychiatrist,” he said. “Also, there’s a stigma when it comes to mental illness. We have that kinda cowboy mentality, frontier mentality of taking care of your own, and people see depression as a weakness.
“The words I often see when I review suicides is that the person thought they were a burden. That they weren’t serving a purpose anymore or they’re tired of dealing with things. When you feel that way, you’re not going to ask for help.”
• In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In the UK, the Samaritans can be contacted on 116 123. In Australia, the crisis support service Lifeline is on 13 11 14.
First, you're making an inference that white-suffering is caused or worsened by being prescribed opioids. That assertion never appears in this article.
Second, where is the evidence expanded Medicaid/Obama-care insurance improves the treatment of chronic pain or mental disorders? I'm not seeing that. You can't make chicken salad out of chicken-****.
Third, I think that this article makes more of a case for rise of demagoguery in our national politics than it does for chronic pain treatment.
Finally, I think that there is a weirdo/condescending narrative about race getting mixed up in the conversation about opioid prescribing. It's dog-whistle. I hear it has, "Yep, those lucky black folks with their stereotypes about becoming drug addicts or diverters and fewer aspirations for social advancement and a fair shake in this society are being spared this scourge..." I find it troubling....
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Rural white middle class suffering is largely economic/education related. The suffering isn't helped with opioids, but by
god we've given it the old college try, and we've killed and addicted a lot of people along the way. PHARMA and their minions
have made a lot of money on this broken model.
Obama just release a billion dollars to help with the opioid epidemic, that's a start. While this will largely be applied to
expanding addiction treatment lots of folks I talk to realize that the suffering long precedes the addiction and it needs treatment too. That treatment - treatment of the cause of suffering - will likely be part medical, but part social/educational. You don't need
nociception to explain suffering.
Race is a part of this whether we like it or not. This is largely a rural, poor white crisis. These are the folks who were left behind
when the mill closed down, logging closed down, fishing closed down, when the job was outsourced, etc and they didn't have a plan b. These are the folks who went to Malhuer and those who Multnomah Co like to like to caricature as neanderthal's , racists, polygamists, red necks, white trash, fundamentalists, etc. These are the people who are voting for Trump.
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Thats a lot of misplaced blame. And complete BS.
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http://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1er.htm
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CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016
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http://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1er.htm
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CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016
Early Release / March 15, 2016 / 65
http://www.cdc.gov/mmwr/volumes/65/rr/pdfs/rr6501e1er.pdf
Just making it easier to navigate.
Guess everyone in the country on 90+ meq should trigger a referral to Roger Chou.
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https://cdn1.sph.harvard.edu/wp-con...rd-Poll-Mar-2016-Prescription-Painkillers.pdf
Broad support for limiting opioid painkiller prescriptions
Poll: Broad support for new opioid prescription guidelines
Injury control
A better surveillance system for tracking police homicides
A new STAT-Harvard poll finds bipartisan support for new federal guidelines advising physicians to give patients with acute pain no more than a three-day supply of opioid painkillers. Seven in 10 Americans support the guidelines, which also advise doctors to try other treatment options before issuing prescriptions. About half of those surveyed believe that prescription painkillers are an extremely or very serious problem in their state. One in three of those surveyed held doctors responsible for the nation’s opioid epidemic—about as much as hold individual users responsible.
Robert Blendon, Richard L. Menschel Professor of Public Health and Professor of Health Policy and Political Analysis at Harvard T.H. Chan School of Public Health, who oversaw the poll, told STAT in a March 17, 2016 article that the consensus for government action on opioid addiction was remarkable. He said, “Republicans and Democrats can talk about this together. They can move on legislation.”
Read STAT article: 1 in 3 Americans blame doctors for national opioid epidemic, STAT-Harvard poll finds
Broad support for limiting opioid painkiller prescriptions
Poll: Broad support for new opioid prescription guidelines
Injury control
A better surveillance system for tracking police homicides
A new STAT-Harvard poll finds bipartisan support for new federal guidelines advising physicians to give patients with acute pain no more than a three-day supply of opioid painkillers. Seven in 10 Americans support the guidelines, which also advise doctors to try other treatment options before issuing prescriptions. About half of those surveyed believe that prescription painkillers are an extremely or very serious problem in their state. One in three of those surveyed held doctors responsible for the nation’s opioid epidemic—about as much as hold individual users responsible.
Robert Blendon, Richard L. Menschel Professor of Public Health and Professor of Health Policy and Political Analysis at Harvard T.H. Chan School of Public Health, who oversaw the poll, told STAT in a March 17, 2016 article that the consensus for government action on opioid addiction was remarkable. He said, “Republicans and Democrats can talk about this together. They can move on legislation.”
Read STAT article: 1 in 3 Americans blame doctors for national opioid epidemic, STAT-Harvard poll finds
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Yes!
The New York Times[/paste:font]
The New York Times[/paste:font]
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Seeking Painkillers in the Emergency Room
STUART BRADFORD
By HELEN OUYANG
MARCH 25, 2016
A couple of months ago, a patient well known to the emergency room where I work came in requesting his usual cocktail of narcotic pain medications. It was early Saturday morning, before the usual bustle of patients had begun, and I had some time.
The patient was well documented in the electronic medical record for his frequent emergency room visits for painkillers. To further confirm, I called his pharmacy, and as soon as the pharmacist heard the patient’s name, he sighed loudly, said he knew him well, and began listing the litany of different doctors and hospitals from which the patient had gotten narcotic painkillers.
I then sat down with the patient for a good 25 minutes — a considerably long time in a busy, urban emergency room— and explained why I could not give him what he wanted. It was clearly stated in his medical record that he had an extensive history of opioid abuse, and the shopping-around for prescriptions, as suggested by his pharmacy, further validated that. I knew if I waved him off with another supply of painkillers, I would only perpetuate his addiction problem.
He protested loudly and repeatedly said, “I don’t know why you can’t be like all the other docs and just give me the drugs. Everybody does it.” Finally, realizing that he would not get what he wanted, he stormed out after shouting at me: “If you doctors don’t want me taking the drugs, why’d you all give me all those pills after my surgery last year?”
Patients like him are not uncommon in the emergency room. A 2014 study confirmed that from 2001 to 2010, the percentage of emergency room visits during which opioids were prescribed jumped by 10 percent. My patient’s story stuck with me because I was actually able to spend time counseling him instead of caving to his request — and because he had the insight to know that his addiction started with a doctor’s prescription.
The opioid epidemic is explosive, and laws are being passed to address the problem. Two-thirds of emergency room visits involving overdoses are due to prescription drugs. The highest number of deaths caused by opioid painkillers was in 2014. The data for 2015 has yet to be released.
But, as one of my colleagues whom I greatly respect said to me in the emergency room recently: “Why wouldn’t I give patients a Percocet prescription? It makes their life easier and my life easier.” Another colleague overhead this and wholeheartedly agreed, speaking truth to the fact that the system is set up so that refusing these demands is much more difficult and time-consuming than it is to simply give in to them.
I know it, too. I’ve had patients seeking painkiller prescriptions who kept the hospital administrator’s number in their cellphones and have called pre-emptively before I’ve even had a chance to talk to them. I’ve had patients who’ve had tremendous outbursts in the emergency room, completely disrupting care and taking up the time and attention of many of the hospital staff members, often to the detriment of other patients. This sometimes results in my colleagues asking if I could simply prescribe a couple of pills so the patients would leave.
Several years ago, I even had a patient formalize a letter of complaint to the state health department that I did not give her the opioids she requested. At the very least, I have to worry about patient satisfaction scores, which have come to be valued ever more greatly as they’re now linked to Medicare reimbursements. For individual physicians, low scores may result in a slap on the wrist or decreased pay or, in extreme cases, even be grounds for dismissal.
I appreciate that new safeguards are being implemented. In New York State, where I now work, a higher-level electronic prescribing system is rolling out to closely track and protect against narcotic painkiller over-prescribing; my colleagues and I all went through the training process and are mandated to start the new system on March 27. Under the new system, only digital prescriptions that are electronically transmitted to the pharmacy are allowed, and if a physician wants to prescribe a narcotic painkiller, an additional security verification step is required. In Massachusetts, where I used to work, a law was passed to limit narcotic prescribing to a seven-day supply after a surgery or injury.
