Opioid Crisis! Alarm! Panic!

 

The opioid crisis has struck America. I know, because my health insurance has notified me of such. It’s Cigna’s “goal to offer access to coverage for safe, effective and affordable medications.” They want me to know that starting July 1st, they will restrict my coverage to amounts that they consider to be safe.

I was shocked, just shocked, to see that “accidental opioid overdoses reportedly kill more people than car accidents.”

Thank God Cigna is there to save me from myself!

I mean, with my Butalbital-ASA-Caffeine that I take rarely for migraines, it’s so important that they prevent me from taking it frequently. Also, without this letter, I never would have known that it was a narcotic or opiate. Butalbital is usually classed as a barbituate, but who am I to judge? This letter explains to me just how dangerous all of this is!

Thank God that they are here to save me from myself and my appropriate medical knowledge.


Coming to a mailbox near you: coverage limits on drugs that will be reclassed as “opiates” simply because the insurance does not want to cover larger amounts and does not want to be responsible for potential overdoses. I wouldn’t be so outraged if the Pharm D. who signed this inane form letter had a specific provision stating that not all medications in this were opiates, but were going to be subject to increased oversight. It particularly irks me that their Chief Pharmacy Officer is spouting information from Cleveland Clinic and is being completely indiscriminate. Less educated people would just accept that they had somehow been on opiates all this time and simply did not know. I consider this letter to be an example of bad faith and inappropriate education, bordering on fraudulent misinformation. It increases panic and increases the stigma for people who happen to use and need opiates for pain control.

Just be aware. Misinformation is not just on the news anymore.

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  1. jef1944 Member
    jef1944
    @

    I don’t really get the addiction thing. I had severe back problems for several months in 2011 (couldn’t sleep in a bed from August to October because I couldn’t lay flat for more than about 30 seconds – slept face down in a recliner instead). Was on Percocet for about 2-3 weeks, then my doctor switched me to Vicodin because she was worried about dependency. I was taking Vicodin like candy for several weeks then cut down to 1 or 2 a day for a few months, before quitting.

    They killed the pain nicely, but I didn’t notice any “recreational” effect from either one, and didn’t have any withdrawal problems after I quit.

    @miffedwhitemale

    I don’t know why anyone would take hydrocodone for recreational effect, I have inadvertently taken the med beyond what I needed for comfort, and landed up feeling awful with a weird headache. I’ve had to increase my dose over time, because my condition tends to get worse as I age, but this has taken over 10 years. As for the problem with seniors, too many doctors in the past gave opiates to seniors to keep them quiet, I know they did with my mother, she didn’t need as high a dose as they gave her.

    • #31
  2. TheRightNurse Member
    TheRightNurse
    @TheRightNurse

    jef1944 (View Comment):
    As for the problem with seniors, too many doctors in the past gave opiates to seniors to keep them quiet, I know they did with my mother, she didn’t need as high a dose as they gave her.

    There’s a pretty serious problem with overmedicating the elderly and by elderly, I mean over 65.  There are too many comorbid issues and their kidneys do not filter the way that they used to…

    • #32
  3. jef1944 Member
    jef1944
    @

    @therightnurse

    I’m 72, and learned the hard way that there are some drugs that affect those over 65. My insurance company changed a sleeping medication, and I didn’t learn until after I had taken it for a while that the dosage my PCP prescribed was double the amount someone my age is supposed to take. The change happened during the time my husband was dying of lung cancer, so I wasn’t paying as good attention to what was happening as I should., but one day my insurer called and advised me that this sleeping med didn’t wear off in the AM in patients over 65. This  didn’t really sink in until a few weeks after my husband passed, my life was in such  a disarray,  that I wasn’t fully aware how groggy I was every morning, it was my niece who finally opened my eyes, she had worked in nursing homes and knew this meds affect.  I have since stopped all sleeping meds, and I feel so much better in the AM.

