Monday, July 2, 2018

New Florida Laws: You're Only Permitted Severe Pain for Three Days

July 1st means new Florida state laws usually go into effect, and we've had a few notable laws.  The state passed 105 new laws.

The title is a jab at the legislature; they'd like to pass such a law but clearly can't, so they did the next best thing: they've ruled a doctor can only prescribe three days worth of narcotic pain medication except for unusual circumstances.
Opioids: Physicians will be limited to prescribing a three-day supply for acute pain unless strict conditions are met for a seven-day supply. Physicians and pharmacists will also be required to consult the state's database to review a patient's history. Healthcare professionals also will need to take some courses on responsibly prescribing opioids.
Seems a ridiculous burden on doctors' offices - who seem to be pretty busy all the time, even here in small city USA.

Last July, I wrote a couple of pieces on trying to make sense of it all (first, second).  Aesop at Raconteur Report did a similar look in a few articles and came to more or less the same conclusions I did.  Short version: I think there's a deliberate attempt to conflate prescription opioid problems with illegal heroin overdose.  We don't have prescription drug problem, we have a "junkies shooting adulterated heroin problem".  So why the public ruse?  The old advise to "follow the money" leads me to the company that makes naloxone, the anti-narcotic drug administered to people in overdose.  It was being pushed that virtually everyone should carry it everywhere as a lifesaver; it was even pushed on librarians to have it available for the library junkies who OD while watching internet porn in the library (do you have that where you are?).  The price of naloxone had gone up 17x.  Going down that rabbit hole led directly to Hillary Clinton and the Obama administration.

But we have to "do something" - right or wrong - "for the children".  As I always say, if you don't ask the right question, you'll never get the right answer. 

Another law they passed was to raise the legal age of marriage and put a legal limit on the difference in age between people entering a marriage.  I had no idea that was a problem so serious it demanded legislative attention. 
Marriage: Anyone under 17 will not be allowed to marry. Anyone marrying a 17-year-old must be no more than two years older, while minors will need parental consent. The old law allowed 16- and 17-year-olds to marry with the consent of both sets of parents. There was no minimum age if a judge approved and a pregnancy was involved.
People whose mugshot was shown on a website or other public place and were not convicted have the right to get it taken down.
Mugshots: A person may request the removal of their arrest booking photo from a website or anywhere else where it can be publicly accessible if they were charged but not convicted. The law also prevents websites and publications from charging for the removal. Removal requests must be sent via registered mail and include proof of identification.
One of the things many of have been saying about this "we can't separate the illegal alien parents from their children" outrage is that we separate parents from their children all the time.  It's called breaking the law.  Whenever anyone goes to prison they're separated from their family.  Why should illegal aliens be a special class?  Florida passed a law along those lines that's one of those "I didn't know that was not already the way it's done" things.
Incarcerated parents: The Department of Children and Families will be required to involve the incarcerated parent of a child who receives child welfare services in their case planning and progress.
There are many more, and worth a look if you live in the state, just in case you need to check to make sure they didn't change something important in your line of work.  I just noted something that makes it seem the SJW contingent in the state is still pushing things.
Statuary Hall: The state's request to replace the statue of Confederate Gen. Edmund Kirby Smith with civil rights leader Mary McLeod Bethune in Washington, D.C., becomes official.
and there's always time for the legislature to do the really important things:
State symbols: The Loggerhead Turtle permanently becomes the official state saltwater reptile and the Florida Cracker Horse (Marshtackie) the official state horse. Florida Cracker Cattle has also been designated as the official state heritage cattle breed.

 Florida Senate - stock photo.


  1. This has always been a red herring. Almost all of the opiod deaths are due to fentanyl. Almost all the illegal fentanyl is made in China and comes across the Mexican border. It is very difficult to get addicted to prescription pain medications when taken as prescribed. Usually when addicts use prescription drugs they are merely using what is available because they are already addicted. If you wanted to use prescription drugs to feed a drug habit you need multiple pills, crushed up and even then ingesting them is not the best way to get relief so they usually find a way to inject them.

    There is something else going on here. For some reason there are people and organizations who want to limit access to pain meds. They know the facts and they know they are lying about the reasons so there is some other reason for their efforts

    1. 1) Illegal fentanyl is cooked in garages, genius.
      The distribution chain is down the block, not across the Pacific.

