A Debate On Pain Medication Delivery

[oldfart]

Checking on you, Huggy ...

Have you got a workable management plan, yet?

My mom's new issue is apparently a manufacturing hiccup with her Avinza. Thankfully, just an inconvenience and not more serious. She has to drive 20 minutes further to fill that Rx. Expected to be resolved next month.

In a word, yes.

My general provider, whom I had already established a high value of trust and a great relationship with, has taken over responsibility for all of the pain management issues I have been dealing with. He has been absolutely good for his words and has made me work less than the specialist to prove I am capable of much of the responsibility to not abuse the prescribed medications. At this time I am getting three scripts at a time that last three months. My daily med intake for chronic pain is 90 mg of morphine spread out evenly over 24 hours. I also have an emergency back up script of Oxycodone 5mg which I can take as needed when I have unusual discomfort that breaks past the morphine.

I am living better in the last 6 months than I have for several years. For some unexplained reason the tolerance to the morphine hasn't really been a problem. It is still just about as effective as it was when I started it back in January. Maybe when you take into account that I am much more active than before when I couldn't move very well it is just possible that the over all pain is less. For whatever reason I am grateful of the benefits of the meds and my life is much improved.

To any lucky enough to get into a quality pain specialty clinic or have a provider that gives a damn and wants to take responsibility to prescribe pain medications I do have this one piece of advice. From my experience with methadone as the starter drug in the specialty clinic I would suggest that you attempt to get morphine instead. It is much easier and safer to regulate dosage. Comparing the methadone in it's drop off effects or my body's tolerance to it the methadone was about maybe 25% as effective after 6 months. I can't say for sure but There HAS to be SOME loss of effect of the morphine but I'll guess it couldn't be more than 25%.

So thanks for checking in on me. I hope your mom has Drs that care as much as mine do.

Sean

Glad to hear you are doing better. Wish you all the best. Chronic pain sucks, and staying on the program (especially the at home exercises on your own) can be a drag.

 

[waltky]

Big Pharma - anything for a buck...

US Drug Makers Push Profitable, But Unproven, Opioid Solution
December 15, 2016 - Pilloried for their role in the epidemic of prescription painkiller abuse, U.S. drug makers are aggressively pushing their remedy to the problem: a new generation of harder-to-manipulate opioids that have racked up billions in sales, even though there's little proof they reduce rates of overdoses or deaths.

More than prescriptions are at stake. Critics worry the drug makers' nationwide lobbying campaign is distracting from more productive solutions and delaying crucial efforts to steer physicians away from prescription opioids - addictive pain medications involved in the deaths of more than 165,000 Americans since 2000. “If we've learned one lesson from the last 20 years on opioids it's that these products have very, very high inherent risks,” said Dr. Caleb Alexander, co-director of Johns Hopkins University's Center for Drug Safety and Effectiveness. “My concern is that they'll contribute to a perception that there is a safe opioid, and there's no such thing as a fully safe opioid.”

The latest drugs - known as abuse-deterrent formulations, or ADFs - are generally harder to crush or dissolve, which the drug makers tout as making them difficult to snort or inject. But they still are vulnerable to manipulation and potentially addictive when simply swallowed. National data from an industry-sponsored tracking system also show drug abusers quickly drop the reformulated drugs in favor of older painkillers or heroin. In the last two years, pharmaceutical companies have made a concerted under-the-radar push for bills benefiting the anti-abuse opioids in statehouses and in Congress, where proposed legislation would require the Food and Drug Administration to replace older opioids with the new drugs.

OxyContin pills, an opioid drug, are arranged for a photo at a pharmacy in Montpelier, Vermont, Feb. 19, 2013. The U.S. market of 'abuse-deterrent' painkillers is currently dominated by OxyContin, patent-protected until 2030.​

The lobbying push features industry-funded advocacy groups and physicians, along with grieving family members, who rarely disclosed the drug makers' ties during their testimony in support of the drugs. Besides the tamper-resistant pills, ADF opioids are being rolled out in other forms, including injectable drugs and pills that irritate users when they're snorted or contain substances that counteract highs. Making painkillers harder to abuse is a common-sense step. But it's also a multibillion-dollar sales opportunity, offering drug makers the potential to wipe out lower-cost generic competitors and lock in sales of their higher-priced versions, which cost many times more than conventional pills. The big companies hold multiple patents on the reformulated drugs, shielding them from competition for years - in some cases decades.

Though abuse-deterrent painkillers represented less than 5 percent of all opioids prescribed last year, they generated more than $2.4 billion in sales, or roughly a quarter of the nearly $10 billion U.S. market for the drugs, according to IMS Health. The field is dominated by Purdue Pharma's OxyContin, patent-protected until 2030. “We at Purdue make certain that prescribers and other stakeholders understand that opioids with abuse-deterrent properties won't stop all prescription drug abuse, but they are an important part of the comprehensive approach needed to address this public health issue,” Purdue spokesman Robert Josephson said in a statement.

Like a spokeswoman for Pfizer Inc., Josephson also noted that some public health officials, including the Food and Drug Administration, have endorsed using ADFs. “We need every tool that we can have in our toolbox,” said Kentucky state Rep. Addia Wuchner, a Republican who has worked on several bills to benefit reformulated opioids. “The extra steps are worth the effort in order to prevent this escalation of more addiction.” The current industry campaign draws on the same 50-state strategy that painkiller manufacturers successfully deployed to help kill or weaken measures aimed at stemming the tide of prescription opioids, a playbook The Associated Press and Center for Public Integrity exposed in September.

Intense and costly lobbying