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Old 03-14-2019, 02:26 PM  
Holladay Holladay is offline
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Busted ankle and Opioids

My big dogs were playing with me while I was on a sheet of ice. Boom goes the dynamite!

Surgery, plates and screws. I have a bottle of Oxycodone 5 mg x 42 pills. 1 pill every 4 hrs.

The day after op, I was popping them like candy. Helped a bit. 3 days after, 1 per 3.5 hrs. 6 days post op I will take 2-3 for the whole day. Wakeup, Bedtime and a misc.

So the question is how does a person become addicted to these suckers?

I still have 5 more weeks in the cast, then 2-4 in a boot.

Tomorrow, I'll see if just ibuprofen 200 mg will do.

Do they use get high? Trips? Or is there pseudo pain that people use to feel better?
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Old 03-14-2019, 05:19 PM   #46
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Originally Posted by Munson View Post
Several years ago, I pulled something in my lower back. It hurt so bad that I couldn't even stand up straight. I was hunched over like an 80 year old man, even though I was around 30 at the time.

I ended up taking a combination of hydrocodone (painkiller) and flexeril (muscle relaxer) for about 2 weeks. Those pills worked so great it was almost scary. I got the deepest, most peaceful sleep I've ever had in my life. Even though I personally didn't feel the slightest bit addicted, I can see how other people could get hooked.

I stopped taking the pills as soon as I could because the opioids mess with your digestive system. My intestines were so backed up that you could see it on an x-ray.
Broke my hand and had to have surgery. The opioids backed me up too. Quit them after a few days and dealt with it.

Not able to post video with this device, but the "Frank can't poop" vid is good for a laugh.


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Old 03-14-2019, 05:25 PM   #47
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Originally Posted by 'Hamas' Jenkins View Post
This is incorrect.



This is dangerously ill-informed.

No, it isn't. Most people are responsible and take meds responsibly. While I would be a fool to say it never happens, the odds of someone developing drug-seeking behavior by following their physician's advice is small. Avoiding taking pain meds when you are in legitimate pain and following a doctor's orders simply to avoid anti-drug hysteria is foolish. Human being have been taking drugs for millenia. It isn't going to stop. It is hard-wired into our brains as higher-functioning mammals. The idea that you can become helplessly enslaved to some drug without your knowing about it is simply hysterical.

Look at how many people drink alcohol. Yet on a percentage basis, far more abuse alcohol than opioids. Roughly 15% of people who drink alcohol abuse alcohol yet the CDC study cited earlier, which did not distinguish between use and abuse, noted 6% of opioid users were using a year after their prescription.

I'm not saying to not be careful and I'm not saying that this is no big deal. But if I got on this board and said, "Hey, I had a drink of whiskey last night and it tasted good but I'm really concerned if I drink tonight I will become an addict," most people would say, "My experience contradicts your fears." Yes, some people do develop an addiction to alcohol. Yes, you should be careful. But you should also weigh the risks and having the government and the media hysterically blare out worst case scenarios does not allow for a reasonable assessment of the risks and a rational weighing of options.

You cannot do this; you can only take controlled substances back to a select few year-round locations designated for year-round takeback or thousands of designated sites on the DEA's annual TakeBack day, which is in late April this year.



Pharmacists won't fill those scripts because they don't want to contribute to abuse and diversion of opioids, and there are usually a few doctors in every town that will over-prescribe meds.



You aren't qualified to make these claims.
I've been a criminal defense attorney for 25 years. I was a public defender for about 8 of those years 4 of them in rural Alaska where the rates of drug abuse are beyond description.

You ever address a 14 year old's addiction problem because she is huffing gas to stop thinking about when she was gang raped and she lives in a dry village so she cannot afford the $150 for a 750ml bottle of rot gut vodka? I have.

You ever represent someone whose alcohol problem is so bad that her BAC was over .5 when she was arrested for DUI (legal limit is .08 and .4% is generally considered fatal)? I have.

You ever represent someone who cannot really finish a sentence because he was grinding up oxys and smoking them for several years? I have.

