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>* If you get an initial opioid script from a doctor for more than 10 days, you have a 20% chance of being on opioids a year after. Again not a moral failing. [

>* If you get an initial opioid script from a doctor for more than 10 days, you have a 20% chance of being on opioids a year after. Again not a moral failing. [0] It should be noted that people who are bad enough off to need opiods, may continue to be bad off for a long time. Not because of the opiods, but because of having a condition so bad that doctors are willing to give you opiods. A script for more than a few days of opiods is very rare. I had a complete back fusion with 21 vertebrae drilled into and only had ~7 days prescribed.

Spooky23 9y ago
Great point that isn't often made. I also had an incredibly painful back problem and spinal fusion. My doctors were aggressive about minimizing opiod use... almost excessively so. I probably had about 5 rounds of hydrocodone in a 5 day hospital stay.
- adventured 9y ago
  What did you do for the pain post surgery (the following month or more, assuming some pain persisted)?
  - Spooky23 9y ago
    PT, ibuprofen/acetaminophen and heat packs. I was pretty much pain free in about two weeks, which was an incredible relief on many levels. Honestly, for that type of pain, opioids are only marginally effective anyway.
- Bartweiss 9y ago
  I've seen quite a few doctors complain that they feel pressure to minimize opioid dosing below what they consider medically justified, even for inpatient care. We seem to have focused on restricting ideal-case prescriptions, even though we know the major problems are improper prescribing and slipping dosage schedules. (Oxycodone is labelled for 12-hour relief, but only offers ~8. The result is an addicting high/low cycle, movement off prescribed schedules, and running out of medicine early even during legitimate use - which leads people to illegal sources and makes addiction easier.) It's particularly silly for patients with short-term problems who won't even be getting opioid prescriptions on release. Someone laid up in a hospital bed on a morphine drip is not in a high-risk pool for going home and trying to recreate that experience. http://www.latimes.com/projects/oxycontin-part1/ http://www.latimes.com/projects/oxycontin-part1/
Clubber 9y ago
Yes, with all this drama about the opioid crisis (sequel to the meth crisis, sequel to the crack epidemic, sequel to LSD crisis (Charles Manson), sequel to the reefer madness, sequel to the original Prohibition), people miss the point that they have very valuable uses. What youngsters and middle aged folks like me don't really grasp (I'm starting to) is that getting old fucking hurts, sometimes a lot. Having a managed opioid addiction is a hell of a lot better than being bedridden, both physically and mentally.
- refurb 9y ago
  It's on the verge of being a moral panic! A few years back it was meth, then before that cocaine/crack and before that? Heroin! We've come full circle!
- fragmede 9y ago
  The most frustrating part of the failed War on Drugs is that pain management doesn't have to be Sophie's choice between being in pain or being addicted to opiates, but thanks to a chilling effect on research due to the DEA's classification of cannabis as Schedule I, the mainstream medical establishment sees long-term opiate use to manage chronic pain as acceptable practice. 29 states plus Puerto Rico, Guam, and DC all recognize the medical benefits of cannabis including pain management. Presumably there's something when smoking the plant (whether THC or CBD, or some other as-of-yet undiscovered chemical) that's proven to be beneficial. In the face of the opioid epidemic, isn't it time for the DEA and the Federal government to think that there might be something to this stuff? Instead, the current classification is that cannabis has a higher abuse potential than cocaine, Vicodin and methamphetamines!
  - Clubber 9y ago
    I suspect it's like laughing gas. It has more to do with making the patient not care as much about the pain (distraction) rather than direct pain management though numbing / blocking receptors.
    - superdug 9y ago
rabboRubble 9y ago
Very true. Also true that some doctors have prescribed opioids irresponsibly. I recall an article, of course can't find it now, about a police officer's daughter (or was it niece?) who got an initial 30 day script for a torn rotor cuff. Some time after, after he confronted her about her weird behavior, did she tell him what was going on and how the addiction started.
zkms 9y ago
> but because of having a condition so bad that doctors are willing to give you opiods I concur. I've been prescribed opioids post-surgery and also for painful outpatient procedures (when the topical anaesthetic just didn't cut it) and thus had a period of my life a couple years ago where I took quite a bit of prescribed opioids (that in 2017 likely would not have been permitted due to far stricter restrictions on prescribing). I never ended up addicted, nor did I use non-prescribed opioids (even though purchasing them could have been trivial, I had bitcoin and the original Silk Road was around then) nor did I obtain opioid prescriptions under hinky pretences. The reason for taking them went away, and so did my (medically-sanctioned) opioid use. This isn't to say that opioids are harmless (if they were, they'd be a placebo); but judicious use of pharmaceutical-grade opioids over long periods need not result in any adverse effects.
