18 ms·

I find it pretty terrifying how many people there are in here jumping to defend opioids. Seems kinda off-topic for an article about how predatory practices in m

I find it pretty terrifying how many people there are in here jumping to defend opioids. Seems kinda off-topic for an article about how predatory practices in marketing potentially harmful substances can be problematic. I mean, nobody is suggesting that opiods shouldn't be used to treat pain, are they? They are just saying that that misinformation campaigns run for the purpose of increasing profit at the expense of human lives isn't a great thing.

alkonaut 7y ago
There are certainly cases where opioids should be prescribed as painkillers. But in the US, when weighing two bad things (pain, and adverse effects of a drug), pain seems to be considered more important than elsewhere, since doctors prescribe more of it. It must be that elsewhere doctors more frequently say “yes, your condition is painful, but if normal painkillers don’t help, the next alternative is worse than the pain”. It’s not clear to me why this discrepancy exists. Pharma can’t be the only reason. Maybe the private insurance system is a factor (“I paid a lot for this healthcare now fix my pain or I’ll take my business elsewhere”)?
- bobthepanda 7y ago
  Anecdotally, I have heard grumblings from nurse friends that a big annoyance is that "patient satisfaction" is now a big portion of performance reviews, since patients' satisfaction can go down for things that make them better. Keep in mind that not only insurance is a factor, but also the fact that many hospital systems themselves are private and have lots of cost pressures. A fair amount of advertising I've seen is for hospital systems.
  - jcims 7y ago
    Or patient satisfaction can go down because they are the face of a system that has many operational 'opportunities' to improve efficacy of care in the inpatient setting. They are grumbling because they have almost zero control over any of it.
  - noelsusman 7y ago
    Patient satisfaction is part of performance reviews because CMS decided to use it as an input for their hospital ratings that are posted online. They also adjust payments to hospitals based on the results. Also, most hospitals in the US are nonprofits, though that doesn't free them from cost pressures or the need to advertise.
- harimau777 7y ago
  This is pure speculation, but I could see several scenarios that might produce the discrepancy: America's fear of regulation results in more workers being injured and developing chronic pain. America's broken healthcare system means that people are less likely to have access to alternatives such as physical therapy, meditation, counseling, etc. America's weak social safety net means that people have to relieve their pain so that they can continue working. Cultural factors result in people being less accepting of pain as part of their lives.
  - jcims 7y ago
    Or humans in America like getting fucked up on pills and make excuses to get them. It's probably a little bit of everything. Definitely seems to be some profit motive behind a good chunk of it though.
- Spooky23 7y ago
  It really is about companies like Purdue that pushed these drugs and worked to change the protocols around pain management. Even generic manufacturers of cheap generics were making a fortune due to volume. My mom ran different units in busy NYC hospitals in the 80s. At that time, the protocols for most pain events were Tylenol and/or Motrin. Getting more than 600mg of Motrin was unusual. When I had back problems in the early 2000s, the protocols were totally different. If you had back pain, once the newer NSAIDS like Vioxx and Celebrex were mostly removed from the market, the substitute was an opioid. In my case, physical therapy, motrin/aleve, etc helped until surgery was required. I know a few people who went to opioid route, and a couple of them have struggled with dependency.
tyingq 7y ago
"nobody is suggesting that opiods shouldn't be used to treat pain, are they?" Many doctors and pharmacies in the US have swung the pendulum to that end. Probably for liability reasons.
- EamonnMR 7y ago
  Or because they realize that if they prescribe opioids they are possibly dooming a patient.
  - tempestn 7y ago
    Are you arguing that opioids shouldn't (ever) be used to treat pain?
    - siebckwbd 7y ago
