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OxyContin's 12-hour problem

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Re: OxyContin's 12-hour problem

#321

Post by DanBC »

MichaelGG wrote: post #266
DanBC wrote: post #255

Earlier quoted context omitted.

> With proper availability, opiates are very well tolerated. This just is not true. With proper availability people develop tolerance, and require higher doses. That does becomes high enough to become dangerous, and so they need to change to a different, stronger opiate. They develop a tolerance to that too. Eventually they're cycling through 2 or three different opiates (sometimes at the same time) at very high dose…

What you keep saying in these threads is that opiates aren't effective. Why then do people continue to use them? Certainly if you're in pain, you're not taking a gram of morphine-equivalent per day just because. If there are effective alternatives, why are they not used? Then with pain under control, you can slowly (over a year, say) taper down.

I'm not saying it. National organisations are saying it - Public Health England (part of government); the Faculty of Pain Medicine (part of the Royal College of Anaesthetists); NICE (The National Institute for Health and Care Excellence, a non-departmental public body) all say it. So, unusually, do the CDC: http://www.cdc.gov/vitalsigns/opioid-prescribing/index.html

If they were effective and if addiction could be safely managed you wouldn't see increasing rates of people addicted, taking dangerous amounts, and dying of overdose. http://www.theguardian.com/us-news/2016/mar/17/cdc-guideline...

People take opiates because doctors inappropriately prescribe them (in some countries); because the word "opiate" is well known; because people reject other treatments; and because people stick to the med they know. That's why co-proxamol (and very dangerous, ineffective medication, is still being prescribed today even though there are many other better meds).

They continue taking them, at massive doses, because they're addicted. And that's the problem - if they were addicted but getting pain relief we could understand the continued use of opioids as first line treatment, but most people don't get good pain control with opiates for long term pain. They end up having to mix different meds, these combinations are often dangerous. https://www.theguardian.com/science/2014/dec/09/us-patients-...

Re: OxyContin's 12-hour problem

#322

Post by DanBC »

marincounty wrote: post #272
DanBC wrote: post #255

Earlier quoted context omitted.

> With proper availability, opiates are very well tolerated. This just is not true. With proper availability people develop tolerance, and require higher doses. That does becomes high enough to become dangerous, and so they need to change to a different, stronger opiate. They develop a tolerance to that too. Eventually they're cycling through 2 or three different opiates (sometimes at the same time) at very high dose…

There are multiple, large studies of rest home patients on opoids. The conclusion, patients did not build up a tolerance. (I know Dr. Dean Edell cited these studies many times, when he was on the air. He wasen't the typical media Doctor.)

You're talking about acute, short term, pain. I have repeatedly said that I am not talking about short term pain. I am talking about chronic, long term, pain.

Re: OxyContin's 12-hour problem

#323

Post by Cthulhu_ »

koolba wrote: post #264
Cakez0r wrote: post #262

Earlier quoted context omitted.

* Make it illegal to advertise or market any drug that requires a prescription.

Hell yah. It's not a coincidence that America is the only country that allows direct to consumer advertising of medication. Here's another one: ban all forms of compensation from drug companies to doctors. No more bribes^Wconference trips.

I've seen ads (either in the US or UK) that didn't market drugs directly, didn't name any brands or anything, but was basically "If you have erectile dysfunction, go see your doctor, there may be something for you".

Re: OxyContin's 12-hour problem

#324

Post by Cthulhu_ »

cant_kant wrote: post #260

Sensible doctors do not believe drug company marketing. I get large amounts of ad-junk from drug companies that ends up unread in the bin. I refuse to meet with drug company representatives. I smile politely at them if I bump into them in the corridor and suggest that they leave their ad-junk with my secretary. My staff then file their ad-junk in the trash bin. On Friday, I had a drug company representative attempt t…

My mother works for a doctor, she's gotten some drug company swag and passed it on. I have (had?) a pen somewhere with a floating viagra pill, and a notebook in the form of a Cialis box.

Re: OxyContin's 12-hour problem

#325

Post by GordonS »

_acme wrote: post #306
goldenkey wrote: post #225

Earlier quoted context omitted.