    • #33
  4. TheRightNurse Member
    TheRightNurse
    @TheRightNurse

    jef1944 (View Comment):
    The change happened during the time my husband was dying of lung cancer, so I wasn’t paying as good attention to what was happening as I should., but one day my insurer called and advised me

    I am so sorry.  You shouldn’t have to pay as much attention.  Pharmacies have alerts.  There are ways that people are supposed to be prevented from overdose or dangerous cross reactivity that were invented because people are only human.  Everything changes as we age and as we get sick.

    I’m glad someone caught it and that you’re doing better.

    • #34
  5. RightAngles Member
    RightAngles
    @RightAngles

    If they don’t stop trying to save us from ourselves, pretty soon we’ll have a generation of people who think it’s okay to jump off a cliff because “If it were bad for me, there’d be a law.”

    • #35
  6. jef1944 Member
    jef1944
    @

    RightAngles (View Comment):
    If they don’t stop trying to save us from ourselves, pretty soon we’ll have a generation of people who think it’s okay to jump off a cliff because “If it were bad for me, there’d be a law.”

    Yes, I think we already have some of this thinking.

    • #36
  7. TheRightNurse Member
    TheRightNurse
    @TheRightNurse

    RightAngles (View Comment):
    If they don’t stop trying to save us from ourselves, pretty soon we’ll have a generation of people who think it’s okay to jump off a cliff because “If it were bad for me, there’d be a law.”

    We already do.  Base jumping.

    ..and of course, we made laws.  SMH.

    • #37
  8. Midget Faded Rattlesnake Contributor
    Midget Faded Rattlesnake
    @Midge

    jef1944 (View Comment):
    They killed the pain nicely, but I didn’t notice any “recreational” effect from either one, and didn’t have any withdrawal problems after I quit.

    @miffedwhitemale

    I don’t know why anyone would take hydrocodone for recreational effect, I have inadvertently taken the med beyond what I needed for comfort, and landed up feeling awful with a weird headache.

    I get that terribly with opiates. And one time, while getting IV morphine in the hospital, I just stopped breathing. Not. Fun. At. All. Asthmatics, I’ve since heard, are known have some weird sensitivities to opiates  – histamine release from the mast cells or something. Undoubtedly others are similarly sensitive, too.

    Sometimes I wonder whether maybe my body just can’t know what it’s like for an excess of this sort of stuff to be fun. The downsides are bad enough that I’m really better off on tiny doses of fentanyl after a surgery than on larger equivalent doses of morphine. Time-release fentanyl is a godsend to me, although I know the same thing that makes it a godsend to me (its efficacy at minute doses) makes it a nightmare when it’s used to, say, cut heroin with unreliable lab technique.

    • #38
  9. TheRightNurse Member
    TheRightNurse
    @TheRightNurse

    Midget Faded Rattlesnake (View Comment):
    when it’s used to, say, cut heroin with unreliable lab technique.

    That’s really the problem.  Poor quality control.  All of this could be solved with just a little education or just blanket decriminalization of all drugs!

    • #39
  10. Midget Faded Rattlesnake Contributor
    Midget Faded Rattlesnake
    @Midge

    Wiley (View Comment):
    I am 100% behind the sentiment that government and insurance companies shouldn’t try to protect us from ourselves. Still, the opiate crisis is probably real. I have an elderly relative who has become an addict to opiate pain killers. It has triggered paranoia, dis-inhibition, and bouts of rage. Her addiction is now a crisis in the larger family. I think this becoming a problem in the elder population in general.

    We’ve had similar problems in my family with the elderly and humble alcohol. As @therightnurse points out above, the elderly can’t metabolize the way they used to, and even drinking habits that wouldn’t impair you at all in your prime can turn you into an embarrassing souse if you continue them unaltered once your metabolism’s slowed enough.

    I’m not saying the opiate crisis isn’t real here. Just that my personal experience suggests that the particular drug of abuse might matter less than being elderly or disabled (or believing yourself disabled and without hope) and not making use of support networks to keep your behavior decent (either because the support networks aren’t there, or they are and they’re just not being used).

