Here's a skeptical take on the conventional wisdom that, while not completely convincing, is probably more worth reading than anything by avwal:

http://grokinfullness.blogspot.com/2...on-opioid.html

The most convincing points to me are the lack of any measured increase in people with prescription drug abuse problems and the difference in timing between the changes in prescription drug deaths and heroin deaths.

TN and OH have more opioid scripts than residents, so I think the "lack of any measured increase in people with prescription drug abuse problems" is a bit dubious.

I love the assumption that we wouldn't be almost as happy to string up pharma execs as the NRA and gun manufacturers

Pharma is a double edged sword, without them we are still living in the 1800s from a medical standpoint, but they obviously do a ton of unethical stuff. I wouldn't pretend to know what the solution is.

There are legitimate opioid uses. Pain management after surgery for example. But there is definitely a problem with the lack of established protocols to ween people off the stuff, doctors giving it out like candy (my surgeon gave me a month supply, most of which I still got in my kitchen), and the near impossibility of separating the addicts from people in real need.

Purdue’s questionable practices definitely contribute but I really don’t think it’s the main cause.

Sounds like gun grabbers are looking at taking my sweet, sweet pain meds too!

Bro, you are completely wrong and there's no such thing.

My contention is this q12h thing is completely irrelevant. It has nothing to do with the problem.

And also that the linked articles don't know what they're talking about and contain flat wrong assertions that's getting quoted as truth itt (e.g "without q12 dosing oxycontin offers little advantage...")

Just a suggestion for the future: When you don't know what you're talking about try not to needlessly be an a**hole. That doesn't really accomplish anything and better discussions are had when people are civil.

meh nevermind.

That's a disappointment to me. I'd been hoping that, after 50+ years of failure, a different approach might be considered.

Eight or nine years ago I went to the emergency room which ultimately ended up with me having emergency surgery followed by a nine day hospital stay.

I was in the ER for eleven hours as they were running tests and trying to secure me a room in the ICU. This particular part of the ER was very close quarters and only separated by curtains. Over that eleven hours I got to hear between 35-40 patients coming through for treatment for a wide range of ailments. Say there were 40 people. I would say the doctor offered opiate pain medicine four or five times. I would say patients themselves asked to get opiates thirty times and the other five times nothing was asked or offered (in two cases patients refused).

From a front line standpoint patients want drugs. It is a combination of things for sure. Healthcare treatment has shifted over the years where pain management and limiting patient suffering has become a priority. However as this has happened you have an increase in addiction and in patients faking symptoms so it has put doctors in a dicey predictament. Pain is one of the most difficult symptoms to verify and takes trust and people reading skills on the part of the care giver.

A couple months ago I fractured my shoulder in multiple places. The next day I ended up going to the Er (not knowing how bad it was) and when first examined the doctor prescribed a low dosage of hydrocodone. After getting my x-rays back he saw I had two significant fractures and the ball joint of my shoulder was, in his words, “like a jumbled mess of Rice Krispies”. At that point he started shooting me up with diludad. So in that example he had physical evidence to help make a determination on pain treatment.

The reality, though, is most of the time there are no magic tests or identifiers to clearly define how much pain one might be in. So it becomes a real tough situation for prescribers. Not treating pain at all is not an option and opioids can absolutely provide extreme relief in situations and can sometimes be the best option. Unfortunately their addictive nature creates all these issues that make it hard on prescribers.

As for the pharmaceutical companies, again, they push these drugs as hard as they can and try to convince doctors to prescribe them as often as possible. I would love for someone to provide details of a company like Perdue running luxury seminars for doctors detailing the problems and issues with over prescribing oxy and potential alternative treatments. Of course that doesn’t happen. Instead they are pushing doctors to prescribe them for anything they possibly can. The opioid epidemic has moved beyond prescription drugs as it has evolved into heroin on the streets. However pharmaceutical companies do deserve blame for being part of the origin of the problem and they should still absolutely be required to provide better education to prescribers when it comes to treating patients with pain.

I don’t remember the author or book (dream city or something like that) but it was written by an la times reporter and focused on a smaller city in Ohio but also covered smaller cities all over the country. The basis was all these people from ONE town in Mexico would come to this small town and flood the market with heroin. They had a system where they would have a phone dispatcher where users could call up there orders. These drug dealers would basically be driving around and through the dispatcher would be directed to meet customers in a parking lot of a fast food restaurant, for example. They didn’t carry guns and they didn’t fight with each other because they were all essentially related as they came from that same town in Mexico. If some of them got arrested, new people from that town would move there and keep going.

