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The Painkiller That Saves Money But Costs Lives
Hugh Pickens writes "Over 2,000 patients have died since 2003 in Washington State alone by accidentally overdosing on a commonly prescribed narcotic painkiller that costs less than a dollar a dose and the deaths are clustered predominately in places with lower incomes because Washington state has steered people with state-subsidized health care — Medicaid patients, injured workers and state employees — to methadone because the drug is cheap. Methadone belongs to a class of narcotic painkillers, called opioids, that includes OxyContin, fentanyl and morphine. Within that group, methadone accounts for less than 10 percent of the drugs prescribed — but more than half of the deaths and although Methadone works wonders for some patients, relieving chronic pain from throbbing backs to inflamed joints, the drug's unique properties make it unforgiving and sometimes lethal. 'Most painkillers, such as OxyContin, dissipate from the body within hours. Methadone can linger for days, pooling to a toxic reservoir that depresses the respiratory system,' write Michael J. Berens and Ken Armstrong. 'With little warning, patients fall asleep and don't wake up. Doctors call it the silent death.'"
because of the way it works, junkies don't prefer it. so who cares if a bunch of people die needlessly, at least it prevents people from getting high. the drug war matters more.
No perchance, and it was idiotic to even say, since you have easily looked it up and see that its protection was basically stripped from a defeated Germany in 1947. Wikipedia is your friend, laziness is not.
Tequila: It's not just for breakfast anymore!
As little as 100 years ago people were using perfectly legal opium compounds such as paregoric, with little or no social problems. The fact that people are dying and people are having their lives ruined by this failed "war on drugs" and the solutions are even worse than the problem just goes to show that government has no clue what it's doing.
Seven puppies were harmed during the making of this post.
How can you accidently take more than the prescribed amount?
Can't decipher the doctor handwriting?
I don't think I know anyone who takes pain drugs, so I have no personal knowledge. However, I found a short article about Methadone on the Seattle Times web site recently when I was looking at Google Health news. Even the summary seemed obviously suspicious, so I looked at the article.
..."
To me, that article and all the data to which the Slashdot story linked screamed incompetence or fraud. Now that I've read a little of the linked data, I realize the writers are at least partly incompetent. Possibly only whoever started them looking was engaged in fraud to sell more expensive drugs.
I just discovered that I'm not the only one who thinks that. Short quotes, read the full comments:
"It does not matter if you switch every body to oxycontin or oxycodone. These drugs are terrible at controlling pain and all are very dangerous."
"... I have an issue with how the Seattle Times is drawing a correlation between poverty and methadone poisoning.
Possibly Methadone is more often given to people who have little education, and who are therefore more likely to overdose because they didn't understand the instructions, or because they have other issues that confuse them.
Doctors don't generally like to prescribe pain killers. They worry about addiction, they worry about the DEA auditing their prescribing habits and yanking their license, without which it's kind of hard to be a doctor.
When they prescribe methadone, is it really out of cost, or have they grown so fearful of prescribing Oxycontin that somehow methadone seems like a reasonable alternative? And how many of those fears are medical/pharmacological, and how many are "if I prescribe Oxycontin I'll get in trouble" or "gee, there's a lot of press about Oxycontin, I shouldn't prescribe it"?
Actually here around it's better known as a "legal" (when given in the correct programme) substitution drug for heroine. (Basically instead of letting junkies do crimes to get their hand at illegal drugs, let's doctors prescribe it, with the official "goal" of getting the junkie some time in the far future clean).
And it's that narcotic, that you do not only need special prescriptions, nope, the drug is usually not given out to the "patient", they are forced to go in daily to the pharmacy and consume it on site.
One last thought, opiates are known to create very strong addictions, hence locally they are usually only administered in very restricted circumstances, e.g. as after care after surgery known to induce extreme pain, if really any other pain medication does not help, but only for a short term till the reasons can be fixed, and mostly for terminally ill patients (where the addiction aspect is irrelevant, but the painless sleep potentially into death is quite relevant).
