Comment by zkms | Hacker News Reader

Comment by zkms | Hacker News Reader

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> It only increases diversion to the black market by directly increasing demand. My own grandparents have had to buy pain pills in the past.

Yes. I know people with chronic illnesses (of many types) who've had to resort to various black markets for opioids, all this stupid "diversion control" and trying to shit-test patients in the ED to see if they're "drug-seekers" actually has a deep and nasty cost.

Of course someone who presents to the ED with a physical condition that causes immense pain is, inherently, going to be a "drug seeker". So now people need to be all "tsundere" about that (i-it's not like i WANTED you to prescribe me opioids, or anything, BAKA!), and pretend that they don't know what drug/dosage works for them (apparently, it's only opium-seeky people who know anything technical about opioids) even if they're well-versed about what works for them and their medical condition. It's a very nasty and adversarial state of affairs, that screws over everyone.

The DEA (and other flavours of doorkickers) targeting doctors and deputising them as law-enforcement agents who have to decide between the evil undeserving addicts and the deserving patients in pain is what has created this affair. Blame the prohibitionists, as this is a problem of their own making -- the crackdowns on "pill mills" and "overprescribing doctors" is what denies people a safe and legal source of pharmaceutical-grade opioids and forces them onto the black market of illegal, overpriced, and fentanyl-contaminated opioids (which leads, of course, to the deaths that are used to justify even more crackdowns).

Crackdowns on "over-prescribing" invariably lead to people who experience chronic pain being denied medical access (or being subjected to extremely invasive and degrading treatment to weed out "drug seekers"). The DEA cracking skulls over opioids and investigating doctors is literally the only reason illicit fentanyl (and its even more dangerous analogues like carfentanil) even is a thing. I am so very doubtful that more door-kicking and prosecutions will miraculously work after decades of it making shit worse.

While working abroad in the States, I was prescribed benzodiazepines for panic attacks. When I later came home, I went to see a GP and asked whether I could receive a refill for a medication that was running out. I told that I had used it as my last resort to alleviate panic attacks when I was unable to control my feelings otherwise. I had another abroad trip coming, so I said I would feel secure to have that last line of defense with me. The GP asked what that sort of medication might have been, and I presented the drug as "benzo" called $US_BRAND.

The doctor looked at me for a moment and said that as you are using that term, benzo, you are aware of its abusive use. In no circumstances can we prescribe the drug same drug for you, since that would include doctor supervision before, during and after its consumption. After that the GP wrote something with the keyboard and proceeded to ask me how exactly was I able to get these drugs. I told the scenario after which I has been prescribed the drugs. The doctor responded that it sounds maltreatment to prescribe the said drug in such circumstances and that my story sounds odd. He said that he cannot prescribe me any drugs at this time.

I'm now concerned what the doctor wrote to the state wide system and whether that might affect my treatments in the future. Either way, this whole paranormality over "drug seekers" is insane -- the GP did not even suggest seeing a specialist or offer alternative drug. He just declined and became anxious which I read as he wanted me out of his office as soon as possible. He was young, I give you that, but it makes me wonder what kind of horror stories do they tell about my kind of "drug seekers" in the med school.

I had a similar experience before when trying to get painkillers in the UK. There's a deep institutional narcophobia here.

Thankfully I was eventually able to get a prescription for an effective opioid, after an NSAID-induced bleed almost killed me.

The experience made me write up an Advance Decision (Living Will) to make it clear that if I'm ever unable speak for myself, I want my pain or mental distress to be adequately treated. The thought of being in severe pain or anxiety, and being left to suffer, terrifies me.

It's not "narcophobia", it's a desire to actually treat pain effectively without leaving people i) still in pain and ii) addicted to a harmful medication.

It's not a choicest between "treating pain effectively without leaving people still in pain and addicted to harmful medication", it's a fuzzy, gray spectrum between giving out no medication, treating pain ineffectively while having no addicts, and prescribing pain medication with abandon and having many addicts.

There are a few options that let you shift the balance one way or the other, but the parent is saying that they're leaning too far towards leaving people in pain from a fear of creating drug addicts.

The US is still far and away the leading prescriber of opioid medication, so to call it "narcophobia" is alarmist nonsense.

Especially since it's not affecting end of life treatment, which is where people really care abut it.

It is directly affecting end-of-life treatment. My grandfather is jumping through more and more hoops to fill his prescriptions each month.

The insurance company has the gall to tell his doctor they know better, and often want the doctor to justify the prescriptions. My grandfather is on deaths door, he stays alive through sheer will. The doctors gave him 2 years to live...6 years ago. Fair to say that's end-of-life, right?

I moved out here to take care of them, so I'm in the thick of this day in, and day out. Insurance companies, Picking up prescriptions in triplicate in writing and hand delivering them, etc. I'm scared to pick up the controlled substances alone because of the way the clerks look at me, so I have to drag one of my poor grandparents to the pharmacy with me, again and again. every month.

