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Subvisual Haze posted:I once had a patient in my pharmacy who was on chronic Hydrocodone-APAP at a fairly high scheduled dose (but not extremely high). She expressed to her PA that she would like to lose weight so her PA prescribed her Contrave, an exciting new weight loss medication that he must have heard about in a commercial. Contrave contains bupropion and naltrexone as its active ingredients. Naltrexone blocks opioid receptors. This was the same PA who was prescribing her Hydrocodone. As a side note, if someone is on chronic acetaminophen + an opiate, after a while the entirety of the analgesic effect comes from the Tylenol. The opiate is just so they don't go into frank withdrawal.
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Jan 22, 2017 01:37
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Albino Squirrel posted:Look, the naltrexone blocks the hydrocodone, which gives her withdrawal, which gives her the shits, which leads to weight loss! What's so hard to understand here buddy! It happens more often than I'd like to admit. It's a joke line I like to use when I'm precepting pharmacy students or residents "but [Drug A] is for X, and[anti-Drug A] is for y!" As if your body gives a poo poo what the intended purpose of the chemicals are. Like the patient on tamoxifen (an estrogen blocker to help prevent or slow growth of breast cancer) who complained to their doctor about hot flashes and got a prescription for estradiol. At least that one involved two different prescribers 
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Jan 22, 2017 02:09
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Jan 22, 2017 02:44
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To be fair to the docs, from what I know pharmacology isn't really the meat of their training. They know what to prescribe to treat conditions, but not the many different interactions and synergies and delicious metal taste in your mouth issues can crop up. That's more for the pharmacists of the world to figure out when they're being dispensed. That said, are drug reps as.. well, shady, as I understand them to be in the US? I believe Canada has a much different system that drug reps work in, and if you ever attended a lunch and learn, you know most drug companies buy you wicked good food.
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Jan 22, 2017 04:29
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spliffaz posted:To be fair to the docs, from what I know pharmacology isn't really the meat of their training. They know what to prescribe to treat conditions, but not the many different interactions and synergies and delicious metal taste in your mouth issues can crop up. That's more for the pharmacists of the world to figure out when they're being dispensed. I had that happen to me a few years ago. I was on Lexapro and Welbutrin, then my doc added trazodone for my chronic insomnia. Didn't check about possible interactions, guess the pharmacist didn't either, and I developed Serotonin syndrome (got every symptom short of seizures and death). I ended up hospitalized for nearly a week, and my dad contacted a pharmacist he knew who was flabbergasted that not only was I prescribed that combination by a doctor, but that my pharmacist didn't red flag it.
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Jan 22, 2017 04:55
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The opiate epidemic has been in the veterinary news recently as New Jersey has a new law that requires those who prescribe controlled substances to need to look up the patient's info in the online database to ensure the patient isn't drug seeking. The hard part is that in our realm, the patient is an animal and the client is the person... so many DVMs are worried that it's not even legal (let alone smart) for us to be looking at the client's info (which looking at the human's info is what's required) since 1) they're not our patient and 2) we don't know the doses used in human med (since we regularly complain about pharmacists trying to change our benzo rxs why would we know wtf to do with people). Oklahoma I believe has already required DVMs to do this, but I guess nobody bothered until it came up in NJ? I dunno. Up until tramadol went schedule 4 it was handed out almost like candy to our patients since we didn't worry of addiction in our patients and it had minimal long term systemic effects in comparison to what can happen with NSAIDs. Heck, in cats there wasn't really any good long term pain control other than gabapentin since the last major NSAID in cats (meloxicam) got a black box label (though some other NSAIDs are trying to fit in) and sending burprenoprhine for oral use was somewhat common.