refurb 9y ago
Agreed. The 20% is a bit of a hokey number. It's basically saying 20% of all opioid scripts are for chronic pain, which sounds like a pretty reasonable number to me.
- yarg 9y ago
  Opiods should never be used as a treatment for chronic pain; they have rapidly decreasing efficacy coupled with rapidly increasing addictiveness. My (totally unsourced and straight from my arse) guess is that both the decrease in efficacy and the increase in dependency are going to occur at a rate perportional to the current dosage. As far as I can tell the user's desired dose will increase at an exponential rate - making the drugs thoroughly nsuitable for long term usage.
  - michaelmrose 9y ago
    Exponential is a poor description of increase in tolerance which doesn't even procede at the same pace for different individuals on the same dose. It creates a false notion of mathematical certainty. Further for conditions that must be managed because they are impossible to fix opiods are hard to replace. Opoids may provide a managable solution to managing pain for decades for some patients while singing koom ba ah, meditating, discussing your feelings or alternative therapies are largely snake oil.
- Bartweiss 9y ago
  The linked study tries to assess the number of chronic pain prescriptions and comes up with 1%, which is where they get the claim that 20% indicates addiction. That said, the methodology for this (checking how many scripts are for long-lasting, high-dose opioids) looks dubious at best, and misses non-chronic, recurring illnesses that might lead to multiple prescriptions.
rjbwork 9y ago
I've never really had a problem with opiods. I've gotten prescriptions for oxycodone a number of times. The only time I had any problem was when I broke my hand in 2 places, and they gave me a 2 months supply (filled twice, not all at once) of 10mg. I had some of the standard opiod side effects, but no withdrawal or addictive behavior. I actually just had a prescription this year for a car accident, and did not find myself compulsively taking them or anything like that. On the other hand, I don't find they help me as much as others seem to be helped by them in terms of pain killing properties. I wonder why this is?
- Bartweiss 9y ago
  I've had a similar experience; a mild dose of oxycodone had no high, no withdrawal, and unremarkable pain relief. Individual variability is pretty high with opioids, both in efficacy and in metabolism speed. It's more pronounced with things like tramadol, but also true of oxycodone. At a guess, you might just be seeing much less impact from a given dose than other patients (and likely addicts might well be seeing more).
- wastewaste 9y ago
  because of renewed formular? I'm no pharmacist nor chemist, but my impression with drugs is that the popular names and actual composition are two different things. All they need is approval and if it helps relieve or avoid addiction I'm sure a minor change in, I don't know, isomery or adding a tiny functional extra tail to a big molecule doesn't preclude approval.
  - rjbwork 9y ago
    It was generic Oxycodone. No name brand, no fancy time release, in both aforementioned cases. The first being in 2011.
- xkcd-sucks 9y ago
  Because addiction is an empirical behavioral phenomenon (you can't stop taking it and it makes your life worse) whereas tolerance+withdrawal are physical phenomena that correlate with, but are not, addiction. Current understanding is basically "addiction means not having your shit together," described in terms of predisposing factors such as stress, depression, physical dependence etc.
Bartweiss 9y ago
Yeah, I'd really like to see that statistic corrected for long-term prescriptions. Or better yet, controlled for diagnosis. Following that link, we see that patients issued 30 days of opioids via multiple prescriptions have a 30% chance of one year use, but patients issued 30 days up front have a 45% chance. Interpreting that as evidence for shorter prescription windows looks like unproven causation to me. There's presumably a reason some patients get 30 days as their initial dose, and that's not being controlled for. The study suggests that since only 1% of patients got strong and long-lasting opioids, prescriptions for chronic conditions must be rare, but that seems wrong twice over. First, as noted in the article, 10% got tramadol at some dose, and may well be chronic patients. Second, recurring health issues are overlooked; a patient getting 30 days of opioids up front may not have a chronic condition, but might well have a recurring issue that leaves them needing subsequent scripts. More broadly, we seem to be attempting to control opioids on the supply side in particularly foolish ways. It's already known that major problems include over-prescribing doctors and dosage cycles that produce withdrawal, but attempts to treat the problem focus on restricting well-meaning prescribers.

