Opioid settlements against pharmacies

It’s hard to see how this is an indictment of opioids, their manufacture etc…especially since it’s hearsay and personal recall after the fact. A tragic story, for sure and one that’s probably repeated many times …whether that one extra thing is a 5mg tablet of oxycodone, an extra shot of whatever, or deciding to get behind the wheel of a car. A parent should never have to bury a child under such circumstances but I’d say that there’s more underlying stories such as this than popping one oxy

I fancy that folk who haven’t experienced severe, debilitating pain…acute or long term…don’t appreciate that it actually is a bit more than discomfort that can be dealt with.

Thinking back to whe dh had his bio-Bentall procedure (a bone saw to his sternum, rib cage jacked open for 6+ hours needed more than a couple of Tylenol and that’s for sure) The incongruity of reading the hospital’s attempt at patient education…“ask your doctor if opioids are necessary” sort of thing…on the inside of every elevator that went up to cardio thoracic ICU didn’t escape me. Especially since dh, apparently, isn’t a slow metaboliser of opioids (as was my good fortune) If I didn’t get that oxy inside him on schedule because he was fast asleep, say, sure enough the pain would start to kick in before he woke, his breathing got shallower from the pain…reducing an already low O2 sat…and, wallop Afib and alarms chirruping and bringing staff in on the double.

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This is also true of convicts who are released from prison. Some law enforcement people suggest that released convicts be immediately started on Medically Assisted Treatment (MAT) for opioid addiction, which quells cravings before said ex-addicts have a chance to hook up with a potentially-fatal opioid dose. But this sensible suggestion has not been widely adopted.

Wendy

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Most recent studies indicate that this “deaths of despair” model may only be significant for the more recent phase of opioid overdoses that stem from illicit drugs like heroin and fentanyl.

Mortality data indicate that the earlier “prescription opioid phase,” from about 2000 to 2011, most affected adults in the age range of 25-54, Native American/Alaskan Natives and Whites, and rural more than urban populations. In this phase, the epidemic was most severe in areas of high physical disability rates, which, following epidemiological research, we use as an indicator of physical pain. We found little evidence that local economic misfortune accounted for the substantial geographic differences in the severity of this phase across State rural areas or counties. https://www.ers.usda.gov/webdocs/publications/100833/err-287.pdf?v=1708

In short, from 2000-2011 large numbers of patients were prescribed opioids for pain relief and this led to an increase in opioid deaths that did not correlate with local economic conditions.

The problem is that opioids are problematic for long-term pain because of physiological tolerance (larger doses required over time) and its addictive potential. This is what drove the initial rise of addiction from prescription drugs. From the linked paper:

“We found the geography of the prescription painkiller phase of the opioid epidemic during the 2000s to be largely shaped by State rural area and county differences in physical disability rates, which we took to be a measure of the prevalence of chronic pain. Whatever difficulties physical disability entails, the prescription phase brought more difficulties, as addiction grew and prescriptions proved eventually unable to quell the pain, resulting in rising opioid deaths.

Heroin and synthetics like fentanyl are impacting a different demographic than the prescription drugs, and there is some evidence to suggest the impact of economic difficulties. However, the most recent and detailed studies indicate that the primary driver of opioid addiction is drug availability rather than despair. Or as the linked paper concludes:

> "There is no doubt that the economic trends over the past 20 years have placed tremendous stress on the prime-working-age population whose schooling did not extend beyond high school. But the rises in drug overdose mortality that have characterized, first, the prescription opioid phase of the epidemic and, more recently, the illicit opioid phase, seem to have reflected more the increasing availability of more dangerous opioids than growing stress or despair"

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A side-effect of the opioid epidemic is that doctors/emergency rooms won’t dispense pain medication in a timely manner anymore. When I had my kidney stone a few years ago, I arrived at the emergency room and was writhing on the floor, but they wouldn’t give anything for the pain until a scan showed a stone. Finally a few hours later, after the scan, they gave me dilaudid via my IV. After 2 days in the hospital they sent me home with a prescription for [I think} percocet. I filled it, and I took HALF a pill (and then a few weeks later had to discard the rest of them). Unfortunately, half a day after being released I ended up in a different hospital with severe abdominal pain, so I spent nearly a week in the hospital due to that darn kidney stone. I didn’t take any strong pain medication in the second hospital, maybe they gave me something like tylenol.

