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Punishing People in Pain

2017 March 30
by Ian Welsh

So, now reliable pain relief is only available from illegal sources?

The Ohio governor unveiled a plan Thursday that targets the place where experts say many opioid addictions begin — the doctor’s office.

Gov. John Kasich’s order limits the amount of opiates primary care physicians and dentists can prescribe to no more than seven days for adults and five days for minors…

…The new limits, which have gotten the blessing of the Ohio Board of Pharmacy, the State Medical Board, and the state’s dental and nursing boards, do not apply to patients who take prescription painkillers for cancer treatment or to dying patients who are already receiving hospice care, Kasich said.

There are plenty of reasons other than cancer and hospice care. It’s a little unclear how strict this will be,

“Health care providers can prescribe opiates in excess of the new limits only if they provide a specific reason in the patient’s medical record,” the state said in a statement.

Nonetheless, I find this crazy and punitive to people who actually need pain medication. Many doctors are already reluctant to prescribe painkillers due to crackdowns, and this will drive people even further towards buying illegal drugs. You certainly want people on codeine or morphine in preference to various synthetic opioids, which can be far more dangerous.

Ohio doesn’t have an opioid addiction problem because of availability; it has one because of deep socioeconomic problems which manifest as personal despair and breakdown. Some people will always use drugs, but “epidemics” of drug use happen when people don’t have better options.


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40 Responses leave one →
  1. Tomonthebeach permalink
    March 30, 2017

    I have been conducting research or directing addiction research since 1976. Over the past 2 decades, physicians were increasingly being criticised in journal articles for underutilizing opioid medication to treat pain. The conventional wisdom at the time was that patients were needlessly suffering because physicians were overly concerned about addicting patients and/or an overly zealous DEA. Those criticisms were justified, and professional organizations began encouraging a reconsideration of pain medication practices.

    Fast forward to today. Doubtless some physicians have gone overboard in prescribing opioids for pain. As an example, four years ago, my primary care physician recklessly prescribed a month’s supply of hydrocodone for an acute sciatica attack. I switched PC docs the next week.

    Was the medical field wrong then and right now to curtail opioid prescriptions? Should healthcare turn back the clock and under prescribe for pain? Absolutely not.

    What recent studies have been suggesting is that the bulk of overdosing is due to self-medication for psychological pain derived not from being cut by a scalpel, but being cut from the workforce.

    Did Kasich’s order signal a return to undermedication for pain? NO. It simply require physicians to monitor more closely the need for opioid medication on a weekly basis. This is prudent patient supervision, and it will likely reduce the volume of legal opioids available for abuse. However, it will not stop the overdose problem – just move abusers to the illicit market.

    Restore hope for a future is likely the most effective intervention Kasich could do if he was sincere about opioid abuse. President Trump has loudly asserted that he will restore everybody’s jobs — that is, when not distracted by insulting the media, Congress, most world leaders, and our intelligence. Let’s hope he can at least do that.

  2. EGrise permalink
    March 30, 2017

    Enforcement is easy and politically popular.

    Doing something about the root cause is difficult, expensive and takes a long time, therefore it’s much less popular politically.

    Kasich did what every other politician would do.

    And so the downward spiral continues.

  3. The Stephen Miller Band permalink
    March 31, 2017

    It’s just one more way to criminalize The Little People for living. The message is clear — suck it up and be obeisant slaves. At the same time, amidst the Russian Meddling scandalous spectacle, a legislative agenda is still being pushed through Congress and it’s basically being done under the cover of the scandalous spectacle that’s hogging the spotlight. Yesterday, Pence was the deciding vote in the Senate for the bill that defunds Planned Parenthood. Couple that with Trump signing the executive order allowing construction of the Keystone Pipeline to commence and the attack on Net Neutrality and Tax Reform that gives huge tax cuts to The Rich at the expense of programs like Meals on Wheels and a pattern emerges. It’s called Sadistic Feudalism without any pretense that it’s anything but.

