# Opioids: Last Week Tonight With John Oliver



## Bobw235 (Oct 24, 2016)

Last year my wife had surgery on her spine and received Oxycodone for post-surgical pain. I can recall the doctor warning her about safeguarding the prescription and making sure she took the pills to stay ahead of the pain. Fortunately my wife didn't need them for more than about 45 days and recently discarded the remainder of her prescription. Never filled the last scrip they gave her.

I write all of this as an introduction to a 19 minute segment that John Oliver did last night on the subject of opioids and how the crisis got started. He takes a long look at the pharmaceutical industry (including Purdue Pharma) and how they were largely responsible for the current crisis in not only opioid addiction, but also the rise in heroin addiction. While some of this piece is funny, the segment is very serious and his team really brings to light a very serious problem. Highly recommend it if you have the time to watch.

It's also interesting to see this segment in light of the reading I'm doing for my upcoming volunteer program with a local hospice, where management of pain is such a huge part of what they do. As the reading is making clear, management of pain in the final stages of life is critical for a peaceful death in many cases.


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## jnos (Oct 24, 2016)

Thanks for posting. And thank you for volunteering for hospice--much needed and appreciated by so many.


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## Ameriscot (Oct 25, 2016)

Well done on volunteering for hospice.  You are a good one, Bob.


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## bluebreezes (Oct 25, 2016)

I'm a big fan of John Oliver's and I love how he can really nail serious issues. I don't have an HBO subscription currently, but fortunately his show is on YouTube.


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## Ameriscot (Oct 25, 2016)

bluebreezes said:


> I'm a big fan of John Oliver's and I love how he can really nail serious issues. I don't have an HBO subscription currently, but fortunately his show is on YouTube.



He's the funniest of the late night hosts.  Watch him on Youtube all the time!


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## debbie in seattle (Oct 25, 2016)

Saw that Sunday night.   So true.


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## oldman (Oct 27, 2016)

We have talked about this a few times here on this forum. Up until three years ago, I counseled substance abuse (drugs and alcohol) addicts having been certified from Penn State University. I only watched a few minutes of the video and did not find anything funny about addiction, so I turned it off. Opioids, or opiates in this country as well as world wide has become pandemic. A lot of the addicts that I spoke with, especially those above the age of 35 told me that they got their start from doctors giving them pain pills for sprains, broken bones or a surgical procedure. I also took some after my surgeries. I found them to be very helpful with controlling pain, but also with giving me a euphoric feeling like I had never experienced. Because of my short term use with these drugs, I can understand how some people get hooked on these types of pain killers. Morphine, which is contained in most of these pills, has a very addictive effect. 

There are two parts that have become the most dangerous to one's life that is connected with them. One is the fact that as people continue to take these drugs their body become immune to the potency and the user feels a need to increase the dosage to achieve the same effect as they first experienced when they began taking them. Soon, they are taking such a high dose that they actually can stop their heart. The more pills a person takes, the lower the blood pressure and the slower the heart rate until the heart just no longer beats and death occurs. The second part is when the user begins buying their pills off of the street. Like any other street drug, the more the user becomes addicted to their drug, the higher the price. It can literally bankrupt a family, not to mention destroy the family. 

Entering a detox clinic is not easy for most middle or lower income Americans. The price of a long term rehab facility has increased tremendously over the last 20 years. An addict entering a long term rehab facility can expect to pay $30,000.00 and up. There are some free or low cost clinics, but the waiting line to be accepted is exhaustingly long and unfortunately, they are sometimes staffed by less than average therapists and counselors. Once a person has gone through the detox portion, the rehab comes next and that can last a minimum of another 28 days. 

It's a long, slow process to get clean, but staying clean is the next step and not so easy for many addicts. Over the six years that I counseled addicts, I heard stories that broke my heart and when the day is over, it's very hard to put these unfortunate people out of your mind. It almost becomes a part of you and your life. On occasion, I would go home and find myself wondering what  "John" or "Sue" is doing. Are they out on the street buying pills, are they at home getting high or are the really working at getting clean. I have been told by several addicts the main reason why they never wanted o get clean was because of all of the horror stories they heard about going through with withdrawals. Withdrawing from pills is one thing, but withdrawing from Heroin is definitely another and it can make a person wish that they were dead. Methadone is not really an answer. It's like putting a band aide on a cut that needs stitches.


