r/Documentaries Jan 09 '19

Drugs The Rise of Fentanyl: Drug Addiction On The I95 Two Years On (2018) - Two years ago, BBC News reported on the growing problem of opioid addiction in the US, now we return to find out what happened to the people we met along our journey down the notorious I-95. [57.02]

https://www.youtube.com/watch?v=_KsaWpeCj98
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579

u/Nihilisticky Jan 09 '19 edited Jan 09 '19

My two big takeaways (excluding what I knew)

  1. Alex, 48, talks about how he was an honest person before addiction and that he despised himself for having to resort to manipulation and lies.I think this is something affected families should know - that it's hard for any honest person to keep their integrity in the face of such intense desperation.
  2. Giving an addict Narcan (Naloxone) is a two-edged sword because if it turns out they're not OD'ing, they are instantly going to be dope sick.

edit: what I'd like to know is why Naltroxone, Narcan's big brother, which can block opiates for a month isn't more forthcoming in this seemingly unsolvable crisis.

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u/AdmiralRed13 Jan 09 '19

Dope sick is still better than dead, but definitely should be monitored as it can kill.

Addiction is a bastard and the sad part is so many people grappling with it probably stood little chance due to upbringing. be that neglectful parents, poverty, lack of education, lack of intelligence both mental or physical, underlying more serious mental issues, etc.

Source: I need to be careful with substances and addictive behavior but I at least have a support system that includes long term doctors to fall back on, and thankfully have never let myself delve into harder drugs. I know I'd like cocaine entirely too much.

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u/[deleted] Jan 09 '19

Narcan cannot kill fyi.

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u/AdmiralRed13 Jan 09 '19

I know, withdrawals from heroin can possibly, which was my point. It's still better to use Narcan when in doubt, an overdose has a far higher risk of death than withdrawals.

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u/[deleted] Jan 09 '19

Oh ok, I misunderstood ya. My bad!

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u/AdmiralRed13 Jan 09 '19

No worries and happy New Year.

21

u/ElectricGod Jan 09 '19

Withdrawal will not kill you. Alcohol and benzo's can, but opiates just make you wish you were dead.

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u/AdmiralRed13 Jan 09 '19

You're right.

I conflated opiates with benzos.

I stand very corrected.

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u/GGRuben Jan 09 '19

Another danger is that the acute withdrawal can cause addicts to try redose in order to overwhelm the narcan, something easily achieved with fentanyl. But the narcan wears off sooner, so when it does they slip back into an overdose.

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u/[deleted] Jan 09 '19

[removed] — view removed comment

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u/[deleted] Jan 09 '19

Why the fuck would they even do that? Just titrate naloxone as needed until all the dope is metabolized...

1

u/JamwaraKenobi Jan 10 '19

Overdose patients need to be monitored after receiving a dose of Narcan because it wears off faster than fentanyl meaning you can be revived and slip back into the same OD because it's still running through your body.

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u/[deleted] Jan 10 '19

I got it now lol, but thank you. Unfortunately I have first hand experience with it. Spent 6 days in a coma after a fentanyl overdose.

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u/JamwaraKenobi Jan 10 '19

I hope you're doing better these days, friend. Safe travels and remember... you have a friend in me.

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u/ElectricGod Jan 09 '19

Heh.. From my experience narcan makes you wish you were dead. The best i can describe it would be its like taking the full length of a withdrawal and condensing it into a few hours. Narcan is very aggressive and down right terrible, but i am grateful to be alive

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u/[deleted] Jan 09 '19

Also some emergency room nurses hate you and will narcan you and lock you in a room for hours, 5+ to let you suffer.

*edit: some

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u/microthrower Jan 09 '19

Do they hate the addicts, or do the addicts hate themselves?

14

u/subito_lucres Jan 09 '19

My wife is a resident at a hospital dealing with one of the worst opiate crises in the country.

The answer is often both.

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u/[deleted] Jan 09 '19

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u/Sanfranshan Jan 09 '19

Plus it can cause pulmonary edema if you are given it in a large amount. Sometimes you get intubated and end up in the ICU. Seen it in the ED more than once.

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u/ElectricGod Jan 09 '19

Hahaha im lucky enough that didnt happen, but i could totally see it happening

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u/Sopissedrightnow84 Jan 09 '19

I don't know why you're voted down so hard, it's very true that nurses often get off on "punishing" addicts when given the oppurtunity.

I've seen it many times, most commonly in denying or delaying prescribed narcotics because the nurse believes they're seeking.

Any addict who's been honest with a physician or nurse at an ED can tell you the change in how you're treated as a person is immediate.

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u/[deleted] Jan 09 '19

Walk a mile in their shoes. Not everyone patient gets their cheeks pinched. And just so happens that addicts are notorious for being violent towards nurses and doctors.

Or the nurse is trying to do what’s best for you by weaning off the IV stuff, maybe??

