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PostPosted: Thu Mar 30, 2017 1:59 pm 
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Ohio Limits Opioid Prescriptions to Just Seven Days

[url]
This is what you would see if you check out www.odreport.com:[/url]

http://www.nbcnews.com/storyline/americas-heroin-epidemic/ohio-limits-opioid-prescriptions-just-seven-days-n740531


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PostPosted: Thu Mar 30, 2017 3:31 pm 
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Why not 2 days? And why not add hard prison time for any doctor who takes too much pity on individual patients and gives out 3 day scripts? Maybe 5 years for each offense. That sounds about right.

There are two issues here, the much needed and appropriate use of pain medication...and addiction.
You're not going to help either group by making life even more difficult for people in pain that it already is....

If there's one thing we should have learned by now, drug addiction is an ongoing societal problem
that cannot be solved by legislators. The war on drugs... so-called.... has been catastrophic in its effects, and has only substantially worsened the very problem it's trying to address.

Prohibition didn't work in the 1920s and it will never work now.The distinction between drugs and alcohol
is simply an arbitrary legal fiction.

I have to add Doctor J, I don't know for sure where you stand on this, though the thread title and your
abundant compassion and understanding for your patients... and for those if us needing help on the forum,
lead me to believe I'm not going to be insulting you in any way. I sure hope not anyway...


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PostPosted: Thu Mar 30, 2017 8:55 pm 
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Not at all. As much as I wish for solutions to the opioid problem, I'm repeatedly impressed by the ignorance of the people who hold the power to affect change. Another article mentioned a proposal in Pennsylvania to create a government agency to watch over doctors who prescribe buprenorphine medications, and pay for the agency by charging doctors with the waiver a fee of $10,000 each year. The person who introduced the bill was quoted about the 'huge buprenorphine problem' in PA. Buprenorphine could completely eliminate deaths from overdose, were it used as first intended--- but they have a BUPRENORPHINE problem?!

The opioid problem started in the 1990's, when the commission that provides accreditation of hospitals was on the bandwagon of improving pain treatments. The government cited hospitals for NOT prescribing enough opioids to patients in pain. Suddenly those posters went up in every hospital with little smiley-faces ranging from grins to frowns, so that people who couldn't communicate verbally would be able to point at the frowning face, showing they were in pain. Is that stupid or what? (sorry-- that was very rude of me...) But really-- as if nurses can't SEE the frown, so we need to have a picture of a frown for patients to point to?!

That mentality spread to doctors, as the word was out that pain was being undertreated. Pharma picked up on those messages, and Oxycontin and other potent opioids came out.

Now, state and Federal governments are aggressively prosecuting doctors for doing the things they were told to do 10 years ago. So doctors are dropping patients to avoid investigations-- leaving patients to seek out illicit opioids, in order to avoid losing their jobs because of withdrawal symptoms.

I've read articles suggesting that opioids aren't even REALLY needed after surgery. I hope the people writing those articles get to have THEIR surgeries that way some day!


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PostPosted: Fri Mar 31, 2017 8:04 am 
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I had no idea about the gov. push for more opiates in the 90's. But entirely typical. So the government steps in and with plenty of help from Big Pharma creates a nationwide opiate epidemic. Then 20 years
later they're bumbling back in to undo that mistake.

Is there any doubt that this too will have unintended but perfectly foreseeable consequences?


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PostPosted: Fri Mar 31, 2017 10:31 am 
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There is no dought in my mind that we will over correct this problem How many people in this country will die or suffer for it?
With the state Government s stepping up to control bupe ,as in Pennsylvania, W VA, and others, I am now feelling that our treatment may be at risk. I believed in this med so much that I had no fear of ever losing it. Today, im just not sure.
When gov changes or makes these new rules against drs and opioid rx, how loug will it take before they come after Sub treartment as well ?
Thanks for tbe post Dr J. It rings loud and clear to me. A Bupe problem? Ya, this is the feeling in many states from tbe police to some Governors.

