Incredibly sad.  And yes, quite a waste. It seems like Fentanyl has overtaken plutonium as the most dangerous substance on the planet. 

That said, not trying to pick a fight -- just an honest question: why should pro athletes be tested for anything other than PEDs?  

 

So it's MLB's fault that he drank and got high? It's sad, but he was a grown man with an addiction problem. Don't see how that's on MLB.

An attorney has been hired.  Someone in the organization knew/got him the drugs.   Finger pointing.  But in the end, he took the cocktail and it was a tragic loss of life.   Sad sad sad.

Maybe something good will come out of this.

 

Not trying to pick a fight either but even your correction is misguided IMO. I am making an assumption here but doubt anyone on this board knows anything about Skaggs personally. What we do know is that he had TJ surgery in 2015 and was more then likely prescribed some form of opioid for pain management. Not saying this is how it all began for him but having had multiple surgeries in my life time with both fetanyl and oxycodone being prescribed (not together of course), I can see how easy it is for people to join the 2 million+ who are currently addicted in this country. Fortunately for myself, I was educated about the dangers and limited the use. Most recent surgery I used nothing but CBD to manage the pain/inflammation (highly recommend by the way). 

Just not a fan of people judging someone who may have started their journey to opiod addiction via a doctor's prescription. "Before you judge a man, walk a mile in his shoes"

Before any writes offs Skaggs as a drug addict who made his own decisions drugs can own you. It may not have been his choice to take opioids. They may have been prescribed as part of recovery from surgery.

When I saw the news the first thing I Googled was, “Did Skaggs have Tommy John surgery?” Skaggs died from taking prescription drugs a person can become addicted to in a matter of days. It could turn out the Angels or a doctor associated with the Angelscould be found complicit in his death.

It’s not MLB’s job to test for anything but PEDs. But the Angels and their medical staff had responsibility to make sure Skaggs didn’t become addicted to drugs that were part of his recovery. 

The shite is about to hit the fan on opioids ...

https://www.cbsnews.com/news/j...pioid-abuse-lawsuit/

A friend’s son with a 160 IQ was on his way to an Ivy League lacrosse career until he tore his ACL. He was prescribed opioids as part of recovery. After dropping out of college, six years and several trips to rehab he died in his mother’s arms of an overdose.

 

Last edited by RJM

How about this from Brad Ausmus:  "Quite frankly, I had to Google what fentanyl was."

I can believe the coaching staff wasn't aware Skaggs was abusing painkillers--high-functioning drug abusers aren't necessarily easy to spot.  But for the Manager to say he had never even heard of fentanyl?  That seems like he's in CYA mode.  (But maybe I'm being too cynical...)

https://www.espn.com/mlb/story...lcohol-skaggs-system

coachld posted:

Just not a fan of people judging someone who may have started their journey to opiod addiction via a doctor's prescription. "Before you judge a man, walk a mile in his shoes"

Really agree with you coachld.  Many, many people caught in the opioid trap took their first steps there through a doctor's legitimate prescription for a bad back, etc.  At some point, it isn't really a "choice" for the addict anymore and they need help.  Team doctors and other healthcare professionals working for the MLB (and for colleges) need to be on the lookout for signs of this.

From what I understand he was not on a prescription, but he was being given the "prescription" drugs by somebody on the training staff in the Angels locker room to manage pain. Odds are that there are others on the team who very well could've ended up in the same situation. I would assume the family hiring a lawyer would be the first step in finding where the drugs were coming from. Whether the trainers were getting it for him at his request or they were saying take this for the pain - if it turns out a trainer was providing the drugs a $h!tstorm is about to hit the Angels. 

I have to write a bit on this subject since my son had two friends in the last couple years who have passed r/t Fentanyl, both college baseball players. First I understand that when a tragedy happens everyone looks for someone or some entity to blame. MLB is a large organization ranging from young men just starting out on adulthood and more mature men, my wonder is what is being done on a teaching level for legal and none legal use of opioid drugs along with just drugs in general? We now have the legal/recreational use of marijuana and some of the stronger compounds of this are very potent. The heading MLB drug testing a shame? from what I have seen there is a growing number of people who are reproducing meds to look like prescription pills and other illegal drugs that would not normally have Fentanyl but are added. Fentanyl is a very strong med and only takes a couple of grains over what would be a normal level to kill someone.

I also have to say I get the injury aspect and the wanting to overcome any obstacle these players have to continue on with their dream IE pain! We say abusing painkillers, was that the case or was a med acquired that was a fake with the Fentanyl added? Let's broach a question of drug testing, is everyone tested ? are some overlooked because staff may know they are but need that particular player? This is an ongoing problem with collegiate and I am sure professional sports.

Who is to blame? I definitely can not put an answer on that one. Yes, we have to take responsibility for our actions but the makers of this horrible combo are truly demons knowing what the outcome can be. I can say for the two boys that were just barely 18 and Skaggs 27 no matter the age or reason/cause a true tragedy.

 

The answer as to who is to blame can be fairly discerned from Purdue Pharma's (and Sackler family's) recently broached settlement to outstanding cases and its' bankruptcy.

