Prescription Drugs

No Opiates for the Masses?

A push to fight painkiller abuse may do more harm than good.

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Pills
Credit: Fillmore Photography / photo on flickr

There is no problem so bad that government-imposed remedies cannot make it worse, spawn new problems or both. A new confirmation of that phenomenon may be on the way, thanks to new recommendations from an agency intent on curbing the use of opiates. 

On Tuesday, the Centers for Disease Control and Prevention issued guidelines for medical professionals to discourage them from prescribing these medicines to relieve pain. It has grounds for concern: Drug overdoses are now the leading cause of accidental death in the United States, with prescription and nonprescription opiates accounting for the biggest share of those fatalities. 

Things apparently are getting worse. Since 2001, the number of deaths from overdoses involving legal prescription opiates has more than tripled, while the rate for heroin, an illicit drug, has risen sixfold. 

These trends are the byproducts of a worthwhile change: more aggressive efforts by doctors to prevent suffering. In the 1990s, experts realized that patients suffering from both acute and chronic pain were being deprived of remedies. They also concluded that the danger of those patients becoming addicted had been exaggerated. The word went out, and over the past two decades, prescriptions for opioid painkillers have more than doubled. 

The increase has been a blessing to millions of people whose ailing bodies had become cauldrons of misery. But alarmists think the side effects outweigh the benefits. So the CDC advises physicians to limit such prescriptions for short-term pain (say, from surgery) to three days or less. 

As for chronic, persistent pain, it recommends that patients first be treated with ordinary painkillers (such as ibuprofen or acetaminophen), physical therapy or antidepressants. If opiates are eventually used, doctors are told to monitor patients to make sure the drugs are actually doing the job. 

It all sounds reasonable, but the guidelines pose real risks. They will undoubtedly dissuade some medical professionals from offering medicines that can be extremely helpful. By giving priority to the danger of overprescribing, the CDC will create errors on the side of under-prescribing. 

But it's better to give some patients medicines they don't need than deny other patients medicines that they do. The CDC advice would tilt medical practice in the opposite direction. A broad effort to diminish the medical use of opioids will increase the net total of suffering. 

There is more than enough already. "Pain affects millions of Americans; contributes greatly to national rates of morbidity, mortality, and disability; and is rising in prevalence," said a 2011 report commissioned by the federal Institute of Medicine. "Currently, large numbers of Americans receive inadequate pain prevention, assessment, and treatment."

The American Academy of Pain Medicine, which represents pain specialists, was distinctly lukewarm on the CDC advice. It stressed that opioids "are an important option—as part of a comprehensive multidisciplinary approach—that must remain available to physicians and appropriately selected patients." It also noted the need "to ensure that it does not inadvertently encourage under-treatment, marginalization, and stigmatization of the many patients with chronic pain that are using opioids appropriately." 

The new guidelines, billed as voluntary, feature a club in the closet. Medical professionals whose judgment contradicts the CDC's may find themselves under scrutiny from regulators, insurance companies and the Drug Enforcement Administration. "Just the knowledge that you are being watched casts a chilling effect," Jeffrey Singer, a general surgeon in Phoenix, told me. 

States that impose prescription monitoring programs do see a decline in opioid prescriptions. But a working paper by Angela Kilby, a Ph.D. candidate in economics at MIT, documents that they lead to more unrelieved pain, higher costs, more missed workdays and a temporary jump in overdose deaths from heroin. 

One possible explanation for this last result is that when pain victims lose their legal opiates, some resort to the illicit version—which can be especially hazardous because it varies so much in potency and purity. Without a doctor's supervision, these patients may be more prone to mix opiates with other drugs. Most overdose fatalities stem from combining heroin with alcohol, cocaine or prescription medicines.

An old maxim says, "We all have strength enough to bear the suffering of others." There is no doubt that when prescription painkillers are widely available through physicians, some people will fake symptoms to get drugs to misuse or sell. But punishing the innocent to get the guilty is a formula for increasing the sum of suffering.

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  1. This is a good start, but there is much more. First of all, addiction doesn’t start with legit pain prescriptions. It starts with ‘borrowing’ from your relatives and this results in a ‘disease’ that results in stealing from your neighbors. That’s right, after being told a million times “Don’t do drugs” you do them anyway and this results in a ‘disease’ that makes you do drugs or at least steal the money for them. (Maia Szalavitz has done a lot of good work on that issue.)