Basically, cost accounting and medicine do not mash to well, and especially state run (but private insurances are not much better, but they tend to do it on a case by case base) systems have a tendency to go for cheap treatments even if they are not medically sound. (And using heavy addiction inducing drugs as a general pain killer medication is not sound policy). The only way (locally) to get them to do the right thing is usually to force the "cost controlling" MDs (it's always MDs here around that need to decide) to put their decision in writing including the reasoning, and mention that one needs this for the Social Court (locally we've got special courts for stuff related to social services and employment situations, and they usually tend to rule favorably), ... => more than once the MD reevaluated her decision while trying to formulate the reasoning.
I prefer the Crystal Method.
Tic-Tac-Toe, Global Thermonuclear War, and relationships all have the same winning move.
. . . faced with a life full of incurable, chronic, unbearable pain . . . this "silent death" might seem like a more pleasant option for some folks.
It would seem like an alternative for a doctor forbidden by law from assisting a patient requesting euthanasia. The doctor prescribes the medication and describes the risks. It is the patient's choice to take a lethal amount.
Schroedinger's Brexit: The UK is both in and out of the EU at the same time!
18 years ago I messed up my back, 8 years ago I did it again. The second time around didnt have the results of the first. I live with constant pain while awake unless laying down.
Pain is depressing, it ruins your attitude and life. I have learned to live with it, with pain pills to manage the pain. When sent to pain management every so often to get the pain medication adjusted methadone is always pushed, I am also low income. I have done a lot of study of pain drugs and will always tell the doctor that is one medication I want to avoid. At present I am on Percoset (oxycodone/acetaminophen). While it isnt as cheap as the methadone on my crappy insurance, my life is way more important than the $10 a month extra it costs me.
But the problem may not be the drug itself but the idea that some people in pain have that they can avoid pain completely. This isnt always the case when you are on these types of medication. You can control pain, you can moderate pain. But if you think that if I take a pill or two extra it will get rid of it altogether you are on a slippery slope. My brother tried that, he ended up taking more and more pills because over time your body starts resisting them. Thats where the danger lies. You take so many that you end up killing yourself by overdose, like my brother did at 36.
I trust Microsoft as far as I could comfortably spit a dead rat
I think that has to do more with its use as a heroin replacement for addicts than its use as a painkiller...
10 PRINT CHR$(205.5+RND(1)); : GOTO 10
The key point of the linked article was not that those who were given the drug overdose because they have less education and cannot read the medical instructions, but that they are given the drug because it all they can afford given the status of their medicare. Poverty does not discriminate between those who are educated and those who are not. We shouldn't blame the victim, blame the doctors and the insurance companies.
Here in the UK Methadone has been used as a heroin substitute for some years. It's considered to be more addictive than heroin but of predictable quality and supply, hence its use.
The glaringly obvious solution of the State control and supply of heroin to addicts is apparently beyond those who make such decisions. Far better to throw money up the wall buying a substitute and then pretend you're handing out medicine.
...is more of this. Republicans want to turn Medicaid into a block grant program to states, with eroding value because payments won't keep up with inflation. States, squeezed to do more with less, will continue to do the cheap thing instead of the right thing for the poorest, most vulnerable (those with no cash to buy influence), and the poor will suffer and die in a greater and growing proportion to the rest of us.
They'll do the same thing to Medicare. So keep it up, poor and middle class, keep voting directly against your own economic interests, and watch your mortality rates soar.
I heard that the Nazis developed methadone because they wanted a pain killer that wouldn't be as addictive as other opiates.
They figured that if they made the side effects sufficiently horrible, people wouldn't get addicted to it.
How wrong they were...
In the free world the media isn't government run; the government is media run.
And, what's more, there are pieces of shit who advocate even canceling what little we give to the unfortunate.
figures why the world is STILL deep in shit in godfrigging 21st century.
Read radical news here
With a skilled doctor and a well-instructed patient, Methadone is a perfectly legitimate and normal Opioid pain reliever. The longer effects of the drug (vs. other options) mean the level in the bloodstream stays more level. Yes, if the patient cannot follow instructions, or the doctor is not aware of how Methadone is metabolized in the body, this can be harmful; there are tradeoffs with almost any drug. You can hardly blame the drug if the doctor ignores the prescribing information or the patient doesn't properly taper off of other painkillers while starting up the Methadone.