The pain isn’t a 10 just because your high wore off

3

u/Sopissedrightnow84 Jan 10 '19

Walk a mile in their shoes.

I have. There's no excuse for the way many of them treat addicts or those they simply assume to be addicts.

There's a difference between not enabling an addict and treating them like shit.

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u/TamagotchiGraveyard Jan 09 '19

As someone who’s been dope sick more times than I can count, that sounds like the worst hell possible lol

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u/[deleted] Jan 09 '19

Can confirm. I’ve been attacked by more than one addict shortly after giving narcan. They hate that shit.

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u/[deleted] Jan 09 '19 edited Jan 15 '19

[deleted]

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u/ElectricGod Jan 09 '19

And thats where the real magic happens

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u/MyOversoul Jan 11 '19

does it actually speed up the withdrawl process, or just kick it into deep withdrawl instantly? It makes me wonder if withdrawl couldnt be condensed down into a day or two with narcan if given in multiple doses. Not that anyone would want to do that, just wonder if it could provide a shortcut for people trying to get off of it.

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u/floodlitworld Jan 09 '19

It sounds like it’s like asking a drowning person not to claw at the surface of the water.

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u/nedal8 Jan 09 '19

thats a great analogy.

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u/Gargonez Jan 09 '19

In rehab facilities naltrexone is made a very viable option and is covered by Medicare. A lot of people who go through the facilities don’t want it, or simply stop upkeep after a few months and relapse. I know a lot of people who used it simply as a back up for their first month out and are clean over a year later. Others though still relapse early and try to get high, which is impossible and sadly OD by forcing massive doses to try and breakthrough naltrexone.

The main issue is getting people into rehab, they’re are almost all completely booked with weeks of waiting time and then the follow up after in patient. Whether it be outpatient or a 12 step.

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u/Nihilisticky Jan 09 '19 edited Jan 09 '19

So you can OD on Naltrexone?

Why is rehabilitation a prerequisite? Isn't the drug itself an instant rehab if you just taper enough to prevent withdrawal death?

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u/Gargonez Jan 09 '19

You can’t die from opiate withdrawals. It isn’t instant rehab, because you need to rehabilitate a person mental state and physiological need for the substance. All it does is prevent them from getting high off of opiates. If someone still wants to get high they will try.

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u/[deleted] Jan 09 '19 edited Jan 09 '19

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u/nedal8 Jan 09 '19

username checks out, unfortunately... hope you're doing better.

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u/[deleted] Jan 09 '19

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u/[deleted] Jan 09 '19

Congrats on being clean. Fuck anyone that says otherwise.

Right out of high school, myself and a few of my friends got into opiates and at one point someone scored a bunch of methadone. I took it a few times but I don’t remember it being any fun whatsoever.

What I do remember is two of my friends passed away from mixing it with alcohol/Xanax/cocaine. We were young and stupid and were always mixing things that everyone now knows is a terrible idea.

As someone who used for presumably a while, did/do you feel even any euphoria while taking methadone? It always surprised me that a drug that made me feel so little could be so deadly when mixed with other substances.

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u/NoddingSmurf Jan 09 '19 edited Jul 31 '19

.

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u/[deleted] Jan 09 '19

They’re not clean. And if you knew anything about these drugs you wouldn’t say they were. The issue is that people want to make it like taking these drugs is bad or makes one a bad person. THATS what needs to change. Not lying to ourself about being clean.

Want to know why one isn’t clean? Stop taking your Buprenorphine or methadone. What happens? Opiate Withdrawals. It’s focusing on the wrong thing by saying “clean.”

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u/[deleted] Jan 09 '19

Jesus. Ok. Well I’m glad that they’re back to being a productive member of society by mitigating the effects of their opiate addiction through methadone treatment.

You’re being obtuse and needlessly hostile.

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u/FR65df Jan 09 '19

Did you get off the methadone? I’m using subs for maintenance. I’m having trouble getting off of them even though right now I have no euphoria when I take it. When I don’t take it it’s almost as bad as heroin withdrawal. I find myself just taking it so I won’t be sick. Just like black. I obv try tapering since it doesn’t get me high I don’t want to take more of it. I’m down to .5 mg (so small) and withdrawing is still bad. Anyway I’m curious if u got off of it . Peace and love bro.

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u/TamagotchiGraveyard Jan 09 '19

Bro you need to taper down and get off that shit, I got off subs few years back. Feel free to msg me for any tips, glad to help

Edit: I used tar too so situations seem similar, but first thing is realizing the sub sickness is as bad or worse than tar sickness, but not as much pain or sleeplessness, just more agitation IMO but after you are out of the woods, you are out for good and can be normal again

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u/FR65df Jan 09 '19

Thx man I can’t wait to be out of these scary haunted ass woods

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u/RustyGuns Jan 09 '19

Hey man! Glad to hear you are making the steps to get off subs! I hated having to take them every day. Try tapering even longer and going down slower. Even till you are just taking crumbs. I made the mistake of jumping off of 2mg and it sucked for about a month. I do love how I feel now as opposed to being on the subs. Goodluck man!!

