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Nice Guy Eddie

The OxyContin family

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4 minutes ago, Updawg said:

Kapoor and four other executives were found guilty last year of orchestrating a criminal conspiracy to bribe doctors to prescribe the company's medication, including to patients who didn't need it. They then lied to insurance companies to make sure the costly oral fentanyl spray was covered.

The law changed regarding pharmaceutical marketing in 1987 and 1992. Lots of the perks that sales reps and companies used to offer are no longer possible. Apparently, Kapoor was breaking the law and went to jail.

Opioids have been around since 3400BC. They were first used in modern medicine in 1853 and synthetic heroin was developed and sold by Bayer as a safer alternative to morphine in 1898. Oxycodone was approved by the FDA in 1950.

In 1969, the World Health Organization (WHO) abandoned the belief that the medical use of morphine inevitably led patients to dependence, stating that drug tolerance and physical dependence do not, in themselves, constitute “drug dependence.”

The American medical landscape in the 1980s was characterized by “opiophobia” – a fear of prescribing opiates and other opioids, with President Reagan asking Americans to join a national crusade not to tolerate drugs by anyone, anytime, anyplace. In response to the growing recognition of the need for pain management, the pendulum then swung the other way with a significant increase in opioid use for all types of pain. Then, in the 1990s, time-release prescription opioids hit the market, continuing into the 2000s.

In the 2000s, Purdue advertised Oxycontin as non-addictive because the drug was designed to be released within the body over a 12-hour period; however, recreational drug users quickly learned to get “high” by crushing or dissolving these time-release pills.

 

 

 

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On 8/26/2019 at 6:26 PM, Chad Fuck said:


The doctors weren’t organized into a conspiracy to addict vast swaths of the American people.

And surprising as it may be, a lot of doctors are, in fact, clueless about this stuff.  Back in 2003, a GP straight up told me in no uncertain terms that methadone was not addictive, and he absolutely believed that to be true, despite methadone being perhaps the most addictive opioid on the planet, due to its insanely long half life.  

And speaking of methadone, here's a cool story, bro.

When I moved to Scottsdale a few years ago I went to work for a substance abuse treatment facility that's one of the largest in Phoenix-metro.  After working there a while, I came to learn that the doctor who served as our clinical director and the owner of the facility were partners in a string of methadone clinics throughout the area.

Being a rehab, we always had a huge contingent of opioid addicts in the program, and their "detox" would begin with methadone or suboxone "tapers."  Only they weren't forced to taper.  They had the option of long-term methadone "maintenance," which meant every morning they'd be transported to one of the clinics owned by the doc and the facility owner, and quickly hooked on methadone--which is a metric fuckton harder to get off than short acting opioids like heroin or oxy, etc.

Once hooked on methadone, you can absolutely count on that patient coming back to your clinic either 1) Forever or 2) Until they run completely out of money and have no way of getting more.  I was on a high dose of methadone for 7 years and went through cold turkey withdrawals, the acute phase of which lasted for weeks.  I wouldn't sentence Hitler to something like that.  I'd just shoot him in the head.

That is hands down the most disgusting thing I've encountered in the treatment business, which is chock full of a lot of bad actors.

I work for a professional intervention company now, and will never work in treatment again, unless it's strictly homeopath/naturopath type deal.  Patients in just about any treatment center get so over medicated it's just heart breaking to witness.

 

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3 minutes ago, Augustus said:

And surprising as it may be, a lot of doctors are, in fact, clueless about this stuff.  Back in 2003, a GP straight up told me in no uncertain terms that methadone was not addictive, and he absolutely believed that to be true, despite methadone being perhaps the most addictive opioid on the planet, due to its insanely long half life.  

And speaking of methadone, here's a cool story, bro.

When I moved to Scottsdale a few years ago I went to work for a substance abuse treatment facility that's one of the largest in Phoenix-metro.  After working there a while, I came to learn that the doctor who served as our clinical director and the owner of the facility were partners in a string of methadone clinics throughout the area.

Being a rehab, we always had a huge contingent of opioid addicts in the program, and their "detox" would begin with methadone or suboxone "tapers."  Only they weren't forced to taper.  They had the option of long-term methadone "maintenance," which meant every morning they'd be transported to one of the clinics owned by the doc and the facility owner, and quickly hooked on methadone--which is a metric fuckton harder to get off than short acting opioids like heroin or oxy, etc.

Once hooked on methadone, you can absolutely count on that patient coming back to your clinic either 1) Forever or 2) Until they run completely out of money and have no way of getting more.  I was on a high dose of methadone for 7 years and went through cold turkey withdrawals, the acute phase of which lasted for weeks.  I wouldn't sentence Hitler to something like that.  I'd just shoot him in the head.

That is hands down the most disgusting thing I've encountered in the treatment business, which is chock full of a lot of bad actors.

I work for a professional intervention company now, and will never work in treatment again, unless it's strictly homeopath/naturopath type deal.  Patients in just about any treatment center get so over medicated it's just heart breaking to witness.

 

Yeesh, yeah, I can see that a lot of treatment outfits get overrun by the profit motive pretty quickly, but that's something else.

I understand that most methadone treatment is intended to taper.  I also understand that most does not.

 

 

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I think the Oxycontin story started innocently enough, but with a dose of profit motive.

But not long after, they went whole-hog-bananas profit and threw any legitimate medical objective out the window.  And in the process, they fucked up medicine for a couple of decades or more.  And a shit-ton of people.

