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Opioids could kill nearly half a million people across America over the next decade as the crisis of addiction and overdose accelerates.

Deaths from opioids have been rising sharply for years, and drug overdoses already kill more Americans under age 50 than anything else. STAT asked leading public health experts at 10 universities to forecast the arc of the epidemic over the next decade. The consensus: It will get worse before it gets better.

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  • and why because of the purity and the cost . lased with who knows what and needing to “sleeze” around to get it . that is why so many overdoses occur.
    Friends after following ALL arguments to the end one solution is the only sane way to stop the carnage.
    These drugs MUST be legalized with few restrictions .
    Question- will you go out and get strung out when it becomes legal–I seriously doubt it!!!!!!!!

  • Thx Lauri, read the white paper and agreed with most of it, except the 1% get addicted. Good article by docs who care. Sorry to see no reference to buprenorphine and its safety and effectiveness. Same reasons as I already suggested, sorry to say. Epidurals used frequently with very rare episodes of arachnoiditis. More common with surgery. Have had many patients get them and none with more than a few weeks relief even when receiving a standard 3 injections. More common with surgery. PAIN AND ADDICTION is a book and available on Amazon. Edited and organized by ASAM.
    As far as the 1%, couldn’t find references on the link or full article. Note that Purdue, maker of Oxycontin, and others are being sued about their claims in the 90’s of only 4%. 15-20% have the genetic risk. Only article people can find about 4% was a letter to editor. Acute pain has some protective benefit to reduce addiction, but not chronic.

    • Bob, read the first paragraph of the full-report Cochrane study, then skip to the very last paragraph: “Signs of opioid addiction were reported in 0.27% of participants in the studies that reported that outcome. All three modes of administration were associated with clinically significant reductions in pain, but the amount of pain relief varied among studies. Findings regarding quality of life and functional status were inconclusive due to an insufficient quantity of evidence for oral administration studies and inconclusive statistical findings for transdermal and intrathecal administration studies.”

      Thousands (actual number unknown, because it’s more often mis-reported as “failed back surgery syndrome” — and many who have had back surgery have ESIs both before and after surgery), of arachnoiditis victims would disagree with you. As a victim of this invasive insult to my body, I am permanently damaged, and people should be fully made aware of its risks (and non-FDA-approved status) as part of informed consent.

    • Suboxone ,buprenorphine, is nothing but another billion dollar scam by big Pharma, Medical Fascism. It sticks to your receptor sites like concrete and man is it difficult to come off of……………. first yes insurance pays up to about a year then 10$ a wack – big money . Yes it stops the detox symptoms , yes but at what costs–made with industrial chemicals . ONLY SOLUTION TO THIS WHOLE MESS IS TO FOLLOW PORTUGAL AND CANADA AND LEGALIZE THESE DRUGS , PERIOD AND END OF STORY . At that point it will become a ho hum topic like ” Oh yeah, you inject opioids , thats nice , what else do you do.”Boring at best , no more full prisons , much fewer overdoses and sure as you know it , the drugs have won the war on drugs. Better living through CHEMISTRY .

  • Bob, here is the link to the “less than 1% of long-term use patients on opioid therapy become addicted.”

    BTW, epidural injections, pain pumps, and spinal cord stimulators all put the patient at risk for dural puncture and the lifelong agony of Adhesive Arachnoiditis. The steroid has never even approved for use in the spine! Yet people are crippled daily by this barbaric, risky procedure — most cases of arachnoiditis are iatrogenic, and therefore covered up by doctors.

  • Laurie, you are incorrect about opioids causing only 1% addiction. In the 90’s we were told Oxycontin caused only 4%. Also wrong. 15-20% of the population have the genetics for addiction, which is why so many got addicted to opiates when we realized we were undertreating pain. The basics are to have a full evaluation by your doctors. Treat surgically when available and seems sensible. See a pain specialist and review what is available, such as implantable stimulator wires, and others. When treatment options are exhausted and you need to manage chronic pain, use the multidisciplinary options available, then safe medications for most of us in proper dose like tylenol and anti-inflammatories. If all the above doesn’t bring the functional abilities we need, opioids are an option. Since buprenorphine is much safer and effective for most patients, and has alone caused no deaths, it is safer for you and for society. Jim, the book EVIDENCE BASED CHRONIC PAIN MANAGEMENT goes over most pain issues and explains what helps, based on scientific evidence. It also points out what doesn’t help, such as lumbar steroid injections. Cervical steroid injections do. Laurie, it is sad there is so much prejudice (‘flagged as an addict”). It is one of many reasons physicians don’t use much buprenorphine, as it “is a drug for addiction.” Read PAIN AND ADDICTION, just published by ASAM. I will read WHITE PAPER.