As someone who has chronic pain, tapentadol has been a godsend for me. Its an opioid which also has norepinephrine agonist effects to help reduce pain in a multi mechanistic way. It was developed as a 2nd generation version of Tramadol, which is also a very amazing drug. Tapentadol is brand name Nucynta and cost 1500 for a 30 day supply compared with morphine at My energy levels and ability to be active during an ent…

To counter your anecdote, tapentadol (Nucynta) leaves me extremely foggy and out of it at doses below the required dose for pain relief -- far loopier than hydrocodone, oxycodone or oxymorphone.

I'm the same, as I was with straight SNRIs too. I think some people just can't tolerate SNRIs and SSRIs. But for those who can, they can make a big difference to pain levels

Re: OxyContin's 12-hour problem

#326

Post by GordonS »

pappyo wrote: post #7

The pervasiveness of OC provided by doctors is amazing. Even as of a year ago, I went into the hospital for back pain and left with a script for two fist fulls of oxy. I looked at the doctor and legitimately thought he was trying to get me hooked. And this was at a world renowned hospital. I have to wonder if Purdue is involved in some kickbacks to Dr's who (over)prescribe.

'fist fulls' is a rather strange unit of measurement for pills!

Re: OxyContin's 12-hour problem

#327

Post by GordonS »

DanBC wrote: post #46
CydeWeys wrote: post #22

Earlier quoted context omitted.

I fractured my tibia recently and the urgent care gave me a short prescription for Percocet (which contains oxycodone like Oxycontin and also acetaminophen). I didn't end up picking it up as I don't have a car and mobility is understandably limited when you've fractured your tibia, but the past the first day the pain wasn't bad enough to need it anyway, and ibuprofen sufficed. And I am a wimpy person who does not do…

> Experiencing pain has a limited risk potential in most people, especially when the pain is linked to a temporary condition. People living with long term pain are at increased risk for death by suicide. That doesn't mean we should just hand out opiates (which should not be used for chronic pain), but that we should take pain relief a bit more seriously. Living in pain sucks .

Agreed. I've had severe nerve pain for 6 months now, and I honestly don't know how the hell I would have coped if I hadn't found something that worked for me. Opioids.

I've tried gabapentin, pregabalin, duloxetine etc, but had terrible side effects with them all. I was at my wits end before I was put on opioids.

Re: OxyContin's 12-hour problem

#328

Post by rdancer »

dlitz wrote: post #223
KaiserPro wrote: post #182

There is a difference between marketing and actual use. Its a synthetic opioid, which means it has all the variability of opioids. Any decent doctor should know this, and the guides, if they were any good will indicate it. For example codamol is now not prescribed in a hospital setting for under 5s, after one child died because they had large amounts of the enzyme required to processes it all at once. This caused res…

> Any decent doctor should know this It sounds like they did, at first, and the manufacturer (ostensibly the experts on this particular drug) pushed back hard .

More like "nagged" than "pushed". The responsibilities of a salesman vs. doctor are clearly delineated. The salesman sells. The doctor must not outsource his decision making to the salesman.

What people underappreciate is that salespeople provide a vital role. Their job is to aid buyers in choosing what to do with their money. If doctors were susceptible to fraud of other underhanded sales tactics, that'd be alarming — they're the smart ones, are they not? But it's not that. They're not being duped. They succumb to corruption, or actively seek it.

Re: OxyContin's 12-hour problem

#329

Post by SeanDav »

cant_kant wrote: post #260

Sensible doctors do not believe drug company marketing. I get large amounts of ad-junk from drug companies that ends up unread in the bin. I refuse to meet with drug company representatives. I smile politely at them if I bump into them in the corridor and suggest that they leave their ad-junk with my secretary. My staff then file their ad-junk in the trash bin. On Friday, I had a drug company representative attempt t…

Depends on what you mean by "Sensible doctors". Clearly, doctors are influenced by marketing, otherwise pharmaceutical companies would not have spent and continue to spend, multiple millions of dollars targeting doctors.
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