7 ms·

I've lost at least two elderly, extended family members this way. Both applied both a patch and took a pill, which caused an OD. The issue is that many opioid

I've lost at least two elderly, extended family members this way. Both applied both a patch and took a pill, which caused an OD. The issue is that many opioids and non opioids gap between the therapeutic dose range and LD50% is often dangerously narrow. Complication #0: serum bioavailable molecule assay is rarely monitored. People metabolize and clear drugs at vastly differently rates. Complication #1: Hospital mistakes still happen quite frequently, despite many measures to prevent them, especially with inexperienced and overworked nurses/assistants. Complication #2: cummulative dosing error or interactions, especially multiple, independent prescriptions for similar opioids with different administration routes (patches, sprays, pills, injections) Complication #3: overprescription of opioids because they're cheap, especially to veterans, which also leads to prescription and hard drug addictions. Solution: opiods need to be singularly controlled at home or in the hospital by an integrated, blood/interstitial fluid measuring/dispensing unit to avoid OD and push back on abuse. Plus, anyone taking opioids should also have narcan or equivalent antidote readily available, and wear a medalert QR code bracelet which lists relevant conditions and medications should they be found unresponsive. Finally, avoid painkillers as much as possible and take the least dose which reduces stress level.

creshal 11y ago
> overprescription of opioids because they're cheap It's a bit scary how eager doctors are to prescribe them. "Hey doc, I'm in pain" – "Here's a bottle of painkillers, NEXT" Bitch, I don't want painkillers, I want you to figure out why my body is hurting when it's not supposed to. It's surprisingly frustrating to talk doctors into looking for the cause instead of treating the symptom. Thankfully, the metamizole they kept filling me up with is not nearly as addictive as opioids and we have free health care, so I didn't have to pay a dime for the repeated blood analyses and CT it took find the cause. Otherwise I'd probably have bigger problems right now.
- thaumasiotes 11y ago
  > I don't want painkillers, I want you to figure out why my body is hurting when it's not supposed to. It's surprisingly frustrating to talk doctors into looking for the cause instead of treating the symptom. To be fair, this is related to the symptom you're asking them about. Pain often occurs with no apparent cause. As an extreme example, it is normal for amputees to experience the sensation of a "phantom hand" where their hand would be if it hadn't been amputated. The phantom hand can feel pain. I'm fairly confident that there is nothing physically wrong with the hand someone doesn't have, even if it is in pain.
  - pc86 11y ago
    Pain sometimes occurs with no known cause. I don't know if I'd go so far as to say "often."
    - thaumasiotes 11y ago
      This is prominent in the experience of doctors, which is what's relevant to how they behave. People who aren't seeing a doctor because they have nothing wrong with them and aren't in pain rarely complain about how the doctor treats them, and have virtually no effect on doctors' worldview.
  - Lawtonfogle 11y ago
    But the pain isn't in the hand. Pain is in the head, caused by signals which normally come from the hand, and results in feelings that the head places onto the hand. So phantom pains in amputated limbs are caused by real things. Maybe the nerve that use to communicate the pain from the hand is sending in a false signal due to another reason. Maybe something in the brain is misfiring and some other sensation from another part of the body is registering as pain in the hand. Even if there is no outside of the brain cause for the pain, the brain is still feeling the pain so there is still an actual problem, just one with the brain. So while there might not be much to do if the brain is just crossing signals incorrectly for a couple of days, I would still suggest significant pain be checked out and a doctor you are paying should help look into it.
    - thaumasiotes 11y ago
      > So while there might not be much to do if the brain is just crossing signals incorrectly for a couple of days Chronic pain lasts for years, or forever. An incredible amount of effort has gone into understanding it. We can't blame practitioners for knowing that they don't understand pain and aren't likely to in the future, and therefore deciding to treat it with painkillers.
      - Lawtonfogle 11y ago
facetube 11y ago
Complication #0 actually seems even worse when private insurance is tossed in to the mix: much of the monitoring that would be prudent is excluded by my employer-based insurance company as "not medically necessary". For example, I can't get them to pay for a CYP2D6 test to determine if I'm an ultrarapid metabolizer of a particular drug, nor can I get them to pay for blood level monitoring of the active metabolite to determine if I'm in the therapeutic range. In fact, tests across cytochrome P450 have a blanket exclusion. This is a $20,000 per year policy; probably the best the US health system has to offer.
- cat-dev-null 11y ago
  Argh, that's frustrating. Perhaps biohacker folks may work on how cheap the chems are for these sorts of tests "unapproved" DIY/out-of-pocket way to do it? This seems like a TED / TEDx speaker-worthy problem begging for a cheaper/easier solution.

