Ohio’s New Opioid Regs Scare Chronic Pain Sufferers

[Flagg]

There's a difference between being physically addicted to opioids (not getting a dose for about 16-24 hrs and thus going into withdrawal which includes such fun things as nausea/vomiting, diarrhea, seeing and feeling various things crawling on walls/your body, and feeling overall that death would be better than it continuing) and being psychologically addicted, where the sole reason you take them is to get high (and to stave off withdrawal).

If you want to be technically correct, what you refer to as "physically addicted" is properly referred to as being physically dependent and the psychological problem is addiction.

And yes, the distinction is important. There are a lot of medications that result in physical dependence in addition to opiates, such as long-term corticosteroids, that can provoke serious withdrawal symptoms. Yet those medications are not stigmatized as opiates are. That's a strictly social distinction, that physical dependence/tolerance of opiates is all too often seen as a moral failing while an equal or greater dependence on corticosteroids carries no such burden.

Yeah, you're 100% correct, it's just that so many assholes in ER's and some other doctors I've seen use "dependent" and "addicted" as if they are the same thing. And it really beats you down and makes you feel like a POS despite being allergic to all NSAIDs, steroids, and as I found out over 2 weeks ago, codien. So it's either opioids, Tylenol, or a hammer to the head.

[Flagg]

The FDA's involvement is mostly to say whether a drug can be sold for human consumption. There is a burden of research which the scheduling system makes prohibitive for marijuana to do that. Do we're in a catch 22 of high potential for abuse (which is true, as far as it goes) but no accepted medical use, and no accepted medical use because we can't do the research.

What high potential? I've never heard of anyone dying from marijuana withdrawal.

Abuse is not the same as addiction. It's fuzzy, but abuse is more or less "getting recreationally intoxicated" which is why alcohol is explicitly excluded from the CSA.

You're full of shit, dude. Study after study has shown marijuana to have real medical benefits from helping with glaucoma, anxiety, and certain types of pain, not to mention those suffering from cancer and HIV/AIDS. It's legal both medicinally and recreationally in my state and the only reason I don't use it medicinally along with my pain meds is that it's a bit too expensive, while my prescription for hydromorphone is fully paid for by Medicare and Medicaid.

And frankly, I'd rather have 100 stoned people at a party as opposed to a single drunk person.

[Broomstick]

Yeah, you're 100% correct, it's just that so many assholes in ER's and some other doctors I've seen use "dependent" and "addicted" as if they are the same thing.

Yes, well, that is a problem - my spouse was more than once viewed first as a drug-seeker/addict until the magic words "cancer diagnosis" were spoken. Even then, we had a problem with an ER nurse who protested he'd been given too much painkiller. I'm sorry, honey, it was an actual emergency, that's what it took to get things under control long enough to get him a procedure to deal with the acute problem, and afterwards he needed a hell of a lot less. Yes, sometimes when trying to figure out the appropriate dose you overshoot, that doesn't instantly turn someone into an addict and competent medical professionals adjust the next dose to something a little better.

Also, there are plenty of medical types who, while presumably competent in one area, are pretty awful outside it. Like the dude who was covering for our regular primary care physician my husband's last week of life who clearly did not handle dying and death at all well. Barely came into the room, almost ran off as soon as he could. Fortunately, we could get someone else to take over that role who could deal with it.

Unfortunately, if you're in pain and ask for someone to replace a doctor or nurse who isn't up to speed with your problem you're accused of "doctor shopping".

And then there is the issues of people who are both true addicts AND have genuine medical conditions that legitimately require pain relief - hoo boy, that's a mess....!

[General Zod]

Based on my limited experience of trying to see a doctor about my back pain, I ended up giving up because I didn't feel like I was being taken seriously and had a nagging suspicion the doctors probably thought I wanted drugs. I can't imagine how bad it is for people with far more serious problems.

[Flagg]

That's why the FDA, which colludes with the DEA moved marijuana up to a schedule 1 drug, essentially saying it's more addictive than cocaine and just as addictive as heroin, which is fucking ridiculous.

