More than a third of US adults prescribed opioids in 2015

WOW!!!   :   [

Compare to SOMA in Brave New World.  Also see articles and quotes at the end of this blog to verify that in the not too distant past, this guess would have been more or less correct.  Also note that this is a distinctively “American problem”.

Richard Waguespack  August 1 at 10:17pm ·

I find this very hard to believe – My guess would be 12-15 percent tops and as low as 6-7 percent. Any insight about the validity of this article?

More than a third of US adults prescribed opioids in 2015
By Andrew M. Seaman Reuters Health – The United States needs to curb excessive opioid prescribing and improve access to pain management techniques, suggests a new government study. “A very large… ca.news.yahoo.com

Keith LePage

Looks like a real journal. http://annals.org/…/prescription-opioid-use-among-u-s…

Prescription Opioid Use Among U.S. Adults: Our Brave New World | Annals of Internal Medicine | American College of Physicians
Acknowledgment: The author thanks Maxim D. Shrayer, PhD, and Robert H. Fletcher, MD, MSc, for reviewing earlier drafts of this manuscript.
annals.org  August 1 at 10:38pm

Richard Waguespack

I guess there are several different definitions of opioids. August 1 at 10:54pm

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Keith LePage

The prototypical opioid is morphine. However, any compound that interacts with one of the opioid receptors, and produces a morphine-like effect is considered an opioid. For example Dextromethorphin, which is contained in many cough syrups, is a dextrorotary opioid. August 1 at 11:06pm

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Keith LePage

Of course the primary target of the Dextrophin, metabolic product of Dextromethorphan is the NMDA receptor and is called a dissociative analgesic. August 1 at 11:12pm

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Richard Waguespack

For several years in private practice in SC I treated a number of patients with dissociative disorders. I thought giving medication of almost any kind blunted the effect of the abreactive therapy and made it take much longer to bring about integrations.  August 1 at 11:21pm

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Richard Waguespack

Why do they refer to dextroamphetamine as a dissociative analgesic? August 1 at 11:25pm

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Keith LePage

There are four classed of opioid receptors;mu, kappa, delta and NOR. A fifth, zeta, was proposed several years ago, but was found to share very little homology with any other OR. There a number of subtypes in each class.  August 2 at 8:27am

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Keith LePage

A dissociative analgesic (Dextroamphetamine, PCP, Ketamine) induces memory loss. This effect is likely due to high density of NMDA receptors (the high affinity binding site for these compounds) found in the hippocampus. Blockade of NMDARs inhibits short-term memory. Dextroamphetamine is an amphetamine and to my knowledge is not considered a dissociative analgesic.  August 2 at 8:35am

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Richard Waguespack

Thanks. Anything affecting memory, especially long term memory would present major obstacles for therapy focused on dissociative disorders. Yet, I bet there are physicians prescribing such medication to people with dissociative disorders because they did not even recognize them or believe in them or care… they treat symptoms in a superficial way… it may be getting better these days with more education.  August 2 at 11:54am

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Keith LePage

Unfortunately, the inappropriate use pharmaceutics in the treatment of dissociative disorders is still widespread.  Amphetamines are often viewed as “genius” drugs that enhance learning and memory. While there is evidence that such drugs enhance learning, the therapeutic window is narrow and the abuse potential is high. August 2 at 12:09pm

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Richard Waguespack

Morphine is considered an opiate, right?… close to the original chemical formula of secretion from opiate bulbs. August 1 at 11:27pm

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Keith LePage

Yes. Morphine is considered the prototypical opioid. Morphine was originally thought to be a good tool to combat opium addition. Heroin was once thought to be the cure for morphine addiction. Methadone is……. Well you get the idea. Substituting one opioid derivative another addictive opioid has not been a particularly successful strategy. August 2 at 12:09pm

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Richard Waguespack

The way I see it, Methadone is true synthetic and Morphine is an opiate… right… (?) the “prototypical” is the chemical structure model for synthetics to fit into…  August 2 at 12:32pm

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Keith LePage

There are many synthetic opioids such Hydromorphine, Demerol, Fentanyl, Diluadid etc. They nomenclature is based on the structure from which they have been derived from. August 2 at 12:34pm

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Keith LePage

I spend a good bit of time evaluating novel synthetic opioids. The goal was to develop compounds with less likely to cause dependence while maintaining the analgesic benefits.  August 2 at 12:37pm

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Richard Waguespack

Better to be on Methadone (or other more advanced synthetics as you mention), even though it may hurt a bit because addicts do very bad things when their supply runs out.  Methadone has little high and creates some basis of stability. I think detox centers need to find ways of moving people off methadone with higher success rates with little recidivism… but since it depends on willpower and character in short supply with most addicts, we have a problem, a human rather than a chemical problem, primarily – there must be a law of diminishing return in improving synthetics. You should mean “synthetic opiates”…right??… I think this definition offers a more contained representation — these days opioid is too broad with more license to move away from the original prototype as you say… a ‘synthetic of a synthetic’? If we have synthetic opioids then we are really in trouble because maybe even Tylenol would fit the category, right…? I am exaggerating for the sake of discussion…do you agree with my take here?  August 2 at 12:48pm

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Keith LePage

Acetaminophen may act on TPRV1 and endogenous cannabanoid pathways. I am unaware of any activity at any of the opioid receptors. The date is incomplete. Actually, I believe most of today’s abuse is tied to synthetics such as Oxycontin, Dilaudid, Fentanyl and so on. Just fyi, most pharmacologists steer clear of the word “addiction”. Dependence is a more accurate term when discussing biological activity.  Addiction is more of a psychological state that my very well include dependence on some drug.
August 2 at 12:49pm

