Legalized pot: 25% decrease in painkiller deaths

[Loren Pechtel]

Yeah, but when you're getting what you can in the way of pills--C3s (which contain acetaminophen) are easier to get than C2s (which normally don't.)

And NSAIDs don't fry your liver, excessive quantities can do things to your kidneys, though.

I was thinking of acetaminophen in particular, but I just looked it up and it isn't usually classified as an NSAID because of its low peripheral anti-inflammatory activity, although, it is mechanistically related to the NSAIDs. That is to say, it is a COX-2 inhibitor, thus it inhibits prostaglandin synthesis in the CNS, which is how it acts as an analgesic, but it has low activity in the periphery (where an injury would likely occur) and thus doesn't effectively act as an anti-inflammatory drug. Interesting.

Yeah, NSAIDs are aspirin, ibuprofen and like drugs but not acetaminophen.

Excess NSAIDs are a kidney threat, excess acetaminophen is a severe liver threat.

 

[untermensche]

The people who die from opioid overdose are many times using the drug for intoxication, not pain.

But when they are given a safer drug, marijuana, to use for intoxication, the death rate goes down.

Another reason to legalize marijuana. Probably the safest known intoxicant.

Most people using opioids wont want to substitute with marijuana. The nature of opioids is that you want more opiods. My gut tells me this is from people substituting for pain management.

The nature of opioids is that you will have withdrawal if you stop taking them.

If you are using them for pain it is true you will eventually need more and more and eventually you will have to switch to another kind of opioid. But this process is slow and people generally don't die because of it.

But if you are using them to get high the danger of overdose is much greater.

And my take on this data, if it is true, is that if marijuana is used for the high people are less likely to use the opioids to get high. And with less use of opioids for intoxication we see less deaths from them.

 

[ZiprHead]

I'm wondering if the decrease in opioid deaths is due to the recent crack-down by the feds on pill mills and doctors who over-prescribe. It might have nothing to do with marijuana.

 

[KeepTalking]

I'm wondering if the decrease in opioid deaths is due to the recent crack-down by the feds on pill mills and doctors who over-prescribe. It might have nothing to do with marijuana.

Actually reading the article should disabuse you of this notion:

In states with a medical marijuana law, overdose deaths from opioids like morphine, oxycodone and heroin decreased by an average of 20 percent after one year, 25 percent by two years and up to 33 percent by years five and six compared to what would have been expected, according to results in JAMA Internal Medicine.

Meanwhile, opioid overdose deaths across the country increased dramatically, from 4,030 in 1999 to 16,651 in 2010, according to the Centers for Disease Control and Prevention (CDC). Three of every four of those deaths involved prescription pain medications.

 

[ZiprHead]

Actually reading the article should disabuse you of this notion:

In states with a medical marijuana law, overdose deaths from opioids like morphine, oxycodone and heroin decreased by an average of 20 percent after one year, 25 percent by two years and up to 33 percent by years five and six compared to what would have been expected, according to results in JAMA Internal Medicine.

Meanwhile, opioid overdose deaths across the country increased dramatically, from 4,030 in 1999 to 16,651 in 2010, according to the Centers for Disease Control and Prevention (CDC). Three of every four of those deaths involved prescription pain medications.

Yeah, I guess I should have looked closer at the article. I do know that the crack-down occurred only over the last couple years. My wife was a bookkeeper/accountant for a guy that owned a chain of pharmacies and they had to change their practices to avoid running afoul of the feds. They started turning away many patients with valid prescriptions.

 

[Bronzeage]

I'm wondering if the decrease in opioid deaths is due to the recent crack-down by the feds on pill mills and doctors who over-prescribe. It might have nothing to do with marijuana.

Not in my neighborhood.
From a November 2013 article:

They say a recent crackdown on prescription painkillers — and a 2001 law that eliminated life sentences for heroin dealers — has fueled the local heroin market.

“The squeeze created by the prescription monitoring program has made drug cocktails harder to obtain, and as a result, the market has re-discovered heroin,” said Pete Adams, executive director of the Louisiana District Attorneys Association.

 

[Loren Pechtel]

Yeah, I guess I should have looked closer at the article. I do know that the crack-down occurred only over the last couple years. My wife was a bookkeeper/accountant for a guy that owned a chain of pharmacies and they had to change their practices to avoid running afoul of the feds. They started turning away many patients with valid prescriptions.

As far as I'm concerned that amounts to malpractice. Of course the system won't see it that way.

 

[arkirk]

Yeah, I guess I should have looked closer at the article. I do know that the crack-down occurred only over the last couple years. My wife was a bookkeeper/accountant for a guy that owned a chain of pharmacies and they had to change their practices to avoid running afoul of the feds. They started turning away many patients with valid prescriptions.

