Are Opioids the New Religion of the Masses?
Did Americans suffer four times as much chronic pain in 2007 as in 1999? Probably not; but (according to the November 18 edition of the New England Journal of Medicine) they were four times as likely to die of accidental overdoses of opioid medication prescribed by doctors to treat pain. Indeed, in the state of Washington, death from overdose of medication is now the leading cause of accidental death, exceeding road traffic accidents. Moreover, it seems that the legal prescription of pain killers has introduced abuse of opioids into rural areas where it hardly existed before.
In Oklahoma, for example, methadone (the drug most commonly used as a substitute for morphine or heroin in the treatment of addicts, and also used as an analgesic) was implicated in the deaths of 21 people between 1994 and 1996; but between 2004 and 2006 it was implicated in the deaths of 377 people. (I take the figures from the October 2010 edition of the American Journal of Preventive Medicine.) The figures in the same state in the same years for hydrocodone were 9 and 220, for oxycodone 1 and 220, and for fentanyl 2 and 78, respectively. It seems that abuse of such drugs on a large scale is now happening, and diversion on to the black market also.
Most deaths associated with opioid analgesics occur when the person is taking other drugs as well, notably benzodiazepine anxiolytics (drugs like valium). Either doctors continue to prescribe combinations of drugs known to be dangerous, or patients consult different doctors and deceive them as to what they are already taking (or, of course, they resort to the black, or open, market).
It might be argued that the 11,499 deaths in the U.S. caused by opioid drugs in 2007 (mainly of people between the ages of 35 and 54) were a small price to pay for the increase in pain relief that such drugs give. After all, four million Americans receive such a drug in the course of a year; only slightly more than a quarter of one per cent of them die as a result. All benefits have risks attached; in any case, is a doctor his patient’s keeper?
This sounds like an argument for legalization – people would not have to fake disability for drugs if access were easier.
So faking pain is the problem, not the overuse of the drugs?
And if they’re easier to get people won’t take as many?
Genius.
Prohbition works great, doesn’t it. Use of stimulants is as old as humanity. Now people are faking disability for access to drugs. Wouldn’t it be more efficient to give them access without all of the costs associated with the faking? Also, if they had to work, they wouldn’t have as much time to take drugs and maybe have less of a desire.
Sorry I didn’t lay out my argument more clearly, but I guess I over-estimated your genius.
Yes Dr. Darymple, chronic pain is nothing other than an excuse to get free happy pills from the doctor instead of paying taxes on the alcohol they drink otherwise!
It’s not like the middle-aged body has suffered any wear and tear that causes harmless but painful and limiting conditions!
So, let’s ban all the painkillers — none of them work anyway and who needs pain relief anyway — morally it is a sign of weakness and depravity, righteous people do not take any drugs of any kind, they let just mother nature take care of them naturally.
Folks, wear your headache with pride, and for everything else, there is whiskey and if that don’t work, the trusty wooden mallet.
RightwingHippyChick,
What?
Thanks in advance for the clarification.
Walt
What I took away from this article was that in many cases drugs other than opioids would be more effective and provide less chance of lethal complications. Also that if other medications were prescribed then many would find the just don’t really need them after all.
The factiod that there are more official invalides in England than after WW I is astounding. That very much sounds like many people sucking the life blood from their fellow countrymen because they can.
Opioids are prescribed because they’re (relatively) cheap (and in high doses blunt your brain enough you don’t feel much of anything), the designer painkillers that really work with small doses are often bloody expensive.
In the UK, it’s a combination of not having to work and still getting a decent income through social security, combined with a government run healthcare system that’s so rigid you often don’t have access to medication unless you are listed as an invalid (thus, you may be quite capable of work, but for the relatively minor condition you do suffer from you won’t get treatment unless you get yourself listed as 100% disabled to hold a job). Don’t you love parallel bureaucracies?
Wow, I really am looking forward to socialized medicine.
J.T. – Can you qualify the statement “..you often don’t have access to medication unless you are listed as an invalid ..”?
I don’t think that is true.
It’s not true.
Doctors are accused frequently of overprescribing in the UK just as they are in the US.
Yah, I’d like to take that mallet to the doctor’s fingers… The doctor who screwed up my hand instead of fixing it. Give him a taste of the pain I go through every freaking day since he malpracticed on me.
How did your hand get screwed up in the first place? Was it the doctor’s fault? Or is it HIS fault because he failed to fix it to your satisfaction?
Here’s 2 cents from 1 person: Americans for the last 25 years and more simply don’t get enough exercise and are overweight. I have seen many a young woman, overweight, with a cane and bandages around their knees walking in the streets of my city; this was not seen when I was a child and Americans were not so fat.
I have climbed many volcanos, hiked the Inca Trail twice, skipped rope and ridden bicycle like a madman and lifted well over 3 million pounds a year in a warehouse from age 44 to 54 and have no aches or pains to show for it. Use it or lose it. One does not feel pain after the 10th softball game but after the first. In India this year at age 56, I played frisbee on a beach like I was a teenager and noticed nothing different from when I was young that didn’t have to do with not having played frisbee rather than age – use it or lose it. People who exercise to the point their resting pulse is below 50 are not in need of painkillers. That’s one anecdote for what it’s worth.
Yoga is another thing that can change a life with chronic pain. It’s not as easy as plopping a pill into one’s mouth but it is a life saver. I swear by yoga cuz some chronic pain is simply due to imbalance in our posture over the years and yoga restores this balance.
Dear Mr. May,
I am glad you are in such good shape and continue to live a healthy active life! I was a bodybuilder in my younger days and have a degenerative back condition now that causes me excruciating pain. Without pain medication I cannot get off the couch to play with my children, I cannot fix them meals or go to work to earn money to shelter them. I’m sorry, but yoga cannot fix this nor can being active. For me, it is not a use it or lose scenario. It is likewise not the case for many others. People with shrapnel in their body, people who’ve had their feet crushed in a car accident. I know these people and they were very active before being crippled by pain. Unfortunately the attitude that pain medication is overprescribed and unneeded makes it very difficult for them to achieve adequate pain control. Trust me, it’s not fun going to a doctor and having to prove yourself not a criminal to be able to have a life with your children. It’s humiliating. I don’t wish this kind of chronic pain on anyone, I want the world to be free of pain and suffering. I am angry with people who abuse these medications because it makes them harder for those who need them to obtain them.
I appreciate where you are coming from and again I am very pleased that you are in as good as shape as you are. I hope I am in this good a shape one day and I hope my children lead as pain-free and active life as you have. Know, however, that regardless of the tone of this article, opioid medications are the only resort for some of us. For me, they allow me to live and actively play with my children. Why does Dr. Dalrymple want to take that away from me and my children? It sounds like because a small number of people abuse and mix medications to get high and some of them die from it. Why should this limit my access to adequate pain control? The bigger question is why are opioid medications so stigmatized? Nobody is honestly saying alcohol and Tylenol should be outlawed because some people mix them and die from liver toxicity. They just say people shouldn’t mix alcohol and Tylenol. So fine, don’t mix Valium and Fentanyl! Now may I please have access to my pain medication without being subjected to the Spanish Inquisition?
Pardon my lengthy and over-the-top reply, but I get frankly ticked off whenever doctors assert that the way to stop these, granted unfortunate, deaths from opioid medications is to stop prescribing them and subjecting millions of people to insufferable pain.