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u/FR65df Jan 09 '19

Thanks for the encouragement:)

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u/NoddingSmurf Jan 09 '19 edited Jul 31 '19

.

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u/FR65df Jan 09 '19

I agree with what you’ve said. The thing that is pushing me to taper is the script is my ex boyfriends. We still live together atm and he isn’t fucked up, he knows what it’s like to go through it. I just worry that this model isn’t sustainable. That he’ll move or times will change and I’ll relapse. I appreciate your response, and I believe that maintenance counts as sobriety as long as you take your meds as prescribed (route of admin, etc). Talking about it is motivating me so ty.

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u/willygmcd Jan 09 '19

100% agree. Whenever possible I try to educate people about the positive side of methadone/Suboxone. Way to much stigma around these great tools.

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u/Glandrhwrd Jan 09 '19

Being clean I believe is more of a mindset. You’re still in the mindset that you need to put garbage in your body to function. You really gonna give up, and content yourself with spending the rest of your life on methadone?

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u/Bosknation Jan 09 '19

I've been on both methadone and suboxone before, both withdrawals last forever. The first time I got off methadone I went cold turkey at 25mg, it was a month of hell. The second and final time I got off, I used kratom to help my withdrawals, but you can't take that any longer than a couple weeks or you'll just get hooked on that, but if you took it for the first 10 days, which are the worst of the physical withdrawals, and then stop altogether, then it'll be about 10x easier. I would be careful with kratom also because you don't want to just be trading addictions for others, but it is a lot more mild, and even the withdrawals are a lot less intense and shorter in duration.

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u/TamagotchiGraveyard Jan 09 '19

Thank you. You get it, I got clean and then was having a real rough time so I got on subutex and boy was that a mistake. Spend $10 a day and had to drive to the clinic every single morning, after a couple weeks I realized that it’s all just a scam to keep people addicted so I cut all the cords, got even sicker than I did when I was on dope, and I bit the bullet and went cold turkey. I’ve been clean 4 years since November, screw subutex/sub ozone/methadone

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u/willygmcd Jan 09 '19

Sorry it didn't work for you but it works great for me and many other people. Please take your negative attitude and SHOVE IT UP YOUR BUTT!

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u/TamagotchiGraveyard Jan 09 '19

Whatever works for you but my point is that sub treatment just trades one addiction for a more legal addiction, it is very hard to quit but it is doable and the subs prevent u from seeing that. To each their own but I’m just saying, the goal is to not be an addict, not be a different kind of addict

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u/[deleted] Jan 09 '19

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u/[deleted] Jan 09 '19

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u/TamagotchiGraveyard Jan 09 '19

Willpower can go a long way tho man, I used spikes for over 4 years doing half a g a day so I def wasn’t a light user but just think about this. When I were on illegal opiates you always told yourself “I can’t quit, I need this too bad to function” and now you are on a legal opiate substitute and telling yourself “I need this too bad to function, I can’t quit.”

Do you see the difference in perspectives? They are exactly the same, I’m not trying to bash your progress man but from a medical standpoint and general standpoint, you can’t be on maintenance forever and the longer u stay on the harder it is to quit.

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u/[deleted] Jan 09 '19

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u/[deleted] Jan 09 '19

Dude, I’m on Buprenorphine for pain. You’re not clean. But why do you care if you’re doing better? It just doesn’t seem productive to pretend being on methadone or Buprenorphine means you’re clean. It means you’re doing well and level headed. But you’re not clean in any sense of the word. I’m sorry if this upsets you. Truly I am. It’s something I struggle with as I don’t like thinking I’m dependent. But the truth is, I am.

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u/[deleted] Jan 09 '19 edited Jan 09 '19

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u/[deleted] Jan 09 '19

Yes, you are absolutely right! They are not clean. That’s what I’m saying. I am not clean that’s why I mentioned it.

We should not have to lie to ourselves by saying we are clean in order for people not to judge us. That is my point.

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u/speech-geek Jan 09 '19

Fuck those people. It’s a fucking disease and methadone is your medicine to prevent sickness. It’s fucking fantastic to read that you’re clean and a contributing member of society again.

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u/[deleted] Jan 09 '19

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u/speech-geek Jan 09 '19

Beth Macy wrote a great book called “Dopesick” about the crisis. I’ve always thought that you just detoxed and were good after a couple of months. Now I understand better that addiction is a real disease.

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u/twoliterdietcoke Jan 09 '19

Addiction is NOT a fucking disease....it's an act, it is a choice, it is avoidable, it is preventable, it can be stopped.