About 10 years ago my knees started hurting and they never stopped and I've been to doctors around the globe pretty much and nobody can identify why I have this pain. I tried a few types of medication and realized that I can't live my life on drugs, so I learned to live with the pain, I just learned not to pay attention. I tell you what, if you want to get your ass kicked by somebody who doesn't care about pain anymore, talk to me, I'll arrange it in a hurry.
You can't handle the truth.
Washington State is controlled by Democrats. The majority of both houses of the legislature there are Democrats, as is the current governor and the last two governors before her. I expect, though, that you're too busy hating Republicans to recognize the Democrats are no different.
Space game using normal deck of cards: http://BattleCards.org
Doctors are overpaid
Can we please stop this shit? Blaming doctors doesn't help you, and they are generally not overpaid. For the length and stress of their training, the debt they incur, and the difficult lifestyle many specialties must endure permanently, most doctors are actually underpaid - in overall salary, in compensation per hour, or both.
I know primary care physicians who've been forced quit the business after 30 years and had to go work somewhere else. How does a doctor who can't afford to be a doctor, and doesn't have enough savings to retire after 30 years, fit with your ignorant screed that doctors are overpaid?
I also know surgeons, many of whom do make $300,000 a year, and I've never seen one of them sit still for more than 15 minutes, to watch a movie or lecture, without passing out. They work a minimum of 60 hours a week and constantly get paged for surgery in the middle of the night, whether or not they're actually 'on call'.
So many types of doctor make so little that people are quitting left and right, while med students refuse to even consider the specialty, and many other types work so many hours with such a poor quality of life that their compensation per hour (not to mention per 3 am emergency call) makes engineering and business look like much better careers.
Many doctors are underpaid; many others are overpaid but massively overworked and overstressed. The cross-section of doctors who are both overpaid and live comfortable lifestyles is much, much smaller than you think.
Methadone's pharmacokinetics give it a long half-life, and therefore a long duration of action. This is an asset in managing chronic pain from cancer and some other diseases. Methadone has much less tendency to lose its analgesic effect through habituation. Morphine, for example, while an effective pain reliever due to its action on the mu-opioid receptor, has a metabolite that acutally upregulates perception of pain due to action on the NMDA system. This latter effect probably accounts for most of the often-observed dose escalation needed to maintain effective analgesia in patients treated with morphine. The primary danger of methadone is that physicians who are unaware of its comparitively slow pharmacokinetics overdose their patients because they escalate the dose too fast. It is critical to make changes (either increase or decrease) in methadone dosage *slowly* - when that is done, the drug can provide chronic pain relief with a much better combination of safety and long-term effectiveness than many of the other opiates. As always, ignorance seems to be the most deadly disease.
IIRC Heroin was developed as a less addictive substitute for morphine. The history of opioid development is amusing in a macabre fashion.
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CINC, 4th Penguin Legion
I can't believe the number of comments here about doctors being assholes, overpaid, incompetent, etc. You ungrateful, ignorant people need to wake up and realize that doctors are just as miserable under this system as the rest of you.
First, doctors hate the most expensive parts of medicine even more than you do; they'd be ecstatic to see that business go away. Patients incur as much as half of their lifetime medical costs in the last six months or year of their life. Doctors who know it's simply time for someone to die are forced to keep them alive for a few last weeks or months by whining families who can't accept death and by stupid laws that require extreme intervention to the very end. Many people won't sign DNR orders until they've already hung on far too long, if ever; the families rarely sign them for someone too far gone to sign themselves. It's gotten so bad there's even a phenomenon called the Silent Code, when the physician running an emergency resuscitation tacitly lets a terminal and hopeless patient slip away; they walk the line between honoring laws / families' wishes and the Hippocratic duty to do no harm by not prolonging suffering. Most doctors wish that palliative care and letting people go at their time could be official; a significant minority favor outright assisted suicide. Those brave enough to take some action now do things like silent codes. How does risking your license and reducing your billable hours by letting a patient die display the kind of greedy, insensitive behavior you people seem to think almost all doctors display?
And as for the money, doctors as a whole are not overpaid; doctors may average almost $200,000 a year, and the existence of specialist surgeons who make $700,000 a year makes it easy to assume they're all overpaid, but a complete statistical look at doctor's salaries - one that includes median, mode, and spread indicators- will tell you that the typical salary is pretty fair for a field that involves a minimum of 11 years higher education (often stretching past 15), $150,000+ in educational debt, and usually takes a lot more than 40 hours a week.
