12 ms·

The making of an opioid epidemic

99 points by benbreen 8y ago

21 8y ago
This seems to be part of a bigger trend. Do you feel a bit of pain? Unacceptable. We got to make it go away. Medicate it until you don't feel a thing. Could your kid scrape a knee on the playing ground? Unacceptable, wrap it all in rubber. Could you be offended by some text in a classic book? Unacceptable. Trigger warning, counseling on hand, feel free to skip it or read it together with a group in a safe space. Something someone said makes you feel funny? Unacceptable. Report, protest, de-platform.
- umvi 8y ago
  No one likes to hear "too bad, deal with it" as the response to their perceived problem, but I'm afraid we as a society are losing the essential skill of "dealing with" accidents, injustices, or just plain bad luck in favor or making someone else shoulder the blame.
  - candiodari 8y ago
    Alternative explanation: the quality of care has been declining, for instance because of the ridiculously higher administrative spending in healthcare. And the thing about painkillers is that they "fix" (to the patients' satisfaction) a hell of a lot of problems ... while bringing in extra money for the doctor and hospital. Any incompetent doctor, or just one that doesn't get the time to diagnose (administrators need to be paid, and that's justified by "productivity" of doctors. Productivity mostly means faster diagnoses. One very effective way to do that, of course, is just to make incomplete diagnoses) Secondly giving a painkiller is almost never a stupidly wrong decision (unlike taking out a kidney that then in a biopsy turns out to be fully healthy, regardless of how many symptoms matched). So it's ALSO low risk ! And I assure you, there are no words in the universe that cause administrators to drool half as much as the words "low risk". Didn't we want market-based medicine ? Well, this is one instance where the market based choice is blatantly obvious. Secondly I fear like now we're seeing the opposite reaction: people are acting against patients that have chronic pain and would not be able to function without constant painkillers. These patients will go back to self-medication (ie. alcohol and/or cocaine, both "decent" painkillers) like people did 50 years ago. It is not a good evolution to replace morphine with alcohol or cocaine.
  - freedomben 8y ago
    I agree, although I think it is important to keep in mind that everyone has different levels at which "deal with it" is appropriate. I've heard people say that about patients fresh out of back surgery, which I find to be ludicrous. I think this should be something between only a person and their doctor.
  - timeseries2018 8y ago
    Eventually, the economy will crash, or at least the cheap energy will run out, and then people will be forced to get tough again.
  - watwut 8y ago
    Just "dealing with" injustices is enabling injustice through. And I am fully willing to help people in accident or bad luck assuming they will help me in bad luck.
  - Nasrudith 8y ago
    Losing it? I personally doubt we had it in the first place. Just look at the rich and very not new history of scapegoating. Blame the victim rather than admit a problem. Leprosy is a result of your sin. Smallpox however is blameless because it could happen to anyone. Lash out at the vulnerable rather than the source of the problem. Survival bias is what leads to the perception of this lost golden era. Where all of the pioneer's children are healthy without doctors - nevermind the graves of the seven children and two other wives. We didn't have PTSD before WW1 just ignore all of the self medicating civil war veterans. This tendency isn't a moral component so much as a result of exposure and memory. Possibly a survival bias itself that remembering everything would be really bad for mental health.
  - thomasz 8y ago
    You have never experienced real pain.
- neffy 8y ago
  "The two doctors made no secret of who they blamed for “this preventable cause of death and disability”. “It’s about money. Money has influence, and it influenced the joint commission,” said Lucas." See also: https://www.nytimes.com/2018/05/29/health/purdue-opioids-oxycontin.html https://www.nytimes.com/2018/05/29/health/purdue-opioids-oxy... And: https://www.forbes.com/sites/alexmorrell/2015/07/01/the-oxycontin-clan-the-14-billion-newcomer-to-forbes-2015-list-of-richest-u-s-families/#27608d3175e0 https://www.forbes.com/sites/alexmorrell/2015/07/01/the-oxyc...
- talltimtom 8y ago
  Counterpoint from Denmark that has the same movements of “wrap your kid in bubble wrap” and “it’s offensive to wear sombreros”, we don’t see an overuse of opioids or penecilum because the medical system isn’t for profit and you aren’t a customer, you are a patient. Show up saying you feel a flu coming on and would like some penicillin to curb it? The doctor will laugh at you and tell you to come back when you visibly sick, and even then she’ll tell you to just try sleeping it off. Only as a last resort do they actually prescribe harder drugs. Also, you need prescriptions even for larger packs of ibuprofen and paracetamol. The issue in USA really seems to me to be drive in large by the fact that people are customes who want drugs and doctors are salespeople who want to sell drugs. With opioids it just so happens that the legal barrier got lowered enough that everyone who wanted it for all the wrong reasons could justify buying it anyway, and then they did.
