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The doctors. Anyone who spends the better part of a decade studying medicine can't be ignorant about opioids and addiction, regardless of what the slimy Purdue

by stef25 8y ago

The doctors. Anyone who spends the better part of a decade studying medicine can't be ignorant about opioids and addiction, regardless of what the slimy Purdue representative tells them. The only excuse they have for the blatant over prescribing of opioids (2 months worth of oxy for getting wisdom teeth pulled kind of thing) is that if they don't do it, the patient will just go to another doctor. But how can you justify setting someone up with fistfuls of oxy (knowing full that heroin / fentanyl and a world of misery for them and their loved ones is just around the corner) just "to make money" ? > Or is it the responsibility of patients to not seek strong opiates for the smallest aches? What the patient seeks is irrelevant. The only one who decides what prescriptions a patient should take is a doctor. Personally I suffered from lower back pain for about 10 years and went from one useless quack to the next. Eventually I found a physio who taught me how to strengthen my core, now I'm at the gym 2x a week and loving it, did couch25K (and beyond) and am pain free for 3 years. All I sought was pain relief but pills is not what I needed. If I was in W-Virginia instead of the EU I guess I'd be shooting heroin by now. The US health care system is broken in more ways than one, no doubt this is made worse by various societal factors like joblessness.

free652 8y ago
For wisdom teeth I got 25 tablets - that's like around a week worth. So other "patients" ask upfront for more tablets?
- matwood 8y ago
  Wow. I had my ACL done and got 3 days worth of Oxycontin (6 tablets, 1 every 12 hours). I didn't want to finish taking them because they made me hallucinate. Looking back, I probably could have gotten by after the first day with only ibuprofen. The doctor was very concerned about staying ahead of any pain though.
- zolthrowaway 8y ago
  Yes, many people will take the largest script the doctor will prescribe. Insurance generally helps cover the cost of the prescription, so reselling them can be really lucrative. Even in your scenario, 25 pills seems like a lot. Many people will be totally pain free in 2-3 days. No one needs 8 pills a day for wisdom teeth. Let's say they take 4 a day for 3 days, that's still 13 pills leftover. Go to any manual labor job (construction for example) in the Midwest. You will find people wanting to buy leftover prescriptions and people selling them. It's a pretty large black market. The vast, vast majority of people I know doing construction, laying asphalt, etc are all daily drinkers, potheads, or addicted to opiates. It's honestly super depressing.
  - ensignavenger 8y ago
    Since the insurance charges the same for a large prescription versus a small one, even if you aren't planning on selling them, it makes sense from a financial perspective to get the extra pills, just in case you do need them. (If there are complications, or if something else happens, etc.)
nonbel 8y ago
I have a friend who had brain surgeries as a child and then again a few years ago. He said even though he weighed 2-4x more for the recent surgery they gave him half the morphine dose he got when younger. Apparently that dose was only enough make his feet itchy without sufficient pain relief, but they said they couldn't give him any more for whatever reason (legal, hospital policy, etc). If that story generalizes it may be that somehow outpatients are getting too much painkillers while inpatients are not getting enough. The latter group is, of course, much less likely to get addicted.
mtw 8y ago
> found a physio who taught me how to strengthen my core, now I'm at the gym 2x a week and loving it Most other patients demand quick and effective pain relief. When most doctors operate within a system that promotes total customer satisfaction and when they know an opioid is going to make the pain go away right now, the opioid prescription is easier. Plus this will make extra dollars for the system. Changing this would require mindset change for patients (I need to endure the pain and follow a clean diet/exercise), and having doctors look to 360 treatments, including diet, sleep and exercise recommendations, instead of opioids
- ce4 8y ago
  Here's a discussion from 7 months ago about exactly that. US patient came to another country and was faced with a mindset change and subsequently wrote an article about it in the nyt titled "After Surgery in Germany, I Wanted Vicodin, Not Herbal Tea" [0]. [0]: https://news.ycombinator.com/item?id=16252372 https://news.ycombinator.com/item?id=16252372
js2 8y ago
> The doctors. Certainly training them to prescribe less is a place to start: Doctors trained at lower-ranked American medical schools prescribe more opioids https://www.economist.com/graphic-detail/2017/08/23/doctors-trained-at-lower-ranked-american-medical-schools-prescribe-more-opioids https://www.economist.com/graphic-detail/2017/08/23/doctors-...
ams6110 8y ago
> 2 months worth of oxy for getting wisdom teeth pulled kind of thing Surely this is not the norm? My son had his wisdom teeth out a few years ago, they gave him about a day's worth of hydrocodone and told him to take Tylenol after that. And all the doctors my family has seen for the past couple of decades have been pretty conservative about prescribing anything narcotic for pain.
- akuji1993 8y ago
  Here in the EU, the doctor didn't give me any strong opiod. They just pulled the tooth and sent me home. When the pain reached a score of 8 / 10 on my personal score card, I took one Tylenol and another 1/2 before bed that day and didn't take anything else the next day.
  - maccard 8y ago
    > When the pain reached a score of 8 / 10 on my personal score card, I took one Tylenol What's a 10/10 on your personal score card, out of interest? I hope you understand that your 8/10 may be akin to a 2/10 for someone else.
    - akuji1993 8y ago
