6 ms·

No, it's a good thing. It means people that are addicted (by choice or not) don't need to resort to crime or desperation to buy essential medicines. Less docto

No, it's a good thing. It means people that are addicted (by choice or not) don't need to resort to crime or desperation to buy essential medicines. Less doctors "pushing" really means more doctors being very critical of patients. Which means more people in pain, scared to make too big a fuss, lest they be labeled an "addict" or "seeker". We don't accept (in theory) a legal system that condemns innocent people to suffer, why should we accept a health system that does the same?

DanBC 11y ago
A number of people in this thread are saying the answer is either to prescribe opiates, or to leave people in pain. People who need opiates should be able to get them, but that's a small number of people. Giving opiates to the rest does very little to treat their pain, and leaves them with an opiate addiction. Most people with long term pain don't need better access to opiates. They need better access to pain clinics with the range of meds and physical therapies they have. (And yes, opiates if those are needed.)
capote 11y ago
> No, it's a good thing. It means people that are addicted (by choice or not) don't need to resort to crime or desperation to buy essential medicines. This seems twisted to me. Okay, so they don't do crime, but they get their stuff easier and stay addicted/get worse/die. Isn't it best to eliminate the motivation for doctors to overprescribe, but still force people to see their doctors for a fix? This way maybe the doctors can intervene and help them out.
- MichaelGG 11y ago
  Don't understate the "do not do crime". I've known addicts and the biggest damage they cause (apart from dying when they OD on unknown-quality junk) is that they become thieves and liars. No one trusts them and it tears relationships apart. Both are fixed by having more legal availability. If they were simply able to get opiate as easily as pot, then addicts for the most part would be just like potheads. Perhaps being useless, perhaps seen as a drain or whatever, but not dangerous, not bad people like some junkies turn into. With proper availability, opiates are very well tolerated. Being addicted, by itself, is not a big deal. Apart from the negative pieces you see like this one, opiates are still a huge success for many people. Not just physical pain, but emotional pain, depression, and stress. Keep an eye out for pinned pupils and notice how many professionals have them. There's this stigma that addiction is inherently bad. Yet it only applies to "fun" drugs like opiates. No one, in general, goes on about the terribleness it is to be addicted to antipsychotics or insulin or antidepressants. At best, you hear how annoying it is, having to always make sure you've got your gear - but I've not seen people go on about the intrinsic badness of addictions lifesaving medications cause. What should be available is more public health awareness, and a cultural shift. People should be free to get addicted, but easily obtain services to help with it, without being labelled or criminalized. You don't need to rob people of liberty and cause suffering by requiring a paid gatekeeper to watch over everyone.
  - DanBC 11y ago
    > With proper availability, opiates are very well tolerated. This just is not true. With proper availability people develop tolerance, and require higher doses. That does becomes high enough to become dangerous, and so they need to change to a different, stronger opiate. They develop a tolerance to that too. Eventually they're cycling through 2 or three different opiates (sometimes at the same time) at very high dose. And their pain is not being managed. > addicted to antipsychotics or insulin or antidepressants No tolerance, no seeking, no preoccupation, no continuing to take them when you know they're doing you harm -- those things are not addictive.
    - deleted 11y ago
      [deleted]
    - MichaelGG 11y ago
      What you keep saying in these threads is that opiates aren't effective. Why then do people continue to use them? Certainly if you're in pain, you're not taking a gram of morphine-equivalent per day just because. If there are effective alternatives, why are they not used? Then with pain under control, you can slowly (over a year, say) taper down.
      - DanBC 11y ago
        I'm not saying it. National organisations are saying it - Public Health England (part of government); the Faculty of Pain Medicine (part of the Royal College of Anaesthetists); NICE (The National Institute for Health and Care Excellence, a non-departmental public body) all say it. So, unusually, do the CDC: http://www.cdc.gov/vitalsigns/opioid-prescribing/index.html http://www.cdc.gov/vitalsigns/opioid-prescribing/index.html If they were effective and if addiction could be safely managed you wouldn't see increasing rates of people addicted, taking dangerous amounts, and dying of overdose. http://www.theguardian.com/us-news/2016/mar/17/cdc-guidelines-against-prescribing-opioids http://www.theguardian.com/us-news/2016/mar/17/cdc-guideline... People take opiates because doctors inappropriately prescribe them (in some countries); because the word "opiate" is well known; because people reject other treatments; and because people stick to the med they know. That's why co-proxamol (and very dangerous, ineffective medication, is still being prescribed today even though there are many other better meds). They continue taking them, at massive doses, because they're addicted. And that's the problem - if they were addicted but getting pain relief we could understand the continued use of opioids as first line treatment, but most people don't get good pain control with opiates for long term pain. They end up having to mix different meds, these combinations are often dangerous. https://www.theguardian.com/science/2014/dec/09/us-patients-opiate-painkillers-prescribed-dangerous-drug-cocktails https://www.theguardian.com/science/2014/dec/09/us-patients-...