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Jan 22, 2017 05:44
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LadyPictureShow posted:I had that happen to me a few years ago. I was on Lexapro and Welbutrin, then my doc added trazodone for my chronic insomnia. Didn't check about possible interactions, guess the pharmacist didn't either, and I developed Serotonin syndrome (got every symptom short of seizures and death). There's a few things that might have happened. -Pharmacist just plain screwed up. Unfortunate, does happen and in this case isn't very interesting for this discussion (not trying to downplay that you almost died, of course). -Alarm Fatigue made them miss the interaction because lol at how the screen explodes the moment you have two antidepressants for the same patient. -Related to the previous one, My Pharmacy Software Sucks (let me list you the various way it sucks compared to Your Pharmacy Software). Heck even on the same systems, some chains will have all the alerts just tucked away in the corner where everyone ignores them while others have the software set up so that it bugs you every, single, time. -Pharmacist called doctor, doctor said YEAH ITS FINE I KNOW WHAT I'M DOING I'VE GIVEN THIS OUT TO PLENTY OF PATIENTS, pharmacist goes "well... ok...", of course whenever this happens I let the patient know what I discussed with the doctor and how there can very possibly be an issue and I don't recommend it but it's what the doctor gave and if you do go ahead and take it, be very aware of x symptoms because there is a good chance it might happen to you. Then I write all this poo poo down somewhere attached to the prescription. Most people will go back to the doctor at this point (thankfully) but I've had people just charge ahead heedless of danger. -Hey so I'm working a 300 script day with only two pharmacists on duty at a time and oh cool someone just asked me from like halfway across the store where the laxative are and god damnit I forgot to fax the doctor for refills that was like half an hour ago also the phone is buzzing from that old lady calling again asking if the delivery guy had arrived yet also I'm trying to figure out the last couple digits on this Blue Cross card but the laminate is peeling off and there is what I hope is not a booger obscuring it also damnit you're back already okay Trazodone 50mg qhs prn for sleep 30 tabs k looks good
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Jan 22, 2017 06:22
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How well do doctors respond when the pharmacist calls up and says hey you hosed up.
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Jan 22, 2017 06:29
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I would blow Dane Cook posted:How well do doctors respond when the pharmacist calls up and says hey you hosed up.
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Jan 22, 2017 07:05
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I would blow Dane Cook posted:How well do doctors respond when the pharmacist calls up and says hey you hosed up. During my years as a pharmacy tech, I always tried to be diplomatic when I called doctors and didn't rub their noses in their mistakes. Most of them understood I was doing them a favor when I pointed out drug interactions or incorrect dosages, and had the patient's best interests at heart. Occasionally a doctor would get an attitude and say things like, "I think I know more about practicing medicine than some pill counter in a white smock," but most of them appreciated the calls. It was more common to get flack from the customer, who resented the delay in getting his script filled while I spoke to the doctor.
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Jan 22, 2017 07:44
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Eej, you make a good point. I'm not so much mad that the bad combination didn't get caught, since it's a pretty goddamn rare reaction, the HOSPITAL ignoring it was the hosed up part. My stay amounted to being ignored about the problem starting after taking the new med, and being booked for 'severe alcohol withdrawal' (the symptoms are kinda similar). You'd at least expect the goddamn ER doctors to do a cursory check when a patient repeatedly tells them to check their medications and contact their doctor. Instead I was taken off all meds and put in the psych ward.
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Jan 22, 2017 16:03
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I would blow Dane Cook posted:How well do doctors respond when the pharmacist calls up and says hey you hosed up. Most of the time it's just like "oh right, drat, ok, give x instead thanks" but there are the occasional curmudgeonly old dudes who get all offended that we questioned their years of experience and judgement. Young doctors can vary from being super on the ball with their pharmacological choices to putting you awkwardly on the spot to pick a drug for the patient (I don't know what their case file looks like, man) but that usually only happens for antibiotics so that's pretty straightforward. LadyPictureShow posted:Eej, you make a good point. It might be a "rare" reaction in terms of occurring so if you weren't actually told that Lexapro + Trazodone had a risk of Serotonin Syndrome or that Wellbutron + Trazodone had a risk of increasing both drugs' chance of giving you seizures then the pharmacist dropped the ball on that one. Every pharmacy software I've used will pop up a giant window blocking everything you're doing that you have to click or hit a ctrl+key combo to make go away so that you can't ignore that there is a potentially life threatening reaction (which you can then at least mention to your patient when they pick it up). Even then, we go through hundreds of trees a year automatically printing out drug information sheets to shove in your bag that should have that potential side effect somewhere in there, which you then have to spend like 5 minutes of your life ripping up or blacking out your name before dumping it in the recycling bin. Like, even if you decide to take the medication combination at least you know the risk of what you're getting into and if you do get it and seek medical help, the exact name of the reaction you're having so that the doctors don't fart around and hum and haw and potentially misdiagnose you. I'm not advocating for a dim view of the medical profession as a whole here but sometimes knowing the magic words related to your medical conditions can just jumpstart our thinking process into the right direction, especially when your problems are usually very vague and could look like a whole bunch of other things other than what you're experiencing.
