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OwlFancier
Aug 22, 2013

PT6A posted:

That's ridiculous. If I knew I was going to die, not only would I use whatever painkillers I could get, but I'd become addicted to every other substance as well, because why the hell not? You better believe I'm gonna smoke 2 packs a day if I know I'm dying in a few months anyway.

Pride is often terminal.

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PT6A
Jan 5, 2006

Public school teachers are callous dictators who won't lift a finger to stop children from peeing in my plane

OwlFancier posted:

Pride is often terminal.

But what's there to be proud of? I moderate my alcohol intake and I quit smoking cigarettes because they're bad for my health and impair my ability to function in society. If those things stopped being issues, the mere fact of physical dependence on a substance and/or addiction wouldn't faze me in the least.

OwlFancier
Aug 22, 2013

PT6A posted:

But what's there to be proud of? I moderate my alcohol intake and I quit smoking cigarettes because they're bad for my health and impair my ability to function in society. If those things stopped being issues, the mere fact of physical dependence on a substance and/or addiction wouldn't faze me in the least.

Addicts are bad people, I don't want to be a bad person, so I can't be an addict, addicts are weak and pathetic, I'm better than them, I might be dying but I can die with dignity etc etc.

The word has a stigma attached to it. Much like criminal, despite most people breaking the law.

Broken Machine
Oct 22, 2010

PT6A posted:

But what's there to be proud of? I moderate my alcohol intake and I quit smoking cigarettes because they're bad for my health and impair my ability to function in society. If those things stopped being issues, the mere fact of physical dependence on a substance and/or addiction wouldn't faze me in the least.

Strangely enough a lot of people don't enjoy getting blasted or want to go out in a drugged out haze, and so there's no appeal to them to go on a huge bender. Also cannabis is good enough for pain management that many prefer it, as they can still be more or less lucid instead of nodding off.

PT6A
Jan 5, 2006

Public school teachers are callous dictators who won't lift a finger to stop children from peeing in my plane

Broken Machine posted:

Strangely enough a lot of people don't enjoy getting blasted or want to go out in a drugged out haze, and so there's no appeal to them to go on a huge bender. Also cannabis is good enough for pain management that many prefer it, as they can still be more or less lucid instead of nodding off.

Yeah, cannabis leaves you totally functional :rolleyes:

I'm a fan of it, but let's not pretend it doesn't get you really hosed up.

boner confessor
Apr 25, 2013

by R. Guyovich

PT6A posted:

Yeah, cannabis leaves you totally functional :rolleyes:

I'm a fan of it, but let's not pretend it doesn't get you really hosed up.

it doesn't if you smoke below your threshold

i mean a couple shots won't get most people slurring and stumbling either

Hardawn
Mar 15, 2004

Don't look at the sun, but rather what it illuminates
College Slice
I've been on suboxone/zubsolv for almost three years and I loving hate it. I'm such a fool for listening to my brother and the super nice doctor he worked with to bump me up the waiting list to be one of the 100 patients he could prescribe buprenorphine/naloxone to. I only stayed in rehab for 9 days before my insurance denied the claim, stating "me being there wasn't a necessity" even though I had a needle habit for 13 months and a nasal habit for a year and a half before.
So I had almost 15 days clean of everything and was feeling fantastic then I see the doctor, and he recommends subs to help keep me off. I agreed without understanding the long term, and at the time suboxone was being prescribed as a short term solution, then I realized we never had any discussion regarding getting off, so after that I was determined to at least try to take less over time. I never really took above 12mgs which is 1 1/2 of a sublingual strip. Getting onto suboxone was the biggest mistake in MY recovery. withdrawal from heroin sucks, but when I went to my brother first, we went to a GP and he prescribed me a medicine to lower my blood pressure and an anti-nausea medicine and I had the easiest withdrawal I've ever had in my life. I was fully truthful and got excellent care to ease me into being opiate free. It's not good that the stigma of abusing/addiction keeps people away from getting the early help. I definitely kept preferring to not be judged by my dealer than to be forever branded a junkie in my medical files when I wasn't visiting the doctor to aquire pills.

Just another thought, heroin still isn't exactly popular or cool, at least in my experience interacting with other recreational drug users. Pills are cool, heroin is strong as gently caress and a fraction of the price. Plus it has a seeding introduction system that older junkies cultivate new junkies who have fresh money. I didn't actually get my dealers number until my "friend" was wanting to get high so bad I had to go pick some up and drop a needle and spoon off at the cracker barrel.

