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Friday, August 04, 2017

Ban opioids

After watching drug overdose deaths soar in my state over the last 15 years, it finally dawned on me what the answer is.

Ban opioids. There is no reason to allow the continued manufacture of this poison. The Food and Drug Administration erred in approving this nearly 20 years ago.

West Virginia leads the nation in drug overdose death rate -- and has for 15 years or so.

We are No. 1 with 41.5 drug overdose deaths per 100,000 people.

New Hampshire is second at 34.3.

Those are 2015 numbers. The chart shows 2014.

In 2016, twice as many people died of synthetic opioid abuse as were murdered:
Abuse of drugs like Oxycontin and Vicodin killed 17,536, an increase of 4 percent.
From Dr. Scott Gottlieb of the FDA:
Working together, we need to do all we can to get ahead of this crisis. That’s why we’ll also be soliciting public input, through various forums, on what additional steps FDA should consider. I look forward to working closely with my FDA colleagues as we quickly move forward, capitalizing on good work that has already been done, and expanding those efforts in novel directions. I will keep you updated on our work as we continue to confront this epidemic.
Nope. The time to work together is over.

Ban them.

I get that these pain killers help people.

But the harm outweighs the benefit.

To be sure, the people responsible for these deaths are the people who abuse these drugs. But the companies are unable (maybe unwilling) to safeguard their products from this abuse. This is a responsibility they neglect.

People will argue that the war on drugs is a failure, but the reason is too many politicians seem to be in bed with the drug cartels. How else to explain the tolerance of gangs and murders -- as long as the crime stays in designated areas and involves non-white young men in early adulthood.

But I am going off topic.

The Food and Drug Administration should rescind its approval of synthetic opioids.

Other treatments are available that do not cost 17,536 deaths a year.

Ban 'em.

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  1. There are no safe drugs Don.

  2. Here a history of a program to track control controlled dangerous substances such as opioids:

    In 2012, prior to the recent concern about the massive increase in drug use and drug addiction, in particular opioids in Cecil County, MD and across the US, I wrote to my State Delegate about a proposed drug prescription monitoring program I had developed.

    This program was conceived to track prescription of CDS (controlled dangerous substances) drugs and doctor shopping. It would seem to be applicable to the opioid problem. The data collected would seem to be useful for Cecil County law enforcement. While the heroin use up tick seems to be more of a problem of unsecured borders, the opioid problem seems more related to overuse of such medications.

    Since funding for this program was seemingly limited in the past and I did not see any media mention of the Maryland Prescription Drug Monitoring Program (PDMP) and its progress, I wrote my friend Country Executive Dr. Alan McCarthy and the Cecil County Council whether or not this program is being pursued. Dr. McCarthy responded quickly to my questions.

    The following is a synopsis of his reply with more information on the Maryland Prescription Drug Monitoring Program at

    PDMP is currently available to all prescribers & pharmacists in Cecil County; providers have free, online access. However, currently there is no confirmation that all Cecil prescribers are currently using the PDMP.

    Information is that 62% of ALL Maryland prescibers & pharmacists are registered with the PDMP.

    All practitioners authorized to prescribe CDS (controlled dangerous substances) must have been registered with the PDMP by July 1, 2017. (This applies to physicians, physician assistants, nurse practitioners, nurse midwives, dentists, podiatrists and veterinarians.) Effective July 1, 2018, "prescribers must, with some exceptions, query and review their patient’s PDMP data prior to initially prescribing an opioid or benzodiazepine AND at least every 90 days thereafter as long as the course of treatment continues to include prescribing an opioid or benzodiazepine..."

    It has not been confirmed that the Cecil County Sheriff’s office is using the PDMP for tracking and enforcing overuse of prescription drugs.

    The DEA in 2012 told me they don't have the resources to do what I proposed but my investigation revealed that my state did. This tracking program should be a nationwide, state oriented program to severely limit misuse. My concern is that Maryland government from the passage of SB 883 in 2011 has allowed almost 7 years for it to be fully implemented. July 1, 2018 for prescriptions for opioids and other controlled dangerous substances to be tracked and their use. With the concern expressed about this epidemic, why was this program not implemented sooner; the actual tracking of prescriptions is one year away.

  3. This comment has been removed by the author.

    1. I've always felt that the Opiod mess was to keep Deporables down and out-on purpose. I've has lots of surgery and metal in my body over the years, and I've developed
      a distaste for using opioids in any fashion. legal Pot is bad enough.
      Your system makes sense, for those who really need it and for those who abuse it..
      though I am sympathetic to Don's ban... TG McCoy

  4. "Ban opioids. There is no reason to allow the continued manufacture of this poison."

