It’s not often that I say this but good for Joe Manchin:
One Democratic senator called on Trump to withdraw the nomination of Rep. Tom Marino (R-Pa.) to lead the Office of National Drug Control Policy, a position requiring Senate confirmation. Another quickly introduced legislation to undo the law that Marino championed and that passed Congress with little opposition.
In a statement, Sen. Joe Manchin III (D-W.Va.) said he was “horrified” to read details of an investigation by The Washington Post and “60 Minutes” that detailed how a targeted lobbying effort helped weaken the Drug Enforcement Administration’s ability to go after drug distributors, even as opioid-related deaths continue to rise. He called on Trump to withdraw Marino’s nomination.
I assume the nomination will go through anyway.
And as opioids 100 people a day, Trump will do nothing. Eventually, there will be some symbolic bullshit that he’ll do that, that will make Fareed and Van Jones declare that he’s become presidential, but that’s about it.
Roger Moore
Joe Manchin isn’t perfect, but he actually cares more about his constituents than about big business, and that’s about the best we can expect to get from WVa.
Corner Stone
MSNBC is showing a “Democrats in Disarray” panel and I want to punch every single one of these people in the face.
ETA, Chris Jansing is easily the most irritating interviewer on this network. She interrupts guests just to ask a question she thinks will make her seem smart.
misterpuff
Obama signed the original bill. Let the Cheeto Wig know that. Overturned immediately.
Tilda Swintons Bald Cap
@Roger Moore: He’s being primaried by someone who has zero chance of winning.
Dolly Llama
On each and every appointment, it’s like they go out and look for the most antithetical nominee possible for the entity, that entity’s worst enemy. HUD. DEA. EPA. Education. It’s uncanny.
bystander
Is it possible Manchin is turning into a Democrat? Or is this just a sign that a go-along-to-get-along guy like Manchin has a sense of how deeply the electorate is going to turn on repubs? Of course uis state is ravaged by the opioid crisis, so maybe it’s that. Anyway, good for Joe.
@Corner Stone: Had to turn that off.m repubs seize the conversation, define the terms and the lazy “journalists” like Jansing are only too happy to have somebody else do the thinking for them.
lgerard
Best observation in the New Yorker article about Mike Dense
Pence, who has dutifully stood by the President, mustering a devotional gaze rarely seen since the days of Nancy Reagan
heaven help us
oatler.
Fuck the DEA.
hellslittlestangel
Yeah, credit where due. Manchin really is a Democrat. Terribly conservative, but at least he doesn’t view his constituents as marks to be fleeced.
sherparick
Trump will twit that all the DOs are the fault of Obama and all the Mexican drug dealers/immigrants.
Brachiator
I would love to see how Trump supporters, especially those in the states most affected, rationalize this one.
@lgerard:
Nancy had her Ronnie, Pence has his Donnie.
hellslittlestangel
@lgerard: Pence calls his wife “Mother.” The Orange Better One should start calling Pence “Mommy.”
Mart
Made it thru the 60 minutes segment last night. Disgusting, especially all the DEA lawyers who jumped ship to protect the distributors from the law. Thought we were supposed to fear Mexican gals with calves the size of cantaloupes who were bringing in all the drugs; not old white dudes in suits working for Fortune 500 companies.
Once on a plane sat next to an 80 year old dude who decided to tell me his life story. He had made a fortune producing Oxycontin. I think he made a bigger fortune by developing and selling software to get thru FDA paperwork. He said they sold the software to six of the seven major pharmas. He was concerned that interest rates are too damn low, so he only has so many hundreds of thousands to spend each year, what with the kids and grand kids wanting their share. As we were parting ways he hollered, “Isn’t Trump Great!” I smiled, wondering how many people his pills and software helped kill.