Hardawn fucked around with this message at 11:51 on Jan 29, 2016

pangstrom
Jan 25, 2003

Wedge Regret

Hardawn posted:

I've been on suboxone/zubsolv for almost three years and I loving hate it. I'm such a fool for listening to my brother and the super nice doctor he worked with to bump me up the waiting list to be one of the 100 patients he could prescribe buprenorphine/naloxone to. I only stayed in rehab for 9 days before my insurance denied the claim, stating "me being there wasn't a necessity" even though I had a needle habit for 13 months and a nasal habit for a year and a half before.
So I had almost 15 days clean of everything and was feeling fantastic then I see the doctor, and he recommends subs to help keep me off. I agreed without understanding the long term, and at the time suboxone was being prescribed as a short term solution, then I realized we never had any discussion regarding getting off, so after that I was determined to at least try to take less over time. I never really took above 12mgs which is 1 1/2 of a sublingual strip. Getting onto suboxone was the biggest mistake in MY recovery. withdrawal from heroin sucks, but when I went to my brother first, we went to a GP and he prescribed me a medicine to lower my blood pressure and an anti-nausea medicine and I had the easiest withdrawal I've ever had in my life. I was fully truthful and got excellent care to ease me into being opiate free. It's not good that the stigma of abusing/addiction keeps people away from getting the early help. I definitely kept preferring to not be judged by my dealer than to be forever branded a junkie in my medical files when I wasn't visiting the doctor to aquire pills.

Just another thought, heroin still isn't exactly popular or cool, at least in my experience interacting with other recreational drug users. Pills are cool, heroin is strong as gently caress and a fraction of the price. Plus it has a seeding introduction system that older junkies cultivate new junkies who have fresh money. I didn't actually get my dealers number until my "friend" was wanting to get high so bad I had to go pick some up and drop a needle and spoon off at the cracker barrel.
How impaired are you on that stuff? I've heard very different things, some of which is dose etc. but some of it just seems to be idiosyncratic or something. Seems everyone agrees tapering and getting off it is a really difficult, though.

Maybe somebody can give a better summary, but for people who don't know much about this: With opiates there is an abstinence school of thought--Dr. Drew is probably the most visible face of this--and then there is a harm reduction school of thought. Well some of the harm reduction stuff is uncontroversial (giving needles etc.), but the place where they diverge is the maintenance drugs like methadone and suboxone. It's mostly a high risk/reward and high investment (abstinence) vs. a safer but less-ideal outcome (maintenance) issue. Even Dr. Drew thinks that people with awful problems and complicating factors should consider maintenance, or at least he does now that a bunch of his former patients are dead. On the other hand, maintenance drugs can be seen as a little "expedient" from the practitioner's or the system's standpoint, sort of a like a battlefield surgeon who just amputates limbs. There is a good chunk of harm reduction practitioners who wouldn't give those drugs to their own kid if the kid was in the same situation as Hardawn was, is what I'm saying.

Guavanaut
Nov 27, 2009

Looking At Them Tittys
1969 - 1998



Toilet Rascal
Isn't the best maintenance drug for heroin addiction just heroin? It's ridiculously cheap as a prescription drug*, because it's been out of patent forever and is simple as hell to produce, and the Swiss clinics and the work of Dr. John Marks at his Liverpool clinic shows that giving metered pharmaceutical grade doses to patients gives them freedom from dealers and constantly trying to find ways to come up with cash while allowing them to taper at their own pace. And also drives a lot of dealers out of the area or forces them to resort to more visible dealing that gets them arrested. Which in turn reduces violent crime and gang membership.

*Except in the US, where it is Schedule I and can't be prescribed by anyone, because reasons.

pangstrom
Jan 25, 2003

Wedge Regret
Vancouver is trying something similar. Maybe Canada and Europe can figure it out so that it works so well the US can come up with enough cover / attitudes can change enough to do something similar here. The success of the taper is the hard part... like if you're a betting man and somebody says they're starting to taper, put your money on relapse.

Guavanaut
Nov 27, 2009

Looking At Them Tittys
1969 - 1998



Toilet Rascal
Definitely, it's not easy. But the raw stats from John Marks's study shows that a generous compassionate heroin maintenance has better outcomes than other opioid maintenance while reducing ODs, drug dealing, gang violence, theft and robbery, and HIV transmission.

And then they shut him down under DEA pressure. :ughh:

It's a bit like the wet house programs for homeless people with alcoholism; we know enabling alcoholism is a bad thing, but pragmatically wet houses, compassion, and optional recovery seems to cause less overall suffering and sometimes better results.

Broken Machine
Oct 22, 2010

Guavanaut posted:

Isn't the best maintenance drug for heroin addiction just heroin? It's ridiculously cheap as a prescription drug*, because it's been out of patent forever and is simple as hell to produce, and the Swiss clinics and the work of Dr. John Marks at his Liverpool clinic shows that giving metered pharmaceutical grade doses to patients gives them freedom from dealers and constantly trying to find ways to come up with cash while allowing them to taper at their own pace. And also drives a lot of dealers out of the area or forces them to resort to more visible dealing that gets them arrested. Which in turn reduces violent crime and gang membership.

