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PT6A posted: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. There's at least a bit of a logistics issue here. A person who has been discharged from the hospital might not have someone who can take them back to the drug store if Tylenol/Advil doesn't work, so it at least makes sense to prescribe for worst case scenario.
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May 29, 2016 18:31
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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. They always ask even when there's a big sign behind me saying "no oxy/norco/Percocet/Vicodin/Xanax scripts". I walk to my car with my white coat on and have been hit up by people on the parking lot. There was a mess student who lived near the hospital that had to stop wearing their short white coat because they got harassed for opiates on more than one occasion just walking home.
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May 29, 2016 18:44
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bitcoin bastard posted:There's at least a bit of a logistics issue here. A person who has been discharged from the hospital might not have someone who can take them back to the drug store if Tylenol/Advil doesn't work, so it at least makes sense to prescribe for worst case scenario. Hadn't thought of that, I was just in a dental office so I would've had to go to a pharmacy to fill an actual prescription anyway.
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May 29, 2016 19:40
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PT6A posted:Hadn't thought of that, I was just in a dental office so I would've had to go to a pharmacy to fill an actual prescription anyway. Although your point is taken about common procedures getting a bit of an over-call in terms of painkillers, and I think there's a move in dental surgery to go from opiates to non-opiate management of routine procedures like wisdom teeth.
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May 29, 2016 19:50
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Albino Squirrel posted:Even in an outpatient situation, the general rule is to prescribe the painkiller that is usually required; although your patient could come back to ask for more powerful painkillers, it's an inconvenience for both them and the prescriber (also, they're in pain until they get the new drugs). Makes sense, I guess I got lucky with my extraction too (I had one other tooth pulled before I got braces, and it was about the same, but I guess other people have a more painful experience), so I'm not sure what painkiller would usually be required. It's way less painful than having my braces adjusted was, and they never gave me anything for that. I think age is an issue too. If I were in my late teens or early 20s, before my cousin died from an overdose and such, I probably would've requested opiate-based medication just to see what it's like. Now I realize it's just another thing I could become addicted to, so it's an option I'm perfectly happy to decline.
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May 29, 2016 21:21
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Albino Squirrel posted:Even in an outpatient situation, the general rule is to prescribe the painkiller that is usually required; although your patient could come back to ask for more powerful painkillers, it's an inconvenience for both them and the prescriber (also, they're in pain until they get the new drugs). It has a cultural component too. In America getting your wisdom teeth out means strong painkillers. In Britain it means 'go home, buy some OTC paracetamol'. People don't expect to get anything, so they don't miss it.
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May 29, 2016 23:40
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What's kind of funny about the wisdom teeth talk is that I actually consider that my first experience with IV drugs. When my dentist was talking to me, I expressed some interest in the IV cocktail they were planning to put me under with. My dentist offered to give me the IV Fentanyl first, so I could feel it before whatever benzo they use to actually put you to sleep kicked in. I said hell yes. The rush was insane, and I didn't experience anything like it again until the first time I shot Oxy.
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May 30, 2016 00:40
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I think I got some kind of morphine when I went to the hospital for appendicitis. Spent the majority of christmas eve puking and rolling around with stomach cramps but whatever they gave me made me go incredibly dizzy halfway through the syringe and I spent the rest of the night grinning at the wall in a wheelchair waiting to be x rayed.
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May 30, 2016 00:45
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dethkon posted:What's kind of funny about the wisdom teeth talk is that I actually consider that my first experience with IV drugs. When my dentist was talking to me, I expressed some interest in the IV cocktail they were planning to put me under with. My dentist offered to give me the IV Fentanyl first, so I could feel it before whatever benzo they use to actually put you to sleep kicked in. I said hell yes. The rush was insane, and I didn't experience anything like it again until the first time I shot Oxy. That, uh, seems really irresponsible.
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May 30, 2016 05:22
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PT6A posted:That, uh, seems really irresponsible. It was. What teenager is going to turn down a free high, Doctor approved? It was the most profound drug experience I ever had at that point. Looking back, I wouldn't be surprised if he was a drug "enthusiast" himself.
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May 30, 2016 05:58
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dethkon posted:It was. What teenager is going to turn down a free high, Doctor approved? It was the most profound drug experience I ever had at that point. Looking back, I wouldn't be surprised if he was a drug "enthusiast" himself. And to think I was a little concerned with the enthusiasm with which I was offered nitrous (which I had every intention of requesting anyway, even though I didn't really NEED it).
