Prescription Regulation

[Heuristic]

There is absolutely no reason to worry about possibility of addiction. The vast majority of pain sufferers treated with opioids do NOT become psychologically addicted, even if they become physically tolerant. When you take opioids to kill pain instead of to get high, they are fairly easy to taper off of under medical supervision.

I'd have to disagree with you there, though I don't think your argument actually supports your conclusions.

You said that the "vast majority" of those treated with opiod analgesics do not become addicted. But even if only 30% of those who used analgesic O became severely addicted, that's a very serious risk-factor to consider in prescribing it. If the time of acute pain is relatively short, the acute pain itself not extreme... look, I've been in severe pain and I'm not trying to minimize the issue... but a severe addiction can lead to many, many more problems, long after the need for the medication fades. It's far better for a patient to moderate the severe pain with less dangerous medications, and then be pain-free, than it is for the patient to relieve completely the severe pain with highly addictive medications, and then continue to seek the medications long after the need for them has passed.

The tapering argument makes sense if the patient is not psychologically addicted; then they will have no resistance to decreasing the medication gradually, since they're not using it to get high.

However, since the euphoric, even slightly euphoric, and anxiolytic properties of opiod analgesics tend to occur even in many patients who have a genuine need for them, I guess I question whether the incidence of psychological addiction or dependence is as rare as you say. This makes a reliance on tapering more difficult, since if the patient simply doesn't want to taper, he may try to find alternative means to obtain the medication, or other substances to replicate the effects of the medication.

I have nothing vested in these opinions, of course, and I'm happy to change my mind.

In the case of patients who are experiencing chronic severe pain, I think it's a different matter. These patients, including those who become severely addicted, would likely benefit from the stronger medications.


I wanted to emphasize that point because I think we both agree on it.

Beyond your argument though, the major problem patients face in obtaining these medications is when they come in contact with a new doctor--who is right to be extra cautious in prescribing these medications, since, even if we assume that only 30% become severely addicted--or 20%--those poor individuals will show up at his door in far greater numbers than those who are not severely addicted. If the patient has a condition resulting in severe chronic pain, and the patient provides the appropriate access to his medical records, then there should not be any problem.

In cases where it is far less clear that the patient has a condition resulting in severe chronic pain, or the patient does not have medical records, and cannot provide access to a previous doctor... yeah, there are going to be problems, but there should be problems.


I think one of the benefits of a centralized electronic medical record database is that it will enable doctors, with a high degree of confidence, to really see the patient's history, to prescribe with confidence, and to do so with LESS fear of investigation because they will have very clear, very reliable, information on which to base their prescriptions.

It still amazes me, frankly, that the US is so far behind with respect to EHRs.

 

[Snowbear]

I am new to this message board and would like to start off my postings with the most important issue in my life right now....... prescription drug regulation.

I just want to throw the question out there.......

How many of you feel the federal government should impose tougher, stricter prescription drug regulations?

I think that the federal government should impose much tougher guidelines on schedule 1-5 drugs. I will wait to share my side of the argument until I see some responses to the issue.

Now I am not talking about the penalties for violating the various controlled substances acts, but the actual process for obtaining and filling prescriptions in the US.

Please share your opinions with me on here.

Thank You

The best tool will be when the remaining states get Prescription Monitoring Programs in place. I think about 35 states have it now.

The Federal Gov. does NOT have the authority to regulate the practice of medicine, so it would be up to each state to put in place regulations to regulate medical treatment. IMO you are confusing the regualtion of the practice of medicine with the regulation of distribution of controlled drugs.

Blue light is probably NOT the most effective place to be lobbying for stricter drug laws. I have written 10 to 15 letter to my elected officials INSISTING that my doctors NOT be hampered in treating my chronic pain condition. I have made many phone calls, sent many emails and attended 2 meetings at our state legislator. You may want to do the same if you feel strongly that the Federal Gov. should regulate the practice of medicine.

My opinion is almost completely opposite your opinion -- its not acceptable to me to place any restrictions on me or my doctors regarding prescriptions and I have been very vocal about that subject. I am sorry that people are abusing drugs, but I don't intend to quietly let that interfere with my medical treatment.

Pardue (producer of Oxycontin) is setting up grass roots organizations in every state, manned by chronic pain patients to try and make sure nothing stands in the way of us getting proper treatment.

Whats more likely to happen in the next 25 years is the Federal Gov. will pay for all health care, so they will directly control all medical practice in that way. It will make what both of us are saying obsolete.

