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each year 19,000 americans die from prescription opioid overdoses and another 10,000 die from heroin overdoses which often start with prescription opioid use.

each year 19,000 americans die from prescription opioid overdoses and another 10,000 die from heroin overdoses which often start with prescription opioid use. In my experience (as an anaesthesiologist), people who use opioids as a response to non-pain problems are some of the most miserable people there are. It might work for a couple of weeks, but soon you're tolerant, addicted, intermittently withdrawing and your life becomes a wreck. "The prevalence of suicide attempts among opioid addicts is reported to lie between 8% and 17%, with some studies reporting an even higher rate among special groups of addicts. " http://www.ncbi.nlm.nih.gov/pubmed/9018906 http://www.ncbi.nlm.nih.gov/pubmed/9018906 Using MDMA might be useful as it is non-addictive, but again habitual use leads to decreasing benefits and increasing problems.

dools 11y ago
Saying that prescription opioid use is a cause of heroin overdoses ignores the fact that the reason people move to heroin is because of the paranoia about addiction which causes their prescriptions to be cut off in the first place. In the same vein (no pun intended) I've been looking for stats but not being able to find anything about what percentage of prescription opioid overdoses occur while the patient is being actively prescribed, versus those which occur when the patient is obtaining the drugs illegally once their prescription has been cut off because doctors are afraid they'll become addicted.
- fucking_tragedy 11y ago
  > afraid they'll become addicted. Someone who isn't addicted to highly addictive substances doesn't engage in risky behavior, disregarding consequences and their well-being, by seeking out undosed, more potent and potentially adulterated highly addictive street drugs. Maybe their doctor has a valid concern. Opioids are rarely an effective treatment for non-cancer and chronic pain if taken regularly for a variety of reasons. Ideally, if a doctor is going to stop refilling a prescription of an opioid addicted patient, they should be referred to appropriate services. Detoxification, pain management and mental health specialists should be all be involved for the patient's well-being. The patient should never be cut off cold-turkey like that.
  - ownagefool 11y ago
    You sure about that? I'd imagine given enough pain for a long enough duration, I'd find a solution that either cures or kills me.
- oxide 11y ago
  contrary to popular opinion these days, I think pain is undertreated and routinely so. quality of life should take priority over dependence concerns especially in the elderly.
  - brianwawok 11y ago
    But what is the root cause of pain? I used to be depressed and in a lot of pain. I could have got anti depressants and anti pain rXs. Turns out I was just fat and my body was mad at me. Switched to an active lifestyle and everything got better. Does that mean it would work for everyone? No. But no doctor told me to go run. they either gave me medicine A or B or C, and changed doses to try and minimize side effects. It's terrible but I understand. I can't go to an overweight depressed friend and tell him he needs to fix his life not take drugs for his bad back.
  - DanBC 11y ago
    Opioids are not a suitable treatment for long term pain, especially in the elderly. People need rapid access to pain management clinics, with weight loss and strength building exercise, and access to meds (which in long term pain are often not opioids). Giving those people opioids increases their risk of accidental death, and suicide. It gives them an addiction. But worse it does not treat their pain - they will still have the pain.
    - oxide 11y ago
      This is ignorant at best and naive at worst. God help anyone you treat, and if you aren't a medical professional its probably for the best. Your comment makes me physically ill.
      - deleted 11y ago
        [deleted]
      - aminok 11y ago
        You sound like a drug abuse apologist.
      - 11y ago
- raverbashing 11y ago
  > that the reason people move to heroin is because of the paranoia about addiction which causes their prescriptions to be cut off in the first place Well it seems they are right, if people will move to an illegal substance right after they get cut from it
  - md224 11y ago
    Pretty sure if coffee was outlawed tomorrow you'd see a lot of people moving to illegal substances. Doesn't mean people can't handle the substance, just means people who are cut off from substances they depend on will go out of their way to satisfy that dependency.
  - Sophistifunk 11y ago
    This is a tautology. You're not "right" to fear illegal drug use if your reaction to said fear (cutting off access to quality-controlled, measured doses) causes it.
- kaitai 11y ago
  There's a piece missing from this argument: opioids were inappropriately prescribed to start with in many cases. Think of all those folks with back pain. Back pain is complex and difficult to treat, but huge components come from 1) the stupid chairs we sit in 2) at our stupid jobs that encourage hours of sitting 3) in our cities that discourage biking or walking to work, all in the context of 4) a food system that gives us crap to eat that makes us mildly addicted to sugar and salt and makes us unhealthy. So the real cure for back pain for a lot of people is to go back 20 years in time, make a commitment to taking care of their physical selves, aligning their eating, transportation, work, and recreation with health. The second-best cure is physical therapy. Physical therapy right now! But that costs money and time and no one believes it works (it does!!!) so the pain med is seen as the proximate best answer. Brings us back to the original original post, actually.
md224 11y ago
I appreciate your input as a medical professional. Are you familiar with studies using NMDA receptor antagonists to reduce opiate tolerance? For example, here's a study they did on mice: http://www.ncbi.nlm.nih.gov/pubmed/10763858 http://www.ncbi.nlm.nih.gov/pubmed/10763858 Also, don't you think your sample is biased as a doctor? As in: the people you're likely to encounter in your line of work are those that are in need of medical care?
humbleMouse 11y ago
I think mushrooms might be a better drug to give people than opiates. Send people to the redwood forest for a week to stay in a small cabin and eat mushrooms/smoke weed/eat good food and see how depressed they are afterwards!