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Richard Waguespack

It would be better to have conversations like this on beingbecoming.us or waguespack-seminars.org Wish I had thought of that.  August 2 at 12:50pm (Edited August 13 at 10:07am)

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Keith LePage

Feel free to copy to your page.  August 2 at 12:50pm

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Richard Waguespack

I might edit a little and put in a blog and put your picture on the bottom with a description and then invite others from around the world to comment. I will put a google translator on the page.  August 2 at 12:52pm

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Keith LePage

Sounds good. Pays to keep the old noggin in action.  August 2 at 12:53pm

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Keith LePage

Do you own a copy of Goodman and Gilman? August 2 at 12:54pm

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Richard Waguespack

No question… use or lose…. please comment on the conceptual issue I brought up… August 2 at 12:54pm  (Edited August 13 at 10:13am)

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Richard Waguespack

I have Psychopharmacology: Straight Talk on Mental Health Medications by Joe Wegmann, RPh, LCSW. He is a pharmacist and clinical social worker like me. How good are Goodman and Gilman in balancing and supplementing and withholding medication interventions in reference to the other treatments available? August 2 at 12:59pm

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Richard Waguespack

Like psychotherapy.  A medical malpractice attorney I know should take note… the new normal for physicians it to refer for such treatments and recognize the limitations of what they may be attempting. August 2 at 1:00pm

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Keith LePage

G&G is the “gold standard” for describing the physiological actions of therapeutics.  August 2 at 12:59pm

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Richard Waguespack

: ] In what phenomenological background? Meds and organicity only? August 2 at 1:00pm

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Richard Waguespack

Of course, this term “organicity” as I mention in first chapter of my forthcoming book Being Becoming: Integrative Theory has undergone many changes… and in terms of interventions may require a much broader synthesis… August 2 at 1:02pm

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Richard Waguespack

I hope you will see fit to endorse… August 2 at 1:02pm

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Keith LePage

It is a reference material that describes the pharmacology of a therapeutic (site of action, pharmacokinetics, structure etc). I would think it would be a valuable resource to anyone seeking to describe medicinal interventions. August 2 at 1:04pm

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Richard Waguespack

I can send you a fairly advanced draft for your comments, especially on first chapter “Re-Framed Physiology”.  August 2 at 1:05pm

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Keith LePage

I would be happy to review portions in which I have some expertise. Remember that I am not a clinician.  August 2 at 1:06pm

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Richard Waguespack okay… thanks…August 2 at 1:07pm

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Keith LePage

Have to run. Good talk, Richard.  August 2 at 1:07pm

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Janice Cooper Beard

I can believe this. I had two surgeries in the last year and both times the doctor insisted I leave with a script for one, even with my stating I did not want or need one. when I was being discharged a few weeks ago, the NP asked what level my pain was, I told her zero. She said I had to have a pain script to leave the hospital. My discharge papers said my pain was a level 3! I guess that was to justify pain script…August 2 at 11:08pm

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Richard Waguespack

I find it a good practice to fill the prescription and keep it in the medicine cabinet for those really bad days when an aspirin or Tylenol or Motrin just does not do enough… They should be the furthest thing from one/s mind +/- 340 days out of the year… Maybe our supreme academic pharmacist Keith will have a comment.   August 2 at 11:13pm

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Janice Cooper Beard (Retired Math Teacher, Meridian MS Public Schools)

Richard Waguespack scripts are still on my desk…..I just don’t take them. If I am in enough pain, I will give myself a toradol injection. August 3 at 12:14am

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Keith LePage Pharmacologist.

Richard Waguespack  I agree with you, Richard. The prudent use of pain meds is fine. If pain continues to require the use of pain medication for more than 5 – 7 days one should contact one’s physician. The potential for abuse, and subsequent dependence, associated with pain medication is great and trained supervision of their use is critical. I would also caution people to keep such drugs in a private and secure location. Particularly if other people have access to your medicine cabinet.  August 3 at 8:59am

Conclusion of FB Dialog which ends here.  HOWEVER IT MAY CONTINUE ON THIS SITE!!!        :   ]

See Postscripts Below for future discussions.  August 13 10:29am

 According to Here are 10 opiate addiction statistics in the making : 

“Between the years 1999 and 2010, sales for prescription painkillers to hospitals, doctors and pharmacies increased fourfold. By 2010, the number of pain medications prescribed was enough to keep every single American medicated for one month’s time.”

“Since 1999, the number of overdose deaths from pain medications has increased by 300 percent. In 2008, opiate addiction statistics deaths resulting from prescription pain meds totaled 14,800. This number amounts to over and above the combined total for heroin and cocaine-related deaths.”

Supplemental Note:  According to CDC Centers for Disease Control and Prevention, The amount of opioids prescribed per person was three times higher in 2015 than in 1999.  [180 MME to 640 MME].  Further, “a dose of 50 MME or more per day, doubles the risk of opioid overdose death, compared to 20 MME or less per day.  At 90 MME or more, the risk increases 10 times.

Final Note: One must wonder if other drugs such as Benzodiazepines are included or excluded from these statistics.  What is the difference between pain and antianxiety medications in the minds of statisticians?  What are some statistical blind spots that may mask our country’s drug crisis?  What can we do about such issues?

This commentary is not to be construed as individual medical advise.  Please consult with your own personal physician(s) or other authorized health professional(s).