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Coroner letters changed habits of doctors whose patients died of overdoses

latimes.com

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Re: Coroner letters changed habits of doctors whose patients died of overdoses

#61

Post by throwaway91241 »

cm2012 wrote: post #18

One note: Research pretty thoroughly debunks the idea that a substantial percent of opioid as addictions come from prescribed pain treatments: https://www.fivethirtyeight.com/features/what-science-says-t... Now this article is about something different - teaching doctors the warning signs of when already addicted patients are drug seeking, so they can avoid prescribing then. The key fact here is that almost all of th…

You keep posting this article, but it has no evidence in it. It links to several papers that tangentially support your claim. Let's look at a different paper that somewhat refutes it:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4032801/

Here's the raw data on prescriptions and outcomes summarized in that paper, built from claims data for 2000–2005:

  Opioid Dose and Days Supply
                         total       addiction
  No opioid use          371,371     150 (0.04%)
  Low dose, acute        90,415      111 (0.12%)
  Low dose, chronic      6,902       50 (0.72%)
  Medium dose, acute     83,542      101 (0.12%)
  Medium dose, chronic   3,654       47 (1.3%)
  High dose, acute       12,378      15 (0.12%)
  High dose, chronic     378         23 (6%)
So acute opioid doses 3x your risk of addiction, no matter the strength. And long term dosing will 18x to 150x your risk, depending on the strength. Relatively few people are receiving chronic (90+ days) opioid doses, but those that are have a significant risk of addiction.

I'm not the right person to do this analysis properly, but I'd hardly call this "thoroughly debunked"

Re: Coroner letters changed habits of doctors whose patients died of overdoses

#63

Post by GordonS »

DanBC wrote: post #44
lesserroneous wrote: post #28

I will admit I'm biased: my mother died of an overdose. She was a drug addict. I, on the other hand, have a painful autoimmune disorder, but I've never taken medication. Yet every doctor I've met in the past ten years has looked at me and immediately treated me like a drug addict. Personal experience aside (as it really is not quantitatively demonstrative of anything larger) I've done my best to research this issue,…

People think that opioids are an effective treatment for long term pain. They aren't. They don't work to treat the pain and the patient develops a tolerance and so ends up taking large quantities putting their health at risk. > Patients are seeing their medication reduced without tapering, they are given no other option than to "suck it up," These are both bad, but these are both symptoms of the sometimes terrible he…

> People think that opioids are an effective treatment for long term pain. They aren't

I don't think it's helpful to make a blanket statement like that. There is no one size fits all where pain and analgesics are concerned, and genetics play a large role in what works and what you can even tolerate due to side effects. Opioids of course should not be the first choice, but they should be an option.

I've been living with chronic pain for years now, and have been maintaining the same opioid dose - they bring their own issues, but they make a huge difference to my quality of life. Anecdotally, through support groups, I know several others in the same situation.

There is something of mini war on opioids going on here in the UK, spurred by what's happening in the US and stoked by hate rags like the Daily Mail. People who successfully manage long-term pain using opioids should not be shamed and treated like drug addicts.

Re: Coroner letters changed habits of doctors whose patients died of overdoses

#65

Post by mmt »

lesserroneous wrote: post #28

I will admit I'm biased: my mother died of an overdose. She was a drug addict. I, on the other hand, have a painful autoimmune disorder, but I've never taken medication. Yet every doctor I've met in the past ten years has looked at me and immediately treated me like a drug addict. Personal experience aside (as it really is not quantitatively demonstrative of anything larger) I've done my best to research this issue,…

> opiate-related deaths account for .02% of the population.

This statement is potentially misleading, since it leaves out the "per year" part. To compare it to the number of chronic pain sufferers, as you've done, you'd need to add up all the deaths of people who would otherwise still be alive.

Even just using the wild approximation of adding up the deaths in Table 27 of what you've linked (interpolating the missing 8 years with the lowest number), brings the percentage above 0.17% or almost 1 in 500.

One of the reasons for alarm is that the fatality rate has been increasing (and may even be accelerating), having more than tripled since 1999. Compare that to vehicle deaths, which have been on a downard trend, even per population.

Re: Coroner letters changed habits of doctors whose patients died of overdoses

#66

Post by mnm1 »

Do the people conducting these studies really think that getting doctors to prescribe less opiates to existing patients and having patients resort to the black market where heroin is often cut with fentanyl, carfentanyl, or other much deadly opiates is really a good idea? Somehow reduced prescriptions are equated with positive outcomes without any proof. I guess the thinking must be that if the patient overdoses off of street opiates it's somehow not as big of a deal as if they overdose off prescribed opiates. At least these doctors won't feel so bad about patients they are directly killing by cutting them off their prescriptions. From experience, most doctors don't even care about or can even fathom the consequences of taking someone dependent on opiates (as well as other drugs that must be tapered like benzodiazepines) so them stopping prescriptions without properly tapering patients off is no big deal while the patients literally scramble to save their lives by getting the drugs from the black market. But hey, the numbers look good and sound good to a society that thinks war should be waged on addicts and that they are better off dead than in recovery. That certainly explains our ridiculous regulations as regards to methadone, an extremely effective treatment for opiate addiction, when used to treat addiction (must be taken in liquid form from a clinic each day etc. etc) vs. when taken for pain. It's almost like these laws were written by people who want addicts to die rather than recover. They are. Doctors who stop prescriptions without offering the patient a chance to recover are essentially sentencing the patient to a possible death penalty either because the patient goes to the black market or because they can't and go through withdrawl which can indeed kill both directly and through suicide. They should really try to remember the Hippocratic oath they are violating and think about the patients they are directly trying to kill in the name of prescription reduction and useless, dumb government statistics.

