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posted by martyb on Monday September 25 2017, @12:59PM   Printer-friendly
from the addiction-sucks dept.

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.


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  • (Score: 4, Insightful) by Virindi on Monday September 25 2017, @01:24PM (23 children)

    by Virindi (3484) on Monday September 25 2017, @01:24PM (#572645)

    The morality police are just doing great, pressuring companies into restrictive policies and funding "programs". Too bad it just makes life difficult for people who actually need such medications...but nobody cares about that. It's more important to make sure people can't get high!

    As for this supposed "epidemic"? Drugs have been around and readily accessible for a very, very long time. Perhaps this "epidemic" is more reflective of more people being unhappy than it is of drug availability?

    No, we can't think like that. Have to crack down on...someone! Make those pharmacies run scared and do everything they can to try to look "hard" on drugs!

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  • (Score: 2, Insightful) by Anonymous Coward on Monday September 25 2017, @01:32PM

    by Anonymous Coward on Monday September 25 2017, @01:32PM (#572651)

    Because no-one votes for a sheriff who is soft on crime. Doesn't matter *WHY*, just that he is or looks soft on crime.
    Chances are, with the data exchange they do with the DEA, the world's largest extra-legal police force, they got sick and tired of the continuous questions they received and just said "fuck this shit, we'll bend".

    Just take a look at the DEA and figure out how much money is involved in just running that agency, how many people, and more importantly, how many companies, would lose money if you scaled back the 'war on drugs'. Onces you've got that figured out, you'll know exactly why these things happen and why suddenly this opioid crisis is a thing. The DEA is the equivalent of a mafia enforcer, with the difference that the mafia lives by a code, the DEA lacks that bit.

  • (Score: 3, Informative) by c0lo on Monday September 25 2017, @02:24PM (2 children)

    by c0lo (156) Subscriber Badge on Monday September 25 2017, @02:24PM (#572662) Journal

    but nobody cares about that.

    On the contrary, buddy, on the contrary.
    Something tells me marijuana oils are equally effective and a lot less addictive.
    Supplementary, marijuana preparations are cheaper in terms of production costs.

    As for this supposed "epidemic"? Drugs have been around and readily accessible for a very, very long time. Perhaps this "epidemic" is more reflective of more people being unhappy than it is of drug availability?

    Oh, for fucks' sake. Celebs are visible, for each of them there are thousands of invisible others who "benefited" from the said availability

    Heath Ledger [wikipedia.org] - dead by OD on a cocktail of oxycodone, hydrocodone, diazepam, temazepam, alprazolam and doxylamine,

    Prince [wikipedia.org] - dead by fentanyl

    Rush Limbaugh [cbsnews.com] - arrested on long-running prescription fraud on pain killers

    If you google, you'll find heaps of others.

    --
    https://www.youtube.com/watch?v=aoFiw2jMy-0 https://soylentnews.org/~MichaelDavidCrawford
    • (Score: 1, Touché) by Anonymous Coward on Monday September 25 2017, @05:19PM (1 child)

      by Anonymous Coward on Monday September 25 2017, @05:19PM (#572718)

      Something tells me marijuana oils are equally effective and a lot less addictive.

      What would that be? It certainly isn't any good scientific evidence that tells you that Cannabis oils are equally effective as opioids at managing pain.

      • (Score: 0) by Anonymous Coward on Monday September 25 2017, @05:50PM

        by Anonymous Coward on Monday September 25 2017, @05:50PM (#572729)

        And even if it is as effective for some people, it certainly is not for everyone.

  • (Score: 5, Insightful) by Runaway1956 on Monday September 25 2017, @02:31PM (7 children)

    by Runaway1956 (2926) Subscriber Badge on Monday September 25 2017, @02:31PM (#572665) Journal

    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)

      by HiThere (866) Subscriber Badge on Monday September 25 2017, @05:08PM (#572716) Journal

      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)

        by Runaway1956 (2926) Subscriber Badge on Monday September 25 2017, @05:38PM (#572724) Journal

        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

          by HiThere (866) Subscriber Badge on Monday September 25 2017, @10:33PM (#572820) Journal

          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

        by Anonymous Coward on Monday September 25 2017, @06:08PM (#572731)

        The actual answer seems to be that there is no currently validated satisfactory way to deal with chronic pain.