    Next up is that the overdoses are typical intentional, not accidental, as evidenced by multiple drug intoxication – typically every bottle in the house. Hard to argue “it was an accident” and in fact the addicts freely admit to multiple suicide attempts. Meaning, opiates are just another means of death of out many, e.g. guns. And finally, pain patients are often miserable, and these guidelines will push many over the edge. Whose deaths will then be labeled as ‘addiction’. Even though the evidence shows that the epidemic of suicide is mostly out of general despair. And then the CDC will cry, “People are dying, we must restrict opiates even further!”

    And then produce propaganda telling kids it all starts with an innocent prescription (see James Comey – FBI – Chasing the Dragon) and NIDA – Drugs make you commit crimes, why take the chance?

    1. Having said all that, I think the solution is for pain patients to attend their local 12 Step meetings and meet the ‘addicts’ for whose sins they are suffering. To the extent they refuse, I see it as a belief in the religion of ‘government should solve all my problems’ and honestly I never had much sympathy for such people.

      (Also the NIDA link above should be: Drugs make you commit crimes, why take the chance?.)

      1. Addicts struggling within the gnarly web of socialized morality spun between prison and their own dysfunction are left few choices other than to submit to the state and its religion/Marxian inspired jurisprudence.

        Sympathy for these people doesn’t indicate emotional deficit.

      2. I think the solution is for pain patients to attend their local 12 Step meetings and meet the ‘addicts’ for whose sins they are suffering.

        This reminds me of something ?.

      3. we could always, I don’t know, make drugs not a crime and eliminate those problems overnight.

        I know, I know. I’m talking crazy now.

      4. It might also help if the media didn’t teach everyone how to abuse the drugs like they did with Oxycontin. Make sure you don’t crush those pills, because its just like heroin. You can sell those pills for $40 each, so don’t do it.

        1. “It is the prohibition that makes anything precious.”
          – Mark Twain (1835-1910)

          Just end prohibition. Then the risk premium disappears and anyone who wants the damned things can get them after education and agreeing to regular oversight to help them properly apply the drugs and regulate their intake; but not to force them to accept advice.

          Crime related to prohibition (violence over turf wars and rip offs) would disappear overnight. A person can buy a suitcase of cocaine or heroin for practically nothing in the third-world nations where they are chiefly produced. The risk of getting caught for attempting to import the drugs through the law enforcement gauntlet is what adds value. Well, that and the likelihood you might end up the victim of being ripped off or killed by the avaricious or a competitor. Remove the risk premium and the supply will dry up because there’d be no way to make money.

          A $1K of cocaine purchased in Columbia would only be worth the value added by the importer: assurance of purity and the cost of shipping and distribution and a profit. Maybe one could double their money but I doubt the dealer could indemnify himself against damages awarded in a civil action because someone was injured or died as a result of using the drugs.

          The 100+ year model of legislate, arrest, prosecute and imprison has never worked and might not even work in a totalitarian society. It has failed, continues to fail and will fail in the future, the very definition of INSANITY!

    2. Have you ever been in chronic pain–injuries that limit daily life–We have the right to have access to pain medication ,( it is a word law ) persons with a life-threatening or life-limiting illness , should have full access. Last year, more than 30,700 Americans died from alcohol-induced causes, including alcohol poisoning and cirrhosis, which is primarily caused by alcohol use.So will you push for prohibition. Are you the same person who championed in medical or legalize Marijuana knowing that the drug czars would change their crops to poppy–When this country stops being a nanny state and holds those accountable for ones own actions will we ever function correctly as a society .
      )

      1. I think AddictionMyth favors increased access to opiate prescriptions. I think his first sentence is praising Chapman’s article, not the CDC guidelines. But I could be wrong because it isn’t completely clear…

        1. Yes, praising the article. It never ceases to amaze me how easy it is to be misinterpreted. My name is “AddictionMyth” for god’s sakes. I believe that ‘addiction’ is a myth/scam/fraud/religion/day-at-the-beach. (It is *not* a disease, it is *not* a disorder – learning or otherwise, it is *not* a character flaw, drug use should *not* be criminalized, the CDC guidelines are totally psycho.) The main problem is that law enforcement is running out of crimes, so they try to create new ones.

          1. AFAICT, “addiction” is a belief system shared by “addicts” & others.

    3. “Hard to argue “it was an accident”

      I vehemently disagree. ‘Accidental’ overdosing is an exceptionally easy thorny thicket to become trapped in even for experienced users- though the issue is typically the bane of the ignorant.

