Comment by csharptwdec19 | Hacker News Reader

Comment by csharptwdec19 | Hacker News Reader

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>Someone I know once got Opioids to take home after a hospital visit, she said she didn't want them, they urged her to take them anyway. Turns out the hospital was sponsored by the producer of the pills.

> This is not just over-prescribing, this is intentionally creating addicts and should be criminalized asap.

I'll devils advocate. But only barely.

So, lets say your friend didn't take them, went home, and day 2 something gets way more sore. If she tried to go back to the hospital to tell them, there is a possibility she gets the wrong doctor, gets a note on her file as 'seeking', and then is up a creek without a paddle.

This doesn't take away from the issues with overprescription and marketing. But speaking as someone who had to learn about some of this, the hospital did the shitty but correct thing

Source: because of the sheer -volume- of ADD meds I have to take and my aspergers, I got a good course from my doc on understanding how not to accidentally look like a seeker

Fun story about seeking actually. A dentist prescribed me opiates (two different kinds but I can't remember what) for wisdom tooth removal. I filled the prescription in case I needed them but ibuprofen ended up being fine.

Later my psychiatrist retired so I needed to find a new one. The new psychiatrist interrogated me about my use of opiates. He asked if I had taken opiates before. I answered no because I hadn't. This was his gleeful gotcha moment where he pulls up my prescription history to find the opiate prescription and accuse me of lying about drug abuse.

It was a university health system and he was pushing a new medication on me. That same day I found out the manufacturer of the drug he wanted to put me on had made a $10 million donation to the university. I guess he was going to try to get me to feel like a drug abuser and like I have no choice but to take this new medication?

Anyway, he was successful at making me feel like I was a drug abuser so I just left and stopped taking psychiatric medications altogether. I probably didn't need them. Also you can be labeled a seeker even if you fill the prescription instead of going back to get it.

Why do you need opiates of all things to deal with tooth removal?!

its a procedure with a painful recovery?

because it hurts.

This has been common in the US for decades now, I was prescribed them as a minor for my wisdom tooth removal. I was also fine with ibuprofen.

I'm assuming there were significant kickbacks to oral surgeons from the opioid sales people.

That is extremely standard, why would you assume there "were significant kickbacks from opiod sales people?"

Most of the time it would be generic vicodin and cost under $20 for enough to take for a few days.

Wisdom tooth removal is a whole different ballgame than plain tooth removal, with painful complications possible (e.g. “impacted” wisdom teeth).

The same reason I had to go to a specialized surgeon, have a pre-visit to analyze the problem teeth, and be put under for the operation. I basically had a surgeon digging around in my jaw with operating tools for two hours - and I was a barely functioning person for like a week afterwards.

It's pretty painful, especially if you have all four removed at once. But, I think pharmaceutical propaganda has made people believe that there is really a way to kill the pain. Something I've learned from opiate addicts is that it doesn't make the pain go away - it just makes you feel good enough to forget the pain.

It was my opinion before doing it that I would be feeling some amount of pain no matter what I did. So I just followed the other aftercare instructions first - ice it, take ibuprofen, (lightly) swish with warm salt water. The pain was reduced enough that I didn't feel the need to take the opiates.

Im with you. I had the full 4 wisdom teeth removed at once and I got by just fine with ibuprofen. However, you have to understand that like most things in biology, there's a bell curve which exists for measureable pain tolerance. There are definitely people who find that level of pain unbearable in the same way you and I might find a hot poker unbearable. It's not irresponsible as a provider to offer pain meds for that.

As someone that's had back pain my entire adult life, not everyone has the same constitution. Understanding, of course, that not all pain is 'the same'. My level of tolerance is likely because I understand the /significant/ risks of addiction. I'd rather not be in pain, obviously, but not at the risk of being a junkie.

I definitely get the impression that a lot of people sucked into pain med addiction are not the sort that have had a lot of previous experience with pain. Making it doubly irresponsible to prescribe such highly addictive medications for them.

I wonder what I’d get labelled as. About 7 years ago, I got a prescription for 30 Tylenol #2s after I fell off my bike and broke my collarbone and black eyed myself.

I took ~10-15 then and would occasionally take one as needed in the intervening 7 years and still have some left.

Would this paint me as a responsible user or a monster taking prescription meds without doctor’s supervision)?

Neither, because you didn't share the story. Oh wait, you did under a pseudonym. Look, nobody cares about such a small thing. You should dispose old medicine after expiration date, and you should not use strong drugs recreational / without prescription.

That being said, I did same with Ritalin. It helped me focus during times I needed (same reason it got prescribed though not for using it casually but regularly). Eventually I got rid of it though.

Heck, even Ibuprofen 600+ mg can only be bought with prescription. For a oral medicine / huge swelling I had to get a procedure, and this helped. I got prescribed Oxazepam because of my fear of needles. I used 1x 10 mg before the night of procedure, 2x 10 mg an hour or so before procedure. I walked like a drunk. Yep, I get why this stuff is addicting.

I kinda suspect the codeine doesn’t work for me and one day I’ll get morphine or something and go “ohhhhh, I get it now”.

(Tylenol with small amounts of codeine is over the counter here, but meh).

