Author Topic: The CDC issues new guidelines on the use of opioids in managing chronic pain  (Read 6008 times)

MillCreek

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MillCreek
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Quote from: Angel Eyes on August 09, 2018, 01:56:15 AM
You are one lousy risk manager.

BobR

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There they go painting with that very wide brush again with their recommendations.

Not all opioid users are abusers. I know quite a few that are very compliant with their dosing regime. I also know some abusers. The abusers will find the docs that won't follow the guidelines and will end up getting their opioids and the docs will get rich.

As the opioids are tapered away from society you will see a resurgence of heroin abuse and an uptick in deaths due to ODs and possibly suicides due to people who believe death is preferable to constant pain. We have already seen tapering of opioids as a trigger to SI in the VA. We had 3 people make the celestial transfer last week in town due to some new heroin hitting the streets.

There is not a good solution but cutting people off from opioid therapy after years of allowing it will have to be managed very carefully. I can already see the increased pharmacy robberies as people look for their drugs.

bob


MillCreek

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Over on this side of the mountains, we have seen quite the uptick in heroin use as prescription opioids get harder and much more expensive to obtain illicitly.  Heroin is much cheaper and more available.
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Quote from: Angel Eyes on August 09, 2018, 01:56:15 AM
You are one lousy risk manager.

zxcvbob

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There they go painting with that very wide brush again with their recommendations.

Not all opioid users are abusers. I know quite a few that are very compliant with their dosing regime. I also know some abusers. The abusers will find the docs that won't follow the guidelines and will end up getting their opioids and the docs will get rich.

As the opioids are tapered away from society you will see a resurgence of heroin abuse and an uptick in deaths due to ODs and possibly suicides due to people who believe death is preferable to constant pain. We have already seen tapering of opioids as a trigger to SI in the VA. We had 3 people make the celestial transfer last week in town due to some new heroin hitting the streets.

There is not a good solution but cutting people off from opioid therapy after years of allowing it will have to be managed very carefully. I can already see the increased pharmacy robberies as people look for their drugs.

bob


I think they are deliberately creating a problem so they can get additional funding or police power to fight it.  They really couldn't care less about people in chronic pain, or acute pain that last a month or so.
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Heroin substitution and the upswing in related overdoses have resulted in beat cops being issued naloxone around here.  Apparently a significant percentage of ODs saved with it come up swinging.  A higher percentage than training suggested.

Opiate abuse is huge, but making them hard to get doesn't solve the problem.

cassandra and sara's daddy

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You can get naloxone OTC here if you take a class. I wanna take it keep some at home and in car.


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cassandra and sara's daddy

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There they go painting with that very wide brush again with their recommendations.

Not all opioid users are abusers. I know quite a few that are very compliant with their dosing regime. I also know some abusers. The abusers will find the docs that won't follow the guidelines and will end up getting their opioids and the docs will get rich.

As the opioids are tapered away from society you will see a resurgence of heroin abuse and an uptick in deaths due to ODs and possibly suicides due to people who believe death is preferable to constant pain. We have already seen tapering of opioids as a trigger to SI in the VA. We had 3 people make the celestial transfer last week in town due to some new heroin hitting the streets.

There is not a good solution but cutting people off from opioid therapy after years of allowing it will have to be managed very carefully. I can already see the increased pharmacy robberies as people look for their drugs.

bob

So much truth and reality.

Bet you dollars to donuts the "officials" making the recommendations have better political knowledge than understanding of pain management and addiction


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It is much more powerful to seek Truth for one's self.  Seeing and hearing that others seem to have found it can be a motivation.  With me, I was drawn because of much error and bad judgment on my part. Confronting one's own errors and bad judgment is a very life altering situation.  Confronting the errors and bad judgment of others is usually hypocrisy.