      1. Agreed. When people are taking multiple medications it’s all to easy to get them confused, especially when they’re in a bit of a drug/pain/lack-of-sleep induced mental haze. It’s amazing what pain can do to your cognitive abilities, especially when it keeps you from sleeping.

        1. It’s amazing what pain can do to your cognitive abilities, especially when it keeps you from sleeping.

          Another good reason to make opioids more accessible, not less so.

          1. No, I don’t think that one’s a reason to make them either more or less accessible.

            Linda Twigg died under conditions that made her death probably accident, although suicide can’t be ruled out. She’d gotten off her methadone maintenance in favor of GHB, which has no cross-tolerance with opiates but impaired her judgment, as may be inferred from observ’ns by others in the days leading to her death (although others’ opinions are that her behavior was just normal for her personality). So when somebody brought her heroin, she was like a na?ve user & easily ODd fatally. GHB’s (or GBL’s, which is superior in all respects IMO) effect is a lot like booze.

            1. What you described is an intentional overdose.

              1. “Intentional” maybe, but under condition of mental impairment.

                1. That is, if you’re so blotto that you forget you no longer have tolerance to that amount of heroin, you may intend to take that much, but I doubt you intend the consequence. It’s like if it’s dark and you forget that you removed a step on the stairs because you’re working on them, and then you fall thru, you could be said to have intended to take a step, but not that you intended to fall where there was no longer a step.

          2. Agreed! It’s the whole “by prescription only” mindset that has created most of our current pharmaceutical problems, including the drug war. Enough is enough. Let people decide for themselves what substances to take or not take. A medical practitioner is qualified by training, testing and experience to give advice. Providers cannot, and should not be expected to, solve all problems for all people, especially with pills. And putting the responsibility on providers for limiting access to “dangerous” drugs is ineffective and frustrating … providers who do a good job of assessing, diagnosing and recommending appropriate treatment, and then MONITORING the effects of that treatment have more than enough to do without additional burdens.

      2. I vehemently disagree. I’ve attended many AA meetings and almost universally they claim that their suicide attempts were (1) intentional and (2) they gave reasons for them – feeling lonely, angry at mother, angry at bf/gf. The reason people think that it’s accidental is that they watched “Requiem for a Dream” and believed every word. Also Trainspotting.

        1. I’ve had relatives whose deaths were taken as accidental but were in some cases definitely suicides & in others arguably-to-probably so.

        2. Funny, I actually remember reading the online account of a recreational drug user who said that watching “Requiem for a Dream” made him *want* to take more drugs. So much for the after-school special approach.

      3. Accidental overdoses in my home state are fairly common. Lately there have been a few batches of heroin sold that have been cut/laced with fentanyl and they have resulted in several OD’s, some fatal. Being that there is no way of knowing what’s in clandestinely manufactured drugs, let alone the doses of the compounds that are expected to be in them, accidental overdoses can and do happen with regularity.

        This is not to say that pharmaceutical grade drugs don’t also lend themselves to accidental overdose

    4. It’s easy to argue it was an accidental overdose, especially when it’s an elderly patient dealing with chronic pain or terminal disease.

      After all, (generally speaking) if it’s a suicide, then there’s no life insurance. If it’s an accident, there’s life insurance.

      Knowing this, I think many involved in the chain, from the EMTs on the scene, to the family members, to the coroner, are likely to agree it was an accident and move on.

      1. Yes, I forgot to mention that very important reason, besides the embarrassment.

        1. Also, if you like mystery fiction, when a death turns out to be a suicide, it’s often like a cruel trick on the reader, almost cheating.

      2. Actually, most life insurance policies cover suicides as long as the policy has been in effect for at least 2 years.

    5. Indeed, because of embarrassment to families, attempted & successful suicides by any means are under-reported. And then there’s a grey area of cases where it seems the distraught person didn’t care whether s/he lived or died, so the safety of the implements was practically not an issue. Sure, you could design implements that make it practically impossible to kill yourself with them, but that raises their cost, usually diminishes their usefulness or convenience, and does nothing for cases like that because the person toying with death will find another means. (In that grey area I have in mind the case of Jack Bova, who in the hours leading to his death was acting bizarrely & boisterously, took out a handgun in view of a neighbor, waved it around, then shot himself in the head. Viewed in just that instant it’s a suicide, but considering the minutes around it, it might’ve been, “Look at me, see if I care about my life!”)

