10 ms·

The problem with the backlash against opiod use in the US is that people who actually have to have the drugs are finding it increasingly harder to get. As a di

by oaf357 10y ago

The problem with the backlash against opiod use in the US is that people who actually have to have the drugs are finding it increasingly harder to get. As a disabled veteran with nerve damage I am rationing pain medication daily. I cannot afford to have a manageable pain day due to the fact I might have a week of excruciating pain. As you may or may not know, little can be done for functional nerve damage. Some experimental procedures are available but in general, only the symptoms can be treated. For me this means a lot of different muscle relaxers and an opiod for when things are beyond control. But, the opioids have become increasingly more difficult to get prescribed because of recent DEA rule changes and legislation affecting these medications. This basically means, for me at least, I will take my own life at some point as the pain will be too unbearable and I won't be able to acquire the medications necessary to control it.

markdown 10y ago
Is Kratom legal in your state? Many people use kratom to manage pain, while others use it to get off opioids.
- curuinor 10y ago
  Kratom is indeed not an opoid but still is a painkiller. However, unfortunately, it still can be addictive.
  - darpa_escapee 10y ago
    Kratom is 100% an opioid and is addictive in exactly the same way opiates and opioids are.
    - sudojudo 10y ago
      Could the next person please source their comment. Kratom seems a bit controversial.
      - darpa_escapee 10y ago
        There is no controversy unless one is fooled by Kratom peddlers' "non-addictive" rhetoric. I don't have the time to beyond Wikipedia, but there are sources cited in the article. A simple Google search would solve the problem here as well. The main active substances in Kratom are Mitragynine and 7-HO-Mitragynine. According to Wikipedia[0]: > Mitragynine is an indole-based opioid and the most abundant active alkaloid in the plant Mitragyna speciosa, commonly known as kratom[1] and biak-biak.[2] Dry kratom leaf contains roughly 1.2–2.1% mitragynine.[3] > Mitragynine itself acts primarily via μ-opioid receptors, though its oxidation product mitragynine pseudoindoxyl, acts as an even more potent and selective μ-opioid agonist but with less affinity for δ or κ receptors.[9][10] Another alkaloid with a major contribution to the μ-opioid activity of the kratom plant is the related compound 7-hydroxymitragynine, which, while present in the plant in much smaller quantities than mitragynine, is a much more potent μ-opioid partial agonist. Mu-opioid receptor agonism is how opioid drugs of abuse work. Kratom contains opioids that bind to mu-opioid receptors in the brain and opioids that bind to mu-opioid receptors in the brain cause opioid addiction. [0] https://en.wikipedia.org/wiki/Mitragynine https://en.wikipedia.org/wiki/Mitragynine
        GordonS 10y ago
        It's a bit more nuanced than you state - kratom also contains mu-opioid antagonists. Furthermore, mitragynine and 7-OH-mitragynine are G-protein-biased agonists of the mu-opioid receptor - which also do not recruit β-arrestin following receptor activation. It is β-arrestin recruitment that is responsible for the main side effects of opiates - respiratory depression, constipation, histamine release and build up of tolerance (which is what leads to withdrawals upon cessation). This is a very big deal, and may well go some way to explain why for many kratom has no withdrawal symptoms or addictive properties.
        darpa_escapee 10y ago
        > This is a very big deal, and may well go some way to explain why for many kratom has no withdrawal symptoms or addictive properties. Take Kratom every day for two weeks and get back to me. These are side effects you experience under Kratom intoxication: > respiratory depression, constipation, histamine release and build up of tolerance (which is what leads to withdrawals upon cessation) Each and every one of those. Anyway[0]: >RESULTS: More than half of the regular users (>6 month of use) developed severe Kratom dependence problems, while 45% showed a moderate Kratom dependence. Physical withdrawal symptoms commonly experienced include muscle spasms and pain, sleeping difficulty, watery eyes/nose, hot flashes, fever, decreased appetite, and diarrhoea. Psychological withdrawal symptoms commonly reported were restlessness, tension, anger, sadness, and nervousness. The average amount of the psychoactive compound, mitragynine, in a single dose of a Kratom drink was 79mg, suggesting an average daily intake of 276.5mg. Regular users who consumed ≥3 glasses Kratom per day, had higher odds of developing severe Kratom dependence, withdrawal symptoms, and inability to control Kratom craving. > CONCLUSIONS: The findings from this study show that regular Kratom use is associated with drug dependency, development of withdrawal symptoms, and craving. These symptoms become more severe with prolonged use and suggest a stronger control of the drug. [0] https://www.ncbi.nlm.nih.gov/pubmed/24698080 https://www.ncbi.nlm.nih.gov/pubmed/24698080
    - deleted 10y ago
      [deleted]
- bigbugbag 10y ago
  Isn't kratom for musculoskeletal pain ? Would it work for nerve pain ?
  - darpa_escapee 10y ago
    Kratom isn't indicated for anything. If the pain-relief can be mediated with drugs such as hydrocodone, tramadol, oxycodone and maybe even SSRIs, it is within the realm of possibility for Kratom to work for that type of pain.
  - deleted 10y ago
    [deleted]
