drp:
Our clinic, for example, uses NO opiates for non-cancer pain.

I strongly support multimodal therapy, and trying to avoid opiates for fibromyalgia (the one noncancer pain you mention). But your clinic works well because other clinics are available for those patients who do benefit greatly from opioids. Bad osteoarthritis, for example.

space_cadet_28: So let's summarize. The government prefers to reduce painkiller abuse rather than reduce pain suffering.

exactly...don't even talk to me about the new restrictions on liquid morphine and liquid oxycodone.

/Hospice nurse
//government has recently made my job a WHOLE lot more difficu,to keep my patient's pain controlled when they can't swallow anymore.
///fark them

This is good news .... for Canada.

Marley: Gyrfalcon: Opiates are Bad Drugs. There are no good Bad Drugs. All Bad Drugs are Bad. It doesn't matter if some responsible people use Bad Drugs because they need them for real chronic pain; because there are some stupid idiots who abuse Bad Drugs, all Bad Drugs have to be criminalized, taken off-market, or made hard to get. Because they are Bad Drugs, and we can't be seen as promoting Bad Drugs in any way.

Bad Drugs get people addicted, and addicts are Bad People. Bad Drugs make Bad People, so they are Bad. Bad! Bad! Bad!

Wow. That's bad.

Who's bad?

Marley

Please oh please tell me how you kicked this crap. My PM doctor thinks I'm
not addicted because I don't take more than he prescribes and I don't do
it for fun.

Another former *codone addict here (lortab, percoset, dilaudid and morphine), several years ago, broke my wrist severely and the doctor was one of those who gave me a refill of 200 Lortab 10's about every 2 weeks.
Ended up taking 10-15 or more every day for several months, and when I finally ran out, had to get off of it cold turkey.
Not fun, and not the way I recommend getting off of those.
Took about 4 days of sweating, cramps, fever, "itchy blood sydrome" and insomnia to get off the physical part of the withdrawal, the mental/emotional withdrawal, however, is a lot more complicated and can take years to recover from depending on the severity of the addiction.

Vicodin is a combination of hydrocodone and acetaminophen; Percocet is oxycodone and acetaminophen. While oxycodone is available without the acetaminophen (as OxyContin) hydrocodone is not available alone in the United States. A ban would be problematic for patients and doctors alike.

FAIL

Vicoprofen has been around for years. I guess it's only problematic for those who are allergic to ibuprofen.

Let me just weigh in for a second.

1) According to UpToDate, Acetaminophen toxicity is the #1 cause of acute liver failure in the US;

2) Tylenol is so benign at its normal doses that the general public does not understand the potential consequences of taking too much;

3) Death from tylenol poisoning (intentional or accidental) is horrific. Often, the liver damage (and imminent death) is irreversible, but patients are awake and lucid for a day or two before their body really begins to fail. They have to be told sometimes that they have less than a week to live.

4) The headline is a bastardization of the article and subby is a douche.

And lets not forget Bayer, after being forbidden to sell it in North America proceeding to sell AIDS contaminated drugs (new window) in Europe and Africa

Alacritous: Riffington: Which specific medications are you referring to? None of the dozens that had been mentioned on this thread, I hope.

Vioxx (new window) is one that immediately springs to mind. There are others.

Doctors didn't prescribe Vioxx for patients because they were paid off, they prescribed it because it was a wonderful pain medicine that didn't cause much GI Bleed. There was always a question whether it actually could lead to an increase in cardiac events, or whether it simply wasn't cardioprotective like NSAIDS. When that question was finally answered, the drug was removed from the market. It took a long time to properly answer it because a tiny increase in a very common event is hard to pin down. It's actually quite unfortunate that it was removed from the market rather than just given a black box warning, because it was a good drug for certain people.

