Opioids/Painkiller drugs: FDA to Approve Zohydro despite everyone saying not to

[Cliron]

Opioid addicts: get your IV's or snorting trays ready.

From my facebook rant: "Not satisfied with consuming >90% of the world's hydrocodone in its current formulations, America is about to approve use of a drug with 10 times the hydrocodone than a regular vicodin pill but without all that silly stuff that makes crushing/injecting it more difficult.

As the country is going through an epidemic with the current formulations....Whats going to happen when a Moonshine-esque player enters and makes the rest of the playing field seem like Smirnoff Ice in comparison?

Very worrying crossroad, which should be watched with a discerning eye, especially if you or loved ones live in an area particularly effected by the epidemic."


Other things to note:

The drug doesn't have any "filler" (paracetamol, ibuprofen etc) that make snorting/ IV'ing more difficult.

50mg of Hydrocodone = 50mg of Morphine when taken orally.
50mg of Hydrocodone = 333.33 mg of codeine (if it helps to think of how many tramadol you'd need to take to have the same morphine equivalence)

There are no prescription requirements, such as being only available for cancer pain.

One Zohydro can apparently kill a child that is opioid-naive. Having written a CDC grant specifically about children and prescription drugs, I can say that this happens more often than you'd like to think.

Most deaths from opioids occur from prescription drugs rather than heroin (I think its about 75% prescription to 25% non-prescription if I recall correctly). With most people now starting their addiction journey with prescription drugs and then moving onto heroin when supply is not available / cost.

And one of the most sickening aspects for myself, is that whereas there are no restrictions on prescriptions for these drugs (a doctor can prescribe high doses of opioids to hundreds of patients), there are very stringent restrictions on access to treatment; with physicians having to opt into training to be able to dispense buprenorphine (having to take a course and registering with the lolDEA) and are limited to 30 patients (which can then be upgraded to 100 after a year, but most don't avail of this).
So the experts in this field who treat our addicted brothers and sisters, no matter how skilled they are limited to 100 patients at a time. Whereas, Dr. Broseph, the crappy-pain doc can help create hundreds of addicts a year.


So BG, how has the opioid epidemic effected you? Has your community been effected? What are your thoughts on Zohydro? Are you pro-opioids or "opioid-phobic"?

Or is this issue too far removed from our day-to-day lives, because of the bias that prescription=good? If I was talking about a heroin epidemic would you react differently?

Acceptable overview:
http://www.huffingtonpost.com/andrew...ampaign=buffer

[vagus]

Drug dealing very profitable.

[Byrthnoth]

The best part of it all is that opiates aren't even very good at reducing pain. They reduce pain complaints, but don't do a whole hell of a lot for the pain itself (especially if used for long periods of time).

[CadburySylph]

Vermont is plagued by opiate abuse. Heroin is getting big around here too.

[kuronosan]

The fuck, FDA.

[ringthree]

I see zero opioid abuse, they hide it well enough. I don't doubt it happens, but honestly, you just sound like one of those people where your brother died from being an addict, which sucks, but I don't know if that means we should deny opioids to people with chronic pain.

[BaneTheBrawler]

I get severe Opioid Induced Constipation. Completely shuts down my intestinal muscles.... while my microbes keep going to town, making gas and poo. Worst pain ever. Original pain isn't even dulled.

[Cliron]

The best part of it all is that opiates aren't even very good at reducing pain. They reduce pain complaints, but don't do a whole hell of a lot for the pain itself (especially if used for long periods of time).

Byrth, you are a pleasure. Its a common misconception (both by health professionals and non health professionals) that long-term opioid use is effective in treating chronic pain and is based on science. To date, (i'm almost certain) that there have been no study to show that long term (1yr>) use of opioids are effective for Chronic Opioid Therapy (COT).

However, in practice, alot of patients are prescribed opioids for an extended period of time (especially in the US).

Page 2: table on Myths and facts on COT.
http://www.supportprop.org/education...rescribing.pdf

Also, I recommend looking at Hyperalgesia. http://en.wikipedia.org/wiki/Hyperalgesia
Also, to note is that support for High dose (>120mg morphine equivalent) is practically non-existent but often occurs in reality.

Ringthree

I see zero opioid abuse, they hide it well enough. I don't doubt it happens, but honestly, you just sound like one of those people where your brother died from being an addict, which sucks, but I don't know if that means we should deny opioids to people with chronic pain.

