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The whole "opioid" shit fight can be summarised as: Pharmaceutical companies needed a way to profit from developing alternatives to morphine so they developed

by dools 8y ago

The whole "opioid" shit fight can be summarised as: Pharmaceutical companies needed a way to profit from developing alternatives to morphine so they developed a bunch of dangerous bullshit then convinced everyone it was safer than morphine even though it's not. Morphine is awesome and has as its only long term side effect constipation. If it ain't broke, don't fix it. Prescribe morphine, including to heroin addicts who are, after all, simply addicted to morphine which isn't actually that dangerous. The only thing that makes heroin dangerous is the fact that it's not prescribed by a licensed pharmacist. Think about it: if you're addicted to pain medication maybe you're experiencing some pain. So like, prescribe them the pain medication, then help them deal with the cause of the pain. Drug policy is so stupid.

TheOtherHobbes 8y ago
There's no money in making it smarter. If ever there was evidence of the appalling effects of using the profit motive as a proxy for intelligent policy, this is it.
DanBC 8y ago
> So like, prescribe them the pain medication, then help them deal with the cause of the pain. A lot of pain, most pain probably, does not have a cause. It is this type of long term pain that is hardest to treat. We know psychological therapy helps people live their lives with pain (it's used with cancer patients), but patients reject it because "my pain is real, not in my head". We know weight loss and exercise helps some people (especially those with musculo-skeletal problems), but we know how hard weight loss is and a year of weight loss and physical therapy is rejected by some patients (a few say "ignore the fat, treat the illness", and a few can't cope with the idea that treatment is being "paused" for a year). And it's this group who are being most poorly served by opioid meds: they develop a tolerance for opioids until they're taking very high levels. So now they have an opioid addiction, all the side effects of the meds, and they're still in pain.
- dools 8y ago
  I'm not referring exclusively to physical pain
adrianN 8y ago
I think another important side effect that you neglect to mention is physical dependence on the drug and the need to constantly increase the dosage to achieve the same effect.
- GordonS 8y ago
  I don't think it's true that you always need to constantly increase the dosage. I've been on the same dose of dihydrocodeine for years, and effectiveness is just the same today as when I started. I do take magnesium daily, as opioids cause constipation and this helps. Magnesium is an NMDA antagonist, and there is a lot of evidence that these prevent the buildup of tolerance.
- dools 8y ago
  If the dosage can be safely consumed who cares if it needs to be increased?
bionoid 8y ago
> Morphine is awesome and has as its only long term side effect constipation. Honest question.... Long-term morphine use will not dull the mind?
- dools 8y ago
  Nothing I have ever read suggests any mental impact of morphine use.
  - pdkl95 8y ago
    Well, there can be a very strong mental impact for some people. Vertigo, drowsiness, or a general "fogginess" common side effects some people experience. This isn't unusual: lots of medications have similar side effects, hence the common waring given on prescriptions about not driving or operating heavy machinery until you're familiar with how your body responds to the medication. However, those are acute effects that go away as the drug wears off. With long-term use, this type of negative effect often reduces with the increase in tolerance, eventually reaching an equilibrium at some lower level of effect (tolerance works both ways: both negative and positive effects go down as ability to tolerate the drug increases). Most of the native effects from chronic use of morphine is sociological ("increased risks of being arrested").
  - bionoid 8y ago
    That's interesting, thanks. My cousin is a recovering heroin addict, and the mental impact is clear as day. I had not considered that long-term morphine use would be significantly different/better in that regard.
devwastaken 8y ago
I think you're massively downplaying addiction. Sometimes it is physical pain at first, but you get hooked on it. Not everyone does heroin because they actually need that level of pain medication. They do it because it feels amazing. They get dependence on it, and then keep doing it. Read the Heroin diaries by Nikki Sixx of Motley Crue if you want a good look into that. I don't know where you're getting that morphine isn't dangerous. It's highly addictive and deadly if dosed wrong, and you absolutely build tolerance over time which changes your dosing.
- dools 8y ago
  A substance's addictive ness does not equate to lethality. The reason it's dosed incorrectly is because it is manufactured and sold in an unregulated environment. That is the cause of its lethality. Also I'm not referring exclusively to physical pain, but trauma or lack of emotional and social connection.
  - bluntfang 8y ago
    >The reason it's dosed incorrectly is because it is manufactured and sold in an unregulated environment. How do you know it isn't because more of it makes you feel more of the effects?
    - deleted 8y ago
      [deleted]
  - eletious 8y ago
    The addictive nature of the substance combined with the body's growing resistance to it leads to users of the substance to use larger doses to achieve the same high, in some cases not exercising any caution about dosage, leading to overdose.
    - viggity 8y ago
      wife is a social worker - she has told me that most common reason for overdoses is the first use after being sober for an extended period of time. Someone will get clean, abstain for weeks/months/years, have a personal tragedy, and (this is the important part) immediately use the same dose that they used before quitting. And it is way way too much.
maccard 8y ago
> Drug policy is so stupid. In a nutshell, yes. The solution isn't as clear-cut as you'd make it out to be unfortunately. > Morphine is awesome and has as its only long term side effect constipation. That's sugar coating it. Morphine is a great solution to many things, but it's extremely addictive, and has more side effects than constipation (shallow breathing for one, which combined with alcohol can make for a nasty combination). Medical advice is also that opiods as a whole generally aren't effective for long term pain management. > The only thing that makes heroin dangerous is the fact that it's not prescribed by a licensed pharmacist. That's also a huge oversimplification. Source of the prescription/doses is definitely an issue (see how _most_ people manage dosages of other drugs - paracetamol/asprin/alcohol when left unattended) but ultimately it's the supply of the drugs - if I buy 100mg of morphine tablets from a pharmacy, I can be reasonably sure that it's 100mg of morphine, and that it's been stored in the correct environments, but if I buy it off some guy on the street, I've no idea if it's cut with fentanyl. > Think about it: if you're addicted to pain medication maybe you're experiencing some pain. So like, prescribe them the pain medication, then help them deal with the cause of the pain. That's _definitely_ an over-simplification. There's plenty (too much) being prescribed when it's not needed, and the usage isn't being monitored. When people do develop addiction issues, there is no help available for them. Vox [0](best source I could find with a 5m google sorry) has a reasonable explanation of the issue (with citations), and it's definitely not "give people in pain more opiods because morphine is safe" [0] https://www.vox.com/science-and-health/2017/8/1/15746780/opioid-epidemic-end https://www.vox.com/science-and-health/2017/8/1/15746780/opi...
- snarf21 8y ago
  You are correct but I think the main point the parent had was that this problem was created by greed. We never had this kind of opioid epidemic when people got prescribed morphine instead of oxy. I also think we need to look at pot and other combinations of drugs that have been shown to better manage chronic pain than any opioid. I personally don't think the oxys of the world should be used outside of clinical environments and only for acute pain.
- dools 8y ago
  I'm not saying "give people who are dependent more opioids" I'm saying that while you're treating the problems that drove them to become dependent in the first place, it makes sense to give them easy access to clean drugs so they don't have to deal with 2 personal crises at once. For example, Heroin Assisted Treatment: http://www.sdf.org.uk/heroin-assisted-treatment-provided-glasgow/ http://www.sdf.org.uk/heroin-assisted-treatment-provided-gla...

