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Medicine Stats Science

The Painkiller That Saves Money But Costs Lives 385

Posted by timothy
from the while-poppies-burn-in-afghanistan dept.
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.'"
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The Painkiller That Saves Money But Costs Lives

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  • by Anonymous Coward on Sunday December 18, 2011 @08:31AM (#38415742)

    because of the way it works, junkies don't prefer it. so who cares if a bunch of people die needlessly, at least it prevents people from getting high. the drug war matters more.

  • Re:Nice (Score:0, Insightful)

    by Anonymous Coward on Sunday December 18, 2011 @08:42AM (#38415804)

    And this is exactly why having registered commenters score +1 just for posting is so wrong. Meanwhile, on-topic posts by ACs go unnoticed and will get repeated by registered users.

    And no, we will not register unless there comes a time when other users cannot ban you for what you say.

    So back to the topic... Doctors are idiots, law enforcement is corrupt and evil and pharmacists are complicit. This is what you get.

  • This is ridiculous (Score:5, Insightful)

    by Dunbal (464142) * on Sunday December 18, 2011 @08:43AM (#38415812)
    As little as 100 years ago people were using perfectly legal opium compounds such as paregoric, with little or no social problems. The fact that people are dying and people are having their lives ruined by this failed "war on drugs" and the solutions are even worse than the problem just goes to show that government has no clue what it's doing.
  • by oodaloop (1229816) on Sunday December 18, 2011 @08:51AM (#38415856)
    I prefer the Crystal Method.
  • by syousef (465911) on Sunday December 18, 2011 @08:53AM (#38415870) Journal

    How can you accidently take more than the prescribed amount?
    Can't decipher the doctor handwriting?

    Forget you've taken it and take it again. Anyone can become distracted but the very old (prone to memory related illnesses) and very young (in the care of others) are particularly susceptible.

  • by Zironic (1112127) on Sunday December 18, 2011 @08:54AM (#38415878)

    As far as I know, usually what happens is that while the drug is strong, it's not effective in treating chronic pain because the effectiveness is erratic.

    The patient will then take more of the drug, because they think that their dose is too low since it's not being effective, thus ending up overdosing themselves.

  • by GreatBunzinni (642500) on Sunday December 18, 2011 @08:57AM (#38415898)

    From the article, it sounds like this is not a problem caused by cheap drugs but by piss-poor medical care. If a patient is given a specific form of Opioid which is known for stuff such as 'With little warning, patients fall asleep and don't wake up", and it does so frequently that they even gave this form of death the pet nickname, "silent death", then it does look like the only problem is that patients aren't monitored accordingly. To put it in other words, it does sound like they are putting the blame on a drug for a problem which is caused by incompetent medical staff which are routinely slacking off monitoring their patients and doing their rounds. Giving poor people sub-standard health care to the point of being considered neglect is a much more serious problem than providing cheap drugs.

  • by PolygamousRanchKid (1290638) on Sunday December 18, 2011 @08:59AM (#38415908)

    . . . faced with a life full of incurable, chronic, unbearable pain . . . this "silent death" might seem like a more pleasant option for some folks.

    It would seem like an alternative for a doctor forbidden by law from assisting a patient requesting euthanasia. The doctor prescribes the medication and describes the risks. It is the patient's choice to take a lethal amount.

  • by swb (14022) on Sunday December 18, 2011 @09:03AM (#38415924)

    I'd wager cost has nothing to do with it and that they're being prescribed methadone over Oxycontin because of the reputation Oxycontin has, and the doctors don't want to be associated with Oxycontin.

    And it's not that Oxycontin is a 'bad' medication, but it's gotten caught up in our moralistic, war on drugs mindset.

  • by swb (14022) on Sunday December 18, 2011 @09:08AM (#38415948)

    Worse than that, I don't even think the DEA applies medical logic -- I think their logic is all about drug control. They could care less about whether clinically effective medicine is taking place, they just want fewer painkillers in civilian hands.

  • by subreality (157447) on Sunday December 18, 2011 @09:19AM (#38416002)

    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 works! If you give a junkie a reliable, free supply of opiates, they quit the cycle of binging then stealing things when they run out, are generally able to function in society, and gradually wean themselves off. It is more effective than any other treatment.

    Methadone is particularly effective because for this because it's very long-acting. It doesn't provide a reward rush when you take it, and it doesn't crash fast leaving them desperately craving.

    they are forced to go in daily to the pharmacy and consume it on site.

    Sure. Heroin users are used to gauging their dose by the immediate response. Methadone is really slow, so they think they didn't take enough and take more, only to end up overdosing when it hits. For non-addiction prescriptions they just give you a 30-day supply.

    And using heavy addiction inducing drugs as a general pain killer medication is not sound policy

    What would you suggest for severe pain? Advil isn't going to do it.

  • by Anonymous Coward on Sunday December 18, 2011 @09:28AM (#38416048)

    ...is more of this. Republicans want to turn Medicaid into a block grant program to states, with eroding value because payments won't keep up with inflation. States, squeezed to do more with less, will continue to do the cheap thing instead of the right thing for the poorest, most vulnerable (those with no cash to buy influence), and the poor will suffer and die in a greater and growing proportion to the rest of us.
     
    They'll do the same thing to Medicare. So keep it up, poor and middle class, keep voting directly against your own economic interests, and watch your mortality rates soar.

  • by Lumpy (12016) on Sunday December 18, 2011 @09:33AM (#38416074) Homepage

    You've never been in serious pain then.