- vt240 10y ago
  I use Kratom to manage lower back pain. It is about as effective as Tramadol with less side effects and contraindications for me. I'd give it a 1/10 on my addiction scale (with 1 - THC to 10 - A Year of Liquid Opium Poppy Daily Dose), and a 5/10 on my analgesic scale (1-Aspirin to 10-Opium Poppy). I don't think the mechanisms are well understood. It definitely wipes out opiate withdrawal symptoms within hours of taking a small dose. And I've never had any physical symptoms from even month long cessation. I like to say 'my' scale, because efficacy and addictive properties of opiates and opiate analogs like Tramadol and Kratom vary pretty wildly. Tramadol is known to have and Kratom also seems to havem some strong SSRI actions also, not found in the other opiate analogs, Oxycodone, Hydrocodone, or nartural opiates.
- wturner 10y ago
  I have horrid anxiety ( to the point where I can literally freeze up when put on-the-spot stressful situations ) and I use Kratom lightly to deal with it. I noticed I was using a bit more than I thought was reasonable and I decided to do a hard stop and check for side effects. Well, the side effect in my case was horrid restlessness and anxiousness. It lasted for about 5 days. There is no throwing up or headaches, but basically all the anxiety I was mitigating came rushing back times 3 and it's extremely unpleasant. When researching online I did not find anyone else with this experience. When you use Kratom consecutively it's easy to build a tolerance. At the time I was consuming about 2 tablespoons a day 7 days a week for about a month. Kratom when used sparingly is a good tool, but don't abuse it. Generally its doesn't "feel" addictive but don't assume that it is without side effects and use it lightly. I use it about 3 times a week and I limit my dosage to one teaspoon a day. This seems to give me the benefits without the side effects. I don't feel addicted to it and have no desire to consume more than this. Just a heads up :)
  - vt240 10y ago
    My friend who takes Kratom for his severe anxiety also suffers from the same amplification effect during withdrawal. From his discription, "unbearable agitation and electric bolts". I'm taking 1tsp/6hr daily but will typically stop taking it entirely when I can get the inflammation in my back down and the pain subsides. I've never really experienced more than a couple of days of what I would describe as mild agitation and unsettled feeling. I can' t even compare it with my opiate withdrawal symptoms of years past: 14 days of electric body, vomiting bile, uncontrolled bowls, violent chills and spending half the day in the tub and the other half in bed with a high fever, and etc. So you're not alone in your experience, and I always wrote it off as Kratom's actual metabolic action not being really well understood, and why I always think the comparison to Tramadol is better than other opiates.
  - GordonS 10y ago
    As a counter point, I've been taking 4x 3g doses almost every day for over a year, and there hasn't been any development of tolerance.
oxide 10y ago
This is the direct result of the "crackdown." It only increases diversion to the black market by directly increasing demand. My own grandparents have had to buy pain pills in the past. Doctors are terrified to prescribe painkillers to those in need lest they be prosecuted by laymen who think they know better. Pain is being under-treated now more than ever. My ER has a massive info-poster in the lobby explaining why I won't be receiving dilaudid, fentanyl, or oxycodone. Opiates are in the news every other day, either prescription abuse or fentanyl-laced heroin stories in local and national paper as well as cable news. What good has it done? There will always be abusers. Like DRM only hurting paying customers, stricter regulations and lawsuits against doctors ironically only end up hurting non-abusers. Dependent folks, like my grandparents, who get a massive quality of life increase thanks to these drugs, especially considering the lifetime of abuse they've put their bodies through, and been through. That's who ends up getting the shit end of the stick. Not the junkie. Someone's Grandma. A vet.
- zkms 10y ago
  > It only increases diversion to the black market by directly increasing demand. My own grandparents have had to buy pain pills in the past. Yes. I know people with chronic illnesses (of many types) who've had to resort to various black markets for opioids, all this stupid "diversion control" and trying to shit-test patients in the ED to see if they're "drug-seekers" actually has a deep and nasty cost. Of course someone who presents to the ED with a physical condition that causes immense pain is, inherently, going to be a "drug seeker". So now people need to be all "tsundere" about that (i-it's not like i WANTED you to prescribe me opioids, or anything, BAKA!), and pretend that they don't know what drug/dosage works for them (apparently, it's only opium-seeky people who know anything technical about opioids) even if they're well-versed about what works for them and their medical condition. It's a very nasty and adversarial state of affairs, that screws over everyone. The DEA (and other flavours of doorkickers) targeting doctors and deputising them as law-enforcement agents who have to decide between the evil undeserving addicts and the deserving patients in pain is what has created this affair. Blame the prohibitionists, as this is a problem of their own making -- the crackdowns on "pill mills" and "overprescribing doctors" is what denies people a safe and legal source of pharmaceutical-grade opioids and forces them onto the black market of illegal, overpriced, and fentanyl-contaminated opioids (which leads, of course, to the deaths that are used to justify even more crackdowns). Crackdowns on "over-prescribing" invariably lead to people who experience chronic pain being denied medical access (or being subjected to extremely invasive and degrading treatment to weed out "drug seekers"). The DEA cracking skulls over opioids and investigating doctors is literally the only reason illicit fentanyl (and its even more dangerous analogues like carfentanil) even is a thing. I am so very doubtful that more door-kicking and prosecutions will miraculously work after decades of it making shit worse.
