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heroin in a capsule hysteria again

Once again, hysteria hits the media with this article that i read, it is unbelievable the hysteria and misconceptions that are with this drug what is actually weaker than oxycontin. hydrocodone is weaker than oxycodone and they are more upset with this narcotic than oxy. will it ever stop? no it will get worse and worse then before we know it all narcotics will be banned. hysteria on my part, maybe maybe not. but it is happening now.
jon

WASHINGTON – State and federal lawmakers are working in tandem to get the controversial painkiller Zohydro ER permanently shelved, even as the head of the Food and Drug Administration defends the agency’s decision to approve the powerful opiate some critics call “heroin in a capsule.”

Since its approval last October, Zohydro, an extended-release form of hydrocodone, has come under scrutiny from members of Congress, state attorneys general, doctors and addiction specialists who have worked to block the pill from being sold in the U.S.

FDA Commissioner Margaret Hamburg strongly defends the agency’s approval, arguing that Zohydro’s benefits outweigh the negative consequences. Simply put, she says, people in pain need more options.

But others, like Sen. Joe Manchin, D-W.Va., say the agency should rescind its approval of the painkiller. Manchin, whose home state leads the nation in prescription overdoses and abuse, has worked with New York Sen. Chuck Schumer to overturn the approval.

The lawmakers have called on outgoing Health and Human Services chief Kathleen Sebelius to force the FDA to rescind its approval, citing the alleged danger of the drug and as well as the growing abuse of prescription drugs in the country. Overdoses from prescription drugs have risen steadily over the past decade and account for an estimated 16,000 deaths a year in the United States.

Three Republican lawmakers -- Sens. Mitch McConnell of Kentucky, Lamar Alexander of Tennessee and Tom Coburn of Oklahoma -- have also joined the call.

In March, Manchin submitted legislation, the “Act to Ban Zohydro,” which offered a 13-point argument on why the federal agency should rescind its approval.

Among his complaints, which have been echoed by doctors and others in the medical field, is the potential for abuse and addiction.

According to the Institute of Medicine, 100 million adult Americans suffer chronic pain every year, and the cost to the nation is between $560 billion and $635 billion annually.

Zohydro ER involves a powerful formula of hydrocodone, the opiate that’s the main ingredient in Vicodin. Critics argue that Zohydro’s potency makes it dangerous and open to abuse because it lacks a tamper-resistant feature which lets it be ground up, snorted or injected.

On Thursday, Hamburg called the “recent attention” by state policymakers on opioid abuse “commendable” on her FDA Voice Blog, but said instead of blocking the sale of Zohydro based on a fear of abuse and addiction, providers should screen patients before they prescribe the drug and while they are on it.

Zogenix Inc., the San Diego, Calif.-based company behind the drug, says it has “taken extraordinary steps to support the appropriate use of Zohydro ER through a voluntary, comprehensive set of educational tools and safeguards to augment the FDA industry mandated class-wide Risk Evaluation Mitigation Strategy (REMS) for extended-release opioids.”

The company also adds that as part of their continued effort to provide “additional safeguards against potential diversion, overdose and misuse of Zoyhydro ER,”

Zogenix has created a board of experts, though it does not say what those experts will do.

The company also says it provides consumers taking Zohydro ER “access to free locking pill bottle caps and discounted safe-storage units to prevent others in the home from obtaining easy access to medicine that was not prescribed for them.”

The FDA’s decision in October 2013 to approve Zohydro over the objections of its staff and advisory committee raised eyebrows in the medical community, with many questioning the motivation behind green-lighting the drug.

Others, though, questioned Manchin’s motives, since his campaign to kill Zohydro could benefit his daughter, Heather Manchin Bresch, the CEO at rival pharmaceutical company Mylan.

Melanie Sloan, executive director at Citizens for Responsibility and Ethics in Washington, told FoxNews.com that Manchin’s push has more to do with the skyrocketing number of prescription overdoses in his state than any type of financial gain for his daughter. She also said Manchin has spoken against drugs Mylan has introduced too.

“His state has a lot of overdoses,” Sloan said. “He had to get on board with this and push for the ban.”

The fight against Zohydro is also being fought on the state level.

So far, 29 states have asked the federal agency to reverse its decision.

Vermont Gov. Peter Shumlin announced an emergency order that would make it illegal for doctors there to prescribe the drug.