      Probably just vanishingly. Anyways rare enough that a market for illicit prescription opioids would be difficult to sustain. I had a bone marrow biopsy, where they can’t anesthetize you and sure burrowing into my bone with a scalpel hurt. But whatever. Life is pain.
    - FussyZeus 7y ago
      For a great many years, they were almost solely for people with serious, chronic pain. Cancer sufferers or people with severe diseases. It wasn't until Oxycontin and the marketing push associated with it that it became so widely prescribed as a regular use pain-killer. That's of course when the addiction rate for opioids went through the roof. Entirely disconnected I'm sure. I don't know if they should be used for pain. I'm not educated enough on it to make a statement like that, for or against. What I can say with absolute certainty is Purdue Pharama created a disaster on the scale of natural events by selling legal medication. Every facet of that should be analyzed so we can make sure it never happens again.
      - tyingq 7y ago
        Hydrocodone is an opiate, and was used pretty regularly for pain from wisdom extraction, lacerations, etc. Was used for years with little fanfare before oxycontin and friends. It is now lumped in with them.
Lazare 7y ago
> I mean, nobody is suggesting that opiods shouldn't be used to treat pain, are they? Well...yes. Some are quite explicit about it, but even the ones who aren't are advocating for a policy where that is an inevitable result at the margins, yes. It's not like there's a box with a switch that says "dispense opioids responsibly for real issues" on one side and "just hand them out like candy" on the other, and we're debating toggling it. If you make opioids harder to get, then some people who should get them will now not (which is bad), and some people who should not get them now won't (which is good), but the correct balance is deeply unclear, and unlikely to be determined in the middle of a moral panic. Note in the linked article, especially, the offhand discussion of "pseudo-addiction". > If patients reported withdrawal symptoms like nausea or the shakes, the reps were trained to call this “pseudo-addiction.” A doctor who was skeptical of this concept could find studies to back it up — many of them conducted by J. David Haddox, Purdue’s scientific adviser. His research claimed that these symptoms resembled drug-seeking behavior but were actually caused by unrelieved pain. This pain, of course, could be treated by increasing the opioid dosage; these patients should not be diagnosed with addiction. Though “pseudo-addiction” became a popular term in medical literature, there has been no empirical evidence backing up the concept. This is, frankly, absurd. Are we really questioning whether under-treated pain can sometimes exist, or can cause nausea or shaking? Are we really going to go down the "let's see empirical evidence" road when discussing, effectively, the concept of pain? Here's some empirical evidence; go kick a wall, now your foot hurts. That isn't the feeling of painkiller withdrawal. For a lengthy discussion of this, I recommend the inimitable Scott Alexander: https://slatestarcodex.com/2019/09/16/against-against-pseudoaddiction/ https://slatestarcodex.com/2019/09/16/against-against-pseudo... In particular check out his "case 1". Yes, the push against over-prescribing opioids mean real people in real pain will not get the treatment that our current understanding of medical science says they should receive. The costs may be worthwhile, but they exist.
- akira2501 7y ago
  > and some people who should not get them now won't (which is good) It checks a box. Whether or not the long term result is actually positive or "good" for that individual seems far less clear, particularly if your plans only extend as far as cutting off their supply. > but the correct balance is deeply unclear, and unlikely to be determined in the middle of a moral panic. I feel like drug abuse is indicative of other more serious underlying problems, and unless you address those, you're just shifting problems from one domain to another.
war1025 7y ago
Both my mom and my wife found that opiods cause more trouble than good for them in terms of pain relief, while Tylenol and Ibuprofen work just fine. My mom had surgery recently and the oxycodone had her nauseous and vomiting through the night the first night after her surgery. After which she decided to just not take them. Not to mention that opioids put your digestive tract basically to sleep, leading to severe constipation.
- dominotw 7y ago
  hydrocodone is not equivalent to Tylenol.
