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deoju posted:The Governor of Maine vetoed a bill that would make naloxone more available yesterday because... Do recall, though, that the governor of Maine is one of the stupidest people without a clinical diagnosis of deficiency. Edit: your link is broken.
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Apr 23, 2016 08:09
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deoju posted:Making something less lethal lets it cause more harm? Got it. What we should be doing is make it more lethal, that way it won't cause any harm. See also adding acetaminophen to codeine and similar. You can "discourage abuse" by killing the poo poo out of people.
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Apr 23, 2016 11:02
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Grundulum posted:Do recall, though, that the governor of Maine is one of the stupidest people without a clinical diagnosis of deficiency. Yes, but he keeps finding new and interesting ways to express it! Here's a fixed link so you don't have to go back a page.
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Apr 23, 2016 13:01
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moller posted:See also adding acetaminophen to codeine and similar. You can "discourage abuse" by killing the poo poo out of people. Well sort of. There is evidence out there that adding acetaminophen to opiates increases the analgesic efficacy. We often give iv Tylenol to post op patients on pca pumps for this very reason.
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Apr 26, 2016 05:29
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moller posted:See also adding acetaminophen to codeine and similar. You can "discourage abuse" by killing the poo poo out of people. That's not why the add acetaminophen to codeine or other opiates. Dying of acute liver failure from Tylenol OD is ugly. Real ugly, and expensive. Like days to weeks of ICU and slow decline plus or minus a liver transplant and a lifetime of followup and immunosuppression. Lot cheaper to just OD on the opiate, usually.
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Apr 26, 2016 16:06
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This is a really good documentary on the subject. I posted this in the opiod thread in TCC if I missed it being posted earlier I apologize. http://www.pbs.org/wgbh/frontline/film/chasing-heroin/ My take on this is that they did a really good job of showing the desperation and backed-into-a-corner mentality that a lot of addicts have. You have health professionals and cops, families and junkies themselves who are all desperate to do something, anything to loosen heroin's grip. Hiccups in social services, laws and how they're enforced, potency fluctuations and the sheer hopelessness and magnitude of the crisis all help contribute to a sad, lovely feedback loop and the bottom line is nobody has a system or program or treatment plan that works. Edit: there are some really, really graphic scenes of people shooting up, their faces changing, slamming dope into the neck veins. kliksf fucked around with this message at 18:59 on Apr 26, 2016 |
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Apr 26, 2016 18:52
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Rhandhali posted:That's not why the add acetaminophen to codeine or other opiates. Dying of acute liver failure from Tylenol OD is ugly. Real ugly, and expensive. Like days to weeks of ICU and slow decline plus or minus a liver transplant and a lifetime of followup and immunosuppression. From a regulatory standpoint, acetaminophen is absolutely added to opiates as a poison. There are clear downsides to combination products(unable to change doses for example, is it ideal that a patient would have to supplement with OTC tylenol if they decide to reduce their opiate dose) as opposed to taking two separate pills. The regulators obviously don't intend for patients to overdose on acetaminophen but rather want patients to recognize acetaminophen toxicity and refrain from any increased use of the combination product.
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Apr 27, 2016 03:07
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Rhandhali posted:That's not why the add acetaminophen to codeine or other opiates. Dying of acute liver failure from Tylenol OD is ugly. Real ugly, and expensive. Like days to weeks of ICU and slow decline plus or minus a liver transplant and a lifetime of followup and immunosuppression. Although assuming for profit healthcare the former is much more lucrative than the latter. Is APAP's usage as an abuse deterrent just a persistent urban legend? I mean, a quick google turns up hundreds of lay sources but not a single drug company or journal article saying "we add this so you die before you get a buzz." An opiate user could build up quite a tolerance over time and a neophyte could likely survive a heroic (10x?) dose of hydrocodone etc but the shockingly low LD50 of acetaminophen never changes. Also, the FDA has been issuing recommendations regarding lowering the amount of APAP in combination pain killers and pharmaceutical companies have responded by introducing new anti-abuse methods such as changing the physical structure of the pills to make them difficult to chop or dissolve. It seems that if the response to a scaling back of APAP in opiates is research into new abuse deterrents then the APAP was there, at least in part, as an abuse deterrent. I have no horse in this race because I don't know any hopheads, but it seems like such a weird confluence of factors if the combo meds are purely benign.