Re: Coroner letters changed habits of doctors whose patients died of overdoses

#67

Post by justinjlynn »

jazoom wrote: post #60
justinjlynn wrote: post #49

Earlier quoted context omitted.

> Opioids are not effective at treating long term pain OK, so, please expand on this asssertion. Also, what does then?

Not GP but I can expand. Over long periods of use the body develops tolerance to opioids and to get the same level of relief the dose must be increased. This seems to go on forever. Last year I had a patient on 10x what would probably be lethal for me (about 200 times a basic starting dose) and they didn't affect him much at all. He had been on the opiate train for about 30 years.

Indeed, clearly we need to develop a better understanding of the causes of chronic pain and how to treat them directly rather than managing symptoms.

My primary concern is maintaining or improving quality of life without impacting the length too negatively. It's difficult to justify saying "sorry, that thing you were taking to make your life bearable makes my colleagues think I'm no better than drug dealer so, uh, you can't have it any more, here's a pamphlet on mindfulness" - if anything it should be buying time for us to find real solutions instead of symptomatic treatment.

And that's all opioids really do for those that take it - buy time. If we're going to reduce opioid use we need to treat it as we're treating antibiotics and make sure we're carefully watching outcomes to make sure we're not dropping opioids but raising suicide rates.

We owe it to patients to solve their problems and not just treat their symptoms when it's clear they won't heal on their own.

Not a GP either.

Re: Coroner letters changed habits of doctors whose patients died of overdoses

#68

Post by johnpowell »

selectodude wrote: post #35
johnpowell wrote: post #27

Earlier quoted context omitted.

I went to the dentist around four months ago to get a tooth pulled. I was given 36x325Mg Hydrocodone (not a typo) and 14x600 Mg Ibuprofen. Which is pretty absurd. I only used 6 of the Ibuprofen. I'm not sure why I wasn't just given a two day supply of Hydrocodone and if more was needed I could have just called it in asking for a more if the pain was bad. It was such a over-prescription I hope it was just sloppy handw…

You were reading the bottle wrong. Those pills were either 5mg or 10mg of hydrocodone with 325mg of acetaminophen. 36 of those, while a lot, is really not more than 4-5 days worth. They only last 4-6 hours each. 325mg hydrocodone would have killed you several times over unless you’re, like, a late stage cancer patient or a severe heroin addict.

You are correct. It says Hydrophone-Acetomaminophen 5-325MG Tab Mall.

But there is a line break. after "5-" so since I am not a doctor I think my interpretation is a reasonable one.

You knew exactly what I meant, so cool.

Re: Coroner letters changed habits of doctors whose patients died of overdoses

#69

Post by srinivgp »

DanBC wrote: post #47
cm2012 wrote: post #25

Earlier quoted context omitted.

There's almost no chance of you developing an opiate addiction from a prescribed dose if you don't already have a history of addiction: https://www.google.com/amp/s/fivethirtyeight.com/features/wh... This is a false narrative that needs to go away.

You're pushing a narrative created by opioid manufacturers: "These meds aren't addictive if used to treat pain". That's only true (if it is true) if they're used short term. People in this thread aren't talking about acute pain, they're talking about chronic (long term) pain. It's likely that opioids are addictive if used long term to treat long term pain. Here's what actual doctors say: https://www.rcoa.ac.uk/facult…

Repeat after me. Addiction is not dependence. Dependence is not addiction. When I read "dependence is expected", I will not interpret it as "addiction is expected", and I will ESPECIALLY not immediately assume tolerance, drug seeking, preoccupation, or harming oneself just because of dependence.

Re: Coroner letters changed habits of doctors whose patients died of overdoses

#70

Post by jazoom »

justinjlynn wrote: post #67
jazoom wrote: post #60

Earlier quoted context omitted.

Not GP but I can expand. Over long periods of use the body develops tolerance to opioids and to get the same level of relief the dose must be increased. This seems to go on forever. Last year I had a patient on 10x what would probably be lethal for me (about 200 times a basic starting dose) and they didn't affect him much at all. He had been on the opiate train for about 30 years.

Indeed, clearly we need to develop a better understanding of the causes of chronic pain and how to treat them directly rather than managing symptoms. My primary concern is maintaining or improving quality of life without impacting the length too negatively. It's difficult to justify saying "sorry, that thing you were taking to make your life bearable makes my colleagues think I'm no better than drug dealer so, uh, yo…

GP = Grandfather Post. It's a reference to the comment you replied to.
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