Should narcotic pain killers be sold without a prescription?

[X Factor]

no you are incorrect that alcohol is only physically addictive in rare cases....the stats say otherwise.
this I agree with

absolutely, my guy marathons, he can psych himself past the pain
oh yes, but perhaps because people lie

there is a reason for this though I am not clear on why...I would say it is because many people who are in extreme pain can not get enough to relieve the pain and that is a terrible thing

even when people are at the end of their life sometimes not enough pain meds are given...they end up in excruciating pain...that should NEVER happen

I disagree. I was given two narcotics for a kidney stone...why would I take oxy when I could tolerate the pain on what they had given me before they sent me home...I could cope without the use of a narcotic...I filled both scripts in case I could not tolerate the pain but I never took one

I think people can handle it because I know I can

I think folks who need pain meds should have them and the government should not regulate the doctor/patient relationship like they're trying to do now. By the same token, I don't believe narcotics should be available over the counter. I'm sorry, but it's simply true that making something easier to get makes it more available. It may not be perfect, but requiring prescriptions seems the best compromise.

 

[Harry Guerrilla]

what he said

I saw some pretty outrageous actions of "pain clinics" including a case where a once legitimate doctor was issuing more Oxy prescriptions than the rest of Southern Ohio combined. He'd charge 100 bucks for an appointment-an appointment that would last a couple minutes and the "patients" would go out of his office around back to his "dispensary" and get 30 doses of oxy

he basically got a life sentence after several of his "patients" died. Don't know if getting rid of prescriptions might not change anything

I am undecided to be honest.

Seeing my parents become addicts (one was hospitalized at least half a dozen time for accidental OD) and others.
Not sure I could form a policy on this that's good.

 

[Chomsky]

Any restriction placed on a drug transfers power to the black market, including prescriptions.

The lion's share of RX narcotics on the street come from patients who have prescriptions, or from pharmacy robberies. Very little comes direct from drug manufacturers.

By making an RX narcotic over the counter, you remove selling power from the black market, and have better control over quantities sold (to reduce overdoses, etc). It also provides the opportunity for buyers to receive additional education, advice about the drug, and help with addiction if they need it.

From a harm reduction perspective, this is highly desirable, since you can't stop drug use but you can reduce drug death. Considering that more people die from prescription drugs every year than all other illegal drugs combined (including alcohol), this needs serious attention.

What people need to realize is that addiction is a disease, and you won't stop addiction by restricting drug access. As long as drug manufacturers are making a drug, addicts will obtain it. The drug laws must start shifting toward harm reduction and away from punishment because the situation is getting worse every year.

Excellent post!

It would be interesting to compare the crime and violence fostered upon society through Prohibition, in relation to the supposed crime and violence these laws are claimed to prevent!

I suspect the (serious) crime & violence component of the War on Drugs far surpasses that of the drug use itself!

 

[Chomsky]

Seeing my parents become addicts (one was hospitalized at least half a dozen time for accidental OD) and others.
Not sure I could form a policy on this that's good.

I empathize with your situation Harry, and I have quite a bit of personal knowledge of iatrogenic dependency & addiction.

The thing to keep in mind, is: to 'not throw-out the baby with the bath water.

Pain suffering, chronic or transient, is a terrible affliction, and I believe the citizens should have an expectation to be able use whatever form of personal relief is necessary.

As to your parents, I would never be so callous as to call them collateral damage, but their personal addiction does not necessarily lead to you, I, or anyone else having these same travails to their degree if we we were to require pain meds - not all pain med users follow the same pathology. And even if you & I were to, is that not our free choice? I've been involved in opiate and pain support groups, and I can assure you there are pain suffers who make a conscious decision to live with the trade-off of opiate dependency & addiction, rather than suffer pain at levels which they deem the worse evil.

And who am I to fault their choice?

I'll close by wishing you the best in your support of your parents; there likely isn't one of us today that hasn't been touched by addiction, either ours or a loved one's, and I'm sorry to see it hit so close to home in your instance.

 

[tres borrachos]

I had to say "No" because it's just not a good idea.