Whereas, my post may come off as opioid phobic, I'm certainly not. I believe in responsible opioid prescribing, in incidences that the literature shows it to be effective in.
Opioids are a very powerful and potent tool, that when mishandled have great effects on the recipients. Physical dependence occurs after a relatively short amount of time (a few weeks->90days) wherein, if discontinued your brain goes 'what the fuck' and you go into withdrawals (which, are awful). Think smokers, but, alot worse.

On a personal level, not that it really matters on what I've said thus far, I've no personal experience with opioids. No family connection, or friends. I work as a psych researcher, in topics of medication adherence, COT, and Medication assisted therapy (MAT) for opioid addiction.

If anything, I'm further removed because I'm not American and have only been here for a short period of time. This is very much an America-centric epidemic, reflected in the fact that America consumes over 80% of the worlds opiates and 99% (might be 98) of the world's hydrocodone.

[Byrthnoth]

Yeah... pain is mostly peripheral and opiod receptor levels/activity rapidly adapt to opiod exposure. What doesn't adapt as quickly are the central effects, which don't reduce pain as much as distract from it by making you (for lack of a better term) pretty fucking high. After a while the central effects do adapt, usage levels go up, you're popping pills just to feel normal again, dot dot dot, you die, the end.

Rather than just upping the opiod dosage, they should be looking at alternative pain medications/treatments. For instance, opiods would be about equally effective at treating pain if they only worked on the peripheral nervous system. Where are my synthetic opiods that can't cross the blood brain barrier, drug companies? Oh right. No one actually wants those because they wouldn't make you high despite treating the pain equally well. Being high is arguably part of the treatment in this case, as it makes the pain "more bearable." Too bad you adapt to it and become dependent on it. For someone who is recovering from minor surgery or something it doesn't really matter. However, some percentage of "successful" invasive surgeries (like 10%) cause the patient to spontaneously develop persistent pain. What for them? The idea is that you're supposed to wean yourself off opiates and take the low part of your trip when you're physically feeling better. Someone with persistent pain never gets that part, so the end up taking more and more opiates to compensate for the central habituation. You go in for typical surgery and end up with a life-long expensive habit that eats up your digestive tract and gives you "crackhead-like-tendencies." Lucky you!


Pain management:
Acetaminophen (Tylenol) - Works, but isn't strong enough
Acetylsalicylic Acid (Aspirin) - Works, but isn't strong enough
Laughing Gas - Makes you not care about the pain
Opiods - Temporary analgesia followed by you not caring about the pain
Ketamine - Makes you not care about the pain
Everything else that puts you to sleep - Probably has no effect on the pain, but you're at least not there to feel it. This is sort of the ultimate "high," but it obviously leaves you non-functional so it's not a solution.

[BaneTheBrawler]

isn't aspirin also a blood thinner? p. sure that's why i can't take it. and also because something something something liver damage something something.

[Waraji]

Is it legal? Yes. Are you automatically being forced to shove it down your throat? No. Free Market. We could use less population in the world.

[Byrthnoth]

Aspirin and Tylenol cause stomach problems. Aspirin also causes hearing loss (over a long period of time, possibly just because it's a blood thinner).

[hey]

The best part of it all is that opiates aren't even very good at reducing pain. They reduce pain complaints, but don't do a whole hell of a lot for the pain itself (especially if used for long periods of time).

They are about the only thing that usually makes a significant difference for my pain. They make me feel like absolute shit though, so i only take them if i'm ready to die otherwise.

[Esvedium]

When I shattered my radius to the point of needing a plate and screws to mangle it all back together, I was on Vicodin for the pain, and I agree with Byrth, it doesn't actually reduce the pain, so much as make me not care about the pain. I knew my arm still hurt, I just didn't give a shit. Luckily for me, I don't have an addictive personality (or whatever you want to call it), so when I didn't need them anymore, I just stopped taking them, like when I quit smoking, I just crumpled up ~half a pack of smokes and stopped right there, but I can see how they would be powerfully addictive to some people.

I'm neither pro- not -phobic on opioids, they have their place for short-term pain, like what I went through, but for chronic pain, I think they are fairly ineffective in actually dealing with the pain. I don't know of anything that is 'better', though...

[Cliron]

@Waraji: Whereas I can respect your opinion and the naive optimism in the ability for humans to "choose" it represents, its generally an awful argument to make in my eyes.

You say that opioids are not 'shoved down your throat', but arent they to a degree? Whereas many doctors will say they aren't appropriate for long term use and that they should be used in conjunction with other treatments (physio, physical therapy, surgery, yoga etc etc etc), you'll find in reality a lot of doctors who do just prescribe the opioids and wait 90 days and rinse and repeat.

