23 ms·

Painkillers now kill more Americans than any illegal drug

415 points by davidbarker 11y ago

mc32 11y ago
So painkillers used against prescription kill more people than any individual illegal drug and since people demand painkillers to treat chronic pain physicians are looking to treat chronic pain with alternatives one such is using MJ as one of those alternatives because misuse doesn't result in fatal overdoses, generally. Vox, stop with the hyperbola.
- rhema 11y ago
  There's not much content in this article. However, if people tend to use a drug beyond its prescription, with very bad results, that's still a reason to change things. I mean, ipads do not have a big red button with "rm -r /" listed. I don't see why the drug industry should be exempt from designing constraints that prevent user error.
  - brillenfux 11y ago
    I don't think there's much you can do here. There will always be those people who nod their doctor off and then go on and do what they want.
  - merpnderp 11y ago
    You can't even imagine the pain and suffering the constraints currently in place cause legitimate users of pain killers. Doctors are so scared of the DEA they're doing crazy things. Someone very close to me had a ruptured disc, killing the nerves in her spine, so much that just standing would cause pain that made her black out or vomit. And even though she'd never been prescribed anything for pain, she had to hover over a urinal crying uncontrollably, to take a drug test to make sure she wasn't an addict. If the line is between people suffering horrendous incomprehensible pain and people making a choice to abuse drugs. Well I'm pushing that line right up against the people who get the luxury of making a choice.
    - digler999 11y ago
      I dont know the details of her situation, but I think chronic pain management goes something like this: * patient such as your friend has excruciating pain, requiring the heaviest of the narcotics (say oxycodone/oxymorphone, instead of a "mere" hydrocodone that you'd get for wisdom teeth or something ). * these narcotics are so incredibly dangerous that they must be taken exactly as prescribed for the following reasons. 1) Patients have a temptation to take an extra one (or snort one) to achieve a euphoric and addicting "high" that can be irresistible once its experienced. 2) In some cases taking even one or two extra pills can kill the patient. 3) Patients have incentive to Not take them because some pills can fetch up to $40 EACH on the black market. 4) not taking them exactly as planned can cause a tolerance buildup or reduction, which can stymie the physician's efforts to find the safest minimal and effective dose for continuous pain management. * To combat all 4 of these factors, pain management specialists enter into "contracts" with their patients that they will treat their pain, if and only if, they agree to take the pills EXACTLY according to plan. To affirm compliance to this plan, the patients are subjected to random drug testing. Not just to see if they are getting high (over using them ), but also to see if they are using them at all, (i.e. not selling the pills for a massive profit ). IIRC, if you show up to your test and they find no painkillers in your urine, you can be taken OFF the plan, i.e. no pills for you. tl;dr they drug test patients to make sure a precise plan is being followed because there are at least 4 separate "failure modes" to chronic pain management. I learned most of this from news articles and reading junkie's tales on /r/opiates. I'm not an expert, nor user, but I just find the whole topic very interesting. Please correct me if I've said anything wrong.
      - merpnderp 11y ago
        The person I was referring to was so traumatized by the experience she went to a surgeon two days later and begged for the surgery, even though she was strongly advised to give the pain pills and anti-inflammatories time to work. The surgeon scheduled her 12 hours later and she's been better than new for several years now....Luckily. People have agency. And should be allowed to make their choices. Especially in cases where not allowing them to make their own choice starts hurting innocent people. And by hurting, I mean that very very literally in this case. The type of pain that causes people to end their lives. Caused by a system more afraid of a bad decision than of leaving people alternating between howling and sobbing in pain for days.
- seiji 11y ago
  holy run on sentence batman I posted this yesterday if it helps: https://matt.sh/heroin https://matt.sh/heroin
- haroldp 11y ago
  19,000+ dead people a year is a astounding fact, not hyperbole. If I were being hyperbolic, I'd call that "Over Six 9/11s per year".
  - mikeash 11y ago
    That wouldn't even be hyperbole, that's still just factual, with an emotionally loaded comparison. Hyperbole would be like, "painkillers kill a trillion people a year!"
  - mc32 11y ago
    It affects a lot of people yes. It's also a big problem. It's the juxta that's done in a fashion to get clicks. The article is also rather light on details. The juxta bothers me because Rx drugs are a necessity as judged by physicians, it's not a lark. Illegal drugs on the other hand are not prescribed, for the most part, and are a different issue altogether. They address perhaps other pains, but conflating them in this sense seems dishonest.
    - chillwaves 11y ago
      It seems you are not catching the point of the article. Did you read? The problem is addiction and people turning to illegal drugs after becoming addicted to legal RX.
- Igglyboo 11y ago
  Opiate pain relief is orders of magnitude better than marijuana.
  - delecti 11y ago
    It's more orders of magnitude more dangerous and addictive (in that marijuana is almost impossible to OD on, and isn't addictive at all). Marijuana is certainly not the magical silver bullet some make it out to be, but it's incredibly effective for many people whose only other recourse would be opiates.
    - cik2e 11y ago
      Kratom is a great and currently legal alternative. It works on opioid receptors and cannot be fatally overdosed. Unfortunately, many sates are already moving on banning it. Big pharma lobby for the win.
      - fapjacks 11y ago
        Stock up while you can. However some states have unbanned it, and others yet are not voting their bans into legislation. There's hope yet, but it will be a hard fight, particularly with the FDA.
      - Igglyboo 11y ago
        Kratom still comes with risks of withdrawal. Pure leaf kratom would be difficult to OD on, but extracts and tinctures could easily be overdosed on.
        fapjacks 11y ago
        What are you talking about? Link to any case of death that has been attributed exclusively to an overdose of kratom. You can't, because it doesn't exist.
    - corin_ 11y ago
      FYI, cannabis certainly can be addictive, just without serious physical dependance. And even on the mentally addictive side, obviously far less than opiates - but certainly there are people who fit the definition of being addicted to weed.
- k-mcgrady 11y ago
  >> "people demand painkillers" I might be completely wrong here so please correct me if I am. Why would a doctor care what a patient demands? Tell them no. There's nothing they can do about it. I can't demand any prescription drugs from my doctor (I'm in the UK) - and I've tried once. Do doctors in the US worry about losing money if they lose a patient or this that not the case? Edit: Thanks to those who responded. Although I suspected it it still blows my mind that people don't see how and of an idea that is.
  - bronson 11y ago
    Yep! Prescribing drugs can be very lucrative. http://latimesblogs.latimes.com/lanow/2012/03/doctor-murder-charges-painkillers-prescription-deaths.html http://latimesblogs.latimes.com/lanow/2012/03/doctor-murder-... She made $5 million in 3 years. There are offices like this all over the US.
  - facetube 11y ago
    When you inexplicably decide that health care is a "marketplace" of rational and informed actors, patients become customers that need to be pleased, and lost patients become lost revenue. We are in a world of hurt over here, please send help.
  - brandonmenc 11y ago
    > Why would a doctor care what a patient demands? Because pain diagnosis is self-report. "I'm in pain and I know this drug works, please give it to me" is not an unreasonable request.
- 0xffff2 11y ago
  I don't see what conic sections have to do with this...
- mikemackle 11y ago
  Unfortunately, there are almost no effective treatments for chronic pain available other than opiod painkillers and there is significant vested interest in the pharmaceutical industry to keep it this way. Whenever I see an article like this, it is frustrating as there is an alternative to opiods for chronic pain management that is just as effective, carries no risk of overdosing, minimizes the the chance for dependence (and in fact is often used by those looking to break opiod dependence) and at scale, could be available for fractions of a penny. As a bonus, it can also serves as an actual replacement to ADD and antidepressant medications as well as serving as an effective tool against other types of addiction (e.g. alchoholism) and has 100s of years of "clinical trials" in the real world to support its safety. http://www.scientificamerican.com/article/should-kratom-be-legal/ http://www.scientificamerican.com/article/should-kratom-be-l... Unfortunately, the powers that be have no interest in changing the status quo particularly when it would undercut patented money making drugs currently available, so very little research is conducted into this area and those who wish to do so are often actively thwarted to the point one has to conclude that there is not actually a real desire to address this problem.
cpfohl 11y ago
Knowing what I know about opioid painkillers, I don't think I'd ever accept a script for them. I'd accept them in the hospital, but never in a bottle that goes home with me...
- bryanlarsen 11y ago
  Knowing what I know about pain and how well that opiod painkillers combat that pain, and knowing that what I've experienced isn't anywhere close to what some people have experienced, I'd absolutely accept a script for opiod painkillers if I needed one.
  - maxerickson 11y ago
    Having had several short term prescriptions for opioids in the past, it certainly makes sense to me to be quite thoughtful about whether they are necessary. But that's still quite a ways from absolute refusal to consider using them.
- Igglyboo 11y ago
  No one ever got hooked with the bottle of Tylenol 3 they send you home with after you get your wisdom teeth out. But when it's oxy or hydromorphone I'd agree, also I don't even want to think about having morphine or fentanyl patches in my possession.
