BS: The opioid problem

Subject: BS: The opioid problem
From: Donuel
Date: 02 Jun 16 - 08:16 PM

If you need it, take it but if you take it, you will need it.

Some factoids;

Any mixture of alcohol with Percocet is hazardous from both the Tylenol and the opioid.

Oxycodone does not include Tylenol and comes in 5, 10, 20 and 30 mg.
A small dose of 5mg twice a day in an alcohol free lifestyle is relatively safe. Once doses go higher so do the hazards.

OxyContin is a time release form of opioid and is heavier effect for a longer time than Oxycodone.

Fentanyl is stronger than morphine or heroin, some say 100 times more powerful. The hazards with or without alcohol are most assuredly dangerous and possibly fatal.


Stopping the use of Opioids:

It requires about 18 days or more to feel good after stopping opioid use. This is difficult for the working poor to take the better part of a month off to withdrawal. Withdrawal can be compared to the flu that lasts 2 weeks or more.

Anyone who says no one can do it themselves are selling something.
Family support is naturally a great benefit.


.............


Like the fictional Soma that enhanced the power of Big Brother's control, opioids are a sure fire best seller for drug companies while dumbing down the users.

Vicodin Hydrocodone fits into the opioid hierarchy but is more likely to have more variable results with different people.

To those who need it, don't worry, a well managed regime by a respondsible doctor can be quite safe.

For those who don't need it but use it, stop all increased doses and do not even try Fentanyl. Then stop and suffer the flu.

Subject: RE: BS: The opioid problem
From: keberoxu
Date: 02 Jun 16 - 08:22 PM

Massachusetts has a notorious problem of deaths from opioid overdoses, it is an ongoing feature story in mass media here.

Subject: RE: BS: The opioid problem
From: Janie
Date: 02 Jun 16 - 08:59 PM

Long term opioid addiction has long term rebound effects. Severe anxiety is a long term post withdrawal effect that many people experience. Good idea to get into cognitive/behavioral treatment to learn to reduce and manage this. Too many former addicts end up relying on, and sometimes abusing benzos as a result, or end up 'going back out' because, for good reason, doctors won't prescribe benzos long term. And abrupt benzo withdrawal for people who take high doses, prescribed or otherwise, can be lethal, unlike opioid withdrawal.

A word here though, re addiction. There is a difference between physical dependence and addiction. There are many medications and substances, not just medications with potential for addiction, on which people can develop a physical dependence, meaning abrupt cessation vs tapering of dose will lead to withdrawal symptoms. In addiction, the person also has a psychological craving for the drug and will seek higher and higher doses to get the psychological effect of the drug. For long time addicts or alcoholics, it may eventually not be about feeling high, but just feeling 'normal.'

There is no doubt there is an epidemic of opioid addiction going on, and heroin has made a big comeback as the street supply of prescription opioids has been further reduced by state and federal policies. Because the addiction has for a number of years now also spread into the middle socioeconomic class, it is getting a lot more attention.

Hard, if not impossible to put the cat back into the bag. I think harm reduction programs such as methadone and suboxone clinics make more and more social sense. They need to be well run and well supervised.

There is also the real need for good management of severe chronic pain, and opioids are always going to be part of that equation. The difficult piece there, and one which needs more research and much better training of clinicians as well as national policies, is how to help people with severe chronic pain who are also addicts. Intervention and support for families of addicts is sadly lacking.

Subject: RE: BS: The opioid problem
From: Steve Shaw
Date: 02 Jun 16 - 09:16 PM

Two years ago my doctor prescribed tramadol for my back pain. I won't go into all the gory details, but within three weeks I was physically dependent. It took me three hellish nights, thrashing around on the downstairs sofa with no sleep, sweating like a pig, constipated like hell, to get myself back on to anything like an even keel. You have been warned

Subject: RE: BS: The opioid problem
From: Janie
Date: 02 Jun 16 - 10:05 PM

Steve's post makes clear that pain management needs to be very individualized.

In most parts of the USA, good pain clinics have long waiting lists and bad pain clinics are pill factories.

And most Primary Care practices are not trained or equipped to treat even acute pain, and decline to prescribe opioids at all out of fear and the hassle when some one is an addict.

I think I am probably not the only person on Mudcat who did a lot of drugs when young. Fortunately, and probably just because of genetic factors, I never developed an addiction to opioids. I never thought it was fun to feel nauseous or to actually puke. After my accident last fall I was on IV morphine for several days, then on oral opioids for about two weeks post surgery on a regular schedule while in the nursing home for rehab, then a prn dosage regimen. After about a week of the original introduction of opioids I did not need medication to counteract the nausea. After I got home I took a low dose at night when the pain was sufficient to keep me from sleeping for about another week, then stopped all together with no problem because I did not need them anymore. I also have a high tolerance for chronic moderate pain. That is probably also genetic combined with social learning or maybe a stoic personality. I have low tolerance for severe, acute pain and am grateful for the opioids during that time when the acute pain was otherwise intolerable.