      2) It's very easy to get addicted to prescription narcotics if taken as prescribed, if you're not in acute pain. If you're taking them for chronic pain, or worse, because you're a junkie, physical and psychological addiction is as easy as falling off a log. Your body gets habituated, and needs more and more for the same high, because you have opioid receptors built into you, and the synthetic stuff is loads stronger than endorphins, by design.

      0 for 2. Science, it's a thing.

      The reason for their efforts is to push naloxone, which money trail was previously tracked right back to Shrillary, Fat Bill, and the Clinton Foundation.

      The internet moves pretty fast; try and keep up.

      30 points taken away from Ravenclaw.

    2. Aesop I like your blog and don’t mind your confrontational style. I suspect that since you are in the medical field you resent any non-medical person swimming in your pool and thus feel the need to strike out at them. But you have misstated or over stated your case.

      “Illegal fentanyl is cooked in garages, genius. The distribution chain is down the block, not across the Pacific.”
      MOST illegal fentanyl comes from China through Mexico and across our Southern border. The reason this is important is almost all of the deaths from overdoses is because of fentanyl.

      “It's very easy to get addicted to prescription narcotics if taken as prescribed”.
      That is a common myth. It is ‘possible’ to misuse prescription narcotics and thus become addicted BUT 99% of addicts did not get addicted from drugs prescribed to them by a doctor and then taken as prescribed. SOME people get a lot of narcotics from their doctor and then pop them like M&Ms and DO get hooked on them and then they CLAIM that they took them as prescribed. Hell, I would say that too rather than admit I gobbled them like candy.

    3. I have no problem with the medically ignorant "swimming in my pool". What I resent is people telling others that water isn't wet, or that it can be breathed.

      Most illegal fentanyl isn't being shipped here from China.
      The pure fentanyl may be shipped from there, but it mainly ends up in places from Tijuana to Columbia, where it's then smuggled here for processing, for backroom production right here in the States. The stuff can be cut and processed anywhere, and both the original elements and some of the processed supply are mostly coming up from Mexico.

      The idea that what's hitting the street is coming from China is ludicrous, because it'd be retarded to process the pills there, where you'll get shot in the head on the spot if caught, when all they have to do is get a kilo of pure fentanyl from there, and then turn it into 500,000 doses in Mexico, or inside some industrial lab in the Rust Belt here. You don't smuggle an iceberg into the country when tap water is free.

      A kilo of pure fentanyl can be turned into $5-10M worth of counterfeit pills, and batches have been seized with each one at a fentanyl strength that approaches the LD50 dosage, which is where the vast majority of opioid ODs and deaths have been coming from, not from people taking Rx prescriptions.

      I see that as a feature, not a bug.
      A couple of rich batches, and you wipe out the junkie population in a town almost overnight.
      No demand, no problem.

      But hey, thanks for straightening me out on how prescription opioid narcotics and addiction work.
      And to think I wasted all that time in school learning that everything you wrote was complete baloney, and a few decades of experience showing what I wrote is absolutely the case have all been shot to hell by one internet post.

      But it turns out your straw man had nothing to do with reality. Addicts become addicts because they're addicts.
      Some of them find out with Rx meds and chronic pain issues, and some of them find out because they'll try anything to get high.

      Which doesn't make Rx meds any harder to get addicted to. It just means that it works exactly like I said for non-acute pain.
      Most people don't get a lot of narcotics from their doctor, but people who get narcotics from their doctor for a long time because of chronic pain become habituated and then addicted to opioids, because that's how your body works, when you take the drugs exactly as prescribed. And then, when they can't get more, or they need higher dosages to get the same level of relief, they get cut off, end up in pain management, and then try drug-seeking in the ER. Some also turn to street pharmaceutical suppliers. And in doing the latter, if they get a rich batch of acetyl fentanyl or carfentanyl, they end up dead.

      Don't believe me though.

      Ask Rush Limbaugh why he has cochlear implants after taking 100 Vicodin/day for a few years.

      Hint: he didn't start out "popping them like candy" 100/day. That's how he ended up. After taking Rx opiates as prescribed.

      So you figure out how that happened.

    4. And hey, don't believe me on the supply chain.
      Read this article from the Baltimore Sun last October, where they lay it out in detail.

      Legal production in China shipped to Mexico, smuggled here by drug cartels, and processed in local spots; in one case, in the back of a barber shop.