    One wonders, all those Russians connected to the alleged Russian Hacking of the Presidential Election and Trump’s alleged ties with the Russians that have ended up dead under mysterious circumstances, does it make Flynn a little nervous? He’s ready to spill the beans for immunity and we all know Putin despises rats. Does Putin have the balls to extinguish him like he did Erovinkin and Mikhailov. We’ll see.

  4. Peter VE permalink
    March 31, 2017

    A friend of mine was cut off from his opioid prescription for chronic pain. After several weeks trying to have it reinstated, he committed suicide. Since then, I’ve been cultivating Papaver somniferum.

  5. V. Arnold permalink
    March 31, 2017

    Peter VE
    March 31, 2017

    Excellent; but be very careful; serious shit comes down on those who choose nature.

  6. Steeleweed permalink
    March 31, 2017

    My wife has been in constant pain since she got run over by a Mercedes in 1978 (Ironically, driven by a doctor). As a result, she’s had an ankle fused, both hips. a shoulder and one knee replaced. The other knee needs to be replaced, but it won’t happen. Each major surgery takes something out of her and I don’t think she’d make it through another. The effects of the accident also manifest in exacerbating the arthritis that comes with age. And if not causing her IBS – the jury is out on that one – it certainly makes it much worse.

    It took us years to finally find a pain specialist – as opposed to anesthesiologists who do pain management as a sideline. Due to the current paranoia of officialdom, he has to be very strict and careful. Her other MDs prescribe for 3 months because the insurance copypay is much less (i.e.; $3500+ for one month, $60 for 3 months) but he sees her and prescribes monthly – and it costs her $90 instead of $15. She’s also subject to random urine tests to make sure she’s using the painkillers instead of selling them.

    She recently had a Spinal Cord Stimulator implanted and does help, but not enough that she can stop the Fentanyl patches and it only cuts her Dilaudid use from 4/day to 2 or 3.
    Today she’s happy if the stimulator and opiates get the pain level from 8-9 down to 5.

    I raised the issue of implanting a drug pump instead of the stimulator. Not having to go thru the digestive tract and waste 95% of the drugs and cause bowel issues, pain pump doses are minimal and do not disrupt the digestive system. The pump’s reservoir is refilled monthly via hypodermic.

    Sounds like a win/win, doesn’t it. But while pain pumps are very effective for pain relief and with minimal side effects, they are also low-profit to the medical industry and very few MDs work with them.

    All too often, the healthcare business is more about business than healthcare.

    Re pain management and addiction. etc., I had a discussion of this at the Agonist, which I crossposted to http://www.steeleweed.com/2015/10/30/managing-the-pain/

  7. wendy davis permalink
    March 31, 2017

    @ Peter VE: how ghastly and needless your friend’s suicide was; i’m so sorry for your loss.

    as for growing papaver somniferum, i do as well. now it may just be due to the fact that we’re in about zone 6a or 6b, but the pods are small and don’t ooze latex when scored. dammit. i really want some for my alternative healing kit bag.

    in the meantime, it’s one of the most gorgeous flowers on the planet, especially their reproductive organs.

  8. sglover permalink
    March 31, 2017

    In other drug war news: This is actually NOT from The Onion, although it sure sounds like it belongs there. Here is what Republican fossil Grassley and Dem relic Diane Feinstein are spending their time on: “Feinstein, Grassley Introduce Bill to Combat Candy and Fruit Flavored Drugs Marketed to Children”

    So Feinstein & Grassley apparently believe that dealers are hot for the ever so lucrative third grader demographic. It’s also not clear how **flavor** adds appeal to substances that are smoked or snorted. But I guess in the pockmarked brains of these two it all makes sense.

    Just think — people like this are allowed to write laws!!!!!

    Just think — people like this are allowed to write laws!!!!!

  9. March 31, 2017

    sglover:
    I keep telling people that if I came into $50 million somehow, I’d move back to CA(I was born there) and primary DiFi. I believe she’s up next year. Plenty of people are hoping she’ll retire and go away.