  - jontas 11y ago
    That is absolutely untrue.
  - evincarofautumn 11y ago
    Still, when I had my wisdom teeth out at 17, I threw away the painkillers. I knew that they would be problematic for me, so I decided to not even go there.
josefresco 11y ago
Relevant: http://www.pbs.org/wgbh/frontline/film/chasing-heroin/ http://www.pbs.org/wgbh/frontline/film/chasing-heroin/
swillis16 11y ago
All it takes is one or two extra pills to get high from the standard opioid pain prescription. It would've been nice to see this mentioned in the article but it seems pretty light on content.
- mapt 11y ago
  All it takes is the standard opioid pain prescription. That's getting high. Opioids get you high. That's what's necessary for pain relief: Altered neurological states in which pain coming in from the nervous system doesn't have such a strong effect on the conscious mind. It's that simple. Deal with it. Drugs have effects. Usage doesn't cross some threshold dose and instantly become abuse.
  - encoderer 11y ago
    Oh, I disagree. There is most certainly a difference between therapeutic use for pain reduction, and the euphoric response normally associated with an opiate high. Most people using opiates on-label are not getting high from them. Even if they do the first couple times they take them, that passes.
    - daodedickinson 11y ago
      I definitely got stratospheric on my prescribed dose of one single Ambien pill (couldn't recognize myself in a mirror, saw kaleidoscopic visions, 2d videos became 3d portals into other dimensions). Absolutely some people could get high on one opiate pill. I understand your skepticism, but I'd like to assure you there is tremendous metabolic diversity.
      - encoderer 11y ago
        I didn't say anything about one pill not being enough to get you high. Also, that's not even the question I addressed. The GP said "That's what's necessary for pain relief." -- which is an overstatement.
    - 11y ago
julie1 11y ago
Prescribing opium ... a trend that have not been seen in the world since victorian era in the UK. Opium having the reputation to make people amorph losing their will to rebel. The new trend is opioid are now cheap and not prescribed to the rich but the poor. Religion used to the opium of the people they said, and now that opium is cheap, religion is not needed anymore to make people servile. I love this new era of progress. Tomorrow we make an application to help parents poor sell their kids body part on the internet for the cure of richer people? I mean, let's try to make even more dystopic. We can do better. That is what progress is. Making system more efficient.
user_0001 11y ago
What are the rates like compared to other countries? Does the US just over prescribe painkillers, meaning more flood to the blackmarket? Is it people are getting it from the Dr and accidentally ODing? Are the Drs prescribing without care, so those who want the drug for a high and no medical reason can? I never knew painkillers to be used as party drug / fun drug in the UK (outside of the heroin using demographic) nor ever heard of some one ODing on prescribed painkillers. Seems strange it is such a big issue in the US
- teslabox 11y ago
  Some of the prescription opioids are contaminated with Tylenol, which is very toxic to the liver when consumed in excess.
  - toufka 11y ago
    They incorporate tylenol to help prevent addiction and overdose. Too much tylenol makes you sick - very unpleasantly. Too much opiods and you feel great, until you die. The tylenol is designed to provide an edge to taking too much so that the curve correlatibg dose to pleasure doesn't always angle upwards. Being very sick, and even having liver problems is generally better than death.
    - dionidium 11y ago
      Being very sick, and even having liver problems is generally better than death. I would submit to you that deliberate contamination of a drug for the sole purpose of inflicting harm in search of a greater good is an outrageous policy.
      - neverknowsbest 11y ago
        Agreed. An opiate OD can be reversed if caught in time. NSAID ODs box your liver.
      - onetwotree 11y ago
        I completely agree. Former and current opiate addicts I've met have told me that when contaminated pills are all you've got to stave off withdrawal, the risk from Tylenol poisoning doesn't really even cross your mind. Adding risk (whether it's the risk of liver failure or prison time) to addiction behaviors doesn't do a damn thing, because addiction is a disease that fundamentally destroys our ability to make rational cost-benefit decisions when our drug or behavior of choice is concerned.
krschultz 11y ago
I've never taken an illegal drug in my life. I've smoked a cigarette about 5 times. I drank in college but lately I've cut that out of my life as well. I had a security clearance with drug testing requirements for a while and now I just don't like the feeling of a hangover from alcohol or the risk of ingesting random plants/chemicals made by shady people. In short: I'm the most vanilla, square, anti-drug person you can find. I don't want to use them, and I think other people would be better off if they reduced their usage as well. Yet I can not for the life of me understand why drugs are illegal. Not just pot, all drugs. I'm totally onboard with making it our public policy that we want to reduce the use of drugs. That makes perfect sense to me. It does not make sense to me why anyone still believes that using the criminal justice system as the mechanism for getting to that goal is the right path. We are spending insane amounts of money on a failed approach while also generating huge negative side effects by creating an enormous group of people with criminal records. It's probably the worst thing this country has done to our own people since segregation and it seems like all of the policy people understand this. Why can't we get political will to do something different?
- beamatronic 11y ago
  >> insane amounts of money I think you said it yourself - not to be snarky or anything. But someone has found a way to get rich, and they use their funds to lobby to keep the current system in place.
  - unusximmortalis 11y ago
    exactly. for as long as you can pour money into lobbying and thus influence (mild term) laws, those laws governing people, lives, don't expect anything good to happen. of course the current system allows ways to fight against this but those ways are so hard implement compared to the way of lobbying (pour insane amount of money cause you have it and they generate even more money) that has no sense practically. am I skeptical? no. we have everything we deserve. and we will continue to have exactly what we deserve, not a single bit more or less.
  - mathattack 11y ago
    It boggles my mind that it's somehow acceptable for the folks running prisons to be able to lobby for the 3 strikes laws. http://thinkprogress.org/politics/2010/09/16/117661/sb1070-prison-lobby/ http://thinkprogress.org/politics/2010/09/16/117661/sb1070-p...
FussyZeus 11y ago
Is this really surprising? All the benefits of illegal drugs without the risks involving prison time and public disgrace. All you need to do is figure out what things to tell your Doctor to make him think you need one of these things, and you have a legal (and probably insurance funded) supply. Not saying of course that everyone who gets these doesn't need them, I'm sure many do, but we have something like 90% of the worldwide consumption occurring in the States, so something is clearly up.
joveian 11y ago
This seems like a particularly limited article, although a better slant than many. The NY Times just had this (also not wonderful, but with some additional information) article a few days ago: http://www.nytimes.com/2016/03/07/us/heroin-epidemic-increasingly-seeps-into-public-view.html http://www.nytimes.com/2016/03/07/us/heroin-epidemic-increas... While the title mentions heroin, the article at least mentions that deaths are frequently due to more deadly prescription painkillers being mixed in. One thing I wonder that I haven't seen addressed (I'm not sure if there is even data available) is how many overdose deaths are due to use of multiple drugs at the same time (alcohol for example makes many drugs more deadly). Hopefully there will be more and better reporting on the issue. IIRC (and wikipedia agrees at least), these numbers mean that drug overdoes are now killing non-trivially more people in the US than car accidents.
- marincounty 11y ago
  I have a feeling it's going like this; patient goes to doctor and complains of pain. Doctor reluctantly prescribes an opioid. Patient likes the way the opioid makes them feel. Yea, their pain becomes tolerable because they feel better. A lot better than any antidepressant. Right now, a lot of people in the United States are misserable on a lot of levels. It's not just their back pain, or the roaming pain--misery seems to bring. It's the economy. It's finding a place other than a room in your baby boomer's parent's home. It's even finding a shit job--a shit job used to be easy to find. Now--shit jobs are just aweful. Plus, you are competing with very desperate immigrants that happily work for minimum wage, and have no social qualms living like caned Sardines. (I 'm not stereotyping. A lot of immigrants don't see anything weird with a sharing a small room with multiple family members.) In the U.S. it's looked down upon. Especially in the formative years, where you are trying to prove to that perfect person you are a Superman/Superwoman. You are the one. You are the independent winner. You are the one he/she should marry, or just have sex with. It's not your fault you not the big baller. And no it's not just getting the B.S. Degree. It's a whole lot more than that. Back to the person in pain on opioids. The drugs make them feel better. This is what they think they need to function in this world--some Do! Physical pain is Real? The big problem is opioids lose their efficy over time. Doctors don't tell the patient in pain up front about tolerance. Why--because in a lot of medicine, a good doctor wants to induce the placebo effect, along with the effect from the drug, and their not idiots. Some actually want you to feel better. They all don't just don't care about the office visit fee. I think? (While opoids do require more, and more over time in order to get the original effect; there are studies done in Rest Homes, with older subjects where tolerance of opoids did not materialize. The studies are numerious, and many doctors were taught opoids are safe in med school.) In