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The danger of all these opioid rulings is that it might get a lot more difficult for people who suffer from pain that needs opioids to actually get them. After

The danger of all these opioid rulings is that it might get a lot more difficult for people who suffer from pain that needs opioids to actually get them. After seeing these rulings, what company in its right mind would actually manufacture opioid pills any more? Doctors are going to be very, very, conservative about how they prescribe.

Ididntdothis 7y ago
How does the prescription rate in the US compare to other countries? When growing up in Germany i never heard of opioids being prescribed besides maybe cancer patients. But in the US I was always given plenty of opioids for even pretty small problems. A while ago I had to get really serious with my girlfriend after only two weeks of them because she already couldn’t handle the withdrawal.
- hn_throwaway_99 7y ago
  I've seen many times that doctors in the US are all too happy to prescribe medication to deal with pain but give exceedingly little instruction or support for how to go off these addictive medications.
- ender341341 7y ago
  ~15 years ago they handed out prescriptions pretty easily. Most reputable places are pretty stingy with them now though. Last time I was in for pain they gave me a prescription for ibuprofen.
btilly 7y ago
The real problem isn't in the manufacture of opioid pills, it is in false advertising around them. In particular don't advertise as 2x a day with the advice to increase the prescription if there are withdrawal effects, when the correct prescription is to go to 3x a day and do not increase the dosage. The false advertising is a recipe to increase sales but create a serious drug addiction that will need to be supplemented somehow.
uptown 7y ago
Good. Just look at the volume of pills prescribed and you can see that overprescription is at the root of the problem. https://beta.washingtonpost.com/investigations/76-billion-opioid-pills-newly-released-federal-data-unmasks-the-epidemic/2019/07/16/5f29fd62-a73e-11e9-86dd-d7f0e60391e9_story.html https://beta.washingtonpost.com/investigations/76-billion-op...
- Spivak 7y ago
  You say good until you have a very real pain disorder and getting the medication that makes life bearable and not want to kill yourself becomes a part time job.
  - ptah 7y ago
    "make life bearable" -> bad choice of words as that would justify junkies shooting up heroin too
  - GordonS 7y ago
    As someone that understands pain only too well, I agree. I suffer from chronic pain and am prescribed (weak) opioids to help manage that pain. I've tried numerous other medications, but the ones I'm on are the only ones I can tolerate and that actually help at all. I am responsible, only ever taking them as prescribed. Even with some pain management, life is not easy; with none, it is unbearable - I honestly don't know if I'd still be here without any pain management. Opioids are plainly being over-prescribed in the US, but we have to be really careful not to withdraw them from those that actually need them.
    - milkytron 7y ago
      Out of curiousity, have you ever tried cannabis? I wonder how it compares when some truly needs pain treatment.
      - GordonS 7y ago
        I'm in the UK, so can't legally access "raw" cannabis. But, I recently got a prescription for Sativex, which is essentially a very expensive cannabis tincture. My biggest issue with it is that you end up swallowing most of it - and eating cannabis is very different to smoking, as THC is metabolised to 11-OH-THC, which is much more psychoactive. I found it made me really anxious, which is not nice at all! I've been experimenting with it, trying to ensure I don't swallow any of it. It does help with the pain, but only a little... and it impairs me in the process - it's really important to me that I can still function cognitively. I also find the way it helps is different than opioids - it's kind of similar to alcohol, in that it's more like a distraction from the pain, whereas opioids actually negate some of the pain. There is a lot of good evidence for cannabis helping with neuropathic pain, so I'd encourage others to try it if they legally and financially can.
JacobDotVI 7y ago
Turns out doctors have better opioid options today but not all of them take advantage of such an option. https://marginalrevolution.com/marginalrevolution/2019/05/how-much-did-physicians-drive-the-opioid-crisis.html https://marginalrevolution.com/marginalrevolution/2019/05/ho... >In August of 2010, Purdue Pharma replaced old OxyContin with a new, anti-abuse version of OxyContin. The new version was just as good at reducing pain as the old but it was more difficult to turn it into an injectable to produce a high. If physicians are altruists who balance treating their patient’s pain against their fear of patient addiction and downstream abuse then they should increase their prescriptions of new Oxy. From the point of view of health, the new Oxy is simply a better drug and with less abuse to worry about altruistic physicians should be more willing on the margin to prescribe Oxy to reduce pain. So what happened? Prescriptions for Oxy fell immediately and dramatically when the better version was released.
- Scoundreller 7y ago
  Sounds more like patients stopped asking for it by name and/or patients just switched to the black market entirely. In my non-US jurisdiction, the big insurers used it as an opportunity to say: "Switch to something that seems less addictive than oxycodone entirely instead of switching them to some other oxycodone"
