SoylentNews is people
SoylentNews
CVS is finally trying to do something about the opioid epidemic:
Drug-store chain CVS Health announced Thursday that it will limit opioid prescriptions in an effort to combat the epidemic that accounted for 64,000 overdose deaths last year alone.
Amid pressure on pharmacists, doctors, insurers and drug companies to take action, CVS also said it would boost funding for addiction programs, counseling and safe disposal of opioids.
[...] The company's prescription drug management division, CVS Caremark, which provides medications to nearly 90 million people, said it would use its sweeping influence to limit initial opioid prescriptions to seven-day supplies for new patients facing acute ailments.
It will instruct pharmacists to contact doctors when they encounter prescriptions that appear to offer more medication than would be deemed necessary for a patient's recovery. The doctor would be asked to revise it. Pharmacists already reach out to physicians for other reasons, such as when they prescribe medications that aren't covered by a patient's insurance plan.
The plan also involves capping daily dosages and initially requiring patients to get versions of the medications that dispense pain relief for a short period instead of a longer duration.
[...] "The whole effort here is to try to reduce the number of people who are going to end up with some sort of opioid addiction problem," CVS Chief Medical Officer Troyen Brennan said in an interview.
It appears this initiative is limited to initial filling of prescriptions — there is no mention of changes in the handling of refills.
(Score: 5, Insightful) by Runaway1956 on Monday September 25 2017, @02:31PM (7 children)
Virindi, did you miss all the articles about big pharma actually PUSHING drugs that were either not required, or not required in such large doses? We do have a problem today, in that, pharma pushed their dope for profit, without regard for the patient's needs. Opiods are still being pushed. I took a little ride in an ambulance just about a year ago. The ambulance attendants had been indoctrinated to push that damned morphine. I wasn't in serious pain - at worst, I was very uncomfortable. So - morphine. WTF for? There was no good reason to give me morphine, other than to pad the bill for riding to the hospital.
Let me ask you - if you were suffering discomfort that might be confused with a bad case of indigestion, would you ask for morphine? If not, what drugs would you ask for?
Much worse than a single dose in my case, I know TWO men who have been hospitalized for life threatening injuries. Both tell the same story about self-administering morphine. They were told, "If it hurts, just push the button!" Both tell me that they felt no pain - but the morphine felt so good, they turned into button-pushing fools.
Over the past couple decades, the medical community has been irresponsible and negligent by pushing those drugs onto people who don't need them, or need them in much smaller doses than have been offered.
Maybe CVS is over reacting - and maybe not.
I do understand where you are coming from. If you have a genuine NEED for pain relievers, you are NOT in any condition to trot down to the doctor's office every couple days for a script, then traipse to the pharmacy, to wait in line for it to be filled. In cases such as this, the DOCTOR has a responsibility to explain to the pharmacist that there is a genuine NEED for the script, as written. If Doc thinks you need ten pills per day for the next 30 days, then the pharmacist should just fill a couple bottles full, and send you on your way.
"It will instruct pharmacists to contact doctors" is the proper thing to do here, IMHO.
(Score: 5, Informative) by HiThere on Monday September 25 2017, @05:08PM (4 children)
The problem is that opioids are habituating, i.e. not only do you get addicted, but the amount you need to take for a certain amount of relief keeps increasing. So does your tolerance, but more slowly. So for serious pain you "soon" get to the point where you can't relieve the pain without killing yourself, and if you try to quit the pain is worse than it would have been without the opioids in the first place.
Advanced opioids are a truly lousy treatment for chronic pain. I'm not sure this applies to raw opium. Historical records are a bit sketchy and unreliable, but they don't seem to indicate this problem. OTOH, that was mainly for smoked or chewed opium, which has a much slower onset.
So the question becomes, "What better choices are there?". Back when they were still doing research on it, it was reported that LSD could relieve the pain of advanced terminal cancer. Well...it didn't actually relieve the pain, but it caused people to be able to ignore it. This was for cases where the "cocktail" had stopped working. So that might work. Someone earlier recommended marijuana. I'm not really sure. I haven't seen any research on it, but it seems plausible. Mescaline and psilocybin should also be investigated. Note that *NONE* of the drugs I've suggested are addictive. Marijuana is habituating, but not in the same sense as opioids, as the required dose doesn't keep increasing. The others aren't even habituating. LSD has been called "anti-addictive" in that it becomes unpleasant to take multiple doses in close proximity, and if you take them too close together it doesn't even work. Alcohol is a decent pain reliever, but at the doses necessary to relieve pain you become incoherent, and it doesn't reduce inflamation at all.
For some reason people keep recommending acetaminophen, which I don't understand at all. That's one drug I've actually tried, and it doesn't do ANYTHING for me at any safe dose. Aspirin and Ibuprofen are much more effective. But those only work for low levels of pain. At the levels I normally need to deal with they suffice, and if for some reason I can't use them, alcohol suffices...but not for very long at a time. Unfortunately, usually I worry about inflamation as much as pain, which means that alcohol is useless.