I generally don’t take ANY medication at all, not aspirin, not tylenol, not advil, etc. Nothing. The only medication I will take is antibiotics if prescribed by the doctor for infections or to forestall possible infections (before certain dental work or surgery). I am quite afraid of narcotics and avoid them as much as possible.

The industry pumped out pills in massive quantities and evaded the legal controls meant for opioids. Not sure why you are not following that? Are you just wanting to see addicts as guilty people? So the guilty of the powerful can be totally ignored?

It seems personal to you that this is all about addicts having problems.

The reality is the corporations did not follow the law and thousands of people died. Those people some of whom were addicts and some of them were incarcerated were still loved family members. Life is not that cheap that the big box stores have special rights.

Because the manufacturers were pumping out so many pills they were on the street. Not just sold as prescriptions. High school students were dying from street drugs. Not sure how you ignore that by seeming your labeling addicts as the culprit.

Not a bad idea…along with excess alcohol etc. I certainly try to do that and I’m sure others do too…certainly anyone who’s been prescribed opioids appropriately in the past. Best way to accomplish it is to avoid anything that might provoke a need for such industrial strength pain medication. However, as you’ve read upstream and experienced yourself, that isn’t always something you can accomplish voluntarily.

Along with clean needle programmes and other harm reduction strategies. It’s a conundrum for sure. The country that has such a long track record in leading the world in societal harm from substance abuse seems to be best at avoiding workable management strategies (look at Prohibition)

My awareness of substance abuse began in the early 1970s…and, of course, it wasn’t a new thing back then either. Our (dh and me) alma mater had one of the UK’s largest methadone treatment centers and the general neighborhood in SE London probably had the largest concentration of drug addicts too. Our pain management lectures ran the gamut of somewhat judgemental clinicians who wanted to instill the ability to recognise “drug seeking behaviour” into us (pretty important, if you think about it…being able to actually recognise PAIN!) to pure neuropharmacologists who emphasised the different central responses to opioids with either pain management or recreation (something you mentioned earlier) This was the era when there was a lot of work going on with identification of brain receptors…too time crunched in the course to do a real deep dive but enough of a taster to pique an interest that’s stuck. I think most of my practical grasp (I hesitate to call it “understanding”…I know enough to realise I don’t know enough for that!) has come from addicts themselves…the stuff they do/did to facilitate their addiction. More practical pharmacology than any lecture

It was something of a stunner for my parents etc to be aware of the extent of the problem (and that their innocent little cherub had to be immersed in it😉)…but with no internet to open their eyes, why would they?

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That almost has zero truth or reality to it. What was happening was your daughter plays high school sports. She gets injured. The doctor puts her on oxy. Now it would be just Tylenol because of what happened. Her odds of becoming an addict because some not all doctors committed malpractice soar. She is dead two months later. Or she lives longer as an addict and then is dead two years later in a confluence of events.

A central feature of this problem the pharma manufacturing complex was pumping out so many pills they were on the street. That particularly means suburbia.

I said “malpractice”. Absolutely. My dad was a doctors’ doctor. He was very aware since the day he became a doctor of malpractice involving opioids and minor tranquilizers. When he came to America he saw the valium addictions raging. Widows grieving were prescribed valium. The number one demographic addiction throughout the 1960s into the 70s was valium for older women.

Not directed at anyone particular…if you find yourselves looking down your bloody noses at addicts saying it is not me…one bit of malpractice and it can be you.

If you find yourself “understanding” that is what “doctors did back then”…that absolutely is false. Most doctors did not commit malpractice when valium was the number one addiction for older women.

If you find yourself saying addicts will get their drugs at any cost…then face those drugs are made in an over abundance to find more addicts. Not the other way around.

PS in cases of chronic pain in the states of higher than $7.25 min wage…meditation and mindfulness is often offered because studies show chronic pain symptoms can be cut by 50% with the approach. Pain is relative and a 50% reduction in pain is a great liberation. I said $7.25 because there is a purposeful need in a state with $7.25 to deny treatment as well. When wages and treatment are denied for completely idiotic reasons there really is mostly crap for medical care.