Frankensteinbeck
@Dolly Llama:
It’s not an accident. Trump passionately hates regulations. He’s a mean, spiteful motherfucker, period. The people whose advice he trusts most are anti-government ideologues. Trump is deliberately trying to break as much of the federal executive branch as possible. He wants the parts that hurt brown people, and that’s it.
JPL
https://twitter.com/PhilipRucker/status/919981521230090241
rikyrah
Kyle GriffinVerified account @kylegriffin1
Kushner’s plan to recast the indebted 666 5th Ave. is collapsing, may imperil the family’s ownership.
https://twitter.com/kylegriffin1/status/919968852217393158
catclub
@Dolly Llama: Not quite true. For DHS they got the deputy who had already been running the place. lazy approach.
The Moar You Know
@Brachiator: Same way they rationalize everything else; watch libs stroke out over the sheer idiocy, and guffaw heartily over what heartburn they’ve given us again.
It’s Biff Tannen’s world and we’re all just living in it.
Enhanced Voting Techniques
@lgerard: What’s wrong with a NOT gay love between two, white, Jesus certified 100% NOT gay men? It’s like everyone just assumes these days that gay bashing evangelicals are queerer than a three dollar bill in private.
Surprised Trump hasn’t done one of EO signing ceremonies were he declares the Opioid Crises fixed, or has Trump become that lazy he can’t even be bothered with even symbolic gestures now?
catclub
@Corner Stone: Chris Jansing is easily the most irritating interviewer on this network
except maybe this ;)
Betty Cracker
Trump’s Rose Garden thingy is about how great his relationship with McConnell is, from what I gather from 2nd hand reports. Ain’t no way I’m watching that pig snuffling on live TV.
Nicole
Would have been nice if Manchin had opposed the legislation, too.
The WaPo article is one of the few that left me just as mad at Dems as at Repubs.
hellslittlestangel
@JPL: According to the Post, The Orange Better One is “planning to announce an economic plan.” But you have to wonder if he’s really only planning to plan the plan.
The Moar You Know
@JPL: He’s probably having them all shot. It might be the first thing he does I approve of.
Elizabelle
@ Doug J: I don’t assume the nomination will go through.
Opioid addiction is a major issue in areas that gave rise to Trump supporters. I don’t see the payoff to Trump from pursuing this one. Is Marino tied to some tranche of money that Trump and his grifters can snatch?
Other nominations have failed. (The Carls Jr sociopath who was up for Sec. Labor.)
Elizabelle
Also, FWIW, rather than Marino, I thought you might be linking to Michael (W Speechwriter) Gerson’s column in the WaPost this weekend.
WaPost, Gerson: Republicans, It’s time to panic.
Jesus Fuck. Not like we didn’t just have an election with that issue at center stage.
Wake up, Gerson. You and your GOP pals are too damn slow on the uptake.
Although, props to Gerson for this:
[And then the paean to the Generals and Rex Tillerson, the only “sane” people in the administration, people whom Gerson fears might leave their public, ahem, service.]
Ends with plea for Republicans to literally grow a spine. Only the Republicans can save us.
And when they decide to do so, they can join their Democratic colleagues, who have always been there.
Enhanced Voting Techniques
@Betty Cracker:
So in other words Trump just got caught backstabbing McConnell. Well those two truely deserve each other.
JPL
@Betty Cracker: I read the same thing, and someone on twitter said he has a lot of those events. bff
gocart mozart
I think taht is a bit unfair to Jones. When he said what he said about Trump’s speech, he meant it as a warning not as a compliment. i.e. “if Trump can stick to the script and pretend to be a competant POTUS he will be able to fool a lot of people and will be very dangerous.” Albeit this is more clear in his response to the criticism (which I can’t find a clip of right now) rather than in his original statement
the Conster, la Citoyenne
@Corner Stone:
One of the Sanders minions on the DNC “Unity Commission” was on Fox again shit talking the Dems, so they’re doing Putin/GOP’s work to distract media from focusing on Trump/Russia without both-sidesing it.
