Skepticism

Pain, Drugs, and the Joy of Online Discussions

Something happened yesterday that made me want to discuss a number of issues here, but I’m not sure if I can get them all into one post. I’ll try, anyway.

A few days ago at SkepchickCon (which was amazing and which I will try to post about later), I was having drinks with Greg Laden, Pamela Gay, and a few other folks. I made a comment expressing surprise that the FDA is considering a ban on Vicodin and Percocet, drugs that I’ve always considered amazingly helpful. I don’t have chronic pain issues, but as many of you know I do play physically demanding sports and also get hit by cars a lot. I also have serious back problems that I can usually keep under control with physical therapy but often require heavy-duty pain meds. I was a little horrified that the magical drugs might go away.

Greg and Pamela explained that the problem was the combination of drugs contained in those pills—an opioid, which can be addictive, and acetaminophen, which can destroy the liver. The idea (as I understand it) is that if those are separated, people who become addicted to the op can at least take less of the acetaminophen and thus spare their livers. Also, people with pain may be able to continue taking the opioid but with lesser doses of acetaminophen because separating the two will make it possible for patients to determine if they are able to achieve adequate pain control without the full dose of acetaminophen contained in each combination pill.

That struck me as rather logical and even kind, since it’s not often I hear our government attempt to actually help people with drug addictions, other than stupidly insisting they stop taking drugs. However, I was curious to hear the opposing viewpoint, which is why I was happy to see just such a viewpoint pop up in my feed reader yesterday, courtesy of “amandaw” at Feministe, a feminist blog I read quite a bit.

Unfortunately, the post didn’t really clarify anything for me. She wrote that after the ban, chronic pain patients would have “to jump through an increasing number of hoops to obtain effective treatment,” but then failed to explain what that would entail. She made a case for why opioids are necessary for some patients, which isn’t an issue here since opioids were not being banned. She then suggests that if doctors are willing to advise patients to take Tylenol with their opioid, then they should be willing to advise them not to abuse a Tylenol/opioid combination. That seems to oversimplify the difficulty of addiction, but even if true, it doesn’t explain why this would significantly impact the lives of patients currently taking the combo drugs.

She also talks a good deal about how her life would be awful without Vicodin, and how difficult it is for her to get her needed dosage. This may be true, but it still didn’t explain for me what would change if the Tylenol were taken separately.

After reading the post several times, I clicked through to read the comments in the hopes that someone would answer the question. Happily, someone did. In comment #17, W. Kiernan explains that the combination drug is classified as Schedule III, while the opioid alone is Schedule II. This means that it’s easier for a patient to get the combination drug, which means they will face additional hurdles unless the opioid are reclassified.

Reading that allowed me to make up my mind on where I stand: before these drugs are banned, the government must reclassify those opioids and ensure that patients will still have access to the pain meds they need. Also, accessibility to the full spectrum of evidence-based pain management services should be enhanced. As amandaw mentioned in her post, the use of pain meds is only one part of management.

The other comments on the thread, though, really surprised me. “Malathion” takes issue with another commenter’s assertion that “People who take these medications KNOW that they can cause liver damage.” Malathion says:

The problem is – this isn’t really true. According to the New York Times, “even recommended doses can cause liver damage in some people. And more than 400 people die and 42,000 are hospitalized every year in the United States from overdoses.” I’ve been prescribed Vicodin before, and I had no idea that a recommended dose could hurt me.

I agree with you that patients’ rights suffer when the government regulates with a heavy hand. But the medical profession has proven unable to properly manage drug interactions — over 20,000 deaths were caused by drug interactions in 2004. http://www.washingtonpost.com/wp-dyn/content/article/2007/02/23/AR2007022301780.html

I also agree that educated medical consumers like you (people with access to the internet and other sources of research and the ability to effectively advocate for themselves with doctors) can and should be able to make these decisions for themselves, in an ideal world. But the government is supposed to protect everyone, not just those people smart enough/resourceful enough to figure out their prescriptions for themselves.

In making these comments, I am in no way saying that I don’t think people have a right to narcotic pain relief. That seems to be the crux of the problem here — it’s harder to get plain narcotics prescribed than it should be.

To which amandaw responded:

See folks, we have to “protect” those stupid, clueless, completely-removed-of-agency people who might abuse things. We’re the smart people, but some folks out there aren’t like us! They just don’t know how to manage their own lives, so we have to do it for them, yanno? Sigh, the abled man’s burden.

I won’t reprint the entire thread here, but I wanted to give a taste of the way that facts and an opposing viewpoint, which is expressed incredibly politely, are met with ridicule and strawmen. I made the mistake of stepping in, writing:

Amandaw: Mark and others have offered very well-reasoned and factual input to this discussion, clarifying important information about why these drugs may be banned and what that means for those who require them for pain management. Mark’s post had no attitude and not once did he imply anything about “God’s Gift To Us.” He didn’t even write that anything was “just that easy,” despite your use of quotes.

I read Feministe often and agree with the bulk of what’s here, but your OP and follow-up comments have surprised me. Instead of fostering a discussion about the topic, you’ve responded to reasonable facts with emotional appeals, insults, and strawmen. I understand that the topic is of extreme importance to you, but you might make a more persuasive argument if you addressed the points made and realized that no one is attacking you.

In response, I was told I was privileged, patronizing, and not a feminist. The moderator said I was out of line. I was told that people with disabilities have a right to be angry, that I am ignoring them, and that I obviously don’t want to understand their viewpoints. My statement is completely twisted to mean things completely removed from the topic, such as that women have to “play nice.”

Reading the responses left me seriously depressed. On Bug Girl’s advice, I turned to our good friend Lucy, a pain-management specialist, skeptic, and all-around amazing woman, to help me better understand the many issues surrounding this topic. Her response was so illuminating that I’m going to post it here—she says the comments on that blog are understandable, considering:

“They cannot respond to the facts and opposing viewpoints in a rational way because ironically, they have adopted their own position of privilege – the PWD. Somehow, being a PWD means you have exclusive access to truth and cannot be questioned or doubted. It means that the usual standards of scientific evidence applied in medicine no longer count. So, anecdote (lived experience) trumps the insight and information of professionals. ONLY PWD can understand disabilities and can make rational decisions about their management. The FDA, doctors etc. are not to be trusted.

“Some of this does indeed come from a long history of inadequate care for people with pain. As recently as three decades ago, even people dying from cancer were denied opioids in the last few weeks of life for fear they would become addicts. And today, while opioids are more readily available to people with chronic non-cancer pain, there still exists a stigma against these people.

“However, there is a need for balance. Access has to be balanced with safety. Availability of safer formulations of drugs (the schedule change you mention), development of newer safer mechanism targeted drugs without addictive potential, and increased health related literacy due to warning on all products containing acetaminophen are potential outcomes of this change that we can and will work towards.”

I’m interested to hear what you all think about any of the topics I’ve touched on in this ridiculously long and overly serious post. Feel free to choose from the following:

1. The proposed ban: good idea or bad idea or something else?
2. Are regulations like this imposed to protect us or control us?
3. Is there a point where just asking questions or offering opposing facts becomes in and of itself offensive? Does this compare to the way many of us feel about Holocaust deniers or 9/11 conspiracy theorists?

Obviously I’m not going to moderate this discussion quite as severely as Feministe considers the norm, but I will ask you all to keep your comments civil. This incident has reinforced one of the things I love about the Skepchick community, which is our ability to discuss and debate topics while remaining relatively civil and occasionally even changing our minds.

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Rebecca Watson

Rebecca leads a team of skeptical female activists at Skepchick.org. She travels around the world delivering entertaining talks on science, atheism, feminism, and skepticism. There is currently an asteroid orbiting the sun with her name on it. You can follow her every fascinating move on Twitter or on Google+.

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198 Comments

  1. The problem with acetaminophen is that a lot of products contain it not just prescription pain relievers. It’s in cold medicine and other otc drugs where people are unaware of it. It’s way too easy to take the recommended dose of one or two medications and end up going over the recommend limit for acetaminophen. This isn’t just a problem for pain killer junkies. It’s a problem for everyday people who have a cold, headache, an injury and a glass of wine for dinner. The ban also regulates other products that contain acetaminophen not just prescription pain killers. If I remember correctly they are also revising the dosing on children’s acetaminophen and cold products.

    I’m all for the ban. It’s not really a ban after all just a separation of drugs. In my experience acetaminophen alone is a better pain reliever than any opioid I’ve ever taken and I’ve had a few. I realize for some people they are wonderful and help them get their lives back. In my case I was still in pain when I took them I just didn’t care about it or anything else.

  2. So what is the big deal if someone needs to essentially be a medically managed narcotic addict for the rest of their lives if the alternative is being bed ridden, depressed and unable to function along with being in constant pain? Fuck the moralizing and treat the person and their pain in a reasonable and rational manner. As for separating the narcotic and acetaminophen, well that seems fine if patients are not placed at risk of being denied necessary medications and doctors are not given reasonable options.

  3. Persons quoted in the Tara Parker-Pope’s column in the New York Times today made great points: Acetaminophen is in *everything* and may not be labelled. You can very easily go over your 4g/day recommended safe dose without thinking about it.

    http://www.nytimes.com/2009/07/07/health/07well.html

    It seems like making folks take these drugs a la carte is a good way to avoid these interactions.

    I, too, was unaware of the Schedule II and III implications. Isn’t it great there’s a public comment period to ferret out issues like that?

  4. I read the original post and the comments earlier, and just went back to catch up, only to discover that the mod approach to any dissenting post in that thread is to put a picture of panda in it, even on those posts which are polite but not in agreement with the OP. I find that such a singularly unhelpful, unintelligent and counter-productive tactic, I am ashamed to have visited. I have some interest in the subject and a few anecdotes of my own to counter those of the OP, but pain relief and diagnosis-of-exclusion conditions such as fybromyalgia or ME are such emotional topics, and the standard of debate on the other blog so low, I don’t think I’ll bother.

    All I will say is that drugs and the prescription of them will inevitably change as new information and standards become available. Any such change will undoubtedly upset people at the ‘heavy user’ end of the scale.

  5. I came to say what Pinkbunny did.
    Also I agree with Lucy.
    I’ve been jumped in a conversation and called all of those things too when I pointed out that the science disagreed with the groups conclusion.

  6. …you’ve responded to reasonable facts with emotional appeals, insults, and strawmen.

    I realize that this is by no means empirical evidence, but this kind of vehement, angry response in a discussion that is relevant to one’s ability to obtain an addictive substance seems eerily familiar to me, as someone who has lived with an addict for nine years. When a rational person suddenly behaves irrationally when his supply is threatened…it ain’t proof, but it raises a flag.

  7. 1.) I see both sides of the issue now, I never really looked at it from the perspective of saving people hooked on the stuff.

