Origins of the Opioid Crisis

Beebo Brink

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We've debated the various responsibilities of pharmaceuticals and doctors in other threads, specifically about the Sackler family. This article, however, really brings home the way in which the drug industry knowingly manipulated doctors to sell more of their products.

I was a drug rep. I know how pharma companies pushed opioids.

Some of the doctors in my territory seemed to think of themselves as impervious to my charms. They acted as if they just nodded along, they could get my free samples and rush me out the door, no harm done. They didn’t realize how easily I could find out if they’d lied about how many scrips they would write. I’d be back the next week, guilt-tripping them about why they had underdelivered. That’s because, in addition to the extensive personal information we gathered — psychological profiles, their kids’ birth dates, who was having marital problems — sales reps had access to extensive databases about doctors’ prescribing habits.
 

Zaida Gearbox

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In 1996 we had an inmate win a significant lawsuit against her doctor for facilitating her addiction to opioids. It is 23 years later. Why is this STILL going on. It was NEVER a secret how addictive this shit is... The only one that might have been a secret was tramadol. When I had my bad accident - my doctor basically wrote me a permanent script for tramadol. At that time she said it was not addictive, and the reason she wrote me that script as an alternative to narcotics. Several months later I decided I didn't want to take the tramadol anymore because I've always been very determined to not get addicted to pain killers. Getting off tramadol was one of the hardest things I've ever done.
 

Beebo Brink

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Why is this STILL going on. It was NEVER a secret how addictive this shit is... The only one that might have been a secret was tramadol. When I had my bad accident - my doctor basically wrote me a permanent script for tramadol. At that time she said it was not addictive, and the reason she wrote me that script as an alternative to narcotics.
My wife has had a number of hospitalizations over the past two or three years for severe abdominal pain due to ulcers and inflammation, then there was surgery for the knee with the torn meniscus. All of the doctors and nurses urged her to take painkillers, they insisted that she could not become addicted if she was in pain. I'm pretty sure tramadol was what the knee surgeon prescribed, specifically because of my wife's concern about addiction. He said, "This one isn't addictive." We Googled it as soon as we got home and within five minutes found significant evidence of it being very addictive.

And it's so difficult to resist believing them, because they're supposed to know what they're doing, right? Fortunately, both my wife and I are old-school about pain (it's got to be pretty bad before we reach for pills) and paranoid about falling into the addiction trap that surrounds us here in West Virginia. The opioids were a last result, when she was worn out by pain, and then she would only take them for a day or two, just enough to break the pain cycle.
 

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In 1996 we had an inmate win a significant lawsuit against her doctor for facilitating her addiction to opioids. It is 23 years later. Why is this STILL going on. It was NEVER a secret how addictive this shit is... The only one that might have been a secret was tramadol. When I had my bad accident - my doctor basically wrote me a permanent script for tramadol. At that time she said it was not addictive, and the reason she wrote me that script as an alternative to narcotics. Several months later I decided I didn't want to take the tramadol anymore because I've always been very determined to not get addicted to pain killers. Getting off tramadol was one of the hardest things I've ever done.
I switched to old-school Tylenol #4 from Tramadol and I think I dodged a bullet. Codeine I can keep on an as-needed basis.
 

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Random link, not at all related to the topic.

Edit: And another one:
 

Aribeth Zelin

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Thing is, when you tell the oral surgeon that you can't take opiates, that you are allergic, that they make you sick, and they go, 'Okay, so have some tramadol...' and you know there is a reason this is bad, but don't remember why until after you are violently ill, while still recovering from having three teeth removed. But there really aren't any alternatives for surgical pain available where I live [not sure if there are any at all].
 
