S03.E27: Opioid Abuse

[Athena]

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Main segment: Opioid abuse
Segments: Third presidential debate, Alfred E. Smith Memorial Foundation Dinner

 

[Lantern7]

I'm grateful that Michael Grimm resigned and wound up in the pokey before John shined a light on voters from Staten Island. I'm hoping for this congressman of Wisconsin to guest host Tosh.0 and play "Is It Rashist?"

And thanks for laying the lumber on the rump, John. The groping booth and the small hands were awesome touches. That should hold us until Sam comes back tomorrow night.

[KerleyQ]

When the Emmy thing came up at the debate, my son said "so, someone just give him an Emmy so he'll go away!"  I responded "well, you know, John Oliver has one."  And, sure enough... 

[Primetimer]

Healthcare professionals were wary about prescribing opioids back in the '90s, so uh -- how did we get to where we are now?

View the full article

[atomationage]

Some favorite quotes:  "Heroin has full coverage" to Drumpf wondering how heroin goes along with trees and ponds, "fancy drunk"with that bottle of wine you've been saving,  Harold the gorilla plushtoy will destroy your life, "fuck you, maybe" to HRC getting her period,  "pseudo-diarrhea" at Chipolte, Drumpf and a "charity groping booth, "It's You" at Drumpf not knowing who the audience was booing at the Al Smith Dinner, "Henry Kissinger is the world's leading authority on horrific bombings", "open Mic night at Rascal McBigots", "something teenage Pinocchio would yell at Gepetto before slamming his door" about "you're the puppet".

Edited October 24, 2016 by atomationage
puppet

[attica]

Me, I would have gone with 'fuck you' before 'she's 68', but I get that the joke works better the other way. 30 years of investigations just to justify the fundamental misogyny going on here is exhausting to me.

[cpcathy]

I hope John really doesn't give Trump his Emmy! I don't know if they are even transferable, Oscars aren't, but John earned that Emmy, Trump does not deserve it!

[attica]

As one of the lucky ones who can use opioids for pain without getting addicted (don't ask me how! I just take 'em until I'm better and then stop.) I'm a little grumbly that the pendulum will swing back the other way, making my docs gun shy about forking over the script. And of course, saying Honest-I-only-need-30-days'-worth-to-last-me-a-year sounds like something a junkie would say. But nothing over-the-counter offers the same level of relief. Unless I lived in Europe, where you can get tylenol+codeine OTC. Which I don't. And overseas airfare seems a bit extreme to avoid seeing a doctor...

Edited October 24, 2016 by attica
moar thoughts

[dusang]

13 minutes ago, attica said:

As one of the lucky ones who can use opioids for pain without getting addicted (don't ask me how! I just take 'em until I'm better and then stop.) I'm a little grumbly that the pendulum will swing back the other way, making my docs gun shy about forking over the script. And of course, saying Honest-I-only-need-30-days'-worth-to-last-me-a-year sounds like something a junkie would say. But nothing over-the-counter offers the same level of relief. Unless I lived in Europe, where you can get tylenol+codeine OTC. Which I don't. And overseas airfare seems a bit extreme to avoid seeing a doctor...

I'm 98% certain you can get acetaminophen+codeine OTC in Canada. So if you're close to the border.  Or one more reason to move if things go bad on Nov 8.

[movingtargetgal]

I remember way back before the HOSPICE movement hit the mainstream, doctors were afraid to give too much pain medication to terminal patients because they did not want their patients to become drug addicts.  There was a concern that these pain meds could shorten the patient's life. Terminal patients, in the last days of their lives, were allowed to remain in agonizing pain because of this philosophy.  Ten years ago when my grandmother was dying from lung cancer (those f**king cigarettes) HOSPICE  helped us care for her.  Pain management was the major part of her care.  We all agreed that grandma would not be in pain and we were able to give her pain meds as needed.  She died peacefully at home with her family around her.  The fact that we could help ease her pain gave us so much comfort during those awful days.  I can't imagine having to watch my beloved grandmother cry out in pain as she lay dying.