Lets just wait and see what Chris Christie comes up with as the new leader. I just pray for some commen sence here.
We all read and hear how Big Phar works. But maybe tbe makers of our medicine will help us in the loug run. RB/Indevor... It is just a shame how mixed up the powers that be are in regards bupe. It has gotten worse since I started, not better. It seems to me that this forum and JJ s blog are the only places where the real truth is.

Amazing how much time is spent getting the truth out at our newcommer meeting.

Raz


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PostPosted: Fri Mar 31, 2017 11:37 am 
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Unbelievable. The ignorance of those in power never ceases to amaze me. Stupid is, as stupid does.

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PostPosted: Fri Mar 31, 2017 4:18 pm 
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Does this article make anyone more optimistic? Or is it another example of "Well, look who just caught up!!"

"The American College of Physicians (ACP) has issued a new policy statement with recommendations for preventing and treating substance abuse. The statement, published online March 27 in the Annals of Internal Medicine, emphasizes that substance abuse is a chronic medical condition and should be treated as such.

"Substance use disorders are treatable chronic medical conditions, like diabetes and hypertension, that should be addressed through expansion of evidence-based public and individual health initiatives to prevent, treat, and promote recovery," Nitin S. Damle, MD, MACP, said in an ACP news release. Dr Damle is president of the ACP.

The new policy will be discussed at the ACP Internal Medicine meeting, which opens in San Diego, California, on March 30.

Hospitalizations for opioid use disorder nearly doubled between 2002 and 2012, according to the statement.

ACP emphasizes that substance abuse heavily burdens society, places the health of individuals and families in jeopardy, disrupts communities, and drains healthcare resources. Although substance abuse is common among the general US population, prison populations suffer from even higher rates of the problem.

Unfortunately, access to treatment remains limited. In 2014, 22.5 million Americans needed treatment for substance abuse, but only 18% received it. In comparison, 77% of those with hypertension received treatment, as did 73% of those with diabetes and 71% of those with major depression.

To develop the policy statement, the ACP's Health and Public Policy Committee reviewed relevant material from PubMed, Google Scholar, news articles, policy documents, websites, and other sources. The committee also based recommendations on input from other ACP committees and nonmember experts.

The statement provides both clinical and health policy recommendations. It focuses on illicit drugs and misuse of prescription drugs, especially opioids. In the context of the paper, "illicit drugs" refers to marijuana, cocaine, heroin, hallucinogens, and inhalants. Although many states have legalized or decriminalized marijuana, the authors categorize it as illicit because federal law still prohibits it. Likewise, the ACP recognizes that alcohol and tobacco use pose serious problems to public health problems, but considered them outside the scope of the article.

To combat the growing problem of prescription drug abuse, the ACP recommends:

that physicians familiarize themselves with evidence-based guidelines about pain management and controlled substances, and follow them as deemed appropriate;

expanding access of naloxone for overdose prevention to opioid users, law enforcement, and emergency medical personnel;

expanding access to medical-assisted treatment and lifting barriers that limit access to medications for treating opioid use disorder such as methadone, buprenorphine, and naltrexone;

improved training in the treatment of substance use disorders, including buprenorphine-based treatment; and

establishing a National Prescription Drug Monitoring program and improving existing monitoring programs.

"Physicians can help guide their patients towards recovery by becoming educated about substance use disorders and proper prescribing practices, consulting prescription drug monitoring systems to reduce opioid misuse, and assisting patients in their treatment," Dr Damle said in the news release

He also strongly encourages prescribers to check Prescription Drug Monitoring Programs in their own and neighboring states before writing prescriptions for controlled substances.

Other ACP recommendations emphasize addressing stigma about substance abuse in the general population and medical community. The ACP recommends treatment through individual and public health interventions, rather than heavy reliance on criminalization and imprisonment.

The group also calls for health insurance coverage of mental health conditions and evidence-based treatment of substance use disorders, as well as upholding parity rules. Moreover, they recommend expansion of the professional workforce that treats substance abuse and embedding training for such treatment throughout medical education.