ScottBurson 10y ago
Did you see this? https://news.ycombinator.com/item?id=13760598 https://news.ycombinator.com/item?id=13760598
careersuicide 10y ago
I think what's missed most in all of the talk about opiods lately is that there are people who need them just to function, and not for reasons of addiction. In January of 2014 I broke my hand. Not just a fracture. I completely shattered my second metacarpal in my right hand (my dominant hand) and did extensive damage to the surrounding tendons, ligaments, and skin. The surgeon who put my hand back together said it looked like a gunshot exit wound without a corresponding entrance wound. The entire top of my hand had been flayed open. After the surgery I was given hydrocodone, enough for a week. The only reason I didn't just kill myself that week was because I had pain killers. When the dose would wear off the pain was unreal, blinding, and totally consuming. The only worse pain I've ever been in was the night I broke my hand. Needless to say I had the prescription refilled weekly until my second surgery three months later to take out all of the pins. And again for three months after that until my third surgery to release the tendons so I could use my hand again. And for three months after that while I did thrice weekly physical therapy. I cannot emphasize enough how much I needed the pain killers just to get through life for those nine months. Even with them there were some nights I couldn't sleep because the pain in my hand was so severe. Of course, by the end of the nine months I was pretty well physically addicted, but, knowing my time was up I tapered off and haven't needed them since. For another six months I still needed frequent acetaminophen and ibuprofen to take the edge off of the throbbing in my hand. I'm not saying at all that there isn't a problem big with opiod addiction. But recent conversations I've seen about opiods leave me with the impression that most people just don't get it. They think that either people just need to deal with pain or that some sort of non-medicine alternative is what's needed for most people on opiods. And that may be true for some. But unless you've been in the kind of pain that makes you seriously consider killing yourself I don't really think you can appreciate just how important opiod pain killers are to some people. I'm afraid we're going to lose something that helps a great deal of people all because we have this idea that addiction is somehow a moral failing and we've structured drug policies around that belief.
- poikniok 10y ago
  Hope you don't mind me asking, but given how horrifying the hand injury sounds I thought I might inquire, what happened that broke your hand? The only thing I can think of that might result in an injury like that is maybe a severe cycling crash? Regardless hope you are doing well now!
srinivgp 10y ago
Yep. My wife regularly decides to under-medicate rather than risk having to radically under-medicate later. And politicians attack the weak to appear strong, and we the weak sometimes have to cry ourselves to sleep, or die, or whatever is needed to cope.
Mo3 10y ago
I have to ask, have you tried cannabis for your nerve pain?
- logicallee 10y ago
  I second this question. Cannabis is so benign it's literally legal in several states. It's less addictive than alcohol. Everyone smokes it everywhere regardless of legality: you know several recreational pot smokers (for sure), or people who did it in the past. (And then simply stopped.) I realize you would end up "high" but I, too, am curious whether you've ever tried it. Given your description and the fact that you almost certainly wouldn't get in trouble. I realize you work in IT and maybe don't want to get high, so I don't mean to imply that this is a good alternative - just curious, like the other poster. Thank you.
  - Mo3 10y ago
    Just to add to this, you don't end up being high for long. As tolerance sets in, psychoactive effects decrease and CBD-related pain and anxiety effects increase.
  - sergior 10y ago
    For me it worked much better than opioids, but where I live it is illegal and not all variety works the same. It is a real shame and makes me feel sad, because it could be real life changer for me. I tried things like CBD oil that is legal, but it is not the same and doesn't really work. I work in the IT and being high is out of question, sadly it is difficult in the black market to obtain variety that would work for pain without such side effects. It was helpful in the evening to go through the night without waking up from pain. Other medication like for example Amitriptyline, would make you feel tired the next day which is not the case with cannabis. But I don't want to be a criminal.
curun1r 10y ago