On the other side, doctor's over prescribing  opioids to their patients is a real problem.  There are many unethical doctors out there who see patients like they are on an assembly line, handing out "legal" prescriptions for these drugs.  Patients will also "doctor shop" and go to multiple physicians and hospitals to get their "needs" met.  As regulations and monitoring of these drugs have made it more difficult for addicts to obtain the "legal" drugs, the market for heroin and other illegal drugs has skyrocketed.  Last year I went to pharmacy I had never been to before to get my ambien refilled.  I had to show them my driver's licence.  It came back on the computer that it was 3 days too soon for me to get the prescription filled and with a red pen the pharmacist wrote "can not be filled until ...".  I felt a little like a criminal.  All I wanted to do was save myself an extra trip and to fill my prescription while I was in the same store doing my food shopping.  The pharmacist apologized and explained about how strict the new laws are.  Before then I had heard of the increased use of heroin on the streets but I had not understood why.  It was an eyeopener for me.

[The Luvly Junkie]

4 hours ago, cpcathy said:

I hope John really doesn't give Trump his Emmy! I don't know if they are even transferable, Oscars aren't, but John earned that Emmy, Trump does not deserve it!

Joke or not, I wouldn't worry if Ollie-Scone puts his Emmy on the line. That proposition to Trump alone qualifies him to earn another Emmy next year. It's a win-lose-win guaranteed to satisfy either party. Also, I think Ollie-Scone is more level-headed enough to see his Emmy as a physical symbol of recognition for hosting and writing on a show that he is engrossingly passionate about. Ollie-Scone and his "I'm just doing my job, now play 'Exit Stage Music' to make my achievement less awkward" mindset has nothing to lose <3

[KerleyQ]

3 hours ago, attica said:

As one of the lucky ones who can use opioids for pain without getting addicted (don't ask me how! I just take 'em until I'm better and then stop.) I'm a little grumbly that the pendulum will swing back the other way, making my docs gun shy about forking over the script. And of course, saying Honest-I-only-need-30-days'-worth-to-last-me-a-year sounds like something a junkie would say. But nothing over-the-counter offers the same level of relief. Unless I lived in Europe, where you can get tylenol+codeine OTC. Which I don't. And overseas airfare seems a bit extreme to avoid seeing a doctor...

I'm kind of similar, except I have to take them pretty much every day.  (I have an autoimmune disorder that causes extreme pain, and the medication that treats the disorder tried to kill me, so I'm kind of stuck with needing painkillers to stay out of the hospital.)  I think that some people just don't have the chemical make up to be an addict, and I'm, luckily, one of those people.  (I've had this condition for more than a decade, and after the initial few visits with the pain clinic, where we experimented with different meds and doses until we hit on what worked, I've never asked for an increased dose or more pills in all of that time.)  I get concerned when I hear how much some would like to change the system.  I know that there needs to be some change, because it is, currently, a little too easy for an addict to doctor shop and pharmacy hop to get them filled.  If they can track and limit the purchase of Sudafed, like they do here in Illinois, they should also be able to track and limit the purchase of pain pills.  That way if someone goes to multiple doctors and then takes one prescription to CVS, one to Walgreens, one to a local privately owned, pharmacy, etc, something will trigger in the system, flagging them as a potential abuser.  Any patient getting a prescription for certain pain medications would have to sign something similar to what I sign with my pain clinic which, among other things, gives the physician and pharmacy permission to discuss the prescription with any other doctor who prescribes similar medications.  

[mjc570]

i very much liked the first part of the episode, especially the Emmy bit because it is so true, but the main segment just didn't interest me.  Yes, of course it is a huge problem, but really, who doesn't know that?  I don't feel I learned anything new from watching the segment, and learning new things is one of the best reasons to watch the show. 

I should note that I certainly don't mean to minimize the drug problem, or suggest that it be presented humorously, but there was just no reason I could see for that extended segment.

[MrWhyt]

41 minutes ago, mjc570 said:

 I don't feel I learned anything new from watching the segment, and learning new things is one of the best reasons to watch the show. 

you're not the only person in the audience,

[Victor the Crab]

Loved the opening segment where Ollie shows us why Drumph Is the miserable humorless loser he truly is. Dangling the Emmy was the piece de resistance. Will Drumph be pathetic enough and take the bait?

I've never been on painkillers before, and I swear to God I hope I never have to. Perhaps it's different here in Canada, I don't know.

Ollie seems to enjoy revealing to us just how hacky Chris Matthews is.

[atomationage]

Re-watching, I missed the part about Rascal McBigots being "Long Island's fourth best alt-right comedy club." 

Also, in the Emmy bit, "you don't even have to take her furniture shopping".  I missed that because the audience was screaming when he pulled the Emmy out. 

I had to look up Love Actually.  I don't remember much about it.   The supporting cast had Andrew Lincoln and Martin Freeman, among others. 

