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I don't mean to detract from your anecdote but the Florida and the CDC clearly sees a link in overprescription of pain killers and the death rate. The root caus

I don't mean to detract from your anecdote but the Florida and the CDC clearly sees a link in overprescription of pain killers and the death rate. The root cause is the way we are handling opiates in general which changed in 2001 and the prioritization of "comfort" of the patient when they are in pain. Anecdotal, I've been in pain, multiple times in my life, where Doctors were literally confused by the fact I wasn't taking pain medication and immediate would prescribe opiates without a second thought. A couple even made comments [one Doctor who used to treat soldiers assumed it was a macho thing and told me I was being silly, just take the drugs]. The main reason I don't take pain killers is I've got medical allergies so I reserve the handful of things I can take for emergencies but they'll casually try to suggest/prescribe them for trivial things. > People I went to high school with no hope for the future were doing meth because it was 3 minutes of bliss in stark contrast to the whirlpool of suck their lives had become. Yeah, but would you agree they would turn to drinking if they wouldn't/couldn't do illegal drugs? http://www.cdc.gov/media/releases/2014/p0701-opioid-painkiller.html http://www.cdc.gov/media/releases/2014/p0701-opioid-painkill... > Health care providers in the highest prescribing state, Alabama, wrote almost three times as many of these prescriptions per person as those in the lowest prescribing state, Hawaii. Most of the highest prescribing states were in the South. Previous research has shown that regional variation in use of prescriptions cannot be explained by the underlying health status of the population. > The Vital Signs report also contains a study highlighting the success of Florida in reversing prescription drug overdose trends. Results showed that after statewide legislative and enforcement actions in 2010 and 2011, the death rate from prescription drug overdose decreased 23 percent between 2010 and 2012. Florida officials had taken these actions in response to a 28 percent increase in the drug overdose death rate over the preceding years (2006-2010). > Declines in death rates in Florida for specific prescription painkillers (oxycodone, methadone, and hydrocodone) and sedatives paralleled declines in prescribing rates for those drugs. This report was based on Florida Medical Examiners Commission data from 2006 to 2012 and IMS Health National Prescription Audit data from 2008 to 2012. They do the same with antibiotics: http://www.cbsnews.com/news/doctors-urged-to-stop-prescribing-antibiotics-for-colds-and-flu/ http://www.cbsnews.com/news/doctors-urged-to-stop-prescribin... > Despite years of warnings, doctors still overprescribe antibiotics for acute respiratory infections even though most are caused by viruses that those drugs cannot help. The consequences are serious: overuse of antibiotics is fueling the rise of drug-resistant superbugs, and patients can suffer significant side effects from drugs they don't really need. http://www.newyorker.com/business/currency/who-is-responsible-for-the-pain-pill-epidemic http://www.newyorker.com/business/currency/who-is-responsibl... > The Joint Commission, which accredits health facilities, issued pain-management standards in 2001 that instructed hospitals to measure pain—you may be familiar with the smiling-to-crying faces scale—and to prioritize its treatment. Elizabeth Zhani, a spokeswoman for the Joint Commission, told me that their standards “were based upon both the emerging and compelling science of that time, and upon the consensus of a broad array of professionals.” Yet Purdue, according to a report issued by the U. S. Government Accountability Office, helped fund a “pain-management educational program” organized by the Joint Commission; a related agreement allowed Purdue to disseminate educational materials on pain management, and this, in the words of the report, “may have facilitated its access to hospitals to promote OxyContin.” > In a policy drafted by several people with ties to narcotics makers, including Haddox, the Federation of State Medical Boards called on the boards to punish doctors for inadequately treating pain, according to the Wall Street Journal. The Federation also reportedly accepted money from pharmaceutical firms to produce and distribute narcotics-prescribing guidelines. In an e-mail, the Federation maintained: “[Our] most recent policy reflects the considerable body of research and experience accrued since our last series of formal policies related to opioid prescribing and addiction were adopted in 2004. Our latest guidelines, adopted this year, acknowledge that evidence for the risk associated with opioids has surged, while evidence for the benefits of opioids for long-term use has remained controversial and insufficient.” > In 2007, Purdue Pharma and three of its top executives pleaded guilty to criminal charges that they had misled the F.D.A., clinicians, and patients about the risks of OxyContin addiction and abuse by aggressively marketing the drug to providers and patients as a safe alternative to short-acting narcotics. (Doctors had been taught that because OxyContin was time-released, it wouldn’t cause a high that would lead to addiction.)