Massachu
I have 4 fusions from L5-3, the latest last May '12 where they fixed my disc that broke.They went through my side this time. I take 40 mg of oxycontin 4x a day and 4 fenatyl lollipops 300 micro gms 4x a day.
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Comments

  • My two cents , are just that, two cents, but given the sheer number of recent heroin od's and deaths in my county in the last year and a half, 30 in the last year, which is about 10% of the cases brought into the medical examiner's office, leaves me wondering just how many of those, were related to patients who used an illegal and often lethal street drug, because they suddenly were not able to get proper pain management?
    Heroin has made a resurgence in it's use around us lately and in many other areas across the country......and often, too often, we are hearing and seeing deaths. Too often, there were histories of some of them being pain patients, who couldn't find a doctor......now, why that is, I don't know......but according to the information I am aware of, they were on pain meds at one time but for whatever reason now are not.......so they are turning to heroin. I have to believe that some of them were legitimate pain patients, and while I don't know the reason that they were no longer on pain medications, the idea that someone would turn to a substance with a long, long history of deaths and overdoses related to it's use, is frightening......
    I wish those who create and advocate for these bans and stupid laws, would have the foresight to see what the implications and ramifications of these laws that are pushed through with no real concept of the negative impact that passing them creates.
    I am not one who believes that misusing or abusing opiates is ever a good thing, and I am vocal about it, but this recent rash of non sensical deaths and over doses has me wondering how it is possible to document which of these deaths are directly related to the untreated pain that some of them were attempting to self medicate by the use of a street drug?
  • My pennies go with your cents Sandi. I decided to be very open about my brothers death. He 'chose' to take his life with my fathers prescription pain medications. It was not an accident but he is a statistic on one of those lists. He had suffered physical pain for years but it was the emotional that pushed him over the edge. Since I have started talking about this I am amazed how many families share this heart wrenching experience & uncontrolled pain was frequently a factor.

    You guys know I'm not an advocate for handing out narcotics lightly but I have to confess, I can feel my attitude changing. I find myself wondering what is the lesser of the 2 evils, over prescribing or under? I know in a perfect world doctors would have some scientific crystal ball & always make the right call but that's not the case. So many leave pain management because of perceived lack of treatment. Depression goes hand in hand with chronic pain & I believe that needs to be better addressed but patients self medicating on the street are never going to get any support at all.

    I'm still torn between the two arguments but 'the times they are a changing' & not for the better. Let's be sensitive, it's heartbreaking to realize what people are going through. Most of us are in control of our own lives & I don't know if nature or nurture enables us to do do this. We are fortunate.
    Osteoarthritis & DDD.
  • EnglishGirlEEnglishGirl Posts: 1,825
    edited 05/04/2014 - 5:17 AM
    I was discussing Zohydro with my pain management doctor. He will prescribe but only if a patient has a record of unmanageable side effects with other medications. This basically means he won't because of the current situation. Most side effects can be managed by adding more medications. He was very sad that he is being influenced by public opinion. He has some patients (including myself) that 'could' benefit from this medication but, in his words, he doesn't want to "go there until the dust settles".

    That specific medication is harder to argue because it does not contain any tamper proof measures. Most do not understand why this was released to market in its current form. The idea that "1 pill could kill a child" is rediculous, any 1 of my meds would kill my kids!. We should all store our meds responsibly. This isn't "heroin in a capsule" (we have that in England with good results) its just Hydrocodone in an ER form.
    Osteoarthritis & DDD.
  • sandisandi Posts: 6,302
    edited 05/04/2014 - 5:53 AM
    I am sorry for the loss of your brother and even sorrier that he felt that that was his only option. The most recent death here was what appears to be a direct result of untreated pain......he was seeing a doctor, moved to this state and now , several months later, is dead......due to a heroin overdose but his family stated unequivocally that he was not able to get his pain managed by a doctor here.....It makes me sad and breaks my heart for his family, and for those others who I must assume have also died for similar reasons.
    As to the overmedicated thing- I think that the worst thing that any doctor can do is allow a patient to get to extremely high levels of narcotics. If medication isn't working for a patient at 200 mg per day total, why would the doctor allow them to continue to escalate? Why not change the medication? Or use adjunct therapies? Why use two short acting or immediate release medications, instead of a long acting one for baseline pain and keep the IR versions for acute episodes?
    I know that tolerance becomes an issue, but one easy way to mitigate that occurring is simply to rotate to another opiate...doing that, decreases tolerance issues drastically.....will one opiate work as well as another? Maybe not, but maybe it will stop patients from getting to ridiculous dosages 6 months into being in pain management......I read other forums for pain /spine issues, always have......and I have seen posters, new to pain management who started out on meds at a nominal dose, and getting great pain relief, but after reading for a few weeks to a few months, they have gone from 5 mg oxycodone or vicoden, to hundreds of milligrams in a few months time.......one particular patient was getting 270-30 mg Roxicodone, I can't recall the amount of methadone (think it was 90-120 mg of methadone per day), and I believe it was 6-2 mg tablets of a benzo........from one doctor. The conditions he was given this amount of medication for was DDD, and a disc bulge....The patient became furious when his former doctor retired and the new doctor wouldn't give him the same meds, at the same dosage....The original doctor did him no favors by allowing that kind of dosage of opiates over a short period of time....and the mixture of benzo's and the methadone can be fatal....let alone adding 270 mg 4 of oxycodone to the mix. No one needs that amount of immediate release medication for "breakthrough" pain....
    Another, started out on Nucynta, 50 mg........was loving the way it relieved his "pain", made him happy, cheerful, gave him energy---in 4 short months, he was taking 600 mg per day, and admittedly abusing the meds, running out two or three weeks early....but his doctor was so understanding and gave him lots of "leeway " in adjusting his dosage.....and just kept writing him new prescriptions......
    I look at those situations and I place the blame solidly on the doctors that allowed that to occur......Yes, some people metabolize opiates a bit differently and some opiates work better than others, but to allow a patient to get to those ridiculous amounts of medications is definately overmedicating/ self medicating.......those doses aren't to treat pain, they are to treat the demanding patient who is too big of a headache to try to reign in..
    If a relatively new patient is coming in and despite dosage adjustments to a moderate level of opiates isn't relieving their "pain" , doctors should and are supposed to not continue to use that medication, and either try others or if those fail as well use other modalities. If the patient is laying in bed, not doing anything other than using pills to help themselves, then maybe opiates aren't the answer in those cases.........the risk /benefit scenario comes into play....
    Then on the flip side, we have other patients who have legit conditions, who should be given the option to at least trial opiates to see how they do...if they are able to function in their daily lives,or return to work, and take care of their families, those people should have the option open to them....
  • but all of these recent heroin related deaths are really concerning me..........and it is making me incredibly sad, for them, for their families, and makes me wonder how many of them were not "addicts' in the traditional sense, but pain patients who weren't being treated.
  • Very true Sandi. We've talked about being on high doses & crazy numbers of different meds in the past. My doc was definitely doing me no favors. I was thinking more of the doctors who now refuse to prescribe any narcotic medications for any reason.