My own use of use of opi’s  

I was Given this  pain relief after I had a  

Carotid artery dissection —
which begins as a tear in one of the main carotid arteries of the neck, which allows blood under arterial pressure to enter the wall of the artery and split its layers. The result is either an intramural hematoma or an aneurysmal dilatation, either of which can be a source of microemboli, with the latter also causing a mass effect on surrounding structures.

aka the worst  head pain in your life - almost died from it — 

i knew the history of this drug and was  skeptical of it - I took it for 5 days and saw myself watching the clock till my next dose - it was scary - after 5 days I stopped and took 4 Advil’s every 4 hours that also did the trick . Just let’s  say that drug leads you to Another place and it wasn't nice .

my doc asked how is the pain - do you need a refill ? I’m like no I’m taking Advil .

 

c2019 posted:

My own use of use of opi’s  

I was Given this  pain relief after I had a  

Carotid artery dissection —
which begins as a tear in one of the main carotid arteries of the neck, which allows blood under arterial pressure to enter the wall of the artery and split its layers. The result is either an intramural hematoma or an aneurysmal dilatation, either of which can be a source of microemboli, with the latter also causing a mass effect on surrounding structures.

aka the worst  head pain in your life - almost died from it — 

i knew the history of this drug and was  skeptical of it - I took it for 5 days and saw myself watching the clock till my next dose - it was scary - after 5 days I stopped and took 4 Advil’s every 4 hours that also did the trick . Just let’s  say that drug leads you to Another place and it wasn't nice .

my doc asked how is the pain - do you need a refill ? I’m like no I’m taking Advil .

 

I had same experience after it being prescribed for back pain.  

Then I had an emergency room level episode and was given a dose of fentanyl. 

OMG. Indescribable. Made me want more back pain.

 

Six years agoI had an aortic dissection and four strokes. I was fortunate to beat the one in six odds. After five weeks in ICU and rehab I was sent home. 

My cousin, a doctor picked me up at the rehab center (I had to learn to walk again). After driving me home he wanted to see what I was given for medication. In his words they gave me enough Percocet to choke a horse. He took them from me. Percocet contains oxycodone and acetaminophen.

I was sick the first two nights at home. I called my cousin. each of those nights. He told me I was probably given Percocet for five weeks and I was experiencing withdrawal symptoms.

The prescription came from one of the top heart surgery hospitals in the world. I had the doctor who invented the surgery done on me. Another cousin, a pharmacist told me doctors typically don’t know shite about drugs. But they love prescribing them. They tend to buy into the sales pitch from the pharm rep. This puts the pharmacies in control.

When the investigation into the Angels ends I believe the shite is going to hit the fan on all of MLB. I’m betting Skaggs was getting painkillers under the table and it’s a common MLB practice. 

 

Last edited by RJM
smokeminside posted:
c2019 posted:

My own use of use of opi’s  

I was Given this  pain relief after I had a  

Carotid artery dissection —
which begins as a tear in one of the main carotid arteries of the neck, which allows blood under arterial pressure to enter the wall of the artery and split its layers. The result is either an intramural hematoma or an aneurysmal dilatation, either of which can be a source of microemboli, with the latter also causing a mass effect on surrounding structures.

aka the worst  head pain in your life - almost died from it — 

i knew the history of this drug and was  skeptical of it - I took it for 5 days and saw myself watching the clock till my next dose - it was scary - after 5 days I stopped and took 4 Advil’s every 4 hours that also did the trick . Just let’s  say that drug leads you to Another place and it wasn't nice .

my doc asked how is the pain - do you need a refill ? I’m like no I’m taking Advil .

 

I had same experience after it being prescribed for back pain.  

Then I had an emergency room level episode and was given a dose of fentanyl. 

OMG. Indescribable. Made me want more back pain.

 

Are you sure it wasn’t IV dilaudid?  Fentanyl is usually used for surgery or sedation. Fentanyl also comes in a patch form, mostly used for terminal pain. People love IV dilaudid (not funny).

Hmmm. It might have been. I thought I heard Fentanyl but I was in so much pain they might have said abracadabra  sisboombah. 

Opiods have been over prescribed for decades. Any minor procedure was followed by script of oxy. We can blame pharma but the pusher was the person with the prescription pad

2022NYC posted:

Opiods have been over prescribed for decades. Any minor procedure was followed by script of oxy. We can blame pharma but the pusher was the person with the prescription pad

Doctors come out of med school trained prescriptions are the answer to everything. 

RJM posted:
2022NYC posted:

Opiods have been over prescribed for decades. Any minor procedure was followed by script of oxy. We can blame pharma but the pusher was the person with the prescription pad

Doctors come out of med school trained prescriptions are the answer to everything. 

I mean no disrespect to either of you. But your statements are an oversimplification of the problem(s). For example, are you aware that hospitals’ payments are dependent upon patient surveys?  This system of reimbursement is perpetuated by Medicare (our government). And the rest of the insurance companies follow suit. Trust me when I tell you that drs and hospitals surveys are negatively affected if patients do not get what they want, even if what they want is unhealthy. Sad but true. 

Last edited by RoadRunner

Pain remediation in medicine has an awful track record and at times willful disregard of the rising addiction numbers. Medicine learned the hard way with antibiotic stewardship to limit the huge problem of drug resistance. This was not a surprise to anyone with the ability to do something. The manufacturing numbers over the past decades prove it. Skaggs is another sad statistic on the thousands of tragedies that occur in this country. Yes I wish baseball and other organizations would be in front of this epidemic. I was trained to use a narcan spray, still many youth orgs are afraid to support this training.