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Apr 27, 2016 06:12
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Knifefan posted:From a regulatory standpoint, acetaminophen is absolutely added to opiates as a poison. There are clear downsides to combination products(unable to change doses for example, is it ideal that a patient would have to supplement with OTC tylenol if they decide to reduce their opiate dose) as opposed to taking two separate pills. The regulators obviously don't intend for patients to overdose on acetaminophen but rather want patients to recognize acetaminophen toxicity and refrain from any increased use of the combination product. As a bonus, you have people doing kitchen chemistry to remove the acetaminophen, which introduces a whole new set of risks.
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Apr 27, 2016 06:47
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moller posted:Although assuming for profit healthcare the former is much more lucrative than the latter. Formulation decisions regarding controlled substances are often driven by scheduling concerns. A component of the formulation of Acetaminophen/Opiate combination products was a desire to avoid a Schedule II classification(although this point is now moot and the combination products exist mostly due to regulatory inertia). From the Controlled Substances Act Section 811 (g): Controlled Substances Act posted:(3) The Attorney General may, by regulation, exempt any compound, mixture, or preparation containing a controlled substance from the application of all or any part of this subchapter if he finds such compound, mixture, or preparation meets the requirements of one of the following categories:
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Apr 27, 2016 07:07
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Konstantin posted:As a bonus, you have people doing kitchen chemistry to remove the acetaminophen, which introduces a whole new set of risks. Well not really kitchen chemistry. It just involves water and a very fine cheesecloth.
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Apr 27, 2016 08:12
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Fun thing about street value: Tylenol #3s go for a couple of dollars a pill up here. Generic acetaminophen/codeine pills of the same strength go for about a dollar. And codeine 30s go for about 50 cents. It makes no sense to me, because it's the same amount of codeine in each pill. I presume there is some pain benefit to the acetaminophen (and it probably predominates if you're opioid tolerant) but it doesn't explain the 'brand value' of T#3s. I make it a point to usually prescribe codeine pills, partly because I don't want people overdosing on acetaminophen (which is a horrible death), but also because I don't want my patients selling their pills for coke.
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Apr 27, 2016 17:17
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Albino Squirrel posted:Fun thing about street value: Tylenol #3s go for a couple of dollars a pill up here. Generic acetaminophen/codeine pills of the same strength go for about a dollar. And codeine 30s go for about 50 cents. Tylenol's probably more expensive to get, just like how generics are cheaper in a real drug store too.
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Apr 27, 2016 17:19
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Albino Squirrel posted:Fun thing about street value: Tylenol #3s go for a couple of dollars a pill up here. Generic acetaminophen/codeine pills of the same strength go for about a dollar. And codeine 30s go for about 50 cents. Where the gently caress do you live? Can't GIVE away those fuckers in my hood.
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Apr 28, 2016 12:35
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Here's a story regarding APAP and Hydrocodone I thought was illuminating: Back when I worked at a dispensary there was a doctor who wrote recommendations for cannabis and he ended up losing his medical license. The case grew out of a divorce proceeding and apparently at some point while they were married he wrote his wife a total of 4 prescriptions for Vicodin between a Thursday and following Monday. In the records of the hearing that resulted in the revoking of his license it was noted that the amount of acetaminophen prescribed over that short a period of time was enough to expose his patient to liver toxicity and possibly death and was deemed grounds to prevent the doctor from practicing medicine. Nowhere in the proceedings, which were all public record, nowhere was it mentioned that he wrote a script for his wife, nowhere did they mention the controlled substances aspect, either of which I imagine would be enough to cost you your license, but the explicit reason on the web site for stripping the doctor of his license was essentially tylenol poisoning.
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Apr 28, 2016 18:38
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kliksf posted:Nowhere in the proceedings, which were all public record, nowhere was it mentioned that he wrote a script for his wife, nowhere did they mention the controlled substances aspect, either of which I imagine would be enough to cost you your license, but the explicit reason on the web site for stripping the doctor of his license was essentially tylenol poisoning. Isn't that partially because Tylenol poisoning is one of those no-poo poo, will kill you and there's nothing we can do things? I know we had a researcher on post use Tylenol overdose as a way to kill himself, and it was surprising that it both worked so well and was such a long and excruciating way to die.