Best Regards,
–Martin M.
A whole lot of whining and supposition, but nothing really useful in this article. Mt Dalrymple should lay off the egg nog.
One thing noticeably lacking: what Mr.Dalrylmple prescribes his patients since he freely admits opioids don’t work. A useful piece of information that’s strangely absent from the article. Wonder why that is…
I hope Dalrymple suffers a horrible nerve injury through NO FAULT of his own and has to live WITHOUT PAIN RELIEF FOR THE REST OF HIS MISERABLE, PREACHY LIFE.
I have had FOUR major surgeries and my pain mgmt doctor finally said “STOP LETTING PEOPLE CUT ON YOU”. He explained that my only remedy was pain mgmt through opiods (among other things). I now live a pain-free life, but am in continual fear that idiots like this Dalrymple are the fools that head up the groups that want to outlaw opoids for pain relief.
I gotta go, this guy has given me a headache. Go to hell Dalrymple.
Thank you. Now I don’t need to express my sincere thought about this article and its author and get banned for life.
Thanks for saying that 2Texans. I am able to work full time and take care of my family and enjoy gardening and walking my dogs because I have access to very mild opiods, which I use very sparingly. I had been using darvocet until the FDA removed it from the market because it was not “effective enough for the risks involved” but it had been very effective for me. And I too spend a certain amount of my time worrying about having my pain relief taken away, losing my job and my and my family’s health insurance.
One of the major causes of death associated with painkillers is the government’s insistence that opiates be mixed with acetaminophen (Tylenol) in order to discourage overuse. Acetaminophen is a great drug but its overdose level is fairly low. It’s easy for someone to fry their liver. Acetaminophen overdose is now second only to lifetime alcohol abuse as the major cause of liver failure. Addicts in particular can poison themselves because they can’t control their compulsion to take the laced painkillers.
I am appalled at the tradeoff we seem to have decided on wherein protecting addicts from the consequences of their lack of self-restraint is deemed more important than preventing pain in people with injuries or disease. I don’t see why one innocent person has to suffer in pain just because some other person is an idiot.
I have a chronic condition and the paperwork hoops I have to continuously jump through just to get my medication is infuriating. Oddly, its much easier to get addictive opiates than drugs that have a stimulating effect. All that paperwork doesn’t exist to protect me, it exist to protect someone else from the consequences of their own behavior but I am the one who looses the time and access to medication for their (dubious) benefit.
If it comes down to a tradeoff between people in real pain being under medicated versus protecting addicts I say we strongly biases the system towards treating pain and let the addicts fry themselves.
How many of those “accidents” were not really accidents?
exactly right, shannon. the acetominophen in Vicodin is far worse than the hydrocodone, when your liver can’t get rid of enough of it. but all the docs worry about is the opiate part.
Like commentators above, I have contrary experiences with relieve for severe chronic pain. I’ve seen the difference in my 31 year old daughter who has nerve pain in her back and one foot and severe degeneration in her shoulder. No pain meds: can’t get out of bed, not enough brain available past the pain to think constructively nor participate effectively with physical therapy. With morphine derivatives: Usable IQ is knocked down about 20%, lives in the now, has trouble planning for the future but can do some physical therapy. With methadone: controls pain, out of wheelchair for short distance walking with cane and brace, IQ normal, can plan, participate in life, and, retains her creativity. Her ‘useful’ day is shorter than mine, but methadone gives her back a quality life. She is an artist. Surgery has failed her. TENS units are ineffective. What alternatives are left? Of the choices for her, methadone provides the better balance between pain and enjoying life of all options so far available.
“The British welfare state thus achieved the miracle of producing more invalids than the First World War: millions of them in fact.”
Keep the people fed, fill them with alcohol or drugs to dull their senses, and they will tolerate anything from their government. Give them just enough to live on without having to do too much, make sure more and more of them are addicted to drugs supplied by the state, and the government can do what it wants without being “troubled” by those annoying voters. That is where we are now and where the progressives want to keep us.
Ah, lovely article. Written by someone, no doubt, who either has never needed prescription pain meds, or else has a doctor who isn’t afraid to prescribe them when he needs them (and the reason many doctors won’t is at least partly due to scaremongering by idiots like the author of this piece).
I have read many essays and articles by Mr. Dalrymple, and I assure you that he is the very opposite of an idiot. Go watch TV. Intelligent discussion is clearly beyond your abilities.
Sure. After all, there were neither chronic pain, nor opium, before.
As a 20 year veteran of Emergency Room nursing..I personally have heard every excuse in the world. Opioids are now apparently a civil right. I have seen people scream at the top of their lungs that it was their “right” to have Oxycontin. At least twice a week I pull a Fentanyl patch out of some dead persons throat, overdosed. Now our children have unlimited access to these, your, RX’s. A dramatic increase is seen in child opioid overdoses. I sn’t that special. Oh and let’s not forget that now every 3rd person in America is bi-polar and on Seroquel. GET HELP PEOPLE…Addiction is a progressive, fatal illness. Period…
Seems like we have a cultural divide between patients who insist on the human right to a pain-free life and paranoid doctors/nurses who think that everyone is an overdosing addict that needs parenting, and who no longer regard pain as something unacceptable.
I also have to question whether such health professionals have respect for their patients at all — I’ve seen this callous and unprofessional attitude a number of time now.
Leaving a patient deliberately in pain is the same as torturing them and one wonders what other things such a ‘professional’ is capable of — which is another reason to take a closer look at the track record of such people with a view to removing anyone unsuitable like that from the profession.
Ahhhhh..now we are “torturing” you. Heard it all before. All of it…20 times a day…and of course we should be “scrutinized” for other “evil” behavior because we won’t give you NARCOTICS whenever you DEMAND it. God knows we don’t save lives or take care of truly needful patients. When at least 40% of my shift is spent dealing with drug addicts, I get a bit peeved. Try not using narcotics for awhile hun…see how that works.
I have to side with the veteran nurse here. The fact is that we know what happened with penicillan overprescription that now results in resistant viruses, as well as the cyclic booms in trendy diagnoses that have no real definition or so broadened as to be meaningless requiring meds. I spent some time working at a health clinic after decades out of the medical field and was horrified at how much time was spent by the doctors trying to stop patients from shopping doctors to get drugs they don’t really need, screaming phone calls about it, suspicious nurses and pharmacies questioning patients who come in with prescriptions for sensitive meds. It was such a sea change from what I saw before in medical, and so disturbing, I couldn’t wait to get out of the field and won’t return to it. I’d rather flip burgers than work in medical. Unless you see it for yourself, it’s hard to imagine the poppycock going on.
Thank you for making my point for me…
Let’s recap:
1) you think that 40% of your patients are undeserving drug addicts who should just deal with their pain instead of bugging important staff like you.
2) you accuse anyone who points out that people like you are unprofessional psychopaths who deliberately torture people by refusing them pain relief as a ‘drug addict’.
3) You have been victimizing patients like that for 20 years, and it’s likely that the culture in your clinic is similar to yours (or you’d have been sacked by now).
From your activist position it’s only a small step before you end up ‘deciding’ other moral matters for your patients.
This is why a lot of people dislike it intensely when health professionals get professionally obsessed about how the rest of us should live their live.
