The realities of opiate pain killers

http://www.emeraldcoastpain.com/wordpress/wordpress/2014/12/04/the-realities-of-opiate-pain-killers/

Similarly, efforts to curb prescription painkiller abuse — for example, creating “abuse-deterrent” capsules — don’t seem to be as effective as hoped. “Making pills harder to crush and snort doesn’t make them less addictive,” says Kolodny…

Doctors were told that these patients didn’t face a high risk of addiction, “since the maker of Oxycontin saw a fear of addiction as a barrier to sales,” he says.

Actually, chronic pain patients don’t face a high risk of addiction. In fact, addiction rates for any drug are not high compared to the rest of the population — except in the case of cigarettes and alcohol, of course.

And Kolodny, didn’t you sell buprenorphine in the same ways?  (See Wired article from 2005.)

(April 2005) The Bitter Pill

http://archive.wired.com/wired/archive/13.04/bupe.html

“We’re doing all the work for the drug company,” Sederer says laughing. “Here you have a couple of psychiatrists launching a marketing campaign!”

Kolodny reminds his colleagues of the drug’s advantages. He stresses that bupe in the form of Suboxone is safe and almost impossible to abuse, a huge selling point at many of the clinics they will visit…

Sounds like Big Pharma selling opioids… And I believe they got in trouble for that.

Until the early 20th century, you could order just about any narcotic you wanted from the Sears, Roebuck & Co. catalog: morphine, heroin, opium. But in 1914, Congress passed the Harrison Narcotic Act, barring doctors from prescribing opiates to known addicts…

Meanwhile, methadone regulations effectively ostracized addiction treatment from the medical mainstream. Most med schools leave it off the curriculum for all but psychiatry students, who get a mere four weeks of exposure. When young doctors train at big-city hospitals, most of their encounters with addicts are hard cases showing up in the ER in the middle of the night. “The top attendings make fun of them,” Salsitz says…

The doctors ask about side effects. Good news there. They ask whether it shows up on a drug screen (methadone does, so many people who might face a urine test at work avoid it). Nope, Kolodny says, a bupe patient’s urine tests negative – more good news. They ask about the potential for black-market dealing; inmates learn to hold their methadone in their throat, spit it back up, and sell the spit. That’s pretty much impossible, Kolodny says, to nods of approval. Will inmates be able to keep receiving bupe after they leave prison? Some, but not all, Kolodny says. That’s because of the nearly 300 doctors in New York licensed to prescribe bupe, only a handful will accept Medicaid, even though it covers the treatment.

I can see why bupe gained popularity in some circles…

On the drive back to his office downtown, Kolodny’s Treo rings twice, just minutes apart. Two more people looking for bupe treatment at his private practice…

12/17/2014, The doctors that prescribe the most painkillers

http://www.advisory.com/daily-briefing/2014/12/18/the-doctors-that-prescribe-the-most-painkillers

A 2011 report from the Government Accountability Office (GAO) raised similar concerns and called on Medicare regulators to do more to stop the over-prescription of addictive painkillers. Medicare officials responded by collecting data on doctors with suspect prescribing habits, and they will have the authority to use the data to disqualify doctors from participating in Medicare starting next year…

Andrew Kolodny, founder of Physicians for Responsible Opioid Prescribing, says the data show more needs to be done to regulate the prescription of controlled substances. Currently, “we wait ’till these doctors kill people … It doesn’t make any sense,” he says.

You know, Kolodny, doctors kill over 400,000 people every year with mistakes and errors — how come I never hear you complain about those doctors killing so many people?  And I’m confused, because sometimes you say stuff like:

“It’s not that doctors are intentionally causing an epidemic…”

http://consumer.healthday.com/mental-health-information-25/addiction-news-6/fatal-ods-from-narcotic-painkillers-have-tripled-in-u-s-694223.html

And other times, like now, you blame doctors and call them murderers. Considering the problems you’ve had with prescribing buprenorphine in your own practice, I’m wondering: How many of your own patients have tragically overdosed?  Do you understand that treating patients with chronic problems — like addiction and pain — means these doctors are treating a patient population with a higher likelihood of not only more medical problems, but a shorter life span?

Seriously, Mr. Kolodny, you’ve got some gall, calling other doctors murderers.  I’m just gonna say it… you’re an asshole.