But the truth is, a deep cultural shift within our health care system is needed. Physicians need to know that if they don’t prescribe a narcotic because it’s not clinically indicated, or worse yet, because the patient already has an addiction problem, that they have the backing of administrators at every level, from their own department to the head of the hospital all the way up to state officials. If patients are seeking narcotics and have a documented history of doing so — and become combative or refuse to leave after discharge — they may need to be escorted out of the emergency room by security and their treatment terminated to avoid interrupting the care of other patients.
What my patient said to me that Saturday morning is right: We health care providers created the problem. Now it’s up to us to take steps to try to solve it. Beyond these new prescribing laws, on-site drug counseling ought to be in place. Drug rehabiliation programs need to be expanded, and dedicated staff should be available in the emergency room to enroll patients into them directly. But it begins with doctors not jumping immediately to prescribe narcotic painkillers — and a health care system that allows them to say no.
Helen Ouyang is an emergency physician at NewYork-Presbyterian Hospital and an assistant professor of medicine at Columbia University.
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Opioid Abuse in Chronic Pain — Misconceptions and Mitigation Strategies Nora D. Volkow, M.D., and A. Thomas McLellan, Ph.D
http://www.nejm.org/doi/pdf/10.1056/NEJMra1507771
http://www.nejm.org/doi/pdf/10.1056/NEJMra1507771
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http://www.nejm.org/doi/full/10.1056/NEJMoa1505409
Naltrexone a better choice than methadone for addiction.
Because susbstitutuon with a pure mu for a pure mu? Everywhere a moomoo.
Naltrexone a better choice than methadone for addiction.
Because susbstitutuon with a pure mu for a pure mu? Everywhere a moomoo.
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Oregon 27th in US population [1] but 11th in US oxcodone Rx's [2]. Something is wrong with this picture.
1. http://www.ipl.org/div/stateknow/popchart.html
2. https://projects.propublica.org/checkup/drugs/2954
1. http://www.ipl.org/div/stateknow/popchart.html
2. https://projects.propublica.org/checkup/drugs/2954
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thats not what your links are showing. looks like 11th in oxycodone claims, and 23rd for percocet...
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Indiana doctor arrested after federal agents raid home http://wishtv.com/2016/03/23/indiana-doctor-arrested-after-federal-agents-raid-home/
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http://www.medscape.com/viewarticle/861351
Addiction, Empathy, and Opioid Alternatives
Helen Riess, MD
Introduction
It's not news that we're in the midst of a national opioid epidemic. According to figures compiled by the American Society of Addiction Medicine, 1.9 million American citizens are presently living with prescription opioid abuse or dependence, while another 517,000 Americans are living with heroin addiction. The human toll is catastrophic—both for those in the grips of addiction and for those who know someone affected. Recently Massachusetts Governor Charlie Baker signed a new law aimed at stemming Massachusetts' opioid addiction crisis that will limit prescriptions and mandate student screenings, substance abuse evaluations in emergency departments, and monitoring programs to reduce doctor shopping. As the rate of opioid addiction—and opioid-related deaths—has skyrocketed, these measures must go hand in hand with new trainings for healthcare workers in productive and potentially life-changing conversations that will transform how drug-dependent patients are treated. The finger pointing at both patients and doctors has become rampant. This type of thinking is counterproductive. As hospital visits for opioid use soar, medical professionals need to be equipped with communication toolkits that will truly benefit patients.
First, a little background.
Since the 1990s, society has castigated physicians for minimizing the pain expressed by patients. As a result, pain management became a primary target for physician training, which resulted in overprescribing rather than withholding or underprescribing pain medications.[1,2] Opioids are medications that work by reducing the intensity of pain signals reaching the brain. By diminishing the effects of painful stimuli, they also affect brain areas controlling emotions associated with pain. For some patients, once introduced to a dramatic disappearance of pain, their desire to remain pain free—both physically and emotionally—can lead to overwhelming addiction, with its many associated antisocial behaviors. Oftentimes with drug-addicted patients, there is an additional undercurrent of problems: sexual and physical abuse, depression and mental illness, socioeconomic hardship, and more.
Patients struggling with addiction are some of the most difficult patients to treat—and even for seemingly impenetrable physicians, a stigma surrounding addiction persists. Empathic, skilled conversations by medical professionals with their patients can help save many lives of patients who are facing potentially hopeless and devastating futures. However, most physicians aren't trained to enter into productive and empathic conversations with drug-addicted patients. These patients are often viewed as weak, self-indulgent, and lacking willpower and therefore refusing to help themselves.
Additionally, drug-addicted patients often use manipulative tactics to get the substances they crave. Manipulative tactics usually backfire, leading medical professionals to further distance themselves and dislike the patients who employ them. The helplessness in the addict gets transferred to helplessness in the physician caring for the addict. Therefore, physician training in these difficult conversations is essential. Too often, more prescriptions become the "solution" to mediate the helplessness that is at the core of the drug-addicted individual and their physicians.
Opioid Alternatives
What gets lost here is the desperation, shame, and self-loathing that accompany drug addiction. Medical doctors must not lose sight of the desperate person behind the behaviors, which can be extremely off-putting and lead to feelings of disgust, helplessness, and even contempt for the drug seeker. Empathy is crucial. Training programs are available and must be prioritized by medical institutions to address this culture-made crisis. When medical professionals aren't equipped with the tools and skills to meet the desperate person behind the wall of addiction, conversations are abruptly ended, and relationships are severed, often before the problem is named and a dedicated team is mobilized to help the individual.
True empathy does not mean continuing to write prescriptions. Empathy means asking questions and humanizing the patient, which can result in finding hope for a drug-free future by showing an alternative pathway to recovery. These alternatives will not immediately be desired or accepted by drug addicts. However, when there is a uniform message throughout the medical world that recovery is attainable by addressing the underlying anxiety, fear, and hopelessness that drug addicts face, there is hope for a new future.
Studies show that opioids are not always the best treatment for chronic pain.
Addiction, Empathy, and Opioid Alternatives
Helen Riess, MD
Introduction
It's not news that we're in the midst of a national opioid epidemic. According to figures compiled by the American Society of Addiction Medicine, 1.9 million American citizens are presently living with prescription opioid abuse or dependence, while another 517,000 Americans are living with heroin addiction. The human toll is catastrophic—both for those in the grips of addiction and for those who know someone affected. Recently Massachusetts Governor Charlie Baker signed a new law aimed at stemming Massachusetts' opioid addiction crisis that will limit prescriptions and mandate student screenings, substance abuse evaluations in emergency departments, and monitoring programs to reduce doctor shopping. As the rate of opioid addiction—and opioid-related deaths—has skyrocketed, these measures must go hand in hand with new trainings for healthcare workers in productive and potentially life-changing conversations that will transform how drug-dependent patients are treated. The finger pointing at both patients and doctors has become rampant. This type of thinking is counterproductive. As hospital visits for opioid use soar, medical professionals need to be equipped with communication toolkits that will truly benefit patients.
First, a little background.
Since the 1990s, society has castigated physicians for minimizing the pain expressed by patients. As a result, pain management became a primary target for physician training, which resulted in overprescribing rather than withholding or underprescribing pain medications.[1,2] Opioids are medications that work by reducing the intensity of pain signals reaching the brain. By diminishing the effects of painful stimuli, they also affect brain areas controlling emotions associated with pain. For some patients, once introduced to a dramatic disappearance of pain, their desire to remain pain free—both physically and emotionally—can lead to overwhelming addiction, with its many associated antisocial behaviors. Oftentimes with drug-addicted patients, there is an additional undercurrent of problems: sexual and physical abuse, depression and mental illness, socioeconomic hardship, and more.
Patients struggling with addiction are some of the most difficult patients to treat—and even for seemingly impenetrable physicians, a stigma surrounding addiction persists. Empathic, skilled conversations by medical professionals with their patients can help save many lives of patients who are facing potentially hopeless and devastating futures. However, most physicians aren't trained to enter into productive and empathic conversations with drug-addicted patients. These patients are often viewed as weak, self-indulgent, and lacking willpower and therefore refusing to help themselves.
Additionally, drug-addicted patients often use manipulative tactics to get the substances they crave. Manipulative tactics usually backfire, leading medical professionals to further distance themselves and dislike the patients who employ them. The helplessness in the addict gets transferred to helplessness in the physician caring for the addict. Therefore, physician training in these difficult conversations is essential. Too often, more prescriptions become the "solution" to mediate the helplessness that is at the core of the drug-addicted individual and their physicians.
