Lumi: SU: Lumi: 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.

addiction and physical dependence are not interchangable terms. addiction may encompass physical dependence but physical dependence doesn't itself describe the phenomena of addiction.

And what are these special phenomena of addiction? Jonesing, bad behaviors used to attain the drug of abuse, being mean to people, really wanting to use the drug? That kind of stuff?

From the body's standpoint, people who are "dependent" on a drug looks exactly the same as people who are "addicted" to a drug.

Just because "addiction" has had additional behavioral attributes attached to it in the past 15 years since I received my GED in psychopharm doesn't mean there is any physical difference between the two.

Why are people so adamant on this point? Are they so reluctant to admit they are addicted to their painkillers? Or do they just want some way to differentiate themself from the "bad" people who go about getting their fix the wrong way (illegally, not to help with pain, etc.)?

"Me? Oh, I do admit I've developed a dependence on my Vicodin. Doc says it can't be helped...oh no, I'm not addicted [laughs]. I'm no Rush Limbaugh [both laugh]!"

I have a fair amount of experience in the treatment of addiction. I've always understood "dependence" to be a situation where the drug is necessary and prescribed. "Addiction" is a similar or identical behavior set, but in someone who does NOT have a medical need for the drug(s) they are taking.

Anyway, if you look at the 12-step programs, addiction is a pattern of behavior characterized by obsession and compulsion with *having* certain things -- drugs, food, sex, clothes, etc. NA's definition of addiction is broad enough that it specifically says that addiction doesn't even refer to any specific drug -- just the behaviors of obsession and compulsion. The only reason drugs come into play is because addicts need to stop using drugs before they can correct the underlying behaviors. (honestly -- read the 12 steps of NA. There isn't a single reference to drugs.)

What sucks is that acetaminophen is one of the few painkillers that isn't also a blood thinner. So if you end up in pain after an injury and also on blood thinners (warfarin or heparin), now you are screwed.

bullock.: 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.


What? They died because they took too much? They couldn't read the bottle or did the doctors prescribe too much? If the doctors are truly at fault and they lose their license the system is working.

If the people are taking too much and killing themselves, Darwin is working. I don't see how it's the doctor's fault.

Farking bean counters like you just don't have the concept of "acceptable loss." You're the farking reason I have to deal with tylenol after major mouth reconstruction surgery. Why the fark do we have the shiat at all if it's not doing to be prescribed? Christ, it's not like I'm asking for a morphine drip.

Ask for two days of oxy until the inflamation subsides and all of a sudden I'm a suspected junkie. Meanwhile the little old farking lady next to me is walking out with two months of oxy scrips for a pulled tooth.

No, you assholes are worse than the abusers. You've already got the doctors scared shiatless as it is.

co-conspirator: I am not an MD, I am a PhD who researches eye-movement disorders (but there are several neurologists in our lab from whom I have learned a bit here and there).

Some neurologists have prescribed gabapentin to treat acquired nystagmus, especially if it is associated with oscillopsia (visual perception that the world is moving).

How 'bout that, I've got to come to Fark for my education. I described oscillopsia exactly that way, and no one ever told me what it was called. I hated it.

After four treatments of the Epley maneuver and a couple of months of Brandt-Daroff exercises at home, I can bend over to pick something up without falling over or vomiting. But it's not a complete cure, and like the pharmacy techs who think I'm a criminal when I call about my prescriptions, the folks at the neurologist's office treated me like I was faking it.

I'm glad they figured it out, because it's such a thrill sitting up and lying down and making the whole world spin.

Nocens: bullock.: 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.


What? They died because they took too much? They couldn't read the bottle or did the doctors prescribe too much? If the doctors are truly at fault and they lose their license the system is working.

If the people are taking too much and killing themselves, Darwin is working. I don't see how it's the doctor's fault.

Farking bean counters like you just don't have the concept of "acceptable loss." You're the farking reason I have to deal with tylenol after major mouth reconstruction surgery. Why the fark do we have the shiat at all if it's not doing to be prescribed? Christ, it's not like I'm asking for a morphine drip.

Ask for two days of oxy until the inflamation subsides and all of a sudden I'm a suspected junkie. Meanwhile the little old farking lady next to me is walking out with two months of oxy scrips for a pulled tooth.

No, you assholes are worse than the abusers. You've already got the doctors scared shiatless as it is.

I was pleased to see that a lot of people in this thread understand why these meds are dangerous. Which you apparently don't.

You should consider the fact that nothing will prevent you from taking tylenol and hydrocodone or oxycodone separately, so people can up their opioid dose without destroying their livers. This is just common sense, not protecting stupid people.

