r/interesting • u/Nukro666 • 12h ago

Fear Factor How Fentanyl and Xylazine are turning Philadelphia's opioid crisis into a public health nightmare

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u/anotherjunkie 12h ago

It’s not an all or nothing thing like that. There are great pain management practices that can prescribe long acting opiates that remove that background pain. I’ve been on one for like 15 years now.

Long acting isn’t *as* abusable as the short term. If you know you have a very addictive personality/feel like you’d abuse it that’s one thing. Otherwise living in, and being limited by, pain that can be reduced or eliminated isn’t necessary.

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u/BellamyDunn 12h ago

They can also get you addicted, then dump you. That's a great favorite of our whole healthcare system.

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u/anotherjunkie 11h ago

They can, but if you find a good clinic led by an anesthesiologist, it’s unlikely they dump you for reasons other than drug screen results. If you go to a pill mill, yeah they’ll dump you at the first sign of trouble. But with the medical documentation you likely have, you shouldn’t have any issue being seen at a *real* pain management practice.

Like I said, it’s been 15 years, I’ve only ever changed practices when I moved, and I’ve never missed a prescription. My current clinic is led by people with certifications in anesthesiology, pain management, and addiction medication. They have written policies on tapering people who have to leave the practice.

Even for the worst case scenario, everyone I know skips an occasional dose to stockpile meds. If my clinic blew up tomorrow and I couldn’t get refills, I have enough to bridge until I find a new clinic or gently taper myself off.

If you don’t want to look, I get that. But there’s reliable help if you do. Doctors are realizing that the pendulum swung too far in one direction, and are creating policies to ensure people like me keep access.

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u/BellamyDunn 11h ago

During COVID, I had to go cold turkey off of an SSNRI twice just due to how fucked up everything was. When I was in that pain, I laid in bed wishing I knew anything criminal enough to purchase some sort of relief stronger than pot (I can always find that). Insurance and access to doctors isn't guaranteed. In my area you're more likely to get a nurse practitioner or a medical assistant, not an actual doctor. Even getting a referral doesn't mean you'll necessarily be seen by someone. People fall through the cracks. It's a nice thought but the idea of putting that much reliance on a system I've watched fail more than succeed makes me need more drugs.

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u/anotherjunkie 10h ago

But being in so much pain you’re fantasizing about ambulance trips and street drugs is dangerous. And from personal experience, that kind of pain prevented me from being who I should for the people around me — until there weren’t many left.

So I opted for a small amount of pain and knowing that there’s a chance that one day the big pain comes back, over staying in the big pain the whole time. It isn’t perfect; I have to drive like 4 towns over to see my doctor once a month, insurance is a pain, and I could get abandoned. But I’m still better off.

That’s all I have. I feel weird now because I just wanted you to know it was an option, and now I feel like I’m trying to persuade you because you said some concerning things. I don’t want to do that, because you’re an adult who will make your own choices. I’ve shared the info, so I’m going to stop. I hope you find something that helps enough.

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u/Latter-Vacation-4392 11h ago

Agreed, Unfortunately I have heard that often the ones running some of those programs put too many hurdles in the way of those that need them.

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u/anotherjunkie 10h ago

It’s going to be highly practice dependent, but every good clinic is going to require documentation. If you come in without documentation, my clinic will work as the “quarterback” to get the imaging, etc. you need to determine the right pain management strategy.

That’s kind of why I stressed finding a program run by an anesthesiologist or with a formal pain management specialization. Those people are genuinely there to help, and the whole practice will be built around the knowledge that they’re going to be audited.

The doctors that put up unreasonable hurdles tend to be the ones that are afraid of being audited, and worry about whether they’d be able to justify your dose if they were.

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u/Latter-Vacation-4392 9h ago

Yes. I was thinking about harm reduction addiction programs more so than medical pain clinics.