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## Bobw235 (Oct 27, 2016)

While Oliver certainly injects humor and sarcasm into his pieces, I agree with Oldman above, that there's nothing funny about opioid abuse/addiction. The point that Oliver brings to light in the video however is the insidious marketing efforts by large Pharma to convince doctors and others that it was okay to dispense this stuff so freely. Much of the current epidemic is layed at the feet of the pharmaceutical industry, particularly Purdue Pharma and one other that he names in the piece. Purdue paid a heavy fine for their efforts, but the cat was out of the bag. This country does little in the way of helping those who are addicted, and now it's led to an ever-widening heroin crisis.


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## oldman (Oct 27, 2016)

The distribution of opiates became so bad in Florida that pill mills were actually being able to do business. I remember one case in particular where two brothers were in the pill mill business and they had an on-site M.D. that would write the Rx and give it to the customer (not patient), who would then take it to the counter to have it filled. Of course, there was a premium that had to be paid to receive this service. These two jackasses made millions before the DEA caught up to them. 

The last that I knew, Florida had established a database whereby patients that would take their Rx to a legitimate pharmacy would have their Rx recorded into the database that showed name, date of birth, date of issue and the prescriber of the Rx and number of pills distributed. Each patient was only permitted a certain number of pills per a 30-day period. This is good, but it's only a start. How does anyone contain the number of pills sold on the street? 

I remember my surgeon issuing me an Rx for 100 pills of Hydrocodone, 7.5-500 (Vicodin)  to be taken 2 every 4 hours. The 7.5 number is the amount of Hydrocodone and the 500 number represents the amount of Acetaminophen. This is above the suggested amount of Acetaminophen as suggested by the FDA. If taken according to the dosage, this would mean that the user would be taking 6 grams of Acetaminophen, which the FDA only recommends that the amount of Acetaminophen should not exceed 4 Grams per day. 

Hydrocodone is the generic for Vicodin. Oxycodone is the generic for Percocet and Hydromorphone is the generic for Dilauded. All are considered very hazardous drugs and should not be used for recreational purposes.


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## Butterfly (Oct 27, 2016)

Maybe I'm weird, but I took my fair share of opioids during the period directly before and after I had my hips replaced in 2013 (surgeries a month apart), and never once did any of them make me feel "good" or high.  My doctor insisted I take them as directed and not "be a hero" because, he said, the body can't heal as well or as quickly if it is fighting pain.  I even had to keep a little chart.  The only thing they did was take the pain away, which they are supposed to do.  

I never had the inclination to increase the dosage, nor to take them after the pain subsided.  So I guess it's hard for me to imagine why people would take them when they don't need them for pain.  I didn't feel any euphoria or anything like that at all, just a bit sleepy.  The oxycontin made me feel a bit woozy (and not in a good way), but nothing from the others at all except, as I said, a bit sleepy sometimes.  Maybe they affect some people differently??


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## 911 (Oct 28, 2016)

Butterfly.... Not all opiates contain morphine. If you were given a drug that contained codeine for example, you may have just been a little fuzzy headed. Regardless, if you take any opiate and drive, be careful not to get stopped. If you do, you may be checked for alcohol or other substances and the penalties, at least here in PA are very stiff (expensive).


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## anodyne (Oct 28, 2016)

Butterfly said:


> Maybe I'm weird, but I took my fair share of opioids during the period directly before and after I had my hips replaced in 2013 (surgeries a month apart), and never once did any of them make me feel "good" or high.  My doctor insisted I take them as directed and not "be a hero" because, he said, the body can't heal as well or as quickly if it is fighting pain.  I even had to keep a little chart.  The only thing they did was take the pain away, which they are supposed to do.
> 
> I never had the inclination to increase the dosage, nor to take them after the pain subsided.  So I guess it's hard for me to imagine why people would take them when they don't need them for pain.  I didn't feel any euphoria or anything like that at all, just a bit sleepy.  The oxycontin made me feel a bit woozy (and not in a good way), but nothing from the others at all except, as I said, a bit sleepy sometimes.  Maybe they affect some people differently??



