5 ms·

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

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!
- careersuicide 10y ago
  So, apparently everyone else in the entire world gets the "don't touch garage door springs" talk from a parent or other responsible adult as a child. I didn't (and my brother did!!!). About six months after moving into my house I was fed up with the janky garage door opener that came with it so I went to Home Depot and bought a new one. I managed to assemble the new one myself with only a few hiccups. It then came time to remove the old garage door opener. I first took down the actual motor unit that was attached to the ceiling and got it set on the ground with the rail still attached. The end of the rail was attached to a metal bracket that formed a right angle with lots of holes for bolts to go through[0] which was then attached to the drywall above the garage door. I got up on a ladder and set to removing the bolts. The last bolt, unbeknownst to me, was attached to a piece of metal through which the garage door spring went [1]. What happened next all tool place within maybe 1/4 a second. As soon as I turned the socket wrench enough to loosen the bolt I heard a loud pop and felt something hit my hand. HARD. I looked down at my hand and saw blood. "No big deal, I cut myself on things all the time. We've got lots of bandages." Then I noticed the subcutaneous tissue (your hand doesn't have much, but there's still enough that deep cuts look different). "Okay this is gonna need stitches, I better get down and take care of this." And then I saw the bone. "ohfuckohfuckohfuck." I hopped down off the ladder and ran inside and started screaming "CALL 911!!!" to my girlfriend who was upstairs. I made it to the kitchen where I got a dish towel, put my hand on the counter, and clamped down as hard as I could. The paramedics arrived about 5 minutes later (we live very close to a fire station). By then I'd calmed down but was so full of adrenaline I could barely hear or see anything. At one point I blanked out for maybe 30 seconds? I'm not entirely sure. The EMT said it was an adrenaline dump and that it was fairly normal. Of course when I got to the ER every single nurse who heard the story said I was lucky to be alive. If it had hit my head it would have caved in my skull (and I was on a ladder...). Apparently that happens more than you'd think. They eventually hooked me up with a drip of hydromorphone. "This is the good stuff." one nurse said. Bullshit. I was in so much pain it barely did anything. It brought it from 10/10 to 9.5/10. That's using my new 10 point scale. I thought I'd experienced a 10 before when one time my dentist started drilling before the lidocaine had fully kicked in. I'd put that at about a 6 now. I really cannot describe in words how bad the pain that night and the following months was. My hand is a lot better now though. The third surgery gave me back my mobility and the physical therapy got me back up to about 60% of the strength I had before. I'll never be able to point straight with my right index finger, but I can make a fist and type. As a programmer both are very important. [0]: Exactly like this https://mobileimages.lowes.com/product/converted/040395/040395515567.jpg https://mobileimages.lowes.com/product/converted/040395/0403... [1]: Basically this, except mine is shaped slightly different http://www.truetex.com/gar913.jpg http://www.truetex.com/gar913.jpg
DanBC 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. I think what's missed is that there's no evidence that long term high dose opioid use does anything to treat pain. We have lots of evidence of harm caused by long term use of opioid medication. The problem with the current US crackdown on opioids is not reduced use of opioids, but with the lack of anything else being offered. People with long term pain need a package of care, probably provided by specialists in pain management. That package should include exercise (where indicated), psychological help, alternative prescribing, and if needed some opioid prescribing.
- GordonS 10y ago
  Anecdotal, but I've been taking opioids for over a year now, to treat pain caused by suspected nerve damage (I couldn't tolerate gabapentin and a slew of other non-opioid medications), and they still work just fine. I'm also not an addict and feel no compulsion to take them other than for reducing otherwise unbearable pain.
  - noir_lord 10y ago
    I'm on Gabapentin, what was it that you couldn't tolerate if you don't mind me asking? The only thing I noticed when I started taking it (other than the fact I could actually function again) was that it makes me tired and the withdrawal if I forget to take it/forget to fill a script is pretty horrible.
    - epmaybe 10y ago
      If I understand gabapentin can sometimes cause hypersensitivity reactions.
    - GordonS 10y ago
      It made me feel like I was drunk, so I couldn't work, drive, safely look after the kids, or generally live normally. I had the same thing with pregbalin.

