MOHWowbagger: 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.

So about 1/2 of the cases are suicide attempts. Of the other half, most of them were already taking the drug and took more than the amount directed by their attending physician.

Your point was that this was some huge dangerous substance and the FDA as doing us a favor. You break the numbers down and clearly it's not an EVERYBODY PANIC!!!! drug. 1/2 tried to kill themselves and the other half are popping pills like crazy. That's hardly a reason to remove a safe drug from the public for what will likely be replaced with a substitute from a pharma company with a lot less research data.

The FDA is clearly overstating the problem .

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?

The apap potentiates the painkilling of the oxy or hydro making a 5mg oxy work as well as a 20 or so.

Yeah, vicoden doesn't give me any kind of high at all, and its pain relieving ability is maybe just a bit better than a double dose of naproxen. Thankfully I've never been in a medical situation where I needed pain relief, because I worry that the stronger related meds might also be ineffective.

And for all the people talking about legalizing pot for pain relief, I have a question. Several years ago, I distinctly remember a friend of mine who said she had a prescription for something called Marinol, which is basically purified THC. So, if Marionl can be legally prescribed, then why is it necessary for pot to be legalized? To me this situation is similar, though not entirely analogous, to opium being illegal, but we have tons of drugs derived from it that can be legally obtained and used by prescription.

Just for the record, I'm actually in favor of marijuana legalization, but I still have a few questions, I guess.

Shrew2u:

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.

Well, just be careful with that stuff. I started the exact same way. One for bed...then two for bed....then three for bed, wake up at midnight, pop another two. I'd gotten to the point to where I was taking 200mg of tramadol every 4 hours just to function, no buzz at all. Never noticed it as an addiction, and my doc (vet affairs, course) has the "Not scheduled, not addictive" mentality. Decided last week I had a problem, stopped my refills, and staggered down. I'm on Day 4 of no Tramadol, and it's a true bastid.

For some reason, Aleve helps, along with Seroquel.

MrHappyRotter: Yeah, vicoden doesn't give me any kind of high at all, and its pain relieving ability is maybe just a bit better than a double dose of naproxen. Thankfully I've never been in a medical situation where I needed pain relief, because I worry that the stronger related meds might also be ineffective.

And for all the people talking about legalizing pot for pain relief, I have a question. Several years ago, I distinctly remember a friend of mine who said she had a prescription for something called Marinol, which is basically purified THC. So, if Marionl can be legally prescribed, then why is it necessary for pot to be legalized? To me this situation is similar, though not entirely analogous, to opium being illegal, but we have tons of drugs derived from it that can be legally obtained and used by prescription.

Just for the record, I'm actually in favor of marijuana legalization, but I still have a few questions, I guess.

Marinol is a synthetic version of THC and its affects vary person to person. By most accounts (anecdotal in my case) it doesn't work so well.

Most people that truly use cannabis for pain relief don't smoke it, they ingest it, as it works way better and lasts longer than just smoking it.

MrHappyRotter: And for all the people talking about legalizing pot for pain relief, I have a question. Several years ago, I distinctly remember a friend of mine who said she had a prescription for something called Marinol, which is basically purified THC. So, if Marionl can be legally prescribed, then why is it necessary for pot to be legalized? To me this situation is similar, though not entirely analogous, to opium being illegal, but we have tons of drugs derived from it that can be legally obtained and used by prescription.

Two cancer patients have told me that Marinol does not provide the pain relief that smoking a joint does, and it does not ease the nausea of chemotherapy or enable the patient to actually eat.

I admit that's a ridiculously small sample, but it's all the terminal cancer patients I knew. And even if ordinary adults have to be "protected" from the eee-vil weed, why on earth are we depriving terminal cancer patients?

Actually, hydrocodone is sold alone in it's polystyrex form as Tussionex®, a delicious, pineapple-flavored cough medicine which gives one a very pleasant buzz (better than vicodin!). I am sure someone else has mentioned this by now but I am not about to read through 205+ comments just to say that. It is late (23:24 EDT) and I am tired. Have a good night, y'all!

abiigdog: Your opinion seems to be at odds with each other or at least it would seem your saying YOU deserve the power of med recommendation not the FDA, when I'd argue that decision should be in the patients hands and not in your or the FDA's ultimately.

You shouldn't take options away from either the doctors or the patients.

Taking options away from the FDA, OTOH, is fine by me, as long as all parties are informed. Acetaminophen isn't exactly thalidomide, is it?

The PROBLEM isn't the acetaminophen. The PROBLEM is the fact that people are abusing them. And they will continue to abuse them, especially if these pills are "pure".