*Except in the US, where it is Schedule I and can't be prescribed by anyone, because reasons.

In Switzerland's maintenance program, the average addict only needs treatment for three years before they get clean. Instead, addicts are getting street heroin of unknown purity, often cut with fentanyl, and killing themselves.

pangstrom
Jan 25, 2003

Wedge Regret

Guavanaut posted:

Definitely, it's not easy. But the raw stats from John Marks's study shows that a generous compassionate heroin maintenance has better outcomes than other opioid maintenance while reducing ODs, drug dealing, gang violence, theft and robbery, and HIV transmission.

And then they shut him down under DEA pressure. :ughh:

It's a bit like the wet house programs for homeless people with alcoholism; we know enabling alcoholism is a bad thing, but pragmatically wet houses, compassion, and optional recovery seems to cause less overall suffering and sometimes better results.
Yeah I really elided over those aspects of addiction in an earlier post. Just giving the stuff out fixes so much violence and theft etc. that in the wide view it is a no brainer. Totally agree that we should keep the default outcome as the context... Like yes this is imperfect but it is way better than the alternatives.

Hardawn
Mar 15, 2004

Don't look at the sun, but rather what it illuminates
College Slice
My impairment is low, but my dose is pretty small. Small enough that I wake up every morning with stomach problems, a runny nose and sneezing fits until I take my dose, but still managed enough that you wouldn't know unless I told you. Know my co-worker seems to be taking enough some days to be slurring his words and being in a daze, but I honestly think he is using again.

I've given a strip (8mgs) to people with very little opiate tolerance and it'll floor them and also possibly make them vomit. If I drink any alcohol or ingest cannabis there is an additional layer of drowsiness(if I get too comfortable on the couch I could fall asleep sometimes), but not to exactly the level of feeling so good you are nodding off. People can definitely get some sort of high from it, but honestly you'd just go score more opiates and save the subs for withdrawal.

I watch a documentary on Amsterdam I believe and they this welfare problem where these addicts come in to work and are given three beers or their fix of whatever drug then begin work. In American, there's a lot more money in housing criminals. Also as a response to the person who talked about getting clean in jail, I could see a lot of people using that as the best way to separate themselves from the drug, but with the increased prevalence of heroin in prison, you could still be getting high.

MikeCrotch
Nov 5, 2011

I AM UNJUSTIFIABLY PROUD OF MY SPAGHETTI BOLOGNESE RECIPE

YES, IT IS AN INCREDIBLY SIMPLE DISH

NO, IT IS NOT NORMAL TO USE A PEPPERAMI INSTEAD OF MINCED MEAT

YES, THERE IS TOO MUCH SALT IN MY RECIPE

NO, I WON'T STOP SHARING IT

more like BOLLOCKnese
The Valuum's thread in A/T has a huge amount of information on drug culture in prison, in particular how people bankrupt themselves and their families trying to get extortionately priced smuggled opiates while in the prison system. It's a great read and a real eye-opener on drugs in US prisons.

pangstrom
Jan 25, 2003

Wedge Regret
Reading his first 20ish posts in that thread (which is really good) I was pretty surprised when I clicked on his profile to see he's still posting, or at least was as of a few weeks ago. Opiate addict who is not a fan of rehab and is white-knuckling after getting out of prison, that's what people call a bad fact pattern.

edit: Okay should have actually read a few posts further back, sorry, seems like he's okay at least.

pangstrom fucked around with this message at 19:14 on Jan 29, 2016

IAMNOTADOCTOR
Sep 26, 2013

Hardawn posted:

I've been on suboxone/zubsolv for almost three years and I loving hate it.

Your not tapering the dosage anymore? Not to be a dick, but the general experience with cold turkey heroin is that the relapse rate is quite high even if the first month goes well.

Re: the person suggesting heroin as a maintenance drug. Heroin is a short working opioid whereas methadone is long working. Its difficult to dose heroin in such a way that you suppress the detox symptoms without inducing a heroin high.

I've always felt slightly iffy about long term free heroin and methadone administration. It's undoubtedly better for society but it looks a lot like palliative sedation of the patients. In a sense you are slightly giving up.

the great deceiver
Sep 23, 2003

why the feds worried bout me clockin on this corner/
when there's politicians out here gettin popped in arizona

pangstrom posted:

Reading his first 20ish posts in that thread (which is really good) I was pretty surprised when I clicked on his profile to see he's still posting, or at least was as of a few weeks ago. Opiate addict who is not a fan of rehab and is white-knuckling after getting out of prison, that's what people call a bad fact pattern.

edit: Okay should have actually read a few posts further back, sorry, seems like he's okay at least.

