4 ms·

Yeah, much of the 'opioid crisis' is entirely manufactured by how we've dealt with things. If doctors had recognized opioids as habit-forming and planned ahead

Yeah, much of the 'opioid crisis' is entirely manufactured by how we've dealt with things. If doctors had recognized opioids as habit-forming and planned ahead of time to wean patients off of them with a long period of gradual tapering down in dosage (so if it takes 6 months or more, so what?) before quitting. Instead, they decided 'addiction' was a moral failing and simply stopping giving anyone prescriptions no matter how legitimate the need. One thing that rarely gets mentioned is how abundantly SAFE opiates are. If you know what you're getting, know what dosage it is, and know it's not adulterated with other substances, you can use opiates for decades without significant health complications (aside from constipation). Overdoses primarily happen with people mixing medications, trying to use unfamiliar medications recreationally (nothing can save a stupid person who wants to get high but can't be bothered to figure out what the right dose for that is for their body mass), or, most often now, having to get things from a black market where the supply is unknown potency or contents. Fundamentally there is one group of people who is angry that other people are using a chemical to feel good because they feel that if other people aren't suffering as much as they have then they were cheated somehow. And they've been driving policy since the 80s, costing countless lives and monumental amounts of resources. Just to make sure no one has an easier time of life than they had.

DanBC 9y ago
> One thing that rarely gets mentioned is how abundantly SAFE opiates are. If you know what you're getting, know what dosage it is, and know it's not adulterated with other substances, you can use opiates for decades without significant health complications (aside from constipation). But there's little evidence that opioids are effective for treating long term pain. We know about 10% of people who take prescription opioids will become addicted, and that tends to be the people using them for chronic (long term) pain. > Fundamentally there is one group of people who is angry that other people are using a chemical to feel good because they feel that if other people aren't suffering as much as they have then they were cheated somehow. And they've been driving policy since the 80s, costing countless lives and monumental amounts of resources. Just to make sure no one has an easier time of life than they had No, that's wrong. There are people who see that opioids are massively over prescribed in the US, which is causing untold harm and death. Trying to cut back on that massive over-prescribing has to happen. The problem lies with a fucked up health system that doesn't provide drug & alcohol rehab; and just cuts people off from their meds cold turkey.
- otakucode 9y ago
  My original comment was unclear, I can see that from both replies I got. I was not claiming that opiates were effective for long-term pain relief. I wasn't addressing their ability to relieve pain at all. I was referring only to the toxicity and health consequences of long-term opiate use alone. I also do not specifically consider 'dependence' to be a negative consequences in the scenario I described because I specifically mentioned a reliable, known clean supply. SSRI anti-depressants are similarly heavily prescribed and cause tremendous dependence. That only becomes an issue if a substance has other health consequences, or supply is disrupted. There are a surprisingly large number of long-term wealthy opiate addicts who are not suffering from any sort of physical pain they are trying to cure. They are addicted, certainly, but manage their addiction like an alcoholic or smoker manages theirs. Unlike the alcoholic or smoker, however, they are unlikely to develop any cancers, cirrhosis, or other significant complications other than the constipation I mentioned. Constipation is inevitable because the gut has opioid receptors just like the brain does, only when those in the gut meet a receptor agonist, they stop gut movement. That's how Immodium A-D works. It's actually an opiate. But one formulated such that it will not cross the blood-brain barrier. Also, my later statement, about the people who want to make sure no one is having it easier than they are, was in reference to the moralizers and the original drives to make various substances illegal as well as the 1980s 'war on drugs' push and similar. Drugs are not illegal because they're bad for you. That was never the basis of any of the laws. Poisons are not illegal to produce, possess, or ingest, generally speaking. Only chemicals which make people happy are. Those concerned with dealing with the current opiate crisis certainly are not among that group of people simply angry that they didn't have the 'easy out' of popping a pill to be happy. I count myself among those deeply concerned. I live in West Virginia, a state with one of the highest rates of deaths from heroin overdose due to the restriction of the availability of prescription opiates with absolutely no attempt to provide any alternative to those dependent upon prescription opiates other than turning to heroin. Dependence is simply a fact of opiate use. It's not evil. And it's not intractable. It CAN be dealt with by doctors, if they educate themselves through sources other than lying pharma company reps and avoid the inane moral stance that a patient should be able to stop taking them suddenly and any failure to do so is a moral one. Taper their dosage down. Do it over 6 months or a year if necessary. They're not blowing out their liver or kidneys or anything, and opiates are among the cheapest drugs there are (the non-synthetics at least), so there is no reason to hurry and try to force the patient to bear the discomfort of withdrawal. There is a hidden big problem behind that, though. It will only really work with patients who do not have other issues in their life which make stopping the use of opiates untenable. As we know from animal research, if you put mammals in a restrictive, unstimulating environment, they will naturally turn to addiction. If put in a stimulating, pleasant environment, they will avoid addiction and even wean themselves off automatically... but that requires providing people with a better life. The simple fact is that many people have terrible lives and desperately want an escape. I'm not sure what can be done in those situations... it almost seems immoral to ask them to drop the only thing that makes them feel good and simply bear their situation because we don't like the idea the pills are helping them.
astura 9y ago
>One thing that rarely gets mentioned is how abundantly SAFE opiates are. If you know what you're getting, know what dosage it is, and know it's not adulterated with other substances, you can use opiates for decades without significant health complications (aside from constipation). It rarely gets mentioned because it's false. First off, opiates are usually inefficient for long term pain management. We, at least, have no evidence they are effective for long term (>2 months) pain management and if you actually talk to pain patients the problems with long term opiate use are very obvious. I'm not talking about junkies on the street either, I'm talking about normal people who are obtaining their medication legally through a licensed physician, not the black market. Patients often rapidly develop tolerance and then dependence. The can also induce hyperalgesia - a paradoxical increase in pain caused by long term opiate use, this is why patients on high doses of opiates usually feel less pain when weened off the drug. Additional side effects are disruption of hormone production, lethargy, listlessness, and sleep apnea. There's just SO MUCH we don't know about long term use bit it's very clear there is significant harm with questionable benefit in a subset of the population. >Fundamentally there is one group of people who is angry that other people are using a chemical to feel good because they feel that if other people aren't suffering as much as they have then they were cheated somehow Total nonsense.

