Let's Talk About The Opioid Problem

[singlesline]

You guys needed a prescription to carry naloxone? They give that stuff away over the counter at the pharmacy here for several years now (ampules and needle, so needs a bit of knowledge to administer). My understanding it’s completely synthetic with no proteins, so no risk as an allergen, and little to no risk to any other contraindications (other than the chance the user wakes up and clocks you cause you just killed their high).

Honestly I don’t know how it works, but I don’t think we needed a prescription to carry it.

You could still get it at pharmacies in some states or from community groups without a prescription. Maybe the loophole was just that it was behind the counter and required talking to a pharmacist. Now it is approved otc.

I have some in a drawer somewhere from when my wife was trained to use it…but it is just the cheap stuff: vials and syringes, no auto injector or nasal spray.

[mcski]

It's the lay friendly delivery system that makes Narcan, like epipen, expensive. (Or so the company would like us to believe. ) Mayve we need to start teaching high schoolers how to draw up and give injections (when they're not studying critical race theory and being groomed by pedophile teachers). And the general public. Like CPR. When I went home from the hospital taking 80mg of oxycodone a day they were required to send me home with a narcan injector. Covered by insurance. I'd like to see the govt cover the cost.

When my dad came out of surgery for a major surgery, the docs had him on too high a dose. They didn’t realize I guess because he was old and maybe the resident just didn’t realize he should have been more alert. But within seconds it was pretty clear he was close being in serious trouble. When I finally got the doc to realize he should be much more coherent at that point, he called for the narcan. It was fucking amazing how quickly he went from being unintelligible and floppy to completely alert. Prob a min max. That narcan should distributed everywhere free and in large quantities. No reason no to have a life saver like that widely available and free

[Trackhead]

You should see what happens when a rookie healthcare worker gives a full dose of narcan…....it’s like an exorcism complete with profuse sweating, vomiting, and shit. We used to do narcs infusions for some with overdoses of long acting narcotics.

[old goat]

In your opinion, was that anywhere near necessary?

Surely you could ride out the pain for a few days/weeks without needing a heroic dose of heroin? I mean that used to happen all the time, sure you may not be comfortable, but isn't it better than chasing the dragon?

I know of an ex addict that refused pain medicine after an appendix removal. He was in rough shape for a few days, but he came out of it with his sobriety.

Yes it was necessary. T3 vertebral fracture, 14 rib fractures, acetabular fracgture. What happens when people don't get enough pain medication is they don't breathe, they don't get out of bed, they get pneumonia and blood clots. They take too much tylenol and motrin and kill their liver, kidneys, and stomach. Don't talk about stuff you know nothing about.

You should see what happens when a rookie healthcare worker gives a full dose of narcan…....it’s like an exorcism complete with profuse sweating, vomiting, and shit. We used to do narcs infusions for some with overdoses of long acting narcotics.

Yeah--important for the public using narcan to realize that the narcotic often lasts longer than the narcan and people can stop breathing again. Don't just give one dose and think all is well. Have a second dose available. Call for an ambulance and get them to the hospital to make sure the OD is well worn off.

[BCMtnHound]

The over-the-counter naloxone kits we get here have three 1mL (0.4mg/mL) ampules, 3 vp syringes, alcohol wipes, gloves and a cpr mask. The cpr mask with gloves being probably the most important parts of the kit.

Thankfully, I have never used the kit except in practice, but my sis who works with social services in Victoria has had a few no duff exercises. Not fun.

Reminds me, need to restock the ampules, they expired this month.

[Trackhead]

Yeah--important for the public using narcan to realize that the narcotic often lasts longer than the narcan and people can stop breathing again. Don't just give one dose and think all is well. Have a second dose available. Call for an ambulance and get them to the hospital to make sure the OD is well worn off.

We used to give Revex in early-mid 2000's for opioid overdose. Longer half-life than Narcan. Narcan half-life is something like 40 minutes vs Revex at 10 hours. Longer duration for onset, but a great follow-up to Narcan.

Stuff was discontinued in 2008 and just reemerged under generic apparently. Makes discharging opioid OD's from ER quicker/safer in some instances.

[Thaleia]

Yeah--important for the public using narcan to realize that the narcotic often lasts longer than the narcan and people can stop breathing again. Don't just give one dose and think all is well. Have a second dose available. Call for an ambulance and get them to the hospital to make sure the OD is well worn off.

This. I'm no expert but living in Canada where Narcan has been accessible for years even I know it's the first step in stopping an overdose, not the final step.