Finally, the ACP calls for studies that evaluate the effectiveness of public health interventions targeted at substance abuse, such as syringe exchange programs and safe injection sites.

The study was supported by the ACP. The authors have disclosed no relevant financial relationships.

Ann Intern Med. Published online March 27 2017."

Any optimism?

Amy

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PostPosted: Fri Mar 31, 2017 7:40 pm 
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Godfrey, take a look at the 5th vital sign, speaks to Dr Js point on the start of all this. Also look at 'Press Ganey scores'. The fear that patients would give a bad customer satisfaction review also led to Dr's caving to patient demands for opiates.

Razor, you are incredible w all you do all you do at your weekly clinic's newcomer meetings. I cannot even imagine how hard it is meeting after meeting, trying to dispel the crapolla and get the truth out on bup each meeting. Seriously great work you are doing. Thank you.

Thanks Amy for all you do including your post above, It does make me feel better. I've been discouraged today reading the poor Dr. care three recent posters experienced but then have to sorta give the Drs a pass bc of all the crapolla info out there that Dr's learn. Seems very few Drs really learn about bup like Dr J and docm2. Plus, so much has to change w bup treatment especially far beyond to the state and federal level that MAT aka ORT can and does work well... BTW, I don't give rehabs a pass bc they well know they have a high fail rate and folks relapse or die even faster due to lowered tolerance from their time off drugs during rehab. I was lucky - another rehab resident who snuck bup in, taught me about bup and at 30 days I left to start bup. Great decision and now almost 6 yrs off.

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PostPosted: Sat Apr 01, 2017 12:11 pm 
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Pelican, I too went to a rehab where a girl snuck in buprenorphine! She got busted though by someone telling on her and kicked out.

The rehab I went to wasn't very motivated imo. I always felt like they were just going through the motions. I had all these pre conceived notions that I'd have one on one time each day with an addiction counselor to work through my issues and feelings.... nope. Group meetings and lots of NA meetings in the city the rehab was in. And don't get me wrong, it did help me, but no one on one time and especially the constant cravings, I somehow knew I'd relapse. 5-6 months later and I did.

I know not all rehabs are that way but I'm sure there's a lot like the one I went to.... being treated as a group instead of an individual and nothing to help with cravings but step work, just doesn't seem realistic to me.

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PostPosted: Sat Apr 01, 2017 9:32 pm 
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Would this law in Ohio pertain to Buprenorphine too? Some primary care doctors prescribe Suboxone as well as prescribe opioids for chronic pain treatment. Would they be limited too? Just curious about more details of this law.

All the restrictions that the government is imposing on medicine is really irritating, actually infuriating. We keep ping- ponging from one extreme to the other. Some doctors were prescribing excessively- for the abundance of reasons listed above. Some acted unethically, sometimes criminally during all of these years leading up to the crisis we are in now. The overwhelming majority of doctors, at least in my opinion, were trying to follow recommendations and give their patients the best care possible. I think we need to spend more time on better educating physicians and the public on usage of opioids, pain management, and treatment of addiction. And research to understand all of it better and keep creating/ discovering new treatments for pain and addiction.

I was/am a chronic pain patient and became addicted to opioid painkillers. I was not able to use them properly- but I understand their utility in both acute and chronic pain. Plenty of people take opioids for chronic pain appropriately without developing addiction. And majority of people who get opioids for acute pain take a few pills till the pain is gone and move on with their life (I could never understand how someone could end up with extra opioid pills).

My point is opioids in and of the themselves self are not instantly addicting and dangerous. Addiction has to have psychological, chemical, genetic, environmental and other components in order to develop and grow. It's not like if you brush up against a pill or an addict that you are going to "catch" addiction. To me this what the media perpetuates. Restricting opioids to 7 days really is so far away from addressing the whole problem- I worry that we will focus on restricting and prohibiting drugs to the detriment of all the other factors. And it sets a bad precedent for our government to intervene with medical care ( I know that already happens - but I don't like it). Hope I didn't get off on too much of a tangent- this just really gets to me.