Opioid Alternatives
What gets lost here is the desperation, shame, and self-loathing that accompany drug addiction. Medical doctors must not lose sight of the desperate person behind the behaviors, which can be extremely off-putting and lead to feelings of disgust, helplessness, and even contempt for the drug seeker. Empathy is crucial. Training programs are available and must be prioritized by medical institutions to address this culture-made crisis. When medical professionals aren't equipped with the tools and skills to meet the desperate person behind the wall of addiction, conversations are abruptly ended, and relationships are severed, often before the problem is named and a dedicated team is mobilized to help the individual.
True empathy does not mean continuing to write prescriptions. Empathy means asking questions and humanizing the patient, which can result in finding hope for a drug-free future by showing an alternative pathway to recovery. These alternatives will not immediately be desired or accepted by drug addicts. However, when there is a uniform message throughout the medical world that recovery is attainable by addressing the underlying anxiety, fear, and hopelessness that drug addicts face, there is hope for a new future.
Studies show that opioids are not always the best treatment for chronic pain.
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Want to add to the list of red flags:
Last physician arrested for dealing drugs. No opiates for you.
http://accesswdun.com/article/2016/2/367724/union-general-hospital-ceo-arrested
Last physician arrested for dealing drugs. No opiates for you.
http://accesswdun.com/article/2016/2/367724/union-general-hospital-ceo-arrested
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http://www.startribune.com/reliance...reatest-mistake-in-medical-history/375906361/
Reliance on opioids: One of the greatest mistakes in medical history
Opioids were never safe and never right for the noncancer pain for which they were given. But given they were, in abundance, with overseers' blessings. That is finally changing, too late for many.
By Paul John Scott
APRIL 16, 2016 — 6:48PM
STAR TRIBUNE
Star Tribune
It may not become common knowledge anytime soon, but if Shakespeare was right that the truth will out, Americans are headed for a remarkable realization.
The worst public health crisis in our time was brought about by the practice of medicine.
There’s little precedent for the pivotal role of American health professionals in the creation of the Great Painkiller Plague of the early 2000s — a genie of opioid and opioid-equivalent use, addiction and early death that until now has been effectively mischaracterized as “opioid abuse,” and which multiple federal entities have now begun scrambling to put back in the bottle.
In the past, great waves of sickness were spread through close contact, poor hygiene and tainted wells. Beginning in the 1990s, however, it fell upon unwitting doctors and a captured medical system to set in motion this drug group’s signature trajectory in far too many users: tolerance, addiction, sobriety, relapse, overdose. That our medical system managed to trigger this by telling us something as unconvincing as it did says as much about our times as it does about the power of the opium poppy.
The system told us we could take heroin, more or less, for back pain.
The long-delayed correction of that lie may finally have arrived, to judge from the flurry of regulatory and legislative efforts now underway to reel in the propaganda of the opioid era. Congress is set to deliver comprehensive addiction and recovery legislation. The president has authorized a $1.1 billion initiative to combat addiction with new medications. And last month saw the release of new guidelines from the Centers for Disease Control and Prevention (CDC) that define long-term use of opioids as medically unsound.
Because the federal government cannot direct the activities of doctors, it will fall to the state medical boards and legislatures to give these guidelines teeth — to treat the professional practices that got us here as unethical and subject to sanction. It’s hard to imagine those laws sweeping the land. But if Minnesota lawmakers should care to join Massachusetts and Florida in reigning in doctors, they now have official support from the federal agency for public health.
As of last month, the CDC has described opioid use as an epidemic, and one caused by prescribing, as opposed to the diversion of drugs produced for legitimate new use. It has been suggested that physicians offer the pills in no more than three-day doses, warning that, when it comes to opioids for non-cancer chronic pain, “for the vast majority of patients, the known, serious, and too-often fatal risks far outweigh the unproven and transient benefits.”
Even the U.S. Food and Drug Administration is walking back its long-standing embrace of the harm-denying mind-set that gave us these pills. After approving the sale of every last tablet and opioid-use indication that created this problem, the agency has decreed that labels for all opioid pain pills must now carry warnings about their potential for addiction, overdose and death.
That’s the FDA for you. Runs over your kid in the parking lot, then shows up at the funeral with a plate of brownies.
But sources who know believe the new CDC guidelines mark a substantial shift in thinking. “It has championed the message that the medical community caused this epidemic,” says Andrew Kolodny, president of Physicians for Responsible Opioid Prescribing and chief medical officer of Phoenix House, a national network of treatment providers.
Kolodny believes doctors will listen to the CDC, which is not beating around the bush. “For the very first time, the federal government is sending a clear message to the medical community that treating common conditions with long-term opioids is inappropriate, and that by doing this we are harming our pain patients and fueling an epidemic of addiction. We have not heard that before now.”
• • •
We may not have heard that doctors are behind the problem before now, but we have heard the outrageous numbers that measure the opioid epidemic. They defy reason. Prescribing rates depict an early 2000s proliferation of pain pill prescriptions that was hopelessly disconnected from what should have been a stable percentage of patients whom the drugs could actually help.
Few would suggest that the pre-Oxycontin early 1990s represented some sort of dark ages in medical care — of lives destroyed by narcotic-free sciatica, headache, neck pain, sprained ankles, fibromyalgia and post-dental-work anguish. Yet following widespread promotion beginning in the mid-1990s, the use of slow-release opioids for chronic conditions was greeted like the invention of penicillin in wartime. By 2010, painkillers had become the third-most prescribed class of drugs in the country. By 2012, there were 289 million opioid prescriptions dispensed in the U.S. — roughly a bottle of opioids for every adult in the nation.
Prior to that time, these conditions had been treated with Advil and Tylenol; long-term use of opioids was known to create tolerance and dependence, the hallmarks of addiction and increasing need. To this day there are no randomized control trials showing that opioids are safe and effective for long-term use. To the contrary, animal and observation studies suggest the drugs actually make pain worse over time, a paradoxical effect known as hyperalgesia.
“Back pain, neck pain, headache pain, fibromyalgia, there’s actually no indication that opioids help those conditions,” according to Jeannie Sperry, a pain-management clinician in the Comprehensive Pain Rehabilitation Center at Mayo Clinic. “… [A]fter about 30 days they start making pain worse.”
Should we think of the pills as treatments, or narcotics? Given their ineffectiveness for chronic use, opioids for chronic pain are effectively Schedule 1 drugs (addictive drugs with no medical benefit ) masquerading as Schedule 2 drugs (addictive drugs with limited medical benefit). At a minimum, the Drug Enforcement Administration would have had every right to deny each request seeking higher production limits for these narcotics. But the nation’s drug police did not raid the warehouses filling up with Percocet, Vicoden and OxyContin, because, when it comes to prescription drugs and their production, physicians are the parties to whom even law enforcement defers.
This enabled a fourfold rise in opioid prescribing between 1999 and 2015, a trend accompanied by a four-fold rise in opioid overdose. In his recent New England Journal of Medicine position statement accompanying the new guidelines, CDC director Thomas Frieden described the relationship of prescribing and sickness as a “tightly correlated epidemic of addiction, overdose and death from prescription opioids.”
Death rates have begun rising in the era of opioids, but for whites only, a suggestion that the epidemic has indeed been passed along through contact with the medical system. Two groups historically denied access to health care — blacks and Hispanics — have not seen death rates rise. It’s likely that in this way stigma has spared minority communities from claiming their share of the 165,000 Americans killed by painkillers.
Because 80 percent of heroin users started out on pain pills, and the two drugs act the same way within the body, their combined death rate is a more accurate measure of harm. At 28,000 deaths annually, the toll now rivals that from car accidents and firearms.
Opioids have created secondary sickness in the form of opioid-induced hypogonadism (it’s believed to be part of the demand for drugs targeting “Low T” — testosterone), hearing loss and, of course, opioid-induced constipation (the subject of a notorious, dystopian Super Bowl advertisement). The demand for new drugs to wean patients off opiates will be high as well. One, Suboxone, sells for more than $500 a month and, according to opinions shared online, requires an even lengthier period of withdrawal than do opioids.
• • •
Doctors were misled in this misadventure and should be angry at their leadership, which allowed the capture of continuing medical education by the likes of Purdue Pharma, makers of OxyContin. As has been widely documented, the company spent $200 million for 20,000 opioid training lectures given to doctors, often at tony resorts, and the investment paid off. The drug has earned Purdue $35 billion so far.