Millard Filmore
Sorry, I do not understand. As opioids do what to 100 people a day?
catclub
and the press falls for it every time. His empty podium shots while someone else is giving a real speech shows how he wins the attention wars.
@JPL:
catclub
@Millard Filmore: kill
No Drought No More
“Eventually, there will be some symbolic bullshit that he’ll do that, that will make Fareed and Van Jones declare that he’s become presidential..”.
You forgot Dianne Feinstein. I was appalled to learn over the weekend that as late as this August- that is, months after those two naifs uttered their “attaboy”- that Dianne floated the patently preposterous hope that Trump might yet grow into the office… Which informs me she should legally change her name from ‘Dianne’ to ‘Dingbat’. I’m serious. By god, she may as well at this point.
Cheryl Rofer
Here’s what Trump said at his cabinet meeting, before the Rose Garden thingy. Put all together, it’s…unhinged.
A sample:
Citizen Alan
@Mart:
Sometimes I think the worst thing about Democrats, and I am probably guilty of it too, is that we are basically nice civilized people who generally cannot bring ourselves to cause a big scene when unexpectedly confronted by evil, whether in the form of a racist Uncle at a family gathering or a perfect stranger who obnoxiously gloats about the lives he’s ruined in pursuit of wealth while you’re stuck sitting next to him on a plane.
Major Major Major Major
Good for Manchin.
I had a couple friends yesterday tell me that Feinstein was “basically a Republican”, and I told them, no, Feinstein is a Democrat you don’t like very much. Joe Minchin is a Democrat you like less. Republicans are insane.
They agreed, but people gotta stop saying stuff like that casually IMO.
Barbara
@Mart: I once sat next to a 35 year old guy from Kentucky who told me his life story — how he had played football in college before joining the Navy and became completely addicted to prescription pain killers, to the point that he was using quantities that should have killed him. Basically, football had destroyed his knees and other joints and he was in so much pain, any time he was prescribed pain medication he used more and more of it than prescribed. He was working with a doctor to find different ways of approaching his pain. This was more than ten years ago. Many addicts (not all) have similar stories. I realize these drugs have legitimate uses, but 30,000 dead people is a lot to overlook.
brendancalling
@JPL: I watched some of that. Didn’t seem like he was announcing anything, just ranting like the fucking crazy person he is
Bostondreams
@Betty Cracker:
Apparently to declare that Obama, and other presidents, never called the families of dead soldiers. HE, of course, calls when appropriate.
This man is disgusting.
Frankensteinbeck
@Cheryl Rofer:
Damn, it galls him that he can’t seem to destroy the ACA, doesn’t it? He’s moved on to ‘claim he did’, which suggests he has both given up, and he can’t let the failure go.
A Ghost To Most
@Citizen Alan: It’s time to stop being nice, and start calling liars liars, and fascists fascist.
Time to get noisy, not nice.
Fair Economist
@Major Major Major Major:
I was trying to put together an De Leon vs. Feinstein “issues comparison” for a comment on GOS last night and was surprised to find the official gap between them was relatively small. De Leon is for $15 per hour – but so is Feinstein. De Leon is for single-payer – but so is Feinstein. De Leon is against school vouchers – but so is Feinstein (although once upon a time she wasn’t). De Leon is for more aggressive cap and trade – and so is Feinstein. Feinstein is probably more hawkish on foreign and security issues but De Leon, as a state senator, hasn’t had anything to say on those issues yet. He has pushed for targeting programs for low-income areas, which she hasn’t, but she hasn’t had many opportunities to do so either. Although, based on reputation and emphasis, he’s more liberal, I couldn’t find any direct hard positions they’ve both taken to prove it.
