5 ms·

is this still a problem? from personal experience, the last time I needed pain managed the #1 concern was not getting me addicted, #2 was pain management itself

by munin 11y ago

is this still a problem? from personal experience, the last time I needed pain managed the #1 concern was not getting me addicted, #2 was pain management itself. they were very cautious to start anything "strong" (morphine) and very, very eager to end it. from these and other anecdotal experiences I have a hard time accepting that doctors handing out strong painkillers like candy and getting their patients hooked on them is a genuine problem, do you have any data?

dalke 11y ago
For another, related, account from 1999, see http://www.asktog.com/readerMail/1999-11-PumpReaderMail.html http://www.asktog.com/readerMail/1999-11-PumpReaderMail.html : > My wife, The Doctor, is a board-certified addictionologist, in addition to being an internist, with a subspecialty in prescription drug addiction and signficant experience in running drug and alcohol treatment centers. > She has informed me that (1) most “enlightened” doctors are liberal with narcotics for those who have not been previously addicted and stingy with those who have been hooked, and (2) these doctors don’t know what the hell they are doing. ... > What about the danger of getting people re-hooked? If the medication level, no matter how high, is kept below the threshold of euphoria, the chances for re-hooking the patient are low. And if the patient does become hooked, there are programs and facilities that can handle that problem. > The worst part about asking the patient if he or she has previously been hooked is that patients not in recovery, who are likely to con you out of all the drug they can, are going to lie, while patients in recovery, who will use the pump responsibly, are going to tell the truth. Therefore, those addicts who are most likely to get in trouble with high doses will receive high doses, while the rest are left in significant pain. > In my own case, I wrote down on my drug history that I had once had a single methadone tablet. This was prescribed by my oncologist while I was recovering from cancer some 20 years ago. I took one tablet and concluded, based on the side effects, that I’d rather die than take another. Nonetheless, one of the seven anesthesiologists that took turns deciding, a couple months ago, how much narcotic the pump would supply me “today,” took this fleeting mention of methodone to indicate that I was a dangerous heroin addict who had been on methadone maintainance. So he did the only thing reasonable. He reduced my pain medication to almost nothing. This would suggest that even in 1999 the order was still your #1/#2.
freshyill 11y ago
When I had major surgery three years ago, the button to give myself a dose of hydromorphone only worked every 10 minutes. I imagine systems like this are pretty common. When I left the hospital five days later, my prescription wasn't anything nearly so strong—and this was a surgery with a months-long recovery.
alexqgb 11y ago
Doctors in general are generally cautious. The problem can be traced to a small number of corrupt doctors who decided to abandon their medical scruples so they could make very lucrative livings as semi-legal dealers of high-grade narcotics. The Feds eventually cracked down on this racket, but not before it had spawned a tremendous number of white, middle-class addicts who found themselves turning to the black market in heroin for their fixes. These people, in turn, are running headlong into the insanely punitive legal structures developed to terrorize, brutalize, and demonize black users when crack became a thing in the 80s. Given a choice between accepting the punishments they were happy to dole out to others or abandoning this particular vector for racism, bigoted white people are deciding they can find other ways to keep the spirit of Jim Crow alive and well. For them, the Drug War has failed not because it failed to get rid of drugs (that was never the point) but because it's no longer as discriminatory as it used to be.
- mc32 11y ago
  I think it's more complicated than that simplistic take. Just imagine the numbers of people behind bars if that tactic were followed thru. It was pretty much untenable as it was but we'd be looking at what, locking up 5 per cent of the population? If you look at who supported the drugs policies, blacks supported them almost as much as whites did. Drugs were ravaging neighborhoods, and back then, this is how societies had treated drugs addicts. Russia, China, Singapore, African countries, etc. It wasn't till the Swiss experimented with alternative back in the nineties that others began looking at alternative policies in treating drugs addicts. Then we had a number of countries in Europe begin to try alternative methods to treat their addicts and people began to see these alternatives were more effective than jailing addicts and now we're seeing similar approaches in the US.
  - alexqgb 11y ago
    That's a simplification, to be sure. And yes, there was support for the idea of drug enforcement in the places where the drug trade spawned the most violence. But the enterprise went badly sideways from there, quickly degenerating into an excuse for detaining and harassing black people en masse, long after the violence that triggered the crackdown has abated.