That's sort of not at all true.

No, it really is. I only quoted this part (though I concede on the agencies that were responsible for the schedualing of drugs) because marijuana is flat out, in no way, shape or, form more addictive than cocaine or methamphetamines. And it sure as hell isn't as addictive as heroin, nor does it have the same negative side effects of heroin, cocaine, methamphetamines, or even alcohol. In fact marijuana isn't physically addictive at all in my experience.

[General Zod]

That's why the FDA, which colludes with the DEA moved marijuana up to a schedule 1 drug, essentially saying it's more addictive than cocaine and just as addictive as heroin, which is fucking ridiculous.

That's sort of not at all true.

No, it really is. I only quoted this part (though I concede on the agencies that were responsible for the schedualing of drugs) because marijuana is flat out, in no way, shape or, form more addictive than cocaine or methamphetamines. And it sure as hell isn't as addictive as heroin, nor does it have the same negative side effects of heroin, cocaine, methamphetamines, or even alcohol. In fact marijuana isn't physically addictive at all in my experience.

A lot of the reason marijuana's illegal has to do with racism with invented rationalizations for "safety", but that's another thread topic.

[Flagg]

Yeah, you're 100% correct, it's just that so many assholes in ER's and some other doctors I've seen use "dependent" and "addicted" as if they are the same thing.

Yes, well, that is a problem - my spouse was more than once viewed first as a drug-seeker/addict until the magic words "cancer diagnosis" were spoken. Even then, we had a problem with an ER nurse who protested he'd been given too much painkiller. I'm sorry, honey, it was an actual emergency, that's what it took to get things under control long enough to get him a procedure to deal with the acute problem, and afterwards he needed a hell of a lot less. Yes, sometimes when trying to figure out the appropriate dose you overshoot, that doesn't instantly turn someone into an addict and competent medical professionals adjust the next dose to something a little better.

Also, there are plenty of medical types who, while presumably competent in one area, are pretty awful outside it. Like the dude who was covering for our regular primary care physician my husband's last week of life who clearly did not handle dying and death at all well. Barely came into the room, almost ran off as soon as he could. Fortunately, we could get someone else to take over that role who could deal with it.

Unfortunately, if you're in pain and ask for someone to replace a doctor or nurse who isn't up to speed with your problem you're accused of "doctor shopping".

And then there is the issues of people who are both true addicts AND have genuine medical conditions that legitimately require pain relief - hoo boy, that's a mess....!

Yeah, I remember one night in the ER when this no pain relief = no eating or drinking anything without it being so much fucking worse started, we could hear the Physicians Assistant and the nurses talking at the nurses station, a solid 50 feet from the ER room using my full name, joking around about how I just wanted drugs and that they should tell me the best place to buy smack so I wouldn't occupy their ER rooms.

[Flagg]

That's sort of not at all true.

No, it really is. I only quoted this part (though I concede on the agencies that were responsible for the schedualing of drugs) because marijuana is flat out, in no way, shape or, form more addictive than cocaine or methamphetamines. And it sure as hell isn't as addictive as heroin, nor does it have the same negative side effects of heroin, cocaine, methamphetamines, or even alcohol. In fact marijuana isn't physically addictive at all in my experience.

A lot of the reason marijuana's illegal has to do with racism with invented rationalizations for "safety", but that's another thread topic.

Dude, it's everything from racism, William Randolph Hearst fearing hemp would replace wood pulp for paper putting his lumber holdings would crater, and the general hysterteria every generation has to put up with coming from their parents.

[FireNexus]

What high potential? I've never heard of anyone dying from marijuana withdrawal.

Abuse is not the same as addiction. It's fuzzy, but abuse is more or less "getting recreationally intoxicated" which is why alcohol is explicitly excluded from the CSA.

You're full of shit, dude. Study after study has shown marijuana to have real medical benefits from helping with glaucoma, anxiety, and certain types of pain, not to mention those suffering from cancer and HIV/AIDS. It's legal both medicinally and recreationally in my state and the only reason I don't use it medicinally along with my pain meds is that it's a bit too expensive, while my prescription for hydromorphone is fully paid for by Medicare and Medicaid.

