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With Google, Bitcoins, and USPS, Feds realize it's stupid easy to buy fentanyl
A congressional report released Wednesday lays out just how easy it is for Americans to buy the deadly opioid fentanyl from Chinese suppliers online and have it shipped to them via the government's own postal service. The report also lays out just how difficult the practice will be to stop.
After Googling phrases such as "fentanyl for sale," Senate investigators followed up with just six of the online sellers they found. This eventually led them to 500 financial transaction records, accounting for about $766 million worth of fentanyl entering the country and at least seven traceable overdose deaths.
[...] "Thanks to our bipartisan investigation, we now know the depth to which drug traffickers exploit our mail system to ship fentanyl and other synthetic drugs into the United States," Republican Senator Rob Portman of Ohio said in a statement. "The federal government can, and must, act to shore up our defenses against this deadly drug and help save lives."
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Congress Reacts to Reports that a 2016 Law Hindered DEA's Ability to go after Opioid Distributors
Opioid Crisis Official; Insys Therapeutics Billionaire Founder Charged; Walgreens Stocks Narcan
(Score: 2) by sjames on Monday January 29 2018, @05:09PM (6 children)
There are a lot of components to it. Some seem to be matter of mental training while others seem to be inherited traits. Also there is more than one variety of pain. In addition to the obvious and dramatic cases of congenital insensitivity (which can be quite a problem), there seem to be people who are inherantly able to dismiss pain with ease and others who simply can't. Others can easily learn to dismiss pain, while others have only limited success.
There really seems to be something to acupuncture, fMRI has even demonstrated activity in relevant areas of the brain when skilled acupuncturists work on some conditions but not when the subject receives a similar sham treatment. Western medicine has very little information on how, why, or when acupuncture works. It's worth a try when someone is in pain.
For something that is so obviously real and is such a part of everyone's life, we really don't have much scientific grasp of it. We don't even have a way to objectively measure it. For that reason, we need to be careful with decisions about what people who are not ourselves need and don't need WRT pain management. I know what I can deal with, but even if you have a similar condition, I really don't know if you are experiencing more or less pain nor if it is more or less troubling for you. Techniques that may (or may not) reduce the need for opiates are very much worth a try but when you try them, only you can tell me if it worked well enough for you. When I try them, only I can tell you if I still need opiates or not.
For all of those reasons, we need law enforcement and legislators to quit practicing medicine without a license and without even examining the patient. We need better education for actual medical personnel including alternative pain management techniques and in MANY cases, sensitivity training (not the same sort corporate HR likes, I just don't know what else to call it). But I do not think opiates, including very strong ones, can just be dispensed with any time soon.
(Score: 2) by JoeMerchant on Monday January 29 2018, @05:37PM (5 children)
Oh, but, hey, that doesn't stop the ER staff from asking the question: "Rate your level of pain on a scale from 1 to 10?"
As for opiates, they too have a widely varied response curve. When my wife was given morphine post-partum, it did nothing for her pain or blood pressure, but it did give her very disturbing hallucinations and respiratory depression. My grandfather (on the other side) decided to pull out a catheter from his femoral artery the first night they gave him morphine - that resulted in an additional two weeks in the hospital, and a change of pain meds.
The M.D.s I have known all seem too wrapped up with "treating real problems" to worry about pain, except perhaps as it might affect the vitals they are attempting to control (like BP). Personally, I think we need to work out a way to increase the number of people allowed to practice medicine at the M.D. level, so this artificial scarcity of the doctors' time can go away, and they can start spending time treating the whole patient instead of high paying little specialty sub-systems of the patients.
🌻🌻 [google.com]
(Score: 2) by sjames on Monday January 29 2018, @06:21PM (4 children)
The staff have to use rate your pain. It's the only measure they have. In many ways it's better than an objective measure, it's the subjective pain that must be treated in order to help the patient improve. It would help though if they really understood what might affect the patient's subjective measure. For example, if the patient presses the call button to request pain meds and it takes an hour to get them, their future pain rating (and their subjective sense of pain) will go up. The sinking feeling that you may not get needed help is like that. OTOH, if the patient knows relief will be prompt, they may decide that 5 is more like a 3.
