The Next Mormon Schism

[Green Monstah]

If you're going to self medicate you've got three options, booze, illegal drugs or legal drugs. I don't think people in Utah have more reasons to self medicate they just have fewer options.

I agree. It's one of the reasons I hope that one day we'll start taking the "mild barley drink" language in D&C 89 seriously!!!

[statman]

I'm guessing you're meaning this as a sort of knock on northern Utah County, as if there were something unique about 'Utards' who live there.

Guess what? There is. They're almost all Mormon. And so are you.

You're not wrong--Utahns certainly have a very high use of pharmaceuticals (although I'll dispute your contention that painkillers are used to any higher degree here--out of the five states I've practiced, Utah falls right in the middle, and WAY below both Arizona and Nevada). I see this as a commentary on the predominant means to coping with difficulties in life, not as any geographical oddity. Read that how you want.

First - let me start by saying that a pharmacist knows WAY more about a what is going on in the community than a physician. A physician know what he prescribes, and may know what his/her coworkers prescribe. But a pharmacist sees the aggregate of what EVERYONE prescribes.

There are three major differences between here and elsewhere (she's licensed in UT, IL, TX, NC, & SC). 1) there simply are more scripts for pain killers written in Utah than elsewhere, although the elevated base rate for writing scripts for pain killers in general isn't all that huge. There are definitely more, but not all that many more. 2) The most troubling issue is "opiate inflation" - doctors/dentists here prescribe stronger painkillers and a lot more of them than elsewhere. Just an example that fits average prescription patterns in the last area we lived v where we live now:

IL DR/Dentist-----------UT DR/Dentist
Nothing----------------Nothing
OTC-------------------Hydrocodone
Codeine APAP----------Hydrocodone/Oxycodone
Hydrocodone-----------Oxycodone
Oxycodone-------------Oxycodone

And if they give you anything strong - where an IL dentist might write a script for 12 tablets, the Utah dentist writes it for 25.

Difference 3) There are a WHOLE LOT of these - monthly maintanence scripts for Hydrocodone/Oxycodone - usually for 60 tablets - and given to all different strata of adults. Some probably are in pain, and this is the minimum amount that can keep them going - pump-up the ibuprofen during the day, and take two Oxy's to sleep through the night. Legitimate use. These are not people in severe pain - they require 3 or 4 times that much for steady pain, and if it's for intermittant severe pain, they don't need to fill it like clock-work every month. Many/most of these scripts are nothing more than "mother's little helper scripts" - and are often accompanied by other goodies like Xanax or benzos.

Now for the perspective of scale - The last pharmacy my wife worked at in IL was very similar to the one she worked at in TX. Busy neighborhood CVS. Middle class neighborhood bording areas where some were very wealthy. Some older folks, lots of families with kids, not so many singles. Filled about 350-400 scripts a day. Both of those are quite similar to whaere she works now. Similar neighborhoods, similar customers/patients/clients (whatever they're called nowadays), similar pharmacy sales volumes.

In IL and TX, she used to go through a stock bottle of 1000 codeine tablets in about a week. Here she essentially sells no codeine - she's had the same stock bottle of codeine tablets in her pharmacy for over a year. Yeah, it's not a great paiin killer, and there's a certain percentage of patients for whom it simply does not work (they lack an enzyme to metabolize it), but as a drug that lets a patient feel like the doctor is doing somehting for them, it's a great starting place.

Here she sells a bit more hydrocodone than she sold in IL & TX - perhaps 10-20% more total. If you were just looking at Lortab scripts, you wouldn't think there was that much of a difference. But that's not the big difference.

In TX & IL, her busy suburban stores went through about a 1000-pill stock bottle of Oxycodone in a year. People who got them were usually those who'd just had surgery - including oral surgery, but they usually only got Oxycodone for a day or two and got stepped down to either Hydrocodone or Codeine after that.

The vast majority of total pain scripts were split just about evenly between Codeine or Hydrocodone. She actually dispensed more really big-guns pain killers to cancer patients (morphine, methodone, fentonyl, etc) than Oxycodone.

In Utah, she goes through one to two stock bottles of Oxycodone in a WEEK (50 - 100 times as much Oxycodone being prescribed in a pharmacy of similar size). Pain scripts here are split just about evenly between Hydrocodone and Oxycodone. And the big guns cancer scripts are at about the same rate in all three places...

Why is this the case? Why do Utah doctors/dentists choose not to dispense the weakest pain killers & instead continually 'kick it up a notch?' One explanation is that Codeine isn't a great pain killer, and as noted before, simply doesn't work for some people, so they just skip it. But if that's the total explanation, we'd expect just to see a ton more Lortab scripts. That's not the case. The guys who'd get Lortab elsewhere genearlly get Percocet here. And nobody really gets more than a couple days of Percocet anywhere else. It's just not prescribed that much.

(Again all this is based off of her observation of aggregate patterns in the prescription of pain-killers)

Maybe BYU fans really are whiners because they're legitimately all in agonizing pain?