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Blakenzy

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Antibiotic abuse and misuse is a bigger threat to mankind than people overdoing opioids, but you don't see any restrictive guidelines on those.
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K Frame

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"As the opioids are tapered away from society you will see a resurgence of heroin abuse and an uptick in deaths due to ODs..."

Too late. Heroin abuse and ODs are up dramatically all over the country, and have been rising as the price of heroin has been plunging.

Many people who have been addicted to pain medications long term are finding heroin cheaper and more potent.

The situation has gotten so bad in the DC metro area that more and more police and other first responders, and even schools and other public facilities, are being outfitted with Narcan.
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MillCreek

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^^^I rarely see people overdosing and dying on antibiotics, nor do I see people committing property crimes, robberies or prostitution to buy antibiotics.  44 people per day in the US die from opioid overdose, according to CDC and NIDA statistics.
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MillCreek
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Quote from: Angel Eyes on August 09, 2018, 01:56:15 AM
You are one lousy risk manager.

K Frame

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^^^I rarely see people overdosing and dying on antibiotics, nor do I see people committing property crimes, robberies or prostitution to buy antibiotics.  44 people per day in the US die from opioid overdose, according to CDC and NIDA statistics.

I have to agree with Blakenzy.

While antibiotic abuse doesn't cause the kinds of social distress that opiates do, the potential for a return to the time when common, minor infections resulted in death is very real, and will reach a FAR wider swath of the population. It's made even more frightening by the rise of the anti-vax movement.

Antibiotics were the single greatest factor in the rather incredible jump in average life expectancy post World War II. Many now believe we stand a very good chance of having that reverse.
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KD5NRH

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Antibiotic abuse and misuse is a bigger threat to mankind than people overdoing opioids, but you don't see any restrictive guidelines on those.

Funny; people have been gulping down all the allicin they want for centuries, but it still works pretty darn well.  Guess the magic superbugs that will kill us all if everyone has access to azithromycin on a Saturday night without a $750 ER bill somehow can't build up a resistance to plain old raw garlic.

K Frame

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So, you're saying garlic is the cure all for all bugs, and that people didn't die of infections if they ate it?

Bull.

Garlic is an effective TOPICAL antimicrobial but its efficacy has never been established/proven in an ingested for.



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KD5NRH

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So, you're saying garlic is the cure all for all bugs, and that people didn't die of infections if they ate it?

People die of infections while eating and/or being injected full of every modern antibiotic.

Quote
Garlic is an effective TOPICAL antimicrobial but its efficacy has never been established/proven in an ingested for.

As in most cases, because there's not enough money to be made in trying to market milligrams of something folks can buy 100 grams of for a buck, so the research to "prove" effectiveness is a waste of money to anyone with the resources to do it.

K Frame

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"People die of infections while eating and/or being injected full of every modern antibiotic."

Who ever said that they didn't?

What I said is that antibiotics were pretty much solely responsible for the biggest leap in life expectancy, EVER.

Yes, even when penicillin and the various sulfa drugs was the new wonders of the world, and antibiotic resistance wasn't even a thing, people still died from infections, for myriad different reasons. But far FEWER people died of infections than before.


"As in most cases, because there's not enough money to be made in trying to market milligrams of something folks can buy 100 grams of for a buck, so the research to "prove" effectiveness is a waste of money to anyone with the resources to do it."

 :facepalm:

You do realize where virtually all early antibiotics came from, right?

From nature.

Garlic was investigated for years as a potential source of new antibiotics (as were literally thousands of other plants, and especially the molds that grew on plants. Lincomycin, for example, came from a moldy cantaloupe found at a fruit stand in Lincoln, Nebraska, in the late 1940s).

People understood its properties even back then, and the Russians, during WW II, used large amounts to treat wounds. Garlic's active mechanism against microbes is little to no different than the increasingly common sulfa drugs of the period. It made no sense, and still makes absolutely no sense, to grow and process millions of tons of raw material to get the same effectiveness of something that can be synthesized quickly and easily via a chemical process.
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KD5NRH

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You do realize where virtually all early antibiotics came from, right?