This is a pain in the ass for pharmacies because if you plan to sell plain hydrocone (without APAP combined) it becomes a schedule 2 drug. Which makes a lot more paperwork and time to dispense. This whole thing is a load of BS, there are so many different strength combinations that doctors have a lot of choices for the patients anyways.

/drunk slashies
//prefers alcohol mediated liver toxicity

namatad: Alacritous: I'll bet that shortly before or shortly after this ban takes effect that a product will come on the market conveniently that does the same thing as the banned combinations... Any money on which company it'll be that brings it?

no bet
but yah, there will soon be a hydrocodone only type pill
and in all fairness, why is the acetaminophen there in the first place?

So that you would develop a liver that needs servicing. You know, the General Motors plan.

We need to add a new class of labels to medications:

"Take at your own risk"

Simply put: if you suffer harm, no matter how obvious or severe, you can't sue, nor can your family should you die.

And no, a company can't just put it on there. The FDA must mandate it. Once mandated it's required in order for the medication to be sold.

No lawsuits, no class actions, no appeals. Should be defined in the constitution so nobody can argue it. No exceptions, none. Even if it was made of 100% rat poison.

Everyone wins.

Riffington: There was always a question whether it actually could lead to an increase in cardiac events

That's when you should be doing more testing, not marketing it full speed ahead.

Riffington: I strongly support multimodal therapy, and trying to avoid opiates for fibromyalgia (the one noncancer pain you mention). But your clinic works well because other clinics are available for those patients who do benefit greatly from opioids. Bad osteoarthritis, for example.

It's true, some patients who we decline to give narcs to will go elsewhere. Chronic pain patients tend to have high doctor turnover, at least until they find a plan that's working for them.

The sad fact is that the overwhelming majority of these patients never reach a pain-free state. We can help their symptoms become livable, but most will be on some lifelong polypharmacy regimen. Given that, we feel that lifelong daily opiates, with their side effects, tolerance and withdrawal characteristics, are better off avoided in almost every case.

To tell the truth, I always had more trouble convincing a patient to go see the pain psychologist ("What, you think it's all in my head?") than to give up or forgo the narcs. Most don't want to be on narcs any more than I want to prescribe them ...

Riffington: Alacritous: Riffington: Which specific medications are you referring to? None of the dozens that had been mentioned on this thread, I hope.

Vioxx (new window) is one that immediately springs to mind. There are others.

Doctors didn't prescribe Vioxx for patients because they were paid off, they prescribed it because it was a wonderful pain medicine that didn't cause much GI Bleed. There was always a question whether it actually could lead to an increase in cardiac events, or whether it simply wasn't cardioprotective like NSAIDS. When that question was finally answered, the drug was removed from the market. It took a long time to properly answer it because a tiny increase in a very common event is hard to pin down. It's actually quite unfortunate that it was removed from the market rather than just given a black box warning, because it was a good drug for certain people.

I felt freaking great on the third day taking Vioxx, well until the crushing chest pain started. More pissed at the stupid doctor that gave it to me for a minor shoulder injury and passed it off as "better than tylenol" without mentioning any risks.

BOZ: THIS...Dilaudid (hydromorphone) works better than oxycontin or hydrocodone for me any old time.

Dilaudid is a short-acting pain killer. It acts quickly and lasts for four to six hours. So is hyrdocodone.

Oxycodone is longer-lasting narcotic.

Different drugs, different uses. I take both because one alone doesn't fill the need.

MOHWowbagger: Let me just weigh in for a second.

1) According to UpToDate, Acetaminophen toxicity is the #1 cause of acute liver failure in the US;

2) Tylenol is so benign at its normal doses that the general public does not understand the potential consequences of taking too much;

3) Death from tylenol poisoning (intentional or accidental) is horrific. Often, the liver damage (and imminent death) is irreversible, but patients are awake and lucid for a day or two before their body really begins to fail. They have to be told sometimes that they have less than a week to live.

4) The headline is a bastardization of the article and subby is a douche.