It is my sense that as long is a person is actually in chronic or acute pain, the likelihood of addiction is relatively low.  But as soon as that pain becomes tolerable and opioid use continues, it's nelly bar the door.

I'm also not quite convinced that all the opioid addicts are addicted to them in the same way I was addicted to alcohol.  They just lack the fortitude to suffer withdrawal, which is no mean thing.  But once free of them, I suspect they could stay free.

Edited by TwiceHorn

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20 minutes ago, TwiceHorn said:

Yeesh, yeah, I can see that a lot of treatment outfits get overrun by the profit motive pretty quickly, but that's something else.

I understand that most methadone treatment is intended to taper.  I also understand that most does not.

 

 

In my 7 years of patronizing the Huntsville Clinic (closest methadone clinic to where I lived in College Station) I don't recall meeting anyone there who was tapering their dosage.  Met tons of folks who, like me, were doing incremental increases.

The clinic doesn't make money if you get off methadone, and these aren't non-profits.  So there's no encouragement by them to lower your dosage or get off the medication altogether.

 

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I should add, just so it doesn't sound like I'm condemning methadone maintenance for anyone/everyone:

I met more than a few people for whom I believe methadone maintenance was probably the only realistic alternative for them.  They were able to work, go about their lives in otherwise normal fashion, drive safely, etc.

But they weren't people who were likely to ever embrace a recovery program that required complete abstinence.

Whether because they were just so dopamine deficient, or just so unwilling or unable to process through their underlying issues... I don't know.  But I accept that it was better for them to be on methadone than the lifestyle they'd otherwise be living.

I'm very glad I'm not in charge of making that decision for them.  

But that's a far different issue from the ethical questions around treatment center clinicians owning methadone clinics.

Edited by Augustus

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1 hour ago, DefinitelyNotHollywoodColt said:

Virtually everything posted since your idiotic first take refutes it. Impressive level of ignorance, even for you.

your irrational hatred of cancer patients is shameful. 

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1 hour ago, TwiceHorn said:

...it's nelly bar the door.

...

Where the hell did that come from? I have never heard that (in place of Katy bar the door) before, and only Google hit I find is from Michigan law blog. Is this some weird regional colloquialism?

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The government of this country is so fucking beholden to corporate interests. What’s best for corporate America is best for America.

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16 hours ago, Augustus said:

And surprising as it may be, a lot of doctors are, in fact, clueless about this stuff.  Back in 2003, a GP straight up told me in no uncertain terms that methadone was not addictive, and he absolutely believed that to be true, despite methadone being perhaps the most addictive opioid on the planet, due to its insanely long half life.  

And speaking of methadone, here's a cool story, bro.

When I moved to Scottsdale a few years ago I went to work for a substance abuse treatment facility that's one of the largest in Phoenix-metro.  After working there a while, I came to learn that the doctor who served as our clinical director and the owner of the facility were partners in a string of methadone clinics throughout the area.

Being a rehab, we always had a huge contingent of opioid addicts in the program, and their "detox" would begin with methadone or suboxone "tapers."  Only they weren't forced to taper.  They had the option of long-term methadone "maintenance," which meant every morning they'd be transported to one of the clinics owned by the doc and the facility owner, and quickly hooked on methadone--which is a metric fuckton harder to get off than short acting opioids like heroin or oxy, etc.

Once hooked on methadone, you can absolutely count on that patient coming back to your clinic either 1) Forever or 2) Until they run completely out of money and have no way of getting more.  I was on a high dose of methadone for 7 years and went through cold turkey withdrawals, the acute phase of which lasted for weeks.  I wouldn't sentence Hitler to something like that.  I'd just shoot him in the head.

That is hands down the most disgusting thing I've encountered in the treatment business, which is chock full of a lot of bad actors.

I work for a professional intervention company now, and will never work in treatment again, unless it's strictly homeopath/naturopath type deal.  Patients in just about any treatment center get so over medicated it's just heart breaking to witness.

 

This is gottdam horrifying, but not surprising.  

It's the medical version of the the payday loan industry.

 

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22 hours ago, Augustus said:

And surprising as it may be, a lot of doctors are, in fact, clueless about this stuff.  Back in 2003, a GP straight up told me in no uncertain terms that methadone was not addictive, and he absolutely believed that to be true, despite methadone being perhaps the most addictive opioid on the planet, due to its insanely long half life.  

And speaking of methadone, here's a cool story, bro.

When I moved to Scottsdale a few years ago I went to work for a substance abuse treatment facility that's one of the largest in Phoenix-metro.  After working there a while, I came to learn that the doctor who served as our clinical director and the owner of the facility were partners in a string of methadone clinics throughout the area.

Being a rehab, we always had a huge contingent of opioid addicts in the program, and their "detox" would begin with methadone or suboxone "tapers."  Only they weren't forced to taper.  They had the option of long-term methadone "maintenance," which meant every morning they'd be transported to one of the clinics owned by the doc and the facility owner, and quickly hooked on methadone--which is a metric fuckton harder to get off than short acting opioids like heroin or oxy, etc.

Once hooked on methadone, you can absolutely count on that patient coming back to your clinic either 1) Forever or 2) Until they run completely out of money and have no way of getting more.  I was on a high dose of methadone for 7 years and went through cold turkey withdrawals, the acute phase of which lasted for weeks.  I wouldn't sentence Hitler to something like that.  I'd just shoot him in the head.