my case, and the people I know opoids are far from being a non-addictive drug, or tolerance resistant. But the drug has been so vilified, and stereotyped who knows. All those addiction t.v. shows, and even well meaning professionals have told us for years, getting off opoids is very hard. I truly wonder just how difficult getting off opioids is--if we weren't conditions into thinking it's the most difficult drug to kick? I know when I'm told something is going to be a bitch to get off of--it's always worse than the times I didn't know how difficult the withdrawal will be. And the greatest junkie (Burrows) once said something like, 'Geting off opoids is not as hard as they say.' Now to the opoid deaths. I don't know about the deaths among very ill patients whom are on patches like fentanal. I know about the guy with the bad back who was given opoids. Then the doctor stopped the refills. That patient went to the black market to get their opoid, usually heroin because it's cheaper. At this point, their lives are usually a complete mess. If they are poor, they usually have a record with the authorities. Every day becomes a nightmare. "I'll few drinks along with the heroin--who cares?" A hit of meth--who cares? A sleeping pill with the opoid--who cares? Who cares? I've given up. I can't function like my parents did. Death from overdose follows. We have a problem. I think there's a short term solution to a drug problem, and an out of touch society. A society that's still living in the 50's in terms of expectations. That short term solution is Buoenorpine. It can help a lot of these people whom are addicted to opioids. Don't require the addict to pay a fortune for this drug. Don't make them pay for expensive office visits. Just give them the drug. If they sell it, or abuse it; they go back to herion. As to people in extreme pain, let Medical doctors treat it. Leave them alone. Let them do their jobs. No government official should be telling them how to alleviate cancer pain, or any physical pain. Hell, they shouldn't have to take a special course in order to prescribe bupenorpine. They shouldn't be limited to 100 patients. Leave MD's alone. Again--leave medial doctors alone. Let them prescribe what they feels works. If the patient abuses the drug--that's not the doctors fault. If you think the average doctor is willy nilly writing prescriptions for opoids--well just see what happens when you see a doctor, and complain about pain. Most likely you will be offered 400 mg's of Ibuprofen. Doctors are very leary of writing a script for any opoid. Good luck getting one. The DEA is breathing down their backs. As a society, the people in real physical pain are being told they can't have opoids. It all seems fine, until you are that person in intense pain in that exam room. So yes we live in a country that expects a lot from its citizens. We are all suspose to be successful. Even the poor are expected to "make it"--whatever that means anymore. At the same time jobs have gone away. We are in this sharing economy. A economy that just seems to serve the wealthy? The glow from opoids is enticing in this judgmental society. Bupenorpine might be a quick answer to a complex problem? A real problem. What do we have to lose at this point? I'm tired of hearing about overdose from opioids. Really tired! A least freely provide naloxone over the counter?
njharman 11y ago
Joining cigs and alcohol, eh?
disposeofnick9 11y ago
I've lost at least two elderly, extended family members this way. Both applied both a patch and took a pill, which caused an OD. The issue is that many opioids and non opioids gap between the therapeutic dose range and LD50% is often dangerously narrow. Complication #0: serum bioavailable molecule assay is rarely monitored. People metabolize and clear drugs at vastly differently rates. Complication #1: Hospital mistakes still happen quite frequently, despite many measures to prevent them, especially with inexperienced and overworked nurses/assistants. Complication #2: cummulative dosing error or interactions, especially multiple, independent prescriptions for similar opioids with different administration routes (patches, sprays, pills, injections) Complication #3: overprescription of opioids because they're cheap, especially to veterans, which also leads to prescription and hard drug addictions. Solution: opiods need to be singularly controlled at home or in the hospital by an integrated, blood/interstitial fluid measuring/dispensing unit to avoid OD and push back on abuse. Plus, anyone taking opioids should also have narcan or equivalent antidote readily available, and wear a medalert QR code bracelet which lists relevant conditions and medications should they be found unresponsive. Finally, avoid painkillers as much as possible and take the least dose which reduces stress level.
- creshal 11y ago
  > overprescription of opioids because they're cheap It's a bit scary how eager doctors are to prescribe them. "Hey doc, I'm in pain" – "Here's a bottle of painkillers, NEXT" Bitch, I don't want painkillers, I want you to figure out why my body is hurting when it's not supposed to. It's surprisingly frustrating to talk doctors into looking for the cause instead of treating the symptom. Thankfully, the metamizole they kept filling me up with is not nearly as addictive as opioids and we have free health care, so I didn't have to pay a dime for the repeated blood analyses and CT it took find the cause. Otherwise I'd probably have bigger problems right now.
  - thaumasiotes 11y ago
    > I don't want painkillers, I want you to figure out why my body is hurting when it's not supposed to. It's surprisingly frustrating to talk doctors into looking for the cause instead of treating the symptom. To be fair, this is related to the symptom you're asking them about. Pain often occurs with no apparent cause. As an extreme example, it is normal for amputees to experience the sensation of a "phantom hand" where their hand would be if it hadn't been amputated. The phantom hand can feel pain. I'm fairly confident that there is nothing physically wrong with the hand someone doesn't have, even if it is in pain.
bobby_9x 11y ago
It makes sense just based on statistics. Americans have more access to pain killers than any illegal drug and just based on this, will result in more mis-use (and death). If illegal drugs were all made legal tomorrow, we would see something similar.
deleted 11y ago
[deleted]
joesmo 11y ago
Send patients home with Narcan and train the people they live with to administer it as well. Have every EMT, firefighter, and police officer in the nation carry and know how to administer Narcan. Have it be part of every single first aid kit sold in this country. Remove the social stigma of drug abuse. Remove penalties for people who help others who are overdosing. You'd think someone would have some common sense in this country but you'd be wrong. It will never get better the way things are going now. It's ridiculous to even have a fucking article like this that doesn't mention the numerous tried and true solutions that exist but are simply not being put into place because the people in power in this country want to see people dying. The problem isn't that we don't have solutions. Solutions are a plenty. The problem is that no one in America cares. No one in this country gives a shit that people are dying. Most people want it to happen. They support the fucking drug war. They want people to die. Until this fucking shit changes, people will continue to die and idiots will continue to wonder what can we do? So many fucking things, I don't even have time to write them all down. That's the fucking sad part.
- jdietrich 11y ago
  The Scottish government started providing naloxone (Narcan) to opiate users on a large scale in 2010. Naloxone and first aid training was offered to users of needle exchange services, prison leavers and other people at risk of opiate overdose. In the first year there were 365 confirmed uses of naloxone, but that is believed to be a significant underestimate of overall use. The evidence is clear - naloxone works. http://www.gov.scot/Resource/0045/00451251.pdf http://www.gov.scot/Resource/0045/00451251.pdf
- merpnderp 11y ago
  If you stripped away all the anger and emotion in your comment, it would still read just as inflammatory. Maybe more so. Because it's absolutely true. Even though addicts are sick and need help, that's not how they are viewed. They're viewed as lazy worthless members of society who can go die in a gutter. Yet the most brilliant colleague I ever worked with had be resuscitated twice from heroin overdoses. A hyper productive individual, capable of incredibly feats of software engineering who yet maintained a great work life balance. And while he was sick, society viewed him as a worthless parasite.
musgrove 11y ago
If 47k deaths per year is an "epidemic" as the author terms it, the 610k that die each year from heart disease must be an all-out pandemic. It never was a war on drugs. Drugs are inert and aren't capable of fighting a war. It's a war on addiction. And good luck winning that on a national scale with "laws."
- jhulla 11y ago
  Spot on. Addiction causes fundamental changes in the brain. Helping addicts is a complex process well beyond fining or imprisoning them. The goal is to reverse the addiction. It doesn't happen by punishing an addict. This is a useful paper: "Imaging the Addicted Human Brain", http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2851068/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2851068/
- 6stringmerc 11y ago
  If you live long enough you eventually die of something, right? Now, if 85% of those heart disease deaths were in the 15-28 year old cohort, that might be something quite stunning. I agree declaring 'war' on addiction is a ridiculous concept, because it's more than likely a statistical constant (with a range) within the human species. A certain amount of people will get addicted, be it drugs, food, or the internet. It's just kinda sorta what we do, and I'd be a big fan if as a society and culture we looked toward methods to save ourselves constructively, rather than use the authority of the state to lock people away, generally speaking.
6stringmerc 11y ago