I think that may be true, Butterfly. I have severe arthritis in my hands, neck, and knees, for which I have been taking two 10mg Hydrocodone per day for nearly three years. I get adequate pain relief, but no warm and fuzzy feeling and no desire to take more than needed/prescribed. I was prescribed oxycontin by one doctor but it made me feel woozy, so I asked my current doctor to put me back on Hydrocodone. I guess we are lucky that we aren't predisposed to addiction, if that's what's making the difference.


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## Butterfly (Oct 28, 2016)

911 said:


> Butterfly.... Not all opiates contain morphine. If you were given a drug that contained codeine for example, you may have just been a little fuzzy headed. Regardless, if you take any opiate and drive, be careful not to get stopped. If you do, you may be checked for alcohol or other substances and the penalties, at least here in PA are very stiff (expensive).



Yeah, I got a big lecture from my doc about that.  I wasn't allowed to drive for 6 weeks after each surgery, anyway.


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## fureverywhere (Oct 28, 2016)

Ummm, not an addict but I can appreciate comfortably numb. Hubby had a hideously bad reaction to codeine or narcotics in any form. Extreme vomiting etc, etc...certainly not pain relief. Me and Oxy? Meh...no difference really. Ativan is a good thing. All systems down. Xanax, they'll tell you it's addictive. If you need something for nights to turn it all off. Not every night but yes.


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## oldman (Oct 31, 2016)

Did you know that the most addictive narcotic is "Nicotine?" This is why it is so hard for so many people to quit smoking. People will say it's hard to quit smoking because it's a habit, but so is shooting Heroin. Smoking is a habit, but above that, it is also an addiction. In this instance, there is a fine line between a habit and an addiction.


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## Ameriscot (Oct 31, 2016)

oldman said:


> Did you know that the most addictive narcotic is "Nicotine?" This is why it is so hard for so many people to quit smoking. People will say it's hard to quit smoking because it's a habit, but so is shooting Heroin. Smoking is a habit, but above that, it is also an addiction. In this instance, there is a fine line between a habit and an addiction.



I definitely agree with that.  Quitting smoking is the hardest thing I've ever done.  It's the nicotine + the psychological addiction.


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## oldman (Oct 31, 2016)

I can remember back when we were able to smoke while flying. At one time, we had three pilots on the flight deck; Captain, First Officer and an Engineer (or Navigator). If all three would smoke, it was horrible. That only lasted for a short time on the flight deck before most airlines in the U.S. did not allow smoking on the flight deck. I did smoke at that time and I would step outside the cockpit and grab a few puffs to hold me over. Habit, addiction or whatever you want to call it, all I knew at that time was when I needed a smoke, I needed it now.


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## tnthomas (Oct 31, 2016)

oldman said:


> Did you know that the most addictive narcotic is "Nicotine?" This is why it is so hard for so many people to quit smoking. People will say it's hard to quit smoking because it's a habit, but so is shooting Heroin. Smoking is a habit, but above that, it is also an addiction. In this instance, there is a fine line between a habit and an addiction.



I have had inmates tell me that nicotine cravings were worse than heroin's.


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## BlunderWoman (Oct 31, 2016)

I don't know if I'm off topic on this but- I found out when my gall bladder was about to rupture that morphine had no effect on me whatsoever. I did not realize they had given it to me twice already in my IV so I complained to my nurse and said " Why haven't I received anything for pain yet when I'm in so much agony?" He said " I've already given you morphine twice and I can't give you anything else right now it would be an overdose." Here I am someone who has never done drugs or taken any pills habitually and morphine not only did not work on me, but may have even intensified the pain. The nurse came back in finally and gave me dilaudid which did work and told me that there are some people that morphine does not work for and that it has been known to intensify pain for some people. I thought that was so strange when it happened to me.


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## oldman (Oct 31, 2016)

BlunderWoman said:


> I don't know if I'm off topic on this but- I found out when my gall bladder was about to rupture that morphine had no effect on me whatsoever. I did not realize they had given it to me twice already in my IV so I complained to my nurse and said " Why haven't I received anything for pain yet when I'm in so much agony?" He said " I've already given you morphine twice and I can't give you anything else right now it would be an overdose." Here I am someone who has never done drugs or taken any pills habitually and morphine not only did not work on me, but may have even intensified the pain. The nurse came back in finally and gave me dilaudid which did work and told me that there are some people that morphine does not work for and that it has been known to intensify pain for some people. I thought that was so strange when it happened to me.