This reminds me of the episode of house where Amber takes some flu medication that can't be metabolized out of her system and is slowly dying of organ failure. Oh and the whole House messed up on Vicodin season finale.

It makes me wonder if the people writing it have some sort of bombshell agenda to be revealed and the FDA is trying to get a jump on the PR side of it by banning tylenol now so they look less stupid.

Bohemian: I felt freaking great on the third day taking Vioxx, well until the crushing chest pain started. More pissed at the stupid doctor that gave it to me for a minor shoulder injury and passed it off as "better than tylenol" without mentioning any risks.

As a patient, you do have a responsibility to yourself to read the label, the drug information sheet mandated to be bundled with the medication... of freaking google it.

Yea the doctor ideally should say something... but if you didn't make any effort to know what your taking, I'd argue your worse than the doctor.

drp: The sad fact is that the overwhelming majority of these patients never reach a pain-free state. We can help their symptoms become livable, but most will be on some lifelong polypharmacy regimen. Given that, we feel that lifelong daily opiates, with their side effects, tolerance and withdrawal characteristics, are better off avoided in almost every case.

What area of medicine are you in? Serious question.

This has nothing to do with addiction. The FDA met about Vicodin,Percocet,and Tylenol. They were meeting to discuss the labeling being changed because of liver failure. Then it turned in to a just ban it. Soooo. ANYWAY.

MOHWowbagger: Let me just weigh in for a second.

1) According to UpToDate, Acetaminophen toxicity is the #1 cause of acute liver failure in the US;

2) Tylenol is so benign at its normal doses that the general public does not understand the potential consequences of taking too much;

3) Death from tylenol poisoning (intentional or accidental) is horrific. Often, the liver damage (and imminent death) is irreversible, but patients are awake and lucid for a day or two before their body really begins to fail. They have to be told sometimes that they have less than a week to live.

4) The headline is a bastardization of the article and subby is a douche.

Do you know why it's the number one cause of acute liver failure? It's not because Mavis and Harvey took too much to kill a headache. It's the number one cause because if you walk into an ER room in this country during an 18 hour shift, there is some dumbshiat who swallowed an entire bottle in the attempts to kill themselves.

Subby isn't a douche. People who read simplistic conclusions without any real knowledge behind the data are misinformed, and use their tiny amount of information as a battering ram and call other people douches are in fact far douchier.

Alacritous: That's when you should be doing more testing, not marketing it full speed ahead.

The problem is that some adverse effects are so rare that it's statistically, mathematically impossible for premarket drug testing to prove them safe.

These are problems that become evident after many patients take the drugs over a long time. This is why all new drugs are carefully surveilled after approval. Now, some drug companies may deliberately conceal bad data during drug development, and that's inexcusable.

But just because a drug is found to have a harmful effect after its approval doesn't mean that either the testing was inadequate, or even that more testing would have revealed the effect.

Believe it or not, the FDA is pretty conservative when it comes to approving new drugs. Sometimes excessively so.

/ lookin' at you, Sugammadex

ArmoredFelix: All of you farking nancies that are taking pills to cope with your pain grow up and quit being pathetic little biatches. Yes, I realize that pain is relative but you are not in pain. You are experiencing mild discomfort.

You're like my idiot section commander.

Yes, mild discomfort is something many people call pain.

When my farking hand is crushed from a motorcycle accident it isn't mild discomfort, my bones were split down the farking middle.

drp: Believe it or not, the FDA is pretty conservative when it comes to approving new drugs. Sometimes excessively so.

There were known problems with Vioxx, and the FDA actually helped them cover it up. Read the article I linked. there's more information available.

Stay Cool Babylon: Shrew2u: /tramadol ftw - far better for pain relief than vicodin

Really? I'm not up to speed on the latest and greatest drugs, but I have taken Tramadol. It sorta sucks. In recommended dosages it's (to me) no better than a couple ibuprofen. The hydros or oxys actually eliminate or mitigate the pain in their prescribed amounts. I have to take so much Tramadol that I'm high as a kite (which is sorta awesome, don't get me wrong).