And frankly, I'd rather have 100 stoned people at a party as opposed to a single drunk person.

I'm not discussing my personal beliefs over its benefits, but whether it is considered to have proven and accepted medical benefits under the law. If it isn't grandfathered in from common practice prior to the current incarnation of the FDA drug approval process, it wouldn't be considered to have currently accepted medical use unless it undergoes those kinds of trials. Which are impossible due to the legal impediments.

So it has "potential for abuse" (people like to use it to get high) and lacks "accepted medical use" (it hasn't undergone the kind of controlled trials necessary to establish medical efficacy of the kind you'd demand from literally any other medical treatment that was to be marketed as such) primarily due to legal impediments from it currently having that status. Again, while there is some compelling research, the law is designed so getting the amount of research needed to be an accepted medical use is basically impossible.

We're getting bogged down in the semantics of how the terms are understood legally vs how they're understood colloquially. Marijuana fits the legal definition of schedule 1, largely due to the fact that it has always been under the legal definition of schedule 1 since such a definition existed. Until we have a more logical scientific exemption, that's going to be hard to change.

And more than that, schedule 1 doesn't mean "equally harmful". By any definition, LSD is less harmful than heroin. So is MDMA. Both are schedule 1 because both are desirable recreational substances and both haven't cleared the research hurdles needed to be counted as medicine. And like marijuana, both have likely medical uses that largely are unproven because the substances were banned before the research was done.

If I were designing a system of prohibition, alcohol would be on the list way sooner than weed, LSD, or MDMA. But I'm discussing the system that exists.

[FireNexus]

That's why the FDA, which colludes with the DEA moved marijuana up to a schedule 1 drug, essentially saying it's more addictive than cocaine and just as addictive as heroin, which is fucking ridiculous.

That's sort of not at all true.

No, it really is. I only quoted this part (though I concede on the agencies that were responsible for the schedualing of drugs) because marijuana is flat out, in no way, shape or, form more addictive than cocaine or methamphetamines. And it sure as hell isn't as addictive as heroin, nor does it have the same negative side effects of heroin, cocaine, methamphetamines, or even alcohol. In fact marijuana isn't physically addictive at all in my experience.

Nobody in this thread ever said marijuana is more addictive than meth or cocaine. Not even the DEA currently takes that tack. "Potential for addiction" is not the legal hurdle, "potential for abuse" is. And that is a hell of a lot lower of a hurdle. One which alcohol never has to contend with because nobody wanted to relive the 20s and they would have if it had been made to.

[FireNexus]

I'd also point out that current guidance from the DEA indicates that while the law seems to say that abuse potential must necessarily be higher than drugs would be placed in schedule 3 (the first of the schedules that differentiates abuse liability, as scheduled 1 and 2 are considered to have equivalent abuse potential, the difference being accepted medical use), the fact that the schedules 3-5 require accepted medical use prima facie means that any drug with any potential for abuse and no commonly accepted medical use or scientifically demonstrated (to FDA prescription drug standards) safety under medical supervision would be considered schedule 1. To whit:

When it comes to a drug that is currently listed in schedule I, if it is undisputed that such drug has no currently accepted medical use in treatment in the United States and a lack of accepted safety for use under medical supervision, and it is further undisputed that the drug has at least some potential for abuse sufficient to warrant control under the CSA, the drug must remain in schedule I. In such circumstances, placement of the drug in schedules II through V would conflict with the CSA since such drug would not meet the criterion of "a currently accepted medical use in treatment in the United States." 21 USC 812(b).

— Drug Enforcement Administration, Notice of denial of petition to reschedule marijuana (2001)

So while marijuana is likely about the same abuse liability as pure THC, which currently is classified as schedule III. But because whole marijuana has not been allowed to undergo the kind of rigorous study that pure THC has, it is not accepted for medical use and schedule I.