That's really not as unusual as some people may think. Without going into all of the medical terminology about proteins and such, some people do not get an effect from morphine and in fact, some people may actually have their pain increased from the use of morphine. Dilaudid, also known as Hydromorphone, has its own set of problems. This is why most doctors will start out with small doses such as 1 cc and then increase it as necessary. Biggest issue with Dilaudid is breathing cessation. If you ever get an injection of Dilauded, take note if you begin to have an issue with breathing. I know we have a few R.N.'s here on the forum and they know more about this than me, but I have seen people overdosed on this drug and all but stopped breathing. On the other hand, I have also known addicts to use Dilauded pills, crushing them and then cook them for injections. Some people (addicts) will go to great lengths to get a high.


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## Ameriscot (Oct 31, 2016)

BlunderWoman said:


> I don't know if I'm off topic on this but- I found out when my gall bladder was about to rupture that morphine had no effect on me whatsoever. I did not realize they had given it to me twice already in my IV so I complained to my nurse and said " Why haven't I received anything for pain yet when I'm in so much agony?" He said " I've already given you morphine twice and I can't give you anything else right now it would be an overdose." Here I am someone who has never done drugs or taken any pills habitually and morphine not only did not work on me, but may have even intensified the pain. The nurse came back in finally and gave me dilaudid which did work and told me that there are some people that morphine does not work for and that it has been known to intensify pain for some people. I thought that was so strange when it happened to me.



I had one of those morphine pumps after my hysterectomy.  I used the maximum allowed but still had pain.


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## oldman (Oct 31, 2016)

tnthomas said:


> I have had inmates tell me that nicotine cravings were worse than heroin's.



I had a friend tell me that when he stopped smoking he was going through his trash to try to find a butt, so he could catch a drag or two to stop the withdrawals. I forget a lot since I no longer counsel addicts, but I believe that nicotine has a half life of about 2 hours, meaning that after that time, the user will begin to look for a cigarette, or a butt, or if he chooses to stay off of the smokes, he will start his withdrawals. I know that when I quit, I was a miserable person and anyone around me was also miserable, so I tried to stay clear of my friends. I quit when I went on vacation, so that I would be away from most everyone that I knew. Cold turkey, no gum, patches or anything. Just me and my madness.


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## BlunderWoman (Oct 31, 2016)

oldman said:


> That's really not as unusual as some people may think. Without going into all of the medical terminology about proteins and such, some people do not get an effect from morphine and in fact, some people may actually have their pain increased from the use of morphine. Dilaudid, also known as Hydromorphone, has its own set of problems. This is why most doctors will start out with small doses such as 1 cc and then increase it as necessary. Biggest issue with Dilaudid is breathing cessation. If you ever get an injection of Dilauded, take note if you begin to have an issue with breathing. I know we have a few R.N.'s here on the forum and they know more about this than me, but I have seen people overdosed on this drug and all but stopped breathing. On the other hand, I have also known addicts to use Dilauded pills, crushing them and then cook them for injections. Some people (addicts) will go to great lengths to get a high.



I have a completely  fear/phobia  of addiction. I have sciatica and I don't take anything other than aleeve for the pain and I try not to even take that. After I fractured my neck last year I never took the oxycontin they sent me home with. I didn't notice any trouble breathing because right after that I was wheeled in for surgery & it was lights out after talking to the anesthesiologist for a couple of minutes.


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## BlunderWoman (Oct 31, 2016)

Ameriscot said:


> I had one of those morphine pumps after my hysterectomy.  I used the maximum allowed but still had pain.



Maybe it doesn't work for you either.


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## Ameriscot (Oct 31, 2016)

oldman said:


> I had a friend tell me that when he stopped smoking he was going through his trash to try to find a butt, so he could catch a drag or two to stop the withdrawals. I forget a lot since I no longer counsel addicts, but I believe that nicotine has a half life of about 2 hours, meaning that after that time, the user will begin to look for a cigarette, or a butt, or if he chooses to stay off of the smokes, he will start his withdrawals. I know that when I quit, I was a miserable person and anyone around me was also miserable, so I tried to stay clear of my friends. I quit when I went on vacation, so that I would be away from most everyone that I knew. Cold turkey, no gum, patches or anything. Just me and my madness.