    So when did you get your medical degree and license to be able to make such a strong claim? No reason to manufacture such drugs? No reason at all? Would you be willing to suffer from severe pain after an operation to back up your statement? Or would prefer the temporary relief such drugs can offer? I recently had knee replacement surgery and was placed on an IV of oxycontin for the first 24 hours after surgery by my surgeon. This treatment was to relieve the pain from the surgery enough so that I could get out of bed, start walking, and get right into my PT exercises. Now as it happened, the IV made me nauseous, so it was replaced by oxycontin in pill form, so that over the next two days, before I was released from the hospital, I was able to sleep at night, then get out of bed the next morning to walk with the assistance of crutches and a walker. after two days in the hospital, I was released with a four-week prescription for the drug, which I took for another week so that I could sleep at night and continue my PT. At that point I replaced it with extra strength acetaminophen, which seemed to work fine for me at my rapid stage of recovery, and I returned the unused oxycontin pills to my HMO for safe disposal.

  5. I thought I read somewhere recently that some group of scientists were working on a vaccine that made a person incapable of feeling the high associated with certain drugs.

    1. Vaccines are for big compounds like proteins. Opioids are small. In fact, the best stuff is 5 peptides in length (Enkephalins; 1000x as potent as heroin). Anyone with a peptide synthesiser could put the cartels out of business and kill off the population.

      Antibodies also don't normally cross the blood brain barrier unless you do some really weird things.

      Maybe you're thinking of Naloxone.

  6. Unfortunately, I don't know if the ban will help at this point. Heroin is cheaper than prescription opioids in many areas.

    If the prescription availability is really the driver - and not a symptom of broader social issues - then yes, do it, and expect heroin use to skyrocket.

    If, on the other hand, banning opioids simply causes a switch, then we have to look harder.

    I don't think we really know the answer. I do know that heroin and oxycontin usage vary inversely to each other, e.g. when one is up, the other is down.

    I read a study that suggested relatively small percentage of the serious opioid abuse and deaths are related to people who start for legitimate medical reasons and progress. The vast majority are people who seek out illicit drugs to begin with.

    If this stat is true - and I can't vouch for it - it speaks to a deeper issue.

    I say this knowing that full well I have had a serious back and serious shoulder injury twice in my life. It was excruciating, and nearly the only reason I was even able to sleep for a week in both cases were opioids. Until I was able to get to an ER and have my injury looked at it, I would move my shoulder joint to create excruciating pain - and release the bodies natural pain killers just so I could manage. It was quite an experience ;-)

    So I sympathize with the pain killer need argument. There is societal benefit, especially for those who are able to return to work and function that couldn't otherwise. It has real merit when you look at the number of people who would be sidelined, unproductive, without access to good pain killers.

    I suspect that ultimately we will have to innovate our way out of this mess. I think the problem is deeper than just prescription access. I think we have societal issues driving this.

  7. It's a double whammy--synthetic opioids (oxy vics) are short acting compounds that mimic the action of the endogenous brain opioids (what ever they are). They bind directly at the incoming pain area in the spinal cord and they also hijack the reinforcement area up at the higher brain areas. That higher area is the identical region that Meth and Coke affects. So, while opioids are the absolute 110% gold standard in analgesia, it also "hooks" people and causes behavioral tolerance (addiction).

    Also, if you ask someone who is taking synthetics for post surgical pain (which is what they are technically for) they will report that they still have pain but just "don't care" about it.

    It's the "don't care" part that everyone is missing. Everyone wants to "escape" and "don't care". They just pick their poison to do it.

    The maybe dirty maybe not dirty secret is that there are no less than 5 receptors for opioids, some of which, when bound by experimental compounds, cause profound analgesia yet they do not cause behavioral tolerance in rats. Big Pharma knows that but are they working on a patent (hint: no)?

    1. "Also, if you ask someone who is taking synthetics for post surgical pain (which is what they are technically for) they will report that they still have pain but just "don't care" about it."

      You can ask me about that, and NO, after my knee surgery I felt pain without the medicine and the oxycontin relieved it. It was nothing like "I don't care." It was, "Damn, doctor! What the hell did you do to my body in those 90 minutes I spent with you in the operating theater yesterday?" Now, I do have a fairly high tolerance for many sources of pain, which is why I was able to delay so long in having the surgery, but I'd say the oxycontin did more than just make me ignore pain; it lessened the level of pain so I could function. And after I got home, once the pain was reduced to the point where acetaminophen could alleviate it, I had no inclination to continue on the oxycontin the doctor prescribed for me. I have no idea why some people become addicted to it; it had absolutely no addictive appeal to me.