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May 30, 2016 15:23
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dethkon posted:It was. What teenager is going to turn down a free high, Doctor approved? It was the most profound drug experience I ever had at that point. Looking back, I wouldn't be surprised if he was a drug "enthusiast" himself. Interestingly, when you gently caress up and have to go into rehab as a doctor, there's something like a 90% success rate in maintaining sobriety. I think the difference between that and the general population is that a) there's immediate access to inpatient treatment which tends to last longer than publically-funded rehab; b) there's frequent and random drug testing to keep you honest, and c) the College holds your very lucrative career in the balance if you relapse.
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May 30, 2016 16:52
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Isn't part of it also that being an anesthesiologist is a pretty stressful job because of how fast things can go wrong?
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May 30, 2016 17:08
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jabby posted:It has a cultural component too. In America getting your wisdom teeth out means strong painkillers. In Britain it means 'go home, buy some OTC paracetamol'. People don't expect to get anything, so they don't miss it. OneEightHundred fucked around with this message at 18:11 on May 30, 2016 |
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May 30, 2016 17:46
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OneEightHundred posted:Saw something recently on this saying that a large problem is just opiate painkillers being prescribed for too long, and some new recommendations came out that they shouldn't be prescribed for more than a week. I don't know what the typical dentistry experience is, but I got 30 days of hydrocodone/APAP after getting my wisdom teeth out. I switched to 600mg ibuprofen after 2 days and was off painkillers after a week. So that's 23-28 days of unnecessary pills.
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May 30, 2016 17:48
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Albino Squirrel posted:My professional, medical opinion is that that is a loving retarded dose for wisdom teeth. No kidding. I was under the impression that codeine/related meds were generally ineffective wrt teeth pain. A handful of meperidine/promethazine is normal, yeah?
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May 30, 2016 17:59
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The_Book_Of_Harry posted:No kidding. I don't know why they didn't just start on prescription-strength ibuprofen and go to something stronger if that wasn't enough. AFAIK dentists and similar are one of the main "reliable" sources of prescription opiates though, so it's not that unusual.
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May 30, 2016 18:15
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Like I thought it was an exaggeration, but they really hand out opiates and other heavies like they were candy in the US  [edit] I've had wisdom teeth pulled, and after the local anaesthetic to the gums I was told to take non-prescription pain killers like ibuprofen if the pain got too much. Getting overloaded with opiate based pills which you don't even need seems absurd. Or a junkie's wet dream I guess. Nosfereefer fucked around with this message at 18:22 on May 30, 2016 |
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May 30, 2016 18:16
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Re: wisdom teeth chat: I was prescribed 2-4 weeks worth of Vicodin along with Tylenol when I had my wisdom teeth pulled as a teen. I remember that the Vicodin didn't do anything to help with pain and I was disappointed that they didn't "get me high" like other people who I had known who I guess were, uh, enthusiastic about Vicodin's intended effects so I just stick to taking only Tylenol. The main issue was accidentally knocking the gauze loose and getting blood everywhere in the first few days after surgery and to not gently caress with the stitching in the gums. 
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May 30, 2016 19:33
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Nosfereefer posted:Like I thought it was an exaggeration, but they really hand out opiates and other heavies like they were candy in the US Yeah, but see, if you end up a junkie, it's your fault because Personal Responsibility and Bootstraps and other Reasons.    (There really should be a smilie that fuses downs guy and patriot guy into one smilie).
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May 30, 2016 19:36
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Albino Squirrel posted:Oh man, anaesthesia attracts the enthusiasts like you wouldn't believe. One of my surgeon friends had to go searching for the anaesthetist because they couldn't find him for the start of surgery, only to find him in the OR bathroom, unconscious and tied off with a needle in his arm. "Doctor" is also a respected position in society so a doctor is more or less guaranteed to have a strong support group. Turns out that's one of the biggest indicators of whether a person will recover from addiction or not. The socially isolated probably don't feel much like they have anything going for them and go back to using. Plus just having somebody around that says "hey I care about you and don't want to see you do this to yourself" is a pretty strong motivator to get clean.
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May 30, 2016 19:41
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Albino Squirrel posted:My professional, medical opinion is that that is a loving retarded dose for wisdom teeth. I received 30 Percocets after a spill on some rocks took some skin off my leg/hands. No broken bones. I used 3.
