4 ms·

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 p

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.
  - mannykannot 10y ago
    The response of abusers to the reduction of everyone's access to medication does not depend on where you stand on the war on drugs; it is, or will be, a matter of fact. Maybe more evidence is needed, but pseudo-quantitative arguments with made-up statistics that support your view on the war on drugs are not evidence.
    - brianwawok 10y ago
      The response of abusers to the reduction of everyone's access to medication does not depend on where you stand on the war on drugs; it is, or will be, a matter of fact. Sure. But your willingness to WANT this outcome will depend on your stance on the war of drugs. A blanket ban of all opioids with a harsh prison sentence (say, crack-cocaine level) would both decrease opioid addiction, and increase prison population. Your stance on the war of drugs will point to if you think this is a good trade off or not. Maybe more evidence is needed, but pseudo-quantitative arguments with made-up statistics that support your view on the war on drugs are not evidence. My view on the war of drugs has little to this argument. However as mentioned above, your feelings on it may influence how you feel about the broader opioid epidemic and how you want to react to it.
      - mannykannot 10y ago
        I would recommend an approach that is more evidence-based.
  - GordonS 10y ago
    99% addiction rate? Source please.
DanBC 10y ago
> 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). This is an almost offensively simplistic depiction of long term pain. Those people with the bad backs are not all faking it; it's not all in their heads; they have real pain and it's debilitating. They need something to help them live. And your A / B choices are wrong too. You give people with long term pain access to pain management clinics which include psychological support; explanation that pain treatment will usually not be able to prevent pain; access to physiotheray and exercise (although these don't do much for some types of long term pain) and access to medication - and this will sometimes be opioid meds. > As a society Why is the US getting it so wrong though? Why is the US prescribing such vast quantities of opioids?
- brianwawok 10y ago
  > Those people with the bad backs are not all faking it; it's not all in their heads; they have real pain and it's debilitating. They need something to help them live. I am not sure if we agree or disagree. There ARE legit people with bad backs that need and should get pain meds. There are also millions of people with a prescription to an Opiod that have no actual pain. For example, see https://www.theatlantic.com/health/archive/2017/02/kentucky-opioids/515775/ https://www.theatlantic.com/health/archive/2017/02/kentucky-... Are you telling me almost 1 in every 2 people in that town have debilitating pain, and NEED Opiods to survive day to day? I cannot believe that is true. > Why is the US getting it so wrong though? Why is the US prescribing such vast quantities of opioids? Many reasons. a) Doctors get paid to do stuff. If you refuse to give medicine, no one will come to you, and you won't get money. So in the doctors financial interest to prescribe. b) Some people really DO need medicine. Do you risk screwing those that DO need it to spite the rest of the people? c) Culture. American lifestyle loves pop a pill to fix a problem. If you can equally fix something with physical therapy or a pill, 9/10 people will pop a pill.
  - DanBC 10y ago
    I'm telling you that people with severe pain need treatment for that pain, but also that if the pain is long term that treatment is probably not opioid meds. People with real pain sometimes should not be given opioids. Your suggestion (that the problem is fixed if we stop giving opioids to people who aren't in pain) misses the fact that most of the opioid problem is because people in real actual pain have been misprescribed opioids.
SomeStupidPoint 10y ago
The problem you elide is that switching from A to B, as the US has done, can take a lot of time. In the transition, you drive the usage of illegal drugs through the roof and spike the number of deaths. It's possible that these behaviors, once prevalent, take generations to switch out of, by which time, it's entirely possible that our formulation of drugs will be better. So even if B would be better now, it's possible that our transition from A to B is pointless (the problem would have solved itself in the same time) and leads to a worse outcome than just remaining with plan A. This kind of secondary analysis is usually totally missing from these debates, but is what is actually driving the harm of the opioid crisis.
- brianwawok 10y ago
  For sure, this is true about almost any kind of debate like this. One view is to say that you may need to have short term struggles to get to a long term better place. Which may be true, but it also depends if the new long term place is actually a better place - or did you do a lot of short term struggles for nothing?
- joshjje 10y ago
  Not to mention that that increase in illegal market usage gives more fuel to the fire for people to believe or be led to believe that more of the same restrictions are necessary, a self fulfilling prophecy almost. Of course its not that simple, but seems to be what happens.
intrasight 10y ago
There is a third choice: c) Develop that missing test
- brianwawok 10y ago
  Sure, I know nothing about this. Can you do some kind of brain scan while you poke someone in the injury, see what kind of pain registers?
  - intrasight 10y ago
    That's pretty much what would be involved. "You say 'it hurts'. Let's see what your brain says". Probably in few years time these new "quantum diamond NV centers" will be able to do this in a doctor's office. https://phys.org/news/2016-12-neural-quantum-sensors.html https://phys.org/news/2016-12-neural-quantum-sensors.html
  - beagle3 10y ago
    Medasense seems to have a solution for that, without actually requiring a brain scan. The technology was developed for assessing pain/discomfort of unconscious people - who can't participate in the "which face best describes you" assessment game
mannykannot 10y ago
Given the persistence of the completely-illegal drugs market, I do not think you can assume that option b) will reduce deaths or addiction.