[pellegrino]

I'm not sure how to react. This is the second time in two days that someone has accused me of being a non-believer. I guess if I don't believe according to their standards then I'm not. The beating continues, hope my hands are strong enough to take it.

Indy, when you're ready to put aside your presumptions, assumptions and binary thinking then I'll be happy to discuss this with you further. Until then, I've got better things to do with my time.

[byu71]

I'm not sure how to react. This is the second time in two days that someone has accused me of being a non-believer. I guess if I don't believe according to their standards then I'm not. The beating continues, hope my hands are strong enough to take it.

Indy, when you're ready to put aside your presumptions, assumptions and binary thinking then I'll be happy to discuss this with you further. Until then, I've got better things to do with my time.

Gee, you handle this so much calmer and reasonably than I do when confronted with the same accusation. Do you mind if I refer to your response when I am confronted over on CB.

[Tim]

I'm not sure how to react. This is the second time in two days that someone has accused me of being a non-believer. I guess if I don't believe according to their standards then I'm not. The beating continues, hope my hands are strong enough to take it.

Indy, when you're ready to put aside your presumptions, assumptions and binary thinking then I'll be happy to discuss this with you further. Until then, I've got better things to do with my time.

Don't forget... if you let go it'll be your fault and your fault alone. Indy Coug Chapter 1 Verse 1.

[Indy Coug]

I'm not sure how to react. This is the second time in two days that someone has accused me of being a non-believer. I guess if I don't believe according to their standards then I'm not. The beating continues, hope my hands are strong enough to take it.

Indy, when you're ready to put aside your presumptions, assumptions and binary thinking then I'll be happy to discuss this with you further. Until then, I've got better things to do with my time.

Ummm.... where did I call you a non-believer? My comment to you was that if you refuse to acknowledge modern revelation as a part of this discussion, then the discussion is pointless.

[Indy Coug]

Don't forget... if you let go it'll be your fault and your fault alone. Indy Coug Chapter 1 Verse 1.

For some, the beatings come through their active imaginations and/or undying desire to succumb to some form of conscientious objector martyrdom.

[ERCougar]

First - let me start by saying that a pharmacist knows WAY more about a what is going on in the community than a physician. A physician know what he prescribes, and may know what his/her coworkers prescribe. But a pharmacist sees the aggregate of what EVERYONE prescribes.

There are three major differences between here and elsewhere (she's licensed in UT, IL, TX, NC, & SC). 1) there simply are more scripts for pain killers written in Utah than elsewhere, although the elevated base rate for writing scripts for pain killers in general isn't all that huge. There are definitely more, but not all that many more. 2) The most troubling issue is "opiate inflation" - doctors/dentists here prescribe stronger painkillers and a lot more of them than elsewhere. Just an example that fits average prescription patterns in the last area we lived v where we live now:

IL DR/Dentist-----------UT DR/Dentist
Nothing----------------Nothing
OTC-------------------Hydrocodone
Codeine APAP----------Hydrocodone/Oxycodone
Hydrocodone-----------Oxycodone
Oxycodone-------------Oxycodone

And if they give you anything strong - where an IL dentist might write a script for 12 tablets, the Utah dentist writes it for 25.

Difference 3) There are a WHOLE LOT of these - monthly maintanence scripts for Hydrocodone/Oxycodone - usually for 60 tablets - and given to all different strata of adults. Some probably are in pain, and this is the minimum amount that can keep them going - pump-up the ibuprofen during the day, and take two Oxy's to sleep through the night. Legitimate use. These are not people in severe pain - they require 3 or 4 times that much for steady pain, and if it's for intermittant severe pain, they don't need to fill it like clock-work every month. Many/most of these scripts are nothing more than "mother's little helper scripts" - and are often accompanied by other goodies like Xanax or benzos.

Now for the perspective of scale - The last pharmacy my wife worked at in IL was very similar to the one she worked at in TX. Busy neighborhood CVS. Middle class neighborhood bording areas where some were very wealthy. Some older folks, lots of families with kids, not so many singles. Filled about 350-400 scripts a day. Both of those are quite similar to whaere she works now. Similar neighborhoods, similar customers/patients/clients (whatever they're called nowadays), similar pharmacy sales volumes.

In IL and TX, she used to go through a stock bottle of 1000 codeine tablets in about a week. Here she essentially sells no codeine - she's had the same stock bottle of codeine tablets in her pharmacy for over a year. Yeah, it's not a great paiin killer, and there's a certain percentage of patients for whom it simply does not work (they lack an enzyme to metabolize it), but as a drug that lets a patient feel like the doctor is doing somehting for them, it's a great starting place.

Here she sells a bit more hydrocodone than she sold in IL & TX - perhaps 10-20% more total. If you were just looking at Lortab scripts, you wouldn't think there was that much of a difference. But that's not the big difference.

In TX & IL, her busy suburban stores went through about a 1000-pill stock bottle of Oxycodone in a year. People who got them were usually those who'd just had surgery - including oral surgery, but they usually only got Oxycodone for a day or two and got stepped down to either Hydrocodone or Codeine after that.