That is hands down the most disgusting thing I've encountered in the treatment business, which is chock full of a lot of bad actors.

I work for a professional intervention company now, and will never work in treatment again, unless it's strictly homeopath/naturopath type deal.  Patients in just about any treatment center get so over medicated it's just heart breaking to witness.

 

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On 2/9/2020 at 5:14 PM, Bevo said:

In the 2000s, Purdue advertised Oxycontin as non-addictive because the drug was designed to be released within the body over a 12-hour period; however, recreational drug users quickly learned to get “high” by crushing or dissolving these time-release pills.

Not saying this wasn't the case with a lot of people, but there are enough stories out there on people who were hooked on it and not doing this. 

Also that Netflix documentary is great at making you question law enforcement. At least 4 different agencies couldn't do what 1 state board did. Unbelievable. 

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On 2/9/2020 at 5:40 PM, Augustus said:

And surprising as it may be, a lot of doctors are, in fact, clueless about this stuff.  Back in 2003, a GP straight up told me in no uncertain terms that methadone was not addictive, and he absolutely believed that to be true, despite methadone being perhaps the most addictive opioid on the planet, due to its insanely long half life.  

And speaking of methadone, here's a cool story, bro.

When I moved to Scottsdale a few years ago I went to work for a substance abuse treatment facility that's one of the largest in Phoenix-metro.  After working there a while, I came to learn that the doctor who served as our clinical director and the owner of the facility were partners in a string of methadone clinics throughout the area.

Being a rehab, we always had a huge contingent of opioid addicts in the program, and their "detox" would begin with methadone or suboxone "tapers."  Only they weren't forced to taper.  They had the option of long-term methadone "maintenance," which meant every morning they'd be transported to one of the clinics owned by the doc and the facility owner, and quickly hooked on methadone--which is a metric fuckton harder to get off than short acting opioids like heroin or oxy, etc.

Once hooked on methadone, you can absolutely count on that patient coming back to your clinic either 1) Forever or 2) Until they run completely out of money and have no way of getting more.  I was on a high dose of methadone for 7 years and went through cold turkey withdrawals, the acute phase of which lasted for weeks.  I wouldn't sentence Hitler to something like that.  I'd just shoot him in the head.

That is hands down the most disgusting thing I've encountered in the treatment business, which is chock full of a lot of bad actors.

I work for a professional intervention company now, and will never work in treatment again, unless it's strictly homeopath/naturopath type deal.  Patients in just about any treatment center get so over medicated it's just heart breaking to witness.

 

My mom was a heroin / codeine addict who maintained on methadone for years. 

It's a long story. When I was 8, she lost all custody of me because she was in active addiction and enlisting me in her scams. (Shoplifting -- we'd walk into supermarkets and toy stores and just walk right out with whatever we wanted. White privilege, I guess, and she played on that by her calculating that store employees would think that no mother would be so horrible as to do what they thought she might be doing with her kid in tow. I guess...and when she did get busted, I was not with her, so maybe it worked.

Anyway, she lost custody of me and headed back to Texas (we were living in Nashville at the time) with my half-brother and had two more kids with my stepdad. Those were the years she stayed on methadone. Then in the late '80s she came back to Nashville because Steve Earle hired my stepfather (his old running buddy from San Antonio) to be his guitar roadie. Mama and Steve were drug buddies, my stepfather was a pothead and a bit of a drinker but no kinda addict. Anyway, he worked for Steve from about 1986 until Steve hit the wall, went to jail, and got sober, but by the time he cleaned up, mama had driven my stepdad crazy.

Even when she was maintaining, it was a massive drain on the family financially. That shit ain't cheap, and mama would only work sporadically. So every now and then my stepfather would bring up her kicking, and man, she could go from smiling to a fucking door-slamming, cussing, screaming, breaking shit viper at the mere mention of her even thinking about quitting.

So he gave up. And then along about 1991 the state of Georgia started offering a much heftier dose than what was available in Tennessee, so some enterprising Georgia MD thoughtfully opened up a clinic on the state line, two hours down I-24 from Nashville. Mama and her junky buddies would pile in a van every weekend and go down there and stock up. They all thought they were gonna get rich selling off the excess, but you know how that goes.

I'd been renting an attic apartment from her and my stepdad during that time, and it was cool to get to know her as an adult. I saw her only two or three times for a couple of hours apiece from the time I was 18 until I was 19, so the couple of years I rented from them was my chance to get to know her and my brother and two little sisters, who were then about 5 and 3. And everything was going okay, I guess, when I moved out and headed off on a trip to Europe that was meant to be three months but lasted for three years. (Eloped with an Englishwoman.)

By the time I got back to Nashville, my stepfather had booted her out of the house. She had started trading off Methadone and malt liquor and vodka and quickly become as bad a worse a drunk as she had been a junky way back when. She had driven him to a suicide attempt in one of their fights -- he picked up a big bottle of her methadone and chugged it right in front of her. He told me later he did that because he saw it as the "instrument of my family's destruction."  He recovered, barely, and she ended up running off with an alcoholic guitar player who she soon wore out and there she was again, putting another set of kids in mortal and legal danger. Eventually my stepfather got her out of their lives. I tried to take her in but she was such a disaster in her 48 hours under my roof my wife told me it was her or mama, and by this time we had my son to think about too.

So we moved back to Texas and left her up in Nashville, where she died in the streets, horribly. (Run over by a car while trying to run across I-65 in the wee hours to get another beer.)