  10. The Stephen Miller Band permalink
    March 31, 2017

    sglover, too funny. Half the grocery store is filled with shit that turns kids minds & bodies to mush and destroys their health, i.e, sugar drinks & sugar cereals & chips & crackers & cookies, and yet I see no legislation addressing this toxic poison being marketed to children.

    I don’t know about you, but I call the following Child Abuse and yet Congress and The Government are concerned about what sglover mentioned. Insanity!!

    Advertising to Children

    Also, does anyone else remember when Trump said “I’ll be great for women’s health — nobody will be better for women’s health than me”? What has he done so far for women’s health? I’m waiting. A new pill that prevents them from bleeding?

  11. Hugh permalink
    March 31, 2017

    I read that Kentucky was about to enact a law like Ohio’s but with a 3 day limit.

    I agree with Tomonthebeach. Addiction or chemical dependency is not defined by how much, how often, or how long a patient takes a medication, but whether it is being used to address pain or another issue. If for pain, no addiction. For something else, addiction.

    The opioid epidemic is a direct reaction of people to seeing their lives destroyed by a rapacious, callous ruling class of kleptocrats. Their hypocrisy is manifold in that they destroy people’s chances of having a decent life, pushing them into using drugs, promoting many of those same drugs (like Oxycontin), and then prosecuting them as criminals for using and selling drugs.

  12. Steeleweed permalink
    March 31, 2017

    @Hugh: My take is that it’s the excess meds beyond what’s needed to reduce the pain that causes the physical addiction. It’s usually the psychological side and the social environment that keeps people addicted.

  13. Hugh permalink
    March 31, 2017

    Steeleweed, what I gave you is the clinical definition of addiction. Physical dependency is another issue. If someone stops opioids cold turkey, they will have withdrawal symptoms. Opioids are not the worst for withdrawal. Stopping medicines for high blood pressure can cause rebound hypertension. Stopping steroids after being on them for a while is dangerous and requires a taper. And suddenly stopping tranquillizers in the benzodiazepine family, like Valium, can kill you.

    It is a question of calibrating the drug to the symptom. This is complicated by a patient being untruthful about their level of pain. There is a back and forth about this. The physician will likely see a discrepancy between the alleged level of pain and the underlying condition, note a pattern of drug seeking, and seek to limit and reduce the offending medications. The patient, on the other hand, may doctor shop or visit emergency rooms for medication, or buy illicitly.

    Then there is the whole recreational drug dimension where medically treated pain is not an issue. Some recreational drugs like alcohol have been around for thousands of years. So the definition for addiction would be modified to the more generic criteria of some level of drug use at which the person can not function normally in the activities of their daily life and/or at which their drug use poses a significant threat to them physically.

  14. March 31, 2017

    Put things clearly – enforcement does not when done en masse. The reptiles want enforcement, it’s easier.

  15. Tom permalink
    March 31, 2017

    As long as Americans are okay with a drug war, this shit will continue. It will take the millennials voting enmasse at state levels to effectively legalize drugs and move them to taxation. If we did this, the drug cartels go out of business and the gun crimes drop.

  16. highrpm permalink
    April 1, 2017

    The opioid epidemic is a direct reaction of people to seeing their lives destroyed by a rapacious, callous ruling class of kleptocrats. Their hypocrisy is manifold in that they destroy people’s chances of having a decent life, pushing them into using drugs, promoting many of those same drugs (like Oxycontin), and then prosecuting them as criminals for using and selling drugs.

    misdirected/ misplaced priorites: tying up assets in wall street amazons instead of in the next generation by making post-secondary education available for free to any and all. a crime beyond description of evil.

  17. The Stephen Miller Band permalink
    April 1, 2017

    ….instead of in the next generation by making post-secondary education available for free to any and all. a crime beyond description of evil.

    A free college education for everyone is not all it’s cracked up to be. Many more people today are receiving college diplomas than forty years prior or even twenty years prior, but there is no indication they’re better off or any indication they are any more intelligent and able to think critically, independently and objectively for themselves.