I was a heroin/opiate addict for almost a decade and ended up doing 3 years in federal prison for dealing. Rehab was worthless and 12-step programs were a crock of poo poo. I've been off dope for almost 4 years now and I hate to say it but what turned me around was going to prison.

One thing that I don't think has been mentioned that I have noticed as a major contributing factor is the rise of black tar heroin. Back in the heyday of Oxy most addicts seemed to be smoking their pills. Black tar, as opposed to powder, was able to be smoked just like Oxy so it was a much easier transition to make than popping a pill right to hitting a needle. A lot of people who I think otherwise would never touch heroin are surprisingly ok with smoking it.

Hardawn
Mar 15, 2004

Don't look at the sun, but rather what it illuminates
College Slice

IAMNOTADOCTOR posted:

Your not tapering the dosage anymore? Not to be a dick, but the general experience with cold turkey heroin is that the relapse rate is quite high even if the first month goes well.

I've always felt slightly iffy about long term free heroin and methadone administration. It's undoubtedly better for society but it looks a lot like palliative sedation of the patients. In a sense you are slightly giving up.

That's why I put the emphasis on MY recovery in one of my posts. Hindsight is always 20/20 or whatever. I personally got to a crossroads moment where my path was ride it till death, or risk using while on drug probation and eventually do time. After I did my ten days in rehab, I believe I had enough time to truly evaluate and accept where I was and choose to not continue with the lifestyle of being a junkie. I wasn't perfect, and I did opiates a few times, but each time after I decided that the whole thing wasn't worth trading what I was able to develop in the interim.

My regret of taking suboxone started with I ran out my prescription the first time and immediately I got what are known as PAWS(post acute withdrawal symptoms). I then started to research getting off subs cold turkey and found very little peer-reviewed studies regarding tapering/jumping off at any dosage. I did find a few doctors on YouTube prescribing vitamin and supplements and to deal with the month plus of paws. So after that I decided that stopping then wasn't really going to be able option at that time, so I went back to my doctor to pee in a cup to get more.

I don't think providing long-term care is giving up, putting people in boxes and then turning a profit from it is giving up, IMO. Like in AA giving up the substance doesn't cure you as a potential drain on society or make you less of a piece of poo poo as a human, but going through the steps and self-identifying behavior patterns can facilitate that change into making you a contributing member of society, drug addiction is an unnecessary stigma when everyone does something to help regulate their mood, some are just less "destructive" than others.

Weldon Pemberton
May 19, 2012

Another new documentary that focuses on fentanyl prescriptions for non-cancer patients and street heroin cut with fentanyl. Around the middle, it goes into some of the scummy practices used by companies like Insys to get people with mild pain using their product. They had someone who was told to say "uh huh" on the phone to insurance companies when asked if the patient had cancer, the only disease that guaranteed it would be covered, because "uh huh" doesn't count as "yes" and they couldn't be held liable. Another company put out an ad with an old man sucking on a fentanyl lollipop like it's no big deal and was forced to pay out millions of dollars.

TheImmigrant
Jan 18, 2011
I went to a rich-person rehab early last year, and was amazed at the number of perfectly good white kids hooked on heroin in the Deep South. I'm talking the high-school football hero who'd gotten hooked on Oxy after a knee injury, and moved to heroin when scripts ran out and street Oxy became too expensive. I'm talking the children of judges and business moguls. No one notices or cares when some ghetto-rear end dude in inner-city Baltimore gets hooked on herAHWN, but when cheerleaders start stealing mommy's walking-around cash, people take note.

pangstrom
Jan 25, 2003

Wedge Regret

the great deceiver posted:

I was a heroin/opiate addict for almost a decade and ended up doing 3 years in federal prison for dealing. Rehab was worthless and 12-step programs were a crock of poo poo. I've been off dope for almost 4 years now and I hate to say it but what turned me around was going to prison.
So as a policy issue, i.e. beyond your personal experience, would you recommend prison for other addicts over rehab/12-step stuff?

Weldon Pemberton posted:

Another new documentary that focuses on fentanyl prescriptions for non-cancer patients and street heroin cut with fentanyl. Around the middle, it goes into some of the scummy practices used by companies like Insys to get people with mild pain using their product. They had someone who was told to say "uh huh" on the phone to insurance companies when asked if the patient had cancer, the only disease that guaranteed it would be covered, because "uh huh" doesn't count as "yes" and they couldn't be held liable. Another company put out an ad with an old man sucking on a fentanyl lollipop like it's no big deal and was forced to pay out millions of dollars.
Thanks for the tip, will watch tonight. That "uh huh" thing would be implausible if you put it in a work of fiction.

the great deceiver
Sep 23, 2003

why the feds worried bout me clockin on this corner/
when there's politicians out here gettin popped in arizona

pangstrom posted:

So as a policy issue, i.e. beyond your personal experience, would you recommend prison for other addicts over rehab/12-step stuff?