Do you know how happy I would have been to find pure hydrocodone when I was all junked out? Do you know how excited I was everytime I found pure oxycodone?

This is a baaaaad idea.

I have both Vicodin and Percocet on my shelf, so I'm getting a kick ETC.

/Fentanyl is evil stuff
//was on it for a month and a half
///rather have a tooth pulled out of the top of my head without anesthetic rather than go through that withdrawal again
//Demerol, however, rocks
/BYO laxatives

Marley:

Two cancer patients have told me that Marinol does not provide the pain relief that smoking a joint does, and it does not ease the nausea of chemotherapy or enable the patient to actually eat.

I admit that's a ridiculously small sample, but it's all the terminal cancer patients I knew. And even if ordinary adults have to be "protected" from the eee-vil weed, why on earth are we depriving terminal cancer patients?

Okay, and keep in mind that I'm playing devil's advocate, but what if the same is true for opium vs its legal derivatives? I'm wouldn't be surprised if you'd find people that say pure opium works on their pain better than any of the opiate drugs.

nuclear_asshat: MOHWowbagger: 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.

So about 1/2 of the cases are suicide attempts. Of the other half, most of them were already taking the drug and took more than the amount directed by their attending physician.

Your point was that this was some huge dangerous substance and the FDA as doing us a favor. You break the numbers down and clearly it's not an EVERYBODY PANIC!!!! drug. 1/2 tried to kill themselves and the other half are popping pills like crazy. That's hardly a reason to remove a safe drug from the public for what will likely be replaced with a substitute from a pharma company with a lot less research data.

The FDA is clearly overstating the problem .

Are you being serious? They're not removing tylenol from the public. They're removing it from two combination meds in an effort to prevent accidental toxicity. Both drugs will still be available to use or abuse as much as you want. You're screaming conspiracy because you'll now have to take an oxycodone AND a tylenol instead of one combination pill?

vertiaset: You can get a natural, longer lasting high from exercise and meditation. Plus, you get the added benefit of ... you know ... not dying.

Pussy.

IsThatYourFinalAnswer: Shrew2u:

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.

Well, just be careful with that stuff. I started the exact same way.

Roger Wilco. Last night was probably my last tramadol, since I've been able to walk upright without yelping today. Hope so - the pain relief is nice, but I'd rather be able to have a nice glass of chardonnay before bedtime!

"Combo" drugs are actually one of the major causes of liver failure, and not usually because of intentional drug abuse. I see nothing wrong with forcing the drugs to be sold separately (and more cheaply too).

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.

Viox was great for my back, I really miss it :(

MrHappyRotter: Okay, and keep in mind that I'm playing devil's advocate, but what if the same is true for opium vs its legal derivatives? I'm wouldn't be surprised if you'd find people that say pure opium works on their pain better than any of the opiate drugs.

I'm not sure I understand the question. (Too much Vicoprofen, I guess.) You're asking if pure opioids work better than narcotics/APAP combination should we use that instead?

My understanding is that in terms of pain relief, it doesn't. I have no experience, so I'm talking out of my ass, but I'm told that the APAP or ibuprofen enhance the effect of the narcotic. Plus there's that whole "harder to snort" thing.

It's the APAP that's cooked my liver, though. Switching to Vicoprofen, which only comes in lower dose tablets, was horrific.

preshrink: Acetaminophen is a messy drug and probably shouldn't have been approved in the first place. For those of us who regularly punish our livers, it's a really bad idea. Plus, acetaminophen doesn't work for shiat.

There are already plenty of other options, eg., Nurofen Plus (ibuprofen and codeine), or the aforementioned opiate + NSAID as separate pills. I don't know if Nurofen is already approved by the FDA (it *would* be very convenient if such approval somehow reactivated/renewed the patent and lined *somebody's* pockets).

Unless you're married to someone with a diagnosed NSAID allergy, chronic pain, and trying NOT to develop an addiction.

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

Pain is pain, but not all pain should be treated the same way.

The first article you cited is not a set of practice guidelines or even a consensus statement. It's a review article with some recommendations - and even it specifically states that opiates should never be first-line treatment for chronic pain. I could also cherrypick similar articles advocating non-opiate approaches.

The second article included the bit "There is currently no nationally accepted consensus for the treatment of chronic pain not due to cancer" and I have to agree with this. I am by no means suggesting that it is inappropriate to prescribe opioids for non-cancer pain - indeed, in this very thread there's another anesthesiologist who does.

Chronic use of acetaminophen or NSAIDs is BAD. PERIOD.

Why are you so willing to make this (incorrect) blanket statement, but so angry when I say that chronic use of opiates usually works out poorly?

