I lost access to my medication because I moved to a new state and no doctors want to take on a new patient for fear of the DEA. Pain patients are super risky, and every script they write is scrutinized by the government. My quality of life has dropped a lot. Thank God I found Kratom (it really works for moderate pain), but rumor is that will be banned soon too in the US (where we love our drug wars). Also kratom doesn't help much during flare-ups. I'm now bed-ridden during those periods whereas before at least I could work.
Please consider the unintended consequences of a well-meaning war on opioids. They are not evil. In fact for many of us they are the only thing that allows us to live semi-normal lives.
I eventually found a doctor that prescribed low-dose naltrexone (not a controlled substance) in 2mg/night doses and the pain has dropped from a nightly 8-9.9 to about a 6 or 7 except when there's a flare-up, and the next day I'm not in as much pain until later in the day. Still sucks, but I can eventually get to sleep. I have no idea how long it will work (I've found many pain meds eventually stop working for me) but for now, one day at a time...
If you send me an email at firstname.lastname@example.org . I'd be happy to send you some samples as well.
I tried quite a few different strains of Cannabis but wasn't able to find anything that worked for me. Some high CBD strains did help a bit, but it was a mild help. It also wore off within an hour or two so I had to redose constantly, which wasn't feasible at work.
Would oil be much different than a high CBD flower?
My uncle passed away. The cancer kept reoccurring which was due to mutations (gene-related). My uncle's isn't related to me blood-wise, but his sons are. They have the same gene. I, AFAIK, don't have that gene. My uncle grew his own marihuana (within Dutch legal limits) because he got cancer. Before that, not.
I'm a proponent of medical marihuana however I've became an opponent of recreational marihuana usage. I am very sensitive to drugs in general and had a few psychoses in the past on marihuana (recreational usage though).
We're from The Netherlands and my father had MS and could've used medical marihuana back in the days (90's and 00's) to relax his muscles better. He declined because he was against marihuana in general. Given my uncle's positive experience, and gives I know it can work, that's saddening.
Also, I've recently started using Prozac (to make me less oversensitive; I have autism). It works, but I need to be careful with other drugs (even alcohol). I use an oxazepam when I need a needle because I have anxiety for needles.
That being said, I'm glad there's a change of breeze regarding marihuana in the world and in the USA.
Sometimes it can be an autoimmune condition like multiple sclerosis or rheumatoid arthritis. Sometimes it can be downright mysterious such as many cases of fibromyalgia.
Opiates turned off the pain for 2 hours out of three, and for a third hour I suffered. I did not get a full night's sleep for 6 weeks.
Severe pain makes your life a living hell and is responsible for a lot of suicides.
I don't take pain killers now because my back got better, but I have other needs for controversial medications. It is a life of constant anxiety as the government keeps changing the rules. You never know from one appointment to the next whether the system will throw you under the bus again.
I feel bad for people in your situation, but I feel like increased scrutiny is sort of a necessary evil. I got a vasectomy a couple years back, and despite me feeling nothing but a bit of soreness for two days, my doctor wrote my a prescription for 45 days of codeine. I didn't take them out of fear of it becoming a problem, but someone less informed could seriously be hurt by that.
Would it change your viewpoint at all to know that a lot of chronic pain patients are now committing suicide rather than face a life where they are bed-ridden and dependent on a loved one for care? And all they need is a medication and they could have some quality of life? What about the people who have been responsible with their prescriptions but are now forced to buy potentially deadly black-market opioids like heroin and fentanyl from a dealer that is surely less concerned about their health and safety than their doctor, if they want relief?
That is extremely non-compassionate. I would never wish that on you or anyone else.
I don't think that is what you are trying to say, but I struggle to see how your logic doesn't ultimately reduce to that.
Edit (after thinking more): your example of the codeine is definitely a good example of over-subscribing, but my dad had a vasectomy that ended up being a horrible recovery. Luckily he was able to sit on the couch with a bag of ice under his balls and watch football for a week, but the man was in some serious discomfort.