      It might also have been a 7/10. When I had surgery on my back, right above my buttocks, they dug a hole deep right onto my bone and then it had to heal on its own, took 4 months to close. The first two days were a solid 9.5/10.
  - freeflight 8y ago
    Yup same here in Germany, you can ask for something against the pain, but that will usually only get you a prescription for Ibuprofen 600/800 mg. Took those way to long over jaw issues until I got stomach problems, asked the dentist for something else and he prescribed metamizole drops. Didn't use many of those as they sometimes give me kidney pains.
- toomanybeersies 8y ago
umvi 8y ago
> What the patient seeks is irrelevant. The only one who decides what prescriptions a patient should take is a doctor. That kind of rubs me the wrong way, but I'm not sure why. I like having the option of overriding the doctor if I disagree.
- stef25 8y ago
  It would be fair to make choices in the sense of picking a longer treatment that doesn't force you to stay home from work, vs a shorter treatment that would. And of course "another round of chemo" or "I can't be f*cked anymore" are valid choices. But really, when things like opiates are involved patient input is rarely useful.
  - skookumchuck 8y ago
    > But really, when things like opiates are involved patient input is rarely useful. Since there is no method for determining the level of a patient's pain, and opiates are for pain management, how can you conclude that?
    - stef25 8y ago
      Yeah, I didn't phrase that properly. Of course patients should communicate how much pain they are in, but they shouldn't communicate the type of painkillers that are to be prescribed.
- roenxi 8y ago
  Maybe one of the following? These are a couple of takes of that attitude from a few slightly different viewpoints. * Removal of agency from the patient in relation to how their body is treated; anti-individualism. * Decision making power assigned to an agent who does not have skin in the game; anti-system-thinking. * Attitude runs counter to having a strong sense of personal responsibility; anti-some-morality-systems. * Imposition of doctors value system overrides patient values; not-sure.
- amaccuish 8y ago
  In the NHS, that isn't possible. You either take the doctor's treatment, or you get no treatment at all. You can go around, asking different doctors, or having a discussion with your doctor, but you will not be prescribed something you don't need. The incentive being, that with a tax payer funded system, money should go to those who actually need it. It is understood here I guess that the doctor is the expert, not you.
dominotw 8y ago
> 2 months worth of oxy for getting wisdom teeth pulled kind of thing I saved mine after wisdom tooth/root canal combo and used them as mood enhancer later. I am not sure I am addicted to them though. I find this theory hard to believe that opioid overdose is an end result of series of missteps starting from wisdom tooth oxy prescription.
- nioesd 8y ago
  Keep in mind that some people are at much higher risk for becoming addicted to opiates. You may have been able to take them recreationally without major issue, but the same behavior could have a much more severe consequence for someone in that at-risk group.
  - dominotw 8y ago
    > some people are at much higher risk Why is that? Something in their genetic makeup? Wonder if its possible to identify these ppl preemptively.
    - dwaltrip 8y ago
      Possibly that, but life experiences and environmental factors (stress at work, etc) play a huge role.
    - freeflight 8y ago
      Genetics play a huge role [0], but so do social and environmental factors. [0] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2442454/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2442454/
- toomanybeersies 8y ago
  Most of the population drinks alcohol. Most of the population are not alcoholics. I haven't abused opioids for recreational purposes, but I know people who have saved their prescribed codeine and gotten fucked up on it. They aren't addicted. I also walk to the supermarket every day, past the safe injection centre filled with smackheads. I've seen dead heroin addicts wheeled into the ambulance. Not everyone is as susceptible to addiction as others, but the more opioids/alcohol/other drugs you take, the more likely you are to get addicted.
LeifCarrotson 8y ago
Look for the root cause,not the proximal one. You can certainly blame one bad doctor. You could probably blame a group of associated doctors, if the problem was associated with a certain hospital or medical school. But when the problem is something that thousands and thousands of individual doctors mess up, it's hard to blame them all. Personally, I blame the slimy Purdue salesmen and the idiot bureaucrats who let prescription drug companies advertise prescription drugs on TV, or give kickbacks to doctors who prescribe their medicine. Without these awful incentives, you wouldn't have this widespread failure.
- stef25 8y ago
  This is like saying web developers aren't responsible for thousands of websites getting hacked through some plugin, because the authors of a plugin simply said it was cool, and they advertised it as such and the devs got some affiliate kickback every time they implemented it on a site. The analogy doesn't work 100% but pretty close :)
  - mercer 8y ago
    To alter the analogy, perhaps these web developers might be implementing said plugin because their manager told them to, and once said plugin took off clients started demanding it. Most web developers that I know who have this problem fit this description. they don't like doing any of this, but it's what they're told to do. Or alternatively they're barely 'developers' and care about other things instead (many designer-developers, for example).
village-idiot 8y ago
American doctors are persistently and openly reluctant to prescribe lifestyle changes for fear of patient anger and noncompliance. Even in cases where the medical advice is something along the lines of “get some exercise or start planning your own funeral”. Obviously doctors continuing to hand out pills (opioids, statins, etc.) to patients who really need therapy, exercise, or dietary changes is helping to reinforce the problem.