Last edited by 2022NYC

Some of the broad comments regarding physicians and opiods on this thread are ignorant at best and illustrate why there is an opioid epidemic.  While there will always be physicians that prescribe inappropriately, most prescribe responsibly.  While there will always be those patients that abuse opioids and cause themselves to become addicted, most do not. 

The problem is with a culture that is not willing to accept pain.  Everyday I have patients that believe they need a narcotic opioid in instances when they don't.  The one notion that can't be denied is that Skaggs was an abuser if not an addict.  As sad as his and many other situations are, you do ultimately have to accept responsibility for the things that you ingest.  

 

I am sharing a FB post from someone who deals with folks in all stages of addiction recovery.  

"So here we have it. Another public death due to the effects of drugs and alcohol. And this quote from a loved one, who is grieving a terrible loss and is doing the best they can. “That is completely out of character for someone who worked so hard to become a...”

For the rest of us who are not experiencing a personal loss....

#1. It is not about character.
#2. It is not about work ethic, dreams, talent, or trying.
#3. It is not about being a good (or bad) person.

Please. We need to learn this for a million different reasons.

1. If we think it is about character we will stigmatize those who use and not provide the kind of support that helps them not use.
2. If we think that successful, decent, kind, focused, caring, skilled, gifted and talented people do not use, oh boy, we are going to miss opportunities to educate about the effects of the use of drugs AND alcohol on our brain and body OR 
3. seek help for people who need it but are functioning at a high level.
4. If we think this is NOT an epidemic that potentially effects every member of our community, then we might feel irrationally protected from the possibility that someone we love might be vulnerable to a tragic outcome.

STOP. SAYING. WE CANNOT BELIEVE THIS HAPPENED TO (fill in the blank). Please. It is happening."

Pedaldad posted:

Some of the broad comments regarding physicians and opiods on this thread are ignorant at best and illustrate why there is an opioid epidemic.  While there will always be physicians that prescribe inappropriately, most prescribe responsibly.  While there will always be those patients that abuse opioids and cause themselves to become addicted, most do not. 

The problem is with a culture that is not willing to accept pain.  Everyday I have patients that believe they need a narcotic opioid in instances when they don't.  The one notion that can't be denied is that Skaggs was an abuser if not an addict.  As sad as his and many other situations are, you do ultimately have to accept responsibility for the things that you ingest.  

 

I'm sorry Pedaldad but this is a gross oversimplification of the problem.  I'm am sure that you prescribe responsibly, but over-prescription is indeed part of the problem.  As is big pharma encouraging (perhaps incentivizing) doctors to prescribe, and the patients wanting the prescription.  There is also a real problem with pill mills in this country.  I know those are NOT responsible doctors, but they ARE doctors.

By the time a pain patient is an opioid addict, he or she isn't able to simply "accept responsibility" for what he or she is ingesting.  It really isn't about personal responsibility at that point.  This is especially true when what he or she is ingesting turns out to be from some sketchy factory in China.

Pedaldad posted:

Some of the broad comments regarding physicians and opiods on this thread are ignorant at best and illustrate why there is an opioid epidemic.  While there will always be physicians that prescribe inappropriately, most prescribe responsibly.  While there will always be those patients that abuse opioids and cause themselves to become addicted, most do not. 

The problem is with a culture that is not willing to accept pain.  Everyday I have patients that believe they need a narcotic opioid in instances when they don't.  The one notion that can't be denied is that Skaggs was an abuser if not an addict.  As sad as his and many other situations are, you do ultimately have to accept responsibility for the things that you ingest.  

 

When doctors give out prescriptions like candy at Halloween that can become addictive in a matter of days and don’t monitor or arrange monitoring the patient THEY'RE part of the problem. A patient should be able to trust his doctor to DO NO HARM.

Last edited by RJM

I’m not sure if the following is true or I notice because I’m disgusted by it. There seems to be a disproportionate number of prescription medication ads on television. There seems to be one every break. There are ads for problems I didn’t even know existed. 

These ads are targeted at consumers to request the medication from their doctor. Advertising people are good at what they do. Maybe there needs to be a removal of prescription medication ads from television. Hard liquor ads were once removed when they were perceived to encourage young people to drink.

Last edited by RJM

The harsh fact is physicians are part of the problem. The largest physician professional organization created an opiod task force about 5 years ago to address the crisis by advocating for major changes both institutionally and practices.

"In the late 1990s, pharmaceutical companies reassured the medical community that patients would not become addicted to prescription opioid pain relievers, and healthcare providers began to prescribe them at greater rates. This subsequently led to widespread diversion and misuse of these medications before it became clear that these medications could indeed be highly addictive"

This is an exerpt from the National Institutes of Health, one of our nation's most prestigious research agency.

The full text is here:

https://www.drugabuse.gov/drug...-overdose-crisis#ten

Last edited by 2022NYC
2022NYC posted:

The harsh fact is physicians are part of the problem. The largest physician professional organization created an opiod task force about 5 years ago to address the crisis by advocating for major changes both institutionally and practices.

"In the late 1990s, pharmaceutical companies reassured the medical community that patients would not become addicted to prescription opioid pain relievers, and healthcare providers began to prescribe them at greater rates. This subsequently led to widespread diversion and misuse of these medications before it became clear that these medications could indeed be highly addictive"

This is an exerpt from the National Institutes of Health, one of our nation's most prestigious research agency.