- Lazare 7y ago
  So your offering an anecdote of two people who tried a strong painkiller, and discovered they only needed a weaker one, as evidence of...what? That nobody every needs strong painkillers? Paracetamol and ibuprofen are the right choice in a lot of cases, but I don't think any medical professional would dream of suggesting they're the only painkillers that you'll ever need!
  - jcims 7y ago
    I think the point is they were offered opioids in a pain management setting that didn't require them.
  - war1025 7y ago
    My point was that in my personal experience, both my wife, recovering from a C-section, and my mom, recovering from reconstructive surgery on her arm where they broke and plated her forearm back together, found that pain was perfectly manageable and had fewer side effects with standard pain medications. This suggests to me that opioids are not needed nearly so often as they are prescribed, even if they are warranted in certain situations.
- kranner 7y ago
  As a counter-anecdote, NSAIDs like Ibuprofen cause GI tract bleeding in me (a haemophilia patient) and have put me in hospital twice, once in the ICCU with my family called to say their goodbyes etc. If I have a severely painful joint bleed (common in my condition) or surgery, I'm taking the opioids.
dominotw 7y ago
> nobody is suggesting that opiods shouldn't be used to treat pain, are they? Literally everyone is suggesting this. Not sure if you had any surgeries/medical producers these days. You will now get prescription strength ibuprofin or something like that instead of opioids. My father in law spent one month straight of sleeping < 1 hr /night due to post op pain but the doc refused to prescribe opioids. So yes, lots of people are suggesting not using opioids for pain. Perhaps you are using a different/extreme definition of pain in your sentence.
- Supermancho 7y ago
  > You will now get prescription strength ibuprofin or something like that instead of opioids. That is incorrect. "You will" is not the same as "You are more likely to". They still give intraveneous delotin when your appendix bursts or your gall bladder duct is blocked in the short term. It should come as no surprise, that major medical surgery (eg some pain from open heart surgery), is not mitigated by ibuprofin and the like.
  - dominotw 7y ago
    > That is incorrect. "You will" is not the same as "You are more likely to". Yes you are right. That's what i meant. thank you.
loeg 7y ago
> They are just saying that that misinformation campaigns run for the purpose of increasing profit at the expense of human lives isn't a great thing. Sure, no one can reasonably disagree with that. I don't think folks defending opioids are staking that claim. To your earlier question, > I mean, nobody is suggesting that opiods shouldn't be used to treat pain, are they? Kinda, yes, actually. Or rather, since regulators and doctors cannot actually tell the difference between someone in pain and someone not in pain, the response to a perceived overprescription crisis has been to swing towards underprescribing — restricting access to and increasing the difficulty of obtaining opioids for everyone.
adolph 7y ago
I find it kinda terrifying how willing people are to blame pharma cos when the largest increase in deaths has to do with non-pharma opiods. Availability of illicitly manufactured synthetic opioids (e.g., fentanyl) that traditionally were prescription medications has increased. This has blurred the lines between prescription and illicit opioid-involved deaths. In one study in 27 states, Gladden et al. examined data on drug products obtained by law enforcement that tested positive for fentanyl (fentanyl submissions) and deaths involving synthetic opioids other than methadone (referred to as synthetic opioids). From 2013 to 2014, fentanyl submissions increased by 426%. The increases were strongly correlated with increases in synthetic opioid deaths but not with pharmaceutical fentanyl prescribing rates, suggesting that the increases were largely due to IMF. In a recent report, fentanyl was detected in at least half of the opioid overdose deaths from July to December 2016 in 7 of the 10 states examined. [0] 0. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5844400/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5844400/ The CDC describes overdose deaths as occurring in three waves [1]. Normal pharmaceuticals are involved in wave one, starting in the 1990s. Clearly pharma co.s aren’t involved in wave two, heroin. What’s their culpability for wave three, the synthetic opiods starting in 2013? NIH above says not majorly. If pharma cos aren’t the source of fentanyl and wave two’s heroin, why are they the media focus point? 1. https://www.cdc.gov/drugoverdose/epidemic/index.html https://www.cdc.gov/drugoverdose/epidemic/index.html