JMTQp8lwXL 7y ago
This is literally the argument J&J made as their defense. It should be noted as such.
droithomme 7y ago
> it might get a lot more difficult for people who suffer from pain that needs opioids to actually get them I've had severe chronic pain for over a decade from an auto accident. It's well documented as are the injuries. I've never been offered opioids and have been told by multiple doctors that surgery would be pointless and counterproductive. If I was offered opioids I'd turn them down since I understand the potential for abuse. However it would have been nice to be asked. Fact is no doctor I've seen will prescribe them to any other than people with stage 4 cancer, people actually in the hospital following surgery, or the like. Yet every two bit junkie creep and criminal in the area has an unending forever supply that originated in legal sources made by reputable pharma corps and sold by honest pharmacists having received a legit script. How is this? Pain clinics. Pain clinics are prescribing these things. Not regular doctors who for over a decade have been scared to hell of prescribing them no matter how bad off a legit patient is. So will it "get a lot more difficult for people who suffer from pain that needs opioids to actually get them"? I say no, because those people aren't getting them right now anyone. Excepting cancer, people in the hospital, and some other specific cases. But it's OK. Because those of us with severe incurable chronic pain need to just learn to live with it. Opioids provide short term cures, rapidly develop tolerance and addiction. They are not good choices for chronic pain. Nor is anything else apparently. The field of medicine is in the medieval period, as far as how most people experience it. Propaganda about genetic cures and Star Trek like technology is fiction, mostly pushed by lying companies and speculators. Most cancers your choice is to die without treatment since your insurance if you have it isn't going to pay for much and you'll go bankrupt on the copays. Then you die same date as you would have otherwise, probably earlier because the therapy weakens you and makes you sick and miserable. You'll also experience utter misery and horror during your last few months. Choosing to reject modern medical miracles is the best choice for most people with serious problems. Or go after stuff that at least does no physical harm, like alternative treatments, faith healing, or other quakery that's at least cheaper and less miserable. Yet the medical field peddles false hope to the overwhelming majority of people with this problem. Same goes for chronic pain. Surgery will make you worse and pills will ruin your health and may turn you into a criminal addict. Mountebanks selling such false hope really are dealers in misery and horror.
- 01100011 7y ago
the-pigeon 7y ago
Honestly I've never heard any explanation for why something as dangerous as OxyContin is ever prescribed. There's lots of safer alternatives. There could be some niche cases for it but as a general pain killer it should never be used.
- 01100011 7y ago
  Because it's an important tool for pain management in some individuals. I would rather train doctors to appropriately use the tools at their disposal instead of removing tools from their toolbox.
  - Scoundreller 7y ago
    It's hard to compete with pharma marketing as Continuing Education. Yet we pretend that doctors are supposed to be immune to the effects of marketing...
    - GordonS 7y ago
      Then why not change the system? US is rather unusual in allowing direct drug marketing to consumers, and "marketing" to physicians.
- stordoff 7y ago
  The problem is this line of thinking is that it can prevent them from being used in cases when it _is_ appropriate. I have a somewhat similar situation in the UK - the prescribing guidelines say benzodiazapines generally should only be used for sleep for up to 4 weeks (as they _can_ become ineffective, and can be used recreationally), so I semi-frequently[1] have to fight being switched to the so-called z-drugs (typically zopiclone). These have much more severe side-effects for me (memory loss[2] and vision alterations vs. occasional slight drowsiness). This is despite the dose being static for well over a year (20mg/day), and they are still effective. Going three or more days without sleep was at least a monthly incident before taking tamazepam, and missing a night was weekly - three days has only occurred once since, and missing a night's sleep is rare. This has resulted in an improvement to my other symptoms. [1] basically anytime I see a doctor other than my regular doctors, who understand the situation [2] I do not believe thinking you have only blinked, then looking at the clock and realising over four hours have passed is a safe situation. I suspect I just fell asleep, but I don't remember that, or even waking up -- I thought I was just checking the time, and then four hours disappeared. This happened on multiple occasions, and I'm fairly sure I didn't just misremember the time (though even that would be disconcerting), as it was also brighter outside.
alkonaut 7y ago
> Doctors are going to be very, very, conservative about how they prescribe. Conservatively is how most strong opioids should be presrcribed. The general rule is that they should not be prescribed for chronic non-cancer pain.