I've represented people who started abusing oxys because their body hurt after years of pouring concrete but without health insurance, they had no access to health care. I've represented people who started drinking to stop thinking about the death of their child. I've represented people who refuse to touch drugs but make a good amount of money off it. I've represented physicians who were investigated for 'over-prescribing'. I've represented people prosecuted for forging prescriptions when they were caught seeking their fifth oxy prescription in one day (different doctors and different pharmacies).

The majority of my clients have addiction issues of some kind. I have hired numerous experts regarding substance abuse, drug-seeking behavior, psychological effects of various chemicals, recidivism, treatment and "cure". I have worked with treatment providers, treatment courts, clients, prosecutors, probation officers, physicians, social workers, and therapists to address my client's needs and help them get treatment. I have read numerous article, treatises and journals about addiction in an effort to represent my clients.

No, I am not a physician, nor am I a drug treatment provider, but based upon my experience and what I have studied, as outlined above, I am qualified to say that the risks someone will develop drug-seeking behavior from taking pain meds as directed following surgery are low.
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Old 03-14-2019, 05:30 PM   #48
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I’ve taken Oxy for chronic pain. After the first couple of days, never got “high” from it. Never brought full pain relief. Just level 8 pain down to 3-5. Took it for years.

Only got a couple of weeks of insomnia getting off it. Cold turkey worked for me. But, you can just read anywhere that my experience is different from most. That shit is highly addictive. Take only as really really needed to function as a human being.
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Old 03-14-2019, 05:31 PM   #49
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Old 03-14-2019, 05:31 PM   #50
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Quote:
Originally Posted by SupDock View Post
Respectfully, you are way off base and unqualified to make these claims.

This article in no way supports your argument.
Your answer is not an answer to the points I raise but an attack upon my credentials. As such, it is logically fallacious and unrelated to this discussion.

We disagree about the potential risk of following a physician's recommended pain medication. I believe the risk of developing drug-seeking behavior is low. You disagree. Given your apparent perception of risk, I would expect that you would not prescribe any opioids. If you do prescribe opioids for pain you are logically inconsistent with your stated opinion about the risk of developing drug-seeking behavior.
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Old 03-14-2019, 05:37 PM   #51
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Originally Posted by frozenchief View Post

No, I am not a physician, nor am I a drug treatment provider, but based upon my experience and what I have studied, as outlined above, I am qualified to say that the risks someone will develop drug-seeking behavior from taking pain meds as directed following surgery are low.
You are in no way qualified to make that statement.

The current recommendation is to remain on opiates for the shortest time possible for acute and post-operative pain due to the risk of dependence.

You have back-pedaled significantly from your original statement that it takes "months or longer" to develop an addiction. I have shown you evidence that the risk increases significantly at the 5 day and 15 day mark.
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Old 03-14-2019, 05:42 PM   #52
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Originally Posted by frozenchief View Post
Your answer is not an answer to the points I raise but an attack upon my credentials. As such, it is logically fallacious and unrelated to this discussion.

We disagree about the potential risk of following a physician's recommended pain medication. I believe the risk of developing drug-seeking behavior is low. You disagree. Given your apparent perception of risk, I would expect that you would not prescribe any opioids. If you do prescribe opioids for pain you are logically inconsistent with your stated opinion about the risk of developing drug-seeking behavior.
you are wrong and have no credentials to talk about the risk of developing an opiate dependence. There is no fallacy in that statement. most of what you say contradicts empiric evidence which I have quoted.

I never said anything about taking opiates as prescribed, all I said was that there is risk of dependence even from even a short-term prescription.

I do prescribe opiates, and follow the CDC guidelines to minimize risk, because the risk definitely exists. This contradicts nothing that I say. All medications have risks, controlled medications have higher risks that need to be taken very seriously.
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Old 03-14-2019, 06:01 PM   #53
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Originally Posted by SupDock View Post
you are wrong and have no credentials to talk about the risk of developing an opiate dependence. There is no fallacy in that statement. most of what you say contradicts empiric evidence which I have quoted.

