The Painkiller That Saves Money But Costs Lives 385
Hugh Pickens writes "Over 2,000 patients have died since 2003 in Washington State alone by accidentally overdosing on a commonly prescribed narcotic painkiller that costs less than a dollar a dose and the deaths are clustered predominately in places with lower incomes because Washington state has steered people with state-subsidized health care — Medicaid patients, injured workers and state employees — to methadone because the drug is cheap. Methadone belongs to a class of narcotic painkillers, called opioids, that includes OxyContin, fentanyl and morphine. Within that group, methadone accounts for less than 10 percent of the drugs prescribed — but more than half of the deaths and although Methadone works wonders for some patients, relieving chronic pain from throbbing backs to inflamed joints, the drug's unique properties make it unforgiving and sometimes lethal. 'Most painkillers, such as OxyContin, dissipate from the body within hours. Methadone can linger for days, pooling to a toxic reservoir that depresses the respiratory system,' write Michael J. Berens and Ken Armstrong. 'With little warning, patients fall asleep and don't wake up. Doctors call it the silent death.'"
Re:it is harder to get high on (Score:5, Interesting)
Wait: You use it as a painkiller? Why do you do that? It's almost the worst opioid you could possibly use for that!
There is no way that methadone should be used for anything other than treating opioid addiction.
Makes sense now (Score:0, Interesting)
So that's why they were handing methadone out to Occupy protesters in my town. "Maybe they will fall 'asleep' in the park so we can get them out easy."
Is it cost, or painkiller paranoia? (Score:5, Interesting)
Doctors don't generally like to prescribe pain killers. They worry about addiction, they worry about the DEA auditing their prescribing habits and yanking their license, without which it's kind of hard to be a doctor.
When they prescribe methadone, is it really out of cost, or have they grown so fearful of prescribing Oxycontin that somehow methadone seems like a reasonable alternative? And how many of those fears are medical/pharmacological, and how many are "if I prescribe Oxycontin I'll get in trouble" or "gee, there's a lot of press about Oxycontin, I shouldn't prescribe it"?
Well, pain killer, lol (Score:1, Interesting)
Actually here around it's better known as a "legal" (when given in the correct programme) substitution drug for heroine. (Basically instead of letting junkies do crimes to get their hand at illegal drugs, let's doctors prescribe it, with the official "goal" of getting the junkie some time in the far future clean).
And it's that narcotic, that you do not only need special prescriptions, nope, the drug is usually not given out to the "patient", they are forced to go in daily to the pharmacy and consume it on site.
One last thought, opiates are known to create very strong addictions, hence locally they are usually only administered in very restricted circumstances, e.g. as after care after surgery known to induce extreme pain, if really any other pain medication does not help, but only for a short term till the reasons can be fixed, and mostly for terminally ill patients (where the addiction aspect is irrelevant, but the painless sleep potentially into death is quite relevant).
Basically, cost accounting and medicine do not mash to well, and especially state run (but private insurances are not much better, but they tend to do it on a case by case base) systems have a tendency to go for cheap treatments even if they are not medically sound. (And using heavy addiction inducing drugs as a general pain killer medication is not sound policy). The only way (locally) to get them to do the right thing is usually to force the "cost controlling" MDs (it's always MDs here around that need to decide) to put their decision in writing including the reasoning, and mention that one needs this for the Social Court (locally we've got special courts for stuff related to social services and employment situations, and they usually tend to rule favorably), ... => more than once the MD reevaluated her decision while trying to formulate the reasoning.
Re:Accidental overdose? (Score:2, Interesting)
Easily. How can you accidentally do anything?
Re:Is it cost, or painkiller paranoia? (Score:5, Interesting)
You raise a good point. I see a pain specialist because of tendon and back problems. Regular doctors are regularly audited, but pain specialists are super audited, and the DEA puts so much pressure on them, that they do NOT like to prescribe pain killers at all if they can help it. (Based on input from 3 different doctors here). They have to keep records beyond the norm, prove that other methods were tried first, etc. I had not had a physical last year, and he wouldn't re-up my prescription until I did. His reasons weren't my health, he flatly said that he could get in trouble. So now our national health policy is party "ruled" by the DEA, a bunch of fucking idiots with a faulty agenda and no real world experience in front line medicine....great.
I live with pain (Score:5, Interesting)
18 years ago I messed up my back, 8 years ago I did it again. The second time around didnt have the results of the first. I live with constant pain while awake unless laying down.