Have you ever tried meditation? For me, it's completely redefined my relationship with pain. I realized how little of my pain was physical. The vast majority was my mind exaggerating the physical pain that I felt. I now see how monks are able to self immolate without reacting to that pain. I don't have anything approaching their ability, but I have been able to entirely stop taking pain killers and I had a serious injury misdiagnosed because the doctor didn't think I was exhibiting the pain associated with that injury.
bigbugbag 10y ago
You could look into pain management techniques to turn the unbearable pain into hopefully a bearable one. Meditation, breathing techniques, biofeedback,... that kind of thing. I don't know if this applies to nerve damage pain, but cannabis has a quite a history of being effective with pain.
thret 10y ago
I know that as a veteran, you are more likely to take your own life simply because you have the courage to do it. Please don't though! Anything but that. This is the only game in town, so play it all the way through. And thank you for your service.
michaf 10y ago
Probably you know about the opioid alternatives, but did you try anticonvulsants [1] for your nerve pain? I had nerve damage after a surgical procedure, and opioids did not really help. A doctor suggested to try Gabapentin, which greatly reduced pain down to tolerable levels. While anticonvulsants probably have their own risks, they seem much less addictive than opioids, and are probably easier to get on prescription. [1] https://en.wikipedia.org/wiki/Anticonvulsant https://en.wikipedia.org/wiki/Anticonvulsant
- sergior 10y ago
  I was prescribed Gabapentin for neuropathic pain and it did little for the pain but brought in a whole lot of nasty side effects. I was feeling terribly sick and everyday getting more depressed and thinking I am going to die and then severe anxiety came in that lasted for months after I stopped taking this medication. I am back on opioids now.
  - michaf 10y ago
    Sorry to hear that. For me the only side effect was some drowsiness, but I heard that it can come with more severe side effects for others. Best of luck with your further pain management!
  - GordonS 10y ago
    I also tried gabapentin for suspected nerve damage, and it made me feel like I was drunk - that's not a state that would allow me to live a normal life, working, driving etc
DanBC 10y ago
There is no evidence of efficacy of high dose opioids for long term pain. https://www.rcoa.ac.uk/faculty-of-pain-medicine/opioids-aware/clinical-use-of-opioids/effectiveness-for-long-term-pain https://www.rcoa.ac.uk/faculty-of-pain-medicine/opioids-awar... Self poisoning is a common method of suicide (second most common in the US) and opioid medication are the most common meds used.
- GordonS 10y ago
  Actually, I came across a paper recently which did find long term opioid use effective. I'm on mobile now, but if I remember later I'll post a link.
  - DanBC 10y ago
    Cool, but I linked to a review of many papers, including systematic reviews. Your single study is going to have to be remarkable to persuade me over that.
erik_landerholm 10y ago
Have you tried CBD?
brianwawok 10y ago
So there are two big camps of people going to the doctor for pain med (gross simplification, obvious it is more of a spectrum). People like you, that need the pain meds to live. And people that have a "bad back" aka they grab their back and groan and act like it hurts to get a powerful drug and be high (or sell for a nice profit). If I understand pain theory correctly, there isn't really a good way for a doctor to do a test and say "you are really in insane pain" vs "2 advils will cure you". Then the choice is either: a) Be generous with pain meds. Some abusers that don't need it will get them to either use or resell. Some will lead to deaths, due to addiction or increased supply on the black market. But all people in real pain are treated. b) Be stingy with pain meds. Some legit people in pain could end up taking their own life due to not being able to live with the pain. But there will be less deaths and addiction outside of people in pain. As a society, it seems a hard choice. Either way some very vulnerable people are going to be hurt. Ideally we would come up with better pain meds with no abuse potential, but that doesn't help things right now.
- biofox 10y ago
  I'm not sure the outcome for option B is so clear cut. Removing access to medication doesn't remove the primary cause driving people to seek drugs, be it pain or psychological issues. I suspect people with high abuse potential will just resort to alternatives: street drugs or alcohol.
  - brianwawok 10y ago
    Perhaps, perhaps not. It depends where you stand on the war on drugs. It seems fairly common that professional working people get on an opioid for something (say a fall), and then become addicted. These people can live for years on the Opioid, perhaps working a professional job. Now sure, if you ban opioid they could go and buy some black tar heroine and meth... but I am doubtful 100% of people would make that jump. Alcohol is a different beast. Obviously some people become addicted, let's call it 10%. But 10% addiction rate is a lot lower than a 99% addiction rate that long term opioid use has. So the net benefit of less opioids is almost certainty going to be less people addicted to drugs.
DougN7 10y ago
My wife is in a similar situation. I've heard pain killers only become addictive if you take them when not in pain. But when you're in excruciating pain, and the meds only dull the pain somewhat, there is no addictive euphoria taking place. So people like my wife who have been on them for a decade, and probably will for the rest of her life, could taper down and give them up very quickly if their pain went away.