Spooky23 9y ago

Great point that isn't often made. I also had an incredibly painful back problem and spinal fusion. My doctors were aggressive about minimizing opiod use... almost excessively so. I probably had about 5 rounds of hydrocodone in a 5 day hospital stay.

adventured 9y ago
What did you do for the pain post surgery (the following month or more, assuming some pain persisted)?
- Spooky23 9y ago
  PT, ibuprofen/acetaminophen and heat packs. I was pretty much pain free in about two weeks, which was an incredible relief on many levels. Honestly, for that type of pain, opioids are only marginally effective anyway.
Bartweiss 9y ago
I've seen quite a few doctors complain that they feel pressure to minimize opioid dosing below what they consider medically justified, even for inpatient care. We seem to have focused on restricting ideal-case prescriptions, even though we know the major problems are improper prescribing and slipping dosage schedules. (Oxycodone is labelled for 12-hour relief, but only offers ~8. The result is an addicting high/low cycle, movement off prescribed schedules, and running out of medicine early even during legitimate use - which leads people to illegal sources and makes addiction easier.) It's particularly silly for patients with short-term problems who won't even be getting opioid prescriptions on release. Someone laid up in a hospital bed on a morphine drip is not in a high-risk pool for going home and trying to recreate that experience. http://www.latimes.com/projects/oxycontin-part1/ http://www.latimes.com/projects/oxycontin-part1/

Clubber 9y ago

Yes, with all this drama about the opioid crisis (sequel to the meth crisis, sequel to the crack epidemic, sequel to LSD crisis (Charles Manson), sequel to the reefer madness, sequel to the original Prohibition), people miss the point that they have very valuable uses. What youngsters and middle aged folks like me don't really grasp (I'm starting to) is that getting old fucking hurts, sometimes a lot. Having a managed opioid addiction is a hell of a lot better than being bedridden, both physically and mentally.

refurb 9y ago
It's on the verge of being a moral panic! A few years back it was meth, then before that cocaine/crack and before that? Heroin! We've come full circle!
fragmede 9y ago
The most frustrating part of the failed War on Drugs is that pain management doesn't have to be Sophie's choice between being in pain or being addicted to opiates, but thanks to a chilling effect on research due to the DEA's classification of cannabis as Schedule I, the mainstream medical establishment sees long-term opiate use to manage chronic pain as acceptable practice. 29 states plus Puerto Rico, Guam, and DC all recognize the medical benefits of cannabis including pain management. Presumably there's something when smoking the plant (whether THC or CBD, or some other as-of-yet undiscovered chemical) that's proven to be beneficial. In the face of the opioid epidemic, isn't it time for the DEA and the Federal government to think that there might be something to this stuff? Instead, the current classification is that cannabis has a higher abuse potential than cocaine, Vicodin and methamphetamines!
- Clubber 9y ago
  I suspect it's like laughing gas. It has more to do with making the patient not care as much about the pain (distraction) rather than direct pain management though numbing / blocking receptors.
  - superdug 9y ago

rabboRubble 9y ago

Very true. Also true that some doctors have prescribed opioids irresponsibly. I recall an article, of course can't find it now, about a police officer's daughter (or was it niece?) who got an initial 30 day script for a torn rotor cuff. Some time after, after he confronted her about her weird behavior, did she tell him what was going on and how the addiction started.

zkms 9y ago

> but because of having a condition so bad that doctors are willing to give you opiods I concur. I've been prescribed opioids post-surgery and also for painful outpatient procedures (when the topical anaesthetic just didn't cut it) and thus had a period of my life a couple years ago where I took quite a bit of prescribed opioids (that in 2017 likely would not have been permitted due to far stricter restrictions on prescribing). I never ended up addicted, nor did I use non-prescribed opioids (even though purchasing them could have been trivial, I had bitcoin and the original Silk Road was around then) nor did I obtain opioid prescriptions under hinky pretences. The reason for taking them went away, and so did my (medically-sanctioned) opioid use. This isn't to say that opioids are harmless (if they were, they'd be a placebo); but judicious use of pharmaceutical-grade opioids over long periods need not result in any adverse effects.