  - arkades 8y ago
    We don’t make money by prescribing drugs. Those of us on risk sharing contracts - most of us, directly or indirectly, to a greater or lesser extent - lose money by prescribing drugs. Your comment has little factual basis.
    - k_sh 8y ago
      The patients don't, but doctors[0][1][2][3][4] and drug manufacturers[5][6][7] and distributors[8] do. [0]: https://edition.cnn.com/2018/03/11/health/prescription-opioid-payments-eprise/index.html https://edition.cnn.com/2018/03/11/health/prescription-opioi... [1]: https://www.healthleadersmedia.com/strategy/doctor-tied-insys-opioid-kickback-probe-gets-prison-term https://www.healthleadersmedia.com/strategy/doctor-tied-insy... [2]: http://www.waff.com/2018/08/22/doctors-indicted-overprescribing-opioids-kickbacks/ http://www.waff.com/2018/08/22/doctors-indicted-overprescrib... [3]: https://www.kansascity.com/latest-news/article214834685.html https://www.kansascity.com/latest-news/article214834685.html [4]: https://www.hsph.harvard.edu/news/hsph-in-the-news/opioids-doctors-prescriptions-payments/ https://www.hsph.harvard.edu/news/hsph-in-the-news/opioids-d... [5]: https://www.vox.com/science-and-health/2018/9/7/17831710/richard-sackler-opioid-epidemic-buprenorphine https://www.vox.com/science-and-health/2018/9/7/17831710/ric... [6]: https://www.masslive.com/news/index.ssf/2018/06/mayors_join_lawsuit_alleging_b.html https://www.masslive.com/news/index.ssf/2018/06/mayors_join_... [7]: https://www.usnews.com/news/politics/articles/2018-05-16/6-more-states-sue-opioid-manufacturers-for-nationwide-epidemic https://www.usnews.com/news/politics/articles/2018-05-16/6-m... [8]: https://www.theatlantic.com/business/archive/2017/09/opioid-crisis-responsibility-profits/538938/ https://www.theatlantic.com/business/archive/2017/09/opioid-...
- T4NG 8y ago
  These arent the same issue, though I agree we shouldnt take medication lightly for depression or pain but there still exists a massive industry specialized for american consumers to have these products pushed on them from all angles.
- draw_down 8y ago
  Come on.
- emersonrsantos 8y ago
  This isn't new. The "sanatorium" concept was lost somewhere in the 20th century. The sanatorium idea was the cure by the gradual restoration of health. Today is almost medication every time. Zero to little attention to physical and mental health restoration. It's like plastic surgery.
  - Nasrudith 8y ago
    We have that still when called for - it is called rehab. Medicines fix things as well in many cases - at times far less gradual.
- Retra 8y ago
  It's hypocritical that you don't just accept this as the way it is and move on.
BaronVonSteuben 8y ago
As someone who has chronic pain and tried everything under the sun, but only found relief in opioids, it sucks to see this attack on pain doctors by people who largely aren't affected by it. I lost access to my medication because I moved to a new state and no doctors want to take on a new patient for fear of the DEA. Pain patients are super risky, and every script they write is scrutinized by the government. My quality of life has dropped a lot. Thank God I found Kratom (it really works for moderate pain), but rumor is that will be banned soon too in the US (where we love our drug wars). Also kratom doesn't help much during flare-ups. I'm now bed-ridden during those periods whereas before at least I could work. Please consider the unintended consequences of a well-meaning war on opioids. They are not evil. In fact for many of us they are the only thing that allows us to live semi-normal lives.
- CelestialTeapot 8y ago
  I don't know your situation, but can empathize. In my state, you have to see a pain specialist and jump through the hoops on a regular basis. For me, opioids dulled the pain at night enough to sleep, but, they won't regularly prescribe it for my condition because, "it doesn't work." I eventually found a doctor that prescribed low-dose naltrexone[1] (not a controlled substance) in 2mg/night doses and the pain has dropped from a nightly 8-9.9 to about a 6 or 7 except when there's a flare-up, and the next day I'm not in as much pain until later in the day. Still sucks, but I can eventually get to sleep. I have no idea how long it will work (I've found many pain meds eventually stop working for me) but for now, one day at a time... 1 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3962576/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3962576/
- 14 8y ago
  It is a shame that doctors have now started leaving patients suffer out of fear of addiction. Surely there has to be a middle ground? I feel there is a risk they go too far and by not addressing pain in people they put those people at higher risk of doing desperate things like take other drugs available on the black market. I hate the feeling you get off opiods. But when I threw my back out over the counter medications did not even come close to touching the pain. It truly was crippling. Doctors would not give me anything but a family member had a handful of I forget what now but it was a prescription opiod of some type from a past surgery and it was the only thing that would even take a dent out of the pain. When my back came back I immediately stopped taking anything for it. But I truly do fear it happening again. I know I won't be able to access stronger pain medications if I have it happen again.
