Do we have a thread about the opioid epidemic?

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Postby DasLofGang » Sun Jul 09, 2017 2:35 pm

butler county ohio, everybody
heaven’s full of murderers
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Postby pantsoclock » Sun Jul 09, 2017 8:30 pm

You know what's good? Good Samaritan laws that prevent prosecution for possession in cases where you call emergency services for an overdose: http://www.drugpolicy.org/911-good-samaritan-fatal-overdose-prevention-law
I pay tax to help pay for things like police..fire..parks..but it goes to Ferguson like people and foreigners who are scamming our stupid government that is full of pasta thieves like this guy
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Postby inspectorhound » Sun Jul 09, 2017 8:52 pm

pantsoclock wrote:You know what's good? Good Samaritan laws that prevent prosecution for possession in cases where you call emergency services for an overdose: http://www.drugpolicy.org/911-good-samaritan-fatal-overdose-prevention-law

guess who wet his pants over a heroin immunity policy that wasn't even in his county!

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Postby bear » Sun Jul 09, 2017 8:57 pm

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hpn.center - the #1 source for all your boarding needs
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Postby cocoon man » Sun Jul 09, 2017 9:05 pm

ceo wrote:
hologram wrote:You aren't truly sorry

because judging from your story you'll find yourself to sleep with any dirty type of seduction

But of course with "journalistic intentions" you were looking for a story to dwell onto the insusceptible

but please keep pretending heroin is a passing charade!


It's unfortunate that you didn't have the same experience. I'm sorry to hear that.


Yeah sorry you're officially the dumbest person who boards here

Not sorry I mean congratulations you've just won a lifetime supply of the dirty brown
BILL GATES I'M YOUR STEPSON
I'M SO PROUD TO SHARE YOUR GENES
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Postby gold and glass » Sun Jul 09, 2017 9:51 pm

someone died in the bathroom of the last greyhound bus i was on
we all had to stand at the side of the bus and watch them drag his body off
fuck you and your corporation
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Postby Delphic » Sun Jul 09, 2017 10:21 pm

I pop a lot of opiates and have been for a while. It made me feel nice when I was down. Over time it sort of made my personality feel less awful or something. Its really hard to describe. But I think it's bad for me and I've started really realizing that in a meaningful way. I threw up a lot of blood not long ago, so there's that too. I'm doing okay right now. I haven't posted for a while because I get caught up in things. This was a really long winded post. Laugh out loud!
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Postby viachicago » Tue Jul 11, 2017 1:39 am

chimp wrote:
viachicago wrote:
that graph would seem to suggest that Drs were increasingly lax in prescribing opiate pain pills


I get this criticism but as a doctor when someone comes to you with significant pain what are you supposed to do? There really isn't a straightforward answer. I try to spare opioids as much as possible but you have to treat pain.


It definitely has a legit use and there are ppl who Def need to be on it where nothing else will work. I definitely did not need to be for wisdom tooth removal or a strained muscle however. They're massively overprescribed. I was just handed this shit without a single warning as an impressionable late teen/early 20 something and so were all my friends. What do they think is going to happen exactly. Other countries do not have this same sort of problem and still manage to provide exceptional healthcare. At this point it's a combination of massive marketing efforts from pharmaceutical companies to drs, and a general population that now expects extremely strong pills or they think they're getting ripped off somehow. I think the medical community definitely deserves some blame for how this has all transpired
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Postby blackbetty » Tue Jul 11, 2017 2:26 am

viachicago wrote:
chimp wrote:
viachicago wrote:
that graph would seem to suggest that Drs were increasingly lax in prescribing opiate pain pills


I get this criticism but as a doctor when someone comes to you with significant pain what are you supposed to do? There really isn't a straightforward answer. I try to spare opioids as much as possible but you have to treat pain.