      That's not "coming from" China, other than them being the source of the components.

      It's being shipped here by Columbian and Mexican drug cartels.
      They already have the business, the experience, the networks, and the inclination.
      And now they can turn a $2500 kilo of fentanyl in $5M worth of street drug.
      It's a license to print money, for very low risk (other than wiping out your customer base overnight, or sloppy processing getting the person doing it killed).

      I don't make stuff up, and while I don't know everything, what I do know, I know damned well.
      Write it on your hand in case you forget. ;)

    5. I am afraid that I do not share your enthusiasm for the death of the entire population of a town's drug addicted population. You are making the problem of drug addiction into a function of faulty character, rather than a physical reaction to either a genetic factor, or to a normal conclusion that follows long term chronic pain.
      Anonymous is looking the other way while the truth is obvious to anyone who is willing to really accept it. Not believing the truth doesn't change it. But it really doesn't make much difference how the opioid problem started or who is to blame. What does make the difference is what are we as a nation going to do about this problem, that makes sense from every side.

      It seems that just blaming big pharma for being profit seeking is pretty much pointless, and unfair to the companies whose mission is to make money, and who did not make the drug cartels in Mexico and Latin America.
      It still must be remembered that there is a difference between a person who is seeking drugs merely to satisfy their addiction, and those who, through no fault of their own, have a medical condition that involves chronic pain. That the government has not got a clue on how to handle both types of people, is simply not a surprise. The Feds are expert at writing rules, but they are terrible at writing rules that fit everyone. As is usually the case, with the government, one size fits none.
      As to the issue of opioid tolerance, I can tell you that it is certainly real. But that is also the case with other classes of drugs, to some extent.

    6. "I am afraid that I do not share your enthusiasm for the death of the entire population of a town's drug addicted population."

      It's not "enthusiasm". It's merely an appreciation for gravity, elegantly working.

      People either have moral agency, or they do not. If they do not, then any law is pointless.

      There's a word for a society with no law.
      It is not something to aspire towards.

    7. "Most illegal fentanyl isn't being shipped here from China.
      The pure fentanyl may be shipped from there, but it mainly ends up in places from Tijuana to Columbia"

      A distinction without a difference.

      Fentanyl is what is killing most addicts. Some die from simple overdose of their traditional drug of choice but 90% of the deaths are the result of cutting the drug with fentanyl because of the huge profit that be had because it takes a tiny amount of fentanyl to give the addict their 'hit". But for the very same reason it takes just a tiny bit more fentanyl to be deadly and the people who are mixing the drug for sale on the streets are not skilled enough to know the difference.

      None of this is secret or even debatable so you have to ask why the emphasis is on big pharma and pain medication which is not the problem. I did not say pain medications are not abused by addicts but pain medications are not what is causing those 60,000 deaths a year even when they are abused by the addicts. Fentanyl is the problem. Most pure fentanyl comes from China through Mexico to the U.S. This too is fact and not arguable. You can choose your words anyway you want to in an attempt to make it appear different but that is the bottom line.

      My question is still; why the emphasis on prescription drugs when everyone knows they are not the problem? Something else is going on and that is what we need to uncover.

    8. Aesop,
      I apologize for overstating your position on drug addicts. I do find that it is not always accurate to say that a person addicted to drugs has a moral issue, as you do seem to imply, with this last response. Most medical authorities have declared that addiction is a disease, whose mechanisms are both varied and complex, at best. To abandon those who are addicted simply because they are breaking the law is short sighted, in some ways.
      Let's say, for the sake of argument, that we don't legislate against a person doing anything that doesn't hurt anyone else, sort of like the idea of personal freedom implies. So now, the drug addict, even if they sit in a corner and do nothing but stay high all the time, is not breaking the law, in and of itself, simply because of the fed gov deciding that getting high is a crime. So now, we can look at the next step, that being, the problem of the addicted being a drain on the resources of society, such as emergency medical treatment for overdoses and the like.
      If society didn't pay for medical expenses of those who choose to harm themselves like this, would it be different? Because then you can look to the argument of how obesity is also a self inflicted wound that costs society as a whole due to increased medical expenses.
      The other concern is that often drug addicts steal to support their addiction. However, the true cost of narcotic or opiod medications is actually not all that great, save for the fact that it is illegal to purchase drugs without a prescription. So if those types of drugs were no longer regulated, and the price fell to the actual cost of making them, most drug addicts would not be forced to steal to feed their habit.
      I know that I have gone from arguing against holding addicts as criminals, to almost desiring the removal of drugs from the government controls that have been in place for years. I think that what I am actually looking for is a more reasonable policy from the DEA and the government in regards to both chronic pain patients, and how we as a society deal with drug addicts. Certainly there is a high percentage of addicts that probably have no hope of being rehabilitated or reintroduced back into a productive role in society. And I am not suggesting that we abandon the method of protecting the public from their own ignorance, via government regulation. While that sounds like the utopian libertarian paradise, it carries more problems with it than it solves. What I am suggesting is that when the government chooses to make changes to rules that affect such a huge amount of people, who are not for the most part drug addicts, but merely chronic pain patients with very real concerns, they must slow down, and make the changes with more of an eye to how it will affect not only the people in the latest television stories, but also the majority of narcotic users, who are not addicted, but still are dependent on them for the ability to survive from day to day due to serious chronic pain. Making doctors into criminals for attempting to treat patients with these issues, is, in a word, boneheaded, but sadly, not an unexpected response from the government, who has a reputation of over reacting to most of the issues that they tackle, with predictable results