    6. This is a horrible start. I am convince that the FDA and CDC cause far more injuries, misery and death than they prevent – and at a high price.

      For starters, look at two simple examples of requirements for “prescriptions” that should not exist. Metformin is one of the most commonly prescribed drugs in America (50,000,000 people take it). It’s useful in treating diabetes and pre-diabetes. It’s safer than aspirin. It has a 20+ year track record with the biggest downside being some nausea in some people. A year’s supply costs $50… until you add in the cost of getting a prescription. With lost time from work, doctors office fees and time to get the prescription filled, you’re looking at adding something like 600%.

      Same thing with CPAP. A machine that should cost about $200 instead goes for $1000 – and requires a $2000
      “sleep study”. Bottom line: For what should cost $200, you pay $3,500+ – a $17,000% increase in cost… all for a machine that blows a little air in your nose. The pressure is only about 20 millibars. How much is that? Let’s put it this way: If you blow up a child’s party balloon, you’re at greater risk. So should the FDA require prescriptions for party balloons? Or stop their asinine intervention in CPAP therapy?

      (cont)

      1. Finally, with regard to opioids. What if someone WANTS to die? Not a bad way to go. And face it, if you had a condition that put you in constant pain, and the means to end your own life peacefully – might you not decide to do so? So the FDA/CDC isn’t “saving” anyone. They’re just condemning them to live in a life of pain – or maybe go buy a gun and blow their brains out (which the anti-gun morons then use as “evidence” that guns are too dangerous!!)

        We’re better off without the government meddling in medicine. My final argument in that regard: Obozocare.

  2. The CDC guidelines are recommendations that aren’t binding to professionals but they are still troubling. Sure, recreational users and addicts are checking out but so what? There are a lot of people with untreatable chronic pain that aren’t terminal and they need their meds. Hopefully these recommendations won’t be codified into law which would make doctors gun shy about prescribing opiates and would result in needless suffering.

    I hope the CDC’s happy-they’ve placed me in a position where I agree with Chapman who’s a miserable columnist and a damn fool if I’ve ever seen one.

    1. If a doctor ever goes on trial for prescribing painkillers to some patient she “should have known” was an addict, then the prosecutor will try to throw the CDC guidelines in the defendant’s face to show that she wasn’t practicing *real* medicine.

      So, these guidelines are only “nonbinding” in the most technical sense.

      1. Yeah pretty much. I’ve seen people get razed for deviating from the “guidelines”, even when the science behind them is flimsy at best. In this particular case the CDC is reacting to political pressure to DO SOMETHING!!! rather than actually assessing evidence or anything.

        I’ve been around long enough to remember when without any evidence whatsoever the medical profession was told that pain was “the fifth vital sign” and that we were undertreating it (I’ve lost count of the “my pain is a 100 out of 10” people). Couple that with the recent link of reimbursement to patient satisfaction and you have quite the conundrum for a doctor who wants to get paid but also wants to practice responsible medicine.

        1. “Long enough”?! Seems like yesterday.

      2. But at least the doctor can rebut with some other prestigious organiz’n’s recommend’ns.

      3. Most narcotic prescriptions are not compassionate, they’re lazy. Increasingly busy providers simply throw prescriptions at their patients without stopping to think, or do any kind of cost/benefit analysis. Some elderly patients have a dozen or more prescriptions from four or five “specialists” … the side effects and drug-drug interactions compound logarithmically. Stop! Enough is enough …

      4. In Florida, the Attorney General Pam Bondi is a witch on a witch hunt for prescription drugs. They call places that prescribe more than the AG “thinks is right” “Pill Mills” and land on them with both feet.

        What a waste of taxpayer money.

    2. They don’t need to be law. The threat is enough by itself. My long term doctor quit prescribing pain meds four months ago. Not just for me, but for anyone. The doctor he referred me to wouldn’t write one for more than half as much as I already had. Then he tried to refer me to a pain clinic that I can’t afford.

      Almost 30 years of almost constant pain and taking pain meds as needed with no problem with addictions and now I get thrown out on the dogpile.

      Thanks, all you moralizers that don’t care who else gets hurt so that you can feel all high and mighty. I’ll know who to blame when they turn off my power tomorrow because I haven’t been able to work in a couple of months.