I never said anything about taking opiates as prescribed, all I said was that there is risk of dependence even from even a short-term prescription.

I do prescribe opiates, and follow the CDC guidelines to minimize risk, because the risk definitely exists. This contradicts nothing that I say. All medications have risks, controlled medications have higher risks that need to be taken very seriously.
I doubled my Oxy after two months to 325. But stayed at that dosage for years. Just took 40 a month. I was always concerned about addiction. Didn’t work as well as it did at first but didn’t go up on the number taken or dosage. Never added alcohol or any other drug to supplement.

I do think that addiction is tied to your personality or pre-disposition to addiction. I was able to get off them pretty easily compared to others. Consider myself really lucky.
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Old 03-14-2019, 06:03 PM   #54
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Originally Posted by BigRedChief View Post
I doubled my Oxy after two months to 325. But stayed at that dosage for years. Just took 40 a month. I was always concerned about addiction. Didnít work as well as it did at first but didnít go up on the number taken or dosage.

I do think that addiction is tied to your personality or pre-disposition to addiction. I was able to get off them pretty easily compared to others. Consider myself really lucky.
Congratulations on getting off and staying off. How did you feel after you were off?
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Old 03-14-2019, 06:14 PM   #55
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Originally Posted by SupDock View Post
Congratulations on getting off and staying off. How did you feel after you were off?
I got the shot of steroids directly into the spine. That got me to pain free. That was the most wonderful thing to be pain free. Not needing the Oxy anymore was nothing compared to that feeling. I did a shit ton of drugs in my youth. Not interested in reliving those days from decades ago.
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Old 03-14-2019, 06:16 PM   #56
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Originally Posted by SupDock View Post
you are wrong and have no credentials to talk about the risk of developing an opiate dependence. There is no fallacy in that statement. most of what you say contradicts empiric evidence which I have quoted.

I never said anything about taking opiates as prescribed, all I said was that there is risk of dependence even from even a short-term prescription.

I do prescribe opiates, and follow the CDC guidelines to minimize risk, because the risk definitely exists. This contradicts nothing that I say. All medications have risks, controlled medications have higher risks that need to be taken very seriously.
You say I am wrong when I have consistently said that risk is low. You say I am wrong when you cite a study that did not discuss drug-seeking behavior. it merely described use, which could be because of drug-seeking behavior and could be someone is seriously injured.

Here are two scenarios:

1. Person is prescribed opioids by physician. Person takes them long enough to develop drug-seeking behavior. Because of that drug-seeking behavior, that person is still using opioids 1 year after initial prescription.

2. Person is prescribed opioids by physician. Person continues to be in great pain because they suffered tremendous injuries. Because those injuries cause that person pain a year later, that person continues to use opioids a year after initial prescription.

The article you gave made no effort to distinguish between scenario 1 and scenario 2, yet that is a significant distinction on this topic. The article only notes "drug use" when the distinction between those two scenarios is indeed significant.

It also noted that taking opioids for longer than 30 days is a sign of a risk that someone will keep taking them. That is consistent with what I said.

OP is concerned about being addiction. Fine. That is a good sign. It shows that he has some positive incentives to avoid drug-seeking behavior and lowers the risk that he will wind up demonstrating drug-seeking behavior. This is something that is taught frequently in drug-counseling treatment: if you don't want to change, you won't. If OP doesn't want to be an addict, he has a powerful incentive to avoid such. And taking opioids for a few days is a low (emphasis on low) risk. So is riding in a car. So is flying on a Boeing 737-Max. So is drinking booze. So are a lot of things.

I get that there are few ways to ruin your life than by abusing controlled substances. and I agree that you shouldn't take opioids longer than necessary for a whole bunch of reasons (one reason why marijuana can be a good idea for persons with pain management issues). But paranoia/hysteria about addiction does not help the situation at all.

Part of my issue is I do not like the CDC or the DEA. I think it is not the government's business what medications someone is on. And from my side of the fence, I see a lot of harm done in the name of harm prevention, including people addicted to opioids. And an inordinate focus upon the negative without putting it into context is a way to do harm in the name of harm prevention.