    As well, universities these days are rackets and increasingly corporatized, so what’s needed before handing out get-one free coupons to any & all is complete and comprehensive education reform at all levels, not just post-secondary.

    Post-secondary administrative spending is off-the-charts and the funds are increasingly misspent and misdirected. Universities should be no frills environments and all about LEARNING. Everything else should be secondary, but as it stands now, everything else is first priority and LEARNING is secondary if it happens at all.

    If you hand out a free post-secondary education to any & all without engaging in holistic, comprehensive education reform at all levels, you are throwing taxpayer money down the drain and into a black hole of unbridled, irresponsible, misdirected university administrative spending.

  18. The Stephen Miller Band permalink
    April 1, 2017

    This chart shows the out-of-control college spending the past several decades./A>

    This chart shows why.

    And, keep in mind, not everyone, and I’d say that “not everyone” is the majority, is college/university material nor should they be. Somebody has to make the french fries, so to speak, and those people need/requires specific technical training, not a generalized college/university education.

    Learning should be a lifelong pursuit.endeavor/obligation for everyone, but learning doesn’t necessarily mean a college/university education nor should it mean a college/university education. There’s something to be said for auto-didacticism.

  19. Willy permalink
    April 1, 2017

    TSMB’s UCB management chart implies a business management culture gone horribly wrong.

    Somewhat along the lines of the post, a credentialed physician informed me that my pain killer addicted friend must hit bottom, although every medical organization of which that doctor is a part advertises that this is not the case, and they can help. Do they just want the business? Since that doctors clinic corporatized, it has grown rapidly. But their reviews have tanked. I’m thinking the bean counter culture has ruined their core business, to the detriment of their customer, the patient.

  20. grayslady permalink
    April 1, 2017

    A couple of years ago, when I had a pinched nerve in my neck, I experienced run-out-in-the-street-screaming levels of pain. Fortunately, I have a doctor who understands pain. She also understands that each patient reacts to medications differently. She started me on a high level, tapered steroid program and then switched to 10 mg hydrocodone up to four times per day plus acetaminophen. (A prescription of 5 mg hydrocodone is the common dosage from dentists after a tooth is pulled–just for reference.) Hydrocodone really makes me sick to my stomach, but, without it, I couldn’t have managed the neck exercises that were necessary to bring the condition under control. It took five months of medication before the neck exercises worked, although, during the last month, I was only taking the pills once or twice a day. I had no ill effects from stopping the medication, but will need to do the neck exercises for the rest of my life to keep the pain at bay. I’m thankful my doctor was willing to trust me to only use the pills as necessary. I fear for people who are truly in pain and whose lives will be made more difficult by various proposed regulations.

  21. Escher permalink
    April 1, 2017

    On paper, providing a specific reason in the patient’s record isn’t a high bar. I think it’s very likely, though, that healthcare organizations will read this and impose prescription restrictions on their providers that go above and beyond the letter of the law.

  22. Steve McQueen permalink
    April 1, 2017

    I am in chronic pain. Spinal stenosis, foriminal stenosis, collapsed disks, osteoporosis arthritis, fusions, etc., it’s enough pain to require daily medication. My last visit to my doctor resulted in a near-shouting match, he was almost unwilling to renew my prescription. I am on the MINIMUM dosage of hydrocodene, just 5mg., with no history of abuse, addiction, nothing. I’m middle-age, non-smoker, no bad habits, etc., there is no reasonable reason to deny me medication. The doctor told me that it was very unlikely I was going to be allowed any pain medications in the future. So either I eat a bullet or start drinking when my meds run out. Daily exercise helps, but nights are the worst (intolerable). I’m now being treated like an addict. The doctor is afraid of losing his license and is under orders to deny pain medication (his words). It’s absolutely insane.

