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Thread: Heroin

  1. #1
    Member Sensei's Avatar
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    Heroin

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    The picture says it all. I just worked 4 days in the emergency department starting Wednesday and kept a count of my patients; 1/4 of my patients were heroin overdoses or someone wanting detox. Two more were patients with infective endocarditis from IV drug abuse; historically I¬’d see a couple of cases PER FUCKING YEAR. This week is not an outlier as NC EMS agencies have dispensed 20,000 doses of Narcan this year which doesn¬’t count the many more doses dispensed by police and fire departments. One municipality in OH literally added a refrigerated container box car unit to its morgue to keep up with the volume of bodies. A local middle school is considering stocking Narcan after a near fatal overdose by a student last month.

    This problem is the direct result of the medical community providing easy access to prescription narcotics for 20 years and not challenging bullshit statements like this:
    1) ¬“Patients with non-cancer related chronic pain can be safely managed on long-term opiates with negligible chance of abuse and addiction.¬”
    2) ¬“Pain is the 5th vital sign.¬”
    3) ¬“Many of patients do well on long-term opiates, so we should not be too draconian in our approach to physician who care for these patient.¬”
    My favorite is the last one. My reply is, ¬“Yeah, well SOME patients well with blood letting. Let me know when you can define ¬‘doing well¬’ or predict who it will be.¬”

    All of that is self-serving bullshit used to justify a shitty approach to medicine that lines physician and Pharma pockets while resulting in 300,000 dead. In other words, thank you state medical boards, Joint Commission, and DHHS for doing a bang-up job with policing your own.


    Looking beyond the deaths, we face a possibility of a lost generation to opiates. Many of the blue collar employers in my region estimate that 1/3 of their applicants fail the drug test.

    Now, a word to those who want to ¬“end the war on drugs.¬” You now have a little taste of what happens when we unleash low-cost, highly addictive drugs on the population. In other words, if you really want to know why you are sitting in a waiting room with chest pain or appendicitis (or if your ambulance never showed up), it¬’s because 25% of my beds are occupied by overdoses.
    Last edited by Sensei; 11-26-2017 at 01:32 AM.
    I like my rifles like my women - short, light, fast, brown, and suppressed.

  2. #2
    happy sharps enabler Totem Polar's Avatar
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    Brutal.

  3. #3
    Site Supporter Lon's Avatar
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    Well said. All our OD deaths go to that morgue in OH you mentioned. I/we saw a huge spike in heroin after Ohio instituted the prescription database that doctors now have to check before writing scripts for pain and other meds. Before that doctor shopping was rampant and mostly uninvestigated since it was too time intensive.
    Formerly known as xpd54.
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  4. #4
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    Two thumbs up...

    Iíve done my best to avoid posting on this subject in the past, considering there are no easy answers and lots of strong opinions, but couldnít agree more with Senseiís post above. Iíd also consider adding overprescribing Adderall and other stimulants to young developing brains a contributing factor in methamphetamine abuse to your hate. Or prescribing strong anti-depressants to a young teenager with typical young teenager issues who then commits suicide. We are told the youngíuns brains are not fully developed until they are 26 and canít even have a beer because it damages their development... Even if the drugs themselves donít have lasting effects, establishing a pattern of behavior where drugs are the ďAĒ answer to your issues; what could possibly go wrong?

    I did a case on a doctor deliberately overprescribing opiates to a minority group. Original complainants were other medical professionals. Had a clear pattern over years and numerous patient files evidencing he was not practicing medicine as spelled out in 1919 Supreme Court cases regarding the same subject... Could not get a criminal prosecution because Ďcould not prove a motiveí (which is not an element of the crime).

    In support of ďThis has all happened before, and will all happen againĒ, a good overview of what happened a century ago:

    https://www.ncbi.nlm.nih.gov/books/NBK234755/

    And we are told drugs need to be legalized and addiction fought with the medical model. I might agree, if that model was how we dealt with leprosy a couple of centuries ago; e.g. complete segregation from society so as not to infect others. Until then, physician heal thyself.

  5. #5
    ...it tolls for thee blues's Avatar
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    Having worked narcotics cases for years both on the street side and the international trafficking side I can relate to the frustration. There seems to be no answer that comes close to solving this dilemma.

    You see the devastation in the streets, in the mules that body carry at great personal peril, and oftentimes in the agents and police themselves that witness and are exposed to some brutal scenes on a day to day basis.

    I've gotten so turned off by big pharma and the way drugs are advertised on TV like typical consumer products and so widely dispensed that I can barely stand to turn on the set. Five minutes of news and 25 minutes of drug commercials showing how happy folks are now that they're on Brain-Ex.

    When I went in to the ER a year ago to have both my hands stitched up, despite my protestations they didn't want me to leave that night without taking a handful of Vicodin capsules home with me. I told them I didn't want them and wouldn't use them and would call for a pain killer if needed. They insisted. So, I took them home and a year later they still sit where I set them on a shelf in my medicine cabinet. But what if I had less self-restraint and personal discipline? What if I just said to myself "well, they know best and wouldn't give them to me if i didn't need them"? The potential for going down a long dark road, that's what.

    Beyond whether "drugs" are legalized in this country, without a significant change to the mindset and culture from big pharma and the medical professionals on down to the public at large, this abuse and over-medication whether self administered or prescribed will just hasten our demise as a people and (formerly) great nation.

    I've gotten to the point where I will only go to the doctor if I need stitches or something arising out of a traumatic onset. That's on me, but it's in large part a reaction to the "there's a pill for that" mentality which is what actually sickens me.
    Last edited by blues; 11-26-2017 at 09:55 AM.

  6. #6
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    Crazy. The health care system is in lots of trouble. Sad state.

    The last few years I’ve had trouble getting opiate prescriptions (legit short term ones for pain control on major injuries) filled at the pharmacy. After 5 days in the hospital with the wife and twins during the birth process I didn’t look the most professional. If I suspect I might need to get a opiate prescription I dress up now and make sure the hair is well combed, lot less issues.

  7. #7
    Site Supporter 03RN's Avatar
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    I'm good with ending the war on drugs and I'm ok as using pain as a VS.

    The problems arises when opiates are the go to. There's a lot of other pain reliever's. Nsaids, acetaminophen, plus non pharmacutical methods that take time and energy to implement. Whose got time for that when we're understaffed.

    It's a whole shit show but making something illegal doesn't help. I'm of the opinion that the failure of the family in modern society along with our modern social media culture has done more harm than the war on drugs has helped.

  8. #8
    Site Supporter 03RN's Avatar
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    As per your chart I find it interesting that it took 10 years for deaths to increase after implementing pain as a vital sign.

  9. #9
    @Sensei I disagree that physicians are having their pockets lined with the opiod crisis. You could certainly point to specific pain clinics, or pain specialists perhaps, but your typical MD isn't getting a kickback, if that's what you're alluding to.

    It is true, however, when you make policy without strong evidence, as JCHAO did when they adopted pain as the 5th vital sign, you expose yourself to unintended consequences.

  10. #10
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    Iím sure Iím the odd man out here but, I think most prescription drugs should be legal and over the counter. The FDA should only regulate their purity. I also happen to think everything class III should be cash and carry over the counter too.

    Why? Because itís a self balancing system. Eventually people will self select. I run opioid overdoses all the time, sometimes the same people, week after week, month after month, and eventually they self select which corrects the problem. Once theyíre dead they arenít our problem anymore. Drug control works about as well as gun control.


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