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Archive for the ‘Read the directions’ Category

Friend of mine returned to the gym after about a week and a half away. Since it was too short a time for a vacation, I asked where he’d been. He said that he had some minor day surgery, but it was enough to keep him away from the gym for a while. Then his face took on a funny look, and he asked, “You know what those bastards gave me.” Any number of things came to mind but not wanting to appear any more stupid that I already am, I answered no. “They gave me a prescription for 20 oxycodone pills.” It didn’t surprise me that Pete was upset since I’ve had similar experiences.

According to the Substance Abuse and Mental Health Services Administration (ASAM), drug overdose is the number one cause of accidental deaths in America. There were 47,055 lethal drug overdoses in 2014 and that number is continuing to grow. Of those deaths, nearly 19,000 were related to prescription pain relievers. To give you an idea of how fast this epidemic is growing, “…the overdose death rate in 2008 was nearly four times the 1999 rate; sales of prescription pain relievers in 2010 was four times those in 1999; and the substance use disorder treatment admission rate in 2009 was six times the 1999 rate. In 2014, 467,000 adolescents – those 12 to 17 years old – were current nonmedical users of pain reliever with 168,000 having an addiction to prescription pain relievers.” 1

When you are recovering from surgery, and you know this as well as I, there is often pain involved. That wonderful ‘kickipoo joy juice’ they give you to knock you out is great stuff, and if you’re having what I call “laundry service surgery,” that is, in by nine and out before five, the drugs in your system are probably still dulling the pain. Once the Versed and whatever else is in your system wears off, you hurt. How much you hurt depends a great deal (a) on what was done, and (b) your tolerance for pain. In all probability, you will receive, with your discharge directions, a prescription for some kind of pain relief. All too often, that prescription drug will be an opioid. “Opioids are a class of drugs that include the illicit heroin as well as the licit prescription pain relievers, oxycodone, hydrocodone, codeine, morphine, fentanyl, and others.”1

In an article by Dr. Celine Grounder, a public health specialist and a medical journalist, she asks the question, “How did doctors, who pledge to do no harm, let the use of prescription narcotics get so out of hand?” Would that there were some simple answers. One reason is because an article that was written for Pain and a letter sent to The New England Journal of Medicine. In both cases it was suggested that opioids/narcotics could be safely used to treat non-cancer patients on what seems to be a longer term basis with little concern for addictive behavior. That opened the flood gates for pharmaceutical manufacturers of these narcotics to market their products aggressively for other kinds of pain. In other words, it became open season to create a new group of drug addicts…and it was all legal.

In doing some research for this essay, I came across one article which indicated that “A recent review of medical studies showed that addiction to narcotic pain medications exists, but is not too common. On average, only about 4.5% of patients using narcotic pain relievers developed an addiction to narcotic pain medication!” I really wanted to ask the author to which medical studies he was referring and also to ask what rock he’s been living under for the past decade. Every day, about 60 people die from opioid overdose; 44 of those are from painkillers and 16 are from heroin.

Why do I keep mentioning heroin? We all know it’s an illegal drug, but as I said above, it is one short step away from many of the legal pain relievers prescribed by physicians. In a 2014 survey of people in treatment for opioid addiction, ninety-four percent said they chose to use heroin because prescription opioid prescriptions were ‘far more expensive and harder to obtain.’”2 Dr. Andrew Kolodny, executive director of Physicians for Responsible Opioid Prescribing (PROP) maintains that the pharmaceutical industry misled the medical community about the safety of opioids beginning around 1996. He believes that this led to a tremendous overprescribing of oxycodone and hydrocodone. In a speech given last September, he told the audience, “These two chemical alterations of opium are so similar to heroin they should be called ‘heroin pills.’”

Pete’s wife filled his prescription. He told me that because he has young kids and didn’t want that $**t around, he took them to the police station. I have to admit that my bottle is still in a cabinet but we don’t have callers so I’m not too concerned.

There’s no question that we have an opioid epidemic in this country. It will continue to result in more and more overdoses until such time as pharmaceutical companies are forced by law to chemically alter their “heroin pills” to reduce potential addiction. In addition, doctors should consider the patient and the potential consequences before so easily prescribing opioids. However, the most important person here is the patient. Yes, there are times when surgical pain can be tough and require medication, but does it really require something that could hook and then kill you?

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  1. Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (2015). Behavioral health trends in the United States: Results from the 2014 National Survey on Drug Use and Health. Rockville, MD: Substance Abuse and Mental Health Services Administration.
  2. Cicero TJ, Ellis MS, Surratt HL, Kurtz SP. The changing face of heroin use in the United States: a retrospective analysis of the past 50 years. JAMA Psychiatry. 2014:71(7):821-i826

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On prior occasions, I have spoken at length (a) about the number of prescription and non-prescription medications that are my daily fare, and (b) about the warnings that generally take up one or two pages of small type which I am expected to read and understand. In the information booklet of one product on drugstore shelves is this warning: “Do not use if you cannot see clearly to read the information in the information booklet.” They’re kidding, right? No, they are not! Perfect eyesight is not actually a prerequisite for reading these pages…a 50 to 100 power magnifying glass will do quite nicely, thank you very much! If you don’t believe me, go to your local drug store – not dealer, store – and pick up a bottle of, hmm, okay a bottle of Aleve. Go ahead, I’ll wait…not all day, but I’ll wait.