sageabilly 11y ago
"...overprescription of pain killers" Yup, definitely a problem. Not so much in my county that I saw, but definitely a problem. And then the people who have them prescribed to them are selling them to get money because they have none. Another anecdote- I did a brief stint as an in-home healthcare aide in college and the sweet old lady I took care of who was in the 1st stages of dementia sold her painkillers to her neighbor at $3 a pill "Because he says he will get them to people who can't afford to go to the doctor, poor dears." Also, if you're able-bodied and out of work, you're definitely not able to afford to go to the doctor or pay for prescription painkillers. "...they would turn to drinking if they wouldn't/couldn't do illegal drugs?" Probably/definitely not. There's one ABC store in my entire county (population 50K now, closer to 25K in 2001) and again, really hard to be anonymous with your drinking when you went to high school with everyone who works at the ABC store and it's where everyone in the entire county goes to get their booze so chances are you'll see your brother in law and your best friend's grandmother and your ex-girlfriend's uncle while you're in there. Drugs can be done in the shadows and hidden way more effectively than booze. RE: overprescription: I have no idea why this is a thing. Profit margins on painkillers mean salespeople give under the table kickbacks to underpaid rural doctors in return for more prescriptions? Aging population on Medicaid becomes only cash cow for rural doctors after so many people lose their jobs (and health insurance) so they have to start prescribing more pills that they know Medicaid will pay for? Lack of doctor education leads to overprescription because they don't know any better? It's a big unknown, and not addressed in the article at all.
- fweespeech 11y ago
  > "...overprescription of pain killers" Yup, definitely a problem. Not so much in my county that I saw, but definitely a problem. And then the people who have them prescribed to them are selling them to get money because they have none. Another anecdote- I did a brief stint as an in-home healthcare aide in college and the sweet old lady I took care of who was in the 1st stages of dementia sold her painkillers to her neighbor at $3 a pill "Because he says he will get them to people who can't afford to go to the doctor, poor dears." Also, if you're able-bodied and out of work, you're definitely not able to afford to go to the doctor or pay for prescription painkillers. Yeah, the New Yorker article I linked to mentioned that as well but I didn't quote it: > And then there are the real-life Walter Whites. I once helped care for a patient with lung cancer who wasn’t taking his narcotics, unbeknownst to his doctors. This patient’s cancer had spread to his bones and other organs, which can be incredibly painful. But he was selling his prescription narcotics to help support his wife and himself. So when given these high-dose narcotics in the hospital, he overdosed—though not fatally, fortunately. --------- > "...they would turn to drinking if they wouldn't/couldn't do illegal drugs?" Probably/definitely not. There's one ABC store in my entire county (population 50K now, closer to 25K in 2001) and again, really hard to be anonymous with your drinking when you went to high school with everyone who works at the ABC store and it's where everyone in the entire county goes to get their booze so chances are you'll see your brother in law and your best friend's grandmother and your ex-girlfriend's uncle while you're in there. Drugs can be done in the shadows and hidden way more effectively than booze. Fair enough, the idea of literally one store for an entire county didn't occur to me honestly. --------- > RE: overprescription: I have no idea why this is a thing. Profit margins on painkillers mean salespeople give under the table kickbacks to underpaid rural doctors in return for more prescriptions? Aging population on Medicaid becomes only cash cow for rural doctors after so many people lose their jobs (and health insurance) so they have to start prescribing more pills that they know Medicaid will pay for? Lack of doctor education leads to overprescription because they don't know any better? It's a big unknown, and not addressed in the article at all. The pain management guidelines for hospitals was set by Big Pharma, basically. Similar tricks are used to encourage doctors to do the same. https://www.cms.gov/openpayments/ https://www.cms.gov/openpayments/ For instance, exists because of these payments. And yes, I'd say its likely a combination of "feel good" marketing [e.g. It is safe, just give it to your patient to help the feel better] and kickbacks. And yeah, its not addressed in the article at all. Florida [from the CDC article I linked to] ended up passing a bunch of laws which reduced overdose deaths by shutting down "pill mills" and such. http://www.drugfree.org/join-together/florida-combats-prescription-drug-abuse-with-laws-and-enforcement/ http://www.drugfree.org/join-together/florida-combats-prescr... > After the state cracked down on pill mills and instituted other changes, the number of prescription drug-related deaths decreased in Florida in 2011. Deaths related to oxycodone decreased more than 17 percent. There are no doctors from Florida on the Drug Enforcement Administration’s (DEA) list of physicians who purchase the most oxycodone, the article notes. Its not perfect but some combination of improved enforcement and better incentives for doctors is needed. I doubt education is the issue given the fact cash and subverting the bodies that create the standards is what Big Pharma seems to target.