    Personally, I am all for separating the acetaminophen from the opioid narcotics as I find its inclusion to be personally unnecessary. I understand its original conclusion was to both deter its misuse and allow for the combination drugs to be placed on Schedule III. The problem here, as you’ve stated, is if the drugs are not reclassified and due to the “combination ban”, pain meds are harder to come by for those who actually need them.

    It does seem minor, but the fact that we will be “going back” to 325mg tablets of OTC tylenol seems silly. I know that I am just going to end up taking 3 tablets.

    2.) I am certain the intention of these regulations is to protect us. I don’t see any profit motive in changing these around; in fact I find that drug companies probably would be against this, considering most or all of the opioid pain medications that I’m aware of are available in generic form.

    3.) Let me just put it this way: the people at the Feministe blog are flat-out in the wrong here. They’re exhibiting classic signs of groupthink, almost militarily. The difference between this and Holocaust-deniers and 9/11 “truthers” is that the OP on Feministe is a complete opinion piece, whereas in dealing with 9/11 and the Holocaust, we’re dealing with facts and evidence. It’s not like you were saying “Vicodin doesn’t work and only addicts like it”, or “People who take Vicodin and Percocet are idiots”.

  8. Pinkbunny has a good point and one which I have heard used in the media as one reason for this proposed ban. However, there has to be a point where the average adult takes some responsibility to read the bottle or box before taking the drug. My Vicodin always came with warning stickers on the bottle about the acetaminophen content and the “no alcohol” rule.

    I have been on and off Vicodin for years for back pain due to spinal injuries and disk surgery. However, my wife is an RN BSN, so she also monitors my medications to prevent any problems. She’s caught a few errors, both by pharmacies and MDs.

    I am against the proposed ban unless they do something like Rebecca suggested about the Schedule II and III classifications. There are enough barriers to people getting the pain management drugs they need as it is, especially narcotics-based pain medication. Doctors that prescribe “too much” end up with visits from the DEA. I resent some bureaucrat (without an MD) deciding what my pain management requirements are. It’s none of their business unless they have clear and compelling evidence of criminal activity or intent.

  9. Well, I have a few questions.

    I can understand the cause for concern for people with chronic illnesses which will require a lifetime of medication. For those without those conditions, who either take your average OTC medication or due to some random illness/injury, such as being hit by cars, need occasional prescription, how can you end up taking enough acetaminophen (from now on-called aceto) to cause permanent damage to your liver? It seems like everything is quantifiable. You need no more the X grams of this per day, Y ounces of that per day, etc. Has someone sat down and figured what a “safe” amount of aceto per day? Week? Month? Year? I think first we need to find that out, then come up with reasonable scenerios how one would go over it. I think this is a little knee-jerk. IMHO, it seems the people AND the government have this reaction-people die from it. Ban it, regulate it, demonize it. They don’t sit down and ask themselves how much of a risk is it. While 400 deaths and 42,000 hospilizations are a result of accidental misdosages of aceto, how many people medication, OTC and prescriptions on a yearly basis? If its out of 50,000, yes, that’s a substantial risk. If its 42 Million, well, that’s a risk of 1/10 of 1%.

    Finally, and after this, I swear I’ll be quiet, for a bit, no, I don’t think asking questions about this subject is offensive, as long as its framed properly. This is a debate in progress. This is nothing like 9/11 conspiracy theories or holocaust deniers. The latter two are things whick the book has been written and the debate is over, but some people didn’t like the ending. This topic is a work in progress.

  10. I don’t know if the proposed ban on combo opiods/analgesics is necessary, though I think it may be more parsimonious than other options that could help limit the dangers of those drugs.

    I will say that there is no reason to assume that everyone understands the dangers of acetominophen: I consider myself a rather intelligent person, but I had ABSOLUTELY NO IDEA about the relatively small gap between the recommended and toxic doses of acetominophen/paracetamol until I went to the UK, where the warnings are far clearer.

    I also accidentally took far more acetominophen than I should have one day when I forgot it was in a particular cold med and took a full dose of that AND Tylenol. I wasn’t in any actual danger, but if I didn’t catch it and did that again when it was time to take another dose, I would have been in trouble.

    It’s probably a great idea to make warnings on the OTC products more explicit. Due to the extraordinarily high number of acetominophen-containing products on the market, it’s probably easier to do this than to make a case and ban all of them.

    It’s probably simpler to tighten control over the (often) higher dose prescription combo drugs to help protect those people who are unaware of the risks and/or fall into a pattern of abuse.

    It’s a thin line between protection and control, and I really don’t know where I stand. I do know, however, that it should never be offensive to point out facts, and that it is cowardly to couch irrationality in the language of power dichotomies. Just because a group is marginalized doesn’t give them a trump card in a debate. Everyone needs to have their facts straight; everything else is just dressing.

  11. I REALLY don’t appreciate having my gender thrown in my face when I’m weighing in on an issue that I have a complicated take on.

    Yeah, I’m a man. But I also consider myself a feminist, gay rights advocate, and so on. I really don’t appreciate being told that I have to shut up and be lectured at, and if I disagree, that _I_ am being condescending and lecturing.

    Respect is a matter of mutuality. If you insult me and attack my motives, personality, and gender, that’s not respect. That’s a low blow. If you appeal to perspectives I may not have considered, I’m _very_ inclined to listen and learn. But these lazy appeals to gender and feminist themes about being told to “shut up and calm down” simply because I don’t agree with someone’s tone or arguments just piss me off. It exploits very real problems to make a rhetorical swipe.

    Women in Afghanistan are silenced all the time, with violence and degradation. It’s incredibly upsetting. Women on political blogs who can’t take even a little criticism of their arguments without then claiming to be put-down victims more than justified to stick a “boot up the ass” of anyone who doesn’t agree are exploiting sexism and suffering, not fighting it.

  12. 1. The proposed ban: good idea or bad idea or something else?

    Absolutely a good idea. And about time, for that matter. It’s been 6 years since I stopped working in a pharmacy, where I was a certified technician, and the argument has been going on since before I started working in that field. The pharmacists I worked for were so exasperated by how readily prescribed it was, despite health risks. Another thing to remember is that not everybody is… well… smart. They’ll go to the doctor, get the prescription, have it filled and take Tylenol, in conjunction with the prescription, later when their head hurts. A lot of people rely on the false logic that if a doctor prescribes it, it can’t be bad for you.

    2. Are regulations like this imposed to protect us or control us?

    These regulations are there to protect the consumer. Yes, if the opioids aren’t reclassified, it will make it more difficult to get them. But honestly, with an understanding doctor who knows that you’re in pain and not just a pill seeker, it shouldn’t be that much harder. Doctors aren’t out to get us. Neither is the FDA.

    3. Is there a point where just asking questions or offering opposing facts becomes in and of itself offensive? Does this compare to the way many of us feel about Holocaust deniers or 9/11 conspiracy theorists?

    I personally don’t see a comparison at all. What conspiracy theorists have, besides paranoid delusions and sandwich boards, is an evidence-lacking argument against historical fact (in the cases you cited). Asking questions about something that you haven’t personally experienced, or something that wasn’t explained to the extent that it should/could have been isn’t anything but acting as an informed and curious human being. You didn’t act presumptuous and say “c’mon, you’re fine – everybody hurts at some point.” You asked questions in search of a logical and rational answer. The problem is that they weren’t willing to respond logically or rationally.

  13. Obviously, the entire regulatory structure of the FDA is FUBAR and needs to change. Anything they within that framework is therefore by definition a mistake leading from one SNAFU to another.

    On question 3…

    I would not find it offensive for someone who thought that the holocaust had not happened to ask me questions and offer alternate evidence. I think it’s okay for people to be wrong about things and to engage in information gathering and testing activity. There was a time that I was convinced that HIV did not cause AIDS, but by asking questions and presenting evidence I was able to learn that my questions could be answered and my evidence sucked donkey balls.

    Most AIDS, Climate Change, and Autism deniers do NOT ask questions and do not offer evidence that can be tested, they just insult you and make untestable and untested or even factually incorrect pronouncements as if they are an authority.

  14. “1. The proposed ban: good idea or bad idea or something else?”

    It sounds good to me. A problem was recognized and this was the most effective solution. I don’t by the argument that Big Pharma is going to make out like a bandit on this one.

    “2. Are regulations like this imposed to protect us or control us?”

    Well, there is a bit of the nanny-state in all regulation. This example is not particularly egregious, however. To me it is similar to banning lawn darts. They can be used safely, but so many people weren’t it was necessary to do away them.

    “3. Is there a point where just asking questions or offering opposing facts becomes in and of itself offensive?”

    Yes of course there is, but I don’t think this is what happened here. The original article left no doubt in my mind that the author had no intention of being reasonable. The moderator’s note was particularly telling. I read it as “agree with me or else.” I haven’t heard of PWD before, but it fits. In a larger sense some people just get used to the non-stop attention and control a disability or past trauma has given them. They are not prepared to discuss it reasonably nor are they particularly interested in getting past it. The quintessential expression of this was the old woman in _Cold Comfort Farm_. Her trauma? “I saw something nasty in the woodshed.” She used this to define her life and bully everyone around her.

    As to amandaw, “I’d take her too, but she’s gloomy. ”

    And just one more quote, I love this movie so, “It means endless, horrifying torment! It means your poor, sinful bodies stretched out on red-hot gridirons, in the nethermost, fiery pit of hell and those demons mocking ye while they waves cooling jellies in front of ye. You know what it’s like when you burn your hand, taking a cake out of the oven, or lighting one of them godless cigarettes? And it stings with a fearful pain, aye? And you run to clap a bit of butter on it to take the pain away, aye? Well, I’ll tell ye, there’ll be no butter in hell! “

  15. @infinitemonkey: Minor Quibble here…

    I had an epic debate in this forum with True Skeptic over 911. It lasted for weeks, hundreds of posts. And the thing is: it was okay for TS to ask the questions he asked and to disagree with the final analysis.

    What wasn’t okay was that he insisted that he knew things he didn’t, refused to admit any mistakes when they were pointed out, and continually repeated the same irrelevant points.

    The problem with Denialism is not that the debate is over. Someone may be new to the debate and unfamiliar with the evidence. The problem with Denialism is the unwillingness to actually engage in critical thinking on the topic.

  16. I feel like this how situation would go away if the law required doctors to spend 5 minutes explaining the medication they were prescribing before they let the patient out the door. I broke both my arms (yes, at the same time) and got prescribed oxycodone and a year later I got my wisdom teeth pulled out and was prescribed vicodin (which, if I understand correctly, they are in the same family of drugs). The total extent of my conversation with the doctor was this: here is a prescription to help manage the pain. That was it.

    I feel lucky that I am a bit of a freak in that I do research and do ask my pharmacists when I pick up the medication what, if anything, would cause problems if I took it with my pain medication. And I always read the warning labels. But I think most people do not do that, and I think most people lack the basic information that some drugs interact badly with other drugs. This is why I do not think that a “ban” is the only or correct solution. Instead, to be effective, any attempt to solve a drug problem or people misusing the drug must also include education, which I think would be most effective if a doctor, or nurse took the time to explain what the drug is, and what should and should not be taken with it, when it was prescribed.