by dools 8y ago

TheOtherHobbes 8y ago

There's no money in making it smarter. If ever there was evidence of the appalling effects of using the profit motive as a proxy for intelligent policy, this is it.

DanBC 8y ago

> So like, prescribe them the pain medication, then help them deal with the cause of the pain. A lot of pain, most pain probably, does not have a cause. It is this type of long term pain that is hardest to treat. We know psychological therapy helps people live their lives with pain (it's used with cancer patients), but patients reject it because "my pain is real, not in my head". We know weight loss and exercise helps some people (especially those with musculo-skeletal problems), but we know how hard weight loss is and a year of weight loss and physical therapy is rejected by some patients (a few say "ignore the fat, treat the illness", and a few can't cope with the idea that treatment is being "paused" for a year). And it's this group who are being most poorly served by opioid meds: they develop a tolerance for opioids until they're taking very high levels. So now they have an opioid addiction, all the side effects of the meds, and they're still in pain.

dools 8y ago
I'm not referring exclusively to physical pain

adrianN 8y ago

I think another important side effect that you neglect to mention is physical dependence on the drug and the need to constantly increase the dosage to achieve the same effect.

GordonS 8y ago
I don't think it's true that you always need to constantly increase the dosage. I've been on the same dose of dihydrocodeine for years, and effectiveness is just the same today as when I started. I do take magnesium daily, as opioids cause constipation and this helps. Magnesium is an NMDA antagonist, and there is a lot of evidence that these prevent the buildup of tolerance.
dools 8y ago
If the dosage can be safely consumed who cares if it needs to be increased?

bionoid 8y ago

> Morphine is awesome and has as its only long term side effect constipation. Honest question.... Long-term morphine use will not dull the mind?