- harimau777 7y ago
  As I understand it, the argument is that the prescription opioids got people addicted and when they could no longer get prescription opioids they turned to illicit opioids. Can anyone comment on the validity or invalidity of that argument?
  - bobcostas55 7y ago
    ~75% of opioid misuse starts with people using them without a prescription. [0] ~90% of people who are prescribed opioids never develop addiction problems. [1] Despite being in the midst of an opioid crisis with skyrocketing mortality rates, the mortality rate from prescription opiates has been ~stable for the last ~15 years. [2] [0] https://www.samhsa.gov/data/sites/default/files/NSDUH-DetTabs2014/NSDUH-DetTabs2014.htm#tab6-47b https://www.samhsa.gov/data/sites/default/files/NSDUH-DetTab... [1] https://www.ncbi.nlm.nih.gov/pubmed/25785523 https://www.ncbi.nlm.nih.gov/pubmed/25785523 [2] http://www.ncsl.org/portals/1/documents/health/APeeples0118_32103.pdf http://www.ncsl.org/portals/1/documents/health/APeeples0118_...
bobcostas55 7y ago
>I mean, nobody is suggesting that opiods shouldn't be used to treat pain, are they? SSC had a good piece on that: https://slatestarcodex.com/2019/09/16/against-against-pseudoaddiction/ https://slatestarcodex.com/2019/09/16/against-against-pseudo...
conanbatt 7y ago
And then, pot is legalized, and the marketing machine will be pushing that. As I grow older, I've become way more conservative about legalizing drugs.
- Ididntdothis 7y ago
  You should become more conservative about drug marketing and profits, less about legalization.
philwelch 7y ago
> nobody is suggesting that opiods shouldn't be used to treat pain, are they? If there's enough overreaction to opioid dependency, it does impede the use of opioids to treat pain. Making it harder to get opioids also, typically, makes it harder to get opioids to treat pain. Bureaucratic systems, put simply, suck. Whenever you talk about the "opioid epidemic", a large part of what you're talking about is people buying heroin and fentanyl from drug dealers. Making it harder to get oxycodone does zero to stop people from buying heroin and fentanyl on the street. It does a hell of a lot to stop the use of oxycodone to treat pain.
- Spooky23 7y ago
  That’s the tail end of the problem. Drug companies claimed that newer versions of opioids weren’t addictive, and produced bogus research that backed those claims. So the protocols changed, and doctors in many areas of practice started treating opioids like ibuprofen. Hydrocodone or oxy isn’t the best choice for chronic pain, and as chronic users take it, their tolerance increases and their ability to get an effective, legal prescription slowly goes away. The black market offered cheaper, but more dangerous alternatives.
  - threatofrain 7y ago
    I feel like this also suggests that doctors suck. If engineers couldn't interpret the information coming from the security community and due to their inability to deal with their own industry inputs they got thousands of people killed per year, it would be a far more serious deal. As far as I know, Google isn't getting thousands of people killed, but nobody is talking about reigning in the medical community. Somehow there's no egg on the medical community's face. Is medically checking the doctor now the responsibility of patients?
    - nullc 7y ago
      > As far as I know, Google isn't getting thousands of people killed per year, At google's scale it doesn't take much bureaucratic indifference to have an outsized effect. I would be surprised if google wasn't-- but it's spread out over thousands of distinct causes. Like maps effectively directing people to turn onto railroad tracks and google being unwilling to do anything about it (https://www.theverge.com/2019/8/12/20802036/google-apple-microsoft-map-rail-crossing-ntsb https://www.theverge.com/2019/8/12/20802036/google-apple-mic...), or maps and especially waze directing highway level flows of traffic through residential neighborhoods.
mirimir 7y ago
The point is that people have the right to choose what to do with their bodies. Laws against drug use are morally equivalent to laws against abortion, homosexuality, etc.