Primum non nocere. Still remember that part?

Primum non nocere is precisely why I avoid prescribing narcotics to certain subsets of patients. My education, training, and experience have led me to conclude that in the long run, most find that their quality of life is scarcely improved by chronic opiate use but instead they've added opiate tolerance and dependence to the equation (note that tolerance & dependence are not the same thing as addiction, which is actually rare in chronic pain patients taking opioids).

1.61803399: Dear submittard, I hope your liver fails from toxic overuse of acetominophen. RTFA.

time to think up yet another alt

ttc2301: I have both Vicodin and Percocet on my shelf, so I'm getting a kick ETC.

/Fentanyl is evil stuff
//was on it for a month and a half
///rather have a tooth pulled out of the top of my head without anesthetic rather than go through that withdrawal again
//Demerol, however, rocks
/BYO laxatives

Yes, Fentanyl is very bad, but, when front line opiates just aren't cutting it...you gotta do what you gotta do.

/Spinal cord tumors and several spinal surgeries...The thing is, I don't feel a buzz at all. I get a better buzz from a Mojito. But do not mix the two...

If pain management was simple anyone could do it.

Unfortunately, it's not. In part because we're not completely sure what pain really is or how it works.

I'd be thrilled to find something that works for my arthritis but doesn't mess with my Crohn's. NSAIDS are trouble because of GI irritation; acetaminophen is an extra worry because I take a potentially nasty hepatotoxic immunosuppressive; and codeine-derived drugs screw up intestinal motility.

Vioxx was marginally useful while it lasted.

I'm (probably) not drug-seeky as I've never finished any opioid prescription.

I conclude that it would be nice to live in a medical marijuana state.

MrHappyRotter: Yeah, vicoden doesn't give me any kind of high at all, and its pain relieving ability is maybe just a bit better than a double dose of naproxen. Thankfully I've never been in a medical situation where I needed pain relief, because I worry that the stronger related meds might also be ineffective.

And for all the people talking about legalizing pot for pain relief, I have a question. Several years ago, I distinctly remember a friend of mine who said she had a prescription for something called Marinol, which is basically purified THC. So, if Marionl can be legally prescribed, then why is it necessary for pot to be legalized? To me this situation is similar, though not entirely analogous, to opium being illegal, but we have tons of drugs derived from it that can be legally obtained and used by prescription.

Just for the record, I'm actually in favor of marijuana legalization, but I still have a few questions, I guess.

Marinol is worthless, take it from a hospice nurse

i have to say that tramodol does very well for my chronic back pain. i have 3 herniated discs in my lower back. most docs are scared to death to prescribe the stuff that is safe and that works because of all the publicity of abuse.

i would be just fine with a decent hydro/oxy script, but no doc will do it. in the meantime, i will continue to humor my doc by going to physical therapy, chiro, massage, and everything else they suggest but i really just wish they'd give me what works instead of having to maintain some pretty shady contacts to get the meds i need.

/have insurance
//people w/o insurance seem to get better care when it comes to pain

Littleturtle: Marinol is worthless, take it from a hospice nurse

Doesn't do jack-sh*t for nystagmus, either, while cannabis does. But I will never be able to conduct a real (i.e. N>1) study or publish the results.

numb3r5ev3n: I've seen people screwed up by "prescription" narcotics. I know that pain management is an issue for some people, but it's also true that these medicines are too much for some to handle, and they become addicted.

There has to be a better way.

There isn't. Everyone who takes narcotics becomes addicted. That's what narcotics do.

In fact, there's nothing wrong with a little opiate addiction in those who suffer chronic pain. Ask anyone who takes vicodin if they'd rather have regular bowel movements or suffer the excruciating pain that the vicodin relieves. Constipation sucks, they'll tell you, but the pain is worse.

The ridiculous part is when morphine drips for the terminally ill are cut back to reduce risk of addiction, causing them to suffer needlessly.

And a hydrocodone-only pill better be on the market the moment vicodin is yanked, because I don't want to see one of my loved ones try to make it through the day without one.

I like how they said 'Bad news for Dr Greg House!' Because for those of us that follow the show (sadly) that's the first farking thought that popped into our sad little minds.

"Oh no! Poor Dr House!"

A BIG vote here for Celebrex. It's the ONLY pain reliever I've ever used that works. All the others might as well have been sugar pills. Plus, it is safe as houses, compared to most other NSAIDs.

Crackers Are a Family Food: namatad: forget it, there are already a million other combos out there
hydrocodone with (aspirin, ibuprofen, blah blah blah blah)

so people will have to switch ...
but probably wont be the end of the world

The problem with that is that many people, such as myself, are allergic to NSAIDs, so those combos are out of the picture for us.