If the MDs were REALLY doing their job, they'd know that adequate pain control will actually improve the patient's objective condition as well as their compliance with medical instructions.
In many places, P.A.s and R.N.s are assuming greater responsibility, but they seem to be in short supply as well. Part of it is that we've let the costs of medical school increase out of control.
(Score: 2) by JoeMerchant on Monday January 29 2018, @06:37PM (3 children)
Don't get me wrong, I know several good doctors - it's just a shame that they're in the minority.
Cost of med school is one thing, but on top of that, cost no object there's a limited number of seats in the program every year. In the US they explain this by pointing to a limited number of seats in the post-graduate rotations programs - and I call BS on that. By limiting availability of seats in the program, they allow the price of the program to climb sky-high, and justify the cost of the program with "ROI" from insane specialist compensation levels on graduation. Plenty of people who are intelligent and motivated enough to become M.D.s are kept out by either the cost of school, or the arbitrary pre-med weed-out and MCAT process.
Doctors with limited rotations experience, give them a new title and limited responsibilities. Let them fulfill rotations requirements as apprentices with existing M.D.s as lesser-partners in practice... there are hundreds of possible solutions, but the only one the AMA pursues is limited supply.
🌻🌻 [google.com]
(Score: 2) by sjames on Monday January 29 2018, @08:16PM (2 children)
There are good doctors out there, I know a few as well. They sometimes have a hard time applying that when time is short and student bills are huge though, so I suspect many could do better given half a chance.
This is one reason I would like to see a single payer system. It would provide the leverage needed to hopefully put the U.,S. healthcare on par with western Europe.
(Score: 2) by JoeMerchant on Monday January 29 2018, @09:01PM (1 child)
1990 Dusseldorf, actual case of blood poisioning presented on my left wrist. Walked to the desk of the hostel I was staying at and asked where is the nearest hospital? "oh, you're kind of in a bad spot here, halfway between two" - they were both ~10 minutes walk. I walk in to the E.R. "oh, we're very sorry, the doctor is with someone else right now, it will just be a few minutes" - literally less than 5 minutes later, I had the full attention of a doctor and nurse for the next 90 minutes, no other patients arrive (because of all the other open hospitals, maybe?) while they meticulously cleaned the wound, obtained and administered both antibiotics and a tetanus series, applied a plaster cast, schwester Silke asked if she could join me and my friend for a beer later, the bill was 35DM, but I only had 20s and 10s, they rounded down to 30, and the followup visit to remove the cast and check healing was free.
2010 Gainesville, Florida, suspected case of blood poisioning presented on my left wrist at 4:30pm Sunday. Called around to the "doc-in-a-boxes" but they were all closed or closing before I could get there, E.R. is the only option. Self-drive to the E.R. - have to park in the crowded out-lot then walk across the empty access restricted lot with one Mercedes and one Porsche parked up front. Present at the window, explain "blood poisioning, see the red streak on the wrist?" yeah, yeah, take a seat over by the apparent TB case. Oh, look, it's football playoffs and they just kicked off. Not one single, patient is taken back for anything but financial consultation or B.S. preliminary X-rays and other pump-up-the-billing with non-MD staff work. The waiting room is stacked full by the 4th quarter, car wreck victim on a stretcher moaning in pain. Patriots score and wrap up the game with less than a minute to play: BOOM, patients being taken back to see the M.D.s one every 3 minutes. I get glance at the red streak, a script for antibiotics, but, sorry, the on-site pharmacy is closed, you'll have to go across town to fill this at this hour... Total bill for this abuse started negotiations at $3500, came to about $150 out of pocket.
🌻🌻 [google.com]
(Score: 2) by sjames on Tuesday January 30 2018, @02:03AM
Sounds about typical, sadly. If the urgent care was anything like the one near me, it's just as well. Apparently they can't do an IV and if you look even vaguelky dehydrated, they'll send you to the ER. Yeah, paramedics can do it by the roadside, it can be done in the clubhouse at an MLB game, but it's beyond "urgent" care. 8 hour wait (so much for any sense of urgency). Bill from collection agency arrives before bill from the ER does (months later). Yes, they sent it to collections before even trying to bill it.