 

[Harry Guerrilla]

I empathize with your situation Harry, and I have quite a bit of personal knowledge of iatrogenic dependency & addiction.

The thing to keep in mind, is: to 'not throw-out the baby with the bath water.

Pain suffering, chronic or transient, is a terrible affliction, and I believe the citizens should have an expectation to be able use whatever form of personal relief is necessary.

As to your parents, I would never be so callous as to call them collateral damage, but their personal addiction does not necessarily lead to you, I, or anyone else having these same travails to their degree if we we were to require pain meds - not all pain med users follow the same pathology. And even if you & I were to, is that not our free choice? I've been involved in opiate and pain support groups, and I can assure you there are pain suffers who make a conscious decision to live with the trade-off of opiate dependency & addiction, rather than suffer pain at levels which they deem the worse evil.

And who am I to fault their choice?

I'll close by wishing you the best in your support of your parents; there likely isn't one of us today that hasn't been touched by addiction, either ours or a loved one's, and I'm sorry to see it hit so close to home in your instance.

I don't have any good idea on what to do or any idea if there is a good idea.
I've seen several ugly, rather desperate sides of it.

With all that said, I'm usually fine with letting anyone do anything they want to themselves, as long as it doesn't bounce back on me and mine.

 

[Mr Person]

Seems this ongoing conversation about legalizing drugs rarely touches on drugs that are legal but requiring a prescription. For many of the same arguments in favor of legalizing "street" drugs, do you think narcotic pain killers should be available "over the counter"? Personally, I don't think so, but then, I oppose legalizing drugs.

Tough question given the factors in play.

I'm definitely in favor of decriminalization of everything.

I'm definitely in favor of legalization with restrictions - like alcohol - for anything less addictive and harmful than alcohol, which is actually most drugs. Then you have a few that are even more addictive and cause even more health/social/economic damage to the addict, like meth, heroin, crack, powder cocaine. (I don't say more harm overall because alcohol and tobacco have the lead in total harm, but that's in part due to legalization and full availability)

I know I don't want CVS selling baggies of heroin next to the tylenol; I think countries like Switzerland have the most sensible approach when it comes to a drug like that. Namely, set up clinics where you go, admit you are an addict, and get administered a controlled dose of pure heroin. There's no evidence that people are going through all the hassle just to try out heroin, rather, the effect has been a reduction in overdoses. At a certain point, reducing harm is all a policy can do.

Of course, the problem with decriminalizing personal possession but keeping it illegal for people to sell heroin on the street means that violent armed gangs can fund themselves via drug sales. (Indeed, organized crime only exists in America because of our experiment with ethanol prohibition). I suspect it would be extremely hard to puzzle out (1) precisely how much use of drugs like heroin would increase if we didn't fight the Drug War at all, ie, full legalization with regulation rather than decriminalization, and (2) whether or not this would be balanced by the reduction in overall harm from severe weakening and/or obliteration of violent drug gangs that would result from their revenue disappearing.....

...they can't all just switch to burglary or join the mafia.

I suppose I still haven't entirely made up my mind about what the best policies for things like heroin (and I include perscription opiates given that they're all in the same general family, with the same general risks - it's just that heroin is the riskiest).


Of course, it can be borderline impossible to have a rational and dispassionate discussion about this on the national stage. Too many people have some religiously derived or elsewhere derived ardent opposition to decriminalization/legalization "because drugs are bad mmmkay..." Too many politicians find it easy to get elected pandering to those people. And of course, addiction is a very real and damaging thing, so tons of people will have a personal experience with addiction, be it themselves, their family, or their friends. It is naturally much harder to take an objective view on something like this if one has had a first hand damaging experience versus not.

 

[molten_dragon]

Yes, but the users are turning to heroin due to their not being able to obtain prescription drugs!

Yeah, but the real problem is that they're abusing prescription drugs and getting addicted to them in the first place, because some doctors prescribe them like candy. Being addicted to oxycontin isn't as bad as being addicted to heroin, but it's not such a good thing that we should be making it happen more often.

