painKiller

[sway2sway]

[Shark, you are right, some of my posts are like homework, that or miscellaneous musings, or trashy deletions (this one being the 1st kind).....but so be it]

I read this article about a survey that had been done in poorer countries, regarding the use and availabity of painkillers for those dying. It's a pretty sad state. I mean even in richer countries where dying people are liberally given narcotics, many still have unresolved pain...and to think of dying of cancer or aids or whatever, in an au naturel state, that could be real ugly.

From that article:
"A survey of specialists in Africa, Asia and Latin America has produced a disturbing portrait of the difficulties in offering pain relief to the dying in poor countries. Many suffer routine shortages of painkillers, and the majority of specialists got no training in pain relief or opioid use during their medical education."

Then I read this other article, called 'Drugs Banned, Millions Die in Pain'
http://www.nytimes.com/2007/09/10/health/10pain.html?ref=health

From that one:
"Like millions of others in the world’s poorest countries, she is destined to die in pain. She cannot get the drug she needs — one that is cheap, effective, perfectly legal for medical uses under treaties signed by virtually every country, made in large quantities, and has been around since Hippocrates praised its source, the opium poppy. She cannot get morphine.

That is not merely because of her poverty, or that of Sierra Leone. Narcotics incite fear: doctors fear addicting patients, and law enforcement officials fear drug crime. Often, the government elite who can afford medicine for themselves are indifferent to the sufferings of the poor."

So, I'm thinking I've read about ideas that they should transform Afghanistan's illegial opium(heroin) industry into a legal opium (morphine and derivatives) one. Which sounds like a good idea to me, the farmers don't lose their livelyhood, poor people get medicine that they need...win-win. A proposal was put forward by red cross organizations, I don't know if any countries were backing it, sounded good to me.

http://stopthedrugwar.org/chronicle/454/afghanistan_opium_licensing_proposal_gains_support

It says that despite all the efforts to erradicate the lil' poppy over there, the production is actually up 60% this year. It also said it would not be difficult to pay the farmers at least the equivalent of what they are already getting, and at this point in time the farmers have only one way to sell the opium, illegally. it's quite interesting, no point paraphrasing the whole thing.

But then,
the bubble burst.
I read this one: Afghan opium plan NOT feasible
http://www.smh.com.au/news/world/afghan-opium-plan-not-feasible-drugs-board/2005/11/23/1132703236247.html

From that:
"An oversupply of opium used for medical purposes around the world means plans to use Afghanistan's illicit crops for such purposes cannot get off the ground, the world's independent drug monitoring body says.

The Senlis Council, a think tank specialising in drug policy, said on Monday that Western countries were wasting millions of dollars trying to stamp out the illegal opium trade in Afghanistan. Instead, the council said a licensing system should be developed to allow Afghans to sell opium legally for use in painkillers such as morphine and codeine.

However, Beate Hammond, a spokeswoman for the International Narcotics Control Board, told smh.com.au from Vienna that, although the final figures for 2005 were not finalised, the global supply of raw opiates exceeded demand this year - and this had been the case for the last five years."


Well, what up with that? There is too much morphine globally (so they say), but not enough in the poor countries. So is it the governments of the poor countries that are the problem, afraid and ignorant of what may happen? Or are the facts & figures wrong? Or are we hogging all the opiates? Are they being sold on the street? I don't know, I don't really get it all, but it seems like it might be a bit of everything. I just started reading the one article, then you get another question, so you read another, which adds another question, or a contradiction, and round and round ya go, huh?

[Barefoot2Dream]

This is a topic that opens a whole flood of emotions within me. It does seem so cruel to deny painkillers to the dying. No one should have to live out their last days (or months or years) in agonizing pain. But it is so true that these drugs incite fear: fear of addiction and crime. But that fear isn't completely without reason.

No big surprise the parts of the world where opioid use and related problems are predominant: North America, Western, South and South-East Asia, Europe and the middle East.

The cost of opioid use to individuals and to society as a whole, is high. Opioid dependence results in significant costs to society through unemployment, homelessness, family disruption, loss of economic productivity, social instability and criminal activities.

My step-father lived with chronic pain. He put his trust in his doctors and began taking painkillers. You can guess: all of opioid descent. He eventually couldn't return to work... lost his insurance...became depressed. My mother and he seperated for a short time. No work, no insurance, waiting for help, he wound up at a state mental health clinic and one of the local low income clinics. This is where he was prescribed the granddaddy of them all, methadone, to kick the addiction of vicodin (logical, right?). It killed him and broke 7 grandchildren's hearts.