emersonrsantos 8y ago
> Portenoy toured the country, describing opioids as a gift from nature and promoting access to narcotics as a moral argument. Being pain-free was a human right, he said. In 1993, he told the New York Times of a “growing literature showing that these drugs can be used for a long time, with few side-effects, and that addiction and abuse are not a problem”. Just very similar to what is said about benzos, marijuana and are starting to be said about LSD, GHB and the likes. We need more scientific evidence to know the toll these narcotics and psychotropics can cause to us in the long term, like the same scrutiny they treated the tobacco industry.
- zbentley 8y ago
  We do. But man getting evidence in this area is hard. Human tendencies towards pleasure (from basic desire for good feelings/self-gratification to utterly destructive addiction) and towards greed (from dealers/cartels to HMOs) are both actively confounding the discovery and codification of good data regarding drug use, benefits, and abuse.
- alphabettsy 8y ago
  I don’t find this argument compelling. We knew for a long time that opiates were addictive, they’ve been in common use forever. We’ve come to learn that much of the information they were pushing shouldn’t have been trusted and that they seriously misrepresented these newfound non-hazardous opioids.
- collyw 8y ago
  LSD is quite the opposite of addictive. Its showing very promising results for stopping addiction.
nicetryguy 8y ago
> Dentists gave them to teenagers after pulling their wisdom teeth. Not just one or two days’ worth of pills, but a fortnight or a month’s worth, which, if they did not draw the intended recipient in, frequently sat in the medicine cabinet waiting to be discovered by someone else in the family. This happened to me! I got my wisdom teeth removed circa (2005-06), and they gave me a bottle of 50 generic OxyCodone pills. Fifty! I took maybe 3 or 4 of them over the next couple days, hated the way they made me feel "robotic and distant", and just rode it out on Motrin afterwards. They sat in the cabinet until i ended up selling the rest to a "friend" a few years later. I hate to think what could have happened if i Really liked them....
- deleted 8y ago
  [deleted]
- quasse 8y ago
  This was definitely still happening as late as 2011, I had a friend who spent two weeks basically nodding off because of the amount of opioids they were given after a routine wisdom tooth removal.
  - bigger_cheese 8y ago
    They are scarily strong. A few years ago. I woke up vomiting and in extreme pain. Housemate drove me to 24 hour clinic. I was stuck in waiting room for hour or so. Eventually I got to see doctor. Clinic was not really confidant they knew what was wrong with me and told my housemate to take me to the hospital. I was stuck for another hour or two in waiting room at hospital all the while in extreme pain and vomiting. I was diagnosed with a kidney stone and I was given a morphine drip. Almost immediately I was out like a light I don't even remember drifting off - scarily strong stuff I went from worst pain of my life to sleeping like a baby.
- 24gttghh 8y ago
  Same here (2008-2010). That shit made me sick and it only helped for like an hour anyways (0hr: took pill; 1hr: pain relief + nausea; 2-3hr: pain resurgence; 6hr: take another; rinse, repeat.). I stopped taking it after a day. I can appreciate its usefulness for chronic conditions, but damn, it's criminal how many I was prescribed in retrospect.
pnathan 8y ago
There are lawsuits against the makers of Oxy for misrepresenting and pushing Oxy as such a miracle cure. It seems to be well understood by now that opioids are/were highly over prescribed, and there are a ton of addicts now whose lives have been ruined. I also want to note that drugs often make life feel better, and a lot of peoples' lives for the past decade+ haven't been great. There is a social component to addiction that is inadequately talked about. I would also suggest considering pressing your electeds regarding funding for long-lived independent drug studies for drugs such as ecstacy/MDMA, LSD, etc, as well as passing legislation inhibiting regulatory capture. I would like to see, for instance, marijuana effects thoroughly studied legally in long-lived large-cohort studies. There is potential here, but no silver herb, er, bullet.
- mistrial9 8y ago
  a leading example : State of Tennessee vs Purdue Pharma; case 1-173-18; filed 15May2018 in Knox County, TN
golemiprague 8y ago