So, yeah, while Feinstein is somewhat disappointing for a *California* Democrat, she certainly is in no way a Republican.
cmorenc
@gocart mozart:
The problem with dry sarcasm is that the better you are at presenting it, the more likely people will mistakenly take you seriously at face value and consider you a fool for harboring the sentiments presented. That’s a well-known problem with written dry sarcasm, but often people fail to recognize how easily spoken dry sarcasm is potentially subject to the same problem, unless you’re someone whose professional gig is delivering dry sarcasm, because they have the right context and skill to deliver it with just the right amount of *wink* *wink* “nudge* *nudge* to convey the intended sense of meaning, without crossing over into wet, sloppy sarcasm that’s too heavy-handed to be funny.
Fair Economist
@Barbara:
The primary problem is opiates are used to treat chronic pain (like the man you met) but they aren’t effective for that. They only work for a couple of months, after which people taking opiates have as at least as much pain as people who never took them.
The secondary problem is that people are sent home with 30-day supplies of opiates for conditions where they’re needed for a few days at most, like wisdom tooth extractions (a specific major cause of addiction). Even if the person getting them doesn’t become addicted the pill bottle often sits around the house for somebody to experiment with – and contains enough to get them addicted without any additional source.
Nicole
@Citizen Alan:
Unsurprising that a majority of women are Democrats. This is how we’re raised to go through life. Don’t make a scene.
Boatboy_srq
@sherparick: Makes you wish Oxycontin (and Viagra too) were a product of Medellin. DEA would be all over that.
Gravenstone
@Elizabelle:
They weren’t slow on the uptake, they were willfully blind to the reality of Trump’s manifest unfitness to the office. Because they felt that getting their party back into the Presidency was far more important than the occupant actually being able to function in the office.
Gravenstone
@Millard Filmore: From context, I would assume kill 100 people daily.
catclub
@No Drought No More:
However long it takes Feinstein to wake up, it would take longer for Obama to give up the search for reasonable Republicans he can deal with.
I love him, but his ‘waiting for the fever to break’ was maddening.
Boatboy_srq
@Enhanced Voting Techniques: The assumption is only made because it’s so often proven right.
Mart
@Citizen Alan: I did not get into politics as my being an old grey haired man he “knew” I was in the club, all old white guys do. I pick my fights. I like stating that I did not trust Obama – as he was too moderate.
He was 80, sold the company, and was a long retired biking enthusiast. What could I change? Plus, I was hoping to get one of his dozen or so $10,000 bicycles.
Peale
@Fair Economist: Yep. I’m not certain why the medical profession, especially the oral surgeons, went full on “here’s some addictive drugs” instead of prescribing a 3-day supply with a “please call me if the pain persists after three days”. I’m guessing its because that follow-up appointment isn’t reimbursed by insurance.
Mnemosyne
@catclub:
I had an idiot on this very website (not you) cite this behavior by the MSM as yet another example of how the primary was tilted towards Hillary. Apparently showcasing Trump was designed to help Hillary because shut up, that’s why.
Fair Economist
@Peale:
I read something to that effect – it (supposedly) was intended as a cost saving measure because doctor visits are expensive. I believe it was set up as a “one size fits all” deal in the prescription protocol. *That* makes me suspicious because with many cases – notably wisdom teeth, but there are others – there is *no way* you’re going to need a 30-day supply without going back to the doctor. If you need opiates for 30 days after wisdom teeth extraction something has gone horribly wrong and you shouldn’t be at home popping pills.
We now know the drug companies were at times *deliberately* trying to get people addicted and I wonder if this was one of those times.
Boatboy_srq
@Fair Economist: Feinstein’s ongoing brilliance has been in giving her constituents just more than enough not to vote for someone else, without giving any group of them enough to make them truly happy. Nobody voting for her is thrilled, but they are content, and the opposition is increasingly wingnutty.
Duane
@Cheryl Rofer: Unhinged is a polite way to say it. Psychotic is my preference. Obviously, there are many more.