As an example, are you familiar with the death of Jonathan Swift? I give his death because it is historically documented. Modern medicine might have been able to treat him but his is a case in which concern for addiction should go right out the window. And I've seen the DEA prosecute physicians for "over-prescribing" in similar situations. A friend of mine represented a physician who took pain patients few other physicians would. He would not accept patients who demonstrated drug-seeking behavior. If you went to another physician or to a pharmacy other than the one agreed upon between his client and the patient, the patient was kicked out. Many of his patients had suffered severe injuries or were in chronic pain for other reasons. The DEA arrested him. His patients had nowhere to go. I know of one patient who killed herself because of the pain. All so the DEA could show that they were serious about stomping out 'drug abuse'. He was acquitted at trial, but he had learned his lesson.

I think that is inhumane and I think DEA policies are more designed to make sure the populace knows the government is in charge than for any of our well-being. If the DEA was truly concerned about over-prescription of drugs, they would focus upon over-prescription of antibiotics because that creates a much greater public health issue than over-prescription of opioids.

Apparently we are not going to agree. That is fine. I will stipulate that you do not accept my qualifications and that you think I am wrong.
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Old 03-14-2019, 06:39 PM   #57
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Originally Posted by frozenchief View Post
You say I am wrong when I have consistently said that risk is low. You say I am wrong when you cite a study that did not discuss drug-seeking behavior. it merely described use, which could be because of drug-seeking behavior and could be someone is seriously injured.

Here are two scenarios:

1. Person is prescribed opioids by physician. Person takes them long enough to develop drug-seeking behavior. Because of that drug-seeking behavior, that person is still using opioids 1 year after initial prescription.

2. Person is prescribed opioids by physician. Person continues to be in great pain because they suffered tremendous injuries. Because those injuries cause that person pain a year later, that person continues to use opioids a year after initial prescription.

The article you gave made no effort to distinguish between scenario 1 and scenario 2, yet that is a significant distinction on this topic. The article only notes "drug use" when the distinction between those two scenarios is indeed significant.

It also noted that taking opioids for longer than 30 days is a sign of a risk that someone will keep taking them. That is consistent with what I said.

OP is concerned about being addiction. Fine. That is a good sign. It shows that he has some positive incentives to avoid drug-seeking behavior and lowers the risk that he will wind up demonstrating drug-seeking behavior. This is something that is taught frequently in drug-counseling treatment: if you don't want to change, you won't. If OP doesn't want to be an addict, he has a powerful incentive to avoid such. And taking opioids for a few days is a low (emphasis on low) risk. So is riding in a car. So is flying on a Boeing 737-Max. So is drinking booze. So are a lot of things.

I get that there are few ways to ruin your life than by abusing controlled substances. and I agree that you shouldn't take opioids longer than necessary for a whole bunch of reasons (one reason why marijuana can be a good idea for persons with pain management issues). But paranoia/hysteria about addiction does not help the situation at all.

Part of my issue is I do not like the CDC or the DEA. I think it is not the government's business what medications someone is on. And from my side of the fence, I see a lot of harm done in the name of harm prevention, including people addicted to opioids. And an inordinate focus upon the negative without putting it into context is a way to do harm in the name of harm prevention.

As an example, are you familiar with the death of Jonathan Swift? I give his death because it is historically documented. Modern medicine might have been able to treat him but his is a case in which concern for addiction should go right out the window. And I've seen the DEA prosecute physicians for "over-prescribing" in similar situations. A friend of mine represented a physician who took pain patients few other physicians would. He would not accept patients who demonstrated drug-seeking behavior. If you went to another physician or to a pharmacy other than the one agreed upon between his client and the patient, the patient was kicked out. Many of his patients had suffered severe injuries or were in chronic pain for other reasons. The DEA arrested him. His patients had nowhere to go. I know of one patient who killed herself because of the pain. All so the DEA could show that they were serious about stomping out 'drug abuse'. He was acquitted at trial, but he had learned his lesson.

