Elected Barbarian Decides To Act As Your Doctor
Jeffrey Tucker writes at FEE about a Senator's "unfounded and callous ... intrusion into the practice of medicine":
Senator Robert Portman (R-OH) is proposing legislation that would impose a national 3-day limit on opioid prescriptions following surgeries. He will be kind enough to allow exceptions for people dealing with cancer, chronic pain, and "other serious matters"--whatever that means.Government data show there is no correlation between the number of opioids prescribed and their non-medical use or the development of opioid use disorder. Overdose rates skyrocketed during the last 10 years while high-dose opioid prescriptions dropped more than 58 percent and total volume of dispensed opioids dropped more than 29 percent.
Seventy-five percent of opioid-related deaths in 2017 involved fentanyl and heroin, and fewer than 10 percent involved prescription pain pills without also involving heroin, fentanyl, cocaine, tranquilizers, or alcohol.
...To bring the death rate down, Senator Portman should learn a lesson from his home state of Ohio, where a recent embrace of harm reduction measures--expanding needle exchange programs, distributing the overdose antidote naloxone, and increasing access to Medication Assisted Treatment--has led to a 23.3 percent drop in overdose deaths in 2018 according to preliminary CDC data. Harm reduction is a proven strategy for saving lives.
If Senator Portman wishes to craft legislation that can truly save lives, he should propose a repeal of the federal "Crack House Statute." This law stands in the way of many of the country's largest cities that wish to establish Safe Injection Facilities, which are preventing overdoses and saving lives in more than 120 cities throughout Europe, Canada, and Australia.
Sadly, saving lives by handing out clean needles probably isn't the stuff that gets Senators re-elected.
Senator Portman needs to get a blood clot in his leg and go cold turkey on the Opioids after 72 hours.
Isab at August 1, 2019 6:55 AM
First, the side discussion: The evidence is far from conclusive regarding needle exchanges and so forth. I'm not opposed to trying them, but for every study that shows that they help, there's another study that shows that they encourage addiction and have no positive effect. So there's that. I agree that communities should have the freedom to experiment.
Now, the main point: I am really getting sick and tired of the government meddling in medicine. This recent round with the government pressuring doctors to force patients into involuntarily withdrawal, and the resulting suicides, is blood on someone's hands, and everyone knew it was going to happen. The more doctors are discouraged from treating chronic-pain patients due to the DEA looking over their shoulder, the more these patients are funneled into "pain clinics" where the temptations of corruption are greatest. It's a self-fulfulling prophecy.
Most patients who take opioids for chronic pain become addicted. So freakin' what? They are functioning, a lot better than they would be without the drugs. They already have a lot of limits placed on their lives due to their conditions. Why impose more on them? Let them do what gives them a bit of freedom. They are addicts, but they aren't the problematic ones. As the article points out, most "opioid" overdose deaths are really due to combinations of drugs, often opioids combined with heroin and/or fentanyl. I would not be surprised if the latter was actually the cause of death in many of these, because if you're taking illicit fentanyl, it's very hard to know how large a dose you're getting.
And a weird sort of progress: Out in the sticks, as opioid used goes up, meth use goes down.
Cousin Dave at August 1, 2019 7:06 AM
I'd guess "other serious matters" probably encompasses major surgery leaving a patient with limited mobility for a while - e.g., open-heart surgery, spinal surgery, etc. - a limit that would make it difficult and painful for them to get to the pharmacy to refill that prescription three days after their procedure.
For patients who just had lesser surgery or an outpatient procedure, he's proposing we don't send them home with a bottle of 30+ opioids. Even if the person does not himself become addicted, that's a bottle of up to 30 pills that can be stolen or sold.
While, from that perspective, it makes some sense, I'm nonetheless leery of letting government bureaucrats supervise doctors or inject themselves into people's medical care. And the truth is we already have procedures to check on patients regularly using opioids.
I have an acquaintance who had open heart surgery a while back. He has to have periodic blood tests in order to refill his pain medication. Since his mobility is limited, this is not a simple matter for him.
I'm guessing this bill is aimed at people getting one-time prescriptions after surgery - i.e., that bottle of 30+ Vicodin you get after wisdom teeth removal or outpatient surgery. I still have two of them, woefully out of date, in my medicine cabinet.
No. Because people don't want addicts on their streets.
Three years ago I moved out of a town in the San Francisco Bay area that had been taken over by tweakers. They would steal packages off porches and do smash-and-grabs on cars parked on streets (older town, so fewer driveways and garages). They would pass out in the local parks, sleep on the subways and buses. And, once their inevitable mental decline hit TILT, they would wander the streets and scream at random passersby.
And the less-urbanized areas of town were not safe either. The tweakers would camp out near the railroad tracks in the hills above my development. Several grass fires were started every year from that camp. One made it to within 10 feet of my house. It's a bit unnerving watching a helicopter drop flame retardant on your own backyard - and realizing you almost lost your house because some tweaker needed a fix and left the fire burning.
While living in California, I used to work in San Francisco. It's a lovely place, and it has been utterly destroyed by homeless addicts living in the streets. And "living in the streets" means urinating, defecating, medicating, and fornicating in the streets.
A few years ago, driving from a seminar in Phoenix to the airport, I passed dozens of people passed out on suburban sidewalks - drunk or stoned. The neighborhoods flashing by were not ghettos or slums with boarded up housing and dealers on every corner. As far as I could see, they were middle class and working class neighborhoods.
Having needle exchanges doesn't mean that all the addicts will go home to their nice suburban bungalows to medicate and pass out in their own living rooms. It sometimes means they'll wander a block over from the exchange and medicate in the alley behind your house.
