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Off topic, but it's insane to me, people in the US get opioids for small surgeries. Here in Germany I had a motorcycle accident resulting in multiple (around 12

Off topic, but it's insane to me, people in the US get opioids for small surgeries. Here in Germany I had a motorcycle accident resulting in multiple (around 12) face fractures and later I had to get an incredibly painful eye surgery and both times I was given large doses of ibuprofen for the pain (which didn't do much). At the time I wished for better painkillers, but maybe it's actually better that way...

DanBC 8y ago
Opioids are probably ok for short term pain like surgery, where they're given by healthcare professionals in a medical setting. A lot of the US problem is that those patients will then be given a big box of opioids to take home for the next week. They then have some opioids spare which they keep insecurely in a cupboard. A relative or neighbour gains access to these and starts their addiction.
- chrisgd 8y ago
  I agree. I think lowering the cost of inpatient care will lead to more liberal drug policies in hospital and managing recovery until ibuprofen is sufficient for after hospital care.
- mrsteveman1 8y ago
  > A lot of the US problem is that those patients will then be given a big box of opioids to take home for the next week. Even the week isn't really a problem, in fact that's become one of the restrictions here in Ohio because the normal practice was to prescribe entire months at a time. People were ending up with 30-60+ day supplies of extended release medications like oxycontin for recovery from procedures that shouldn't have been all that painful for more than 10-12 days. Now if a doctor wants to prescribe opiates for acute pain after a surgery or something, it can't be more than a 7 day supply, any longer and the pharmacist can't fill it. A completely new prescription is required for every additional 7 day supply. In contrast to what was going on before, that means there are now on average 7-8 opportunities for a doctor to re-evaluate whether opiates are still appropriate over a 60 day period, rather than just 1 (the prescription for the 2nd 30 day supply).
yeahforsureman 8y ago
No, that is crazy. Opioids and opiates certainly have their place in e.g. post-recovery for various types of surgeries. That's just proper and humane pain management. But I recognize the attitude. I live in a Nordic country, and I think they're still pretty conservative with pain management on the public side especially. Although that used to be way worse. I don't think what you described could happen here normally. Availability of stronger opioids like oxycodone and fentanyl are more strictly controlled, and they try to keep them confined to hospital use and only for severe pain, cancer patients etc., at home. But stuff like codeine is prescribed much more and could be the stuff you get to take home after even a smaller surgery.
code_duck 8y ago
Dispensation of opiates varies wildly, like all health care in the US. I went to an ER barely walking with a large visible abscess and received no drugs for pain the entire time, since they clearly had decided I was out for drugs despite no history of any sort of that activity.
thomasfedb 8y ago
Getting the balance here is difficult. Pain inhibits recovery, and badly managed acute pain can precipitate chronic pain. However, strong pain killers are addictive. That said, even the simple analgesics (paracetamol, ibuprofen) have their dangers and we have maximum dosing that should not be exceeded. Paracetamol overdose causes horrible liver damage (up to and including lethal damage), and NSAIDs can cause clotting issues post-surgery, gastrointestinal issues, etc.
- chmod775 8y ago
  > Pain inhibits recovery Not as much as you tearing your wounds open again because your body wasn't able to warn you.
  - thomasfedb 8y ago
    I assume your suggesting that analgesia prevents the detection of wound infection? Pain is hardly the only sign: redness, swelling, heat, discharge, tachycardia, fever, etc.
    - chmod775 8y ago
      > I assume your suggesting that analgesia prevents the detection of wound infection? You misread what I said. Pain is part of the feedback loop that keeps you from straining your skin, muscle and bones past their tearing/breaking point. People who don't feel pain are many times more likely to injure themselves, especially when they already have wounds that might re-open through the wrong movement. Pain is likely to stop wrong movements long before you can make your condition worse. Mostly pain is a "desirable" sensory input. But it's understandable that people don't like it. There's obviously cases where you want to prescribe strong painkillers - but if you're taking those you shouldn't be out and about anyways and have people watching over you. For most post-op pain you shouldn't be on strong painkillers for long though, lest you undo the work your doctors put into you.
lotsofpulp 8y ago
In the US, an orthodontist removed my impacted tooth (whole visit took less than 5 minutes) prescribed hydrocodone or oxycodone and some other pain killer. I didn't choose to pick up the prescription, but it was way overkill for the extremely mild discomfort I felt for the next 16 hours or so. I didn't take a single medicine other than the antibiotics prescribed, but I would have had access to tons of pain killers for no reason.
jacques_chester 8y ago
NSAIDs were counterindicated for my surgery, as they'd increase the risk of internal bleeding. I had to avoid them for 10 days before I went in and come off paracetamol/acetaminophen 3 days prior. An uncomfortable few nights. I think the US is much more liberal in terms of regulation, so it's very much up to the doctor. Mine is an expensive orthopaedic surgeon in NYC, he wouldn't have seen me as an addict with drug-seeking behaviour. Afterwards he gave me a prescription for the lowest-dose hydrocodone; I think I wound up taking it for about 3 days and then I didn't need it any more. I was in pain, so I appreciated having the painkillers there to help. But I also appreciated that I don't want to form a habit, so I came off as quickly as I felt I could.