 

[Chomsky]

Yeah, but the real problem is that they're abusing prescription drugs and getting addicted to them in the first place, because some doctors prescribe them like candy. Being addicted to oxycontin isn't as bad as being addicted to heroin, but it's not such a good thing that we should be making it happen more often.

It's all got to be balanced upon the patient's pain needs.

If the pain is chronic and high, and the opiod is prescribed daily in multiple dosing for a long enough period of time, it is very likely that person will become physically dependent. That's the price to be paid, and why opiod use should be weighed heavily against it's necessity. But for some the necessity is great, and their needs should not be compromised because other members of society act with disregard.

So in this case I'm falling on the side of putting the pain suffers firstly, above the recreational users or prescription abusers that screw-up through their own indiscretions.

We don't want to throw the baby out with the bath water here.

 

[_Sal]

I think folks who need pain meds should have them and the government should not regulate the doctor/patient relationship like they're trying to do now. By the same token, I don't believe narcotics should be available over the counter. I'm sorry, but it's simply true that making something easier to get makes it more available. It may not be perfect, but requiring prescriptions seems the best compromise.

yes it's a pretty good compromise...the problem is saying "folks who need pain meds should have them"

yes this is a logical approach, the thing is, human beings are anything but logical...especially when the individual is dysfunctional to begin with...it's very hard to decide who "needs" them...

 

[_Sal]

Yes, the old drunks are obviously physically addicted to alcohol, but they are not representative of the majority of people with a drinking problem. I bartended years ago, for every drunk coming in with the shakes, there was 10 other people that showed up regularly and obviously had a drinking problem and alcohol obviously controlled their lives, but would not have ended up with convulsions and hallucinations had they quit like the guys that showed up right when you opened and drank a liter or more day or hard liquor.

Spin it how you want, but in terms of a physical addiction, nothing compares with narcotics. Coming off a narcotic addiction can easily be life threatening. Convulsions are common. I had a friend that was a heroine addict (he overdosed years ago) and have known God knows how many drunks and meth addicts. I can tell you that when you kick the habit with a narcotic, they call it kicking the habit because you are in the floor convulsing and kicking. Hell even seizures. Even the worst meth addicts don't go through that (though they will make you think they will due to how strong their brain craves it).

I just can't imagine why on earth anyone would think we should take the most addictive and dangerous drugs on earth and make them over the counter accessible to anyone. We would be a nation of junkies in no time.

I would hope not since you didn't take what was easily accessible to you and neither did I however, perhaps that is not the "norm".

 

[Hawkeye10]

Heroin has gotten so big because we have done so much to keep prescription opiates away from adicts that they are now extremely expensive, for instance I saw that $150 worth of prescription high can be had for $20 in heroin. But me, I would rather people were using prescription drugs, because they are much safer. I want them handed out by doctors though, at least then we can do something to monitor the health of addicts.

 

[ALiberalModerate]

I would hope not since you didn't take what was easily accessible to you and neither did I however, perhaps that is not the "norm".

Ok, lets say for example that half the people that get prescribed a narcotic for pain are very wary of taking it, while the other half are not. Do you have any idea what that half of society would be like if that half could get them over the counter? What possible social good would be served by taking the most addictive drugs known to man, and making them available over the counter without a prescription where you could buy them as easily as you could an aspirin? What do you think drug companies would do in such a situation considering the profit motives they have?

 

[ALiberalModerate]

Heroin has gotten so big because we have done so much to keep prescription opiates away from adicts that they are now extremely expensive, for instance I saw that $150 worth of prescription high can be had for $20 in heroin. But me, I would rather people were using prescription drugs, because they are much safer. I want them handed out by doctors though, at least then we can do something to monitor the health of addicts.

If many doctors were not so quick to prescribe narcotics in the first place, there would not be nearly so many people getting addicted to them. The root the problem is that they are way over prescribed. Making them more available only makes it that much worse.

For example, an obese man goes to his doctor complaining of chronic knee pain. Doctor prescribes him perocet for his knee pain. Obese man takes it, knees feel better, so after a month he goes back to his doctor and gets a refill. Before he knows it, he is addicted and taking more and more to get the same effect.