DanBC 9y ago

> One thing that rarely gets mentioned is how abundantly SAFE opiates are. If you know what you're getting, know what dosage it is, and know it's not adulterated with other substances, you can use opiates for decades without significant health complications (aside from constipation). But there's little evidence that opioids are effective for treating long term pain. We know about 10% of people who take prescription opioids will become addicted, and that tends to be the people using them for chronic (long term) pain. > Fundamentally there is one group of people who is angry that other people are using a chemical to feel good because they feel that if other people aren't suffering as much as they have then they were cheated somehow. And they've been driving policy since the 80s, costing countless lives and monumental amounts of resources. Just to make sure no one has an easier time of life than they had No, that's wrong. There are people who see that opioids are massively over prescribed in the US, which is causing untold harm and death. Trying to cut back on that massive over-prescribing has to happen. The problem lies with a fucked up health system that doesn't provide drug & alcohol rehab; and just cuts people off from their meds cold turkey.

otakucode 9y ago
My original comment was unclear, I can see that from both replies I got. I was not claiming that opiates were effective for long-term pain relief. I wasn't addressing their ability to relieve pain at all. I was referring only to the toxicity and health consequences of long-term opiate use alone. I also do not specifically consider 'dependence' to be a negative consequences in the scenario I described because I specifically mentioned a reliable, known clean supply. SSRI anti-depressants are similarly heavily prescribed and cause tremendous dependence. That only becomes an issue if a substance has other health consequences, or supply is disrupted. There are a surprisingly large number of long-term wealthy opiate addicts who are not suffering from any sort of physical pain they are trying to cure. They are addicted, certainly, but manage their addiction like an alcoholic or smoker manages theirs. Unlike the alcoholic or smoker, however, they are unlikely to develop any cancers, cirrhosis, or other significant complications other than the constipation I mentioned. Constipation is inevitable because the gut has opioid receptors just like the brain does, only when those in the gut meet a receptor agonist, they stop gut movement. That's how Immodium A-D works. It's actually an opiate. But one formulated such that it will not cross the blood-brain barrier. Also, my later statement, about the people who want to make sure no one is having it easier than they are, was in reference to the moralizers and the original drives to make various substances illegal as well as the 1980s 'war on drugs' push and similar. Drugs are not illegal because they're bad for you. That was never the basis of any of the laws. Poisons are not illegal to produce, possess, or ingest, generally speaking. Only chemicals which make people happy are. Those concerned with dealing with the current opiate crisis certainly are not among that group of people simply angry that they didn't have the 'easy out' of popping a pill to be happy. I count myself among those deeply concerned. I live in West Virginia, a state with one of the highest rates of deaths from heroin overdose due to the restriction of the availability of prescription opiates with absolutely no attempt to provide any alternative to those dependent upon prescription opiates other than turning to heroin. Dependence is simply a fact of opiate use. It's not evil. And it's not intractable. It CAN be dealt with by doctors, if they educate themselves through sources other than lying pharma company reps and avoid the inane moral stance that a patient should be able to stop taking them suddenly and any failure to do so is a moral one. Taper their dosage down. Do it over 6 months or a year if necessary. They're not blowing out their liver or kidneys or anything, and opiates are among the cheapest drugs there are (the non-synthetics at least), so there is no reason to hurry and try to force the patient to bear the discomfort of withdrawal. There is a hidden big problem behind that, though. It will only really work with patients who do not have other issues in their life which make stopping the use of opiates untenable. As we know from animal research, if you put mammals in a restrictive, unstimulating environment, they will naturally turn to addiction. If put in a stimulating, pleasant environment, they will avoid addiction and even wean themselves off automatically... but that requires providing people with a better life. The simple fact is that many people have terrible lives and desperately want an escape. I'm not sure what can be done in those situations... it almost seems immoral to ask them to drop the only thing that makes them feel good and simply bear their situation because we don't like the idea the pills are helping them.

astura 9y ago

>One thing that rarely gets mentioned is how abundantly SAFE opiates are. If you know what you're getting, know what dosage it is, and know it's not adulterated with other substances, you can use opiates for decades without significant health complications (aside from constipation). It rarely gets mentioned because it's false. First off, opiates are usually inefficient for long term pain management. We, at least, have no evidence they are effective for long term (>2 months) pain management and if you actually talk to pain patients the problems with long term opiate use are very obvious. I'm not talking about junkies on the street either, I'm talking about normal people who are obtaining their medication legally through a licensed physician, not the black market. Patients often rapidly develop tolerance and then dependence. The can also induce hyperalgesia - a paradoxical increase in pain caused by long term opiate use, this is why patients on high doses of opiates usually feel less pain when weened off the drug. Additional side effects are disruption of hormone production, lethargy, listlessness, and sleep apnea. There's just SO MUCH we don't know about long term use bit it's very clear there is significant harm with questionable benefit in a subset of the population. >Fundamentally there is one group of people who is angry that other people are using a chemical to feel good because they feel that if other people aren't suffering as much as they have then they were cheated somehow Total nonsense.