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If you're human, you are susceptible to addiction. The prudence prescribers have towards handing out addictive substances might save you from being the person w

If you're human, you are susceptible to addiction. The prudence prescribers have towards handing out addictive substances might save you from being the person who abuses their medicine. Much like any other potential side-effect, addiction is a risk that must be heavily weighed and mitigated against. Addiction causes harm, and even death. It isn't a question of personal morals, it's a question of ethics. This is the same country that has experienced a decade-long opioid epidemic because addiction risks of prescription drugs were intentionally covered up, and in many cases, the drugs themselves were overprescribed.

mirimir 8y ago
> Addiction causes harm, and even death. That's mostly because the drug they're addicted to can't readily be purchased. So they're stuck buying stuff illegally. Stuff that's expensive. And with unknown potency. Or even, for that matter, identity.
- DanBC 8y ago
  People with an addiction to legally prescribed opioids are caused harm by that addiction even if they never move to illegal opioids. This is because they're taking very large quantities of opioids and suffering the side effects, and they've developed a tolerance so they need larger more risky doses, and because it's probably not treating the problem they started taking opioids for.
  - mirimir 8y ago
    Maybe sometimes. But the major side effect of opioids is constipation. Unless they're idiots, and overdose for recreation. You don't see respiratory collapse in well-managed opioid patients. It's typically caused by prescriber error. And yes, by idiot thrill seekers, and people carelessly combining their opioids with other drugs (e.g., zolpidem) or alcohol. But that's a minor issue, in the context of the pain relief that they get. I do admit, though, that US doctors have tended in recent years to over-prescribe. Partly because it's faster and less hassle to prescribe opioids than physical therapy. And because physical therapy tends to cost more for patients and insurance companies. And also because the compliance rate for physical therapy tends to be low. People are busy, and want quick results. But still, focusing on addiction as the main problem is, in my opinion, misguided. It's better to focus on people being well, and able to enjoy their lives. And if, for whatever reason, that means taking opioids until they die, that's just how it is.
slfnflctd 8y ago
It was a wicked whipsaw. Hordes of new opiate addicts were created, with more addictive compounds than ever before, at unprecedented levels of availability-- and then their access was yanked away, with seemingly little thought to how addicts would react. Curiously, Fentanyl showed up on the black market in huge amounts around this time... and then users from all walks of life started dropping like flies. Narcan is saving a lot of lives (although it does little or nothing for addiction itself), and kratom looks like a potentially promising way to help addicts stop/reduce their use of harder stuff (if misguided crusaders don't go and ban that everywhere), but everything's a tradeoff and nuance is important. We've got a ton to work on in this area for a long time.
- FireBeyond 8y ago
  > Narcan is saving a lot of lives (although it does little or nothing for addiction itself) Nothing whatsoever, and from a bigger picture hurts. "Ideal" treatment for opiate overdose? Manage respiratory depression/arrest, slowly titrate IM (not nasal) Narcan to keep level of consciousness lower, get to hospital, offer patient treatment options/longer term help. Blast IN naloxone into someone and they'll almost always AMA (against medical advice) on scene. -- paramedic
  - tcj_phx 8y ago
    My girlfriend’s involuntary treatment providers decided to give her a benzodiazepine addiction, on top of the other non-helpful prescriptions they thought she needed. Initially the benzos helped her “anxiety”, but the effect wore off after a month. She ordered heroin from her street pharmacist to get through benzo withdrawal. I said... “we’re not going to do this again.” She said it was barely any heroin at all, that she wasn’t going to get addicted again, and that she just needed it so she could sleep. Just to show me that it wasn’t much she prepared a second shot and injected that too. I don’t think she realized that her tolerance had changed and that benzodiazepines increase the potency of opiates. Then she fell forward, said “I meant to do that”, then her face turned blue and she went non-responsive. I called EMS. They revived her with 2x2mg naloxone. After a few minutes the firefighters decided she was okay. The police officers also decided they didn’t need to intervene. She did very well for about 2 weeks: drinking under control, benzodiazepine withdrawal mostly completed, etc. Narcan/naloxone has much broader effects than just kicking out the opiates from the opioid receptors. The related drug Naltrexone is FDA-approved to help people get their alcohol use under control. I’m not entirely clear on how the anti-opiates help with alcohol use, but I think it has to do with fixing the metabolic problem that is associated with most cases of alcoholism. You’re correct that narcan isn’t much of a treatment by itself. But naltrexone is almost the same drug, keeps people sober long enough to get them stabilized, and partially addresses the long-term emotional pain they’re actually self-medicating for. If addicts are helped out of their “cage”, narcan/naloxone and naltrexone are very useful tools to support them while they recover.
FireBeyond 8y ago
We have 4% of the world's population and 81% of its opiate use. In 2019, you are more likely to die in the US of an opiate overdose than you are to die in a car accident. That staggers me.
- XaoDaoCaoCao 8y ago
  We also like to give our population crap food and then whistle away the tsunami of diabetics and of the obese as those conditions drain TRILLIONS of potential wealth. A diet of pure fat would literally be healthier than the diets of a majority of Americans. At least satiety is activated much sooner. If we examined it, we'd probably find a number of preventable deaths per year far exceeding that from any drug use. Hell, the side effects of our dietary metabolic wreckage probably impel the search for comfort/escape in intoxicated states. Of course simultaneously we're dealing with a breakdown of a post WWII script, in mainstream American society, where the dream is available if you work hard and your purchasing power will only get better as society "progresses". But for the average Joe, the price of everyday consumables (Food, gas, water) and shelter has outpaced inflation. At least electronic soma is cheaper! For me, it's hard to extract our drug problem from the pervasive shitstorm of other factors. PS: MXE was/is the shit. It's a damn shame such a relatively mild dissociative with a promising profile will probably never be allowed for public use until the current generation of puritan drug cop-regulators die off.
  - navjack27 8y ago
    +1 for MXE. Loved that shit

mirimir 8y ago

> Addiction causes harm, and even death. That's mostly because the drug they're addicted to can't readily be purchased. So they're stuck buying stuff illegally. Stuff that's expensive. And with unknown potency. Or even, for that matter, identity.