DanBC 11y ago

A number of people in this thread are saying the answer is either to prescribe opiates, or to leave people in pain. People who need opiates should be able to get them, but that's a small number of people. Giving opiates to the rest does very little to treat their pain, and leaves them with an opiate addiction. Most people with long term pain don't need better access to opiates. They need better access to pain clinics with the range of meds and physical therapies they have. (And yes, opiates if those are needed.)

capote 11y ago

> No, it's a good thing. It means people that are addicted (by choice or not) don't need to resort to crime or desperation to buy essential medicines. This seems twisted to me. Okay, so they don't do crime, but they get their stuff easier and stay addicted/get worse/die. Isn't it best to eliminate the motivation for doctors to overprescribe, but still force people to see their doctors for a fix? This way maybe the doctors can intervene and help them out.

MichaelGG 11y ago
Don't understate the "do not do crime". I've known addicts and the biggest damage they cause (apart from dying when they OD on unknown-quality junk) is that they become thieves and liars. No one trusts them and it tears relationships apart. Both are fixed by having more legal availability. If they were simply able to get opiate as easily as pot, then addicts for the most part would be just like potheads. Perhaps being useless, perhaps seen as a drain or whatever, but not dangerous, not bad people like some junkies turn into. With proper availability, opiates are very well tolerated. Being addicted, by itself, is not a big deal. Apart from the negative pieces you see like this one, opiates are still a huge success for many people. Not just physical pain, but emotional pain, depression, and stress. Keep an eye out for pinned pupils and notice how many professionals have them. There's this stigma that addiction is inherently bad. Yet it only applies to "fun" drugs like opiates. No one, in general, goes on about the terribleness it is to be addicted to antipsychotics or insulin or antidepressants. At best, you hear how annoying it is, having to always make sure you've got your gear - but I've not seen people go on about the intrinsic badness of addictions lifesaving medications cause. What should be available is more public health awareness, and a cultural shift. People should be free to get addicted, but easily obtain services to help with it, without being labelled or criminalized. You don't need to rob people of liberty and cause suffering by requiring a paid gatekeeper to watch over everyone.
- DanBC 11y ago
  > With proper availability, opiates are very well tolerated. This just is not true. With proper availability people develop tolerance, and require higher doses. That does becomes high enough to become dangerous, and so they need to change to a different, stronger opiate. They develop a tolerance to that too. Eventually they're cycling through 2 or three different opiates (sometimes at the same time) at very high dose. And their pain is not being managed. > addicted to antipsychotics or insulin or antidepressants No tolerance, no seeking, no preoccupation, no continuing to take them when you know they're doing you harm -- those things are not addictive.
  - deleted 11y ago
    [deleted]
  - MichaelGG 11y ago
    What you keep saying in these threads is that opiates aren't effective. Why then do people continue to use them? Certainly if you're in pain, you're not taking a gram of morphine-equivalent per day just because. If there are effective alternatives, why are they not used? Then with pain under control, you can slowly (over a year, say) taper down.
    - DanBC 11y ago
      I'm not saying it. National organisations are saying it - Public Health England (part of government); the Faculty of Pain Medicine (part of the Royal College of Anaesthetists); NICE (The National Institute for Health and Care Excellence, a non-departmental public body) all say it. So, unusually, do the CDC: http://www.cdc.gov/vitalsigns/opioid-prescribing/index.html http://www.cdc.gov/vitalsigns/opioid-prescribing/index.html If they were effective and if addiction could be safely managed you wouldn't see increasing rates of people addicted, taking dangerous amounts, and dying of overdose. http://www.theguardian.com/us-news/2016/mar/17/cdc-guidelines-against-prescribing-opioids http://www.theguardian.com/us-news/2016/mar/17/cdc-guideline... People take opiates because doctors inappropriately prescribe them (in some countries); because the word "opiate" is well known; because people reject other treatments; and because people stick to the med they know. That's why co-proxamol (and very dangerous, ineffective medication, is still being prescribed today even though there are many other better meds). They continue taking them, at massive doses, because they're addicted. And that's the problem - if they were addicted but getting pain relief we could understand the continued use of opioids as first line treatment, but most people don't get good pain control with opiates for long term pain. They end up having to mix different meds, these combinations are often dangerous. https://www.theguardian.com/science/2014/dec/09/us-patients-opiate-painkillers-prescribed-dangerous-drug-cocktails https://www.theguardian.com/science/2014/dec/09/us-patients-...