The full text is here:

https://www.drugabuse.gov/drug...-overdose-crisis#ten

Pill mills exist,  over prescriber's - they do exist.  I would certainly not contest that  "bad apple" physicians are participants in this epidemic.  But lets be clear, this citation IS NOT a scientific paper, nor are any of it's references.  Most are opinion that appear in less reputable journals that are the "pay for publication" type. 

Additionally, the premise that physicians were unaware of the potential for addiction and misuse of opioid prescriptions in the 90's and relied on pharmaceutical company propaganda to determine their method of practice is preposterous.  I can tell you as a physician,  you're right if you think - big egos.  Egos big enough not to be told how to prescribe by the pharmaceutical companies or their reps.  This would be like the HC letting the student trainer tell him how to manage his line-up.  Doesn't happen that way, period.  Like I said preposterous.

Ultimately, Skaggs ingested oxycodone and had fentanyl on board.  I doubt those things were prescribed to him.  I am certain he wasn't instructed to take the with alcohol by any physician.

I think Tommy Lasorda said it best when he was with the Dodgers.  He was talking about Darryl Strawberry and his substance abuse suspension when he said(paraphrasing), " We have done Darryl a dis-service by defining his addiction as a disease because it makes him feel as though he has no control over his problem. What he has is a weakness. He needs to recognize that is a weakness, so he understands it is something he can overcome."

Pedaldad posted:
2022NYC posted:

The harsh fact is physicians are part of the problem. The largest physician professional organization created an opiod task force about 5 years ago to address the crisis by advocating for major changes both institutionally and practices.

"In the late 1990s, pharmaceutical companies reassured the medical community that patients would not become addicted to prescription opioid pain relievers, and healthcare providers began to prescribe them at greater rates. This subsequently led to widespread diversion and misuse of these medications before it became clear that these medications could indeed be highly addictive"

This is an exerpt from the National Institutes of Health, one of our nation's most prestigious research agency.

The full text is here:

https://www.drugabuse.gov/drug...-overdose-crisis#ten

Pill mills exist,  over prescriber's - they do exist.  I would certainly not contest that  "bad apple" physicians are participants in this epidemic.  But lets be clear, this citation IS NOT a scientific paper, nor are any of it's references.  Most are opinion that appear in less reputable journals that are the "pay for publication" type. 

Additionally, the premise that physicians were unaware of the potential for addiction and misuse of opioid prescriptions in the 90's and relied on pharmaceutical company propaganda to determine their method of practice is preposterous.  I can tell you as a physician,  you're right if you think - big egos.  Egos big enough not to be told how to prescribe by the pharmaceutical companies or their reps.  This would be like the HC letting the student trainer tell him how to manage his line-up.  Doesn't happen that way, period.  Like I said preposterous.

Ultimately, Skaggs ingested oxycodone and had fentanyl on board.  I doubt those things were prescribed to him.  I am certain he wasn't instructed to take the with alcohol by any physician.

I think Tommy Lasorda said it best when he was with the Dodgers.  He was talking about Darryl Strawberry and his substance abuse suspension when he said(paraphrasing), " We have done Darryl a dis-service by defining his addiction as a disease because it makes him feel as though he has no control over his problem. What he has is a weakness. He needs to recognize that is a weakness, so he understands it is something he can overcome."

As a health care provider, I agree with the above statements. By and large, direct care providers are the good guys. Period. 

Pedaldad posted:
2022NYC posted:

The harsh fact is physicians are part of the problem. The largest physician professional organization created an opiod task force about 5 years ago to address the crisis by advocating for major changes both institutionally and practices.

"In the late 1990s, pharmaceutical companies reassured the medical community that patients would not become addicted to prescription opioid pain relievers, and healthcare providers began to prescribe them at greater rates. This subsequently led to widespread diversion and misuse of these medications before it became clear that these medications could indeed be highly addictive"

This is an exerpt from the National Institutes of Health, one of our nation's most prestigious research agency.

The full text is here:

https://www.drugabuse.gov/drug...-overdose-crisis#ten

Pill mills exist,  over prescriber's - they do exist.  I would certainly not contest that  "bad apple" physicians are participants in this epidemic. 

But lets be clear, this citation IS NOT a scientific paper, nor are any of it's references.  Most are opinion that appear in less reputable journals that are the "pay for publication" type. 

That is a disappointing and inaccurate statement.  Why would the NIH publish this and revise it in 2019? So, only NEJM or JAMA are reputable? The references list a broad range of journals with substantial impact factors. Every major high impact factor peer reviewed journals charge to publish. 

Additionally, the premise that physicians were unaware of the potential for addiction and misuse of opioid prescriptions in the 90's and relied on pharmaceutical company propaganda to determine their method of practice is preposterous.  I can tell you as a physician,  you're right if you think - big egos.  Egos big enough not to be told how to prescribe by the pharmaceutical companies or their reps.  This would be like the HC letting the student trainer tell him how to manage his line-up.  Doesn't happen that way, period.  Like I said preposterous.

Your opinion, and it may be a fair one, however the NIH site and the referenced publication state there was influence. I don't agree with the analogy, physicians are influenced by pharma, pharma is not a student. I would argue, pharma would be the analytics dept feeding stats to the HC (the doctor), rather than the student. 