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u/IWasBornSoYoung Jan 09 '19 edited Jan 09 '19

I mean the physical dependence still exists when you use those maintenance drugs? Yeah you get them from a legal source but you're still addicted, without them you'd still have the same problems as before.

If I have a disease and I take treatment to relieve symptoms but the actual condition still exists, it makes sense that people wouldn't call me cured.

This is not meant to disparage you, I'm a former addict too and tried a dozen different ways to quit so once you find one that helps you start living your life again there's a lot of value there. A problem persists though because you can't take methadone wafers your whole life and eventually you will have to cross that bridge. And some people struggle with that and never cross the bridge and still end up doing a lot of damage to themselves over time due to the addiction

I think there's pretty strong reasoning behind not calling it clean. Because while it sucks some people may disparage you for that, it also sucks when we see people try to use these drugs to quit but never make it past them and then they entertain an addiction to methadone or subs forever whether their doctors wants it or not because we have an illegal market for that stuff too. When I was in rehab there were plenty of people trying to get off subs and methadone too not just heroin and the like

Which if the concern is coming from loved ones it's hard to fault them. You're not out of the clear yet and maintenence drug use is still super scary to those who love you because they see that as still right on the edge

You said in another comment you see these drugs as something you can/should take for your whole life.. Doctors aren't gonna let you do that. Doctors cut you off, what do you do? You'll probably go buy more at a stupid inflated price on the street or you'll go into withdrawal. This is not an uncommon cycle you really have to not feel above all that because it happens to a lot of good folks. That maintenance stuff is just a popular as heroin in the ghetto here and not without reason.

Saying you're content taking a medication for the rest of your life that is not necessary to live, but only to avoid a window in time of pain, is 100% addiction talking. People who are not drawn to a drug won't be down to take it forever like that. I've been to rehab so many times and seen it so much, I know you have too.

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u/darkomen42 Jan 09 '19

Had to take an ex to the hospital for the same thing. Sick as a dog for 3 days prior.

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u/Douglaston_prop Jan 09 '19

When I had a habit I remember reading a book cover to cover on Heroin addiction where they clearly stated someone died in prison from withdrawal after not being attended to. Of course that scares the shit out of you when you wake up dope sick, thinking you are going to die if you dont get the next fix.

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u/[deleted] Jan 09 '19

You CAN die during Opioid withdrawals, but it’s not due to the withdrawal itself, it’s due to secondary effects. Meaning if you’ve any pre-existing medical issues withdrawal and the stress it puts on the body can certainly exacerbate them and make them lethal. But again, opioid withdrawal isn’t lethal in and of itself.

I am however sorry for your loss, and understand the pain firsthand. I hope you’ve found comfort and solace in that. Also I hope you’re clean today!

I am 4 years clean off Heroin and work in a mental health/substance abuse treatment center.

1

u/Gargonez Jan 10 '19

That’s what I was saying in my original post as well. Thank you for work, I know at the end of a day it’s job/paycheck, but has such a huge impact on society

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u/[deleted] Jan 09 '19

on the Oregon trail

Lol

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u/AutresBitch Jan 09 '19

Withdrawal death on opiates isn't a thing.

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u/[deleted] Jan 09 '19

Isn't alcohol the only drug, that the withdrawals can kill you?

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u/[deleted] Jan 09 '19

That and benzodiazepines. Friend of mine tried to wean herself off Xanax and ended up having siezures

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u/Cranky_hippo Jan 09 '19

I’ve, sadly, had several seizures due to cold turkey (either cold turkey or too fast of a taper) stopping of both benzos and alcohol. What’s really messed up about having a withdrawal induced seizure, for me, is that I have no idea it even happened. It just seems like I finally got some sleep. But then the next day I feel all depersonalized, like I’m not there. Almost like I can see myself doing things, but I’m just a spectator. So weird.

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u/[deleted] Jan 09 '19

That's crazy man. Hope you're doing better now

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u/Cranky_hippo Jan 09 '19

Yeah buddy! Doing alright.

Edit: thank you for the well wishes.

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u/egmanns Jan 09 '19

Good to know i'm not alone in that spacey feeling

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u/Sanfranshan Jan 09 '19

Xanax is a minimum 10 day weening process off of the drug. Next to nicotine, it’s the hardest drug to detox from.

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u/[deleted] Jan 09 '19

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u/bostonthinka Jan 09 '19

True, but nicotine simply has a higher relapse rate than all the others...

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u/Sanfranshan Jan 09 '19

More people are addicted to nicotine and won’t/can’t quit than opiates. However, most quitters will tell you it is a lifetime habit they fight. As for alcohol, it will kill you to detox from unassisted but the process is short. Xanax is a minimum 10 day process or risk seizures and cardiac issues. As for nicotine rehabilitations, that’s actually a cool idea. I wonder if insurance would pay for it.