Just don’t do it — if you want to pontificate about the evils of life(tm) join a religion or politics.
you need help..for real…how you extrapolated any of that from my statements is really wild….and somewhat nutty….I suggest you volunteer in your local city ER..see what real life is all about…not your paranoid fantasies…and again..i stress strongly you stop taking any narcotics for a bit…clear the fog…..
jjkrn is right. Sober up.
Regulating a dangerous substance is not “telling people how to live their lives.”
This is no “veteran nurse”. This is something being provocative to gain a little attention.
Hey Nursie, what’s next, trans fat gunshot wounds or McDonald’s car accidents? Maybe people living their lives the way the might choose? Oh no, that might impinge upon others! The age old question. Nursie’s answer – I’ll decide for all of you, because someone allegedly “screamed” for something one too many times.
If some people OD and/or leave dope around for children to consume, then so be it. They are responsible for their actions, others should not be held responsible in a collective way for the mistakes of others.
So Nursie, if someone eating a burger runs a stop sign and wipes out a family, are you as equally outraged?
What a joke, in any case, get another gig. whatever that might be.
You can’t see how she came to her conclusions?
This–
1) you think that 40% of your patients are undeserving drug addicts who should just deal with their pain instead of bugging important staff like you.
could come from this–
When at least 40% of my shift is spent dealing with drug addicts, I get a bit peeved.
This–
2) you accuse anyone who points out that people like you are unprofessional psychopaths who deliberately torture people by refusing them pain relief as a ‘drug addict’.
could come from this–
dealing with drug addicts
or this–
GET HELP PEOPLE…Addiction is a progressive, fatal illness. Period…
And this–
3) You have been victimizing patients like that for 20 years, and it’s likely that the culture in your clinic is similar to yours (or you’d have been sacked by now).
Is clearly a hyperbolic reference to the years you say you’ve worked.
And you’re talking at cross purposes. Having worked in a hospital, I know all about the junkies who are constantly wanting more meds. They exist. But there are also people who need painkillers because of pain. People who have accepted the addiction as a price for a life free of chronic pain.
jjkrn, by conflating the two types you do one set a disservice hence RWHCs frustration with you. RWHC, you have no idea what it’s like to have to deal with people you know are junkies who come in, take appointment slots away from people who are actually sick(including chronic pain patients), who you know will make a scene when told that they’re not getting their fix.
It’s Mr Nursie to you Sparky….show up nite shift sometime Univ of Pittsburgh Presbyterian Hospital…I’ll show you a thing or 2 on my gig…You get to see how adults practice medicine..
Oh gosh, nobody’s ever seen death before, or faced life threatening situations – except Mr. Nursie. Mr. Nursie wants teach all a lesson, that is, he’ll show you! Come to his abode, he’ll attach an electrode!
Poor thing. Pulling dope patches out of dead throats bi-weekly qualifies Mr. Nursie for some special status. And don’t you forget it! He might get mad!
Look Mr. Nursie, if you can’t reconcile your anger at strangers who blow it, then what are doing there? ER – Emergency Room. Emergency.
Go into comedy. But then what will you do when your jokes don’t make it?
Outlaw the audience! Except those on pain meds. They won’t know the difference, right? Then again, would they be morally qualified to pass joke judgement?
Oh, the world is just too complicated! Take the Dope away! Hurry! Hurry! I need protection from reality. No opiates allowed!
jjkrn is an idiotic coward and a self-proclaimed idiotic coward at that. jjkrn may not even be the person they say they are.
Either way, let’s hope that jjkrn gets theirs (i.e. needs pain meds BUT NEVER GETS THEM AS HE/SHE SCREAMS THEM FROM SOME OBSCURE NERVE INJURY). What I wouldn’t give to be standing there looking down at jjkrn and saying “jjkrn, you DO understand that you just have to suck it up and endure your excruciating pain because I’m tired of pulling Duragesic patches out of the throats of junkies in the er!”. “what did you say dear? Your arm feels like it is being struck by lightning and burns?” “Excuse me while I go treat the junkies because you jjkrn aren’t as important. I can use a junkie to tout my superiour knowledge and preach removal of all pain meds.”
These people are all liberals who think they know what Americans should and should not have. Don’t you just wish they’d ALL go to California and fall off the world with the rest of the useless liberals?
Yep, I sound pretty pissed off – BECAUSE I AM. People like jjkrn should be flushed with the rest of the self-righteous medically superior politicians who would rule us.
Twice a week you pull a fentanyl patch out of some dead person’s throat? You alone see over 100 fentanyl OD deaths a year? Really?
Please, please have your daughter read ‘Healing Back Pain, the mind body connection’ by Dr. Sarno. It changed my life!
Who would have thought rugged individualist free-thinking types would have such thin skin?
Surely it’s not difficult to believe that more people than previously are, as Mr. Dalrymple says, using opioids as a recreational drug.
Of course, other people take them for pain.
Yup. A lot of people gain massive benefits from opioids. Many others would be better served however by alternatives which they’re not getting because opioids are an easy way out for doctors and are cheaper for their insurers.
It wasn’t until my mother had become severely addicted TWICE to opioids before her doctors would even consider alternative pain meds to cure her amputation pain (which was crippling, she was in 24/7 excruciating pain, dulled but not removed even by heavy doses of opiod cocktails).
And even then they started her on a cocktail of opioids with other drugs, until she got addicted to opioids again a few months later.
She now has other painkillers, which don’t keep her in a semi-vegetative state and require lower doses to be effective, and now is more or less pain free using those for most of the day.
Without them though, she’s completely incapacitated.
Anyone who’s never suffered severe chronic pain doesn’t have a clue as to how disabling it is and often will think that anyone who is a sufferer must be a weakling who just wants a quick fix of drugs, shouldn’t complain about their minor aches and pains.
They’re completely mistaken. While there are people faking pain to get prescription drugs, there are far more who do suffer and were always completely ignored until pain treatment became a field of clinical expertise not 20 years ago (which is why the number of people diagnosed with chronic pain and receiving treatment has exploded in the last 20 years, before there was simply no published diagnosis, nor anyone to make one).
Seems that quite a few here have trouble distinguishing between drugs given for valid reasons, particularly including pain relief, and the wrong drugs given because a small but significant portion of our population enjoy them despite the leathal possibilities.
No one should be in pain in this day and age but we don’t need to recreationally medicate those who don’t need opioids.
Although it ended too abruptly, I appreciated Dr. Dalrymple’s observations in this essay. He is on to something. Does seem though that many readers are a little sensitive.
It is a medicated life that most of us lead and for the author to point out a truth is awkward for us all.
People suffering chronic pain tend to be sensitive, especially when it’s nerve damage, and not visible injury, causing the pain. Treatment, from what I have seen and experienced, varies from excellent to dismal.
The issue of opioids confuses me a bit, because I’ve had both chronic pain (for which I received excellent treatment from a pain clinic) and a recent bout with severe pain caused by illness. The chronic pain, honestly, was a much more awful experience, mostly because it was chronic, unending, and treating the cause was difficult. Acute pain? They whack you with the pharmaceutical club, you sleep a lot, the illness and pain pass, and you don’t take the drugs any more. But chronic pain? Nerve blocks, medications, physical therapy and a lot of patience. Let’s not discuss the depression and anger.