    In my own family, we’ve had a disagreement over whether a member in late middle age / early elderliness had an opiate problem. Some relatives saw the prescriptions this family member got, observed bouts of pretty severe cognitive and emotional impairment, and panicked. Others observed the rather low rate at which the prescriptions were consumed and observed the bouts of disturbing impairment coincided with consuming alcohol while taking the prescription – in which case, a solution to the “opiate addiction” might be to simply cut out the alcohol. These things can get complicated fast.

    • #40
  11. Midget Faded Rattlesnake Contributor
    Midget Faded Rattlesnake
    @Midge

    ^ I should clarify: a higher proportion of elders in our family never consumed opiates at all, yet nonetheless had (occasionally pretty spectacular) problems in their final years with having continued to drink what was once not an impairing amount for them.

    • #41
  12. TheRightNurse Member
    TheRightNurse
    @TheRightNurse

    Midget Faded Rattlesnake (View Comment):
    “opiate addiction” might be to simply cut out the alcohol. These things can get complicated fast.

    People are often quick to blame the opiates rather than the user.  Most opiate addiction is psychological in nature rather than physical and most of it depends upon the person.  Opiates are a patch, not a permanent solution.  The only people who can have it as a permanent solution are people on their way out because there’s no concern about physical dependence or discontinuation at that point.

    Other people need to look at multiple modalities and find variable solutions.  As a whole, American healthcare is doing this, but they’re villainizing the wrong thing.  It isn’t the opiates.  It is the people that use them.  Not because they’re addicts, but because they misuse, don’t know, or have simply lost hope that anything else will work.

    There are people that consider pain control “anything that keeps me unconscious”; they are too medicated to eat, uninterested in people, and let everything slide while they consume drugs.  This is a crazy expectation.  Pain control is just that: limiting pain to a reasonable level.

    The American people need to learn that life has pain.  Zero is not a reasonable expectation.

    • #42
  13. Nanda Panjandrum Member
    Nanda Panjandrum
    @

    TheRightNurse (View Comment):

    Midget Faded Rattlesnake (View Comment):
    “opiate addiction” might be to simply cut out the alcohol. These things can get complicated fast.

    People are often quick to blame the opiates rather than the user. Most opiate addiction is psychological in nature rather than physical and most of it depends upon the person. Opiates are a patch, not a permanent solution. The only people who can have it as a permanent solution are people on their way out because there’s no concern about physical dependence or discontinuation at that point.

    Other people need to look at multiple modalities and find variable solutions. As a whole, American healthcare is doing this, but they’re villainizing the wrong thing. It isn’t the opiates. It is the people that use them. Not because they’re addicts, but because they misuse, don’t know, or have simply lost hope that anything else will work.

    There are people that consider pain control “anything that keeps me unconscious”; they are too medicated to eat, uninterested in people, and let everything slide while they consume drugs. This is a crazy expectation. Pain control is just that: limiting pain to a reasonable level.

    The American people need to learn that life has pain. Zero is not a reasonable expectation.

    Wisdom, let us attend…

    • #43
  14. Gary McVey Contributor
    Gary McVey
    @GaryMcVey

    Midget Faded Rattlesnake (View Comment):

    We’ve had similar problems in my family with the elderly and humble alcohol. As @therightnurse points out above, the elderly can’t metabolize the way they used to, and even drinking habits that wouldn’t impair you at all in your prime can turn you into an embarrassing souse if you continue them unaltered once your metabolism’s slowed enough.

    Hey! Why are you looking at me like that?

     

    • #44
  15. JLock Inactive
    JLock
    @CrazyHorse

    A bureaucratic response that’s unwieldy, inaccurate, and reactionary to make up for their torpor? What say you TRN? Next you’ll have us believe the four humors do not rule body and mind.

    Now, if you’ll excuse me, I must take to my Pennyfarthing as I’m late for a bloodletting.

