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 Post subject: Re: Suboxone for pain?
PostPosted: Wed Aug 16, 2017 4:36 pm 
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Dee19 wrote:
I found this article, shows each state and what they are suggesting recommending or "requiring"

It's a witch hunt however the CDC is saying they never intended pain patients to just be cut off.

http://www.bendbulletin.com/topics/5342 ... -the-brink


I just wanted to say that this article was well-written and quite shocking. The amount of devastation in the lives of those suffering with chronic pain is beyond comprehension sometimes. Add to it the stress of being cut off by your doctor or being forced to a low amount of a lesser pain medicine and it's no wonder people are deciding to end their own lives rather than suffer. I can't believe it's happening in this so called free country of ours.

The other point I wanted to make for anyone who decides to read the article is actually a warning. I wasn't prepared for the rather large, high definition close up pictures of Oxycontin and Vicodin tablets. I had a horrible anxiety attack after staring at them for a few moments. I just want people to know that pictures can often cause triggers for certain people. I didn't realize I was one of them until earlier when I read the article and had that reaction to the pictures. I'm really glad I'm protected by subs because that picture of oxy's really got me thinking about things I shouldn't be thinking about.

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 Post subject: Re: Suboxone for pain?
PostPosted: Fri Aug 18, 2017 1:21 am 
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Hi, OpenMind, I had the same reaction to the article. Very well written and heartbreaking the way that our healthcare systems swing so far in both extremes. A reasonable response to the opioid epidemic and the overprescribing of opioids by some doctors would be recommending an initiative to do a thorough review of all chronic pain patients taking opioids (by their doctor), and see if there were any ways to decrease doses, possibly by adding other therapies. Doctors would measure patients' responses to all therapies and customize treatment plans for each individual. That would be a reasonable response.

Instead, mass hysteria seems to have taken hold and huge cuts or total cut off of opioid medication is one of the effects of this mass hysteria. Plus, without some sort of taper plan, if the patient's pain is not adequately managed, if there is not a plan in place to replace opioid therapy, and the patient has now lost faith in the healthcare system, these people are more likely to look for pain medications illegally, or turn to heroin when they find it to be more abundant and cheaper. Then the cycle continues. It makes me sad just thinking about it.

The other thing that you said, Open Mind, that is true and has been bothering me is the images of all of these medications. I see this over and over again in news I read online, news on TV, pretty much any place the opioid epidemic is reported on. There are always tons of pills, spilled out of bottle, clear enough so that you can read the letters/ numbers on the pill an know exactly what it is and almost feel it in your hand. The images are everywhere. Just try googling opioid epidemic and you will be overwhelmed by pictures of all your old favorites.

If we are truly all working on this together to end the opioid epidemic, why is the media trying to bait addicts into reading their articles? Why does the nightly news show us images of oxy or heroin or fentanyl? Is it that important to the news story? People who work in media are savvy enough to know that they are gaining the attention of addicts and actually providing easy triggers for addicts. I am not a conspiracy theorist and I'm not sure what the different media sites have to gain by triggering addicts. I just think eliminating some of the imagery would be the responsible thing for media to do. It's not something that can be regulated, but it's subtle stuff like that that can keep the opioid culture growing and thriving instead of slowing it down.

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 Post subject: Re: Suboxone for pain?
PostPosted: Fri Aug 18, 2017 9:37 am 
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Tragic, I agree with your assessment of the media but I think it is much broader.
"if it bleeds, it leads," has been the mantra for ages.
Think of the lurid details they provide during coverage of a rape and how that effects survivors of sexual assault. Or, if you lived through a tornado or hurricane, how they love to show video of stuff blowing around and describing in detail the deaths and destruction.
Combat images are a trigger for vets with PTSD, I could go on.
They don't really care about the impact of what they broadcast accept for gaining viewers or clicks.