Ididntdothis 7y ago

How does the prescription rate in the US compare to other countries? When growing up in Germany i never heard of opioids being prescribed besides maybe cancer patients. But in the US I was always given plenty of opioids for even pretty small problems. A while ago I had to get really serious with my girlfriend after only two weeks of them because she already couldn’t handle the withdrawal.

hn_throwaway_99 7y ago
I've seen many times that doctors in the US are all too happy to prescribe medication to deal with pain but give exceedingly little instruction or support for how to go off these addictive medications.
ender341341 7y ago
~15 years ago they handed out prescriptions pretty easily. Most reputable places are pretty stingy with them now though. Last time I was in for pain they gave me a prescription for ibuprofen.

btilly 7y ago

The real problem isn't in the manufacture of opioid pills, it is in false advertising around them. In particular don't advertise as 2x a day with the advice to increase the prescription if there are withdrawal effects, when the correct prescription is to go to 3x a day and do not increase the dosage. The false advertising is a recipe to increase sales but create a serious drug addiction that will need to be supplemented somehow.

uptown 7y ago

Good. Just look at the volume of pills prescribed and you can see that overprescription is at the root of the problem. https://beta.washingtonpost.com/investigations/76-billion-opioid-pills-newly-released-federal-data-unmasks-the-epidemic/2019/07/16/5f29fd62-a73e-11e9-86dd-d7f0e60391e9_story.html https://beta.washingtonpost.com/investigations/76-billion-op...

Spivak 7y ago
You say good until you have a very real pain disorder and getting the medication that makes life bearable and not want to kill yourself becomes a part time job.
- ptah 7y ago
  "make life bearable" -> bad choice of words as that would justify junkies shooting up heroin too
- GordonS 7y ago
  As someone that understands pain only too well, I agree. I suffer from chronic pain and am prescribed (weak) opioids to help manage that pain. I've tried numerous other medications, but the ones I'm on are the only ones I can tolerate and that actually help at all. I am responsible, only ever taking them as prescribed. Even with some pain management, life is not easy; with none, it is unbearable - I honestly don't know if I'd still be here without any pain management. Opioids are plainly being over-prescribed in the US, but we have to be really careful not to withdraw them from those that actually need them.
  - milkytron 7y ago
    Out of curiousity, have you ever tried cannabis? I wonder how it compares when some truly needs pain treatment.
    - GordonS 7y ago
      I'm in the UK, so can't legally access "raw" cannabis. But, I recently got a prescription for Sativex, which is essentially a very expensive cannabis tincture. My biggest issue with it is that you end up swallowing most of it - and eating cannabis is very different to smoking, as THC is metabolised to 11-OH-THC, which is much more psychoactive. I found it made me really anxious, which is not nice at all! I've been experimenting with it, trying to ensure I don't swallow any of it. It does help with the pain, but only a little... and it impairs me in the process - it's really important to me that I can still function cognitively. I also find the way it helps is different than opioids - it's kind of similar to alcohol, in that it's more like a distraction from the pain, whereas opioids actually negate some of the pain. There is a lot of good evidence for cannabis helping with neuropathic pain, so I'd encourage others to try it if they legally and financially can.

JacobDotVI 7y ago

Turns out doctors have better opioid options today but not all of them take advantage of such an option. https://marginalrevolution.com/marginalrevolution/2019/05/how-much-did-physicians-drive-the-opioid-crisis.html https://marginalrevolution.com/marginalrevolution/2019/05/ho... >In August of 2010, Purdue Pharma replaced old OxyContin with a new, anti-abuse version of OxyContin. The new version was just as good at reducing pain as the old but it was more difficult to turn it into an injectable to produce a high. If physicians are altruists who balance treating their patient’s pain against their fear of patient addiction and downstream abuse then they should increase their prescriptions of new Oxy. From the point of view of health, the new Oxy is simply a better drug and with less abuse to worry about altruistic physicians should be more willing on the margin to prescribe Oxy to reduce pain. So what happened? Prescriptions for Oxy fell immediately and dramatically when the better version was released.