    3. Opioids decrease pain in the short term but actually increase pain when taken long term.

      Any attempt to curb the overuse and overprescription of opioids I’m fine with.

      1. This is seldom the case especially with most types of chronic pain due to RA, cancer, DDD and MS true that the patients will develop resistance to the opioid overtime and then the does has to be increased.
        A good Doctor will monitor the patients for this.

  3. in the face of silk road and the like, this is (hopefully) the death spasms of the drug war. Its gonna get way worse before it gets any better.

  4. Denying pain medication for legitimate purposes is no different than denying access to cancer drugs. It can be a fatal decision. Depression is a fatal* disease and it is often concomitant with severe, chronic pain.

    *Unless it diminishes on its own or is treated, depression usually ends in suicide.

    1. And if you can’t afford the pain clinics to get the pain meds, you can’t afford the psychiatrist to get the anti-depressants either.

  5. Gmail has become No.1 email service provider in the world because of its awesome features, easiness and reliability.

    gmail.com
    gmail sign in

    1. Totally not a compelling article about in-home, DIY M-F sex change procedures.

    2. What the fuck is “igmail”?

      1. Ignominious e-mail. It’s like DracSearch, Tom Scharpling’s search engine that’s like any other except it says “bleh” when it displays the results.

  6. This is terrible. My mother-in-law had chronic pain from scoliosis as a child and botched spinal surgery in her early 70s where they cut into her back and front to implant titanium rails to hold her spine straight, but her osteoporosis was so bad the screws pulled out of her vertebrae within months so she had this loose medieval contraption moving around in her insides and was too unhealthy to have it removed.

    So she was on fentanyl and other meds and we were constantly doing the paper chase to keep her prescriptions filled. The pain doctor had to see her monthly so we would drag her over there, causing her great pain, and the pharmacy if they didn’t have enough or whatever was completely indifferent and if we were unable to get her patches she would just lay there screaming in pain.

    But I’m sure things will be much better for people with chronic pain under the new rules that are much more restrictive and difficult to follow and will further dissuade doctors from medicating them.

    1. That’s a horrible story. Too many pharmacists seem to disregard patients who use medications that are prone to abuse. And general practitioners are increasingly sending people to pain specialists to avoid taking on the liability themselves. All because stupid bureaucrats can’t see the good that drugs do for the abuses they sometimes get.

      1. Can’t see? They hide the good that drugs do and massively exaggerate the abuses as a matter of course. Saying they can’t see it is giving these evil fucks far too much credit.

    2. We’re in the paper chase right now. My wife requires full time RN care (which I provide.) She’s been disabled since she was 16 and dealing with 5/10-8/10 pain daily for the past 5 years. The only medicaid-accepting pain specialist we were able to find in the Denver area left the practice, and in 2 weeks her scripts (37.5 mcg fentonyl patch and 10mg oxycodone for breakthrough pain) will run out. Despite her having 7 other doctors, none want to write for pain meds on account of the scrutiny they may face. Unless we find a new doc, withdrawal will be added to her huge list of daily symptoms.

      Here’s a fun fact: Licensure of pain specialists is overseen by the DEA and NIDA. For patients this means signing a several page contract making treatment contingent on not taking recreational drugs and submitting to regular drug tests. For doctors this means agreeing to follow federal guild lines for treatment. Example- my wife has chronic nausea which is only partially treated since she is allergic to Zofran. Her doctor would like to try medical marijuana, but can not prescribe both opiates and marijuana except for patients with certain types of cancer.

      1. I feel for your wife. I’m in the prime of my life right now and struggling with severe chronic pain due to an incurable genetic condition that often leaves me bedridden. She is lucky to have a loving caretaker like you, I’ll tell you that. There are some people who do ‘t even have that much.

        On a separate note–isn’t marijuana/opioids one of the least risky drug combos? So I’ve read. What gives?

  7. This is terrible. My mother-in-law had chronic pain from scoliosis as a child and botched spinal surgery in her early 70s where they cut into her back and front to implant titanium rails to hold her spine straight, but her osteoporosis was so bad the screws pulled out of her vertebrae within months so she had this loose medieval contraption moving around in her insides and was too unhealthy to have it removed.

    So she was on fentanyl and other meds and we were constantly doing the paper chase to keep her prescriptions filled. The pain doctor had to see her monthly so we would drag her over there, causing her great pain, and the pharmacy if they didn’t have enough or whatever was completely indifferent and if we were unable to get her patches she would just lay there screaming in pain.