Typical Guardian, they talk about the issue completely ignoring the politics around it because it doesn't look nice for the side they support. For 8 years Obama completely ignored the problem, the jobs lost to china, the demise of the blue collar Americans, mainly whites but a lot of blacks also. The pressure illegal immigration put on wages and the blind eye to drug smuggling by Hizbollah operatives in south America just because he wanted to appease Iran. Everybody know that this was part of why Trump won the presidency so how comes the article only focus on doctors and prescriptions and ignores the social and political factors leading to this situation? Are all the Heroin addicts are there because of some drug prescription? give me a break
classichasclass 8y ago
When I first got my medical license about a decade and change ago, pain was the fifth vital sign and we weren't doing enough to deal with it. I (as a California requirement) even had to take CME to do a better job on treating non-malignant pain. Little did we know how the profession was being manipulated. But what I think will happen, and some of the comments in this thread illustrate, is that the pendulum will swing in the other direction. Medicine doesn't know what to do with chronic pain. We can't define it, we have imprecise anatomic correlates, and no patient wants to be told that some fraction of it is in their head even though it's likely a combination of neurologic and psychologic factors. I remember throwing some obvious seekers out of my office but I had a lot of credible chronic pain patients when I left general practice, good people laid low in difficult ways, and I wonder what's happened to them since.
- frankosaurus 8y ago
  Is there a better (read: objective) measure of physical pain than asking the patient to rate it from 1-10?
  - DanBC 8y ago
    The problem with asking everyone about pain, even if they're attending for something else, is that you find out a load of people live with pain. This is a well-understood phenomenom about screening: screening people usually (not always) causes more harm than it fixes. Back when "pain is the 5th vital sign" was being pushed people thought opioids were not addictive if used to treat pain. https://www.bbc.co.uk/news/world-us-canada-40136881 https://www.bbc.co.uk/news/world-us-canada-40136881 And there are drug reps telling you this medication is not addictive and that you're being negligent in leaving pain "untreated". So, you ask everyone if they're in pain. A load of them say "yes", and you can't afford to give them physical therapy and psychological support but you can give them opioids which are dirt cheap and you've been told they're not addictive if used to treat pain. You end up flooding communities with opioid meds. You have a bunch of people still in pain, and with an opioid addiction. And then you have their friends and relatives who aren't in pain but who want to try these meds recreationally getting hooked. It's a public health disaster. To answer your question: ask people about pain, but set expectations first. Opioids are a poor choice for most people with long term pain. Not much better than palcebo for neuropathic pain, but with more side effects and with risk of addiction: https://www.cochrane.org/CD006146/SYMPT_opioids-neuropathic-pain https://www.cochrane.org/CD006146/SYMPT_opioids-neuropathic-... No better than paracetamol for long term back and joint pain: https://discover.dc.nihr.ac.uk/content/signal-000610/opioid-drugs-are-no-better-than-standard-painkillers-for-long-term-back-and-joint-pain https://discover.dc.nihr.ac.uk/content/signal-000610/opioid-...
thinelvis 8y ago
Weed.
bill_from_tampa 8y ago
Persons with chronic pain should have access to treatments that work for them. For some, it may be exercise, or physical therapy, or tylenol, or a TENS unit. For a few, it may be opioids in low or high doses. Treatments need to be able to be individualized to the specific patient - one size definitely does not fit all. Your pain may respond to meditation and tylenol, but somebody with a pancreas that is autodigesting itself or chronic unrepairable partial bowel obstruction with miserable horrible daily disabling pain may actually do better with opiates. When politicians and internet experts begin dictating medical treatment regimens, individual patients will suffer and die, or commit suicide. On the other hand, persons who enjoy abusing substances to get high or blasted or whatever the feeling may be need to have some safe way of feeding their addiction, or they will die, in large numbers. Being dependent on an illegal supply chain stretching from Kowloon to Morelia to San Diego to wherever with no quality control and no oversight is a recipe for disaster -- nobody who buys stuff on the street knows what they are getting. And to boot, actual medical treatment for addiction is not easy to obtain and limited. The much vaunted "clinics" are for rich people who don't need health insurance to pay the bills. So we will continue to have problems in the US, and they won't be fixed.
zeroname 8y ago
Legalize Heroin for everyone again. If you're going to be a junkie and, let's face it, many people will prefer that over debilitating chronic pain, it'll be a safer and healthier alternative than these synthetic opiods. Heroin used to be freely available over the counter and while it certainly did cause problems for its consumers, it wasn't even close to what these synthetic opioids are doing.