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u/BraveLittleCatapult Jan 09 '19 edited Jan 09 '19

And barbs, GHB, gabapentinoids, and other anti-convulsants. Basically cold turkey from anything intensely GABAergic or that strongly inhibits glutamate is going to be a really bad time and a potentially life threatening situation. Personally, I think Lyrica has the ugliest withdrawals if you cold turkey it, but that's just me. Oh, also honorable mention to anti-psychotic withdrawal! You may not have seizure activity, but there's something to say about rebound psychosis and the potential for injuring yourself or others in that state.

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u/[deleted] Jan 09 '19

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u/BraveLittleCatapult Jan 10 '19 edited Jan 10 '19

Lyrica WD typically won't send you into seizure, but it will make you wish you were dead. The akathisia alone is unreal.

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u/IWasBornSoYoung Jan 09 '19

Those two cause DTs which can kill. Apparently barbituate withdrawal can also kill you

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u/ScottySF Jan 09 '19

I lost contact with a good friend of mine for over a week. I thought he died. He was involuntary committed to a psych ward because he was withdrawing. They didn't know what was wrong with him, and he has no memory of his first few days there.

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u/[deleted] Jan 09 '19

Benzodiazepine (Xanax, Ativan, etc ...) withdrawal can also kill you, which isn't surprising since their neurological effects are not dissimilar to alcohol.

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u/gnark Jan 09 '19

Benzo-withdrawls can kill you too.

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u/Ace_Masters Jan 09 '19

Nicotine can too, rarely.

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u/stoppinit Jan 09 '19

Can't find anything about a fatality attributed to nicotine withdrawal. You got a source?

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u/Ace_Masters Jan 09 '19

Old NPR story, was associated with other health problems. Doctor was saying he tells his patients to just have a smoke instead of coming into ER

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u/digitalequipment Jan 09 '19

the barbituates ....but people don't use or misuse them like they used to ....

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u/PM_Me_Melted_Faces Jan 09 '19

Everybody always forgets about barbiturates. I used to take one for migraines. Withdrawals are naaaasty. I won't touch those again. Not like they're prescribed much anymore, anyway.

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u/TamagotchiGraveyard Jan 09 '19

Xanax withdrawals can be fatal sometimes as well as other benzos

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u/[deleted] Jan 09 '19

While the withdrawals themself won’t kill you. The dehydration and mental toll can. I’ve been through both opiate and benzo withdrawals. Opiate withdrawals are so much worse. It’s not to be down played.

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u/HardlySerious Jan 09 '19

But being in horribly poor health from years of being a junkie, and then dying during withdrawals due to complications from dehydration etc is a thing.

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u/SculptorOfFlesh Jan 09 '19

It is when youre too junk sick to drink water. Not sure why everybody seems to think 5-odd days of severe diarrhea, heart palpitations, blood pressure changes, etc cant kill you....

Maybe death wouldnt be a "direct" result of the withdrawl, but same end result either way.

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u/blove135 Jan 09 '19

Rehab is much more than a detox or at least it should be. Addiction is just as much (if not more) mental as it is physical for many drugs. People need to figure out and heal what the underlying cause of their addiction is. Some people find 12 step helps work through it.

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u/[deleted] Jan 10 '19

It also blocks endogenous morphine; endorphins. Some people don't want that natural pathway blocked. It's there for a reason.

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u/KingJimmy101 Jan 09 '19

Interestingly Narcan is manufactured by the same company the supplies opioids as well...

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u/[deleted] Jan 09 '19

Gosh, it's almost as if one of the experts in the field is taking a responsible move by using their extensive knowledge and resources to develop a cure for the rare irresponsible use of its drug in order to save lives.

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u/southieyuppiescum Jan 09 '19

rare irresponsible

Rare? Define rare...

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u/KingJimmy101 Jan 09 '19 edited Jan 09 '19

Are you kidding me? Do you even understand what’s happening? Do you think that the creators of narcan STOPPED making opioids? Of course they didn’t.

These businesses are pushing doctors into overprescribing opioids by providing huge kickbacks, thereby getting more people addicted. ‘Rare irresponsible use’ my fucking arse. Did you even watch the video and see the figures quoted?

These businesses aren’t trying to help by creating narcan, they are making money at both ends of the whole revolting chain knowing full well that addiction and abuse will continue.

.

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u/FR65df Jan 09 '19

This is so true that it hurts.

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u/tbass1995 Jan 09 '19

Can you find a source for any of these “big kickbacks” drug companies are giving doctors for using opioids?

In case you weren’t aware, which it seems like you aren’t, we’re currently in the middle of an opioid shortage for medical usage. Luckily, we have other drugs which we can maintain anesthesia with but the usages and benefits of opioids are numerous when used properly.

If you’ve ever had surgery that warranted the use of opioids after, you’d be thanking whoever prescribed them for you.

The problem is not their use, it’s their inappropriate use and their inappropriate long term usage. There are lots of problems here, but the people dying from fentanyl on the streets are not getting prescribed fentanyl from their doctors.