There are many reasons for our current problem, but 30 years ago we would not treat with opioids what is commonly treated now.
Prior to my psychiatry residency I was in primary care. Unless you had a terminal illness, or an acute injury we didn't prescribe opiates. If you were going to die in the next 6 months I didn't worry if you were going to develop tolerance or higher and higher doses. There was an end game. This was prior to Hospice or Palliative Care and we did the best we could. Sometimes an extra dose of morphine would ease suffering and let patients slip away quietly.
It has befuddled me the past twenty years that somebody would be started on opiates for a chronic condition but would have a life expectancy of several decades. No one was thinking what happens in 2-3 years. The research was very sketchy and short time frames.
Personally, I have thought people with chronic pain needed (and deserved) to be managed by experts leading a team, much as we do with oncology or severe endocrine disorders. Much like what you described in your opening paragraph. Unfortunately, for every team like this there have been hundreds, maybe thousands of doctors just writing scripts and offering no other management. Those patients are going to be in a world of hurt during this painful transition that has been undertaken. Many more are going to be severely mistreated and/or die before this is sorted out and we come to a reasonable balance again.
At times I despair: but I think of the little boy on the beach. The tide has gone out leaving hundreds of starfish stranded and dying. He would pick one up and walk it out to the surf, come back and repeat. A man walking by scoffs and asks what difference does it make. The boy picks up another starfish and says, it makes a difference for this one!


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 Post subject: Re: Suboxone for pain?
PostPosted: Fri Aug 18, 2017 4:55 pm 
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Doc2,
Everything you said makes perfect sense. You really nailed a lot of questions/concerns I've been thinking about. I do wonder at this point since so many have been treated with opioids for so many things, including chronic pain if we can ever really "put the toothpaste back in the tube".

People now suffer a different stranger type of chronic pain than in the past (my opinion only). I know for myself my pain is connected to stress, depression, anxiety, addiction, in that they all influence one another. It is also the cumulative effects of nagging toothache, migraine like pain that leads to the agony.

In the past people would have pain and they had nothing to relieve it. People had to learn ways to deal with it because there was no other option. They would find new ways of dealing with the pain-like praying, meditating, etc. I am not an expert, I am just surmising this. I don't mean to say that "people were stronger in the good old days", but [b]they did not know what they did not have. If you never had the relief from opioids, you would not know that there was a relief to miss.
I think once you do know the relief that opioids provide it becomes psychologically harder to accept pain levels that probably many years ago we would have been able to handle better.

My doctor told me that with opiate addiction people's brains can begin to manufacture pain as a way to ensure that they continue to get pain medication. So, according to him, my pain would be 10x worse when I wasn't taking opiates not just because of withdrawal or hyperalgesia but because my brain is actually magnifying the pain in order to ensure that I would continue to seek out pain meds until I got them. At first I said, "whatever, B.S.", but then I thought, "Hmm. . . maybe." I haven't researched this to find out if it has been studied. Doc2, do you see this? Do you think that is a real phenomenon? Or is this well known and I'm out of the loop?

The part about the boy and the starfish made me cry. I've heard that little story on several occasions but if felt very poignant at this time in my life and in this time in our history (in so many areas). I can't thank you enough for your kind and compassionate care. Keep up the great work.
Best
Tragicom

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 Post subject: Re: Suboxone for pain?
PostPosted: Sun Aug 20, 2017 7:13 am 
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Hi I am sorry for posting the article, I was trying to show how bad it has become. It is a witch hunt and while originally the CDC guidelines were meant for primary care doctor, now the pain management specialists are being targeted. The pharmacists are being asked for report doctors who prescribe opiates and same with insurance.

Another big problem is that while prescribing is down, Maryland reports prescribing is down 70% deaths from heroin, fentanyl are up 116%
So, people being cut off of their pain meds are looking for anything to help their pain. They are finding counterfeit pain medications that look like the pain pills but are actually fentanyl or carfentanil and this is killing people. They don't know that is what they are taking, they are just looking for relief.

It appears to me that cutting people off at the same time these counterfeit drugs are flooding the US is causing death, is that the goal? I don't know of anyone who doesn't want repeat customers so it appears sellers are not aware.
I understand that there were many pill mills. I am glad they are being shut down as they seemed to be a huge problem however there are people out there with horrific pain that is now not being treated. So the choice is to go on buphrenorphine or to die.