What really should happen is obese man goes to his responsible doctor complaining of knee pain, doctor prescribes him an NSAID, tells him to ice them, and tells him that giving him something stronger only masks the real problem which is that he is obese and thus he is destroying his knees because of it. Thus the solution is to reduce his body weight. Maybe the man will do so, maybe not, but he won't end up addicted to narcotics because he has knee pain due to being obese.

 

[Hawkeye10]

If many doctors were not so quick to prescribe narcotics in the first place, there would not be nearly so many people getting addicted to them. The root the problem is that they are way over prescribed. Making them more available only makes it that much worse.

For example, an obese man goes to his doctor complaining of chronic knee pain. Doctor prescribes him perocet for his knee pain. Obese man takes it, knees feel better, so after a month he goes back to his doctor and gets a refill. Before he knows it, he is addicted and taking more and more to get the same effect.

What really should happen is obese man goes to his responsible doctor complaining of knee pain, doctor prescribes him an NSAID, tells him to ice them, and tells him that giving him something stronger only masks the real problem which is that he is obese and thus he is destroying his knees because of it. Thus the solution is to reduce his body weight. Maybe the man will do so, maybe not, but he won't end up addicted to narcotics because he has knee pain due to being obese.

That is what the government keeps saying, we go through waves a pressure to cut down on the prescriptions written, alternating with alarm that so many (allegedly) people are living in pain unnecessarily because of the governmental pressure.

 

[Dernhelm]

Actually, the arguments are mainly for decriminalization, not legalization. For this reason I can't respond to your poll.

Decriminalization means that if a person were caught with small possession of anything, including an illegal RX, they wouldn't be arrested. This proposal emphasizes harm reduction and reduces the prison population. It also provides addicts with a greater opportunity to seek more agency without fear of reprisals.

The current drug scheduling system does not differentiate between users and dealers, only quantities. Decriminalizing small amounts means that users are de facto protected from the law coming down on them and ruining their lives, which I totally support.

Nowhere in the world practices the legalized model you're referring to, btw.

I'm more concerned about reforming what doctors can and can't prescribe. Alot of drug companies are legally through doctors using the american people as guinea pigs to sell drugs that would not always be the best prescription for patients. It's so widespread people casually talk about taking their vicodin or aderall etc since their is little to no repercussion for doctors to over medicate someone unless they are sued for wrongful death but by then it's too late. Drugs sold on the street corner don't matter when your drug dealer is your doctor. But I also agree that much of this should be decriminalized, alot of people just need help and if they got it they would not have turned to drugs in the first place.

 

[Northern Light]

Working in healthcare, I'll never support drug legalization. Maybe an argument for recreational marijuana use, but anything beyond that I cannot support. I'm 36 and work in a nursing home and we are seeing the results of poly substance abuse with people younger than me needing placement in long term nursing facilities because of health complications. And there's even more people that are a decade or so away from utilizing Medicare that have wrecked their bodies so that they have the physical functioning less than that of an 80 year old.

The whole American attitude of pleasure seeking at the expense of healthy living is driving our healthcare system down the drain. Its not just drugs, its food, behaviors etc...but the acute and chronic affects of drugs are catastrophic IMO.

What are some of the effects you're seeing? And do you know which drugs they abused? I'm just curious because your unique experience is interesting.

 

[ALiberalModerate]

That is what the government keeps saying, we go through waves a pressure to cut down on the prescriptions written, alternating with alarm that so many (allegedly) people are living in pain unnecessarily because of the governmental pressure.

Government or not, you would have to be blind to not see how many pill heads are out there due to overprescribing of narcotics and benzodiazepines. To be honest about the only people I have ever known that thought it would be a good idea if we had easier access to prescription narcotics were people that were already addicted to them.

By 2010, the United States, with about five per cent of the world’s population, was consuming ninety-nine per cent of the world’s hydrocodone (the narcotic in Vicodin), along with eighty per cent of the oxycodone (in Percocet and OxyContin), and sixty-five per cent of the hydromorphone (in Dilaudid).

