6 ms·

I remember that about a decade ago, doctors and others were criticizing the DEA for being draconian in their regulations surrounding opiate prescriptions. They

I remember that about a decade ago, doctors and others were criticizing the DEA for being draconian in their regulations surrounding opiate prescriptions. They were complaining that doctors often felt that they couldn't prescribe even when there was legitimate need. I don't know what happened in the interim, whether or how the DEA's policies changed, but if only we had draconian DEA policies aggressively stopping overprescription now. As someone who used to naively believe in legalizing all drugs for recreational use, this addiction epidemic has opened my eyes to why that's a horrible idea.

DanBC 9y ago
> I don't know what happened in the interim The VA noticed a lot of people had untreated pain. They pushed a campaign to make pain the fifth vital sign. Every time someone went into a hospital they'd be asked about pain. Pain was seen as something that absolutely must be treated. They also said that opioids are not addictive if prescribed for pain. It turns out that both of these are mostly wrong. If someone is in pain they'll tell you, you don't need to ask. And if someone has chronic pain they can become addicted to opioids. The VA withdrew that document. Here's a Google cache: https://webcache.googleusercontent.com/search?q=cache:pUQ-mcAJtGwJ:https://www.va.gov/PAINMANAGEMENT/docs/Pain_As_the_5th_Vital_Sign_Toolkit.pdf+&cd=1&hl=en&ct=clnk&gl=uk https://webcache.googleusercontent.com/search?q=cache:pUQ-mc... We knew some time ago that it didn't help. Here's a report from 2006: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1924634/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1924634/
- mjevans 9y ago
  Actually I agree with asking about pain. If someone's REALLY in pain they'll tell you, but if it's "minor suffering" some are predisposed to tough it out. I can't remember having ever been in 'real pain', maybe for that the addictive drugs should be considered under a monitored regime. For lesser pain something lighter should be used.
mgkimsal 9y ago
> but if only we had draconian DEA policies aggressively stopping overprescription now. Not sure what the policies are now, but around me, I can not go get any prescription for any back pain (have really needed it twice in the past 3 years). "Nope, go see your GP" (vs going to a walk-in clinic). The walk-ins around here all have signs on the front door saying "no prescriptions for oxycontin, etc" Now... yes, I could try to "see my GP", which generally means waiting a few days. (and, I don't really have a GP anymore, because I can never get in to see him). What's strange is that about... 6 years ago, going to one of the same clinics, my wife went with an eye problem. Specifically, she'd had a small piece of sand get in her eye, and it was really sort/irritated. Home flushing wasn't working, so we went to the clinic. As she was leaving, they asked if she felt she needed any pain medication. "Well, not really, but it's a bit sore, and I do have a headache". They gave her a script for 14 oxycontin on the spot. Same place last year would not even talk to me about pain medication ("go see your GP").
- nxc18 9y ago
  Those practices (handing out oxy) are a major contributor to the current epidemic, if not the root cause. I've gotten opiate prescriptions I had no business having without asking. I get that some people need pain medication or will suffer, but there's a whole lot of suffering that opiate addiction causes and that is not really factored into the 'do no harm' calculation doctors are supposed to be doing. It really is a great thing to see legitimate restrictions on these prescriptions, as that should cut down on new addicts at the very least.
  - thearn4 9y ago
    I guess part of this is doctors overprescribing to prevent patient complaints, based on how much patient satisfaction surveys are used to rate their year over year performance. I don't know if its the AMA to blame for that or not, but everyone in the system seems to think its an upstream problem.
  - pkaye 9y ago
    I'm hearing on the one side that these legal prescriptions are causing the problems but on the other had others say that these drugs being illegal is causing the problem and if we made them legal that people will use them in a safe manner. If people get addicted them when prescribed legally then how can making them legal have any hope?
WalterBright 9y ago
> why that's a horrible idea Making drugs that people want illegal has never worked. Why should it work now? Besides, the drugs being illegal increases the death rate from them, because users now have little idea of what they are taking, and overdose easily.
- sp332 9y ago
  Prohibition worked pretty well from a public health perspective. https://en.wikipedia.org/wiki/Prohibition_in_the_United_States#Rates_of_consumption_during_Prohibition https://en.wikipedia.org/wiki/Prohibition_in_the_United_Stat... It was the organized crime that was the problem.
  - nsgi 9y ago
    Organised crime is bad for public health
    - sp332 9y ago
      On balance it's still a win. Alcoholism kills a lot of people.
      - koolba 9y ago
        Depends on what you're measuring. If it's pure death rates sure but throw in quality of life and it's not as clear cut. I personally wouldn't want to live in a world where I can't enjoy a glass of whiskey.
        sp332 9y ago
        That's not going to offset fetal alcohol syndrome or people raised by drunk parents or recovered alcoholics living with health issues for the rest of their lives.
        koolba 9y ago
notadoc 9y ago
> As someone who used to naively believe in legalizing all drugs for recreational use, this addiction epidemic has opened my eyes to why that's a horrible idea. You may be surprised to learn that opium and cocaine used to be sold widely at pharmacies over the counter. Curiously, there was not a widespread "epidemic" of addiction. Why is that? Alcohol and nicotine are legal and ubiquitous, where are the epidemics of their addiction? Curiously, smoking has been declining despite it being widely available and very addictive. Blaming the existence of a substance for addiction, and then harassing doctors and patients as a result, is nearing the height of absurdity.
- maxerickson 9y ago
  Don't both alcohol and nicotine have far more dependent users than opioids? What is the comparison meant to illustrate? That easy availability will increase use and that the effects of the drug are the more important matter?