As far as I'm concerned that amounts to malpractice. Of course the system won't see it that way.

Criticizing the "system?" I thought you believed in the system.

 

[ZiprHead]

Yeah, I guess I should have looked closer at the article. I do know that the crack-down occurred only over the last couple years. My wife was a bookkeeper/accountant for a guy that owned a chain of pharmacies and they had to change their practices to avoid running afoul of the feds. They started turning away many patients with valid prescriptions.

As far as I'm concerned that amounts to malpractice. Of course the system won't see it that way.

You are right about the system.

http://www.usatoday.com/story/news/nation/2013/06/11/walgreens-drug-oxycodone-license-80-million/2412451/

"The Centers for Disease Control and Prevention has called abuse of prescription narcotics, particularly opioid pain relievers, an epidemic.

The DEA had previously revoked controlled substances licenses for two Florida CVS pharmacies. In October, Cardinal Health paid $34 million to settle claims it failed to report suspicious sales of painkillers. Since 2009, federal authorities have charged 51 doctors with controlled-substance violations and 192 doctors have voluntarily surrendered their DEA licenses.

The DEA said Walgreens failed to maintain proper controls to ensure it did not dispense drugs to addicts and drug dealers. The DEA requires drug distributors to notify the agency of unusually large or frequent retail pharmacy orders for controlled drugs.

Ferrer called Walgreens' failure to report suspicious orders a "systemic practice that resulted in tens of thousands of violations."

While Walgreens-CVS et al may be able to absorb these costs, small pharmacy owners cannot.

The pharmacies my wife worked for stopped filling controlled drug prescriptions for people that just walked into the stores without a prior history at the stores.

 

[untermensche]

While Walgreens-CVS et al may be able to absorb these costs, small pharmacy owners cannot.

The pharmacies my wife worked for stopped filling controlled drug prescriptions for people that just walked into the stores without a prior history at the stores.

It is up to the discretion of the pharmacist, but I don't know of a single pharmacist working at a CVS in Florida, and I only know about a half dozen, who will take a Schedule II script from somebody who isn't local and isn't already in the computers.

When they come in with the oxycodone scripts as they do throughout the day, every day, the pharmacist just tells them that they are out of the drug.

And now hydrocodone (vicodin) is Schedule II.

This is all because of the hassle you get if you deal with these people, from the DEA.

 

[ZiprHead]

While Walgreens-CVS et al may be able to absorb these costs, small pharmacy owners cannot.

The pharmacies my wife worked for stopped filling controlled drug prescriptions for people that just walked into the stores without a prior history at the stores.

It is up to the discretion of the pharmacist, but I don't know of a single pharmacist working at a CVS in Florida, and I only know about a half dozen, who will take a Schedule II script from somebody who isn't local and isn't already in the computers.

When they come in with the oxycodone scripts as they do throughout the day, every day, the pharmacist just tells them that they are out of the drug.

And now hydrocodone (vicodin) is Schedule II.

This is all because of the hassle you get if you deal with these people, from the DEA.

Yup, doing the same thing her pharmacies did.

 

[Loren Pechtel]

While Walgreens-CVS et al may be able to absorb these costs, small pharmacy owners cannot.

The pharmacies my wife worked for stopped filling controlled drug prescriptions for people that just walked into the stores without a prior history at the stores.

It is up to the discretion of the pharmacist, but I don't know of a single pharmacist working at a CVS in Florida, and I only know about a half dozen, who will take a Schedule II script from somebody who isn't local and isn't already in the computers.

When they come in with the oxycodone scripts as they do throughout the day, every day, the pharmacist just tells them that they are out of the drug.

And now hydrocodone (vicodin) is Schedule II.

This is all because of the hassle you get if you deal with these people, from the DEA.

And so someone on a C2 drug can't move to Florida?


I have no problem with them checking with the doctor's office to ensure it's legit.

I support a database of all controlled substances prescription fills--I wouldn't mind it a bit if they went a little farther and the doc has to refer to a printout of the last year's fills for the patient before writing such a script. (Easy enough to do--the printout has part of a hash of the data. The pharmacist pulls up the same thing on their computer, the numbers should match.)

I do have a problem with them refusing to fill a legitimate prescription that's not from a pill-mill doc.

 

[untermensche]

I do have a problem with them refusing to fill a legitimate prescription that's not from a pill-mill doc.

The DEA will look at a pharmacist with suspicion if they are filling out of the area CII scripts. Why isn't that patient going to a local doctor and pharmacy?

Most pharmacists don't want the bother.