I have chronic pain due to a heriditary, incurable condition. Right now one of my ankles is in an elastic wrap to ease the irritation from arthritis. In our home, we did have a bottle somewhere of Tylenol 3, aka codeine. Regular acetominophen was usually what I got to help with an issue. As I grew into adulthood, I knew the pains I experienced were directly related to my condition, and it was my desire to not really 'cloak' the pain, but avoid it in the first place. Preventive if you will. It helps, but it's clear to me that I wanted to be healthy, and if I have to occasionally take something, so be it. Naproxen sodium has worked quite well of late. The point of all this rambling is that I simply don't want the hassle of becoming addicted to pain pills. Or sleeping pills. Or nasal spray when it's allergy season. I've lived with pain so long for my life that I'm kind of used to it, and I do say so as a point of pride. It's the body I was born with and it's the one I'll have to use for this gig, take care of it. I don't fault people for wanting pain treatment. I think the way the system was set up with pills flooding the US was incredibly destructive, and highly indicative of the dangers of for-profit medicine as a system. Toss in the DEA's drug laws and it just turns patients into criminals and that benefits only a very limited group. When I eventually started seeing commercials on TV for a treatment for opiod induced constipation all I could think about was Trainspotting and that we have a real, genuine problem on our hands in the US.
tosseraccount 11y ago
Rhetorical question: how many of these deaths also involve alcohol?
- Havoc 11y ago
  >Rhetorical question: how many of these deaths also involve alcohol? For opiods...few. For paracetamol...lots.
nathanvanfleet 11y ago
Just so you know, opioid pain killers are actually not useful for chronic pain at all. Over the long term it actually makes patients sense of pain GO UP. It's excellent for non-chronic pain however.
- MichaelGG 11y ago
  What kind of time range are you talking about here? AFAIK there's no human limit to opiate tolerance - patients can often just take more (over time).
- stordoff 11y ago
  Not the best choice, certainly, but I would question not useful. I suffer from chronic pain (mostly headaches), and opioids (tramadol/codeine) are the only drugs[1] that have given any relief. I've been using them for about two years; they are still useful, and when I stop using them the pain is about the same it was before. Fortunately I don't appear to find them addictive - I stopped taking the tramadol after about a year's usage (my consultant raised similar concerns to you - restarted them about three months later as it had been shown they weren't worsening the headaches) cold turkey (I was told it would be worse than stopping heroin), and suffering absolutely no ill effects or withdrawal. [1] Multiple others have been tried (ibuprofen/diclofenac/amitriptyline/sodium valproate/naproxen/gabapentin and a few others I can't remember), and made no difference to the headaches. The amitriptyline is helping with pain in my hands though.
  - vidarh 11y ago
    Just a suggestion because it is often missed by general practitioners: If you've not tried it already, talk to your dentist. Headaches and migraines are often related to teeth or the jaws. Particularly grinding and clenching. Often it can be reduced significantly or go away entirely with a simple night time biteguard.
    - stordoff 11y ago
      My dentist did note that I seem to be grinding my teeth a little (probably at night), but didn't think the headaches were related. I'll mention it again next time I see him to see if there is anything worse trying, even as a long shot. Thanks for the advise.
fapjacks 11y ago
Kratom can solve this problem, but the FDA won't have it.
brandonmenc 11y ago
Lots of comments from people who have no experience with chronic pain aghast that doctors would fulfill patient "demands" for painkillers instead of treating the underlying cause. Pain is self-report, so all a doctor can do is prescribe based on patient demand. Maybe they can't identify an underlying cause, or maybe the treatment (ex: back surgery) is too risky. Spine surgery that might not work and can leave you with say, loss of bladder control? I'd take the pill every time, and if my doctor didn't just hand it over, I'd find another doctor.
- deleted 11y ago
  [deleted]
- catshirt 11y ago
  there is a possible outcome of back surgery that furthers your point and is (i guess arguably) worse than loss of bladder control, which is worse pain.
deleted 11y ago
[deleted]
godgod 11y ago
The war on drugs is a lie and a complete failure. Big Pharam are the biggest drug kingpins in the world...yet their stuff is "legal"
AlleyTrotter 11y ago
Simple comment What about the people who find relief from chronic pain with opioids and have no other option? These people are the ones who will suffer from the " we know whats best for you crowd"
lazyant 11y ago
Are there any alternative treatments of pain that don't involve drugs? for ex http://www.570news.com/2016/03/06/waterloo-man-praises-local-company-for-their-pain-management-device/ http://www.570news.com/2016/03/06/waterloo-man-praises-local...
- corysama 11y ago
  VR simulations of cold environments are seeing success for burn victims. http://www.firsthand.com/portfolio/pain.html http://www.firsthand.com/portfolio/pain.html https://www.hitl.washington.edu/projects/vrpain/ https://www.hitl.washington.edu/projects/vrpain/ I've heard of Mindfulness Meditation being used to change the experience of pain from an act of suffering to an act of simple awareness. I don't know how widespread that technique is deployed though...
- Matrixik 11y ago
  Check here: http://wholehealthsource.blogspot.com/2015/12/healing-back-pain.html http://wholehealthsource.blogspot.com/2015/12/healing-back-p... And read comments (search for Todd Hargrove comment). Looks like there is more pain management science without drugs than many know.
ashwinaj 11y ago
This is why you need a counter balance to monopolistic tendencies of the free market. Be it in the form of regulations or making companies liable for their greedy actions. It has been proven time and time again that systematically removing "common sense" [0] regulations only harms society in the long run. [0] Please don't start a mundane discussion about what "common sense" means.
jrapdx3 11y ago
It's troubling the way this article presents the issue. Treating chronic pain is an enormously complex problem that clinicians have to deal with, especially as it gets bound up with collateral pitfalls of drug dependence, politics of health care delivery systems and conflicting pressures from patients, government regulators and others. While unethical prescribers (not all are physicians) contribute significantly to rising misuse of opioids, the vast majority of practitioners want to do what's best for patients. As the article notes, there are few options for managing chronic pain, leaving opioids the only realistic choice in many instances. None of the providers I know think opioids are preferable, but more like a necessary evil. They prescribe opioids sparingly, reluctantly, diligently. Patients have told me it's become increasingly difficult to get prescriptions for quite modest doses of opioid agents they've used for years without dose escalation. The tendency to throw babies out with the bathwater is not unique to this situation, but no less problematic. Blaming pharmaceutical companies doesn't seem a constructive approach. Probably there's a lot of R&D going on in this domain without much success, meaning it's a very hard problem to solve. I'm certain that a major breakthrough would be eagerly marketed, highly likely the profit margins would be huge. Meanwhile, we're left with the status quo, and manufacturers are meeting market demands. Isn't that how our economy works? Pharma sales are already more highly regulated than nearly all other industries, what more should be done? Few legal drugs are as controlled in the US as schedule II opioids. If there were no such controls it's likely that the number of overdose-related deaths would be higher than it is. No one knows what solution will work, the need to be being careful about changing "rules" should be obvious. The article's advocacy of "medical marijuana" as an alternative is IMO inappropriate. Simply enough, research on the uses of cannabis components for pain treatment is in very early stages. Specific indications and side-effect risks are inadequately understood. Recommending use of these components as treatments for pain is premature.
- jacobwcarlson 11y ago
  > Patients have told me it's become increasingly difficult to get prescriptions for quite modest doses of opioid agents they've used for years without dose escalation. The tendency to throw babies out with the bathwater is not unique to this situation, but no less problematic. I have experienced this as well. Not only are doctors now reluctant to prescribe opioids, but you as a patient are suspected to be a drug-seeking addict by everyone in the chain: doctors, nurses, and pharmacists. People complaining that it's too easy to get pills clearly haven't had to manage a chronic pain condition in the past couple of years.
Havoc 11y ago
I try to stick to Aspirin & Paracetamol for this reason. Even Paracetamol feels a touch dicey @ liver failure stats. However I've been in decent pain for 1 year+ before so I know what its like & can totally understand why people go for the powerful stuff. Continuous pain like that slowly but surely grinds your psyche to fine dust over the long run. Thats the part that people without chronic pain miss...
brbsix 11y ago
The really sad thing about this is that nature has a remedy for the grip of opiate addiction, iboga, yet it is illegal as well.
yarou 11y ago
For some reason, I never saw the appeal of opiates. Granted, I use them somewhat occasionally (as needed) for pain, but they don't really cause in me the compulsive, addictive behavior I've read about. My internet addiction (HN included) is far worse than any chemical substance I've ever used.
c3534l 11y ago
This isn't really surprising. Opiates have long been used as both recreational drugs and effective analgesics. All the major opiates people abuse besides opium itself were created at one point or another as a painkiller. It's unfortunate, but they're also really good at their jobs. I think that if you need prescription painkillers you should have them. Taken without wanton disregard they're actually fairly safe, although physical addiction is always possible.
cplease 11y ago
100 million Americans struggled from chronic pain in the 1990s? (linked video) One in three men, women, and children, suffered from pathological, chronic pain? How can they quote a ludicrous statistic like that straight without comment? Or is that straight statement supposed to distort some watered down, meaningless figure factoid like 100 million people have lingering pain due to some cause at some point in their entire?
trophycase 11y ago
But illegal drugs destroy many more lives.

