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Excerpt: Doctors in many parts of the world — including Canada and some European countries — prescribe more powerful opiates than their peers in the United Stat
by danharaj 10y ago
Excerpt: Doctors in many parts of the world — including Canada and some European countries — prescribe more powerful opiates than their peers in the United States. In England, if, say, you get hit by a car, you may be given diamorphine (the medical name for heroin) to manage your pain. Some people take it for long periods. If what we’ve been told is right, they should become addicted in huge numbers.
But this doesn’t occur. The Canadian physician Gabor Maté argues in his book “In the Realm of Hungry Ghosts” that studies examining the medicinal use of narcotics for pain relief find no significant risk of addiction. I’ve talked with doctors in Canada and Europe about this very issue. They say it’s vanishingly rare for a patient given diamorphine or a comparably strong painkiller in a hospital setting to develop an addiction.
- anon4this1 10y agoDiamorphine is given IV/IM/SC - not orally - which generally means that its use is confined to a short period in the first few hours/days of a hospital admission until the patient can be switched to oral medication. Noone is sent home with diamorphine unless they are end stage palliative and they are on a home syringe driver to get it. OTOH oxycodone is almost always orally administered which means patients stay on it for longer in hospital and are commonly discharged with a prescription for more. The doctors I work with who have done fellowships in USA state that oxycodone is (?was) given out like lollywater compared to hospitals here, where it is only prescribed if the patient has a REALLY good reason they can't have oral morphine.
- DanBC 10y agoBut people in UK do get oramorph, which is a liquid oral morphine.
- anon4this1 10y agoPatients (and addicts) state there is a particular euphoria that oxycodone has (and diamorph/heroin) that morphine doesn't really have. Of course oral morphine does cause addiction, but oxycodone just seems to have greatly increased rates.
- robbiep 10y agoAlthough tablet formulations of diamorph also exist >The doctors I work with who have done fellowships in USA state that oxycodone is (?was) given out like lollywater compared to hospitals here, where it is only prescribed if the patient has a REALLY good reason they can't have oral morphine. My experience as a medical student on elective in the US was this - I couldn't believe the quantities of opiates prescribed cf. Australia
- tcbawo 10y agoI read this recently: Drug wholesalers shipped 780 million prescription painkillers to West Virginia over a six-year period. In a state of 1.84 million residents, the shipments amount to 433 pain pills for every man, woman and child in West Virginia. http://www.nbcwashington.com/news/local/Drug-Wholesalers-Shipped-780M-Pain-Pills-to-West-Virginia-407331135.html http://www.nbcwashington.com/news/local/Drug-Wholesalers-Shi...
- DanBC 10y agoIt's pretty well known that opioids for short term pain pose little risk of addiction; but opioids for long term pain are a bad idea. For long term pain opioids don't treat the pain, and they risk addiction. That's why we have things like "Opioids Aware": http://www.fpm.ac.uk/faculty-of-pain-medicine/opioids-aware http://www.fpm.ac.uk/faculty-of-pain-medicine/opioids-aware
- michaelmrose 10y agoWhat's the better alternative?
- mark_edward 10y agoThis is an odd question, but for people with chronic and essentially untreatable pains (which is many people, particularly older ones): What is the problem with being addicted to opiates if you are going to take them to manage that pain for the rest of your life anyway? I would want the opiates at that point.
- DanBC 10y agoThe opioids do not treat the pain! You end taking life threateningly high doses of opioids, which are not working to reduce your pain. People with chronic pain need other interventions - rapid access to specialist pain clinics being most important.