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Thread: ATTN: Pill Poppers

  1. #151
    Member santasutt's Avatar
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    Default Re: ATTN: Pill Poppers

    A public health perspective.....


    Morbidity and Mortality Weekly Report (MMWR)
    210

    CDC Grand Rounds: Prescription Drug Overdoses — a U.S. Epidemic

    Weekly
    January 13, 2012 / 61(01);10-13


    This is another in a series of occasional MMWR reports titled CDC Grand Rounds. These reports are based on grand rounds presentations at CDC on high-profile issues in public health science, practice, and policy. Information about CDC Grand Rounds is available at http://www.cdc.gov/about/grand-rounds.

    In 2007, approximately 27,000 unintentional drug overdose deaths occurred in the United States, one death every 19 minutes. Prescription drug abuse is the fastest growing drug problem in the United States. The increase in unintentional drug overdose death rates in recent years (Figure 1) has been driven by increased use of a class of prescription drugs called opioid analgesics (1). Since 2003, more overdose deaths have involved opioid analgesics than heroin and cocaine combined (Figure 2) (1). In addition, for every unintentional overdose death related to an opioid analgesic, nine persons are admitted for substance abuse treatment (2), 35 visit emergency departments (3), 161 report drug abuse or dependence, and 461 report nonmedical uses of opioid analgesics (4). Implementing strategies that target those persons at greatest risk will require strong coordination and collaboration at the federal, state, local, and tribal levels, as well as engagement of parents, youth influencers, health-care professionals, and policy-makers.

    Overall, rates of opioid analgesic misuse and overdose death are highest among men, persons aged 20–64 years, non-Hispanic whites, and poor and rural populations. Persons who have mental illness are overrepresented among both those who are prescribed opioids and those who overdose on them. Further defining populations at greater risk is critical for development and implementation of effective interventions. The two main populations in the United States at risk for prescription drug overdose are the approximately 9 million persons who report long-term medical use of opioids (5), and the roughly 5 million persons who report nonmedical use (i.e., use without a prescription or medical need), in the past month (4). In an attempt to treat patient pain better, practitioners have greatly increased their rate of opioid prescribing over the past decade. Drug distribution through the pharmaceutical supply chain was the equivalent of 96 mg of morphine per person in 1997 and approximately 700 mg per person in 2007, an increase of >600% (6). That 700 mg of morphine per person is enough for everyone in the United States to take a typical 5 mg dose of Vicodin (hydrocodone and acetaminophen) every 4 hours for 3 weeks. Persons who abuse opioids have learned to exploit this new practitioner sensitivity to patient pain, and clinicians struggle to treat patients without overprescribing these drugs.

    Among patients who are prescribed opioids, an estimated 80% are prescribed low doses (<100 mg morphine equivalent dose per day) by a single practitioner (7,8), and these patients account for an estimated 20% of all prescription drug overdoses (Figure 3). Another 10% of patients are prescribed high doses (≥100 mg morphine equivalent dose per day) of opioids by single prescribers and account for an estimated 40% of prescription opioid overdoses (9,10). The remaining 10% of patients are of greatest concern. These are patients who seek care from multiple doctors and are prescribed high daily doses, and account for another 40% of opioid overdoses (11). Persons in this third group not only are at high risk for overdose themselves but are likely diverting or providing drugs to others who are using them without prescriptions. In fact, 76% of nonmedical users report getting drugs that had been prescribed to someone else, and only 20% report that they acquired the drug from their own doctor (4). Furthermore, among persons who died of opioid overdoses, a significant proportion did not have a prescription in their records for the opioid that killed them; in West Virginia, Utah, and Ohio, 25%–66% of those who died of pharmaceutical overdoses used opioids originally prescribed to someone else (11–13). These data suggest that prevention of opioid overdose deaths should focus on strategies that target 1) high-dosage medical users and 2) persons who seek care from multiple doctors, receive high doses, and likely are involved in drug diversion.