        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

        by Anonymous Coward on Monday September 25 2017, @08:40PM (#572787)

        Bolivia allows [wikipedia.org] the traditional use of coca leaves.

    • (Score: 3, Interesting) by JoeMerchant on Monday September 25 2017, @08:17PM

      by JoeMerchant (3937) on Monday September 25 2017, @08:17PM (#572777)

      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

      by PartTimeZombie (4827) on Monday September 25 2017, @10:46PM (#572823)

      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.

  • (Score: 2) by c0lo on Monday September 25 2017, @02:36PM (1 child)

    by c0lo (156) Subscriber Badge on Monday September 25 2017, @02:36PM (#572667) Journal

    There: Doctor shopping [nih.gov]

    --
    https://www.youtube.com/watch?v=aoFiw2jMy-0 https://soylentnews.org/~MichaelDavidCrawford
    • (Score: 1, Interesting) by Anonymous Coward on Monday September 25 2017, @05:25PM

      by Anonymous Coward on Monday September 25 2017, @05:25PM (#572719)

      There is a centralized database of addictive prescriptions to avoid this "doctor shopping" problem, but so far its not enforced strongly or not used properly. Addicted people pay good money for prescriptions because addiction is powerful, making redundant or unnecessary pain pills quite lucrative to shady doctors.

  • (Score: 5, Insightful) by Anonymous Coward on Monday September 25 2017, @02:42PM (3 children)

    by Anonymous Coward on Monday September 25 2017, @02:42PM (#572670)

    The morality police? The supposed epidemic?

    If 64,000 Americans died in terrorist attacks over the last year, all of the sand in the Middle East would already be radioactive glass.

    • (Score: 1, Insightful) by Anonymous Coward on Monday September 25 2017, @05:53PM (1 child)

      by Anonymous Coward on Monday September 25 2017, @05:53PM (#572730)

      I'd rather have less safety and more freedom than the opposite. Why make life hard for people who actually need these drugs?

      • (Score: 2) by Mykl on Tuesday September 26 2017, @01:32AM

        by Mykl (1112) on Tuesday September 26 2017, @01:32AM (#572871)

        Individual liberty is a great theory, but when taken to the extreme it doesn't work out so well in practice. Mostly because people don't bother properly informing themselves before making decisions (see: Anti-Vaxxers).

        In any case, this isn't about individual liberty - this is about the free market. You are free to go to a different drug store if you don't want your pharmacist to care for the safety of their customers.

        This is not about making life hard for those that need the drugs. This is about preventing people who don't really need the drugs from being hooked on them simply because it will make some doctors (and Big Pharma) some more money. If you do really need the drugs then your doctor will confirm this with CVS and you can walk out with your armful of opioids.

        I'm actually a little surprised and impressed that CVS did this. It will place them at a relative disadvantage in the market, as those people who are being oversubscribed will simply go elsewhere (free market). Good for them.

    • (Score: 1, Informative) by Anonymous Coward on Monday September 25 2017, @07:34PM

      by Anonymous Coward on Monday September 25 2017, @07:34PM (#572760)

      If 64,000 Americans died in terrorist attacks over the last year, all of the sand in the Middle East would already be radioactive glass.

      But educating people about drug use/effect/impacts isn't as cool as blowing shit up, nor it be used to scare people into complacency. And don't we all want to play with boom-boom sticks because it just looks cool?

  • (Score: 4, Interesting) by Thexalon on Monday September 25 2017, @04:23PM (4 children)

    by Thexalon (636) on Monday September 25 2017, @04:23PM (#572706)

    As for this supposed "epidemic"?