refurb 9y ago

Agreed. The 20% is a bit of a hokey number. It's basically saying 20% of all opioid scripts are for chronic pain, which sounds like a pretty reasonable number to me.

yarg 9y ago
Opiods should never be used as a treatment for chronic pain; they have rapidly decreasing efficacy coupled with rapidly increasing addictiveness. My (totally unsourced and straight from my arse) guess is that both the decrease in efficacy and the increase in dependency are going to occur at a rate perportional to the current dosage. As far as I can tell the user's desired dose will increase at an exponential rate - making the drugs thoroughly nsuitable for long term usage.
- michaelmrose 9y ago
  Exponential is a poor description of increase in tolerance which doesn't even procede at the same pace for different individuals on the same dose. It creates a false notion of mathematical certainty. Further for conditions that must be managed because they are impossible to fix opiods are hard to replace. Opoids may provide a managable solution to managing pain for decades for some patients while singing koom ba ah, meditating, discussing your feelings or alternative therapies are largely snake oil.
Bartweiss 9y ago
The linked study tries to assess the number of chronic pain prescriptions and comes up with 1%, which is where they get the claim that 20% indicates addiction. That said, the methodology for this (checking how many scripts are for long-lasting, high-dose opioids) looks dubious at best, and misses non-chronic, recurring illnesses that might lead to multiple prescriptions.

rjbwork 9y ago

I've never really had a problem with opiods. I've gotten prescriptions for oxycodone a number of times. The only time I had any problem was when I broke my hand in 2 places, and they gave me a 2 months supply (filled twice, not all at once) of 10mg. I had some of the standard opiod side effects, but no withdrawal or addictive behavior. I actually just had a prescription this year for a car accident, and did not find myself compulsively taking them or anything like that. On the other hand, I don't find they help me as much as others seem to be helped by them in terms of pain killing properties. I wonder why this is?

Bartweiss 9y ago
I've had a similar experience; a mild dose of oxycodone had no high, no withdrawal, and unremarkable pain relief. Individual variability is pretty high with opioids, both in efficacy and in metabolism speed. It's more pronounced with things like tramadol, but also true of oxycodone. At a guess, you might just be seeing much less impact from a given dose than other patients (and likely addicts might well be seeing more).
wastewaste 9y ago
because of renewed formular? I'm no pharmacist nor chemist, but my impression with drugs is that the popular names and actual composition are two different things. All they need is approval and if it helps relieve or avoid addiction I'm sure a minor change in, I don't know, isomery or adding a tiny functional extra tail to a big molecule doesn't preclude approval.
- rjbwork 9y ago
  It was generic Oxycodone. No name brand, no fancy time release, in both aforementioned cases. The first being in 2011.
xkcd-sucks 9y ago
Because addiction is an empirical behavioral phenomenon (you can't stop taking it and it makes your life worse) whereas tolerance+withdrawal are physical phenomena that correlate with, but are not, addiction. Current understanding is basically "addiction means not having your shit together," described in terms of predisposing factors such as stress, depression, physical dependence etc.

Bartweiss 9y ago

Yeah, I'd really like to see that statistic corrected for long-term prescriptions. Or better yet, controlled for diagnosis. Following that link, we see that patients issued 30 days of opioids via multiple prescriptions have a 30% chance of one year use, but patients issued 30 days up front have a 45% chance. Interpreting that as evidence for shorter prescription windows looks like unproven causation to me. There's presumably a reason some patients get 30 days as their initial dose, and that's not being controlled for. The study suggests that since only 1% of patients got strong and long-lasting opioids, prescriptions for chronic conditions must be rare, but that seems wrong twice over. First, as noted in the article, 10% got tramadol at some dose, and may well be chronic patients. Second, recurring health issues are overlooked; a patient getting 30 days of opioids up front may not have a chronic condition, but might well have a recurring issue that leaves them needing subsequent scripts. More broadly, we seem to be attempting to control opioids on the supply side in particularly foolish ways. It's already known that major problems include over-prescribing doctors and dosage cycles that produce withdrawal, but attempts to treat the problem focus on restricting well-meaning prescribers.