I tend to think education is the answer. Teach people about the risks, and then give them freedom to decide. If we boil society and our laws down to never requiring or allowing people to take responsibility for their own actions and decisions, then we end up in a bad place IMHO.
Please understand, and maybe I didn't make this terribly clear, but I am not saying I'm against people taking painkillers when needed. Obviously if you have crippling pain of course you should get pills. "Monitoring Doctors More" does not equate to "ban opiodes" any more than saying saying "regulating business" equates to "no business". There's a middle-ground here.
I'd also like to point out that I don't think I'm being non-compassionate in this case. Living in NY I get to see the terror of severe drug addiction every single day when I see (certain) homeless people. It seems "non-compassionate" to me to reduce all of life-crippling addiction to "making a bad decision or lacking self-control".
While some people have more addictive personalities than others, the stronger opiodes are addictive enough to ruin lives. It's easy to dismiss this as "people without self control", but I can almost guarantee that someone in your slightly-extended family has had severe problems with opiodes.
Any level of scrutiny is going to leave some untreated who need it and some people getting it frivolously and perhaps getting addicted. The question is the role of individual responsibility and where the balance lies.
I think it's perfectly reasonable and appropriate for doctors to screen for these sorts of things before prescribing. However I also think making treatment for addiction more available and affordable is a better remediation strategy than having law enforcement monitor and scrutinize every act to the point where doctors are afraid to prescribe, even to patients in need.
A couple of weeks of serious discomfort, especially if a clearly temporary condition, is not something to be erased at every opportunity. It is a normal part of injury and healing and something we should not necessarily expect to automatically numb out of existence with drugs. Which is broadly what the surgeon and medical folks told me after my operation (for something else though). Along with the suggestion to try a couple of Nurofen, but to come back and talk about if it remains too much. I got ONE dose of something opiate based, the morning after. For everything else I was frankly expected to expect serious discomfort that will go away in time. It did, though my rate of swearing rose quite remarkably for a week or two. :)
For chronic conditions where nothing else has worked of course they should be available. After an appropriate level of counselling and warning of the ratcheting down of effect and addictive consequences of extended use. Which suggests a prescription regime that treads lightly down that path. Offer 2 or 3 days of opiates first and explore every avenue before they become a daily medication that you will end up addicted to.
Freedom to decide is what risks ruining it for all, including those chronic patients who have no working alternatives, as their only option becomes hidden behind a layer of freely chosen, but needless addiction. That means it's necessarily slower for those in real need to get enough coverage and dosage, but hopefully only those that truly need end up on a daily dose.
There is a difference in the case of antibiotics because of the issue of drug resistance.
Most of the harm to others from opiate addiction is a secondary effect from the illegality of non-prescription drugs, leading to crime. There is no fundamental reason why someone else being an addict should be harmful to you, apart from your feelings of compassion for them.
Or we dont torture people just because you dont like the possibility, that people could use drugs recreationally. What you describe can easily be avoided with a mandatory explanation by your doctor of the consequences of opioid consumption.
I do disagree with OP, I am hard pressed to see this as well meaning concerns. On the contrary, from my point of view thats pretty close to simply being cruel and to use the term -
Evil. Plain and simply.
It might be a more socially acceptable explanation then centuries of "pain medication is evil, because it interferes with gods will for you to suffer" but it remains the same arrogant disregard for your fellow men.
This might sound overly aggressive to you, but I think it is absolutely necessary to call it out for what it is.
You are willing to let people suffer. You are ok with your decision meaning literal torture fro them. Because you are disconnected from the horrible effect your decision would have. We life in a democracy, careless public outcry leads to real life effects.
Its pretty damn easy to voice your displeasure of being confronted with addicts if you are not the one suffering. And this careless disregard for human life has real life consequences for people whose life are already horrible.
And it is the same shit every few decades. People who are willing to accept "the necessary evil" because they are not the victims.
The world hasnt recovered from the last moral crusade against opioids and the same shit is starting again.