I don't know if there was ever any saving my mom. She was hard-wired to be a junky from the time she was two or three, when she got horribly burned in a BBQ accident in Port Arthur and the doctors pumped her little toddler brain with morphine for a month. Her synapses were re-arranged then and there, and when she and a friend got ahold of some heroin sent home from Nam by her friend's GI brother, wham, she was hooked, addicted from that first hit. So she was kind of a special case, but I still want to kill that Georgia crook for opening that fucking clinic on the Tennessee state line.

 

 

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1 hour ago, BigHorn'13 said:

Not saying this wasn't the case with a lot of people, but there are enough stories out there on people who were hooked on it and not doing this. 

Also that Netflix documentary is great at making you question law enforcement. At least 4 different agencies couldn't do what 1 state board did. Unbelievable. 

Federal law enforcement agencies are fucked.  They're not so much interested in doing what's right as doing what covers them in glory and career advancement.  Sometimes that coincides with what's right.

As bad as state/local law enforcement is, they aren't political in this way, typically.

A huge part of it is that federal criminal jurisdiction almost entirely overlaps with that of the states.  Therefore, federal prosecution is mostly "optional" for the feds.  So they only take winners.

The DEA and FBI don't have any ability to prosecute a case.  They have to bring one to the local US Attorney.  As alluded to, the USA didn't want to bring the charges because trying a case based on medical judgment (or lack thereof) can be difficult.  Not insurmountably so, but they wanted someone else to take the potential loss.

Edited by TwiceHorn

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1 hour ago, MaybeACoordinator said:

My mom was a heroin / codeine addict who maintained on methadone for years. 

It's a long story. When I was 8, she lost all custody of me because she was in active addiction and enlisting me in her scams. (Shoplifting -- we'd walk into supermarkets and toy stores and just walk right out with whatever we wanted. White privilege, I guess, and she played on that by her calculating that store employees would think that no mother would be so horrible as to do what they thought she might be doing with her kid in tow. I guess...and when she did get busted, I was not with her, so maybe it worked.

Anyway, she lost custody of me and headed back to Texas (we were living in Nashville at the time) with my half-brother and had two more kids with my stepdad. Those were the years she stayed on methadone. Then in the late '80s she came back to Nashville because Steve Earle hired my stepfather (his old running buddy from San Antonio) to be his guitar roadie. Mama and Steve were drug buddies, my stepfather was a pothead and a bit of a drinker but no kinda addict. Anyway, he worked for Steve from about 1986 until Steve hit the wall, went to jail, and got sober, but by the time he cleaned up, mama had driven my stepdad crazy.

Even when she was maintaining, it was a massive drain on the family financially. That shit ain't cheap, and mama would only work sporadically. So every now and then my stepfather would bring up her kicking, and man, she could go from smiling to a fucking door-slamming, cussing, screaming, breaking shit viper at the mere mention of her even thinking about quitting.

So he gave up. And then along about 1991 the state of Georgia started offering a much heftier dose than what was available in Tennessee, so some enterprising Georgia MD thoughtfully opened up a clinic on the state line, two hours down I-24 from Nashville. Mama and her junky buddies would pile in a van every weekend and go down there and stock up. They all thought they were gonna get rich selling off the excess, but you know how that goes.

I'd been renting an attic apartment from her and my stepdad during that time, and it was cool to get to know her as an adult. I saw her only two or three times for a couple of hours apiece from the time I was 18 until I was 19, so the couple of years I rented from them was my chance to get to know her and my brother and two little sisters, who were then about 5 and 3. And everything was going okay, I guess, when I moved out and headed off on a trip to Europe that was meant to be three months but lasted for three years. (Eloped with an Englishwoman.)

By the time I got back to Nashville, my stepfather had booted her out of the house. She had started trading off Methadone and malt liquor and vodka and quickly become as bad a worse a drunk as she had been a junky way back when. She had driven him to a suicide attempt in one of their fights -- he picked up a big bottle of her methadone and chugged it right in front of her. He told me later he did that because he saw it as the "instrument of my family's destruction."  He recovered, barely, and she ended up running off with an alcoholic guitar player who she soon wore out and there she was again, putting another set of kids in mortal and legal danger. Eventually my stepfather got her out of their lives. I tried to take her in but she was such a disaster in her 48 hours under my roof my wife told me it was her or mama, and by this time we had my son to think about too.

So we moved back to Texas and left her up in Nashville, where she died in the streets, horribly. (Run over by a car while trying to run across I-65 in the wee hours to get another beer.)

I don't know if there was ever any saving my mom. She was hard-wired to be a junky from the time she was two or three, when she got horribly burned in a BBQ accident in Port Arthur and the doctors pumped her little toddler brain with morphine for a month. Her synapses were re-arranged then and there, and when she and a friend got ahold of some heroin sent home from Nam by her friend's GI brother, wham, she was hooked, addicted from that first hit. So she was kind of a special case, but I still want to kill that Georgia crook for opening that fucking clinic on the Tennessee state line.

Daaamn.

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1 hour ago, MaybeACoordinator said:

My mom was a heroin / codeine addict who maintained on methadone for years. 

It's a long story. When I was 8, she lost all custody of me because she was in active addiction and enlisting me in her scams. (Shoplifting -- we'd walk into supermarkets and toy stores and just walk right out with whatever we wanted. White privilege, I guess, and she played on that by her calculating that store employees would think that no mother would be so horrible as to do what they thought she might be doing with her kid in tow. I guess...and when she did get busted, I was not with her, so maybe it worked.