Good god, no. That was just what did it for me, locking up opiate addicts is a loving retarded policy. I just got to a point in my life where I was done with it. As described in The_Valuum's thread it is incredibly easy and common to get heroin in prison and most addicts keep on using while inside. In an ideal world the best policy imo would be legal prescriptions of clean heroin to addicts while also directing them to healthy and robust social services that will assist them in getting clean and getting their life in order if they so choose. We all know that will never happen in the US though.

edit: one thing that I think most posters here know is that you cannot legislate addiction away. That became extremely clear to me during my ordeal with the justice system. The only way to effectively tackle it is harm reduction/damage control.

the great deceiver fucked around with this message at 06:32 on Feb 4, 2016

pangstrom
Jan 25, 2003

Wedge Regret
I mean, social services are going to be basically treatment. When I hear that stuff sucks the next question is "was this voluntary and how much were you invested" because if not yeah that's a tough putt even if most addicts were not some flavor of antisocial, though I'm interested to hear what you didn't like about them. A lot of programs aren't great.

Thread-relevant news
http://www.pbs.org/wgbh/frontline/article/obama-asks-for-1-1-billion-to-fight-opioid-and-heroin-abuse/

the great deceiver
Sep 23, 2003

why the feds worried bout me clockin on this corner/
when there's politicians out here gettin popped in arizona

pangstrom posted:

I mean, social services are going to be basically treatment. When I hear that stuff sucks the next question is "was this voluntary and how much were you invested" because if not yeah that's a tough putt even if most addicts were not some flavor of antisocial, though I'm interested to hear what you didn't like about them. A lot of programs aren't great.

Thread-relevant news
http://www.pbs.org/wgbh/frontline/article/obama-asks-for-1-1-billion-to-fight-opioid-and-heroin-abuse/

I'm not saying they don't work at all but they definitely don't work for some people. They take a very cult-like approach towards the whole issue, basically saying that they are the only way to get clean and if you leave you'll be back on the streets using. If you're not using and aren't in meetings they say you are a "dry drunk" and it's just a matter of time until you use again. I left and have been off dope for almost 4 years. They honestly feel like a relic of a time when society did not understand addiction at all, mostly because that's exactly what they are.

pangstrom
Jan 25, 2003

Wedge Regret

the great deceiver posted:

I'm not saying they don't work at all but they definitely don't work for some people. They take a very cult-like approach towards the whole issue, basically saying that they are the only way to get clean and if you leave you'll be back on the streets using. If you're not using and aren't in meetings they say you are a "dry drunk" and it's just a matter of time until you use again. I left and have been off dope for almost 4 years. They honestly feel like a relic of a time when society did not understand addiction at all, mostly because that's exactly what they are.
Yeah AA has a lot of that, for sure, my dad basically thinks that way and is strident about it in a real off-putting way. Other treatment perhaps less, but yeah they're "treating" something so the notion definitely isn't that everything boils down to not-using. That view of addiction is the relic, in my view, the "just stop / say no" etc.

There is a notion out there that a lot of "real" addicts have a gnawing something that, once it's consistently fed, never goes away solely by dint of not feeding it. It's unclear to me if the "real" addict distinction is a convenient post hoc thing, but the place I do go to the mat for the AAs and rehabs etc. is the reason a lot of people complain about it is IMO exactly why they could benefit from it. They need to get over themselves, not in like an adolescent shoulder-shruggy way but in a fundamental way where they can rebuild the capacity to regulate their emotions and have relationships with other people. It's going to be uncomfortable and social stuff always has some hokey kayfabe attached and yes, there is an underlying assumption that the people walking in the door could use some improvement. If you feel good in your own skin and have good friends and aren't using then by all means skip it.

Nosfereefer
Jun 15, 2011

IF YOU FIND THIS POSTER OUTSIDE BYOB, PLEASE RETURN THEM. WE ARE VERY WORRIED AND WE MISS THEM
I think there are some underlying notions of cleanness, in that people with current or former addictions in some sense are considered spoiled. It obviously doesn't apply with everything, like coffee. Still I know people who get that reaction to smokers as well.

pangstrom
Jan 25, 2003

Wedge Regret
An LA-area doctor who was egregious about profiting off pill prescriptions (knew her patients were addicts or dealers, had people travelling to come to her, helped work the system to get people pills, got calls from the coroner, etc.) got sentenced to 30 years.
http://www.latimes.com/local/lanow/la-me-ln-doctor-murder-overdose-drugs-sentencing-20160205-story.html

Mooseontheloose
May 13, 2003

You all should watch Heroin Cape Cod when you get a chance
.
I know there have been a few articles about the medical profession basically closing ranks and saying they couldn't of POSSIBLY known about the addiction nature of opiod drugs and taht no one should real blame them. Which seems to me they know a massive class action law suit is coming.

