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Thread: Impact of harsh laws on chronic pain patients...interesting article

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    Quote Originally Posted by snowy View Post
    Hi Whisperjet Alcohol is killing 100,000 Americans per year, do you know if that figure includes car accident deaths caused by DUIs?
    @snowy
    Good Question ! ref post #40 (Document from several years ago.... IMHO likely so !......I may research this......thanks for your inquiry) !!
    Last edited by Whisperliner L1011; 02-18-2019 at 09:08 PM. Reason: post #40 memo
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    Here is link laying out some of the prescribing limits and restrictions across the US.
    https://tinyurl.com/yyug7yaw

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    Quote Originally Posted by Uncle Rob View Post
    Here is link laying out some of the prescribing limits and restrictions across the US.
    https://tinyurl.com/yyug7yaw
    @Uncle Rob...it's interesting that the article mentioned a number of times that these new restrictions have not been determined to have unintended consequences. It may just be anecdotal but here in MA, they were the first to enact a number of the strictest restrictions in the country.

    Deaths by heroin laced with fentanyl shot through the roof but I just read that last year cocaine laced with fentanyl was the number ONE cause of overdose. Might that be "unintended consequences"?
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    @Bawston, I think there is no question the law of unintended consequences comes into play here. There certainly seems to be quite a spike in opioid deaths in the last couple of years, more than a few I am sure because people did not have access to safe, legitimate meds. I think we have grown up, and come a long way, about the use of cannabis. I understand trying to preempt addition, but I think there are more reasoned and thoughtful ways to deal with people who already use opioids/opiates, who these restrictions will not help, in fact quite the opposite. This what they did in Portugal, doubt if the political will exists for this answer.

    https://tinyurl.com/yavupowf
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    @Uncle Rob...I was just reading today that a study committee recommended allowing safe injection sites in Boston. It would be a clean place with staff who could help bring back OD's should that happen. I understand that no one would want it in their neighborhood but I guess, depending on where you are now, people are already dealing with people shooting up in alleys & parking lots also the problem of used needles left for kids & pets. So maybe it is time to face reality & acknowledge that people have always done this & will continue to do so and try to segregate it and make it as safe for everyone.

    As to the laws my state implemented, they're taking credit for those laws causing the drop in prescriptions being written when actually, that had already started before they came up with these laws. It also coincided with OxyContin coming out with their tamper resistant pill so addicts didn't want it anymore because they couldn't crush it to get the full 12 hour dose released at once.
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    Quote Originally Posted by Uncle Rob View Post
    @Bawston, I think there is no question the law of unintended consequences comes into play here. There certainly seems to be quite a spike in opioid deaths in the last couple of years, more than a few I am sure because people did not have access to safe, legitimate meds. I think we have grown up, and come a long way, about the use of cannabis. I understand trying to preempt addition, but I think there are more reasoned and thoughtful ways to deal with people who already use opioids/opiates, who these restrictions will not help, in fact quite the opposite. This what they did in Portugal, doubt if the political will exists for this answer.