  23. SpringTexan permalink
    April 1, 2017

    Yes, what’s happening across the country now is crazy and cruel. More drug warriors.
    http://acsh.org/news/2017/03/25/cdc-opioid-guidelines-violate-standards-science-research-11050

    Many of the core assumptions of the CDC guidelines are supported by only the weakest medical evidence – and others are clearly contradicted by the evidence. Medical professionals have published sharp criticisms of the CDC guideline and of the anti-opioid biases of consultants who wrote the document. A recent paper in Pain Medicine [ref: Pain Med (2016) 17 (11): 2036-2046] offers analysis that shows the writers of the Guideline deliberately distorted the evidence they gathered.

    CDC consultants performed a literature review on the effectiveness and risks of three classes of treatments for severe chronic pain: opioids, non-opioid medicines like Tylenol, and behavioral therapies like rational cognitive therapy. Based on this review, they declared that there is very little evidence that opioids work for pain over long periods of time. But they neglected to inform readers that they had rejected any study of opioid medications that hadn’t lasted at least a year, then declaring that there was no proof that opioids are effective over the long term. But they did NOT reject studies of non-opioid medications or behavioral therapies that were similarly short.

    As the Pain Medicine paper states, “To dismiss trials as “inadequate” if their observation period is a year or less is inconsistent with current regulatory standards… Considering only duration of active treatment in efficacy or effectiveness trials, published evidence is no stronger for any major drug category or behavioral therapy than for opioids.”

    This didn’t keep the writers of the CDC Guideline from recommending that non-opioid treatments be favored over opioids, despite lack of evidence that they work. Nor did it keep the writers from exaggerating opioid risks – using the term “overdose” no less than 150 times in their biased and unscientific practice standard.

    It is time for the CDC to withdraw its misdirected “opioid guideline” for a major rewrite. This time, the effort should be led by pain management specialists, not addiction psychiatrists. Pain patients or their advocates should be voting members of the writers group.

  24. Ian Welsh permalink*
    April 1, 2017

    Steve,

    I’m very sorry to hear it. I once spent a month searching for a doctor who would give me pain medication when I was in so much pain I could barely walk. Getting out of bed was a 5 minute operation, and standing from a sit was damn near impossible. I was treated like an addict by most docs including one who called me that to my face.

    Fucker. I would, quite seriously, step on his hand if he was hanging from a cliff.

    I will be forever grateful to the doctor who did take my pain seriously, as well. Fortunately I didn’t need more than a few months to get to mostly functioning — when I ran into her she was 6 months pregnant.

    And this was 20 years ago, in Canada, long before the full painkiller hysteria hit.

    Marijuana might help, and you may wish to look into it. Such severe issues might be beyond functional therapy , but please consider looking into Hanna Somatics, it sometimes reverses significant problems, including disks, other spinal issues, and so on. For as severe a problems as you have, you’ll need to see a therapist. You should know within a few weeks if it’ll help, maybe sooner.

  25. 01wise permalink
    April 1, 2017

    At our clinic most of the doctors have stopped prescribing controlled substances completely. An increasing number have stopped renewing their DEA certificates so they aren’t even able to prescribe those drugs. So what happens is the patients with pain and other issues requiring controlled drugs are increasingly funneled to just one provider. And so a few weeks ago the closest pharmacy (CVS) decreed that this provider is prescribing too many narcotics and banned her and her patients. So all her patients are unable to use their neighborhood pharmacy, even the majority who never got a controlled substance prescription. This was approved by CVS corporate and there is apparently nothing we can do. It’s obvious that this is going to explode the black market for these necessary medications resulting in no regulation and more deaths. It’s already started.

  26. Tom permalink
    April 1, 2017

    Damn, some of your stories are depressing. I recently had a tooth pulled. My Dentist gave me the good shit and I didn’t feel a thing and actually slept through the procedure. I was then prescribed Codeine with Tylenol and had no pain at all while my gums healed.

    I feel for you guys.