I guess another thing driving this is the super cheap nature of heroin at the moment. Last I heard its 5 dollars a hit in New England.

Broken Machine
Oct 22, 2010

Mooseontheloose posted:

You all should watch Heroin Cape Cod when you get a chance
.
I know there have been a few articles about the medical profession basically closing ranks and saying they couldn't of POSSIBLY known about the addiction nature of opiod drugs and taht no one should real blame them. Which seems to me they know a massive class action law suit is coming.

I guess another thing driving this is the super cheap nature of heroin at the moment. Last I heard its 5 dollars a hit in New England.

In the 90s, there was a huge push, particularly by Purdue Pharmaceuticals, to market the benefits of opiates to doctors for non-malignant pain management. They had all these studies showing how it was safe, plenty of paid off doctors to shill for it, and in the absence of evidence otherwise doctors went along. I don't think doctors blindly prescribing pain pills today are blameless, but when this started most doctors would have had no reason to question the guidance.

https://www.youtube.com/watch?v=hwtSvHb_PRk

Pharma has been doing the same with other drugs for decades, pushing profits over patient outcomes.

Ytlaya
Nov 13, 2005

Hardawn posted:

So I had almost 15 days clean of everything and was feeling fantastic then I see the doctor, and he recommends subs to help keep me off.

What in the gently caress??? Why in the living hell would someone prescribe suboxone to someone who was already clean (and feeling fine to boot)? That makes no sense at all. Suboxone is just as difficult (if not more difficult) to quit if you do anything other than a quick taper after transitioning to it from some other opiate.

pangstrom posted:

How impaired are you on that stuff? I've heard very different things, some of which is dose etc. but some of it just seems to be idiosyncratic or something. Seems everyone agrees tapering and getting off it is a really difficult, though.

Maybe somebody can give a better summary, but for people who don't know much about this: With opiates there is an abstinence school of thought--Dr. Drew is probably the most visible face of this--and then there is a harm reduction school of thought. Well some of the harm reduction stuff is uncontroversial (giving needles etc.), but the place where they diverge is the maintenance drugs like methadone and suboxone. It's mostly a high risk/reward and high investment (abstinence) vs. a safer but less-ideal outcome (maintenance) issue. Even Dr. Drew thinks that people with awful problems and complicating factors should consider maintenance, or at least he does now that a bunch of his former patients are dead. On the other hand, maintenance drugs can be seen as a little "expedient" from the practitioner's or the system's standpoint, sort of a like a battlefield surgeon who just amputates limbs. There is a good chunk of harm reduction practitioners who wouldn't give those drugs to their own kid if the kid was in the same situation as Hardawn was, is what I'm saying.

Zero impairment in terms of ability to function or think or anything like that. I think that most people who are predisposed to becoming opiate addicts tend to not be very impaired by them unless they take huge doses (for example, I've never had some of the symptoms, like nausea, that other people mention on opiates, even before becoming addicted). But I feel zero excitement or enjoyment or anything like that on suboxone. It's like my brain doesn't produce much dopamine anymore or something.

Maintenance drugs are useful in certain situations. They're generally a good idea if the addict isn't ready to quit (and quitting will invariably fail in the long term if it isn't something the addict is truly committed to), since they allow a lot more stability than using other drugs and remove the risk associated with using drugs off the street. This is mostly due to the fact that suboxone only needs to be taken once a day, compared with having to use most other opiates every few hours. And some people are able to feel totally normal on suboxone (I'm unfortunately not one of them, due to the lack of pleasure/happiness I mentioned above), so if you're one of those people it can often be a good idea to just stay on suboxone for the rest of your life, particularly if you're old.

I'm not sure if I'll ever be able to get permanently clean. I can deal with acute withdrawal, but I've always experienced extremely bad PAWS. It's not the depression or anything that gets to me; it's more that I am completely incapable of resting both physically and mentally and perpetually have this feeling of physical discomfort. I can't sleep without (strong, prescribed) chemical assistance, and even when I do it doesn't feel restful. Feeling unrested and uncomfortable 24/7 with no respite ends up driving me crazy after a while. All I can think about is how much I want to be able to just feel comfortable and rest my body. It's horrible and I don't know if I'll ever be able to deal with the year+ of those symptoms that will be necessary for me to fully recover.

Hardawn posted:

I've given a strip (8mgs) to people with very little opiate tolerance and it'll floor them and also possibly make them vomit.

Jesus, yeah, 8mg is a loving massive dose for someone with zero opiate tolerance. Even 2mg will have a huge effect on an average person. Many suboxone doctors actually prescribe doses that are too high; most addicts shouldn't require more than 8mg.

