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Coroner letters changed habits of doctors whose patients died of overdoses
- camel_gopher 8y agoReal
- duncan-donuts 8y agoClearly I'm just a layman but I find it so surprising that the medical community isn't 100% aware of the over prescribing of opiods by now. I have to believe they are totally aware of the situation, but don't know what else to do. Or maybe they're totally fine with it /shrug. I'd love to know more about the medical community's reaction and reformation efforts around the issues with opiods and addiction.
- fjsolwmv 8y agoAwareness in general and being forced to directly think on a specific person you killed are two different things.
- cheeze 8y agoEverybody is aware. Many just don't care.
- thomasfedb 8y agoI think this is mean and unnecessarily so. People have pain and expect doctors to fix it, but the tools we have to treat it are dangerous. Going too far either way will cripple or destroy lives. Getting the balance right isn't a job anybody is envious of.
- slededit 8y agoThe article states most doctors think they prescribe below average amounts - similar to everyone thinking they are an above average driver.
- nostromo 8y agoIt’s entirely possible, even likely, that most doctors prescribe below average amounts.
- rz2k 8y agoSearch: “Pain is the fifth vital sign” There was a very strong campaign to re-educate physicians to not consider pain as only a symptom. It was suggested that there was liability in not treating pain for the sake of getting rid of pain alone, but mostly it didn’t just change prescribing practices out of fear of liability, the focus of attention on pain changed prescribing habits. In practice, someone who hardly has enough time for the patients they see, may subconsciously think that in spite of the prevalence of national opioid deaths, no one they treat has died or destroyed their lives through addiction, simply because those who do also stop booking appointments. These letters sound like a great idea.
- javadocmd 8y agoEven for doctors who express awareness of the problem with opioid prescribing, it's not uncommon to believe that every other doctor is the problem, and not themselves. Either not realizing their prescribing is above average, or realizing but justifying it with the thought that they somehow have a patient population with above average pain needs.
- xup 8y agoAnother factor: Many doctors and hospitals are rated according to patient satisfaction, with reimbursement rates from the government partially based on those satisfaction surveys. And in many cases, if patients have any pain whatsoever, they rate the doctors and hospitals poorly, and therefore the doctors and hospitals get a lower reimbursement rate from the federal government. So doctors and hospitals are incentivized to make patients have no pain whatsoever in recovery, in order to have higher reimbursement rates, even if it means addiction in the long run. Source: Many doctors in my family who talk about their experiences.
- baxtr 8y agoI guess it’s also an cultural issue. If it’s ok to mute any pain, then not giving opioids is maybe not even considered. My father had 2 bad operations last year. He suffered a lot of pain afterwards, but he refrained from taking strong drugs. I’m not sure if he did the right thing and if I’d do the same. But there’s is definitely middle ground between killing every pain and enduring all of it. I found this article interesting: https://www.nytimes.com/2018/01/27/opinion/sunday/surgery-germany-vicodin.html https://www.nytimes.com/2018/01/27/opinion/sunday/surgery-ge...
- cm2012 8y agoJust FYI, doctors very rarely cause opioid addictions: https://www.fivethirtyeight.com/features/what-science-says-to-do-if-your-loved-one-has-an-opioid-addiction/ https://www.fivethirtyeight.com/features/what-science-says-t... As the article shows, at worst they get bamboozled by addicts sometimes, who go to multiple doctors and lie.
- johnpowell 8y agoI went to the dentist around four months ago to get a tooth pulled. I was given 36x325Mg Hydrocodone (not a typo) and 14x600 Mg Ibuprofen. Which is pretty absurd. I only used 6 of the Ibuprofen. I'm not sure why I wasn't just given a two day supply of Hydrocodone and if more was needed I could have just called it in asking for a more if the pain was bad. It was such a over-prescription I hope it was just sloppy handwriting.
- selectodude 8y agoYou were reading the bottle wrong. Those pills were either 5mg or 10mg of hydrocodone with 325mg of acetaminophen. 36 of those, while a lot, is really not more than 4-5 days worth. They only last 4-6 hours each. 325mg hydrocodone would have killed you several times over unless you’re, like, a late stage cancer patient or a severe heroin addict.
