Is endemic private health care a contributing factor in the US opioid crisis?

[StringJunky]

Because money is directly involved in the patient-doctor relationship, do you think it pushes the scale of the problem upwards? When medicine becomes self-funded, I think the dynamic changes between doctor and patient, and they possibly are more likely to succumb to the patient's wishes, rather than advise what's best for them.

About 9 people died every hour last year from opioids (cdc).

Edited June 19, 2023 by StringJunky

[iNow]

It definitely did and likely still does. Doctors in the US were given huge bonuses by some pharmaceutical giants for prescribing more of a specific medication they produced and this exasperated the issue of opioid addition in the US 

[CharonY]

Though I think it is less about the patient's wishes, but rather financial incentives for the MD. 

[StringJunky]

12 minutes ago, CharonY said:

Though I think it is less about the patient's wishes, but rather financial incentives for the MD. 

I was thinking the MD will want them tocome back. If the patient leaves empty-handed, they'll likely go out and shop for another more agreeable one. That's probably one of the major flaws in the P/Healthcare system. With it not being centeralized nationally, with no nationally-linked main patient database system to track individual treatment histories, your average opioid addict can go to the next one, or even go out of state. That's what it looks like to me.

Edited June 19, 2023 by StringJunky

[zapatos]

3 hours ago, StringJunky said:

I was thinking the MD will want them tocome back. If the patient leaves empty-handed, they'll likely go out and shop for another more agreeable one. 

I'm not sure that is an issue for doctors. As far as I can tell, doctors see patients during all available appointment slots on any given day. I decided I wanted to see a dermatologist for a check up and my appointment was six months out. It doesn't seem as if losing a patient has any impact on a doctor's income. This may of course not be true in rural areas, and I am only speaking anecdotally.

[StringJunky]

The most insane thing I ever read was that you could get fentanyl on script. I remember reading about the potency when I first heard years ago, and thought it would only be used on terminal patients and hospital settings. It would be less risky to give them heroin, being 50 times safer in terms of potency.

Edited June 19, 2023 by StringJunky

[zapatos]

1 hour ago, StringJunky said:

The most insane thing I ever read was that you could get fentanyl on script. I remember reading about the potency when I first heard years ago, and thought it would only be used on terminal patients and hospital settings. It would be less risky to give them heroin, being 50 times safer in terms of potency.

Whether you receive fentanyl or any other prescription drug in the same class, one is not safer than another in terms of potency. They are all equally safe.

The risk comes when people take drugs that were mixed in someone's basement.

I had fentanyl about a year ago as I was passing a kidney stone and raised the same concern. Morphine would have given  the same result. They are very good at giving you the correct dose of your selected drug.

[StringJunky]

15 hours ago, zapatos said:

Whether you receive fentanyl or any other prescription drug in the same class, one is not safer than another in terms of potency. They are all equally safe.

The risk comes when people take drugs that were mixed in someone's basement.

I had fentanyl about a year ago as I was passing a kidney stone and raised the same concern. Morphine would have given  the same result. They are very good at giving you the correct dose of your selected drug.

You get a hundred times more morphine molecules than fentanyl for the same analgesia.. The margin for error is that much less to lapse into CNS depression.. Ask Prince.

Edited June 20, 2023 by StringJunky

[zapatos]

20 minutes ago, StringJunky said:

You get a hundred times more morphine molecules than fentanyl for the same analgesia.. The margin for error is that much less to lapse into CNS depression.. Ask Prince.

Maybe I'm just naive but I've always assumed that drugs from pharmaceutical companies were mixed to such a level of precision that you didn't have to worry about over- or under-dosing. 

[CharonY]

22 hours ago, StringJunky said:

I was thinking the MD will want them tocome back. If the patient leaves empty-handed, they'll likely go out and shop for another more agreeable one. That's probably one of the major flaws in the P/Healthcare system. With it not being centeralized nationally, with no nationally-linked main patient database system to track individual treatment histories, your average opioid addict can go to the next one, or even go out of state. That's what it looks like to me.

I think there are different stages where the system influences addiction rates and generally speaking, a centralized and well-maintained system makes it easier to track and crack down on abuse. What you might refer to is if folks already are addicted. 

1 hour ago, StringJunky said:

You get a hundred times more morphine molecules than fentanyl for the same analgesia.. The margin for error is that much less to lapse into CNS depression.. Ask Prince.

It depends on use, often patches are used with rather precise delivery parameters. If used via injection (i.e. manual dosing) human error is going to be a factor, for sure.

[StringJunky]

36 minutes ago, CharonY said:

I think there are different stages where the system influences addiction rates and generally speaking, a centralized and well-maintained system makes it easier to track and crack down on abuse. What you might refer to is if folks already are addicted. 

It depends on use, often patches are used with rather precise delivery parameters. If used via injection (i.e. manual dosing) human error is going to be a factor, for sure.

Right. Cheers.

1 hour ago, zapatos said:

Maybe I'm just naive but I've always assumed that drugs from pharmaceutical companies were mixed to such a level of precision that you didn't have to worry about over- or under-dosing. 

This is true, but human nature is ingenious. I was a drug addict, so am familiar with the scheming one goes through to procure stuff.

Edited June 20, 2023 by StringJunky

[zapatos]

33 minutes ago, CharonY said:

It depends on use, often patches are used with rather precise delivery parameters. If used via injection (i.e. manual dosing) human error is going to be a factor, for sure.

Correct me if i am wrong please, but i thought that just because a drug is 50x stronger than an alternative, that does not mean you inject a volume equal to 1/50th of the weaker drug. You would instead inject a roughly equal volume in both case, but the fentanyl dose would be less concentrated and consist of more 'filler' and less drug. I would expect human error to be roughly the same risk for either drug.

[CharonY]

57 minutes ago, zapatos said:

Correct me if i am wrong please, but i thought that just because a drug is 50x stronger than an alternative, that does not mean you inject a volume equal to 1/50th of the weaker drug. You would instead inject a roughly equal volume in both case, but the fentanyl dose would be less concentrated and consist of more 'filler' and less drug. I would expect human error to be roughly the same risk for either drug.

No, you are right, the volume is generally adjusted for the expected application and provided in a range that is generally convenient to apply. However, some drugs might have a narrower safe range than others. So the impact of e.g. not having enough time between treatments or accidental misdosing can have different effects. That being said, I am not sure where fentanyl sits in terms of relative safety. I think I have read somewhere that switch of medication has to be done more carefully as the effects can be initially stronger than anticipated (at equivalent dosages).