Also- if you are looking for good reads on how the opioid issue began developing in the 90's and continuing today- 2 good books - "American Pain" by John Temple. and Dreamland by Sam Q.
Have a good night.


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PostPosted: Sat Apr 01, 2017 10:28 pm 
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Tragicom, great post, really great post, gave me me real hope you are educated as to what you need from addiction healthcare. So many that come here, understandably, don't.

IDK if bup is affected by the new OH law for pain, GOOD question!!! For addicition -- NO. Bup products are known as longer term.

I recently read both books and agree a good read when folks are ready...

Wish you so very very well and hope you continue to do well. Please continue to let us hear from you and please -- help us help others. That's the whole point here. Help us help others and along the way -- we help ourselves!! It sure works for me...

Anybody watching NCAA tonight? If you've ever been in person, its THE best energy!!

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PostPosted: Sun Apr 02, 2017 6:08 pm 
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Thanks Pelican


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PostPosted: Sun Apr 02, 2017 6:21 pm 
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My reply keeps getting cut off. Having some sort of error message..

Pelican-you have been so helpful to me in the past few days. I have followed the opiod epidemic and tired to educate myself. Did not know much about Bup until I got here and it seems like every day there is more to learn.

I should have put a disclaimer on those books-they could be triggering for some people, especially if new to recovery. I could not read that stuff right now. Read a lot during active addiction. Opioids made me hypomanic so I would stay up all night reading, writing and binge watching t.v. Being so productive on opioids tricked me into thinking I was making life better for myself, contrary to the facts. Luckily Bup gives me energy, but no where close to hypomanic. My moods feel much more stable on bup.

Have a good Sunday.


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PostPosted: Sun Apr 02, 2017 7:58 pm 
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I know enough to know when I need to google something!

I know that hypo means sub/under/low. For example, I know that hypothyroidism means that the thyroid is functioning less than it should be, versus hyperthyroidism means the thyroid is over functioning.

So I wondered what hypomania is, since you, tragicom, seemed to be describing actual mania, not less than mania.? What I found out was that hypomania does not diagnostically rise to the point of mania, but is still mania-like enough to be clinically significant.

In other words, hypomania does not mean the opposite of mania (which would be depression), but it means less than mania, but still having those types of symptoms. Insomnia, stamina, energy, elation, hyperactivity.

I apologize to those who aren't into medical vocabulary and word roots. :D

Amy

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PostPosted: Sun Apr 02, 2017 8:52 pm 
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Thanks for the article Amy. Sure LOOKS like good news.

Yes, hypomania is just below mania. Some people believe that hypomania is a good thing.... that it allows them to accomplish things. But in order to be a disorder according to the DSM a symptom must impair function or cause distress. If something is entirely positive, it isn't 'illness' according to psychiatry!


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PostPosted: Mon Apr 03, 2017 12:12 pm 
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Hi, I guess I should have been more clear- I have bipolar 2- which is a little different disorder than the more well known Bipolar 1. With BP2 I have cycles of severe depression with brief episodes of hypomania, which is basically how you and Dr J describe it. Hypomania can feel amazing (sometimes the extra energy turns into anxiety- which is not fun)- like a drug in and of itself. The problem is I don't make good decisions when hypomanic-the feelings blind you to reality. The hypomanic episodes are so brief and followed by soul- crushing depressions. For me opioids kept the hypomania going- delaying the inevitable crash. And as long as I have hypomania I am sure to suffer from depression. In order to be healthy the goal is to stabilize moods- not too high, not too low. Bup, along with a mood stabilizer is helping right now. Having "normal" moods is both refreshing and sometimes really boring!

Sorry for getting off track with this thread, just wanted to explain my experience with BP2- like anything else everyone has their own unique experiences- so I can only speak for myself.
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