This whole decision is such bullshiat. Like someone else said, I hope every person who voted in favor of this lives the rest of their lives with intractable pain and have nothing to take for it. fark 'em up the ass. Less than three percent of people given these meds abuse them. But now that hydro/oxycodone will need to be prescribed pure, the DEA will claim that abuse potential has just skyrocketed, and they'll be pulled off the market altogether. Just watch.

/bastards
//chronic pain is NOT fun

THIS THIS THIS FARKING THIS

/Media will eat those stories from the DEA up
//STOP listening to the media!!

My favorite post-op med is dilaudid...but it's really not a long term drug. And I would never want to feel like it makes me feel just for fun...I lost an entire week after the last spinal surgery. I remember pretty much NOTHING...

I have to agree that Dilaudid is prob the best drug out there, for in hospital pain control. I was hospitalized with Meningitis a couple of years ago and the headache/neck pain was atrocious. @ mg IV Dilaudid q 3 hours did the trick.

First dose and I understood how easy it is to get addicted to herion.
(IIAC, Dilaudid is only a molecule or 2 off from heroin)

How farking hard is this. If you are on X drugs, do not take Tylenol.

It's the same with drinking. I can't tell you how many idiots I knew that decided Tylenol before bed or Tylenol in the moring was the best thing for a hang over. Go fark you liver.

I'm on my 4th ACL and God Damn those Percosets were farking awesome. I love me some opiates.

/Durnk.

As someone who struggled for several years with an addiction to opiate painkillers, I would like to apologize to everyone who will legitimately suffer if this ban becomes official. It's selfish and stupid people like myself that screw things up for people that truly need help.

Sorry.

Riffington: abiigdog:
On one hand you seem to support the drug decision making on the doctor and the patient, then turn around and claim that it's best patients take the combo drug because they may not follow your directions anyways? Your opinion seems to be at odds with each other or at least it would seem your saying YOU deserve the power of med recommendation not the FDA, when I'd argue that decision should be in the patients hands and not in your or the FDA's ultimately.

A big part of prescription is knowing your patients, and helping them to find a medication (or combination) that will work for them. There are a large number of patients (probably a majority of the patients who have taken oxycodone) for whom a combination of acetaminophen/oxycodone is the best drug. For those patients, that's what they should be prescribed. Other patients should not.

But yes, the FDA (if it adopted this) would be overstepping its bounds. The FDA is there to make sure that drugs do what they say they do. The doctors are there to help patients get the medications most appropriate for them. Ultimately, the patient is the one taking the medication, so obviously they have the final say.

Even if it were shown that the practice of combining acetaminophen and opiates should stop (it has not), the FDA should not be the group making that recommendation. The American Academy of Pain Medicine is a more credible and less political organization, with a better understanding of the issues and the science.

Alacritous: Gyrfalcon: Aspirin is derived from salicylic acid--which is derived from a tree bark; arsenic is a heavy metal. Good god I'm so sick of people wanting "natural" alternatives to "drugs" when most drugs are, in fact, totally natural.

I think people have a problem with being prescribed medications that the doctor is paid(or otherwise enticed) to prescribe. Medications with horrible side effects. Medications where, when the patent has expired, the drug company fiddles with a molecule chain a bit, and rereleases it under a new name and a new patent and full price. Medicines that haven't been properly tested, or when they are tested, negative side effects are marginalized or ignored.

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



Yeah but come on who are we fooling, that ass in the president seat wants to be making ALL MEDICAL decisions for you, or err at least the ones that cost money, it don't get any more political then government ran health care. This ruling is a tea cup of water on a drowning mans head.

I'm on narcotic paint killers right now, so I'm getting a kick out of these posts... :-)

/for real -- 15mg oxy -- no apap.
// :-) :-)
/// what's not to smile about when the pain is gone, and the opiates make you feel good.

P.S. to all you holier than thou types who think it's better to be in chronic pain than addicted to opiates, I suggest you try the pain for a few weeks -- you'd change your tune in a hurry. It's *far* better to be addicted to oxy or it's ilk than experience ongoing severe pain 24/7.

medic2731: I have to agree that Dilaudid is prob the best drug out there, for in hospital pain control. I was hospitalized with Meningitis a couple of years ago and the headache/neck pain was atrocious. @ mg IV Dilaudid q 3 hours did the trick.

First dose and I understood how easy it is to get addicted to herion.
(IIAC, Dilaudid is only a molecule or 2 off from heroin)

Dilaudid is the only drug that ever really controlled the pain after the surgeries...I totally agree with you about understanding how easy it would be to get addicted to heroin. The dilaudid is nasty stuff, but I am glad it is there when it's needed.