    • #45
  16. JLock Inactive
    JLock
    @CrazyHorse

    jef1944 (View Comment):
     

    @miffedwhitemale

    I don’t know why anyone would take hydrocodone for recreational effect, I have inadvertently taken the med beyond what I needed for comfort, and landed up feeling awful with a weird headache. I’ve had to increase my dose over time, because my condition tends to get worse as I age, but this has taken over 10 years. As for the problem with seniors, too many doctors in the past gave opiates to seniors to keep them quiet, I know they did with my mother, she didn’t need as high a dose as they gave her.

    This is the paradoxical effect physicians should be looking for when prescribing all scheduled drugs. In short, those who both need and do not possess addictive heritability or personality — experience non-intoxicating sensations in achieving their sought after equilibrium.

    Others experience the full neurological reward of an opiate — an addiction problem for millennia — one Herodotus called, in the form of the poppy, “That great quasher of grief and restoration of sublime joy”

    Also, if you regularly take any opioid at more than 30-40mg a day and go through sudden cessation — you will experience withdrawal symptoms. Their intensity depending on how high the amount and duration of use.

    There are augmentation medications for this as well. Ones much safer than methadone. And to do my counselor bit — if anyone wants to know more confidentially please pm me.

    • #46
  17. I Walton Member
    I Walton
    @IWalton

    TheRightNurse (View Comment):

    I Walton (View Comment):
    Clearly they are being widely abused, resold after medicare pays for them, over prescribed and too easily renewed and fraudulently prescribed.

    So what is the answer? We have places like the UK where codeine is OTC and they do not seem to have the same abuse problems. So what is it? It can’t simply be physical use and need. It has to be a combination of how the drugs are used, who they are used by, society’s expectations and the ability to access the drugs.

    We can’t control what people do to themselves but we shouldn’t pay for it for them, or help pushers spread the stuff.    All addictive opium based drugs whether legally prescribed or imported illegally are rampantly pushed because the mark ups are in the thousands of percent.  OTC would be better and if combined with drug tests we’d reduce abuse, deaths, and the crime associated with their illegality and the crazy demand from the addicted but some percentage would still kill themselves and abuse the drugs.  I have no idea why.

    • #47
  18. Spin Coolidge
    Spin
    @Spin

    We live in a society in which most of America expect someone else to take care of them.  Don’t be angry at the insurance companies.  Be angry at the people who asked for this.

    • #48
  19. Spin Coolidge
    Spin
    @Spin

    TheRightNurse (View Comment):
    The American people need to learn that life has pain.

    I blame wealth and prosperity.

    • #49
  20. JLock Inactive
    JLock
    @CrazyHorse

    Midget Faded Rattlesnake (View Comment):

    jef1944 (View Comment):
    They killed the pain nicely, but I didn’t notice any “recreational” effect from either one, and didn’t have any withdrawal problems after I quit.

    @miffedwhitemale

    I don’t know why anyone would take hydrocodone for recreational effect, I have inadvertently taken the med beyond what I needed for comfort, and landed up feeling awful with a weird headache.

    I get that terribly with opiates. And one time, while getting IV morphine in the hospital, I just stopped breathing. Not. Fun. At. All. Asthmatics, I’ve since heard, are known have some weird sensitivities to opiates – histamine release from the mast cells or something. Undoubtedly others are similarly sensitive, too.

    Just a declarative statement here — I’ve had clients who went into anaphylactic shock from Codeine. Specifically in the forms of Tylenol #3 and #4 — all opiates and opiod increase histamine response but none quite so much as Codeine.

    They think its what actually killed Elvis now.

     

    • #50
  21. Brian Clendinen Member
    Brian Clendinen
    @BrianClendinen

    I was not aware the overdoses was almost totally being paid for by Private Insurance coverage. I thought it was mostly goverment healthcare and blackmarket and non-insurance is how people were paying for their addiction.

    • #51
  22. JLock Inactive
    JLock
    @CrazyHorse

    Brian Clendinen (View Comment):
    I was not aware the overdoses was almost totally being paid for by Private Insurance coverage. I thought it was mostly goverment healthcare and blackmarket and non-insurance is how people were paying for their addiction.