Edited October 25, 2016 by atomationage
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[stillshimpy]

I'm one of the ....I'm going to go with "lucky" also....people who feels like they are just about to barf themselves into infinity on almost all opiates.  Since I've broken bones and all kinds of fun stuff, that means I can only take them for a very short period of time.   One time for a surgery to reconstruct a bone following a car accident, I became (I was assured by the nurse) the first person in history to beg to be taken off a morphine pump while crying because "this is making me feel awful" (they put me on a demerol pump, much better).  I never realized until the last few years, that considering I had a car accident that caused a lot of pain for a couple of years, I am INCREDIBLY fortunate to have that blessedly genetic trait (sorry, son but it will save you a world of potential grief).  

So having established that my chief concern with the whole crackdown is that there are instances where it is entirely appropriate to prescribe pain medications for people and those times aren't just following surgery, so maybe the better approach would be educating patients about the risks involved?  It's just rather barbaric to expect people with herniated disks to try and zen out to the mindfulness, you know?   

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I should note that I certainly don't mean to minimize the drug problem, or suggest that it be presented humorously, but there was just no reason I could see for that extended segment.

 

 

I can completely understand feeling that way but in fairness, this is a problem that is still in need of a solution.  It's a giant problem and it's killing people left and right. So I think the point of it was simply to get people thinking about 'well, what do we do?' and I have to tell you, I'm not sure what in the world we can do.  

Whereas prescription painkillers caused this problem to escalate to epidemic levels, heroin is always out there.  Oh sure, when I was in college it really was the "have you lost your mind?  What can you possibly be thinking?" drug that no one I personally know ever tried (as far as I know, clearly someone I know must have back in the day) and that's because it carried a big stigma.  It was billed as the drug that could kill you, the stuff of junkies and a few well-known rock star deaths....and honestly, I can't remember anyone having any pain pills back then. Just the usual "I took percocet when I got my wisdom teeth out" type of things. 

Just kind of musing because I never really thought I'd give any serious consideration to "Uh....hmmm.  What would change if we legalized drugs?" but I do now, pretty regularly.  It isn't likely to happen.  I don't even know if that would help but when you have people talking about standing around in groups, hitting each other with bats in order to cause enough injury to get a prescription, it's kind of clear that something has to change.  I know they used to put that crap in just about everything 100 years ago.  Teething remedies (you would so think I was joking but it was supposed to ''calm fretful children"....zounds).  It's small wonder that it was a giant problem at the turn of the 20th century. 

It's just making it illegal to sell opiates without a prescription was the solution then.  In some whacked out version of cyclical history, we're essentially just repeating a problem with a couple of key things changing: We're no longer so daft that we'll rub freaking heroin on a baby's gums to get them stop crying, so at least there's that.  This seems unlikely to provide a solution and I admit, I don't know what the solution could be but someone, somewhere, may have a bright idea.  

I'm glad John did the segment.  I just don't know what in the world can be done to help.  Realistically, there are a lot of situations where people need pain relief.  Also realistically, heroin/opiates have been around for a long time.  It seems as if the most likely solution to all this is the development of a painkiller that eradicates pain and doesn't nearly cripple people with agony from withdrawal when they stop it.   Unfortunately, claiming that that is what they had done is what got us into this mess in the first place.  

I'll admit, that was a grim segment, made grimmer still by the reality that whereas we can see the problem, we're apparently trying every ineffectual thing to solve it and it is getting worse.  I can't be the only person who saw that video of a little girl, a really young toddler, crying and tugging at her mom, as her mom overdosed in the fucking aisles of the Dollar General.  All I could think, as people filmed this with their iphone was, "What the fuck??? GO PICK UP THAT BABY, this is not a spectator sport!!" 

I swear, I sometimes wish they'd just give the damned pain pills away to people that want them....as long as they are laced with a unisex birth control because -- whereas I am almost never the "won't someone think of the children?" person -- that freaking video still haunts the hell out of me.  

Edited October 25, 2016 by stillshimpy
Misplaced a sentence entirely.

[attica]

Of course, quite a lot of pain management protocols could be helped if marijuana was more widely and more legally available*. But you know: war on drugs and all. 

*There was a super interesting piece some time ago on Bryant Gumbel's HBO show, on how NFLers cope with pain, both muscular/skeletal and concussion, that looked at some of the emerging science in that area. My favorite line was from the player who talked about treating his playing-days pain: "I weeded as needed."