As I said, it's a catch 22. An intentional one. But it is the legal circumstance in which we find ourselves until a legislative or judicial solution is undertaken.

[aerius]

I meant Canada and Europe have OTC codeine, and lower rates of prescription opioids consumption. My fault.

I can't speak for Europe, but here in Canada codeine isn't OTC, you need a prescription from the doc to get it. Tylenol 3 prescriptions are pretty common, but anything stronger than that and the docs are pretty strict about it.

[Jub]

I have to say that I hope I never end up in a place where I need anything for chronic pain. I've dealt with a few nasty kidney stones, one of which decided to spend a week-and-a-half in my ureter much to my chagrin, and the difference between having what you need to handle the pain and not is night and day. They tried to start me on Tylenol extra strength and then kick me up to T3's, I can tell you that neither of those did shit for me and both ended up getting thrown up before they could calm down the pain and secondary symptoms. This lead to a few very early AM trips to emergency to get hydromorphone, which was highly effective. I was also lucky enough to have doctors outside of the ER which would prescribe me limited refills.

The only 'bad' experience I had was when the Er nurses decided that IV morphine was the same is hydromorphone, for those that haven't felt the difference, it's not. The hydromorphone was complete pain control, the IV morphine was at best taking the hardest edge off. The nurses then told me that it was common to still feel the pain even with medication and ignored my request to switch to a low dose of oral hydromorphone. My mom, who's a nurse at that same hospital, told me that this was down to cost and that the hospital saves if they give watered down morphine shots versus pills of anything. A fairly minor thing in my case as I got imaged the same day and that lead to me getting pain relief and muscle relaxants which got me through another kidney stone.

[Flagg]

I have to say that I hope I never end up in a place where I need anything for chronic pain. I've dealt with a few nasty kidney stones, one of which decided to spend a week-and-a-half in my ureter much to my chagrin, and the difference between having what you need to handle the pain and not is night and day. They tried to start me on Tylenol extra strength and then kick me up to T3's, I can tell you that neither of those did shit for me and both ended up getting thrown up before they could calm down the pain and secondary symptoms. This lead to a few very early AM trips to emergency to get hydromorphone, which was highly effective. I was also lucky enough to have doctors outside of the ER which would prescribe me limited refills.

The only 'bad' experience I had was when the Er nurses decided that IV morphine was the same is hydromorphone, for those that haven't felt the difference, it's not. The hydromorphone was complete pain control, the IV morphine was at best taking the hardest edge off. The nurses then told me that it was common to still feel the pain even with medication and ignored my request to switch to a low dose of oral hydromorphone. My mom, who's a nurse at that same hospital, told me that this was down to cost and that the hospital saves if they give watered down morphine shots versus pills of anything. A fairly minor thing in my case as I got imaged the same day and that lead to me getting pain relief and muscle relaxants which got me through another kidney stone.

Yeah, morphine never did shit for me, but hydromorphone aka dilaudid works damned well. I take the oral liquid of it so I can you know, eat and drink things instead of dying of dehydration due to the unbearable pain. I'm talking about even bottled water.

[Jub]

Yeah, morphine never did shit for me, but hydromorphone aka dilaudid works damned well. I take the oral liquid of it so I can you know, eat and drink things instead of dying of dehydration due to the unbearable pain. I'm talking about even bottled water.

Dilaudid v morphine is pretty simple, in that hydromorphone is basically advanced morphine.

As for your pain, that sucks. Hopefully, things get better, but given what I can gather from your posts that hasn't been the case for a while. So I guess I hope that you can keep coping until something changes.

[Flagg]

Yeah, morphine never did shit for me, but hydromorphone aka dilaudid works damned well. I take the oral liquid of it so I can you know, eat and drink things instead of dying of dehydration due to the unbearable pain. I'm talking about even bottled water.

Dilaudid v morphine is pretty simple, in that hydromorphone is basically advanced morphine.

As for your pain, that sucks. Hopefully, things get better, but given what I can gather from your posts that hasn't been the case for a while. So I guess I hope that you can keep coping until something changes.