  17. RE: #3
    I think you were correct in feeling attacked by the contempt your alternative opinion but you should have paid more attention to her last paragraph:

    “I will be stricter on this thread. No lecturing, no patronizing. Treat us with respect. If you think you can step in and drop names or pull rank to justify a condescending lecture to people with chronic pain conditions, to tell them how it “really” is, what their life is “really” like or how naive and stupid they are, I’m going to put my boot on your ass. Fair warning.”

    This post was meant to be a one-sided argument from authority, hers. She’ll be responsible for any lecturing, patronizing, and disrespect.

    I do have sympathy for her. It sounds like it has been a real battle to get the medication she needs. Unfortunately she turns her anger against the system on to her readers.

  18. I’m gonna have to agree with wrd on this one. I get the feeling that Amandaw is acting out of emotion, specifically fear, that something that makes it easier for her to live is going to be taken away. Irrationality is almost expected in this case. Even from some one who was previously reasonable.

  19. The alcohol problem with Percocet/Vicodin is not emphasized NEARLY enough. it’s REALLY bad to mix Perc/Vic with booze – and not just in a Nancy-Reagan-don’t-do-drugs sort of way. Alcohol is also hepatotoxic, and mixing Perc/Vic with booze compounds the liver toxicity of acetaminophen. I don’t know the stats, but I’m willing to bet that many Perc/Vic-related fatalities (or cases of acute liver failure) involved alcohol. Unfortunately, it’s very popular to have a vodka-vicodin cocktail – I can’t count the number of gleeful Facebook statuses that have involved vicodin and booze.

    I’m against banning Perc/Vic for several reasons. Banning Perc/Vic will enhance their illegal trade (it’s not like the U.S. is the only place you can get the stuff).It would also be ironic to ban Perc/Vic (which comes in bottles of ~30) and not acetaminophen (Tylenol), which you can get in bottles of 1,000 at Costco. However, acetaminophen is one of the rare analgesics that you can give pregnant/lactating mothers and babies. Aspirin and other NSAIDS are contraindicated and very dangerous to give to children (“baby aspirin” is the worst term ever and should be removed from the English vocabulary). So for obvious reasons, acetaminophen should not be banned either.

    I also live with chronic pain (huge bike/car accident and 13 surgeries) and was initially given HUGE amounts of morphine and demerol in the ICU – but I refused Perc/Vic for all of my outpatient surgeries because the adverse effects (dizziness, itchiness, constipation) weren’t worth it the pain relief. So it’s not like I’m against banning these drugs because I’m addicted – I can’t stand Perc/Vic.

    I’m for stronger warnings and better public education.

  20. My grandmother has been switched off of the combo drug and now takes them individually. Although the cost has gone up by the price of a bottle of Tylenol every so often, it seems like it is easier to manage her pain and not worry about liver damage. The red tape she has to go through each month is pretty much the same, though it may vary from state to state. All in all, I’d say I’m in favor of banning the combos as long as the components are just as available.

  21. This incident highlights the importance of being able to step back and look at a discussion dispassionately. Your comment on Feministe struck me as entirely reasonable and and productive, but was interpreted as a personal attack by people who had already decided that anyone who disagreed with them was their enemy. A very W mindset.

    I’d like to see this larger topic (reclassification, blocking of the combined drug going forward, prevalence of acetaminophen in OTC, etc) as a platform for the importance of providing your healthcare providers (physicians, specialists, and pharmacists) with the full picture of what non-food items you are consuming. Vitamins, supplements, herbal remedies, OTC medicines, aspirin, anything that might cause them to say “Gee, maybe you should stop taking [x] while you’re on this prescription for the following reasons”.

    My wife has at various times had to stop taking various things (including birth control) due to prescriptions for unrelated health issues. Because she kept both her PCP and our pharmacist in the loop they were able to let he know what may and what may not be a problem.

  22. You’ve really hit upon several topics here. In terms of your questions, I think that autobahn made some very good points above.

    I’ve been attacked personally in on-line discussions. The vicious attacks are the easiest to dismiss as they are completely unreasonable. The ones from sources that I respect are the hardest to take, whether reasonable or not.

    In this case, I think you took it personal because you’ve previously had a lot of respect for the people on that board. You shouldn’t (take it personal.) Despite the history, the irrational response by the blogger and the mod are similar to what I’m sure you have heard from other sources and you should treat it the same way.

    I know sometimes it’s disappointing (and frustrating) when you feel like you’ve made every attempt to be thoughtful and fair, only to be shot down or attacked. However, that shouldn’t stop anyone from offering rational opinions where they feel they need to be made. Ultimately, we hope to each make a small difference where we can. There will always be people who back into illogical corners and put on their blinders.

  23. @wendy: I question wether banning Vicodin will increase it’s illegal trade. I was under the impression that the appeal of taking these drugs recreationally was the effect of the narcotic not the effect of the acetaminophen. The pure narcotic version of these drugs would still be available in the US only it wouldn’t come as a combination with acetaminophen. Wouldn’t recreational users just take the non-acetaminophen version instead of going through the more costly/risky process of importing it from overseas? I’m not a recreational drug user so feel free to correct me if I’m wrong on this…

    I do agree that the acetaminophen/alcohol danger needs to be more widely publicized.

  24. “In response, I was told I was privileged, patronizing, and not a feminist.”

    Just like some christians saying those from different sects aren’t really christians. Apparently you’re on the other side of some feminist schism from her. In any case, it’s a cheap cop out. Also, those who accuse others of being privileged and patronizing should be very careful to understand that it is a true minority of people who are not speaking from some level of privilege. That criticism is to easy to turn back around on the accuser.

  25. Acetaminophen has always creeped me out since I learned that the difference between an effective dose and a fatal dose is about a factor of five. (Someone feel free to correct me if I am wrong!) Not that some necessary, life-saving drugs do not also fit that pattern, but this strikes me as exactly the reason that the distinction between “prescription” and “over the counter” drugs exists, and might exist even in a country in that did not care about recreational drug abuse.

    Of course, the painkillers in question are prescription drugs, but the point I want to make is this: I think it is a very bad idea to add acetaminophen to something that people might take in a wide range of doses–especially substances to which people might become addicted. Classifying the combination as a lower schedule drug because it has been “denatured” with something that will kill you if you take very many seems to me to be about as ethical as the USA’s attempts during the 70’s to control marijuana use by poisoning the crop with paraquat–but leaving it in the fields to be harvested, sold, and eventually smoked.

  26. @sethmanapio: My appoligies, I didn’t elaborate. It seems to me as those who actively subscribe to the mentioned trains of thought often employ logical fallacies en masse, includeing, but not limited to, ad hominem. Those who really don’t know are more open to questioning.

    Although, IMHO, I would question if, by now, with all the information available, they REALLY don’t know about these events, are they actually engaging in intellectual pursuits, just being cynical of “Big Government”, or just not taking the time/interest to do any research. (That’s an opinion)

  27. I’m with wrd. That kind of unreasoning panic is, in my experience, typical of an addict who hasn’t taken the “first step”, that is, admitting a problem. Whether amandaw’s dependence is reasonable or not, SHE cannot be logical or reasonable on this topic.

  28. Weird. I just read that post there.

    I had to leave that site (I check in occasioanlly) because they really DO NOT like anyone that disagrees with them. Amandaw cleary kept getting angrier and angrier and just kept ignoring points. It was pretty bad. She’s not the best poster there, by far.

  29. I know folks that have been on both sides of the spectrum from helped to hurt by pain meds. I think that it is time for the FDA and doctors to give more consideration to the types of medication they give out and afford more detailed information to the patient, but the medications should not be banned. That will hurt more people than it helps. Sadly, there will always be those people that think that the world is against them. Rebecca, you were right to step in, even if they did not appreciate your input.

  30. @QuestionAuthority:

    I am against the proposed ban unless they do something like Rebecca suggested about the Schedule II and III classifications.

    Anyway, I agree with this and everything else you said, and just wanted to put it out there, because others seem to have missed it when they say “I agree with the ban”.

  31. I actually had no idea that percocet had acetaminophen in it. And I always thought that vicodin and percocet were completely different. Vicodin (hydrocodone?) made me puke the minute it hit my stomach whereas percocet is what I take for a really bad kidney stone. I don’t think I ever took more than two in one day and then only when it became unbearable. It never occurred to me to take an OTC pain reliever while I was on the “heavy stuff”, but then I’ve never had chronic pain.

    As far as the discussion on the other site goes, it reminds me very strongly of a recent blog kerfuffle around feminism, perceived misogyny and the enforcement of rules. People get so worked up. Of course, I’m just a privileged white male, so I probably don’t get it.

  32. justsayin says:

    July 7th, 2009 at 8:58 am – Edit

    From Rebecca’s twitter account: “So bummed. Discovered 1 of my favorite sources, Feministe, is full of angry, unreasonable people. Just got attacked for not agreeing.”

    You weren’t attacked for not agreeing. You were responded to, in the way that you were responded to, for telling someone to “calm down”, which in effect is minimizing the pain they’re speaking about. But it is interesting that you would immediately run to twitter to have your perspective reaffirmed and backed up by your legions of white male followers.

    Just sayin’.

    THERE. That’s why I had to leave that place. As many of you know, I’m a feminist and pretty loud about it, but DAMN that place is full of people who will NOT discuss ANYTHING–if you disagree with them, or ask that they stop acting angry (when they are clearly angry), you are suddenly not a feminist. Ugh. UGH.

  33. What’s ironic, CyberLizard, is that Rebecca’s blog is called Skepchick and the majority of us are women. Though we’re not condescending assholes to men, and so you melanin-deprived non-vaginal persons are totally welcome here.

  34. @Robert: I think it might help a bit if doctor’s explained more to people about the interaction, but it wouldn’t go away by any means. Even now, good doctors typically *do* explain to their patients that the drugs have tylenol in them, and to be careful, etc., but people just don’t listen very well. Really, I think the biggest impact of these policies will be on the side of OTC drugs. There are a few prescription drugs that have tylenol, but there is a *lot* of OTC stuff that has tylenol, and people give even less thought to it because it’s OTC.

    FWIW, my ex-wife had some significant chronic pain problems, and we dealt with this very issue, since she tried to medicate with tylenol, rather than stronger opioids. There were numerous discussions of, “Wait – how many times have I taken Tylenol today so far?” – and that was even before you add the complication of when she last took a hydrocodone (which have acetaminophen). Personally, we would’ve been very happy to have the separate drugs available, so that she could just keep track of one thing.

  35. I’ve noticed that about Feministe, and that’s exactly why I’m hesitant to offer comments on it, or even continue reading it. The way they disparage commenters for the sin of asking a question about an opposing viewpoint…. yeah. It’s more than a little off-putting.