dools 11y ago

Saying that prescription opioid use is a cause of heroin overdoses ignores the fact that the reason people move to heroin is because of the paranoia about addiction which causes their prescriptions to be cut off in the first place. In the same vein (no pun intended) I've been looking for stats but not being able to find anything about what percentage of prescription opioid overdoses occur while the patient is being actively prescribed, versus those which occur when the patient is obtaining the drugs illegally once their prescription has been cut off because doctors are afraid they'll become addicted.

fucking_tragedy 11y ago
> afraid they'll become addicted. Someone who isn't addicted to highly addictive substances doesn't engage in risky behavior, disregarding consequences and their well-being, by seeking out undosed, more potent and potentially adulterated highly addictive street drugs. Maybe their doctor has a valid concern. Opioids are rarely an effective treatment for non-cancer and chronic pain if taken regularly for a variety of reasons. Ideally, if a doctor is going to stop refilling a prescription of an opioid addicted patient, they should be referred to appropriate services. Detoxification, pain management and mental health specialists should be all be involved for the patient's well-being. The patient should never be cut off cold-turkey like that.
- ownagefool 11y ago
  You sure about that? I'd imagine given enough pain for a long enough duration, I'd find a solution that either cures or kills me.
oxide 11y ago
contrary to popular opinion these days, I think pain is undertreated and routinely so. quality of life should take priority over dependence concerns especially in the elderly.
- brianwawok 11y ago
  But what is the root cause of pain? I used to be depressed and in a lot of pain. I could have got anti depressants and anti pain rXs. Turns out I was just fat and my body was mad at me. Switched to an active lifestyle and everything got better. Does that mean it would work for everyone? No. But no doctor told me to go run. they either gave me medicine A or B or C, and changed doses to try and minimize side effects. It's terrible but I understand. I can't go to an overweight depressed friend and tell him he needs to fix his life not take drugs for his bad back.
- DanBC 11y ago
  Opioids are not a suitable treatment for long term pain, especially in the elderly. People need rapid access to pain management clinics, with weight loss and strength building exercise, and access to meds (which in long term pain are often not opioids). Giving those people opioids increases their risk of accidental death, and suicide. It gives them an addiction. But worse it does not treat their pain - they will still have the pain.
  - oxide 11y ago
    This is ignorant at best and naive at worst. God help anyone you treat, and if you aren't a medical professional its probably for the best. Your comment makes me physically ill.
    - deleted 11y ago
      [deleted]
    - aminok 11y ago
      You sound like a drug abuse apologist.
    - 11y ago
raverbashing 11y ago
> that the reason people move to heroin is because of the paranoia about addiction which causes their prescriptions to be cut off in the first place Well it seems they are right, if people will move to an illegal substance right after they get cut from it
- md224 11y ago
  Pretty sure if coffee was outlawed tomorrow you'd see a lot of people moving to illegal substances. Doesn't mean people can't handle the substance, just means people who are cut off from substances they depend on will go out of their way to satisfy that dependency.
- Sophistifunk 11y ago
  This is a tautology. You're not "right" to fear illegal drug use if your reaction to said fear (cutting off access to quality-controlled, measured doses) causes it.
kaitai 11y ago
There's a piece missing from this argument: opioids were inappropriately prescribed to start with in many cases. Think of all those folks with back pain. Back pain is complex and difficult to treat, but huge components come from 1) the stupid chairs we sit in 2) at our stupid jobs that encourage hours of sitting 3) in our cities that discourage biking or walking to work, all in the context of 4) a food system that gives us crap to eat that makes us mildly addicted to sugar and salt and makes us unhealthy. So the real cure for back pain for a lot of people is to go back 20 years in time, make a commitment to taking care of their physical selves, aligning their eating, transportation, work, and recreation with health. The second-best cure is physical therapy. Physical therapy right now! But that costs money and time and no one believes it works (it does!!!) so the pain med is seen as the proximate best answer. Brings us back to the original original post, actually.

md224 11y ago

I appreciate your input as a medical professional. Are you familiar with studies using NMDA receptor antagonists to reduce opiate tolerance? For example, here's a study they did on mice: http://www.ncbi.nlm.nih.gov/pubmed/10763858 http://www.ncbi.nlm.nih.gov/pubmed/10763858 Also, don't you think your sample is biased as a doctor? As in: the people you're likely to encounter in your line of work are those that are in need of medical care?

humbleMouse 11y ago

I think mushrooms might be a better drug to give people than opiates. Send people to the redwood forest for a week to stay in a small cabin and eat mushrooms/smoke weed/eat good food and see how depressed they are afterwards!