Again sorry for the visuals, I am sincerely sorry. I didn't realize I was just trying to show the article.

Thank you all again for your responses, you have helped me in many many ways


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 Post subject: Re: Suboxone for pain?
PostPosted: Sun Aug 20, 2017 3:38 pm 
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Hi Dee,
Please, no need to apologize, at least from my perspective. I thought it was a really well written and informative article. I think since OpenMind has faced addiction he experienced some triggers and wanted to give other addicts who might experience same triggers a "head's up". Some people on the forum are further along in their recovery and may not be as affected by those images, and I'm sure it bothers some more than others.

I would hate for people not to post articles. Maybe it would be a good idea to give a warning/disclaimer so people know before they open it up and are surprised (although, if you're anything like me that would pique your interest more not less). As I was saying, we have been bombarded with "opioid epidemic" media stories and those are always accompanied by visuals, so it is something we do need to learn how to deal with. As I've stated before, I hate what is happening to your husband and other chronic pain patients. It is not fair to them, and if their treatment isn't broken I don't know why it needs to be fixed.

I am having trouble following you about the counterfeit drugs and cutting people off their meds in this country.'Are you saying that there is some type of connection or conspiracy between the DEA and people selling counterfeit medications? That is really dark thinking that I just can't believe without any evidence. It is an interesting coincidence and a theory that would make a good plot for a Tom Clancy novel, but not very probable in real life.

Again Dee, best of Luck to you and your husband. Keep fighting and doing what you can. We are here to support if you need it.

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 Post subject: Re: Suboxone for pain?
PostPosted: Sun Aug 20, 2017 4:23 pm 
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You're probably right, it's just a coincidence that at the same time there is a crack down on prescribing pain medications there is a flood of pills from China that look like various pain medications, and they are killing people.

It is frightening to me because I worry that people aren't being warned about these fake pills that contain Fentanyl or Carfentanyl.

This started sometime last year. I guess I have been so totally immersed in trying to find help for my husband that I have come across this information.

I recently saw a graph from a Maryland report that while opiate prescription deaths were down by 70% percent, deaths from Fentanyl were up by 116%. I never realized Fentanyl came in any form but a patch or something for surgery.

The below article, Chinese suppliers flood US and Canada" has a picture of fake oxycontin. People have gotten hold of the presses or casts to make the fentanyl in to various pain pills even xanax

https://www.statnews.com/2016/04/05/fen ... -to-china/

Thank you again


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 Post subject: Re: Suboxone for pain?
PostPosted: Sun Aug 20, 2017 6:32 pm 
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Please Dee, you have nothing to apologize for. In fact, I wanted to bring attention to the article because I think it's vitally important for people to become aware of some of the topics covered in it. As Tragicom correctly stated I was simply giving others who are visually-triggered addicts a heads-up that the article was a must-read but contains explicit up-close pictures of the very pills a lot of us almost lost our lives to.

A warning because I care about the people here and I had a really profound reaction to the pictures. This was something I was unaware of ever possibly happening to me. It hasn't happened in the past to the degree that it did this time. I think it's because the pictures were so crystal clear and I can't tell you how many times I've stared at pills that looked EXACTLY like those ones close up in my hand... not wanting to take them and then giving in. I just had an intense emotional reaction and wanted others to be aware before aiming their browsers towards that article. Maybe those with PTSD will know what I mean.

Dee, all of us here are heartbroken over your situation and we want nothing but the best medical care for your husband. Everything you've been going through... everything has been so unfair. There's a part of me that feels almost responsible in a way because I have used diverted medication, and that's one of the reasons why they are cracking down so hard on every patient, regardless if they follow the rules or not. The pendulum is swinging wildly the 'other way' and lives are being lost. Whatever you do, please keep posting. If you think it's important information, I want to know about it. This is partly an information war where knowledge can save thousands of lives!!

