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Mostly wrong. Pills were given out like candy, then restricted which caused demand for cheaper alternatives. Had the drug companies been regulated in the first

Mostly wrong. Pills were given out like candy, then restricted which caused demand for cheaper alternatives. Had the drug companies been regulated in the first place, we might be OK. The pills aren't coming from mules or cartels, they are coming from US companies. The pill supply has to lowered. edit to add: http://www.latimes.com/projects/oxycontin-part1/ http://www.latimes.com/projects/oxycontin-part1/

rwmj 10y ago
The pill supply has to lowered ... in the past. However now the US made that mistake, what's the problem with continuing to give out the pills "like candy", although with tighter controls to make sure that they don't go to create new addicts?
- devopsproject 10y ago
  They don't need to be given out like candy. That's the point. The supply needs to be drastically reduced to prevent new addicts and we should be looking at what other countries are doing for their existing addicts: safe injection sites etc.
- DanBC 10y ago
  People with pain deserve treatment for that pain. For people with short term pain, or who are at the end of life, opioids can be a good choice. For people with long term pain opioids can, rarely, be a good choice, if other things have been tried first, and if there's a careful package of care. Most people with long term pain need variations of / combinations of: 1) Access to evidence based pain management specialist clinics 2) Graded strength building exercise (for musculo-skeletal, not for nerve) 3) Medication that isn't opioids Giving opioids to people with long term pain isn't a good way of controlling their pain (they develop a tolerance) and risks severe harm (on top of addiction). Here's a website from the English Faculty of Pain Medicine, which is part of the Royal College of Anaesthetists. They explain it far better than I can. http://www.fpm.ac.uk/faculty-of-pain-medicine/opioids-aware http://www.fpm.ac.uk/faculty-of-pain-medicine/opioids-aware
  - nyolfen 10y ago
    some possibly sunny news: experiments with a new fentanyl-derived opioid that acts only as a local analgesic and doesn't cross into the brain, meaning no high, non-addictive, and one can't overdose. this is very preliminary (rat experiments) but i'm hopeful: https://arstechnica.com/science/2017/03/tweaking-fentanyls-chemical-structure-may-create-safer-opioid/ https://arstechnica.com/science/2017/03/tweaking-fentanyls-c...
  - curun1r 10y ago
    I'm not sure if this is inherent in your #1, but there should be an increased focus on alternative methods for dealing with pain. For instance, since starting meditation training, I haven't needed so much as a single Ibuprofen. It's not that my incidence of pain has decreased, but my way of thinking about/reacting to that pain has changed dramatically and I can now make just about any pain quickly fade into the background. It's also helped me to clarify the difference between pain and injury to know when I can push through the pain and when I need to pull back and rest. I learned an important lesson, however. Doctors will frequently use the amount of pain someone is experiencing as a diagnostic aid when determining a patient's diagnosis. I had a ruptured eardrum that I saw a doctor for and that doctor misdiagnosed it because I wasn't showing any signs of pain and that injury is supposed to be excruciating. The doctor explained to me that if it was ruptured, I'd be near tears and screaming for pain medication.
    - DanBC 10y ago
      Yes, I agree. Whenever I've mentioned cognitive behaviour therapy for pain control, or meditation for pain control, it derailed conversation into discussion about pain that was "real" or "all in the head", with some people refusing to see that in some cases there's no difference: the patient is in real pain, the pain is debilitating, and the treatment has a psychological component.
johan_larson 10y ago
> Had the drug companies been regulated in the first place, we might be OK. What are you talking about? Everything in medicine is highly regulated. Introducing a new drug is a very expensive process, run in the US by the FDA. It takes all sorts of expensive tests and trials to be allowed to sell a new medicine in the US. Maybe the process messed up in this case. Sure. Many things are possible. But this was regulated start to finish.
thearn4 10y ago
> Had the drug companies been regulated in the first place Were they given out without prescription? If not, I feel like MDs have to share some blame on this.
- cmdrfred 10y ago
  MD's are often compensated based on patient assessments. "Rate your doctor" sort of things. How do you think opioid addicts rate doctors who tell them they have had enough?

rwmj 10y ago

The pill supply has to lowered ... in the past. However now the US made that mistake, what's the problem with continuing to give out the pills "like candy", although with tighter controls to make sure that they don't go to create new addicts?

devopsproject 10y ago
They don't need to be given out like candy. That's the point. The supply needs to be drastically reduced to prevent new addicts and we should be looking at what other countries are doing for their existing addicts: safe injection sites etc.
DanBC 10y ago
People with pain deserve treatment for that pain. For people with short term pain, or who are at the end of life, opioids can be a good choice. For people with long term pain opioids can, rarely, be a good choice, if other things have been tried first, and if there's a careful package of care. Most people with long term pain need variations of / combinations of: 1) Access to evidence based pain management specialist clinics 2) Graded strength building exercise (for musculo-skeletal, not for nerve) 3) Medication that isn't opioids Giving opioids to people with long term pain isn't a good way of controlling their pain (they develop a tolerance) and risks severe harm (on top of addiction). Here's a website from the English Faculty of Pain Medicine, which is part of the Royal College of Anaesthetists. They explain it far better than I can. http://www.fpm.ac.uk/faculty-of-pain-medicine/opioids-aware http://www.fpm.ac.uk/faculty-of-pain-medicine/opioids-aware
- nyolfen 10y ago
  some possibly sunny news: experiments with a new fentanyl-derived opioid that acts only as a local analgesic and doesn't cross into the brain, meaning no high, non-addictive, and one can't overdose. this is very preliminary (rat experiments) but i'm hopeful: https://arstechnica.com/science/2017/03/tweaking-fentanyls-chemical-structure-may-create-safer-opioid/ https://arstechnica.com/science/2017/03/tweaking-fentanyls-c...
- curun1r 10y ago
  I'm not sure if this is inherent in your #1, but there should be an increased focus on alternative methods for dealing with pain. For instance, since starting meditation training, I haven't needed so much as a single Ibuprofen. It's not that my incidence of pain has decreased, but my way of thinking about/reacting to that pain has changed dramatically and I can now make just about any pain quickly fade into the background. It's also helped me to clarify the difference between pain and injury to know when I can push through the pain and when I need to pull back and rest. I learned an important lesson, however. Doctors will frequently use the amount of pain someone is experiencing as a diagnostic aid when determining a patient's diagnosis. I had a ruptured eardrum that I saw a doctor for and that doctor misdiagnosed it because I wasn't showing any signs of pain and that injury is supposed to be excruciating. The doctor explained to me that if it was ruptured, I'd be near tears and screaming for pain medication.
  - DanBC 10y ago
    Yes, I agree. Whenever I've mentioned cognitive behaviour therapy for pain control, or meditation for pain control, it derailed conversation into discussion about pain that was "real" or "all in the head", with some people refusing to see that in some cases there's no difference: the patient is in real pain, the pain is debilitating, and the treatment has a psychological component.

johan_larson 10y ago

> Had the drug companies been regulated in the first place, we might be OK. What are you talking about? Everything in medicine is highly regulated. Introducing a new drug is a very expensive process, run in the US by the FDA. It takes all sorts of expensive tests and trials to be allowed to sell a new medicine in the US. Maybe the process messed up in this case. Sure. Many things are possible. But this was regulated start to finish.

thearn4 10y ago

> Had the drug companies been regulated in the first place Were they given out without prescription? If not, I feel like MDs have to share some blame on this.

cmdrfred 10y ago
MD's are often compensated based on patient assessments. "Rate your doctor" sort of things. How do you think opioid addicts rate doctors who tell them they have had enough?