    As a Social Worker, I see deaths from Opiod “overdose” encompass a lot. More than addicts obtaining it illegally, are older people, as Midge and TRN mentioned earlier, and overweight suffering from things already present like Sleep Apnea (if you take opiods and snore — get to a sleep lab pronto!)

    Over-prescription is what I saw — but I was looking for it as a Mental Health advocate. Up until the recent re-scheduling of the lower-potency opiods (Hydrocodone, Oxycodone, and Oxycontin) — I had clients who were prescribed things like Opana, an incredibly powerful opiod usually only given to those undergoing chemotherapy, for PTSD-related depression.

    There is plenty of blame to go around on this one.

    • #52
  23. civil westman Inactive
    civil westman
    @user_646399

    There will be two main effects of this “crisis.”

    1. Patients who actually benefit from these medications (as your insurance company makes clear) will be unable to get them.
    2. Those abusing prescription medications through doctor shopping and insurance reimbursement will be returning to “self-pay” for street drugs via robbery, breaking & entering, mugging, etc. Expect rates of those crimes to surge.

    As other physicians and nurses have pointed out, not long ago, we were being beaten on to medicate pain with opioids. The statist wind has again shifted 180 degrees. Reminds me of what some former refuseniks used to say: “In the Soviet Union, the past….  is hard to predict.”

    By the way, it is not only “bad people” and “addicts” who crave opioids. As more is being understood about brain opioid receptors, it is becoming clear that a significant proportion of chronic depressives have variation in their opioid receptors. There is a population of “addicts” who, when treated with opioids, are relieved of depression, live normal lives, and do not escalate their doses.

    This is a complex issue with many poorly understood aspects. As we head toward individualized medicine, individualized responses to opioids will undoubtedly be part of the new understanding. Government hysteria rarely describes actual reality and it is disgusting when insurance companies leverage that to limit benefits.

    • #53
  24. The Reticulator Member
    The Reticulator
    @TheReticulator

    Spin (View Comment):

    TheRightNurse (View Comment):
    The American people need to learn that life has pain.

    I blame wealth and prosperity.

    I whine about pain as much as anybody, if not more.

    But once I was getting a crown put on at a HMO-type dentist place, and instead of the usual I drew a Sikh guy. He may or may not have been a long-time American. As he got ready to numb me up I asked, incredulously, “Do you need to numb me up to put a crown on?” He stopped short and said, “No, we don’t need to do that.” I can’t say it was a pleasant experience, but it wasn’t terrible and I didn’t spend the rest of the day purging that numbing poison from my system.  I didn’t ask him about it, but I wondered if his cooperation was because of different cultural expectations.

    When I tried that again more recently with the anglo-saxon, libertarian dentist I have now he insisted on numbing me up, even though I promised I’d try real hard not to bite his fingers off.

    Back in the 60s when I was a teenager and dental drills were slow, I sometimes was able to talk the dentist out of using novocain. It depended on the situation but sometimes he went along with it, and when he didn’t it was because I really needed the novocain.

    A dentist friend of mine, an older man, used to tell how he’d do volunteer work in Central America, and was amazed at the amount of pain people had put up with as an everyday experience before he and his colleagues came along to provide some much-needed dental work.

    • #54
  25. Randy Webster Member
    Randy Webster
    @RandyWebster

    The Reticulator (View Comment):

    Spin (View Comment):

    TheRightNurse (View Comment):
    The American people need to learn that life has pain.

    I blame wealth and prosperity.

    I whine about pain as much as anybody, if not more.

    But once I was getting a crown put on at a HMO-type dentist place, and instead of the usual I drew a Sikh guy. He may or may not have been a long-time American. As he got ready to numb me up I asked, incredulously, “Do you need to numb me up to put a crown on?” He stopped short and said, “No, we don’t need to do that.” I can’t say it was a pleasant experience, but it wasn’t terrible and I didn’t spend the rest of the day purging that numbing poison from my system. I didn’t ask him about it, but I wondered if his cooperation was because of different cultural expectations.