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May 30, 2016 20:09
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Nosfereefer posted:Like I thought it was an exaggeration, but they really hand out opiates and other heavies like they were candy in the US
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May 30, 2016 23:03
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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? How did America overcome the first great opiate addiction crisis in the 20s and 30s?
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May 30, 2016 23:15
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gay rites posted:I received 30 Percocets after a spill on some rocks took some skin off my leg/hands. No broken bones. I used 3. Perhaps some form of incentivizing individuals to return unused drugs would be a good policy intervention? Package pills in single-use containers, pay individuals to return the unused portions, prescribe the unused portions to individuals on medical assistance.
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May 30, 2016 23:17
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ToxicSlurpee posted:The socially isolated probably don't feel much like they have anything going for them and go back to using. If you can find that kind of support, it's more satisfying and longer lasting than any drug. The main reason why I dived into opioids was because it feels like you've got a pair of arms around you. For awhile, anyway.
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May 31, 2016 00:13
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My Imaginary GF posted:How did America overcome the first great opiate addiction crisis in the 20s and 30s?
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May 31, 2016 00:15
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Guavanaut posted:Big rugs and a lot of sweeping. Why did America have an opiate addiction crisis in the 20s and 30s when so many other places did not? Wasn't it connected to Prohibition?
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May 31, 2016 00:26
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Was it the after effects of prohibition? I was just reading a little bit about the prohibition era, 15 states also managed to outlaw cigarettes during prohibition. I never knew that, it must have been a monumental task.
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May 31, 2016 00:27
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My Imaginary GF posted:Perhaps some form of incentivizing individuals to return unused drugs would be a good policy intervention? Package pills in single-use containers, pay individuals to return the unused portions, prescribe the unused portions to individuals on medical assistance. Although, that'd run into problems with insurance handling. Like, if the return is paid to the insurance company, nobody will bother. If the return is paid to insured, and the insurance company pays the deposit, then it'll be a fraud magnet. If the return is paid to the insured and the deposit is paid out of pocket, then the deposit becomes an out-of-pocket cost for any dose actually taken. OneEightHundred fucked around with this message at 02:00 on May 31, 2016 |
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May 31, 2016 01:53
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OneEightHundred posted:The FDA will never, ever permit redistribution of unused drugs for obvious safety and quality reasons, though a deposit/buyback on disposal might still be a good idea. gently caress the FDA. I'm connected to a few health ministers in ssa through project work, and I'm pretty goddamn certain their standards of quality and inventory control ain't up to FDA levels. What if we could solve drug access and affordability along the Swahili Coast, while also reducing the rate of opiate abuse in America by taking unused pills off the street? Now if that Monstanto/Bayer merger goes through, its even more of a loving win-win-win. Americans make money to take pills off the street; developing nations get access to quality prescription mediciation; Monsanto/Bayer makes money off leveraging drugs for access to developing nations' agricultural markets with their GMO products. gently caress insurance companies. They paid, why do they give a poo poo if you take 90 vicodins over 30 days or if you only take 3 after a surgery?
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May 31, 2016 02:00
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My Imaginary GF posted:gently caress the FDA. I'm connected to a few health ministers in ssa through project work, and I'm pretty goddamn certain their standards of quality and inventory control ain't up to FDA levels. e: Which is actually a problem with returning them even for disposal. Really, the simplest solution is to just not prescribe so drat much of it in the first place. OneEightHundred fucked around with this message at 02:11 on May 31, 2016 |
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May 31, 2016 02:05
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OneEightHundred posted:Let me put it this way: The moment some junkie switches the label on a bottle of Oxy with something else and returns it, the whole thing will go down in flames, and someone might get killed in the process. I have seasonal allergies and take Allegra D. The Allegra comes in these single-use packages that you have to pop a pill out of. Why not do the same for opiates, and ensure the package was unopened before shipping them off to the third world? While that may be the simplest solution, it ain't happening so better to figure out a way to work with an imperfect system than ignore an epidemic while seeking perfection.