I’ll take immediately treatable any day.
I am an admirer of Dr. Dalrymple’s essays, but in this case I think he needs a bit more libertarian religion and a lot less Nanny-statism. I have no doubt that there has been a large increase in the abuse of various painkillers, but the “cure” here–ever more government control and less individual freedom–is worse than the disease.
I find it very, very hard to believe there are more accidental deaths via “overdose of medication” than traffic accidents (in Washington or any other state). Always beware of the weasel word “implicated” as in “methadone…was implicated in the deaths of 377 people.” Exactly what constitutes “implicated”? In the case of drunk driving deaths, I believe that a drunk *passenger* in a car crash results in all casualties being counted as “alcohol-related” or “alcohol-implicated” deaths. This is used by people who wish to inflate the figures. Likewise, I would be very wary of most “painkiller implicated” stats. These are often generated by government entities (or government-funded entities) who wish to exaggerate the problem to create a “mandate” for greater powers to help alleviate the “crisis.”
Where, exactly, did he support a nanny state in his piece? He stated quite bluntly that the nanny state in Britain has more “invalids” now that it did after World War I–do you think he meant that as a compliment?
Why did you put up the fallacy of the excluded middle–that the only two choices are either more govt intervention, or more freedom to take opiates?
Dalrymple’s leaving a lot not spelled out, it’s true. If you read his books, you’ll find that he thinks that society has mythologized opiates, romanced them, he calls it, pretending they are some terrible addiction no one can kick, just as he thinks society is seeking the bottom as fast as it possibly can. The solution to both is neither increased debauchery or nanny state-ism. It’s adult responsibility and morality, where people take responsibility for their own actions and their own predicaments, even if such predicaments are “unfair”, and learn to deal with the life they’ve been given, rather than looking for someone else to do that for them.
Wow, I think aa lot of people missed several points. My take away from this was that opiods are probably over prescribed and may not be the most effective pain managment solution. Not that they should be banned, dont work, that doctors are evil or that a bunch of Brits are half stoned lay-abouts. I’ve seen liberal pain killer perscription and subsequent mismanagment lead to the destruction of several lives, inclluding a sister, and seen at least one fatality. The doctors error was in going strait to drugs without trying everything else to fix the problem (not including surgury). Once drugs were offered the person in question abused them and sought multiple doctors to prescribe, which was not the doctors fault but my have been prevented. I think what Dr. Dalrymple alludes to hear is evidence of some other type of breakdown in our society and what looks like increased drug abuse/misuse is a symptom, not the cause. Oxycoton didn’t do much of anything for me after a knee surgery, but rehab and excercise have done a lot. Some people in their 80 are still active and work with little complaint, one man I know has emphezima and still works outside at 8,000 feet. There might be something else going on here.
yeah insurance will pay for the drugs- Medicare limits your effective physical therapy to one month at most per year
Using my disavbled freind as example- she has MS- the drugs really don;t work at ALL for her- yet insurance will pay for any of these super expensive drug- all come wiht horrible =side effects tha require DUH more drugs!~
of sourse theonly thing works for her is to keep muscles stfrong and form spasm only accopmplished by physical therapy – however SHE is not free to decide which her insuracne should pay for
Doctors like drugs- give em a pill and send them home – drugged out- less complaints
I agree those who do need pain meds are being collectively punished for drug addicts behaviors- when my hubby had a toothache I had to bring the dentist to the pharmacy on a SUNDAY to prove his identity
LEGALIZE drugs all of them- Pharma advertise DEADLY drugs on TV and you can get them if your doctor approves yet you cannot light up a less strong than a martini marijuana cig- our priorities are askew- and none of this had stopped one addict from getting what they desire-
Drug fraud is fueled by illegality and making some people lots of money abnd many of these pain mills/Medicare scams are run by doctors- police your own- Drug money/Medicare fraud is funding MUSLIM terror groups- and Obamacare will open the system to BIGGER BETTER THEFTS
Is the author saying we should beef up the Nanny State more? Or less?
Let people take what they want. But they also need to live (or die) with the consequences.
This would also have to be traded off with the number of extra suicides due to chronic pain if pain meds are more limited.
Ah, the libertarian. The choice is more dead or more nanny state. Nothing else could possibly lead to a healthier society.
What the libertarian fails to see is it’s PRECISELY the “more dead” that leads to the bigger nanny state, because a society so unhealthy in this way is unhealthy in so many other ways, and that means the society can’t inhabit the space of civil society well enough on its own. The vacuum is only filled by the govt.
No, it’s not better to choose more dead–because a society where that many able bodied find themselves addicted to pain meds, or using pain meds recreationally, or who otherwise choose to incapacitate themselves with opioids will cease to be able to meet the basic functions of a society rather quickly thereafter. And that doesn’t require a bigger nanny state. But maybe it does require examining the basic premises by which we’ve got more people claiming they need pain meds than ever before, just as we are supposedly more mentally ill than ever before. Why are people becoming increasingly incapable of handling the ups and downs and pains of life without medication? Why do they choose to be patients and victims?
Good article by the doctor and, despite all the screaming to the contrary by some posters, a timely warning. All drugs have side effects and some drugs have severe side effects. It is a trade off and each person has to make the choices. I prefer to live drug and alcohol free. I am much happier that way. I too have had problems with my back and arthritis. I found that in my case that a good physical therapist was able to do wonders and as long as I keep up my exercises all is well. I also have learned to accept the aging process and the resultant physical changes that accompany it. I know that some people who are severely injured or have debilitating pain, like cancer patients, need some form of relief and they should be given all they need. Who cares if a terminally ill cancer victim becomes addicted. That’s the least of their worries. But I also know that too many people in this country are legal drug addicts and the pharmaceutical companies are quite happy with all this.
Last point; the reason that emergency room patients don’t get immediate pain relief is that the ER staff need to find out what they have in their system so they don’t overdose them unintentionally. Common sense.
Dalrymple is a monster of the worst type. If you really want to find out just how cruel he is, read his remarks about how opioid withdrawals are just a walk in the park, that patients who suffer from the abrupt discontinuation of opioids are lying, manufacturing symptoms, and that in fact acute opioid withdrawal needs no treatment whatsoever.
As for his remarks that methadone is particularly ineffective for pain–that is patently false and in fact methadone is a particularly effective pain med, often when nothing else works.
This man is a truly dangerous individual.
As a physician — I’ve got to agree. There are certainly people with chronic pain. But there are many, many more addicts.
Like the nurse above — I’ve heard it all. All very unoriginal. If you only knew the degree to which this is a problem in our country.
In my practice I have noticed a trend that drug seekers tend to be men over the age of 35 and even more frequently peri-menopausal women, but I doubt “access” has much to do with causality. I attended a seminar a few years ago where a pain specialist told a group of community practice providers that it’s better to be snookered by 9 drug seekers than to let even ONE patient with legitimate pain go without relief.
I have a great deal of personal experience with chronic pain. My girlfriend of 15 years has had multiple back surgeries. At one point I was nearly convinced that she was simply an addict and was displaying drug seeking behavior. But there was one critical difference. She was completely open to trying ANY intervention. About 12 years ago she had a pain pump implanted and the difference it made in her life was remarkable. She’s on her third pump now and every time a pump fails she goes through classic withdrawal (bitchy, flu-like symptoms) until a new one can be scheduled to be implanted. She has oral opiates prescribed for breakthrough pain but she hates taking them. Before the pump she gobbled pills like an addict. This is known as pseudo-addiction. These patients will stop taking drugs once they achieve adequate pain control. They take the drugs for the pain not the euphoric side effects.
