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All opioids are addictive. Doctors have to weigh the risks against the benefits, just like they do for any other treatment. Do they err in the direction of ov

All opioids are addictive. Doctors have to weigh the risks against the benefits, just like they do for any other treatment. Do they err in the direction of over-prescribing? Probably. But to say that opioids should never be given to anyone who is not terminally ill would be to err in the opposite direction.

alkonaut 9y ago
The normal practice in most other places (which doctors should be automatically investigated for, if systematically diverging from) is to only prescribe the most potent opioids in exceptional cases such as to terminally ill cancer patients. This seems to work pretty well. EDIT: added "exceptional cases" - this can be other cases than just cancer, see e.g reply
- carbocation 9y ago
  Medicine is not so black-and-white.
  - alkonaut 9y ago
    It's not. But the practice of prescribing opioids is wildly different in other countries. So the base assumptions when weighing the benefits and drawbacks (addiction) need to change. Basically, doctors should try more alternatives and doctors need to tell patients that the pain may be the lesser evil compared to opioids. This also requires changed expectations from patients, about what doctors can do about pain.
- cperciva 9y ago
  I agree that the most powerful opioids should be used very sparingly. But that's quite different from restricting the use of addictive opioids -- which is to say, all of them.
  - alkonaut 9y ago
    Yes, this is only really a discussion about the most potent opioids like oxycodone, and only for long term prescription use. Use of opioids in an IV in a hospital after a major surgery isn't what's discussed. That happens everywhere and doesn't seem to cause addiction problems.
- xenadu02 9y ago
  My wife had to have a full spinal fusion. You probably don’t even have the mental tools necessary to start thinking about that kind of pain. The sort of pain that causes people to consider suicide as a preferable alternative. Because of the intense back pain leading up to the surgery she was already taking high opiate doses. After the surgery she was taking doses of hydromorphone (5x as strong as morphine) that would kill you or me with a single dose. I would appreciate it if the HN peanut gallery would take a moment to stop and consider others before spouting off. Take this opportunity to do some research into the humiliating procedures the war on drugs has visited upon patients and doctors, then ask yourself if we really need more of the same. For example: did you know my wife had to hobble into the pain management office and pee in a cup on several occasions? Just to make sure she was taking the drugs (the torso-length scar on her back being insufficient). The fact that someone selling the pills could have simply taken some the morning of the test made the farce even more absurd.
  - alkonaut 9y ago
    I think this example would be one of the cases where the most potent opioids would be prescribed in any country. I'm not advocating never prescribing them - only to do it in exceptional cases.
    - spraak 9y ago
      Then that differs from what you'd said of "terminally ill"
      - alkonaut 9y ago
        Right - that wasn't the correct formulation. The formulation used is of course "exceptional cases", and terminal cancer is just one such example. I edited that my post above (sorry if your reply looks odd after the edit)
  - cperciva 9y ago
    For example: did you know my wife had to hobble into the pain management office and pee in a cup on several occasions? Just to make sure she was taking the drugs (the torso-length scar on her back being insufficient). The scar really isn't sufficient. There have been many cases of relatives (usually spouses, but sometimes children or parents) stealing pain medication which was prescribed for post-operative pain, and then coercing their victim into not reporting the theft. As horrible as it is, the drug testing was there to protect your wife.
datawarrior 9y ago
Where I live the two major hospitals now have surveys after every doctor visit where you "grade" the doctor and your experience. This has caused a lot of doctors to just give patients whatever the hell they want because otherwise their career may be in jeopardy. Add to this the inherently difficult process of figuring out just how much pain a person is in and prescribing the correct medication. It really is a lose/lose situation for doctors these days. The changes have to come from above them at the administrative level.

alkonaut 9y ago

The normal practice in most other places (which doctors should be automatically investigated for, if systematically diverging from) is to only prescribe the most potent opioids in exceptional cases such as to terminally ill cancer patients. This seems to work pretty well. EDIT: added "exceptional cases" - this can be other cases than just cancer, see e.g reply

carbocation 9y ago
Medicine is not so black-and-white.
- alkonaut 9y ago
  It's not. But the practice of prescribing opioids is wildly different in other countries. So the base assumptions when weighing the benefits and drawbacks (addiction) need to change. Basically, doctors should try more alternatives and doctors need to tell patients that the pain may be the lesser evil compared to opioids. This also requires changed expectations from patients, about what doctors can do about pain.
cperciva 9y ago
I agree that the most powerful opioids should be used very sparingly. But that's quite different from restricting the use of addictive opioids -- which is to say, all of them.
- alkonaut 9y ago
  Yes, this is only really a discussion about the most potent opioids like oxycodone, and only for long term prescription use. Use of opioids in an IV in a hospital after a major surgery isn't what's discussed. That happens everywhere and doesn't seem to cause addiction problems.
xenadu02 9y ago
My wife had to have a full spinal fusion. You probably don’t even have the mental tools necessary to start thinking about that kind of pain. The sort of pain that causes people to consider suicide as a preferable alternative. Because of the intense back pain leading up to the surgery she was already taking high opiate doses. After the surgery she was taking doses of hydromorphone (5x as strong as morphine) that would kill you or me with a single dose. I would appreciate it if the HN peanut gallery would take a moment to stop and consider others before spouting off. Take this opportunity to do some research into the humiliating procedures the war on drugs has visited upon patients and doctors, then ask yourself if we really need more of the same. For example: did you know my wife had to hobble into the pain management office and pee in a cup on several occasions? Just to make sure she was taking the drugs (the torso-length scar on her back being insufficient). The fact that someone selling the pills could have simply taken some the morning of the test made the farce even more absurd.
- alkonaut 9y ago
  I think this example would be one of the cases where the most potent opioids would be prescribed in any country. I'm not advocating never prescribing them - only to do it in exceptional cases.
  - spraak 9y ago
    Then that differs from what you'd said of "terminally ill"
    - alkonaut 9y ago
      Right - that wasn't the correct formulation. The formulation used is of course "exceptional cases", and terminal cancer is just one such example. I edited that my post above (sorry if your reply looks odd after the edit)
- cperciva 9y ago
  For example: did you know my wife had to hobble into the pain management office and pee in a cup on several occasions? Just to make sure she was taking the drugs (the torso-length scar on her back being insufficient). The scar really isn't sufficient. There have been many cases of relatives (usually spouses, but sometimes children or parents) stealing pain medication which was prescribed for post-operative pain, and then coercing their victim into not reporting the theft. As horrible as it is, the drug testing was there to protect your wife.

datawarrior 9y ago

Where I live the two major hospitals now have surveys after every doctor visit where you "grade" the doctor and your experience. This has caused a lot of doctors to just give patients whatever the hell they want because otherwise their career may be in jeopardy. Add to this the inherently difficult process of figuring out just how much pain a person is in and prescribing the correct medication. It really is a lose/lose situation for doctors these days. The changes have to come from above them at the administrative level.