They were very careful to limit their business to only small and medium size cities as they didn’t want to get into run ins with the large violent gangs in the big cities. They managed to spread affordable and easily delivered heroin to safe locations all across the country.

I will try to see if I can dig up the author and book title. I know Marc Maron had him on his podcast like a year ago.

On another note pharmaceutical companies have to work harder on formulations. The extended release versions are always able to be extracted so addicts can ingest the larger dose all at once. I really do not know what the solution is to any of this and I am not sure we have a good shot of solving these issues with Street heroin offering much more bang for the buck over prescription medicine.

This?: http://www.samquinones.com/books/dreamland/

opioids are a serious issue, but who's responsible for the mongoloid epidemic?

Awesome post all around. One thing wrt the bolded. The profit margin on reselling Rx drugs is enormous. A person getting 60 oxycontin might be paying $1-$5 copay for the whole bottle. It's pure profit.

"Chronic pain" is often a qualifying condition in states with medical marijuana. Legalization would improve access even more; can't get addicted to opiates if you never use them, instead relying on pot.

oh ok. I guess there is just some hudge conspiracy then.

THERE IS NO SUCH THING AS q8h OXYCONTIN

THERE WAS NEVER A PATENT

IT DIDNT RUN OUT

does repeatedly posting cryptic messages and refusing to make an actual argument qualify as "needlessly being an a**hole"?

how about pedantically nitpicking a relatively minor mistatement while avoiding the longer post with straight quotations from the article?

I mean, you could have started with this:

and actually explained why its wrong. which, ofc, you still havent done.

nah, just arrogantly and sarcastically accuse everyone of falling for a "conspiracy", avoid all arguments, and then pounce on a small error.

so, we can go with the article that ya know, uses facts and documents and to describe the situation, or bow to your authority which hasnt even provided an argument or theory.

Victor you're missing the point.

Even if Purdue Pharma never made Oxycontin, plain oxycodone has been around forever. Cheap and generic.

The doctors (and nurses and pharmacists) have been taught forever that pain is vital sign and it must be controlled.

These two prescriptions risk the same addictiveness, risk of making it to the black market, etc.

Patient 1:
OxyContin 80mg q12h #60

Patient 2:
Oxycodone IR 20mg q3h #240

Whether you crush 1 OxyContin 80mg or 4 oxycodone 20mg you get the same effect when you snort them.

This whole story isn't because Purdue Pharmaceuticals is pure evil. All they did when they marketed this drug to the doctors is just told docs when they were taught in school. Treat pain. Patient shouldn't be in pain. Less pills is better. It's not anymore complicated than that.

this doesnt sound correct to me. at least, I am pretty sure that you have always been able to snort or smoke it, just depends on your tolerance. so a new user always could.

my understanding, at least from the onslaught of opiod news in ohio, is that the dope being sold now is largely fentanyl or carfentil or some other super potent chemical.

so yes, the potency of that is tons higher, but it really isnt the same as heroin.

Yes this is correct.

but if patient 1 says, "hey doc, after like 6 or 8 or 10 hours, my pain comes back and I start to feel crappy" and the doc follows Perdue's protocol of increasing the dosage of their 12hr Oxy, then the patient is getting more sweet loving and highly addictive opiod pumped into their body.

and since

patient 1 could quite quickly get prescribed much higher dosages and thus much more opiod and thus much higher risk of addiction and much worse withdrawals from such a possible addiction.

Victor you are correct when you say:

But I want to you realize the following fact:

The Purdue Reps CANNOT advise physicians to prescribe the medication at a q8h interval because it was not approved for that frequency and it would be a false claim.

It appears finally in late 2016 the FDA eased up on off-label claims.

And the reason generic oxycodone didn't lead to an epidemic like OxyContin did is ________________________?

The reasons doctors were prescribing the **** out of OxyContin in situations where they previously would have avoided strong opioids is __________________________?

People were still abusing generic Percocet and generic Vicodin in the late 2000/ early 2010s. Those are immediate release medications. In the media OxyContin is just a sexier medication. And there's an actual drug company to go after there, not just a slew of generic companies from India.

Well HCAHPS surveys and other patient satisfaction surveys started in 2006. Gotta get those scores up. And one of the easiest ways is to give out candy.... errr.... opioids.

It wasn't until late 2016 that they finally removed the pain questions from those surveys.