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Thing is, when you tell the oral surgeon that you can't take opiates, that you are allergic, that they make you sick, and they go, 'Okay, so have some tramadol...' and you know there is a reason this is bad, but don't remember why until after you are violently ill, while still recovering from having three teeth removed. But there really aren't any alternatives for surgical pain available where I live [not sure if there are any at all].
I guess I got lucky. I had to have two teeth removed. They gave me a scrip for 20 pills of something labeled APAP / codeine which is codeine with tylenol. But I only needed around 3. It didn't hurt that much. No withdrawal symptoms for that small usage.
 

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My wife has had a number of hospitalizations over the past two or three years for severe abdominal pain due to ulcers and inflammation, then there was surgery for the knee with the torn meniscus. All of the doctors and nurses urged her to take painkillers, they insisted that she could not become addicted if she was in pain. I'm pretty sure tramadol was what the knee surgeon prescribed, specifically because of my wife's concern about addiction. He said, "This one isn't addictive." We Googled it as soon as we got home and within five minutes found significant evidence of it being very addictive.
When I was receiving radiotherapy to the throat, a terribly painful experience, I was on hefty doses of co-codamol, fentanyl and morphine for several months.

Obviously when I started the treatment and the oncologist warned me about the sort of pain relief I'd need, I raised my concerns about becoming dependent or addicted, but he said no, not to worry, so long as I was scrupulous about following his directions, I had nothing to worry about.

Sure enough, I was able to come off them all, other than the occasional co-codamol when needed, in a matter of weeks at the end of the therapy, under his direction -- I think because they weren't getting me high so much as reducing the pain to a bearable level of discomfort.

That is, the pain was still there when I took them, but it didn't bother me so much, though if I was more than 15 or 20 minutes late for a dose of morphine for spike pain certainly I knew about it (and that was while I was wearing a fentanyl patch too).

I think the fact you're taking it under medical supervision for genuine pain relief rather than for recreational purposes really does make a difference.
 

Beebo Brink

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I think the fact you're taking it under medical supervision for genuine pain relief rather than for recreational purposes really does make a difference.
It's the definition of "genuine pain" that may be critical. It has to be more than just discomfort.
 
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Innula Zenovka

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It's the definition of "genuine pain" that may be critical. It has to be more than just discomfort.
That could well be it. The oncologist told me he couldn't promise me that the treatment would be pain-free, but he could reassure me that he'd be able to help me reduce the pain to a bearable level of discomfort, which is exactly what he did.
 

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I switched to old-school Tylenol #4 from Tramadol and I think I dodged a bullet. Codeine I can keep on an as-needed basis.
One of the 'fortunate' things about having seizures is my list of what I can and can not take is pretty strict ... I am not even allowed a common aspirin. I can take tylenol and once in a blue moon a dr will prescribe something stronger after consulting with my neuro or looking up what I can and can not do. Getting my wisdom teeth pulled was fun when the dentist found out his preferred method of knocking me out was a no go.
 

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We've debated the various responsibilities of pharmaceuticals and doctors in other threads, specifically about the Sackler family. This article, however, really brings home the way in which the drug industry knowingly manipulated doctors to sell more of their products.

I was a drug rep. I know how pharma companies pushed opioids.
1) They dox people?

2) How in the world does anyone think giving them access to a prescribing database is at all a good idea or even needed for their job?
 

Brenda Archer

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One of the 'fortunate' things about having seizures is my list of what I can and can not take is pretty strict ... I am not even allowed a common aspirin. I can take tylenol and once in a blue moon a dr will prescribe something stronger after consulting with my neuro or looking up what I can and can not do. Getting my wisdom teeth pulled was fun when the dentist found out his preferred method of knocking me out was a no go.
I have a parallel situation with blood thinner, a lot of over the counter pain killers are forbidden. I can have Tylenol, but I’m scared of what doing it long term would do to my liver. I can have opioids, but I don’t want to do that outside of the hospital. I had them when I was recovering from surgery and the doctor had to insist. I had stopped eating from pain I wasn’t very aware of.
 