    But I’m sure things will be much better for people with chronic pain under the new rules that are much more restrictive and difficult to follow and will further dissuade doctors from medicating them.

    1. I did not even hit submit twice I don’t think, dammit.

      1. The squirrels were so moved by your story they wanted to make sure everyone saw it. I’d like to think that every politician could be cured of their hate for opiates just by meeting someone like your mother-in-law, but I know it’s not true. The prison-industrial complex needs to eat too.

        1. There is nothing wrong with the average politician that deep fat frying would ‘t cure…………

  8. People in chronic pain chronically take pain relievers

    What else do you need to know about “addiction” ?

    1. But…but addiction is bad. Better people die of concomitant depression than for one person to die of addition.

      /progressive busy body

      1. I used to work with plenty of self-deccribed conservatives who would agree whole-heartedly with you, Mr. Progressive Busy Body — when it comes to DRUGS!

        1. You’re right, I left out the other end of the nanny continuum. There are so many similarities between lefties and righties that one might think that authoritarians are all the same.

          1. +1 Nolan chart

  9. I’ve had a couple of kidney stones and wisdom teeth out and never had a pain pill prescription or had to worry about the reliability of street drugs. I just use this one weird trick – http://www.ratemydrugdealer.com. It’s fast and it’s free to use and a reliable crowd-sourced reference to find the best drug deals in your area for all your non-prescription prescription needs. It’s just what the doctor didn’t order!

    1. Did anyone click on that link? What happened if they did?

      1. I got a page not found type error.

        1. I got arrested.

  10. Further. If these drugs are so “addictive” why doesn’t everyone who tries them get addicted?

    That alone is proof the drugs are not addictive.

    I had a shot of morphine after some minor surgery. It was lovely. It did not cause me to “chase the dragon”.

    1. Yet.

      /drug warrior

      1. In technical terms, MSimon is what would be referred to as a “recovering addict.”

        1. The minor surgery was in ’64. So I have been recovering for 52 years?

          1. But you never know when you might have a relapse and start stealing and seeking out hard drugs like heroin. Can’t be too careful with those devilish drugs. They’ll just jump out from behind a hedge and attack you.

            1. MSimon has been playing “It was lovely” over and over in his mind for *52 years*.

              If that’s not addiction, I don’t know what is.

              *** bites lip ***

          2. Once you’re an addict, you’re always an addict.

            1. Once you’re an addict, you’re always an addict.

              The US Navy gave me the morphine. I blame the government. Where do I apply for my check? Or free opiates. I hear you can turn those into real money.

              1. According to american socialist in the Brickbat comments, you can’t blame the government for bad stuff, because his email inbox is full of spam from non-governmental entities!

                To be fair, though, american socialist is a stupid, stupid person.

    2. “Voodoo pharmacology”.

      Some drugs certainly appear to be more likely to be the focus of an addiction than others. But of course addiction a complicated psychological mess and not a simple cause and effect thing.

    3. Studies have shown that patients with chronic pain who take their medication as directed have a much lower instance of developing physical dependence to opiates.

      While addiction can include physical dependence, the crux of the problem is centered in the mind. (What I believe after 13 years of avocational work with substance abusers)

      1. Exactly. So when you switch doctors and get hassled by the new doctor to “try going without painkillers for a while,” making the leap to illegal opiates or heroin seems reasonable.

  11. We should start manufacturing RU486 with an opiate additive. No government bureaucracy would dare limit that prescription.

  12. “Just the knowledge that you are being watched casts a chilling effect,” Jeffrey Singer, a general surgeon in Phoenix, told me.

    Oh, come on, Jeff. You should be relieved you don’t have to watch yourself.

    1. When I relieve myself I prefer to be unwatched.

      1. Hmm. “The Unwatched Masses” — nice band name.

  13. It has grounds for concern: Drug overdoses are now the leading cause of accidental death in the United States, with prescription and nonprescription opiates accounting for the biggest share of those fatalities.

    A lot of those are probably not accidents, but suicides… suicide is nobody else’s business but the person who made the choice.

    The remainder, which is idiots Darwinning themselves by not following the instructions for the drug, are also no cause for concern. Certainly not enough to justify forcing others to live in pain when there are remedies available.