  36. @marilove: Same here. And same with Feministing, though to a lesser extent (Jessica Valenti is awesome, but her co-bloggers started getting on my nerves). It’s really irritating, because I like to read about feminist issues, but I can’t stand the sanctimonious bullshit from some of the writers on those two sites.

    Mind, those attitudes are obviously not in any way unique to feminist sites, but they do seem endemic to a lot of special-purpose communities. Console wars topics on gaming forums comes to mind; some people just can’t tolerate any compliments paid to a game console other than the one they own. It’s weird, but it happens.

    People usually talk about the Overton Window as a model for explaining why extremist positions come to be seen as moderate or at least acceptable, but I think the same thing can apply in the other way, where a specialised community, through its inherently insular nature, shrinks its window of acceptable discourse to exclude perfectly reasonable and moderate positions or behaviours as being unacceptably extremist or offensive. That sort of thing might explain why sites like this one or Pandagon can discuss feminist issues or medical issues or whatever and have productive disagreements without people getting all butthurt. Both have a feminist bent to them, but neither are particularly specialised and cover a range of other topics that prevent an insulated habitat of ideas (Telsa help me, I nearly said “ideosphere”) from forming.

  37. @pciszek: “Acetaminophen has always creeped me out since I learned that the difference between an effective dose and a fatal dose is about a factor of five.”

    Estimates for the LD-50 of acetaminophen vary, but they are fairly high. The nasty thing about overdose is if you succeed it’s a long (potentially days long) and painful death. If you don’t it’s an extremely long and painful recovery with a good chance of permanent damage. This is not one of the brighter ways to check out. (Ah the joys of growing up in a house with a pharmacist and a toxicologist. Dinnertime was so informative.)

  38. @pinkbunny: acetaminophen and alcohol are both metabolized by the cytochrome P45o enzymes in your liver, and when you take both you get drunk faster. this is probably the predominant effect when you mix the perc/vic (which is like 95% tylenol) with alcohol.

    Percodan is another alternative – it’s oxycodone (active ingredient in Percocet and Oxycontin) with aspirin instead of tylenol. Too much percodan gives you ulcers and other delights, so not ideal.

    Oxycontin is oxycodone in a time-release form with no other active ingredients – which means you can crush it up and snort/shoot it. More oxycontin is not good thing either.

    Adding acetaminophen to oxycodone (to make percocet) and hydrocodone (to make vicodin) doesn’t just give better pain relief – it also prevents shooting it up.

  39. Oh hi, I’m malathion. Thank you for bringing some attention to the frankly bizarre dynamics on Feministe — which seems to have been worsening in the past few months. Two of the newer bloggers, Amandaw and Cara, pretty much will not tolerate anything other than complete agreement with their posts. Otherwise, you get called out on your “privilege.” It’s taken to an absurd extent in the Vicodin post. I have no problem with the concept of privilege — I think it’s very useful — but it’s grown into this monster that brooks no dissent.

    Anyway, one thing to consider here is that the FDA actually does not have that much of a role in the doctor-patient relationship, other than requiring that certain drugs be sold by prescription. The FDA primarily regulates pharmaceutical companies and distributors by approving or banning drugs and imposing labelling and marketing requirements. The doctor can then decide how and to whom to prescribe the drugs and is free to go “off label” and prescribe them for whatever purpose he feels is medically appropriate.

    So the only way the FDA can effectively act here is to ban the drug, since it can’t step in and mandate that doctors educate patients in a certain way about the dangers of the drug. What you end up with is the FDA using the blunt tool of banning, because it has no few other hard compliance measures to use.

  40. Personally, I think the combo drugs should be separated. The main argument against doing so is the drug classification, which should be changed. However, one additional problem is that taking two separate prescriptions, or one prescription and one OTC medication could be more expensive and generally more complicated for the patient. I used to have a prescription plan that charged me the same amount for any prescription. Taking two separate drugs would cost me twice as much.

    However, I still think that the drugs should be separated. It gives patients and doctors more control over dosing. I’ve only had one experience with Percocet, and it was just awful for me. If I need to use it in the future, it would be nice if I could have the same dose of acetaminophen and a lower dose of the opioid.

  41. Again, one of the reasons they mixed the narcotics with other analgesics was so they couldn’t be injected or snorted. There are tight regulations on Oxycontin for this very reason – junkies were knocking over pharmacies left and right to get the stuff. It’s NOT necessarily a good idea to have more stand-alone narcotics.

    Doctors can always tailor dosing to individual patient needs (i.e. lower or separate doses). In any event, the dangers of acetaminophen overuse need to have more emphasis.

  42. @PrimevilKneivel: What Amandaw doesn’t realize is that she’s alienating people who agree with her.

    I mean, I don’t disagree with her. Though I think going the route with the Schedule II and III classifications is the best way to go, I don’t necessarily disagree with her.

    But I’m not going to tell her that or anyone else in that thread that, because if I don’t 100% agree with everything she has said and just “nod nod, yes yes” I’ll be told I’m not a feminist.

    Also, if she didn’t want a DISCUSSION, why leave the comments on? Why make the post at all?

    I’ll be avoiding all of her posts in that blog (not that I visit much anymore), which I’m sure wasn’t her intention, but damn, the panda shit was condescending and ridiculous.

  43. @Chelsea: @marilove: You know, I think that the example given shows low online ethicacy. If someone has issue with what is said on twitter, then the argument should be brought up on twitter, not brought back to the forum. Its almost like a second jumping. Personally, I don’t see much of a reason to continue to patronize such a place, but I am a melonin-deprived, non-vaginal person.

  44. I haven’t been on a chronic medication regimen in more than a decade, and the only times I’ve been prescribed painkillers were after wisdom-tooth removal and again after a root canal. But if I did have to take Vicodin for a serious condition, all else being equal, I’d rather the combination were split. The more pills I have to take each day, the more hard core I am.

  45. @wendy: You make a really good point.

    Oxycontin makes me itch something *fierce*. I thought maybe I was allergic, but I guess it’s a normal reaction. Not pleasant at all. I’d scratch my face off before I had a chance to become addicted.

  46. @infinitemonkey: “Personally, I don’t see much of a reason to continue to patronize such a place, but I am a melonin-deprived, non-vaginal person.”

    Do you not see a reason to patronize such a place because of that poster and the reactions, or because it’s a feminist blog? Confused.

    Feministing.com tends to be a bit better.

  47. @infinitemonkey: “If someone has issue with what is said on twitter, then the argument should be brought up on twitter, not brought back to the forum.”

    I’m not necessarily opposed to topics like that jumping sites, which is why I did it in the first place. When the mod told me my first comment was out of line, I realized that there was nothing else I could say there that would be welcome. Twitter is my go-to place to whine, since I can hit more personal topics there than I would on Skepchick. It was only after posting there that I realized this would make a really wonderful discussion topic for Skepchick, which thus far I think it has.

  48. @wrd:
    That was my reaction too. That sudden, from nowhere anger and blame.

    Although I hesitate to ever endorse pulling a tool from the doctor’s arsenal, *if *the opoid dosage classification is changed from Schedule III to Schedule II, I think that this is a matter of protecting us, not controlling us. Actually, because of the tendency to overtake acetaminaphine, possibly an argument could be made that it should not be sold as a combination at all, whether OTC (a la cold meds) or prescribed, but should remain available as a stand-alone drug, both OTC and in controlled prescription doses.

    Interestingly, I think the regulation of the other significant component of Percocet, the oxycodone, is motivated as much or more by a desire to control us than regulating acetaminophen is. The regulation of acetaminophen is primarily to prevent potential liver damage, perhaps lethal although perhaps not. Not to make light of the possible ill physical effects of opioids, but I think the regulation of oxycodone is motivated more by a desire to prevent people from using it recreationally than by a desire to prevent physical harm. In short, the main reason oxycodone is restricted is to control our behavior. Yes, preventing recreational use also prevents addiction initiated by recreational use. That may in itself be a good argument for regulation, although I think it bears discussion.

  49. Really enjoying these comments.

    @wendy. I agree with you re: your concerns about opioid abuse. This is a bit off topic but have you heard about the abuse-resistant formulations that are being developed? I went to a symposium about them and thought they were interesting. We’ll see what develops…

    Here’s more info (a little dated but a good overview): http://www.msnbc.msn.com/id/17581544/

  50. The thread on Feministe is just one more example of how difficult it is to have a productive discussion and debate anywhere on the internet. I find it really depressing. Skepchick and many of the SciBlogs are the few places I found that seem to have a minimum of irrational outbursts, for which I’m glad. I can’t count how many different blogs and sites I’ve joined, seeing interesting content, only to drop out after realizing that most of the discussions devolve into la-la-la’ing and name calling.

    Is there any good way to participate in such discussions? I’ve always ignored the ‘trolls’ and just replied to the people who seem genuinely interested in debate. But that’s kind of hard when the original poster is one of the worst violaters of the flame rule.

  51. @Rebecca: I was being silly–implying that you should start replying to everyone with Pandas, since that Amanda poster-mod can’t seem to respond without them any more. Unless you’re not seeing the pandas all over the comments there?

  52. @Rebecca: Well, there’s a difference between bringing a discussion to another place, or whining in your personal twitter … and them someone taking that twitter and using it against you in the original discussion. I dunno, it was just off.

  53. I forgot to mention – my orthopedic surgeon recommended I take 500 mg acetaminophen + 400 mg ibuprofen – works just as well as Vicodin, and negligible risk for addiction, and no opiate side effects. That’s what I post-surgery (if I took anything at all – I’m fucking hardcore).

  54. @Rebecca: Wow, indeed. It was like she completely disconnected from reality.

    We can’t imbed pictures here, but from now on, whenever I disagree with someone or don’t like something they say, I’m just going to yell, “PANDA! PANDA! PAAAAANDA!”

  55. I’ve started writing a comment on this three times so far, only to scrap each one. This is so far out of my realm of experience that I can’t even tell if I have an opinion on it, let alone what that opinion might be.

  56. @Robyne_BR: I’ve caught myself getting a bit too involved, even here. Know what I do? Step away. If you see me disappear completely from a thread (especially if it involves rape, or something equally as sensitive) that I was really involved with, and I don’t come back even the next day (sometimes I get distracted lol), it’s usually because I’m not able to argue effectively and logically any longer, and I recognize that. So I leave the thread and move on to the next one.

    That Amanda person really should have done the same, because you can clearly see that she is just getting angrier and angrier.

    Then out come the Pandas.

  57. @wendy: But in this case, it isn’t the addiction that we are discussing, but rather the liver damage that acetaminophen can cause.

    Also, “works just as well as Vicodin,” — that may very well be true for you, but not for everyone, especially those with chronic pain.

  58. A couple of thoughts:

    I don’t think the ban is necessarily appropriate. However, I have always felt that when options include only blends of different drugs that this is bad. I did not know about the schedule II/III issue. It is paramount, in my opinion, that this be fixed. Perhaps the ideal solution is to fix the Schedule II/III problem, decouple the mixes, not ban the blends, and increase awareness of the important facts.