I have clients and a few family members with medical conditions thst require long-term opioid pain medications who manage them quite well and without addiction, though would definitely need taper schedule to come off of them because of physical dependence. I also have family members and clients who are or have been addicted.

Subject: RE: BS: The opioid problem
From: Donuel
Date: 02 Jun 16 - 10:17 PM

Janie you are well informed but there seems to be a slight edge of dogma in your claim of, hard if not "impossible" claim. Also drug abuse cessation spas that advertise on TV make self serving propagandistic claims.

Benzos? Benzedrine the stimulant?

Steve, 3 days on the couch? Sounds better than a drug replacement spa at 5 grand a week.

I do not condemn all spas but I am against preaching anything that robs people of their own independent power and self determinism.

Subject: RE: BS: The opioid problem
From: Janie
Date: 02 Jun 16 - 11:26 PM

Sorry you understood my post in that way, Donuel. I'm pretty sure I am not dogmatic. I currently work as a mental health clinician for a non-profit that historically treated only substance abusers, is still primarily substance abuse in it's philosophy, and too dogmatic and behind the times and current research in it's over-reliance on the 12 step model as the only way.

What I mean by 'cat out of the bag' is that drug abuse in general, and opioid abuse in particular are now so wide spread within our society that a national approach that insists on abstinence only, versus harm reduction for some is bound to fail.

Subject: RE: BS: The opioid problem
From: Donuel
Date: 03 Jun 16 - 01:53 AM

No you are not dogmatic, the current treatment options are a bit top heavy. You wrote of the actual state of the art of healing exactly where it is right now.

Anyway I was still writing regarding your first post when you finished your second detailed and honest account of your experience. One sentence takes me many minutes sometimes.

The 12 step programs which are as effective as no program at all (5%) is what is dogmatic.

What is good is that I have learned some new things.

now you know I like to kibbutz.

Subject: RE: BS: The opioid problem
From: Janie
Date: 03 Jun 16 - 06:30 AM

I forgot to answer your question re benzos. Benzodiazepines. A class of medicines used to treat anxiety and as a muscle relaxer. Valium (diazepam), Xanax (alprazolam), Klonopin (clonazepam), and Ativan (lorazepam) are common examples.

Subject: RE: BS: The opioid problem
From: Donuel
Date: 03 Jun 16 - 07:07 AM

Janie, Does your hospital know that you make an excellent spokes person and media manager?

Subject: RE: BS: The opioid problem
From: mkebenn
Date: 03 Jun 16 - 09:23 AM

People's body chemistry varies so. My friend will take loritabs if he can get them, and he says they give him energy? I played with cke in the '80s and never felt any physical need for it. DID NOT try crack when offered, so am not sure if the instant addiction is justified. The opioid problem in my part of the U.S. is that when the person can no longer access the drug legally, they turn to street heroin with it's problems of purity and all. Mike

Subject: RE: BS: The opioid problem
From: Jeri
Date: 03 Jun 16 - 11:13 AM

I get a small number of Percocet for migraines that don't go any other way. I get tested for other drugs, and the VA has a pretty good monitoring problem. A person could probably get around it, but I don't want to be addicted and I hate the feeling of not being in control. While I've definitely felt the pull, the system seems to keep me from falling into that hole. It takes a medical profession OK with being the grown-up and saying "no more for you" and a patient willing to trust them. Obviously, there is a load of potential for this to all go sideways.

Subject: RE: BS: The opioid problem
From: Janie
Date: 03 Jun 16 - 09:02 PM

You make a good point, Jeri, though it is a bit more complicated than saying 'no more for you.' Especially for small private practices. It takes education, training and resources - all things many practices lack and do not have the time or resources to acquire.

Front desk staff needs trained also. Addiction doesn't happen overnight. Doctors want to help and to heal. And drug seekers can be very persistent. As I mentioned above, some addicts also have chronic pain.

There are no easy answers or one size fits all approach. Sounds like your VA clinic/facility has a reasonable approach that involves a clear contract between prescriber and client/patient.

Subject: RE: BS: The opioid problem
From: Rapparee
Date: 03 Jun 16 - 09:37 PM

I brought myself off clonazipam a couple years ago at my doctor's suggestion. I simply reduced the dosage over three or four weeks and gave whatever was left to the local cop shop for disposal.

I do not like to use opioids, but I will if I must (e.g., post surgery). And I always as the doctor for the smallest possible dose.

As a side note, the Veterans Administration severely limited access to hydrocodone, oxycontin, and similar drugs a couple years ago. They are available, but primarily post in-house surgery or for veterans in constant pain from injuries.

Subject: RE: BS: The opioid problem
From: Janie
Date: 03 Jun 16 - 10:06 PM

Sounds like the VA has developed a sound approach. Includes elements of a programmatic approach that includes clear contracting with the patient and that can be adapted to the individual needs of the patient based on full and careful evaluation.

Subject: RE: BS: The opioid problem
From: leeneia
Date: 04 Jun 16 - 12:33 AM

I've just started a book called "The Unbroken Brain", and it has a lot of interesting and surprising facts about drug use and addiction. See if your library has it.