 

[Coolio]

I'd have to disagree with you there, though I don't think your argument actually supports your conclusions.

You said that the "vast majority" of those treated with opiod analgesics do not become addicted. But even if only 30% of those who used analgesic O became severely addicted, that's a very serious risk-factor to consider in prescribing it. If the time of acute pain is relatively short, the acute pain itself not extreme... look, I've been in severe pain and I'm not trying to minimize the issue... but a severe addiction can lead to many, many more problems, long after the need for the medication fades. It's far better for a patient to moderate the severe pain with less dangerous medications, and then be pain-free, than it is for the patient to relieve completely the severe pain with highly addictive medications, and then continue to seek the medications long after the need for them has passed.

Disagreed completely. In a world where opioids are regulated by medical professionals, there's no excuse for allowing any patient to suffer from even mild pain. Perhaps if addiction is a concern the doctor should try educating the patient on the dangers of opioid addiction, instead of denying them access to real painkillers.

Aspirin and ibuprofen should be wiped off the face of the earth.

The tapering argument makes sense if the patient is not psychologically addicted; then they will have no resistance to decreasing the medication gradually, since they're not using it to get high.

However, since the euphoric, even slightly euphoric, and anxiolytic properties of opiod analgesics tend to occur even in many patients who have a genuine need for them, I guess I question whether the incidence of psychological addiction or dependence is as rare as you say. This makes a reliance on tapering more difficult, since if the patient simply doesn't want to taper, he may try to find alternative means to obtain the medication, or other substances to replicate the effects of the medication.

If these drugs are so desirable to legitimate, non-drug-seeking patients, maybe the patients should be getting prescribed daily opioids. I personally think all opioids should be OTC though.

 

[Heuristic]

Disagreed completely. In a world where opioids are regulated by medical professionals, there's no excuse for allowing any patient to suffer from even mild pain. Perhaps if addiction is a concern the doctor should try educating the patient on the dangers of opioid addiction, instead of denying them access to real painkillers.

Okay. Well two things. One, there are things a lot worse than mild pain. Those worse things should be a part of the equation.

Two, for long term use the evidence of efficacy for most opiods as analgesics is not particularly compelling.

Three, the doctor knows a lot more than the patient about the risks/benefits of a medication. I'm not in favor of eliminating a prescription requirement.

and ibuprofen should be wiped off the face of the earth.

I used to pop the ibuprofen like candy. Had a scrip for the 800mg pills. Not great for the stomach, though there are ways to mitigate that, but it certainly did help with pain.

If these drugs are so desirable to legitimate, non-drug-seeking patients, maybe the patients should be getting prescribed daily opioids. I personally think all opioids should be OTC though.

Totally disagee about making opiods OTC. That's a prescription for disaster, in my view.

These drugs can be desireable in certain severe cases, particularly with the elderly. But use past 6 months with most of them isn't terribly useful; they just become addictive, and the patient just ends up wanting them.

 

[garuda]

Totally disagee about making opiods OTC. That's a prescription for disaster, in my view.

In many countries some opiates are OTC, they somehow get by without descending into madness.

In the one I have direct experience with the products are sold without restriction just on pharmacy shelves like any other product and they sell so poorly they are often out of date, sometimes two years old and dusty! So why aren't they selling like hot cakes? It appears so called drug "misuse" might be a cultural problem.

 

[Coolio]

It appears so called drug "misuse" might be a cultural problem.

That's my opinion too. Maybe there is something so spiritually and emotionally painful and traumatic about being a human living within these cultures where opioids are so addictive that they really are a proper treatment. I see opioids as the proper anti-depressants for certain people.

 

[Heuristic]

In many countries some opiates are OTC, they somehow get by without descending into madness.

In the one I have direct experience with the products are sold without restriction just on pharmacy shelves like any other product and they sell so poorly they are often out of date, sometimes two years old and dusty! So why aren't they selling like hot cakes? It appears so called drug "misuse" might be a cultural problem.

Two things.

One, a descent into madness shouldn't be the threshold indicator for "hey, we have a lot of drug abuse going on." There can be serious problems well before a descent into madness.

Two, I'm not entirely sure which country you're talking about, so I can't comment on it. But let's say you're right. In some countries, due to culture, perhaps due to the economic conditions prevalent in a developing world economy, visible and reported abuse of opiates seems less than in the West. But we're talking about the West, specifically about the US. Shouldn't we evaluate the impact of laws as they relate to our particular culture, or nation?