    1. Quite a few are actually accidents, believe it or not. A majority are caused by combinations of drugs rather than a single agent in the case of prescription medications, and by the highly variable potency of street drugs (a cap of heroin may get you high, not get you high, or kill you), not to mention the possibility of damaging additives. I’m not saying that there aren’t suicides out there, but I haven’t seen any data that suggest there have been an increase in the popularity of suicide by pill ingestion.

      1. I believe it. Not a lot of junkies want to kill themselves. They’ve found something that gets rid of all the nasty stuff in their lives and found a weird sort of purpose to life.

  14. I propose that accidental overdose being a leading cause of death is a relatively good thing. It’s certainly better than, say, traffic accidents or violent deaths being a leading cause.

    1. #1stworldproblems

  15. As an RN, we were taught, pain is whatever the patient says it is. It is not your responsibility to judge them.
    In 2004, I attended a Cancer Seminar.
    Each specialist said the same thing, pain is a real and debilitating condition. It hampers the recovery,and mental well being of the patient. If you deny them pain relief, they will find their own way, and that most likely will be illicit drugs.
    As one said, if you find heroin in their system, most likely you are under-medicating your patient.
    What amazes me is very few see a connection between the crackdown on prescription painkillers, and the explosion of heroin abuse.

    The CDC doesn’t worry me, it’s the DEA. They raid MD offices, confiscating patient files that have been given opiate prescriptions. Pharmacies are mandated to report these prescriptions to the DEA.
    There are DEA agents in pharma factories, randomly searching employees.
    An MD that has ‘over-prescribed’ has their license revoked and is placed on a national database, along with their patient names. There is no formula for what is, over-prescribing, that is at the discretion of the DEA agent.

    My MD now refuses to prescribe any pain medication for fear of a DEA raid. Many hospitals are now required to drug test any patient that arrives complaining of pain. If they test positive, no opiate pain medication.
    All the DEA is doing is driving these people to street drugs, removing the ability of the healthcare system to properly monitor them.

    1. It’s just amazing. Take away access to the free market and people will flock to the black market. How is this happening?

      /sarc

    2. My MD now refuses to prescribe any pain medication for fear of a DEA raid.

      This is very common, unfortunately.

      What just amazes me is that it is very difficult to prescribe pain meds for hospice patients. Yup, people who will be dead soon need to live out their final days in pain, so they don’t get addicted. Its lunacy. Sadistic lunacy.

  16. What a morally degenerate country this has become. Better 100 people suffer excruciating pain than one person become an addict.

    The CDC guidelines are recommendations that aren’t binding to professionals but they are still troubling

    Let me introduce you to the lawyer make concept of foreseeability in tort law. Some courts and juries believe and expect that doctors should have the omniscience of God.

    1. The fist step is getting an honest understanding of pain killer addiction.

      People in chronic pain chronically take pain relievers

      It is undiagnosed and so far undiagnosable by tests kind of pain that is causing the problem. PTSD mostly. But there are probably others.

  17. Am I the only one to notice that the generation that ‘tuned in, and dropped out’, has implemented the most draconian drug laws?

    1. Also, the people complaining about kids these days and their “everyone deserves a trophy” mentality are typically the people that gave them the trophy.

    2. Not sure that’s true. The previous generation was responsible for an awful lot of it. It wasn’t the boomers who came up with mandatory minimums or New York’s Rockefeller drug laws and at least some of that has been rolling back. I’d say it’s a very mixed bag.

  18. Hmm small world stuff. I posit this just because it is true, not to consciously make a point…

    I’m in my late 20’s, my buddy is house sitting for his uncle, I crashed over there with him. He discovered they were sitting on a plethora of pain killers, Oxycodone or some such; he’s got a bit more experience drug-wise though I’ve dabbled in pills, (mastered whiskey and weed). Long story short, crushed and snorted one last night and *cough* this morning *cough* before work. The effects are pretty benign, though it’s exciting just to flout authority. So yeah, not much else to say, a day in the life of a troubled man with no purpose for living.

    #just a statistic

    1. And you were hurting who by doing that?
      I worked in a county with a 22% unemployment rate, some of my fellow RN’s would refuse to give painkillers because “all we are doing is encouraging them to be lazy.”

      I’m glad their lives were trouble-free and felt no compunction in denigrating others.

      When you have a large portion of your population sitting idle for whatever reason, some will turn to drugs just to get through life. EOS.

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  20. RE: No Opiates for the Masses?

    We’ll all need some opiates if Comrade Bernie, Hitlery or Trump the Grump get elected.
    Talk about cruel and unusual punishment!