    A friend of a friend is a pain management doctor who has recently left the clinic he was working at to open his own practice. He admitted that he doesn't want the issues that come with prescribing these days so his 'plan' is to have his patients GP's prescribe narcotics if they wish to continue using them but his stance in general is very anti-narcotics. He talks about narcotics causing pain & lowered immunity..you know? All of 'those' studdies. I appears that an increasing number of doctors are taking that stand. I know pain management is a relatively new field. I live in a very new area & I'm amazed by how many new clinics are opening in the strip malls & medical complexes around here. It seems like physical therapy practices are becoming PM clinics. A GP who used to refer a patient for PT is now sending them to PM so there is less prescribing & more focus on alternative therapies because they are frequently seeing less serious cases than in the past. I thought this was great in some ways but now I'm questioning it.

    I'm a true believer in 'The Blend'. There is no level of narcotics that will give a comparable level of functioning but I am becoming afraid that my doctors may move or change their practices & stop prescribing. I know that I would not be able to function without my meds & my only option would be to return to England & rely on that support system to help raise my children. Others do not have that option..where will they turn?

    Maybe I'm being over influenced by spending time here & reading the problems some are facing. I don't know but I fear the times are changing...
    Osteoarthritis & DDD.
  • I rotate my medications. There is a level that I've fixed in my mind that I will never go above. Like you, I don't understand why doctors don't follow this practice. I was told in England that rotation rather than escalation is now part of the European guidelines for prescribing.
    Osteoarthritis & DDD.
  • a little of the subject but i have always been an advocate of legalizing heroin in the US. for the most part it is in england and it is probably the most effective pain med. the guy in the movie lone survivor about the seal whose whole team was killed and he was saved by afghan villagers who gave him heroin for his wounds said it was better than morphine for him. if some one is going to use it legally or illegal, keep it under govt control and tax the heck out of it and keep it out of the hands of the gangs
    i have always been a libretarian when it comes to legalizing drugs.
    jon
    I have 4 fusions from L5-3, the latest last May '12 where they fixed my disc that broke.They went through my side this time. I take 40 mg of oxycontin 4x a day and 4 fenatyl lollipops 300 micro gms 4x a day.
  • I know what you mean Jon but just for anyone reading & getting the wrong end of the stick... Heroin isn't 'legalized' or 'decriminalized' like marijuana in many European countries. There is a prescription heroin which like methadone has proven to be a highly effective pain med which (studdies show) helps with nerve related pain better than most other narcotics. The war on drugs is a mess. Overcrowding prisons isn't the answer & what Jon is saying really isn't off track. When 'the system' treats addiction as a sickness that needs treatment it not only efficiently helps those with 'just' addiction, it also finds those who are self medicating for a variety of illnesses both mental & physical. Spending millions throwing these people into prison every month isn't 'working' by any definition.
    Osteoarthritis & DDD.
  • if someone wants it they will get it. might as well control it and tax it. the amount of taxes would help take care of the debt and take it out of the hands of gangs. but the hysteria about legalizing drugs wont do that ever. the old police chief here was for the legalization of drugs and went on national tv to espouse it.
    jon
    I have 4 fusions from L5-3, the latest last May '12 where they fixed my disc that broke.They went through my side this time. I take 40 mg of oxycontin 4x a day and 4 fenatyl lollipops 300 micro gms 4x a day.
  • Some European countries are far better at dealing with this than England. I spent a lot of time in Amsterdam & the anti-drug movement by teenagers is amazing. They want their 'needle parks' back as family, sports parks. The liberal stance on drugs is actually producing a generation of kids who seem to have a healthier attitude than zero tolerance countries!
    Osteoarthritis & DDD.
  • English, I'm so very sorry that you loss your brother. I can't even begin to imagine the effect that this has had on you and your family. I don't know all the details, but I feel safe in assuming that this is an exact example of chronic pain that was under treated. Emotionally, he must of felt it was too much to handle & could not see relief in his future. I sincerely hate that he felt this was the only way to end his suffering.