Ultimately, Skaggs ingested oxycodone and had fentanyl on board.  I doubt those things were prescribed to him.  I am certain he wasn't instructed to take the with alcohol by any physician.

At the time of his tragic death? probably. He had TJ surgery and possibly other chronic injuries. Could he have been given opiods? Again, there seem to be confusion on physicians being part of the problem and THE PROBLEM.

I think Tommy Lasorda said it best when he was with the Dodgers.  He was talking about Darryl Strawberry and his substance abuse suspension when he said(paraphrasing), " We have done Darryl a dis-service by defining his addiction as a disease because it makes him feel as though he has no control over his problem. What he has is a weakness. He needs to recognize that is a weakness, so he understands it is something he can overcome."

Interesting interpretation of a disease, not mine.  It is an illness, like gambling that is easy to blame the individual but in my opinion is a bigger societal problem.

 

 

Last edited by 2022NYC

Lasorda was ignorant.  Addiction is a disease, and has been recognized as such by such crackpot organizations as the American Medical Association since the 1950's. 

Lasorda was an above average manager. But he was also a showboating, media loving buffoon. Who made him an authority on addiction? His view is very 50’s/60’s. But that’s ok. My mother is about his age and she thinks all blacks look alike. 

Last edited by RJM

IWe all agree that there is an opioid epidemic.  We all agree that there are a certain amount of physicians that have played a role.  But let me shed some light on my background vs others that have chosen to write some very inflammatory, inaccurate, and unproductive remarks on this topic.

I am surgeon in my early 50s, and know full well what medicine was in the 90's as well as today.  For the past decade I have been part of the ortho faculty in a level 1 trauma center at one of are nation's largest academic institutions.  This means my partners and I take care of the patients no one else wants - the train-wreck traumas(literally and figuratively), the homeless, the uninsured, the chemically dependent - they all get dumped on our front door with injuries that make most look the other way.  So I am an authority on this thread topic.

I know what constitutes a peer reviewed scientific article, and the citation referenced above simply doesn't come close, but it is not void of poignant information.  The referenced citation is actually a newsletter  from the National Institute of Drug Abuse.  The excerpt chosen is misleading, it leaves out the sections that states 21 - 29% of people prescribed opioids misuse them (patient not complying with how they were prescribed, i.e. personal responsibility) and this directly leads to an opioid disorder in 8-12%.   Additionally 4-6% of those that misuse the opioid medications will develop heroin addiction.

The internet is a great thing, but medical sources are being cited that people really don't understand. Additionally, using inflammatory hyperbole -"giving out prescriptions likeHalloween Candy" or "lead to addiction in a matter of days" is grossly inaccurate and irresponsible as to the source of the problem.  It clearly is abuser driven as this newsletter suggests.

My pain management colleagues can treat patients that require opioid pain medicines for years without them ever developing physical dependence or psychological addiction with proper counseling and patient compliance to the dosing regimen. 

Referring to the AMA as a credible source of medical information shows a complete lack of understanding as to what the AMA is.  It is not a medical organization.  It is a political organization with a political agenda, not a defender of medical integrity.  In fact, it only has about 10-12% membership of the practicing U.S. medical docs.  Most members are hold overs from the ]70s, or have a political agenda that coincides with the AMA.  Membership cost is nominal (less than $500 per year) but most of us choose not to participate because we don't agree with a political organization that pretends to be a proponent of healthcare.

Personally, I never write for opioids for anything other than significant trauma and post-operative pain control.  Very rarely more than a few days, never more than 2 weeks even in the most dire injuries/surgeries.   Heaven forbid you show up on the operating table with a crushed limb.  But if you do, I promise you that you part of your medical management will include a scheduled regimen of opioids to assist in pain control.  I will promise you that you will appreciate it.    I also promise you that if written responsibly by the physician (almost always the case) and if you follow that regimen (less frequently the case), you will run little to no risk of addiction.  If you abuse/misuse it, that is where the problem is.

Pedaldad posted:

 

Personally, I never write for opioids for anything other than significant trauma and post-operative pain control.  Very rarely more than a few days, never more than 2 weeks even in the most dire injuries/surgeries.   Heaven forbid you show up on the operating table with a crushed limb.  But if you do, I promise you that you part of your medical management will include a scheduled regimen of opioids to assist in pain control.  I will promise you that you will appreciate it.    I also promise you that if written responsibly by the physician (almost always the case) and if you follow that regimen (less frequently the case), you will run little to no risk of addiction.  If you abuse/misuse it, that is where the problem is.

I have had major surgery including brain surgery as a result of a tbi from a fall, and have been able to avoid taking opioids as a personal choice and have gotten through the pain management issues, but how do you tell someone else to “suck it up buttercup” and avoid things they are prescribed? I have a son who is a freshman in college, and will now be receiving treatment from trainers and doctors away from me if necessary, and reading this thread scares the hell out of me. From a doctors standpoint, if you try to manage pain from surgery under a lesser painkiller will the pain eventually go away as the surgical wounds heal? Just trying to understand why anyone would ever want to risk the opioid addiction?!

2019Lefty21 posted:
Pedaldad posted:

 

Personally, I never write for opioids for anything other than significant trauma and post-operative pain control.  Very rarely more than a few days, never more than 2 weeks even in the most dire injuries/surgeries.   Heaven forbid you show up on the operating table with a crushed limb.  But if you do, I promise you that you part of your medical management will include a scheduled regimen of opioids to assist in pain control.  I will promise you that you will appreciate it.    I also promise you that if written responsibly by the physician (almost always the case) and if you follow that regimen (less frequently the case), you will run little to no risk of addiction.  If you abuse/misuse it, that is where the problem is.