> so I just left and stopped taking psychiatric medications altogether

Wow, for some conditions that sounds like not at all an outcome a psychiatrist would like to be responsible for.

These medications - zolpidem and adderall were easy to get off of. It was maybe a month of discomfort and then things started to get back to normal. They were helpful with getting my life back on track. I stopped taking the zolpidem when the retiring psychiatrist ignored a refill request (that I made during business hours with advanced notice). I decided from there that I wasn't going to be dependent on medication to fall asleep.

The new psychiatrist was how you might expect any psychiatrist to be - fake sincerity. So yes, there was a sense of "oh no we don't want you to stop cold turkey ;) why don't you take this new medication." The recommendation to change to a new medication manufactured by a major donor to the university was a red flag that made me decide to stop altogether.

Right, not saying anything about your situation or pretending to know the details. But the phrasing was reminding me of people I have been close to who take antipsychotics. Medication compliance is a huge issue with those, a good doctor will be extremely cautious.

What is seeking? Is it trying to get more pain meds to primarily fuel addiction/ selling? Or is it seeking attention and so can be ignored?

Would they be a seeker if they took home the meds and not actually take them? The drs would then think "why more pain med, they are already on some?"

or of they didn't accept and take home the meds from the drs? So then the drs would think when they return "they are here asking for more help when they rejected the help we gave them before, are they seeking attention?"

Perhaps it means something else?

'Seeking' in this case is trying to get pain meds.

> Would they be a seeker if they took home the meds and not actually take them? The drs would then think "why more pain med, they are already on some?"

No, that's not seeker behavior. An 'extreme' example of seeker behavior would be to take the pills home, and try to come up with the best excuse possible to have 'lost' them.

> or of they didn't accept and take home the meds from the drs?

This is the scenario I'm talking about more. The problem is, if the patient comes back, depending on where the patient went, they might not get the same doctor as before (Thinking scenarios like urgent Care, ER, etc). And when you are in a lot of pain, you might not always think/act rationally. Ironically your desire to deal with immediate severe pain could in fact look from the outside as someone going through withdrawls.

Ahh I see! Thanks for the clarification.

A seeker is someone without a legitimate reason or medical history nevertheless trying to get their hands on prescriptions for controlled substances.

It's annoying as hell, because if you make the unfortunate mistake of associating with an onverly nervous doctor and you're on a controlled substance, it can lead to a life ruining adjustment of your dosage. (Happened to me right after a job loss.)

Showing up with a 20 odd year file of history of successful treatment history on something helps, but you still have to be hyper vigilant about finding a prescriber willing to work with you without being flaky. Yoy can't even think of moving or long term visitation somewhere unless you're made of enough money to do some recon work ahead of time to find a doc at a new location, or return wherever your old one is for the interim to top up fill your prescriptions.

As a person with a valid medical justification, I'm basically already in a gilded prison created by DEA where I have to essentially mother-may-I either the insurance company or physician anytime I want or need to relocate for more than 30 days.

And God help you with tolerance built up. Then you're adding a new monthly family member unless you figure out how to nutritionally supplement for your particular body chem to get around it.

I will shed no tears over massive fefunding of DEA or restriction of their Draconian scope, but I have the feeling I'll never see it, because there is too much self-destructive potential and black market incentuve for illegal trade to ever become small enough without an organization putting pressure on it. That may be some level of Stockholm Syndrome talking though, as I'm not sure I don't just tell myself that to keep myself from wasting my time shouting into the wind.

Yes I see how getting that label can be life ruining! Thanks for clarifying.

Are doctors by default nervous about this? Can't they share your file between them? (I'm in Europe, so my experience is different, sorry I don't know these basics).

Is the fear from doctors and the draconian DEA's scope left over from the "War on Drugs"?

Yes, a big portion of Electronic Healthcare Records is getting all relevant records to be capable of following you everywhere digitally. The paper equivalent before ACA was a foot to a foot and a half stack of papers you picked up from your old physician.

The fear comes from DEA as they track metrics from pharmacies, and are tge source of all prescription pads for controlled substances. If you end up looking suspicious enough to look into, you could very quickly find yourself in very hot water. You could lose access to the privilege to write controlled substance prescriptions, which means lost patients, have your license revoked, or any other unpleasant outcome.

You have to have a good relationship with your physician, because if for whatever reason the start feeling overly exposed professionally, your adverse health outcome is less severe to them than possible investigation by authorities or jeopardization of their ability to see patients.

The sad thing is, I can't even really blame them. It's 100% reasonable from their point of view, and from an outsider's, but as a patient trying to navigate your own physiology in a way that doesn't end in catastrophic consequences for yourself, those you know and love, and those depending on you to play your part in the grand scheme of things, it sure does feel like everyone is a-okay letting you take the fall for the sake of the perverse incentives created by the regulatory environment.

The official medical-system approved thought process, which Greene & Chambers are defending in this paper, is “Since he is displaying signs of drug-seeking behavior, he must be an addict trying to con you into giving him his next fix.”

https://slatestarcodex.com/2019/09/16/against-against-pseudo...

Are you and GP talking about "take" as in "take the prescription, and fill it if you need to", or "fill the prescription", or "swallow the pills"?

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