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I guess I got lucky. I had to have two teeth removed. They gave me a scrip for 20 pills of something labeled APAP / codeine which is codeine with tylenol. But I only needed around 3. It didn't hurt that much. No withdrawal symptoms for that small usage.
I was prescribed Percocet when I got my wisdom teeth removed. I took one, and never needed any more. When I had kidney stones about six years ago, I was put on morphine and admitted. Thankfully, it did its job, I passed the stone, and never felt any withdrawal symptoms. I've been pretty lucky in both cases.
 

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My dentist said to take paracetamol if needed, max 4 times 1000 mg a day, when he removed my wisdom teeth. That did not make it painless all the time during the days after treatment, but it was good enough to live trough these days. After 2 days pain was so far down that I could stop with the paracetamol.
Pain is a very personal experience I guess.
 

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I suspect that if I experienced an accident today like the one in 2013, that there'd be a lot more reluctance to give me tramadol. Even at the time I had concerns because of what I knew about synthetic opioids, but now I know that the medical staff didn't have all the information.
The constipation was more of a pain than the broken wrist.
 

Innula Zenovka

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My dentist said to take paracetamol if needed, max 4 times 1000 mg a day, when he removed my wisdom teeth. That did not make it painless all the time during the days after treatment, but it was good enough to live trough these days. After 2 days pain was so far down that I could stop with the paracetamol.
Pain is a very personal experience I guess.
Interestingly (or I found it so), of all the opiate painkillers I was on -- morphine, fentanyl and co-codamol -- the product that came with the sternest warnings against exceeding the prescribed dose was the co-codamol, because of all the paracetamol it contains and the damage that could do to my liver, not because of the high codeine content.
 
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Bea McMahon

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Yanno how they all say you are supposed to get more conservative as you get older? Didn't work in my case. Maybe that's because the greedheads decided their mission was to undo not only the New Deal, but most of the 20th Century government regulatory programs.
Nationalize Big Pharma. And maybe we should consider whether or not the French had the right idea in their revolution.
 

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I once worked with a wonderful doctor's surgery in the UK, the James Wigg Polyclinic, which was originally founded in the 1880s. The original doctor had his own style of NHS, long before it became a thing (in 1944), where he fleeced the rich customers and subsidised or treated free, the poor customers. They have a policy of not allowing drug companies in AT ALL, and they don't have anything with a brand on it in the clinic at all either. Instead of posters with brands they have art, and a resident artist. They have dance classes for people with dementia and organize a work experience scheme for people working with the receptionists. If the NHS is amazing (and it is) this GP clinic is the pinnacle of what might be achieved if medical services were run right. I find it most astonishing that the US actually spends more per head on health than we do in the UK and yet doesn't provide for everyone as a right. And the additional curse of drug addiction to legally prescribed drugs is just terrible.

I'm not saying that there is none in the UK - Tramadol is widely prescribed, and Co-Codamol too. I have big boxes of both which were prescribed for kidney stone pain. And I'm not saying that drug companies don't try to bribe doctors - a friend who worked at an internationally-recognized centre of excellence hospital told me that doctors who agreed to participate in a conference arranged by a drugs manufacturer were handed envelopes of cash for "expenses". But the incentives to prescribe certain drugs are not there at the moment, and I think that's the reason it isn't such a big problem here as in the US. I have to fervently hope that things don't change in the future.
 

Aribeth Zelin

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I was on assorted opiates when I went through my jaw breaking after I had three wisdom teeth removed, a jaw infection and other BS, had me on them 24/7 for over 6 months; coming off of them was not at all difficult, since it was during this time that I started having bad hallucinations, itching and other bad side effects. I had been trying to stop taking them for three months by the time the pain was bearable enough -to- stop.

Anyway, from what I understand, pot is -great- for pain relief, and isn't addictive, but that's a controlled substance still in a fair chunk of the US. Instead, they only give opiates for pain, and its not really an option for myself or my spouse [who has also started having the bad side effects, as he found out after he had his thyroid removed.