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I will admit I'm biased: my mother died of an overdose. She was a drug addict. I, on the other hand, have a painful autoimmune disorder, but I've never taken me

I will admit I'm biased: my mother died of an overdose. She was a drug addict. I, on the other hand, have a painful autoimmune disorder, but I've never taken medication. Yet every doctor I've met in the past ten years has looked at me and immediately treated me like a drug addict. Personal experience aside (as it really is not quantitatively demonstrative of anything larger) I've done my best to research this issue, and I'm still somewhat at a loss. Based on these numbers and the 2016 CDC list of leading causes of death, opiate-related deaths account for .02% of the population. On the other hand, I would guess we have quintuple that in people who suffer chronic pain. Though, I can't say how many use their medication as prescribed, I would guess it's at least more than .02% of the population. Addiction is not simple, and even people who started responsibly taking medication could develop an addiction. I don't think it's fair, however, to punish the many people who depend on pain relief. Lax laws in the 80s and 90s have now pendulum-swung to the other side. Patients are seeing their medication reduced without tapering, they are given no other option than to "suck it up," and all along, they are variously demonized or treated as though they are weak. It's a complicated situation that I am not equipped to solve. I do think there needs to be a middle ground. There needs to be a better effort that will help the entire patient population. https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm

DanBC 8y ago
People think that opioids are an effective treatment for long term pain. They aren't. They don't work to treat the pain and the patient develops a tolerance and so ends up taking large quantities putting their health at risk. > Patients are seeing their medication reduced without tapering, they are given no other option than to "suck it up," These are both bad, but these are both symptoms of the sometimes terrible healthcare in the US. People should have access to pain management clinics.
- justinjlynn 8y ago
  > They don't work to treat the pain and the patient develops a tolerance and so ends up taking large quantities putting their health at risk. As you've already asserted in your other comments here and I've asked elsewhere, could you expand on this assertion?
  - DanBC 8y ago
    https://www.rcoa.ac.uk/faculty-of-pain-medicine/opioids-aware https://www.rcoa.ac.uk/faculty-of-pain-medicine/opioids-awar... > 1. Opioids are very good analgesics for acute pain and for pain at the end of life but there is little evidence that they are helpful for long term pain. > 2. A small proportion of people may obtain good pain relief with opioids in the long-term if the dose can be kept low and especially if their use is intermittent (however it is difficult to identify these people at the point of opioid initiation) > 3. The risk of harm increases substantially at doses above an oral morphine equivalent of 120mg/day, but there is no increased benefit. > 4. If a patient is using opioids but is still in pain, the opioids are not effective and should be discontinued, even if no other treatment is available. > 5. Chronic pain is very complex and if patients have refractory and disabling symptoms, particularly if they are on high opioid doses, a very detail assessment of the many emotional influences on their pain is essential. https://www.rcoa.ac.uk/faculty-of-pain-medicine/opioids-aware/condition-patient-context/challenges-of-long-term-pain-management https://www.rcoa.ac.uk/faculty-of-pain-medicine/opioids-awar... > The experience of pain is complex and influenced by the degree of tissue injury, current mood, previous experience of pain and understanding of the cause and significance of pain. Previous unpleasant thoughts, emotions and experiences can also contribute to the current perception of pain and, if unresolved, can act as a barrier to treatment. The assessment of chronic pain needs to be wide-ranging and comprehensive. The persistence of symptoms is particularly relevant in relation to prescribing where patients may be exposed to cumulative harms of drugs over prolonged periods. If a patient continues to have pain despite taking a number of medications, drugs should be sequentially tapered or stopped to establish continued utility. Similarly, if a patient reports reasonable pain relief from a medication regimen in the longer term, it is also necessary to taper medications intermittently to assess whether the symptoms have resolved spontaneously or whether the patient is relatively pain free because of continued efficacy of medication. https://www.rcoa.ac.uk/faculty-of-pain-medicine/opioids-aware/condition-patient-context/role-of-medicines-in-pain-management https://www.rcoa.ac.uk/faculty-of-pain-medicine/opioids-awar... > Medicines are generally less effective for persistent pain than for other types of pain. When medicines are prescribed they should be used in combination with other treatment approaches to support improved physical, psychological and social functioning.