I have had major surgery including brain surgery as a result of a tbi from a fall, and have been able to avoid taking opioids as a personal choice and have gotten through the pain management issues, but how do you tell someone else to “suck it up buttercup” and avoid things they are prescribed? I have a son who is a freshman in college, and will now be receiving treatment from trainers and doctors away from me if necessary, and reading this thread scares the hell out of me. From a doctors standpoint, if you try to manage pain from surgery under a lesser painkiller will the pain eventually go away as the surgical wounds heal? Just trying to understand why anyone would ever want to risk the opioid addiction?!

I sucked it up post aortic dissection surgery after being sent home. I have a very high pain tolerance level. During my five week recovery at the hospital and rehab I was given Percocet for five weeks. But being in the hospital it was monitored. My cousin, a doctor took the Percocet away from me when I went home. He called the hospital and told them to prescribe something less dangerous. I went through withdrawal. It was a pleasant distraction from my recovery (sarcasm). 

The problem is patients back on their own, unmonitored with powerful, addictive medications. Relative to baseball you can’t just send a player home post TJ surgery with powerful, additive meds and expect everything to be ok. He wants to get back on the field as soon as possible before he loses his job. The player has to be monitored for signs of addiction. 

I can fully understand a person playing around with levels of medication and thinking they’re smart enough to handle it. I did it while dealing with negative side effects. But I wasn’t playing around with opioids. 

 

RJM posted:
2019Lefty21 posted:
Pedaldad posted:

 

Personally, I never write for opioids for anything other than significant trauma and post-operative pain control.  Very rarely more than a few days, never more than 2 weeks even in the most dire injuries/surgeries.   Heaven forbid you show up on the operating table with a crushed limb.  But if you do, I promise you that you part of your medical management will include a scheduled regimen of opioids to assist in pain control.  I will promise you that you will appreciate it.    I also promise you that if written responsibly by the physician (almost always the case) and if you follow that regimen (less frequently the case), you will run little to no risk of addiction.  If you abuse/misuse it, that is where the problem is.

I have had major surgery including brain surgery as a result of a tbi from a fall, and have been able to avoid taking opioids as a personal choice and have gotten through the pain management issues, but how do you tell someone else to “suck it up buttercup” and avoid things they are prescribed? I have a son who is a freshman in college, and will now be receiving treatment from trainers and doctors away from me if necessary, and reading this thread scares the hell out of me. From a doctors standpoint, if you try to manage pain from surgery under a lesser painkiller will the pain eventually go away as the surgical wounds heal? Just trying to understand why anyone would ever want to risk the opioid addiction?!

I sucked it up post aortic dissection surgery after being sent home. I have a very high pain tolerance level. During my five week recovery at the hospital and rehab I was given Percocet for five weeks. But being in the hospital it was monitored. My cousin, a doctor took the Percocet away from me when I went home. He called the hospital and told them to prescribe something less dangerous. I went through withdrawal. It was a pleasant distraction from my recovery (sarcasm). 

The problem is patients back on their own, unmonitored with powerful, addictive medications. Relative to baseball you can’t just send a player home post TJ surgery with powerful, additive meds and expect everything to be ok. He wants to get back on the field as soon as possible before he loses his job. The player has to be monitored for signs of addiction. 

I can fully understand a person playing around with levels of medication and thinking they’re smart enough to handle it. I did it while dealing with negative side effects. But I wasn’t playing around with opioids. 

 

I can't explain the choice to keep someone on Percocet five weeks post surgery, especially not for aortic dissection surgery.  Without knowing the details,  this does not seem appropriate. 

As to why to take pain med post procedure: 

There is a real risk of developing a pain syndrome if you are under medicated during a serious injury or post surgery.  Complex regional pain syndromes (CRPS) are rare but very real in the extremities.  So let us assume pitcher x has a UCL repair (Tommy John) and has fear of opioids and chooses just to "deal with the pain".  There is increased chance that this individual develops CRPS. 

Imagine a grown athlete that comes in a few weeks post surgery crying in unbearable pain with his throwing arm wrapped in a pillow because even the breeze of a fan causes an intense sharp, stabbing pain that can't be stopped.  This is a rare but real entity post injury/surgery.  Talk to someone who has had it and you will come across people in extreme desperation.

Now you are facing being unable to work, sleep, drive, or even move because every small stimulus creates so much pain that it takes over your life.  You start to self medicate with alcohol or whatever you can get your hands on.   Your hope changes from full recovery and return to the field to maybe someday just being able to get back to normal daily activities.  Individuals have even committed suicide because of the despair. 

Generally, I advise my patient to take their prescribed pain med for the day of surgery/injury, the day after surgery/injury, and beginning day 3 to take it only if needed.  Most individuals will turn a corner about 3-5 days after surgery, once the inflammatory phase of healing has been passed.  That does not mean they are pain free, but have enough reduction in acute pain that they don't need medicine.  The need to take opioids beyond this point starts to raise flags for me. 

There are medicines that can assist in pain control, but in my world we generally avoid NSAIDS (ibuprofen, naproxen, etc) if bone is involved because it adversely affects healing times.   Other meds also have potential for abuse and intravenous tylenol is sometimes employed to reduce the quantity of opioids required for pain control in extreme situations.