- OpenMind

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 Post subject: Re: Suboxone for pain?
PostPosted: Mon Aug 21, 2017 7:52 am 
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I've been hearing about these fake pills for awhile now. It's extremely scary to think that someone thinks they're buying an oxycodone 30 (or whatever) and they're actually getting a pill made to look like one that's came from someone making them in their home! How dangerous is that?

Back when I was using, I was just happy to find something. If my regular dealers didn't have anything and a 'friend' could go to someone they knew and get something I'd take it without hesitation. Heck I was just wanting relief most of the time and would have taken anything. Evidently u cannot trust that anymore (not that it was smart at all to do that even then) or you'll end up with something fake that could potentially kill u. Ppl thinking that they have this tolerance and one pill won't do much of anything and then die because it's fentanyl. It's getting more and more dangerous for addicts and ppl are out to make a buck at the expense of a life.

Could u imagine, some of these ppl working in these 'labs' are probably addicts themselves and that's who's dosing the pill u just bought..... ur lives literally in their hands. Gosh that's scary.

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 Post subject: Re: Suboxone for pain?
PostPosted: Mon Aug 21, 2017 9:07 pm 
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All that you have said , Jenn, and what you have pointed out about fake pills, Dee sounds really scary. What I think I have learned from the news is that fentanyl is the biggest culprit right now in people dying.
We don't have to focus on the evil doctors running the pill mills 5-10 years ago dispensing OxyContin like candy right now.
Maybe we just need to focus on getting fake crap and mainly fentanyl off the street as the most urgent issue right now. That's along with promoting addiction treatment and Suboxone for those who need it . . .

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 Post subject: Re: Suboxone for pain?
PostPosted: Mon Aug 21, 2017 10:04 pm 
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http://www.pewtrusts.org/en/research-an ... erred-drug

From the article:
Quote:
Best known as a medication to help fight addiction, methadone represents only 2 percent of all opiate painkillers prescribed in the U.S. But it is involved in one out of every three accidental overdose deaths, according to data gathered by the U.S. Centers for Disease Control and Prevention (CDC).


It is not coming from the treatment clinics, but the medicine cabinets of patients.


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 Post subject: Re: Suboxone for pain?
PostPosted: Mon Aug 21, 2017 11:22 pm 
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Thx docm2. Right on point of this thread.

Dee's been spot on:
DEA Proposes Significant cuts to Opioid PaIn Production in 2018
https://www.dea.gov/divisions/hq/2017/hq080417.shtml

https://www.federalregister.gov/documen ... essment-of

July/Aug 2017:
Physical Medicine Specialist MD w a small pain practice for short term opiate use, who transitioned patients off, was murdered after a 2nd appt w patient, by husband of patient for Dr refusing further opiate scripts. 52% of prescribers are threatened for more opiates.

Dept of Justice Launches Pilot Program to Crack Down on Pill Mill Docs. Attorney General announced the formation of the Opioid Fraud and Abuse Detection Unit, a new Department of Justice pilot program that will focus on opioid-related healthcare fraud, using data to identify and prosecute individuals contributing to the prescription opioid epidemic.

Look up pill mill Dr's sentenced to jail. One Dr got $90K in fees in 1 month alone. I think 2 sentenced in July or Aug.

Ya, I feel for those patients w real pain bc they could be even more in a world of hurt...

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 Post subject: Re: Suboxone for pain?
PostPosted: Tue Aug 22, 2017 4:03 am 
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docm2 - Who is most likely to have access to methadone? Addicts right? Who is most likely to try larger doses of methadone and risk overdose? Addicts again. And yet it's showing up to all of these reported OD's and deaths. Why? The average chronic pain patient that has just been cut off just happens to know "some guy" with supposedly potent pain killers and they think they can handle it because they really believe they have somewhat of a tolerance that protects them, and that's probably true. But then we find out later it was either a fake pill or it was laced with fentanyl. Instant game over.

As a doctor, where do you think the focus should go? Tighter restrictions on prescriptions of all opioids or maybe just a select few such as methadone, oxycodone and fentanyl? Of course we all agree that we need access to treatment with buprenorphine and in my opinion it should be wide spread but responsibly managed. But what do we do about the real pain patients that have severe, chronic pain and are honest patients that jump through all of the hoops? What's happening to Dee's husband is more than a shame, it almost sounds negligent to me.