Who Is Responsible for the Pain-Pill Epidemic? - The New Yorker

The fact is the only ones who benefit from the overprescribing of narcotics are the drug companies that make them. Its the best of all worlds for them, they have doctors overprescribing their highly addictive product (a product they spend billions marketing to doctors so they will overprescribe it), that they then get lifetime customers out of the patients those narcotics are over prescribed to because they become addicts, who then will do anything to buy more of their product - including only seeing doctors that will overprescribe that drug companies product. Then when someone points out the obvious, that we are creating millions of drug addicts due to the overprescribing of narcotics, then you hear how if we don't prescribe so much, we will have millions living in unnecessary pain... as if the terminal cancer patient on morphine while in hospice care is the problem.

 

[Neomalthusian]

Government or not, you would have to be blind to not see how many pill heads are out there due to overprescribing of narcotics and benzodiazepines. To be honest about the only people I have ever known that thought it would be a good idea if we had easier access to prescription narcotics were people that were already addicted to them.



Who Is Responsible for the Pain-Pill Epidemic? - The New Yorker

The fact is the only ones who benefit from the overprescribing of narcotics are the drug companies that make them. Its the best of all worlds for them, they have doctors overprescribing their highly addictive product (a product they spend billions marketing to doctors so they will overprescribe it), that they then get lifetime customers out of the patients those narcotics are over prescribed to because they become addicts, who then will do anything to buy more of their product - including only seeing doctors that will overprescribe that drug companies product. Then when someone points out the obvious, that we are creating millions of drug addicts due to the overprescribing of narcotics, then you hear how if we don't prescribe so much, we will have millions living in unnecessary pain... as if the terminal cancer patient on morphine while in hospice care is the problem.

Not sure they spend billions marketing opioids, but otherwise pretty much in agreement with everything you've said. Personally I think the profit motive, whether via organized crime or Big Pharma, can't really ever be ethical when it comes to these types of drugs.

 

[molten_dragon]

It's all got to be balanced upon the patient's pain needs.

If the pain is chronic and high, and the opiod is prescribed daily in multiple dosing for a long enough period of time, it is very likely that person will become physically dependent. That's the price to be paid, and why opiod use should be weighed heavily against it's necessity. But for some the necessity is great, and their needs should not be compromised because other members of society act with disregard.

I'm not suggesting we should ban them or make them hard for people who need them to manage chronic pain to get. But, while those people do become physically dependent on the drugs, they're not the type that's likely to abuse them recreationally and then switch over to heroin when they can no longer get them. They need them too badly to do that.

But there are some doctors out there, including a couple I've been to, that hand out large amounts of narcotic painkillers for minor things that need only a very small amount, if any. And that's how people get hooked on them for fun.

 

[WI Crippler]

What are some of the effects you're seeing? And do you know which drugs they abused? I'm just curious because your unique experience is interesting.

Early onset dementia, lack of coordination, failure to thrive (usually happens in conjunction with other disease processes but was reserved for infants and elderly until recently) kidney failure, liver disease, congestive heart faliure. Typically the medical report will list "polysubstance abuse" and note a history of illicit drug use whether its self reported or reported by family members. It's not really a unique experience. If you work in a healthcare setting where social workers are also heavily involved you see a lot of it. If you work out patient clinics you might not experience it as much as people that can make it to that setting usually are capapbe of operating at a independent level of functioning.

 

[Northern Light]

Early onset dementia, lack of coordination, failure to thrive (usually happens in conjunction with other disease processes but was reserved for infants and elderly until recently) kidney failure, liver disease, congestive heart faliure. Typically the medical report will list "polysubstance abuse" and note a history of illicit drug use whether its self reported or reported by family members. It's not really a unique experience. If you work in a healthcare setting where social workers are also heavily involved you see a lot of it. If you work out patient clinics you might not experience it as much as people that can make it to that setting usually are capapbe of operating at a independent level of functioning.

So was it any drug, or specific ones? Was there a common thread?

And were they current users or strictly past users?

Sorry for all the questions, my interest is piqued.