    Regarding the nature of the discussion itself: Rebecca, I think you got your ass judged. Judged, juried, and convicted.

    (I’ll send you a nice cake. With a file in it.)

  59. @marilove – with Vic/Perc, the addiction/tolerance and liver damage go hand-in-hand because as one becomes more tolerant or addicted to the opioid, the more Vic/Perc one has to take. Thus increasing the risk of liver damage.

    This is also a concern with Excedrin (vitamin Ex) – it contains acetaminophen + aspirin (work on separate pain pathways so better pain relief) plus caffeine (also improves pain relief but is also addictive). Caffeine withdrawal itself can also induce migraines, so Excedrin really perpetuates its own use (thus risk of liver damage, aspirin-induced ulcers, and kidney damage).

    As for the acetaminophen/ibuprofen combo, I should have clarified that I’m not making any drug recommendations – just repeating what my surgeon said. Likewise, I’m not recommending no painkillers after surgery – unless you’re fucking hardcore like I am :)

    @Lucy – WHOA!! what’s up with Utah on that painkiller map?? I grew up there!

  60. Hi and thanks for the sanity. I have a chronic pain condition and vicodin rx. My specific diagnosis is one that I often don’t mention – fibromyalgia – because it is dismissed as a made up illness and other such name-calling. My good day pain levels can be equated to what a bad day of flu aches is; the bad days are what I imagine being run over by an SUV filled with cinderblocks would feel like. I know full well that finding a balance between pain management and drug side-effects is annoying, to say the least, but can be done in a fairly successful manner with the right specialist MD. It isn’t easy, and involves tough choices regarding the amount of pain or zombie-headedness you’re willing to live with, but it is possible. I find that the best thing that anyone with health issues can do is advocate for their own care, do extensive research, ask many questions of doctors and other professionals and not waste time and energy feeling sorry for themselves, behavior which will only alienate others and cause your very real pain to be ignored. It took me a long time to find the right balance between maintenance and flare meds from a variety of classes (nsaids, anti-convulsants, muscle-relaxers, snris and opiates). I welcome the separation of hydrocodone from apap, as long as the schedule changes as well. It will give me more control over my own care, something that all chronic pain patients should welcome. If they don’t welcome the empowerment this can give them, I wonder what their real motivation is.

    Thanks again for the sanity.

  61. @Rebecca: I think you need to appeal your conviction on the grounds of entrapment. If a blogger is spoiling so hard for a fight (or someone to beat up) that she ignores agreement in favor of yelling at anyone who disagrees on even the small points, she should perhaps be honest enough to just close the comments and find some form of catharsis that doesn’t involve unwilling victims. And I say that as a blogger who has done just that.

  62. @wendy:

    Adding acetaminophen to oxycodone (to make percocet) and hydrocodone (to make vicodin) doesn’t just give better pain relief – it also prevents shooting it up.

    Does it actually prevent people from shooting it up, or just kill those who do? There is a difference. Hence my comparison to paraquat.

  63. As a chronic pain sufferer, let me add a few points of salience:

    * acetaminophen is a completely safe drug when taken as directed. The NY Times piece today by Tara Parker-Pope lays out some of the nonsense being spread about this medication.

    * drugs like Vicodin and Percoset have limited use for chronic pain. The active ingredient, oxycodone, appears in such low doses in these medications as to be virtually useless for people like me.

    * to ban, or limit the availability of, drugs containing acetaminophen, such as Vicodin, would be worse than futile. It would simply create a black market for the drugs, and force otherwise law-abiding citizens to choose whether to break a ridiculous law or go without the medication. Or they might be tempted by the snake-oil of “alternative medicine,” and we all know how that story ends.

    * the mainstream news media is doing its typical superficial job of covering this story. So 400 people die annually of acetaminophen poisoning — tragic for them and their families, trivial when compared to all other drug-related fatalities. But while we’ve learned to expect this sort of hype from the media, there is no excuse for the FDA to start meddling in how doctors treat their patients’ pain.

    I leave you with this word of warning, taken from a June 30 NT Times article:

    “More people will be suffering from pain,” said Dr. Sean Mackey, chief of pain management at Stanford University Medical School. “More people will be seeing their doctors more frequently and running up health care costs.”

  64. When I broke my collarbone, coincidentally after being hit by a car, I requested Norco, roughly double the opiate and half the acetaminophen, then broke the pills in half. Prescription was the same price but went twice as far. As far as addiction, opiates keep me awake, so I can’t take them for very long. Just a lucky part of my chemistry, I guess.

  65. Thanks for your summing up of the issue. You actually do a better job explaining Amanda’s position than she does herself.

    It’s sad when a writer you admire decides to surround herself only with sycophants. To be more precise, it’s the beginning of the end for them as an actual thinker.

  66. I work in the medical field (lab tech), I am a budding skeptic (just got caught up on all the SGU podcasts), and my wife has had to deal with a chronic pain for two years before she got some semi-perm relief from steroid shots into the spine.

    The separation of the acetaminophen is a good idea, I have seen way to many overdoses. These type of decisions are for the consumer protection.

    “3. Is there a point where just asking questions or offering opposing facts becomes in and of itself offensive? Does this compare to the way many of us feel about Holocaust deniers or 9/11 conspiracy theorists?”

    I am not surprised by the response. PAIN is bypassing logic. There is no truth denying or conspiracies. There is pain, absence of pain and fear the pain will return. Pain manages your life and your family’s life. Once you get a ritual (valid or not) that gives you some type of relief, you will do anything to maintain that ritual.

    I read the original blog and posts. I think you got blind sided because the blog was intended to be an angry vent, not a rational discussion. Your comments were not offensive. As an analogy, consider an injured pet. The pet will lash out and hurt you even when you are trying to help.

    Chronic pain sufferers are seeing their only oasis being taken away from them. There is anger, panic and frustration because of PAIN. “Offering opposing facts” must wait for a pain free day.

  67. @Steve: I’m going to side with you and say I have no idea where to begin since I don’t know all the facts! I went to the post after reading Rebecca’s tweet, and I thought it was pretty good to show the viewpoint of at least one chronic pain sufferer and how the ban might affect her.

    What happened in the comments after was atrocious, and may be why I can’t bother going to that site, though I’ve often tried. The whole “privilege” this just saddens me, because there’s a whole body of evidence to consider in such decisions, and those of us that are not afflicted will have questions and may bring up points, that doesn’t call for being shot down.

    In a somewhat related note, I went to my student health center yesterday after something kind of scary happened to me, and I had this nurse practitioner who literally spent an hour and a half with me, going through my medical history, going over my recent problems, explaining the biology of the situations (diagrams and all!), did a full exam, ran tests, answered all my questions… it was simply amazing. Now if it were the case that all patients had access to that kind of care all the time, especially when prescriptions were involved then maybe the situation would be better? In a perfect world, chronic pain suffers would have both the access to what they need as well as an understanding of the medications and complications. Alas, we do not live in that world just yet, and I find malathion’s comments particularly poignant in that respect.

  68. @marilove: I make my call based soley on the EVENTS described. I cannot make a call on the CONTENT. I have no authority to make such a call. Not that I have some mandate of heaven to decide what is ethical or unethical.

    @Rebecca: I’m not saying what happens on feminista stays on feminista, and you should be ashmed for tweeting it. From what I can gather, you used non-specific information-other than the blog. So, no one could single out the specific person-which I consider very cordial on your part. But, the fact the the mysterious they brought that back to the site. To me, its kinda like trying to drag you back to his/her battle, instead of fighting it on your turf.

    Is any of this making any sense?

  69. Overall, I would say the ban is bad. Doctors know the risks and should completely inform their patients. These risks can be managed. To make it even harder for people with chronic pain to find relief is cruel. All drugs are or can be dangerous, so simply telling us the ban is for our own good is not good enough. It is a control issue.

    As for unaskable questions, I would say no. However, some subjects have reached a point where there really isn’t any need to discuss further, such as the reality of the Holocaust. Finally, every single group has a sub-group of people with huge chips on their shoulders. Doesn’t what you say or how you say it. If it isn’t exactly in line with their views, they will shread you.

  70. The problem so much of US drug policy is complete nonsense. Why is cannabis illegal and tobacco not? Nicotine is more addictive than are opiates, and has no legitimate medicinal use.

    There is every expectation that US drug policy will continue to be complete nonsense, unless Obama can produce some real change at the FDA and DEA.

  71. As a PWD I am appalled by anyone who would seek to minimize the value of other simply because their experience is not the same. As someone else already pointed out, we all have positions of privilege in some way and to claim that disagreement is nothing more than the exercise of that privilege does us all a disservice. You didn’t deserve that reaction, which I think you know. Sure, it’s hard out here for a gimp, but so what? Isn’t it hard out here for all of us in some way?

  72. @jawmo: “to ban, or limit the availability of, drugs containing acetaminophen, such as Vicodin, would be worse than futile. It would simply create a black market for the drugs, and force otherwise law-abiding citizens to choose whether to break a ridiculous law or go without the medication.”

    Or… to get their doctor to switch their prescription. I mean, it’s not like Percocet and Vicodin are the only drugs approved for the treatment of chronic pain. And, while it may be harder to get a prescription for uncut hydrocodone or oxycodone, it’s not impossible. So it’s not like there would be no legal options at all for chronic pain sufferers who needed to get meds.

  73. @maidden: Amanda Marcotte on Pandagon had a very interesting take on the “safe space” thing. Check it: http://pandagon.net/index.php/site/diversity_of_tone_safe_spaces_and_trigger_warnings/

    Anyway, the safe space idea bugs me, too. I mean, it’s not so terrible in theory, especially since it’s typically connected to genuinely awful things like rape and domestic abuse that are known to cause long-term psychological (PTSD) problems. However, in practice, the safe space policies seem to chill discourse and get wielded as a weapon to stifle discussion in favour of a feel-good circle jerk. Maybe some people actually need that sort of thing to cope and move on with their lives, but it certainly doesn’t help the wider public discourse.

  74. THANK YOU!!!!

    Yeah, this is why I stopped reading Feministe, because phrases like “well-reasoned and factual” get put in scare quotes, and people respond to science with PANDAAAAAAAS!

    OK, Rebecca’s questions!
    1. I do not know. I don’t understand either pharmacology or the psychology of addiction well enough to have an informed opinion. It seems like a pain in the ass for non-addicts, but maybe worthwhile to help addicts in a roundabout way.
    My perspective: I was hospitalized for about two weeks ten years ago for an abcessed branchial cleft cyst (the remnants of gills we had in an earlier evolutionary stage, apparently) and was put on IV morphine before and after surgery. Morphine is awesome. You feel AMAZING. But of course it’s addictive, so they weaned me off the on-demand drip as soon as possible, which was relatively easy considering that I was a teenager. I was not given heavy painkillers after release, which was a good thing, because if I had had any way to continue taking opiates I would have done so.
    Yes, I had a shitty pain-filled couple of weeks after surgery, but I got over my morphine addiction quite quickly.
    2. Fine line, but hopefully a).
    3. Asking questions if you genuinely do_not_know or have something to add is good. “Asking questions” as in “How do we REALLY know that the IPCC are really scientists and not actually reptoids?????” is never good or helpful. After reading as much of the Feministe thread as I could, I definitely think you were doing the former.