    Prevention Strategies

    Some promising strategies exist for addressing these two high-risk groups. The first is use of prescription data combined with insurance restrictions to prevent "doctor shopping" and reduce inappropriate use of opioids. Users of multiple providers for the same drug, people routinely obtaining early refills, and persons engaged in other inappropriate behaviors can be tracked with state prescription drug monitoring programs or insurance claim information. Public and private insurers can limit the reimbursement of claims for opioid prescriptions to a designated doctor and a designated pharmacy. This action is especially important for public insurers because Medicaid recipients and other low-income populations are at high risk for prescription drug overdose. Insurers also can identify inappropriate use of certain opioids for certain diagnoses (e.g., the use of extended-release or long-acting opioids like transdermal fentanyl or methadone for short-term pain).

    A second strategy is improving legislation and enforcement of existing laws. Most states now have laws against doctor shopping, but they are not enforced uniformly. In contrast, only a few states have laws regulating for-profit clinics that distribute controlled prescription drugs with minimal medical evaluation. Laws against such "pill mills" as well as laws that require physical examinations before prescribing might help reduce the diversion of these drugs for nonmedical use. In addition, a variety of other state controls on prescription fraud are being employed. For example, according to the National Alliance for Model State Drug Laws, 15 states required or permitted pharmacists to request identification from persons obtaining controlled substances as of March 2009.*

    A third strategy is to improve medical practice in prescribing opioids. Care for patients with complex chronic pain problems is challenging, and many prescribers receive little education on this topic. As a result, prescribers too often start patients on opioids and expect unreasonable benefits from the treatment. In a prospective, population-based study of injured workers with compensable low back pain, 38% of the workers received an opioid early in their care, most at the first doctor visit (14). Among the 6% who went on to receive opioids for chronic pain for 1 year, most did not report clinically meaningful improvement in pain and function, even though their opioid dose rose significantly over the year.

    Evidence-based guidelines can educate prescribers regarding the under-appreciated risks and frequently exaggerated benefits of high-dose opioid therapy. Such guidelines especially are needed for emergency departments because persons at greater risk for overdose frequently visit emergency departments seeking drugs. Guidelines will be more effective if health system or payer reviews hold prescribers accountable for their behaviors.

    A public health approach to the problem of prescription drug overdose also should include secondary and tertiary prevention measures to improve emergency and long-term treatment. Overdose "harm reduction" programs emphasize broader distribution (to nonmedical users) of an opioid antidote, naloxone, that can be used in an emergency by anyone witnessing an overdose. Efforts also are under way to increase the ability of professionals responding to emergencies to administer optimum treatment for overdoses. Substance abuse treatment programs also reduce the risk for overdose death (15). Continued efforts are needed to remove barriers to shifting such programs from methadone clinics to office-based care using buprenorphine. Office-based care can be less stigmatizing and more accessible to all patients, especially those residing in rural areas.

    Washington is an example of a state that has moved aggressively to improve medical practice in opioid prescribing by developing interagency opioid-dosing guidelines.† The guidelines emphasize a dosing "yellow flag" at 120 mg/day morphine equivalent dose for new patients with chronic pain. The guidelines were introduced in April 2007 as a web-based tool, including 2 hours of free continuing medical education and specific "best practice" guidance, use of a patient-prescriber agreement, and judicious use of random urine drug screening. Eighteen months after introduction of the guidelines, a survey was conducted of primary-care physicians to assess overall concerns and acceptance of dosing guidance and to identify gaps in knowledge that might be addressed by new guideline tools. A majority of prescribers surveyed were not using all the best practices, likely because they did not have brief, usable tools. For example, only 38% were using random urine screens often or always, and 69% never or almost never tracked physical function. As a result, brief, open source tools such as patient questionnaires were added for ease of incorporation into routine practice. Additionally, Washington has focused on improving practitioner access to pain specialists. Specific methods are under development to offer "pain proficiency" training to primary-care prescribers, who can then become mentors/consultants to their colleagues, particularly in rural areas. In addition, the University of Washington has made twice-weekly pain consultations with a panel of specialists available. In March 2010, the Washington state legislature passed legislation that repealed permissive prescribing rules for opioids and instituted new rules largely reflective of the dosing guidance and other best practices emphasized in the guidelines.

    The National Response

    At the national level, the White House Office of National Drug Control Policy establishes policies, priorities, and objectives for the nation's drug control program to reduce illicit drug use, manufacturing, and trafficking; drug-related crime and violence; and drug-related health consequences. In May 2010, President Obama released the National Drug Control Strategy, which outlined the Administration's science-based public health approach to drug policy. In 2011, the strategy was expanded to place special focus on certain populations, such as service members and their families, college students, women and children, and persons in the criminal justice system.