Pain is depressing, it ruins your attitude and life. I have learned to live with it, with pain pills to manage the pain. When sent to pain management every so often to get the pain medication adjusted methadone is always pushed, I am also low income. I have done a lot of study of pain drugs and will always tell the doctor that is one medication I want to avoid. At present I am on Percoset (oxycodone/acetaminophen). While it isnt as cheap as the methadone on my crappy insurance, my life is way more important than the $10 a month extra it costs me.
But the problem may not be the drug itself but the idea that some people in pain have that they can avoid pain completely. This isnt always the case when you are on these types of medication. You can control pain, you can moderate pain. But if you think that if I take a pill or two extra it will get rid of it altogether you are on a slippery slope. My brother tried that, he ended up taking more and more pills because over time your body starts resisting them. Thats where the danger lies. You take so many that you end up killing yourself by overdose, like my brother did at 36.
Re:Accidental overdose? (Score:5, Interesting)
We have money for bombs, but not people. (Score:5, Interesting)
figures why the world is STILL deep in shit in godfrigging 21st century.
Re:Heroin substitute. (Score:5, Interesting)
We have tons of rules regarding where methadone clinics can go, how many people they can serve, under what conditions people can use it, how long, etc. So you end up seeing a lot of methadone prescribed for "chronic pain", despite the fact that it really kinda sucks for the whole "pain management" thing that opiates normally excel at.
Really, it does one and only thing well - It keeps people from going into withdrawal.
So basically, when you see a cluster of poor minorities with loq education OD'ing on this stuff, it doesn't mean their doctors have failed, it means a not-quite-ex-addict tried to get high on it and learned the hard way that it doesn't work very well for that, either.
Re:it is harder to get high on (Score:5, Interesting)
I disagree entirely. You have to select patients very carefully, but it works wonders on some. I'm a pharmacy resident at a mid-sized hospital, and I did a pain consult on a patient who was sedated and intubated in the ICU. Poor nurse was out of her mind giving him Dilaudid shots every 30 minutes so he wouldn't spike his BP and breathe against the ventilator (both signs of inadequate pain control). Wanted to give him a longer acting opioid for basal pain control. Can't use OxyContin or MSContin here cause you can't crush it to put it in a feeding tube. Guy was also morbidly obese so it would take several days for a Duragesic patch to saturate all the subcutaneous binding sites. Methadone turned out to be the perfect answer.
Obviously you have to be extremely careful, but I don't have a problem with using methadone so long as the patient has good renal function, good hepatic function, good respiratory function (or a protected airway) and isn't taking any drugs that lengthen the QTc interval. This tends to rule out your older, sicker patients, and I suspect that most of the deaths from methadone toxicity happens in them.
In the case specifically addressed in TFA, the fact that the patient was on both methadone and Oxy simultaneously is mind-boggling. Especially in the setting of sleep apnea. More blame rests on the prescriber than on the drug.
Re:Is it cost, or painkiller paranoia? (Score:4, Interesting)
When they prescribe methadone, is it really out of cost, or have they grown so fearful of prescribing Oxycontin that somehow methadone seems like a reasonable alternative? And how many of those fears are medical/pharmacological, and how many are "if I prescribe Oxycontin I'll get in trouble" or "gee, there's a lot of press about Oxycontin, I shouldn't prescribe it"?
Well, let me just tell you: I am not an "addictive personality" and have never had any problems whatsoever like that; I was on Oxy for 1 week after shoulder surgery, and wow; I actually went through (mild) withdrawal--headaches, night sweats, chills... Of course for me there was no temptation to get more to ease those symptoms, instead my reaction was "wow, I sure wouldn't want to take this shit any longer".
And oh yeah, I did feel really good on it, no question about that...
Re:This is ridiculous (Score:5, Interesting)
I have a problem with chronic kidney stones. My PCP eventually sent me to a pain clinic, where a doctor evaluated my current meds, my current needs, etc. I got a prescription for Oxycontin. Upon trying to fill this prescription, there were only two pharmacies that could fill it (several manufacturers were shut down due to illegal selling/distribution). One was at the pain clinic where I got the script, and the other was at CVS where I always filled all of my other prescriptions. The pharmacist was way way way beyond rude and pretty much called me a junky. I was absolutely furious. This man has made an extreme judgement of who I was because of my need for a powerful painkiller.
I come to find out this particular person owns http://banoxycontin.com/ [banoxycontin.com]. It was obvious this person had an agenda and I was just one of his targets to push it. I can't get anymore into the resolution of the situation, but rest assured I won.