  27. wendy davis permalink
    April 1, 2017

    @ Steve McQueen

    dunno if you live in a state where mmj or rec mj is legal or not, but if so, mr. wendydavis had brought home some capsules of dried high cbd cannabis last week. the whole herb quasi-movement, remember it?

    at any rate, after 5 capsules, i was slightly encouraged, esp. as i dinnae feel like filling the tub for a bath was akin to walking up the stairs to the guillotine. ( i fall sometimes now.) we’ll try to score some of those seeds to grow more.

    oh, bother. the gong of real life just rang, but briefly: also googledy/bing: celadrin, topical and oral, turmeric (the curcumin) as anti-inflammatory, as are shitake mushrooms (taste like fish paste, ish), stopain x-strength w/ msn and glucosamine. oh, find relief; immobility and chronic pain suck. the permanent relief to it all sometimes beckon, but some of us have others to consider if we can provide strength and succor to them as we…live on.

    best to you.

  28. Lindy permalink
    April 2, 2017

    I hope that those who are in pain will look into kratom. I only heard about it last fall when there was a lot of hoopla over the DEA deciding to ban it.

    https://www.washingtonpost.com/news/wonk/wp/2016/10/12/the-dea-is-reversing-its-insane-decision-to-ban-the-opiate-like-plant-kratom-for-now/?utm_term=.633f475bfffd

    I’ve taken loads of Vicodin, especially over the last decade for dental extractions, abcesses, dry sockets, etc. and I like kratom fine. Doesn’t make me overly sedated, or depressed, or give me rebound insomnia like Vicodin. I took Ultram on a semi-regular basis while you could still get it online because it gave me just enough relief from pain that I could sleep. Had many years of chronic Lyme with numerous aches and pains that would really kick up under stress.

    It is incredibly helpful, psychologically, to know there is something available for pain when it’s more than I can stand. Otherwise I’d be too frequently fighting anxiety or panic trying to get by on NSAIDs which are damaging to the heart and liver.

    There are many varieties of kratom (which is related to the coffee plant) and colors. It takes a little learning to understand which is more sedating, or stimulating. Green Leaf Kratom is probably one of the best vendors out there, and they have a handy ratings page that tells you the level of pain relief, sedation or stimulation you can expect from each variety. After trying about a dozen I find I use Bentuangie the most often. Gives a fair amount of both pain relief and sedation and kicks in more gently and slowly than others. Only about a half teaspoon works fine.

    I just got an email from one kratom vendor yesterday that helped me understand why it’s not as easy to get as it used to be, even though still legal.

    “After weeks of frustratingly dealing with payment service providers, we have finally found a solution that will accept our business. For those who don’t know, kratom is very hard to get payment processing for. Banks can get fined by VISA or Mastercard for hundreds of thousands or even millions if the merchant provider is not set up properly – We can thank Obama and “Operation Chokepoint” for this. Its really sad when a merchant selling lethal and fully auto weapons have an easier time getting approved than a simple “tea” business.”

  29. Ché Pasa permalink
    April 2, 2017

    The idea the there is an opioid addiction epidemic caused by despair among white folk needs to be supported better than it has been. It’s a useful narrative for some political/economic interests — but is it true?

    It’s much like the belief that the ghettos were filled with crack-heads back in the day (still?), or that tweakers ruled the margins of young white male society. Of course, in those days, it didn’t matter why there were crack-heads and tweakers. What mattered was eradicating them. Right?

    Now we have a supposed situation with opioids — primarily legitimately used as pain killers — among despairing white folks who supposedly abuse them to escape their existential despair, rather than for the prescribed reason of pain relief. Why they despair is made much of. They’re white and they believe they have no future. Thus, supposedly, they turn to opioids. And they get addicted and overdose and die. And it’s a tragedy.

    How do they get them? From doctors (for the most part) who — in my view — deliberately and with some malice over prescribe them. In effect, “eradicating” their patients.

    Policy makers are apparently torn. They really don’t care about people in pain, as has been demonstrated over and over again with the increasing restrictions placed on pain management. These days, it can be difficult to get any sanctioned medical pain treatment at all, unless at the end of life when most restrictions come off.