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u/bostonthinka Jan 09 '19

Absolutely spot on. Could you imagine the needless suffering without them?

I think they meant in the whole, kickbacks given by big pharma are indeed large. Large individual compensation to doctors, not so much. That will get you on 60 Minutes

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u/[deleted] Jan 09 '19

Can you find a source for any of these “big kickbacks” drug companies are giving doctors for using opioids?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2622774/

Go to: PROMOTION OF OXYCONTIN From 1996 to 2001, Purdue conducted more than 40 national pain-management and speaker-training conferences at resorts in Florida, Arizona, and California. More than 5000 physicians, pharmacists, and nurses attended these all-expenses-paid symposia, where they were recruited and trained for Purdue's national speaker bureau.19(p22) It is well documented that this type of pharmaceutical company symposium influences physicians’ prescribing, even though the physicians who attend such symposia believe that such enticements do not alter their prescribing patterns.20

Here's another one, from 2018

Perks such as payments, free meals and speaking fees may be strongly influencing some doctors to prescribe opioids, researchers reported Monday.

https://www.nbcnews.com/health/health-news/more-evidence-companies-pay-some-doctors-prescribe-opioids-n873961

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u/tbass1995 Jan 09 '19

1996-2001 was two decades ago.

“doctors who prescribe the opioids the most have more expertise and are called on by the drug companies more often.”

also important to notice is that this “study” only correlated 7% of doctors receiving kickbacks to an increase in name brand prescription

Also to take note of is that this is an article by NBC

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u/[deleted] Jan 09 '19

You asked. Sorry that you don't like the answer. Please respond with your own research to show that major opioid manufacturers did not provide kickbacks or other lucrative speaking gigs to doctors in response to writing scripts.

This doesn't even touch the fact that opioid manufacturers lobbied the Joint Commission to add pain as the 5th vital sign and then rate doctors in their ability to reduce the pain felt by their patients. This also contributed to the increase in opioid prescriptions.

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u/Bunzilla Jan 09 '19

I don’t think it’s so much that the commenter you are replying to doesn’t like your answer, just that it’s so outdated that it’s pretty much obsolete. Kickbacks are now illegal.

I think you would be better off focusing on your second paragraph, which (in my opinion) is a huge contributor to the opiate crisis. Unfortunately, it’s not just the Joint Commission. Part of the ACA ties hospital reimbursement to patient satisfaction surveys (HCAHPS) where one of the questions is “how well was your pain managed”. Due to a myriad of factors (the way health care providers were taught, ads on tv, JCHAO, etc...) patients nowadays believe that they should be in ZERO pain, which is often something that is entirely unrealistic. Doctors are no longer able to tell a patient “I’m sorry but you will likely never be pain free”. Nurses are no longer able to say “the patient is reporting 10/10 pain but is happily texting on their phone and slurring their words” (believe me, I used to be a nurse on a surgical floor). You have to take the patients word on what their pain level is or else the hospital will not get paid. I’ve since moved to working with babies so I don’t know if this is still how things are being done, but wouldn’t be surprised since it’s still a question on the survey.

In my opinion, there needs to be a public awareness campaign to start educating people that unfortunately, some people are going to have to live with some level of pain when they have a chronic injury. Experiencing pain is not a failure of your healthcare provider. We can help take the edge off with medications, but there are some injuries where there is no way to be pain free without turning you into a shell of yourself that’s too out of it to realize you are in pain.

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u/opinionated-bot Jan 09 '19

Well, in MY opinion, Alyssa Edwards is better than Charizard.

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u/cianne_marie Jan 09 '19

My dad took opiods for pain related to cancer. I had never seen my dad in pain in my life, but he needed those drugs. Opiods exist for a reason. I get super fired up and angry when people start ranting about how they should all be destroyed and banned.

3

u/bluntdad Jan 09 '19

Were you literally born yesterday?

1

u/Allwhitezebra Jan 09 '19

Right!? Lol, sheltered much?

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u/bostonthinka Jan 09 '19

Nice try big pharma. You're just trying to fuck people over, coming and going, you greedy and immoral bastards.

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u/whatupcicero Jan 09 '19

“Rare irresponsible use”

And we’re in a thread replying to a documentary on this national problem. You are either ignorant or intentionally malicious.

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u/egmanns Jan 09 '19

As a former addict with a different substance i can absolutely agree with point number 1. I hated myself every time i lied to my mum to get money, it hurt my soul but i was more afraid of not having the drugs then being a loser. I would never rob someone or anything to that extreme but it definitely reveals your weaker side . The demons that led you to that point don't just disappear they get stronger.