The only trick is know your patient. I have a few chronic pain patients and they’re usually not much problem at all. They’re very predictable and usually quite compliant. The random drug seeker poses the real clinical challenge. Once again I’ve noticed a trend. These folks are usually new patients, they have symptoms that are very difficult to objectively evaluate, they request specific drugs and claim “allergy” to all other alternatives.
Pain management is an art form. I greatly admire the guys and gals who do this sort of thing as their primary practice. I recommend any physician who has any doubt about a patient should arrange for a consult with a pain specialist. But denying a patient in pain relief is as immoral as denying a starving patient food.
Lots of psychopathic Dr. Mengele-types posting on this thread today. I bet they get off on patients’ pain.
As a physician, I deal with this issue daily. It is highly emotional on both sides, and there is a tremendous amount of ignorance as well as a general lack of empathy and objectivity. Do I have THE solution? No. But, I have A solution.
Let the DOCTORS handle it!! Unfortunately, right now, doctors are in a no-win situation, damned if we do and damned if we don’t! I recommend that everyone get off the physicians’ backs and let us deal with it.
Will doctors solve it perfectly? Nope. Will people still die? Yep. Will some suffer? Yes. Will it be all-in-all a better situation than what we have now? Absolutely!!!
Wow, it sounds like a liberal chat site here. Much demonization and denigration of posters.
Just maybe the nurses and doctors have seen a thing or two. They don’t seem to be saying no one should be helped, they are just saying the idiots who are crashing the system are a problem.
“Much demonization and denigration…”
“…idiots who are crashing the system…”
So much for consistency. “Wow”. “…like a liberal…” Touched for the very first time.
Then after you get those idiots under control how will you handle those indoctrinated with the filtered and cooked prescription information passed down from a corrupt pharmaceutical industry that commonly bribes the FDA and their local doctor salesmen trained not to cure disease but to push their products.
Just the admitted data on deaths caused by wrongly prescribed medication should sound an alarm for any that stray far enough from their unique circles to face the truth and learn that their license to practice will at risk if they break the rules already legislated to protect pharmaceutical sales. Maybe then the money trail involved in obamacare will become evident.
Look here: to get an idea what a physician trained in Europe to cure disease has to face when upsetting the most prominent cancer clinic in the US by curing patients they sent home to die with simple amino acids. His analysis of autopsies performed on deceased victims of inoperable brain tumors all proved to exhibit a deficiency of the particularly cheap amino acid he used in treatment and cure of the living. Needless to say his patients followed him to court where every possible angle was used by boards of barristers retained by the FDA and their bed partners in the AMA to discredit his success including the first ever seizure of patient records by the IRS
Thirty four years have passed and they still maintain a stranglehold on his practice.. Wiki this: . One would assume that clinical trials could be finished in 17 years with hospice patients waiting in line. See 2 movie trailers at website.
My wife suffers chronic pain. Hers is from nerve damage. I’ve been to the pain management clinics and have seen both sides of this issue. The patient in chronic pain begging for relief but scared of the side effects and the possibility of addiction (Oxy for both of them and yes they’re both addicted but only take their proscribed amounts) is one. The other is the toothless vagrant smelling strongly of alcohol or God only knows what else loudly demanding they get THEIR pills. Dr. Dalrymple (if a longtime reader you’ll know his background) is a thoughtful man (read some of his other pieces available online, e.g. NRO) but his experience in Britain’s prison system and NHS have given him ample understanding of the opiod problem we’re encountering in the Western world. He isn’t wishing ill on those encountering these issues. He’s seriously concerned, as am I, that we’re being given as patients these highly addictive and sometimes unneccessary prescriptions in too large a margin. AND that many times these pain clinics (I’ve been to a couple myself as she has severe difficulty driving) are mainly acting as dealers to undeserving addicts. More than a half dozen have been busted in my area of Florida this year for giving out these drugs knowingly to people who don’t NEED them. Keep a civil mind about this folks and I’m here to tell you that for my loved one this is an issue. By the way, she smokes cannabis and it helps take the edge off. Perhaps not of the pain but the depression and anger.
Hey, you guys don’t have any vicodin on ya, do ya?
Have been working ER’S for 17 years. I work in an inner city hospital, drug seekers make up half of our patients, of the 50% roughly 70% are on Medicare/Medicaid. And yes, they are drug seekers, whether to use them or sell them out on the street. In our state we have had in initiate a Prescription Monitoring Program in the emergency room. If the physician suspects drug seeking he calls every hospita within a 100 mile radius to find out the number of times the patient has visited for any pain related symptoms.
When we have the same patient 5 times in two weeks for ‘toothache’ or possible UTI and low back pain(they actually prick their finger in the bathroom, put blood in their urine to make it more real)and they are on Mediciaid, you, the taxpayer is paying for their addiciton to painkillers. And it is an addiciton. Chronic pain patients are on a strictly prescribed regiment. Many times they takes double in one day and run out by the end of the month. their doctor will not prescribe anymore and they come to the ER. N
Next, teenagers and young adults take them in place of alcohol and illegal drugs and we deal with the overdoses.
This all started in the late 80′s and mid 90′s with HMO’s. Doctors doled out drugs like candy so they could squeeze as many patients as they could in one day. The insurance companies mandated care and fees so the docs had to adapt. Rather than spend time with each patients they joined forces with Big Pharma and got their patients out faster.
Now we are dealing with the effects-more and more people on opioids, anti-depressants, anti-psychotics, tranquilizers, etc. We’ve had kids as young as 12 hopped up on so many meds it breaks your heart.
Yes those who take advantage (or attempt to do so) are the problem. They are the bane of the healer and the target of the government. They also make the lives of people with real, persistent pain a good facsimile of living hell. If one has a condition which manifests itself as constant, debilitating pain with the inevitable consequence of constricting life all one wants is relief.
Due to the government induced fears of health care professionals a person who complains of persistent life destroying pain faces not only enormous obstacles in receiving treatment but is denigrated by being viewed as a drug abuser. The threat and reality of humiliation at the hands of health care providers is a very powerful disincentive in seeking proper pain management.
It is only desperation, the desperation which results from years of not having a real life, of seeing self-obliteration as the only alternative which forces a person to undertake the search for a healer who can and will treat the pain, which is to say, cure the disease for pain is the disease more often than those without pain realize.
The search may take months, perhaps even years. Often it will end in failure. But, pain is a powerful motivator so the search continues until finally, fortunately, it ends with a good relationship between a skilled and dedicated medical practitioner and the patient. When this happens both parties are happy, satisfied, grateful.
I have become convinced from both personal experience and history that the answer is libertarian in nature. The medical community should use its expertise to the best of individual and collective ability, but the final choices–and consequences–reside with the patient. When night falls the individual be they pain sufferer or abuser must accept and live (or die) with the results of personal decision.
The physician, the nurse, the pharmacist have discharged their ethical and professional responsibilities when they fully inform the patient as to all alternatives, the costs and benefits of each as well as the very real risks which may exist with any analgesic. The patient then makes the choice and takes the consequences be they good or ill.