    • Bob, here is the link to the “less than 1% of long-term use patients on opioid therapy become addicted.”

      BTW, epidural injections, pain pumps, and spinal cord stimulators all put the patient at risk for dural puncture and the lifelong agony of Adhesive Arachnoiditis. The steroid has never even approved for use in the spine! Yet people are crippled daily by this barbaric, risky procedure — most cases of arachnoiditis are iatrogenic, and therefore covered up by doctors.

    • I went to ASAM’s website; it appears to be a site for addiction medical provider continuing education. I don’t know what I’m looking for; can you provide a direct link to the article you mention?

  • Jim, you are correct. Throwing out the opioid baby with the epidemic is nonsense. But, there are better ways to manage your pain, with a multidisciplinary approach, and non-steroid anti-inflammatories. and tylenol. There is a British book, EVIDENCE BASED CHRONIC PAIN MANAGEMENT. The key is to manage your function, not your pain. Sorry, we can’t get rid of it all. If you function ok, your pain will be better, but never perfect. One problem for people that do use opiates is tolerance they develop, so they work less well with time, requiring higher doses. If your opiate is working after years, fine. If it isn’t, you will find buprenorphine has a lot less tolerance develop, once you find the right dose. It is safer, Sched. lll, and your doc can call it in and doesn’t need a special license to treat your pain, just write “for pain” on the rx. Used without other sedating meds or sedating diseases, it has no deaths. Zero! And it works for most of my patients over the last 14 yrs. If your doc won’ t Rx, find another who will.
    Your comment about the epidemic being about drugs mixed with heroin is accurate. Drugs similar to fentanyl are easy to make and come via China and other countries. They are 100 to 10,000 times stronger. Not so good if you expect regular heroin in your Fix. We could provide a product that is pure and people know what they are getting, like we do with nicotine and alcohol, and make $ taxing it. Prohibition and wars on drugs have never worked. Google the Portugal experience, or look at Oregon decriminalizing. Allow rx in Jails. Time to accept this as the brain disease it is, instead of telling people to just say no or make better ‘choices’. We will always have addiction, but we don’t need the crime that goes with it. Must address the brain disease in an individual different than we do the issues of society with drugs. Read CHASING THE SCREAM by Johan Hari.

    • So rather than opiates and opioids, which are safer, you want us to poison our livers with tylenol and our kidneys and GI tracts with NSAIDS? You want us to switch to buprenorphine — and get flagged as an addict forever? We need to REDUCE pain in order to INCREASE function, not the other way around. We are smart enough to know that our pain will not be completely eliminated! This is a sad way to placate the DEA and the other alphabet-soup agencies interfering with our doctors and our health care. Fewer than 1% of chronic pain patients become addicted. We need to treat the PROBLEM, not attack the innocent. I wish I could post the ATIP graph here, which shows that when legal rx-precribing goes down — and it’s gone down every year since 2012 — that ILLEGAL drug use has increased exponentially. You REALLY need to read Red Lawhern’s White Paper; get the real facts.

    • Locking people up has never worked, and WILL never work. I had to look up Buprenorphine, then realized it was Naloxone. I received a flier from my pharmacy along with my refill once, recommending that I keep some Naloxone on hand in case of an “accidental overdose”. The first thing that came to my mind, is why would I have to worry about that, when I’ve been safely taking my oxycodone for quite a few years, with no issues or concerns whatsoever? The next thought, as Lauri pointed out, was that asking for Naloxone could conceivably cause some people to infer that I might not be taking my Oxycodone in a safe manner, as prescribed. I decided that since there was no possibility after all these years, that I was going to suddenly start taking my meds in any way other than as prescribed, it might not be in my best interests to ask for something I don’t need.

      As for the Tylenol, I actually worry more about what that could be doing to my liver, and I’m glad that they reduced the Tylenol in 10 mg Oxycodone from 750 mg to 325. I didn’t notice any decrease in the efficacy of my Oxys when they made that change.

      I take 45 mg of Oxycodone a day, consisting of 10 mg tablets that I break in half. I only take 5 mg at a time, and if I’m not feeling better after an hour, I may take another 5 mg. My needs fluctuate during the day, depending on my activity lever, with the worst time of day usually being from around 6-10 PM. Somehow, I manage to make it work because I know I have to budget my medication even more stringently than I do my money. I’ve been at the same dosage for about three years now.