- GordonS 8y ago
  > People think that opioids are an effective treatment for long term pain. They aren't I don't think it's helpful to make a blanket statement like that. There is no one size fits all where pain and analgesics are concerned, and genetics play a large role in what works and what you can even tolerate due to side effects. Opioids of course should not be the first choice, but they should be an option. I've been living with chronic pain for years now, and have been maintaining the same opioid dose - they bring their own issues, but they make a huge difference to my quality of life. Anecdotally, through support groups, I know several others in the same situation. There is something of mini war on opioids going on here in the UK, spurred by what's happening in the US and stoked by hate rags like the Daily Mail. People who successfully manage long-term pain using opioids should not be shamed and treated like drug addicts.
  - DanBC 8y ago
    You're right, blanket comments aren't great. The blanket comment of "most people are harmed by long term opioid use, and don't get much benefit" is true though. Your experiences support the point I'm making though: if it's working, and if the dose is maintained at a low level, opioids are better than nothing. But that involves people agreeing a plan before hand, and continuing checks. (See the links I've already posted elsewhere in this thread). Luckily the Daily Mail have no influence on healthcare. Your use of opioids is supported by RCA, and NICE.
    - GordonS 8y ago
      > But that involves people agreeing a plan before hand, and continuing checks AFAIK, The only 'checks' in place for me is that I can't request repeat prescriptions more often than my subscription, just the same as for any other medication. > Luckily the Daily Mail have no influence on healthcare. Your use of opioids is supported by RCA, and NICE. I wish it were so. The RCA and NICE are in turn supported by the government, and unfortunately many politicians pander to the ignorant outcries of Daily Mail influenced voters.
- zkms 8y ago
  > They don't work to treat the pain and the patient develops a tolerance and so ends up taking large quantities putting their health at risk. That's not how opioid tolerance works. As dose needed to achieve desired effect (analgesia) increases, so does does needed to cause respiratory depression. It's not like there's a single fixed lethal dose and the hapless addict is drawn into it closer and closer. Anyway the overwhelming majority of opioid-related deaths, at least in US, occur with concomitant use of benzodiazepines or EtOH (which is something inherently dangerous) and that is, if anything, an argument against prohibition, since people potentiating their opioids with EtOH or benzos is pretty flagrantly downstream of scarcity of opioids. Long-term use of pharmaceutical-grade opioids (in precisely measured doses, and without the scarcity that drives people to compound with alcohol or benzos) is far safer than you imply it is. It's prohibition that's made opioid use perilous, not the actual pharmacological qualities of the drugs (which have been used by humanity for millennia by now). > People should have access to pain management clinics. ...pain management clinics that do what, besides prescribe opioids? Fix the actual root cause? Do surgery?
  - karambahh 8y ago
    Pain management covers pain medication but also nerve stimulation via electrodes which can be a great relief.
mmt 8y ago
> opiate-related deaths account for .02% of the population. This statement is potentially misleading, since it leaves out the "per year" part. To compare it to the number of chronic pain sufferers, as you've done, you'd need to add up all the deaths of people who would otherwise still be alive. Even just using the wild approximation of adding up the deaths in Table 27 of what you've linked (interpolating the missing 8 years with the lowest number), brings the percentage above 0.17% or almost 1 in 500. One of the reasons for alarm is that the fatality rate has been increasing (and may even be accelerating), having more than tripled since 1999. Compare that to vehicle deaths, which have been on a downard trend, even per population.