by stef25 8y ago

free652 8y ago

For wisdom teeth I got 25 tablets - that's like around a week worth. So other "patients" ask upfront for more tablets?

matwood 8y ago
Wow. I had my ACL done and got 3 days worth of Oxycontin (6 tablets, 1 every 12 hours). I didn't want to finish taking them because they made me hallucinate. Looking back, I probably could have gotten by after the first day with only ibuprofen. The doctor was very concerned about staying ahead of any pain though.
zolthrowaway 8y ago
Yes, many people will take the largest script the doctor will prescribe. Insurance generally helps cover the cost of the prescription, so reselling them can be really lucrative. Even in your scenario, 25 pills seems like a lot. Many people will be totally pain free in 2-3 days. No one needs 8 pills a day for wisdom teeth. Let's say they take 4 a day for 3 days, that's still 13 pills leftover. Go to any manual labor job (construction for example) in the Midwest. You will find people wanting to buy leftover prescriptions and people selling them. It's a pretty large black market. The vast, vast majority of people I know doing construction, laying asphalt, etc are all daily drinkers, potheads, or addicted to opiates. It's honestly super depressing.
- ensignavenger 8y ago
  Since the insurance charges the same for a large prescription versus a small one, even if you aren't planning on selling them, it makes sense from a financial perspective to get the extra pills, just in case you do need them. (If there are complications, or if something else happens, etc.)