Why do you think they're looking at me funny? It's narcophobia. They think I'm an addict pulling a fast one.

Keep that in mind next time you say it isn't affecting end-of-life care.

Someone's grandfather out there was and is affected, directly, by the recent upswing in what can certainly be described as "narcophobia."

A doctor shouldn't have to explain himself to a fucking insurance company, ever.

If I paid my premium, pay my fucking bill. Keep that corporate nose out of my personal medical affairs and pay the bill like I pay you to do.

I'm sorry, but you painted with such a wide brush that I couldn't help but retort.

Unless you meant hospice care. In which case you're probably more wrong. These guys are trained sticklers. The second your love one stops breathing, hospice will be there not to comfort you, or have a kind word. They're there to bag up all the painkillers and fill the bag with kitty litter.

If that's not narcophobia, I don't know what is.

You can't undertreat pain and expect the problem to go away, btw. All that does is encourage blackmarket diversion of legit meds.

The harder you make it to get them, the more money they'll be worth, the more risk people will take to steal them wholesale. Expect more delivery truck robberies, more pharmacy hold-ups and break-ins. There will always be abusers, no laws will change or reduce that.

> When I later came home, I went to see a GP

Was this in England?

No. This was in Finland, through the public sector healthcare.

Benzos are only used for short-term treatment of anxiety. You get withdrawal symptoms after taking relatively small dosages for a few days. There are also many adverse effects like being unable to retain any new information. E.g. when I briefly took them, I was unable to memorize a 4-digit pin. I gave up after 15 minutes. I couldn't do it. It was terrifying.

Benzos are pretty terrible. That second doc did you a favor.

The only somewhat useful advice I have to offer is to quit smoking if you do smoke. Smoking increases the base anxiety level quite a bit.

> Benzos are pretty terrible. That second doc did you a favor.

I knew that when I saw the GP, hence the "last resort". My experience with the drug was morbid as well -- the world felt soft for an hour, after which I would pass out. I would wake up in 4-6 hours feeling normal again. Only later did I find out that the aforementioned side effects with the additional and overlapping prescription of codeine, I could have died in my sleep.

But the point being, I am no doctor and I was living in a confusing state of mind. So when I went to see him, I thought that benzos are the way to treat me. But instead of being referred to a mental health department or given beta-blockers as a less intrusive medication, I just received a no as an answer. It left me with mixed feelings. I mean, the doctor was right that the benzos were not the solution, but he should have told me what I need, instead of just declining what I want.

Luckily enough I was able to accept the fact that I could be mentally ill, so I sought appropriate help by myself. Luckily, my case was handled by psychiatric who taught me how to treat the pre-cursor to my anxiety, the panic attacks, instead of the anxiety itself. When I learned that I could handle the panic attacks just like any emotion -- and without drugs -- I was able to shrug the anxiety away.

Condemning a patient who seeks opioids as a treatment when they don't know for better is not much of a favor. I felt like I was treated like a drug abuser and my state wide profile most likely now states me as a possible one. All of this because I could not remember the translation of the drug and instead referred to it as what I have seen thrown out on the Internet from time to time. I would not be surprised if I would have received better treatment would I have had referred to the drug with its marketing name only, but I did not think that would have helped much in a foreign country.

Also thanks for the smoking tip! Although, I do not smoke, but I do moderate the amount of caffeine I consume nowadays. Getting over the panic attacks did require quite a few lifestyle changes in addition to self-reflection.

>I could have died in my sleep.

The risk is real, but it's more geared toward recreational users.

Taking therapeutic doses of codeine (to which you become tolerant) along with whatever benzo that doctor gave you (ativan, xanax, clonazepam, whatever) also at therapeutic dosages doesn't present a huge risk of respiratory failure, IMO.

Harm reduction communities shout DO NOT MIX because if you don't, the teenagers asking these questions on Bluelight and Reddit will say one of each is safe, why not two of each? etc until they're dead. They're abusing the drugs, see. That's the difference.

If you weren't abusing them, you had little to no chance of dying in your sleep. At least not from 30-60mg codeine + 1mg of xanax.

Anyway, this class of drug can steal your soul. I speak from experience. Abuse of them only leads to one path, a path that involve seizures and mood swings.

>I'm now concerned what the doctor wrote to the state wide system and whether that might affect my treatments in the future

You have the legal right to review such entries. You also have the right to have erroneous entries corrected. If you're worried this might cause issues with future treatment, the sooner you act the better.

See: http://www.hus.fi/potilaalle/potilasasiakirjat_tietojen_sala... http://www.hus.fi/potilaalle/potilasasiakirjat_tietojen_sala...

Thank you, I have been unaware of this.

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