Pain Meds

If there are 7.4 billion people on earth, and 324 million of them live in the United States, then the U.S. has 4.6% of the world’s population.  Why, then, do we take 80% of the world’s opioids?

Ever since the March 15 publication of CDC Guideline for Prescribing Opioids for Chronic Pain, the internet has been full of responses to those guidelines.  Some in favor, some against.  In general, it seems that those who take (or anticipate taking) pain medicine want easier access to pain meds, while those who aren’t in pain want to reduce the number of drug overdoses by reducing people’s access to prescription narcotics.

Those of us in Washington state have been thinking that the rest of the country doesn’t know how good they have it.  In Washington, doctors don’t have a lot of discretion.  The politicians have dictated how physicians are to practice medicine.  For patients wanting pain medication for chronic pain, consultation with a pain specialist is required by law.  Unfortunately, there aren’t enough pain specialists.  Monthly appointments get expensive – both in paying for the doctor, and in paying for the tests to prove you’re taking the medicine correctly.  Patients have told horror stories.  There’s the MS patient denied pain medicine.  And the patient whose cancer surgery caused nerve pain.

Reducing the number of deaths caused by opioid overdose is a noble goal.  I have dear family friends whose daughter-in-law died from an accidental pain medication overdose.  She had Raynauds and severe joint pain, but no rheumatologist, no arthritis diagnosis or treatment.  That is a tragedy.  Her primary physician prescribed pain medicine to reduce her pain and improve her quality of life.  She was a great wife and a great mom and the pain meds made the difference so that she could function.  One night she took her pain medicine like usual and went to bed.  The next morning she didn’t wake up.  Somehow she’d taken too much.  That single dosing accident means that her kids have no mom and her husband is raising their children alone.  The fact that she was not an addict won’t bring her back.

This is not a small problem.  We’re losing 11,000 people a year to prescription opioid overdoses.  Add to that all the ER visits for prescription overdoses that the person survives (420,000, but it isn’t clear what time period those numbers cover).  A recent study found that when opioids are prescribed for chronic pain, 1/550 people die of an overdose.  On average, this OD takes place 2.6 years from the first prescription.  The numbers get worse, though.  As tolerance builds and doses increase, those numbers climb.  At high doses, the OD death rate is 1/32!

What is the Solution?

I am sympathetic to those who see the death rate due to opioid overdose and want to reverse its upward trend.  When I started this post, I was in favor of the new guidelines.  The more I have learned, however, my position has changed.  Perhaps crusaders have the wrong target.


If we’re going to protect people from themselves, then why not go after the big offenders?  Car crashes kill three times as many people as opioid overdoses.  Alcohol abuse kills nearly seven times as many.  Cigarettes kill nearly half a million people every year.  Where is the outrage?

The fact is that prohibition didn’t work, and I don’t believe the new guidelines will work, either.  Do we want a free nation as envisioned by our forefathers, or do we want the government micromanaging our lives?  At some point, people need to take personal responsibility.

The key is personal responsibility.  As long as doctors can be sued when a patient dies after taking opioids differently than prescribed, doctors will remain reluctant to prescribe opioids for chronic pain patients.  Our current system isn’t working.  Patients who have a legitimate need for pain control can’t get it, but criminals who don’t care about the law have no trouble obtaining narcotics.  Something has to change.

I never thought I’d say this, but maybe the solution is to slap warning labels on the bottles and set opioids on the grocery store shelf next to the wine and whiskey.  Or put the drugs beside the cigarettes.  Chronic pain patients could choose between pain pills and other methods of pain management.  Hospital emergency departments would no longer have to deal with drug seekers.  Pharmacists would lose half their blog fodder.  People would no longer lose their homes due to medical bills incurred in an attempt to obtain pain relief.  I am sure that the death rate would climb, but the fault would rest squarely on the shoulders of the victim, more in line with alcohol and cigarette deaths.

Patients should still consult with physicians to learn about types of pain relief that would be good to try, but the doctor would no longer bear liability.  After that consultation, the patient could stop at the store to pick up the best medication given the situation, cutting out the insurance company.  Pain medicine would cost less and be more available.  Patients would no longer bear the financial expense of monthly doctor’s appointments and lab work.  No more time off work and loss of income due to travelling to/from those appointments.

At some point, we have to admit that the government nanny model doesn’t work.  Give people the tools to make decisions, then set them free.


See Also:

Sun Sensitivity

SunWarningAvoiding sun exposure — a requirement with certain prescriptions — presents a problem sometimes.  Since I normally burn in 15-20 minutes and am afraid to find out what a medicine that makes me more photosensitive would do, I usually use lots of sunscreen and stay out of the sun.  Sunscreen use is important, but not a cure-all for photosensitivity.  When outdoors, it’s important to find (or create) shade.