The messages in these lectures depicted the potential for addiction from opioids as minimal. State medical boards were persuaded to inform doctors they could be punished for not prescribing opioids for chronic pain. The pain lobby even persuaded hospitals and the VA system to adopt pain as a “fifth vital sign.”
That explains why a receptionist approached me recently as I waited for an appointment for an age-related condition. The receptionist asked whether I was in pain and, if so, to rate it on a scale of 1 to 10. I may have notified them on the phone that I was somewhat uncomfortable, but at the time of my “fifth vital sign” check I was reading a “National Geographic,” an indication that the sign in my case was surely not vital.
The CDC has stated that prescriptions for acute pain should not be written for longer than three days. It says that long-term use of opioids should begin only after all other methods have failed, and even then after a thorough briefing on the risks and whether they are outweighed by the small benefits. It basically is saying there is no good reason for opioids over the long haul unless your life is an uncomplicated horror show of misery that you would like to enhance with drug addiction.
It’s a sound public safety message that is currently being violated by every single doctor in America. A survey just released by the National Safety Council shows that 71 percent of doctors prescribe opioids for back pain and that 99 percent prescribe the pills for longer than three days. Nearly 1 in 4 doctors in the survey said they had given them out in 30-day bottles, a duration shown to make changes in the brain.
So we may have been lied to about the safety of opioids, but the lying goes back a long way with this one. Designers at Bayer picked the name Heroin for their cough syrup opiate because they wanted users to believe they were taking something heroic. They were trying to make a safer form of morphine, but accidentally made a stronger form instead. They lied about that, too, and eventually heroin was banned. For some reason, all talk of banning opiates outside of hospitals has no traction today. “That train has left the station,” as one partisan blasted on Twitter.
Decades before heroin, the pharmacist who isolated the active ingredient of opium called his discovery morphine. He told the truth. Morpheus was the god of dreams.
Which is where opiates have taken us, into the land of dreams, sometimes nightmares from which you never wake. That happened to a young man of 25 found dead of a heroin overdose in a bathroom at the Apache Mall in Rochester, Minn., last summer.
If you could see the Apache Mall, with its Macy’s and its Gap, you would know that this event deposited the opioid epidemic at the doorstep of small-town America. The deceased’s name was John Weivoda, and he had just completed treatment. He wanted more time to stabilize his sobriety, according to his father, but the insurance stopped after four weeks.
Like many kids, he had dabbled in drugs as a teenager, but according to his twin brother, whom I met last fall at a rally outside the Federal Office Building in Minneapolis, John did not discover opiates until he hurt his back while laying carpet.
He was given the drugs by a doctor, “and it kind of snowballed on him,” Weivoda’s brother said.
It makes me feel lucky that when I hurt my back at 26 in the early 1990s, all they offered were muscle relaxants.
Bathrooms in malls and fast-food courts are becoming new places of death in our time, according to a recent New York Times story, with addicts hoping to get the drugs in their system as soon as they acquire them. This is the sort of trend that changes the landscape. It places the sense of urgency we are supposed to feel about noncancer chronic pain in its proper context.
It’s true what chronic pain patients say — their pain is real. But the greater good for society in this story is no mystery.
We just might need to return to the impossibly cruel and premodern pain-control methods of the Clinton years.
Reliance on opioids: One of the greatest mistakes in medical history
Opioids were never safe and never right for the noncancer pain for which they were given. But given they were, in abundance, with overseers' blessings. That is finally changing, too late for many.
By Paul John Scott
APRIL 16, 2016 — 6:48PM
STAR TRIBUNE
Star Tribune
It may not become common knowledge anytime soon, but if Shakespeare was right that the truth will out, Americans are headed for a remarkable realization.
The worst public health crisis in our time was brought about by the practice of medicine.
There’s little precedent for the pivotal role of American health professionals in the creation of the Great Painkiller Plague of the early 2000s — a genie of opioid and opioid-equivalent use, addiction and early death that until now has been effectively mischaracterized as “opioid abuse,” and which multiple federal entities have now begun scrambling to put back in the bottle.
In the past, great waves of sickness were spread through close contact, poor hygiene and tainted wells. Beginning in the 1990s, however, it fell upon unwitting doctors and a captured medical system to set in motion this drug group’s signature trajectory in far too many users: tolerance, addiction, sobriety, relapse, overdose. That our medical system managed to trigger this by telling us something as unconvincing as it did says as much about our times as it does about the power of the opium poppy.
The system told us we could take heroin, more or less, for back pain.
The long-delayed correction of that lie may finally have arrived, to judge from the flurry of regulatory and legislative efforts now underway to reel in the propaganda of the opioid era. Congress is set to deliver comprehensive addiction and recovery legislation. The president has authorized a $1.1 billion initiative to combat addiction with new medications. And last month saw the release of new guidelines from the Centers for Disease Control and Prevention (CDC) that define long-term use of opioids as medically unsound.
Because the federal government cannot direct the activities of doctors, it will fall to the state medical boards and legislatures to give these guidelines teeth — to treat the professional practices that got us here as unethical and subject to sanction. It’s hard to imagine those laws sweeping the land. But if Minnesota lawmakers should care to join Massachusetts and Florida in reigning in doctors, they now have official support from the federal agency for public health.
As of last month, the CDC has described opioid use as an epidemic, and one caused by prescribing, as opposed to the diversion of drugs produced for legitimate new use. It has been suggested that physicians offer the pills in no more than three-day doses, warning that, when it comes to opioids for non-cancer chronic pain, “for the vast majority of patients, the known, serious, and too-often fatal risks far outweigh the unproven and transient benefits.”
Even the U.S. Food and Drug Administration is walking back its long-standing embrace of the harm-denying mind-set that gave us these pills. After approving the sale of every last tablet and opioid-use indication that created this problem, the agency has decreed that labels for all opioid pain pills must now carry warnings about their potential for addiction, overdose and death.
That’s the FDA for you. Runs over your kid in the parking lot, then shows up at the funeral with a plate of brownies.
But sources who know believe the new CDC guidelines mark a substantial shift in thinking. “It has championed the message that the medical community caused this epidemic,” says Andrew Kolodny, president of Physicians for Responsible Opioid Prescribing and chief medical officer of Phoenix House, a national network of treatment providers.
Kolodny believes doctors will listen to the CDC, which is not beating around the bush. “For the very first time, the federal government is sending a clear message to the medical community that treating common conditions with long-term opioids is inappropriate, and that by doing this we are harming our pain patients and fueling an epidemic of addiction. We have not heard that before now.”
• • •
We may not have heard that doctors are behind the problem before now, but we have heard the outrageous numbers that measure the opioid epidemic. They defy reason. Prescribing rates depict an early 2000s proliferation of pain pill prescriptions that was hopelessly disconnected from what should have been a stable percentage of patients whom the drugs could actually help.
Few would suggest that the pre-Oxycontin early 1990s represented some sort of dark ages in medical care — of lives destroyed by narcotic-free sciatica, headache, neck pain, sprained ankles, fibromyalgia and post-dental-work anguish. Yet following widespread promotion beginning in the mid-1990s, the use of slow-release opioids for chronic conditions was greeted like the invention of penicillin in wartime. By 2010, painkillers had become the third-most prescribed class of drugs in the country. By 2012, there were 289 million opioid prescriptions dispensed in the U.S. — roughly a bottle of opioids for every adult in the nation.
Prior to that time, these conditions had been treated with Advil and Tylenol; long-term use of opioids was known to create tolerance and dependence, the hallmarks of addiction and increasing need. To this day there are no randomized control trials showing that opioids are safe and effective for long-term use. To the contrary, animal and observation studies suggest the drugs actually make pain worse over time, a paradoxical effect known as hyperalgesia.
“Back pain, neck pain, headache pain, fibromyalgia, there’s actually no indication that opioids help those conditions,” according to Jeannie Sperry, a pain-management clinician in the Comprehensive Pain Rehabilitation Center at Mayo Clinic. “… [A]fter about 30 days they start making pain worse.”
Should we think of the pills as treatments, or narcotics? Given their ineffectiveness for chronic use, opioids for chronic pain are effectively Schedule 1 drugs (addictive drugs with no medical benefit ) masquerading as Schedule 2 drugs (addictive drugs with limited medical benefit). At a minimum, the Drug Enforcement Administration would have had every right to deny each request seeking higher production limits for these narcotics. But the nation’s drug police did not raid the warehouses filling up with Percocet, Vicoden and OxyContin, because, when it comes to prescription drugs and their production, physicians are the parties to whom even law enforcement defers.