I honestly don't believe this is out of negligence (most of the time) but a complex multitude of factors such as demands of doctors on a day-to-day basis, doctor education, lack of other effective pain reducing medications, patient factors such as drug seeking behaviours (hey, these opioids made the pain go away and make me feel good...Im going back to my deale...err...my doc. Oh wait the doc doesn't want to give me more? I'll either go to another doc next door or scream and shout until I get some) etc.

And to get at your point of "choosing". Are you as the consumer/patient in a rational state of mind to be able to make decisions after complex invasive surgery/ a horrific accident/ chronic pain/ etc? These medications exist because there is pain out there that majority of people have no experience of and never will, are you telling me that if the doctor offered you a remedy while in a torment of pain that cripple your day to day actions, you'd be able to say "lolno opioids bad doc, give me some aspirin thx'?

Personally, its become a troupe for me in my research/reading: 'Accident happened...doctor prescribed me opioids....I thought because the doctor prescribed em that they would fix the pain (keep in mind average person has no medical background)...he prescribed them for a long time...I started needing more...doctor suddenly decides to stop prescribing (even though they had no problem prescribing for 6months++)...words like "addict" are thrown around...prescriptions discontinued'. The cliche, then diverges that the person tries to find another doctor, or tries other methods of getting opioids/ opiates (street prescription drugs, or heroin[most people don't start their opioid careers with heroin]), or tries to access addiction medication services to taper off opioids (quickly learning that it is INCREDIBLY expensive to avail of such services, getting branded and have to incorporate 'addict' into their self concept, and if they are still suffering from chronic pain? Forget about it. Most doctors/psychiatrists throw up their hands and say "I dont know how to treat you").

[Cliron]

Happens more in some groups more than others (for a million reasons), but recently the Veterans Affairs (VA) have gotten into alot of hot water.

http://abcnews.go.com/US/vas-lack-pa...ry?id=22673643

VA's Lack of Pain Treatment Options Led to Opiate Addiction, Vet Says

Also, top tip: although there is some variation and complexity, a simple rule of thumb is that any 'unnatural' formulation of morphine/opiate =opioid (any pill). Whereas, 'more natural' versions of it = opiates (think heroin)

[Cream Soda]

I don't even know what the fuss about painkillers are. I threw my back out in November and they weren't very affective. I had to take 2 hydrocodone just to be able to bike to school and another upon arrival.

Taking up to 2 at a time, and up to 6 a day, I never once got the feeling of any sort of "high" or enjoyment. Just slightly reduced pain.

When my back recovered, I was able to stop taking them on day 1, without any desire whatsoever to take any more. I have about 100 of them left sitting next to my bed and haven't even considered opening the bottle other than the 2 days after I got hit by the city bus and fractured my shoulder. (but even then I just went with 600mg ibuprofin)

[hey]

I don't even know what the fuss about painkillers are. I threw my back out in November and they weren't very affective. I had to take 2 hydrocodone just to be able to bike to school and another upon arrival.

Taking up to 2 at a time, and up to 6 a day, I never once got the feeling of any sort of "high" or enjoyment. Just slightly reduced pain.

Because as with every medication, they affect everyone differently. It may not have been very effective for you, or it may not have made you feel high, but it does for others.

[Callisto]

Only effect the epidemic has had here is wiping out idiot rich white kids in the west suburbs. They get into their parent's vicodin, or get their own, then drive to the west side of the city and pick up heroin, then inevitably OD and/or steal from their parents or whatever. Highest concentration of opioid OD deaths by me is in the richest neighborhoods.

[Mad Dog Ben Richards]

this strikes a nerve with me.

one of my best friends is addicted to dope and it started from oxy. he's total garbage now I barely talk to him.

one time he had black and blue marks on his hand and it was all swollen and he tried to tell me spiders were biting him in the middle of the night. I was like I don't know whats worse that you didn't do anything about said spiders or that you actually think I believe that. I was all but convinced he was sticking himself in his hand until I saw the breaking bad episode where that guy smashes his hand with a hammer to go get pain killers.

I tried to help but everything is a lie with him now. I busted into his apt with my friends and took away all his shit and threw it out at 7/11. didn't matter. for 2014 I have heard he has more days missed then days at work and still has his job but his boss is an asshole according to him..... everyone else is an asshole he says. everyone is out to get him and poor little him. the truth is he is the asshole.

whats even worse is people who expect others to pick up the tab in rehab for these clowns with crap like it's not their fault and they eat up the excuses the addicts lay on hard and thick to generate sympathy which will enable them to slide through another day. I'm so past the sympathy for him or anyone who takes that crap.

don't even get me started on the whole I cant afford insurance but I can drop my bills on smokes and drugs all week long aspect.