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Jan 22, 2017 17:29
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Albino Squirrel posted:Look, the naltrexone blocks the hydrocodone, which gives her withdrawal, which gives her the shits, which leads to weight loss! What's so hard to understand here buddy! Thanks God the patient didn't use the naltrexone drug; just the mere mention of precipitated withdrawal causes me to react viscerally. Regarding doctor ignorance, I think the problem isn't so much the lack of pharmaceutical training (though more couldn't hurt, since there often aren't a very large number of drugs frequently prescribed in some specialties - opiates for pain doctors being a prime example), but more the fact that many doctors seem to think they're experts in areas they aren't. It's like they think being a doctor also gives them some sort of authority in science in general, when from my experience most doctors aren't any better than a layperson when it comes to thinking scientifically, evaluating/reading research or scientific media, etc.
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Jan 22, 2017 18:02
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I would blow Dane Cook posted:How well do doctors respond when the pharmacist calls up and says hey you hosed up. In the hospital some are gracious, others are dicks. Just like everyone else in life. At least in the hospital I have access to the full chart, and functions of the EMR that the doc doesn't have.
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Jan 23, 2017 00:04
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Eej posted:Most of the time it's just like "oh right, drat, ok, give x instead thanks" but there are the occasional curmudgeonly old dudes who get all offended that we questioned their years of experience and judgement. Young doctors can vary from being super on the ball with their pharmacological choices to putting you awkwardly on the spot to pick a drug for the patient (I don't know what their case file looks like, man) but that usually only happens for antibiotics so that's pretty straightforward. I currently take trazodone (50mg QHS) and lexapro (10mg QAM) and methadone (80mg QAM). It's the first time in 10 years on/off psych medications that I've ever felt real improvement. I spent several hours on PubMed the other night, reading everything I could that seemed to address potential risks of the combination. Negative reactions seem dramatic but rare, and the combination is widely prescribed throughout the US. I was considering trying to add bupropion to my regimen (for smoking cessation) until I read this paper Are Pharmacotherapies Ineffective in Opioid-Dependent Smokers? Reflections on the Scientific Literature and Future Directions. Now I'm not sure the slim benefit justifies the risk of wrecking something that seems to work well.
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Jan 24, 2017 18:12
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People who have died from overdoses last year in NH was more than triple the amount of those who died in car crashes. The repeal of the ACA would shut down access for thousands in drug treatment in the state. http://nhpr.org/post/obamacare-repeal-looming-nh-substance-abuse-programs-watch-and-wait
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Jan 24, 2017 22:51
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The_Book_Of_Harry posted:I currently take trazodone (50mg QHS) and lexapro (10mg QAM) and methadone (80mg QAM). It's the first time in 10 years on/off psych medications that I've ever felt real improvement. Yeah, the danger is just from the Trazodone and Lexapro combo, and under normal circumstances/doses there won't be a problem (and even if there was, you'd notice symptoms before it became dangerous, unless you just suddenly took some much larger dose). I experienced mild serotonin syndrome symptoms once, a long time ago back when I was mixing large doses of Tramadol with whatever antidepressant I was also on at the time, but the serotonin weirdness from an excessive dose of Tramadol far outweighs what would usually occur from a normal dose of Trazodone/Lexapro/etc.
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Jan 24, 2017 23:10
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OhFunny posted:People who have died from overdoses last year in NH was more than triple the amount of those who died in car crashes. People also don't realize that they can pay some taxes to the ACA and see people get treatment, or they can pay a gently caress ton more in taxes to have the court system pay for treatment, since there isn't enough room in jails for drug offenders, they instead get to go to halfway houses and treatment on the states dime anyway. It just costs more because there's a lot more overhead with court ordered programs versus voluntary treatment.