415 points by davidbarker 11y ago

mc32 11y ago

So painkillers used against prescription kill more people than any individual illegal drug and since people demand painkillers to treat chronic pain physicians are looking to treat chronic pain with alternatives one such is using MJ as one of those alternatives because misuse doesn't result in fatal overdoses, generally. Vox, stop with the hyperbola.

rhema 11y ago
There's not much content in this article. However, if people tend to use a drug beyond its prescription, with very bad results, that's still a reason to change things. I mean, ipads do not have a big red button with "rm -r /" listed. I don't see why the drug industry should be exempt from designing constraints that prevent user error.
- brillenfux 11y ago
  I don't think there's much you can do here. There will always be those people who nod their doctor off and then go on and do what they want.
- merpnderp 11y ago
  You can't even imagine the pain and suffering the constraints currently in place cause legitimate users of pain killers. Doctors are so scared of the DEA they're doing crazy things. Someone very close to me had a ruptured disc, killing the nerves in her spine, so much that just standing would cause pain that made her black out or vomit. And even though she'd never been prescribed anything for pain, she had to hover over a urinal crying uncontrollably, to take a drug test to make sure she wasn't an addict. If the line is between people suffering horrendous incomprehensible pain and people making a choice to abuse drugs. Well I'm pushing that line right up against the people who get the luxury of making a choice.
  - digler999 11y ago
    I dont know the details of her situation, but I think chronic pain management goes something like this: * patient such as your friend has excruciating pain, requiring the heaviest of the narcotics (say oxycodone/oxymorphone, instead of a "mere" hydrocodone that you'd get for wisdom teeth or something ). * these narcotics are so incredibly dangerous that they must be taken exactly as prescribed for the following reasons. 1) Patients have a temptation to take an extra one (or snort one) to achieve a euphoric and addicting "high" that can be irresistible once its experienced. 2) In some cases taking even one or two extra pills can kill the patient. 3) Patients have incentive to Not take them because some pills can fetch up to $40 EACH on the black market. 4) not taking them exactly as planned can cause a tolerance buildup or reduction, which can stymie the physician's efforts to find the safest minimal and effective dose for continuous pain management. * To combat all 4 of these factors, pain management specialists enter into "contracts" with their patients that they will treat their pain, if and only if, they agree to take the pills EXACTLY according to plan. To affirm compliance to this plan, the patients are subjected to random drug testing. Not just to see if they are getting high (over using them ), but also to see if they are using them at all, (i.e. not selling the pills for a massive profit ). IIRC, if you show up to your test and they find no painkillers in your urine, you can be taken OFF the plan, i.e. no pills for you. tl;dr they drug test patients to make sure a precise plan is being followed because there are at least 4 separate "failure modes" to chronic pain management. I learned most of this from news articles and reading junkie's tales on /r/opiates. I'm not an expert, nor user, but I just find the whole topic very interesting. Please correct me if I've said anything wrong.
    - merpnderp 11y ago
      The person I was referring to was so traumatized by the experience she went to a surgeon two days later and begged for the surgery, even though she was strongly advised to give the pain pills and anti-inflammatories time to work. The surgeon scheduled her 12 hours later and she's been better than new for several years now....Luckily. People have agency. And should be allowed to make their choices. Especially in cases where not allowing them to make their own choice starts hurting innocent people. And by hurting, I mean that very very literally in this case. The type of pain that causes people to end their lives. Caused by a system more afraid of a bad decision than of leaving people alternating between howling and sobbing in pain for days.
seiji 11y ago
holy run on sentence batman I posted this yesterday if it helps: https://matt.sh/heroin https://matt.sh/heroin
haroldp 11y ago
19,000+ dead people a year is a astounding fact, not hyperbole. If I were being hyperbolic, I'd call that "Over Six 9/11s per year".
- mikeash 11y ago
  That wouldn't even be hyperbole, that's still just factual, with an emotionally loaded comparison. Hyperbole would be like, "painkillers kill a trillion people a year!"
- mc32 11y ago
  It affects a lot of people yes. It's also a big problem. It's the juxta that's done in a fashion to get clicks. The article is also rather light on details. The juxta bothers me because Rx drugs are a necessity as judged by physicians, it's not a lark. Illegal drugs on the other hand are not prescribed, for the most part, and are a different issue altogether. They address perhaps other pains, but conflating them in this sense seems dishonest.
  - chillwaves 11y ago
    It seems you are not catching the point of the article. Did you read? The problem is addiction and people turning to illegal drugs after becoming addicted to legal RX.
Igglyboo 11y ago
Opiate pain relief is orders of magnitude better than marijuana.
- delecti 11y ago
  It's more orders of magnitude more dangerous and addictive (in that marijuana is almost impossible to OD on, and isn't addictive at all). Marijuana is certainly not the magical silver bullet some make it out to be, but it's incredibly effective for many people whose only other recourse would be opiates.
  - cik2e 11y ago
    Kratom is a great and currently legal alternative. It works on opioid receptors and cannot be fatally overdosed. Unfortunately, many sates are already moving on banning it. Big pharma lobby for the win.
    - fapjacks 11y ago
      Stock up while you can. However some states have unbanned it, and others yet are not voting their bans into legislation. There's hope yet, but it will be a hard fight, particularly with the FDA.
    - Igglyboo 11y ago
      Kratom still comes with risks of withdrawal. Pure leaf kratom would be difficult to OD on, but extracts and tinctures could easily be overdosed on.
      - fapjacks 11y ago
        What are you talking about? Link to any case of death that has been attributed exclusively to an overdose of kratom. You can't, because it doesn't exist.
  - corin_ 11y ago
    FYI, cannabis certainly can be addictive, just without serious physical dependance. And even on the mentally addictive side, obviously far less than opiates - but certainly there are people who fit the definition of being addicted to weed.
k-mcgrady 11y ago
>> "people demand painkillers" I might be completely wrong here so please correct me if I am. Why would a doctor care what a patient demands? Tell them no. There's nothing they can do about it. I can't demand any prescription drugs from my doctor (I'm in the UK) - and I've tried once. Do doctors in the US worry about losing money if they lose a patient or this that not the case? Edit: Thanks to those who responded. Although I suspected it it still blows my mind that people don't see how and of an idea that is.
- bronson 11y ago
  Yep! Prescribing drugs can be very lucrative. http://latimesblogs.latimes.com/lanow/2012/03/doctor-murder-charges-painkillers-prescription-deaths.html http://latimesblogs.latimes.com/lanow/2012/03/doctor-murder-... She made $5 million in 3 years. There are offices like this all over the US.
- facetube 11y ago
  When you inexplicably decide that health care is a "marketplace" of rational and informed actors, patients become customers that need to be pleased, and lost patients become lost revenue. We are in a world of hurt over here, please send help.
- brandonmenc 11y ago
  > Why would a doctor care what a patient demands? Because pain diagnosis is self-report. "I'm in pain and I know this drug works, please give it to me" is not an unreasonable request.
0xffff2 11y ago
I don't see what conic sections have to do with this...
mikemackle 11y ago
Unfortunately, there are almost no effective treatments for chronic pain available other than opiod painkillers and there is significant vested interest in the pharmaceutical industry to keep it this way. Whenever I see an article like this, it is frustrating as there is an alternative to opiods for chronic pain management that is just as effective, carries no risk of overdosing, minimizes the the chance for dependence (and in fact is often used by those looking to break opiod dependence) and at scale, could be available for fractions of a penny. As a bonus, it can also serves as an actual replacement to ADD and antidepressant medications as well as serving as an effective tool against other types of addiction (e.g. alchoholism) and has 100s of years of "clinical trials" in the real world to support its safety. http://www.scientificamerican.com/article/should-kratom-be-legal/ http://www.scientificamerican.com/article/should-kratom-be-l... Unfortunately, the powers that be have no interest in changing the status quo particularly when it would undercut patented money making drugs currently available, so very little research is conducted into this area and those who wish to do so are often actively thwarted to the point one has to conclude that there is not actually a real desire to address this problem.

cpfohl 11y ago

Knowing what I know about opioid painkillers, I don't think I'd ever accept a script for them. I'd accept them in the hospital, but never in a bottle that goes home with me...

bryanlarsen 11y ago
Knowing what I know about pain and how well that opiod painkillers combat that pain, and knowing that what I've experienced isn't anywhere close to what some people have experienced, I'd absolutely accept a script for opiod painkillers if I needed one.
- maxerickson 11y ago
  Having had several short term prescriptions for opioids in the past, it certainly makes sense to me to be quite thoughtful about whether they are necessary. But that's still quite a ways from absolute refusal to consider using them.
Igglyboo 11y ago
No one ever got hooked with the bottle of Tylenol 3 they send you home with after you get your wisdom teeth out. But when it's oxy or hydromorphone I'd agree, also I don't even want to think about having morphine or fentanyl patches in my possession.
- jontas 11y ago
  That is absolutely untrue.
- evincarofautumn 11y ago
  Still, when I had my wisdom teeth out at 17, I threw away the painkillers. I knew that they would be problematic for me, so I decided to not even go there.

