Do we have a thread about the opioid epidemic?

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Postby Peptobysmal » Wed Sep 06, 2017 3:19 pm

Very cool, congratulations. Those folks have saved my ass in the past and now that I've been clean for awhile I have considered doing similar volunteer work. And Suboxone has been a major part of my recovery -- I have seen people make the most remarkable turn arounds on it. I donated $100 to your organization; it was a win-win because it balanced my checking account to a cool $666.00 8-)
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Postby Grumby » Wed Sep 06, 2017 3:34 pm

girl was literally sleep walking, about to collapse on dope outside my job today. i should have asked if she needed help but waited too long. such a bummer.
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Postby Grumby » Wed Sep 06, 2017 3:55 pm

i got chills cause i know how that was how it ended for my friend. he walked into a convenience store practically comatose and when the article about his death came out the dude who was at the cash register left a comment on facebook that he knew "his battle was over"
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Postby wario lopez » Wed Sep 06, 2017 7:35 pm

chimp wrote:i work in the UK, i dunno how things are in the US and maybe practice is totally different there. but yeah at least part of the problem in my experience is that many people have (what appears to be) a very low tolerance for any pain and expect to be completely pain-free. this leads to pressure on prescribers to give more powerful analgesia and ultimately we don't have any great options apart from opioid based drugs


i know this is an old post, but i would like to respond to it. having worked in programs to reduce opioid overprescribing, i've found that the most effective way to reduce the amount of opioids needed for those in pain are interdisciplinary approaches. so we identified everyone in our health care system that was on over 100 morphine milligram equivalents daily and those on concurrent benzodiazepines that would be a great risk of overdose and as part of continuing opioids, they also had to engage in a program that involved a ton of different modalities for dealing with pain. we used cognitive behavioral therapy for pain, acupuncture, tens units, physical therapy, biofeedback, meditation, nerve blocks, patient education, support groups, insomnia help, etc. and we were able to get nearly all of our patients under that 100 morphine milligram equivalents per day. the CBT for pain especially helped people rethink pain and how much they let it affect them personally and emotionally, and increased their tolerance for pain. unfortunately, most doctors, due to the silo nature of health care and lack of interprofessional collaboration, are not put in positions to link people up to these services and it's much easier to write a prescription than to spend time speaking with patients about these different modalities. the burden for pain management often falls on primary care providers who often are seeing high volumes of patients and who don't often have access to these kinds of services.
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Postby gargamel » Wed Sep 06, 2017 7:40 pm

couldn't marijuana also be integrated into what PB is talking about?


most of my family lives in a small town, including my 4 siblings, and i live in fear of them falling into opioid abuse
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Postby wario lopez » Wed Sep 06, 2017 7:47 pm

also just wanted to leave this article in here: https://www.vox.com/policy-and-politics/2017/9/6/16262456/claire-mccaskill-insys-opioid-epidemic

A major pharmaceutical company lied and misrepresented its powerful opioid product for profit, putting people at risk in the worsening opioid epidemic, according to a new bombshell report by Sen. Claire McCaskill (D-MO).

The report, which McCaskill’s office has described as the first round of an investigation into opioid companies, details the workings of Insys Therapeutics, which manufactures the fentanyl drug Subsys. According to the report, Insys misrepresented Subsys to get insurers to pay for it, letting the company sell its product to people who didn’t need and shouldn’t have access to such a powerful drug.

“In the case of Subsys patient Sarah Fuller, an audio recording reveals that an Insys employee repeatedly misled representatives of Envision Pharmaceutical Services to obtain approval for her prescription,” the report found. “The result, in the case of Ms. Fuller, was death due to allegedly improper and excessive Subsys use.”

McCaskill’s report provides a grim snapshot of how the opioid epidemic became the deadliest drug overdose crisis in US history: Driven by a quest for profit, opioid makers and distributors misled doctors, insurers, patients, and the general public about their drugs — claiming that they are safe and effective for conditions that they would turn out to be neither safe nor effective for. The drugs proliferated across the US, and tens of thousands of people have died annually for years as a result of opioid overdoses.