    https://tinyurl.com/yavupowf
    Great article, thanks so much for sharing! It makes me very hopeful to read something like this especially, as it points out, when Portugal is a religious and conservative country; if such a change in attitude can occur there, perhaps it can happen in the US, too. Maybe.
    The article brought up two of my favorite points when arguing for legalization (my preference, though decriminalization is certainly a start). The first: "if drugs were legalised, not just decriminalised, then these substances would be held to the same rigorous quality and safety standards as food, drink and medication." For the 2nd, I couldn't find a one sentence quote, but the article points out that legalization renders the black market obsolete, and when the bottom drops out of the black market, the crime rate also drops like a lead balloon. (OTOH, Prohibition actually creates organized crime; alcohol brought us the Mob, drugs = cartels).
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    Quote Originally Posted by blueroan17 View Post
    Great article, thanks so much for sharing! It makes me very hopeful to read something like this especially, as it points out, when Portugal is a religious and conservative country; if such a change in attitude can occur there, perhaps it can happen in the US, too. Maybe.
    The article brought up two of my favorite points when arguing for legalization (my preference, though decriminalization is certainly a start). The first: "if drugs were legalised, not just decriminalised, then these substances would be held to the same rigorous quality and safety standards as food, drink and medication." For the 2nd, I couldn't find a one sentence quote, but the article points out that legalization renders the black market obsolete, and when the bottom drops out of the black market, the crime rate also drops like a lead balloon. (OTOH, Prohibition actually creates organized crime; alcohol brought us the Mob, drugs = cartels).
    I haven't read the article yet, but lately have been listening to youtubes/ted talks on harm reduction. Since SO MANY kids are dying, the powers that be might FINALLY listen to some of the folks in the trenches. They know that harm reduction saves lives dramatically over the "zero tolerance" criminalization of drug use. Since so many "rich" kids are now dying, I think there will be even greater push to find answers that actually work, instead of these neanderthal ideas that don't...
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    @jaders...what I find interesting is that many of the people dying of overdoses of heroin/cocaine/fentynal are in the age bracket that went through the school DARE programs which was supposed to stop kids from even trying drugs. In my state this program was mandated for fifth grade & my daughter would come home with stories back then of how a group,of kids would go and try whatever the DARE officer (this was presented by cops) would take about.

    Obviously the educational approach to the dangers of drugs didn't work any more than sex education prevented kids from having sex. It seems that in the case of sex, what did help was access to contraceptives so that when kids did what they inevitably will do, the consequences weren't as bad as they could have been - STD's or pregnancies. Kind of makes me think that creating a safe environment at least might save lives.

    And I just have to say once again...the numbers of people dying from these OD's - nobody can convince me that they're all from some kid having a sports injury and being prescribed Vicodin.
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    Quote Originally Posted by Bawston View Post
    @jaders...what I find interesting is that many of the people dying of overdoses of heroin/cocaine/fentynal are in the age bracket that went through the school DARE programs which was supposed to stop kids from even trying drugs. In my state this program was mandated for fifth grade & my daughter would come home with stories back then of how a group,of kids would go and try whatever the DARE officer (this was presented by cops) would take about.

    Obviously the educational approach to the dangers of drugs didn't work any more than sex education prevented kids from having sex. It seems that in the case of sex, what did help was access to contraceptives so that when kids did what they inevitably will do, the consequences weren't as bad as they could have been - STD's or pregnancies. Kind of makes me think that creating a safe environment at least might save lives.

    And I just have to say once again...the numbers of people dying from these OD's - nobody can convince me that they're all from some kid having a sports injury and being prescribed Vicodin.
    It's my personal opinion that NO ONE understands why some folks get addicted and some don't. I do know that heroin has just become very socially acceptable and easy to try as well. It's probably true that a lot of kids raided their parents "stash" at first, but they also do that with alcohol and probably just as many become "addicted" to that too. Look at shows like House and a lot of others. Somehow opiates - vicodin especially, became "hip." So did oxycontin. But I still think it's an individual issue, why one kid goes down the self-destructive path, and the other one doesn't.

    Don't know if you've read the book, Wild - by Cheryl Strayed that was a big hit about her hiking the Pacific Crest Trail. She talked her self-destructiveness and use of heroin, but obviously she turned that around. There's also a number of studies about the Viet Nam phenomenon where so many servicemen were using heroin daily in Nam and when they all came home, the government thought there was going to be a HUGE problem because of this, but only about 1 in 10 guys continued to use heroin when they got home. In my opinion, it's NOT the drug, it's the person...