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.
- mannykannot 10y ago
  The response of abusers to the reduction of everyone's access to medication does not depend on where you stand on the war on drugs; it is, or will be, a matter of fact. Maybe more evidence is needed, but pseudo-quantitative arguments with made-up statistics that support your view on the war on drugs are not evidence.
  - brianwawok 10y ago
    The response of abusers to the reduction of everyone's access to medication does not depend on where you stand on the war on drugs; it is, or will be, a matter of fact. Sure. But your willingness to WANT this outcome will depend on your stance on the war of drugs. A blanket ban of all opioids with a harsh prison sentence (say, crack-cocaine level) would both decrease opioid addiction, and increase prison population. Your stance on the war of drugs will point to if you think this is a good trade off or not. Maybe more evidence is needed, but pseudo-quantitative arguments with made-up statistics that support your view on the war on drugs are not evidence. My view on the war of drugs has little to this argument. However as mentioned above, your feelings on it may influence how you feel about the broader opioid epidemic and how you want to react to it.
    - mannykannot 10y ago
      I would recommend an approach that is more evidence-based.
- GordonS 10y ago
  99% addiction rate? Source please.

DanBC 10y ago

> 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). This is an almost offensively simplistic depiction of long term pain. Those people with the bad backs are not all faking it; it's not all in their heads; they have real pain and it's debilitating. They need something to help them live. And your A / B choices are wrong too. You give people with long term pain access to pain management clinics which include psychological support; explanation that pain treatment will usually not be able to prevent pain; access to physiotheray and exercise (although these don't do much for some types of long term pain) and access to medication - and this will sometimes be opioid meds. > As a society Why is the US getting it so wrong though? Why is the US prescribing such vast quantities of opioids?

brianwawok 10y ago
> Those people with the bad backs are not all faking it; it's not all in their heads; they have real pain and it's debilitating. They need something to help them live. I am not sure if we agree or disagree. There ARE legit people with bad backs that need and should get pain meds. There are also millions of people with a prescription to an Opiod that have no actual pain. For example, see https://www.theatlantic.com/health/archive/2017/02/kentucky-opioids/515775/ https://www.theatlantic.com/health/archive/2017/02/kentucky-... Are you telling me almost 1 in every 2 people in that town have debilitating pain, and NEED Opiods to survive day to day? I cannot believe that is true. > Why is the US getting it so wrong though? Why is the US prescribing such vast quantities of opioids? Many reasons. a) Doctors get paid to do stuff. If you refuse to give medicine, no one will come to you, and you won't get money. So in the doctors financial interest to prescribe. b) Some people really DO need medicine. Do you risk screwing those that DO need it to spite the rest of the people? c) Culture. American lifestyle loves pop a pill to fix a problem. If you can equally fix something with physical therapy or a pill, 9/10 people will pop a pill.
- DanBC 10y ago
  I'm telling you that people with severe pain need treatment for that pain, but also that if the pain is long term that treatment is probably not opioid meds. People with real pain sometimes should not be given opioids. Your suggestion (that the problem is fixed if we stop giving opioids to people who aren't in pain) misses the fact that most of the opioid problem is because people in real actual pain have been misprescribed opioids.

SomeStupidPoint 10y ago

The problem you elide is that switching from A to B, as the US has done, can take a lot of time. In the transition, you drive the usage of illegal drugs through the roof and spike the number of deaths. It's possible that these behaviors, once prevalent, take generations to switch out of, by which time, it's entirely possible that our formulation of drugs will be better. So even if B would be better now, it's possible that our transition from A to B is pointless (the problem would have solved itself in the same time) and leads to a worse outcome than just remaining with plan A. This kind of secondary analysis is usually totally missing from these debates, but is what is actually driving the harm of the opioid crisis.

brianwawok 10y ago
For sure, this is true about almost any kind of debate like this. One view is to say that you may need to have short term struggles to get to a long term better place. Which may be true, but it also depends if the new long term place is actually a better place - or did you do a lot of short term struggles for nothing?
joshjje 10y ago
Not to mention that that increase in illegal market usage gives more fuel to the fire for people to believe or be led to believe that more of the same restrictions are necessary, a self fulfilling prophecy almost. Of course its not that simple, but seems to be what happens.

intrasight 10y ago

There is a third choice: c) Develop that missing test

brianwawok 10y ago
Sure, I know nothing about this. Can you do some kind of brain scan while you poke someone in the injury, see what kind of pain registers?
- intrasight 10y ago
  That's pretty much what would be involved. "You say 'it hurts'. Let's see what your brain says". Probably in few years time these new "quantum diamond NV centers" will be able to do this in a doctor's office. https://phys.org/news/2016-12-neural-quantum-sensors.html https://phys.org/news/2016-12-neural-quantum-sensors.html
- beagle3 10y ago
  Medasense seems to have a solution for that, without actually requiring a brain scan. The technology was developed for assessing pain/discomfort of unconscious people - who can't participate in the "which face best describes you" assessment game

mannykannot 10y ago

Given the persistence of the completely-illegal drugs market, I do not think you can assume that option b) will reduce deaths or addiction.