I should have stuck a disclaimer on that "ftw" - more like "ftw for me", since X level of pain relief for many people can take so many different forms, even for the same general type of pain. Mr. Shrew and I are similar in that vicodin does diddly squat except make us fuzzy-headed anymore (NTTAWWT, we did enjoy the buzz), while tramadol gives fast and lasting actual pain relief without the fuzzy head feeling.

Stay Cool Babylon: Shrew2u: /tramadol ftw - far better for pain relief than vicodin

Really? I'm not up to speed on the latest and greatest drugs, but I have taken Tramadol. It sorta sucks. In recommended dosages it's (to me) no better than a couple ibuprofen. The hydros or oxys actually eliminate or mitigate the pain in their prescribed amounts. I have to take so much Tramadol that I'm high as a kite (which is sorta awesome, don't get me wrong).

Tramadol has its uses so don't knock it. I use it for break through pain and would much prefer it to having to use something that is more of an opioid. Tramadol also doesn't make you massively high or out of it. What works for one person won't work for another.

LavenderWolf: When my farking hand is crushed from a motorcycle accident it isn't mild discomfort, my bones were split down the farking middle.

OWOWOWOWOWOWOWOWOWOWOW shiat!

So, what did you take for THAT undoubtedly massive pain?

cacophony_lo: What area of medicine are you in? Serious question.

Anesthesiology.

Several months of chronic pain clinic and interventional pain are part of all anesthesiologists' residency training. Some go on to do a yearlong fellowship in chronic pain and make that the focus of their practice. I didn't, but I'm reasonably comfortable with most chronic pain management. I wouldn't do radiofrequency ablation procedures, neurolytic blocks, and a few other things, but the rest of it's within my scope of practice.

That said, I don't plan on doing much chronic pain management in the future because, frankly, the non-procedural stuff doesn't pay anywhere near as well as passing gas for surgery.

America chugs cock for a living. What a pathetic country.

IANAD and all that, but Tramadol can be some nasty stuff long term. The first pass metabolite is about 100 times more active than the tramadol itself. Toss in the SSRI effects it has, and it's a ugly beast to break from.

/in the process of dropping a Tramadol dependence
//it sucks
///alot

kidsizedcoffin: mattknows: Shrew2u:

/tramadol ftw - far better for pain relief than vicodin

You're a farking idiot if you think that. Period, no discussion.

I think it depends on the person. My GF has a cyst and the vicodin doesn't do jack for it. She took some tramadol, and it made her pain lessen and she was able to sleep. Different pain meds can bet better for different people and conditions.

However, you made it a blanket statement that it was "far better for pain relief...", when the opposite is, for the majority, the truth.

Oh and if she has a cyst causing that much pain, sounds like it needs to get drained. A ruptured cyst is not something she wants.

Did anyone read the !@#$%^ article? The reason they're banning Vicodin is that it consists of a drug which works, combined with a LARGE dose of Tylenol designed to cause liver damage in people who would otherwise abuse Vicodin... now they're just taking the tylenol out of the vicodin so that legit patients don't get liver damage. If you actually WANT vicodin, you can just take hydrocodone and over-the-counter tylenol pills together and get the EXACT SAME THING.

So, in other words, this "ban" is a ban on taking choices away from patients. Hard to see how that's a bad thing.

Great. Now I have to go back to using PCP and tequila as a pain killer. It does the job but you usually end up hurting more the next day.

nuclear_asshat: MOHWowbagger: Let me just weigh in for a second.

