Opioid Epidemic Chat with Dr. Hooten

After a recent out-patient surgery, I felt so much overall relief. I asked what was in the surgical IV and was told that it must have been the Fentenyl that alleviated my pain. I requested patches and now use a 25 mcg and also a 12 mcg patch (at the same time) every three days. I also need two 3/525 hydrocodone pills plus two Extra Strength Tylenol (as per my physician and my pharmacist's recommendation) to assist with high levels of pain from scoliosis, severe rheumatoid arthritis, fibromyalgia, neuropathy and Lyme Disease symptoms. I am very concerned about my pain levels but I am also worried about my liver!!! Once in awhile, I need a shot of whiskey to "tame my system"....I also take a Xanxa (.25) or two to sleep. I have tried Cannibus while on vacation as it is illegal in my state. It only seems to help if I take it before my pain levels exasperate. I have taken the condensed Pain Clinic class at Mayo without any help from it -- I took it when it was new and they had us sit on hard folding chairs while they showed us a PowerPoint Presentation. I am not willing to return due to the extreme cost of living in Rochester for three weeks, etc too.....I do yoga; I have regular weekly massages; I have tried Rolfing; I have tried acupuncture; I have tried chiropractic; I have had multiple spinal injections; I have had 34 surgeries. I am still in great pain and I have to plan my family life around this situation. I have a very relaxed lifestyle as I am on disability and take time to take care of my body with healthful eating and treatments. I do not know what else to do! Any advice would be greatly appreciated. Thank you so much!

Is Tramdol a opioid ?
Jeanne Harmon

f simply paying closer attention to the patient on chronic opioid therapy allows providers to provide better care, to prescribe more confidently, and by "paying closer attention" I mean adhering to all of the many new guidelines, prescribing rules, and best practices published over the past few years and discussed today, then why does study after study show doctors aren't following these best practices today and why won't leading provider organizations like the AMA and the AHA come out in favor of required prescribing protocols? In other words, what do you think it will take to really engage the provider community in taking more concrete steps to prevent misuse in the first place instead of advocating for things after the fact -- like treatment after addiction or naloxone after overdose?

Your remarks rang a bell with me @ajacobskind, because you reflect pretty well how I felt a month ago. Today, I'm not so certain. In general, you'll probably agree that painkillers should be readily available to the millions of people who need them. You may agree, as well, that cannabinoids should be readily available everywhere for medical purposes. I'm not personally affected by either class of medications, but I am personally incensed by the extend and depth of suffering that people endure as a consequence of government bungling, cultural obsolescence, and medical carelessness.

The opiod epidemic needs to be discussed in light of the latest report from the federal Substance Abuse and Mental Health Services Administration on the current epidemic of painkiller use. Here's the link: http://www.samhsa.gov/data/sites/default/files/NSDUH-FFR2-2015/NSDUH-FFR2-2015.htm.

Within the fertile data fielded here is the following statement: "Most painkiller use isn't misuse, which SAMHSA defines as any use of painkillers in a manner not directed by a doctor."

How's that for a policy declaration? Misuse (or abuse) doesn't occur when the substance is used as "directed by a doctor." The problem you cite is a little different -- you're actually talking about abuse resulting from medical professionals who don't care or bother to give directions for the use of the painkillers.

So I'm with you on closing down those avenues for putting painkillers on the streets without diligent medical directions, so long as you're with me on opening the outputs further for providing painkillers for so many who need them to make their lives bearable.

@predictable. Scientific insight must strike the right balance between providing maximum relief from suffering while minimizing associated risks and adverse effects. By making pharmacogenetic testing standard procedure before prescribing the opiates or other habit-forming drugs we would significantly decrease the amount of misuse, would you agree?

Thanks
Dawn

You got that right, @dawn_giacabazi! Standardizing resort to pharmacogenomic testing (PGT) should be a high priority of all medical professional agencies and organizations. It's the current favorite device for greatly improving the efficiency and effectiveness of therapies that involve medications. I'm reminded again of the SAMHSA report's declaration that proper use of a medication is "directed by a doctor." In that way, PGT becomes a doctor's indispensable tool for formulating their best directions convincingly!

Are there any long term effects of taking oxycodone (oxynorm)for chronic pain? I take approximately 75ml per day.
I'm aware of the addictive nature of this drug but am intolerant to everything else for neuropathic pain which in my case is quite severe.

What is the feeling that users get from heroin? Why do people start drugs if they don't have a condition

after 12 years on opiod prescription pain use, I am quite sure my body is addicted, so what do you see for my future pain relief

I'm not surprised the Connect members have great questions 🙂
Keep your questions coming. Dr. Hooten is taking them live. Thanks Vivien.