It definitely has a legit use and there are ppl who Def need to be on it where nothing else will work. I definitely did not need to be for wisdom tooth removal or a strained muscle however. They're massively overprescribed. I was just handed this shit without a single warning as an impressionable late teen/early 20 something and so were all my friends. What do they think is going to happen exactly. Other countries do not have this same sort of problem and still manage to provide exceptional healthcare. At this point it's a combination of massive marketing efforts from pharmaceutical companies to drs, and a general population that now expects extremely strong pills or they think they're getting ripped off somehow. I think the medical community definitely deserves some blame for how this has all transpired


I work in an ED and this feels like shaming to me. Pain is notoriously hard to objectively evaluate. I would also like to say there is less od deaths in states with recreational mj
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Postby chimp » Tue Jul 11, 2017 2:31 am

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
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Postby chimp » Tue Jul 11, 2017 2:43 am

like for every person who says "man i totally didn't need that drug, what was that doctor thinking" there will be someone else who is like "that pain was unbearable". trust me i see these people. some seem to experience pain that is way out of proportion to what it seems to me that they "should" be feeling. that leaves you in a really difficult position as the clinician

it's highly subjective and of course the way to decide is by taking a proper history and using your clinical judgment but i'm just saying it's not straightforward
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Postby chimp » Tue Jul 11, 2017 2:52 am

its probably not totally dissimilar to the antibiotic prescribing thing where are a lot of people are also like "why are doctors so dumb on this"

i genuinely believe that part of the problem in both cases is that patients are now prepared to be a lot more demanding of healthcare professionals and now are much more supported in that by regulatory and legal mechanisms. patients as a group are more likely to sue or formally complain if they don't get what they want and that means that increasingly doctors give people what (it's perceived that) they want which isn't always the same as what they should have. again i'm speaking from the UK context but i doubt it's very different in the US. i'm not defending this state of affairs i'm just offering an explanation
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Postby chimp » Tue Jul 11, 2017 3:10 am

i've come under a shit ton of pressure to inappropriately prescribe antibiotics, especially to kids. i had one father try to make me sign a piece of paper to say that i was legally responsible if his kid became more unwell after me not giving him antibiotics. had another dude take my name and professional registration number after refusing to give antibiotics. i get indignant in these situations but a lot of people will just crumple probably. anyway not totally the same thing but similar dynamic in some cases
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Postby blackbetty » Tue Jul 11, 2017 3:26 am

Chimp keep doing the right thing. It's the same here in my experience. The decline of health care into customer service (and pharmaceutical companies as advisers) is a total death wish
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Postby blackbetty » Tue Jul 11, 2017 3:31 am

My understanding is a new, organic route to opiate synthesis has been discovered which will probably be exploited in illegal trade and exacerbate the epidemic
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Postby blackbetty » Tue Jul 11, 2017 3:34 am

Pretty much treat it like a plague and avoid exposure. It reminds me of the first message ever telegraphed

I guess it's worth mentioning this conversation changes with end-of-life care
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Postby gershon » Tue Aug 29, 2017 11:52 pm

Bump!

I volunteer with Shot in the Dark, Phoenix's (yes, that city) largest syringe access and naloxone distribution program in Arizona. It's an all volunteer organization with no paid employees and we all donate our own time and services to the community. We completely rely on donations and grants to supply naloxone and harm reduction materials. We aren't state funded and have to operate outside of state sponsored healthcare. We have understandings with local law enforcement to let us operate in peace...

We are seriously low on funding and that's why I'm posting this donation link here:

https://www.gofundme.com/phoenix-harm-reduction-fundraiser

If you want to know more, let me know. Please donate or share the link if you're inclined. Thanks!
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Postby unome » Wed Aug 30, 2017 2:45 am

On the bright side, low dose Naltrexone has done wonders for my fibromyalgia
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Postby captain » Wed Aug 30, 2017 4:07 am

fentanyl will kill between 400-500 vancouverites in 2017

http://nationalpost.com/news/canada/dru ... d-fentanyl
ive been thinkin about my life lately and in short im goin A-WALL
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Postby gershon » Mon Sep 04, 2017 9:53 pm

I have a job interview with a methadone/suboxone clinic and treatment center tomorrow:)
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Postby Peptobysmal » Tue Sep 05, 2017 12:51 am

That's real awesome Gershon, good for you.
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Postby gershon » Tue Sep 05, 2017 12:53 am

Thanks, nickward:)
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Postby gershon » Tue Sep 05, 2017 6:38 pm

gershon wrote:I have a job interview with a methadone/suboxone clinic and treatment center tomorrow:)


One more interview on Thursday and it seems like I've pretty much got the job. I'll still be able to volunteer with the syringe access/naloxone program at nights, too:)
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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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