      One thing I’ve noticed in addition to the tolerance phenomenon, is The Law of Decreasing Returns. The higher your daily intake is, the less relief you’ll experience from an increase of a given dosage. For example, you’ll perceive more benefit from an extra 5 mg if you’re starting from an old dosage of say 30 mg a day, than you will starting from a previous dosage of 40 mg a day. It’s simply a percentage problem.

      The only other way I’ve found to control my pain is to reduce my activity level, and even more importantly, get more sleep. All of this takes a lot of self-discipline, but that’s the only way you can make this work long term.

      As a side note, I tried spinal steroid injections years ago, but I’m diabetic, and my glucose levels went completely off the scale. It did work, but only for three days. Not a very good option for me.

  • STAT is doing a huge disservice to chronic pain sufferers who take reasonable amounts of opiates under the care and supervision of responsible doctors. WE are not the junkies, the recreational drug users, or the dealers. We’re just trying to remain functional while dealing with chronic, unrelenting pain. If you’ve never experienced it, consider yourself very fortunate, and also consider the fact that all of us living with it were just like you… until the day that we were injured or developed a disease. You are not in that position solely by the grace of God, with no guarantees for the future. I’m so sick of reading articles like this, full of hysterical lament and concern for a problem you clearly don’t understand, or deliberately misrepresent. Nearly ALL of these opiate deaths you cite are caused by heroin junkies, Fentanyl abusers, and people self-medicating with street drugs and NO doctor supervision. Why can’t you report this “Opioid Epidemic” fairly and honestly, and tell us how many of these deaths were people using drugs legally and responsibly? I’d be willing to bet that it would amount to no more than a tiny percentage. Personally, I’d rather be one of them that try to live in pain every moment of my life. I’m 70 years old. I’ve injured my back twice, just trying to earn a living. If I die today or ten years from now… what difference does it really make? At least I’ll be out of pain.

  • The DEA & the Prez did NOT think this Opioid problem through! It’s fine to get the pain pills, etc out of the hands of junkies & those who just want to get high, BUT what in hell are the millions of chronic pain sufferers suppose to do? You think the opioid deaths will go down but surprise! I guarantee they will go up and from the innocents who need them, not only to survive, but to have some semblance of a life. So their only recourse is to get heroin from the streets (and they will) and they will be in so much pain, they will keel over from a stroke or heart attack because their vitals are off the charts, or they will decide this is no way to live & WILL commit suicide!!! So right there the people who DC o need it to just function, you’ll be losing them in one of three ways because they will be so desperate to just try and somehow escape the pain. It will happen and I hope the Prez, DEA, CIA and FBI will be proud of themselves. If you think I’m exaggerating, I’m not…it happened to me last night. I had been out of my pain meds for about six weeks. Couldn’t sleep, couldn’t eat (lost 27 lbs in a month & I can’t afford to lose any more weight), there was no way to escape the pain. I considered suicide, I just couldn’t take the pain any more. This is no way to live. I haven’t even been able to pay my bill’s, so now my credit is in the toilet. So just before, I called a cab, waited for two hours and went to the Hospital Emergency Room. As soon as I walked in the door, a nurse took my vitals (which are normally right on the money 120/80. My BP was 299/116 and my heartrate was 249! All from PAIN!!! Suffice it to say everyone freaked. The nurse yelled across the room at two other nurses and they rushed me in to see a doctor. They took my vitals again and it actually went up! There were only four meds I was taking, two no-no drugs, something for the nerve pain (not on the list) and one for anxiety. The doctor was concerned about the two, but figured it was better to give me something then have me die on him right in front of everybody from a stroke or heart attack. They kept me hooked up to t B/P cuff and told me I’d be there for at least three hours to monitor me as he couldn’t let me leave, the shape I was in. After an hour, it went down slightly, but still dangerously high. Long story short, I was there for three hours & it never did go down anywhere close to normal, but enough that he felt I’d least get out of the hospital, b4 I’d die of a major heart attack or stroke. Unfortunately I had to wait again for two hours to get a cab to get home. I realize this is a horrible thing to say, but I hope, I really do, that the prez gets something that will cause Ihim such unimaginable, everday pain, because that’s the only way he’s going to get it. Walk a mile in my shoes and all…You guys REALLY better rethink your grand Opioid plan, or else you’re going to have more dead bodies and probably a huge HEROIN problem to boot.

