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  #21  
Old 15 March 2017, 01:19 AM
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I'd be like "I agree. The government should pay for both. Mortality is a basic fact of life that affects everyone, regardless of virtue, exercise, or diet. A sensible healthcare policy acknowledges this"
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  #22  
Old 15 March 2017, 06:47 PM
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Ali Infree Ali Infree is offline
 
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I agree that medications that save lives should be freely available. With naxalone, the issue of cost keeps coming up, not just because the manufacturer is raising said cost.
Naxalone saves lives, although the increasing use of fentanyl means that this drug can't always make a difference. In Huntington WV, fentanyl caused 25 overdoses in a couple of hours, two people died despite the use of up to 7 doses of naxalone.
A couple of points in favor of using this drug to save lives. 1) Funerals cost much more. West Virginia has exhausted its state funds for funerals largely because of the rate of opioid deaths. I have helped a family get state help for a funeral in the past (so far in the past that the state would only pay $1000, not the $1250 in the link). It is a harsh transaction and more expensive than naxalone.
2) Families deal with these deaths from overdoses and abuse by telling stories. Twenty-two years ago, I buried my brother who drank himself to death. My parents never got over this, and my mom blamed my father for enabling my brother's death by regularly buying him cases of beer. My dad was trying to keep the peace in the household by supplying my brother with his needed substance. Many of these stories are corrosive in so many ways.
That cost is hard to calculate.

Ali
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  #23  
Old 20 March 2017, 04:29 PM
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Bumping this up to post this link.
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  #24  
Old 20 March 2017, 05:26 PM
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DawnStorm, that seems to me to have a potential huge market even aside from any potential abuse issues, just for people who have trouble remembering whether they've taken their pills.

Hey, if they're cheap enough, and the timer goes high enough, I might get one for the medication the dog takes only twice a week. I've been standing the bottle on its head for a day or so after use, but that only really works if I remember to put it right side up again before the day I need to use it.
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  #25  
Old 20 March 2017, 05:56 PM
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According to their website, it is designed for keeping track of when you took the med (or at least opened the bottle). So it could also prevent taking the meds too soon (forgetting that you did take it and then taking it again an our later, etc.)

Other than mistaken overdose, I do not see how this product would prevent intentional misuse of the medication. It does not lock or anything for the set number of hours. One way I could see is if it is a teen or child, the parent could see that the med was taken too early. Same with a spouse, etc. But this product does not stop an independent, unmonitored person from intentionally taking too much or too frequently.


Back to the OP, I missed it first time around. I think that except for on the margins, it will not cause more addiction. What I mean by margins is that, sure there is probably some teen or young adult somewhere who does not try drugs out of fear, and could be convinced to try it if their buddy said "I have this Narcan, so nothing will happen to you but even if it does I'm set." But I think that some policy makers have unrealistic views of young people. Overall it will help more people than not.

Your question brought to my mind immediately the debate/objection to the public health effort to give clean needles in Baltimore (I'm sure elsewhere)in the 1980's and 90's.

The pro was it would help reduce the spread of HIV, HepC, HepB to people who were already using IV drugs. The secondary pro was that it might bring some portion into other public health programs and even drug treatment.

If saving the person with addiction was not enough for you (not you, "you") then it also had the benefit of reducing the virus spread to to their sexual partners. And if that was not enough for you, it could even potentially reduce spread to newborns (mom doesn't get HIV, baby doesn't).

The cons were:
-Cost: Nothing is free of course, so it must have cost something. But "we" would be spending it on "those addicts."
-"We're enabling addicts."
-I don't recall, but I would think that someone would say it would make more people use of the needles were free. (They were not giving away heroin!). That is just ridiculous.
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  #26  
Old 20 March 2017, 10:48 PM
RichardM RichardM is offline
 
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On the subject of preventing/reducing opiod abuse, I saw in this morning that several states are considering bills that would allow a person to refuse being prescribed them for pain control. I'm not sure why such laws are required. I already refuse to get such prescriptions. Last April when I was in the ER getting my knee drained so I could walk, the doctor asked if I wanted something for the pain. I told him no, that I would just take ibiprophen. (sp) He just told me to take 3 200 mg tablets instead of the normal 2.
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  #27  
Old 20 March 2017, 11:54 PM
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I did the same with a broken bone a couple years ago. I had slept OK with some ibuprofen before admitting this wasn't just a sprain. (It was a tiny rural hospital and the doctor wasn't about to tell me what to do.) I regretted my decision a bit the next night - when the real pain came. Ow.