josefresco 11y ago

Relevant: http://www.pbs.org/wgbh/frontline/film/chasing-heroin/ http://www.pbs.org/wgbh/frontline/film/chasing-heroin/

swillis16 11y ago

All it takes is one or two extra pills to get high from the standard opioid pain prescription. It would've been nice to see this mentioned in the article but it seems pretty light on content.

mapt 11y ago
All it takes is the standard opioid pain prescription. That's getting high. Opioids get you high. That's what's necessary for pain relief: Altered neurological states in which pain coming in from the nervous system doesn't have such a strong effect on the conscious mind. It's that simple. Deal with it. Drugs have effects. Usage doesn't cross some threshold dose and instantly become abuse.
- encoderer 11y ago
  Oh, I disagree. There is most certainly a difference between therapeutic use for pain reduction, and the euphoric response normally associated with an opiate high. Most people using opiates on-label are not getting high from them. Even if they do the first couple times they take them, that passes.
  - daodedickinson 11y ago
    I definitely got stratospheric on my prescribed dose of one single Ambien pill (couldn't recognize myself in a mirror, saw kaleidoscopic visions, 2d videos became 3d portals into other dimensions). Absolutely some people could get high on one opiate pill. I understand your skepticism, but I'd like to assure you there is tremendous metabolic diversity.
    - encoderer 11y ago
      I didn't say anything about one pill not being enough to get you high. Also, that's not even the question I addressed. The GP said "That's what's necessary for pain relief." -- which is an overstatement.
  - 11y ago

julie1 11y ago

Prescribing opium ... a trend that have not been seen in the world since victorian era in the UK. Opium having the reputation to make people amorph losing their will to rebel. The new trend is opioid are now cheap and not prescribed to the rich but the poor. Religion used to the opium of the people they said, and now that opium is cheap, religion is not needed anymore to make people servile. I love this new era of progress. Tomorrow we make an application to help parents poor sell their kids body part on the internet for the cure of richer people? I mean, let's try to make even more dystopic. We can do better. That is what progress is. Making system more efficient.

user_0001 11y ago

What are the rates like compared to other countries? Does the US just over prescribe painkillers, meaning more flood to the blackmarket? Is it people are getting it from the Dr and accidentally ODing? Are the Drs prescribing without care, so those who want the drug for a high and no medical reason can? I never knew painkillers to be used as party drug / fun drug in the UK (outside of the heroin using demographic) nor ever heard of some one ODing on prescribed painkillers. Seems strange it is such a big issue in the US

teslabox 11y ago
Some of the prescription opioids are contaminated with Tylenol, which is very toxic to the liver when consumed in excess.
- toufka 11y ago
  They incorporate tylenol to help prevent addiction and overdose. Too much tylenol makes you sick - very unpleasantly. Too much opiods and you feel great, until you die. The tylenol is designed to provide an edge to taking too much so that the curve correlatibg dose to pleasure doesn't always angle upwards. Being very sick, and even having liver problems is generally better than death.
  - dionidium 11y ago
    Being very sick, and even having liver problems is generally better than death. I would submit to you that deliberate contamination of a drug for the sole purpose of inflicting harm in search of a greater good is an outrageous policy.
    - neverknowsbest 11y ago
      Agreed. An opiate OD can be reversed if caught in time. NSAID ODs box your liver.
    - onetwotree 11y ago
      I completely agree. Former and current opiate addicts I've met have told me that when contaminated pills are all you've got to stave off withdrawal, the risk from Tylenol poisoning doesn't really even cross your mind. Adding risk (whether it's the risk of liver failure or prison time) to addiction behaviors doesn't do a damn thing, because addiction is a disease that fundamentally destroys our ability to make rational cost-benefit decisions when our drug or behavior of choice is concerned.

krschultz 11y ago

I've never taken an illegal drug in my life. I've smoked a cigarette about 5 times. I drank in college but lately I've cut that out of my life as well. I had a security clearance with drug testing requirements for a while and now I just don't like the feeling of a hangover from alcohol or the risk of ingesting random plants/chemicals made by shady people. In short: I'm the most vanilla, square, anti-drug person you can find. I don't want to use them, and I think other people would be better off if they reduced their usage as well. Yet I can not for the life of me understand why drugs are illegal. Not just pot, all drugs. I'm totally onboard with making it our public policy that we want to reduce the use of drugs. That makes perfect sense to me. It does not make sense to me why anyone still believes that using the criminal justice system as the mechanism for getting to that goal is the right path. We are spending insane amounts of money on a failed approach while also generating huge negative side effects by creating an enormous group of people with criminal records. It's probably the worst thing this country has done to our own people since segregation and it seems like all of the policy people understand this. Why can't we get political will to do something different?

beamatronic 11y ago
>> insane amounts of money I think you said it yourself - not to be snarky or anything. But someone has found a way to get rich, and they use their funds to lobby to keep the current system in place.
- unusximmortalis 11y ago
  exactly. for as long as you can pour money into lobbying and thus influence (mild term) laws, those laws governing people, lives, don't expect anything good to happen. of course the current system allows ways to fight against this but those ways are so hard implement compared to the way of lobbying (pour insane amount of money cause you have it and they generate even more money) that has no sense practically. am I skeptical? no. we have everything we deserve. and we will continue to have exactly what we deserve, not a single bit more or less.
- mathattack 11y ago
  It boggles my mind that it's somehow acceptable for the folks running prisons to be able to lobby for the 3 strikes laws. http://thinkprogress.org/politics/2010/09/16/117661/sb1070-prison-lobby/ http://thinkprogress.org/politics/2010/09/16/117661/sb1070-p...

FussyZeus 11y ago

Is this really surprising? All the benefits of illegal drugs without the risks involving prison time and public disgrace. All you need to do is figure out what things to tell your Doctor to make him think you need one of these things, and you have a legal (and probably insurance funded) supply. Not saying of course that everyone who gets these doesn't need them, I'm sure many do, but we have something like 90% of the worldwide consumption occurring in the States, so something is clearly up.

joveian 11y ago

This seems like a particularly limited article, although a better slant than many. The NY Times just had this (also not wonderful, but with some additional information) article a few days ago: http://www.nytimes.com/2016/03/07/us/heroin-epidemic-increasingly-seeps-into-public-view.html http://www.nytimes.com/2016/03/07/us/heroin-epidemic-increas... While the title mentions heroin, the article at least mentions that deaths are frequently due to more deadly prescription painkillers being mixed in. One thing I wonder that I haven't seen addressed (I'm not sure if there is even data available) is how many overdose deaths are due to use of multiple drugs at the same time (alcohol for example makes many drugs more deadly). Hopefully there will be more and better reporting on the issue. IIRC (and wikipedia agrees at least), these numbers mean that drug overdoes are now killing non-trivially more people in the US than car accidents.