If only everyone needing pain meds had a baseball size tumor to proof that they are "legitimate patients"
Doctors therefore do the obvious thing to protect themselves - they don't prescribe opiods.
But what I think will happen, and some of the comments in this thread illustrate, is that the pendulum will swing in the other direction. Medicine doesn't know what to do with chronic pain. We can't define it, we have imprecise anatomic correlates, and no patient wants to be told that some fraction of it is in their head even though it's likely a combination of neurologic and psychologic factors. I remember throwing some obvious seekers out of my office but I had a lot of credible chronic pain patients when I left general practice, good people laid low in difficult ways, and I wonder what's happened to them since.
That can't be emphasized enough in this debate. In short: if you arrived at some magical scan or test that indicated the presence, by degree of nerve stimulation of hand-over-a-hot-flame-type pain, and only prescribed painkillers to people over some threshold, you'd still be both excluding people who were personally suffering as much or more as those who made the cut, and including people who did not experience the same discomfort.
The human sensorium has a lot of experiences in common, but also a ton of differences.
This is a well-understood phenomenom about screening: screening people usually (not always) causes more harm than it fixes.
Back when "pain is the 5th vital sign" was being pushed people thought opioids were not addictive if used to treat pain. https://www.bbc.co.uk/news/world-us-canada-40136881
And there are drug reps telling you this medication is not addictive and that you're being negligent in leaving pain "untreated".
So, you ask everyone if they're in pain. A load of them say "yes", and you can't afford to give them physical therapy and psychological support but you can give them opioids which are dirt cheap and you've been told they're not addictive if used to treat pain. You end up flooding communities with opioid meds. You have a bunch of people still in pain, and with an opioid addiction. And then you have their friends and relatives who aren't in pain but who want to try these meds recreationally getting hooked.
It's a public health disaster.
To answer your question: ask people about pain, but set expectations first. Opioids are a poor choice for most people with long term pain.
Not much better than palcebo for neuropathic pain, but with more side effects and with risk of addiction: https://www.cochrane.org/CD006146/SYMPT_opioids-neuropathic-...
No better than paracetamol for long term back and joint pain: https://discover.dc.nihr.ac.uk/content/signal-000610/opioid-...
I also want to note that drugs often make life feel better, and a lot of peoples' lives for the past decade+ haven't been great. There is a social component to addiction that is inadequately talked about.
I would also suggest considering pressing your electeds regarding funding for long-lived independent drug studies for drugs such as ecstacy/MDMA, LSD, etc, as well as passing legislation inhibiting regulatory capture. I would like to see, for instance, marijuana effects thoroughly studied legally in long-lived large-cohort studies. There is potential here, but no silver herb, er, bullet.
This happened to me!
I got my wisdom teeth removed circa (2005-06), and they gave me a bottle of 50 generic OxyCodone pills. Fifty!
I took maybe 3 or 4 of them over the next couple days, hated the way they made me feel "robotic and distant", and just rode it out on Motrin afterwards. They sat in the cabinet until i ended up selling the rest to a "friend" a few years later.
I hate to think what could have happened if i Really liked them....
A few years ago. I woke up vomiting and in extreme pain. Housemate drove me to 24 hour clinic. I was stuck in waiting room for hour or so. Eventually I got to see doctor. Clinic was not really confidant they knew what was wrong with me and told my housemate to take me to the hospital. I was stuck for another hour or two in waiting room at hospital all the while in extreme pain and vomiting.
I was diagnosed with a kidney stone and I was given a morphine drip. Almost immediately I was out like a light I don't even remember drifting off - scarily strong stuff I went from worst pain of my life to sleeping like a baby.
Looking back, what a blessing that was. Haven't taken another opiate since. Never will.
Just very similar to what is said about benzos, marijuana and are starting to be said about LSD, GHB and the likes. We need more scientific evidence to know the toll these narcotics and psychotropics can cause to us in the long term, like the same scrutiny they treated the tobacco industry.