creshal 11y ago

> overprescription of opioids because they're cheap It's a bit scary how eager doctors are to prescribe them. "Hey doc, I'm in pain" – "Here's a bottle of painkillers, NEXT" Bitch, I don't want painkillers, I want you to figure out why my body is hurting when it's not supposed to. It's surprisingly frustrating to talk doctors into looking for the cause instead of treating the symptom. Thankfully, the metamizole they kept filling me up with is not nearly as addictive as opioids and we have free health care, so I didn't have to pay a dime for the repeated blood analyses and CT it took find the cause. Otherwise I'd probably have bigger problems right now.

thaumasiotes 11y ago
> I don't want painkillers, I want you to figure out why my body is hurting when it's not supposed to. It's surprisingly frustrating to talk doctors into looking for the cause instead of treating the symptom. To be fair, this is related to the symptom you're asking them about. Pain often occurs with no apparent cause. As an extreme example, it is normal for amputees to experience the sensation of a "phantom hand" where their hand would be if it hadn't been amputated. The phantom hand can feel pain. I'm fairly confident that there is nothing physically wrong with the hand someone doesn't have, even if it is in pain.
- pc86 11y ago
  Pain sometimes occurs with no known cause. I don't know if I'd go so far as to say "often."
  - thaumasiotes 11y ago
    This is prominent in the experience of doctors, which is what's relevant to how they behave. People who aren't seeing a doctor because they have nothing wrong with them and aren't in pain rarely complain about how the doctor treats them, and have virtually no effect on doctors' worldview.
- Lawtonfogle 11y ago
  But the pain isn't in the hand. Pain is in the head, caused by signals which normally come from the hand, and results in feelings that the head places onto the hand. So phantom pains in amputated limbs are caused by real things. Maybe the nerve that use to communicate the pain from the hand is sending in a false signal due to another reason. Maybe something in the brain is misfiring and some other sensation from another part of the body is registering as pain in the hand. Even if there is no outside of the brain cause for the pain, the brain is still feeling the pain so there is still an actual problem, just one with the brain. So while there might not be much to do if the brain is just crossing signals incorrectly for a couple of days, I would still suggest significant pain be checked out and a doctor you are paying should help look into it.
  - thaumasiotes 11y ago
    > So while there might not be much to do if the brain is just crossing signals incorrectly for a couple of days Chronic pain lasts for years, or forever. An incredible amount of effort has gone into understanding it. We can't blame practitioners for knowing that they don't understand pain and aren't likely to in the future, and therefore deciding to treat it with painkillers.
    - Lawtonfogle 11y ago

facetube 11y ago

Complication #0 actually seems even worse when private insurance is tossed in to the mix: much of the monitoring that would be prudent is excluded by my employer-based insurance company as "not medically necessary". For example, I can't get them to pay for a CYP2D6 test to determine if I'm an ultrarapid metabolizer of a particular drug, nor can I get them to pay for blood level monitoring of the active metabolite to determine if I'm in the therapeutic range. In fact, tests across cytochrome P450 have a blanket exclusion. This is a $20,000 per year policy; probably the best the US health system has to offer.

cat-dev-null 11y ago
Argh, that's frustrating. Perhaps biohacker folks may work on how cheap the chems are for these sorts of tests "unapproved" DIY/out-of-pocket way to do it? This seems like a TED / TEDx speaker-worthy problem begging for a cheaper/easier solution.