This means there is no role for the government as “protector” and “guardian.” Well, isn’t that just too damn bad.
i must side on the side of the doctors
everyday on tv there are ad’s for tons of prescription meds that demonstrate that all one needs to do for the meds is show up at a doctor’s and demand it
nvm that all have the possible side-effect of death; doctors must be inundated with countless claims for all kinds of prescription drugs before any consultation or examination even begins
anyways, definitely feels like pjm has gone into the twilight zone on this article and/or i just fast forwarded to april 1st 2011
Wow a lot of people REALLY NEED their opiates on this comment section. Maybe Dalrymple is onto something here.
There is a lot of demonization of the author using the typical excuse of “I am entitled to ___ because of WHAT I HAVE BEEN THROUGH”.
Listen to yourselves.
I’ve had chronic pain since 2007, when an oral surgeon took out a wisdom tooth that didn’t need to come out. 4 operations and a missing part of my jaw later,after trying all sorts of other things, my BRITISH doctor prescribed me Methadone.
Dr Caroline King, wherever you are, God bless you forever!
Methadone literally saved my life. it manages the pain in my jaw and it also does a nice secondary job on my knee, which will need to be replaced soon, they tell me. (until then–deal with it, they said.) I can work, I can deal with life, I can function, all without pain. unless you’ve had chronic pain YOU DON’T UNDERSTAND WHAT IT’S LIKE.
my doctors are super-careful about my Rx, so it’s amazing to hear that so many people are getting so much they’re dying. I suspect it’s less about the Methadone and more about the drug combinations and other lifestyle things we’re not hearing about.
Are they still taking back x-rays with the patient laying stretched out with his spine as flat as possible? I knew someone who had a “slippery disk”. Stretching out flat like that hid the mis-alignment that was pinching the nerves. He finally went to a chiropractor who took a “normal posture” x-ray. In this case, 2+2= “lay flat as much as possible and sleep on back on a hard mattress”.
Michael, pray you never have a chronic problem and end up with a string of wanna-be “omniscient gods” who keep telling you that you are punishing yourself for something or it’s “psychosomatic”, “all in your head”, simply because they cannot find the cause of the problem.
I can see the point of working with drugs that relieve the pain but don’t buzz the patient. I take a few drugs for different types of pain, and none of them are like the opiods. Sometimes they can cause a little mental fog, but I am thankful the drugs exist.
I have been in some emergency rooms tough, where the staff seems like they work in a rehab center. They discuss peoples pain as ‘genuine, in tears’ or not genuine (druggie!). They are set in their thinking and their patterns. I was asking for ice and they were talking about pain medication with a sneer and a thin veneer of contempt. It’s time health care professionals admit they are 50% of the problem.
This is a tough situation for me. On one hand I am a cop that has seen about ten prescribed medication death causing overdoses in the past year a a half in a small rural tennessee county. On the other hand my wife has chronic pain from an on duty incident she had when we were working for an inner city agency. She would be unable to function on a daily basis without pain meds (and this is after several Rhyzotimy surgeries). We certainly have a problem in this country right now with overprescribed pain meds, and yet they are a godsend for people who want to live normally and be productive. I don’t know what the answer is, but we certainly have a problem with meds either be over prescribed or obtained illegally.
The people that abuse opioid’s claim to have chronic pain make life hard for people like myself that suffer from chronic pain.I have had seven back surgeries due to degenerative disc disease.I also had four vertebra in my neck fused.I take opioids for pain.But I am not a abuser.
Thank god medical care isn’t a subject for politicization, can you imagine some sleaze trying to promote an ideology at the expense of others?
Dr. Dalrymple is a well known author and, for at least 2 decades, activist against opioids — this in every sense of the word: he writes books and multiple articles against opioids on a medical level, and his specialty, a societal level. There is no questioning his intelligence.
On the other hand, and not to be too crude, clearly both President Bill and Secretary of State Hillary Clinton are highly intelligent (no, I find their politics anathema), I merely wanted to make that point.
Of all the drugs people abuse, I am not sure why he seems to focus almost exclusively on the class of opioids. Perhaps someone in his family was addicted — this is not uncommon (and bears in no way upon his intelligence nor insight).
On the other hand, clearly there are a list of addictive drugs, which I’m not about exhaustively delineate, but which are non-palliative (not useful in aiding you in a medically approved manner) — and which the Doctor seems unconcerned with. A few would be:
–Cocaine,
–all “speed-related” drugs like Methamphetamine (used to be simply “amphetamines”,
–Crack (a highly addictive form of cocaine which Dr Dalrymple regularly ignores in his diatribes and which have wiped out many African American communities)
–and a whole new host of legal drugs (due to the fact that they are so new, no law has been passed against them known generally as “designer drugs — an old one of course was “X” or “ecstasy.” I’ll stop there.
So, what’s my point?
I am a high functioning white collar worker who formerly was physically (and psychologically, although no more thank G-d) addicted to various pain pills (generally weaker opioids) for approximately 4 – 5 years 15 year ago. Due to my education perhaps, I never took anything without researching it. I never inserted a needle into any part of my body, and I never did Heroin. Nevertheless, one can still get highly addicted to “simply” Percodan (oxycodone) which, when I moved to LA I found everywhere.
I soon realized that I had to leave LA if I was every going to get my life back, and so I did. After attempting a cold turkey withdrawal (and, you can believe me or not, but I did not sleep for 30 straight days WHILE going to work as a high paid computer consultant — and actually doing good work).
Nevertheless the big bugaboo of opioid addiction, which I have yet to see Dr Dalrymple ever mention (he often says that “kicking the physical opioid symptoms is ‘similar to having the flu’ — my experience(s) begs to differ) is not “getting clean once” its staying clean for the rest of your life.
Any emotional, psychological, and even physical stress could immediately snap me back into horrible withdrawals. This is when I realized I needed a longer term solution, with all due deference to Dr.Dalrymple.
I went onto to methadone maintenance therapy (which is phenomenally difficult to to in the USA as compared to any country in Europe — perhaps a source of his frustrations?)
To make along story short, I m now within spitting distance of weaning myself off ultra-slowly after years — which is exactly what my body needed, I have a theory that the length of time you abuse, is the length of time you need to “wean down (if you want the highest chance of avoiding recidivism).
As anyone knows who has read my comments on PJM< I am a liberal who was mugged by reality. Thus, I find Dr Dalrymple's writing on more political matters both incisive and entertaining. However I must say, out of direct experience, that he has fallen into a trap so many people I know feel when I tell them I'm taking methadone. They say, "but isn't that just for heroin users lying in the gutter?" as I stand there in my suit and tie doing high-paid expensive consulting work.
Perhaps the good Doctor would, purely so that he knows of what he talks: addict himself just Physically to an opioid, and then see and report honestly if "kicking the withdrawals was akin to "just having the flu…?"
The fact is that methadone gave me my life back.
So you haven’t read his Romancing Opiates, have you?
Because he finds both anecdotal and statistical evidence to show that the claims of the severity of opioid addiction are dramatically overblown, and that yes, it’s like the flu. Maybe you don’t remember how it feels to get the flu?