Stupid people are people who take one pill instead of two when the combination puts their liver at risk.

Approximately two years ago, Forest pharma was promoting the newest and bestest evar hydrocodone and ibuprofen combo. I just rolled my eyes wondering how much this "new" combo drug was going to cost the patient. Makes me wonder if they didn't see this coming and were planning accordingly.

The government is banning a habit forming product because people abuse it?

That's unpossible!

BobaFeet: ubertwit: re: The FDA is a joke. If you trust what the FDA tells you, you deserve what you get.

no. the fda isn't a joke. you're a joke ya farking simpleton.

Yes, the FDA is a joke. It took the hiring and firing of 10 FDA chiefs before they found one that would approve aspartame for human consumption... and that chief just happened to be Donald Rumsfeld who had a monetary interest in aspartame... you know... coming from Monsanto and all. There is now overwhelming evidence that aspartame is a neuro-toxin and carcinogen, yet it is still on the market.

The FDA is controlled by pharma, fast-tracking untested medications so they can be tested on the public. The FDA has one responsibility which is to protect the public from dangerous food and drugs... There isn't a single thing in a typical grocery store that is safe for human consumption and drug regulations are practically nil.

The current head of the FDA is a numbskull. He recently wrote a book about food and thinks he's a genius because he figured out that the combination of fat, sugar and cheese create morphine-like reactions and addictions in the human body. This is something that has been known for quite some time. He talks like he's on horse tranquilizers.

Go ahead and trust the FDA. My guess is you're fat and/or sick.

Who's the simpleton, moran? Read-up, it might do you some good.

The current head of the FDA is a she, Margaret Hamburg, and she's no numbskull. Instead of making random accusations about how pharma controls the FDA, why don't you come up with something specific?

The rest of your post displays a similar level of ignorance about what the FDA does, and how long medications take to be approved.

Animatronik: Nocens: bullock.: 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.


What? They died because they took too much? They couldn't read the bottle or did the doctors prescribe too much? If the doctors are truly at fault and they lose their license the system is working.

If the people are taking too much and killing themselves, Darwin is working. I don't see how it's the doctor's fault.

Farking bean counters like you just don't have the concept of "acceptable loss." You're the farking reason I have to deal with tylenol after major mouth reconstruction surgery. Why the fark do we have the shiat at all if it's not doing to be prescribed? Christ, it's not like I'm asking for a morphine drip.

Ask for two days of oxy until the inflamation subsides and all of a sudden I'm a suspected junkie. Meanwhile the little old farking lady next to me is walking out with two months of oxy scrips for a pulled tooth.

No, you assholes are worse than the abusers. You've already got the doctors scared shiatless as it is.

I was pleased to see that a lot of people in this thread understand why these meds are dangerous. Which you apparently don't.

You should consider the fact that nothing will prevent you from taking tylenol and hydrocodone or oxycodone separately, so people can up their opioid dose without destroying their livers. This is just common sense, not protecting stupid people.

Stupid people are people who take one pill instead of two when the combination puts their liver at risk.



You missed my point entirely. Comprehend much?

Let me spell it out.

I don't give a fark if its mixed with another drug if I'm doubled over in pain and have no chance of getting something for it whether it's mixed or pure because of the abusers.

Two days of a mixed pain killer (four farking pills) is not putting my damned liver at much risk if any.

After a bad car wreck while I was stationed in Germany, the Army doc were giving me percocets like it was candy for about 6 weeks. Started getting dependent on it and after the medics said something along the lines of "U no can has more percocets. Not yours." I was having fits for a couple days until I dove into a bottle of Bacardi 151 to break the withdrawl from the pills. Since then, I've not touched the stuff. vicodin, oxycontin, percocet... I won't touch the stuff even after getting teeth pulled

Nocens: You missed my point entirely. Comprehend much?

Let me spell it out.

I don't give a fark if its mixed with another drug if I'm doubled over in pain and have no chance of getting something for it whether it's mixed or pure because of the abusers.

Two days of a mixed pain killer (four farking pills) is not putting my damned liver at much risk if any.

OK, I can see where you're coming from. Unfortunately, i think most people who take these drugs don't need them. They are extremely powerful and should ONLY be used by people with the worst pain.

I had surgery twice over the last few years and each time the pain afterward was severe and lasted for a week or two. I was given scrips for opioids both times, but I took ibuprofen instead because my fear of opioids was much greater than the pain. People need to fear these drugs, there are many addicts and many people who are addicts but don't realize it.

