Opiod crisis.

[OETKB]

Just saw this on my home news channel. Not the first time.

http://www.wral.com/opioid-crisis-childhood-friends-die-on-same-day-half-a-mile-apart/17067566/

Opioid crisis: Childhood friends die on same day, half a mile apart

 

[biminiLX]

Just saw this on my home news channel. Not the first time.

http://www.wral.com/opioid-crisis-childhood-friends-die-on-same-day-half-a-mile-apart/17067566/

Opioid crisis: Childhood friends die on same day, half a mile apart

I've been trying to stay silent on this, but this article is such an example of how the media and politicians have misrepresented this crisis.
First, I'm a BOARD CERTIFIED PAIN MEDICINE physician.
I see and live this crisis every day, and I do everything I can to be part of the solution, not the problem.
For those that want to help, advocate to your local representatives to fund treatment programs.
A solution starts with education and you should know not everyone who takes prescription OPIOIDS (correct spelling) is an addict.
Addiction is a complex psychological disorder; there is a significant difference between addiction, tolerance, dependency (both physical and psychological) and most importantly pseudo-addiction.
To clarify, I do not receive any payments or have a financial incentive to write opioids.
I would also state that ANY doctor with a DEA number can write opioids, but those with board certification actually have training in appropriate use and more importantly, signs of misuse. For those who have any medical training, you should recognize how little medical education is given on pain treatments and even less on addiction.
I could go on all night on this subject, but at the end of the day, I am an advocate for my patients and I know how important and effective Chronic Opioid Therapy can be for those who suffer with debilitating injuries and disease.
To wrap up on this article, I see 2 teenagers suffering from depression and poly substance abuse.
They died from FENTANYL AND HEROIN, not prescription opioids. The article states one was given opioids for appropriate medical procedures, while also stating they were drinking and smoking at age 12, yet the scripts 'flipped the switch'. Many this week have referenced 3/4 heroin users started with prescription opioids. Well, for those who really have taken the time to become educated on the crisis, know this is old data. Now more than half of heroin/fentanyl users have never had a legitimate opioid script.
We have done a very good job at reducing pill mills and inappropriate prescribing. More work needs to be done obviously, but the focus needs to shift to first calling this what it is, a Heroin and Fentanyl epidemic, not just 'opioids'. And second, putting money where it can do the most help, by funding treatment, increasing the number of addictionologists, and abuse deterrent prescription opioids.
Great to see a discussion here, now back to fast cars.
-J

 

[OETKB]

I've been trying to stay silent on this, but this article is such an example of how the media and politicians have misrepresented this crisis.
First, I'm a BOARD CERTIFIED PAIN MEDICINE physician.
I see and live this crisis every day, and I do everything I can to be part of the solution, not the problem.
For those that want to help, advocate to your local representatives to fund treatment programs.
A solution starts with education and you should know not everyone who takes prescription OPIOIDS (correct spelling) is an addict.
Addiction is a complex psychological disorder; there is a significant difference between addiction, tolerance, dependency (both physical and psychological) and most importantly pseudo-addiction.
To clarify, I do not receive any payments or have a financial incentive to write opioids.
I would also state that ANY doctor with a DEA number can write opioids, but those with board certification actually have training in appropriate use and more importantly, signs of misuse. For those who have any medical training, you should recognize how little medical education is given on pain treatments and even less on addiction.
I could go on all night on this subject, but at the end of the day, I am an advocate for my patients and I know how important and effective Chronic Opioid Therapy can be for those who suffer with debilitating injuries and disease.
To wrap up on this article, I see 2 teenagers suffering from depression and poly substance abuse.
They died from FENTANYL AND HEROIN, not prescription opioids. The article states one was given opioids for appropriate medical procedures, while also stating they were drinking and smoking at age 12, yet the scripts 'flipped the switch'. Many this week have referenced 3/4 heroin users started with prescription opioids. Well, for those who really have taken the time to become educated on the crisis, know this is old data. Now more than half of heroin/fentanyl users have never had a legitimate opioid script.
We have done a very good job at reducing pill mills and inappropriate prescribing. More work needs to be done obviously, but the focus needs to shift to first calling this what it is, a Heroin and Fentanyl epidemic, not just 'opioids'. And second, putting money where it can do the most help, by funding treatment, increasing the number of addictionologists, and abuse deterrent prescription opioids.
Great to see a discussion here, now back to fast cars.
-J

Thanks for these insights doc. I was the one to post the "80% of heroin users were introduced to opioids through legitimate scripts for pain management" in the second post of this thread. I had read it in of piece of literature in the lobby of UNC's main hospital about 18 months ago while at their psych clinic waiting for someone very close to us. Wonder why they would still be putting these stats out there? I couldn't say how old the literature was but I recall it being in informational handouts they had there for patients and family of patients. I just remember being struck by that statistic.