- pdkl95 8y agoAdditionally, 600mg Ibuprofen is just 3 of the common over-the-counter 200mg pills. The adult dose for OTC Ibuprofen is 1 or 2 of the 200mg pills, so 600mg is only 150%-300% larger. Whi8le that kind of higher dose can become a problem if used continuously for more than a few days (be careful with any medication), it's a fairly standard dose for a handful of days after a dental procedure. It's certainly not "absurd". (I've been prescribed 1200mg Ibuprofen "every 4-6 hours" a couple times)
- johnpowell 8y agoI am not saying the ibuprofen was a problem. I'm saying it should have been the first thing recommended. I was told to take the ibuprofen for swelling and the hydrocodone for pain.
- johnpowell 8y agoYou are correct. It says Hydrophone-Acetomaminophen 5-325MG Tab Mall. But there is a line break. after "5-" so since I am not a doctor I think my interpretation is a reasonable one. You knew exactly what I meant, so cool.
- icu 8y agoLA Times seems to be blocked for the UK, presumably due to GDPR.
- draw_down 8y agoBummer.
- evfanknitram 8y agoI assume blocked in all of EU.
- tehlike 8y agohttp://archive.is/TN3Uz http://archive.is/TN3Uz
- orblivion 8y agoI found the letter to be crafted very cleverly. "This person died unnecessarily because of your decisions" then while you're feeling guilty and vulnerable "Here's a program to show you how you can atone"
- deleted 8y ago[deleted]
- cm2012 8y agoOne note: Research pretty thoroughly debunks the idea that a substantial percent of opioid as addictions come from prescribed pain treatments: https://www.fivethirtyeight.com/features/what-science-says-to-do-if-your-loved-one-has-an-opioid-addiction/ https://www.fivethirtyeight.com/features/what-science-says-t... Now this article is about something different - teaching doctors the warning signs of when already addicted patients are drug seeking, so they can avoid prescribing then. The key fact here is that almost all of the deceased had gotten prescriptions from multiple doctors.
- jeffdavis 8y agoWhat is the predominant mechanism of becoming addicted then?
- cm2012 8y ago"Far greater risk comes from simply being young and from using alcohol and other recreational drugs heavily. Ninety percent of all drug addictions start in the teens — and 75 percent of prescription opioid misuse begins when (mainly young) people get pills from friends, family or dealers — not doctors. Opioids are rarely the first drug people misuse."
- simonbarker87 8y agoYou could still draw a link: high prescription rates of opioid pain killers normalises the use of them and as such someone is more likely to be offered them by family and friends for something minor. Also, is “throughly” debunked really the case? That makes it sound like there can be no link at all, but higher levels of these in society legally could lead to an increase in abuse. On complex topics like this it is rarely possible to talk in absolutes.
- cm2012 8y agoWhat's debunked is the very common narrative in this thread that poor Uncle Billy went to the doctor with a bad back and came back a rabid addict. Non addicts becoming addicts from regular prescriptions is very rare according to all studies. There is definitely a big complex drug ecosystem otherwise, though.
- justinjlynn 8y agoIt had a direct impact on several doctor's prescription habits. This is a good thing. Now, did it do so while ensuring doctors maintained the same pain management outcomes for their patients? I am dubious and concerned this doesn't appear to have been addressed in their studies.
- kelnos 8y agoAs a potential patient, I'm pretty sure I'd prefer to endure a little extra pain if the alternative is an increased likelihood of painkiller addiction that could lead to death.
- cm2012 8y agoThere's almost no chance of you developing an opiate addiction from a prescribed dose if you don't already have a history of addiction: https://www.google.com/amp/s/fivethirtyeight.com/features/what-science-says-to-do-if-your-loved-one-has-an-opioid-addiction/amp/ https://www.google.com/amp/s/fivethirtyeight.com/features/wh... This is a false narrative that needs to go away.
- Lxr 8y agoNon AMP: https://fivethirtyeight.com/features/what-science-says-to-do-if-your-loved-one-has-an-opioid-addiction/ https://fivethirtyeight.com/features/what-science-says-to-do...