    In the beginning of my CP journey, my dr's started me on hydrocodone as time went on, it was raised up to its highest dose. Then on to the next opiate. But, I do remember him saying, "I wish they made hydrocodone in an ER version,it would work so well for so many, including myself, they would, in his words, make a killing!" I have a different PM dr now, but I wonder, now that they have an ER version, if he is prescribing it or if he is reluctant because, as English put it, waiting for the "dust to settle?" It's so wrong that stigma and our government is in charge of how our pain is managed.

    I feel like Sandi does, I wonder how many of the OD stats are chronic pain patients that were under-medicated or un-medicated?? We never hear whether or not the person was in physical pain or emotional pain, due to not having their pain properly managed. I use to be one of those people that felt if you had real pain and medical evidence to back it up, then you would be properly managed, after spending more and more time here, I see that, that is not always the case & that I have just simply been one of the lucky ones, give the fact that my pain has always been managed. Here on SH there really are legitimate people who are not having their pain managed at all. Aaron (anelsen15) is one of those people who has suffered for years with little to no help. This is not right (Aaron, please don't be upset that I used you as my example) As you read here you can tell the real sufferers verses the ones who have themselves convinced of it.

    As far as the heroin goes, if my pain was not treated at all and I could not find a dr that would help me, I can not say I would not turn to heroin & in turn I would end up be a statistic. I know for a fact I have CP, 2seperate body parts have lead me to my PM clinic and my PM dr. I have Chronic pancreatitis along with several spinal conditions. I could not imagine not having each of these properly treated. Right now, I have my pancreas pain under control and my spine is a work in progress. During a full blown pancreas attack, if dr's & hospitals did not allow me access to medications, I'm 100% positive that I would not be able to endure that pain for long, without reaching out to any means necessary to get it under control. There is no doubt that the rise in heroin use and deaths is a direct result of the, so called, "war on drugs" This campaign has done nothing to stop illegal drug usage, in my opinion, all it has done has made it harder for people in real pain, by giving them even more hoops to jump through and the opening in those hoops has gotten even smaller and harder for us to get through. I don't have the answers, but what I do know is that the people in charge of our country do not have the answer either. They should not be allowed to govern the way dr's treat their patients. (I know I said this twice, but I feel strongly about it)

    There is a young person here (I will not mention the name) but this young person just recently admitted to turning to heroin because his pain is not being treated, as of yet. By reading the stories this person writes, it is obvious that a great deal of suffering in pain is taking place. I can only imagine how hard it is to beat through each long day, w/o sleep, feeling isolated, being young and not being able to enjoy life due to the pain. Finally, getting to the point and rationalizing it your mind that, you would do anything to just have, even a couple of hours w/o such mind consuming pain that you would turn to heroine for relief......I have had this mind altering/consuming pain that I know for a fact I would turn to the benefits that heroin would offer me if I could not get help for my pain.

    In my opinion there is way too much scrutiny being associated with Zo-Hydro. It is a medication developed for chronic pain patients....There are CP'ers out there that are not responding to anything else, this could be the one for them that would allow them to be able to control their pain enough to be able to have their life back. Do I think it needs the protective coating? Yes, I do. Anyone who is an addict is going to manage to get their hands on drugs from now to eternity. I don't know the answer to this dilemma but I do feel that continuing to make things difficult for people that really suffering is wrong.
  • edited 05/04/2014 - 12:54 PM
    I have mixed feelings about the legalization of all drugs thing. It's really not the case that if you want it you can get it, one can't just walk out there door and find a cocaine at the end of the street. I hungout with a lot of party-types in high school and my friends would often have trouble finding various drugs and I live in a very drug-ridden city.

