Use and Abuse of Prescription Painkillers
http://thedianerehmshow.org/shows/2011-04-21/use-and-abuse-prescription-painkillers
Public health experts say the abuse of prescription medication is the fasting-growing drug problem in the United States. A new Obama administration initiative aims to reduce addiction levels by 15 percent over the next five years. Among others elements, it would require doctors to receive special training for prescribing painkillers. Many in law enforcement laud the proposals. But people who need powerful drugs to manage chronic pain are concerned. They fear tougher rules for physicians will make it harder for them to get relief. An update on what's being called a public health epidemic.
Guests
Dr. Paul Christo
director of the Multidisciplinary Pain Fellowship Program at The Johns Hopkins Hospital; former director of the Blaustein Pain Treatment Center; host of "Aches and Gains," a weekly radio show in Baltimore.
Dr. Nora Volkow
director of the National Institute on Drug Abuse of NIH.
Charles Horner
chief of police, Portsmouth (Ohio) Police Department.
Dr. Robert Dupont
president of the Institute for Behavior and Health; former director of the National Institute on Drug Abuse.
Comments
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Abdominal surgery involving the retraction of the liver may be the most painful procedure a human being can survive. I awoke from surgery to resection my small intestine in Houston, Texas the summer of 2006 and the scorching and radiating agony will always remain vivid in my memory. That is why the Greeks depicted disobedient Titan Prometheus as having his liver pecked at by vultures. But I summoned the will to refuse to press the button to inject narcotics. My caretakers explained that I needed analgesic intervention in order to recover and heal, but I was stubborn. The had to induce a coma in order to keep me at rest and save my life.
After I was awakened a PA took the time to explain and provide audiovisuals supporting the capacity of a body in severe pain to avoid addiction even under tremendous narcotic dosage. Somehow we have a balancing equilibrium where we can even remain lucid when drugged for real pain.
I then took my meds willingly without fear of addiction, but I had to endure some discomfort and acute pain in order to get well.
Now I wonder about those with real emotional and psychic pain who self-medicate to survive. We should investigate whether they too have an automatic adjustment according to their need. It is not the narcotics making them a menace, but what they must do to get the narcotics. After all, we drug psychotics to prevent violence. It might be better if Rush Limbaugh were in seclusion on Oxycontin than spewing his hateful bile on radio. He is obviously in pain. I know because of my empathy.
I had to fight for every pill after my major back surgery. When they sent me home I tapered off the oxycontin with great ease. My battles in the hospital seemed so unnecessary and petty, especially that one of our rights as patients is to be treated for pain. I didn't understand the problem. I felt no burst of energy, no high and no need to continue to take the pills past the prescribed time, so why were the drugs so hard to get right after major surgery? But recently a colleague was prescribed the same major narcotic pain killer after a dental procedure. He said that he felt great and was getting a lot of work done, had cleaned everything off his desk, etc. Whoo! I said that was so different from my reaction. Maybe different people have totally different responses to these drugs and the addiction problem is based on that. My colleague, by the way, did not become addicted. His drug of choice is beer!
I've cervical spinal disease. A fusion with plate C-5-C7 in 1998.
I'm presently herniated above the plate one level and below the plate two levels. (imagine sciatica in both arms)
I've lived with constant daily pain going on eight years. I'm in my late 50s. Narcotics improve the quality of my life. They do not remove pain, but allow my mind to set it aside and perform with higher function than without the medication. I don't require much, they are being used in conjunction with mediation and relaxation therapies.
West Coast streamer
After reading about this in the news yesterday, I noticed there was absolutely no mention whatsoever about treatment of this existing sickness, just talk of waging war against it and it's unfortunate vintims. I say sickness because that is what it is. I am getting sick and tired of these people being labeled as a junkies. I was put on pain medication a while back for radical surgery on my hand. After being prescribed painkillers for the injury, I found myself addicted. I am no longer addicted but because of embarrasment of being labeled as a drug addict by my physician and society's view I was made to feel like a criminal, many people would rather get the pills on the streets than face the physician or the withdrawl symptoms. The withdrawl symptoms are the main reason there are so many people addicted. They get the pills just to not get withdrawl sickness. They usually don't even get high from the dosage they take, usually it's just enough to curb the withdrawl symptoms. Society needs to drop the lebels and get physicians to address the issue if a patient comes into their office to admit to the abuse they need to prescribe something to get them off of them, besides a treatment facility. Most people don't have the time nor money to go into treatment for 30 or 60 days. They have jobs.