You do realize how all modern antibiotics came about, right?  Economic incentives.  There's a strong disincentive to prove that eating $3 worth of raw garlic would have the same effect as eating $30-$3000 worth of pills your company holds the patent on.

Quote
Garlic was investigated for years as a potential source of new antibiotics (as were literally thousands of other plants, and especially the molds that grew on plants. Lincomycin, for example, came from a moldy cantaloupe found at a fruit stand in Lincoln, Nebraska, in the late 1940s).

But not as an antibiotic in itself.  Patent a process to make it into something else, and you have a viable product with a dirt cheap precursor.  Not so if you release research showing that your process really isn't necessary for efficacy.

Quote
People understood its properties even back then, and the Russians, during WW II, used large amounts to treat wounds. Garlic's active mechanism against microbes is little to no different than the increasingly common sulfa drugs of the period.

And yet those all still work in the vast majority of cases.  How is that, if resistance is such an issue?

Quote
It made no sense, and still makes absolutely no sense, to grow and process millions of tons of raw material to get the same effectiveness of something that can be synthesized quickly and easily via a chemical process.

Millions of tons?  Synthesized quickly and easily?  What's easier than growing garlic in 95% of the US, and just how much do you expect to use at a normal dose of 10-20 grams/day?  16 pounds would keep someone on 20 grams/day every day for a solid year.  Processing is just breaking the bulb apart and shucking the cloves, which pretty much anyone with .05% or more Greek or Italian ancestry can do purely by instinct.

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"You do realize how all modern antibiotics came about, right?  Economic incentives.  There's a strong disincentive to prove that eating $3 worth of raw garlic would have the same effect as eating $30-$3000 worth of pills your company holds the patent on."

Wrong.

First, you need to define your terms. What's a "modern" antibiotic?

Penicillin? Streptomycin? Clindicin? Vancomycin?

Given that ALL antibiotics are under 100 years old, all are "modern" unless you start defining arbitrary terms and exceptions.


"But not as an antibiotic in itself."

Wrong. It was well understood that simply eating a shitload of garlic (even quantities that would gross out an Italian) would provide success much different from a placebo. The compounds IN garlic that provide the antimicrobial effect don't work that way because the human digestive system rips them apart into component pieces that have no use. Thus, your argument of IT'S ALL MONEY GRUBBING WHORES!! is as invalid as it is silly.


"And yet those all still work in the vast majority of cases.  How is that, if resistance is such an issue?"

Are you really that dim? It's because we're in the BEGINNING phase of the rise of resistant bacteria, NOT the end.

Many antibiotics will remain effective in many cases for many years to come, but on a downward slope as the resistant bacteria spread and as more and more strains of once non-resistant bacteria become resistant.

The reason this is becoming more and more urgently discussed is one of prudence. It's the same reason you don't wait for the fire in your house to burn it to the ground before you call the fire department.


"Millions of tons?  Synthesized quickly and easily?  What's easier than growing garlic in 95% of the US, and just how much do you expect to use at a normal dose of 10-20 grams/day?  16 pounds would keep someone on 20 grams/day every day for a solid year.  Processing is just breaking the bulb apart and shucking the cloves, which pretty much anyone with .05% or more Greek or Italian ancestry can do purely by instinct."

The active ingredient, the antimicrobial part of the average bulb of garlic, is roughly 0.05% of its weight, if that much. You're assuming that the supply would be constant, that the quality would be constant, and once again, that the effective ingredients in the garlic would somehow magically take on antibiotic properties when ingested that they do not, and will never, have.

Your arguments show an incredible lack of understanding of what's going on with the rise of resistant bacteria, where we are currently headed, and what the potential outcome might well be in our lifetimes.

You're also arguing from the naturopath's perspective, but totally ignoring the work that's already be done and which completely disproves your theories.

I'd say try again, but you've got no basis from which to try.