    On a complete off-topic, wtf is with the Feministe re-definition that chronic pain=disability? Maybe, but maybe not, especially if it’s correctable through pharmaceuticals. I mean, I have really bad eyesight (that I correct with contact lenses). I mean, REALLY bad eyesight, as in I actually CAN’T READ the big E on the eye chart. But through modern opthamalgic technology I have the same quality of life as normal-sighted people, except that I have to buy contact lenses. Do I count as a PWD and do I get to call people un-feminist?

  75. 1. The proposed ban: good idea or bad idea or something else?

    As others have pointed out, I don’t think we’re looking at straight-up bans here, but a more nuanced re-shuffling of the way acetaminophen is dispensed. Regarding the opioid angle and access/compliance/etc., a lot is going to depend on the scheduling.

    Not to diminish the dangers of acetaminophen, but I think this is more importantly a sort of harbinger of other problems we’re going to face as drug combos (particularly OTCs) continue to be marketed and packaged to target the idiots that unfortunately comprise the majority of the consumer population.

    Hardly ANYONE reads the stupid “Active Ingredients” label. Tylenol PM? For Christ’s sake, take a dose of Tylenol and a dose of Benadryl. IT’S THE SAME DAMN THING.

    I love to hear people getting into debates about the effectiveness of different OTC sleep aids that have the same active ingredient. Good grief.

    Or cold medicine. Oh my lord, don’t get me started. I predict that’s where the next big “duh” hammer is going to come down, on the kaleidoscope of pretty-colored cold “remedies” mixed-and-matched every day by label-ignorant morons.

    Of course, all of the half-decent cold and cough medicines were yanked off the shelves years ago to protect “us,” so perhaps we’ll ultimately escape a horrifying epidemic of accidental guaifenesin overdoses. Or whatever.

    2. Are regulations like this imposed to protect us or control us?

    I like to presume good intentions, but who the hell knows? From where I sit, it seems to me that ALL drugs should be regulated in one domain and one domain only: quality control.

    Reasonable people will consult reputable physicians, pharmacists, and third-party information sources (when appropriate) before they pop a pill or suck down some syrupy concoction. The rest will be culled. So be it.

    3. Is there a point where just asking questions or offering opposing facts becomes in and of itself offensive?

    I dunno. Maybe in certain social situations. Like at a funeral or something. Time and a place for everything. But that discussion you participated in? Pshaw. Perfectly appropriate, as near as I could tell.

    Does this compare to the way many of us feel about Holocaust deniers or 9/11 conspiracy theorists?

    Yeah, pretty much. Social mores aside, the bottom line is, people not willing to consider opposing viewpoints all get painted with the same deserved brush, as far as I’m concerned.

    Taking the flip-side of your last question (in case I’m mistaking your meaning), I’m not going to presume to lecture you on the role of plausibility and the utility of turning a deaf ear to those who can’t come up with any new scientific evidence (or worse, any scientific evidence at all). You’re obviously plenty savvy to that jazz. :-)

    Sorry you got dinged on a favorite haunt. I know that sucks. But from my perspective (sure, an admittedly biased perspective), you don’t have anything to apologize for.

    Keep up the awesome work.

  76. @Joshua:

    It’s the sanctimonious tone of the “this blog is a safe space” proclamations which gets to me almost more than anything else. The people involved can take a bloody long time to say, essentially, “We’re going to ban people we think are fuckwits and the rest of you will thank us for it.”

    My concern is that stifling dissent, even with the best of intentions, can propagate an insidious kind of groupthink: one in which the group members fail to recognize that not all the people who seek resolution and peace do so in the same way.

  77. Dangers of too much acetaminophen aside (and because a doctor once failed to mention to me ‘By the way, avoid tylenol while you’re on this prescription,’ I’ve personally experienced that; it wasn’t pretty, to say the least), I fail to see how this topic relates to feminism at all, and certainly not to any degree that one could question Rebecca’s feminism because of her view on it. That strikes me as a complete non sequitur. So far as I know, drug use isn’t a gendered issue, though I’m ready and willing to be enlightened if I’m wrong.

  78. @Joshua:

    It just makes me wonder, safe for whom? I sure don’t feel safe posting comments to those blogs. And isn’t every place “safe” if you’re just gonna nod and agree with everybody else? I guess they shouldn’t so much call it a “safe space” for agreement as an “unsafe space” for disagreement.

    I guess I’m just a free-speech nut, but I much prefer PZ’s way of managing the comments: let the hordes loose on the trolls. I just can’t picture him replacing comments he disliked with pandas. Cephalopods, maybe. Probably not, though.

  79. @marilove: “Also, if she didn’t want a DISCUSSION, why leave the comments on?”

    But Marilove, if you don’t leave the comments on, how could you ever learn how condescendingly superior you should feel towards the people who disagree with you?

    – Emory

  80. @SJBG:

    I fail to see how this topic relates to feminism at all, and certainly not to any degree that one could question Rebecca’s feminism because of her view on it.

    Yeah, same here. All I can think of is that it’s just an attempt at a low-blow against Skepchick. A dumb, inaccurate, silly one, at that. That, and she clearly likes pointing out how anti-female everyone is, when it has no bearing on the discussion at all.

    PANDAAAAAAAAAS

  81. @SJBG: “I fail to see how this topic relates to feminism at all”

    It relates to feminism in that it has to do with disability, and people with disability are devalued by society much in the same way that women are. Also, there are people with disability who happen to be women.

    But I know where you’re coming from, I also get unsure at times about how much separation there should be between human rights banners with different focuses. Is gay marriage a gay issue or a feminist issue? Is violence against trans women a trans issue or a feminist issue? Is there a point to having the advocacy groups split up when the overlap area is so large?

    Which is why most of the time I identify myself as a humanist, not just as a feminist.

  82. @maidden:
    No, PZ’s way is NOT how you create a welcoming environment. I never comment there anymore, and if I slip up and contribute, I always regret it.

    Pharyngula is filled with hate and hostility, and I don’t need that.

    So, I understand where they are coming from on their comments policy, even if the implementation is spotty.

  83. @Liesl: We’ve all got our problems, but some are more difficult than others. You’re right, that kind of reaction does everyone a disservice, though. What bothers me the most about the perceived position of privilege is that the person invoking that is alienating potential allies to their cause! Wouldn’t it be best if chronic-pain sufferers have legions on non-chronic pain sufferers lobbying with them to ensure access to what they need?

    @bug_girl: I think I like Bad Astronomy’s comment policy the best… don’t be a jerk. I don’t mind that Pharyngula is overrun by angry hoardes at times, but I found trying to get into an actual discussion too difficult. It’s just not worth it to wade through the mess. This blog is really the best place I’ve found, if only I found more time to do so… :-)

  84. @maidden: “It relates to feminism in that it has to do with disability, and people with disability are devalued by society much in the same way that women are.”

    Ah, I see… Thanks! I see the connection now, but it still seems a bit of a leap. Unfortunately, there are several groups who are devalued by society, so jumping from one topic to another based on that one very broad common denominator, in this particular case, seems more like a contrived ‘low-blow’ as @sporefrog said.

  85. @southern_reckoner:

    I read the original blog and posts. I think you got blind sided because the blog was intended to be an angry vent, not a rational discussion

    The problem is that the intention of that site is NOT to be about angry vents, but rather discussions. That is the entire point of that entire blog. Otherwise they would have shut off comments (or, more appropriately, taken it to a persona blog instead of a very popular feminist blog that gets tons of hits every day).

  86. @marilove said:

    If I’m bored at work, I just read the comments over at PZ Myer’s blog. ENTERTAINMENT!

    Yar! Me too.

    Savage entertainment. A vigorous and volatile cocktail of fun, fury, bombast, and bile, with a frisson of infotain thrown in to soften the blow.

  87. @marilove: So, there’s two different meanings of “free speech”.

    The first is the legal definition, e.g. as enshrined in the First Amendment to the US Constitution; this pertains specifically to interactions between a government and its citizens — i.e., the government is not allowed to place any restrictions on speech per se (though the consequences of exercising the legal right to free speech are fair game, e.g. shouting “fire” in a theater). Obviously, the legal definition does not apply to interactions between individuals, or between any given individual and a non-government community.

    But free speech is also a humanistic principle. Indeed, the laws that protect speech are a specific implementation of a commitment to the principle of free speech. This definition is not limited in the way that the legal one is, such that if I you were trying to have a conversation with someone else about something I don’t like, and I were to start yelling “LALALALALACAN’THEARYOULALALALALA” at the top of my lungs in such a way that you can’t carry on your conversation, I’d technically be violating the principle of free speech, even though I’m not legally doing anything wrong. Same goes for replacing your words on a blog comment thread with pictures of pandas. (But note that sticking my fingers in my ears and just ignoring your conversation would not violate the principle of free speech.)

    But as with most things, there’s a balance to be had. I value the principle of free speech rather highly, but I’ve still banned people from my blog for trolling. Same happens here. Sometimes, you can make the determination that someone is obviously not advancing a discussion, or is arguing in bad faith, or whatever else, and that this behaviour constitutes their attempt to shout “LALALALALA” and impede other people’s free speech. Thus, you might conclude that it’s better to make an exception and silence them than to allow their behaviour to negatively affect the discussion that others are having.

    Or you might just decide that people who politely disagree with you aren’t worth listening to and replace all their comments with pandas. Whichever.

  88. @Joshua: I see your point.

    Moderation in such sites as that feminist blog is needed, though. They have a HIGH chance of trollage, and of people with VERY different view-points but who aren’t necessarily trolls (ie, they are sincere) coming in and derailing the discussion. I’ve seen it happen. So I get that they need some tight moderation over there.

    But Rebecca was CLEARLY wanting to have a mature discussion and wasn’t at all being offensive, but some posters over there won’t take *any* disagreement. It’s gotten REALLY bad over the lat year or so, so I just avoid them now.

    Feministing.com is far better at handling moderation, imo. They don’t tend to delete or go “ANTI-FEMINIST!!!!” nearly as much, and when someone does come in disagreeing, the discussion tends to go a lot smoother.

  89. Oh but feministing.com’s layout sucks. I keep hearing they are going to fix that, but I dunno. I can’t comment because it’s a difficult process and half the time the page doesn’t work. Which sucks because I quite like that blog.

  90. @Joshua:

    Actually, I don’t think hydrocodone (the active ingredient in Vicodine, Lortab, Lorcet, etc) exists as a stand-alone drug like oxycodone does (e.g. Oxycontin).