There is a real psychological toll that people are having to pay as a fear response ripples across our country in reaction to the opioid crisis. I'd really like to understand this from a professional physician's standpoint please. We need to hear from people like you and Dr. Junig who know how to treat addiction and care for patients in a humane manner. I feel like the politicians are steering us in the direction that makes them sleep easier at night. Policies such as mandatory limits on dosage across the board and forced aggressive tapers regardless of individual factors can't be considered fair medical practice.

Please, if you could take a few moments. Thank you.

- OpenMind

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 Post subject: Re: Suboxone for pain?
PostPosted: Tue Sep 05, 2017 9:10 pm 
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Hi all. I've been away, I volunteered to help victims of Hurricane Harvey. Very overwhelmed by all of it. I wanted to come back to update. My husband saw his doctor, he is going to continue to taper him down to 30 mg, then do the induction. Im so relieved! I really appreciate everyone's time. I'm sure I'll be back with more questions.


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 Post subject: Re: Suboxone for pain?
PostPosted: Wed Sep 06, 2017 8:08 am 
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In addition to tapering down to 30 mg, his pain doctor is going to give him 2 weeks or so of a short acting narcotic. Does anyone know what that should be?
The doctor was different yesterday, explained things better, assured husband that he would allow him to wean down to 30 mg then short acting narcotics until he is inducted.
Thank you all again. I am forever grateful to each and every one of you
Open Mind, I wanted to add that my husband sees a pain management doctor. It was decided many years ago that the best long acting drug for my husband was Methadone. If any problem with insurance we could pay for it out of pocket.
Dee


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 Post subject: Re: Suboxone for pain?
PostPosted: Wed Sep 06, 2017 11:49 am 
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Any short acting opioid will do, Dee. I can't think of why oxycodone wouldn't work.

Bless you for volunteering, Dee!

Amy

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 Post subject: Re: Suboxone for pain?
PostPosted: Fri Sep 08, 2017 7:45 am 
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Thank you Amy, I appreciate the response. While this is not a perfect solution, at least he is not just being cut off completely like many people I see.


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 Post subject: Re: Suboxone for pain?
PostPosted: Fri Sep 08, 2017 6:03 pm 
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Dee19 wrote:
Thank you Amy, I appreciate the response. While this is not a perfect solution, at least he is not just being cut off completely like many people I see.


This is such great news Dee. I think some prayers have been answered. I know several of us have been really worrying about your situation. Feeling like there's nothing you can do to help someone in need is a horrible feeling, but at least your husband is now under the care of someone who will minimize his suffering and that means the world to me. Thanks for the update.

- OpenMind

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 Post subject: Re: Suboxone for pain?
PostPosted: Thu Sep 14, 2017 11:28 am 
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OpenMind wrote:
Dee19 wrote:
Thank you Amy, I appreciate the response. While this is not a perfect solution, at least he is not just being cut off completely like many people I see.


This is such great news Dee. I think some prayers have been answered. I know several of us have been really worrying about your situation. Feeling like there's nothing you can do to help someone in need is a horrible feeling, but at least your husband is now under the care of someone who will minimize his suffering and that means the world to me. Thanks for the update.

- OpenMind


Thank you so much OpenMind for your assistance as well as many others. It has been a challenge to deal with. More so for my husband, I am glad to know there are so many people out there willing to help a stranger. I'm sure I will be back and hope perhaps I can help someone the way you all have helped me.


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 Post subject: Re: Suboxone for pain?
PostPosted: Thu Sep 21, 2017 7:37 pm 
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Hi Dee, It's really good to hear that they are going to be right there with your hubby as he tapers instead of just cutting him off or worse. I can't wait to see how he feels when he gets on Suboxone. I feel like it will be better for him. He will probably be pleasantly surprised at how much better his body and mind will feel having all his receptors saturated with Suboxone instead of dealing with this constant taper. I wish you guys the best of luck with the taper down to 30 mg. Sincerely, Angie aka Bamagirl


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