Scoundreller 7y ago
Sounds more like patients stopped asking for it by name and/or patients just switched to the black market entirely. In my non-US jurisdiction, the big insurers used it as an opportunity to say: "Switch to something that seems less addictive than oxycodone entirely instead of switching them to some other oxycodone"

JMTQp8lwXL 7y ago

This is literally the argument J&J made as their defense. It should be noted as such.

droithomme 7y ago

> it might get a lot more difficult for people who suffer from pain that needs opioids to actually get them I've had severe chronic pain for over a decade from an auto accident. It's well documented as are the injuries. I've never been offered opioids and have been told by multiple doctors that surgery would be pointless and counterproductive. If I was offered opioids I'd turn them down since I understand the potential for abuse. However it would have been nice to be asked. Fact is no doctor I've seen will prescribe them to any other than people with stage 4 cancer, people actually in the hospital following surgery, or the like. Yet every two bit junkie creep and criminal in the area has an unending forever supply that originated in legal sources made by reputable pharma corps and sold by honest pharmacists having received a legit script. How is this? Pain clinics. Pain clinics are prescribing these things. Not regular doctors who for over a decade have been scared to hell of prescribing them no matter how bad off a legit patient is. So will it "get a lot more difficult for people who suffer from pain that needs opioids to actually get them"? I say no, because those people aren't getting them right now anyone. Excepting cancer, people in the hospital, and some other specific cases. But it's OK. Because those of us with severe incurable chronic pain need to just learn to live with it. Opioids provide short term cures, rapidly develop tolerance and addiction. They are not good choices for chronic pain. Nor is anything else apparently. The field of medicine is in the medieval period, as far as how most people experience it. Propaganda about genetic cures and Star Trek like technology is fiction, mostly pushed by lying companies and speculators. Most cancers your choice is to die without treatment since your insurance if you have it isn't going to pay for much and you'll go bankrupt on the copays. Then you die same date as you would have otherwise, probably earlier because the therapy weakens you and makes you sick and miserable. You'll also experience utter misery and horror during your last few months. Choosing to reject modern medical miracles is the best choice for most people with serious problems. Or go after stuff that at least does no physical harm, like alternative treatments, faith healing, or other quakery that's at least cheaper and less miserable. Yet the medical field peddles false hope to the overwhelming majority of people with this problem. Same goes for chronic pain. Surgery will make you worse and pills will ruin your health and may turn you into a criminal addict. Mountebanks selling such false hope really are dealers in misery and horror.

01100011 7y ago

the-pigeon 7y ago

Honestly I've never heard any explanation for why something as dangerous as OxyContin is ever prescribed. There's lots of safer alternatives. There could be some niche cases for it but as a general pain killer it should never be used.

01100011 7y ago
Because it's an important tool for pain management in some individuals. I would rather train doctors to appropriately use the tools at their disposal instead of removing tools from their toolbox.
- Scoundreller 7y ago
  It's hard to compete with pharma marketing as Continuing Education. Yet we pretend that doctors are supposed to be immune to the effects of marketing...
  - GordonS 7y ago
    Then why not change the system? US is rather unusual in allowing direct drug marketing to consumers, and "marketing" to physicians.
stordoff 7y ago
The problem is this line of thinking is that it can prevent them from being used in cases when it _is_ appropriate. I have a somewhat similar situation in the UK - the prescribing guidelines say benzodiazapines generally should only be used for sleep for up to 4 weeks (as they _can_ become ineffective, and can be used recreationally), so I semi-frequently[1] have to fight being switched to the so-called z-drugs (typically zopiclone). These have much more severe side-effects for me (memory loss[2] and vision alterations vs. occasional slight drowsiness). This is despite the dose being static for well over a year (20mg/day), and they are still effective. Going three or more days without sleep was at least a monthly incident before taking tamazepam, and missing a night was weekly - three days has only occurred once since, and missing a night's sleep is rare. This has resulted in an improvement to my other symptoms. [1] basically anytime I see a doctor other than my regular doctors, who understand the situation [2] I do not believe thinking you have only blinked, then looking at the clock and realising over four hours have passed is a safe situation. I suspect I just fell asleep, but I don't remember that, or even waking up -- I thought I was just checking the time, and then four hours disappeared. This happened on multiple occasions, and I'm fairly sure I didn't just misremember the time (though even that would be disconcerting), as it was also brighter outside.

alkonaut 7y ago

> Doctors are going to be very, very, conservative about how they prescribe. Conservatively is how most strong opioids should be presrcribed. The general rule is that they should not be prescribed for chronic non-cancer pain.