So some doctors are overpaid, and some doctors are callous. Show me a profession with neither of those problems. The majority of doctors are paid no more than a fair wage (or even not enough), care deeply about their patients, hate the waste and legal bullshit of medicine much more than you do, and are really tired of taking shit from people who think they like the system this way or got into medicine for the money.
The longer you assholes complain about doctors being stupid or only caring about money, the more stupid pricks who only care about the money will be the only ones willing to go to medical school. That's already starting, in my opinion. Enjoy reaping what you've sown.
In terms of pharmacodynamics, methadone is a garden variety opiate. It has two major distinctions: it has good oral bioavailability, and it is long-acting (i.e. it has slow pharmacokinetics). These are major advantages for people with chronic pain. Morphine has poor oral activity, and also wears off fast. This makes it good for intravenous infusion in a hospital setting, but terrible for patients with severe chronic pain. One aspect of opiate analgesia is that once the pain "breaks through," it is hard to knock it down again. Opiates work best for pain relief if blood levels are kept reasonably constant. So with a short acting opiate, patients have to be constantly popping pills. A long-acting opiate makes it possible for a patient with chronic pain to live something approaching a normal life.
Respiratory depression by opiates tracks very well with pain relief, so it is not plausible that the respiratory depression would greatly outlast the pain relief, as claimed in the article. Moreover, we have a huge amount of experience with methadone, because it is widely used for opiate maintenance in opiate addicts. Opiate addicts take methadone under supervision, so they can't escalate their doses. So we know that when methadone is taken as prescribed on a regular basis, it is safe and effective, and toxic levels do not build up in the body.
I think that this is a problem of poor patient and physician education and poor choices by physicians in prescribing a long-acting drug to patients who don't really understand what that means. The average patient has no experience with long-acting pain relievers, because all of the commonly used medications such as hydrocodone are short-acting. The pain relief of a long-acting opiate lasts a long time, but it is also slow in onset. This is an unavoidable aspect of the pharmacokinetics of long-acting drugs. That means that you can't wait until you start hurting, then take a methadone pill and expect the pain to go away in under an hour, as with short-acting drugs. It will take days for the pain relief from methadone to build up to its full level. A patient who doesn't understand this is likely to think, "It isn't working," and take more than the prescribed dose--and then when it does build up, they end up in respiratory depression.
There is no way to have a long acting opiate pain killer drug that does not carry the same risk as methadone. The same hazards apply to oxycontin (which is a time-release formulation of a short-acting opiate, oxycodone).
So the patient needs to be told in no uncertain terms, "This isn't a drug where you can wait until you start hurting and then take a pill. It won't work, and it is dangerous to take it that way. You must take it on schedule, every day. You can't take extra even if you are hurting. If you miss a pill, don't take extra to make up. If you take more than the prescribed dose, or take it more often than prescribed, you may DIE." And the doctor needs to be absolutely certain that the patient understands this and is capable of complying. If not (or if there is not a reliable care-giver capable of controlling dosing), then the patient should be prescribed a short-acting narcotic (although this carries its own, different risks).
That and patients don't understand methadone kinetics (not too surprising). There is a tendency to 1) take extra doses to help dull the pain (or deal with withdrawal issues) and 2) medicate with something else. Typically the something else is alcohol. The combination of alcohol and methadone is especially dangerous. Two potent respiratory depressants with very different kinetics.
Methadone is the poster child for all that is screwed up with pain control and addiction in this country. As usual, it is popular to shoot the 'messenger'. Until the ability to deal with narcotic addiction is wrestled away from the DEA and until patients in general feel like their problem is more of a medical one than a legal one it's just going to get worse. As an ER doc, I'm seeing methadone in a lot of urine drug screens these days. Talking to patients (the ones that will talk, anyway) they are mostly taking it to deal with withdrawal symptoms when they can't get their drug of choice. Of course, that leads them to manage their problem on their own with a very dangerous drug. Not a terribly safe nor effective combination.
Faster! Faster! Faster would be better!
Your signature could not be more perfect.
