5 ms·

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/investig

by 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.
goldenkey 7y ago
Easy for you to say when you don't live with chronic pain. Morphine makes life bearable and allows me to work and contribute to society. I would otherwise be in bed all day from the chronic pain. Having chronic pain is like being under water. And pain relief is like coming up for air. These laws have made it so I can literally only get a maximum of 90mg of morphine daily when I really need 200mg, what I used to be on. It's terrible that those of us who actually use these drugs responsible are being screwed over, and average joes like yourself demonize opioids when they have medicinal value. I will agree that synthetics are bad and I specifically ask for morphine versus Oxycodone or Hydrocodone. The synthetics are pretty much just a way to make more money and they are way more addictive.
- refurb 7y ago
  You had me until the end. There is nothing about the synthetic opioids that make them more addictive.
  - socialist_coder 7y ago
    Not 100% true, the extended release version of Oxycontin was actually more addictive than other variants.
    - refurb 7y ago
      OxyContin became popular because it was commonly prescribed and you could crush up the pills to get the entire dose at once, instead of over 8 hours.
  - Gibbon1 7y ago
    Friends of my that are ex-addicts say Oxycodone is the shizzle. Also Oxycontin was marketed as having a 12 hour dosing schedule. But the half life is about 2/3rds if that. That sets up a yoyo dosing schedule that's known to be highly addictive.
    - ceejayoz 7y ago
refurb 7y ago
Don’t let the media scare you with big numbers. 76B doses is about a 6 month script for every patient with chronic pain in the US.
- ceejayoz 7y ago
  That's just doing the same number fuckery in the other direction. 76B doses being a six month supply would mean 416M doses a day for America's 50M people with chronic pain (not all of which have pain conditions suited to opiate treatment, incidentally). Almost ten doses a day for each and every one one of them?
  - refurb 7y ago
    The 76B is over 6 years. And it's by dosage units, so if your doctor says "take two every four hours", you'll be consuming 12 each day. The number isn't that shocking.
    - ceejayoz 7y ago
      I'm contesting the "76B doses is about a 6 month script for every patient with chronic pain in the US" statement, as well as the idea that every chronic pain patient needs opiate treatment. > if your doctor says "take two every four hours" That'd be weird for an Q12H drug, wouldn't it?
      - refurb 7y ago
        This is all opioids prescriptions. 12 hour dosing is a small fraction of that. Most opioids are dosed every 4 hours.
- uptown 7y ago
  Not every patient needs opioids.
stordoff 7y ago
About 8% of Americans (19.6 million people)[1] have high-impact chronic pain (chronic pain that limited life or work activities on most days or every day during the past 6 months), and the 76 billion pills figure spans six years. That figure accounts for 3/4 of total opioid pill shipments (it's oxycodone and hydrocodone only)[2], so the total shipped is around 101.3bn. So, if we assume chronic pain suffers sufferers need 4 pills a day[3], that gives us: 19.6 million people * 4 pills/person/day * 6 years ~= 172bn pills Given that figure is significantly _more_ than the actual number prescribed, it doesn't strike me as overprescripton. Yes, there are issues with diversion, and the number of pain sufferers may be inflated by people faking pain (to get opioids or malingering for other reasons), but the volume of pills prescribed alone don't suggest there is a major issue. Furthermore, 11.6 million 'true' high-impact chronic pain sufferers would still get you to the shipped figure[4], and I find it hard to believe that 8 million people are faking pain, especially as the data is gathered from a survey, rather than a situation that may result in opioids or any other non-clinical benefit. [1] https://www.cdc.gov/mmwr/volumes/67/wr/mm6736a2.htm https://www.cdc.gov/mmwr/volumes/67/wr/mm6736a2.htm [2] https://www.washingtonpost.com/graphics/2019/investigations/dea-pain-pill-database/ https://www.washingtonpost.com/graphics/2019/investigations/... [3] I (non-US) am on (up to) 8 opioid-containing pills per day, so taking 4 as a rough average doesn't seem unreasonable [4] 11.6 million people * 4 pills/person/day * 6 years ~= 101bn pills
- ptah 7y ago
  you are assuming that all sufferers of high-impact chronic pain need opioids. for some types of pain ibuprofen/paracetomol/etc is way mroe effective
  - GordonS 7y ago
    This is a good point. For inflammation-type pain, paracetamol or NSAIDs (Nonsteroidal anti-inflammatory drugs) can be remarkably effective. For neuropathic pain, gabapentoids are likely a better first-line treatment, with SNRIs (Serotonin–norepinephrine reuptake inhibitors) or TCAs (tricyclics) as second-line. There are of course many people for whom opioids are appropriate, but they should only be used where less potentially harmful medications have been tried first. My understanding of the situation in the US is that they are often prescribed as 1st-line treatments, or inappropriately after surgeries where NSAIDs would be more appropriate.