  2. Note that the law says "Acute pain" not "chronic pain"

    While I agree that this law solves nothing, I still think it is important to understand what is being legislated.

    1. Seems to me it's regulating pain killers for post-op and post injury. You're a (former) EMT - those patients you bring to the ER get pain pills for three days for their fractures and foot-long lacerations.

      Post surgery and post-ER visit are the only times I've ever taken any opioids, so I have no concept of other uses.

      But I still think it's punishing the innocent and doing nothing about the real "problem" they think they're solving.

      As Anon953PM says, I think this whole national "opioid crisis" story isn't what it seems. I just don't see what it really is. I have some ideas. For another time.

    2. The SEA will not give Doctors any set prescribing guidelines, like how much it for what patients, etc. So the Doctor is left to guess, and will are on the side of caution, because better the patient suffers in pain than the Doctor lose their license. I have seen it once already, and I am sure that they are going to do so for examples. As for why, just like always, follow the money. There is literally billions of dollars to be made in marijuana, and the pump is being primed to make it legal, and oh so profitable. That would be my first guess.

    3. The patients who go to the ER cannot get narcotic prescriptions any more. The hospitals stopped doing that years ago. The reason for that is that there are so many drug seekers out there.
      I agree that there i no crisis. People are using narcotics at the same rate that they always have. It's just that many of the users have discovered that it is harder to get busted if you can get your doctor to give you a prescription than if you are buying on the street. AS a medic, I would get at least 2 or 3 people who were faking illnesses in order to get drugs.
      The most successful of those was a 50 year old man who had a previous heart attack. The EKG showed heart damage that was nearly impossible to tell apart from a currently occurring heart attack. He would complain of the symptoms of a heart attack, the responding medic would look at his EKG, and BAM- he would get morphine. He got morphine from me twice before we figured it out. There was another guy who had a kidney stone. He used that in a similar fashion. I could go on, but let's just say that there is a problem. It just isn't any better or worse than it has been for years.

    4. @pigpen51: As for why, just like always, follow the money. There is literally billions of dollars to be made in marijuana, and the pump is being primed to make it legal, and oh so profitable. That would be my first guess.

      That's kind of where I think the path leads, but a twist. I think it's leading to an effort to deregulate heroin so that anyone can shoot up whenever/wherever they want. Sort of some version of the places in Europe that have done it. And turned to open sewers because of it - like San Francisco, El Lay, and any place that allows it.

  3. On August 4, 2017 at 1:10 PM Aesop wrote:

    the people who lived in America prior to the Harrison [Narcotics] Act aren't the folks of today. Period. Full stop.

    Nonsense, humans are not blank slate enough to be modified that far. Subject humans to the same economic/political conditions as a previous timeperiod, and their behavior will adjust to the previously observed setpoints. We know present-day humans understand those prior setpoints, because in order to lie like liberals they have to know what holes in their arguments they have to evade.

    I suspect this readership might know something about chronic back pain. The real thing, from bone problems, which is never going to heal and can't be repaired. I hear there are a few older folks in Florida, too. If somebody told you your supply of maintenance pain meds was going to go permanently intermittent due to politicians grandstanding, what wouldn't you do?