I agree patients should be allowed to refuse without any special laws. Still, it helps to have it in writing. So I think such laws are not necessarily a bad idea.
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  #28  
Old 21 March 2017, 12:14 AM
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I don't see how they're remotely necessary; it sounds as if at best they'd require additional recordkeeping on top of what must already be a huge amount of it. An adult of sound mind can always, already, refuse any medical treatment whatsoever. The most they can do is make you sign a form saying that you're going against medical advice.

And it's my impression that free needle dispensaries are still controversial; though I agree that they shouldn't be. -- I have a diabetic dog. Her insulin is OTC; but I need a prescription to get her insulin syringes. The only reason I can imagine for that is that New York State is trying to keep the syringes out of the hands of users of illegal drugs; which, of course, is only going to lead to their using and re-using whatever they can get. As an inability to legally obtain syringes clearly doesn't stop drug addiction, preventing people from buying them is only going to produce infected drug users instead of uninfected ones. I don't see how that's any improvement, myself.
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  #29  
Old 21 March 2017, 11:49 AM
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Quote:
Originally Posted by thorny locust View Post
I don't see how that's any improvement, myself.
I think the point of a lot of those laws is just punitive, or they are made by people who just don't get it. They cut HIV rates by about 20-40%, and increse the chances of people to get help.
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  #30  
Old 21 March 2017, 11:53 AM
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Quote:
Originally Posted by thorny locust View Post
I don't see how they're remotely necessary; it sounds as if at best they'd require additional recordkeeping on top of what must already be a huge amount of it.
I agree that they aren't necessary and shouldn't be. I don't know what kind of additional record keeping you mean. Maybe I misunderstand the laws; I can't imagine what that would be.
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  #31  
Old 21 March 2017, 11:58 AM
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It's at least one more thing to put in the chart.
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  #32  
Old 21 March 2017, 01:05 PM
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Quote:
Originally Posted by dfresh View Post
I think the point of a lot of those laws is just punitive, or they are made by people who just don't get it.
Among the things they just don't get is that infected people infect other people -- including people not in the category they're trying to punish.

They also apparently just don't get that not everyone who ever took an illegal drug is thenceforth entirely irredeemiable. Or else they're somehow under the delusion, despite all evidence, that the absence of an easily accessible stock of clean needles will stop people from taking drugs.
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  #33  
Old 21 March 2017, 01:08 PM
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Quote:
Originally Posted by Lainie View Post
It's at least one more thing to put in the chart.
Wouldn't they have to write that on the chart with or without explicit laws protecting that right? (ETA - Maybe I wasn't clear what I meant by "have it in writing". I just mean to have a written law, not that the doctor and patient would have to have something in writing.)

Last edited by ganzfeld; 21 March 2017 at 01:24 PM.
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  #34  
Old 21 March 2017, 02:30 PM
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I was just thinking that if you ever had to prove you gave your patients the right to refuse, you'd want to note it in their chart. I don't know that my doctor has always made a note when I've passed on pain meds.
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  #35  
Old 21 March 2017, 02:36 PM
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The point of a law specifically stating something that is already legal may be to make it clear to patients that they can do that and encourage them to do so.
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  #36  
Old 21 March 2017, 02:59 PM
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I need to stay out of the debate on this, but factually/from experience I will say that patients can refuse any treatment or request alternatives, but having this in a law would make it more clear as GenYus said.

My guess is that although the laws do not require a written consent- it is an advanced directive type thing to refuse it, but specific consent is not needed (currently the medications would be included by implication in the general consent to treatment)- that hospitals and health systems will move toward having a consent or refusal for everyone so that the hospitals can reduce mistakes and liability from someone not wanting the med but not having the form signed. If someone does not have the opt-out signed, you don't know for certain if that is because it was misplaced, not signed yet, or that they do not want to opt-out. Bottom line (my guess) is that patients will be asked to in writing express their decision either way- similar to how you are asked to sign an advanced directive when you are admitted to a hospital, even if you do want all care in all situations. They could put the opiods as a check box choice on the general admission consent so not need a separate form necessarily.

Anyway, here is an article about the laws and the rational of those proposing them:

http://bigstory.ap.org/article/23d5e...-prescriptions
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