Anyway, she lost custody of me and headed back to Texas (we were living in Nashville at the time) with my half-brother and had two more kids with my stepdad. Those were the years she stayed on methadone. Then in the late '80s she came back to Nashville because Steve Earle hired my stepfather (his old running buddy from San Antonio) to be his guitar roadie. Mama and Steve were drug buddies, my stepfather was a pothead and a bit of a drinker but no kinda addict. Anyway, he worked for Steve from about 1986 until Steve hit the wall, went to jail, and got sober, but by the time he cleaned up, mama had driven my stepdad crazy.

Even when she was maintaining, it was a massive drain on the family financially. That shit ain't cheap, and mama would only work sporadically. So every now and then my stepfather would bring up her kicking, and man, she could go from smiling to a fucking door-slamming, cussing, screaming, breaking shit viper at the mere mention of her even thinking about quitting.

So he gave up. And then along about 1991 the state of Georgia started offering a much heftier dose than what was available in Tennessee, so some enterprising Georgia MD thoughtfully opened up a clinic on the state line, two hours down I-24 from Nashville. Mama and her junky buddies would pile in a van every weekend and go down there and stock up. They all thought they were gonna get rich selling off the excess, but you know how that goes.

I'd been renting an attic apartment from her and my stepdad during that time, and it was cool to get to know her as an adult. I saw her only two or three times for a couple of hours apiece from the time I was 18 until I was 19, so the couple of years I rented from them was my chance to get to know her and my brother and two little sisters, who were then about 5 and 3. And everything was going okay, I guess, when I moved out and headed off on a trip to Europe that was meant to be three months but lasted for three years. (Eloped with an Englishwoman.)

By the time I got back to Nashville, my stepfather had booted her out of the house. She had started trading off Methadone and malt liquor and vodka and quickly become as bad a worse a drunk as she had been a junky way back when. She had driven him to a suicide attempt in one of their fights -- he picked up a big bottle of her methadone and chugged it right in front of her. He told me later he did that because he saw it as the "instrument of my family's destruction."  He recovered, barely, and she ended up running off with an alcoholic guitar player who she soon wore out and there she was again, putting another set of kids in mortal and legal danger. Eventually my stepfather got her out of their lives. I tried to take her in but she was such a disaster in her 48 hours under my roof my wife told me it was her or mama, and by this time we had my son to think about too.

So we moved back to Texas and left her up in Nashville, where she died in the streets, horribly. (Run over by a car while trying to run across I-65 in the wee hours to get another beer.)

I don't know if there was ever any saving my mom. She was hard-wired to be a junky from the time she was two or three, when she got horribly burned in a BBQ accident in Port Arthur and the doctors pumped her little toddler brain with morphine for a month. Her synapses were re-arranged then and there, and when she and a friend got ahold of some heroin sent home from Nam by her friend's GI brother, wham, she was hooked, addicted from that first hit. So she was kind of a special case, but I still want to kill that Georgia crook for opening that fucking clinic on the Tennessee state line.

 

 

Last paragraph.  She was behind the 8 ball to start.  Sorry, man.   
 

So many docs gloss over ‘do no harm’.  As in, ‘of course I won’t’.  Easy to cross that line.  Damn shame.  

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Props to those of you all that have broken the cycle of addiction or dependence. I'd like to throw my two cents in on drug addiction, abuse and treatment. I am certified and have a waiver for treatment of opioid use disorders. I work first hand with a drug dependence treatment program.

1) There is a a difference between addiction and dependence. Some have both. Addiction is defined more by a set of behaviors and motivations to obtain a drug, use said drug and accelerate use. Dependence is when you need the medication to prevent withdrawal or cannot bear the disease process the medication is treating (methadone treatment for previous addiction, chronic opioids for cancer pain, etc.).

2) Short acting opioid are more likely to cause addiction because of the intense high with release of dopamine, norepinephrine, etc. Long acting opioids can cause addiction more often than short IF the long acting is crushed or mutilated into a short acting form (crushing old oxy formulations, cutting into Fentanyl patches). Long acting opioids in unadulterated form like methadone are not more addicting but are harder to quit due to long half life and more intense withdrawal symptoms.

3) Y'all qualify but tend to throw methadone treatment centers under the bus and there are likely bad actors but in my experience, they are usually trying to do the right thing. With addicts and people dependent on opioids you are dealing with a population of people who tend to continue to make bad choices. A lot of these people are stuck in families with addiction, poor socio-economics and poor education so they have never been taught or shown there is another way. For those who take the programs seriously, the treatments can mean a productive and more fulfilling life.  There are no good proven studies that show homeopathy and naturopathy work for true drug addiction. 

4) There are many people who actively attempt tapers of their treatments at drug treatment centers. It is a very precarious process. Do not do it cold turkey. 90% of those who try cold turkey or even just counseling methods are back on opioids within 6 months.

5) Buprenorphine with naloxone would be my treatment of choice for most but it is limited in availability due to cost per day and lack of providers to supervise and dispense.

6) Until we have a better understanding of the genetics of drug addiction, you are playing potluck with taking opioids. It really doesn't matter if you take them for fun or for pain. 