You may not be able to believe what his book shows. Okay. But you should read it. The mind can convince itself of things, and perhaps yours has convinced you to make things worse for yourself. You might ask yourself why.
I don’t suffer from chronic pain, nor do I do drugs (well, beer excepted), so I may have no credibility here. Wouldn’t the addicted and those seriously suffering from chronic pain turn to illegal drugs otherwise?
My mother died from cancer, and I can’t imagine what she would have gone through absent the drugs. I’d probably have considered buying illegal drugs for her.
Both sides have valid arguments, but in the end, we’re talking about somebody’s life. I’m not convinced we can save people (addicts) from themselves. I’m not cruel enough to want someone who needs pain medication to go without. I’m with the balanced (and I’m sure some will argue wishy-washy) on this one.
The primary cause is increase in freedom without any increase in responsibility. i.e. it is a moral crisis.
A friend of mine was badly rear-ended by an illegal immigrant with no driver’s license who disappeared. For years now she’s been in agonizing pain and is completely disabled. Doctors refrain from prescribing opoids to her to avoid addiction, but the other pain treatments are either not covered by Medi-Cal, or Medi-Cal restricts how often they’ll pay for them. The nerve blocks are pricy and can only be done so often. So she suffers.
Pain itself is damaging to the health. Most people don’t get addicted to opoids when they take them for a chronic life-long condition.
theCork said, “Most people don’t get addicted to opoids [sic] when they take them for a chronic life-long condition” — he is absolutely correct in this!
One can do (if one wishes) a search on articles in the NYT from about 20 – 30 years ago when a flurry of studies were done showing exactly that! People who take opioids for pain, and not for anything else (abuse), can in fact taper off quite easily and without withdrawal symptoms. Thus many people’s “fear of getting addicted” when taking an opioid, as long as it’s under a competent doctor’s supervision and as long as it’s for only the length of time the pain exists, turn out to have nothing whatsoever to worry about!
I’m all for clamping down on abuse, but punishing valid chronic pain patients need for opioids — which then allows them to function in society and pay taxes — is a pendulum which swings back and forth in this society every 20 years or so.
Furthermore, as I mentioned above, I was an abuser, but I found it phenomenally difficult to get onto Methadone maintenance — the only path available to me to get my life back. In this respect, Europe (and I hate to compliment anything about them) has a much better system in that they allow obvious abusers to obtain Methadone (not take home supplies, but on the spot Methadone).
It may not be well known by most people, but Methadone effectively blocks any “high” one can obtain from any other opioid! This is why Nurses at methadone clinics make sure the patient swallows all his dose — they do not want him to “divert” the methadone (and sell it) for money to someone else, and then get high on a street drug.
Because of this effective blocking of a high from other opioids by Methadone, many addicts in fact hate Methadone because of just that effect! Is almost entirely blocks any high one could otherwise obtain from another opioid (due to the fact that almost all the brains μ-opioid receptors are “plugged up” with Methadone molecules). Only for perhaps the first couple of weeks on Methadone maintenance does an addict receive a mild high. After that, her feels “normal” all the time — and addicts generally, unless they are truly serious about getting better, abhor feeling “normal!”
Methadone is a wonder drug when properly monitored, regulated, and doled out. This, unfortunately is not done in this country.
I’m supposing Mr Dalrymple is seeing Britain imploding? I would think if I voluntarily spent my entire career in wastebasket places- obscure islands, prisons, welfare clinics- I would necessarily have a bleak view of all humans. I don’t ask after a city, when my brother vacations there, for that reason. I don’t want the ass- crack view of the city- but the face and hands view.
There are drug addicts. There always have been. The words for drugs and their effects are in indo- european. Consult Wayland-Barber, for chapters and essays all about all sorts of drugs. The dispenser of opium was deified- Hera. We have Pacific Northwest religious paerphenalia- bongs.
I’m not sure that the British habit of regulating one’s work life- one has to be ‘disabled’ to qualify for certain drugs——is necessarily translated to America, where one can require certain drugs to function, and yet still work. Maybe, seeking government benefits is the issue. I know in my state, benefits will just let you starve slowly, rather than live on in indignity. People move out to high- benefit states. I pity their taxpayers.
I had an accident, and spent two years having ‘pain seizures.’ Having neither insurance, nor the wherewithal to get on welfare, I researched pain relief on my own. I worked in a textbook store, so it was possible to do this, easily. I did legal cocktails- I was convinced I needed to not become dependent on opioids. I was sure I’d be out of it, eventually. I was right, thank goodness. But I can see someone else not being as fortunate.
If you do have pain issues, seriously, go look up “magnesium.” It won’t solve your problem on its own, but it will help you mitigate. Take it at dinner, take it at bedtime. it’s sedative, and purgative. You’ll be sleepy and flatulent if you take it during the day. Don’t take too much- it will stop your breathing if you do. it’s what they prescribe to stop migraines and seizures, for instance.
If that helps some- give it six weeks- add Vitamin D, so you don’t dissolve your teeth. ask me how i know. the magnesium is competitive with calcium. if you have vitamin d, the D regulates cal/mag balance.
after that, add some fish oil, to rebuild your nerve cells outer layers. They won’t be as irritable. Weird, but effective.
really. I’m not saying this will solve your problem, but it does help some to enough.
I work at a federal rehab facility. A person with chronic pain is the type of patient we work with.
First: addiction is common. 75% of addicts have a job/carrier. They are successful in life and free of suspicion that they are in fact addicted to something. At least half of all addicts fail to recognize their own addiction, half of the other half are activily fighting that lable.
The biggest increase in drug related deaths is from prescribed medications.(not illicit drugs) Giving prescriptions for less than 10-12 pills at a time is the ideal way to “hand them out” but this is functionally a punishment for all concerned.
Statistically, the most dangerous opioid is methadone, yet ironically this is the drug being “pushed” by the authorities for use in chronic pain. The elevated lethality of this drug is probably because it is unique; it has a 24hr half life–most opioids have a 4-6hr half life. Combining methadone with benzo’s is a wildly popular recreational activity, and this combo is responsible for a large percentage of inadvertent od’s. It seems to be that methadone deaths are always secondary to multiple drugs being ingested in addition to the methadone. Trading or selling drugs is common amongst chronic pain patients.
There has been a progressive increase in the potency of ER prescribed analgeics over the years, we used to give out T3′s (tylenol #3) all the time in the ER, and now the drug of choice for the ER is hydrocodone.
Marijuana is effective for certain types of pain; particularly peripheral neuropathies. It does not work for severe or post-traumatic pain, but we don’t really know how it fits into the pallet of analgesics because it is illegal to do research about it.
Most people with chronic pain have the wrong expectations; the goal should be the ability to return to a productive life, not to reach the unobtainable goal of becoming pain free.
The unreasonable regulations and criminalization of doctors’ prescribing decisions are the root of the problem, and what makes Dalrymple look look a cruel insensitive monster, instead of a guy who is just trying to deal with unreasonable levels of government interference in his profession.
Fact – chronic pain patients need relief, and it is no mystery how it can be obtained. In many cases, opioids.
Fact – the government loves to investigate prescribers of opioids and imprison them.
So the Dalrymples of the world are not as insensitive as they seem, they are merely more sensitive to their own career prospects and freedom than their sensitivity to the suffering and freedom of their patients.