The vast majority of total pain scripts were split just about evenly between Codeine or Hydrocodone. She actually dispensed more really big-guns pain killers to cancer patients (morphine, methodone, fentonyl, etc) than Oxycodone.

In Utah, she goes through one to two stock bottles of Oxycodone in a WEEK (50 - 100 times as much Oxycodone being prescribed in a pharmacy of similar size). Pain scripts here are split just about evenly between Hydrocodone and Oxycodone. And the big guns cancer scripts are at about the same rate in all three places...

Why is this the case? Why do Utah doctors/dentists choose not to dispense the weakest pain killers & instead continually 'kick it up a notch?' One explanation is that Codeine isn't a great pain killer, and as noted before, simply doesn't work for some people, so they just skip it. But if that's the total explanation, we'd expect just to see a ton more Lortab scripts. That's not the case. The guys who'd get Lortab elsewhere genearlly get Percocet here. And nobody really gets more than a couple days of Percocet anywhere else. It's just not prescribed that much.

(Again all this is based off of her observation of aggregate patterns in the prescription of pain-killers)

Maybe BYU fans really are whiners because they're legitimately all in agonizing pain?

1) Codeine is not "a great start". It's no more effective than ibuprofen in the aggregate, except for producing more nausea. And it kills the occasional rapid-converter. Like propoxyphene (Darvocet), it should be off the market. So nice job, IL docs...
2) Here's a breakdown of narcotic use by state:

http://www.lasvegassun.com/multimedia/rx_interactive/

Of the places your wife has worked, only TX and IL are "WAY LESS" in terms of oxycodone use. This has nothing to do with culture and everything to do with aggressive and early prescription drug monitoring programs in these two states. These are controversial, by the way, as some think we're scaring doctors out of treating pain.
3) I love how oxycodone is "mother's little helper" while fentanyl, morphine, and methadone treat cancer pain. I'll take overuse of oxycodone over methadone any day.

So no, Utah's really not all that unique in terms of narcotic use, and any uniqueness is derived more from lax government oversight of prescribing patterns than anything cultural. But even if we grant you that Utah uses WAY MORE narcotics and that ANYWHERE ELSE, patients don't get the same narcotic prescriptions, what's your point? I find it curious that some of the biggest Utah detractors are also the Church's biggest defenders. Guess what Utah culture is? It's the Church--freebased. So why do Church members, when surrounded by other church members, need a "mommy's little helper" to get through life?

[wuapinmon]

For some, the beatings come through their active imaginations and/or undying desire to succumb to some form of conscientious objector martyrdom.

Indy, you're a good guy, but this thread is not your finest moment.

[Indy Coug]

Indy, you're a good guy, but this thread is not your finest moment.

LOL. Nice homage.

[Moliere]

Indy, you're a good guy, but this thread is not your finest moment.

[wuapinmon]

You're just jealous that Dolly Parton didn't write a song about you.

[Portland Ute]

1) Codeine is not "a great start". It's no more effective than ibuprofen in the aggregate, except for producing more nausea. And it kills the occasional rapid-converter. Like propoxyphene (Darvocet), it should be off the market. So nice job, IL docs...
2) Here's a breakdown of narcotic use by state:

http://www.lasvegassun.com/multimedia/rx_interactive/

Of the places your wife has worked, only TX and IL are "WAY LESS" in terms of oxycodone use. This has nothing to do with culture and everything to do with aggressive and early prescription drug monitoring programs in these two states. These are controversial, by the way, as some think we're scaring doctors out of treating pain.
3) I love how oxycodone is "mother's little helper" while fentanyl, morphine, and methadone treat cancer pain. I'll take overuse of oxycodone over methadone any day.

So no, Utah's really not all that unique in terms of narcotic use, and any uniqueness is derived more from lax government oversight of prescribing patterns than anything cultural. But even if we grant you that Utah uses WAY MORE narcotics and that ANYWHERE ELSE, patients don't get the same narcotic prescriptions, what's your point? I find it curious that some of the biggest Utah detractors are also the Church's biggest defenders. Guess what Utah culture is? It's the Church--freebased. So why do Church members, when surrounded by other church members, need a "mommy's little helper" to get through life?

Bazinga!

Signed,

A horrible over-prescribing Utah dentist.

[Jacob]

The Proclamation was modern revelation?

If we are to accept the premise of modern revelation through Mormon prophets then I think we are bound to accept the proclamation as revelation. If not, then I can't think of anything that would qualify as modern revelation. We are left to deny modern revelation.

Indy is right. We don't have to accept modern revelation through prophets, but if we do, then the proclamation is pretty much it.

Though I will admit that official proclamations of the sort have been mistaken/redacted before.

[SoonerCoug]

I'm really disappointed in all you jokers for getting off the topic.

I think the schism is going to occur in about 50 years, and I think it's going to be over ordination of actively gay married men (men married to men) to the priesthood and leadership positions.