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Originally Posted by grizy
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.
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.