    When developing a national approach to address prescription drug overdose, any policy must balance the desire to minimize abuse with the need to ensure legitimate access to these medications, and its implementation must bring together a variety of federal, state, local, and tribal groups. The Administration's plan for addressing prescription drug abuse, Epidemic: Responding to America's Prescription Drug Abuse Crisis, which was released in April 2011, includes four components: education, tracking and monitoring, proper medication disposal, and enforcement.

    The majority of health-care providers receive minimal education regarding addiction and might be at risk for prescribing an addictive medication without fully appreciating the potential risks. Therefore, the first component of the plan calls for mandatory prescriber education. This would require prescribers to be trained on appropriate prescribing of opioids before obtaining their controlled substance registration from the Drug Enforcement Administration (DEA). Parents and patients also must be educated about the dangers and prevalence of prescription drug abuse and how to use prescription drugs safely. To achieve this, the plan calls for a public/private partnership to develop an educational campaign directed at parents and patients.

    The second component of the plan calls for prescription drug monitoring programs to be operational in all states and mechanisms to be in place for data sharing. As of May 2011, 35 states had operational monitoring programs, and 13 additional states had passed enacting legislation.

    The third component, proper medication disposal, is essential because the public lacks a safe, convenient, and environmentally responsible way to dispose of medications that are no longer needed. DEA is drafting rules to provide easier access to drug disposal. In support of medication disposal efforts, DEA held National Prescription Drug Take-Back Events in 2010 and 2011. During the first two such events, approximately 309 tons of drugs were collected at over 5,000 sites across the country.**

    The fourth component calls on law enforcement agencies to help decrease prescription drug diversion and abuse. The majority of prescribers are responsible, but unscrupulous persons continue to operate outside of legitimate medical practice. These persons must be held accountable, and the plan outlines specific actions the federal government can take to help law enforcement agencies effectively address pill mills and doctor shopping.

    Reported by

    Leonard Paulozzi, MD, Grant Baldwin, PhD, Div of Unintentional Injury Prevention, National Center for Injury Prevention and Control, CDC. Gary Franklin, MD, Washington State Agency Medical Directors' Group, Olympia, Washington. R. Gil Kerlikowske, MA, Christopher M. Jones, Pharm D, Office of National Drug Control Policy, Washington, DC. Neelam Ghiya, MPH, Tanja Popovic, MD, PhD, Office of the Director, CDC. Corresponding contributor: Leonard Paulozzi, lbp4@cdc.gov.

    References
    1. CDC. Policy impact: prescription painkiller overdoses. Atlanta, GA: US Department of Health and Human Services, CDC; 2011. Available at http://www.cdc.gov/homeandrecreation...ief/index.html. Accessed January 9, 2012.
    2. Substance Abuse and Mental Health Services Administration, Office of Applied Studies. National admissions to substance abuse treatment services. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2009.
    3. Substance Abuse and Mental Health Services Administration. The DAWN report: highlights of the 2009 Drug Abuse Warning Network (DAWN) findings on drug-related emergency department visits. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2010. Available at http://www.samhsa.gov/data/2k10/dawn...highlights.htm. Accessed January 9, 2012.
    4. Substance Abuse and Mental Health Services Administration. Results from the 2009 National Survey on Drug Use and Health: volume 1: summary of national findings. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2010.
    5. Boudreau D, Von Korff M, Rutter CM, et al. Trends in long-term opioid therapy for chronic non-cancer pain. Pharmacoepidemiol Drug Saf 2009;18:1166–75.
    6. US Department of Justice, Drug Enforcement Administration. Automation of Reports and Consolidated Orders System (ARCOS). Available at http://www.deadiversion.usdoj.gov/arcos/index.html. Accessed January 9, 2012.
    7. Edlund MJ, Martin BC, Fan MY, Braden JB, Devries A, Sullivan MD. An analysis of heavy utilizers of opioids for chronic noncancer pain in the TROUP Study. J Pain Symptom Manage 2010;40:279–89.
    8. Katz N, Panas L, Kim M, et al., Usefulness of prescription monitoring programs for surveillance—analysis of Schedule II opioid prescription data in Massachusetts, 1996–2006. Pharmacoepidemiol Drug Safety 2010;19:115–23.
    9. Dunn KM, Saunders KW, Rutter CM, et al. Opioid prescriptions for chronic pain and overdose. Ann Intern Med 2010;152:85–92.
    10. Bohnert AS, Valenstein M, Bair MJ, et al. Association between opioid prescribing patterns and opioid overdose-related deaths. JAMA 2011;305:1315–21.
    11. Hall AJ, Logan JE, Toblin RL, et al. Patterns of abuse among unintentional pharmaceutical overdose fatalities. JAMA 2008;300:2613–20.
    12. Ohio Department of Health. Ohio drug poisoning fact sheet: epidemic of prescription drug overdoses in Ohio. Available at http://www.healthyohioprogram.org/di.../drugdata.aspx. Accessed January 9, 2012.
    13. Lanier WA. Prescription opioid overdose deaths—Utah, 2008–2009. Presented at the 59th Annual Epidemic Intelligence Service Conference. Atlanta, GA, April 19–23, 2010.
    14. Franklin GM, Rahman EA, Turner JA, Daniell WE, Fulton-Kehoe D. Opioid use for chronic low back pain: a prospective, population-based study among injured workers in Washington State, 2002–2005. Clin J Pain 2009;25:743–51.
    15. Yoast R, Williams MA, Deitchman SD, Champion HC. Report of the Council on Scientific Affairs: methadone maintenance and needle-exchange programs to reduce the medical and public health consequences of drug abuse. J Addict Dis 2001;20:15–40.