nonbel 8y ago

I have a friend who had brain surgeries as a child and then again a few years ago. He said even though he weighed 2-4x more for the recent surgery they gave him half the morphine dose he got when younger. Apparently that dose was only enough make his feet itchy without sufficient pain relief, but they said they couldn't give him any more for whatever reason (legal, hospital policy, etc). If that story generalizes it may be that somehow outpatients are getting too much painkillers while inpatients are not getting enough. The latter group is, of course, much less likely to get addicted.

mtw 8y ago

> found a physio who taught me how to strengthen my core, now I'm at the gym 2x a week and loving it Most other patients demand quick and effective pain relief. When most doctors operate within a system that promotes total customer satisfaction and when they know an opioid is going to make the pain go away right now, the opioid prescription is easier. Plus this will make extra dollars for the system. Changing this would require mindset change for patients (I need to endure the pain and follow a clean diet/exercise), and having doctors look to 360 treatments, including diet, sleep and exercise recommendations, instead of opioids

ce4 8y ago
Here's a discussion from 7 months ago about exactly that. US patient came to another country and was faced with a mindset change and subsequently wrote an article about it in the nyt titled "After Surgery in Germany, I Wanted Vicodin, Not Herbal Tea" [0]. [0]: https://news.ycombinator.com/item?id=16252372 https://news.ycombinator.com/item?id=16252372

js2 8y ago

> The doctors. Certainly training them to prescribe less is a place to start: Doctors trained at lower-ranked American medical schools prescribe more opioids https://www.economist.com/graphic-detail/2017/08/23/doctors-trained-at-lower-ranked-american-medical-schools-prescribe-more-opioids https://www.economist.com/graphic-detail/2017/08/23/doctors-...

ams6110 8y ago

> 2 months worth of oxy for getting wisdom teeth pulled kind of thing Surely this is not the norm? My son had his wisdom teeth out a few years ago, they gave him about a day's worth of hydrocodone and told him to take Tylenol after that. And all the doctors my family has seen for the past couple of decades have been pretty conservative about prescribing anything narcotic for pain.

akuji1993 8y ago
Here in the EU, the doctor didn't give me any strong opiod. They just pulled the tooth and sent me home. When the pain reached a score of 8 / 10 on my personal score card, I took one Tylenol and another 1/2 before bed that day and didn't take anything else the next day.
- maccard 8y ago
  > When the pain reached a score of 8 / 10 on my personal score card, I took one Tylenol What's a 10/10 on your personal score card, out of interest? I hope you understand that your 8/10 may be akin to a 2/10 for someone else.
  - akuji1993 8y ago
    It might also have been a 7/10. When I had surgery on my back, right above my buttocks, they dug a hole deep right onto my bone and then it had to heal on its own, took 4 months to close. The first two days were a solid 9.5/10.
- freeflight 8y ago
  Yup same here in Germany, you can ask for something against the pain, but that will usually only get you a prescription for Ibuprofen 600/800 mg. Took those way to long over jaw issues until I got stomach problems, asked the dentist for something else and he prescribed metamizole drops. Didn't use many of those as they sometimes give me kidney pains.
toomanybeersies 8y ago

umvi 8y ago

> What the patient seeks is irrelevant. The only one who decides what prescriptions a patient should take is a doctor. That kind of rubs me the wrong way, but I'm not sure why. I like having the option of overriding the doctor if I disagree.