“Led by an Insys employee named Elizabeth Gurrieri, IRC employees reportedly received significant financial incentives and management pressure — including quotas and group and individual bonuses — to boost the rate of Subsys authorizations.”

At the same time, an internal document uncovered by McCaskill’s team found that IRC failed to maintain “even basic measures” to make sure staff weren’t lying and misleading insurers so they would pay for Subsys when patients didn’t really need the drug. The unit took part in a lot of shady behavior as a result, even allegedly falsifying patients’ medical records to help them attain prescriptions.

Here’s the problem: Subsys is a very powerful drug. It is highly potent and addictive. That’s why it’s meant for cancer pain patients. These patients typically need end-of-life care, meaning the risk of addiction isn’t as big of a concern, and many have already developed a tolerance to opioids from previous use.

So when Insys representatives misled and in some cases flat-out lied about a patient’s needs, they helped push a dangerous drug to people who didn’t need it. The results are often misuse, addiction, and death.

Insys was apparently aware of this, McCaskill’s report found: “According to a class action lawsuit, Insys management ‘was aware that only about 10% of prescriptions approved through the Prior Authorization Department were for cancer patients,’ and an Oregon Department of Justice investigation found that 78% of preauthorization forms submitted by Insys on behalf of Oregon patients were for off-label uses.”


Based on an audio recording, the team found that an Insys employee misrepresented herself as “with” the office of Fuller’s doctor to representatives for a pharmacy benefit manager. The Insys employee then suggested — albeit with careful wording to avoid the use of the word “cancer” — that Fuller, who did not have cancer, needed Subsys for “breakthrough pain.” The prescription was approved. Fuller later died “due to an adverse reaction to prescription medications.”
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Postby wario lopez » Wed Sep 06, 2017 7:48 pm

gargamel wrote:couldn't marijuana also be integrated into what PB is talking about?


most of my family lives in a small town, including my 4 siblings, and i live in fear of them falling into opioid abuse


yes, but it wasn't logistically available in the system i was working with.
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Postby wario lopez » Wed Sep 06, 2017 8:16 pm

goddamn, check out this graph from that article
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Postby gershon » Thu Sep 07, 2017 12:52 pm

Nickward wrote:Very cool, congratulations. Those folks have saved my ass in the past and now that I've been clean for awhile I have considered doing similar volunteer work. And Suboxone has been a major part of my recovery -- I have seen people make the most remarkable turn arounds on it. I donated $100 to your organization; it was a win-win because it balanced my checking account to a cool $666.00 8-)


Awesome, thank you, we really appreciate it!
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Postby gershon » Sat Sep 09, 2017 6:53 pm

Our volunteer syringe access program and naloxone distribution got an NPR-affiliate radio piece and article put out recently:

https://kjzz.org/content/527188/phoenixs-underground-needle-exchange-offers-lifeline-opioid-users

And I got the job at a medically assisted therapy [MAT] center:) woo hoo, passionately employed:)
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Postby Grey Poupon » Sat Sep 09, 2017 7:16 pm

Never mind I misread the graph (twice)
My listening experience in balanced mode reveals the great depth of EARTH
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Postby blackbetty » Wed Nov 08, 2017 4:17 am

http://www.esquire.com/news-politics/a12775932/sackler-family-oxycontin/

By the end of the decade, clinical proponents of opioid treatment, supported by millions in funding from Purdue and other pharmaceutical companies, had organized themselves into advocacy groups with names like the American Pain Society and the American Academy of Pain Medicine. (Purdue also launched its own group, called Partners Against Pain.) As the decade wore on, these organizations, which critics have characterized as front groups for the pharmaceutical industry, began pressuring health regulators to make pain “the fifth vital sign”—a number, measured on a subjective ten-point scale, to be asked and recorded at every doctor’s visit. As an internal strategy document put it, Purdue’s ambition was to “attach an emotional aspect to noncancer pain” so that doctors would feel pressure to “treat it more seriously and aggressively.” The company rebranded pain relief as a sacred right: a universal narcotic entitlement available not only to the terminally ill but to every American.
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Postby landspeedrecord » Wed Nov 08, 2017 10:17 am