alkonaut 7y ago

There are certainly cases where opioids should be prescribed as painkillers. But in the US, when weighing two bad things (pain, and adverse effects of a drug), pain seems to be considered more important than elsewhere, since doctors prescribe more of it. It must be that elsewhere doctors more frequently say “yes, your condition is painful, but if normal painkillers don’t help, the next alternative is worse than the pain”. It’s not clear to me why this discrepancy exists. Pharma can’t be the only reason. Maybe the private insurance system is a factor (“I paid a lot for this healthcare now fix my pain or I’ll take my business elsewhere”)?

bobthepanda 7y ago
Anecdotally, I have heard grumblings from nurse friends that a big annoyance is that "patient satisfaction" is now a big portion of performance reviews, since patients' satisfaction can go down for things that make them better. Keep in mind that not only insurance is a factor, but also the fact that many hospital systems themselves are private and have lots of cost pressures. A fair amount of advertising I've seen is for hospital systems.
- jcims 7y ago
  Or patient satisfaction can go down because they are the face of a system that has many operational 'opportunities' to improve efficacy of care in the inpatient setting. They are grumbling because they have almost zero control over any of it.
- noelsusman 7y ago
  Patient satisfaction is part of performance reviews because CMS decided to use it as an input for their hospital ratings that are posted online. They also adjust payments to hospitals based on the results. Also, most hospitals in the US are nonprofits, though that doesn't free them from cost pressures or the need to advertise.
harimau777 7y ago
This is pure speculation, but I could see several scenarios that might produce the discrepancy: America's fear of regulation results in more workers being injured and developing chronic pain. America's broken healthcare system means that people are less likely to have access to alternatives such as physical therapy, meditation, counseling, etc. America's weak social safety net means that people have to relieve their pain so that they can continue working. Cultural factors result in people being less accepting of pain as part of their lives.
- jcims 7y ago
  Or humans in America like getting fucked up on pills and make excuses to get them. It's probably a little bit of everything. Definitely seems to be some profit motive behind a good chunk of it though.
Spooky23 7y ago
It really is about companies like Purdue that pushed these drugs and worked to change the protocols around pain management. Even generic manufacturers of cheap generics were making a fortune due to volume. My mom ran different units in busy NYC hospitals in the 80s. At that time, the protocols for most pain events were Tylenol and/or Motrin. Getting more than 600mg of Motrin was unusual. When I had back problems in the early 2000s, the protocols were totally different. If you had back pain, once the newer NSAIDS like Vioxx and Celebrex were mostly removed from the market, the substitute was an opioid. In my case, physical therapy, motrin/aleve, etc helped until surgery was required. I know a few people who went to opioid route, and a couple of them have struggled with dependency.

tyingq 7y ago

"nobody is suggesting that opiods shouldn't be used to treat pain, are they?" Many doctors and pharmacies in the US have swung the pendulum to that end. Probably for liability reasons.

EamonnMR 7y ago
Or because they realize that if they prescribe opioids they are possibly dooming a patient.
- tempestn 7y ago
  Are you arguing that opioids shouldn't (ever) be used to treat pain?
  - siebckwbd 7y ago
    Probably just vanishingly. Anyways rare enough that a market for illicit prescription opioids would be difficult to sustain. I had a bone marrow biopsy, where they can’t anesthetize you and sure burrowing into my bone with a scalpel hurt. But whatever. Life is pain.
  - FussyZeus 7y ago
    For a great many years, they were almost solely for people with serious, chronic pain. Cancer sufferers or people with severe diseases. It wasn't until Oxycontin and the marketing push associated with it that it became so widely prescribed as a regular use pain-killer. That's of course when the addiction rate for opioids went through the roof. Entirely disconnected I'm sure. I don't know if they should be used for pain. I'm not educated enough on it to make a statement like that, for or against. What I can say with absolute certainty is Purdue Pharama created a disaster on the scale of natural events by selling legal medication. Every facet of that should be analyzed so we can make sure it never happens again.
    - tyingq 7y ago
      Hydrocodone is an opiate, and was used pretty regularly for pain from wisdom extraction, lacerations, etc. Was used for years with little fanfare before oxycontin and friends. It is now lumped in with them.

Lazare 7y ago

> I mean, nobody is suggesting that opiods shouldn't be used to treat pain, are they? Well...yes. Some are quite explicit about it, but even the ones who aren't are advocating for a policy where that is an inevitable result at the margins, yes. It's not like there's a box with a switch that says "dispense opioids responsibly for real issues" on one side and "just hand them out like candy" on the other, and we're debating toggling it. If you make opioids harder to get, then some people who should get them will now not (which is bad), and some people who should not get them now won't (which is good), but the correct balance is deeply unclear, and unlikely to be determined in the middle of a moral panic. Note in the linked article, especially, the offhand discussion of "pseudo-addiction". > If patients reported withdrawal symptoms like nausea or the shakes, the reps were trained to call this “pseudo-addiction.” A doctor who was skeptical of this concept could find studies to back it up — many of them conducted by J. David Haddox, Purdue’s scientific adviser. His research claimed that these symptoms resembled drug-seeking behavior but were actually caused by unrelieved pain. This pain, of course, could be treated by increasing the opioid dosage; these patients should not be diagnosed with addiction. Though “pseudo-addiction” became a popular term in medical literature, there has been no empirical evidence backing up the concept. This is, frankly, absurd. Are we really questioning whether under-treated pain can sometimes exist, or can cause nausea or shaking? Are we really going to go down the "let's see empirical evidence" road when discussing, effectively, the concept of pain? Here's some empirical evidence; go kick a wall, now your foot hurts. That isn't the feeling of painkiller withdrawal. For a lengthy discussion of this, I recommend the inimitable Scott Alexander: https://slatestarcodex.com/2019/09/16/against-against-pseudoaddiction/ https://slatestarcodex.com/2019/09/16/against-against-pseudo... In particular check out his "case 1". Yes, the push against over-prescribing opioids mean real people in real pain will not get the treatment that our current understanding of medical science says they should receive. The costs may be worthwhile, but they exist.