by oaf357 10y ago

markdown 10y ago

Is Kratom legal in your state? Many people use kratom to manage pain, while others use it to get off opioids.

curuinor 10y ago
Kratom is indeed not an opoid but still is a painkiller. However, unfortunately, it still can be addictive.
- darpa_escapee 10y ago
  Kratom is 100% an opioid and is addictive in exactly the same way opiates and opioids are.
  - sudojudo 10y ago
    Could the next person please source their comment. Kratom seems a bit controversial.
    - darpa_escapee 10y ago
      There is no controversy unless one is fooled by Kratom peddlers' "non-addictive" rhetoric. I don't have the time to beyond Wikipedia, but there are sources cited in the article. A simple Google search would solve the problem here as well. The main active substances in Kratom are Mitragynine and 7-HO-Mitragynine. According to Wikipedia[0]: > Mitragynine is an indole-based opioid and the most abundant active alkaloid in the plant Mitragyna speciosa, commonly known as kratom[1] and biak-biak.[2] Dry kratom leaf contains roughly 1.2–2.1% mitragynine.[3] > Mitragynine itself acts primarily via μ-opioid receptors, though its oxidation product mitragynine pseudoindoxyl, acts as an even more potent and selective μ-opioid agonist but with less affinity for δ or κ receptors.[9][10] Another alkaloid with a major contribution to the μ-opioid activity of the kratom plant is the related compound 7-hydroxymitragynine, which, while present in the plant in much smaller quantities than mitragynine, is a much more potent μ-opioid partial agonist. Mu-opioid receptor agonism is how opioid drugs of abuse work. Kratom contains opioids that bind to mu-opioid receptors in the brain and opioids that bind to mu-opioid receptors in the brain cause opioid addiction. [0] https://en.wikipedia.org/wiki/Mitragynine https://en.wikipedia.org/wiki/Mitragynine
      - GordonS 10y ago
        It's a bit more nuanced than you state - kratom also contains mu-opioid antagonists. Furthermore, mitragynine and 7-OH-mitragynine are G-protein-biased agonists of the mu-opioid receptor - which also do not recruit β-arrestin following receptor activation. It is β-arrestin recruitment that is responsible for the main side effects of opiates - respiratory depression, constipation, histamine release and build up of tolerance (which is what leads to withdrawals upon cessation). This is a very big deal, and may well go some way to explain why for many kratom has no withdrawal symptoms or addictive properties.
        darpa_escapee 10y ago
        > This is a very big deal, and may well go some way to explain why for many kratom has no withdrawal symptoms or addictive properties. Take Kratom every day for two weeks and get back to me. These are side effects you experience under Kratom intoxication: > respiratory depression, constipation, histamine release and build up of tolerance (which is what leads to withdrawals upon cessation) Each and every one of those. Anyway[0]: >RESULTS: More than half of the regular users (>6 month of use) developed severe Kratom dependence problems, while 45% showed a moderate Kratom dependence. Physical withdrawal symptoms commonly experienced include muscle spasms and pain, sleeping difficulty, watery eyes/nose, hot flashes, fever, decreased appetite, and diarrhoea. Psychological withdrawal symptoms commonly reported were restlessness, tension, anger, sadness, and nervousness. The average amount of the psychoactive compound, mitragynine, in a single dose of a Kratom drink was 79mg, suggesting an average daily intake of 276.5mg. Regular users who consumed ≥3 glasses Kratom per day, had higher odds of developing severe Kratom dependence, withdrawal symptoms, and inability to control Kratom craving. > CONCLUSIONS: The findings from this study show that regular Kratom use is associated with drug dependency, development of withdrawal symptoms, and craving. These symptoms become more severe with prolonged use and suggest a stronger control of the drug. [0] https://www.ncbi.nlm.nih.gov/pubmed/24698080 https://www.ncbi.nlm.nih.gov/pubmed/24698080
  - deleted 10y ago
    [deleted]
bigbugbag 10y ago
Isn't kratom for musculoskeletal pain ? Would it work for nerve pain ?
- darpa_escapee 10y ago
  Kratom isn't indicated for anything. If the pain-relief can be mediated with drugs such as hydrocodone, tramadol, oxycodone and maybe even SSRIs, it is within the realm of possibility for Kratom to work for that type of pain.
- deleted 10y ago
  [deleted]
vt240 10y ago
I use Kratom to manage lower back pain. It is about as effective as Tramadol with less side effects and contraindications for me. I'd give it a 1/10 on my addiction scale (with 1 - THC to 10 - A Year of Liquid Opium Poppy Daily Dose), and a 5/10 on my analgesic scale (1-Aspirin to 10-Opium Poppy). I don't think the mechanisms are well understood. It definitely wipes out opiate withdrawal symptoms within hours of taking a small dose. And I've never had any physical symptoms from even month long cessation. I like to say 'my' scale, because efficacy and addictive properties of opiates and opiate analogs like Tramadol and Kratom vary pretty wildly. Tramadol is known to have and Kratom also seems to havem some strong SSRI actions also, not found in the other opiate analogs, Oxycodone, Hydrocodone, or nartural opiates.
wturner 10y ago
I have horrid anxiety ( to the point where I can literally freeze up when put on-the-spot stressful situations ) and I use Kratom lightly to deal with it. I noticed I was using a bit more than I thought was reasonable and I decided to do a hard stop and check for side effects. Well, the side effect in my case was horrid restlessness and anxiousness. It lasted for about 5 days. There is no throwing up or headaches, but basically all the anxiety I was mitigating came rushing back times 3 and it's extremely unpleasant. When researching online I did not find anyone else with this experience. When you use Kratom consecutively it's easy to build a tolerance. At the time I was consuming about 2 tablespoons a day 7 days a week for about a month. Kratom when used sparingly is a good tool, but don't abuse it. Generally its doesn't "feel" addictive but don't assume that it is without side effects and use it lightly. I use it about 3 times a week and I limit my dosage to one teaspoon a day. This seems to give me the benefits without the side effects. I don't feel addicted to it and have no desire to consume more than this. Just a heads up :)
- vt240 10y ago
  My friend who takes Kratom for his severe anxiety also suffers from the same amplification effect during withdrawal. From his discription, "unbearable agitation and electric bolts". I'm taking 1tsp/6hr daily but will typically stop taking it entirely when I can get the inflammation in my back down and the pain subsides. I've never really experienced more than a couple of days of what I would describe as mild agitation and unsettled feeling. I can' t even compare it with my opiate withdrawal symptoms of years past: 14 days of electric body, vomiting bile, uncontrolled bowls, violent chills and spending half the day in the tub and the other half in bed with a high fever, and etc. So you're not alone in your experience, and I always wrote it off as Kratom's actual metabolic action not being really well understood, and why I always think the comparison to Tramadol is better than other opiates.
- GordonS 10y ago
  As a counter point, I've been taking 4x 3g doses almost every day for over a year, and there hasn't been any development of tolerance.