    On the other hand, because so many white folks are now on opioid pain meds for their despair and so many are dying because of it — so many so often, the morgues and funeral homes don’t have room for all the bodies, so they say — the already restricted or prohibited drugs for people in pain are to be further restricted and prohibited. Supposedly to “save” despairing white folks’ lives.

    No, there’s something else going on, just as there was during all the other furious drug-panics going back to the turn of the twentieth century. When policy makers really don’t care a whit about people in pain but do care massively about restricting or prohibiting access to medications that effectively control pain, it should be obvious that this is about population control and revenues. Cui bono, eh?

    Like many who have commented, and like our host, I live with a chronic condition that sometimes causes extreme and debilitating pain. I am being treated for the condition primarily with cortico-steroids and immunosuppressants, but I have received nothing at all specifically for pain for more than five years. It’s as if my doctors are so frightened of prescribing pain medication when needed that they won’t do it, period. What I was told to do during this latest episode of pain was “increase your steroid dose until the pain dissipates.”

    Nothing else was even suggested.

  30. V. Arnold permalink
    April 2, 2017

    Ché Pasa
    April 2, 2017

    Hell, I’d just go to the street and score some heroin.
    Fuck those cowardly doctors! Do what you must…

  31. marieann permalink
    April 2, 2017

    As a former RN I am absolutely appalled by these stories. One of the first things we were taught in school is the patient’s pain is what he says it is. Everybody’s pain threshold is different, what is mild pain to one can be excruciating to another….and this does NOT mean some patients are people are wimpy.

    Being a nurse is hard work, so I an now(in retirement) experiencing the pain from back injuries and arthritis. I am so glad I have a supportive doctor.

    I finally bought a TENS machine last week and I find it helping. I add it to my regime of Physio and Massage. I want to postpone the narcotic solution as long as possible.

  32. Peter permalink
    April 2, 2017

    It appears to me that these new restrictions on doctor’s prescriptions will only drive some people more quickly into the Black Market where the abuse of and the profit made on these drugs thrives. Politicians are not known for their wisdom but this interference between doctor and patient seems almost intended to promote the illegal market.

    A pain pill that costs about 15 cents in a prescription sells for $3 to $5 on the street so the diversion of these drugs attracts the usual suspects, businessmen and the politicians who protect them, it couldn’t happen without them. The recent report of the massive numbers of these pills being shipped to Appalachia shows the corruption reaches at least to some of the manufactures and distributors of these drugs. I wonder if there will be any real investigation of these suppliers and local distributors or if their politicians quietly run interference for them.

  33. paintedjaguar permalink
    April 2, 2017

    This is one of the cruelist parts of the US medical/legal racket. If you can’t afford care, not only are you expected to just die (and don’t be stupid, the Democrats are just as much at fault), but you are supposed to die in as much pain and misery as your disease and situation might dish out. You aren’t even allowed to crawl into some hole and self-medicate. No easy death for you, slacker!

  34. Willy permalink
    April 2, 2017

    Addiction or chemical dependency is not defined by how much, how often, or how long a patient takes a medication, but whether it is being used to address pain or another issue. If for pain, no addiction. For something else, addiction.

    Assuming that Kasich and all the other Ohio players already know this, how does the common man (especially those in chronic pain) get them to work on their behalf? Dumb question, but I’d think the answers are many.

  35. Ché Pasa permalink
    April 3, 2017

    @V. Arnold

    Heroin? Nah. Morphine!

    Seems there’s an issue being raised but not addressed about where and how all these “despairing” white folk get their opioids that are killing so many that the morgues have no room.

    It should be obvious when manufacturers send many millions of pills to backwater pharmacies and — surprisingly — outbreaks of “opioid addiction” ensue. Doctors prescribe; pharmacies dispense; there’s no doubt a street trade with the prescriptions, but there are restrictions on how much can be dispensed at any one time. Are those restrictions being ignored? Are the pharmacies simply doling out the meds willy-nilly? Are doctors deliberately over-prescribing? Most of the problem is with prescription medications, not with heroin and such.

    But what of the supposed black market?