[Jersey Guy 87]

My wife has had a number of surgeries over the past 6-7 years for some problems with her knee/ankle/foot.  Every single surgery her surgeon has essentially pushed opiates on her - she gets a prescription before her surgery date, the nurses at the surgery center give her a filled prescription in post-op, another prescription is offered at the first checkup, etc.  She can't stand them - yes, they help with the pain immediately after surgery but she hates the fogginess they cause her and gets off them as soon as she can.  But if she liked the feeling I could see easily how she'd become an addict - the doctors are writing the prescription before they even ask her if she needs more.  Her most recent surgery (we're hoping it's her last) she specifically told the doctor to not write her a prescription because she didn't need it - she still had 80% of the pills from her previous surgery left over.

And I think that's where the problem comes from - we went from a system where opiates were rarely prescribed and often denied to people with terminal illness to a system where doctors are writing prescriptions left and right without really assessing the need.  And a lot of people aren't like my wife - they find the painkilling aspects to outweigh the foggy mind aspect (or enjoy the foggy mind aspect) and so they take the prescription, use all the pills, get a refill, etc.  And then they've got a problem.  We need doctors to find a balance so we get needed pain medication to people who need it but don't overprescribe so people can more easily become addicted.

[OneWhoLurks]

Quote

 

What Oliver completely missed is the huge role that pharma is already starting to play in fighting the epidemic—through medicines that help addicts recover and through developing next-generation pain drugs. For instance, medication-assisted treatment (MAT), in which certain drugs are used to wean addicts off of powerful opioids, is a critical part of addiction therapy, according to public health officials.

In fact, the Obama administration announced in July that it was significantly expanding access to buprenorphine, which mimics the painkilling effects of opioids without the same level of the addictive “high,” after concluding that not nearly enough Americans could get their hands on it. The Food and Drug Administration (FDA) also approved the first-ever implant to treat opioid addiction, which releases a stream of buprenorphine for up to six months, in May. The treatment is meant to help ensure that addicts stick with their recommended regimens.

These types of critical innovations aren’t just limited to the addiction treatment sphere. Duke University has been exploring therapies that target different pain receptors than opioids do, with the hope that these new drug classes could eventually treat pain just as well without the addictive side effects.

 

John Oliver's Anti-Pharma Rant Had One Glaring Omission

[Danny Franks]

There is a depressing sameness to any episode where John looks at the practices of corporations and their potentially harmful products.

They aggressively market their product, they aggressively attack anyone who criticises their product, they pay for unreliable testimony that their product is not harmful, and they outright lie about everything under the sun, just to make more money. I'm sure this angers and bums the hell out of John and his team, just as much as it does the audience.

Fortunately, I have no experience with any sort of painkiller addiction. None of my family or friends have ever struggled with it. But my girlfriend is an anaesthetist, so she is very, very aware of the dangers of painkilling drugs and sedatives. It seems like they're much harder to get legally in the UK, thankfully. We're not even allowed to buy more than two boxes of paracetamol at a time!

But in the US, it seems like there's such a huge, profitable industry centred around pushing drugs onto people, that any attempts to regulate it are doomed to failure. Again, this is starting to sound so familiar....

The Drumpf stuff is all open goal stuff for John, now. He doesn't even need to try, or to do any research at all, to make the man look like a buffoon. Hell, old Trumper does that well enough all on his own. But I do agree, how do you manage to blow a tame, anaemic dinner roast in such spectacular fashion? I guess the seminal moment for me was when Drumpf made a crack about Melania's speech. That really summed him up. Obviously, someone said 'Okay, Donnie, the key tonight is to be self-deprecating and charming. Can you do it?' and he thought this must mean mocking his wife. Because if you can make mean jokes about your wife, that's like... humble... right.

As for Glenn Grothman? Well, he's just an example of how spectacularly fucked up some corners of the US can be. I honestly don't know anyone who would vote for this guy, and I do know some people with very old fashioned views.

Edited October 25, 2016 by Danny Franks

[attica]

16 minutes ago, Danny Franks said:

We're not even allowed to buy more than two boxes of paracetamol at a time!

(That's acetaminophen to USers.) And that shit will fuck up your liver real good. 

[iMonrey]

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I had to look up Love Actually.  I don't remember much about it. 

Never saw it, had to look it up too. What's with Chris Matthews' obsession with it? Weird.