DanBC 8y ago
People with an addiction to legally prescribed opioids are caused harm by that addiction even if they never move to illegal opioids. This is because they're taking very large quantities of opioids and suffering the side effects, and they've developed a tolerance so they need larger more risky doses, and because it's probably not treating the problem they started taking opioids for.
- mirimir 8y ago
  Maybe sometimes. But the major side effect of opioids is constipation. Unless they're idiots, and overdose for recreation. You don't see respiratory collapse in well-managed opioid patients. It's typically caused by prescriber error. And yes, by idiot thrill seekers, and people carelessly combining their opioids with other drugs (e.g., zolpidem) or alcohol. But that's a minor issue, in the context of the pain relief that they get. I do admit, though, that US doctors have tended in recent years to over-prescribe. Partly because it's faster and less hassle to prescribe opioids than physical therapy. And because physical therapy tends to cost more for patients and insurance companies. And also because the compliance rate for physical therapy tends to be low. People are busy, and want quick results. But still, focusing on addiction as the main problem is, in my opinion, misguided. It's better to focus on people being well, and able to enjoy their lives. And if, for whatever reason, that means taking opioids until they die, that's just how it is.

slfnflctd 8y ago

It was a wicked whipsaw. Hordes of new opiate addicts were created, with more addictive compounds than ever before, at unprecedented levels of availability-- and then their access was yanked away, with seemingly little thought to how addicts would react. Curiously, Fentanyl showed up on the black market in huge amounts around this time... and then users from all walks of life started dropping like flies. Narcan is saving a lot of lives (although it does little or nothing for addiction itself), and kratom looks like a potentially promising way to help addicts stop/reduce their use of harder stuff (if misguided crusaders don't go and ban that everywhere), but everything's a tradeoff and nuance is important. We've got a ton to work on in this area for a long time.

FireBeyond 8y ago
> Narcan is saving a lot of lives (although it does little or nothing for addiction itself) Nothing whatsoever, and from a bigger picture hurts. "Ideal" treatment for opiate overdose? Manage respiratory depression/arrest, slowly titrate IM (not nasal) Narcan to keep level of consciousness lower, get to hospital, offer patient treatment options/longer term help. Blast IN naloxone into someone and they'll almost always AMA (against medical advice) on scene. -- paramedic
- tcj_phx 8y ago
  My girlfriend’s involuntary treatment providers decided to give her a benzodiazepine addiction, on top of the other non-helpful prescriptions they thought she needed. Initially the benzos helped her “anxiety”, but the effect wore off after a month. She ordered heroin from her street pharmacist to get through benzo withdrawal. I said... “we’re not going to do this again.” She said it was barely any heroin at all, that she wasn’t going to get addicted again, and that she just needed it so she could sleep. Just to show me that it wasn’t much she prepared a second shot and injected that too. I don’t think she realized that her tolerance had changed and that benzodiazepines increase the potency of opiates. Then she fell forward, said “I meant to do that”, then her face turned blue and she went non-responsive. I called EMS. They revived her with 2x2mg naloxone. After a few minutes the firefighters decided she was okay. The police officers also decided they didn’t need to intervene. She did very well for about 2 weeks: drinking under control, benzodiazepine withdrawal mostly completed, etc. Narcan/naloxone has much broader effects than just kicking out the opiates from the opioid receptors. The related drug Naltrexone is FDA-approved to help people get their alcohol use under control. I’m not entirely clear on how the anti-opiates help with alcohol use, but I think it has to do with fixing the metabolic problem that is associated with most cases of alcoholism. You’re correct that narcan isn’t much of a treatment by itself. But naltrexone is almost the same drug, keeps people sober long enough to get them stabilized, and partially addresses the long-term emotional pain they’re actually self-medicating for. If addicts are helped out of their “cage”, narcan/naloxone and naltrexone are very useful tools to support them while they recover.

FireBeyond 8y ago

We have 4% of the world's population and 81% of its opiate use. In 2019, you are more likely to die in the US of an opiate overdose than you are to die in a car accident. That staggers me.

XaoDaoCaoCao 8y ago
We also like to give our population crap food and then whistle away the tsunami of diabetics and of the obese as those conditions drain TRILLIONS of potential wealth. A diet of pure fat would literally be healthier than the diets of a majority of Americans. At least satiety is activated much sooner. If we examined it, we'd probably find a number of preventable deaths per year far exceeding that from any drug use. Hell, the side effects of our dietary metabolic wreckage probably impel the search for comfort/escape in intoxicated states. Of course simultaneously we're dealing with a breakdown of a post WWII script, in mainstream American society, where the dream is available if you work hard and your purchasing power will only get better as society "progresses". But for the average Joe, the price of everyday consumables (Food, gas, water) and shelter has outpaced inflation. At least electronic soma is cheaper! For me, it's hard to extract our drug problem from the pervasive shitstorm of other factors. PS: MXE was/is the shit. It's a damn shame such a relatively mild dissociative with a promising profile will probably never be allowed for public use until the current generation of puritan drug cop-regulators die off.
- navjack27 8y ago
  +1 for MXE. Loved that shit