    * Additional information available at http://www.namsdl.org/presdrug.htm.

    † Additional information available at http://www.agencymeddirectors.wa.gov.

    Additional information available at http://www.whitehouse.gov/ondcp/2011...ntrol-strategy.

    Additional information available at http://www.whitehouse.gov/sites/defa...abuse_plan.pdf .

    ** Additional information available at http://www.deadiversion.usdoj.gov/dr...ack/index.html.

  2. #152
    old school DFrank's Avatar
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    Default Re: ATTN: Pill Poppers

    You're out of your element.
    FYF 08/23-08/24
    Chvrches 09/19
    Banks 10/16
    Digitalism 11/08

  3. #153
    ankle biter guedita's Avatar
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    Default Re: ATTN: Pill Poppers

    Live and let pop.

    9/12: Shifted @ Mercer
    9/24 - 28: Decibel Festival
    10/3-5: Hardly Strictly Bluegrass Festival
    10/4: Ought @ BoH
    10/5: The War on Drugs, Cass McCombs @ The Fillmore
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  4. #154
    Rover canexplain's Avatar
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    Default Re: ATTN: Pill Poppers

    Quote Originally Posted by guedita View Post
    Live and let pop.
    Love ya gal. Live and let live .. cr****
    Have Another Hit Of Colorado Sunshine

  5. #155
    Dark Lord mountmccabe's Avatar
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    Default Re: ATTN: Pill Poppers

    Quote Originally Posted by HotHamWater View Post
    I can't prove this because they injected me before I had time to object, but I really believe I could have gone through the root canal without any anesthetic.
    That's intense. They could not give me enough Novocaine that it didn't hurt and eventually I stopped saying how much it hurt so they would just finish.


    Quote Originally Posted by HotHamWater View Post
    No joke, I don't like the feeling of being on any medication/drug. Not anymore, at least.
    This suggests a very different story and one that is entirely respectable.
    Quote Originally Posted by SoulDischarge View Post
    See how wrong you are, Tommy? Randy is agreeing with you.

  6. #156
    Endearingly Dislikable RotationSlimWang's Avatar
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    Default Re: ATTN: Pill Poppers

    So Tommy had a little problem and now he's being a cunt about it. This is why I don't get clean.
    Quote Originally Posted by amyzzz View Post
    Hannah, I don't know that pigs have big weiners, and my early 20's facination with dogs because of weiner size, I think. If that helps.

  7. #157
    Coachella Junkie getbetter's Avatar
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    Default Re: ATTN: Pill Poppers

    I personally hate taking pills.Its such a boreding way to do drugs.Now hot rails thats fun.
    Translation

    Quote Originally Posted by WhyTheLongFace View Post
    Still pretty serious about this.