The actual answer seems to be that there is no currently validated satisfactory way to deal with chronic pain. The ways that might work are illegal even to investigate. The known traditional methods (chewing cocoa leaves or smoking opium) are illegal, and may have undesirable side effects (besides addiction, a known undesirable side effect). I'm not counting alcohol, as that's QUITE unsatisfactory for chronic pain, and has numerous known undesirable side effects. For acute pain it can be useful.
Javascript is what you use to allow unknown third parties to run software you have no idea about on your computer.
(Score: 2) by Runaway1956 on Monday September 25 2017, @05:38PM (1 child)
I feel for you man. And, I have no idea what the answers are. As you say, it's illegal to even research some things that look promising. You've hit everything that I've ever had access to, I think. Personally, I prefer novocodone and oxycontin (spelling?) for severe pain - but both are opioids, and addictive. (wait one - novocodone? Maybe I got that one wrong, internet search suggests that I meant oxycodone)
Acetaminophen seemed to work for me, years ago. In recent years, it's near worthless. The wife has had some "Tylenol 3" that seemed to be very effective. Not sure how or why - what's in it? Ahhh, codeine, another opioid. It seems we just can't get away from opium, without breaking the law.
Personally, if/when the day comes that I'm in chronic, terrible pain, I'll probably explore the cannabis options, and avoid the opium if possible. All of my drug use has been very short term - in fact, I've never finished a pain releiver prescription. I use the drugs to weather the first hours or days of excruciating pain, then wean myself. But - if there's no cure for what's ailing you, then there will be no weaning. Cannabis seems to fill that sort of need better than opium.
Sometimes, life sucks, doesn't it?
(Score: 2) by HiThere on Monday September 25 2017, @10:33PM
Actually, my severe pain has always been acute, but it has caused me to do a bit of reading. There are lots of other people who deserve sympathy, but I'm just annoyed.
Javascript is what you use to allow unknown third parties to run software you have no idea about on your computer.
(Score: 1, Informative) by Anonymous Coward on Monday September 25 2017, @06:08PM
Or rather, there's no way to deal with chronic pain that works for everyone.
In the account you replied to, the anecdote about the self-admining morphine feeling too good to resist... well, I bet most people are like that. When I was in the hospital and in quite a bit of pain, they gave me the morphine shot, and yes, it took the edge off the pain (rather, made me not notice it much), but when they came back and offered it again, I said no. Because for me it didn't feel that good, just a bit less bad.
After that, I've been on hydrocodone for 10 years. Yep, ten years. Without it, I'd have long since blown my brains out. But it just takes the edge off the pain, enough to let me keep going. I have not sought an increase in dosage in any of those ten years, although I have asked for more pills for a given period, just this past year, because the days I can skip a pill are getting fewer. No, I'm not immune to pain or anything, it's just that the opiods don't work all that well on me -- which has helped me not become a junkie on them.
If, though, the various moralizing agencies take these things away from me because other people can't or won't control themselves on them, then I might as well start dealing heroin or whatever the hell works. I don't mind trying within reason to make changes that help those people, just make it still possible for people like me who really do have chronic pain for real medical issues to get what we need to, literally, stay alive.
(Score: 0) by Anonymous Coward on Monday September 25 2017, @08:40PM
Bolivia allows [wikipedia.org] the traditional use of coca leaves.
(Score: 3, Interesting) by JoeMerchant on Monday September 25 2017, @08:17PM
My wife was in ICU in 2001 when "rate your pain on a scale of 1-10" was just coming into fashion, along with the DIY morphine button on the IV drip. Following the MD's instructions, she was pressing the button to supposedly help control her blood pressure. In reality, the morphine was suppressing her respiration, giving her nightmare hallucinations that were increasing her blood pressure, and necessitating an oxygen cannula which caused her nasal septum to crack and bleed and cause her more stress...
Solution? Ignore doctors, stop pressing button, 2 hours later remove cannula, SaO2 is fine now, hallucinations go away, blood pressure drops... duh.
I think many "standard of care" practices are applied in ways that increase billable event bottom lines, with little or no regard to the patient beyond trying not to kill them, because that's bad for repeat business...
🌻🌻 [google.com]
(Score: 5, Insightful) by PartTimeZombie on Monday September 25 2017, @10:46PM
I had a PCA device (Patient Controlled Analgesia) in hospital, after fairly major surgery, and it only worked a certain number of presses, after that it paged the nurse instead.
I think it was something like 5 pushes per hour, after that the nurse would come to see me because I must be in extreme pain or something.
The truth is, after a couple of doses I was off my face and pushed the button because it seemed like fun. Also the nurse was hot.