So, perhaps some kind of help beyond simply facilitating their addiction is needed. But the government doesn't have the money. You see, the government spent it all regulating hair braiding and dog walking.
Conan the Grammarian at August 1, 2019 7:11 AM
I suspect that part of the "other serious matters" will be anyone who has a prescription for adderall, which is a Schedule II drug.
I posted a link to the "Lunky Lumpenlinks." page about the 3 day stupidity in Florida. Living in Tallahassee, I've learned that when the 'slature is in session, it is wise to hide yo women, children, and wallet.
I R A Darth Aggie at August 1, 2019 8:20 AM
Oh, hell, this alone is worth reposting that link:
https://www.acsh.org/news/2019/07/30/florida-officials-successfully-withheld-pain-meds-surgical-patients-arent-they-special-14191
So, they're getting the smack from undocumented pharmacists?
I R A Darth Aggie at August 1, 2019 8:22 AM
I lived there for a while in the '90s. I'd love to say that with the presence of two universities, a community college, a nationally-ranked high school, and the state government, the collective intelligence of the place was high, but I can't.
Conan the Grammarian at August 1, 2019 8:24 AM
Florida Man strikes again. The smart play is to lock such external power sources so you don't find some random Tesla 3 parked on your lawn charging from your power.
https://jalopnik.com/entitled-tesla-jackass-parks-on-strangers-lawn-steals-1836730035
I R A Darth Aggie at August 1, 2019 8:27 AM
We used to call them independent pharmaceutical representatives.
Conan the Grammarian at August 1, 2019 8:27 AM
"A few years ago, driving from a seminar in Phoenix to the airport, I passed dozens of people passed out on suburban sidewalks - drunk or stoned. "
Interesting... was this in the neighborhood west of the airport? I go to Phoenix a lot and I'm trying to picture the area you're talking about.
Cousin Dave at August 1, 2019 12:58 PM
To be honest, I'm not sure. The seminar was at one of the big hotels downtown and the car service drove me to the airport, so I didn't pick the route. I just remember being shocked at the number of people passed out on the sidewalk with empty liquor bottles on the ground next to them.
It was 114º the day before, so heat may have played a role.
Conan the Grammarian at August 1, 2019 1:08 PM
Please recall the provision for opioid tracking in this proposal.
You still have to do something other than give stuff away. Given the choice, many, if not most people will choose to GET things, rather than DO things.
Doing requires, well, you know, effort. Ugh!
Radwaste at August 1, 2019 2:34 PM
"harm reduction measures--expanding needle exchange programs, distributing the overdose antidote naloxone,"
How is this any less government "adulting" for us than banning YouTube's autoplay? It's all the same thing - using my tax dollars to get between people and the consequences of their stupid choices.
While I don't support this legislation, Americans Do need to cowboy up when it comes to medical pain management. In Asia, post operative pain medication use is one-fifth what it is in the USA, and their patients heal faster.
bw1 at August 1, 2019 4:53 PM
While I don't support this legislation, Americans Do need to cowboy up when it comes to medical pain management. In Asia, post operative pain medication use is one-fifth what it is in the USA, and their patients heal faster.
bw1 at August 1, 2019 4:53 PM
You can’t trust statistics coming out of any Asian country. Addiction is conserved. Japan is quite proud of their harsh drug laws, and no opioids. What they don’t tell you about is the sky high rate of alcoholism because it is one of the few effective pain killers that is readily available. Lots of pain in Japan and people are self medicating dangerously with what they can get.
Isab at August 1, 2019 10:26 PM
> alcoholism because it is one
> of the few effective pain killers
> that is readily available.
The word "available" doesn't have enough syllables to describe all suffering that gets swept out of sight from these topics.
Crid at August 2, 2019 3:53 AM
Crid at August 2, 2019 4:06 AM
"What they don’t tell you about is the sky high rate of alcoholism because it is one of the few effective pain killers that is readily available."
This was in reference to the rate of pain medication use in immediate post-operative INPATIENT care following major surgery and was based on hospital records. Is it your contention that how many people the day after open heart surgery get up and go out to a bar, and what do they do with their chest tube?
bw1 at August 4, 2019 4:57 PM
"What they don’t tell you about is the sky high rate of alcoholism because it is one of the few effective pain killers that is readily available."
This was in reference to the rate of pain medication use in immediate post-operative INPATIENT care following major surgery and was based on hospital records. Is it your contention that how many people the day after open heart surgery get up and go out to a bar, and what do they do with their chest tube?
bw1 at August 4, 2019 5:24 PM
"self medicating dangerously with what they can get."
Dangerously isn't a given. We owe some great strides in our society to functional drunks.
In general, our most of the population are are indolent crybabies with regard to medical pain, and there are perverse incentives in place to encourage that. Medicaid reimbursement for hospital stays is dependent on a patient satisfaction questionnaire that is heavily biased in favor of overly aggressive pain management. The best strategy for getting full reimbursement is to make sure they can't possibly complain that they suffered "too much" pain.
My brother was in the ER for a split lip that required stitches and the nurse tried to give him Fentanyl, over his strident objections. He finally had to physically overpower her, take the syringe, and put it in the sharps dispenser. Nurses in the hospital have tried to give my mother Fentanyl for mild arthritis in her arm.
We've come a long way in our approach to pain since the first appendectomy, where the surgeon was also the patient. It hasn't been a purely beneficial progression.
bw1 at August 4, 2019 5:35 PM
But that's not to say that politicians should be making the decisions - after all, they created the perverse incentives in the first place.
bw1 at August 4, 2019 5:36 PM
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