by uptown 7y ago

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.

goldenkey 7y ago

Easy for you to say when you don't live with chronic pain. Morphine makes life bearable and allows me to work and contribute to society. I would otherwise be in bed all day from the chronic pain. Having chronic pain is like being under water. And pain relief is like coming up for air. These laws have made it so I can literally only get a maximum of 90mg of morphine daily when I really need 200mg, what I used to be on. It's terrible that those of us who actually use these drugs responsible are being screwed over, and average joes like yourself demonize opioids when they have medicinal value. I will agree that synthetics are bad and I specifically ask for morphine versus Oxycodone or Hydrocodone. The synthetics are pretty much just a way to make more money and they are way more addictive.

refurb 7y ago
You had me until the end. There is nothing about the synthetic opioids that make them more addictive.
- socialist_coder 7y ago
  Not 100% true, the extended release version of Oxycontin was actually more addictive than other variants.
  - refurb 7y ago
    OxyContin became popular because it was commonly prescribed and you could crush up the pills to get the entire dose at once, instead of over 8 hours.
- Gibbon1 7y ago
  Friends of my that are ex-addicts say Oxycodone is the shizzle. Also Oxycontin was marketed as having a 12 hour dosing schedule. But the half life is about 2/3rds if that. That sets up a yoyo dosing schedule that's known to be highly addictive.
  - ceejayoz 7y ago

refurb 7y ago

Don’t let the media scare you with big numbers. 76B doses is about a 6 month script for every patient with chronic pain in the US.

ceejayoz 7y ago
That's just doing the same number fuckery in the other direction. 76B doses being a six month supply would mean 416M doses a day for America's 50M people with chronic pain (not all of which have pain conditions suited to opiate treatment, incidentally). Almost ten doses a day for each and every one one of them?
- refurb 7y ago
  The 76B is over 6 years. And it's by dosage units, so if your doctor says "take two every four hours", you'll be consuming 12 each day. The number isn't that shocking.
  - ceejayoz 7y ago
    I'm contesting the "76B doses is about a 6 month script for every patient with chronic pain in the US" statement, as well as the idea that every chronic pain patient needs opiate treatment. > if your doctor says "take two every four hours" That'd be weird for an Q12H drug, wouldn't it?
    - refurb 7y ago
      This is all opioids prescriptions. 12 hour dosing is a small fraction of that. Most opioids are dosed every 4 hours.
uptown 7y ago
Not every patient needs opioids.

stordoff 7y ago

About 8% of Americans (19.6 million people)[1] have high-impact chronic pain (chronic pain that limited life or work activities on most days or every day during the past 6 months), and the 76 billion pills figure spans six years. That figure accounts for 3/4 of total opioid pill shipments (it's oxycodone and hydrocodone only)[2], so the total shipped is around 101.3bn. So, if we assume chronic pain suffers sufferers need 4 pills a day[3], that gives us: 19.6 million people * 4 pills/person/day * 6 years ~= 172bn pills Given that figure is significantly _more_ than the actual number prescribed, it doesn't strike me as overprescripton. Yes, there are issues with diversion, and the number of pain sufferers may be inflated by people faking pain (to get opioids or malingering for other reasons), but the volume of pills prescribed alone don't suggest there is a major issue. Furthermore, 11.6 million 'true' high-impact chronic pain sufferers would still get you to the shipped figure[4], and I find it hard to believe that 8 million people are faking pain, especially as the data is gathered from a survey, rather than a situation that may result in opioids or any other non-clinical benefit. [1] https://www.cdc.gov/mmwr/volumes/67/wr/mm6736a2.htm https://www.cdc.gov/mmwr/volumes/67/wr/mm6736a2.htm [2] https://www.washingtonpost.com/graphics/2019/investigations/dea-pain-pill-database/ https://www.washingtonpost.com/graphics/2019/investigations/... [3] I (non-US) am on (up to) 8 opioid-containing pills per day, so taking 4 as a rough average doesn't seem unreasonable [4] 11.6 million people * 4 pills/person/day * 6 years ~= 101bn pills

ptah 7y ago
you are assuming that all sufferers of high-impact chronic pain need opioids. for some types of pain ibuprofen/paracetomol/etc is way mroe effective
- GordonS 7y ago
  This is a good point. For inflammation-type pain, paracetamol or NSAIDs (Nonsteroidal anti-inflammatory drugs) can be remarkably effective. For neuropathic pain, gabapentoids are likely a better first-line treatment, with SNRIs (Serotonin–norepinephrine reuptake inhibitors) or TCAs (tricyclics) as second-line. There are of course many people for whom opioids are appropriate, but they should only be used where less potentially harmful medications have been tried first. My understanding of the situation in the US is that they are often prescribed as 1st-line treatments, or inappropriately after surgeries where NSAIDs would be more appropriate.