 

[garuda]

Two things.

One, a descent into madness shouldn't be the threshold indicator for "hey, we have a lot of drug abuse going on." There can be serious problems well before a descent into madness.

Two, I'm not entirely sure which country you're talking about, so I can't comment on it. But let's say you're right. In some countries, due to culture, perhaps due to the economic conditions prevalent in a developing world economy, visible and reported abuse of opiates seems less than in the West. But we're talking about the West, specifically about the US. Shouldn't we evaluate the impact of laws as they relate to our particular culture, or nation?

Well you did say it would be a recipe for disaster, which I doubt would be the case. Are you aware of the open market in the USA for poppy pods? You can order as much as you want no questions asked, and if you browse threads here you will see its no joke as far as effects as there has even been a fatal pod OD. So basically there is already OTC opiates in America and life goes on.

Lets say tomorrow cough syrup with only codeine as a active ingredient was made OTC in the USA, sold only to those over 18. Do you really think this would cause problems? Of course there would be recreational use, but I'm not talking about that.

 

[Heuristic]

Well you did say it would be a recipe for disaster, which I doubt would be the case. Are you aware of the open market in the USA for poppy pods? You can order as much as you want no questions asked, and if you browse threads here you will see its no joke as far as effects as there has even been a fatal pod OD. So basically there is already OTC opiates in America and life goes on.

The discussion was about the legalization of all opiates. The question therefore is whether the legalization of all opiates would result in a disastrous situation. I think it would. I think rates of addiction would skyrocket, with the usual negative social and economic side-effects.

I suspect "poppy pod" use isn't as common as heroin use, or the abuse of various opiate analgesics, which may be why enforcement is a low priority; frankly I know very little about poppy pods. Even if laws against it aren't enforced, I don't regard widespread availability of poppy pods as the equivalent to an OTC market for all opiates in the US.

say tomorrow cough syrup with only codeine as a active ingredient was made OTC in the USA, sold only to those over 18. Do you really think this would cause problems? Of course there would be recreational use, but I'm not talking about that.

I think it would depend on the amount of codeine in the syrup and the manner in which the syrup was sold.

But this is a much finer question than the one under discussion, which is: should all opiates be legalized?

 

[garuda]

Well in my opinion yes, all opiates should be legal to sell to those over 18 without restriction. They should be regulated like all other drugs for purity and safety, and can be sold at pharmacies. Eventually they could be sold through stores geared for recreational use, such as liquor and tobacco are sold now.

Addiction would not be forced on anyone, it is a personal choice. And when you can spend $3 USD at the corner CVS for your drug of choice the desperation would be taken out of addiction. It would no longer be glamorous and sexy to buy drugs, it would be as exciting as buying Tylenol. With this stability and lack of risk drug addicts lives would be normalized.

 

[Heuristic]

Well in my opinion yes, all opiates should be legal to sell to those over 18 without restriction. They should be regulated like all other drugs for purity and safety, and can be sold at pharmacies. Eventually they could be sold through stores geared for recreational use, such as liquor and tobacco are sold now.

Addiction would not be forced on anyone, it is a personal choice. And when you can spend $3 USD at the corner CVS for your drug of choice the desperation would be taken out of addiction. It would no longer be glamorous and sexy to buy drugs, it would be as exciting as buying Tylenol. With this stability and lack of risk drug addicts lives would be normalized.

Is it particularly glamorous and sexy to be a heroin, or meth, addict? A crack addict?

If the argument is that by making opiates widely available we will reduce their allure, I'm not sure the facts support that argument. I don't think they're particularly sexy at the moment. "Heroin chic" is used ironically.

I also disagree that desperation would be taken out of the equation if these drugs were suddenly cheaply available. Heroin addicts, for example, tend to be fairly unreliable employees. They tend to get fired. They tend to be poor students, which makes their future employment more difficult to obtain. At least in the United States, there are limits to the public dollars we will provide for your support. Unemployment runs out. Public housing requires money. And so forth.

Now, I think your argument here is that legalization would result in

1) a decline in use, and

2) a decline in the crimes associated with their use.

I think the first prediction is almost certainly wrong.

I think the second prediction may be wrong, but I'm much less certain, and, for me, that's one of the strongest arguments for legalization.

But let's not forget the huge cost society will pay as a result of chronic health problems, child abuse and neglect, and lost productivity, as a result of an increase in the use of these drugs.