The "war on drugs" causes shit like this. It ends up just being a witch hunt and there are too many innocents that end up burning
Re:Both Major Parties' Face of Future Medicine... (Score:3, Interesting)
The hell with all of you. This thing isn't a partisan issue, though historically the Republicans have been the biggest proponents of the War On Drugs (TM), it is completely true that Democrats have not done much of anything to do away with it. Partly that's because anybody who does anything contrary to what police, prosecutors, judges, and the private prison system wants are immediately subjected to a well-financed publicity barrage calling them "soft on crime" (unless, that is, the crime is that of stealing money from poor and middle class people through banking fraud, but I digress...) Partly it's because most actual Democratic politicians are just as corrupt and profit-driven as their Republican counterparts, even if those values aren't the same as their supporters. In the US we have a choice between "ultra right-wing" and "mildly right-wing packaged as 'liberal' for political purposes" when it comes to electing people these days.
It is because of both Democrats and Republicans that I have to have a record made with the DEA every time I want to buy some damned cold medicine, Obama has not told his so-called Justice Department to shut up about medical marijuana--continuing a harassment policy began by his Republican predecessor. There are no choices in politicians these days, only marketing.
The poster who said that it's more important to prevent people from getting high than it is to prevent them from dying these days is spot on. There is something else though: if this is to save money, it is because sufficient money is not provided for the program. Republicans more than Democrats (other than the now-decimated Blue Dogs) oppose properly funding health initiatives, and they love means-testing them. Why? Because it's easier to cut a program which serves poor people in this country than it is to cut a program that serves everyone. That's pretty much their irrational hatred of Medicare and Social Security in a nutshell by the way. The only thing Republicans wanted to fund with Medicare is the prescription drug "benefit", which was entirely their idea and which contains a prohibition against negotiating with drug companies for lower prices. Therefore, it's a giveaway of tax money to large corporations--a Republican specialty. However, do you hear Democrats calling them out on it loud and clear? No? Why not? Everyone needs to start asking questions like that.
Re:I live with pain (Score:5, Interesting)
You just illustrate the problem with the war on drugs. You're taking acetaminophen. The only reason it is in the pills is to kill you if you dare to take too much. They could either prescribe the oxycodone on its own or in combination with a safer NSAID and it would only be safer and more effective.
Too many painkillers are designed with a LACK of safety being a design criterion - all because we'd rather kill people who get the dosing wrong rather than risk somebody getting high.
Re:methadone is very useful in managing chronic pa (Score:2, Interesting)
you're an idiot (Score:3, Interesting)
the most potent destroyer of freedom in the entire history of mankind, by orders of magnitude, is no government, it is drug addiction
there is no stronger bars that the most depraved government can build then the bars the drug addiction place in your mind. a constant interrupt switch "get high... get high... get high" makes unable to work, maintain a relationship, think thoughts of philosophy, art, design, anything deep because of the pain of withdrawal
and this is the real story of the history of opium addiction, and "little or no social problems" from 100 years ago, you idiot:
http://opioids.com/opium/opiumwar.html [opioids.com]
drug addiction as a tool to destroy a society you want to subjugate
i understand that people here detest government regulations and impositions on human freedoms. but why that means we have to accept a far worse form of freedom destruction, drug addiction, is beyond my understanding
Re:methadone is very useful in managing chronic pa (Score:2, Interesting)
That and patients don't understand methadone kinetics (not too surprising). There is a tendency to 1) take extra doses to help dull the pain (or deal with withdrawal issues) and 2) medicate with something else. Typically the something else is alcohol.
As someone who has dealt with severe pain from an accident before, I think the tendency to take extra doses or self-medicate with alcohol as well is understandable. When the pain is so strong that it cuts through everything else, the risk of death seems a small price to pay to dull the pain. I'm not exaggerating. If you're in enough pain, rational thought goes out the window.
More effective pain treatment options would probably prevent some of these deaths. Perhaps we should be less concerned about addicts pill seeking, and more concerned about pain management.
Re:it is harder to get high on (Score:4, Interesting)
Because the library author already took care of that detail. Put the cursor on diamorphine and press F3 (Eclipse):
const Narcotic diamorphine = C21H23NO5;
The chemical formula isn't specific enough. Different compounds can have the same chemical formula but entirely different structure and are known as isomers.
It gets even more confusing when you have compounds that look the same on first glance but differ due to chirality.