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My erection lasted more than 4 hours.

Hey now... that's all for recreational activities.

The opioid epidemic is much more complicated than anyone in here has mentioned and is much more than just say no, just don’t do it, personal responsibility, doctors are bad, RX vs non RX opioids etc.

I’ve been working on this and related subjects for over a decade in 12 States but it’s really intensified lately. Most of the latter part of this week and all of next week will be dedicated to it. The admin change did change the approach a bit (not for me to decide better or worse in here). I’d say there is more focus on the criminality now but it’s still the same people working on it.

I worked on a project about 10 years or so ago trying to get doctors, particularly in nursing homes to stop prescribing Propoxyphene (think darvon etc). It was pretty well established the pain relief was no better than Tylenol alone (NSAIDs areterrible for you too), but the addition of the narcotic brought all the side effects of narcotics with no added benefits. Yet even with the established proof of this drs, patients, and nursing homes resisted to the bitter end just using Tylenol. It couldn’t possibly be as effective. I’d bet some in here have considered or heard someone consider it something great. It wasn’t, and we knew it. As a result, while we did change the behavior of many communities and could prove the benefit or our work in peer reviewed journals we still had wide segments that would not budge. Luckily the FDA came along pulling it from the market thus shuttering my project.

Antimicrobial stewardship has much the same issues. I can’t possibly get better without antibiotics. And yes, marketing plays a part in both Propoxyphene type situations and antimicrobial stewardship. People get convinced they know something and no amount of information is going to change their minds. If their doctors are problematic to them they will change.

I was in a conversation with doctors and pharmacists in Alaska I work with yesterday afternoon. Much of the conversation was around the fact that long lasting opioids have no merit other than end of life or some cancer patients. Yet they are too widely prescribed for many of the same reasons Propoxyphene was. We are trying to design ways to address this on the front end as well as in review. This was just one part of a conversation that talked about probably 10 different approaches we are trying in their state alone (things like limiting scripts to 3-5 days, various pain management protocols etc)

Medicare beneficiaries are becoming a bigger part of this epidemic not because they are inherently dopers. They are being prescribed things (some appropriate, some not) for legitimate reasons that are leading to bad places. While some of the crisis is a street drug crisis, much is not. At least the part I’ve been working on daily.

The sound bite conversation doesn’t capture it at all. It’s a fascinating, sad, and thought consuming problem. One that is certainly challenging me and my peers and something I enjoy working on. We will likely never solve it but maybe can make it better for some. Despite all the hours I’ve spent on this I am in no way an expert. It’s too complicated for me to get my arms round it enough to consider myself as such. But we keep plugging in it and are making progress. We can and will make more, and something will happen (like the fda move with Propoxyphene) that will really change things.

I love my job.

Love ya, man...

You should be. What we're doing isn't working.

I'm keeping an open mind about it... I hope and pray that we figure it out. Education and ad campaigns, much like the ads targeting smoking, need to start ASAP.

Yeah we do... but maybe with beer, or scotch... I ain't shootin up.

Macs that’s why I say I’m no expert. I’ve been immersed in it for so long and don’t know the answer. It’s not that easy.

Same with health care delivery systems in general. Some might call me an expert. I don’t. But I’ve lived breath d and studied it for 30-35 years.

I do get annoyed by politicians acting like they experts and summing things up in 30 seconds or less.

In your case we’d invite you in to the the collaborative, listen to your web experience personally and professionally and hope you’d listen to others (you would). Then hopefully everyone would return to where they came better for it and looking at things differently plus they would have a network of people and info to tap in to.

Docs, pharmacist etc won’t solve this. It takes much more than that.

Frank I Love ya man but have to correct you. I don’t actually do anything. I just coordinate and oversee those that do. It amazes me a dumb ass like me was chosen to ride herd over the smart people.

I mean that. I work with some of the smartest people on the world and they humble me folks very day.

The fact that you said this^^ explains why they chose you.

You do not have to be the smartest man in the group to be the leader. You have to be able to put the smart people where they need to be in order to do the most good, or be the most productive.

Leaders don't have to be geniuses. They have to admit they're not, listen to the ones who are, and manage the strengths and weaknesses of the collective group. If you didn't do that, you wouldn't be there.

Edit: You wouldn't be there for long...

Sometimes dip****s get to lead, but they don't last.

Never lol. Drinking beer and antihistamines. If only I practiced what I preach.

Ya know it’s cliche but if someone was to study how to direct culture change it would apply to so many subjects.

This is a culture change issue as much as a medical one.

Wow, this conversation got serious all of a sudden.

Keep up the good work tw! (barking orders and chit).

Frank, keep being the smartest person we know (except for tw, he barks orders at people smarter than you).

Too mushy for me in here now, peace!

Ya, helps... can we go back to trolling cacman now?

That was more fun.

#73 TW ^^^

It didn't help...

So,

I have a hernia in my belly button...

I try to give you credit for being a leader... and then you say shit like that.

Freak.

I'm curious tho how someone can judge the pain someone else is feeling... If a dude has been taking pain pills for years that may make him sound like an addict.... But without the pills he feels severe pain.. does the war on pain pills then force the dude to find illegal drugs just to function everyday..??

That's only because princess Vicki has kept his pie-hole shut and hasn't started with his personal attacks distracting away from the subject, yet. Wait for it…

It’s part of the problem for sure but just one part. There are so many tentacles.

For the record Part D was a Bush expansion and imho a good one although it was a pain in the ass to implement. It added drug coverage, but in the end that’s not really the problem. By paying for them at least you can track them. Private pay or multiple payer is often not on the radar. In some cases we can now identify someone in danger of overdose or adverse event prior to the event. That’s one approach but some folks use multiple docs, multiple pharmacies, multiple payment methods etc. and some of thes are cheap because they’ve been around forever. Thus there is a cash market. That’s one thing the 3-5 day max RX is going after. That and the glut.