    Even a perfect health 20 year old in a scale of 1 to 10, a 10 in pain will not only forget they took a painkiller, but will want the pain to subside so badly that taking another one is certainly a thought process they go through.

    Stick a railroad spike in your head and then pour salt and lime juice on it. Then tell me you will sit there and remember you took a pain pill 30 minutes ago.

  • Washington State is controlled by Democrats. The majority of both houses of the legislature there are Democrats, as is the current governor and the last two governors before her. I expect, though, that you're too busy hating Republicans to recognize the Democrats are no different.

  • by RobinEggs (1453925) on Sunday December 18, 2011 @10:11AM (#38416378)

    Doctors are overpaid

    Can we please stop this shit? Blaming doctors doesn't help you, and they are generally not overpaid. For the length and stress of their training, the debt they incur, and the difficult lifestyle many specialties must endure permanently, most doctors are actually underpaid - in overall salary, in compensation per hour, or both.

    I know primary care physicians who've been forced quit the business after 30 years and had to go work somewhere else. How does a doctor who can't afford to be a doctor, and doesn't have enough savings to retire after 30 years, fit with your ignorant screed that doctors are overpaid?

    I also know surgeons, many of whom do make $300,000 a year, and I've never seen one of them sit still for more than 15 minutes, to watch a movie or lecture, without passing out. They work a minimum of 60 hours a week and constantly get paged for surgery in the middle of the night, whether or not they're actually 'on call'.

    So many types of doctor make so little that people are quitting left and right, while med students refuse to even consider the specialty, and many other types work so many hours with such a poor quality of life that their compensation per hour (not to mention per 3 am emergency call) makes engineering and business look like much better careers.

    Many doctors are underpaid; many others are overpaid but massively overworked and overstressed. The cross-section of doctors who are both overpaid and live comfortable lifestyles is much, much smaller than you think.

  • by RobinEggs (1453925) on Sunday December 18, 2011 @10:52AM (#38416718)
    I can't believe the number of comments here about doctors being assholes, overpaid, incompetent, etc. You ungrateful, ignorant people need to wake up and realize that doctors are just as miserable under this system as the rest of you.

    First, doctors hate the most expensive parts of medicine even more than you do; they'd be ecstatic to see that business go away. Patients incur as much as half of their lifetime medical costs in the last six months or year of their life. Doctors who know it's simply time for someone to die are forced to keep them alive for a few last weeks or months by whining families who can't accept death and by stupid laws that require extreme intervention to the very end. Many people won't sign DNR orders until they've already hung on far too long, if ever; the families rarely sign them for someone too far gone to sign themselves. It's gotten so bad there's even a phenomenon called the Silent Code, when the physician running an emergency resuscitation tacitly lets a terminal and hopeless patient slip away; they walk the line between honoring laws / families' wishes and the Hippocratic duty to do no harm by not prolonging suffering. Most doctors wish that palliative care and letting people go at their time could be official; a significant minority favor outright assisted suicide. Those brave enough to take some action now do things like silent codes. How does risking your license and reducing your billable hours by letting a patient die display the kind of greedy, insensitive behavior you people seem to think almost all doctors display?

    And as for the money, doctors as a whole are not overpaid; doctors may average almost $200,000 a year, and the existence of specialist surgeons who make $700,000 a year makes it easy to assume they're all overpaid, but a complete statistical look at doctor's salaries - one that includes median, mode, and spread indicators- will tell you that the typical salary is pretty fair for a field that involves a minimum of 11 years higher education (often stretching past 15), $150,000+ in educational debt, and usually takes a lot more than 40 hours a week.

    So some doctors are overpaid, and some doctors are callous. Show me a profession with neither of those problems. The majority of doctors are paid no more than a fair wage (or even not enough), care deeply about their patients, hate the waste and legal bullshit of medicine much more than you do, and are really tired of taking shit from people who think they like the system this way or got into medicine for the money.

    The longer you assholes complain about doctors being stupid or only caring about money, the more stupid pricks who only care about the money will be the only ones willing to go to medical school. That's already starting, in my opinion. Enjoy reaping what you've sown.
  • by ColdWetDog (752185) on Sunday December 18, 2011 @11:21AM (#38416922) Homepage

    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. The combination of alcohol and methadone is especially dangerous. Two potent respiratory depressants with very different kinetics.

    Methadone is the poster child for all that is screwed up with pain control and addiction in this country. As usual, it is popular to shoot the 'messenger'. Until the ability to deal with narcotic addiction is wrestled away from the DEA and until patients in general feel like their problem is more of a medical one than a legal one it's just going to get worse. As an ER doc, I'm seeing methadone in a lot of urine drug screens these days. Talking to patients (the ones that will talk, anyway) they are mostly taking it to deal with withdrawal symptoms when they can't get their drug of choice. Of course, that leads them to manage their problem on their own with a very dangerous drug. Not a terribly safe nor effective combination.

  • by sjames (1099) on Sunday December 18, 2011 @11:39AM (#38417068) Homepage

    The problem, I gather, is that the primary selection criterion being used here is "poor'. That's a fairly bad criterion for any medical decision.

    The sad part is that there is no good reason for any of the opiates to be terribly expensive. It doesn't help that our government would rather see chronic pain sufferers dead or screaming in agony rather than admit the war on drugs is a failure.

  • If it were Republicans in power, folks on the right would be beating the drum of fiscal responsibility.

    As they did during the Bush 43 administration?

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