dools 8y ago
Nothing I have ever read suggests any mental impact of morphine use.
- pdkl95 8y ago
  Well, there can be a very strong mental impact for some people. Vertigo, drowsiness, or a general "fogginess" common side effects some people experience. This isn't unusual: lots of medications have similar side effects, hence the common waring given on prescriptions about not driving or operating heavy machinery until you're familiar with how your body responds to the medication. However, those are acute effects that go away as the drug wears off. With long-term use, this type of negative effect often reduces with the increase in tolerance, eventually reaching an equilibrium at some lower level of effect (tolerance works both ways: both negative and positive effects go down as ability to tolerate the drug increases). Most of the native effects from chronic use of morphine is sociological ("increased risks of being arrested").
- bionoid 8y ago
  That's interesting, thanks. My cousin is a recovering heroin addict, and the mental impact is clear as day. I had not considered that long-term morphine use would be significantly different/better in that regard.

devwastaken 8y ago

I think you're massively downplaying addiction. Sometimes it is physical pain at first, but you get hooked on it. Not everyone does heroin because they actually need that level of pain medication. They do it because it feels amazing. They get dependence on it, and then keep doing it. Read the Heroin diaries by Nikki Sixx of Motley Crue if you want a good look into that. I don't know where you're getting that morphine isn't dangerous. It's highly addictive and deadly if dosed wrong, and you absolutely build tolerance over time which changes your dosing.

dools 8y ago
A substance's addictive ness does not equate to lethality. The reason it's dosed incorrectly is because it is manufactured and sold in an unregulated environment. That is the cause of its lethality. Also I'm not referring exclusively to physical pain, but trauma or lack of emotional and social connection.
- bluntfang 8y ago
  >The reason it's dosed incorrectly is because it is manufactured and sold in an unregulated environment. How do you know it isn't because more of it makes you feel more of the effects?
  - deleted 8y ago
    [deleted]
- eletious 8y ago
  The addictive nature of the substance combined with the body's growing resistance to it leads to users of the substance to use larger doses to achieve the same high, in some cases not exercising any caution about dosage, leading to overdose.
  - viggity 8y ago
    wife is a social worker - she has told me that most common reason for overdoses is the first use after being sober for an extended period of time. Someone will get clean, abstain for weeks/months/years, have a personal tragedy, and (this is the important part) immediately use the same dose that they used before quitting. And it is way way too much.

maccard 8y ago

> Drug policy is so stupid. In a nutshell, yes. The solution isn't as clear-cut as you'd make it out to be unfortunately. > Morphine is awesome and has as its only long term side effect constipation. That's sugar coating it. Morphine is a great solution to many things, but it's extremely addictive, and has more side effects than constipation (shallow breathing for one, which combined with alcohol can make for a nasty combination). Medical advice is also that opiods as a whole generally aren't effective for long term pain management. > The only thing that makes heroin dangerous is the fact that it's not prescribed by a licensed pharmacist. That's also a huge oversimplification. Source of the prescription/doses is definitely an issue (see how _most_ people manage dosages of other drugs - paracetamol/asprin/alcohol when left unattended) but ultimately it's the supply of the drugs - if I buy 100mg of morphine tablets from a pharmacy, I can be reasonably sure that it's 100mg of morphine, and that it's been stored in the correct environments, but if I buy it off some guy on the street, I've no idea if it's cut with fentanyl. > Think about it: if you're addicted to pain medication maybe you're experiencing some pain. So like, prescribe them the pain medication, then help them deal with the cause of the pain. That's _definitely_ an over-simplification. There's plenty (too much) being prescribed when it's not needed, and the usage isn't being monitored. When people do develop addiction issues, there is no help available for them. Vox [0](best source I could find with a 5m google sorry) has a reasonable explanation of the issue (with citations), and it's definitely not "give people in pain more opiods because morphine is safe" [0] https://www.vox.com/science-and-health/2017/8/1/15746780/opioid-epidemic-end https://www.vox.com/science-and-health/2017/8/1/15746780/opi...

snarf21 8y ago
You are correct but I think the main point the parent had was that this problem was created by greed. We never had this kind of opioid epidemic when people got prescribed morphine instead of oxy. I also think we need to look at pot and other combinations of drugs that have been shown to better manage chronic pain than any opioid. I personally don't think the oxys of the world should be used outside of clinical environments and only for acute pain.
dools 8y ago
I'm not saying "give people who are dependent more opioids" I'm saying that while you're treating the problems that drove them to become dependent in the first place, it makes sense to give them easy access to clean drugs so they don't have to deal with 2 personal crises at once. For example, Heroin Assisted Treatment: http://www.sdf.org.uk/heroin-assisted-treatment-provided-glasgow/ http://www.sdf.org.uk/heroin-assisted-treatment-provided-gla...