4 ms·

To me this is essentially your argument: I have to suffer with excruciating pain because somebody else might make a bad decision or lack self-control, and my p

To me this is essentially your argument: I have to suffer with excruciating pain because somebody else might make a bad decision or lack self-control, and my pain is worth it just in case it helps somebody else (evidence is lacking there anyway. Prescriptions have dropped precipitously, but opioid deaths are still rising). Would it change your viewpoint at all to know that a lot of chronic pain patients are now committing suicide rather than face a life where they are bed-ridden and dependent on a loved one for care? And all they need is a medication and they could have some quality of life? What about the people who have been responsible with their prescriptions but are now forced to buy potentially deadly black-market opioids like heroin and fentanyl from a dealer that is surely less concerned about their health and safety than their doctor, if they want relief? That is extremely non-compassionate. I would never wish that on you or anyone else. I don't think that is what you are trying to say, but I struggle to see how your logic doesn't ultimately reduce to that. Edit (after thinking more): your example of the codeine is definitely a good example of over-subscribing, but my dad had a vasectomy that ended up being a horrible recovery. Luckily he was able to sit on the couch with a bag of ice under his balls and watch football for a week, but the man was in some serious discomfort. I tend to think education is the answer. Teach people about the risks, and then give them freedom to decide. If we boil society and our laws down to never requiring or allowing people to take responsibility for their own actions and decisions, then we end up in a bad place IMHO.

tombert 8y ago
I appreciate your edit. Please understand, and maybe I didn't make this terribly clear, but I am not saying I'm against people taking painkillers when needed. Obviously if you have crippling pain of course you should get pills. "Monitoring Doctors More" does not equate to "ban opiodes" any more than saying saying "regulating business" equates to "no business". There's a middle-ground here. I'd also like to point out that I don't think I'm being non-compassionate in this case. Living in NY I get to see the terror of severe drug addiction every single day when I see (certain) homeless people. It seems "non-compassionate" to me to reduce all of life-crippling addiction to "making a bad decision or lacking self-control". While some people have more addictive personalities than others, the stronger opiodes are addictive enough to ruin lives. It's easy to dismiss this as "people without self control", but I can almost guarantee that someone in your slightly-extended family has had severe problems with opiodes.
- freedomben 8y ago
  It may surprise you to learn that very few (about 2%) of people who use prescription opioids end up abusing them [1]. Also, there is also no correlation (let alone causation) between lower prescribing rates and lower overdose rates [2]. [1] https://www.politico.com/magazine/story/2018/02/21/the-myth-of-the-roots-of-the-opioid-crisis-217034 https://www.politico.com/magazine/story/2018/02/21/the-myth-... [2] https://www.painnewsnetwork.org/stories/2018/10/30/overdoses-soar-in-2-states-despite-reduced-supply-of-rx-opioids https://www.painnewsnetwork.org/stories/2018/10/30/overdoses...
  - wavegeek 8y ago
    There were similar observations after the Vietnam war. Many soldiers were opiate addicts over there but the vast majority quit when they returned home and were no longer in the hell of combat. Any level of scrutiny is going to leave some untreated who need it and some people getting it frivolously and perhaps getting addicted. The question is the role of individual responsibility and where the balance lies.
- BaronVonSteuben 8y ago
  I totally agree with, "It seems 'non-compassionate' to me to reduce all of life-crippling addiction to 'making a bad decision or lacking self-control'." But I disagree that being prescribed opioids is a primary factor here. Many people with addiction issues, particularly homeless, are suffering from other mental health issues as well. They often abuse many substance both legal and illegal. I think it's perfectly reasonable and appropriate for doctors to screen for these sorts of things before prescribing. However I also think making treatment for addiction more available and affordable is a better remediation strategy than having law enforcement monitor and scrutinize every act to the point where doctors are afraid to prescribe, even to patients in need.
NeedMoreTea 8y ago
We end up in a worse place societally if we go with line of least resistance every time. "Education and freedom to decide" results in patients asking for antibiotics for everything from a common cold upwards, and opiates for every headache and broken bone which has major consequences for everyone. Upto and including the end of the antibiotic era and stories of needless opiate epidemics. A couple of weeks of serious discomfort, especially if a clearly temporary condition, is not something to be erased at every opportunity. It is a normal part of injury and healing and something we should not necessarily expect to automatically numb out of existence with drugs. Which is broadly what the surgeon and medical folks told me after my operation (for something else though). Along with the suggestion to try a couple of Nurofen, but to come back and talk about if it remains too much. I got ONE dose of something opiate based, the morning after. For everything else I was frankly expected to expect serious discomfort that will go away in time. It did, though my rate of swearing rose quite remarkably for a week or two. :) For chronic conditions where nothing else has worked of course they should be available. After an appropriate level of counselling and warning of the ratcheting down of effect and addictive consequences of extended use. Which suggests a prescription regime that treads lightly down that path. Offer 2 or 3 days of opiates first and explore every avenue before they become a daily medication that you will end up addicted to. Freedom to decide is what risks ruining it for all, including those chronic patients who have no working alternatives, as their only option becomes hidden behind a layer of freely chosen, but needless addiction. That means it's necessarily slower for those in real need to get enough coverage and dosage, but hopefully only those that truly need end up on a daily dose.
- wavegeek 8y ago
  > antibiotics There is a difference in the case of antibiotics because of the issue of drug resistance. Most of the harm to others from opiate addiction is a secondary effect from the illegality of non-prescription drugs, leading to crime. There is no fundamental reason why someone else being an addict should be harmful to you, apart from your feelings of compassion for them.