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!

careersuicide 10y ago
So, apparently everyone else in the entire world gets the "don't touch garage door springs" talk from a parent or other responsible adult as a child. I didn't (and my brother did!!!). About six months after moving into my house I was fed up with the janky garage door opener that came with it so I went to Home Depot and bought a new one. I managed to assemble the new one myself with only a few hiccups. It then came time to remove the old garage door opener. I first took down the actual motor unit that was attached to the ceiling and got it set on the ground with the rail still attached. The end of the rail was attached to a metal bracket that formed a right angle with lots of holes for bolts to go through[0] which was then attached to the drywall above the garage door. I got up on a ladder and set to removing the bolts. The last bolt, unbeknownst to me, was attached to a piece of metal through which the garage door spring went [1]. What happened next all tool place within maybe 1/4 a second. As soon as I turned the socket wrench enough to loosen the bolt I heard a loud pop and felt something hit my hand. HARD. I looked down at my hand and saw blood. "No big deal, I cut myself on things all the time. We've got lots of bandages." Then I noticed the subcutaneous tissue (your hand doesn't have much, but there's still enough that deep cuts look different). "Okay this is gonna need stitches, I better get down and take care of this." And then I saw the bone. "ohfuckohfuckohfuck." I hopped down off the ladder and ran inside and started screaming "CALL 911!!!" to my girlfriend who was upstairs. I made it to the kitchen where I got a dish towel, put my hand on the counter, and clamped down as hard as I could. The paramedics arrived about 5 minutes later (we live very close to a fire station). By then I'd calmed down but was so full of adrenaline I could barely hear or see anything. At one point I blanked out for maybe 30 seconds? I'm not entirely sure. The EMT said it was an adrenaline dump and that it was fairly normal. Of course when I got to the ER every single nurse who heard the story said I was lucky to be alive. If it had hit my head it would have caved in my skull (and I was on a ladder...). Apparently that happens more than you'd think. They eventually hooked me up with a drip of hydromorphone. "This is the good stuff." one nurse said. Bullshit. I was in so much pain it barely did anything. It brought it from 10/10 to 9.5/10. That's using my new 10 point scale. I thought I'd experienced a 10 before when one time my dentist started drilling before the lidocaine had fully kicked in. I'd put that at about a 6 now. I really cannot describe in words how bad the pain that night and the following months was. My hand is a lot better now though. The third surgery gave me back my mobility and the physical therapy got me back up to about 60% of the strength I had before. I'll never be able to point straight with my right index finger, but I can make a fist and type. As a programmer both are very important. [0]: Exactly like this https://mobileimages.lowes.com/product/converted/040395/040395515567.jpg https://mobileimages.lowes.com/product/converted/040395/0403... [1]: Basically this, except mine is shaped slightly different http://www.truetex.com/gar913.jpg http://www.truetex.com/gar913.jpg

DanBC 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. I think what's missed is that there's no evidence that long term high dose opioid use does anything to treat pain. We have lots of evidence of harm caused by long term use of opioid medication. The problem with the current US crackdown on opioids is not reduced use of opioids, but with the lack of anything else being offered. People with long term pain need a package of care, probably provided by specialists in pain management. That package should include exercise (where indicated), psychological help, alternative prescribing, and if needed some opioid prescribing.

GordonS 10y ago
Anecdotal, but I've been taking opioids for over a year now, to treat pain caused by suspected nerve damage (I couldn't tolerate gabapentin and a slew of other non-opioid medications), and they still work just fine. I'm also not an addict and feel no compulsion to take them other than for reducing otherwise unbearable pain.
- noir_lord 10y ago
  I'm on Gabapentin, what was it that you couldn't tolerate if you don't mind me asking? The only thing I noticed when I started taking it (other than the fact I could actually function again) was that it makes me tired and the withdrawal if I forget to take it/forget to fill a script is pretty horrible.
  - epmaybe 10y ago
    If I understand gabapentin can sometimes cause hypersensitivity reactions.
  - GordonS 10y ago
    It made me feel like I was drunk, so I couldn't work, drive, safely look after the kids, or generally live normally. I had the same thing with pregbalin.