I was in philly this past weekend, couldn’t walk a block without seeing needles on the ground, even in nicer neighborhoods

it was so much worse than it was even 2 years ago... startling
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Postby chandler » Wed Nov 08, 2017 10:25 am

yeah it's bad here

we import a lot of addicts from surrounding counties, jersey
i've been getting really into pestcest too lately. haven't really been able to find much good ant stuff, though. anybody have any links to some good biting vids/pics?
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Postby Merciel » Wed Nov 08, 2017 11:25 am

Yeah I saw a guy pretty much dying on the steps of a Fishtown rowhouse last time I went to a show up there.

We don't see it too much in our neighborhood but it's definitely a big problem.
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Postby landspeedrecord » Wed Nov 08, 2017 11:29 am

ya I was in kensington where my friends just bought this *amazing* modern 3-story building, and I realize that hood is right next to fishtown which is pretty sketch, but to walk around cobblestone streets littered with needles and baggies is just... surreal

have any of y'all gone through narcan training//carry it around with you?
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Postby Merciel » Wed Nov 08, 2017 11:33 am

Fishtown is more gentrified than Kensington, which is ground zero for our opioid problem. If you were there, I'm not surprised you saw it all over. It is all over.

I don't carry Narcan and haven't done the training. It isn't offered in our office (which might change with the new administration, who knows) but a dose in my hands would be inefficiently placed anyhow, since I don't live in an area where it's a routine enough occurrence for it to be worth preparing me over somebody else.
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Postby Alexis » Wed Nov 29, 2017 10:05 am

has anyone seen this?? they filmed it in Arkansas about 20-40 miles outside of Little Rock but i see all kinds of meth addicted people in Conway but it's on HBOGO

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Postby ZONKER » Wed Nov 29, 2017 10:18 am

Alexis wrote:has anyone seen this?? they filmed it in Arkansas about 20-40 miles outside of Little Rock but i see all kinds of meth addicted people in Conway but it's on HBOGO



No I haven’t but thank you, drug docs are right up my alley

And props to gershon and PB, keep doing good work ya’ll - we really appreciate it <3
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Postby gershon » Thu Nov 30, 2017 8:15 pm

landspeedrecord wrote:have any of y'all gone through narcan training//carry it around with you?


Yes, my life currently revolves around harm reduction. I volunteer with a syringe access program and a naloxone distributor. Two of my closest friends go around doing naloxone trainings in treatment centers, Native reservations, hospitals, corrections, police departments and more in our county. I do on the street outreach and train people on how to use narcan/naloxone and give them clean syringes and a place to dispose of old ones.

I’m working for a medicine assisted treatment (MAT) center now which doses people on methadone, suboxone, or vivitrol.

The hardest part is convincing lawmakers to treat syringe access as a necessary part of treating opioid use in Phoenix, AZ.
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Postby gershon » Thu Nov 30, 2017 8:29 pm

No, wait, the hardest part is finding funding sources and donors.
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Postby wario lopez » Thu Nov 30, 2017 8:54 pm

i used to do a lot of naloxone education and distribution in my previous job. we actually heard back from some patients that they successfully used it on others/themselves/had it used on them. so that's a few lives saved. i'm currently working on implementing an education program for my current job. we're also taking major strides in deprescribing of benzos for those on opioids, as they greatly increase the risk of overdose. while writing this policy, i came across some surprising data.