tombert 8y ago

I appreciate your edit. Please understand, and maybe I didn't make this terribly clear, but I am not saying I'm against people taking painkillers when needed. Obviously if you have crippling pain of course you should get pills. "Monitoring Doctors More" does not equate to "ban opiodes" any more than saying saying "regulating business" equates to "no business". There's a middle-ground here. I'd also like to point out that I don't think I'm being non-compassionate in this case. Living in NY I get to see the terror of severe drug addiction every single day when I see (certain) homeless people. It seems "non-compassionate" to me to reduce all of life-crippling addiction to "making a bad decision or lacking self-control". While some people have more addictive personalities than others, the stronger opiodes are addictive enough to ruin lives. It's easy to dismiss this as "people without self control", but I can almost guarantee that someone in your slightly-extended family has had severe problems with opiodes.

freedomben 8y ago
It may surprise you to learn that very few (about 2%) of people who use prescription opioids end up abusing them [1]. Also, there is also no correlation (let alone causation) between lower prescribing rates and lower overdose rates [2]. [1] https://www.politico.com/magazine/story/2018/02/21/the-myth-of-the-roots-of-the-opioid-crisis-217034 https://www.politico.com/magazine/story/2018/02/21/the-myth-... [2] https://www.painnewsnetwork.org/stories/2018/10/30/overdoses-soar-in-2-states-despite-reduced-supply-of-rx-opioids https://www.painnewsnetwork.org/stories/2018/10/30/overdoses...
- wavegeek 8y ago
  There were similar observations after the Vietnam war. Many soldiers were opiate addicts over there but the vast majority quit when they returned home and were no longer in the hell of combat. Any level of scrutiny is going to leave some untreated who need it and some people getting it frivolously and perhaps getting addicted. The question is the role of individual responsibility and where the balance lies.
BaronVonSteuben 8y ago
I totally agree with, "It seems 'non-compassionate' to me to reduce all of life-crippling addiction to 'making a bad decision or lacking self-control'." But I disagree that being prescribed opioids is a primary factor here. Many people with addiction issues, particularly homeless, are suffering from other mental health issues as well. They often abuse many substance both legal and illegal. I think it's perfectly reasonable and appropriate for doctors to screen for these sorts of things before prescribing. However I also think making treatment for addiction more available and affordable is a better remediation strategy than having law enforcement monitor and scrutinize every act to the point where doctors are afraid to prescribe, even to patients in need.

NeedMoreTea 8y ago

We end up in a worse place societally if we go with line of least resistance every time. "Education and freedom to decide" results in patients asking for antibiotics for everything from a common cold upwards, and opiates for every headache and broken bone which has major consequences for everyone. Upto and including the end of the antibiotic era and stories of needless opiate epidemics. A couple of weeks of serious discomfort, especially if a clearly temporary condition, is not something to be erased at every opportunity. It is a normal part of injury and healing and something we should not necessarily expect to automatically numb out of existence with drugs. Which is broadly what the surgeon and medical folks told me after my operation (for something else though). Along with the suggestion to try a couple of Nurofen, but to come back and talk about if it remains too much. I got ONE dose of something opiate based, the morning after. For everything else I was frankly expected to expect serious discomfort that will go away in time. It did, though my rate of swearing rose quite remarkably for a week or two. :) For chronic conditions where nothing else has worked of course they should be available. After an appropriate level of counselling and warning of the ratcheting down of effect and addictive consequences of extended use. Which suggests a prescription regime that treads lightly down that path. Offer 2 or 3 days of opiates first and explore every avenue before they become a daily medication that you will end up addicted to. Freedom to decide is what risks ruining it for all, including those chronic patients who have no working alternatives, as their only option becomes hidden behind a layer of freely chosen, but needless addiction. That means it's necessarily slower for those in real need to get enough coverage and dosage, but hopefully only those that truly need end up on a daily dose.

wavegeek 8y ago
> antibiotics There is a difference in the case of antibiotics because of the issue of drug resistance. Most of the harm to others from opiate addiction is a secondary effect from the illegality of non-prescription drugs, leading to crime. There is no fundamental reason why someone else being an addict should be harmful to you, apart from your feelings of compassion for them.