This enabled a fourfold rise in opioid prescribing between 1999 and 2015, a trend accompanied by a four-fold rise in opioid overdose. In his recent New England Journal of Medicine position statement accompanying the new guidelines, CDC director Thomas Frieden described the relationship of prescribing and sickness as a “tightly correlated epidemic of addiction, overdose and death from prescription opioids.”
Death rates have begun rising in the era of opioids, but for whites only, a suggestion that the epidemic has indeed been passed along through contact with the medical system. Two groups historically denied access to health care — blacks and Hispanics — have not seen death rates rise. It’s likely that in this way stigma has spared minority communities from claiming their share of the 165,000 Americans killed by painkillers.
Because 80 percent of heroin users started out on pain pills, and the two drugs act the same way within the body, their combined death rate is a more accurate measure of harm. At 28,000 deaths annually, the toll now rivals that from car accidents and firearms.
Opioids have created secondary sickness in the form of opioid-induced hypogonadism (it’s believed to be part of the demand for drugs targeting “Low T” — testosterone), hearing loss and, of course, opioid-induced constipation (the subject of a notorious, dystopian Super Bowl advertisement). The demand for new drugs to wean patients off opiates will be high as well. One, Suboxone, sells for more than $500 a month and, according to opinions shared online, requires an even lengthier period of withdrawal than do opioids.
• • •
Doctors were misled in this misadventure and should be angry at their leadership, which allowed the capture of continuing medical education by the likes of Purdue Pharma, makers of OxyContin. As has been widely documented, the company spent $200 million for 20,000 opioid training lectures given to doctors, often at tony resorts, and the investment paid off. The drug has earned Purdue $35 billion so far.
The messages in these lectures depicted the potential for addiction from opioids as minimal. State medical boards were persuaded to inform doctors they could be punished for not prescribing opioids for chronic pain. The pain lobby even persuaded hospitals and the VA system to adopt pain as a “fifth vital sign.”
That explains why a receptionist approached me recently as I waited for an appointment for an age-related condition. The receptionist asked whether I was in pain and, if so, to rate it on a scale of 1 to 10. I may have notified them on the phone that I was somewhat uncomfortable, but at the time of my “fifth vital sign” check I was reading a “National Geographic,” an indication that the sign in my case was surely not vital.
The CDC has stated that prescriptions for acute pain should not be written for longer than three days. It says that long-term use of opioids should begin only after all other methods have failed, and even then after a thorough briefing on the risks and whether they are outweighed by the small benefits. It basically is saying there is no good reason for opioids over the long haul unless your life is an uncomplicated horror show of misery that you would like to enhance with drug addiction.
It’s a sound public safety message that is currently being violated by every single doctor in America. A survey just released by the National Safety Council shows that 71 percent of doctors prescribe opioids for back pain and that 99 percent prescribe the pills for longer than three days. Nearly 1 in 4 doctors in the survey said they had given them out in 30-day bottles, a duration shown to make changes in the brain.
So we may have been lied to about the safety of opioids, but the lying goes back a long way with this one. Designers at Bayer picked the name Heroin for their cough syrup opiate because they wanted users to believe they were taking something heroic. They were trying to make a safer form of morphine, but accidentally made a stronger form instead. They lied about that, too, and eventually heroin was banned. For some reason, all talk of banning opiates outside of hospitals has no traction today. “That train has left the station,” as one partisan blasted on Twitter.
Decades before heroin, the pharmacist who isolated the active ingredient of opium called his discovery morphine. He told the truth. Morpheus was the god of dreams.
Which is where opiates have taken us, into the land of dreams, sometimes nightmares from which you never wake. That happened to a young man of 25 found dead of a heroin overdose in a bathroom at the Apache Mall in Rochester, Minn., last summer.
If you could see the Apache Mall, with its Macy’s and its Gap, you would know that this event deposited the opioid epidemic at the doorstep of small-town America. The deceased’s name was John Weivoda, and he had just completed treatment. He wanted more time to stabilize his sobriety, according to his father, but the insurance stopped after four weeks.
Like many kids, he had dabbled in drugs as a teenager, but according to his twin brother, whom I met last fall at a rally outside the Federal Office Building in Minneapolis, John did not discover opiates until he hurt his back while laying carpet.
He was given the drugs by a doctor, “and it kind of snowballed on him,” Weivoda’s brother said.
It makes me feel lucky that when I hurt my back at 26 in the early 1990s, all they offered were muscle relaxants.
Bathrooms in malls and fast-food courts are becoming new places of death in our time, according to a recent New York Times story, with addicts hoping to get the drugs in their system as soon as they acquire them. This is the sort of trend that changes the landscape. It places the sense of urgency we are supposed to feel about noncancer chronic pain in its proper context.
It’s true what chronic pain patients say — their pain is real. But the greater good for society in this story is no mystery.
We just might need to return to the impossibly cruel and premodern pain-control methods of the Clinton years.
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I'm with Joe, milligram tax on opioids used >3mo for non-cancer pain in working-aged adults.
Battling chains of addiction
Manchin proposes opioid ‘treatment fee’ to fund substance abuse centers
0
BLUEFIELD — When it comes to the treatment of those who are battling the chains of drug addiction, there is no current funding source dedicated for substance abuse treatment centers.
But a proposed “treatment fee” sought by U.S. Sen. Joe Manchin, D-W.Va., could raise one-and-half to two billion dollars a year toward the funding of substance abuse recovery centers. Manchin said the government currently charges no tax on opioids. He is proposing a treatment fee of one penny per milligram fee for every milligram produced going toward substance abuse treatment.
Manchin is hoping to find bipartisan support for the proposed legislation.
“It (the opioid epidemic) is one topic that we all agree on,” Manchin, who spoke with members of the Daily Telegraph’s editorial board last week, said. “It is one topic that you never have a problem getting a co-sponsor to work with you on.”
However, Manchin admits that finding bipartisan support for a proposed “treatment fee” — even if it is only a penny — won’t be easy. Many Republican lawmakers have vowed to oppose any tax increase.
“I know there is going to be an awful lot of push back on the bill I’m going to put through,” Manchin said. “But it’s one penny. It will be a fee of one penny for treatment centers around the country to take care of the epidemic we have.”
Nationally, more than 40 Americans die every day from painkiller overdoses. West Virginia still leads the nation in drug-related overdose deaths, more than twice the national average. In Virginia, the prescription drug-abuse crisis claimed more lives in 2014 than vehicle crashes.
Manchin said the revenue stream that would be created by the legislation would go toward supporting existing drug-treatment centers while providing funding for the construction of new substance abuse recovery centers.
Manchin points to the prescription narcotic epidemic in West Virginia when he cites the need for additional substance abuse treatment centers. He says many who worked in the coal industry — and suffered injuries — were prescribed pain medication by doctors who failed to take into consideration the highly addictive nature of the narcotics.
“The doctors were not properly trained,” Manchin said. “No one has been properly trained on this. So it’s gotten to an epidemic proportion. So we are now starting to put the genie back in the bottle. We are reigning it in. Now that we have an epidemic in West Virginia, and especially throughout southern West Virginia, and you don’t have the treatment centers.”
Manchin said it is time for the pharmaceutical companies, who he said helped to “spawn this problem” to now become a part of the solution.
“We charge a fee or a tax for cigarettes and we charge it for tobacco,” Manchin said. “Now we definitely know how damaging opiates are to your health and society.”
Battling chains of addiction
Manchin proposes opioid ‘treatment fee’ to fund substance abuse centers
- By CHARLES OWENS Bluefield Daily Telegraph
- Apr 3, 2016
0
BLUEFIELD — When it comes to the treatment of those who are battling the chains of drug addiction, there is no current funding source dedicated for substance abuse treatment centers.
But a proposed “treatment fee” sought by U.S. Sen. Joe Manchin, D-W.Va., could raise one-and-half to two billion dollars a year toward the funding of substance abuse recovery centers. Manchin said the government currently charges no tax on opioids. He is proposing a treatment fee of one penny per milligram fee for every milligram produced going toward substance abuse treatment.
Manchin is hoping to find bipartisan support for the proposed legislation.
“It (the opioid epidemic) is one topic that we all agree on,” Manchin, who spoke with members of the Daily Telegraph’s editorial board last week, said. “It is one topic that you never have a problem getting a co-sponsor to work with you on.”