[ironhippy]

Yes it was necessary. T3 vertebral fracture, 14 rib fractures, acetabular fracgture. What happens when people don't get enough pain medication is they don't breathe, they don't get out of bed, they get pneumonia and blood clots. They take too much tylenol and motrin and kill their liver, kidneys, and stomach. Don't talk about stuff you know nothing about.

Can I ask questions about stuff I don't know anything about? Because that's what I did.

Seems like when patients take too much opioids they also don't breathe? 80 mg seems like a lot, enough to send you home with narcan.

I was just questioning if you felt it was necessary because I respect your opinion.

[XXX-er]

I think its a given that Fentynal from an anesthetist with years of medical training/ no face tats in a medical setting is different than buying it in a back alley off someone named " slash " ?

[ironhippy]

I think its a given that Fentynal from an anesthetist with years of medical training/ no face tats in a medical setting is different than buying it in a back alley off someone named " slash " ?

are you referring to my comments? Mine were specific to this comment:

taking 80mg of oxycodone a day they were required to send me home with a narcan injector.

Which doesn't seem all that different than when you get it from a guy with face tats on the corner...

I understand the use of pain medication, especially in a hospital setting, I was specifically questioning sending patients home with enough medication that requires having narcan on hand.

[XXX-er]

did you miss the part where the old goat has played a retired know-it-all surgeon with years of medical training, also his opinions on all kinds of things are always really good,

especialy compared to this lot on TGR

not sure about the face tats but you never know ?

[singlesline]

Reminds me, need to restock the ampules, they expired this month.

Yeah, mine are expired too, but the guy who did the training with my wife said that they are actually good for many years past expiration (and in the state she received the training in, it was even legal for people to distribute it past the expiration date).

Un-expired is obviously better but as long as it was stored away from light/heat, it should be perfectly fine and I don't think anyone is going to complain if you save their lives with a shot that happens to be a little stale.

[Trackhead]

Seems like when patients take too much opioids they also don't breathe? 80 mg seems like a lot, enough to send you home with narcan.

I was just questioning if you felt it was necessary because I respect your opinion.

What he means by “not breathing”in the post operative context is they don’t take deep breaths (if they have chest trauma for example) because it hurts. They don’t get out of bed, because it hurts. Less pain meds can then cause poor post operative lung function (atelectasis-pneumonia), deep vein thrombosis (blood clots) etc. There are plenty of other post operative pain sequela that go well beyond the scope of this forum. In summary:effectively managing post operative pain is important for recovery.

[old goat]

We used to give Revex in early-mid 2000's for opioid overdose. Longer half-life than Narcan. Narcan half-life is something like 40 minutes vs Revex at 10 hours. Longer duration for onset, but a great follow-up to Narcan.

Stuff was discontinued in 2008 and just reemerged under generic apparently. Makes discharging opioid OD's from ER quicker/safer in some instances.

Good to know. I wasn't aware of it.

Can I ask questions about stuff I don't know anything about? Because that's what I did.

Seems like when patients take too much opioids they also don't breathe? 80 mg seems like a lot, enough to send you home with narcan.

I was just questioning if you felt it was necessary because I respect your opinion.

My apologies for taking your post the wrong way and for my snippy answer. Yes I think it was necessary. The tolerable dose is somewhat dependent on pain--someone in a lot of pain will tolerate a higher dose without stopping breathing. While I was still in the hospital I was already cutting back from even more because they were having a hard time waking me up and I was a little afraid to fall asleep. So apparently I don't have what it takes to be an addict--I was very happy to get off the stuff., which I didn't have any trouble doing when the pain eased up. And the shit I had when I had cut the dose is in the Guiness book of records. I never used the Narcan--I think it was in the form of an autoinjector, not nasal, and I tried to give it away but no one official wants unverified meds under that circumstances and in my sheltered existence I didn't know anyone unofficial who might use it.
The 80mg day was 10mg every three hours as needed. The narcan prescription is required by CA law.

What he means by “not breathing”in the post operative context is they don’t take deep breaths (if they have chest trauma for example) because it hurts. They don’t get out of bed, because it hurts. Less pain meds can then cause poor post operative lung function (atelectasis-pneumonia), deep vein thrombosis (blood clots) etc. There are plenty of other post operative pain sequela that go well beyond the scope of this forum. In summary:effectively managing post operative pain is important for recovery.

Thanks for clarifying my lousy answer.