Alacritous: 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.

Further phase 3 testing would not have given any more information, since we were talking about a tiny increase in a common problem. The only way to detect that is via phase 4 surveillance, which is what happened, and what's appropriate. If you need a million people to actually measure an effect, then you need to just put the drug out there and market it and monitor it.

The sad part of this is that many people do take these medicines safely and appropriately. So the few bad apples spoil the whole bunch so to speak. The typical person has a wisdom tooth extracted, takes a couple of vicodins a day for 2 days then feels better and is not totally miserable for those two days. Perhaps there needs to be limits on how many can be purchased or something to limit how many a person can get at a time or something like that. Still I looked this up just now and it says that the average young person can take up to 4 grams of acetominophen a day safely. That would be the equivelent of 8 Vicodin a day...my guess is that if you need more than that then you are either addicted to it and are taking it for "fun" or you have developed tolerance to it and it probably is not working anyway in which case you probably need to be moved to a more potent analgesic or have some alternative treatment prescribed.

Personally I think this is just another example of the Obama effect. That is to say, we are going to run this country and now we are going to control every aspect of your lives. Next thing you know they will be taking my blood pressure medication away.

Riffington: The only way to detect that is via phase 4 surveillance, which is what happened, and what's appropriate.

There were over 30,000 cases of cardiac events or death from vioxx. You'd think something like that might have shown a glimmer of possiblity somewhere during the prerelease phases.

Alacritous: Riffington: The only way to detect that is via phase 4 surveillance, which is what happened, and what's appropriate.

There were over 30,000 cases of cardiac events or death from vioxx. You'd think something like that might have shown a glimmer of possiblity somewhere during the prerelease phases.

Not if 10 million people were taking the drug and 15,000 would have had cardiac events anyway if they weren't taking the drug (arthritis patients tend to be older and tend to have heart issues more than younger people). i pulled those numbers out of my ass, but his point that you need phase 4 studies is valid: the effect may have been small enough to not be detectable in Phase 3 trials.

Lumi:
Just because "addiction" has had additional behavioral attributes attached to it in the past 15 years since I received my GED in psychopharm doesn't mean there is any physical difference between the two.

Why are people so adamant on this point? Are they so reluctant to admit they are addicted to their painkillers? Or do they just want some way to differentiate themself from the "bad" people who go about getting their fix the wrong way (illegally, not to help with pain, etc.)?

Because there are important clinical differences. Let me describe two situations, and you tell me if you can spot the difference.

Patient 1 is prescribed opioids for worsening back pain. She uses them as prescribed, but after a few weeks discovers that she has to use her emergency "rescue" meds more often; I therefore go up a little on her dosage to account for the narcotic tolerance she is developing. Eventually, she has an operation that helps this back pain greatly. She is physically dependent on the opioids, so stopping them abruptly after she recovers from the operation makes her miserable for a few days. Afterwards, she does not really crave opioids, but uses them when appropriate (in above-average dosages).

Patient 2 is prescribed opiates for worsening back pain. She uses more than are prescribed, both to relieve pain and for the thrill, requiring higher and higher doses. Eventually, her physician accuses her of abusing them. He takes them away, leaving her in excruciating pain as well as withdrawal. She finds a new doctor to give her opioids, and the same thing happens. She is associating withdrawal with high pain levels, and even after she has an operation that helps the back pain, she still continues to crave the opioids. She finds three different physicians to prescribe her opiates, and also buys some from friends. She is fired after stealing some from a coworker. She visits a rehabilitation program, but four months later is again using medications illegally.

Doctors define addiction and physical dependence differently, because they affect human lives very differently. Physical dependence is unfortunate, but not nearly as unfortunate as poorly-treated pain. Addiction is a tragedy.

Animatronik: Alacritous: Riffington: The only way to detect that is via phase 4 surveillance, which is what happened, and what's appropriate.

There were over 30,000 cases of cardiac events or death from vioxx. You'd think something like that might have shown a glimmer of possiblity somewhere during the prerelease phases.

Not if 10 million people were taking the drug and 15,000 would have had cardiac events anyway if they weren't taking the drug (arthritis patients tend to be older and tend to have heart issues more than younger people). i pulled those numbers out of my ass, but his point that you need phase 4 studies is valid: the effect may have been small enough to not be detectable in Phase 3 trials.

As mentioned, there was more than a "glimmer of possibility": we knew it increased cardiac mortality over the NSAID rate. We just didn't know to what extent that was the NSAID protective factors vs Vioxx actually causing events. There was clear evidence that Vioxx reduced GI bleed (another major cause of morbidity and mortality) vs NSAIDS. That tradeoff appeared more favorable towards Vioxx in 1999 than it appeared in 2001.
It's easy to be a Monday-morning quarterback, of course.