by munin 11y ago

dalke 11y ago

For another, related, account from 1999, see http://www.asktog.com/readerMail/1999-11-PumpReaderMail.html http://www.asktog.com/readerMail/1999-11-PumpReaderMail.html : > My wife, The Doctor, is a board-certified addictionologist, in addition to being an internist, with a subspecialty in prescription drug addiction and signficant experience in running drug and alcohol treatment centers. > She has informed me that (1) most “enlightened” doctors are liberal with narcotics for those who have not been previously addicted and stingy with those who have been hooked, and (2) these doctors don’t know what the hell they are doing. ... > What about the danger of getting people re-hooked? If the medication level, no matter how high, is kept below the threshold of euphoria, the chances for re-hooking the patient are low. And if the patient does become hooked, there are programs and facilities that can handle that problem. > The worst part about asking the patient if he or she has previously been hooked is that patients not in recovery, who are likely to con you out of all the drug they can, are going to lie, while patients in recovery, who will use the pump responsibly, are going to tell the truth. Therefore, those addicts who are most likely to get in trouble with high doses will receive high doses, while the rest are left in significant pain. > In my own case, I wrote down on my drug history that I had once had a single methadone tablet. This was prescribed by my oncologist while I was recovering from cancer some 20 years ago. I took one tablet and concluded, based on the side effects, that I’d rather die than take another. Nonetheless, one of the seven anesthesiologists that took turns deciding, a couple months ago, how much narcotic the pump would supply me “today,” took this fleeting mention of methodone to indicate that I was a dangerous heroin addict who had been on methadone maintainance. So he did the only thing reasonable. He reduced my pain medication to almost nothing. This would suggest that even in 1999 the order was still your #1/#2.

freshyill 11y ago

When I had major surgery three years ago, the button to give myself a dose of hydromorphone only worked every 10 minutes. I imagine systems like this are pretty common. When I left the hospital five days later, my prescription wasn't anything nearly so strong—and this was a surgery with a months-long recovery.

alexqgb 11y ago

Doctors in general are generally cautious. The problem can be traced to a small number of corrupt doctors who decided to abandon their medical scruples so they could make very lucrative livings as semi-legal dealers of high-grade narcotics. The Feds eventually cracked down on this racket, but not before it had spawned a tremendous number of white, middle-class addicts who found themselves turning to the black market in heroin for their fixes. These people, in turn, are running headlong into the insanely punitive legal structures developed to terrorize, brutalize, and demonize black users when crack became a thing in the 80s. Given a choice between accepting the punishments they were happy to dole out to others or abandoning this particular vector for racism, bigoted white people are deciding they can find other ways to keep the spirit of Jim Crow alive and well. For them, the Drug War has failed not because it failed to get rid of drugs (that was never the point) but because it's no longer as discriminatory as it used to be.

mc32 11y ago
I think it's more complicated than that simplistic take. Just imagine the numbers of people behind bars if that tactic were followed thru. It was pretty much untenable as it was but we'd be looking at what, locking up 5 per cent of the population? If you look at who supported the drugs policies, blacks supported them almost as much as whites did. Drugs were ravaging neighborhoods, and back then, this is how societies had treated drugs addicts. Russia, China, Singapore, African countries, etc. It wasn't till the Swiss experimented with alternative back in the nineties that others began looking at alternative policies in treating drugs addicts. Then we had a number of countries in Europe begin to try alternative methods to treat their addicts and people began to see these alternatives were more effective than jailing addicts and now we're seeing similar approaches in the US.
- alexqgb 11y ago
  That's a simplification, to be sure. And yes, there was support for the idea of drug enforcement in the places where the drug trade spawned the most violence. But the enterprise went badly sideways from there, quickly degenerating into an excuse for detaining and harassing black people en masse, long after the violence that triggered the crackdown has abated.