Mnemosyne
@No Drought No More:
IIRC, that’s a partial quote from Feinstein — like most Democrats what she actually said is that she hopes that he’ll grow into the presidency, but she doubts that he will, which is a very different proposition.
jl
@Peale:
” Yep. I’m not certain why the medical profession, especially the oral surgeons, went full on “here’s some addictive drugs” instead of prescribing a 3-day supply with a “please call me if the pain persists after three days”. I’m guessing its because that follow-up appointment isn’t reimbursed by insurance. ”
Also have to look into the implicit PBM, distributor and manufacturer incentive schemes in their sales contract packages. If someone got a fat profit from pushing these specific pills, there were probably big incentives to prescribe. A big problem with very non-transparent pricing in US medical care is not just different prices being charged to different customers for the same product or service, but hidden cross-subsidies and what amount to kickback schemes for prescribing high margin products.
Clinicians, both physician and pharmacist, have long been very blase abut the extremely high concentration in pharmacy drug distributors and PBM services. So what if nationally, and in most regions, three or four firms control almost one hundred percent of the market, and are allowed great latitude in micro-targeted marketing of complex bundles of drugs, using their very asymmetric information advantage and with almost zero price transparency. What in most other industries would be considered very corrupt kickback schemes thrive in such an environment.
Edit: and I can tell you that a favored chosen few of the pharmacy students I teach earn huge salaries doing ‘research’ that is really, IMHO, marketing research needed to implement such schemes. We talk shop from time to time.
sheila in nc
@Peale: My husband asked the oral surgeon this very question. The response was, “Some people do need this level of pain management. And if you are one of those people, you won’t be functional enough in 3 days to go through all the steps needed to acquire additional meds. So here you go.”
He filled the scrip but only took one pill. Next time he had oral surgery, he didn’t fill the scrip. I’m taking the rest to a Medicine Take Back at work next week.
Barbara
@Fair Economist:
The answer is pretty simple. Until very recently, you could not transmit prescriptions for Schedule II drugs other than by having a hard piece of paper presented by a patient, who therefore needed to return to the office for a refill. So convenience was at the heart of it. Now, Schedule II prescriptions can be faxed and sent electronically under secure conditions to pharmacies, but practices have become ingrained. Some states are beginning to prohibit the prescribing of more than a certain day’s supply because of this issue.
catclub
@Nicole:
But a majority of white women voted for Trump. Not sure your logic makes sense, then.
jl
@sheila in nc: @Barbara: Those are legitimate issues, but do they justify the very large number of days supply that were very often given, that I’ve read about in news reports? I still have to suspect that the sales contracts presented to clinicians and their medical groups played a role.
Important to remember that these organizations don’t sign a few hundred or a thousand contracts for a few hundred or a thousand different drugs. They sign a few contracts for option of delivery over a certain time period of a very large and complex set of drugs, with lots of incentives, and potential discounts written into them.
Doug!
@Nicole:
I wish I could say it was just a few.
Barbara
@sheila in nc: Your husband’s oral surgeon is a jerk. Many dentists and oral surgeons are aghast that kids whose wisdom teeth they pulled have gone on to become full blown opioid addicts and are moderating their behavior. I would actually send your oral surgeon a link to this very shocking Vox article: https://www.vox.com/2017/3/18/14954626/one-simple-way-to-curb-opioid-overuse-prescribe-them-for-3-days-or-less
stinger
Dear Mr. Gerson — When, during his year-long campaign for the presidency or during the decades before that, did Trump evince any of these qualities? Please list those occasions or brief moments. Go ahead, I’ll wait.
jl
@jl: And the contracting is a separate issue from the channel of incentive schemes that go directly from drug manufacturer or distributor to physician. Many organizations still allow those, in some regions of the country, probably most still allow. Those can have an important impact on physician prescribing behavior.
Cheryl Rofer
This is disgusting.