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Jan 25, 2017 00:17
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AA is for Quitters posted:People also don't realize that they can pay some taxes to the ACA and see people get treatment, or they can pay a gently caress ton more in taxes to have the court system pay for treatment, since there isn't enough room in jails for drug offenders, they instead get to go to halfway houses and treatment on the states dime anyway. It just costs more because there's a lot more overhead with court ordered programs versus voluntary treatment.
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Jan 25, 2017 03:50
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Albino Squirrel posted:poo poo, man, that's most social programs. It costs upwards of $100K to 'keep' someone homeless in terms of justice, policing, health care, emergency shelters etc.. Versus about $12K a year to just give them an apartment. Yeah but if you just give them an apartment they aren't earning it. Who cares if it costs more, they aren't getting anything for free on MY dime.
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Jan 25, 2017 04:02
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I don't think you can lay the blame for opioid overdoses , the spread of blood borne viruses and other assorted opioid related harms squarely at the feet of 'over-prescribing doctors' and corporate greed. Allow me to remind this thread the White House Office of National Drug Control Policy actually thought it was a good idea for people to overdose and rejected proven harm reduction measures as 'unscientific' at every opportunity:  Furthermore, iatrogenic opioid addiction is rare (even though it appears to be accepted as quite common ITT). A review published by the The Cochrane Library in 2010 concluded that serious adverse events such as "iatrogenic opioid addiction [during long-term opioid therapy], were rare." http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006605.pub2/abstract The conclusions of a review published in 2012 are as follows: "The available evidence suggests that opioid analgesics for chronic pain conditions are not associated with a major risk for developing dependence." http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2012.04005.x/abstract A study of 9940 persons who received 3 or more opioid prescriptions within 90 days for chronic noncancer pain between 1997 and 2005 identified only 6 fatal overdoses: https://www.ncbi.nlm.nih.gov/pubmed/20083827 Almost every case of opioid related death involves poly substance [mis]use. The stats don't lie: "overdose death among those co-dispensed benzodiazepines and opioid analgesics were ten times higher (7.0 per 10,000 person-years, 95 percent CI: 6.3, 7.8) than opioid analgesics alone (0.7 per 10,000 person years, 95 percent CI: 0.6, 0.9)." https://www.ncbi.nlm.nih.gov/pubmed/26333030 A review of over 1000 fatal overdoses reported that in 96.7% of cases at least one other plausible contributory drug in addition to oxycodone was detected, the most prevalent drug combinations were oxycodone in combination with benzodiazepines, alcohol etc: https://academic.oup.com/jat/article/27/2/57/706312/Oxycodone-Involvement-in-Drug-Abuse-Deaths-A-DAWN An Australian review of all cases of fatal oxycodone toxicity from 1999-2008 and concluded that "In all cases, psychoactive substances other than oxycodone were also detected" http://onlinelibrary.wiley.com/wol1/doi/10.1111/j.1556-4029.2011.01703.x/abstract The steps that need to be taken to reduce the harms of opioid addiction are as follows: Decriminalise all forms of non-medical opioid use. It shouldn't be a crime to make poor health choices. Fund needle and syringe programs and distribute equipment far and wide. Give out naloxone kits for free and offer free naloxone administration training for the families of opioid users. Offer free opioid substitution therapy including Heroin Assisted Therapy. Fund supervised consumption rooms where people can take drugs with staff on hand to help them if needed. Repeal opium prohibition - we know for a fact that opium prohibition led to a dramatic increase in heroin use (most of it IV):  http://adlrf.org.au/wp-content/uploads/2012/02/Westermeyer-1976-The-Pro-Heroin-Effects-of-Anti-Opium-Laws-in-Asia.pdf KingEup fucked around with this message at 15:21 on Jan 26, 2017 |
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Jan 26, 2017 14:54
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I will cobble together a response to that this weekend. Maybe in the meantime you can regale us with what you think happened in the last decade.
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Jan 27, 2017 00:54
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Please source your website comment section quote.
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Jan 27, 2017 06:13
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KingEup posted:Words You're drawing the wrong conclusions from the papers and interpreting the numbers wrong. You're saying it isn't "common" to develop opiate dependence but you're not defining common. The prevalence from the sources you cite are all over the map (0!% to 31%) and they give a median of 4.5%. A 1 in 20 chance of becoming addicted to opiates ain't low.