 

[Loren Pechtel]

I do have a problem with them refusing to fill a legitimate prescription that's not from a pill-mill doc.

The DEA will look at a pharmacist with suspicion if they are filling out of the area CII scripts. Why isn't that patient going to a local doctor and pharmacy?

Most pharmacists don't want the bother.

You investigate, you don't just blanket deny.

 

[untermensche]

The DEA will look at a pharmacist with suspicion if they are filling out of the area CII scripts. Why isn't that patient going to a local doctor and pharmacy?

Most pharmacists don't want the bother.

You investigate, you don't just blanket deny.

I don't know what pharmacy you're talking about, but in real pharmacies, where I live, if you are not local and want some oxycodone you will be turned away.

Filling out of town CII scripts can easily get you in trouble. It isn't worth it. Pharmacists don't get paid more if they fill more scripts.

 

[ZiprHead]

Filling out of town CII scripts can easily get you in trouble. It isn't worth it. Pharmacists don't get paid more if they fill more scripts.

Actually they do if they are the pharmacy owner, as in the case where my wife worked. However, they don't make any money at all if they lose their license.

 

[Sabine Grant]

One of the issues I have encountered in Florida is a lack of inter communication between prescribing physicians. John Doe being on pain killers due to a diagnosed chronic illness necessitating long term pain management and getting another script from a dentist following oral surgery. Med reconciliation is a nightmare when you have multiple health care professionals attending the same patient. If John Doe gets his scripts filled in different local pharmacies, there is no assurance that other scripts for a similar med filled in a different pharmacy will be showing up in the data.

Tampa Bay is notorious for being a pain-mill area. Attracting "pain-mill tourism" meaning an influx of addicted folks out of State. Therefore our local pharmacies being suspicious of patients without a previous local history of filled scripts. Other issue being some of the Tampa Bay located pain management clinics handing out scripts like candy without a clear/cut medical justification. Or being too generous in the amount of pills prescribed at once. If a pain management specialist can monitor whether the patient is taking his meds "for pain as needed" based on a 3 to 4 times a day dose and only for pain on a 30 days prescription, when handing out a script for 90 days, it leaves the patient without follow up visits for 3 months and highly susceptible to take them chronically even without any pain as if taking a blood pressure medication.(keeping in mind the highly addictive property of controlled substances pain meds)

Such issue is aggravated when dealing with independently living elderly seniors who often mismanage their meds.

 

[untermensche]

One of the issues I have encountered in Florida is a lack of inter communication between prescribing physicians. John Doe being on pain killers due to a diagnosed chronic illness necessitating long term pain management and getting another script from a dentist following oral surgery. Med reconciliation is a nightmare when you have multiple health care professionals attending the same patient. If John Doe gets his scripts filled in different local pharmacies, there is no assurance that other scripts for a similar med filled in a different pharmacy will be showing up in the data.

Tampa Bay is notorious for being a pain-mill area. Attracting "pain-mill tourism" meaning an influx of addicted folks out of State. Therefore our local pharmacies being suspicious of patients without a previous local history of filled scripts. Other issue being some of the Tampa Bay located pain management clinics handing out scripts like candy without a clear/cut medical justification. Or being too generous in the amount of pills prescribed at once. If a pain management specialist can monitor whether the patient is taking his meds "for pain as needed" based on a 3 to 4 times a day dose and only for pain on a 30 days prescription, when handing out a script for 90 days, it leaves the patient without follow up visits for 3 months and highly susceptible to take them chronically even without any pain as if taking a blood pressure medication.(keeping in mind the highly addictive property of controlled substances pain meds)

Such issue is aggravated when dealing with independently living elderly seniors who often mismanage their meds.

Another thing pharmacists look at is the dosage and quantity of the drug.

If somebody has a script for 120 30mg oxycodone tablets you just aren't going to get that filled by many pharmacists that don't know you.

If it's a script for 9 5mg tablets you might.

 

[Loren Pechtel]

You investigate, you don't just blanket deny.

I don't know what pharmacy you're talking about, but in real pharmacies, where I live, if you are not local and want some oxycodone you will be turned away.

Filling out of town CII scripts can easily get you in trouble. It isn't worth it. Pharmacists don't get paid more if they fill more scripts.

So someone on a CII simply can't travel?

 

[untermensche]

I don't know what pharmacy you're talking about, but in real pharmacies, where I live, if you are not local and want some oxycodone you will be turned away.

Filling out of town CII scripts can easily get you in trouble. It isn't worth it. Pharmacists don't get paid more if they fill more scripts.

So someone on a CII simply can't travel?

They had best take enough to make it through their trip. It is no crime to carry your prescription drugs across state lines.