    But anyway, ALL painkillers have side effects. While 400 or so die from acetaminophen-induced liver failure every year, the annual deaths from NSAIDs are in the TENS OF THOUSANDS. Now this is a big class of drugs (including aspirin, ibuprofen, naproxen, Celebrex, Vioxx, etc), but they also have some liver/kidney toxicity (as most drugs do), and NSAIDs also carry a significant risk of bleeding and hemorrhage – so many potential interactions with anticoagulants and DIETARY SUPPLEMENTS THAT THE FDA DOES NOT REGULATE (fish oil, vitamin E, omega-3, garlic, ginkgo, etc). I recently wrote a review about drug interactions, and there have been hundreds of cases of increased bleeding with just garlic supplements ALONE. Throw in an anticoagulant or NSAID, and you’ve just compounded the risks of bleeding disorders (like hemorrhagic stroke).

    So banning or shunning acetaminophen-containing products for other analgesics, thinking that they carry fewer risks, would be a COLOSSALLY BAD idea. Separating narcotics from acetaminophen may not be the best idea either, since these are more prone to abuse (injecting, snorting). There’s a reason why Vicodin and Percocet are Schedule III, and the “straight” dope is Schedule II.

    A better idea, as I’ve been saying all along, is stronger warnings and better patient education (which includes doctor-patient and pharmacist-patient communication). Patients also need to take responsibility of their own health, and not overdose or put all the blame on the FDA, doctors, and drug companies.

  91. @wendy: When you explain that, it seems awfully weird that they are concentrating on this one drug, instead of oh, I don’t know, controling supplements. That seems it would save a LOT more people.

    Also, 400 or so a year? THAT IS IT? Dude.

    How many people die from the regular old flu again?

  92. Another note about separating the narcotic from acetaminophen and/or easing the regulations on “uncut” narcotics – check out this DEA report about Oxycontin-related deaths from 2001-2:

    http://www.deadiversion.usdoj.gov/drugs_concern/oxycodone/oxycontin7.htm

    There were “only” 146 “Oxycontin verified” deaths out of candidate 949 fatalities – but that was because they threw out the 318 deaths that also involved acetaminophen or salicylates, as well as the unspecified number of deaths that resulted from “self-inflicted gun shot wound to the head while intoxicated with oxycodone” and “blunt trauma.”

    Deregulate Oxycontin and ban acetaminophen? Uh, yeah.

  93. @marilove: So far, “swine” flu has been implicated in 429 deaths worldwide, while a “regular” flu season kills about 500,000 people worldwide.

    Any single preventable death is one death too many – but when you look at the numbers, it becomes clear that sometimes major problems are overlooked for relatively minor ones.

  94. @rebecca: Thanks again for bringing this up.

    @marilove: Thanks for pointing that out for me. I’ve had some issues with the way the US classifies drugs for a long time. Much of it is much more politically-motivated (read: “War on Drugs”) than science-based.

    @cyberlizard: You and I are the exact opposite. Percocet has that effect on me and Vicodin doesn’t. However, Vicodin has the odd effect of frequently making me an insomniac. That seems odd for a narcotic. I feel exhausted, but alert all night. It reminds me of what some have described as the effect “speed” has on people.

    @wendy and sethmanapio: “The alcohol problem with Percocet/Vicodin is not emphasized NEARLY enough.” Totally agree.

    @sethmanapio: I’m afraid to ask what the effects were on your girlfriend’s long-term health. That’s a horrible mixture…

  95. @bug_girl:

    I wasn’t talking so much about a “welcoming environment” as about a place where the readers can express themselves. Sure, a lot of them are jerks, and anyone stepping into the shark-filled pool might be ripped to shreds, but they’ll still get their say and not be hit with a ban hammer so easily. Or have their words replaced with fuzzy animals.

    I guess I prefer sharks over pandas.

  96. @wendy: “but when you look at the numbers, it becomes clear that sometimes major problems are overlooked for relatively minor ones.”

    That’s my feeling on it. Especially in regards to the prescription drug issue. 400 people? That’s minor, considering how many people die from drug addiction every year. Sigh.

  97. @SJBG: “I see the connection now, but it still seems a bit of a leap.”

    Definitely a leap, I agree, even though I kinda see their point. In the end, what I don’t get is why there are different denominations at all, instead of just “human rights”. Seems to me a lot of people flying the flag of feminism/womanism would be better identified as human rights activists instead of limiting themselves by that gender-related label. But hey, if that’s what they wanna call themselves, that’s what I’ll call them. *shrug*

  98. ANYTHING you put in your body (whether it’s a drug or a food or even water or air) carries a risk/benefit ratio. When used properly, the benefits are supposed to outweigh the risks. When used improperly (wrong dose, wrong route), the risks may outweigh any benefits.

    Let’s use water as an example. Water is good for you – but even drinking too much pure unadulterated water can kill you, and it’s a no-brainer that snorting or inhaling water is a bad idea. Air, on the other hand, is usually ok to snort – but ever get a big bolus of air injected into your veins? Ouch. Or you’re dead.

    Fortunately, most people use water responsibly (even if it’s bottled water, which is a total waste but that’s another topic). But imagine if junkies robbed convenience stores for bottled water, or they robbed your house or broke into your car or mugged you so they could buy bottled water. Or if the street trade of water carried a high rate of fatal gunshot wounds or blunt trauma. Yes, most people use water properly, but what if water could make you lose your job, all your savings, and your family? There better damn well be some regulations on it.

  99. Nicole (sorry, don’t know how to do the @ html thing),

    I totally agree. There’s a weird perceived hierarchy in the disability community of suffering or level of disability that I think does our cause so much harm. If you’re not in a chair, you’re not really disabled. If you don’t use an assistance device, you’re not really disabled. If you only have pain but can otherwise walk, you’re not really disabled. It’s all so ridiculous! Instead of fighting each other we need to fight the attitudes people have about our so-called special status. How many times have PWD been told that we are seeking special treatment when we ask for parking, grab bars, and wide doors? That is the problem.

    Oh, don’t mind me; I get all preachy on this topic. It just pisses me off when PWD make the rest of us look bad because we often need all the help we can get.

  100. @marilove: Benadryl puts me to sleep. That’s actually what Tylenol PM has in it as the sleep-inducing ingredient. Remember that if you’re looking for OTC sleep drugs or you’ll get fucked up rather than sleepy. ;-)

    @lisle: I know what you mean about a “disability hierarchy.” I’m 20% partially-permanently disabled, but other than surgery scars, it’s not too obvious. Some people have given me crap about it. I ignore them and concentrate on what I can do, not what I can’t do. I suppose in the scheme of things I’m “lucky,” as I’m not as obviously disabled as someone say, in a wheelchair 24/7.

  101. @QuestionAuthority: Benadryl is worse somehow than Tylenol PM, at least for me (just because a drug has the same active ingrediant doesn’t mean you’re going to react the same way), but any OTC “sleep aids” basically fuck me up, but do not help me sleep and in fact just make it worse. One time I took that sleep aid that is really benadryl but maketed as a sleep aid, and it was horrible. I actually had to call in sick the next day.

    Benadryl can make you hallucinate if you take enough of it. Basically, my sleep, which is already interrupted enough on a normal night, is even more disjointed, my dreams more odd, and the hangover can last an entire day. It’s awful. I’ve never slept so horribly in all my life, and I am not a great sleeper.

  102. @marilove: I understand what you are saying. I am not defending that site. I do not know anything about the history of the site. How they wish to run the site is on them. I personally did not care for the overall feel of the site.

    I am simply empathizing with people with chronic pain. I remember what my wife went through when she was in severe pain. Rational discussions did not exist when her pain level was high.

    That may or may not account for the comments against Rebecca. But it is worth keeping it in mind.

  103. Two benadryls and 2 oz. of tequila are my personal remedy for hard-core insomnia. Use only as directed.

    On the cost/benefit ratios of regulations (banning Vicodin will “only” save 400 lives): this is actually a very well-studied subject in political science & economists. They calculate that, with respect to workplace safety regulations, the statistical value of a life is $7 million dollars, so to be “efficient” you shouldn’t spend more the $7 million on a regulation unless you’re going to save at least one life. Make of this what you will…

    As I recall from my class on the subject, the most cost-benefit effective health & safety regulation of all time is generally considered to be the seat belt. Thanks, Ralph Nader!

  104. @Gabrielbrawley: Yeah, they do something to me … but they don’t work. They just make my sleep even worse. :(

    I’m afraid to take Ambien (the regular kind) — I wake up so often, even when drugged up (a friend once gave me 2 somas (muscle relaxers) and a xanax; it helped me to fall back to sleep if I woke up, but i still woke up a lot), so I KNOW I would be that person that would do something REALLY STUPID on Ambien, like run around the neighborhood naked or something.

    Am trying to talk myself into making a doctors appointment to request Ambien CR, but I have no idea how to go, “DOC GIMME DRUGS!” without feeling like a fool, so meh.

  105. @Gabrielbrawley: Last night was bad. Couldn’t fall asleep. Fell asleep around 1. Woke up at 2. Then 3. Then 4. Not sure how much sleep I got after that, finally just woke up around 5:30.

    I got a new bed (thanks to some awesome friends) and a better pillow, which helped some–now I can usually get a good 4 hours of solid sleep in, sometimes 5. But after that I’m done for the night, no matter how tired I am. By Friday I am just dead.

    And bad nights are still really bad. :(

    Thankfully I have an awesome friend who occasionally gives me xanax, which is the ony thing that seems to help while at the same time not leaving me feel like ass the next day. I still wake up, but less and I’m a LOT less concerned about it when I do and I have less dreams. Either that or I don’t remember the dreams. Either way, it’s a nice change from waking up every 45 minutes from some crazy ass dream.

  106. @wendy:

    Yes, most people use water properly, but what if water could make you lose your job, all your savings, and your family?

    Make you? Would that be like how Drano jumps out of the bottle and makes you poison your neighbors’ pets? Or how gasoline jumps out of the can and makes you burn down city hall?

    There better damn well be some regulations on it.

    Sure, regulations for quality control and clear labeling. Full stop.

  107. @wendy: The biggest problem with Trainspotting is the same problem with Requiem for a Dream. Heroin users are not beautiful people like the actors in those movies. Heroin addicts are really, really ugly same with meth users. Really, scary ugly.

  108. @Gabrielbrawley: Meth is scaarrrrrrryyyy. I have stories. I’ve never in my life touched it, but I’ve had family who have had major issues with it, along with friends, etc. Meth is bad bad bad.

    Heroin isn’t really available in Arizona. The only opiates you’re gonna get are in pill form lol.

  109. @marilove: This is a common criminal justice case study: if you compare the crimes committed under the influence of marijuana (very very few) with crimes committed under the influence of alcohol (lots and lots), it’s baffling why alcohol is legal (with some restrictions) while marijuana is not. Then you look at the dramatic rise in organized crime that followed dramatic measures to regulate alcohol (the Prohibition), which suggests that some regulatory measures can backfire.