    2. I agree. I've never had Oxycontin, but I've had Percocet after surgery. And what it gave me was actual pain relief, very definitely *not* "I hurt but I don't care." Generally speaking, in fact, the lesser opioids that I have taken after surgery and for a kidney stone (e.g., Vicodin) or for chronic pain (Darvocet, and where it's legal, codeine) have never changed my mood or altered my perceptions at all, except for a natural relief at not hurting. At most they've made me sleepy. My chronic pain is from getting smashed up pretty badly in a 1989 auto accident, so I've been living with it, and taking painkillers for it, for a long time. In recent years, I've also had to deal with bone-on-bone osteoarthritis. When I travelled in countries that allowed OTC purchase of an acetaminophen/codeine compound (weaker than our Tylenol 3) it made a night-and-day difference. That medicine let me spend several weeks sightseeing in Britain on two separate vacations twenty-odd years ago, and it even let me backpack across New Zealand in 2010-11, and I couldn't have done any of that travelling without codeine. I used to take Darvocet, which was almost as effective but made me much sleepier than codeine did, but the government banned it ten years ago. I've still got some Darvocet, actually, put by for an emergency, but it's so old now I'm hesitant to take it any more. So I have to get by on acetaminophen alone, which definitely does not stop the pain, though it does ease the pain enough to let me sleep at night.

  8. Have y'all ever dealt with an addict? A real sniveling nose junkie? Darwin is at work here. Here's a real cold fact....once they get on a needle.....they're no longer any part of us. Look for a real hard core policy of refusing the Narcan(sp) shot for repeat overdoses. That's what's coming, imo.

    Heroin is bad enough, much less all this synthetic looked that are going around. Well, honestly, I've dealt with junkies enough in this life. There's no helping them....yeah, every now and then someone cleans up....but that's not how to bet your money.

    I was remembering all that I've seen from the past. I'm 60 years old now.....I've seen a lot of junkies.....they ain't gonna survive this new synthetic stuff. Darwin ain't kidding. Have you read about some of the designer opoid type drugs like carfenetil(sp)? So, I reckon a ban won't accomplish much. The Cartels will just sell heroin cut with elephant tranquilizer. Y'all need to understand that a junkie ain't a person anymore....nope, not at all.

  9. "Other treatments are available that do not cost 17,536 deaths a year."

    As someone who has used both oxycontin and vicodin to control pain, tell me what those treatments are.

  10. "Other treatments are available that do not cost 17,536 deaths a year."

    Hm. Where have I heard this argument before.

    Wait! I remember now:

    "Other means of dealing with home invaders and assailants are available that do not cost 11,000 deaths a year. Ban guns. Ban them now."

    1. ""Other means of dealing with home invaders and assailants are available..."

      Okay, I'll play along, tell me what those "other means" are. Don't act so butt-hurt.

  11. I currently have a 30 day supply of Oxycodone, an opioid, sitting on my bedroom dresser. It's been there 3 months. My last 30 day prescription, saying "Take as needed for pain" lasted 3½ years. I don't know what causes addiction or alcoholism, and I have both addicts and alcoholics in my immediate and in-law family. What I do know is that no one forces you to take that first, fourth, or 15th drink of the night. Each one is consumed voluntarily. Same with opioids. No one forces you to keep taking them in closer and closer intervals and larger and larger doses.

    There are some pains that Excedrin doesn't work on. Regardless of what all the drug counselors preach, alcoholism and drug addiction are a choice, not a disease. I do finf it interesting that in oder to get a job as an alcohol or drug abuse counselor you must currently be in "recovery" as an alkie or druggie. Could be their "expert" views are somewhat slanted.

  12. This is the most absurd idea I've ever heard. Pray that you never have to live with a condition that causes intractable pain. Opiates are a last resort for those in chronic pain not relieved by any other means. Believe me, medicine has made great strides, but some of us are left behind. I am living proof that one can live with opiates and remain sane and in control.

    Perhaps you would like to bring back alcohol prohibition, since five times as many folks die from drink than from opiates. You need to rethink your idea and then come down on the side of freedom, liberty, and ending the ridiculous War on Drugs.

  13. I work as a hospice chaplain, and I can say unequivocally that simply banning opioids would result in thousands upon thousands of cancer patients dying in unimaginable agony or, more realistically, simply becoming outlaws in using the now-illegal opiates to prevent dying in torturous pain.