As much as I cannot stand the thought of suffering there's still a tiny part of me that feels we, as humans have been living and dying for thousands of years without drugs, right? I know it's my personal witness to the "cost "of these drugs that makes me uneasy about painkiller use, but I really don't know what the answer is. But then my dad's suffering with his various ailments do not compare much to a poor woman lying on the ground with a tumor bursting out her skin on her breast waiting for the cancer to spread and slowly kill her.



I don't know where I was going with this really. Pain is scary. Drugs are scary...... I really miss my dad. There's no painkiller that can stop a heartache.

[Barefoot2Dream]

:( and now my little rant is over. Sway, you are so right. Round and round we go. Wheee!

[Barefoot2Dream]

You got me curious, Sway what the U.S. rationale was for opposing this approach.....

The U.S. Rationale Against Legalization:

http://www.philadelphonic.com/forum/newreply.php?do=newreply&p=48295

This rationale brings up some interesting and valid points.

The licit opium market is not lucrative enough to entice Afghan farmers -

"Drug trafficking is profitable for a reason: users demand dangerous substances to feed their addictions. Creating a legal framework will not put traffickers out of business; rather, they will continue to pay more than the licit system is capable of offering in order to create diversion".

The price difference between licit and illicit opium is so substantial that Afghan farmers would not quit the black market. To make up for the price difference, exorbitant subsidies would have to be offered, which would prove prohibitively expensive. Moreover, the Government of Afghanistan would be obligated to purchase opium stocks, resulting in the crops exponential expansion as more farmers would grow to take advantage of a guaranteed source of income.

There is no legitimate world demand for legally produced opium from Afghanistan - According to the United Nations International Narcotics Control Board world demand for opium-based medicines is fully met. World stockpiles are also sufficient to meet any conceivable future or increased demand.

It is not feasible - Countries which produce licit opium have strict controls, sophisticated law enforcement, and licensing systems - and still admit to significant illegal diversion. The lack of law enforcement and security in Afghanistan has led to the explosion of the current illicit poppy crop, so a licit industry which relies on legal controls could not work. Without safeguards, licit and illicit opium would be indistinguishable. Opium really destined for the black market would be produced under the pretense of a legal system.

Legalization is ultimately counterproductive and dangerous - Legalization would expand and entrench the drug trade, undermining ongoing efforts to bring security and sustainable economic development. This would benefit insurgent groups such as the Taliban who have been known to profit from the trade, as well as criminals and corrupt government officials. Afghanistan would suffer from more violence, lawlessness, and corruption as a result of legalization, not less. Expanding opium cultivation would also come at the expense of important efforts to diversify Afghanistan's economy, making the country's welfare dangerously reliant on one commodity.

[Miss Shark]

I had a hard time even here, getting my mothers pain managed. She didn't get Morphine till the very end, and I can tell you she was in constant and severe pain. It's a little crazy to worry about people that are going to die getting addicted to drugs, no?

I too Barefoot know people that have gone down that slippery slope from oxycontin addiction to worse. I'm very sorry to hear about your dad.

The one thing I will say is that drugs have been around forever. Where is the traditional medicines in Sierra Leon?

Dr. Beetroot continues to sink South Africa deeper and deeper into the Dark Ages:
Speaking after the adoption of the Traditional Health Practitioners Bill in the National Council of Provinces, the minister said the Bill was giving Africans their dignity.
The thumbs-up to the Bill by MPs would lead to the formal and legal recognition by the government of about 200 000 traditional healers in South Africa. The Bill calls for the establishment of the Traditional Health Practitioners Council of SA, whose mandate will be to register and regulate traditional practitioners.
Tshabalala-Msimang, who was in the NCOP to speak during the debate on the Tobacco Products Control Amendment Bill, said she could not help but savour the moment and deviate to talk about the adoption of the Traditional Practitioners Bill.
"Why is it when we talk about Chinese traditional medicine it is accepted, when we talk about Indian traditional medicine it is accepted, when we talk about African traditional medicine it is witchcraft?" she said to applause by MPs.
No alternative medicine of any kind is accepted. It's all worthless bullshit. And what does it say about the "dignity" of Africans (whatever that means), if they have to resort to barbaric and dangerous mumbo-jumbo to feel they have accomplished something? It's typical tribalism in a nutshell, our ways and our traditions and our pointless bullshit - no matter how worthless it is. It's always us vs. them, and if our mumbo-jumbo dictates that we shall die slowly and horribly for no good reason at all, rather than use science-based medicine, then so be it. It's our way of life, and we don't want no white people telling us what to do. Death to evil white imperialism! (And where's that aid money we demand to be given? Can't you evil Westerners see that our people are suffering and dying, despite our great traditional medicine? It's all the fault of colonialism!)