- DanBC 8y agoYou're pushing a narrative created by opioid manufacturers: "These meds aren't addictive if used to treat pain". That's only true (if it is true) if they're used short term. People in this thread aren't talking about acute pain, they're talking about chronic (long term) pain. It's likely that opioids are addictive if used long term to treat long term pain. Here's what actual doctors say: https://www.rcoa.ac.uk/faculty-of-pain-medicine/opioids-aware https://www.rcoa.ac.uk/faculty-of-pain-medicine/opioids-awar... EDIT: FFS, your own link says this: > “Physiological dependence is the normal response to regular dosages of many medications, whether opioids or others. It also happens with beta blockers for high blood pressure,” said Dr. Wilson Compton, deputy director of the National Institute on Drug Abuse. Your link says that opioids create physical addiction. The physical addiction to opioids causes all the factors of the newer definition of adddictive: tolerance, drug seeking, preoccupation, and continuing to take it even though you know it's harmful.
- lesserroneous 8y agoI will admit I'm biased: my mother died of an overdose. She was a drug addict. I, on the other hand, have a painful autoimmune disorder, but I've never taken medication. Yet every doctor I've met in the past ten years has looked at me and immediately treated me like a drug addict. Personal experience aside (as it really is not quantitatively demonstrative of anything larger) I've done my best to research this issue, and I'm still somewhat at a loss. Based on these numbers and the 2016 CDC list of leading causes of death, opiate-related deaths account for .02% of the population. On the other hand, I would guess we have quintuple that in people who suffer chronic pain. Though, I can't say how many use their medication as prescribed, I would guess it's at least more than .02% of the population. Addiction is not simple, and even people who started responsibly taking medication could develop an addiction. I don't think it's fair, however, to punish the many people who depend on pain relief. Lax laws in the 80s and 90s have now pendulum-swung to the other side. Patients are seeing their medication reduced without tapering, they are given no other option than to "suck it up," and all along, they are variously demonized or treated as though they are weak. It's a complicated situation that I am not equipped to solve. I do think there needs to be a middle ground. There needs to be a better effort that will help the entire patient population. https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm
- DanBC 8y agoPeople think that opioids are an effective treatment for long term pain. They aren't. They don't work to treat the pain and the patient develops a tolerance and so ends up taking large quantities putting their health at risk. > Patients are seeing their medication reduced without tapering, they are given no other option than to "suck it up," These are both bad, but these are both symptoms of the sometimes terrible healthcare in the US. People should have access to pain management clinics.
- justinjlynn 8y ago> They don't work to treat the pain and the patient develops a tolerance and so ends up taking large quantities putting their health at risk. As you've already asserted in your other comments here and I've asked elsewhere, could you expand on this assertion?
- tehlike 8y agoFor europeans: http://archive.is/TN3Uz http://archive.is/TN3Uz
- ewjordan 8y agoOpiods have been around forever; pardon my ignorance, but what is different now that makes so many more people get hooked on them? Presumably people felt the same levels of pain in the past as they do now, given the same maladies. Is the situation: A) More surgeries with extremely painful and long recovery periods are happening, where these meds are truly necessary B) Doctors are prescribing opiods more freely for lower levels of pain than in the past C) People are faking pain more often D) People who really do need pain meds are staying on them longer than they should B) seems to be the accusation that I usually see, but have doctors really gotten worse and less careful over time? To an extent that explains the whole crisis? My guess is that D) is the real cause, for may different reasons.
- veeberz 8y agoHave you considered the availability of cheap opioids such as black tar heroin from Mexico? Or fentanyl shipped from China?
- deleted 8y ago[deleted]
- javadocmd 8y agoWhen a problem seems to be getting worse but it seems like not much has changed, consider that the problem used to be just as bad, it's just not being swept under the rug as effectively.