oxide 10y ago

This is the direct result of the "crackdown." It only increases diversion to the black market by directly increasing demand. My own grandparents have had to buy pain pills in the past. Doctors are terrified to prescribe painkillers to those in need lest they be prosecuted by laymen who think they know better. Pain is being under-treated now more than ever. My ER has a massive info-poster in the lobby explaining why I won't be receiving dilaudid, fentanyl, or oxycodone. Opiates are in the news every other day, either prescription abuse or fentanyl-laced heroin stories in local and national paper as well as cable news. What good has it done? There will always be abusers. Like DRM only hurting paying customers, stricter regulations and lawsuits against doctors ironically only end up hurting non-abusers. Dependent folks, like my grandparents, who get a massive quality of life increase thanks to these drugs, especially considering the lifetime of abuse they've put their bodies through, and been through. That's who ends up getting the shit end of the stick. Not the junkie. Someone's Grandma. A vet.

zkms 10y ago
> It only increases diversion to the black market by directly increasing demand. My own grandparents have had to buy pain pills in the past. Yes. I know people with chronic illnesses (of many types) who've had to resort to various black markets for opioids, all this stupid "diversion control" and trying to shit-test patients in the ED to see if they're "drug-seekers" actually has a deep and nasty cost. Of course someone who presents to the ED with a physical condition that causes immense pain is, inherently, going to be a "drug seeker". So now people need to be all "tsundere" about that (i-it's not like i WANTED you to prescribe me opioids, or anything, BAKA!), and pretend that they don't know what drug/dosage works for them (apparently, it's only opium-seeky people who know anything technical about opioids) even if they're well-versed about what works for them and their medical condition. It's a very nasty and adversarial state of affairs, that screws over everyone. The DEA (and other flavours of doorkickers) targeting doctors and deputising them as law-enforcement agents who have to decide between the evil undeserving addicts and the deserving patients in pain is what has created this affair. Blame the prohibitionists, as this is a problem of their own making -- the crackdowns on "pill mills" and "overprescribing doctors" is what denies people a safe and legal source of pharmaceutical-grade opioids and forces them onto the black market of illegal, overpriced, and fentanyl-contaminated opioids (which leads, of course, to the deaths that are used to justify even more crackdowns). Crackdowns on "over-prescribing" invariably lead to people who experience chronic pain being denied medical access (or being subjected to extremely invasive and degrading treatment to weed out "drug seekers"). The DEA cracking skulls over opioids and investigating doctors is literally the only reason illicit fentanyl (and its even more dangerous analogues like carfentanil) even is a thing. I am so very doubtful that more door-kicking and prosecutions will miraculously work after decades of it making shit worse.