    Hardly Strictly Bluegrass Festival 10/03 - 10/05/14
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    Last.fm





  8. #158
    old school HotHamWater's Avatar
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    Default Re: ATTN: Pill Poppers

    Quote Originally Posted by getbetter View Post
    I personally hate taking pills.Its such a boreding way to do drugs.Now hot rails thats fun.
    This post has convinced me that "hot rails" is much more dangerous than taking pills.

  9. #159

    Default Re: ATTN: Pill Poppers

    Real bros do follies.

  10. #160
    Coachella Junkie getbetter's Avatar
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    Default Re: ATTN: Pill Poppers

    Hot rails are almost fda approved, i do not know why you would think that.
    Translation

    Quote Originally Posted by WhyTheLongFace View Post
    Still pretty serious about this.

    Hardly Strictly Bluegrass Festival 10/03 - 10/05/14
    Decibel Festival @ Seattle 09/24 - 09/28/14
    War on Drugs @ Fillmore 10/05/14
    Treasure Island @ Treasure Island 10/18 & 10/19/14
    Moodymann @ PW 10/25/14
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    Last.fm





  11. #161
    old school HotHamWater's Avatar
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    Default Re: ATTN: Pill Poppers

    I don't know why I would think that, either, Zack.

  12. #162
    Coachella Junkie GuyInTucson's Avatar
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    Default Re: ATTN: Pill Poppers

    10/8 - Little Dragon @ Marquee (Tempe, AZ)
    10/11 - Carolina Chocolate Drops @ Rialto Theater (Tucson, AZ)
    11/10 - The Black Keys @ US Airways Center (Phoenix, AZ)
    4/10/15 - 4/12/15 - Coachella

  13. #163
    Coachella Junkie getbetter's Avatar
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    Default Re: ATTN: Pill Poppers

    My Momma would say "Zack your acting like her pussy lace in gold", but woah!


    Someone finally found a pussy lace in gold.
    Last edited by getbetter; 10-30-2012 at 08:24 PM.
    Translation

    Quote Originally Posted by WhyTheLongFace View Post
    Still pretty serious about this.

    Hardly Strictly Bluegrass Festival 10/03 - 10/05/14
    Decibel Festival @ Seattle 09/24 - 09/28/14
    War on Drugs @ Fillmore 10/05/14
    Treasure Island @ Treasure Island 10/18 & 10/19/14
    Moodymann @ PW 10/25/14
    Death From Above 1979 @ The Independent 11/17/14


    Last.fm





  14. #164
    No Clownery full on idle's Avatar
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    Default Re: ATTN: Pill Poppers

    I heard, that when your liver stops functioning fully bc of abuse, painkillers make you so nauseous and sick throughout that they aren't even fun anymore.

  15. #165
    ankle biter guedita's Avatar
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    Default Re: ATTN: Pill Poppers

    The liver is the bonafide buzzkill organ.

    9/12: Shifted @ Mercer
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  16. #166
    Coachella Junkie malcolmjamalawesome's Avatar
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    Default Re: ATTN: Pill Poppers

    Quote Originally Posted by getbetter View Post
    My Momma would say "Zack your acting like her pussy lace in gold", but woah!


    Someone finally found a pussy lace in gold.
    Success.
    Quote Originally Posted by ruetheday View Post
    I don't fucking care. I don't even know who the hell Dave Wang is.
    Quote Originally Posted by Devin the Dude View Post
    you used to be that guy that just Dave Wang's everybody. that guy. he's gone now, and whoever you really are showed up, and that was utter disappointment.

  17. #167
    ankle biter guedita's Avatar
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    Default Re: ATTN: Pill Poppers

    So far tonight I've, quite easily, gotten 2 different old people who have had back surgery to tell me that they'll go refill their scripts and give me the bottle.

    *HAIRFLIP*

    HI TOMMY

    9/12: Shifted @ Mercer
    9/24 - 28: Decibel Festival
    10/3-5: Hardly Strictly Bluegrass Festival
    10/4: Ought @ BoH
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  18. #168
    old school HotHamWater's Avatar
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    Default Re: ATTN: Pill Poppers

    Old people do tend to sacrifice their morals when they get a little attention from anybody. Good job on taking from easy prey, Cara.