    We are so far away from understanding addiction and what drives it. Food, alcohol, drugs, gambling - to me somehow it's a brain chemistry issue which one "works" and why some folks will take it all the way to death/destruction and others turn it around. I sure have no answers, but criminalizing it sure hasn't been an effective answer either. I think harm reduction is definitely going to be the "future" and seeing addiction as a public health issue as well. Americans are so ridiculously "moralistic" about things tho. That we continue to fight for abortion rights, sex ed and easy access to contraception, like you say, when it's proven over and over, what really works - it frustrates me no end how backward America is in all these areas compared to most of the 1st world countries...
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    @Bawston, @blueroan17, @jaders, my thoughts are, having a look at some of the statistic is that well over 1 trillion dollars have been spent since the "war on drugs" started, with around 40 billion being spent every year, with amounts escalating every year. If this money, or a significant portion, of these funds were directed at root causes, such as education, poverty, harm reduction, mental health - a total revamping and total refocusing of the efforts towards real long lasting solutions. The incarceration rates from the 1930s were pretty static until the war on drugs started, then there has been a 500% increase in the last 40 or so years. Not sure what the answer is, but based on the last 40 years of statistics, what is currently in place and is certainly not working. An awful of of money is being spent on this war, who is truly benefiting, there has not been a spike in addiction percentages in the population, although there has been a large spike in related opioid/opiate deaths (as we have been discussing).


    attachmentphp?attachmentid50408 - Impact of harsh laws on chronic pain patients...interesting article.

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    There's certainly a variety of reasons for addiction and I'm with you @jaders about how we somehow make this a moral issue when it's probably a combination of chemistry, biology and as @Uncle Rob pointed out, education and opportunity. If I were living in an area that had little opportunity, poor education, lack of jobs, etc. it would probably be easy to just fall into whatever the norm is for the area. If it's everyone hanging out at some dive bar or your group of friends shooting up, then the peer pressure's going to be intense.

    I cringe every time the government declares a 'war' on something. To me it usually means we're going to throw a lot of money at something just to make it look like we're doing something.

    My father was an alcoholic and whenever I'm asked by a doctor of any family history of alcoholism I say no because it sends up a red flag and probably ruins my chances of getting pain treatment. Now in high school I hung out with a group that was into heavy drinking. It seemed like everyone was trying to outdo each other, myself included. I got to college though and it was of no interest to me. I just didn't drink. Today I may have a couple glasses of wine per month.

    I remember one doctor's appointment where he asked me if I drank and I said no. He raised his eyebrows and said nothing? At the time I was on medication where drinking would have been risky and I didn't drink at all so I repeated NO. He snapped at me and said "so is it because you have a problem drinking?" Geesh...sometimes you just can't win!

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    Quote Originally Posted by Whisperliner L1011 View Post
    @snowy
    Good Question ! ref post #40 (Document from several years ago.... IMHO likely so !......I may research this......thanks for your inquiry) !!
    @snowy..como le va? @Binky @Mrs Parker @Bawston ............"better late than never" .................
    I cannot locate the "specific article Re: Documentation from the CDC ATL regarding my statistics I printed on
    this very thread...ref: post #30 (12 Feb 2019) and post #40 #41 on 18 Feb 2019...........I downloaded those
    stats either from Drug Buyers dot com or LOL Bluelight many years ago..............BUT I have some more
    recent data I discovered (as a packrat) in my former office in the study of my residence (condominium) today
    from years 2004 to 2010 covering seven (7) pages of data and fourteen (14) reliable sources including data
    to address your specific question @snowy !

    My Lenovo 12" Laptop Ultra Book (former IBM ThinkPad) is acting up, so thus, I will give you a synopsis of the
    data I have printed up, from 10 Dec 2010.

