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Old 31 August 2017, 04:32 PM
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erwins erwins is offline
Join Date: 04 April 2006
Location: Portland, OR
Posts: 12,366

That's still a big increase, even with the population increase. And when the point is that large numbers of people are dying, and we should do something about it, using the rate would miss the point. It's the numbers that matter. And I do agree that they matter, and that we should try to prevent most of those deaths.

But I also think this issue is complicated. Because, for example, during the period before the recent more liberal prescribing trend, even patients with near-term terminal illnesses who were in severe pain had trouble getting sufficient pain medication to manage their pain. They were subject to the same kinds of controls that are meant to prevent addiction from long-term use of Rx opioids, or were kept on lower doses than would control their pain because higher doses might hasten their deaths.

Similarly, there are some kinds of chronic pain where addiction to opioids might be an acceptable risk, or even an acceptable side effect. I spent a weekend with an irritated trigeminal nerve due to a dental abscess. I took the maximum dose of my Rx pain meds on schedule for the entire weekend. (I've never before or since taken the maximum dose, or probably more than 3 doses in a row.)

I was able to cope in part because I knew it was being caused by something that would be treated on Monday. Still, it was an indescribably horrifying weekend. Frequently, for people who have chronic trigeminal neuralgia, the alternative to effective pain management -- if surgery is not successful -- is suicide. It's nicknamed "the suicide disease." And I can understand why. (I did not have suicidal thoughts, but I did have some very disturbing recurrent thoughts of pulling my own tooth.)

Comparing numbers from a more tightly controlled time to a more liberal prescribing period isn't as simple as saying that controlling Rx numbers would prevent x number of opioid-caused deaths. Because it might just mean that some people would die in more pain.
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