5 years ago my family physician approach my chronic pain with a multidiscipline approach. Nonsteriodal antinflammatory, exercise, and vicodin. Take any of the three away and adverse effects on my activities are realized. This plan took a physician that was willing to look at my as a person and not as a chart, which turned out not to be the norm
Due to insurance changes I had to seek out another primary care MD. I went through 5 doctors due to their not willing to follow the previous plan of care. I gave up and went to VA who agreed with the plan and to this day I believe I would not be able to work if it wasnt for the VA doctor.
Grady, you sure paint your life in heroic terms. You even rise to the status of titan by "summon[ing] the will to refuse to press the button to inject narcotics." I wonder if in your case the narcotics didn't permanently affect your cognitive and emotional capacity. Your continual inane blathering on these comment boards evidences that those narcotics have unhinged your mental processes
I'm a 65-year-old male. Prescribed opiate analgesics work for my degenerative disc disease. The FDA chose to ban Darvocet, which was my drug of choice for many years. And my mother before she died at 82, as a matter of fact. So my regular physician sent me to a pain clinic, and now i'm on tramadol, which is relatively weak but very effective.
However, i am now required to visit the doctor for each monthly refill. That costs Medicare unnecessarily, and is inconvenient. I understand the problem with black market abuse. but i also dispute "addiction" label. So what if I'm dependent? it helps, it's cheap and effective and as far as i'm concerned, it's safe. as usual, Nanny Government is messing in my personal life.
MED units are the measure of pain medications. The informed patient knows his MED number.
I have the same physician for twenty years. We've had to come to this decision together. We've had to learn together, the process of this disease, as well as treating the pain.
YES Andrea!
Please discuss that there are alternatives to managing pain with prescription medications. There are many wholistic methods to manage pain. I'm aware that they will not work for all but will work for many people.
Accupuncture, massage, are just a couple.
I'm surprised that none of your panelists has mentioned the four population-based studies that have demonstrated a strong relationship between dose of PRESCRIBED opioids and morbidity/mortality. All of these studies has shown at least a 2 fold increase in mortality or morbidity at 100-120 mg/day morphine equivalents. The Dunn et al study (Ann Int Med, 2010) showed a ninefold increased risk at 100 mg/day MED. The most prevalent problem isn't addiction-it is dependence and tolerance. And the tolerance to the euphoric effects occurs prior to tolerance for respiratory depression. It is respiratory depression that kills most people.
I'm sorry NIH. You're beginning to sound like you're intending a STAR CHAMBER!
I work on a psychiatric inpatient unit and about 90% of our admissions are related to abuse/ addiction to drugs. I believe that the addicted brain is so powerful that it convinces people they have severe pain to keep their opiate supply coming. Patients begin using as prescribed but soon need higher doses, then resort to abuse to control their pain that is actually psychogenic. What do your experts think of Subutex?
When I think about the hospitalizations and deaths associated with opioid use, I wonder how many of these are really the result of intentional misuse or abuse by patients and how many are due to medication errors at the prescribing, dispensing or administration phases. Given the high rate of medication errors in the US today and the prevalence of opioid prescribing, it seems likely that a large proportion of this problem is not due to intentional misuse by the patient, but rather poor quality care at various levels of the diagnosis, prescribing, dispensing and administration levels.
Has this issue been studied? What do the experts think?
I would like to hear your experts's opinion on the possibility that many bipolar patients use opiods to self-medicate their symptoms. As with cannabis, they are able to slow down the racingt thoughts and to catch sleep. I have seen those patients in my own practice.
Thank you for another great program,
Manuel Mota-Castillo, M.D.
Psychiatrist
Lake Mary, FL
I think it is irresponsible to have a non-informed, non-medical person such as Diane host this show. She has already falsely stated that legitimate chronic pain patients develop addiction to their opiate medications.