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Jan 27, 2017 07:11
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pangstrom posted:Maybe in the meantime you can regale us with what you think happened in the last decade. The government continued to fund a drug war against people whose personal drug preference was oxycodone and other prescription drugs. The predictable consequences of fighting this drug war intensified. This included a deterioration in the health of prescription drug users (including overdose, BBVs, social breakdown, incarceration and financial problems). This prompted the government to escalate their drug war and crack down (as they always have) on the supply of drugs. This led to an increase in the use of street drugs as the supply of prescription opioids began to dry up. When the (predictable) consequences of fighting the drug war intensified further the government began to blame 'over-prescribing doctors'. It is better if they can shift the blame for the failures of their own drug war (for obvious reasons - they don't have admit that drug prohibition has failed and is actually counterproductive). The government then began to slowly reverse their oppostion to harm reduction such as lifting the ban on federal funding for needle and syringe programs and promoting the use of naloxone, repositioning themselves as the people who would rescue us from the 'opioid epidemic', all while maintaining that the predictable condequences of funding drug prohibition was in-fact entirely the fault of doctors who 'over-prescribe'. The government then promised to save us from 'over-prescribing doctors', 'abuse deterrent formulations' and evil 'doctor shopppers' by getting tougher, introducing prescription drug monitoring programs and 'new guidelines' that are designed to reduce the prescription of opioids. KingEup fucked around with this message at 12:39 on Jan 27, 2017 |
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Jan 27, 2017 07:27
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Lote posted:You're drawing the wrong conclusions from the papers and interpreting the numbers wrong. Under the heading that says: quote:Authors' conclusions It says: quote:serious adverse events, including iatrogenic opioid addiction, were rare. Do you reject the Cochrane findings?
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Jan 27, 2017 07:35
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KingEup posted:Do you reject the Cochrane findings? I would use more up to date findings. You're using a paper from 2010. The author that you're citing wrote the new CDC guidelines in 2016 for prescribing opiates which draw completely opposite conclusions and recommendations.
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Jan 27, 2017 08:15
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KingEup sounds like a Purdue Pharma rep.
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Jan 27, 2017 10:26
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Eej posted:KingEup sounds like a Purdue Pharma rep. What do you think the availability of free generic diamorphine for anyone who currently has a problematic relationship with Oxycontin would do to their sales? The correct way to handle opioid addiction is to say: "oh, you like to crush and inject oxycodone into your groin and you've sold everything you own to pay for it, contracted HIV, alienated everyone who ever cared about yo, spent several years in and out of jail and now you're sleeping rough? Well, from now on we're going to take care of you, the police are going to stop hassling you, here's a nice sanitized secure environment where you can safely use without being robbed or beaten, there are medical professionals always on hand to assist you and you won't have to pay for your gear ever again." KingEup fucked around with this message at 12:48 on Jan 27, 2017 |
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Jan 27, 2017 12:38
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KingEup posted:Decriminalise all forms of non-medical opioid use. It shouldn't be a crime to make poor health choices. Decrim in Portugal has reduced the most harmful forms of drug use by 10-15%. Sharps programs are proven important in the fight against HIV/Aids, with some reports showing a 30% decrease in transmission and an 80% greater likelihood of engagement with other services. The take-home-naloxone program has reduced opioid related deaths in Scotland by 22% in the trial group, against a background 17% rise in the general population. John Marks' Liverpool clinic saw an amazing reduction in crime by the provision of heroin maintenance therapy, and opioid related deaths in the catchment area fell to zero. I don't know the statistics for supervised injection areas, but it seems like Vancouver had some success with them, and it makes sense to do something like that if you're doing the above things. And the prohibition of the safer opioids has always led to increased use of more concerning ones, opium prohibition begat heroin, heroin prohibition begat dibenzoylmorphine, broad semi-synthetic prohibition begat fentanyl, now there's loving carfentanyl on the streets. (And lol at trying to prohibit something that can grow wild in a ditch across half the planet)
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Jan 27, 2017 12:39