7) The crack down on doctor provided opioid prescriptions (known doses) in the last 5 years has led to an increase in indiscriminate use of heroin and lab cooked fentanyl which has increased overdoses and deaths. This was easily predictable.  We haven't fixed the root causes of drug use in our society. 

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21 minutes ago, Newdoc said:

Props to those of you all that have broken the cycle of addiction or dependence. I'd like to throw my two cents in on drug addiction, abuse and treatment. I am certified and have a waiver for treatment of opioid use disorders. I work first hand with a drug dependence treatment program.

1) There is a a difference between addiction and dependence. Some have both. Addiction is defined more by a set of behaviors and motivations to obtain a drug, use said drug and accelerate use. Dependence is when you need the medication to prevent withdrawal or cannot bear the disease process the medication is treating (methadone treatment for previous addiction, chronic opioids for cancer pain, etc.).

2) Short acting opioid are more likely to cause addiction because of the intense high with release of dopamine, norepinephrine, etc. Long acting opioids can cause addiction more often than short IF the long acting is crushed or mutilated into a short acting form (crushing old oxy formulations, cutting into Fentanyl patches). Long acting opioids in unadulterated form like methadone are not more addicting but are harder to quit due to long half life and more intense withdrawal symptoms.

3) Y'all qualify but tend to throw methadone treatment centers under the bus and there are likely bad actors but in my experience, they are usually trying to do the right thing. With addicts and people dependent on opioids you are dealing with a population of people who tend to continue to make bad choices. A lot of these people are stuck in families with addiction, poor socio-economics and poor education so they have never been taught or shown there is another way. For those who take the programs seriously, the treatments can mean a productive and more fulfilling life.  There are no good proven studies that show homeopathy and naturopathy work for true drug addiction. 

4) There are many people who actively attempt tapers of their treatments at drug treatment centers. It is a very precarious process. Do not do it cold turkey. 90% of those who try cold turkey or even just counseling methods are back on opioids within 6 months.

5) Buprenorphine with naloxone would be my treatment of choice for most but it is limited in availability due to cost per day and lack of providers to supervise and dispense.

6) Until we have a better understanding of the genetics of drug addiction, you are playing potluck with taking opioids. It really doesn't matter if you take them for fun or for pain. 

7) The crack down on doctor provided opioid prescriptions (known doses) in the last 5 years has led to an increase in indiscriminate use of heroin and lab cooked fentanyl which has increased overdoses and deaths. This was easily predictable.  We haven't fixed the root causes of drug use in our society. 

From observations on the ground, sociological factors are huge.  It's hard enough for an alcoholic to get away from alcohol, but in all likelihood, most of the alcoholic's drinking acquaintances aren't abusers (some are, of course).

With what I have seen of meth and opioids, a person who gets clean often goes back to a milieu where just about everyone they know is an abuser too.  In some cases, this is a sort of stereotypical "crack den" environment, in others some people remain relatively functional (for the time being), but it's really a way of life.

None of this is to say that it's absolutely necessary to avoid other drinkers/users to get in recovery, but proximity like this makes early sobriety particularly difficult.

Edited by TwiceHorn

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I was in rehab for 28 days last May.  I got to know about 60 guys there on a first name basis and have kept up with about 30 of them.  About 2/3 were opioid guys.  6 of the 60 have died since June.  Talked with another guy recently who was at the same treatment center 4 years ago.  He told me 19 of the 40 guys he was there with had died.  One of the guys in my cabin had been on methadone for 15 fucking years.  He said no one ever tried to get him on maintenance until this stint in rehab.  

Don't know if it has been mentioned above but Harris Wittel's sister has a fantastic podcast called Last Day.  It is worth a listen.    

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2 hours ago, hullabelew said:

I was in rehab for 28 days last May.  I got to know about 60 guys there on a first name basis and have kept up with about 30 of them.  About 2/3 were opioid guys.  6 of the 60 have died since June.  Talked with another guy recently who was at the same treatment center 4 years ago.  He told me 19 of the 40 guys he was there with had died.  One of the guys in my cabin had been on methadone for 15 fucking years.  He said no one ever tried to get him on maintenance until this stint in rehab.  

Don't know if it has been mentioned above but Harris Wittel's sister has a fantastic podcast called Last Day.  It is worth a listen.    

Also recommend Dopey and Don't Die, the podcast from Bob Forrest, Drew Pinsky's right hand man on Celeb Rehab.

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One of the guys I met in rehab turned me on to Dopey. He was actually listening to it real time when Chris died. That guys name was Greg. Greg ODed at Christmas after 8 months sober.

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On 2/10/2020 at 11:39 PM, MaybeACoordinator said:

My mom was a heroin / codeine addict who maintained on methadone for years. 

It's a long story. When I was 8, she lost all custody of me because she was in active addiction and enlisting me in her scams. (Shoplifting -- we'd walk into supermarkets and toy stores and just walk right out with whatever we wanted. White privilege, I guess, and she played on that by her calculating that store employees would think that no mother would be so horrible as to do what they thought she might be doing with her kid in tow. I guess...and when she did get busted, I was not with her, so maybe it worked.

Anyway, she lost custody of me and headed back to Texas (we were living in Nashville at the time) with my half-brother and had two more kids with my stepdad. Those were the years she stayed on methadone. Then in the late '80s she came back to Nashville because Steve Earle hired my stepfather (his old running buddy from San Antonio) to be his guitar roadie. Mama and Steve were drug buddies, my stepfather was a pothead and a bit of a drinker but no kinda addict. Anyway, he worked for Steve from about 1986 until Steve hit the wall, went to jail, and got sober, but by the time he cleaned up, mama had driven my stepdad crazy.