However, Manchin admits that finding bipartisan support for a proposed “treatment fee” — even if it is only a penny — won’t be easy. Many Republican lawmakers have vowed to oppose any tax increase.
“I know there is going to be an awful lot of push back on the bill I’m going to put through,” Manchin said. “But it’s one penny. It will be a fee of one penny for treatment centers around the country to take care of the epidemic we have.”
Nationally, more than 40 Americans die every day from painkiller overdoses. West Virginia still leads the nation in drug-related overdose deaths, more than twice the national average. In Virginia, the prescription drug-abuse crisis claimed more lives in 2014 than vehicle crashes.
Manchin said the revenue stream that would be created by the legislation would go toward supporting existing drug-treatment centers while providing funding for the construction of new substance abuse recovery centers.
Manchin points to the prescription narcotic epidemic in West Virginia when he cites the need for additional substance abuse treatment centers. He says many who worked in the coal industry — and suffered injuries — were prescribed pain medication by doctors who failed to take into consideration the highly addictive nature of the narcotics.
“The doctors were not properly trained,” Manchin said. “No one has been properly trained on this. So it’s gotten to an epidemic proportion. So we are now starting to put the genie back in the bottle. We are reigning it in. Now that we have an epidemic in West Virginia, and especially throughout southern West Virginia, and you don’t have the treatment centers.”
Manchin said it is time for the pharmaceutical companies, who he said helped to “spawn this problem” to now become a part of the solution.
“We charge a fee or a tax for cigarettes and we charge it for tobacco,” Manchin said. “Now we definitely know how damaging opiates are to your health and society.”
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Tax it like cannabis. Our schools win!
http://www.oregonlive.com/marijuana/index.ssf/2016/03/first_month_of_taxed_recreatio.html
http://www.oregonlive.com/marijuana/index.ssf/2016/03/first_month_of_taxed_recreatio.html
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It is quite intersting to me to hear elitist liberals pontificate on how to fix the opioid problem in this country without identifying the true cause. It stems from a larger problem they created: The entitlement mentality... An overwhelming number of people today feel they are entititled to a world without pain. They won't accept the concept that some pain is a normal part of life, and the best treatment often requires lifestyle modification such as losing weight and exercising, and OTC meds . I am not talking about patients with bone on bone arthritis, failed back surgery syndrome, or poorly healed trauma. It seems that often those patients are the easiest to manage. I'm talking about the people with ordinary garden variety joint, neck and back pain who think that justifies 3-4x daily hydrocodone or oxycodone for the rest of their life.
I would be remiss if I didn't place some blame on the pharmaceutical industry with it's disgusting televsion direct marketing that gives people the impression that the answer for everything is a pill.
I really don't know what the answer is, but taxing opioids is not it. Real reform has to come from those of us who actually practice pain medicine, and not from politicians or academicians. However it seems so many physicians want to bury their head in the sand and pretend nothing is wrong.
I would be remiss if I didn't place some blame on the pharmaceutical industry with it's disgusting televsion direct marketing that gives people the impression that the answer for everything is a pill.
I really don't know what the answer is, but taxing opioids is not it. Real reform has to come from those of us who actually practice pain medicine, and not from politicians or academicians. However it seems so many physicians want to bury their head in the sand and pretend nothing is wrong.
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the opioid crisis has nothing to do with elitist liberals.
place the blame where it belongs - with big pharma and the natural tendency of these medications to cause addiction.
place the blame where it belongs - with big pharma and the natural tendency of these medications to cause addiction.
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Government imposing limitations on physicians in order to better serve our patients, is a quintessential "nanny state" big government liberal progressive approach.
Sent from my SAMSUNG-SM-G920A using SDN mobile
Sent from my SAMSUNG-SM-G920A using SDN mobile
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Had a pt in the ED yesterday that was the ground zero target for opiates - metastatic CA with bony mets. She had a pathologic fracture of the femur, between the pin in the hip, and the total knee. I think she's going to end up disarticulated at the hip with a hemi. I couldn't get ahead of her pain, with Dilaudid, morphine, fentanyl, then PCA morphine, then Dilaudid. I felt so bad for her, and I just kept thinking about the POS drug abusing POSs, with their oxy and hydro for "FMS". FML for that.
Just a little vent.
Just a little vent.
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could you put in an epidural, in preparation for doing a neurolytic spinal?
or at least a fascia iliaca block in the ED?
or at least a fascia iliaca block in the ED?
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This was Sunday, and the pt was going to be transferred to the big university ortho onc floor several hours away from our rural hospital. Our pain guy is anesthesia pain, and he is gone on weekends. Our anesthesia coverage is 2 CRNAs, and one will go to the ends of the world for you, and the second one...won't. The second guy was the one on. To be honest, thought, I didn't think of a block (I am sure not doing it).
Thank you for the insight.
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Since you love to overwhelm this thread with nonsensical junk science, I am surprised you didn't at least try and support your clearly racist views with at least one paper.
My urban Baton Rouge and New Orleans populations will be very surprised to learn their drug seeking behavior makes them outliers. I'll be sure to tell my colleagues in NY, Chicago, DC, Philly, DFW, Bay area, Atlanta, LA, Houston, etc. as well that their inner city folks are not a significant part of the problem.
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or
Obama> Michelle O.> Community organizers> Drug Dealers(Big Pharma)
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and now this from the North Carolina Medical Board...
https://s3.amazonaws.com/sermo-asse...8e9b8b05ca083242fed259054a46dc.jpg?1461240833
https://s3.amazonaws.com/sermo-asse...8e9b8b05ca083242fed259054a46dc.jpg?1461240833
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or
lonelobo>ducctape>ssdoc>me>trump.... jk its Friday.
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this is galling.
shouldnt they also be looking at the death rates from fusion surgery? the risk of death from a fusion surgery is much higher than the risk of death from opioid medications (given the relative rarity of fusions vs the relative commonplace use of opioids).
http://www.ncbi.nlm.nih.gov/pubmed/22498991
the mortality rate for opioid medications is roughly 9 per 100,000, per CDC (yes, this figure is total population wise, but even considering that the CDC states that 1 out of every 5 US citizens gets opioid prescription per year, and that # does include death due to heroin, it is a magnitude lower than deaths related to fusions...)
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even more common is being struck by lightening, 1/20K.... all politicians will manipulate data for their agenda.
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IMO not such a bad thing. Remember these: http://www.nytimes.com/2007/06/17/magazine/17pain-t.html?_r=0
http://www.nytimes.com/2007/03/27/science/27tier.html
Some familiar names in those articles, pain mgt "thought leaders" who have suffered no consequence for their
advocacy and conflicts of interest. They should.
http://www.nytimes.com/2007/03/27/science/27tier.html
Some familiar names in those articles, pain mgt "thought leaders" who have suffered no consequence for their
advocacy and conflicts of interest. They should.
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NC Med Board is driven by politics and PR. About 10 years ago an article came to showing that NC was in the bottom end of boards disciplining doctors. Article got a lot of press and then the board started turning the screws to get their numbers up. While a lot of bad apples got what they deserved, a bunch of docs received reprimands and letters of concern that are questionable.
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"Tennova Pain Management Centers will no longer prescribe long-term opiate medications to patients, the health care system confirmed Monday.
Patients of the centers, affiliated with Tennova's Physicians Regional and Turkey Creek medical centers, have been given letters as they come in for appointments, notifying them of the change and offering both 'widely used, non-opiate alternatives' as well as an in-house 'clinically appropriate tapering regimen to transition you to the appropriate alternatives,' the letter said. 'If, despite our best efforts, you experience withdrawal symptoms, please seek treatment at the nearest emergency department.'"
http://www.knoxnews.com/news/local/...35-8f66-3eab-e053-0100007ffe85-377043111.html
Are we happy with where the pendulum is now?
Patients of the centers, affiliated with Tennova's Physicians Regional and Turkey Creek medical centers, have been given letters as they come in for appointments, notifying them of the change and offering both 'widely used, non-opiate alternatives' as well as an in-house 'clinically appropriate tapering regimen to transition you to the appropriate alternatives,' the letter said. 'If, despite our best efforts, you experience withdrawal symptoms, please seek treatment at the nearest emergency department.'"
http://www.knoxnews.com/news/local/...35-8f66-3eab-e053-0100007ffe85-377043111.html
Are we happy with where the pendulum is now?
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Tell patients to call the White House. We have no power anymore...