ScottBurson 10y ago

Did you see this? https://news.ycombinator.com/item?id=13760598 https://news.ycombinator.com/item?id=13760598

careersuicide 10y ago

I think what's missed most in all of the talk about opiods lately is that there are people who need them just to function, and not for reasons of addiction. In January of 2014 I broke my hand. Not just a fracture. I completely shattered my second metacarpal in my right hand (my dominant hand) and did extensive damage to the surrounding tendons, ligaments, and skin. The surgeon who put my hand back together said it looked like a gunshot exit wound without a corresponding entrance wound. The entire top of my hand had been flayed open. After the surgery I was given hydrocodone, enough for a week. The only reason I didn't just kill myself that week was because I had pain killers. When the dose would wear off the pain was unreal, blinding, and totally consuming. The only worse pain I've ever been in was the night I broke my hand. Needless to say I had the prescription refilled weekly until my second surgery three months later to take out all of the pins. And again for three months after that until my third surgery to release the tendons so I could use my hand again. And for three months after that while I did thrice weekly physical therapy. I cannot emphasize enough how much I needed the pain killers just to get through life for those nine months. Even with them there were some nights I couldn't sleep because the pain in my hand was so severe. Of course, by the end of the nine months I was pretty well physically addicted, but, knowing my time was up I tapered off and haven't needed them since. For another six months I still needed frequent acetaminophen and ibuprofen to take the edge off of the throbbing in my hand. I'm not saying at all that there isn't a problem big with opiod addiction. But recent conversations I've seen about opiods leave me with the impression that most people just don't get it. They think that either people just need to deal with pain or that some sort of non-medicine alternative is what's needed for most people on opiods. And that may be true for some. But unless you've been in the kind of pain that makes you seriously consider killing yourself I don't really think you can appreciate just how important opiod pain killers are to some people. I'm afraid we're going to lose something that helps a great deal of people all because we have this idea that addiction is somehow a moral failing and we've structured drug policies around that belief.

poikniok 10y ago
Hope you don't mind me asking, but given how horrifying the hand injury sounds I thought I might inquire, what happened that broke your hand? The only thing I can think of that might result in an injury like that is maybe a severe cycling crash? Regardless hope you are doing well now!

srinivgp 10y ago

Yep. My wife regularly decides to under-medicate rather than risk having to radically under-medicate later. And politicians attack the weak to appear strong, and we the weak sometimes have to cry ourselves to sleep, or die, or whatever is needed to cope.

Mo3 10y ago

I have to ask, have you tried cannabis for your nerve pain?

logicallee 10y ago
I second this question. Cannabis is so benign it's literally legal in several states. It's less addictive than alcohol. Everyone smokes it everywhere regardless of legality: you know several recreational pot smokers (for sure), or people who did it in the past. (And then simply stopped.) I realize you would end up "high" but I, too, am curious whether you've ever tried it. Given your description and the fact that you almost certainly wouldn't get in trouble. I realize you work in IT and maybe don't want to get high, so I don't mean to imply that this is a good alternative - just curious, like the other poster. Thank you.
- Mo3 10y ago
  Just to add to this, you don't end up being high for long. As tolerance sets in, psychoactive effects decrease and CBD-related pain and anxiety effects increase.
- sergior 10y ago
  For me it worked much better than opioids, but where I live it is illegal and not all variety works the same. It is a real shame and makes me feel sad, because it could be real life changer for me. I tried things like CBD oil that is legal, but it is not the same and doesn't really work. I work in the IT and being high is out of question, sadly it is difficult in the black market to obtain variety that would work for pain without such side effects. It was helpful in the evening to go through the night without waking up from pain. Other medication like for example Amitriptyline, would make you feel tired the next day which is not the case with cannabis. But I don't want to be a criminal.

curun1r 10y ago

Have you ever tried meditation? For me, it's completely redefined my relationship with pain. I realized how little of my pain was physical. The vast majority was my mind exaggerating the physical pain that I felt. I now see how monks are able to self immolate without reacting to that pain. I don't have anything approaching their ability, but I have been able to entirely stop taking pain killers and I had a serious injury misdiagnosed because the doctor didn't think I was exhibiting the pain associated with that injury.