99 points by benbreen 8y ago

21 8y ago

This seems to be part of a bigger trend. Do you feel a bit of pain? Unacceptable. We got to make it go away. Medicate it until you don't feel a thing. Could your kid scrape a knee on the playing ground? Unacceptable, wrap it all in rubber. Could you be offended by some text in a classic book? Unacceptable. Trigger warning, counseling on hand, feel free to skip it or read it together with a group in a safe space. Something someone said makes you feel funny? Unacceptable. Report, protest, de-platform.

umvi 8y ago
No one likes to hear "too bad, deal with it" as the response to their perceived problem, but I'm afraid we as a society are losing the essential skill of "dealing with" accidents, injustices, or just plain bad luck in favor or making someone else shoulder the blame.
- candiodari 8y ago
  Alternative explanation: the quality of care has been declining, for instance because of the ridiculously higher administrative spending in healthcare. And the thing about painkillers is that they "fix" (to the patients' satisfaction) a hell of a lot of problems ... while bringing in extra money for the doctor and hospital. Any incompetent doctor, or just one that doesn't get the time to diagnose (administrators need to be paid, and that's justified by "productivity" of doctors. Productivity mostly means faster diagnoses. One very effective way to do that, of course, is just to make incomplete diagnoses) Secondly giving a painkiller is almost never a stupidly wrong decision (unlike taking out a kidney that then in a biopsy turns out to be fully healthy, regardless of how many symptoms matched). So it's ALSO low risk ! And I assure you, there are no words in the universe that cause administrators to drool half as much as the words "low risk". Didn't we want market-based medicine ? Well, this is one instance where the market based choice is blatantly obvious. Secondly I fear like now we're seeing the opposite reaction: people are acting against patients that have chronic pain and would not be able to function without constant painkillers. These patients will go back to self-medication (ie. alcohol and/or cocaine, both "decent" painkillers) like people did 50 years ago. It is not a good evolution to replace morphine with alcohol or cocaine.
- freedomben 8y ago
  I agree, although I think it is important to keep in mind that everyone has different levels at which "deal with it" is appropriate. I've heard people say that about patients fresh out of back surgery, which I find to be ludicrous. I think this should be something between only a person and their doctor.
- timeseries2018 8y ago
  Eventually, the economy will crash, or at least the cheap energy will run out, and then people will be forced to get tough again.
- watwut 8y ago
  Just "dealing with" injustices is enabling injustice through. And I am fully willing to help people in accident or bad luck assuming they will help me in bad luck.
- Nasrudith 8y ago
  Losing it? I personally doubt we had it in the first place. Just look at the rich and very not new history of scapegoating. Blame the victim rather than admit a problem. Leprosy is a result of your sin. Smallpox however is blameless because it could happen to anyone. Lash out at the vulnerable rather than the source of the problem. Survival bias is what leads to the perception of this lost golden era. Where all of the pioneer's children are healthy without doctors - nevermind the graves of the seven children and two other wives. We didn't have PTSD before WW1 just ignore all of the self medicating civil war veterans. This tendency isn't a moral component so much as a result of exposure and memory. Possibly a survival bias itself that remembering everything would be really bad for mental health.
- thomasz 8y ago
  You have never experienced real pain.
neffy 8y ago
"The two doctors made no secret of who they blamed for “this preventable cause of death and disability”. “It’s about money. Money has influence, and it influenced the joint commission,” said Lucas." See also: https://www.nytimes.com/2018/05/29/health/purdue-opioids-oxycontin.html https://www.nytimes.com/2018/05/29/health/purdue-opioids-oxy... And: https://www.forbes.com/sites/alexmorrell/2015/07/01/the-oxycontin-clan-the-14-billion-newcomer-to-forbes-2015-list-of-richest-u-s-families/#27608d3175e0 https://www.forbes.com/sites/alexmorrell/2015/07/01/the-oxyc...
talltimtom 8y ago
Counterpoint from Denmark that has the same movements of “wrap your kid in bubble wrap” and “it’s offensive to wear sombreros”, we don’t see an overuse of opioids or penecilum because the medical system isn’t for profit and you aren’t a customer, you are a patient. Show up saying you feel a flu coming on and would like some penicillin to curb it? The doctor will laugh at you and tell you to come back when you visibly sick, and even then she’ll tell you to just try sleeping it off. Only as a last resort do they actually prescribe harder drugs. Also, you need prescriptions even for larger packs of ibuprofen and paracetamol. The issue in USA really seems to me to be drive in large by the fact that people are customes who want drugs and doctors are salespeople who want to sell drugs. With opioids it just so happens that the legal barrier got lowered enough that everyone who wanted it for all the wrong reasons could justify buying it anyway, and then they did.
- arkades 8y ago
  We don’t make money by prescribing drugs. Those of us on risk sharing contracts - most of us, directly or indirectly, to a greater or lesser extent - lose money by prescribing drugs. Your comment has little factual basis.
  - k_sh 8y ago
    The patients don't, but doctors[0][1][2][3][4] and drug manufacturers[5][6][7] and distributors[8] do. [0]: https://edition.cnn.com/2018/03/11/health/prescription-opioid-payments-eprise/index.html https://edition.cnn.com/2018/03/11/health/prescription-opioi... [1]: https://www.healthleadersmedia.com/strategy/doctor-tied-insys-opioid-kickback-probe-gets-prison-term https://www.healthleadersmedia.com/strategy/doctor-tied-insy... [2]: http://www.waff.com/2018/08/22/doctors-indicted-overprescribing-opioids-kickbacks/ http://www.waff.com/2018/08/22/doctors-indicted-overprescrib... [3]: https://www.kansascity.com/latest-news/article214834685.html https://www.kansascity.com/latest-news/article214834685.html [4]: https://www.hsph.harvard.edu/news/hsph-in-the-news/opioids-doctors-prescriptions-payments/ https://www.hsph.harvard.edu/news/hsph-in-the-news/opioids-d... [5]: https://www.vox.com/science-and-health/2018/9/7/17831710/richard-sackler-opioid-epidemic-buprenorphine https://www.vox.com/science-and-health/2018/9/7/17831710/ric... [6]: https://www.masslive.com/news/index.ssf/2018/06/mayors_join_lawsuit_alleging_b.html https://www.masslive.com/news/index.ssf/2018/06/mayors_join_... [7]: https://www.usnews.com/news/politics/articles/2018-05-16/6-more-states-sue-opioid-manufacturers-for-nationwide-epidemic https://www.usnews.com/news/politics/articles/2018-05-16/6-m... [8]: https://www.theatlantic.com/business/archive/2017/09/opioid-crisis-responsibility-profits/538938/ https://www.theatlantic.com/business/archive/2017/09/opioid-...
T4NG 8y ago
These arent the same issue, though I agree we shouldnt take medication lightly for depression or pain but there still exists a massive industry specialized for american consumers to have these products pushed on them from all angles.
draw_down 8y ago
Come on.
emersonrsantos 8y ago
This isn't new. The "sanatorium" concept was lost somewhere in the 20th century. The sanatorium idea was the cure by the gradual restoration of health. Today is almost medication every time. Zero to little attention to physical and mental health restoration. It's like plastic surgery.
- Nasrudith 8y ago
  We have that still when called for - it is called rehab. Medicines fix things as well in many cases - at times far less gradual.
Retra 8y ago
It's hypocritical that you don't just accept this as the way it is and move on.