Rhandhali
Sep 7, 2003

This is Free Trader Beowulf, calling anyone...
Grimey Drawer

Cantorsdust posted:

This is a big part of it. Running chains of hospitals is now big healthcare business. They meticulously track patient satisfaction scores, pain scores, etc for each doctor. And hospitals themselves are tracked on the same scores by both private sources online and publicly. I know Medicare was considering penalizing you a certain percentage of your reimbursement if your patient satisfaction was too low.

90% of your patients, if asked their satisfaction with their care, would say you're doing a good job, regardless of how well you're doing. They don't know any better. But do you know the number one cause of complaints? Not giving the patient what they want, even if they don't need it, even when it's bad for them.

So when you have 40 patients in your busy ER and you're running from room to room spending 5-10 minutes per patient, and you just need them to go away, are you really going to take the time to sit down and patiently explain to them why you won't be giving them their meds? Or why the patient you're discharging from the hospital can't have "just a little more to cover me until my next refill?" Are you going to risk getting chewed out over easily preventable bad satisfaction scores? No. You'll give the patient what they want. That's, unfortunately, the mindset I see in my collegues. They know there's a problem, but the system actively disincentivizes you to do anything about it.

They're not talking about it, they've been doing it since 2012. You can lose at least 1% of ALL reimbursements if you don't make your patients happy and that number is going up every year. One question on all of the surveys that patients get is something along the lines of "were you happy with your pain control?".

A lot of states have prescription monitoring programs that aren't used. I had a guy who, in the six months that the report covered, had seen something like a dozen prescribers filled over 3,500 pills of pretty much every flavor of oral opiate and benzo. I scanned the report into his record, summarized the results in my discharge summary and handed the patient the report before telling him he wouldn't be getting any with any opiates since, well, he filled about 200 hydromorphone tablets last week and should be well covered. He can take those, the allopurinol/colchicine/indomethacin I did prescribe him for his gout.

Kentucky now requires that all prescribers have access to the prescription monitoring program, whereas in most states it's voluntary. Half the people I work with don't even know about the state PMP. Kentucky also requires that prescribers run a report and document the results before writing outpatient prescriptions. When combined with the pill-mill busting measures (they moved across state lines) it radically decreased the number of prescription opiates in the state. They've been since replaced with a heroin epidemic.

I can't find them anywhere but there are also TV commericals for a gut-specific Narcan called methylnaltrexone used to treat opiod induced constipation. I've used it a couple of times in the inpatient setting and I'm not super impressed. Brown bombs and lactulose have gotten better, cheaper results.

Hardawn
Mar 15, 2004

Don't look at the sun, but rather what it illuminates
College Slice

Rhandhali posted:


I can't find them anywhere but there are also TV commercials for a gut-specific Narcan called methylnaltrexone used to treat opiod induced constipation. I've used it a couple of times in the inpatient setting and I'm not super impressed. Brown bombs and lactulose have gotten better, cheaper results.

Yes the commercials for Opioid Induced Constipation(OIC) have increased several times over the last 6 months. I was seriously taken aback when I first saw one. My favorite part is that I saw multiple commercials for OIC products during the Super Bowl then later we see another commercial(that was shot at my high school) depicting the spirling that happens to young people when they start to use opiates. Not a hint of irony, except the faint cackle of the junkie in the corner, finding just another example of the absurdity of intelligence.(dies)

Beaters
Jun 28, 2004

SOWING SEEDS
OF MISERY SINCE 1937
FRYING LIKE A FRITO
IN THE SKILLET
OF HADES
SINCE 1975

Unkempt posted:

As I understand it it was mainly these bastards.

I used to work with lots of docs and medical researchers. This gem came from some random doc several years ago.



On the other side is an advertisement for the instant release capsules.

Guavanaut
Nov 27, 2009

Looking At Them Tittys
1969 - 1998



Toilet Rascal
Here's a thing about the continuing and ongoing failure of opium policy overseas.

Looking at the timeline the post 9/11 lull seems to match nicely with when Mexican cartels started picking up opiate production instead of just trafficking coke. It's nice when NAFTA partners help each other out.

pangstrom
Jan 25, 2003

Wedge Regret
I haven't watched the new frontline yet, but I will when I get a chance
http://www.pbs.org/wgbh/frontline/film/chasing-heroin/

Ytlaya posted:

Zero impairment in terms of ability to function or think or anything like that. I think that most people who are predisposed to becoming opiate addicts tend to not be very impaired by them unless they take huge doses (for example, I've never had some of the symptoms, like nausea, that other people mention on opiates, even before becoming addicted). But I feel zero excitement or enjoyment or anything like that on suboxone. It's like my brain doesn't produce much dopamine anymore or something.