Even when she was maintaining, it was a massive drain on the family financially. That shit ain't cheap, and mama would only work sporadically. So every now and then my stepfather would bring up her kicking, and man, she could go from smiling to a fucking door-slamming, cussing, screaming, breaking shit viper at the mere mention of her even thinking about quitting.

So he gave up. And then along about 1991 the state of Georgia started offering a much heftier dose than what was available in Tennessee, so some enterprising Georgia MD thoughtfully opened up a clinic on the state line, two hours down I-24 from Nashville. Mama and her junky buddies would pile in a van every weekend and go down there and stock up. They all thought they were gonna get rich selling off the excess, but you know how that goes.

I'd been renting an attic apartment from her and my stepdad during that time, and it was cool to get to know her as an adult. I saw her only two or three times for a couple of hours apiece from the time I was 18 until I was 19, so the couple of years I rented from them was my chance to get to know her and my brother and two little sisters, who were then about 5 and 3. And everything was going okay, I guess, when I moved out and headed off on a trip to Europe that was meant to be three months but lasted for three years. (Eloped with an Englishwoman.)

By the time I got back to Nashville, my stepfather had booted her out of the house. She had started trading off Methadone and malt liquor and vodka and quickly become as bad a worse a drunk as she had been a junky way back when. She had driven him to a suicide attempt in one of their fights -- he picked up a big bottle of her methadone and chugged it right in front of her. He told me later he did that because he saw it as the "instrument of my family's destruction."  He recovered, barely, and she ended up running off with an alcoholic guitar player who she soon wore out and there she was again, putting another set of kids in mortal and legal danger. Eventually my stepfather got her out of their lives. I tried to take her in but she was such a disaster in her 48 hours under my roof my wife told me it was her or mama, and by this time we had my son to think about too.

So we moved back to Texas and left her up in Nashville, where she died in the streets, horribly. (Run over by a car while trying to run across I-65 in the wee hours to get another beer.)

I don't know if there was ever any saving my mom. She was hard-wired to be a junky from the time she was two or three, when she got horribly burned in a BBQ accident in Port Arthur and the doctors pumped her little toddler brain with morphine for a month. Her synapses were re-arranged then and there, and when she and a friend got ahold of some heroin sent home from Nam by her friend's GI brother, wham, she was hooked, addicted from that first hit. So she was kind of a special case, but I still want to kill that Georgia crook for opening that fucking clinic on the Tennessee state line.

 

 

Great googly moogly

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On 2/11/2020 at 10:14 AM, Newdoc said:

There is a a difference between addiction and dependence. Some have both. Addiction is defined more by a set of behaviors and motivations to obtain a drug, use said drug and accelerate use. Dependence is when you need the medication to prevent withdrawal or cannot bear the disease process the medication is treating (methadone treatment for previous addiction, chronic opioids for cancer pain, etc.).

 

7 years on that stuff and got to know a lot others who were.  Now going on 8.5 years clean/sober and having worked with literally hundreds of others in recovery I vehemently dispute that methadone "treatment" is not "addiction." 

It is certainly dependence, no question about it. No one could endure those withdrawals if there's a means to stop them.  But methadone maintenance isn't just about preventing withdrawals for us, it's about making existence somewhat tolerable, and occasionally something that approaches enjoyable.

We're not just proactively medicating withdrawal.  We're medicating the same internal issues that made addicts out of us in the first place.  Methadone may not provide the same euphoria that a short acting opioid delivers, but it damn sure rewards the pleasure centers just the same.  

If that weren't the case, every clinic in the US could slowly taper every patient down to zero and then everything would be just fine.

Jesus Christ, the reason people stay on methadone forever, with ever increasing doses, is precisely BECAUSE it's an addiction.

You even said as much:  "Addiction is defined more by a set of behaviors and motivations to obtain a drug, use said drug and accelerate use."  Getting it from a clinic instead of a dealer changes nothing.

Edited by Augustus

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6 hours ago, Augustus said:

7 years on that stuff and got to know a lot others who were.  Now going on 8.5 years clean/sober and having worked with literally hundreds of others in recovery I vehemently dispute that methadone "treatment" is not "addiction." 

It is certainly dependence, no question about it. No one could endure those withdrawals if there's a means to stop them.  But methadone maintenance isn't just about preventing withdrawals for us, it's about making existence somewhat tolerable, and occasionally something that approaches enjoyable.

We're not just proactively medicating withdrawal.  We're medicating the same internal issues that made addicts out of us in the first place.  Methadone may not provide the same euphoria that a short acting opioid delivers, but it damn sure rewards the pleasure centers just the same.  

If that weren't the case, every clinic in the US could slowly taper every patient down to zero and then everything would be just fine.

Jesus Christ, the reason people stay on methadone forever, with ever increasing doses, is precisely BECAUSE it's an addiction.

You even said as much:  "Addiction is defined more by a set of behaviors and motivations to obtain a drug, use said drug and accelerate use."  Getting it from a clinic instead of a dealer changes nothing.

You’re lumping addiction in with dependence or vice versa. They’re two different ICD 10 codes and yes, it’s splitting hairs and technical. If you take out the use of “dependence” then you have to use “addiction” for everyone. But we don’t. Yes, you can become “addicted” to methadone. I never said you couldn’t.  Most of my patients however are dependent and it’s not great but it beats the pattern of addiction behaviors.