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May 31, 2016 02:16
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The CDC's new recommended guidelines on opioid prescribing are really good. They're so good that I wish a lot of their points weren't just recommendations, but actually had some legal limits to reinforce them. http://www.cdc.gov/drugoverdose/pdf/pdo_checklist-a.pdf
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May 31, 2016 02:54
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Opiate prescriptions aren't just questionable for chronic pain they may be actively harmful. http://www.denverpost.com/2016/05/30/cu-boulder-study-narcotic-painkillers-cause-chronic-pain/. I wonder if Purdue has results like this that they put in the circular file when they were getting Oxycontin approved. They've already been fined for saying that it was less addictive than other pain pills but they could wind up like the tobacco companies if they hid data.
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May 31, 2016 09:44
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My Imaginary GF posted:gently caress the FDA. I'm connected to a few health ministers in ssa through project work, and I'm pretty goddamn certain their standards of quality and inventory control ain't up to FDA levels. What if we could solve drug access and affordability along the Swahili Coast, while also reducing the rate of opiate abuse in America by taking unused pills off the street? The rest of the world for the most part already has cheap, plentiful medication. America has expensive and scarce medication, by design. America's regulatory bodies limit licensing to drug importers, manufacturers, distributors, wholesalers and retailers. The licensing schemes grant essentially monopolies on certain drugs. When the licensed entity that handles a particular drug goes tits up, or has a massive regulatory compliance issue, or fucks up a huge batch of medicine, while inexpensive medication exists on the market abroad, it cannot be legally imported and scarcity occurs. When a licensed entity decides they need to make more money, they increase the price of a drug and make more money because nobody else can sell it for less. Take albendazole for example. It treats parasitic worm infections. It's a common medication which has been in use around the wold for nearly 50 years and costs pennies per pill in most parts of the world. In America, albendazole's distribution is licensed to one entity, Amedra Pharmaceuticals. They sell it for $85 a pill. If they run out, you don't get it. You could go to Mexico and buy a 100 count bottle of the poo poo for a few bucks right now. In fact, if you have a large family and you all get an infection at the same time, it could be cost effective to jump on a jet, fly to Mexico, buy the pills, then fly back and treat your family with your effective but illegal medication. As for taking pills back off the street, Americans already do this in large numbers. Granted, they typically take them off the street then swallow, smoke, snort or inject them, but they're getting used rapidly. The primary issue I see with redistributing patient medication is counterfeit drugs. Counterfeit drugs a thing that sort of exists now, but they're very difficult to inject into the supply stream because there's so much oversight. If there was reverse distribution from patients to pharmacies, it opens up huge opportunities for drug counterfeiters as sketchier pharmacies wouldn't need to maintain as complete a paper trail as to how, where and when they sourced their drugs. I've also heard recommendations to make opioids more expensive to suppress the secondary market, but naturally most of the secondary market comes from prescriptions which are covered by insurance at low or no cost to the patient, and would have no other impact aside from inflating health care costs further.
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May 31, 2016 14:53
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Well, I just had my first recent sudden death relation due to drugs.  It pretty much loving blows.
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Jun 1, 2016 06:04
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I went to an urgentcare for a ridiculously sore throat (I couldn't even sleep, and had a spit-jug next to me at all times). They tested me for strep, and it came back negative. Then they prescribed antibiotics anyway because 'sometimes the test is wrong', and also gave me a prescription for hydrocodone cough syrup. I ended up buying a pack of benzocaine lozenges.
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Jun 1, 2016 18:21
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My Imaginary GF posted:Perhaps some form of incentivizing individuals to return unused drugs would be a good policy intervention? Package pills in single-use containers, pay individuals to return the unused portions, prescribe the unused portions to individuals on medical assistance. You can't regift drugs after they've left the pharmacy. Unit dose maybe, but even then it varies. Takeback programs are only now expanding beyond law enforcement. Until very recently pharmacies were not allowed to take controlled substances back. Edit: People already explained it better than I did. But the real problem isn't the FDA, it's the DEA. Doubling down on failed policies isn't helping anyone. reagan fucked around with this message at 02:05 on Jun 2, 2016 |
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Jun 2, 2016 01:59
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reagan posted:You can't regift drugs after they've left the pharmacy. Unit dose maybe, but even then it varies. Takeback programs are only now expanding beyond law enforcement. Until very recently pharmacies were not allowed to take controlled substances back. That's a bit odd because where I live I think just about any pharmacy will accept drugs for disposal. You could do what my granny used to do I guess and dissolve them then flush them but it's probably not very good for the water supply.
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Jun 2, 2016 02:07
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