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Apr 28, 2016 19:13
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rkajdi posted:Isn't that partially because Tylenol poisoning is one of those no-poo poo, will kill you and there's nothing we can do things? I know we had a researcher on post use Tylenol overdose as a way to kill himself, and it was surprising that it both worked so well and was such a long and excruciating way to die. Depends on when they show up. If they walk up to the emergency room and say "I ate a bottle of Tylenol" they can get a big load of charcoal and that helps bind up the big wad of drug they have lying in their stomach and keeps it from being absorbed. On top of that you infuse acetylcysteine which limits the damage that Tylenol does to the liver. It's not an antidote like narcan or flumazenil but it basically supports the liver while it processes all the extra Tylenol. You keep pumping them full of acetylcysteine until the Tylenol levels drop to a certain level. It works really well, and if a patient shows up early enough they'll (probably) be fine. We see a lot of it and we've gotten good at treating it, something like 96% of patients who have an acute OD do fine if the get therapy in a timely manner The people that don't do well are the ones that wait too long or have a combined OD , pass out and are found down hours later. Or the ones that are chronically overdosing and show up already in liver failure. Tylenol is tremendously safe when you stay at or beneath the recommended dosages, we use it even in chronic liver failure patients who are yellower than a taxi, albeit at a lower dose.
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Apr 28, 2016 20:42
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kliksf posted:Here's a story regarding APAP and Hydrocodone I thought was illuminating: Writing a script for your wife is discouraged but not something that you would lose your license or even go before a disciplinary board. Writing a controlled substance for your wife for the purpose of pain control would potentially run into regulatory issues and subsequently have ethical / legal disciplinary proceedings because you have to have a ton of clinical documentation. Writing four scripts over the course of four days thereby giving a toxic dose of acetaminophen is not excusable in multiple facets any way you cut it. In short, why charge the guy for tax evasion when you got him dead to rights on murder?
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Apr 28, 2016 23:56
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I'd like to hear some information if anyone here knows about Vivitrol. It's a newer opioid antagonist that I'm optimistic about. I've seen a few clients have great results with it, but my knowledge about it is only anecdotal.
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Apr 29, 2016 02:55
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Just had an inlaw die of a methadone, ambien, xanax drug interaction. He had gone the prescription opiates to heroin route over a little less than a decade and was finally seeming to get his poo poo together. Apparently it is a stop breathing in one's sleep sort of a thing.
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Apr 29, 2016 04:02
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BrandorKP posted:Just had an inlaw die of a methadone, ambien, xanax drug interaction. He had gone the prescription opiates to heroin route over a little less than a decade and was finally seeming to get his poo poo together. Apparently it is a stop breathing in one's sleep sort of a thing. Sorry for your loss. Goddamn it, kids. Don't mix benzos and opioids...no matter how good it may feel. And despite the lifesaving potential of methadone, if you take it with too many bars, you will flop. Some people (like my ex) do it all day, every day. A startling number of others simply die.
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Apr 29, 2016 04:43
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Yeah, sorry. Maybe somebody can spell out the specifics with data, but the deaths usually involve taking other depressants (esp. bezos) or, less commonly, just taking too much, either because there is fentanyl in it and/or because it's a relapsing and tolerance is down and/or because they just push it.
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Apr 29, 2016 14:58
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The "this life" podcast (Dr. Drew, Bob Forrest) had Bruce Heischober as a guest and the first half they talked about the practical factors involved with opiates and the healthcare system. They have a range of opinions and experiences and it was interesting. http://podbay.fm/show/1058592078/e/1463424987 The second half is less thread-relevant and more about Carolla-land.