bigbugbag 10y ago

You could look into pain management techniques to turn the unbearable pain into hopefully a bearable one. Meditation, breathing techniques, biofeedback,... that kind of thing. I don't know if this applies to nerve damage pain, but cannabis has a quite a history of being effective with pain.

thret 10y ago

I know that as a veteran, you are more likely to take your own life simply because you have the courage to do it. Please don't though! Anything but that. This is the only game in town, so play it all the way through. And thank you for your service.

michaf 10y ago

Probably you know about the opioid alternatives, but did you try anticonvulsants [1] for your nerve pain? I had nerve damage after a surgical procedure, and opioids did not really help. A doctor suggested to try Gabapentin, which greatly reduced pain down to tolerable levels. While anticonvulsants probably have their own risks, they seem much less addictive than opioids, and are probably easier to get on prescription. [1] https://en.wikipedia.org/wiki/Anticonvulsant https://en.wikipedia.org/wiki/Anticonvulsant

sergior 10y ago
I was prescribed Gabapentin for neuropathic pain and it did little for the pain but brought in a whole lot of nasty side effects. I was feeling terribly sick and everyday getting more depressed and thinking I am going to die and then severe anxiety came in that lasted for months after I stopped taking this medication. I am back on opioids now.
- michaf 10y ago
  Sorry to hear that. For me the only side effect was some drowsiness, but I heard that it can come with more severe side effects for others. Best of luck with your further pain management!
- GordonS 10y ago
  I also tried gabapentin for suspected nerve damage, and it made me feel like I was drunk - that's not a state that would allow me to live a normal life, working, driving etc

DanBC 10y ago

There is no evidence of efficacy of high dose opioids for long term pain. https://www.rcoa.ac.uk/faculty-of-pain-medicine/opioids-aware/clinical-use-of-opioids/effectiveness-for-long-term-pain https://www.rcoa.ac.uk/faculty-of-pain-medicine/opioids-awar... Self poisoning is a common method of suicide (second most common in the US) and opioid medication are the most common meds used.

GordonS 10y ago
Actually, I came across a paper recently which did find long term opioid use effective. I'm on mobile now, but if I remember later I'll post a link.
- DanBC 10y ago
  Cool, but I linked to a review of many papers, including systematic reviews. Your single study is going to have to be remarkable to persuade me over that.

erik_landerholm 10y ago

Have you tried CBD?

brianwawok 10y ago

So there are two big camps of people going to the doctor for pain med (gross simplification, obvious it is more of a spectrum). People like you, that need the pain meds to live. And people that have a "bad back" aka they grab their back and groan and act like it hurts to get a powerful drug and be high (or sell for a nice profit). If I understand pain theory correctly, there isn't really a good way for a doctor to do a test and say "you are really in insane pain" vs "2 advils will cure you". Then the choice is either: a) Be generous with pain meds. Some abusers that don't need it will get them to either use or resell. Some will lead to deaths, due to addiction or increased supply on the black market. But all people in real pain are treated. b) Be stingy with pain meds. Some legit people in pain could end up taking their own life due to not being able to live with the pain. But there will be less deaths and addiction outside of people in pain. As a society, it seems a hard choice. Either way some very vulnerable people are going to be hurt. Ideally we would come up with better pain meds with no abuse potential, but that doesn't help things right now.

biofox 10y ago
I'm not sure the outcome for option B is so clear cut. Removing access to medication doesn't remove the primary cause driving people to seek drugs, be it pain or psychological issues. I suspect people with high abuse potential will just resort to alternatives: street drugs or alcohol.
- brianwawok 10y ago
  Perhaps, perhaps not. It depends where you stand on the war on drugs. It seems fairly common that professional working people get on an opioid for something (say a fall), and then become addicted. These people can live for years on the Opioid, perhaps working a professional job. Now sure, if you ban opioid they could go and buy some black tar heroine and meth... but I am doubtful 100% of people would make that jump. Alcohol is a different beast. Obviously some people become addicted, let's call it 10%. But 10% addiction rate is a lot lower than a 99% addiction rate that long term opioid use has. So the net benefit of less opioids is almost certainty going to be less people addicted to drugs.

DougN7 10y ago

My wife is in a similar situation. I've heard pain killers only become addictive if you take them when not in pain. But when you're in excruciating pain, and the meds only dull the pain somewhat, there is no addictive euphoria taking place. So people like my wife who have been on them for a decade, and probably will for the rest of her life, could taper down and give them up very quickly if their pain went away.