The medical use of opioids and the side effects is a complex subject--balancing the needs of pain patients against the 10% risk of addiction (I feel the percent is a lot less in a closely monitored acute pain setting. In the medical setting perhaps the riskiest thing is sending a patient home from the ER with more than a day or two worth of pills, since there is no guarantee of followup.)

[ironhippy]

My apologies for taking your post the wrong way and for my snippy answer. Yes I think it was necessary. The tolerable dose is somewhat dependent on pain--someone in a lot of pain will tolerate a higher dose without stopping breathing. While I was still in the hospital I was already cutting back from even more because they were having a hard time waking me up and I was a little afraid to fall asleep. So apparently I don't have what it takes to be an addict--I was very happy to get off the stuff., which I didn't have any trouble doing when the pain eased up. And the shit I had when I had cut the dose is in the Guiness book of records. I never used the Narcan--I think it was in the form of an autoinjector, not nasal, and I tried to give it away but no one official wants unverified meds under that circumstances and in my sheltered existence I didn't know anyone unofficial who might use it.
The 80mg day was 10mg every three hours as needed. The narcan prescription is required by CA law.

Thank you very much, I probably didn't communicate as well as I should have. I appreciate your response.

What he means by “not breathing”in the post operative context is they don’t take deep breaths (if they have chest trauma for example) because it hurts. They don’t get out of bed, because it hurts. Less pain meds can then cause poor post operative lung function (atelectasis-pneumonia), deep vein thrombosis (blood clots) etc. There are plenty of other post operative pain sequela that go well beyond the scope of this forum. In summary:effectively managing post operative pain is important for recovery.

Thanks. I understand the differences, I was just trying to make a point. I found it shocking that (in my perception) you would be sent home with enough narcotics that narcan would be required. I don't think it's good for non addicts to consider withholding pain medication prescribed by a doctor.

Old Goats post above really was what I was looking for. Thanks again.

[riser4]

[Thaleia]

Wait - did that video just mock me for watching it?! Shit.

[stealurface831]

havent checked this thread in a few weeks. i assume the collective has come to an unanimously agreed upon plan of action that will totally eradicate the opioid crisis, no?

[Trackhead]

havent checked this thread in a few weeks. i assume the collective has come to an unanimously agreed upon plan of action that will totally eradicate the opioid crisis, no?

That happened on page 1

[old goat]

Thank you very much, I probably didn't communicate as well as I should have. I appreciate your response.



Thanks. I understand the differences, I was just trying to make a point. I found it shocking that (in my perception) you would be sent home with enough narcotics that narcan would be required. I don't think it's good for non addicts to consider withholding pain medication prescribed by a doctor.

Old Goats post above really was what I was looking for. Thanks again.

Presumably someone sent home from the hospital would be on a dose they were tolerating in the hospital. The Narcan would be useful if the patient (or someone in the household) decides to take more at once than they ought to. You have to trust that patients will follow directions and keep the meds out of the hands of others. We like to treat adults as adults but sometimes the trust is broken.

[larilinesign]

Where is all the overdose-inducing fentynal coming from?

Is anyone using it against the USA?

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[ghosthop]

China China China.

They produce many of the precursors and I believe the final product is often produced in Mexico. I think it’s less nefarious world order and more money to be made. Same with the poppy fields in Afghanistan.

[neckdeep]

Where is all the overdose-inducing fentynal coming from?

Is anyone using it against the USA?

Sent from my SM-G988U using Tapatalk

Production and distribution is primarily Mexican cartels. Its a natural fit because the Narcos already had the infrastructure from their industrial scale meth production. Precursor chemicals are mostly sourced from Chinese chemical companies but from across southeast Asia as well. Same as meth. Same companies. The political gangsters who run China aren't in the mood to do us any favors and the current arrangement gives them plausible deniability. To us, its an epic health crisis. To Xi, its just a bargaining chip. As long as the West pokes the Dragon about the ethnic reprogramming of its muslim minorities, the precursor will flow.

There's fentanyl in everything except the fentanyl. If someone offers to sell you fentanyl, it's probably tranq.

This is the basic economics of counterfeiting which is what drives the illegal drug markets these days. Caveat Emptor.

[larilinesign]

Hmm the more you know. Could it possibly be the Russians?

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[dmcd]

There are many alcoholics who have destroyed themselves with a lifetime of drinking, but it’s hard to find junkies who have been on the horse for decades.

Interestingly this is way more true now with fentanyl than in the past. A comedian made a joke about how he wished for the times when you had crack heads because crack heads were around for decades. Fetty users are gone in months.