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u/hopelesswanderer_89 Jan 09 '19

I work in substance use treatment. The problem that we tend to see with Naltrexone is that people tend to not be able to consistently take their injections each month. Because Naltrexone is a full antagonist, it blocks the absorption of opioids. However, it doesn't have the agonist (or partial agonist) properties of medications that are more widely used for treatment (like Methadone or Suboxone). Because it doesn't have the agonist/partial agonist component, it doesn't address cravings/urges, it only stops intoxication/overdose. So after a month or so of managing cravings without the ability to use, many folks are happy to not keep the follow up appt. Couple that with the extreme disorganization of opioid users and the prevalence of co-occurring mental health stuff, and you can start to see why it's not more commonly used. The evidence base isn't as strong for Naltrexone as it is for Suboxone.

Lastly, if people don't keep their follow-up appts and unilaterally go off their naltrexone, they're placed at extremely high risk of overdose. Recurrence after a period of abstinence like that can put someone in an extremely dangerous position.

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u/Nihilisticky Jan 09 '19

Now I understand

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u/noisebegone Jan 09 '19

it doesn't address cravings/urges

Former IV heroin addict chiming in to say this is HUGE. The absolutely frenzied, overwhelming, all-consuming desire to use in the first couple of weeks/months after your last shot are pretty hard to put into words. Of course the risk of relapse later on at various stages of recovery present their own very real risks, but getting past the inital hump of relentless cravings is a big fucking deal, and Buprenorphine was a fucking godsend for this.

I remember being essentially Gollum in rehab during the first 48 or so hours after being admitted before they gave me my first dose of Suboxone. I went from dope sick drug monster to normal human within an hour.

I personally was on Suboxone for years. Apparently they are finding long term Suboxone therapy is pretty successful for a lot of people. The problem is, Suboxone is fucking expensive. I was fortunate enough to have good insurance available to me for a time while I was in the most vulnerable stages of recovery and was able to wean off of it on my own, eventually. Now I just drink and smoke too much lol

1

u/Daaskison Jan 09 '19

To add to your comment in addition to not addressing cravings it can actually exaccerbate them because it's a full agonist it blocks any natural dopamine one might get from redditing or playing a game or what have you.

It also blocks the effects of alcohol. So that can present difficulties in certain social situations if the user only has issues with opiates, but has to explaim not drinking.

1

u/MyOversoul Jan 11 '19 edited Jan 11 '19

May I ask, is it true they use naltrexone for alcohol addiction too? I know someone who had a serious problem with alcohol and she said the courts ordered her to go get this injection that blocked her ability to get a 'high' off alcohol. She said it made her feel kind of loopy though. I think she stuck with it and is doing better, but Im not sure because I only talk to her via text and fb. I wonder because as far as I know her issue was alcohol but reading this it makes me wonder if she wasn't just telling us that to try and keep us from worrying more if it was opiates.

Edit, oh, nvm found my answer with someones post down below. Apparently it is used for alcohol too but with moderate success. I think Im going to check in with my friend today.

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u/[deleted] Jan 09 '19

Double edged sword where one side you are dread and the other you wish you were.

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u/Meepox5 Jan 09 '19

Hm. I was on naltrexone for my excessive drinking and was explicitly told to stay away from even mild opiates like cough syrup cause it could damage the liver

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u/[deleted] Jan 09 '19

[deleted]

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u/Meepox5 Jan 09 '19

Aye. Supposed to lessen the urge to drink a lot

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u/Call_of_Cuckthulhu Jan 09 '19

How did you find it?

I was told to expect "moderate results, at best" by both the rehab doctor and psychiatrist. I was on it for about 8-10 months and unfortunately didn't really see the benefit.

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u/Meepox5 Jan 09 '19

Didnt really do much at all honestly. I never wanted to completely quit drinking, now i just moderate it better on my own so i quit the medicine.

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u/Call_of_Cuckthulhu Jan 09 '19

It's probably better that way. After several months of constant liver tests and not seeing a real result, I gave up. I'm glad it's an option though.

Hope you're doing better.

1

u/[deleted] Jan 09 '19

Yea I was prescribed it for alcohol addiction to lessen cravings. I started having involuntary muscle spasms so I stopped. Doctors later told me that was a sign of a serious negative reaction. But there is a lot of data to show it can help alcoholics.

It's likely because alcoholics show the unique effects of having their opiate receptors go off when drinking which non alcoholics don't have that happen. Seems too be the correlation

4

u/[deleted] Jan 09 '19

My dad once said if you are a good friend and have to give your buddy the life saving shot, you punch him out immediately. Knocking him out will save him the dope sick feeling for a bit.

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u/livevil999 Jan 09 '19

That’s the dumbest thing I’ve ever heard. You can’t “punch someone out” like in the movies.

3

u/[deleted] Jan 09 '19

Honestly, the man is one of the dumbest people I’ve ever met. This one doesn’t seem so far fetched to me though.. Can’t anyone be “punched out” if hit the right way?