marincounty 11y ago
I have a feeling it's going like this; patient goes to doctor and complains of pain. Doctor reluctantly prescribes an opioid. Patient likes the way the opioid makes them feel. Yea, their pain becomes tolerable because they feel better. A lot better than any antidepressant. Right now, a lot of people in the United States are misserable on a lot of levels. It's not just their back pain, or the roaming pain--misery seems to bring. It's the economy. It's finding a place other than a room in your baby boomer's parent's home. It's even finding a shit job--a shit job used to be easy to find. Now--shit jobs are just aweful. Plus, you are competing with very desperate immigrants that happily work for minimum wage, and have no social qualms living like caned Sardines. (I 'm not stereotyping. A lot of immigrants don't see anything weird with a sharing a small room with multiple family members.) In the U.S. it's looked down upon. Especially in the formative years, where you are trying to prove to that perfect person you are a Superman/Superwoman. You are the one. You are the independent winner. You are the one he/she should marry, or just have sex with. It's not your fault you not the big baller. And no it's not just getting the B.S. Degree. It's a whole lot more than that. Back to the person in pain on opioids. The drugs make them feel better. This is what they think they need to function in this world--some Do! Physical pain is Real? The big problem is opioids lose their efficy over time. Doctors don't tell the patient in pain up front about tolerance. Why--because in a lot of medicine, a good doctor wants to induce the placebo effect, along with the effect from the drug, and their not idiots. Some actually want you to feel better. They all don't just don't care about the office visit fee. I think? (While opoids do require more, and more over time in order to get the original effect; there are studies done in Rest Homes, with older subjects where tolerance of opoids did not materialize. The studies are numerious, and many doctors were taught opoids are safe in med school.) In my case, and the people I know opoids are far from being a non-addictive drug, or tolerance resistant. But the drug has been so vilified, and stereotyped who knows. All those addiction t.v. shows, and even well meaning professionals have told us for years, getting off opoids is very hard. I truly wonder just how difficult getting off opioids is--if we weren't conditions into thinking it's the most difficult drug to kick? I know when I'm told something is going to be a bitch to get off of--it's always worse than the times I didn't know how difficult the withdrawal will be. And the greatest junkie (Burrows) once said something like, 'Geting off opoids is not as hard as they say.' Now to the opoid deaths. I don't know about the deaths among very ill patients whom are on patches like fentanal. I know about the guy with the bad back who was given opoids. Then the doctor stopped the refills. That patient went to the black market to get their opoid, usually heroin because it's cheaper. At this point, their lives are usually a complete mess. If they are poor, they usually have a record with the authorities. Every day becomes a nightmare. "I'll few drinks along with the heroin--who cares?" A hit of meth--who cares? A sleeping pill with the opoid--who cares? Who cares? I've given up. I can't function like my parents did. Death from overdose follows. We have a problem. I think there's a short term solution to a drug problem, and an out of touch society. A society that's still living in the 50's in terms of expectations. That short term solution is Buoenorpine. It can help a lot of these people whom are addicted to opioids. Don't require the addict to pay a fortune for this drug. Don't make them pay for expensive office visits. Just give them the drug. If they sell it, or abuse it; they go back to herion. As to people in extreme pain, let Medical doctors treat it. Leave them alone. Let them do their jobs. No government official should be telling them how to alleviate cancer pain, or any physical pain. Hell, they shouldn't have to take a special course in order to prescribe bupenorpine. They shouldn't be limited to 100 patients. Leave MD's alone. Again--leave medial doctors alone. Let them prescribe what they feels works. If the patient abuses the drug--that's not the doctors fault. If you think the average doctor is willy nilly writing prescriptions for opoids--well just see what happens when you see a doctor, and complain about pain. Most likely you will be offered 400 mg's of Ibuprofen. Doctors are very leary of writing a script for any opoid. Good luck getting one. The DEA is breathing down their backs. As a society, the people in real physical pain are being told they can't have opoids. It all seems fine, until you are that person in intense pain in that exam room. So yes we live in a country that expects a lot from its citizens. We are all suspose to be successful. Even the poor are expected to "make it"--whatever that means anymore. At the same time jobs have gone away. We are in this sharing economy. A economy that just seems to serve the wealthy? The glow from opoids is enticing in this judgmental society. Bupenorpine might be a quick answer to a complex problem? A real problem. What do we have to lose at this point? I'm tired of hearing about overdose from opioids. Really tired! A least freely provide naloxone over the counter?

njharman 11y ago

Joining cigs and alcohol, eh?

disposeofnick9 11y ago

I've lost at least two elderly, extended family members this way. Both applied both a patch and took a pill, which caused an OD. The issue is that many opioids and non opioids gap between the therapeutic dose range and LD50% is often dangerously narrow. Complication #0: serum bioavailable molecule assay is rarely monitored. People metabolize and clear drugs at vastly differently rates. Complication #1: Hospital mistakes still happen quite frequently, despite many measures to prevent them, especially with inexperienced and overworked nurses/assistants. Complication #2: cummulative dosing error or interactions, especially multiple, independent prescriptions for similar opioids with different administration routes (patches, sprays, pills, injections) Complication #3: overprescription of opioids because they're cheap, especially to veterans, which also leads to prescription and hard drug addictions. Solution: opiods need to be singularly controlled at home or in the hospital by an integrated, blood/interstitial fluid measuring/dispensing unit to avoid OD and push back on abuse. Plus, anyone taking opioids should also have narcan or equivalent antidote readily available, and wear a medalert QR code bracelet which lists relevant conditions and medications should they be found unresponsive. Finally, avoid painkillers as much as possible and take the least dose which reduces stress level.

creshal 11y ago
> overprescription of opioids because they're cheap It's a bit scary how eager doctors are to prescribe them. "Hey doc, I'm in pain" – "Here's a bottle of painkillers, NEXT" Bitch, I don't want painkillers, I want you to figure out why my body is hurting when it's not supposed to. It's surprisingly frustrating to talk doctors into looking for the cause instead of treating the symptom. Thankfully, the metamizole they kept filling me up with is not nearly as addictive as opioids and we have free health care, so I didn't have to pay a dime for the repeated blood analyses and CT it took find the cause. Otherwise I'd probably have bigger problems right now.
- thaumasiotes 11y ago
  > I don't want painkillers, I want you to figure out why my body is hurting when it's not supposed to. It's surprisingly frustrating to talk doctors into looking for the cause instead of treating the symptom. To be fair, this is related to the symptom you're asking them about. Pain often occurs with no apparent cause. As an extreme example, it is normal for amputees to experience the sensation of a "phantom hand" where their hand would be if it hadn't been amputated. The phantom hand can feel pain. I'm fairly confident that there is nothing physically wrong with the hand someone doesn't have, even if it is in pain.

bobby_9x 11y ago

It makes sense just based on statistics. Americans have more access to pain killers than any illegal drug and just based on this, will result in more mis-use (and death). If illegal drugs were all made legal tomorrow, we would see something similar.

deleted 11y ago

[deleted]

joesmo 11y ago

Send patients home with Narcan and train the people they live with to administer it as well. Have every EMT, firefighter, and police officer in the nation carry and know how to administer Narcan. Have it be part of every single first aid kit sold in this country. Remove the social stigma of drug abuse. Remove penalties for people who help others who are overdosing. You'd think someone would have some common sense in this country but you'd be wrong. It will never get better the way things are going now. It's ridiculous to even have a fucking article like this that doesn't mention the numerous tried and true solutions that exist but are simply not being put into place because the people in power in this country want to see people dying. The problem isn't that we don't have solutions. Solutions are a plenty. The problem is that no one in America cares. No one in this country gives a shit that people are dying. Most people want it to happen. They support the fucking drug war. They want people to die. Until this fucking shit changes, people will continue to die and idiots will continue to wonder what can we do? So many fucking things, I don't even have time to write them all down. That's the fucking sad part.

jdietrich 11y ago
The Scottish government started providing naloxone (Narcan) to opiate users on a large scale in 2010. Naloxone and first aid training was offered to users of needle exchange services, prison leavers and other people at risk of opiate overdose. In the first year there were 365 confirmed uses of naloxone, but that is believed to be a significant underestimate of overall use. The evidence is clear - naloxone works. http://www.gov.scot/Resource/0045/00451251.pdf http://www.gov.scot/Resource/0045/00451251.pdf
merpnderp 11y ago
If you stripped away all the anger and emotion in your comment, it would still read just as inflammatory. Maybe more so. Because it's absolutely true. Even though addicts are sick and need help, that's not how they are viewed. They're viewed as lazy worthless members of society who can go die in a gutter. Yet the most brilliant colleague I ever worked with had be resuscitated twice from heroin overdoses. A hyper productive individual, capable of incredibly feats of software engineering who yet maintained a great work life balance. And while he was sick, society viewed him as a worthless parasite.

musgrove 11y ago

If 47k deaths per year is an "epidemic" as the author terms it, the 610k that die each year from heart disease must be an all-out pandemic. It never was a war on drugs. Drugs are inert and aren't capable of fighting a war. It's a war on addiction. And good luck winning that on a national scale with "laws."

jhulla 11y ago
Spot on. Addiction causes fundamental changes in the brain. Helping addicts is a complex process well beyond fining or imprisoning them. The goal is to reverse the addiction. It doesn't happen by punishing an addict. This is a useful paper: "Imaging the Addicted Human Brain", http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2851068/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2851068/
6stringmerc 11y ago
If you live long enough you eventually die of something, right? Now, if 85% of those heart disease deaths were in the 15-28 year old cohort, that might be something quite stunning. I agree declaring 'war' on addiction is a ridiculous concept, because it's more than likely a statistical constant (with a range) within the human species. A certain amount of people will get addicted, be it drugs, food, or the internet. It's just kinda sorta what we do, and I'd be a big fan if as a society and culture we looked toward methods to save ourselves constructively, rather than use the authority of the state to lock people away, generally speaking.