[Jamoche]

This episode seemed a bit more simplified than I'm used to from LWT - not denying there's a problem, but there's more to it than just "take opoids > get addicted". What happens in other countries? - there are places where you can buy tylenol with codeine OTC!

I've been on pain meds after surgery twice, and realized the first time that the "take every four hours" is bunk - it started wearing off for me at 3:30. Stuck it out for the first round, then said to hell with it and took the next one at 3:30 when I could feel it wearing off again. And then within a day or so I'd stretched it out to 6 hours, then 8, etc. And yeah, I'm one of those people for whom pain meds do nothing beyond making the pain stop, which yes feels awesome but only in comparison; there was nothing beyond that which tempted me to take it when I wasn't in pain.

I saw a report not so long ago that one reason for the big rise in addiction was that one drug had been pushed as lasting for 8 instead of 4 hours, and when that wasn't working for people, instead of being sensible like I was, the drug companies increased the recommended dosage. So people got into this cycle of hours of pain and then a high dose of pain relief, which made it feel *really* good, thus making it more likely they'd seek out that feeling after they didn't need it - in short, they couldn't have designed the process to be more addictive if they'd tried.

[Hanahope]

6 hours ago, Jamoche said:

And yeah, I'm one of those people for whom pain meds do nothing beyond making the pain stop, which yes feels awesome but only in comparison; there was nothing beyond that which tempted me to take it when I wasn't in pain.

And sometimes people have to be taught that pain relief can come from more than just taking a pill.  Depending on the cause of the pain, relief can come from physical therapy, cortisone/epidural shots, and other non-narcotic acts, that can be longer lasting as well.

[dusang]

I was listening to a podcast and they were talking about this rising epidemic of addiction and there was a guy on, just an average young adult (early 20s) with no history of or inclination to substance abuse, and he was in a serious car accident and put on opioid painkillers.  He didn't like them, they made him foggy and such, but he was in pain.  The physical pain morphed into a phantom pain, so he though "I need painkillers" but really it was that he was physiologically addicted to the meds so his body was creating the signals to get more.  He was seriously addicted before he even realized it was a problem. It's not people "chasing a high" who get addicted -- it is people who are in pain, who believe that all they are doing is managing their pain.  It's a very slippery slope.

[Danny Franks]

8 hours ago, Jamoche said:

This episode seemed a bit more simplified than I'm used to from LWT - not denying there's a problem, but there's more to it than just "take opoids > get addicted".

I think you're right. And I think the problem is, as you and others here point out, it's a very complicated subject to try and distill into 30 minutes. There are so many different factors that can come into play, so many different reasons a person might get addicted. All John really did was highlight the problem and highlight the drug companies that have done little to help combat the problem.

He really brushed over the idea of alternative forms of pain relief very quickly. And while I'm dubious about how effective things like meditation can be, I've never tried them, and I could well be dead wrong. So the show wasn't really offering any alternatives to taking opioids for pain relief, but I'm not sure it's really John Oliver's place to do that.

[fastiller]

If you haven't seen The Oxycontin Express, I recommend it highly.  I saw it when it ran on the old CURRENT network.  Marina van Zeller was in at least one of the clips shown on Sunday's show (but I think the graphic showed that the clip was from a separate documentary).

It really is a thorny problem to solve.  Is it only in the US that it's such a large issue?  I repeatedly hear from all sorts of municipalities that they are "the epicenter of the heroin problem" - I've heard it from people (not personally, on shows/docs) in Maine, Massachusetts, Wisconsin, West Virginia, Tennessee, Minnesota.  I suspect that it's not just on MDs to solve it, but also on psych-otherapists, -ologists, -iatrists, etc...

I recall being given a prescription for some opiate or other just before surgery, so I'd fill it the day before and have it right after.  I didn't even bother with the opiate pills, just stuck with the 'triple strength' Tylenol before stepping down to ibuprofen (which agrees with my body much more than other pain killers).  

[Jamoche]

4 hours ago, dusang said:

 It's not people "chasing a high" who get addicted -- it is people who are in pain, who believe that all they are doing is managing their pain.  It's a very slippery slope.

Seems like a big problem is that people aren't told how to manage the pain - just "take this every four hours", whether it's wearing off before the 4 hours are up, is actually working longer than that, or doesn't work for that person at all. My prescription said nothing about tapering off, but I did it anyway - really, did they expect me to go through the whole prescription 4 hours at a time even as my body was repairing itself, and then poof, nothing?