sageabilly 11y ago

"...overprescription of pain killers" Yup, definitely a problem. Not so much in my county that I saw, but definitely a problem. And then the people who have them prescribed to them are selling them to get money because they have none. Another anecdote- I did a brief stint as an in-home healthcare aide in college and the sweet old lady I took care of who was in the 1st stages of dementia sold her painkillers to her neighbor at $3 a pill "Because he says he will get them to people who can't afford to go to the doctor, poor dears." Also, if you're able-bodied and out of work, you're definitely not able to afford to go to the doctor or pay for prescription painkillers. "...they would turn to drinking if they wouldn't/couldn't do illegal drugs?" Probably/definitely not. There's one ABC store in my entire county (population 50K now, closer to 25K in 2001) and again, really hard to be anonymous with your drinking when you went to high school with everyone who works at the ABC store and it's where everyone in the entire county goes to get their booze so chances are you'll see your brother in law and your best friend's grandmother and your ex-girlfriend's uncle while you're in there. Drugs can be done in the shadows and hidden way more effectively than booze. RE: overprescription: I have no idea why this is a thing. Profit margins on painkillers mean salespeople give under the table kickbacks to underpaid rural doctors in return for more prescriptions? Aging population on Medicaid becomes only cash cow for rural doctors after so many people lose their jobs (and health insurance) so they have to start prescribing more pills that they know Medicaid will pay for? Lack of doctor education leads to overprescription because they don't know any better? It's a big unknown, and not addressed in the article at all.

fweespeech 11y ago
> "...overprescription of pain killers" Yup, definitely a problem. Not so much in my county that I saw, but definitely a problem. And then the people who have them prescribed to them are selling them to get money because they have none. Another anecdote- I did a brief stint as an in-home healthcare aide in college and the sweet old lady I took care of who was in the 1st stages of dementia sold her painkillers to her neighbor at $3 a pill "Because he says he will get them to people who can't afford to go to the doctor, poor dears." Also, if you're able-bodied and out of work, you're definitely not able to afford to go to the doctor or pay for prescription painkillers. Yeah, the New Yorker article I linked to mentioned that as well but I didn't quote it: > And then there are the real-life Walter Whites. I once helped care for a patient with lung cancer who wasn’t taking his narcotics, unbeknownst to his doctors. This patient’s cancer had spread to his bones and other organs, which can be incredibly painful. But he was selling his prescription narcotics to help support his wife and himself. So when given these high-dose narcotics in the hospital, he overdosed—though not fatally, fortunately. --------- > "...they would turn to drinking if they wouldn't/couldn't do illegal drugs?" Probably/definitely not. There's one ABC store in my entire county (population 50K now, closer to 25K in 2001) and again, really hard to be anonymous with your drinking when you went to high school with everyone who works at the ABC store and it's where everyone in the entire county goes to get their booze so chances are you'll see your brother in law and your best friend's grandmother and your ex-girlfriend's uncle while you're in there. Drugs can be done in the shadows and hidden way more effectively than booze. Fair enough, the idea of literally one store for an entire county didn't occur to me honestly. --------- > RE: overprescription: I have no idea why this is a thing. Profit margins on painkillers mean salespeople give under the table kickbacks to underpaid rural doctors in return for more prescriptions? Aging population on Medicaid becomes only cash cow for rural doctors after so many people lose their jobs (and health insurance) so they have to start prescribing more pills that they know Medicaid will pay for? Lack of doctor education leads to overprescription because they don't know any better? It's a big unknown, and not addressed in the article at all. The pain management guidelines for hospitals was set by Big Pharma, basically. Similar tricks are used to encourage doctors to do the same. https://www.cms.gov/openpayments/ https://www.cms.gov/openpayments/ For instance, exists because of these payments. And yes, I'd say its likely a combination of "feel good" marketing [e.g. It is safe, just give it to your patient to help the feel better] and kickbacks. And yeah, its not addressed in the article at all. Florida [from the CDC article I linked to] ended up passing a bunch of laws which reduced overdose deaths by shutting down "pill mills" and such. http://www.drugfree.org/join-together/florida-combats-prescription-drug-abuse-with-laws-and-enforcement/ http://www.drugfree.org/join-together/florida-combats-prescr... > After the state cracked down on pill mills and instituted other changes, the number of prescription drug-related deaths decreased in Florida in 2011. Deaths related to oxycodone decreased more than 17 percent. There are no doctors from Florida on the Drug Enforcement Administration’s (DEA) list of physicians who purchase the most oxycodone, the article notes. Its not perfect but some combination of improved enforcement and better incentives for doctors is needed. I doubt education is the issue given the fact cash and subverting the bodies that create the standards is what Big Pharma seems to target.