 

[Booky]

I've been trying to stay silent on this, but this article is such an example of how the media and politicians have misrepresented this crisis.
First, I'm a BOARD CERTIFIED PAIN MEDICINE physician.
I see and live this crisis every day, and I do everything I can to be part of the solution, not the problem.
For those that want to help, advocate to your local representatives to fund treatment programs.
A solution starts with education and you should know not everyone who takes prescription OPIOIDS (correct spelling) is an addict.
Addiction is a complex psychological disorder; there is a significant difference between addiction, tolerance, dependency (both physical and psychological) and most importantly pseudo-addiction.
To clarify, I do not receive any payments or have a financial incentive to write opioids.
I would also state that ANY doctor with a DEA number can write opioids, but those with board certification actually have training in appropriate use and more importantly, signs of misuse. For those who have any medical training, you should recognize how little medical education is given on pain treatments and even less on addiction.
I could go on all night on this subject, but at the end of the day, I am an advocate for my patients and I know how important and effective Chronic Opioid Therapy can be for those who suffer with debilitating injuries and disease.
To wrap up on this article, I see 2 teenagers suffering from depression and poly substance abuse.
They died from FENTANYL AND HEROIN, not prescription opioids. The article states one was given opioids for appropriate medical procedures, while also stating they were drinking and smoking at age 12, yet the scripts 'flipped the switch'. Many this week have referenced 3/4 heroin users started with prescription opioids. Well, for those who really have taken the time to become educated on the crisis, know this is old data. Now more than half of heroin/fentanyl users have never had a legitimate opioid script.
We have done a very good job at reducing pill mills and inappropriate prescribing. More work needs to be done obviously, but the focus needs to shift to first calling this what it is, a Heroin and Fentanyl epidemic, not just 'opioids'. And second, putting money where it can do the most help, by funding treatment, increasing the number of addictionologists, and abuse deterrent prescription opioids.
Great to see a discussion here, now back to fast cars.
-J

Great post as always James.

 

[nxhappy]

some of the shit they sell is beyond me...they might as well hand out H

 

[03Sssnake]

some of the shit they sell is beyond me...they might as well hand out H

the shit out there now is way more potent than heroin, it's terrifying.

Lethal dose comparison

 

[RedVenom48]

WTF, what in the hell would you need carfentanil for??

 

[03Sssnake]

WTF, what in the hell would you need carfentanil for??

drug dealers are spiking heroin with it....killing a lot of people.

 

[biminiLX]

An elephant. Seriously.
It's crazy to think people gamble with their lives using Fentanyl, it's dosed in micrograms and has such a narrow therapeutic window, I never thought I'd hear of people using it recreationally.
It's sad that because it's synthetic and cheap to buy illegally, it's becoming as prevalent as heroin. It's also being used by dealers mixing it into heroin, Coke, marijuana etc so they can increase their street cred of 'having the best stuff'.
We have virtually no defense against a drug as powerful as carfentanyl, and it's Russian roulette every time it's abused.
I heard the Montgomery county coroner (Dayton, OH home of the worst death rate in the country) speak candidly on the topic and it's sad on so many levels.
-J

 

[kirks5oh]

Physician reimbursement has steadily decreased over the past 30 years, forcing doctors to see more patients to make a living. Once a family doctor addresses a patient's blood pressure, cholesterol, diabetes, and erectile dysfunction, during a 10 minute allotted visit, the last thing the patient mentions as the doc goes to leave the room, is their chronic knee pain. It's much easier and quicker to write the pain script than it is to explain to the patient that they need to lose weight, or that nsaids might work just as well, or that working on concrete 12 hours a day might not be good for them. I see this all the time in my practice, where we frequently see 70 patients on our busy office day

There is no reimbursement for the doctor to write pain meds from the insurance companies or pharma companies. Hell, I haven't seen a pharm rep come through my office in years. Doctors can afford their own lunch. When they get a company to deliver lunch for the office, it's listed publicly (sunshine act) on a website as physician reimbursement---which is why most, like me, don't do lunches anymore. Most days I work right through lunch and might have time for a power bar. Doctors don't own stock in drug companies, and 99.9% don't get kickbacks---that's been long gone for years, and it's illegal.

Patients in my practice get pain meds if they have surgery, or a major non-surgical issue (fracture). They don't get them ever, for a chronic issue. That gets referred to a pain specialist like biminilx. there has been huge progress in regards to decreasing pain scripts here in Wisconsin---but until the first issue I mentioned gets addressed, it won't go away.