    When I tried that again more recently with the anglo-saxon, libertarian dentist I have now he insisted on numbing me up, even though I promised I’d try real hard not to bite his fingers off.

    Back in the 60s when I was a teenager and dental drills were slow, I sometimes was able to talk the dentist out of using novocain. It depended on the situation but sometimes he went along with it, and when he didn’t it was because I really needed the novocain.

    A dentist friend of mine, an older man, used to tell how he’d do volunteer work in Central America, and was amazed at the amount of pain people had put up with as an everyday experience before he and his colleagues came along to provide some much-needed dental work.

    I belong to the “You can get used to hanging if you hang long enough” school.

    • #55
  26. RightAngles Member
    RightAngles
    @RightAngles

    Randy Webster (View Comment):

    The Reticulator (View Comment):

    …    A dentist friend of mine, an older man, used to tell how he’d do volunteer work in Central America, and was amazed at the amount of pain people had put up with as an everyday experience before he and his colleagues came along to provide some much-needed dental work.

    I belong to the “You can get used to hanging if you hang long enough” school.

    I belong to the “Just say yes to drugs” school.

    • #56
  27. TheRightNurse Member
    TheRightNurse
    @TheRightNurse

    civil westman (View Comment):
    There is a population of “addicts” who, when treated with opioids, are relieved of depression, live normal lives, and do not escalate their doses.

    Particularly combination partial opiate agonists.  Tramadol is being used for primary depression treatment in the UK (in current studies) and is having good results.  Hell, *Tylenol* helps with depression.  There’s a connection between psychic and physical pain that is still not well understood or appreciated.

    • #57
  28. TheRightNurse Member
    TheRightNurse
    @TheRightNurse

    RightAngles (View Comment):
    I belong to the “Just say yes to drugs” school.

    I’m with you.  Better living through chemistry, but I’ve been getting phantom sharp pain since I was a kid.  People thought I was crazy, so I stopped mentioning it.  I’m now told that’s not uncommon.

     

    Whatever.  It’s my baseline.  It’s not that big of a deal.  Most of the time I can handle terrible pain (as long as I’m not expected to function!).  Not everyone can, but I think most people can handle much more than they expect to.  We have some people in the hospital who are frequent flyers.  They basically just come in to get a few days of IV dilaudid.  It’s unbelievable to me.

    • #58
  29. Midget Faded Rattlesnake Contributor
    Midget Faded Rattlesnake
    @Midge

    Randy Webster (View Comment):

    A dentist friend of mine, an older man, used to tell how he’d do volunteer work in Central America, and was amazed at the amount of pain people had put up with as an everyday experience before he and his colleagues came along to provide some much-needed dental work.

    I belong to the “You can get used to hanging if you hang long enough” school.

    Eh, intense pain that’s time-limited is one thing to endure. Pain with no obvious expiration date is another. I guess I’m in the, “You can get used to hanging if it lasts short enough,” school.

    Labor pains weren’t so bad. Because they were measured in hours, not days. It’s the “Wow, if I count it up, I realize I’ve lost weeks, months, maybe even years to this pain, even if it is ‘low level’,” that I want treated.

    • #59
  30. JLock Inactive
    JLock
    @CrazyHorse

    Midget Faded Rattlesnake (View Comment):

    Randy Webster (View Comment):

    A dentist friend of mine, an older man, used to tell how he’d do volunteer work in Central America, and was amazed at the amount of pain people had put up with as an everyday experience before he and his colleagues came along to provide some much-needed dental work.

    I belong to the “You can get used to hanging if you hang long enough” school.

    Eh, intense pain that’s time-limited is one thing to endure. Pain with no obvious expiration date is another. I guess I’m in the, “You can get used to hanging if it lasts short enough,” school.

    Labor pains weren’t so bad. Because they were measured in hours, not days. It’s the “Wow, if I count it up, I realize I’ve lost weeks, months, maybe even years to this pain, even if it is ‘low level’,” that I want treated.

    That’s the most badass sentence I’ve read today.

    We’re good Rico, g’night.

     

    • #60
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