https://jamanetwork.com/journals/jama/fullarticle/1653518
>50% of overdose deaths are from prescription medications, not street drugs. benzos contribute to about 1/3 of prescription opioid-related deaths, and opioids were involved in over 3/4 opioid-related deaths. 3/4 of overdose deaths are unintentional. these numbers of benzo+opioid combination deaths might even be higher due to tox screens being very poor at detecting synthetic opioids or certain benzos. in fact, commonly abused benzos like xanax, ativan, klonopin, don't show up on urine drug screens at all and often detecting those in the blood is a send out to outside labs.
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Postby gershon » Thu Nov 30, 2017 9:04 pm

At the MAT clinic we do flash ua screens at point of contact, or when the client first comes to us before we dose them and the quick screen DOES screen for benzos, it’s just not as comprehensive as a full screen. Full screen’s are sent out after the flash and those do differentiate between benzos and synthetic opioids. I don’t know what that study is saying...quick screens DO scan for benzos.
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Postby gershon » Thu Nov 30, 2017 9:08 pm

Also, naloxone only works on opioids and opiates, it doesn’t do anything for benzos. So, in a poly overdose situation with heroin and Xanax, they are both depressants and can slow the breathing, but naloxone will only pull the person out of the opiate overdose. Rescue breathing, not cpr, might help after, but the person would seriously need to be taken to a hospital
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Postby wario lopez » Thu Nov 30, 2017 9:41 pm

gershon wrote:At the MAT clinic we do flash ua screens at point of contact, or when the client first comes to us before we dose them and the quick screen DOES screen for benzos, it’s just not as comprehensive as a full screen. Full screen’s are sent out after the flash and those do differentiate between benzos and synthetic opioids. I don’t know what that study is saying...quick screens DO scan for benzos.


it depends on the screen assay. many quick screens only detect 1,4-benzodiazepines such as oxazepam. if someone takes diazepam, then it'll pop because diazepam is metabolized to oxazepam (albeit partially). screen+confirmation is needed for metabolites of other medications. it's more dicey. taken from arup labs:

False positive rates for benzodiazepine immunoassays are relatively low (<5 percent). However, most benzodiazepine immunoassays used for screening are susceptible to false negative results. The false-negative rate for benzodiazepines in an immunoassay screen is approximately 25-30 percent, and is particularly problematic for clonazepam. One reason for false-negative clonazepam results is that the drug appears in the urine almost entirely as 7-aminoclonazepam, a metabolite that is not detected by many commercial immunoassay screens. A similar challenge exists for some other extensively metabolized benzodiazepines.
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Postby wario lopez » Thu Nov 30, 2017 9:44 pm

so yes, while the drug screen does say "benzodiazepines" on there, you actually have to know what assay you're running. because i've had people be prescribed benzos that they are taking and testing negative on them and not a lot of people will order a confirmation test on a negative screen.
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Postby . » Fri Dec 01, 2017 1:08 am

the fact that I see ads for ancillary drugs to help oxyheads go to sleep or take a shit is so jarring to me
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Postby inspectorhound » Fri Dec 01, 2017 1:20 am

saw this ad on tv the other day

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Postby Annie May » Fri Dec 01, 2017 1:20 am

Merciel wrote:Yeah I saw a guy pretty much dying on the steps of a Fishtown rowhouse last time I went to a show up there.

We don't see it too much in our neighborhood but it's definitely a big problem.


Yeah i ran across an unresponsive dude in an alleyway around washington square at work the other day. Someone was already there and had called an ambulance so i went on my way after asking what was going on.
An acquaintance of mine recently died from this stuff and it's been hitting everyone in my circle pretty hard. At his memorial service several former users got up to talk about the epidemic and offer help if anyone needed it which was nice. It's good to see people mobilizing against this problem but stigmatization is still really high and it seems to just keep getting worse.
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Postby Johan POOPLER » Fri Dec 01, 2017 1:23 am

maybe it's the suicidal junkie in me talking but my main problem with the opioid epidemic is that other people are hoggin em all and dying instead of me
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i dunno. it's a very sad aspect of our nature, but also one of the foundations of love

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