Riffington: Animatronik: Alacritous: Riffington: The only way to detect that is via phase 4 surveillance, which is what happened, and what's appropriate.

There were over 30,000 cases of cardiac events or death from vioxx. You'd think something like that might have shown a glimmer of possiblity somewhere during the prerelease phases.

Not if 10 million people were taking the drug and 15,000 would have had cardiac events anyway if they weren't taking the drug (arthritis patients tend to be older and tend to have heart issues more than younger people). i pulled those numbers out of my ass, but his point that you need phase 4 studies is valid: the effect may have been small enough to not be detectable in Phase 3 trials.

As mentioned, there was more than a "glimmer of possibility": we knew it increased cardiac mortality over the NSAID rate. We just didn't know to what extent that was the NSAID protective factors vs Vioxx actually causing events. There was clear evidence that Vioxx reduced GI bleed (another major cause of morbidity and mortality) vs NSAIDS. That tradeoff appeared more favorable towards Vioxx in 1999 than it appeared in 2001.
It's easy to be a Monday-morning quarterback, of course.

Well, that's essentially saying that the apparent effect after Phase 3 was so small that risk-benefit arguments rendered it negligible. Which all changed when the risks becamore more apparent after it went to market. I am not familiar with the particulars of the Vioxx case.

Fact is that people need to be more aware of risks asociated with painkillers. If you have major arthritic pain, such that you can hardly move without a drug, you should be willing to take a riskier drug, because you will suffer health problems associated with lack of mobility (beyond the quality of life argument).

If however, you have an arthritic knee that causes occasional joint pain that is not crippling, a drug like Vioxx is obviously a bad choice. Unfortunately, marketing departments of bg pharma companies all too often work at promoting riskier uses of their drugs - a real problem. Hopefully, genomics will reduce the risk even further and make more medications available to people who need them.

Cap Ten Oblivious: namatad: and in all fairness, why is the acetaminophen there in the first place?

I always thought it was to keep people from using it as a recreational drug.

I haven't read the entire thread, but the acetaminophen or ibuprofen are added to improve pan relief without increasing the narcotic component.

museisluse: Cap Ten Oblivious: namatad: and in all fairness, why is the acetaminophen there in the first place?

I always thought it was to keep people from using it as a recreational drug.

I haven't read the entire thread, but the acetaminophen or ibuprofen are added to improve pan relief without increasing the narcotic component.

If I recall, a lot of the studies showed that pain relief was primarily from the non-narcotic component because the amount of avialable narcotic was limited to prevent respiratory depression and other significant complications of narcotic overdose. Stand-alone products will be limited in effectiveness because of this limitation as well.

Strong oral narcotics will never be used for routine pain control because of liability issues. Cancer patients and chronic pain patients get more powerful narcotics because of tolerance and other obvious reasons.

If your doctor is prescribing Dilaudid 4mg after your routine gallbladder surgery, you may want to think twice about taking it.

NeoBad: The sad part of this is that many people do take these medicines safely and appropriately. So the few bad apples spoil the whole bunch so to speak.

It's not a few bad apples screwing it up for everyone else. It's chronic pain patients who are suffering liver damage in spite of following doctor's orders. My doctor prescribed 10 mg Vicodin (650 mg APAP,) three times a day. I followed my doctor's instructions to the letter. I never took any other prescription or OTC med, other than what he prescribed. I never took more than he prescribed. I stopped drinking alcohol entirely. I did everything right. And a year after the accident I was diagnosed with liver failure.

I don't know what the right answer is. I'd rather not see FDA take Vicodin and Percocet off the market, but it would seem that prescribing them for long-term use is not advisable. Yet my doctor was very annoyed with me when I told him I'd been diagnosed with liver failure and we needed to find something else.

And switching people from Schedule III Vicodin to Schedule II hydrocodone (alone) will be a nightmare for everyone involved. And it will probably make hydrocodone easier for addicts to obtain.

Bestbank Tiger: Just ban it. It would be terrible to just put the information out there and allow people to make an informed decision.

you can't just ban something because it's dangerous. yeah, I have to take percocet daily for a busted knee (I have no insurance to get my knee fixed yet). I barely afford the percs. but I would rather take percs everyday and take that chance of damaging my liver than to not take it at all.

besides you can't just swtich from perc with to perc only. it definitely would be a nightmare.