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Some fun hx. What happened to the poster children of OxyContin from 1998 when Purdue Pharam had a promo video telling physicians how amazing Oxycontin is.
http://www.jsonline.com/watchdog/wa...-children-of-oxycontin-r65r0lo-169056206.html
http://www.jsonline.com/watchdog/wa...-children-of-oxycontin-r65r0lo-169056206.html
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The mobster with the aviator glasses is scary...
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From Dr. Hawkinberry's reviews it seems like he's doing a good job winnowing the wheat from the chaff.
Heavy lifting, thankless work. Hats off to him.
http://www.topix.com/forum/city/buckhannon-wv/T6S4U30MLQESLA36G/p2
Treating Pain Without Feeding Addiction at ‘Ground Zero’ for Opioids
By ABBY GOODNOUGHMAY 11, 2016
Dr. Denzil Hawkinberry, a pain specialist at the Community Care of West Virginia clinic in Bridgeport, examines Daniel Myers, who works at an area ski resort. CreditRaymond Thompson Jr for The New York Times
BRIDGEPORT, W.Va. — The doctors wanted to talk about illness, but the patients — often miners, waitresses, tree cutters and others whose jobs were punishingly physical — wanted to talk only about how much they hurt. They kept pleading for opioids like Vicodin and Percocet, the potent drugs that can help chronic pain, but have fueled an epidemic of addiction and deadly overdoses.
“No history of I.V. drugs?” Dr. Hawkinberry continued, standing close and looking the man in the eye.
“No, never.”
“Never?”
“Never.”
The patient who allowed a reporter to sit in on the exchange would give only his first name, Frank, because he said he wanted to protect his privacy. “I don’t like to be stereotyped like everybody else,” he said. “I don’t want to be looked at at that level, when I am a legit citizen.”
Still, he added, “I’ve never seen an area gone on pills of this scale, ever in my whole life.”
Dr. Hawkinberry prescribed the patient a low dose of hydrocodone, five milligrams, three times a day until he returned in a month — “a therapeutic trial,” he said, to help control the patient’s pain while he started physical therapy.
“These are not decisions that I make lightly,” Dr. Hawkinberry said afterward. “I fret over them; I pore over the risks and the benefits and try to really analyze, both objectively and subjectively, whether or not it’s a good idea.”
Dr. Chouinard said that in addition to improving patient safety, the program had helped her recruit new doctors and nurse practitioners.
“I have family practice docs coming out of residency programs call me and say, ‘I’ve heard your health centers don’t require us to manage chronic pain — can I talk to you?’ ” she said.
If the program has a downside, she said, it is the challenge of replicating it at other community health centers around the country. Community Care, which initially paid for the program with a grant and then lost money on it for a few years, has tried unsuccessfully to hire a second pain specialist as it has grown. Instead, it has relied on four physician assistants who work with Dr. Hawkinberry.
Photo
Mr. Taylor scheduling his next appointment to see the pain specialist, for which he drives two hours.CreditRaymond Thompson Jr. for The New York Times
“If I’m an anesthesiologist, guess what I’m doing? I’m putting people to sleep in the hospital for $400,000 a year,” Dr. Chouinard said. “This is mission-minded work.”
Nor is it clear how much programs like this can help stamp out opioid addiction. West Virginia still has one of the highest rates of drug overdose deaths in the nation, and while deaths caused by prescription opioids are decreasing, those caused by heroin and fentanyl are climbing. One of Dr. Chouinard’s concerns is that people kicked out of Community Care’s pain program for failing urine screens or pills counts could turn to heroin.
Dr. Carl Sullivan III, director of addiction medicine at West Virginia University, said that Dr. Hawkinberry was “one of very few people I could trust to do chronic pain right.” But he said the field of pain management in West Virginia remained “seriously undermanned.” The university’s health system, WVU Medicine, is planning to provide more alternative pain treatments throughout the state, but Dr. Richard Vaglienti, its director of outpatient pain services, said it would take several years to put in place.
Given the high demand for Community Care’s program, patients often have to wait up to six months for their first pain appointment. The hourlong evaluation starts with a urine drug test, a physical exam, a battery of questions to assess the patient’s psychological history and risk of addiction, and a check of the state’s prescription-monitoring database to see whether the patient has been prescribed opioids in the past — a check Dr. Hawkinberry repeats at every follow-up appointment.
Community Care charges the same amount for a pain appointment as for a primary care visit, and the out-of-pocket cost depends on the patient’s insurance. Nearly half are on Medicare, either because they are older or because they qualify for federal disability benefits. About 33 percent are onMedicaid, the government health insurance program for the poor, and 20 percent have private coverage.
The conversations between Dr. Hawkinberry and his staff as they troubleshoot each case highlight just how complex pain can be.
“Degenerative joint disease of her sacroiliac joint, hip pain, fibromyalgia, tendonitis and osteoarthritis of her shoulders,” was how one physician assistant, Jason Kidd, summed up a patient in her 50s last month.
“She’s under a lot of stress,” Mr. Kidd told Dr. Hawkinberry.
Dr. Hawkenberry refilled the woman’s hydrocodone prescription and moved onto the next case, a new patient, a computer network technician with worsening knee and foot pain that his primary care doctor had not been able to help. In the initial screening of the 42-year-old man, a red flag emerged: He said that he had been taking some of his father’s hydrocodone pills in an attempt to quell his pain.
“Was he contrite? Dr. Hawkenberry asked Tracey Sherman, the physician assistant who had done the screening. “Was he obstinate?”
“Not obstinate,” Mr. Sherman said. “Not argumentative at all. I think he just wants some relief.”
Still, the patient had received a “moderate risk” score on the opioid risk assessment test that Mr. Sherman had given him, because he had taken his father’s medicine and because of his relatively young age. Opioids were out of the question, at least for now.
After diagnosing plantar fascitis in the patient’s foot and ordering a knee X-ray, Dr. Hawkenberry gave him a non-narcotic, prescribed physical therapy and told him to come back in a month. If hydrocodone still showed up in his urine at that point, Dr. Hawkinberry warned, he would not see him again.
The patient gave his word.
“My other doctor couldn’t find answers,” he said. “So I’m just glad I could get in here.”
Heavy lifting, thankless work. Hats off to him.
http://www.topix.com/forum/city/buckhannon-wv/T6S4U30MLQESLA36G/p2
Treating Pain Without Feeding Addiction at ‘Ground Zero’ for Opioids
By ABBY GOODNOUGHMAY 11, 2016
Dr. Denzil Hawkinberry, a pain specialist at the Community Care of West Virginia clinic in Bridgeport, examines Daniel Myers, who works at an area ski resort. CreditRaymond Thompson Jr for The New York Times
BRIDGEPORT, W.Va. — The doctors wanted to talk about illness, but the patients — often miners, waitresses, tree cutters and others whose jobs were punishingly physical — wanted to talk only about how much they hurt. They kept pleading for opioids like Vicodin and Percocet, the potent drugs that can help chronic pain, but have fueled an epidemic of addiction and deadly overdoses.
- “We needed to talk about congestive heart failure or diabetes or out-of-control hypertension,” said Dr. Sarah Chouinard, the chief medical officer at Community Care of West Virginia, which runs primary care clinics across a big rural chunk of this state. “But we struggled over the course of a visit to get patients to focus on any of those.”
Worse, she said, some of the organization’s doctors were prescribing too many opioids, often to people they had grown up with in the small towns where they practiced and whom they were reluctant to deny. So four years ago, Community Care tried a new approach. It hired an anesthesiologist to treat chronic pain, relieving its primary care doctors and nurse practitionersof their thorniest burden and letting them concentrate on conditions they feel more comfortable treating.
Since then, more than 3,000 of Community Care’s 35,000 patients have seen the anesthesiologist, Dr. Denzil Hawkinberry, for pain management, while continuing to see their primary care providers for other health problems. Dr. Chouinard said Community Care was doing a better job of keeping them well over all, while letting Dr. Hawkinberry make all the decisions about who should be on opioid painkillers — a role that requires not only expertise, but endless vigilance.
“I’m part F.B.I. investigator, part C.I.A. interrogator, part drill sergeant, part cheerleader,” said Dr. Hawkinberry, who is also an amateur mountain climber.
Evidence that the musician Prince had become dependent on pain pills he took for hip problems before his recent death suggests just how hard it can be, even for people with access to the best doctors, to safely control chronic pain. Community Care is trying to do so for a disproportionately poor population, in a state that has been ground zero for opioid abuse from the very beginning of what has become a national epidemic.