Yeah, unfortunately I'm starting to have some different stomach pain that I'm hoping is just a virus. I really don't want to have to go through "See GI Dr and drink a shitload of barium, get an endoscopy, maybe a CT scan, Dr shrugs shoulders, live with more pain" round 6.

[FireNexus]

I meant Canada and Europe have OTC codeine, and lower rates of prescription opioids consumption. My fault.

I can't speak for Europe, but here in Canada codeine isn't OTC, you need a prescription from the doc to get it. Tylenol 3 prescriptions are pretty common, but anything stronger than that and the docs are pretty strict about it.

I can tell you from personal experience that this is not the case as recently as six months ago in Ontario. I still have the Tylenol 3s I got for the fiancwife's sciatica, which I received by asking the pharmacist for them, in my medicine cabinet.

I assumed this was nationwide, but I have no basis for the assumption.

[Flagg]

I'd also point out that current guidance from the DEA indicates that while the law seems to say that abuse potential must necessarily be higher than drugs would be placed in schedule 3 (the first of the schedules that differentiates abuse liability, as scheduled 1 and 2 are considered to have equivalent abuse potential, the difference being accepted medical use), the fact that the schedules 3-5 require accepted medical use prima facie means that any drug with any potential for abuse and no commonly accepted medical use or scientifically demonstrated (to FDA prescription drug standards) safety under medical supervision would be considered schedule 1. To whit:

When it comes to a drug that is currently listed in schedule I, if it is undisputed that such drug has no currently accepted medical use in treatment in the United States and a lack of accepted safety for use under medical supervision, and it is further undisputed that the drug has at least some potential for abuse sufficient to warrant control under the CSA, the drug must remain in schedule I. In such circumstances, placement of the drug in schedules II through V would conflict with the CSA since such drug would not meet the criterion of "a currently accepted medical use in treatment in the United States." 21 USC 812(b).

— Drug Enforcement Administration, Notice of denial of petition to reschedule marijuana (2001)

So while marijuana is likely about the same abuse liability as pure THC, which currently is classified as schedule III. But because whole marijuana has not been allowed to undergo the kind of rigorous study that pure THC has, it is not accepted for medical use and schedule I.

As I said, it's a catch 22. An intentional one. But it is the legal circumstance in which we find ourselves until a legislative or judicial solution is undertaken.

I'm well aware. Frankly everything the FDA and DEA says about marijuana is full of more bullshit than produced by all actual bulls shitting in the history of bulls. All they have to do is study it's effects on people who would qualify for medical marijuana in states that allow it and they'd have no more excuses. But they choose not to. If they wanted to, they could, period.

But you can sell the second most abused substance in this country (alcohol, the most abused is processed sugar) in grocery stores and advertise it on TV. This is something that is well known to cause all sorts of destructive behavior including such lovely things as domestic violence.

Tobacco products are freely available at 18 even though it's a known fact that they cause cancer to those who smoke and anyone in range to inhale the second hand variety.

But marijuana, we can't have that!

[General Zod]

While we're on the subject.

Insys Therapeutics gave $500,000 to help defeat an Arizona legalization initiative last year. Now, the FDA has just approved its marijuana-based drug.

[Flagg]

While we're on the subject.

Insys Therapeutics gave $500,000 to help defeat an Arizona legalization initiative last year. Now, the FDA has just approved its marijuana-based drug.

Shocking, big pharma is so terrified of something you can grow in your back yard that can treat half the shit they put on the market only to recall them a few years later that they spent half a million bucks to prevent legalization!

[Joun_Lord]

As someone from WV and from a pretty white trash family I do understand pretty well the problems of opiod abuse. Shits really freaking bad around here, alot of abusers both for recreational purposes and because they got hooked by doctors only too willing to push pills on them. There is crime, deaths from overdose, and our health system reeling from dealing with the influx of addicts.