I'd say I had serious cravings after about 90 minutes.  I knew when I quit I was going to be a miserable b*tch for at least 6 months and would wake every day wishing for a cigarette.  I did use the 24 hour patches which did help (but also gave me very vivid dreams).  The date I chose to quit was when I was moving to a new place, so it was somewhere I'd never smoked.  Dumped my leather cigarette case, lighters and all ashtrays in the bin when I moved.  Had a boyfriend that didn't smoke and didn't have any friends that smoked.


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## Ameriscot (Oct 31, 2016)

BlunderWoman said:


> Maybe it doesn't work for you either.



Probably didn't.  They gave me some other kind of pain pills when I left the hospital.  And they worked pretty well.


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## Bobw235 (Oct 31, 2016)

We had a very interesting discussion about the use of opioids to treat pain in connection with my upcoming hospice volunteering. The person leading the discussion noted that there are patients (and/or family members) who are hesitant to avoid asking for pain relief because they fear addiction. As the person explained to us, it's unlikely that one who is dying will become addicted. One of the primary goals within hospice is pain management, thus they start out with higher doses to get the pain under control, then scale it back.


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## BlunderWoman (Oct 31, 2016)

Bobw235 said:


> We had a very interesting discussion about the use of opioids to treat pain in connection with my upcoming hospice volunteering. The person leading the discussion noted that there are patients (and/or family members) who are hesitant to avoid asking for pain relief because they fear addiction. As the person explained to us, it's unlikely that one who is dying will become addicted. One of the primary goals within hospice is pain management, thus they start out with higher doses to get the pain under control, then scale it back.



If I'm terminal and in great pain then I'm going to take all the pain meds I can get


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## Bobw235 (Oct 31, 2016)

BlunderWoman said:


> If I'm terminal and in great pain then I'm going to take all the pain meds I can get



Same here. They told us that sometimes they have to try different pain meds, that morphine, as good as it is, doesn't always do the trick for some conditions (bone cancer was cited), but that they are very good at controlling pain.


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## Ameriscot (Oct 31, 2016)

BlunderWoman said:


> If I'm terminal and in great pain then I'm going to take all the pain meds I can get



Me too, and give me some pot as well!


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## oldman (Nov 3, 2016)

Bobw235 said:


> Same here. They told us that sometimes they have to try different pain meds, that morphine, as good as it is, doesn't always do the trick for some conditions (bone cancer was cited), but that they are very good at controlling pain.



Fentanyl is the most popular pain med for cancer patients with severe pain. You and I do not know what kind of pain they are going through, but I can tell you this, for someone with stage four pancreatic, lung or colon cancer and when they are near death, they are wanting over with now.


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## Butterfly (Nov 3, 2016)

When I dislocated my shoulder a couple years ago, they gave me morphine, but it didn't help much, if at all.  They ended up giving me something else (I don't know what it was and I didn't ask -- all  I wanted was the agony to let up) which helped so they could manipulate the shoulder back in place.  Once the shoulder went back in place, most of the pain was gone, thank God.  That was a horribly painful experience.

Morphine did not help my niece when she was dying of colon cancer, either.


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## anodyne (Nov 4, 2016)

Butterfly said:


> When I dislocated my shoulder a couple years ago, they gave me morphine, but it didn't help much, if at all.  They ended up giving me something else (I don't know what it was and I didn't ask -- all  I wanted was the agony to let up) which helped so they could manipulate the shoulder back in place.  Once the shoulder went back in place, most of the pain was gone, thank God.  That was a horribly painful experience.
> 
> Morphine did not help my niece when she was dying of colon cancer, either.



With some types of pain morphine isn't effective until after 3 or more weeks of the same daily dosage. Morphine in pill form is tricky as it doesn't work the same from person to person. Some people's physiology makes them resistant to the way morphine works when taken in pill form. Those people often have better results with methadone, which is way cheaper but more addictive than morphine and stays in your system much longer. Methadone should never be a first choice for chronic pain relief, but if it works best on chronic pain of the terminally ill then addiction and half-life should be of no concern.


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