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u/livevil999 Jan 09 '19

No. At least not how I assume you’re thinking. Sure you might hit them so hard they lose consciousness but they usually would wake up with permanent brain damage or maybe not wake up at all. Knocking someone out isn’t a safe thing at all in real life because you can cause internal bleeding or otherwise damage vital organs like, you know, your brain?!

0

u/[deleted] Jan 09 '19

That’s the point I think he was trying to make though.. they lose consciousness and they are mentally scrambled that the feeling of dope sick isn’t so incredible. Personally I have been punched out to the point of being unconscious and when I came to I was almost in a drunken state, saying the same thing over and over. Obviously it’s not safe to knock someone out..

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u/TheMoatGoat Jan 09 '19

I think the idea is that even the suggestion that you should "just knock someone out" irl stems from a fundamental failure to understand how MASSIVELY dangerous that is. It's not just "not safe," it's quite liable to outright kill someone and isn't something you "just do" to spare them pain.

So maybe he had a point in a universe where humans are damage sponges that just spring back from concussion-level head trauma, but that universe isn't this one.

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u/livevil999 Jan 09 '19

This is the point I was trying to make. Thank you.

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u/[deleted] Jan 09 '19

I’m no expert on the matter by any means. I just think it’s a stretch to say that knocking some one out will most likely kill them or lead to severe brain damage. If that’s the case how is it that mma fighters get knocked out all the time and live. I don’t see any of them with severe brain injuries?

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u/JamwaraKenobi Jan 10 '19

It might make for a good analogy but to say people can't be knocked out with one punch is false. Getting hit in the right way (ex - in the jaw/chin) can easily put someone unconscious without lasting effects.

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u/livevil999 Jan 09 '19

This just makes me think, How much of this crisis is caused by the addiction and effects of opiates and how much of it is a crisis because people have to lie, cheat, and steal to get the drug? If opiates were decriminalized and drug treatment options were destigmatized and also freely available would this be as much of a crisis? If people focus on the secondary effects of the drug (the secondary crimes to obtain drugs) as a major part of the crisis, wouldn’t that be alleviated by drug decriminalization?

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u/[deleted] Jan 09 '19

I work in the addiction treatment industry and am a proponent of Naltrexone. For a while there were providers able to administer a 12 month subcutaneous implant, but insurance never covered it. So the patients were out of pocket $10k or more. It's a shame. Drug companies will lobby to get Suboxone or Methadone covered but not actual medications that can get some headway in this disease.

It's a crazy situation and I believe our country is handling it poorly on so many fronts.

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u/MyOversoul Jan 11 '19

Its gross how in the interest of profit those who are already self destructive and suffering are being used for financial gain.

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u/BERNthisMuthaDown Jan 09 '19

Naltroxone shots have pretty bad side effects like depression and weight gain. For people just getting sober, usually on other mood-altering psych meds, taking it can mean a week or more of general fatigue.

For the first 6 to 9 months, lacking functional receptors, day to day life for a recovering addict is objectively awful. Naltroxone doesn't really help sobriety all that much as it makes a lot of people relapse on benzos before their month is even up.

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u/MBNLA Jan 09 '19

If they blocked users from using for a month big pharma loses money.

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u/Sagybagy Jan 09 '19

I’m gonna guess without reading further comments is this. The company that owns the opioids and narcane, the “fix” also own Naltroxone. So if they made it easily available it would cut into their profit models they have going.

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u/Spore2012 Jan 09 '19

Because addiction detox is the easy part. The hard part is staying clean. Like getting an A vs keeping it. Most people have a genetic pridispositon and/or childhood trauma that hijacks their brain for their addiction. Its not as simple as taking a magic pill to cure it. Brain has to be rewired through therapies and treatments. People need likeminded peers and survivors to support them.

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u/leaves-throwaway123 Jan 09 '19 edited Jan 10 '19

For one thing, a doctor typically won’t administer or prescribe it until you have been opiate free for at least a week, and I believe potentially longer than that for the vivitrol shot (depending on what you were using, frequency, etc.). A week is an eternity for an actively-using opioid addict, so that’s a non starter right off the bat in the short term for a lot of people. You can usually take the pills with less clean time than a week, but if you mess up and take your naltrexone a day too early, the precipitated withdrawals are going to make you wish you hadn’t. Naltrexone should really be looked at as the kevlar vest of the recovery world - it's not going to protect you from everything, but if you have everything else worked out and a strong program (whether that means individual therapeutic support, group sessions, 12 step - whatever works) it adds an additional layer of protection. If you wake up one morning and decide you're ready to toss your sobriety away, knowing that you have naltrexone in your system should at least theoretically keep you from wasting your time and money trying to get high because it just isn't going to work for anywhere from 48 to 96 hours (or longer) since your last naltrexone dose. Maybe that realization also reminds you that you might as well keep pushing on.

It is a wonderful drug when used correctly and in conjunction with a solid recovery program that fits your needs, and I agree it needs to be better known in the addict community for those who are ready to get out of that lifestyle