Maintenance drugs are useful in certain situations. They're generally a good idea if the addict isn't ready to quit (and quitting will invariably fail in the long term if it isn't something the addict is truly committed to), since they allow a lot more stability than using other drugs and remove the risk associated with using drugs off the street. This is mostly due to the fact that suboxone only needs to be taken once a day, compared with having to use most other opiates every few hours. And some people are able to feel totally normal on suboxone (I'm unfortunately not one of them, due to the lack of pleasure/happiness I mentioned above), so if you're one of those people it can often be a good idea to just stay on suboxone for the rest of your life, particularly if you're old.

I'm not sure if I'll ever be able to get permanently clean. I can deal with acute withdrawal, but I've always experienced extremely bad PAWS. It's not the depression or anything that gets to me; it's more that I am completely incapable of resting both physically and mentally and perpetually have this feeling of physical discomfort. I can't sleep without (strong, prescribed) chemical assistance, and even when I do it doesn't feel restful. Feeling unrested and uncomfortable 24/7 with no respite ends up driving me crazy after a while. All I can think about is how much I want to be able to just feel comfortable and rest my body. It's horrible and I don't know if I'll ever be able to deal with the year+ of those symptoms that will be necessary for me to fully recover.
Yeah, this is a place where, from the outside, people's imaginations usually fail them. People think it's like not eating a cookie or working on a Saturday or something.

Talkc
Aug 2, 2010

Mizuki! Mizuki! Mizuki!
***DEVASTATINGLY HANDSOME***
I threw my back out when i was 21. Doc gave me Hydrocodone. I dont even recall the dosage, just that i took a poo poo ton of it for 4 months. Ended up quitting cold turkey and having massive withdrawal. Only worse thing that i ever went through was a crash and burn fever i got with a UTI and Pneumonia ( 107 degree fever ) that hospitalized me for 2 weeks.

That withdrawal was horrible. I thought i was going to die.

Ive told every doctor ive seen since then, i cant touch the stuff. And yet they keep insisting on trying to prescribe those types of things to me. Mind you i have legitimate problems with chronic pain..... i have nerve damage in my right arm from a nasty car wreck that drives me up the wall. But ill be god damned if i ever have to go through withdrawal like that again.

Meanwhile, i have an aunt who worked as a pharmacist for 25 years, who about 2 decades ago, broke her back slipping and falling, and then instead of going to a doctor, she just decided to push through it, working at her job where she has to stand for 8 hours, for the next 4 weeks with a LITERALLY BROKEN BACK. She ended up so permanently hosed up afterwards that she has had a morphine pump ever since. To top it off she also takes oxy and vicodin by the handfuls, as well as adderal to keep from going narcoleptic. She ended up getting fired from her job managing a pharmacy for 25 years when in one of her drug fueled fugues she misprescribed stuff for the upteenth time, and ended up getting removed from being a pharmacist by the state. I imagine if they took her off all that the withdrawal would probably outright kill her.

Ive always found the stigma against addiction really fascinating in a horrific sorta way. My only thoughts as to the roots of this kinda stigma has to go to the opium scares in the early 20th century, as well as the puritanical movements that led to prohibition. Its an easy thing to try and point fingers at anyways. Seems to me the kind of movement that adheres to religious doctrine as fervently as the evangelical movement, would be a pivotal player in that kind of public outcry. The whole body is a temple thing religious people stick to seems to really damnify drugs, alcohol, etc.

I also have to add i find it horrifying that the 12 step program for AA is a religious indoctrination thing.

Hardawn
Mar 15, 2004

Don't look at the sun, but rather what it illuminates
College Slice
I wouldn't really consider AA yo be an indoctrination program. Are there groups that become more zealous than others? Probably. But the actual steps are more self reflective than the pray the gay away approach

Cugel the Clever
Apr 5, 2009
I LOVE AMERICA AND CAPITALISM DESPITE BEING POOR AS FUCK. I WILL NEVER RETIRE BUT HERE'S ANOTHER 200$ FOR UKRAINE, SLAVA

Hardawn posted:

I wouldn't really consider AA yo be an indoctrination program. Are there groups that become more zealous than others? Probably. But the actual steps are more self reflective than the pray the gay away approach
The AA thread in A/T was closed after it became a debate over the efficacy of AA, so this might be a topic best left for another thread. I'll just say that, because of the lack of much direction nationally, there can be dramatic variation between one group from the next and there is minimal scientific evidence for its efficacy. Anecdotally, when I contacted an organization that nominally oversees groups in Minnesota, asking for distinctly secular groups for a friend who was struggling, the response I got was "I don't know why anyone would want something like that."

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Sergiu64
May 21, 2014

Just piping in to say that my younger brother ODed at 22. There really is some dark demons that kids in HS have to deal with now. Feels like I'd have to raise my kids in some other country if I ever have them.

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