On the other hand, persons who enjoy abusing substances to get high or blasted or whatever the feeling may be need to have some safe way of feeding their addiction, or they will die, in large numbers. Being dependent on an illegal supply chain stretching from Kowloon to Morelia to San Diego to wherever with no quality control and no oversight is a recipe for disaster -- nobody who buys stuff on the street knows what they are getting. And to boot, actual medical treatment for addiction is not easy to obtain and limited. The much vaunted "clinics" are for rich people who don't need health insurance to pay the bills.
So we will continue to have problems in the US, and they won't be fixed.
Heroin used to be freely available over the counter and while it certainly did cause problems for its consumers, it wasn't even close to what these synthetic opioids are doing.
Do you feel a bit of pain? Unacceptable. We got to make it go away. Medicate it until you don't feel a thing.
Could your kid scrape a knee on the playing ground? Unacceptable, wrap it all in rubber.
Could you be offended by some text in a classic book? Unacceptable. Trigger warning, counseling on hand, feel free to skip it or read it together with a group in a safe space.
Something someone said makes you feel funny? Unacceptable. Report, protest, de-platform.
The issue in USA really seems to me to be drive in large by the fact that people are customes who want drugs and doctors are salespeople who want to sell drugs. With opioids it just so happens that the legal barrier got lowered enough that everyone who wanted it for all the wrong reasons could justify buying it anyway, and then they did.
Your comment has little factual basis.
In Germany doctors have a "budget" per quarter allotted by the public insurers for every patient they treat.
All meds and treatments they prescribe come out of that budget, if at the end of the quarter the doctor ends up being above that budget, then he's stuck with those costs and has pay from his own profits.
In a setup like that, the doctor is held personally responsible for not overprescribing.
Just like insurers only pay a certain amount for meds for certain conditions/treatments. Creating pressure on the pharma industry to also offer smaller packages of drugs, instead of forcing wisdom teeth patients to buy a whole 50 pill bottles.
It's not perfect because it suffers from a bit of the opposite problem of underprescription and doctors being shy about prescribing expensive treatments even when they are needed.
But if that really becomes an issue then patients can just change the doctor, they are always free to do that and never forced to visit a specific doctor.
The "sanatorium" concept was lost somewhere in the 20th century. The sanatorium idea was the cure by the gradual restoration of health.
Today is almost medication every time. Zero to little attention to physical and mental health restoration. It's like plastic surgery.
Blame the victim rather than admit a problem. Leprosy is a result of your sin. Smallpox however is blameless because it could happen to anyone. Lash out at the vulnerable rather than the source of the problem.
Survival bias is what leads to the perception of this lost golden era. Where all of the pioneer's children are healthy without doctors - nevermind the graves of the seven children and two other wives. We didn't have PTSD before WW1 just ignore all of the self medicating civil war veterans. This tendency isn't a moral component so much as a result of exposure and memory. Possibly a survival bias itself that remembering everything would be really bad for mental health.
And the thing about painkillers is that they "fix" (to the patients' satisfaction) a hell of a lot of problems ... while bringing in extra money for the doctor and hospital. Any incompetent doctor, or just one that doesn't get the time to diagnose (administrators need to be paid, and that's justified by "productivity" of doctors. Productivity mostly means faster diagnoses. One very effective way to do that, of course, is just to make incomplete diagnoses)
Secondly giving a painkiller is almost never a stupidly wrong decision (unlike taking out a kidney that then in a biopsy turns out to be fully healthy, regardless of how many symptoms matched). So it's ALSO low risk ! And I assure you, there are no words in the universe that cause administrators to drool half as much as the words "low risk".
Didn't we want market-based medicine ? Well, this is one instance where the market based choice is blatantly obvious.
Secondly I fear like now we're seeing the opposite reaction: people are acting against patients that have chronic pain and would not be able to function without constant painkillers. These patients will go back to self-medication (ie. alcohol and/or cocaine, both "decent" painkillers) like people did 50 years ago. It is not a good evolution to replace morphine with alcohol or cocaine.