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May 26, 2016 14:53
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Albino Squirrel posted:I should preface this by saying that I'm a doctor in an inner-city clinic in Western Canada. Although I'm a family doctor by training, the nature of my clientele means that I spend about half my time dealing with either addiction, chronic pain, or both. We have an explicit harm-reduction focus, and run opioid maintenance programs in addition to a needle exchange. You're ABSOLUTELY right that people who are ready to get better do, and those that don't don't. It's no secret that I spent many, many years addicted to heroin, oxy, et al. It's all in my TCC post history I'm sure. I used to swear that Buprenorphine "didn't work" too, when I was younger. It's bullshit, of course it works. Give somebody who's been in full blown withdrawals for 72 hours a Suboxone and ask them to talk that nonsense, they'll be begging for it. Yes, it's also possible to shoot through the blockade effect if you wait long enough and do a big enough shot, but so what? If people still want to get high they'll find a way. Here's the thing that gets me: There is absolutely NO excuse for anyone to be addicted to opiates in the US or Canada. It's the ONLY class of drug that has a legal, state sponsored maintenance program to switch to, and with options! It's not like alcoholics, crack addicts, or meth freaks have anything like that- we should be so lucky! If you want to stop using and make sure that you can't (easily) relapse, get on Suboxone. If you want to get off the needle but still like getting stoned, go on methadone. Years ago I decided to go to the methadone clinic, and I stayed high for 9 straight months, and for only $12 a day. But I wasn't interested in stopping using, I was just looking for a cheaper option- obviously methadone can be a very effective tool to get clean, if used responsibly. Anyway, about 3 years ago I decided that I didn't want to be a junkie anymore. I went to suboxone.com, found a doctor, went the same day, and I haven't touched a bag of dope since. I don't miss heroin, I don't have cravings. I just take my dose every day and let it do what it's supposed to do. In my opinion and experience, a lot people use opiates because they are depressed and want to feel better, or they just love getting high all day. And they're probably depressed and looking to get high all day because they don't have anything to do. Bring jobs back and people will quit doing so much dope. Edit: Here's a sign that's on the front door of the pharmacy I go to. Florida, of course: 
SOME PIG fucked around with this message at 08:06 on May 28, 2016 |
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May 28, 2016 07:43
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pangstrom posted:The "this life" podcast (Dr. Drew, Bob Forrest) had Bruce Heischober as a guest and the first half they talked about the practical factors involved with opiates and the healthcare system. They have a range of opinions and experiences and it was interesting. Thanks for the link. e: Oh poo poo it's Dr. Bruce! I haven't heard him since he used to fill in for Drew in the Loveline days when I was a teenager. SOME PIG fucked around with this message at 10:53 on May 28, 2016 |
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May 28, 2016 07:43
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I just got a wisdom tooth out (normal extraction with no complications under local anaesthetic) and I was offered Tylenol 3 for the post-extraction pain. I didn't take it, opting instead for Ibuprofen, and I haven't even taken those as much as I theoretically could because there's very little pain (I'm taking it twice daily, mainly to reduce inflammation, instead of 4 times per day). If people are being prescribed opiates for this level of "pain" which amounts to a slight stiffness in my jaw, I'm not particularly surprised we have an addiction epidemic. I have a lovely pain tolerance, too. Now, if they gave me some anxiety meds to deal with my constant concerns that I'm going to be careless and dislodge the clot and get dry socket, I'd not say no. PT6A fucked around with this message at 13:58 on May 28, 2016 |
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May 28, 2016 13:56
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dethkon posted:Edit: Here's a sign that's on the front door of the pharmacy I go to. Florida, of course: I worked at an independent pharmacy that should have had that sign posted. That was a loving rodeo.
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May 28, 2016 17:20
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My friend is a psychiatrist and multiple well-to-do parents of his son's friends have broached the topic with him; he says usually they start with a "kidding" move and then a less kidding question. He just says "I don't prescribe opiates" pre-emptively now .
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May 28, 2016 18:30
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Why would a psychiatrist prescribe opiates? Or do you mean as part of a treatment program for someone who's already addicted?
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May 28, 2016 19:03
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pangstrom posted:My friend is a psychiatrist and multiple well-to-do parents of his son's friends have broached the topic with him; he says usually they start with a "kidding" move and then a less kidding question. He just says "I don't prescribe opiates" pre-emptively now . What psychiatric condition does vicodin treat, post-yoga delirium?
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May 28, 2016 19:04
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PT6A posted:I just got a wisdom tooth out (normal extraction with no complications under local anaesthetic) and I was offered Tylenol 3 for the post-extraction pain. I didn't take it, opting instead for Ibuprofen, and I haven't even taken those as much as I theoretically could because there's very little pain (I'm taking it twice daily, mainly to reduce inflammation, instead of 4 times per day). a year later, i got the other three out and only one of them hurt, but it was the worst pain id had in my life and it didnt slow down for a week. i called my surgeons office and was told to just double up on the pain pills, which helped til i ran out after two days. i got a refill and once i stopped bleeding daily from it i was o k i didnt get addicted til years later when i had a disk in my back go out and the sciatica kept me in bed for months
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May 28, 2016 19:51
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PT6A posted:Why would a psychiatrist prescribe opiates? Or do you mean as part of a treatment program for someone who's already addicted?
