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Addicts can and do kill themselves! To the tune of 40,000 times a year with prescription drugs... hence all the concern. Dude's just advocating for status quo.
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Mar 17, 2016 14:32
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Your Dunkle Sans posted:Why do American pharmaceuticals get away with drug commercials on cable TV and the like? As far as I know, it's a uniquely American phenomenon and a really strange one at that. It's not uniquely American, New Zealand does it too! Probably has something to do with corporations being people, advertising is free speech and a lot of pharmaceutical money goes to lobbying.
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Mar 18, 2016 06:25
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blackguy32 posted:I don't see anything wrong with that? It's pain medicine with a antagonist that doesn't really affect the pain part of the medication which gets helps with the itching and constipation that usually goes with these medications. The naloxone is in there to dissuade people from shooting, snorting or smoking the tablets as it blocks the effects of the morphine when not ingested. Same concept as buprenorphine / naloxone combos like Suboxone and Zubsolv. Not necessarily a bad thing, but is realistically unlikely to take off due to cost and established prescriber behaviors.
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Mar 19, 2016 05:03
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dethkon posted:Edit: Here's a sign that's on the front door of the pharmacy I go to. Florida, of course: I worked at an independent pharmacy that should have had that sign posted. That was a loving rodeo.
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May 28, 2016 17:20
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My 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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My Imaginary GF posted:Nah. It's gonna be easier to send his prescribing doctors to jail. Good, gently caress every last one of those drug dealers disguised as medical professionals right off to jail for the murderers they are.
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Jun 3, 2016 03:15
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pangstrom posted:He was just MIGFing. Short of real smoking gun negligence evidence--which you aren't going to get out of a celebrity bunker often--opiates for chronic pain, while a demonstrably bad option, isn't itself illegal. Unless Minnesota doesn't have an effective Prescription Drug Monitoring Program, there's a real good chance that all of his recent prescribers and pharmacists will, at best, be looking for new careers very soon if they didn't clearly demonstrate due diligence. If you're not familiar with Prescription Drug Monitoring Programs, they're databases that allow healthcare providers to see all the controlled substance dispensings made to patients. They show you what it was, how much they got, where they got it, when it was filled and who wrote the prescription. Healthcare professionals are now required to consult their state PDMP databases and evaluate their patient's controlled substance fill history before issuing a prescription or dispensing a medication. You're supposed to be looking for things like early fills, duplicate therapies, multiple doctors, multiple pharmacies, potentially fatal drug interactions, etc. But of course a lot of providers don't do that because they're stupid, lazy or greedy. Because it was specifically fentanyl that killed Prince, it could also be that he obtained some "Street Norco" that's basically fentanyl citrate in a pill. It's a real bad idea to take black-market fentanyl orally. Fentanyl doses are so small you need high-quality properly-maintained equipment to properly dose it. People making Street Norco don't have such equipment, they're eyeballing that poo poo. If they eyeball too much you die.
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Jun 3, 2016 14:56
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pangstrom posted:Sounds great but so far the doctors who have gone to jail for opiate prescriptions are Dr. Tseng and... nobody else as far as I know. Every flood starts as a single drop of rain.
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Jun 3, 2016 15:10
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pangstrom posted:It seems Prince was less a "junkie" and more backed into it later in life with chronic hip pain. Those stories can and often do end the same way but that's a lot more cover for his doctor. AmericanOpioidEpidemic.txt quote:Well 50ish people a die a day in the US from opiate ODs so without evidence that he was awful beyond what we already know I'm not going to bet that Prince's doctor is going to be the second drop. I think people who aren't actively involved with regulators in the field right now are underestimating what's about to happen. There's a regulatory hurricane making landfall. If you haven't already nailed down your poo poo you're hosed. Preventing prescription opioid abuse is now one of the most important public policy objectives in the country. Everyone is changing their stances to reflect that. Regulators are growing bigger balls and sharper teeth. The problem with bureaucracies is they move slowly. Providers killing their patients right now are totally hosed, they just won't find out for a few years until they've gotten around to mining the dispensing data and all the paperwork gets done.
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Jun 3, 2016 18:07
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I may be wrong about the impending prescriber apocalypse. The problem is so pervasive that if you withdrew every medical license over inappropriate opioid prescriptions we wouldn't have many doctors left to practice afterwards. That fact may be the only thing that gets these shitheads off the hook, but I'd still like to see them aggressively prosecute doctors who've already had their licenses taken. I mean look at this goddamned poo poo and tell me it isn't murder.
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Jun 4, 2016 14:19
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The Tseng decision was huge. Most of her criminal prescribing practices occurred between 2006 and 2010 and she just got convicted of murder in late 2015. Hopefully initial appeals will get slapped down, the precedent sticks and DA's can make me happy by sticking these assholes in jail. The medical boards have already done most of the heavy lifting, they just don't have the authority to imprison people who are clearly a threat to society.