stef25 8y ago
It would be fair to make choices in the sense of picking a longer treatment that doesn't force you to stay home from work, vs a shorter treatment that would. And of course "another round of chemo" or "I can't be f*cked anymore" are valid choices. But really, when things like opiates are involved patient input is rarely useful.
- skookumchuck 8y ago
  > But really, when things like opiates are involved patient input is rarely useful. Since there is no method for determining the level of a patient's pain, and opiates are for pain management, how can you conclude that?
  - stef25 8y ago
    Yeah, I didn't phrase that properly. Of course patients should communicate how much pain they are in, but they shouldn't communicate the type of painkillers that are to be prescribed.
roenxi 8y ago
Maybe one of the following? These are a couple of takes of that attitude from a few slightly different viewpoints. * Removal of agency from the patient in relation to how their body is treated; anti-individualism. * Decision making power assigned to an agent who does not have skin in the game; anti-system-thinking. * Attitude runs counter to having a strong sense of personal responsibility; anti-some-morality-systems. * Imposition of doctors value system overrides patient values; not-sure.
amaccuish 8y ago
In the NHS, that isn't possible. You either take the doctor's treatment, or you get no treatment at all. You can go around, asking different doctors, or having a discussion with your doctor, but you will not be prescribed something you don't need. The incentive being, that with a tax payer funded system, money should go to those who actually need it. It is understood here I guess that the doctor is the expert, not you.

dominotw 8y ago

> 2 months worth of oxy for getting wisdom teeth pulled kind of thing I saved mine after wisdom tooth/root canal combo and used them as mood enhancer later. I am not sure I am addicted to them though. I find this theory hard to believe that opioid overdose is an end result of series of missteps starting from wisdom tooth oxy prescription.

nioesd 8y ago
Keep in mind that some people are at much higher risk for becoming addicted to opiates. You may have been able to take them recreationally without major issue, but the same behavior could have a much more severe consequence for someone in that at-risk group.
- dominotw 8y ago
  > some people are at much higher risk Why is that? Something in their genetic makeup? Wonder if its possible to identify these ppl preemptively.
  - dwaltrip 8y ago
    Possibly that, but life experiences and environmental factors (stress at work, etc) play a huge role.
  - freeflight 8y ago
    Genetics play a huge role [0], but so do social and environmental factors. [0] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2442454/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2442454/
toomanybeersies 8y ago
Most of the population drinks alcohol. Most of the population are not alcoholics. I haven't abused opioids for recreational purposes, but I know people who have saved their prescribed codeine and gotten fucked up on it. They aren't addicted. I also walk to the supermarket every day, past the safe injection centre filled with smackheads. I've seen dead heroin addicts wheeled into the ambulance. Not everyone is as susceptible to addiction as others, but the more opioids/alcohol/other drugs you take, the more likely you are to get addicted.

LeifCarrotson 8y ago

Look for the root cause,not the proximal one. You can certainly blame one bad doctor. You could probably blame a group of associated doctors, if the problem was associated with a certain hospital or medical school. But when the problem is something that thousands and thousands of individual doctors mess up, it's hard to blame them all. Personally, I blame the slimy Purdue salesmen and the idiot bureaucrats who let prescription drug companies advertise prescription drugs on TV, or give kickbacks to doctors who prescribe their medicine. Without these awful incentives, you wouldn't have this widespread failure.

stef25 8y ago
This is like saying web developers aren't responsible for thousands of websites getting hacked through some plugin, because the authors of a plugin simply said it was cool, and they advertised it as such and the devs got some affiliate kickback every time they implemented it on a site. The analogy doesn't work 100% but pretty close :)
- mercer 8y ago
  To alter the analogy, perhaps these web developers might be implementing said plugin because their manager told them to, and once said plugin took off clients started demanding it. Most web developers that I know who have this problem fit this description. they don't like doing any of this, but it's what they're told to do. Or alternatively they're barely 'developers' and care about other things instead (many designer-developers, for example).

village-idiot 8y ago

American doctors are persistently and openly reluctant to prescribe lifestyle changes for fear of patient anger and noncompliance. Even in cases where the medical advice is something along the lines of “get some exercise or start planning your own funeral”. Obviously doctors continuing to hand out pills (opioids, statins, etc.) to patients who really need therapy, exercise, or dietary changes is helping to reinforce the problem.