    The CDC [cdc.gov] reports that opioid overdose is the #1 cause of death for Americans under the age of 55. It kills more non-elderly people than car crashes, guns, or suicide. The New York Times [nytimes.com] article on it notes an 8-fold increase between 1990 and today. Based on that, I think it's safe to say that they are trying to respond to a real problem. Their approach might not work, but to claim this is nonsense when people are dying by the thousands is flat wrong.

    Anecdotally: I live near one of the worst areas for overdose deaths in the US, and have buried 2 acquaintances so far, struck down in young adulthood by heroin. Both of them were injured, took their prescribed opioid painkillers, switched to heroin when the prescription ran out, and tried rehab programs but remained hooked, and it went on to kill them.

    --
    The only thing that stops a bad guy with a compiler is a good guy with a compiler.
    • (Score: 2) by HiThere on Monday September 25 2017, @05:32PM (3 children)

      by HiThere (866) Subscriber Badge on Monday September 25 2017, @05:32PM (#572723) Journal

      The thing is, even if they had been able to keep their prescriptions the legal opioids necessary to relieve the pain would have killed them. Probably not quite as quickly. The problem is that the size of the minimum effective dose keeps increasing, and while the tolerance also increases, it increases more slowly. Opioids are truly lousy for chronic pain, though suited to severe acute pain. Even then there are indications that using an opioid for acute pain makes it more likely that you'll eventually become addicted, perhaps decades later.

      That said, there don't seem to be any good choices for severe chronic pain. Certainly none that are legal, and the ones that are illegal are generally illegal to even investigate. Acupuncture is an exception, but reports of it being successful seem to be rare compared to reports of it failing. This could be down to the skill of the practitioner, of course. Skilled meditators seem to be able to suppress extreme acute pain, but I know of no reports on their abilities with chronic pain...and to be effective as a treatment the skill would need to be learned while in the course of chronic pain.

      --
      Javascript is what you use to allow unknown third parties to run software you have no idea about on your computer.
      • (Score: 5, Informative) by Thexalon on Monday September 25 2017, @07:11PM

        by Thexalon (636) on Monday September 25 2017, @07:11PM (#572755)

        That said, there don't seem to be any good choices for severe chronic pain. Certainly none that are legal, and the ones that are illegal are generally illegal to even investigate.

        Absolutely.

        In places that allow research, it appears that cannibis would be a much better choice: It helps a lot with pain, it's not physically addictive, and has far fewer other negative side effects. But for reasons that have far more to do with racism and hippie-punching than science, the US government's official position is that cannibis is more dangerous than PCP [usdoj.gov].

        --
        The only thing that stops a bad guy with a compiler is a good guy with a compiler.
      • (Score: 2) by Mykl on Tuesday September 26 2017, @01:35AM (1 child)

        by Mykl (1112) on Tuesday September 26 2017, @01:35AM (#572872)

        You're assuming that Thexalon's friends were still in pain when they finished their opioid prescriptions. Nothing he said suggests that's the case. More likely (and here's where I make assumptions!) they were simply hooked on an addictive drug.

        • (Score: 2) by HiThere on Tuesday September 26 2017, @04:23PM

          by HiThere (866) Subscriber Badge on Tuesday September 26 2017, @04:23PM (#573219) Journal

          Actually, I wasn't talking about any particular case. Rather I was talking about characteristics of the opioids. I don't know his friends, and that is irrelevant to my point.

          Well, not totally irrelevant. Opioids *are* addictive, and addicts tend, by definition, to strive hard to acquire the drug to which they are addicted. OTOH, I knew a person in college who said that tobacco was a harder drug for him to kick than heroin, and this was later echoed by Synanon. My suspicion is that it varies from individual to individual, but that part of the reason tobacco is so hard to kick is its wide availability. (That's not the only reason. Commercial cigarettes have a secondary addictive substance mixed into the paper. The way I succeeded in quitting the second time was by switching to an organic cigarette [Shermans], and then gradually increasing the time between cigarettes. [The first time was easy. I just quit immediately. That didn't work the second time.])

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