    Restricting access to pain medications for those who need them is cruel and stupid, especially when there is almost unlimited access to the same or similar medications for white folks in “despair.” Who, by the tens of thousands, OD and die. How convenient.

    Perhaps that’s the point of this epidemic….

  36. Steve McQueen permalink
    April 3, 2017

    I’ve tried everything, tens, ginger, turmeric, stem cells, exercise, yoga, marijuana.

    This state permits recreational and medical use of mmj, I’ve tried all kinds of versions. None solve any of the pain issues, which stem from pinched nerves. I’ve even had stem cells injected into the worst region, I think that helped some.

    Yoga, exercise and keep moving is the best, but seriously, nights are the worst. It is impossible to sleep without some kind of pain medication. It’s a physical injury, it’s not psychosomatic, I’ve got several MRI’s, xrays, and seen the best experts, it’s definitely a real injury.

    So far, the hydrocodone does the best job and it’s the lowest dose available, a measly 5mg once at night. I’m not the least bit addicted. I can go “cold turkey” for days or weeks even, but eventually the lack of sleep pretty much destroys me.

    I get high very easily even on very low THC / high CBD and did not find this to offer real pain relief to be honest, it just didn’t work for me. I’ve tried all kinds of versions with almost no real relief. The getting high is a problem, I still work, every day.

    I’ve refused surgery – because 3 out of 5 doctors flat-out told me it would not work and would even compound the problem (fusion). The Mayo Clinic took a look at me too and offered radio-ablative surgery (if I could pay for this), which is a procedure to cut the offending nerves. I’m unable to get this done.

    What bothers me the most however is how I’ve suddenly become a pariah. My pain issues are very real, I’ve endured this for decades and I’ve done everything I can to help myself. But the situation is deteriorating, especially in the doctors office who refuses to offer much help. He has tried to switch me to Gabapentin and a few others (which are alleged to help with pain) but after researching their terrible side effects and withdrawals, I won’t take this shit.

  37. April 3, 2017

    You are not a pariah – you are in pain.

    (41 votes for blocking Gorsuch. Next up the nuke option.)

  38. Tom W Harris permalink
    April 3, 2017

    I am not a Dr., so the following is not medical advice, it’s just anecdotal evidence. I take amitriptyline for an old nerve injury that would otherwise leave me in constant pain and without sleep.

    As time went by, my body became more adept at drug utilization, so I now split a 10-mg pill 4 ways for a 2.5-mg nightly dose. And it’s a cheap drug if you’re on Medicare – about $5 for a30-pill scrip.

  39. ultra permalink
    April 4, 2017

    Tomonthebeach: “Did Kasich’s order signal a return to undermedication for pain? NO. It simply require physicians to monitor more closely the need for opioid medication on a weekly basis.”

    I don’t agree. The new law in Ohio WILL increase the number of people who are already inadequately medicated for pain. Seeing a physician on a weekly basis is expensive, especially for people with poor health insurance coverage, and physicians really don’t have the time to see on a weekly basis all of the patients who are taking pain medications for chronic health conditions.

    There’s a lot of paranoia about narcotic pain medications. Some physicians are very reluctant to prescribe them (when they should), and some kinds of health insurance refuse to pay for the prescriptions of narcotic pain medications, including chemically similar medications that are used to control diarrhea and other health problems, even though their narcotic effects are very mild.

    As a result of this Ohio law, the number of people seeking pain relief drugs from illegal markets will likely increase. People obtaining pain relief in this manner will not be supervised by physicians and they are more likely to use drugs that are more powerful and addicting. In addition to these problems, more people will find themselves being arrested and becoming part of the swollen prison population of the United States.

  40. April 4, 2017

    Thanks for realizing the REAL issues are that of the socioeconomic problems that afflict people.

    The problem with society is that it always has the causation factor all wrong.
    It always treats results and consequences as the causes.
    When, actually, it’s a matter of: First the distress, oppression, and fears—THEN the search for relief of some kind (addictions being among those attempts at finding relief).

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