akira2501 7y ago
> and some people who should not get them now won't (which is good) It checks a box. Whether or not the long term result is actually positive or "good" for that individual seems far less clear, particularly if your plans only extend as far as cutting off their supply. > but the correct balance is deeply unclear, and unlikely to be determined in the middle of a moral panic. I feel like drug abuse is indicative of other more serious underlying problems, and unless you address those, you're just shifting problems from one domain to another.

war1025 7y ago

Both my mom and my wife found that opiods cause more trouble than good for them in terms of pain relief, while Tylenol and Ibuprofen work just fine. My mom had surgery recently and the oxycodone had her nauseous and vomiting through the night the first night after her surgery. After which she decided to just not take them. Not to mention that opioids put your digestive tract basically to sleep, leading to severe constipation.

dominotw 7y ago
hydrocodone is not equivalent to Tylenol.
Lazare 7y ago
So your offering an anecdote of two people who tried a strong painkiller, and discovered they only needed a weaker one, as evidence of...what? That nobody every needs strong painkillers? Paracetamol and ibuprofen are the right choice in a lot of cases, but I don't think any medical professional would dream of suggesting they're the only painkillers that you'll ever need!
- jcims 7y ago
  I think the point is they were offered opioids in a pain management setting that didn't require them.
- war1025 7y ago
  My point was that in my personal experience, both my wife, recovering from a C-section, and my mom, recovering from reconstructive surgery on her arm where they broke and plated her forearm back together, found that pain was perfectly manageable and had fewer side effects with standard pain medications. This suggests to me that opioids are not needed nearly so often as they are prescribed, even if they are warranted in certain situations.
kranner 7y ago
As a counter-anecdote, NSAIDs like Ibuprofen cause GI tract bleeding in me (a haemophilia patient) and have put me in hospital twice, once in the ICCU with my family called to say their goodbyes etc. If I have a severely painful joint bleed (common in my condition) or surgery, I'm taking the opioids.

dominotw 7y ago

> nobody is suggesting that opiods shouldn't be used to treat pain, are they? Literally everyone is suggesting this. Not sure if you had any surgeries/medical producers these days. You will now get prescription strength ibuprofin or something like that instead of opioids. My father in law spent one month straight of sleeping < 1 hr /night due to post op pain but the doc refused to prescribe opioids. So yes, lots of people are suggesting not using opioids for pain. Perhaps you are using a different/extreme definition of pain in your sentence.

Supermancho 7y ago
> You will now get prescription strength ibuprofin or something like that instead of opioids. That is incorrect. "You will" is not the same as "You are more likely to". They still give intraveneous delotin when your appendix bursts or your gall bladder duct is blocked in the short term. It should come as no surprise, that major medical surgery (eg some pain from open heart surgery), is not mitigated by ibuprofin and the like.
- dominotw 7y ago
  > That is incorrect. "You will" is not the same as "You are more likely to". Yes you are right. That's what i meant. thank you.

loeg 7y ago

> They are just saying that that misinformation campaigns run for the purpose of increasing profit at the expense of human lives isn't a great thing. Sure, no one can reasonably disagree with that. I don't think folks defending opioids are staking that claim. To your earlier question, > I mean, nobody is suggesting that opiods shouldn't be used to treat pain, are they? Kinda, yes, actually. Or rather, since regulators and doctors cannot actually tell the difference between someone in pain and someone not in pain, the response to a perceived overprescription crisis has been to swing towards underprescribing — restricting access to and increasing the difficulty of obtaining opioids for everyone.