1) According to UpToDate, Acetaminophen toxicity is the #1 cause of acute liver failure in the US;

2) Tylenol is so benign at its normal doses that the general public does not understand the potential consequences of taking too much;

3) Death from tylenol poisoning (intentional or accidental) is horrific. Often, the liver damage (and imminent death) is irreversible, but patients are awake and lucid for a day or two before their body really begins to fail. They have to be told sometimes that they have less than a week to live.

4) The headline is a bastardization of the article and subby is a douche.

Do you know why it's the number one cause of acute liver failure? It's not because Mavis and Harvey took too much to kill a headache. It's the number one cause because if you walk into an ER room in this country during an 18 hour shift, there is some dumbshiat who swallowed an entire bottle in the attempts to kill themselves.

Subby isn't a douche. People who read simplistic conclusions without any real knowledge behind the data are misinformed, and use their tiny amount of information as a battering ram and call other people douches are in fact far douchier.

After reading your sweeping generalization, I've decided to refrain from calling you a douchebag as well, and instead I'll refer you to the following journal, which says that intentional and unintentional overdoses account for EQUAL incidences of tylenol-induced liver failure each year.

Title: Acetaminophen and the U.S. Acute Liver Failure Study Group: lowering the risks of hepatic failure
Author: Lee WM
Journal: Hepatology 2004 Jul;40(1):6-9

It's not people taking too much tylenol "to kill a headache" (usually), but people with chronic pain problems who try to avoid taking narcotics and think it's safe to just keep taking more tylenol. Or, commonly, people with preexisting liver disease whose threshhold for tylenol-induced injury is lower.

JerkyMeat: America chugs cock for a living. What a pathetic country.

Says the dude hanging out on an American-centric site on July 4th.

Sick people should just die, you're a burden on our failed health system. It's the humane and profitable thing to do.

madblader

Your family m,embers first.

IsThatYourFinalAnswer: IANAD and all that, but Tramadol can be some nasty stuff long term. The first pass metabolite is about 100 times more active than the tramadol itself. Toss in the SSRI effects it has, and it's a ugly beast to break from.

/in the process of dropping a Tramadol dependence
//it sucks
///alot

And there's the rub for any really good pain reliever, really - possibility of addiction and nasty long-term side effects. Which is why I won't take but a single tramadol per day, at bedtime, so I can get some solid shut-eye. If I took it to control the near-constant pain I've been in since Tuesday, I'd probably develop a definite and scary liking for it.

drp:
Our clinic, for example, uses NO opiates for non-cancer pain. If there's an acute exacerbation of a chronic problem, sure, for a few days, but that's it. This pisses some patients off, especially if they were accustomed to getting narcs from other sources. It's hard to convince a person in pain that you have their best interest in mind when you're taking away their oxycodone.

Heh, I can attest to that personally. I recently finished a month-long "boot camp" at a pain rehab clinic for fibromyalgia (yes I may be one of the few people who actually does have it and is not a frigging lazyass drugseeker), and this was their stance, too. I was pretty upset in the middle of a flare when they wouldn't give me anything beyond Celebrex, but when that had passed and everything else they were teaching started to work, I could see they had the right of it--for my condition, at least. Too many of the other patients there were dealing with chronic illness/pain and addiction issues, and christ just one of those is enough. A regime of exercise, stress reduction, meditation, support therapy, massage, muscle relaxants, non-narc non-opiate meds works far better in the long run (and the occasional bit of prescribed medical marijuana when literally nothing else works and I'm climbing the walls). Of course, that's not nearly as easy to keep up with as popping a few pills a day.

And I can see that for the brief period of time I did have a vicodin prescription--which never worked very well to begin with--it was all too easy to become so desperate from the pain that I didn't care about potential liver damage from the ace if a higher dose helped. That kind of pain makes it awfully hard to make rational decisions, imo.

/my $0.02

Dear submittard, I hope your liver fails from toxic overuse of acetominophen. RTFA.

Well hey, when it comes to healthcare, who knows better than the government. Just ask any Fark intellectual.

mattknows: kidsizedcoffin: mattknows: Shrew2u:

/tramadol ftw - far better for pain relief than vicodin

You're a farking idiot if you think that. Period, no discussion.