This past spring and summer I found avoiding the sun especially challenging since my boys played baseball. Outdoors. Every. Day.  High school baseball began in March and ran through mid-May, while community league for my younger son began in April with games in May and June, followed by five weeks of all-stars tournaments, culminating in July’s playoffs.  August saw even more time out in the sun after invitations to turn out for fall ball.  To avoid some serious photosensitivity rashes/blisters, watching my kids play baseball has required some creativity.

I present to you (drum roll…)

The Baseball Chair

Baseball Chair

Unlike commercial portable chairs, my awning extends out to the sides, in front, and behind for extra shade.  It has a flap to block evening sun from the back, as well as flaps that can hang down on the sides when needed.

I can’t tell you the number of parents who approached me and asked about my chair – where I got it, where they could find plans, if I’d make one for them, if they could snap photos and try to make their own…

If you want to make your own chair to watch kids’ sports outdoors without breaking out in hives, this is easy to build.  It has to be for me to make it.  As to cost, I can’t say since I used materials I had on hand:  old PVC pipe and decorator fabric that is now hopelessly out of style.  The base and uprights are made from Schedule 40 so it’s nice and strong, as is the back bar of the awning.  The sides and front of the awning are of the lighter-weight Class 200 PVC.

Notice the handy pockets added to the sides. These are especially nice for holding pencils, the scorebook, snacks, etc.  I want to add a cup holder to one of the uprights, and am looking for a battery-operated fan — that would have been really nice during some of those extra-hot games.

Covered Baseball ChairSince I live in western Washington where we are noted for our liquid sunshine, I made a rain fly for the chair, too.  That aspect of the chair still needs some fine-tuning, but I can attest to the fact that it kept me and the scorebook dry during a few games that were eventually cancelled a few innings later than they should have been.

Parts list:

  • (8) 90-degree elbows
  • (4) 45-degree elbows
  • (4) T’s for the awning
  • (2) T’s for each side you want to hang a pocket on
  • (2) long bolts (must be longer than 2x pipe diameter)
  • (6) washers
  • (2) acorn nuts (rounded caps to completely cover the ends of the bolts)
  • PVC pipe – exact lengths depend on how tall you are, so I won’t give dimensions
  • canvas or strong fabric – you’ll get much better shade if you use a double-layer
  • clear plastic, optional

A few tips I discovered:  regulations change frequently, and plumbers end up with pipe in the warehouse that they can’t use.  Sometimes they’re willing to give it away if you catch them on the right day and ask nicely.  This is not true of the big box stores where you buy materials for do-it-yourself projects.  If you must purchase connectors (T’s and elbows), they’re less expensive in packs of 10.  Some PVC will not stand up to sun exposure, so it’s important to use the right type.

Medrol Dosepak

Medrol (methylprednisolone) is a glucocorticoid similar to prednisone.  Available in 2mg, 4mg, 8mg, 16mg, and 32mg tablets, this steroid can be used to treat bursitis, rheumatoid arthritis, juvenile idiopathic arthritis, ankylosing spondylitis, psoriasis, psoriatic arthritis, and a variety of other conditions.

A fast-taper methylprednisolone dosepak contains 4mg pills conveniently arranged for easy dosing:  6 pills the first day, 5 pills the second day, and so on, decreasing one pill per day.

medrol pack

At my pharmacy, the cash price for these twenty-one pills is $33 ($1.57 per pill); the cost is obviously in the packaging. The cash price for a bottle of seventy 5mg prednisone pills is only $10 (14 cents per pill).  4mg Medrol equals approximately 5mg prednisone, so this is a fair comparison.

Of course, buying a bottle of pills would require you to be able to count to six so you get the right number of pills the first day. It would also require keeping track of which day you’re on. That’s easier said than done, because any condition that would call for that dose of steroid probably puts clear-thinking on hold.  Nonetheless, a simple piece of paper kept on the kitchen counter with the pill bottle would suffice.  Another option would be to put a portion of the money saved toward a pill box (if you don’t already own one).  If you don’t want a bunch of prednisone left for future tapers, you’d still save money buying prednisone instead of Medrol, and just throw the unused medicine in the trash.

Cost is not the only drawback I find.  It amazes me that something marketed for people who might be having difficulty using their hands is so incredibly difficult to open.  Be aware that if you use this medicine, you might need assistance getting at your pills.

If your doctor ever recommends a Medrol dosepak for a quick steroid taper, it might be worth discussing a more economical and easy to use medicine.