Fair Economist
@Barbara:
California has been on this for a while. Years ago I got prescribed opiates for diverticulitis, and only got an 8 day supply IIRC. I only took a few, realized they were opiates, and stopped. Years later I threw them out and there were only 3 pills left. Did I take more than I remembered? Did I try them for migraine and forget that? Or, worst of all, did my son or some of his friends find them and “experiment”? I’ll never know.
FWIW, when I realized it was an opiate prescription, I wondered why I’d gotten it. Sure, diverticulitis hurts, but nothing like a migraine, and I get those all the time. Opiates for *that* pain? Phoo, it was nothing.
jl
@Cheryl Rofer: Most people would learn something from those calls. Trump appears to be an exception.
jl
@Fair Economist: What is infuriating about the situation is that there has been and continues to be under treatment for certain types of severe chronic pain that is effectively treated with opiates, without much risk of addiction. The drug industry ran very hard and fast with preliminary research suggesting that the same situation held with opiates for relatively short spells of acute pain. Because they saw a quick buck in doing that.
So, besides the tragedy of addiction and death, this mess also vastly complicates formulating sound policy for some patients who could benefit from easier and more liberal Rx of opiates for pain management.
Tazj
@Corner Stone: I just saw an excerpt of the interview on my phone and I couldn’t even get through the whole thing. “You have to give people something to vote for.”During the presidential election Hillary was for improving the ACA and increasing the minimum wage, decreased or free college tuition,increasing spending on infrastructure. Now, many Democratic Senators and Bernie Sanders are for Medicare for all, increasing the minimum wage, free or decreased college tuition, voting rights. What the hell do these people want Democrats to say?
That one woman, good grief, “These people (people who voted for Trump) are my family.” There’s a way to confront them, I’ve done it. You say I love you, I think you’re intelligent and a good person but you were wrong about Trump. Then, you bring up a time you were wrong about a politician(John Edwards, Weiner).
Let’s all pretend everything is fine and blame Democrats because some people can’t admit they’ve made mistakes like everyone else who ever lived.
RinaX
@gocart mozart:
Yours is the first comment I’ve seen that he wasn’t serious. The latest things I’ve read on him have him going on about how Dems still need to try to understand Trump supporters. To which I say, fuck that.
Barbara
@jl: @jl:
(1) Most physicians do not dispense drugs in their office unless they need to administer them via injection. So most physicians are prescribing not distributing the drugs and do not profit from drug sales.
(2) The research is virtually overwhelming that acute opioids do not lessen the pain of chronic conditions. I would not argue with someone in chronic pain about this, but anyone who practices evidence based medicine would have a hard time justifying treating chronic pain with products specifically meant to address short-term acute pain, such as that resulting from surgery, kidney stones or broken bones.
jl
@Barbara:
(1) fine, but that does not touch the issues of organizational contracting with distributors and PBMs, which affect what drugs physicians have available to prescribe and organizational directives on protocols.. And the kind of direct distributor or manufacturing to physician incentive schemes I am talking about have nothing to do with actually distributing or dispensing the drug from the office.
(2) I am not a clinician so am going by what I hear from physicians and pharmacists. Give me a link to a review that gives your side of it and I’ll take it to them and see what they say. Not sure we are understanding each other correctly anyway.
tobie
@Tazj:This kills me more than anything else…the revisionist history where HRC is blamed for not standing for anything except that she was not Trump. The irony is that she was the only candidate who had real ideas about what govt could do to revive manufacturing. It seems the WWC hated her for this
jl
@Barbara: Here’s a new report on opioids and pain management, that is roughly consistent with what clinicians tell me. If you think there is something wrong with it, let me know. I’m not a clinician, so my comment may have been misleading in some ways. It occurs to me that I do not know for sure whether the drugs that the industry pushed for treating acute pain are the same as those for chronic cancer pain, for example. If i was misleading on that, then am sorry.
Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use.2017
It’s a National Institute of Medicine report, so should be a link to free access to text on the page.
https://www.ncbi.nlm.nih.gov/pubmed/29023083
japa21
@Barbara: Not entirely true. This is somewhat dependent upon state regulation s. Florida is a state where MDs can prescribe and provide opioids. This is a major issue, specially with workers’ comp claims. I know there are some other states where this is a major issue.
Barbara
@jl:
The problem with using opioids for chronic pain is twofold. First, people really do feel worse when they stop taking them, maybe because they are going through withdrawal but also because there is evidence that long term use of narcotics makes people more susceptible to pain. I have nothing but sympathy for people with chronic pain but their experience doesn’t necessarily lead to the conclusion that greater accessibility to opioids should be a goal. From the article you linked:
ETA the correct paragraph.
Barbara
@japa21: Yes, many states permit physicians to dispense medications in their office but most physicians don’t do it. But you are correct in that for certain types of physicians in certain states, this is very likely a big problem.
jl
@Barbara: If that excerpt shows the point you are making, then I we don’t have a disagreement. I didn’t mean to imply that opioids were a good choice for all chronic pain. I was thinking mainly for cancer and a few other specific degenerative conditions.
jl
@japa21: @Barbara:
Thanks to japa21 for reminding me of workers comp.
Physician dispensing challenges workers comp prescription costs
Business Insurance
Louise Esola
7/19/2017 7:00:00 AM
Twenty states have parameters for physician dispensing, with most of the reforms targeting repackaged wholesale pricing of certain drugs and strengths. Eight states do not allow the practice.
Ms. Wang and other researchers analyzed data from 2011 to 2014 for 26 states and found physicians dispensed fewer prescriptions after states enacted reforms that regulated the prices for drugs dispensed by physicians. Yet physician dispensing was still common in post-reform states, with California, Florida, Illinois, Maryland and Pennsylvania still seeing a large portion — 54% to 64% — of pharmaceutical costs coming from doctors who dispense drugs.
http://www.businessinsurance.com/article/20170719/NEWS08/912314564/Physician-dispensing-drug-strengths-workers-compensation
The article is a little vague, and I assume that 54% to 64% refers to workers comp pharmaceutical costs.
WaterGirl
@Cheryl Rofer: I’ve got money that says Trump is afraid to make those calls because that mean lady whose kid was killed didn’t want to take his calls. That, plus he’s a sociopath with no idea of how actual normal people act. Added to that, he’s so stupid and lazy that he doesn’t even watch other people to see how regular people behave so that he could at least try to pass as normal.
I cannot think of a single redeeming quality that Trump might have.
WaterGirl
@Cheryl Rofer: I think his comments about RBG and other supreme court justices are absolutely horrifying, and disgusting as well.
There is apparently not one statesman who is a republican. Not one. Maybe Corker, but since he’s leaving, he’s still not putting the good of the country ahead of his personal situation.
amygdala
An underappreciated additional setting for inappropriate opiate prescribing has been hospitals. The Joint Commission, which accredits hospitals, was obsessed with pain as the fifth vital sign for a number of years. During their site visits, heaven forbid if a patient had a pain score higher than 4. They’d cluck cluck and hospital admin would be paging you insisting on a stat morphine order. Never mind that you’d documented that the patient had addiction issues and had made it clear he or she didn’t want opiates. It became this knee-jerk response, and at least at my hospital, it wasn’t unusual for these patients to get discharged with big scrips for opiates.
JC has backed off some, but now there are patient satisfaction surveys, which can also punish clinicians for doing the right thing.
Another overlooked issue is what to do about chronic pain patients on currently on opiates that were started years ago. Some of these folks can probably safely be tapered down or off as outpatients. But just as substance misuse patients sometimes require more intensive inpatient treatment, so also will some (many?) of these individuals. Who will pay for that? Do we even have the rehab infrastructure to handle all these patients? How do we do this, lacking an evidence base to guide care?