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On 2/11/2020 at 5:39 AM, MaybeACoordinator said:

My mom was a heroin / codeine addict who maintained on methadone for years. 

It's a long story. When I was 8, she lost all custody of me because she was in active addiction and enlisting me in her scams. (Shoplifting -- we'd walk into supermarkets and toy stores and just walk right out with whatever we wanted. White privilege, I guess, and she played on that by her calculating that store employees would think that no mother would be so horrible as to do what they thought she might be doing with her kid in tow. I guess...and when she did get busted, I was not with her, so maybe it worked.

Anyway, she lost custody of me and headed back to Texas (we were living in Nashville at the time) with my half-brother and had two more kids with my stepdad. Those were the years she stayed on methadone. Then in the late '80s she came back to Nashville because Steve Earle hired my stepfather (his old running buddy from San Antonio) to be his guitar roadie. Mama and Steve were drug buddies, my stepfather was a pothead and a bit of a drinker but no kinda addict. Anyway, he worked for Steve from about 1986 until Steve hit the wall, went to jail, and got sober, but by the time he cleaned up, mama had driven my stepdad crazy.

Even when she was maintaining, it was a massive drain on the family financially. That shit ain't cheap, and mama would only work sporadically. So every now and then my stepfather would bring up her kicking, and man, she could go from smiling to a fucking door-slamming, cussing, screaming, breaking shit viper at the mere mention of her even thinking about quitting.

So he gave up. And then along about 1991 the state of Georgia started offering a much heftier dose than what was available in Tennessee, so some enterprising Georgia MD thoughtfully opened up a clinic on the state line, two hours down I-24 from Nashville. Mama and her junky buddies would pile in a van every weekend and go down there and stock up. They all thought they were gonna get rich selling off the excess, but you know how that goes.

I'd been renting an attic apartment from her and my stepdad during that time, and it was cool to get to know her as an adult. I saw her only two or three times for a couple of hours apiece from the time I was 18 until I was 19, so the couple of years I rented from them was my chance to get to know her and my brother and two little sisters, who were then about 5 and 3. And everything was going okay, I guess, when I moved out and headed off on a trip to Europe that was meant to be three months but lasted for three years. (Eloped with an Englishwoman.)

By the time I got back to Nashville, my stepfather had booted her out of the house. She had started trading off Methadone and malt liquor and vodka and quickly become as bad a worse a drunk as she had been a junky way back when. She had driven him to a suicide attempt in one of their fights -- he picked up a big bottle of her methadone and chugged it right in front of her. He told me later he did that because he saw it as the "instrument of my family's destruction."  He recovered, barely, and she ended up running off with an alcoholic guitar player who she soon wore out and there she was again, putting another set of kids in mortal and legal danger. Eventually my stepfather got her out of their lives. I tried to take her in but she was such a disaster in her 48 hours under my roof my wife told me it was her or mama, and by this time we had my son to think about too.

So we moved back to Texas and left her up in Nashville, where she died in the streets, horribly. (Run over by a car while trying to run across I-65 in the wee hours to get another beer.)

I don't know if there was ever any saving my mom. She was hard-wired to be a junky from the time she was two or three, when she got horribly burned in a BBQ accident in Port Arthur and the doctors pumped her little toddler brain with morphine for a month. Her synapses were re-arranged then and there, and when she and a friend got ahold of some heroin sent home from Nam by her friend's GI brother, wham, she was hooked, addicted from that first hit. So she was kind of a special case, but I still want to kill that Georgia crook for opening that fucking clinic on the Tennessee state line.

 

 

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10 hours ago, Newdoc said:

You’re lumping addiction in with dependence or vice versa. They’re two different ICD 10 codes and yes, it’s splitting hairs and technical. If you take out the use of “dependence” then you have to use “addiction” for everyone. But we don’t. Yes, you can become “addicted” to methadone. I never said you couldn’t.  Most of my patients however are dependent and it’s not great but it beats the pattern of addiction behaviors.

Happy to know I wasn't addicted to methadone for 7 years, increasing over that time from 30mg to 125mg per day, resulting in damage to my colon that resulted in a semicolectomy that resulted in sepsis, coma, kidney failure and paralyzing peripheral neuropathy that required 3 months of assisted living to allow me to walk again.  Hate to think what might've happened if I'd actually become addicted.  

I couldn't care less what codes people like yourself give to these behaviors or your attempts to codify them into categories that ultimately have no impact whatsoever on a solution to the problem.

I could have done what I did with heroin and everyone would have called it addiction.  I did it at a clinic with a prescribed "medication" and people like yourself want to me tell me there's some fundamental difference.  

I still believe there are plenty of people for whom methadone/suboxone maintenance is the best of all possible, realistic solutions.  But clearly I get angry when someone tries to define the addiction out of the equation.  Usually non-addicts.

I'll reiterate:  If dependence were the issue, then problem solved.  Taper everyone slowly down to zero.  In fact, if most of your patients are merely dependent, I assume that's what you're doing?

 

 

Edited by Augustus

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19 hours ago, Augustus said:

Happy to know I wasn't addicted to methadone for 7 years, increasing over that time from 30mg to 125mg per day...

I don’t understand this. Why did the clinic increase your dose? I would assume that the protocol would be: use enough methadone so that patient doesn’t suffer too much withdrawal symptoms, and slowly decrease the methadone over time.

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