I think that is inhumane and I think DEA policies are more designed to make sure the populace knows the government is in charge than for any of our well-being. If the DEA was truly concerned about over-prescription of drugs, they would focus upon over-prescription of antibiotics because that creates a much greater public health issue than over-prescription of opioids.

Apparently we are not going to agree. That is fine. I will stipulate that you do not accept my qualifications and that you think I am wrong.
I am not talking about drug seeking behavior because that is extremely hard to study. I am talking about risk of developing an opiate dependence, which goes up the longer you are on the medication and which the study clearly demonstrates.


Opiates have consistently failed to demonstrate long-term benefit in chronic musculoskeletal pain, which is why as a prescribing physician I'm trying to minimize the risk that a patient will end up dependent on the medication long-term. from a prescribing point of view there is little reason to distinguish between the two situations. My goal is for my patients to not be on chronic opiate therapy for musculoskeletal pain, because their use in this situation is not evidence driven. I am not discounting the fact that in a small minority of patients it will be necessary to be on opiates long-term for their musculoskeletal pain, merely stating that this is the exception rather than the rule.

also, 30 days or more is not consistent with what you said. Will you please address the fact that you said it takes "months or longer" to develop opiate dependence. This is the crux of my disagreement with you

OP should definitely continue his prescription as his pain dictates, but there is definitely risk involved in even short term prescriptions. In OPs case the benefits definitely outweigh the risks.
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Old 03-14-2019, 06:54 PM   #58
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Quote:
Originally Posted by SupDock View Post
I am not talking about drug seeking behavior because that is extremely hard to study. I am talking about risk of developing an opiate dependence, which goes up the longer you are on the medication and which the study clearly demonstrates.


Opiates have consistently failed to demonstrate long-term benefit in chronic musculoskeletal pain, which is why as a prescribing physician I'm trying to minimize the risk that a patient will end up dependent on the medication long-term. from a prescribing point of view there is little reason to distinguish between the two situations. My goal is for my patients to not be on chronic opiate therapy for musculoskeletal pain, because their use in this situation is not evidence driven. I am not discounting the fact that in a small minority of patients it will be necessary to be on opiates long-term for their musculoskeletal pain, merely stating that this is the exception rather than the rule.

also, 30 days or more is not consistent with what you said. Will you please address the fact that you said this takes "months or longer" to develop opiate dependence. This is the crux of my disagreement with you
I see our disagreement. OP asked about becoming 'addicted'. In my experience, 'addiction' = 'drug-seeking behavior'. In your experience, dependence can be addiction. If someone is merely dependent, they might not display or develop drug-seeking behavior. I would agree that dependence does not equal drug-seeking behavior and given that dependence does not create the risk of criminal prosecution or DEA interest, and that dependence, while not healthy, does not create the health risks of drug-seeking behavior*, it is much lower on my radar.

As far as "months", that is likely because its a term of art in my business. 31 days would be 2 months because it has rolled over into a second month. 61 days would be 3 months, etc. For one, as stated above I am focused on drug-seeking behavior as opposed to dependence, which I anticipate would take longer. Second, months could be two months, short as 31 days, or 4+ weeks. I regret the confusion.

* I don't see those with a drug dependence engaging in various risky behaviors, such as needle-sharing, prostitution, or cutting drugs with non-safe substances, such as lye.
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Old 03-14-2019, 06:54 PM   #59
scho63 scho63 is offline
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Quote:
Originally Posted by Holladay View Post
My big dogs were playing with me while I was on a sheet of ice. Boom goes the dynamite!

Surgery, plates and screws. I have a bottle of Oxycodone 5 mg x 42 pills. 1 pill every 4 hrs.

The day after op, I was popping them like candy. Helped a bit. 3 days after, 1 per 3.5 hrs. 6 days post op I will take 2-3 for the whole day. Wakeup, Bedtime and a misc.

So the question is how does a person become addicted to these suckers?
The day you start sucking dick or taking it in the ass for for Oxy, you're an addict....
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Old 03-14-2019, 06:56 PM   #60
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