Pedaldad posted:

IWe all agree that there is an opioid epidemic.  We all agree that there are a certain amount of physicians that have played a role.  But let me shed some light on my background vs others that have chosen to write some very inflammatory, inaccurate, and unproductive remarks on this topic.

I agree there were some inflammatory remarks. As we clearly learned there was poor control of it's prescribed use and were intentionally misled on it's potency and addictive effects. I think the Purdue current lawsuits and previous settled and criminal prosecutions prove that.   

I am surgeon in my early 50s, and know full well what medicine was in the 90's as well as today.  For the past decade I have been part of the ortho faculty in a level 1 trauma center at one of are nation's largest academic institutions.  This means my partners and I take care of the patients no one else wants - the train-wreck traumas(literally and figuratively), the homeless, the uninsured, the chemically dependent - they all get dumped on our front door with injuries that make most look the other way.  So I am an authority on this thread topic.

I am very grateful for physicians like you and your partners. I do appreciate your opinion and responses, I may not agree with them but for the record I disagree with many authorities from Nobel Laureates to law enforcement officials (the radar was not properly calibrated).

I know what constitutes a peer reviewed scientific article, and the citation referenced above simply doesn't come close, but it is not void of poignant information.  The referenced citation is actually a newsletter  from the National Institute of Drug Abuse.  The excerpt chosen is misleading, it leaves out the sections that states 21 - 29% of people prescribed opioids misuse them (patient not complying with how they were prescribed, i.e. personal responsibility) and this directly leads to an opioid disorder in 8-12%.   Additionally 4-6% of those that misuse the opioid medications will develop heroin addiction.

Newsletter from the NIH that referenced peer review journals, again we will just have to agree to disagree on the scientific value of those journals. Yes, there is patient misuse that contribute to this problem, but again IMO this is an expected result from a poorly designed system of dispensing a highly addictive but necessary medication. 

The internet is a great thing, but medical sources are being cited that people really don't understand. Additionally, using inflammatory hyperbole -"giving out prescriptions likeHalloween Candy" or "lead to addiction in a matter of days" is grossly inaccurate and irresponsible as to the source of the problem.  It clearly is abuser driven as this newsletter suggests.

I read the references via pubmed and even read the articles' references. I won't lay out my CV here but I did understand. Yes there was hyperbole, but this is a very personal topic and we are on a public message board and this is quite tame relative to political debates on a baseball thread.  

My pain management colleagues can treat patients that require opioid pain medicines for years without them ever developing physical dependence or psychological addiction with proper counseling and patient compliance to the dosing regimen.

Yes, the majority learned to do it right and they should be applauded. However, the fact is we are in crisis and it was over prescribed. 

Referring to the AMA as a credible source of medical information shows a complete lack of understanding as to what the AMA is.  It is not a medical organization.  It is a political organization with a political agenda, not a defender of medical integrity.  In fact, it only has about 10-12% membership of the practicing U.S. medical docs.  Most members are hold overs from the ]70s, or have a political agenda that coincides with the AMA.  Membership cost is nominal (less than $500 per year) but most of us choose not to participate because we don't agree with a political organization that pretends to be a proponent of healthcare.

I don't disagree about AMA's  political agenda. However they and the ACS opiod task force also support changes to prescription practices.

Personally, I never write for opioids for anything other than significant trauma and post-operative pain control.  Very rarely more than a few days, never more than 2 weeks even in the most dire injuries/surgeries.   Heaven forbid you show up on the operating table with a crushed limb.  But if you do, I promise you that you part of your medical management will include a scheduled regimen of opioids to assist in pain control.  I will promise you that you will appreciate it.   

Again, I thank you for your dedicated and tireless service to others. I have had post-surgical prescribed short dose opiods and I was grateful for them.   

I also promise you that if written responsibly by the physician (almost always the case) and if you follow that regimen (less frequently the case), you will run little to no risk of addiction.  If you abuse/misuse it, that is where the problem is.

The road to misuse/abuse is complex, considering the highly addictive nature of this controlled substance. How it gets misused and abused is relevant. Clearly if the pad was not part of the problems, we would not have PMDPs 

 

2022NYC, it appears you have an issue with doctors in general it seems. As a guy who has had ACL reconstruction, appendectomy, L5 discectomy, I can tell you I appreciate what pedaldad is sharing with this board and it should be taken to heart. Post ACL reconstruction, the pain subsided in 3-5 days (unless my kid or dog jumped on my leg) and OTC pain relievers did the job. Worst pain ever that they weren’t even a consideration - kidney stones - and don’t get me started. WORST PAIN EVER (ladies, I have never given birth so have no frame of reference...but trust me...I cried). 

Thanks Pedaldad, appreciate your knowledge you have shared.

I am not an authority on this topic but still want to join the conversation.  

My dad was a dedicated chiropractor, considered a leader in his field by the institution.  He never stopped schooling, researching, learning, growing within his profession.  He wrote books, was constantly asked to speak at seminars, teach at schools and clinics, etc.  He explored every aspect of related holistic healing - all the various adjustment techniques, acupuncture, healing stones (yeah, that was an interesting period in a conservative midwest household in the 70's), you name it.  And, this was WAY before any of this became the least bit common here in the states.  It was not uncommon for people to share with me, unsolicited, how my dad saved their lives, saved them from desperate physical ailments.  He was, by all accounts, a great doctor (probably much like pedaldad).