Garlic is great, but it's not a *expletive deleted*ing wonder drug in disguise that no one ever though to trying out before because BIG PHARMA CORPORATE GREED!!!!!
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makattak

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Garlic is great, but it's not a *expletive deleted*ing wonder drug in disguise that no one ever though to trying out before because BIG PHARMA CORPORATE GREED!!!!!

On to the tangent we go!

In this instance (the need for new antibiotics), I am firmly in favor of government intervention.

Here is a situation that promotes the general welfare (meaning it benefits EVERYONE in the country), where the economic incentives for the private market are lacking.*

A prize for ANY new antibiotics that deal with the resistant strains (sufficiently large to offset development costs + a profit) provided by the Federal Government would be appropriate.

One of the few areas I can see a need for government. And what is the government doing?

It is proposed that:

-More than $650 million across the National Institutes of Health (NIH) and the Biomedical Advanced Research and Development Authority (BARDA) to significantly expand America’s investments in development of antibacterial and new rapid diagnostics, and to launch a large scale effort to characterize drug resistance.  Earlier this year, NIH-supported scientists developed a novel technique for extracting powerful antibiotics from soil, including teixobactin: the first new antibiotic to be discovered in more than 25 years.  The FY 2016 investment increases support for this kind of innovative research and discovery.
-More than $280 million at the CDC to support antibiotic stewardship, outbreak surveillance, antibiotic use and resistance monitoring, and research and development related to combating antibiotic resistance.
-$47 million at the Food and Drug Administration (FDA) to support evaluation of new antibacterial drugs for patient treatments and antibiotic stewardship in animal agriculture
Nearly quadruples antibiotic research and surveillance funding at the Department of Agriculture (USDA) to $77 million.


So, almost $1 Billion for studies and other items, mainly for government itself.

Hey, what's the average cost to develop a new drug? Oh... $2.6 BILLION.

Well, I see the government is taking this seriously...


*(Development of new antibiotics are unlikely to be rewarded with remuneration sufficient to cover investment within the patent period as they would be competing with the existing ones that are still effective in the vast majority of infections.)
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cassandra and sara's daddy

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^^^I rarely see people overdosing and dying on antibiotics, nor do I see people committing property crimes, robberies or prostitution to buy antibiotics.  44 people per day in the US die from opioid overdose, according to CDC and NIDA statistics.
I suspect that number is low. Often see suicides covered up

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It is much more powerful to seek Truth for one's self.  Seeing and hearing that others seem to have found it can be a motivation.  With me, I was drawn because of much error and bad judgment on my part. Confronting one's own errors and bad judgment is a very life altering situation.  Confronting the errors and bad judgment of others is usually hypocrisy.


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makattak

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With garlic?

http://www.fieldsofflavor.com/korean-green-garlic-pancakes/

I was about to call it an abomination, but now I'm intrigued by the idea.
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Over on this side of the mountains, we have seen quite the uptick in heroin use as prescription opioids get harder and much more expensive to obtain illicitly.  Heroin is much cheaper and more available.

I still have trouble believing that street heroin is more easily attainable, and cheaper, than a bottle of 5/325 Oxy.

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I still have trouble believing that street heroin is more easily attainable, and cheaper, than a bottle of 5/325 Oxy.

It is.

I have a good friend with a chronic pain issue. There is a surgical treatment available, but it's dangerous and has a fairly low success rate. Every month he's incredibly stressed over whether or not his prescription will go through properly, or if he'll be detoxing and in incredible pain because the pharmacy screwed up his paperwork or something. He has to see the doctor monthly, gets drug tested to make sure he's not suing any other drugs etc etc. It's expensive, invasive, and dehumanizing. He's seriously considered heroin as an alternative.

So much pain and misery caused to innocent people because a bunch of fcking busybodies want to tell people what they can put in their bodies. I hope every single DEA employee gets a chronically painful condition and dies a slow painful death.
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