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Jun 4, 2016 15:24
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Albino Squirrel posted:I don't know if that's homicide, if only because there's no clear intent to harm the patients. It is criminally negligent practice, however. "This guy reported he had a two week prescription of oxycodone stolen. I'll give him 50 days this time! That's it right there. Medical professionals are not laypeople. Medical professionals are specifically trained and licensed, and their services are sought out by patients because they are explicitly expected to know this poo poo. It is their very job to know this poo poo. Every prescriber should know that opioids are addictive, patients actively seek out prescriptions specifically for drug diversion, and opioids are lethal in high doses and in combination with other CNS depressants. If they're not familiar with the effect a potentially fatal medication therapy is going to have on a patient, do some loving research or do something else or face the consequences when your fuckup kills someone. The reality is usually not negligence. It is greed. Take Dr. Neuschatz from one of my posts above. Dr. Neuschatz had to have been fully aware of the physiological effects of the medicines he was prescribing. If he was not, he was not fit to practice medicine. He had to have known that you should, you know, loving evaluate the patient and review their clinical history before you start making it rain oxycodone and benzos. He intentionally ignored the harm his prescriptions might cause. He did this because of money. Lots and lots of money. You can squeeze in an awful lot of patients if you barely even talk to them and end up thousands of dollars richer at the end of the day. If you're splitting hairs over whether or not that constitutes murder, the dude should be in jail anyways. Spoondick fucked around with this message at 17:30 on Jun 4, 2016 |
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Jun 4, 2016 17:26
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I'm not out for physician blood, so long as they're actually practicing medicine. I'm more about the doctors who spend 75 seconds of a 300 second visit cutting prescriptions for OxyContin 80mg #360 1 or 2 6 times daily as needed for pain and Alprazolam 2mg #360 1 to 2 every 4 hours as needed for anxiety without checking to see that that patient is also getting oxycodone 30mg #240 and lorazepam 2mg #90 from their PCP. Oops patient died. It's like handing a suicidal man a loaded gun that you purchased especially for him. You even glued felt to the muzzle so it feels so soft and relaxing against his temple. You hand him the gun, and tell him you'll give him another one in 30 days if he still needs it. Sure, you could have told him to get help instead, but he seemed really interested on getting that gun from you and he was paying good. And you're doing this in a professional capacity as a highly trained, licensed suicide prevention specialist with ample knowledge and resources to intervene.
Spoondick fucked around with this message at 16:52 on Jun 6, 2016 |
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Jun 6, 2016 16:07
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jabby posted:That's not a great analogy. The people who want opioids from doctors will do everything in their power to trick them into making the prescription, not to mention threatening to sue/ruin their reputation/otherwise make their lives miserable if they refuse. Plus telling them to 'go get help' is not very helpful if the help isn't available, and simply sending them away empty handed isn't going to break their addiction, just push them towards street dealers. Yes. Those tricky addicts hoodwinked all these unsuspecting doctors into writing them lethal prescriptions. If only doctors were given some sort of training on how to determine if a patient requires treatment or not and how to provide treatment without killing patients. If only there were resources they could utilize to independently and objectively verify their patients clinical histories. If only these doctors didn't have to book 45 patients and take on 30 more walk-ins every day to make 7 figures a year. If only... we could have saved so many lives. Granted, addiction therapy in America needs a shitload of work and it's difficult for people suffering from addiction to get competent help. But. You sure as gently caress aren't helping by giving addicts exactly what they want, free of charge, plus refills. We tried that. Hundreds of thousands are dying. I'm not convinced an addict is better off with a doctor than a street dealer given the number of people prescription drugs are killing. The most insidious aspect of the whole thing is that a lot of prescription drug addicts either don't realize how addicted they are or feel safe or legitimized in their addiction because they're assuming that since their doctor is a trained professional their dosages and medication combinations must be safe, when in fact their doctor isn't paying attention because they don't give a flying gently caress if their patients live or die. I've been on the frontlines of this bullshit for 10 years now. You know what you say when someone asks you to do something you objectively know is unethical or illegal? No. You loving say no. You say no a lot. I've said no to tens of thousands of people. You know how many of them have gotten me in trouble or ruined my reputation? Not a single loving one of them. Everything goes to poo poo if you don't say no. Spoondick fucked around with this message at 04:23 on Jun 7, 2016 |
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Jun 7, 2016 03:46
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Guavanaut posted:Yes, we did. And it worked great. The only people who had a problem with it were handwringing moralists, out of pocket street dealers, and people who actually wished for death to addicts but didn't have the balls to say so out loud. quote:Overdose deaths involving prescription opioids have quadrupled since 1999, and so have sales of these prescription drugs. From 1999 to 2014, more than 165,000 people have died in the U.S. from overdoses related to prescription opioids. quote:Opioid over-prescription is an issue. Giving someone 60 days of high potency narcotics in one container because of minor surgery is an issue. But 'giving addicts exactly what they want, free of charge' works better than any of the alternatives tried to date. It's a shame that's not what they're actually doing. I want addicts to get help. We are not doing enough to help them. I'm in favor of providing methadone and buprenorphone therapies for opioid addicts so long as 1. Clinical data shows efficacy of the therapies. and 2. The people providing the therapy are doing so in a legal, safe manner within established medical practices. I'm a real big fan of evidence-based medicine. We can do some real amazing poo poo with it. I like what works. I don't like what doesn't work. What doesn't work is when doctors claim to be practicing medicine but instead give lethal prescriptions to patients because that's what the patients are asking for. I'm not some handwringing moralist. I want these loving murderers walking around in broad daylight held accountable. Dr. Neuschatz killed 13 people in that complaint I posted alone. For every death listed in the complaint there are 10 to 20 more because of poor documentation or other circumstances preventing the board from bringing them up as evidence. The motherfucker's practice was only open 3 years. There are thousands of doctors who did this. People have a hard time wrapping their minds around the fact the opioid epidemic happened on purpose for money.