I have been in pain for a congenital hip issue as well as back problems leading to surgery. I have had 2 back surgeries and 1 total hip replacement and another total hip replacement coming up. I am only 52 and the amount of pain has caused me to not be able to walk for any great distance. I have been given viocodin for relief of pain. What I would like to say is that knowing, from my own experience, just how addictive vicodin can be, that the hospital I will be having my hip replaced at in May had sent me some ideas for alternatives to medications. There are such things and I would like to know what your panel thinks. Acupuncture, massage, imagery, etc. I think the hospital has given me some viable options to control my pain and had even sent me an imagery CD.
I wish that people with pain would focus more on their eating habits; many foods are related to inflammations and unneeded pain. I had many inflammations for years, for example in my fingers and my feet. By changing my eating habits, by eating more fruits and vegetables, less red meats, cut out dairy, my pains are gone. There are several documents with evidence in this matter for example the document "Food Matters" and "The truth is beautifull" will give insight in the connection between food and illness. As you mentioned a person should take pain medication as immediate care, but once it is long term a person should see how to prevent it in an alternative way.
And one other comment: The commercials on TV for taking medications should be outlawed, because it may be profitable for the pharmacutical companies, but it is detrimental for the American people....
p.s. I am from Europe, so my English is not as good Sorry...
Henriette Brecheisen
I've recorded a daily journal for years to monitor my usage. Available to my doctor with a phone call.
Turning down prescriptions from my dentist, who wrote them as a matter of course, was a problem. Same with an ER doctor who insisted on writing a script and I demanding he destroy it in my presence. That last he was indignant.
I am a sales representative for a company that has developed one of these tamper-resistent opioid formulations to which the doctor is referring. While it would reduce overall healthcare costs, insurance companies did not want to pay for it.
I am a sales representative for a company that has developed one of these tamper-resistent opioid formulations to which the doctor is referring. While it would reduce overall healthcare costs, insurance companies did not want to pay for it.
I'm a chronic painer for some 20+ years, especially following an MVA that put me into the hospital for 5 months and PT & OT for 7 years. Yes, I rate my pain daily on that scale of 10 to be around 5 or 6...
I'm also a VietNam Vet who was exposed to Agent Orange. One of it's "blessings" is that I don't breakdown medications the way normals do...so the least dosage of any med, even pain meds, gives either the worst side effects or lasts for days longer than it should. ASA or Ibuprofen is all that is effective...and I don't take them.
I totally disagree w/these Doctors who push drugs over alternative methods. I learned long ago that you increase pain by "fighting" it (any exposure to child birth classes will tell you that). BioFeedback has helped, accepting the pain helps, yoga, tai chi, swimming, cycling all help...
The addiction is caused by those very Doctors on your show who provide/push the chemical avoidance of pain....why don't they think out of the rut they are in.
Oh, I was an RN w/over 15 years in various ICU's & Level 1 ER...
I heard one of the guests say that these drugs can be formulated so the can not be altered to be can not be snorted and/or taken be needle.
My best guess is that the manufacturers of these drugs are aware of this available process. It is also my best guess is that if this process was started the profit for this class of drugs would be adversely affected... not so much because of the added cost of manufacture, but because of the drop in demand for this class of drugs. When the demand drops bottom line suffers. When the bottom line suffers the price of the common stock in that manufacturer suffers.... when the price of the common stock in that manufacturer suffers the executives.... who have contracts linking bonuses to stock price..... have options to purchase stock..... their compensation suffers.
See how quickly this turned into bashing the poor.
Why do you think people want to take this drugs?
Because life blows for the poor in this country.
Maybe you should be talking about how to have a fairer economic society rather then taking away the relief people are finding in drugs.
I am a 50 year old woman with Cerebral Palsy. I have lots of aches and pains in my joints and muscles due to how I walk. I have arthritis in my neck and back, and a nerve injury to my face. I have an increase in my spasticity due to aging. I am also a recovering alcoholic in a 12 step program. I have chronic pain and have had it since my late 20's. I take Neurontin and Voltarin for pain, and occasionally take Magnesium or a mild muscle relaxant like Flexeril. I do not take any opiods for my pain although some days I wish I could. I deal with my chronic pain through exercise, meditative techniques, prayer and the principles of the 12 steps. It can be done without addictive medications!