Now, the difficult work of addressing the nation’s overreliance on opioids, while also treating debilitating pain, is playing out on a patient-by-patient basis, including in a patchwork of experiments like this one. About 70 percent of the 1,200 patients currently in Community Care’s pain management program receive opioids as part of their treatment, which may also include non-narcotic drugs, physical therapy, injections and appointments with a psychologist.
Many had already been on opioids “for many years before they met me,” Dr. Hawkinberry said, adding that his goal is to get them on lower doses, and to try other ways of managing their pain.
Rigorous screening helps weed out people who are looking to abuse painkillers, Dr. Chouinard said. Patients who are prescribed opioids have to submit urine samples at each monthly appointment and at other random times, and to bring their pills to every visit to be counted. About 500 have been kicked out of the program for violations since it started in 2012.
In addition, Community Care’s pain management clinic is closely monitored by the state as one of six licensed to operate under a 2012 law meant to cut down on pill mills.
The organization’s primary care providers talk frequently with Dr. Hawkinberry about the patients they share with him. Because they use the same electronic medical record system, they can keep close tabs on how their patients’ pain is being treated — and he on how their other health problems, like high blood pressure, are being addressed.
“We can even instant-message each other, and we do that a lot,” said Dr. Kimberly Becher, a primary care doctor at Community Care’s clinic in Clay, a town of 500.
Photo
Roger Taylor, 68, from Clay, W.Va., with a physician’s assistant before an appointment with Dr. Hawkinberry. More than 3,000 of Community Care’s 35,000 patients have seen the doctor for pain management.CreditRaymond Thompson Jr for The New York Times
In the past, Community Care’s doctors would sometimes send patients to outside pain specialists, which Dr. Becher said yielded poor results because of a lack of communication.
The close contact between the in-house pain specialist and the primary care staff has especially helped complicated patients like Frances Key, who was struggling to control her diabetes and high blood pressure when she started seeing Dr. Hawkinberry three years ago. Addressing her back pain with physical therapy and hydrocodone, typically taking one low-dose pill a day, has helped her lose 50 pounds and manage her other chronic conditions.
“I was a mess when I first came — I hurt all the time,” said Ms. Key, who injured her back lifting a deep fryer at her job in a deli. “I can go for a walk now; I can play with my grandkids.”
One day last month, Dr. Hawkinberry saw four new patients and prescribed opioids to one: a carpenter with a congenital hand deformity that had become more painful, keeping him out of work.
He thought hard on the carpenter’s case, which was complicated by stomach ulcers that made him a bad candidate for nonsteroidal anti-inflammatory drugs like ibuprofen, which new guidelines from the Centers for Disease Control recommend trying before opioids.
“What happened here?” he asked the man, studying marks on the inside of his forearm.
The patient told him they were from donating plasma, which brought him extra income.
“No history of I.V. drugs?” Dr. Hawkinberry continued, standing close and looking the man in the eye.
“No, never.”
“Never?”
“Never.”
The patient who allowed a reporter to sit in on the exchange would give only his first name, Frank, because he said he wanted to protect his privacy. “I don’t like to be stereotyped like everybody else,” he said. “I don’t want to be looked at at that level, when I am a legit citizen.”
Still, he added, “I’ve never seen an area gone on pills of this scale, ever in my whole life.”
Dr. Hawkinberry prescribed the patient a low dose of hydrocodone, five milligrams, three times a day until he returned in a month — “a therapeutic trial,” he said, to help control the patient’s pain while he started physical therapy.
“These are not decisions that I make lightly,” Dr. Hawkinberry said afterward. “I fret over them; I pore over the risks and the benefits and try to really analyze, both objectively and subjectively, whether or not it’s a good idea.”
Dr. Chouinard said that in addition to improving patient safety, the program had helped her recruit new doctors and nurse practitioners.
“I have family practice docs coming out of residency programs call me and say, ‘I’ve heard your health centers don’t require us to manage chronic pain — can I talk to you?’ ” she said.
If the program has a downside, she said, it is the challenge of replicating it at other community health centers around the country. Community Care, which initially paid for the program with a grant and then lost money on it for a few years, has tried unsuccessfully to hire a second pain specialist as it has grown. Instead, it has relied on four physician assistants who work with Dr. Hawkinberry.
Photo
Mr. Taylor scheduling his next appointment to see the pain specialist, for which he drives two hours.CreditRaymond Thompson Jr. for The New York Times
“If I’m an anesthesiologist, guess what I’m doing? I’m putting people to sleep in the hospital for $400,000 a year,” Dr. Chouinard said. “This is mission-minded work.”
Nor is it clear how much programs like this can help stamp out opioid addiction. West Virginia still has one of the highest rates of drug overdose deaths in the nation, and while deaths caused by prescription opioids are decreasing, those caused by heroin and fentanyl are climbing. One of Dr. Chouinard’s concerns is that people kicked out of Community Care’s pain program for failing urine screens or pills counts could turn to heroin.
Dr. Carl Sullivan III, director of addiction medicine at West Virginia University, said that Dr. Hawkinberry was “one of very few people I could trust to do chronic pain right.” But he said the field of pain management in West Virginia remained “seriously undermanned.” The university’s health system, WVU Medicine, is planning to provide more alternative pain treatments throughout the state, but Dr. Richard Vaglienti, its director of outpatient pain services, said it would take several years to put in place.
Given the high demand for Community Care’s program, patients often have to wait up to six months for their first pain appointment. The hourlong evaluation starts with a urine drug test, a physical exam, a battery of questions to assess the patient’s psychological history and risk of addiction, and a check of the state’s prescription-monitoring database to see whether the patient has been prescribed opioids in the past — a check Dr. Hawkinberry repeats at every follow-up appointment.
Community Care charges the same amount for a pain appointment as for a primary care visit, and the out-of-pocket cost depends on the patient’s insurance. Nearly half are on Medicare, either because they are older or because they qualify for federal disability benefits. About 33 percent are onMedicaid, the government health insurance program for the poor, and 20 percent have private coverage.
The conversations between Dr. Hawkinberry and his staff as they troubleshoot each case highlight just how complex pain can be.
“Degenerative joint disease of her sacroiliac joint, hip pain, fibromyalgia, tendonitis and osteoarthritis of her shoulders,” was how one physician assistant, Jason Kidd, summed up a patient in her 50s last month.
“She’s under a lot of stress,” Mr. Kidd told Dr. Hawkinberry.
Dr. Hawkenberry refilled the woman’s hydrocodone prescription and moved onto the next case, a new patient, a computer network technician with worsening knee and foot pain that his primary care doctor had not been able to help. In the initial screening of the 42-year-old man, a red flag emerged: He said that he had been taking some of his father’s hydrocodone pills in an attempt to quell his pain.
“Was he contrite? Dr. Hawkenberry asked Tracey Sherman, the physician assistant who had done the screening. “Was he obstinate?”
“Not obstinate,” Mr. Sherman said. “Not argumentative at all. I think he just wants some relief.”
Still, the patient had received a “moderate risk” score on the opioid risk assessment test that Mr. Sherman had given him, because he had taken his father’s medicine and because of his relatively young age. Opioids were out of the question, at least for now.
After diagnosing plantar fascitis in the patient’s foot and ordering a knee X-ray, Dr. Hawkenberry gave him a non-narcotic, prescribed physical therapy and told him to come back in a month. If hydrocodone still showed up in his urine at that point, Dr. Hawkinberry warned, he would not see him again.
The patient gave his word.
“My other doctor couldn’t find answers,” he said. “So I’m just glad I could get in here.”
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So it IS OK to start a pain patient on Norco 5mg TID? I thought COT was never appropriate for chronic non-cancer pain!
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Working aged adults working.
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he still seems to be prescribing more than i would/do, but its a clear step in the right direction for that area.
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My point is not that he was unreasonable. It was that 101N was touting this as an example of good practice.
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I think it is way too early to tell if the pendulum swinging in this direction is bad. I think patients with acute pain appropriate for opioids will get them. I think we will see far fewer getting opioids for life after a back surgery because their pain never went away. I don't believe that the reward for being a useful member of society (employment) should be Norco. I'm sick of wrestling with the decision of who should and who should not get opioids.
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Pick another profession. Some patients will need low dose COT. Not prescribed by their PCP, but that's PART of our role as pain docs.
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