- DanBC 8y agoOpioid sales quadrupled between 1999 and 2014. > but what is different now that makes so many more people get hooked on them? The US VA noticed that pain was not being adequately treated. They created a campaign to make every HCP ask patients about pain. They looked at the science of the time which seemed to be saying that opioids were not addictive if you use them to treat pain. (they're less addictive if used short term for short term pain (post surgery, for example) but more addictive if used long term.) Drug companies put out new formulations that they claimed were less addictive - turns out they were more addictive. US doctors prescribe huge amounts of opioids. The tragedy is that pain is still left untreated. The VA campaign meant people got opioids (cheap, but not particularly effective for long term pain) but didn't get access to pain management clinics. https://www.va.gov/PAINMANAGEMENT/docs/Pain_As_the_5th_Vital_Sign_Toolkit.pdf https://www.va.gov/PAINMANAGEMENT/docs/Pain_As_the_5th_Vital... https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1924634/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1924634/ > Routinely measuring pain by the 5th vital sign did not increase the quality of pain management. Patients with substantial pain documented by the 5th vital sign often had inadequate pain management. https://www.cdc.gov/drugoverdose/data/prescribing.html https://www.cdc.gov/drugoverdose/data/prescribing.html > Sales of prescription opioids in the U.S. nearly quadrupled from 1999 to 2014,1 but there has not been an overall change in the amount of pain Americans report.2,3 During this time period, prescription opioid overdose deaths increased similarly.
- ehnto 8y agoI have a condition that meant that until my late teens, I was in incredible pain daily. My parents asked about painkillers, but my doctor at the time strongly cautioned against them, citing dependence and eventual ineffectiveness. His decision and my parents bravery to listen, when all signs pointed toward the need for relief, is likely why I am a fully functional adult today. That was an insight he had over two decades ago, which is why I find the opioid crisis so damning toward the prescribers.
- sklivvz1971 8y agoI can't read that article. "Unfortunately, our website is currently unavailable in most European countries." In common: we can't be bothered respecting your privacy. OK then.
- MattConfluence 8y agoInterestingly, the article is available to me in Norway, where the GDPR is also in effect, just as in the EU. And the site does indeed load JS from a horrendous number of domains.
- kencausey 8y agoTry https://archive.is/ https://archive.is/
- mdrzn 8y agoBoycott the LA Times until it gets back up in Europe (or just stop posting it on HN).
- tomhoward 8y agohttp://archive.is/TN3Uz http://archive.is/TN3Uz
- mnm1 8y agoDo the people conducting these studies really think that getting doctors to prescribe less opiates to existing patients and having patients resort to the black market where heroin is often cut with fentanyl, carfentanyl, or other much deadly opiates is really a good idea? Somehow reduced prescriptions are equated with positive outcomes without any proof. I guess the thinking must be that if the patient overdoses off of street opiates it's somehow not as big of a deal as if they overdose off prescribed opiates. At least these doctors won't feel so bad about patients they are directly killing by cutting them off their prescriptions. From experience, most doctors don't even care about or can even fathom the consequences of taking someone dependent on opiates (as well as other drugs that must be tapered like benzodiazepines) so them stopping prescriptions without properly tapering patients off is no big deal while the patients literally scramble to save their lives by getting the drugs from the black market. But hey, the numbers look good and sound good to a society that thinks war should be waged on addicts and that they are better off dead than in recovery. That certainly explains our ridiculous regulations as regards to methadone, an extremely effective treatment for opiate addiction, when used to treat addiction (must be taken in liquid form from a clinic each day etc. etc) vs. when taken for pain. It's almost like these laws were written by people who want addicts to die rather than recover. They are. Doctors who stop prescriptions without offering the patient a chance to recover are essentially sentencing the patient to a possible death penalty either because the patient goes to the black market or because they can't and go through withdrawl which can indeed kill both directly and through suicide. They should really try to remember the Hippocratic oath they are violating and think about the patients they are directly trying to kill in the name of prescription reduction and useless, dumb government statistics.
- jaclaz 8y agoI believe that this is mainly a US (or actually North America to include Canada) issue, in most of the EU (Germany being an exception) opioids are not so commonly prescribed outside hospitals or as generic painkillers (i.e. for not really serious illnesses) AFAIK. If you check the maps here: https://ppsg.medicine.wisc.edu/ https://ppsg.medicine.wisc.edu/ the phenomenon seems mostly regional (the colour scale on the map makes very little sense, you need to check the single amounts as everywhere (both North America and EU zone is blue but with very different values ) example 2015, "ME minus Methadone": Canada 661 mg/capita US 484 Germany 517 UK 156 France 151 Spain 233 Italy 131