  21. Is accidental death by OD really all that serious? I don’t mean the raw numbers, I mean that it happens at all? Is it really anything that the government needs to worry about? I think not and therefore there’s no serious reason why heroin shouldn’t be legal and largely unregulated as well.

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  23. Mental health is the avenue to gun control..
    It was used to confiscate guns in Eastern Europe prior to WWII..

    American Psychiatric Asso: Half of Americans are mentally ill..
    After crafting by politicians and Media all will be crazy except for them..

    300 million prescriptions for psychiatric drugs were written in 2009 alone..
    Your children on medication for ADHD?
    Single woman with children diagnosed with depression?

    be careful what you ask for

  24. This opinion misses a key factor: opioid analgesics ultimately increase the patient’s suffering from pain by working only temporarily, while natural mechanisms in the human body “learn” to bypass the opioid receptor blockade and leads to breakthrough pain. It becomes a self-defeating tactic that ultimately leads almost inevitably to increasing doses (tolerance) and physical addiction. The CDC is right. Doctors should NOT prescribe opioid analgesics for chronic, non-cancer (non-terminal) pain and should limit the duration of opioids severely after minor acute painful conditions.

    1. After 30 years with chronic pain, I can categorically tell you that you don’t know what you’re talking about.

      1. I will second that.

  25. Once again the “Nanny State” makes decisions for us.

  26. Before we talk about heroin “overdose deaths” I think we ought to define the term. Heroin and morphine are very safe drugs that the human body processes very well. The idea of a heroin overdose, ( he took too much, it was too pure, etc.) is mythology created by WOD propagandists. Yes, people who use it do sometimes end up dead, but it’s not the heroin that kills them whatever the dose or purity may be.It’s the other stuff.
    If we’re using the term “overdose” to mean “thanks to prohibition a lot of people end up dead because they believe too much heroin can kill them and illegal stuff is pretty expensive so they supplement it with alcohol and other stuff” then we’re on the same page. If we’re using the term in it’s commonly accepted definition, somebody used too much, I gotta disagree. Some interesting history here: http://www.peele.net/lib/heroinoverdose.html

    1. Read that. Good link.

  27. For me this isn’t an academic issue – I am in 24/7 pain and have been for almost 30 years.

    Four months ago, my regular doctor informed me he was no longer writing prescriptions for pain medicine. He referred me to another doctor who would only write a prescription for one half the strength as what I had before. That doctor then referred me to a “pain management” clinic who wanted to first go through all the physical therapies that I went through long ago. Then they required monthly visits

    I can’t afford it.

    Addiction? If I’m having a good spell I can go days without taking anything stronger than my normal anti-inflammatories. If I’m having a bad spell, I need something equally strong.

    How much more proof should anyone need that I’m not an addiction risk after all this time? Why does anyone think it’s ok to put me through hell because of someone else’s bad choices?

    Studies show that long term pain sufferers, even on strong opiates, only have about a 2% addiction rate. We don’t take them to get high, we take them to function, or sometimes just to endure. When we don’t need them we don’t take them.

    So give just a moment’s thought, when you’re off justifying your hobbyhorse by blaming the lazy and escapists, that it’s me who’s paying the price for your control obsessions. A real person who has harmed no one else, not even herself, you’re condemning to a painful hell that you probably have given no second thought to, or dismissed as acceptable collateral damage.

  28. Who needs opiates when we could have CSPAN 24/7?

  29. The best way to get lawmakers to understand exactly how wrong they are is to kneecap all of them with a .45 hollowpoint and then give them Tylenol for the pain, explaining that you’re too concerned with their potential to become a junkie if you actually give them something that works.

    Then give them a massive cocktail of Celebrex, Nurontin, Nortryptaline and a few other drugs that will totally screw up their mind, pack on 50 pounds, mess with their coordination & equilibrium, and leave them unmotivated to do anything other than watch TV for hours without moving except to go to the bathroom.

    1. Exactly

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  32. Interesting that pain is the only symptom directly addressed by the original Hippocratic Oath which states:

    “I will soothe the pain of anyone who needs my art, and if I don’t know how, I will seek the counsel of my teachers.”

    Unfortunately, this oath has been modernized to remove such dated ideas like pain relief.

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  34. The so-called “war on drugs” is nothing more than an excuse for cruelty. Laws that specifically target the elderly, the sick and the disabled go beyond cruelty and descend into true evil.

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