  19. #169

    Default Re: ATTN: Pill Poppers

    So you're saying that you live completely sober? So no alcohol, tobacco, or caffeine?
    You must be a mormon, which means you more than likely do not attend the Coachella Music and Arts Festival.
    Please leave the boards...

  20. #170
    Coachella Junkie stinkbutt's Avatar
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    Default Re: ATTN: Pill Poppers

    Go on
    Quote Originally Posted by roboto View Post
    And stinkbutt leaving a motorhead set when you know he's dying just to talk shit ? Your a shitty person as well .please let mja give you an anal love disease .

  21. #171
    ankle biter guedita's Avatar
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    Default Re: ATTN: Pill Poppers

    Pretty sure Tommy spends plenty a night huffing paint in his parent's basement, Meryl. Don't worry.

    9/12: Shifted @ Mercer
    9/24 - 28: Decibel Festival
    10/3-5: Hardly Strictly Bluegrass Festival
    10/4: Ought @ BoH
    10/5: The War on Drugs, Cass McCombs @ The Fillmore
    10/18-19: Treasure Island Music Festival

  22. #172
    Coachella Junkie nathanfairchild's Avatar
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    Default Re: ATTN: Pill Poppers

    Quality bump Merylvingian.
    September 20 - Skeletonwitch
    September 21 - Nails
    September 23 - The Zombies / Andy Stott
    October 2 - Beck
    October 3-5 - Austin City Limits
    October 10 - Bonobo
    October 20 - Mastodon
    October 23 - 26 - Housecore Horror Festival
    October 29 - The Melvins
    November 7-9 - Fun Fun Fun Fest
    November 18 - Slayer

  23. #173
    ankle biter guedita's Avatar
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    Default Re: ATTN: Pill Poppers

    Her first post was lauding praise upon Skrillex, so, yeah, she's good people.

    9/12: Shifted @ Mercer
    9/24 - 28: Decibel Festival
    10/3-5: Hardly Strictly Bluegrass Festival
    10/4: Ought @ BoH
    10/5: The War on Drugs, Cass McCombs @ The Fillmore
    10/18-19: Treasure Island Music Festival

  24. #174
    MENACING Courtney's Avatar
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    Default Re: ATTN: Pill Poppers

    A+ thread would read again.

  25. #175
    Pedley Rocks JustSteve's Avatar
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    Default Re: ATTN: Pill Poppers

    F-. I coulda used those pills.

  26. #176
    MENACING Courtney's Avatar
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    Default Re: ATTN: Pill Poppers

    This thread is half a year old at this point, but the key here for me is that generally, doctors know shit that I don't. Most doctors I see have gone to school for years and practiced on thousands of patients before they ever get their hands on me. If they write me a script, 99.9% of the time it's probably because it's in the best interest of my health to take the medication. So, although sometimes it can be difficult to resist the urge, I really try not to be a backseat driver about some issue I read something about on the internet once, and I FUCKING TAKE THE PILLS.

  27. #177
    The Encyclopedia bmack86's Avatar
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    Default Re: ATTN: Pill Poppers

    I do something similar, in that I know they have my best interests in mind when writing a prescription, so I sell it for top dollar to the local high school kids and then use the money for more ice cream and comedy DVDs, because ice cream and laughter are the real best medicines.
    Quote Originally Posted by canexplain View Post
    Remember Hitler? I don't but here we are again .. cr****

  28. #178
    MENACING Courtney's Avatar
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    Default Re: ATTN: Pill Poppers

    Also to be fair, anesthetizing high school kids who have to wade through the ridiculousness that is our high school education system is probably some valid form of charity.

  29. #179
    The Encyclopedia bmack86's Avatar
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    Default Re: ATTN: Pill Poppers

    Well, to be less fair, I mostly give them antibiotics, so I'm just helping to breed super bugs. But maybe they'll name a new, extremely vicious strain of syphilis after me!
    Quote Originally Posted by canexplain View Post
    Remember Hitler? I don't but here we are again .. cr****

  30. #180
    Coachella Junkie SoulDischarge's Avatar
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    Default Re: ATTN: Pill Poppers

    Don't raw dog that ho, she got THE MACK.
    Quote Originally Posted by guedita View Post
    Thanks for giving us the opportunity to not give a fuck again.

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