[Miss Shark]

I've run out of lesson time teach, but my interest is piqued

[Barefoot2Dream]

Well said, lady! Although I feel like I took Sway's topic off on another direction than I think she intended, and then Shark ran away with it as well.;)

I hear the word "painkiller" and my mind tends to narrow in on my world, the world close to me. The little "Becca World" I am comfortable in and knowledgable of. It's so sad to think your mother, Shark could not get enough of the pain management she desperately needed, while it was so haphazardly dispersed to my father. It's his birthday next week so it's kind of been on my mind lately.

[sway2sway]

no worries on the direction shift barefoot, your story was interesting and a different angle than I usually consider. that part about the traditional medicine in sierra leone was interesting as well shark, thanks. (Dr. Beetroot makesme think of Dr. Bunsen Honeydew & Beaker, I'm not sure why, maybe cause it seems made up)
I'm too tired for 'homework' today, but I appreciate you guys read it.

[tinkerlion]

i too first thought of my father when reading this. he is now on permanent disability for his headaches. he has been misdiagnosed for so many years it's crazy. doctors just kept throwing painkillers at him. to change his medications the doctors must put him in rehab. it shouldn't be that hard. i'm so proud of the way my dad has handled himself. he hates having to take the medication, but he must have it to be able to semi-function. otherwise he'll stay in bed all day with the pain. i think it's worse now that he's going to the veteran's hospital. the doctors there are so stretched for time that it's hard to get one who will really listen (luckily he's enough of an ass hole to demand and receive the primary care doctor he wanted.) most of his doctors give up very quickly on trying to determine the root of the problem, he was only going to the va for 2 months before they moved him over to pain management fully. the medicine makes it so that my dad has trouble balancing his checkbook. some days going to the store can be a terrible ordeal for him. it's heartbreaking for me to know how full of life and vibrant he use to be (i get my energy and bounciness from my dad.)

sorry for the rant, just gotta get it out sometimes.

[sway2sway]

that's no rant tink, that's sharing your first hand perspective, invaluable.

I was more referring to palliative people, dying within an estimated 6 months. But obviously, pain killer is a loaded word these days. And maybe that is from over-prescription of pain meds, or prescribing the wrong pain meds, or not taking the time to really understand the patient's issues, or not fully exploring adjunctive pain therapy (things which may not even be medication, or meds that are not narcotics), or the way some physicians and patients feel a doctor visit isn't done until there is a transaction of a little slip of paper. In nursey school, we learn there are many types of pain, not only physical, and yet these other sorts of pain can also be felt physically, intensifying the pain of the body. Like if you have unresolved emotional/family issues when you are dying, this can make your physical pain worse and even with all the fancy meds, it ain't gonna touch that, and the result is the patient will still be feeling the physical pain----gotta get at the root.
Then you can move into the overprescription of anti-depressants that is a huge problem as well, I think. I hear about people all the time, that go to see their MD, tell them they aren't doing well for some reason or another, a death, marital problems, children problems....and they come away with a prescription for an anti-depressant. In my opinion, people aren't supposed to always be feeling on top of the world, there are cycles to go through, coping mechanisms to be used, time to be taken.
Sure there is a time for them, but I'm pretty sure the percentage of north americans on them is HUGE, too lazy to look for them now, but.......
I hear all you guys, nothing is cut and dried. There's a lot of perspectives and I feel for em all.

[the duke]

it's interesting to see your points of view. My job is in a pharmacy, and the amount of pain killers that get prescribed...it's amazing. People get panadeine forte (paracetamol and a high level of codeine) for a sore throat along with antibiotics. It's amazing. Sometimes, when people ask for an ibuprofen and codeine OTC pain killer for a headache, i feel like telling them to suck it up. My personal opinion is that people have now come to the point where they can't put up with things. A tiny bit of pain, and people want the strongest thing available. A woman was appalled when I told her the strongest thing I could give her for her pregnant daughter was plain old panadeine. She didn't think that was good enough...and I wanted to ask her if she didn't mind her grandchild having health problems when it was born....it's almost as if people pop paracetamol like lollies.

I don't really know what it's like to see someone in so much pain that they can't bear it, but I'm not one to pop pills when the pain is there. My dad starts cancer treatment soon, so that will probably by my experience. He's what I'd call tough though, and he'll put up with it until he it gets to it's maximum.

Everyone has their own experiences, and I've seen addiction even to codeine which is considered the lightest of the opioids I think.....

sorry to go off on a completely different tangent, but this is where I see it from...