But I also know there are plenty of chronic pain sufferers who NEED pain meds to survive, to not live in constant agony. Punishing them because Cletus Cowfucker wants to get high or sell some pills to Richey McFuckface to buy a new truck seems really shitty. Its not dealing with the problems that led to rampant drug abuse, not taking aim at the social and economic problems that led to greedy fucks pushing pills on poor communities, people so down and out they want to pop pills to dull the pain, and the stigma of addiction that makes treatment hard. Nah lets instead punish other people and ignore the problem, that seems to be the American way of dealing with shit.

This whole thing about still having weed illegal is equally stupid. I don't like marijuana at fucking all and even I can see the benefits of someone toking up and see its a hell of alot safer and less damaging then completely legal tobacco and definitely so for alcohol. I don't think those things should be banned either (shitty tobacco with a bunch of added chemicals, poisons, and glass should be but just on the grounds its an unsafe product like toys with lead in them) but if something that rots off people faces and makes their lungs blacker then Death Metal and shit that leads to drunken brawls and copious amounts of traffic fatalities is legal then so should something that is proven to be far safer.

[mr friendly guy]

Yeah, morphine never did shit for me, but hydromorphone aka dilaudid works damned well. I take the oral liquid of it so I can you know, eat and drink things instead of dying of dehydration due to the unbearable pain. I'm talking about even bottled water.

Hydromorphone is strong stuff which might explain why it works. You can find opiod converters online

http://fpm.anzca.edu.au/documents/opioi ... alence.pdf

The hydromorphone to morphine conversion is that 1 mg of oral hydromorphone is about the equivalent to 5 mg of oral morphine. Of course these are not absolutes since the human body is difficult to get absolutely right, but these conversions are like rules of thumb used by medical professions.

I meant Canada and Europe have OTC codeine, and lower rates of prescription opioids consumption. My fault.

I can't speak for Europe, but here in Canada codeine isn't OTC, you need a prescription from the doc to get it. Tylenol 3 prescriptions are pretty common, but anything stronger than that and the docs are pretty strict about it.

Australia there is some over the counter codeine, but not much. We can get panadeine which is 500 mg of paracetamol (acetimenophen as you guys in North America call it) with 8 mg of codeine over the counter. Anything stronger like panadeine forte (500 mg paracetamol and 30 mg codeine) now needs a doctor's prescription.

[Flagg]

Yeah, morphine never did shit for me, but hydromorphone aka dilaudid works damned well. I take the oral liquid of it so I can you know, eat and drink things instead of dying of dehydration due to the unbearable pain. I'm talking about even bottled water.

Hydromorphone is strong stuff which might explain why it works. You can find opiod converters online

http://fpm.anzca.edu.au/documents/opioi ... alence.pdf

The hydromorphone to morphine conversion is that 1 mg of oral hydromorphone is about the equivalent to 5 mg of oral morphine. Of course these are not absolutes since the human body is difficult to get absolutely right, but these conversions are like rules of thumb used by medical professions.

I meant Canada and Europe have OTC codeine, and lower rates of prescription opioids consumption. My fault.

I can't speak for Europe, but here in Canada codeine isn't OTC, you need a prescription from the doc to get it. Tylenol 3 prescriptions are pretty common, but anything stronger than that and the docs are pretty strict about it.

Australia there is some over the counter codeine, but not much. We can get panadeine which is 500 mg of paracetamol (acetimenophen as you guys in North America call it) with 8 mg of codeine over the counter. Anything stronger like panadeine forte (500 mg paracetamol and 30 mg codeine) now needs a doctor's prescription.

Here in the US, codien is a schedule 2 narcotic and you need a prescription.

[Flagg]

To clarify a bit, Tylenol#3 requires a prescription that your doctor can call/fax into the pharmacy of your choice. Anything stronger, like hydrocodone or oxycodone must be taken to the pharmacy as a physical prescription.

[Highlord Laan]

Well, Kasich is a republican of the contemptible sort, so I'm not really surprised he's willing to ignore people in need to score points. He's also probably hoping to drive down medical costs by putting more desperate people into a position where suicide seems to be the better option.