DanBC 8y ago

People think that opioids are an effective treatment for long term pain. They aren't. They don't work to treat the pain and the patient develops a tolerance and so ends up taking large quantities putting their health at risk. > Patients are seeing their medication reduced without tapering, they are given no other option than to "suck it up," These are both bad, but these are both symptoms of the sometimes terrible healthcare in the US. People should have access to pain management clinics.

justinjlynn 8y ago
> They don't work to treat the pain and the patient develops a tolerance and so ends up taking large quantities putting their health at risk. As you've already asserted in your other comments here and I've asked elsewhere, could you expand on this assertion?
- DanBC 8y ago
  https://www.rcoa.ac.uk/faculty-of-pain-medicine/opioids-aware https://www.rcoa.ac.uk/faculty-of-pain-medicine/opioids-awar... > 1. Opioids are very good analgesics for acute pain and for pain at the end of life but there is little evidence that they are helpful for long term pain. > 2. A small proportion of people may obtain good pain relief with opioids in the long-term if the dose can be kept low and especially if their use is intermittent (however it is difficult to identify these people at the point of opioid initiation) > 3. The risk of harm increases substantially at doses above an oral morphine equivalent of 120mg/day, but there is no increased benefit. > 4. If a patient is using opioids but is still in pain, the opioids are not effective and should be discontinued, even if no other treatment is available. > 5. Chronic pain is very complex and if patients have refractory and disabling symptoms, particularly if they are on high opioid doses, a very detail assessment of the many emotional influences on their pain is essential. https://www.rcoa.ac.uk/faculty-of-pain-medicine/opioids-aware/condition-patient-context/challenges-of-long-term-pain-management https://www.rcoa.ac.uk/faculty-of-pain-medicine/opioids-awar... > The experience of pain is complex and influenced by the degree of tissue injury, current mood, previous experience of pain and understanding of the cause and significance of pain. Previous unpleasant thoughts, emotions and experiences can also contribute to the current perception of pain and, if unresolved, can act as a barrier to treatment. The assessment of chronic pain needs to be wide-ranging and comprehensive. The persistence of symptoms is particularly relevant in relation to prescribing where patients may be exposed to cumulative harms of drugs over prolonged periods. If a patient continues to have pain despite taking a number of medications, drugs should be sequentially tapered or stopped to establish continued utility. Similarly, if a patient reports reasonable pain relief from a medication regimen in the longer term, it is also necessary to taper medications intermittently to assess whether the symptoms have resolved spontaneously or whether the patient is relatively pain free because of continued efficacy of medication. https://www.rcoa.ac.uk/faculty-of-pain-medicine/opioids-aware/condition-patient-context/role-of-medicines-in-pain-management https://www.rcoa.ac.uk/faculty-of-pain-medicine/opioids-awar... > Medicines are generally less effective for persistent pain than for other types of pain. When medicines are prescribed they should be used in combination with other treatment approaches to support improved physical, psychological and social functioning.
GordonS 8y ago
> People think that opioids are an effective treatment for long term pain. They aren't I don't think it's helpful to make a blanket statement like that. There is no one size fits all where pain and analgesics are concerned, and genetics play a large role in what works and what you can even tolerate due to side effects. Opioids of course should not be the first choice, but they should be an option. I've been living with chronic pain for years now, and have been maintaining the same opioid dose - they bring their own issues, but they make a huge difference to my quality of life. Anecdotally, through support groups, I know several others in the same situation. There is something of mini war on opioids going on here in the UK, spurred by what's happening in the US and stoked by hate rags like the Daily Mail. People who successfully manage long-term pain using opioids should not be shamed and treated like drug addicts.
- DanBC 8y ago
  You're right, blanket comments aren't great. The blanket comment of "most people are harmed by long term opioid use, and don't get much benefit" is true though. Your experiences support the point I'm making though: if it's working, and if the dose is maintained at a low level, opioids are better than nothing. But that involves people agreeing a plan before hand, and continuing checks. (See the links I've already posted elsewhere in this thread). Luckily the Daily Mail have no influence on healthcare. Your use of opioids is supported by RCA, and NICE.
  - GordonS 8y ago
    > But that involves people agreeing a plan before hand, and continuing checks AFAIK, The only 'checks' in place for me is that I can't request repeat prescriptions more often than my subscription, just the same as for any other medication. > Luckily the Daily Mail have no influence on healthcare. Your use of opioids is supported by RCA, and NICE. I wish it were so. The RCA and NICE are in turn supported by the government, and unfortunately many politicians pander to the ignorant outcries of Daily Mail influenced voters.
zkms 8y ago
> They don't work to treat the pain and the patient develops a tolerance and so ends up taking large quantities putting their health at risk. That's not how opioid tolerance works. As dose needed to achieve desired effect (analgesia) increases, so does does needed to cause respiratory depression. It's not like there's a single fixed lethal dose and the hapless addict is drawn into it closer and closer. Anyway the overwhelming majority of opioid-related deaths, at least in US, occur with concomitant use of benzodiazepines or EtOH (which is something inherently dangerous) and that is, if anything, an argument against prohibition, since people potentiating their opioids with EtOH or benzos is pretty flagrantly downstream of scarcity of opioids. Long-term use of pharmaceutical-grade opioids (in precisely measured doses, and without the scarcity that drives people to compound with alcohol or benzos) is far safer than you imply it is. It's prohibition that's made opioid use perilous, not the actual pharmacological qualities of the drugs (which have been used by humanity for millennia by now). > People should have access to pain management clinics. ...pain management clinics that do what, besides prescribe opioids? Fix the actual root cause? Do surgery?
- karambahh 8y ago
  Pain management covers pain medication but also nerve stimulation via electrodes which can be a great relief.

mmt 8y ago

> opiate-related deaths account for .02% of the population. This statement is potentially misleading, since it leaves out the "per year" part. To compare it to the number of chronic pain sufferers, as you've done, you'd need to add up all the deaths of people who would otherwise still be alive. Even just using the wild approximation of adding up the deaths in Table 27 of what you've linked (interpolating the missing 8 years with the lowest number), brings the percentage above 0.17% or almost 1 in 500. One of the reasons for alarm is that the fatality rate has been increasing (and may even be accelerating), having more than tripled since 1999. Compare that to vehicle deaths, which have been on a downard trend, even per population.