[Miss Shark]

I know that South Africa is not Sierra Leone, but it seems that they are trying in Sierra Leone not to lose their traditions.

http://www.health.sl/drwebsite/publish/page_354.shtml

Health and Sanitation Minister, Mrs. Abator Thomas told her audience that Sierra Leone now has a national policy on Traditional Medicine, and that there is ample provision for research and development in that document.

The government, Mrs. Thomas said, encourages research and development activities to facilitate the improvement of traditional medicine in Sierra Leone.

She observed that traditional medicine in the country is not systematically structured and regulated to allow the population to have the full benefits of traditional medicine, adding that preparations have also not been subjected to assessment of quality, safety, efficacy and affordability to guarantee rational use of the preparations.

Mrs. Thomas reiterated that issues of conservation, cultivation and preservation of medicinal plants of the country need to be considered along with the protection of the intellectual property rights and the benefits that may arise from the use of traditional medicine knowledge.

Who knew that people would be worried about intellectual property rights for something that has presumably been around forever, freely passed down from generation to generation.

[Miss Shark]

Lastly it would seem there is some hope. If we in the West could only leave other peoples alone, not try to improve them, police them. It just kills me, who the heck do we think we are? Why are we so dead set in thinking that we know what is best for all the world?

http://www.africanloft.com/traditional-medicine-in-africa-a-viewpoint/#comments

How many millions of dollars in development aid have been wasted on failed public health programs and how many lives could have been saved if only Western donors and policy-makers had a little more faith in Africa’s traditional ways and gave Africans a real say in policy design and implementation?

[Barefoot2Dream]

So an investigative team from a Las Vegas news channel was working on a story about the skyrocketing number of methadone deaths in Nevada. They wanted to add a personal touch to the story and flew out a few weeks ago to talk to my mom about my father's death. Yesterday was my Dad's first birthday since his passing and ironically the story happened to air last night.

Anyway, just thought I'd share the video clip. They did a really nice job of capturing my Mom and Dad and I hope his death leads to good things for others down the road.

Death by Prescription (http://www.lasvegasnow.com/global/video/popup/pop_player.asp?ClipID1=1913055&h1=I-Team%3A%20Death%20by%20Prescription&vt1=v&at1=News - Special Coverage&d1=177100&LaunchPageAdTag=News&activePane=info&playerVersion=1&hostPageUrl=http%3A//www.lasvegasnow.com/Global/story.asp%3Fs%3D7328805&rnd=37724)

[sway2sway]

wow! that was done well.
creating awareness is a good thing, I think your family should be proud of that.
are you one of those babies in the pictures?

[tinkerlion]

that's awesome barefoot. how's your mom doing?

i can't get the video to load, don't know if it's the site or my computer. :(

[Miss Shark]

Bummer, barefoot I can't get it to load either. It must have been a hard for all of you.

[Barefoot2Dream]

Hmmm. I had problems getting it to load the first time too. Maybe this (http://www.lasvegasnow.com/Global/story.asp?S=7328805&nav=menu102_2_1)link will work. Scroll down and it's at the bottom titled "Death by Prescription".

Sway, the babies in the clip are just 3 of the 7 grandkids total. Mostly shown is my niece as she was ALWAYS at their house and was Papa's girl. The little guy sitting on his lap with the pink doll bottle in his mouth is my youngest.

This has been an emotional week for me as it marks his first birthday since his passing, one year since the last time I saw him (which was an amazing visit), and the anniversary of that dreaded day we found him upstairs. It's tough but so much of my life has changed because of it. Perhaps I never really would have taken that leap to leave my career and raise my boys full time if his passing hadn't opened my eyes to how short life is.

As for my mom, she doesn't handle things quite so well and is still a wreck. I think that living in the house is a huge reason for that. There's no where you can look that you are not reminded of Dad nor can you ever forget that he died in the house. I've tried staying there with her several times over the last year but always end up dashing out at bedtime to my brother's place. I just can't bring myself to stay there so I can only imagine how hard living there is.

Wow, sorry for the long post. Felt good to get it out though.

[the duke]

wow, I didn't actually realise (even after all your discussion) that methadone can be prescribed as a pain killer for non-addicts. We have a methadone program at our pharmacy for recovering herion users (most of them pretty much just use it as a substitute rather than weaning), and they're the only people who get it. I've also realised that here in Australia we have huge regulations on a lot of medications that other countries don't...and I also found out that there's a lot of stuff you can get over the counter in the US that you'd never be able to here...

I thought the piece they did on your dad Barefoot was really good. I agree with Sway, awareness is the most important thing now. I hope you're coping ok :)