BaronVonSteuben 8y ago

As someone who has chronic pain and tried everything under the sun, but only found relief in opioids, it sucks to see this attack on pain doctors by people who largely aren't affected by it. I lost access to my medication because I moved to a new state and no doctors want to take on a new patient for fear of the DEA. Pain patients are super risky, and every script they write is scrutinized by the government. My quality of life has dropped a lot. Thank God I found Kratom (it really works for moderate pain), but rumor is that will be banned soon too in the US (where we love our drug wars). Also kratom doesn't help much during flare-ups. I'm now bed-ridden during those periods whereas before at least I could work. Please consider the unintended consequences of a well-meaning war on opioids. They are not evil. In fact for many of us they are the only thing that allows us to live semi-normal lives.

CelestialTeapot 8y ago
I don't know your situation, but can empathize. In my state, you have to see a pain specialist and jump through the hoops on a regular basis. For me, opioids dulled the pain at night enough to sleep, but, they won't regularly prescribe it for my condition because, "it doesn't work." I eventually found a doctor that prescribed low-dose naltrexone[1] (not a controlled substance) in 2mg/night doses and the pain has dropped from a nightly 8-9.9 to about a 6 or 7 except when there's a flare-up, and the next day I'm not in as much pain until later in the day. Still sucks, but I can eventually get to sleep. I have no idea how long it will work (I've found many pain meds eventually stop working for me) but for now, one day at a time... 1 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3962576/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3962576/
14 8y ago
It is a shame that doctors have now started leaving patients suffer out of fear of addiction. Surely there has to be a middle ground? I feel there is a risk they go too far and by not addressing pain in people they put those people at higher risk of doing desperate things like take other drugs available on the black market. I hate the feeling you get off opiods. But when I threw my back out over the counter medications did not even come close to touching the pain. It truly was crippling. Doctors would not give me anything but a family member had a handful of I forget what now but it was a prescription opiod of some type from a past surgery and it was the only thing that would even take a dent out of the pain. When my back came back I immediately stopped taking anything for it. But I truly do fear it happening again. I know I won't be able to access stronger pain medications if I have it happen again.