I’ve enjoyed working on this crap through Bush, Bammy, now Trump. I can’t really pin it to an admin. (For the record I’ve never been a fan of bammy care). It’s not Bush, Obama, or Trumps fault. I liked the approach to this under obama better than what I’m seeing under Trump but need to give this admin more time to sow their oats. I’d say at first blush the approach under Bush and Obama was more nuanced and more multifaceted. It seams the newer approach is more simplistic and misses some things.... but again I’m just another opinion, and have to work within whatever play book is in place. And again, regardless of admin many of the same people are working on this. It becomes a resource or focus issue. The resources under this and the past admin are there as far as I can tell.

Drafter we are finding there are better ways to manage pain, but I don’t have all the answers and that is a dilemma. At some point if it takes more and more opioids to control it’s not working and the “cure” or mask is worse than the disease/pain. Also go back to the Propoxyphene example. The person in pain may be convinced it’s better than Tylenol. But it’s not, causes more problems for no additional benefit, and there are better ways. It’s a tough problem. There is a cost benefit equation here. Cost not being money in this case. With opioids the cost can quickly overtake the benefit. They are not magic.

But that is countered by the pussification of the entire nation. Granted not everyone feels pain in the same way, but for crying out loud, some folks just use it for an excuse. Both my wife and I get migraines and yet wit one or two rare exceptions we still went to work.

Too often people want to take a pill and do nothing else, it almost never works that way. You want to see frustration, watch the face of a heat doc explaining lifestyle changes to a recent heat attack victim. He'll be telling them things to keep them alive that he know most will not do but will be back in the hospital begging him to save their lives again. I've seen drug peddlers visit physicians with all sorts of incentives to prescribe their products and offering all soft of incentives both expensive and trivial, ingratiating their company to the docs.

Found it interesting that Anthony Bourdain (recovering coke and heroin addict) addressed the opioid epidemic during a short segment in his show:
http://www.cnn.com/travel/article/massachusetts-parts-unknown-season-4-episode-7/index.html

Some call these soundbites as pushing an agenda. But remember it was similar soundbites and propaganda that pushed the opioid epidemic to the point we have today. And its the same type of soundbites and propaganda in our history that pushed marijuana into the stigma many still believe today. On one hand you have reefer madness and the guberment telling you pot is as bad as heroin. But on the other hand you have the same guberment pushing drugs on patients and paying doctors to over-prescribe opiates while telling you opiates are saving lives. All while ignoring the addictive effects and the patients effected by the over-prescribing of these meds so doctors, insurance companies, and big pharma can reap financially. Hypocrisy at its best. The same guberment pushes health care responsibility and taxes on tobacco manufacturers, but not on drug manufactures. Go figure.

Where I live in CO they want to tax OTC MJ to pay for services to treat addiction to prescription meds and opioid addiction. On top of the MJ mil-levy applied to propoerty oweners, they actually want to tax on OTC medication that was approved by voters to bail-out the gaps left by federally funded health care businesses and insurance companies by promoting the sale and tax of a drug the federal guberment considers as bad as heroin. Again… hypocrisy at its best. If this tax is passed it will result in the only OTC medication in US history that is taxed more than its prescription equivalent. And taxed more than tobacco in CO. If this tax is passed it will set the precedent for other counties and States to pass similar laws. But Narcan is still free here if you overdose from opiates.

Knock-on-wood. I'm healthy, exercise, and eat responsibly. I've never had to go under the knife or have major surgery. My FIL has suffered from shingles for the last 5yrs and chose implanted nerve blocks instead or taking oxy and other opiate pain meds. I hope I never have to make that decision. Like many others, I do not trust that big pharma has my best health interest in mind. Nor do I trust the doctors receiving financial kick-backs for prescribing one drug over another. Health care is a business like any other… all they seek are profits.

In the end, do not vote for the guberment to control your choice in health care.

It’s natural to look for a scapegoat or someone or something simple to blame. It makes us feel better. This is a much more complicated subject than that and there isn’t one easy answer or a singular villain to blame.

I’m telling you the deeper you get in to this the more you say oh crap. But there are things we can do. For those that have a narrow focus of blame and thus some easy fixes all I can say is I hope it makes you feel better because your reality is very different than mine.

I would ask this. While I also consider RX adds a problem in general (not sure what to do about it given free speech and my desire for less government intrusion/control), specifically which adds for which opioids are problematic or contributing to the opioid epidemic?

I’m not asking with the answer in mind or as someone who knows.... I just dont recall seeing many opioid commercials. If the problem is advertising and kick backs I’d think I’d have noticed the advertising. The kick backs have happened. I’ve been involved in some prosecutions. While both are bad and worthy of sunlight, I’m not sure either is a primary driver of this crisis.

Maybe I’m too literal on the subject. There are problematic prescribing patterns that don’t rise to kickbacks or even illegality. There are many reasons for them. In those situations we identify them and educate providers either directly or more preferably through their peers. sometimes they are harder to identify than you think. Data is an issue. It’s a characteristic of a multipayor system. There is good and bad in every model.

But I’m telling you this spiderweb is much more complicated than that. Tip of the iceberg. Easy to get your mind attached to but don’t fool yourself.

They came in the mail... I haven't seen him in about 5 years tho.. I don't know if he's still receiving them or not...

I bet it’s not happening today.

Just watch. 30 day supplies will dry up too.

A lot of times the insurance companies tell the doctor what meds have to be prescribed first, before any other options can be explored.