It's a difficult set of problems to sort out. Personally, I would be in favor of legalizing some drugs that are now currently illegal, such as marijuana, and I would be in favor of massively overhauling the way in which the law treats addicts. I would also be in favor of diverting additional tax dollars towards the development of medications that deter or reduce abuse.

 

[garuda]

Is it particularly glamorous and sexy to be a heroin, or meth, addict? A crack addict?

If the argument is that by making opiates widely available we will reduce their allure, I'm not sure the facts support that argument. I don't think they're particularly sexy at the moment. "Heroin chic" is used ironically.

Absolutely, I have talked to many people that said they romanticized drug use long before they first used, I have known people that wanted to become drug addicts as teenagers as a way to rebel against society and their parents.

Hell look at this rent post here on Bluelight:
http://www.bluelight.ru/vb/showpost.php?p=6976444&postcount=37
<because for me drugs wouldn't be fun if i didnt have to hide it...
idk rolling on mdma cause its legal and having my mom and dad know and not care
cause it would be legal kinda takes the fun out of it.
buying the drugs illegalilly is fun by itself and then doing them..
idk its like ditching school.its fun!
im mean think about it we do drugs mostly cause it feels good.
but also to rebel...so why take out the rebeling part...?
life wouldn't have much of a thrill. >

Drugs would not be as thrilling if they were legal according to this poster.

 

[Tchort]

Okay I think that some may be missing the point here. I am FULLY aware of the patients out there that are in treatment programs to aid in addiction to opiates. What I want to see is a society where we have LESS people addicted to opiates. The only way to do this is through extensive monitoring of the prescription system. Doctors need to be made aware of possible drug-abuse signs before it is too late. We need to be in the business of addiction-prevention, and not addiction-treatment. The more we become focused on prevention, the less we will have to spend on treatment. This is obivious. Methadone, etc. clinics need to be in place to help those that are ALREADY addicted to opiates. And this is not just a problem in the big metro areas anymore either. I live in a small town in south GA and we have had a methadone clinic for about 4 years now. My dad went there until the day he died. I used to stand in line with him waiting for the clinic to open (his health had become so bad he needed someone by his side 24/7). I would talk with the patients at the clinic and ALL of them were there because of LEGAL opiate abuse. NOT ONE of them ever talked about herion. My point is that in todays society we are too relaxed on this problem, too many people are being hurt and killed because the system allows it to happen. The drug manufacturers are not going to do anything about it. They continue to make more potent opioids and providing them to the public. I read an article just today about an opioid that is 10,000 times more potent than morhphine. In another report I read they now use analogues of amphetamine that are 85% more "effective" than previous l- or d- isomers of the chemical. They are putting this in an ADHD drug approved for 6-18 years olds!! 85% effective just means that 85% more of the drug is metabolized by the body, making it that much more potent. Its time that people stand up and say enough is enough. We over-medicate ourselves and then turn to other medications when we need to fix the problem. Pharmaceutical companies only see dollar signs. Doctors do the bidding of the drug companies, and pharmacies only follow the doctors orders. All the while the federal government lets it go on. I say YES to tougher prescription regulations (including but not limited to the ones I discussed in the previous post) and addiction-prevention.

Why should less people be addicted to opioids? What happened to personal liberty? Free choice?

This kind of thinking leads to totalitarianism and police state justice, mock trials, show trials, public executions, etc.

In fact, roughly the same percentage of people abuse drugs and become addicted to opioids as has happened throughout the history of modern medicine.

In the days of OTC Morphine and Heroin, 19th century and early 20th century US and Europe, roughly the same percentage of the population was addicted as they are now.

Who are you to tell me what I can and can't put in my body? Who is the government to do so? Why?

If programs like Methadone maintenance and Buprenorphine maintenance don't cause massive diversion and new addiction cases, why would Morphine or Heroin maintenance? Why shouldn't someone be allowed to decide what they can take?

People will get drugs if they want them. If you tighten the regulations on prescription opioids (which they just did with a new regulation involving CII opioids) people will simply buy them on the black market and/or switch to Heroin. This has happened in countless cases already, without a more severely strict prescription system.

 

[Heuristic]

Well, not all free choices are equally worth protecting. Like it or not, we are a society, and an individual's decision to become an addict has an effect on the rest of us. I don't regard the ability to inject heroin as significant to his autonomy; and so I have no problem regulating it for the public good.