I think it depends on the person. My GF has a cyst and the vicodin doesn't do jack for it. She took some tramadol, and it made her pain lessen and she was able to sleep. Different pain meds can bet better for different people and conditions.

However, you Shrew2u made it a blanket statement that it was "far better for pain relief...", when the opposite is, for the majority, the truth.

FTFY - kid didn't make that statement, I did. And I later modified my statement, if you care to read the thread that far.

namatad: Alacritous: I'll bet that shortly before or shortly after this ban takes effect that a product will come on the market conveniently that does the same thing as the banned combinations... Any money on which company it'll be that brings it?

no bet
but yah, there will soon be a hydrocodone only type pill
and in all fairness, why is the acetaminophen there in the first place?


So it can be a one pill miracle.

I was sick as hell last month. Coughed so much my teeth farking hurt. It hurt to breath because the muscles had spasmed so much. Perkocet killed the cough and the pain. No over the counter medecine could help and I tried them all. Thanks, meth assholes.

Sorry -- don't have time to read all the comments -- but let me just suggest that Percocet without tylenol (good old oxycodone) and Vicodin without tylenol (good old pure hydrocodone) are EVEN MORE DANGEROUS. When I was hooked on opiates (I'm over 9 months clean) I would have LOVED to find some pure oxy or hydrocodone. Easier to snort, shoot, etc.

This is a bad idea.

Oh but keep those cigs and booze coming. They're harmless.

People that don't think non-cancer pain and cancer pain aren't the same really piss me off. PAIN IS PAIN. There is an EPIDEMIC of under-treated chronic pain in the US itself.

Chronic use of acetaminophen or NSAIDs is BAD. PERIOD. There is NOT a consensus of chronic pain doctors that think opiates for non-cancer pain is a bad way to go, in fact it's quite the opposite. Here and here. Read it yourself. Tylenol and Ibuprofen can lead to liver damage, stroke, bleeding ulcers, etc. Opiates don't. OPEN YOUR EYES, "DOCTORS."

Primum non nocere. Still remember that part?

Corectorium

People that think non-cancer pain and cancer pain aren't the same really piss me off.

Proof-read, remember that part, me?

This is stupid. NSAIDS (like Ibuprofen) cause more injury and death than acetominophen, overall.
The gut ulcers, the kidney damage - and you can expect that to get worse.

FDA had better satisfy itself with a black box or it is going to find that its usefulness as an agency is past it's shelf life, and it gets pulled. Enough nannying Tell us what's in the medicine, ensure what's on the label is what is in the product, and does what it claims. perhaps record adverse events.- that's what the FDA is for.

Physicians pharmacists and patients decide whether and what to risk. They pick. Not you.

I wake up in the recovery room after having surgery for a ruptured disc. I have my own attendant with a syringe full of morphine at the ready if I simply groan a bit.

A few beds down, some clown is crying, begging for more painkillers. I mumble something about "give it a frigging rest, some of us are actually in pain. You just want some dope". My attendant laughs a little, and says "oh, I see you noticed that too. By the way, would you like some more morphine?"

/2 ruptured disc, two surgeries, nearly two years of pain management
//glad to be off the opiates

Note that they're not trying to ban painkillers.
Note that they're not trying to ban the restricted chemicals in the Vic and Perc.

The issue here is that acetaminophen is in so many different medications that people are f'ing themselves up by taking too much of it.

Answer to problem: Release Hydrocodone tablets. Doctors can now prescribe either Hydrocodone and Acetaminophen or Oxycodone and Acetaminophen instead of being forced to prescribe combination drugs.

People who have problems get the exact same amount of the exact same drugs as they are now; just without the excessive levels of Acetaminophen from having Acetaminophen in everything.

Bonus: Pure -codone!