emersonrsantos 8y ago

> Portenoy toured the country, describing opioids as a gift from nature and promoting access to narcotics as a moral argument. Being pain-free was a human right, he said. In 1993, he told the New York Times of a “growing literature showing that these drugs can be used for a long time, with few side-effects, and that addiction and abuse are not a problem”. Just very similar to what is said about benzos, marijuana and are starting to be said about LSD, GHB and the likes. We need more scientific evidence to know the toll these narcotics and psychotropics can cause to us in the long term, like the same scrutiny they treated the tobacco industry.

zbentley 8y ago
We do. But man getting evidence in this area is hard. Human tendencies towards pleasure (from basic desire for good feelings/self-gratification to utterly destructive addiction) and towards greed (from dealers/cartels to HMOs) are both actively confounding the discovery and codification of good data regarding drug use, benefits, and abuse.
alphabettsy 8y ago
I don’t find this argument compelling. We knew for a long time that opiates were addictive, they’ve been in common use forever. We’ve come to learn that much of the information they were pushing shouldn’t have been trusted and that they seriously misrepresented these newfound non-hazardous opioids.
collyw 8y ago
LSD is quite the opposite of addictive. Its showing very promising results for stopping addiction.

nicetryguy 8y ago

> Dentists gave them to teenagers after pulling their wisdom teeth. Not just one or two days’ worth of pills, but a fortnight or a month’s worth, which, if they did not draw the intended recipient in, frequently sat in the medicine cabinet waiting to be discovered by someone else in the family. This happened to me! I got my wisdom teeth removed circa (2005-06), and they gave me a bottle of 50 generic OxyCodone pills. Fifty! I took maybe 3 or 4 of them over the next couple days, hated the way they made me feel "robotic and distant", and just rode it out on Motrin afterwards. They sat in the cabinet until i ended up selling the rest to a "friend" a few years later. I hate to think what could have happened if i Really liked them....

deleted 8y ago
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quasse 8y ago
This was definitely still happening as late as 2011, I had a friend who spent two weeks basically nodding off because of the amount of opioids they were given after a routine wisdom tooth removal.
- bigger_cheese 8y ago
  They are scarily strong. A few years ago. I woke up vomiting and in extreme pain. Housemate drove me to 24 hour clinic. I was stuck in waiting room for hour or so. Eventually I got to see doctor. Clinic was not really confidant they knew what was wrong with me and told my housemate to take me to the hospital. I was stuck for another hour or two in waiting room at hospital all the while in extreme pain and vomiting. I was diagnosed with a kidney stone and I was given a morphine drip. Almost immediately I was out like a light I don't even remember drifting off - scarily strong stuff I went from worst pain of my life to sleeping like a baby.
24gttghh 8y ago
Same here (2008-2010). That shit made me sick and it only helped for like an hour anyways (0hr: took pill; 1hr: pain relief + nausea; 2-3hr: pain resurgence; 6hr: take another; rinse, repeat.). I stopped taking it after a day. I can appreciate its usefulness for chronic conditions, but damn, it's criminal how many I was prescribed in retrospect.

pnathan 8y ago

There are lawsuits against the makers of Oxy for misrepresenting and pushing Oxy as such a miracle cure. It seems to be well understood by now that opioids are/were highly over prescribed, and there are a ton of addicts now whose lives have been ruined. I also want to note that drugs often make life feel better, and a lot of peoples' lives for the past decade+ haven't been great. There is a social component to addiction that is inadequately talked about. I would also suggest considering pressing your electeds regarding funding for long-lived independent drug studies for drugs such as ecstacy/MDMA, LSD, etc, as well as passing legislation inhibiting regulatory capture. I would like to see, for instance, marijuana effects thoroughly studied legally in long-lived large-cohort studies. There is potential here, but no silver herb, er, bullet.