Jesus, this is like reading the notes and letters in the back of Naked Lunch. Too bad ole Billy Burroughs is dead.

kermit_the_frog:

P.S. to all you holier than thou types who think it's better to be in chronic pain than addicted to opiates, I suggest you try the pain for a few weeks -- you'd change your tune in a hurry. It's *far* better to be addicted to oxy or it's ilk than experience ongoing severe pain 24/7.

/I couldn't agree more!

Lumi: numb3r5ev3n: I've seen people screwed up by "prescription" narcotics. I know that pain management is an issue for some people, but it's also true that these medicines are too much for some to handle, and they become addicted.

There has to be a better way.

There isn't. Everyone who takes narcotics becomes addicted. That's what narcotics do.

In fact, there's nothing wrong with a little opiate addiction in those who suffer chronic pain. Ask anyone who takes vicodin if they'd rather have regular bowel movements or suffer the excruciating pain that the vicodin relieves. Constipation sucks, they'll tell you, but the pain is worse.

The ridiculous part is when morphine drips for the terminally ill are cut back to reduce risk of addiction, causing them to suffer needlessly.

And a hydrocodone-only pill better be on the market the moment vicodin is yanked, because I don't want to see one of my loved ones try to make it through the day without one.

Sorry, you're wrong on one major point. Not everyone that takes narcotic pain relievers becomes addicted. They will more than likely become dependent. There's a major difference between the two, addiction is for fun, dependence is a medical condition. Please look up the difference between the two.

co-conspirator: Doesn't do jack-sh*t for nystagmus, either, while cannabis does.

It helps nystagmus?? Does it also help with balance issues?

/TBI

Oh man papa bear Rush is going to be stocking up now.

abiigdog: Yeah but come on who are we fooling, that ass in the president seat wants to be making ALL MEDICAL decisions for you, or err at least the ones that cost money, it don't get any more political then government ran health care. This ruling is a tea cup of water on a drowning mans head.

So... how's that paint huffing been working out for you? At least it's over the counter.

/"Take two Krylon and call me in the morning."

MrHappyRotter:
And for all the people talking about legalizing pot for pain relief, I have a question. Several years ago, I distinctly remember a friend of mine who said she had a prescription for something called Marinol, which is basically purified THC. So, if Marionl can be legally prescribed, then why is it necessary for pot to be legalized?

Marinol is synthetic THC that is patented. I have heard it cost about $30 a pill and most people need to take a few to make it work. And it does not work as well as real pot.

RancidOne: Lumi: Sorry, you're wrong on one major point. Not everyone that takes narcotic pain relievers becomes addicted. They will more than likely become dependent. There's a major difference between the two, addiction is for fun, dependence is a medical condition. Please look up the difference between the two.

From a neuropsychopharmacological standpoint there is no difference between dependence and addiction. The chemical mechanisms are identical.

The distinction between "dependence" and "addiction" is a lay one, not a medical one, and "dependence" is simply a nice way to reassure people they aren't filthy addicts. Or something.

Marley: It helps nystagmus?? Does it also help with balance issues?

Some forms, such as infantile nystagmus syndrome (used to be known as "congenital nystagnus")

I suspect it would be a problem to add on top of acquired forms such as vestibular, as there are other issues, such as trauma, involved. But it's vanishingly unlikely I'd get approval to do such a study...

Have another pill, pillhead.

co-conspirator: Some forms, such as infantile nystagmus syndrome (used to be known as "congenital nystagnus")

I suspect it would be a problem to add on top of acquired forms such as vestibular, as there are other issues, such as trauma, involved. But it's vanishingly unlikely I'd get approval to do such a study...

When you do that study, look me up, please. My neurologist told me "It'll just take time." Isn't two years enough?

As someone with a pocket full of Norco whose liver just exploded all over the god damned cat, kicks and so forth.

My father did was a doctor providing chemo to cancer patients 10-15 years ago, he said it was not unusual for patients to come in reeking of pot, partly for the pain, partly for the nausea, he never made a big deal of it, he was happy if they found something to make them feel better. Nevermind it has now been shown to stunt or reduce some tumor growth. We have his chemo chair in our living room now, great conversation piece once someone is situated in it.

And thanks Shrew2u for clearing up the way above misconception about my post.

It is not asinine, it is needed. I work in the insurance field and doctors prescribe it for non-acute, non-cancer pain for far too long. I've had people on my caseload die from too much. The doctors that do this eventually lose their license, but that doesn't bring the dead people back.