I was totally disabled by my untreated pain for a few years, then I was on opioid medication for chronic pain for several years more, during which I was quite effective in my career. I was a cash patient at the time. Then my state passed a law mandating a doctor visit every 30 days before an opioid prescription could be written. That made my medication MUCH more expensive to me – over triple the cost. Luckily, at about the same time the state I live in made another analgesic available, and luckily, it worked for me.
The government has no business restricting medicine to those with a doctor’s prescription. That is one of the reasons we have a crisis in medical costs. My prescription cost $45 per month, but the added and newly mandated office visit added $125 per month to that. But why should society care if I needed the drugs to feel good due to the palliation of my pain, or if I had wanted them just to feel good? We can not longer afford to have our government take care of us in every way, and this could be an easy way to cut down on costs. Meanwhile we put Dalrymple’s ticket on the line every time we ask him to do his job. This is not necessary, and causes too much angst for both doctors and patients.
I have suffered with chronic pain from a work related injury to a trapezius muscle since 1984. I am self employed and work 5 or 6 days a week. Due to the injury I am lucky if I can get 5 hours sleep and not wake up in pain. I take hydrocodone once a week, on the weekend when I don’t have to work the next day, which allows me to get a good 8 hours of sleep at least once a week which I need. I can’t help but feel that when I go to the doctor’s office to get the prescription refilled I am almost made to feel guilty that I want one of the few meds that knocks the pain out for at least a few hours a week. I understand the need for the docs to scrutinize the use of opiates but if I was going to be an addict I think after doing this for 26 years I would be there by now.
“Methadone is particularly poor in [treating chronic pain], and yet it is not only frequently prescribed but implicated in 31 per cent of all opioid deaths, more frequently than any of the others. It is difficult to resist the conclusion that relief of pain is not really what the drugs are being prescribed for.”
Indeed. In the U.S., methadone is by far the opiate most frequently prescribed for addicts, just because they are addicts. (Its once-a-day dosing is convenient for such “maintenance” use.) It does not so dominate the market for treating pain.
I don’t think the article shows that opiates are prescribed too much. One can make as good a case that they are not prescribed enough. Plenty of people in pain do not get enough opiates, and good doctors are afraid of losing their licenses if they do prescribe enough.
I agree that we have a problem with the welfare state and with narcotics, but I wonder how many of the death statistics above are of patients honestly treating their pain (few, I suspect), and how many are of people who obtained their pills illegally, or of addicts who go to methadone clinics but continue to “party” with other depressants. Unfortunately, it is hard to tell the drug-seekers from those in great pain. Perhaps better integrated registries of narcotics recipients would be helpful, but who knows what else the government might do with such information.
It is simply not true that Methadone is not highly useful in treating NON-addictive patients with chronic and long-term pain. My mother died two years ago from bone cancer — a particularly painful type. I spent a lot of time caring for her at home where she wanted to die.
Prior to my suggestion that she be given Methadone, the doctors only wanted to prescribe her Oral Morphine — good for short term, acute pain (think, broken rib). But as someone earlier stated, Methadone has the nature of having a VERY long half life (actually most forms of Methadone have a 12 hour half life — there is one that is longer, but that is a special case, 24 hours is when “normal” Methadone is effectively out of the system). Thus it stays in the system for a long time.
Prior to switching my Mother to Methadone, I had to wake up literally every 2 hours to does her with oral Morphine(!) This was just nuts. Finally when we switched to Methadone, her pain was entirely controlled and she could go to once-a-day dosing. And I could actually sleep instead of loose my mind from sleep deprivation.
For NON-addicts, for people who are dying from a particularly painful type of caner, Methadone is a WONDER DRUG! It is just that simple. I’ve read more books than I care to list about precisely this subject. Further, my entire family and extended family are medical doctors. Again, in non-addicts, I know of what I speak: Methadone can be a god-sent. (both for long term chrinic and actue pain patiens, and for “gettting legal” as an illegal opioid abuser– urine tests ensure you do not continue to abuse other drugs which, when mixed with Methadone become dangerous. However Methadone ON IT’S OWN, is NOT particularly dangerous if the patient is tapered up slowly — or alternately, tapered down slowly).
In fact I’m not aware of ANY(!) deaths at ALL from Methadone BY ITSELF! Deaths ALWAYS come from its use in conjunction with other drugs (including alcohol!) which then combine to severely depress one’s breathing. Taken under a doctor’s supervision, Methadone in fact highly SAFE!
I wonder sometimes, sadly with increasing frequency, does anyone here actually read the article they comment on?
These comments are BIZARRE.
Dalrymple never claimed there was no such thing as chronic pain, or that opiates cannot be used to treat it, only that opioid use has increased; this either indicates an increase in chronic pain, though this is unlikely since there has been a general improvement in the population’s health, or, as Dalrymple intimates, an increase in abuse, over-prescription, and the like, the more likely scenario.
Your personal anecdotes about the usefulness of opiates are entirely besides the point.
Or an increase an in inability to handle said pain, or a belief that life should be pain free.
I don’t doubt people are suffering. The basic state of human condition is suffering. The anger and defensiveness of the posts here, putting up straw man after straw man and fallacy after fallacy just proves Dalrymple’s point–we as a society no longer are wiling to have suffering. But the vehemence with which people shout that they should not have to suffer indicates that something is wrong–and our tolerance for suffering is falling. It is not really possible for a society to function much longer when suffering must be expunged without expunging ourselves.
Okay, if you figure that “The basic state of human condition is suffering”, then you should not object to someone breaking some of your bones so you can enjoy the basic state of the human condition.
Drugs are too easy to get. It’s the consumer’s fault for falling into the traps set by drug companies and the elitists (politicians included), who make money off the sale and use of these drugs. There is something for nearly everyone to buy into, that lines the pockets of the people set on controlling our lives. I can’t think of anything that is currently affecting our lives and our planet, that isn’t being used by the powerful to attain more power and money. And we dunces fall into their traps and then try placing the blame on anyone but ourselves. It all comes down to each individual but the collective is so much more inticing, as companions to our misery.
ditto #22
@Michael Gersh…you are exactly correct. The more laws passed re: opiods, the more difficult they are for the truly needy to obtain. The “wisdom” of having an appointment every 30 days just shows the powers that be have never tried to get to a doctor appointment when in serious pain or disability, or get a disabled person ready, dressed and into a car so they can sit and wait an hour or two to see the pain doctor to get the lousy prescriptions that keep them going for another month. Fortunately for me and my disabled loved one, I have a job, a car and the capability of taking the disabled person to the doctor. And can get time off work for it by using my own sick days. How other people without cars or paid time off do it I have no idea. I guess the people in pain will just suffer.
BTW, the doctor/author is so dopey – pun intended – to ignore that addiction and people stealing opiods from elderly relatives/friends etc is the problem. Not the people in pain who get the drugs legitimately. The people dying are OD’ing…mixing with other pills…not taking them as prescribed. Duh.
Social religion, like social drinking. As opposed to civic religion.
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I must ask, respectfully, if you have access to a pain management clinic? Because really, they can do things for you that will surprise you. They can give you medications that won’t make a mess of you, and maybe find some other therapies that work.
Doctors all too often fall into thinking that some temporary pain relief via opioids will fix you, it seems. Longer term management surely is a better way to think?