    So what concerns me most is thinking of high school kids who have a pretty hard time getting hard drugs would all of the sudden be able to by cocaine as easily as alcohol(which is pretty east btw). There are some definite pluses to legalization but the cons are scary as well.

    As for this article... I hate reading stuff like this, it scares me just like you that one day ALL narcptics for chronic conditions could be banned, which there is a definite push for it among some people as seen here

    http://www.spine-health.com/forum/treatment/pain-medications/new-assault-opioids-reported-wsj

    The ignorance of some people is astounding. This med is only being goven a bad name because the stigma of vicodin and is nowhere near the stength of its supposed 'heroin in a pill'. Ridiculous... And as someone else said overprescribing is an undeniable issue but I think underprescribing(especially for chronic pain patients) is arguably a much worse issue. It took me months to even get a prescript for vicodin after my injury because 'this is a chronic issue so we don't want to put you on painkillers', shouldnt that be all the more reason?

    And lastly the reason why heroin is medically illegal in the US is because it is much more addictive than other opioids. This is because its essential an ultra fast acting and amped up morphine. They combine morphine with acetyl and this mixture causes the drug to plow through the blood brain barrier much faster. Studies show and confirm that the faster a drug kicks after taking the more your brain associated it with pleasure and the thus more addicting it is, making heroin arguably the most addictive of all opioids. (How I know all this: I took a Psychology & BioPsychology classes in college).
  • thoracic spine painthoracic spine pain Posts: 566
    edited 05/04/2014 - 6:03 PM
    I don't really understand the laws in the US. How many deaths are caused by firearms. I know there is an enormous amount of money made. When I worked I realised firearms and weapons were one of the largest contributions to the US economy. You can murder people with firearms.

    Isn't it a double standard to allow and encourage firearms then ban drugs if they are concerned about people's lives?
  • i just read an article on the web about dangerous medicine combinations and guess what the most one mentioned? you got it opoids. apparently opoids and antidepressant meds are dangerous as are opoids and a lot of other meds. the article stated opoids and this med and opoids and that med and opoids and .....and on and on. so opoids should not be used with all sorts of other meds together according to the article. another article stating that under the right cirumstances opoids can kill you
    jon
    I have 4 fusions from L5-3, the latest last May '12 where they fixed my disc that broke.They went through my side this time. I take 40 mg of oxycontin 4x a day and 4 fenatyl lollipops 300 micro gms 4x a day.
  • under prescribing is another issue where as people say i don't get enough pain meds and they dont work. i see this all of the time. however i think some feel that pain meds are not working if they don't get the high feeling. at first pain meds give that high that people want however after a while, it goes away since the body adjust to the meds. this is to say it is not working. they work even though one does not get the high feeling. this is especially true for oxy and other time release meds. the dose is released in small doses where one does not feel it but it is in the blood stream and released at smaller doses. that is why some crush the pill up to get all of the meds at once. but watch out for confusing meds that do not work with the fact that the body gets used to it and time release meds are released at a smaller dose. the meds work and just because one does not get high does not mean that they are not working
    jon
    I have 4 fusions from L5-3, the latest last May '12 where they fixed my disc that broke.They went through my side this time. I take 40 mg of oxycontin 4x a day and 4 fenatyl lollipops 300 micro gms 4x a day.
  • TSP mentioned guns..even cars kill a huge number of people each year. The press whips up the public & politicians respond. I don't see it as a chronic pain war. Since the dawn of time people have collected plants for their narcotic qualities. This is often discussed as a drug 'high' history of mankind but considering this conversation I think it should be considered the chronic pain history of man. Similar issues were raised in the American Civil War, the Union Army used 2.8 million ounces of opium tincture and powder and about 500,000 opium pills. Victorian England worried about alcohol & the working classes & narcotics for those who could afford them. Choose any time in history & you will find those self medicating & others using recreationally. The difference today is we are in danger of not legally having our pain controlled & we don't want to go to the streets & become a statistic.

    Doctors are referring to studdies that show negative effects of narcotic pain meds..increased pain, reduced immunity & using them as reasons not to prescribe these meds under any circumstances other than end of life. As more & more clinics follow this path & GP's refuse to prescribe where will we turn?