    The link is http://[email protected] dot 0rg/cms/?q=node/30 subtitled "Get the Facts Drug [email protected] Facts dot 0rg
    Ref: Annual Causes of Death in the United States about 45 or 46 more target specific data from the A to Z
    in Chapters.......

    from page one Annual Causes of [email protected] in the United [email protected]

    1. Tobacco 435,000
    2. Poor Diet & Physical Activity 365,000
    3. Alcohol 85,000 *
    4. Microbial Agents 75,000
    5. Toxic Agents 55,000
    6. Motor Vehicle Crashes 26,347 **
    7. Adverse Reactions to RX drugs 32,000
    8. Suicide 30,622
    9. Incidents Involving Firearms 29,000
    10. Homicide 20,308
    11. Sexual Behaviors 20,000
    12. All illicit Drug Use, Direct and
    Indirect 17,000
    13. Non-Steroidal Anti-Inflammatory
    Drugs As Aspirin 7,600
    14. [email protected]@na 0

    see * from number 3 (Alcohol) source: Actual Causes of Death in the United States, 2000. [email protected] of the
    Medical Ass0ciati0n (March 10, 2004) G225 V0L 291, No 1O, p. 1238, 1240.
    http:/[email protected] dot com/[email protected]/research/1238dot pdf

    Quote: Correction : "A dagger symb0l sh0uld be added to "alc0h0l consumption in the body of the table
    and a dagger footnote should be added with the 1990 data, deaths from alc0h0l-related crashes are
    included in alc0h0L consumption deaths, but, NOT in motor vehicle deaths. In 2000, data, 16,653 deaths
    from alc0h0L consumption and motor vehicle death categ0ries." unquote from * (see my list above)
    quote "According to the Journal on January 19, 2005" unquote from the same Journal the AMA Jan 19, 2005
    V0L no. 1O, p. 1238, 1240" .................

    ** is ref to [email protected] Deaths from 1999-2007..........I shall either pm you, or, continue this 70 word quotation,,
    due to my time poverty at the moment.........the source I can say is from "M0rbidity Weekly Rep0rt,
    August 20, 2010 VoL 59, no. 32 ([email protected], [email protected], US Center for [email protected] C0ntr0l p. 1026.

    http://www dot cDc dot g0v/mmwr/pdf/wk/Mm/5932 dot pDF

    [email protected] manana Adios ! Senorita @snowy !
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  13. number ONE cause of DEATH is birth---------------------------------smoking pot never killed me but i wish i was dead

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    I don’t know about that last post but otherwise this has been a very interesting and enlightening thread and I’m glad it got bumped up again. I so agree with what others have said here about the root cause of addiction still being a mystery to modern science. I hope someday soon our society stops punishing the un-addicted people who experience chronic pain in the supposed interest of stopping something it doesn’t even understand how to manage anyway.

    A quote from one of the articles posted earlier in this thread: “In the rush to reduce opioid misuse, it is easy to forget that millions of people have safely taken these drugs for years. Data show that less than 8 percent of chronic pain patients become addicted, according to a study that has the director of the National Institute on Drug Abuse as a co-writer. And overwhelmingly, prescription opioid addiction doesn’t begin with a doctor’s prescription: About 80 percent of people who start misusing these drugs are getting them from family, friends and other people’s medicine cabinets — not from legitimate pain treatment.”

    Addiction is a seriously wretched disease, but until we start to understand the actual cause it will continue, whether opioids and other drugs are legal or not.
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    @pippi222...the pendulum swings and right now we’re in a situation that’s hurting pain and surgical patients yet not helping people who need addiction help. So in my mind we’re at lose-lose. Maybe the only good thing that’s come of the new regulations is perhaps more beds being opened for recovery but it seems like a small number are taking advantage of their own free will.

    I think there is less chance of recovery for those who are being forced into a rehab by family or the courts. The root causes aren’t really being addressed.
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  16. unfortunately the root causes are not only biological but socio-economic, @Bawston, and as wages stagnate, more people are looking for relief. prohibition came about when many people were working 12 hour days six days a week. gin was their only outlet. people in the rust belt, people in coal areas, are holding on to a way of life that is no longer viable. that class of people will grow as automation takes more jobs. the average family lives on 30k and is one medical emergency away from bankruptcy. 80% of americans live paycheck to paycheck. take a predisposition to addiction, add poverty, malnutrition, and stress, and you have a crisis that will not be solved by punishing doctors, nor will it be affected by tax cuts for the rich. we don't understand addiction because of its complexity and because people with nothing to live for do not care about recovery.
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    @notcharlotte...Bang! You’ve nailed a major link to the addiction problem. Why would W. Virginia have the highest use and addiction rate? And really, in many cases you’re talking about black lung which I’d take whatever made me feel better too!