DanBC 9y ago

> I don't know what happened in the interim The VA noticed a lot of people had untreated pain. They pushed a campaign to make pain the fifth vital sign. Every time someone went into a hospital they'd be asked about pain. Pain was seen as something that absolutely must be treated. They also said that opioids are not addictive if prescribed for pain. It turns out that both of these are mostly wrong. If someone is in pain they'll tell you, you don't need to ask. And if someone has chronic pain they can become addicted to opioids. The VA withdrew that document. Here's a Google cache: https://webcache.googleusercontent.com/search?q=cache:pUQ-mcAJtGwJ:https://www.va.gov/PAINMANAGEMENT/docs/Pain_As_the_5th_Vital_Sign_Toolkit.pdf+&cd=1&hl=en&ct=clnk&gl=uk https://webcache.googleusercontent.com/search?q=cache:pUQ-mc... We knew some time ago that it didn't help. Here's a report from 2006: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1924634/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1924634/

mjevans 9y ago
Actually I agree with asking about pain. If someone's REALLY in pain they'll tell you, but if it's "minor suffering" some are predisposed to tough it out. I can't remember having ever been in 'real pain', maybe for that the addictive drugs should be considered under a monitored regime. For lesser pain something lighter should be used.

mgkimsal 9y ago

> but if only we had draconian DEA policies aggressively stopping overprescription now. Not sure what the policies are now, but around me, I can not go get any prescription for any back pain (have really needed it twice in the past 3 years). "Nope, go see your GP" (vs going to a walk-in clinic). The walk-ins around here all have signs on the front door saying "no prescriptions for oxycontin, etc" Now... yes, I could try to "see my GP", which generally means waiting a few days. (and, I don't really have a GP anymore, because I can never get in to see him). What's strange is that about... 6 years ago, going to one of the same clinics, my wife went with an eye problem. Specifically, she'd had a small piece of sand get in her eye, and it was really sort/irritated. Home flushing wasn't working, so we went to the clinic. As she was leaving, they asked if she felt she needed any pain medication. "Well, not really, but it's a bit sore, and I do have a headache". They gave her a script for 14 oxycontin on the spot. Same place last year would not even talk to me about pain medication ("go see your GP").

nxc18 9y ago
Those practices (handing out oxy) are a major contributor to the current epidemic, if not the root cause. I've gotten opiate prescriptions I had no business having without asking. I get that some people need pain medication or will suffer, but there's a whole lot of suffering that opiate addiction causes and that is not really factored into the 'do no harm' calculation doctors are supposed to be doing. It really is a great thing to see legitimate restrictions on these prescriptions, as that should cut down on new addicts at the very least.
- thearn4 9y ago
  I guess part of this is doctors overprescribing to prevent patient complaints, based on how much patient satisfaction surveys are used to rate their year over year performance. I don't know if its the AMA to blame for that or not, but everyone in the system seems to think its an upstream problem.
- pkaye 9y ago
  I'm hearing on the one side that these legal prescriptions are causing the problems but on the other had others say that these drugs being illegal is causing the problem and if we made them legal that people will use them in a safe manner. If people get addicted them when prescribed legally then how can making them legal have any hope?

WalterBright 9y ago

> why that's a horrible idea Making drugs that people want illegal has never worked. Why should it work now? Besides, the drugs being illegal increases the death rate from them, because users now have little idea of what they are taking, and overdose easily.

sp332 9y ago
Prohibition worked pretty well from a public health perspective. https://en.wikipedia.org/wiki/Prohibition_in_the_United_States#Rates_of_consumption_during_Prohibition https://en.wikipedia.org/wiki/Prohibition_in_the_United_Stat... It was the organized crime that was the problem.
- nsgi 9y ago
  Organised crime is bad for public health
  - sp332 9y ago
    On balance it's still a win. Alcoholism kills a lot of people.
    - koolba 9y ago
      Depends on what you're measuring. If it's pure death rates sure but throw in quality of life and it's not as clear cut. I personally wouldn't want to live in a world where I can't enjoy a glass of whiskey.
      - sp332 9y ago
        That's not going to offset fetal alcohol syndrome or people raised by drunk parents or recovered alcoholics living with health issues for the rest of their lives.
        koolba 9y ago

notadoc 9y ago

> As someone who used to naively believe in legalizing all drugs for recreational use, this addiction epidemic has opened my eyes to why that's a horrible idea. You may be surprised to learn that opium and cocaine used to be sold widely at pharmacies over the counter. Curiously, there was not a widespread "epidemic" of addiction. Why is that? Alcohol and nicotine are legal and ubiquitous, where are the epidemics of their addiction? Curiously, smoking has been declining despite it being widely available and very addictive. Blaming the existence of a substance for addiction, and then harassing doctors and patients as a result, is nearing the height of absurdity.

maxerickson 9y ago
Don't both alcohol and nicotine have far more dependent users than opioids? What is the comparison meant to illustrate? That easy availability will increase use and that the effects of the drug are the more important matter?