Karnal
Forgive the posting of AC, but Methadone is a wonder drug for those that take it as prescribed. I had never thought of it as a pain reliever and was leary of taking it because of societys label on it. But it does what other pain killers wont. It has allowed me to live a prety normal life. I take twenty mg morning noon and night. I had been on percocet for 10+ years for back injuries from jobs I have had. Percocet is "a hella of a drug" I hated how badly I LOVED it, and couldn't be without it, the high, the relieff of pain. All of it. Methadone just dulls the pain. No HIGH!!!! I LOVE it. I am not stoned all day long, I can live a normal life without nodding off all day long. Even on it I still feel my spine acting like a jackhammer into my ass. But it is liveable on the drug. We went slow. I went from 5mg three times a day for a year to the 10mg three times a day. It is a good tool when used properly.
Eating food induces feelings, not sleeping induces feelings, absorbing the suns rays induces feelings. There are many ways to alter state, this is not a wrong or bad thing. Trying to ESCAPE from bad feelings using a substance is the unhealthy part of the activity, be it food, chemicals, drink etc. You might want to be careful up on that high horse of yours....
Good-bye
So, why doesn't he keep the shit in a safe then?
For large sets, this will be our guide even unto death, for the LORD will work for each type of data it is applied to...
Not only do the kinetics exhibit a long half-life, the actual half life has been shown to be poorly characterized in clinical trials and even seems to vary over the course of treatment. There are also issues with drug-drug interactions with hepatic and intestinal CPY450 isoenzymes. Methadone is a drug that really needs to have regular clinician follow-up and extensive patient education about the nature of the drug and which drugs to avoid using concomitantly. It's a good (and cheap) drug, but it needs to be use intelligently or it loses that cheap characteristic -- death is not cheap as an outcome measure.
the most potent destroyer of freedom in the entire history of mankind, by orders of magnitude, is no government, it is drug addiction
there is no stronger bars that the most depraved government can build then the bars the drug addiction place in your mind. a constant interrupt switch "get high... get high... get high" makes unable to work, maintain a relationship, think thoughts of philosophy, art, design, anything deep because of the pain of withdrawal
and this is the real story of the history of opium addiction, and "little or no social problems" from 100 years ago, you idiot:
http://opioids.com/opium/opiumwar.html
drug addiction as a tool to destroy a society you want to subjugate
i understand that people here detest government regulations and impositions on human freedoms. but why that means we have to accept a far worse form of freedom destruction, drug addiction, is beyond my understanding
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
That and patients don't understand methadone kinetics (not too surprising). There is a tendency to 1) take extra doses to help dull the pain (or deal with withdrawal issues) and 2) medicate with something else. Typically the something else is alcohol.
As someone who has dealt with severe pain from an accident before, I think the tendency to take extra doses or self-medicate with alcohol as well is understandable. When the pain is so strong that it cuts through everything else, the risk of death seems a small price to pay to dull the pain. I'm not exaggerating. If you're in enough pain, rational thought goes out the window.
More effective pain treatment options would probably prevent some of these deaths. Perhaps we should be less concerned about addicts pill seeking, and more concerned about pain management.
taking care of unfortunate people should be 'voluntary' in freaking 21st century. opting in the capitalist system is not voluntary, but, fixing its ills, is. how ironic.
if you are living IN a society, you have obligations. if you want to live with the exquisitely complex and intricate philosophy of 'me me me, my my my, self self self, myself', then go live on a mountain top.
what provided you with the living standards that separates you from the caveman living in a cave, has been the society. and NO - it was not capitalism. technology and living standards have been developing all throughout history.
so either learn up, or shut the hell up. dont recite a mindset that was 'new' 200 years ago.
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I'll go with the more generic Chemical Brothers
For justice, we must go to Don Corleone
There is a "war" on drugs because there are too many inhuman assholes like you in society who cares about nobody but themselves.
If Google really cared they would fix Android Chrome to reflow text, instead of discriminating
Why is this here? What geek appeal does this have? Remember when we used to talk about things like beowulf clusters of things, or that BSD was dying, or the SCO vs Linux lawsuit? Why is this here and why is Kim Song Ils death worthy of note here? Do slashdot editors think that we read nothing else? Or is it just a slow news days in the tech geek world?
Putting it in a safe wont stop a determined criminal. Just like the common Slashdot aphorism that the most powerful encryption can often be defeated by a $5 wrench in a back alley.
sig? uhh, umm, ok