    I just hope that the tides will turn before too many of us are lost. Other countries are paying more attention to the reports indicating tragic results of under management of pain & encouraging rotating narcotics to avoid many of the negatives. The problem we have (USA & England) is 'The evils of prescription meds' make better headlines. As a modern rock band says "One Nation controlled by the media", a lot of our problems start there. If we really want to save lives ban cars & guns!
    Osteoarthritis & DDD.
  • just as with any other public tragedy, the media plays into the hype, and it in turn gives organizations an outlet to proffer their anti sentiments....the more media that gives voice to the anti movement, the more that our representatives feel the pressure to come up with something to make quiet the vocal majority.
    The issue as I see it, is that those of us who use our meds properly don't have an advocate for our side of things, and we don't approach the newspapers or the television stations to discuss the seriousness of undertreatment or the impact that all of these hastily enacted laws are having on our ability to get proper treatment......
  • terror8396 said:
    under prescribing is another issue where as people say i don't get enough pain meds and they dont work. i see this all of the time. however i think some feel that pain meds are not working if they don't get the high feeling. at first pain meds give that high that people want however after a while, it goes away since the body adjust to the meds. this is to say it is not working. they work even though one does not get the high feeling. this is especially true for oxy and other time release meds. the dose is released in small doses where one does not feel it but it is in the blood stream and released at smaller doses. that is why some crush the pill up to get all of the meds at once. but watch out for confusing meds that do not work with the fact that the body gets used to it and time release meds are released at a smaller dose. the meds work and just because one does not get high does not mean that they are not working
    jon
    Very good point, that does seem to happen quite a bit on here where people complain they don't work yet want higher doses, if they don't work why are you taking them at all?

    I think a big part of this also is people say they don't work because they don't take ALL of the pain away. Even the strongest safe dose of a painkiller isn't going to take 100% of your pain away(unless you want to be KO'ed in the process) and I think a lot of people don't understand that. Taking 10-60% of the pain away is a more realistic goal when it comes to painkillers, newbies need to be educated about this more.
  • ( my favorite HP character name), that is exactly why I wrote three articles here on Spine Health, to educate those who are unfamiliar with the goals of a proper pain management program......to educate and change the perceptions about what the proper use of pain medication should be.
    What some consider undermedicated, is not that at all, it is simply that the goals of the patient and the doctor don't meet.....the doctors goal is a reduction of 50% of unmedicated pain levels, but if you have a patient who despite a fair dosage of pain medications is coming in complaining that their pain levels are still an 8 or higher or even higher than they were when they first came in, no doctor is going to continue to provide narcotics......in fact, that is an indicator that they should stop....
  • thoracic spine painthoracic spine pain Posts: 566
    edited 05/05/2014 - 11:33 AM
    Guys sorry wrote the but about guns as I know you guys react strongly if taking your guns away is mentioned.

    English you are so right. It's just the time in history. The Opium wars were fought so England had the right to trade opium in China when the Chinese people wanted to ban the use of opium. Through history money has always come before the welfare of the people.

    Sandi it is so true that people with spine pain haven't got anyone to lobby their case. I must admit before I had my accident I thought people were putting on spine pain to get out of work.

    I had no idea your spinal column was your central nervous system. I just didn't put two and two together before it happened to me, and wondered why the pain was excruciating. When I looked up charities there are a lot for people in wheelchairs but absolutely nothing for people with spine pain who could still walk.

    I think it starts with education and with medical school education. If I was taught my spine was the crane of my anatomy - my spinal cord controls my central nervous system I wouldn't have been so irresponsible with my spine. Remember the post I wrote about Vets getting more pain training that Drs.

    As I'm finding a new GP down here one I went to who I showed my MRI said point bank 'You don't want a spine operation. Another specialist when I was in so much pain all I wanted was an operation as I thought that would stop the pain screamed at me not to have an operation - 'you haven't seen the number of failed spine operations I have to deal with.' I was devastated at the time but looking back he may have been correct.

    I wonder what the statistics are for people with failed back syndrome. It seems like these statistics are swept under the carpet as most Dr's once thy have operated don't seem to want to know you if anything goes wrong. Jon did you ever hear back for the senator you wrote to? Was anything done about it?

    I wish someone like George Clooney would go to bat for spine patients. I know he missed his last movie due to spine pain. But I'm sure he would be getting opiates for his pain without having to jump through hoops. JFK had shocking spine pain and lived on a cocktail of medications. In fact many world leaders had injured their spines and were able to get through as they were properly medicated.

    I am a member of Change.org where they will put up any petition for signature. Maybe we could start a petition for people with chronic pain. They do use the media to put their case. i know politicians only react to the media. I was at a high level presentation on what the government reacts to. The number of organisations that lobby the govt everyday are in their thousands. The govt does not react until it goes into the media or the papers.

    There must be statistics on people who suicide or move to street drugs to ease their pain. I wish spine pain did not have a stigma attached to it.



    It is about the media beating up the public into a frenzy.
  • Some very interesting ideas ^ it's true we do need advocates for and most importantly awareness of chronic pain patients.

    But if you really think about it we do have a lot of unseen advocates, which is why opiates were and still are allowed for chronic pain patients - after all that petition to restrict opiates for chronic pain patients(as seen above) never did go through..

