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Sunday, April 24, 2016

Heroin vs. Opioid Pills

Two responses to my previous entry. First, Steven emails:

Living in Washington state, my experience has been that heroin seems to be easier to get than Rx narcotics.

I know that anecdotes are not evidence, and my experience is probably atypical as I run a feeding ministry, but a night's supply up here is barely more expensive than a pack of cigarettes and I've never heard of anyone having trouble finding it.

On the other hand, my 76-year-old relative was given 48 hours to come in to her doctor for a surprise drug screening. The mandatory "contract" that she had to sign as a chronic pain patient mandated it. She was exempted from the mandatory pill count because her nursing home handles her medication. This contract treats this poor old woman like a god damn junkie for no other reason than her body has broken down on her.

Also, she spends most of her life in pain. The state is crawling so far up the ass of doctors that they are reluctant to write scripts. A high pill count means unwanted attention. We've given up on getting her an adequate dose of opiates. We do the best we can with ibuprofen and cannabis....and pray the cannabis doesn't show up on her next drug screening. (and yes, it's legal up here but is a violation of the "contract" anyway.)

I'm with you, a rational discussion is needed...but I don't think we will agree on the best course of action.

I say let doctors decide how much pain medication their patients need. We don't need bureaucrats looking over their shoulders. I understand that loosening restrictions will lead to more black market pills being available...but so what? If people want to be junkies, let them. They're grown ups and can decide for themselves how they want to live their lives.

Also, wouldn't you rather have people using black market Rx opioids than street heroin? They're made in a laboratory with consistent quality controls instead of an underground operation producing inconsistent product.

Remember those heroin addicts I opened the email with? Most of them turned to heroin when the Vicoden market went dry from the government pressure on doctors. Everyone of them tells me that heroin is easier to get.
Actually, Steven, we agree completely. I'm in favor of medical professionals, not politicians, making decisions about pharmaceuticals and other treatments for pain or any other condition. The way your 76-year-old relative was treated (like too many of that generation) is reprehensible. That said, there's abuse in any system, and when a patient over-consumes opioids because of an irresponsible doctor, that's when we need more scrutiny.

Next, Tom writes:
While I agree that pain prescription abuse is a major problem, it may be some of the laws we have that are to blame.

Prince was able to fill multiple prescriptions because patients doctor shop (which means they go to multiple doctors in a week) and each doctor has no way of knowing that another doctor wrote a similar prescription. Patient privacy laws prevent it. The pharmacy has an obligation to fill each prescription. If they don't they can be sued. People often go to the emergency room to get pain pills.

In the city hospitals, on the weekend, the number one complaint is toothache. I have heard many stories of the little old lady or man getting a script for pain pills so the grandson could sell them, if they didn't they would abuse them.

Another avenue of acquiring is what are referred to as "Dr. Feelgoods." These are doctors who pretty much only write pain medications. They have clinics, usually cash only, and will write the triple play -- Xanax, Ambien, and pain pill of choice (Opana is a big one now). The doctors are writing it for what it is the patient tells them they have. The biggest is fibromyalgia, for which there is no way to test a person and the pain is very subjective.

There are doctors in the area who refuse to write any pain medications or have patients sign a code of conduct which says they will not divert the drugs or abuse them. This is not really a solution but it is what they do.

Another problem we are now seeing with the opiates is that taking them orally will not get them high fast enough. The next step, along with heroin, is injection. So what we have seen is a case like Austin, Indiana a town of 2000, where there have been over 200 cases of HIV and Hepatitis C -- all from one person having the HIV virus and sharing of needles. We are now seeing the secondary wave from that out break in other towns in Indiana and Kentucky. I think we will start seeing more of this in the near future as the heroin usage increases in the poorer areas of the country.
Thank you, Tom. These are the aspects of the pain-pill-addiction problem that are not getting enough attention from news media. As I wrote earlier, perhaps the Prince story will launch more reporting on the subject.