Also, an enforcement-based approach to opiates will only worsen the stigma that chronic pain patients deal with every day. Evidence base aside, there are individuals for whom opiates are the best option and who, in the face of careful monitoring, aren’t diverting or misusing their controlled substances. Asking them to get a scrip filled every three days is unnecessarily punitive and pulling the rug out from under them completely not any better.
Ksmiami
@Tazj: I’m just ready to let them die from obesity, illiteracy and drug addiction- we had good people with good policy and the most vile lowest ppl voted in Trump and the GOP. You can only try to help the innocent
opiejeanne
@Peale: I had my wisdom teeth out in January and my guy gave me about 3 days worth of painkillers. One of the oxys. I think I only used a couple of pills until the pain was not so bad. I hate the way I feel on them, all woozy but not in a pleasant way, and by day two my skin starts itching. I react strangely to codeine, half the time it makes me high for several hours, and then I crash.
? ?? Goku (aka The Hope of the Universe) ? ?
@amygdala:
Pain being the fifth vital sign is definitely stressed in nursing school. During hourly rounding in clinical, it’s one of the 5 P’s. It makes sense since extreme pain can be very debilitating, delaying recovery after surgery since a person in extreme pain is unlikely to want to ambulate or perform their ADLs unassisted.
However, you make a good point that addictive opioids can be overprescribed leading to addiction. With a pain score of 4, either a less addictive pain med (like an NSAID, if not contraindicated) or alternative methods of pain control, like guided imagery, deep breathing, music, should be tried.
WaterGirl
@? ?? Goku (aka The Hope of the Universe) ? ?: I don’t know, if you’re going to the doctor and you’re in a lot of pain, i call bullshit to somebody trying to get them to do deep breathing or listen to music. As tools to help with ongoing chronic pain, sure, but I think it’s possible to go way too far in the opposite direction, leaving people in unnecessary pain.
? ?? Goku (aka The Hope of the Universe) ? ?
@WaterGirl:
Of course. I guess I should of been more clear. Those techniques are meant as adjuncts to the pain medication. I assumed if it was a numerical pain rating of 4 on 1-10 scale, then an something like Tylenol would probably be more appropriate than an opioid pain killer. Ultimately the decision (from the prospective of an RN) on what to prescribe is the physician’s.
amygdala
@? ?? Goku (aka The Hope of the Universe) ? ?: When someone has been getting 10+mg of morphine daily, they can’t just be discharged on NSAIDs, especially with the pressure to get patients home. Wouldn’t surprise me if the PCP gets the blame if addiction sets in, but the problem started in the hospital.
? ?? Goku (aka The Hope of the Universe) ? ?
@amygdala: No, they can’t. That’s for next time with the next patient.
J R in WV
@Barbara:
30,000 people dead is .0085714% of the population. As a number is reads out as 0.000085714.
More people die in traffic accidents. All drugs have side effects. Tylenol can destroy one’s liver with a single accidental overdose much smaller than a typical opioid overdose.
Alcohol caused 88,000 deaths last year, over twice as many deaths as opioids caused. Hysteria much? 37,000 killed in traffic accidents – stop the carnage, end the automobile addiction!!!
18,000 Americans die at home from falling down – make walking illegal!!!
I’ll stop now. It is obvious the opioid epidemic is like prohibition of alcohol in 1919, the prohibition of marijuana in 1935, the election of Donald Trump in 2016, a crazed over-reaction to fluffed up news hype!!
StringOnAStick
@J R in WV: Today is the 1 year anniversary of my BIL dying from a rare and painful cancer. If he hadn’t been married he would have committed suicide at least a year before he died because his pain control was so poor. He’d complain and the office nurse in charge of prescriptions would tell him that’s the most they’ll prescribe for anyone so the answer is “no”. This happened in a different state; we watched a friend die if cancer here and he got much better pain treatment and much stronger drugs. I’m still angry that my BIL was forced to suffer so much with nothing stronger than vicodin, for a guy truly suffering.