There are people with chronic pain who need pain meds to live as close to a normal life as possible. To punish those people because there are those who abuse is wrong. I myself have disc disease, lumbar stenosis and facet arthritis. Life with back pain can be very difficult and NSAIDS can eat a whole in your stomach as well put you at risk for heart attack and other health problems and those meds you can buy at your local drug store. Hmm why arent we targeting those drugs? Something is wrong here. We need appropriate pain meds for those who truly suffer. Not just tylenol and NSAIDS over the counter.
Unfortunately, many colleagues forget that some patients are "rapid metabolizers" and they need higher amount of medications than a regular person to relief their level of pain. Even worse, medications such as Prozac and Paxil block the action of opiods and let patients taking high amounts of opiods and still feeling pain.
As Dr. Volkow said, doctors need more education in pain management.
As a chronic pain patient I have controlled my pain with methodone and marijuana for 25 years and have never needed an increase in either.
the problem is that tolerance buildup gets to the point where docs are afraid for their liscense and cut patients off. that leaves an addicted individual on the street with no one to turn to but the black market!
When I was in intake at the VA pain clinic the doc put me on methodone because it doesn't have the euphoric effect of the other drugs. I jokingly said to her, 'God forbid we should have euphoria when we have chronic pain'. She then loudly lectured me on how she would not risk her liscenes or be a candy store. Her focus certainly was not on pain releif.
We are shooting ourselves in the foot reguarding cancer and pain control by not availing ourselves of marijuana's benefits. With pain control marijuana seems to break the attention problem faced by people in pain. You cannot concentrate or think of anything but the pain. Breaking the attention problem seems to result in the need for LESS pain drugs.
We should llook at the situation in California to see if medical marijuana has changed the opoid drug situation. This pain drug problem seems to be more prevalent in states that do not have medical marijuana laws.
Oh my god. Way to treat the symptoms rather than the cause. It's costing Ohio 3 billion dollars blah blah blah.
Life S*cks for millions and millions and in this country.
Spend the money on helping people have better lives and maybe, just maybe they wouldn't want to get high to get themselves through the day.
Sanctimonious elite.
I have twin sons currently in prison for trafficking opiods. They were taken out of their high school senior class and sentenced to 14 months in prison. I have desperately read everything I can about this problem. I am thrilled to finally hear Dr. Dupont's voice. I have read and reread his book "The Selfish Brain Learning from Addiction". It is absolutely the best source of addiction information I have found. I have heard Dr. Volkow's interviews and look for EVERYTHING these two have to say about this horrible plague that has descended on too many of our young people. I know I am not alone. I belong to 2 support groups (AlAnon is one of them) and I am no less that horrified that there is so much abuse and addiction going on around us.
Diane, you have the two people I have come to follow religiously. This is a topic that is breaking many hearts today, disrupting way too many families.
Thank you for bringing this subject into the public eye. I am an inpatient nurse and see many cases of people who have been prescribed pain medications for legitimate reasons: following car accidents or whatnot. They then found themselves unable to quit when the injury or illness was resolved.
I often wondered at this. How much did one take to create this effect? I could not imagine taking enough prescription medications so as to become addicted, necessitating similar detox measures that we use for persons addicted to illegal drugs.
I then had two experiences that illuminated part of the problem. Twice I have had minor surgeries after which I was in zero pain. Despite my protests, my physician insisted on giving me narcotic pain relievers to go home with. I also sustained a sports injury that created about two weeks of limited mobility. My family physician gave literally one year's supply of ibuprofen. It has been six months since the injury, and the bottle is only half empty.
Thus, outside of "doctor shopping" and other manipulative ways of obtaining pain medication, physicians are contributing-probably with the best intentions-to some of these problems. They are unwittingly pushing medications that the patient may or may not have the wherewithal to regulate themselves. Are there guidelines for limiting the amount of pain medication that is prescribed? In light of this growing problem, will physicians be educated on how much to actually give? Yes, it is troublesome to be consantly refilling prescriptions, but initially prescribing a smaller number of pills cuts down on waste and allows better monitoring of how much the patient is receiving over a long term. If one just gives a large bottle of pills, one does not know what the patient then does with them.