See, see what I told you; the label unfolds and unfolds and the print is so damned small a Hobbit couldn’t read it. I don’t really know what that has to do with it, but you get the point. I don’t believe they actually mean that you should read the directions. They believe that if you watch enough television, you will see their ads where some poor schmuck gives up his Aleve for the day and is in agony by the time he or she gets home. Are they nuts? What person in his or her right mind would give up something that works for something that – for them – doesn’t? Whatever happened to ‘truth in advertising?’

But, enough about Aleve and its dreaded competitor, Tylenol, let us move on to some of the more idiotic warnings that one can read in various medical pamphlets. On the directions for a sun shield – you know; the thing that reflects sun from your windshield in the summer – “Do not drive with sun shield in place! Sounds pretty logical to me. I can’t say that there is anyone in my circle of people I know who would do such a thing but I suppose it is possible…no, it can’t be possible, but…it’s in the directions. Here’s one that you may find on a coffee cup: “Caution: Hot beverages are hot.” Well, duh, do ya think? Remember a while ago when airline pilots were complaining about people aiming laser pointers at them. Perhaps these are the same people who didn’t read this warning on their laser pointer: “Do not look into laser with remaining eye.” Hey, I don’t make these things up; I’m just saving you the time of not having to look these up on the web.

There is only one explanation for these warnings or instructions or whatever the hell you wish to call them. It’s called CYPA; it used to be called CYA, but some folks thought that a might extreme, so now we say, “cover your posterior area,” rather than “cover your ass.” It is, of course, conceivable that some people misinterpreted cover your ass with “throw a blanket over your donkey,” or even, “walk around with your hands violently clutching both butt cheeks; embarrassing, but…orders are orders.

This entire CYPA protocol is particularly evident in hospital pre-op rooms. If you haven’t been in one of these lately, count your blessings; if you have, you know exactly of which I’m speaking. There you are, laying on a bad with your butt exposed to cool [read “freezing”] sheets. The IV nurse has hooked you up to a bottle of saline solution and you’re just waiting to be wheeled in to have your head amputated or whatever. In walks the anesthesiologist or, if you remember M.A.S.H., the ‘gas passer.’ Just kidding, they don’t use gas anymore. He introduces him or herself and begins a long explanation of what is going to be used to put you to sleep. He – it’s a generic term – then goes on to explain precisely, damn near down to the last molecule, what the various drugs will do to or for you. They don’t give a damn about what you’d like to hear; they are required to tell you everything and more about the drugs will be using; it’s the law…to hell with the fact that the more this guy talks, the more you want to rip out the IV and head for the nearest door; he is required by OSHA or HIPPA or the YMCA or whoever, to impart this information to you. Here’s how you stop him. “Is there any anesthetic in my system right now?”

“Not yet but we’re going to…”  he begins

Cut him off. Do not let him get beyond the word, “to.”  You then ask, “Will you be using Versed?”

He will then begin with, “Yes, we will be using Versed, and…” If you allow him one syllable beyond “and,” you’re nuts! You don’t care to know what else they might use…unless, of course, you’re allergic to anesthetics; then you might let him prattle. In any other case, once he has said, “Versed,” let it go. You’ll be fine. Here comes the tricky part. Your anesthesiologist will now say something to the effect of this: “Just gonna give you a little something right now to relax you,” and he will inject some liquid into a port – it’s what they call it – in your IV. What this stuff is, I have never learned, but it is soooo gooood! It’s generally at this point that the surgeon comes in to explain the procedure. He or she waits until this kickipoo joy juice has been injected before stepping through the curtain. They always ask if you know who they are; it’s a standard procedure. I’m always tempted to say, “I’ve never seen this man before in my life,” but operating rooms run on a tight schedule, and one is only allowed to have so much fun. The last time this happened, my response was, “I do, but you’d better talk fast; this stuff is great!” That is the last thing I remember before waking up in recovery. In came the surgeon, still in his scrubs and began to explain what he did. Why do I care? It’s over; done with; we can’t take it back. All I want to hear is one of two words; ‘success’ or ‘failure.’ If it’s the first, we have nothing more about which to speak. If it’s the second, he’s not going to be going anywhere because my hands will be wrapped around his throat demanding an explanation…never really have had to do that.

I sort of got off track there, but back to the warning labels. Just remember a few common sense things: Batteries are not made to “explore” as the label on one indicates. Believe the stroller warning when it says “remove child from stroller before folding.” Don not use silly putty as earplugs…they tell you that although I’m quite certain that some child, somewhere, has already done it. And, by all means, obey the sign in the railroad station that says, “Beware! To touch these wires is instant death. Anyone found doing so will be prosecuted.” Wow, whoever heard of prosecuting a dean person? Yep, orders is orders; follow carefully!

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