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KingEup posted:The government then promised to save us from 'over-prescribing doctors', 'abuse deterrent formulations' and evil 'doctor shopppers' by getting tougher, introducing prescription drug monitoring programs and 'new guidelines' that are designed to reduce the prescription of opioids. ...and here we have the success of US drug policy designed [they say] to reduce the harms of non-medical opioid use laid bare: Success from a law enforcement perspective, hurrah!:  Success from a public health perspective, err... not so much:  quote:"Our results imply that a substantial share of the dramatic increase in heroin deaths since 2010 can be attributed to the reformulation of OxyContin." So much for the government and big pharma rescuing us from the harms of non medical opioid use problem with 'abuse deterrent' formulations of prescription opioids. KingEup fucked around with this message at 13:16 on Jan 27, 2017 |
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Jan 27, 2017 12:57
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Lote posted:I would use more up to date findings. You're using a paper from 2010. The author that you're citing wrote the new CDC guidelines in 2016 for prescribing opiates which draw completely opposite conclusions and recommendations. KingEup: totally agree that harm reduction stuff is definitely part of the solution, though we might disagree on the specifics (I don't have strong opinions here, it's hard to say for sure, though I wouldn't say "open the oxy floodgates" for example). Totally agree taking opiates in isolation isn't that bad for you biologically (though you can push it to losing-your-hearing levels, narcotic bowel syndrome levels [toasticle?], etc.). The thread has been these places and most people agree, I think. In a world where addiction tends to cause other parts of your life and decision-making to unravel, it's a problem... OD is now the leading cause of "injury death". Government policy is PART of that world, sure. That said, surmising that the opiate epidemic cause is "intensification of government crackdown" is weapons-grade obtuse.
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Jan 27, 2017 12:58
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pangstrom posted:That said, surmising that the opiate epidemic cause is "intensification of government crackdown" is weapons-grade obtuse. You reject the view that the government has stepped up law enforcement efforts to fight prescription drug use? You reject the view that this has adverse side-effects, so called 'unintended* consequences'? *Although entirely predictable. When will people realise that the prevelance of prescription opioid use doesn't matter. The only thing that matters is harm. Our focus should be on mitigating the harms of opioid use, not trying to reduce prescriptions, diversion and doctor shopping with law enforcement and stricter prescribing criteria. I don't give a gently caress how many people spend time in the sun for example, only whether they are harmed by the UV light or not*. It shouldn't be any different for opioids. US drug policy is equivalent to banning the sale of sunscreen to deter people from abusing themselves with sunlight. KingEup fucked around with this message at 13:25 on Jan 27, 2017 |
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Jan 27, 2017 13:08
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You're shifting it a bit already, which is fine, but: I reject that that a government crackdown was what got 2+ million people addicted to prescription opiates, which is more THE CAUSE of the epidemic. The government recently cracked down on prescription opiate availability, which many sane doctors had already done on their own, because they didn't want that number to keep going up.
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Jan 27, 2017 13:24
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pangstrom posted:I reject that that a government crackdown was what got 2+ million people addicted to prescription opiates, which is more THE CAUSE of the epidemic. No, the government didn't get them addicted, the government's drug policy exacerbated the harm of taking opioids for non-medical reasons. pangstrom posted:The government recently cracked down on prescription opiate availability, which many sane doctors had already done on their own, because they didn't want that number to keep going up. The preoccupation with 'availability' is the problem. As you can see from the stats I posted above there was a dramatic reduction in opioids prescribed in Ohio but during the same period the harm from taking opioids increased dramatically. Policy choices can have serious adverse consequences, just like drugs. Your so called 'sane doctors' who altered the frequency they prescribed opioids and switched to 'abuse deterrant' formulations are also responsible for harms this has exacerbated. If the number of people dying from opioid involved OD increases after your change in practice, then the only sane thing to do is abandon the practice as a failed experiment. KingEup fucked around with this message at 13:43 on Jan 27, 2017 |
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Jan 27, 2017 13:34
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Yes, what insane doctors, not enlightened about how restriction is the monocausal problem and availability is the monocausal solution like KingEup
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Jan 27, 2017 13:40