mistrial9 8y ago
a leading example : State of Tennessee vs Purdue Pharma; case 1-173-18; filed 15May2018 in Knox County, TN

golemiprague 8y ago

Typical Guardian, they talk about the issue completely ignoring the politics around it because it doesn't look nice for the side they support. For 8 years Obama completely ignored the problem, the jobs lost to china, the demise of the blue collar Americans, mainly whites but a lot of blacks also. The pressure illegal immigration put on wages and the blind eye to drug smuggling by Hizbollah operatives in south America just because he wanted to appease Iran. Everybody know that this was part of why Trump won the presidency so how comes the article only focus on doctors and prescriptions and ignores the social and political factors leading to this situation? Are all the Heroin addicts are there because of some drug prescription? give me a break

classichasclass 8y ago

When I first got my medical license about a decade and change ago, pain was the fifth vital sign and we weren't doing enough to deal with it. I (as a California requirement) even had to take CME to do a better job on treating non-malignant pain. Little did we know how the profession was being manipulated. But what I think will happen, and some of the comments in this thread illustrate, is that the pendulum will swing in the other direction. Medicine doesn't know what to do with chronic pain. We can't define it, we have imprecise anatomic correlates, and no patient wants to be told that some fraction of it is in their head even though it's likely a combination of neurologic and psychologic factors. I remember throwing some obvious seekers out of my office but I had a lot of credible chronic pain patients when I left general practice, good people laid low in difficult ways, and I wonder what's happened to them since.

frankosaurus 8y ago
Is there a better (read: objective) measure of physical pain than asking the patient to rate it from 1-10?
- DanBC 8y ago
  The problem with asking everyone about pain, even if they're attending for something else, is that you find out a load of people live with pain. This is a well-understood phenomenom about screening: screening people usually (not always) causes more harm than it fixes. Back when "pain is the 5th vital sign" was being pushed people thought opioids were not addictive if used to treat pain. https://www.bbc.co.uk/news/world-us-canada-40136881 https://www.bbc.co.uk/news/world-us-canada-40136881 And there are drug reps telling you this medication is not addictive and that you're being negligent in leaving pain "untreated". So, you ask everyone if they're in pain. A load of them say "yes", and you can't afford to give them physical therapy and psychological support but you can give them opioids which are dirt cheap and you've been told they're not addictive if used to treat pain. You end up flooding communities with opioid meds. You have a bunch of people still in pain, and with an opioid addiction. And then you have their friends and relatives who aren't in pain but who want to try these meds recreationally getting hooked. It's a public health disaster. To answer your question: ask people about pain, but set expectations first. Opioids are a poor choice for most people with long term pain. Not much better than palcebo for neuropathic pain, but with more side effects and with risk of addiction: https://www.cochrane.org/CD006146/SYMPT_opioids-neuropathic-pain https://www.cochrane.org/CD006146/SYMPT_opioids-neuropathic-... No better than paracetamol for long term back and joint pain: https://discover.dc.nihr.ac.uk/content/signal-000610/opioid-drugs-are-no-better-than-standard-painkillers-for-long-term-back-and-joint-pain https://discover.dc.nihr.ac.uk/content/signal-000610/opioid-...

thinelvis 8y ago

Weed.

bill_from_tampa 8y ago

Persons with chronic pain should have access to treatments that work for them. For some, it may be exercise, or physical therapy, or tylenol, or a TENS unit. For a few, it may be opioids in low or high doses. Treatments need to be able to be individualized to the specific patient - one size definitely does not fit all. Your pain may respond to meditation and tylenol, but somebody with a pancreas that is autodigesting itself or chronic unrepairable partial bowel obstruction with miserable horrible daily disabling pain may actually do better with opiates. When politicians and internet experts begin dictating medical treatment regimens, individual patients will suffer and die, or commit suicide. On the other hand, persons who enjoy abusing substances to get high or blasted or whatever the feeling may be need to have some safe way of feeding their addiction, or they will die, in large numbers. Being dependent on an illegal supply chain stretching from Kowloon to Morelia to San Diego to wherever with no quality control and no oversight is a recipe for disaster -- nobody who buys stuff on the street knows what they are getting. And to boot, actual medical treatment for addiction is not easy to obtain and limited. The much vaunted "clinics" are for rich people who don't need health insurance to pay the bills. So we will continue to have problems in the US, and they won't be fixed.

zeroname 8y ago

Legalize Heroin for everyone again. If you're going to be a junkie and, let's face it, many people will prefer that over debilitating chronic pain, it'll be a safer and healthier alternative than these synthetic opiods. Heroin used to be freely available over the counter and while it certainly did cause problems for its consumers, it wasn't even close to what these synthetic opioids are doing.