    That’s why I don’t think Percocet and Vicodin should be banned for opiate OR acetaminophen content, nor do I think stand-alone narcotics should be made more easily accessible. Acetaminophen shouldn’t be demonized either, because NSAIDs can be just as bad (if not worse).

    Stronger warnings, better patient education. Maybe everyone should watch Trainspotting or Requiem for a Dream, then go check out some real junkies – right @Gabrielbrawley?

  110. @wendy: I agree. After working in the criminal justice system for 11 years I came to the conclusion that our prohibition laws against drugs are stupid and harmful. I am willing to grant every argument of people who say drugs should be illegal. Drugs are dangerous, drug abuse deystroys lives and families, drugs kill. But here is where I know longer agree. We can’t win a war on drugs, ever. As long as people want to use drugs they will be able to get them. All we have done is cause an unsustainable explosion in prison populations and probation and parole caseloads. Legalize it all, tax the living hell out of it, sell it only through goverment owned drug shops, similar to how Pennsylvania and Virginia sells all alcohol through government owned liquour stores, use all the proceeds for education campaigns and rehab programs.

  111. @Gabrielbrawley: Yes, you are absolutely right – too much restriction doesn’t work. Just look at Utah – my home state – a predominantly religious society that is very strict in terms of drug use and morality, yet is #1 in the country for prescription drug abuse AND online pornography use.

    So it goes.

  112. Agree with Gabriel. I’ve been around since 1957 and I can vouch that the so-called “War on Drugs” is a waste of time and money. I’ve watched it since the 1960’s and there has been little to no progress. Legalize and tax it like tobacco and alcohol.

    I’m very aware of meth, having lived in the meth capital of the US (SW MO) for almost 10 years. Rural WV is almost as bad. That’s frightening stuff and so is the mess that meth labs leave behind (toxic waste sites).

  113. @Gabrielbrawley: There are many functional heroin addicts who you would never suspect of being long term addicts. From my experience the same can not be said of methamphetamines addicts. The downward spiral is typically devastating and eventually totally destructive whereas many smack junkies can maintain at a certain level. Many long term heroin addicts get in trouble when they start adding other drugs like methamphetamines and crack to the mix causing more significant rollercoaster rides involving the inability to self care or care for others.

    @marilove: Serious alcoholics have always been my most difficult clients.

    @wendy: But can you get Mormon free girls??

    @QuestionAuthority: Yep, meth really bad and the war on drugs is really stupid.

  114. @marilove: Heroin is definitely available in Arizona. In my experience, crack cocaine, heroin, and marijuana are available absolutely everywhere. The only drug that I’ve ever known to truly be unavailable was mescaline, and I suspect that that’s only because I wasn’t willing to do the leg work.

  115. @wendy: No I didn’t know that and I can’t imagine the point. Mountain dew tastes like coyote piss, the only point is as a caffeine delivery system. Did you know mormons could get magic underwear made by underarmor when they depoy? That’s how I found out about the magic underwear.

    Hhmn, I wonder if victoria secret makes magic mormon thongs.

  116. Rebecca, I just have to jump in here and underline what Wendy has said about paracetamol and alcohol.

    The combination can be deadly to the liver and knowing what epic boozers you Skepchicks are, (and I love hearing about your meetups and the Skepchick drink competition) I hope you lay off the meds when having a big night out.

    At work I have read several case reports about death by liver failure from paracetamol/alcohol overdose and the actual amounts involved were shockingly small. Can look up figures and detail more chemistry if you are interested.

    In short, my heart would die if I thought you were wrecking yourself. I want to see you as President one day.

    From an unashamed member of the melanin deprived non-vaginal legion.

  117. @Jack99: Thank you for highlighting that danger again. Acetaminophen also makes a hangover worse, so don’t take before, during, or after drinking.

    @Steve: Well, since heart disease is the #1 killer and cancer is #2, and aspirin is known to have preventative effects in both (and the historical use of salicylates precedes Bayer anyway)…

    Of course aspirin is not without adverse effects (e.g. Reye’s syndrome, hemorrhage, ulcers) – but, with everything, it’s always about proper usage and risk/benefit ratio.

  118. @Gabrielbrawley: A parallel argument could be the legalization of firearms – when you compare the stats, it’s clear that crimes committed with firearms is not really correlated with guns/capita ownership or whether they are legal – it has more to do with socioeconomic issues (like whether your country is in some state of civil war) – cf. USA vs. Switzerland vs. South Africa. Michael Moore’s documentary kinda left out the fact that there are not that many guns in S. Africa or Thailand but those countries have really high rates of gun violence.

  119. JOSHUA: True, there are other, stronger prescription opioids out there, but I can tell you from person experience they are much harder to obtain for several reasons. First, doctors are much more reluctant (read: scared shitless) to prescribe them. Second, far fewer pharmacies are willing to stock them due to the fear of being robbed (recall the “Oxycontin scare” of a few years back). Finally, patients themselves have a greater fear of addiction to drugs like morphine and Oxycontin.

    MARILOVE: I have serious sleep problems as well and can tell you that very few meds are worse for you than prolonged sleep deprivation. There are some new meds, such as Lunesta and Rozerem, that are relatively safe and effective. You really have to advocate for yourself to get taken seriously.

  120. @jawmo:

    Lunesta tastes like robot ass. Or rather it makes your mouth taste like robot ass for hours and hours and hours (into the next day). RUINS the taste of food, drink, gum, etc.

    For some people I know, this side effect receded over time. But as far I’m aware, that’s only if you use it every single night.

    Other people supposedly don’t get the metallic taste at all, or just get it very mildly. But I’m not sure those people actually exist. Of course, I’m not sure anyone actually exists.

  121. @QuestionAuthority:

    “Kiss my shiny metal a$$!,” said my namesake. ;-)

    LOL. Would you take a squirt of WD-40 instead?

    —–

    But seriously, let me balance my criticism of Lunesta’s awful taste with an observation about its surprising effectiveness. Well, “effectiveness” is too strong a word; for me anyway. But just the fact that it had SOME sort of soporiphic effect separates it from the pack in a substantive way for me and perhaps for the one of two other people out there with symptoms like mine.

    I’ve taken every single prescription drug for chronic insomnia (on-label, off-label, sideways-label). Every single one. Or damn near it. For decades. No matter who you are (not you specifically, QA, of course), my insomnia whips your insomnia’s ass. Fuckin bring it on.

    You think I’m jerkin yer chain? I wish.

    I live with frequent bouts of the sort of insomnia that I’d not hesitate to wager would kill 99.9% of the posters on Skepchick, SGU, and Bad Astro. Yep, that’s right, I’m a badass. ;-)

    Sure, I’m bragging. But I’ve earned it, bitch.

    I’m not gonna bullshit you. I’m not putting you down or trying to minimize your suffering. Everything is relative, and I’m sure your insomnia sucks and all. But you have reason to be grateful. Take that for what it’s worth.

    I guess that’s one of those truisms of this absurd life: No matter how bad you’ve got it, some else has got it worse.

    I love it when people pull those “words of encouragement” out of their brain’s little folder of aphorisms, as if the knowledge that someone else’s life sucks worse is supposed to provide consolation, and even comfort. That’s a pretty fucked-up principle, as far as I’m concerned.

    But where was I? Oh yeah.

    Anyway, one thing that shines through the slurry of magic pills I’ve popped over the years is Lunesta.

    I can actually tell when I take it (as in, it makes me sleepy; slows my mind down; and on a few rare occasions, I can actually fall asleep). Well, it works like this for at least a few nights anyway. Yeah, my tolerance for any GABA-scrambler is pretty badass too. Builds up super-fast. Yours probably doesn’t.

    But what I’m getting at is that I could eat 30 Ambien (straight or CR; no matter) right now and never notice it. You think that’s impressive? Does that make you hot, my acquired immunity to iocane powder—I mean, Ambien?

    How about staying awake for over a month while taking (as Bill Hicks might say) “heroic” doses of (prescribed) barbiturates like Seconal? How about going through that many, many times over the course of nearly three decades? Admit it, it makes you all tingly in our cockles. :-)

    But I’m rambling like a dick-swinging dipshit. It’s the amphetamines. You laugh.

    THE POINT?

    Do I **HAVE** to have one?

    Well, Lunesta presented some slim hope for this hardcore insomniac, nevermind the nasty taste. Some slim hope, as compared to decades of extensive experience with Luminal (phenobarbital), Seconal, most other barbs, tons of opioids, every benzo under the sun, all the Zs (Ambien, Sonata, Lunesta, Rozarem), trazadone, most of the atyptical antipsychotics (Seroquel, Geodon, Abilify, etc.)…. And the requisite barrel full of psychiatrists and neurologists.

    In that haystack, there’s something that SORT OF looks like a needle, in the form of Lunesta. But the evil Big Pharma conspiracy has still got some work to do. Heh.

    Despite the promise of Lunesta—even tolerating its robot-ass taste (no offense QA; lol)—the only successful insomnia treatment for me remains, well, sleeplessness. Somewhere between 7 and 45 days and nights of zero sleep. That’ll do it, eventually. Happy happy, joy joy.

    Eventually my body overwhelms my brain, and I fall asleep. Usually for about 24 to 72 hours. Then I’m ready-to-roll again. Or at least the pain disappears for about a week.

    Yeah, the pain.

    That’s one thing a lot of people don’t realize about insomnia: Ugh. The fucking pain. And yeah, yeah, your fibromyalgia or your L-whatever vertbra hurts worse. I have no doubt. But shut up, I’m talking. :-)

    Sure, chronic insomnia causes a metric assload of rotten symptoms, but perhaps one of the most pernicious, yet rarely mentioned, is the slowly rising adagio of digging aches that begin to burrow into your joints and your eyes and promise to build into a resounding fortissimo of plain old SUCK. Debilitating? Not in-and-of itself. Distractng? Try it sometime and tell me what you think.

    GABA, GABA, GABA. The mysteries of GABA have confounded me since I was a preteen (since before I even knew what GABA was). And it seems as if Lunesta holds some clue that might help solve the puzzle. My puzzle, anyway.

    So, to the extent that life’s worth enduring, hope for superheroes like me could come in the relatively near future. At least I’ve got my fingers crossed. Because Big Pharma’s my Sugar Daddy, and my Sugar Daddy treats me like the star I am!

    But really, who tasted that robot-ass during the Lunesta trials and said, “Yeah, I think this’ll catch on!” ?

    P.S. — If this rambling, vacuous post serves any purpose at all, it’s as a rather fabulous example of irony.r

    I’m sitting here typing it at nearly 4 AM under the (usual) influence of a 40MG or so dose of Dexedrine dancing across my dendrites; it being a chemical agent not typically classified as a sleep aid. LOL

    And yes, it’s prescribed by an upstanding physician, and I’m taking it as directed. See if you can figure that one out. :)

    Alright. Rambling over. Back to The Kids in the Hall. Oh no wait, it’s The State, actually.

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