    For the past few months I've been reading your blog daily with many an "Amen," but I'm puzzled why you've written something that on its face is so profoundly ignorant as this post. Are you simply trying to be provocative?

    - Milton Stanley Sr., Mud Creek, Tennessee

  14. My previous comment is blunt, but I'm really puzzled here. In places your essay seems to be about synthetic opioids, yet you never explain how synthetic opiods are different from the non-synthetic kinds. And your title, of course, simply says, "Ban Opioids." To read something like what you've written here from an otherwise thoughtful and insightful writer has really got me wondering. Am I missing something?

    - Milton Stanley Sr., Mud Creek, Tennessee

  15. I think you were a bit too subtle for some folks.

  16. ELC, I'd like to think Don was being satiric, but if he was, then, yes, he was a bit too subtle for me. I'm going to assume he's serious until he says otherwise. Don, have you ever looked at the risks of NSAIDs? If you haven't, you should? Do you want a big jump in the number of post-surgical patients with liver and kidney failure, and/or with life-threatening hemorrhages in their stomachs? Because that's what you'll see if the only way to treat post-surgical pain is with aspirin and NSAIDs.

  17. I would never have made it through treatment for throat cancer five years ago without oxycodone and fentanyl. I was banned from taking ibuprofen because it is a NSAID. So it was opioids or nothing.

  18. Criticizing Don't because he isn't licensed is a bit of a cop out. Even physicians get mixed up about narcotics. One time an anesthesiologist at a hospital I was working in was found in a coma in a closet. He thought he was injecting himself with fentanyl and he was using his sufentanyl syringe. Oops. A multiple of the dose he thought he'd get. The same mistake most overdose deaths are attributable to now. He was thirty years ahead of his time.

    I agree with the Darwinists on this one. Only I want the licensing system abolished, too. Part of the reason everybody self medicates is because trying to do so within the system is so expensive. But since we all know this isn't going to happen we will continue to grow the police state.

  19. Hmm, it's a choice. OD on opiods, maybe or take the long way my brother did with alcohol induced liver disease.

    Chronic pain is something people will try to reduce regardless.

    Sure others take the opioids for non-pain reasons. They'll just take something else.

    In the meantime, if you outlaw them, you'll get more cops throwing flashbangs in playpens. And more disposal of the rights free people used to enjoy.

  20. My doctor told me that I seemed to have a pretty high tolerance for pain. I replied that I should have since I've been married twice. That being said, God gave us all the seed-bearing herbs to use for meat, that is, consumption. Opium is a fairly decent pain reliever. The problem is when they synthetically alter and strengthen it. That's what makes it so dangerous. I have had a number of injuries and surgeries and my pain reliever of choice is plain old codeine. The synthetic stuff just doesn't work for me. I take it sparingly as needed and usually end up throwing away half the prescription. But hey, that's just how I am. There are idiots everywhere who just want to escape reality and we'll never be able to stop them. Some doctors are enabling them. But if they can't get their escape legally they'll get it illegally. There is definitely a problem, but group punishment by banning opioid isn't the solution
    - Elric

  21. Don, my wife has needed daily painkillers to control her pain for 20 years. They represent the difference between confined to a bed screaming in agony and being able to live a normal life.

    Anyone advocating for returning her to that state might as well be advocating for her murder.

  22. I am a little person, aka, my spine and joints are deteriorating. This means a lot of peminent nerve damage, muscle cramps, and spasms. The one therapeutic treatment, medical marijuana, cannot legally be prescribed for achondroplastoc spinal stenosis and lordosis. I am also morphine resistant, so none of that group of drugs relieves my pain.

    Ocycodone has effectively controlled my pain for over thirty years, allowing me to raise a family, work, and now enjoy my grandkids. Without it, I'm flat on my back in bed in great pain. The only other pain meds available are too strong, turning me into a drooling slug.

    I would love for someone to tell me why a drug that has worked for millions of people should be banned because some abuse it and become addicted.

  23. Wonderful idea Don, but you kno how doctors are called to ease pain. Perhaps we can add easier access to medical grade marijuana as a substitute. Perhaps patients in need of more exotic pain meds can be kept in hospitals.

  24. Friday the DEA partially agree with Surber, proposing a 20% reduction in opiod production.

    So deaths from illegal use of opiods will surely decline by 3,500 next year!

  25. While they're at it maybe they can do something about cocaine, LSD, PCP, ecstasy, et al.
    Or maybe they can stop doling the shit out like tictacs for even minor things so the dealers have an easy time of getting supplies and making those who actually need the drugs suffer, but then common sense seems to have made a massive disappearance.