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May 29, 2016 01:22
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pangstrom posted:He doesn't / wouldn't, but people ask. There are some fringe-y treatments for anxiety and mood disorders and yeah maintenance from an addiction specialist would be the only typical situation as far as I know. I know addiction is an illness, not a moral or personal failing, but good lord does it seem to be correlated with stupidity in a lot of cases. Will they literally ask anyone with access to a prescription pad or what?
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May 29, 2016 01:50
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PT6A posted:I know addiction is an illness, not a moral or personal failing, but good lord does it seem to be correlated with stupidity in a lot of cases. Will they literally ask anyone with access to a prescription pad or what? When you're addicted, access to your drug is right at the bottom of Maslow's Hierarchy of Needs for you. If you're out of your drug, you don't particularly care about not looking stupid.
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May 29, 2016 02:44
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Ratoslov posted:When you're addicted, access to your drug is right at the bottom of Maslow's Hierarchy of Needs for you. If you're out of your drug, you don't particularly care about not looking stupid. Opiate addiction is also exceptionally nasty because once you get that physical addiction rolling your brain is telling you that you are literally going to die if you don't get any opiates. From what I've read it's worst than feeling like you're starving to death, which is why heroin addicts can want drugs more than food. Opiate addiction is loving brutal.
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May 29, 2016 02:49
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Ratoslov posted:When you're addicted, access to your drug is right at the bottom of Maslow's Hierarchy of Needs for you. If you're out of your drug, you don't particularly care about not looking stupid. Asking for money from a friend/acquaintance would seem to be a more effective way of getting drugs than to ask a doctor to do something outright illegal, though. I'd rather give an addict money than risk my own freedom by actually supplying the drugs. Of course, I'd probably try to avoid either one.
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May 29, 2016 03:00
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ToxicSlurpee posted:Opiate addiction is also exceptionally nasty because once you get that physical addiction rolling your brain is telling you that you are literally going to die if you don't get any opiates. From what I've read it's worst than feeling like you're starving to death, which is why heroin addicts can want drugs more than food.
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May 29, 2016 03:01
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PT6A posted:I just got a wisdom tooth out (normal extraction with no complications under local anaesthetic) and I was offered Tylenol 3 for the post-extraction pain. I didn't take it, opting instead for Ibuprofen, and I haven't even taken those as much as I theoretically could because there's very little pain (I'm taking it twice daily, mainly to reduce inflammation, instead of 4 times per day). I got Tylenol 3s after my wisdom tooth extraction; didn't do a drat thing for my pain but it did make me puke all over my parents' minivan. Also learn from my mistakes, don't have nachos for a few months. PT6A posted:Asking for money from a friend/acquaintance would seem to be a more effective way of getting drugs than to ask a doctor to do something outright illegal, though. I'd rather give an addict money than risk my own freedom by actually supplying the drugs. Of course, I'd probably try to avoid either one. Guavanaut posted:That's also where it gets ethically difficult in terms of terminal illness though. What do you do when someone is at a state where it's arguably true that getting an extra hit of IV diamorphine is beneficial from a whole-life suffering point of view compared to being fed?
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May 29, 2016 05:11
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I don't think there's anything wrong with keeping opiates as an option, but I do see a problem with handing them out as desired before the patient even knows what level of pain they're dealing with. The local anaesthetic didn't come out until a few hours after I was asked what kind of pills I wanted. If the pain was so bad that Ibuprofen wasn't enough, I'd have gone right back to the dentist to have him give me something stronger, of course, and that's perfectly reasonable, I'm just saying that opiates shouldn't be a default option.
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May 29, 2016 05:26
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ToxicSlurpee posted:Opiate addiction is also exceptionally nasty because once you get that physical addiction rolling your brain is telling you that you are literally going to die if you don't get any opiates. From what I've read it's worst than feeling like you're starving to death, which is why heroin addicts can want drugs more than food. That is nonsense. When you are starving your body releases endorphins to deal with the stress, withdrawal is like having the flu.
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May 29, 2016 18:13
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