    • I’ve been saying that all along, Lorraine. You, I, and all the other chronic pain sufferers shouldn’t have to live like this… like we’re the “criminals”. I also wish that those who are so quick to pass judgment and make stupid laws, would experience enough of this misery to develop a little empathy. Do they think we like living this way, and always being at the mercy of someone else’s political whims? I really wish there was some way I could help you. Waiting two hours, just to get a cab ride to the hospital? That’s terrible, and it’s a wonder you even made it. I hope you can find someone to help look out for you so that doesn’t happen again. (((HUGS)))

  • It amazes me how much false info is just being passed along and passed along…. Without the media doing their due diligence.

    First of all, it is NOT prescription drugs that are at the heart of the problem. Never was. It’s street drugs.

    Unfortunately, our govt does not differentiate between illicit opioids and prescription opioids when stating cause of death on a death certificate. Anyone who uses illicit fentanyl, from China or Mexico, and dies, is listed as opioid overdose. Also, in research done by the pain foundation and Dr Michael Schatman, after studying overdose death info posted by coroners, it was found that of 19,000 overdose deaths, only approx. 10% or 1,900 were due only to prescribed opioid(s).

    The rest were due to street drugs and the avg number of substances they had in their system at the time of death was 6. Including heroin (also reported as opioid death), illicit fentanyl (reported as an opioid death) from China or Mexico, alcohol, meth, muscle relaxers, etc…

    More than half of all addicts start by stealing someone else’s prescription medication. Addiction medicine is A HUGE money maker, pain medicine is not. It’s all about the money… Follow the money.

  • Wasn’t going to comment, but now with the new blog, maybe this will help. The reason the DEA doesn’t make it available is that there are no good well controlled double blind evidence based medical studies that prove it works. Most of the info we get is word of mouth that it works. CBD oil has THC in it. My patients test positive for it. There are 3-400 chemicals in cannabis. Some of them might work, but we won’t know until good, large studies tell us. Meantime, nobody is telling about the psychological effects, which are significant and include 3x risk for schizophrenia. AG Sessions wants to fight another war on drugs and lose. We need to decriminalize it as Oregon did a few mo. ago with ALL illegal drugs. We thought it good for kids for seizures. A Colorado study said it was not very effective. “Medical cannabis” is an excuse to use. Just legalize it. We all know smoking will kill you eventually. We allow people to smoke. We should allow people to use pot, but it is time for the Surgeon General to tell us it is addictive for 9% of adults, 17% of adolescents, and has these significant psychological effects we need to know about. Write them on the package like we do for addictive nicotine products, have folks sign a disclaimer they know it is addictive, which should be done for nicotine and alcohol as well, and give them a number to call if they get addicted or have questions. Educate folks about all these addictive substances including alcohol. With pot people need to know it can and will reduce their IQ, dose related. It causes lack of motivation, anxiety, paranoia, and the munchies. It messes with your memory. Its a no brainer about what to do here folks.

    • Good answer, Bob. I’m not a doctor, but I couldn’t agree more as to the effects of smoking pot. I tried it back in the late sixties, but never considered it a necessity in my life, and soon gave it up. I don’t drink or smoke anything now, but that’s clearly by choice. I have tried pot a couple times in the last few years, and the stuff people are smoking today scares the hell out of me. It was not my idea of a good time. Paranoia? I couldn’t even be around anyone else, and I couldn’t wait for it to wear off. I think the stuff people are smoking today is way more dangerous than what people smoked fifty years ago, and anyone who smokes it every day is probably damaging their body and mind more than they realize.

    • The DEA, etc. REFUSES to recognize evidence. Plenty of studies have been done, just not in the US because the US tied itself and the industry up in knots so that it’s very difficult to do. There is a plethora of medical evidence coming from studies in Europe, and in particular, in Israel.

      BTW, I used to be one of those “scoffers” who thought the concept of “medical” marijuana was a joke. After 6 back surgeries, arachnoiditis, and CRPS, it’s no joke. It IS medicine; you are just too blind and prejudiced to see it. Because of it I no longer need to take gabapentin, ambien, flexeril . . . and have cut my opioid medication by half. So don’t speak about what you don’t know about, especially with your heart set on vilifying a medication that works for so many. And like other pain medications, it increases my ability to function to maintain my life and still be of use to others. I far prefer that to being bedridden in a fetal position; I’d rather be making dinner for my family.

      Yes, I am in a legal state — where everything is tested, packaged, and labeled with all those things you mention. Personal responsibility and thorough education is key to everything.

    • Dr Rust,

      There was a very good documentary on Netflix (about 2 hrs) about all they have done in Australia. It started w/ this young man of 20, 24 when he died called Haslim. He kind of got the ball rolling and when they finally passed the law making pot & cabinoid (sp) oil legal and now it’s called “Haslim’s Law”. You should check it out…very, very informative.

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