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Jun 7, 2016 14:01
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Guavanaut posted:That would be a problem of overprescription or inappropriate prescription, which is completely different to giving prescription grade drugs to addicts who would like to get those drugs somewhere other than the street. Giving opioid addicts opioids in a supervised clinical setting to specifically ameliorate the effects of opioid abuse is very different than writing a prescription to someone who clearly presents as an addict, knowingly giving them such high doses and quantities of drugs they would likely die if they actually took them (perhaps taking small consolation knowing that most of them will be diverted (and kill someone else)), and calling it pain management. The former works pretty well. The later kills a lot of people. I understand doctors weren't given enough training on opioids and addiction, and it didn't help that the fine folks at Perdue were talking up how not addictive their opioids were. When the dust settles on this whole thing maybe 10 years from now, I think we're going to see a large majority of the opioid prescription overdoses are linked to a small number of doctors. While your naive GP and metric-obsessed ambulatory care provider weren't helping by giving out too many opioids, I really think pill mills did most of the damage by far. jabby posted:OK I know you're being sarcastic here, but surely you realise that addicts will actually do and say anything to trick doctors into writing them prescriptions? And as a doctor myself, most of medical school focuses on how to diagnose and treat people based on what they are telling you. We genuinely don't get much training on how to spot people who are deliberately trying to mislead us, or on how to deal with it. I'm fully aware. I've been living inside of pharmacies for the last 10 years. After patients trick doctors into writing them prescriptions they try to me to trick me into filling them. I have no medical training whatsoever. My last job was making pizza. I paid $100 to take a test, passed, and got a job in a pharmacy. I prevent a lot of inappropriate prescriptions from being dispensed every day because I pay attention to what I am doing and what is happening. A provider with a medical degree in a clinical setting has far more resources to evaluate the patient and their clinical history, yet they continually make the same mistakes because they are not paying attention to what they are doing and what is happening. Patients are going to lie to you about anything and everything. They will lie to you about losing their clonidine when in fact they are using it to poison neighborhood cats. You take what they say into account, but you also independently verify what you can. The words from the patient's mouth are part of the evidence, not all of it. When you practice this during patient encounters, there is much more contrast between appropriate and inappropriate. When something is inappropriate you can have objective evidence to bring to the patient, you can say no and tell the patient specifically why not. When you're cutting corners though, the easiest thing to cut is independent verification. quote:Yes pill factories are unethical and the doctors that work in them are probably knowingly contributing to harm for money. But you are going way overboard with the idea that A) it's easy to differentiate an addict from a genuine patient, B) it's easy to say no in these days of patient satisfaction based reimbursement and C) doctors are writing 'lethal' prescriptions. Most of the prescriptions I write could be fatal if they aren't taken as directed. I'm not pissed off with doctors, I'm pissed off with murderers who played doctor. Very specifically these pill mills. You don't kill 165,000 people 30 leftover Vicodin at a time. You don't kill 165,000 people with prescriptions and then assume the prescriptions weren't lethal. Those are war crime numbers. You only get that from large quantities of wildly inappropriate prescriptions. Sorry if thousands of medical providers being sociopaths is unbelievable to you, but I can spam this thread with thousands of public documents showing exactly that if that's what you need to see.
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Jun 8, 2016 15:50
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Another large factor in the epidemic people are mostly unaware of is insurance disbursements to pharmacies. A retail pharmacy maybe makes $5 to $10 per prescription they dispense on average, with independents on the low end and major chains on the high end. When you go to a retail pharmacy and hand them a $5 bill for the copay of a 90 day supply of lisinopril, that is almost guaranteed to be the only money the pharmacy will see for that prescription. When I was doing independent pharmacies they were understandably very concerned about maximizing profits. The invoice for the drugs you buy is due in 30 days when insurance takes 6 weeks on average to pay you. You need liquid cash, and higher margin prescriptions are preferable. Schedule IIs had higher margins because of the additional risks and expenses in dealing in them. The Medicaid reimbursement for oxycodone and hydrocodone tablets was about 30% to 50% above cost, with pharmacies usually making hundreds per fill. In an environment where you're barely scraping by on filling routine maintenance medications and narcotics are a windfall, guess which patients pharmacies start bending over backwards for. The California Board of Pharmacy has been massacring independent pharmacies in recent years largely because they yielded to the temptation.
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Jun 9, 2016 18:51
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