Your fears of totalitarianism notwithstanding, an increase in drug regulation has come with an increase in civil rights. So the last century is firmly at odds with your slippery slope warning.

For me, this is all about pragmatism. What is the best way to reduce opiate abuse, taking into account other forms of costs (e.g. other forms of costs: total prohibition results in an illegal trade, resulting in criminal enterprises having a ready and large stream of income, associated violence, diversion of state resources from other enterprises, etc.)?

 

[tobala]

^ Unfortunately, the extreme measures to which enforcement of the regulations has been taken have created entire classes of innocent victims--from pain patients who are inadequately medicated to people accidentally gunned down in the street.

Granted, while there are victims in addicts' lives--themselves, their children, etc.--it can be effectively argued that the "collateral damage" resulting from hysterical repression is much more damaging than that which would have occurred had the addicts been given free (or cheap) access to their drugs of choice.

 

[Heuristic]

^ It certainly can. And that's a pragmatic argument that I'm open to.

I just disagree with the libertarian "hey this is the natural right of every human being" argument.

 

[Coolio]

For me, this is all about pragmatism. What is the best way to reduce opiate abuse, taking into account other forms of costs (e.g. other forms of costs: total prohibition results in an illegal trade, resulting in criminal enterprises having a ready and large stream of income, associated violence, diversion of state resources from other enterprises, etc.)?

Seeing as opioids are the least toxic or harmful of any class of drug, I don't understand why reducing opiate abuse should be the goal of our or any society.

 

[garuda]

Well, not all free choices are equally worth protecting. Like it or not, we are a society, and an individual's decision to become an addict has an effect on the rest of us. I don't regard the ability to inject heroin as significant to his autonomy; and so I have no problem regulating it for the public good.

Your fears of totalitarianism notwithstanding, an increase in drug regulation has come with an increase in civil rights. So the last century is firmly at odds with your slippery slope warning.

For me, this is all about pragmatism. What is the best way to reduce opiate abuse, taking into account other forms of costs (e.g. other forms of costs: total prohibition results in an illegal trade, resulting in criminal enterprises having a ready and large stream of income, associated violence, diversion of state resources from other enterprises, etc.)?

How far are you willing to take it? Does a person have a right to consume "too much" fatty foods, should we make butter prescription only?

Some of us think personal liberty is paramount, rather then what is pragmatic for the state. Using pragmatism as your only guiding principle will take you down some weird paths.

In any event pragmatically addicts are most productive with a steady, safe, and cheap supply of their drug of choice. Imagine how disruptive the lives of tobacco addicts would be if tobacco was illegal. So even pragmatically prohibition makes no sense, prohibition can't stop people from trying opiates.
All it does is serve as a pretext for removing liberties and makes the lives of addicts a living hell.

 

[Heuristic]

How far are you willing to take it? Does a person have a right to consume "too much" fatty foods, should we make butter prescription only?

No, but we can do things that might encourage restaurants to offer healthy altneratives. I'm not in favor of eliminating unhealthy foods; I like them too.

Some of us think personal liberty is paramount, rather then what is pragmatic for the state. Using pragmatism as your only guiding principle will take you down some weird paths.

Some us remember that the point of abstract concepts like liberty, or pragmatism, is that they enhance human lives. That's my yardstick.

In any event pragmatically addicts are most productive with a steady, safe, and cheap supply of their drug of choice. Imagine how disruptive the lives of tobacco addicts would be if tobacco was illegal. So even pragmatically prohibition makes no sense, prohibition can't stop people from trying opiates.
All it does is serve as a pretext for removing liberties and makes the lives of addicts a living hell.

I'm not sure a heroin addict would be nearly as productive as a cigarette smoker. The number of hours lost by employers due to alcohol abuse is already shockingly high. Somehow I don't see heroin being any better.

Now, personally, I would prefer to place addicts into mandatory treatment, including supervised administration of a medication which would block, or render very unpleasant, any attempt to of the addict to get high in his or her preferred method. I'd want the process to be done humanely, of course, and in a medically responsible way. In fact I'd want to give doctors free reign over the program.

 

[garuda]

Now, personally, I would prefer to place addicts into mandatory treatment, including supervised administration of a medication which would block, or render very unpleasant, any attempt to of the addict to get high in his or her preferred method. I'd want the process to be done humanely, of course, and in a medically responsible way. In fact I'd want to give doctors free reign over the program.

Not only would that be monstrous it would fail spectacularly.

Replace addict with homosexual and read back what you wrote, still think its humane and would work?