    Opioids are an agricultural product, they should cost about the same as table sugar. If addicts (medically approved or not) can't afford opioids, government caused that. If the Breaking Bad show were to have synthesized time-release opioids for 50 cents/pound rather than meth, the RV would be followed by a parade of people in wheelchairs crying tears of happiness. But that actually would have been subversive.

    1. You don't get out much, do you?

      You really think the American character of 1900-ish turn-of-the-century America isn't that far removed from today?
      I can't even...

      And pharmaceutical opioids aren't an "agricultural" product, nor have been for a century.
      They're a chemical one. C17H19NO3.

      Heroin comes from opium poppies, yes. And it's an opioid, but not a pharmaceutical, no matter what George Carlin, Lenny Bruce, or the idiots at the Libertarian Party told you.
      Morphine, Dilaudid, et al, are chemically synthesized, and have been for decades. As Casey Stengel used to say, "You could look it up."

    2. You really think the American character of 1900-ish turn-of-the-century America isn't that far removed from today?

      One of the Midwestern states, may have been Wisconsin, got everybody off their welfare roles with a year's warning. Recollection is it happened a decade or two ago. Nearly everybody was capable of working for a living, and the few deserving charity received it.

      Addicts can tolerate an environment where they can buy pills to abuse with an hour's labor, but there is no free medical care and the church charities won't help them unless they reform. Sure, some will die. Most won't. There will be no huge explosion of welfare service costs because those programs won't exist. The perfectly reasonable solution to socialism is to just stop doing it.

      You've already said heroin was being substituted by patients for availability reasons.

    3. Heroin's being substituted by drug-seekers, not people with broken legs.

      And there's NO welfare anywhere in Wisconsin? REALLY?
      It musty be true, I read it on the internet.

      Because everyone there now acts like it's 1900 again, 24/7/365. I suppose the retirees have stopped collecting heir SS and Medicare checks too? And the state has laid off all those wealth-redistribution specialists, from city to county to state, and even the federal ones? But just in Wisconsin?

      Stop, you're killing me, my sides are aching.

    4. This comment has been removed by the author.

  4. Don't just stand there! Do something! This is something, you must do it! The stoopid, it burnnnss. A nice city bus reduced my left ankle to gravel. That was 3 years ago. They tried to cut me off from Dilaudid, because of the dangers of addiction. (3d time in that hospital, very different reasons). I asked for reasons, and it was 'well...'. I called up some of my previous physicians. 'Zero response, on Narco, zero response on morphine. Moderate pain help with Dialaudid, PT requested Marlboro when taken off Dilaudid).

  5. I saw that some big wig, maybe the head of the FDA, said that some chronic pain patients actually have a need for long term opioid treatment. As a chronic pain patient, my first thought was, no shit. I guess I should have gone to med school.

  6. Wait 6 months, SiG.
    There will be breathless headlines in the FL newspapers, screaming "Opioid Epidemic worsens! Prescriptions for Opioids Up 300% since last year! ZOMG!"

    This stuff writes itself.

  7. The important takeaway in this discussion is something is being hidden from us. The medical community and the drug enforcement community knows that most drug users do not first get addicted from a prescription of pain pills. They are introduced to hard drugs while drunk or high on pot. They generally cannot afford the habit and resort to less desirable sources for their fix such as their parents medicine cabinet or going to the ER with phony claims of pain. But even then these prescription drugs are not their first choice because they aren't as good, powerful or as easy to use as street drugs are.

    For some reason the prescription drugs are being scapegoated. It won't result in less drug use or even be effective in stopping future drug use. It will merely improve the market for the Mexican cartel. But in the process millions of legitimate patients will have to suffer with more pain to fullfill the myth that prescription drugs are the primary cause of addiction. Cui Bono???

    1. the limit of 3 days is not unique to florida. I’m in michigan and recently went to my doctor seeking a referral to a back specialist, my back had gone out again. I also asked for a muscle relaxant and a pain reliever (hydrocodone). Doctor wrote script for 3 days said law prevents her from writing more. The week after ( june 27) I had surgery on a totally blown rotator cuff, I kept getting told that I would have terrible pain, they were right. Surgeon prescribed 1 week of hydrocodone if taken at max rate 2 pills every 6 hours. Follow up is 2 weeks after surgery. It appears all doctors are under the gun to minimize opiod use.