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pangstrom posted:Yes, what insane doctors, not enlightened about how restriction is the monocausal problem and availability is the monocausal solution like KingEup Most doctors are not drug policy experts and as many people in this thread have already pointed out, have not received any training in addiction medicine and don't even realise that people can form addictive relationships to Tramadol. I mean how the gently caress did they swallow the bullshit from Purdue that Oxycontin was someone less prone to misuse in the first place? The idea of non-addictive drug that produces euphoria is as absurd as the idea of a non-flammable liquid that is easy to ignite. Most doctors will follow government recommendations without question lest they draw attention to themselves and invite additional surveillance of their prescribing habits. They should however be able to look at the stats and see that adhering to government drug policy has been a counterproductive failure especially when it comes to opioids. KingEup fucked around with this message at 13:58 on Jan 27, 2017 |
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Jan 27, 2017 13:49
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KingEup posted:Most doctors are not drug policy experts and as many people in this thread have already pointed out, have not received any training in addiction medicine and don't even realise that people can form addictive relationships to Tramadol. I mean how the gently caress did they swallow the bullshit from Purdue that Oxycontin was someone less prone to misuse in the first place? The idea of non-addictive drug that produces euphoria is as absurd as the idea of a non-flammable liquid that is easy to ignite. If you're finding that people are arguing with you, it's because you're inconsistent here. KingEup posted:The steps that need to be taken to reduce the harms of opioid addiction are as follows: If they're not ready for traditional OST then harm reduction helps tremendously. For my part I work at a clinic that provides free needles, as well as naloxone kits. We're working on getting a few safer injection sites set up in my city.
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Jan 28, 2017 16:08
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The other thing I'm looking into is hydromorphone-assisted treatment. Kinda like heroin-assisted treatment but bear with me here. For years, doctors in Europe (mostly Switzerland and the Netherlands) have been prescribing injection heroin so that people don't have to go buy it on the street. And it makes sense from a harm reduction perspective; you're only reducing so much harm by providing people clean rigs and a place to inject, if what they're injecting is 'heroin' from the street (usually fentanyl these days, cut with gently caress knows what). There's only one clinic routinely providing heroin-assisted treatment in North America to my knowledge, and that's in Vancouver. Now, there have been a couple of studies in Canada. NAOMI showed that prescription IV heroin is roughly as effective as methadone in reducing street drug use. They included a small hydromorphone arm for 'validation purposes', which showed that hydromorphone was as good as heroin, and that the participants couldn't tell the difference. SALOME repeated the trial, but with a much larger hydromorphone arm, which confirmed that HM is about as good as heroin. And it makes sense! Hydromorphone is roughly the same potency as heroin, as well as being much more widely available - your aunt on facebook who bitches about how we're coddling junkies probably had IV dilaudid when she had her gallbladder out. So I'd argue if we're going to proceed with prescribing opioids for IV use, we should probably go with one which is already available, has a much greater degree of prescriber comfort & familiarity, and doesn't have nearly the same stigma. It's a lot easier to sell 'I'm prescribing intravenous hydromorphone in a controlled environment for the purposes of reducing harm and controlling opioid dependence,' compared to 'I AM LITERALLY PRESCRIBING SMACK.' At least in more conservative environments than the Left Coast.
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Jan 28, 2017 18:52
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Albino Squirrel posted:the initial point of access for people was... doctors! Who probably should have been more careful about opioid prescribing for pain! Who is to blame when someone abuses their horsepower? The dealer who sold the car in the first place? Should the dealer have been more careful about who he sold the car to? Should he have interogated the buyer to see whether he/she had a history of abusing their horsepower? Surely a sane dealer would try to reduce the numbers of motor vehicles they sold so less people would abuse their horsepower. Drugs do not have the power to cause addiction, neither do doctors. Addictions to pain killers form for the same reasons people form addictions to anything else. People who overcome their addictions, and quit pain killers, do so for the same reasons as someone who quits smoking tobacco. Incidentally, millions of people have ended their addictive relationship with tobacco, not because the supply of tobacco has changed, but because they wanted to. Would anyone here argue that the solution to America's cigarette problem is to reduce the supply of them? KingEup fucked around with this message at 22:38 on Jan 28, 2017 |
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Jan 28, 2017 22:29
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