    As for going to change.org that is a good idea. While ER Hydrocodone is probably not going to be the most effective drug in for people with opiod tolerance it would be a nice option for newbies considering Hydrocodone is of a lower schedule than other opiods and you wouldn't have to deal with paper prescriptions and no refills.
  • sandisandi Posts: 6,302
    edited 05/05/2014 - 12:20 PM
    anelsen15 said:
    Sandi,

    I would think 50% be great for many people compared to none lol. Isnt their instances where the meds are not strong enough, or work best and the patient might say its not working and its time for chance? I ask because I was reading about pain the other day and it said the tolerance for pain actually decreases the longer you are in pain, I dont know if its true but could that explain the need to go up sometimes? I have no idea so just curious

    Sure Aaron, but as I said, if the person is given a moderate dosage of meds, which means that there have been a few dosage adjustments, and changes to different opiate combinations and the patient is still complaining of being bed ridden or pain levels that are at the same or higher levels than previous to the use of opiates, then by all measures, opiates are not the answer.....ongoing prescribing of opiates needs to show improvement in function, in activity levels...not staying the same or worsening....if either of those are the case, then there is no medical basis for ongoing prescribing of opiates.
  • Aaron & Sandi. I think you're both right & talking about slightly different situations that should be treated differently when it comes to narcotic dosing. I think it's interesting that there are studdies showing that chronic pain does create physical changes in the brain. I wonder if those changes are much slower for patients who have always had good pain management when compared to those who have had none?

    For me Hydrocodone works far better as a breakthrough med than in should when you compare it's strength to Oxycodone or morphine so the extended release version would be an obvious option for me. Logic dictates that I could have the same pain control with a lower dose of narcotics from the Zohydro. I've also read that some who suffer from terrible itching & other skin problems with narcotics don't when they take hydro. I think they were given reasons for why it was needed & released in its current form without any tamper proof measures.
    Osteoarthritis & DDD.
  • There are several situations when it comes to narcotics, patients who have not been given the opportunity to trial opiates as part of their pain management, those who have, those who have but are given astronomical doses, and those who have been trialed but are seriously undermedicated, and those in the middle....
    Of course, of those groups, there are branches or offshoots of course, and situations that complicate the picture, I think that if the conservative modalities have been given a fair trial and failed, and surgery is not an option, then a trial of opiates is something that should be considered and offered......that being said, I don't agree with using pain medications to avoid a surgical fix, not long term anyway. Temporarily, yes, but to avoid surgery for years, no.....if it can be fixed, repaired, then do that...( I also don't believe in the use of scs to avoid surgery either). Postponing surgery for a good reason, is one thing, but I don't think that most patients realize that the longer they postpone getting the problem fixed, the less likely they are to have good outcomes, and more than that, they may create brand new ones by avoiding the surgery for too long.
    The situation of using astronomical doses of opiates is one that sets up more problems for the patients, in the long term....and really makes the argument for those anti opiate vocal politicians, and groups.....yes, I am aware that there are situations where higher doses of opiates have to be used, especially when it comes to long timers in chronic pain, or intractable pain conditions.....but by and large, for the majority of us, even with severe spine conditions, dosages in the several hundreds of milligrams is not necessary per day. Again I know that there are exceptions but by and large, moderate doses are effective at reducing the pain.
    Then there are the cases where patients are given a trial of opiates and got minimal relief , and their doctor refuses to make any adjustments or changes to see if the patient gets better relief......in many of those cases, it appears that part of the problem is that they are relying on their primary doctors to treat chronic pain.....which is just not a good idea for many reasons........while they versed at treating acute pain sometimes, treating chronic pain is different.....and there are many more options than just the use of vicoden or percocet, yet, most GP's are not willing or educated in using the long acting meds or their dosing, and certainly are not educated in the othe techniques and modalities available to treat pain. Gp's are only going to go with what they know, and most are not comfortable going higher than a certain dosage when it comes to opiates........so the patient is being short changed and often undermedicated.
  • EnglishGirlEEnglishGirl Posts: 1,825
    edited 05/06/2014 - 7:33 AM
    I think many patients don't realize that often you need to throw everything at more serious spine problems & see what 'blend' works. No one thing alone has ever worked for me. Even physical therapy wasn't straight forward because I have several different issues going on. I often read 'tried it for a couple of weeks & it didn't help', you need to stick with these things. It took a while to find the right routine of stretches & exercises for me. It's not just meds that need to be tweaked to find the best dose & mix. Finding the right muscle & nerve med was as important as the narcotics but even then meds alone don't get my pain managed. Meds should be used to help you get & stay moving not to make staying in bed more tolerable.