However, he was also fully immersed in his profession and that meant (at the time) fully buying into the belief that traditional American medicine had little value, how the prescription of medication was almost never appropriate.  All six of us kids rarely if ever saw the inside of a hospital or medical clinic growing up.  Dad handled everything.  Problem is, as was customary of the time and place, Dad smoked and drank regularly.  Much later in life (after retirement), when those things started causing real physical ailments, at some point, traditional medicine was the only avenue.  I believe, only then, did he come to believe that the true approach to proper medical care is a combination of holistic and traditional medicine.  Things have improved over the last fifty years, but there is still a huge chasm between the primary foundations of traditional medicine and holistic medicine. 

I have been involved in other professions and endeavors where I was fully immersed and very well informed in my position and believed 1000% that my actions were the right course.  Later, only after stepping completely away, I sometimes was able to see a bigger picture and came to realize that wasn't the case, even with the best of intentions and tons of experience and knowledge to fall back on.

I believe that even the very best doctors on both sides still tend to rely heavily on their college training and industry status quo as "the truth".  I think there is a bigger picture that has yet to be clearly seen by most that would involve a much more proper blend of prevention, lifestyle, traditional and holistic medicine.  I know we have taken a few baby steps in that direction but we have so far to go.

Another point... I'm guessing that Tyler Skaggs' tragedy was, as has been discussed, tied to some earlier event of prescription due to his TJ and spiraled into addiction.  I agree with those who classify this as disease.  However, it is my perception that the national epidemic involves a much larger contingency of drug abusers that are just looking for the high, who's path with opioids never included actual prescription by a real doctor for a real medical condition.  That is us as a society becoming weaker.  Isn't that the real issue on a national level?  So there is validity to both positions... addiction is a disease and we are responsible for our actions.

   

Last edited by cabbagedad
cabbagedad posted:

I am not an authority on this topic but still want to join the conversation.  

My dad was a dedicated chiropractor, considered a leader in his field by the institution.  He never stopped schooling, researching, learning, growing within his profession.  He wrote books, was constantly asked to speak at seminars, teach at schools and clinics, etc.  He explored every aspect of related holistic healing - all the various adjustment techniques, acupuncture, healing stones (yeah, that was an interesting period in a conservative midwest household in the 70's), you name it.  And, this was WAY before any of this became the least bit common here in the states.  It was not uncommon for people to share with me, unsolicited, how my dad saved their lives, saved them from desperate physical ailments.  He was, by all accounts, a great doctor (probably much like pedaldad).

However, he was also fully immersed in his profession and that meant (at the time) fully buying into the belief that traditional American medicine had little value, how the prescription of medication was almost never appropriate.  All six of us kids rarely if ever saw the inside of a hospital or medical clinic growing up.  Dad handled everything.  Problem is, as was customary of the time and place, Dad smoked and drank regularly.  Much later in life (after retirement), when those things started causing real physical ailments, at some point, traditional medicine was the only avenue.  I believe, only then, did he come to believe that the true approach to proper medical care is a combination of holistic and traditional medicine.  Things have improved over the last fifty years, but there is still a huge chasm between the primary foundations of traditional medicine and holistic medicine. 

I have been involved in other professions and endeavors where I was fully immersed and very well informed in my position and believed 1000% that my actions were the right course.  Later, only after stepping completely away, I sometimes was able to see a bigger picture and came to realize that wasn't the case, even with the best of intentions and tons of experience and knowledge to fall back on.

I believe that even the very best doctors on both sides still tend to rely heavily on their college training and industry status quo as "the truth".  I think there is a bigger picture that has yet to be clearly seen by most that would involve a much more proper blend of prevention, lifestyle, traditional and holistic medicine.  I know we have taken a few baby steps in that direction but we have so far to go.

Another point... I'm guessing that Tyler Skaggs' tragedy was, as has been discussed, tied to some earlier event of prescription due to his TJ and spiraled into addiction.  I agree with those who classify this as disease.  However, it is my perception that the national epidemic involves a much larger contingency of drug abusers that are just looking for the high, who's path with opioids never included actual prescription by a real doctor for a real medical condition.  That is us as a society becoming weaker.  Isn't that the real issue on a national level?  So there is validity to both positions... addiction is a disease and we are responsible for our actions.

   

Thank you for your very diplomatic post. 

collegebaseballrecruitingguide posted:

2022NYC, it appears you have an issue with doctors in general it seems. As a guy who has had ACL reconstruction, appendectomy, L5 discectomy, I can tell you I appreciate what pedaldad is sharing with this board and it should be taken to heart. Post ACL reconstruction, the pain subsided in 3-5 days (unless my kid or dog jumped on my leg) and OTC pain relievers did the job. Worst pain ever that they weren’t even a consideration - kidney stones - and don’t get me started. WORST PAIN EVER (ladies, I have never given birth so have no frame of reference...but trust me...I cried). 

Thanks Pedaldad, appreciate your knowledge you have shared.

I appreciate and am very grateful to the wonderful physicians in my life. I am being critical about prescription practices that  did have a part in the opiod crisis and provided references as well as listed practice changes from their politburo as well as a bonafide professional soceity. If  you construe that as having an issue with doctors...that is your right but I would disagree. 

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