6stringmerc 11y ago

I have chronic pain due to a heriditary, incurable condition. Right now one of my ankles is in an elastic wrap to ease the irritation from arthritis. In our home, we did have a bottle somewhere of Tylenol 3, aka codeine. Regular acetominophen was usually what I got to help with an issue. As I grew into adulthood, I knew the pains I experienced were directly related to my condition, and it was my desire to not really 'cloak' the pain, but avoid it in the first place. Preventive if you will. It helps, but it's clear to me that I wanted to be healthy, and if I have to occasionally take something, so be it. Naproxen sodium has worked quite well of late. The point of all this rambling is that I simply don't want the hassle of becoming addicted to pain pills. Or sleeping pills. Or nasal spray when it's allergy season. I've lived with pain so long for my life that I'm kind of used to it, and I do say so as a point of pride. It's the body I was born with and it's the one I'll have to use for this gig, take care of it. I don't fault people for wanting pain treatment. I think the way the system was set up with pills flooding the US was incredibly destructive, and highly indicative of the dangers of for-profit medicine as a system. Toss in the DEA's drug laws and it just turns patients into criminals and that benefits only a very limited group. When I eventually started seeing commercials on TV for a treatment for opiod induced constipation all I could think about was Trainspotting and that we have a real, genuine problem on our hands in the US.

tosseraccount 11y ago

Rhetorical question: how many of these deaths also involve alcohol?

Havoc 11y ago
>Rhetorical question: how many of these deaths also involve alcohol? For opiods...few. For paracetamol...lots.

nathanvanfleet 11y ago

Just so you know, opioid pain killers are actually not useful for chronic pain at all. Over the long term it actually makes patients sense of pain GO UP. It's excellent for non-chronic pain however.

MichaelGG 11y ago
What kind of time range are you talking about here? AFAIK there's no human limit to opiate tolerance - patients can often just take more (over time).
stordoff 11y ago
Not the best choice, certainly, but I would question not useful. I suffer from chronic pain (mostly headaches), and opioids (tramadol/codeine) are the only drugs[1] that have given any relief. I've been using them for about two years; they are still useful, and when I stop using them the pain is about the same it was before. Fortunately I don't appear to find them addictive - I stopped taking the tramadol after about a year's usage (my consultant raised similar concerns to you - restarted them about three months later as it had been shown they weren't worsening the headaches) cold turkey (I was told it would be worse than stopping heroin), and suffering absolutely no ill effects or withdrawal. [1] Multiple others have been tried (ibuprofen/diclofenac/amitriptyline/sodium valproate/naproxen/gabapentin and a few others I can't remember), and made no difference to the headaches. The amitriptyline is helping with pain in my hands though.
- vidarh 11y ago
  Just a suggestion because it is often missed by general practitioners: If you've not tried it already, talk to your dentist. Headaches and migraines are often related to teeth or the jaws. Particularly grinding and clenching. Often it can be reduced significantly or go away entirely with a simple night time biteguard.
  - stordoff 11y ago
    My dentist did note that I seem to be grinding my teeth a little (probably at night), but didn't think the headaches were related. I'll mention it again next time I see him to see if there is anything worse trying, even as a long shot. Thanks for the advise.

fapjacks 11y ago

Kratom can solve this problem, but the FDA won't have it.

brandonmenc 11y ago

Lots of comments from people who have no experience with chronic pain aghast that doctors would fulfill patient "demands" for painkillers instead of treating the underlying cause. Pain is self-report, so all a doctor can do is prescribe based on patient demand. Maybe they can't identify an underlying cause, or maybe the treatment (ex: back surgery) is too risky. Spine surgery that might not work and can leave you with say, loss of bladder control? I'd take the pill every time, and if my doctor didn't just hand it over, I'd find another doctor.

deleted 11y ago
[deleted]
catshirt 11y ago
there is a possible outcome of back surgery that furthers your point and is (i guess arguably) worse than loss of bladder control, which is worse pain.

deleted 11y ago

[deleted]

godgod 11y ago

The war on drugs is a lie and a complete failure. Big Pharam are the biggest drug kingpins in the world...yet their stuff is "legal"

AlleyTrotter 11y ago

Simple comment What about the people who find relief from chronic pain with opioids and have no other option? These people are the ones who will suffer from the " we know whats best for you crowd"

lazyant 11y ago

Are there any alternative treatments of pain that don't involve drugs? for ex http://www.570news.com/2016/03/06/waterloo-man-praises-local-company-for-their-pain-management-device/ http://www.570news.com/2016/03/06/waterloo-man-praises-local...

corysama 11y ago
VR simulations of cold environments are seeing success for burn victims. http://www.firsthand.com/portfolio/pain.html http://www.firsthand.com/portfolio/pain.html https://www.hitl.washington.edu/projects/vrpain/ https://www.hitl.washington.edu/projects/vrpain/ I've heard of Mindfulness Meditation being used to change the experience of pain from an act of suffering to an act of simple awareness. I don't know how widespread that technique is deployed though...
Matrixik 11y ago
Check here: http://wholehealthsource.blogspot.com/2015/12/healing-back-pain.html http://wholehealthsource.blogspot.com/2015/12/healing-back-p... And read comments (search for Todd Hargrove comment). Looks like there is more pain management science without drugs than many know.

ashwinaj 11y ago

This is why you need a counter balance to monopolistic tendencies of the free market. Be it in the form of regulations or making companies liable for their greedy actions. It has been proven time and time again that systematically removing "common sense" [0] regulations only harms society in the long run. [0] Please don't start a mundane discussion about what "common sense" means.

jrapdx3 11y ago

It's troubling the way this article presents the issue. Treating chronic pain is an enormously complex problem that clinicians have to deal with, especially as it gets bound up with collateral pitfalls of drug dependence, politics of health care delivery systems and conflicting pressures from patients, government regulators and others. While unethical prescribers (not all are physicians) contribute significantly to rising misuse of opioids, the vast majority of practitioners want to do what's best for patients. As the article notes, there are few options for managing chronic pain, leaving opioids the only realistic choice in many instances. None of the providers I know think opioids are preferable, but more like a necessary evil. They prescribe opioids sparingly, reluctantly, diligently. Patients have told me it's become increasingly difficult to get prescriptions for quite modest doses of opioid agents they've used for years without dose escalation. The tendency to throw babies out with the bathwater is not unique to this situation, but no less problematic. Blaming pharmaceutical companies doesn't seem a constructive approach. Probably there's a lot of R&D going on in this domain without much success, meaning it's a very hard problem to solve. I'm certain that a major breakthrough would be eagerly marketed, highly likely the profit margins would be huge. Meanwhile, we're left with the status quo, and manufacturers are meeting market demands. Isn't that how our economy works? Pharma sales are already more highly regulated than nearly all other industries, what more should be done? Few legal drugs are as controlled in the US as schedule II opioids. If there were no such controls it's likely that the number of overdose-related deaths would be higher than it is. No one knows what solution will work, the need to be being careful about changing "rules" should be obvious. The article's advocacy of "medical marijuana" as an alternative is IMO inappropriate. Simply enough, research on the uses of cannabis components for pain treatment is in very early stages. Specific indications and side-effect risks are inadequately understood. Recommending use of these components as treatments for pain is premature.

jacobwcarlson 11y ago
> Patients have told me it's become increasingly difficult to get prescriptions for quite modest doses of opioid agents they've used for years without dose escalation. The tendency to throw babies out with the bathwater is not unique to this situation, but no less problematic. I have experienced this as well. Not only are doctors now reluctant to prescribe opioids, but you as a patient are suspected to be a drug-seeking addict by everyone in the chain: doctors, nurses, and pharmacists. People complaining that it's too easy to get pills clearly haven't had to manage a chronic pain condition in the past couple of years.

Havoc 11y ago

I try to stick to Aspirin & Paracetamol for this reason. Even Paracetamol feels a touch dicey @ liver failure stats. However I've been in decent pain for 1 year+ before so I know what its like & can totally understand why people go for the powerful stuff. Continuous pain like that slowly but surely grinds your psyche to fine dust over the long run. Thats the part that people without chronic pain miss...

brbsix 11y ago

The really sad thing about this is that nature has a remedy for the grip of opiate addiction, iboga, yet it is illegal as well.

yarou 11y ago

For some reason, I never saw the appeal of opiates. Granted, I use them somewhat occasionally (as needed) for pain, but they don't really cause in me the compulsive, addictive behavior I've read about. My internet addiction (HN included) is far worse than any chemical substance I've ever used.

c3534l 11y ago

This isn't really surprising. Opiates have long been used as both recreational drugs and effective analgesics. All the major opiates people abuse besides opium itself were created at one point or another as a painkiller. It's unfortunate, but they're also really good at their jobs. I think that if you need prescription painkillers you should have them. Taken without wanton disregard they're actually fairly safe, although physical addiction is always possible.

cplease 11y ago

100 million Americans struggled from chronic pain in the 1990s? (linked video) One in three men, women, and children, suffered from pathological, chronic pain? How can they quote a ludicrous statistic like that straight without comment? Or is that straight statement supposed to distort some watered down, meaningless figure factoid like 100 million people have lingering pain due to some cause at some point in their entire?

trophycase 11y ago

But illegal drugs destroy many more lives.