    This thread started after some dear friends here really hit rock bottom because of intolerable, unmanaged pain. I think that has greatly influenced the way we're feeling about narcotic therapy at the moment. I don't believe it's the most important aspect of pain management but it is essential in some cases. The mind can only handle so much pain for so long.

    Osteoarthritis & DDD.
  • sandi said:

    Then there are the cases where patients are given a trial of opiates and got minimal relief , and their doctor refuses to make any adjustments or changes to see if the patient gets better relief......in many of those cases, it appears that part of the problem is that they are relying on their primary doctors to treat chronic pain.....which is just not a good idea for many reasons........while they versed at treating acute pain sometimes, treating chronic pain is different.....and there are many more options than just the use of vicoden or percocet, yet, most GP's are not willing or educated in using the long acting meds or their dosing, and certainly are not educated in the othe techniques and modalities available to treat pain. Gp's are only going to go with what they know, and most are not comfortable going higher than a certain dosage when it comes to opiates........so the patient is being short changed and often undermedicated.
    I agree to an extant here but many of us don't have easy access to a pain clinic that prescribes opiate medication. The one in my town only prescribes short term and then transfers the prescription to a gp. From what I've read here many other pain clinics are starting to distant themselves from long term painkiller prescribing as well and thats leaving us in the dust. But I've also found that many GP's are actually pretty educated in chronic pain, my GP has a secondary degree in pharmacology so obviously he's great and another GP at my clinic specializes in palliative care and I've been treated well by him when my Doc was out for 3 months with back surgery, maybe I'm just lucky though.
  • that is why i do not use a clinic. i go to a private pain doctor. clinics are notorious about not giving out narcotics. try to find a private pain doctor not a clinic. just out of boredom i researched clinics and most use injections, therapy and other non medical therapy for pain. my first pain dr sent me to another pain doctor when he retired. no clinics
    jon
    I have 4 fusions from L5-3, the latest last May '12 where they fixed my disc that broke.They went through my side this time. I take 40 mg of oxycontin 4x a day and 4 fenatyl lollipops 300 micro gms 4x a day.
  • edited 05/06/2014 - 8:59 AM
    Agreed about pain clinics here in CA, the one here does the same and even offers 'saline injections' instead of cortisone and also does acupuncture - ugh. Sorry not big on alternative therapies, in my defense I did try it out before knocking it, 5 sessions of acu in total, didnt do a thing for me. For meds I just see GP, for injections/MRI's/PT etc. I see a Sports Injury Specialist.
  • English says "This thread started after some dear friends here really hit rock bottom because of intolerable, unmanaged pain. I think that has greatly influenced the way we're feeling about narcotic therapy at the moment. I don't believe it's the most important aspect of pain management but it is essential in some cases. The mind can only handle so much pain for so long."

    I could not agree with this more, EnglishGirl, narcotics are not the ONLY answer, but they do need to be part of the answer. Conservative treatments can work, but if a person is in too much pain to even get up to try them, then how can they work?? They mention physical therapy but if the pain is too great to do all the stretching and moving around they want and need u to do, then how is it supposed to work. Or if the physical therapy causes pain to a patient then what is the incentive for the patient to return to continue to do something that will cause them anymore pain.

    Sure take that hot bath, but what if the pain is so intense for so long that your personal hyiene has to take a back seat in your life.

    Mediation-if you are in so much pain, how can you possibly concentrate enough to mediated or practice moving your pain to another part of your body? When you have pain that takes over your whole being, including your mind. You can not meditate. And the list goes on. Pain meds are meant to be used to control pain, why they are kept from some and given to others, I don't know & I do believe there are some here who desperately need narcotic pain management who are not getting it. Maybe they could try other treatments to manage their pain and maybe some of the other treatments could work if they had pain meds to tk along with the conservative treatments--such as, injections & PT.

    My opinion has definitely changed on some things here. It has been over the last few days, I have went back and read old stories as well as the up to date ones. For some of us, including myself, it is so easy to forget there are some out there who have not been as lucky as we have as far as the world of pain management goes. Some people, from reading, have some pretty serious and painful issues and they are dealing with then un or under medicated.

    Conservative treatment measures are not the be all to end all. They can help that is for sure, but if a proper level of pain control is not met at the onset or duration of the patients pain issues then the conservative measures are going to be absolutely useless. The pain meds interrupts the pain signals to the brain, if those signals are interrupted then it makes perfect sense that a person will feel up to trying other means of pain control & be more apt to stick with them, giving them more of a chance of getting well or reaching an acceptable level of pain control that will allow them a quality of life. There are some here who just seem to be falling through the cracks & there are some here who are clearly playing the system-it's easy to pick up on the real and the fake after awhile. The real ones, I believe, are not getting the help they desperately need.

    If there is anyone here I have ever offended with my opinions of pain meds and treatments, then I apologize to you.
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