    Plus, there’s always going to be kids trying whatever they hear about. If someone can eat a Tidepod, are they going to be fearful of a little pill? I remember my daughter telling me about a group of boys in her 5th grade class back when they used to have the DARE program. Cops would come in and explain all the dangers of drugs etc. as soon as they heard about huffing they were onto it.
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  18. #58
    After reading @Bawston & @notcharlotte's great post, I find it a bit confusing and interested in the part of an article I have marked in RED. Does this mean if I downed a ton of xannies but had no trace of opioids (never took them), and died, I am included with the opioid deaths or would I have had to take an opioid to be in be included. It does sound like if I killed myself with xannies, I would be included in the opioids deaths. Anyone have any thoughts on this. I am very confused about this one. M

    Site: https://www.drugabuse.gov/drugs-abus...aries-by-state

    "Opioid overdose deaths are identified using underlying cause-of-death codes X40–X44, X60–X64, X85, and Y10–Y14. Opioid overdose deaths as defined, that have T40.1 (Heroin), T40.2 (Other opioids), T40.3 (Methadone), T40.4 (Other synthetic narcotics), T40.6 (Other and unspecified narcotics) as a contributing cause. Age-adjusted death rates were calculated as deaths per 100,000 population using the direct method and the 2000 standard population. Source: The Centers for Disease Control and Prevention, CDC WONDER.


    What really has me wondering is this...

    "Drug-poisoning deaths are defined as having ICD–10 underlying cause-of-death codes X40–X44 (unintentional), X60–X64 (suicide), X85 (homicide), or Y10–Y14 (undetermined intent). Estimates are based on the National Vital Statistics System multiple cause-of-death mortality files (1)"


    So I have poisoned myself ICD-10...drug poisoning
    by Xanax which is an X60 underlying cause of death - intentional suicide
    But I died as a result of T40.6 - Other and unspecified narcotics [/COLOR]

    By all accounts, I have died by suicide using xannies however I am classified as an opioid death. Can someone explain this to me or even want to explain. M






    The original source of the opioid prescribing rates is, IQVIA Xponent 2006–2017. The data source information and description can be accessed from the Centers for Disease Control and Prevention U.S. Opioid Prescribing Rate Maps webpage."
    Additional Data:
    2018 NIDA Opioid Misuse and Addiction Related Funded Research in All States (NIH Project Reporter)
    This page was last updated May 2019
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    I would like to thank @Mecha, @Bawston, and @notcharlotte for spending time for such an informative post. Thank you.
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    @Mecha...I’m not a pathologist or coroner (in some counties you don’t have to be one either to determine the cause of death so numbers can get skewed that way too). What I do know is that something like Xanax is a benzo which in my state is considered a controlled substance that must be logged into the drug database and a doctor is required to go in and review your drug history before prescribing. Doctors are also discouraged, but not prohibited from prescribing both to you.

    Technically, Xanax is not an opioid but is classed as a narcotic...
    Narcotic (opioid) analgesics are used to treat moderate to severe pain. Both benzodiazepines and narcotics (opioids) are common drugs of abuse. Common benzodiazepines include diazepam (Valium), alprazolam (Xanax), lorazepam (Ativan), temazepam (Restoril), and clonazepam (Klonopin).Aug 16, 2018

    In the case you outlined my guess would be that the death would be ruled as an unspecified (or specified) narcotic, either intentional or accidental AND would go into the CDC’s opioid count. Keep in mind that the CDC has already admitted they made a mistake and doubled their opioid death count so their numbers aren’t something I’d rely on.

    Also, if you read a headline that says “woman found in her flower bed of drug overdose” what would automatically jump into your mind given the news coverage these days? The truth is, she could have OD’d on her blood thinning meds and bled out.
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