DanBC 8y ago

Opioids are probably ok for short term pain like surgery, where they're given by healthcare professionals in a medical setting. A lot of the US problem is that those patients will then be given a big box of opioids to take home for the next week. They then have some opioids spare which they keep insecurely in a cupboard. A relative or neighbour gains access to these and starts their addiction.

chrisgd 8y ago
I agree. I think lowering the cost of inpatient care will lead to more liberal drug policies in hospital and managing recovery until ibuprofen is sufficient for after hospital care.
mrsteveman1 8y ago
> A lot of the US problem is that those patients will then be given a big box of opioids to take home for the next week. Even the week isn't really a problem, in fact that's become one of the restrictions here in Ohio because the normal practice was to prescribe entire months at a time. People were ending up with 30-60+ day supplies of extended release medications like oxycontin for recovery from procedures that shouldn't have been all that painful for more than 10-12 days. Now if a doctor wants to prescribe opiates for acute pain after a surgery or something, it can't be more than a 7 day supply, any longer and the pharmacist can't fill it. A completely new prescription is required for every additional 7 day supply. In contrast to what was going on before, that means there are now on average 7-8 opportunities for a doctor to re-evaluate whether opiates are still appropriate over a 60 day period, rather than just 1 (the prescription for the 2nd 30 day supply).

yeahforsureman 8y ago

No, that is crazy. Opioids and opiates certainly have their place in e.g. post-recovery for various types of surgeries. That's just proper and humane pain management. But I recognize the attitude. I live in a Nordic country, and I think they're still pretty conservative with pain management on the public side especially. Although that used to be way worse. I don't think what you described could happen here normally. Availability of stronger opioids like oxycodone and fentanyl are more strictly controlled, and they try to keep them confined to hospital use and only for severe pain, cancer patients etc., at home. But stuff like codeine is prescribed much more and could be the stuff you get to take home after even a smaller surgery.

code_duck 8y ago

Dispensation of opiates varies wildly, like all health care in the US. I went to an ER barely walking with a large visible abscess and received no drugs for pain the entire time, since they clearly had decided I was out for drugs despite no history of any sort of that activity.

thomasfedb 8y ago

Getting the balance here is difficult. Pain inhibits recovery, and badly managed acute pain can precipitate chronic pain. However, strong pain killers are addictive. That said, even the simple analgesics (paracetamol, ibuprofen) have their dangers and we have maximum dosing that should not be exceeded. Paracetamol overdose causes horrible liver damage (up to and including lethal damage), and NSAIDs can cause clotting issues post-surgery, gastrointestinal issues, etc.

chmod775 8y ago
> Pain inhibits recovery Not as much as you tearing your wounds open again because your body wasn't able to warn you.
- thomasfedb 8y ago
  I assume your suggesting that analgesia prevents the detection of wound infection? Pain is hardly the only sign: redness, swelling, heat, discharge, tachycardia, fever, etc.
  - chmod775 8y ago
    > I assume your suggesting that analgesia prevents the detection of wound infection? You misread what I said. Pain is part of the feedback loop that keeps you from straining your skin, muscle and bones past their tearing/breaking point. People who don't feel pain are many times more likely to injure themselves, especially when they already have wounds that might re-open through the wrong movement. Pain is likely to stop wrong movements long before you can make your condition worse. Mostly pain is a "desirable" sensory input. But it's understandable that people don't like it. There's obviously cases where you want to prescribe strong painkillers - but if you're taking those you shouldn't be out and about anyways and have people watching over you. For most post-op pain you shouldn't be on strong painkillers for long though, lest you undo the work your doctors put into you.

lotsofpulp 8y ago

In the US, an orthodontist removed my impacted tooth (whole visit took less than 5 minutes) prescribed hydrocodone or oxycodone and some other pain killer. I didn't choose to pick up the prescription, but it was way overkill for the extremely mild discomfort I felt for the next 16 hours or so. I didn't take a single medicine other than the antibiotics prescribed, but I would have had access to tons of pain killers for no reason.

jacques_chester 8y ago

NSAIDs were counterindicated for my surgery, as they'd increase the risk of internal bleeding. I had to avoid them for 10 days before I went in and come off paracetamol/acetaminophen 3 days prior. An uncomfortable few nights. I think the US is much more liberal in terms of regulation, so it's very much up to the doctor. Mine is an expensive orthopaedic surgeon in NYC, he wouldn't have seen me as an addict with drug-seeking behaviour. Afterwards he gave me a prescription for the lowest-dose hydrocodone; I think I wound up taking it for about 3 days and then I didn't need it any more. I was in pain, so I appreciated having the painkillers there to help. But I also appreciated that I don't want to form a habit, so I came off as quickly as I felt I could.