adolph 7y ago

I find it kinda terrifying how willing people are to blame pharma cos when the largest increase in deaths has to do with non-pharma opiods. Availability of illicitly manufactured synthetic opioids (e.g., fentanyl) that traditionally were prescription medications has increased. This has blurred the lines between prescription and illicit opioid-involved deaths. In one study in 27 states, Gladden et al. examined data on drug products obtained by law enforcement that tested positive for fentanyl (fentanyl submissions) and deaths involving synthetic opioids other than methadone (referred to as synthetic opioids). From 2013 to 2014, fentanyl submissions increased by 426%. The increases were strongly correlated with increases in synthetic opioid deaths but not with pharmaceutical fentanyl prescribing rates, suggesting that the increases were largely due to IMF. In a recent report, fentanyl was detected in at least half of the opioid overdose deaths from July to December 2016 in 7 of the 10 states examined. [0] 0. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5844400/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5844400/ The CDC describes overdose deaths as occurring in three waves [1]. Normal pharmaceuticals are involved in wave one, starting in the 1990s. Clearly pharma co.s aren’t involved in wave two, heroin. What’s their culpability for wave three, the synthetic opiods starting in 2013? NIH above says not majorly. If pharma cos aren’t the source of fentanyl and wave two’s heroin, why are they the media focus point? 1. https://www.cdc.gov/drugoverdose/epidemic/index.html https://www.cdc.gov/drugoverdose/epidemic/index.html

harimau777 7y ago
As I understand it, the argument is that the prescription opioids got people addicted and when they could no longer get prescription opioids they turned to illicit opioids. Can anyone comment on the validity or invalidity of that argument?
- bobcostas55 7y ago
  ~75% of opioid misuse starts with people using them without a prescription. [0] ~90% of people who are prescribed opioids never develop addiction problems. [1] Despite being in the midst of an opioid crisis with skyrocketing mortality rates, the mortality rate from prescription opiates has been ~stable for the last ~15 years. [2] [0] https://www.samhsa.gov/data/sites/default/files/NSDUH-DetTabs2014/NSDUH-DetTabs2014.htm#tab6-47b https://www.samhsa.gov/data/sites/default/files/NSDUH-DetTab... [1] https://www.ncbi.nlm.nih.gov/pubmed/25785523 https://www.ncbi.nlm.nih.gov/pubmed/25785523 [2] http://www.ncsl.org/portals/1/documents/health/APeeples0118_32103.pdf http://www.ncsl.org/portals/1/documents/health/APeeples0118_...

bobcostas55 7y ago

>I mean, nobody is suggesting that opiods shouldn't be used to treat pain, are they? SSC had a good piece on that: https://slatestarcodex.com/2019/09/16/against-against-pseudoaddiction/ https://slatestarcodex.com/2019/09/16/against-against-pseudo...

conanbatt 7y ago

And then, pot is legalized, and the marketing machine will be pushing that. As I grow older, I've become way more conservative about legalizing drugs.

Ididntdothis 7y ago
You should become more conservative about drug marketing and profits, less about legalization.

philwelch 7y ago

> nobody is suggesting that opiods shouldn't be used to treat pain, are they? If there's enough overreaction to opioid dependency, it does impede the use of opioids to treat pain. Making it harder to get opioids also, typically, makes it harder to get opioids to treat pain. Bureaucratic systems, put simply, suck. Whenever you talk about the "opioid epidemic", a large part of what you're talking about is people buying heroin and fentanyl from drug dealers. Making it harder to get oxycodone does zero to stop people from buying heroin and fentanyl on the street. It does a hell of a lot to stop the use of oxycodone to treat pain.

Spooky23 7y ago
That’s the tail end of the problem. Drug companies claimed that newer versions of opioids weren’t addictive, and produced bogus research that backed those claims. So the protocols changed, and doctors in many areas of practice started treating opioids like ibuprofen. Hydrocodone or oxy isn’t the best choice for chronic pain, and as chronic users take it, their tolerance increases and their ability to get an effective, legal prescription slowly goes away. The black market offered cheaper, but more dangerous alternatives.
- threatofrain 7y ago
  I feel like this also suggests that doctors suck. If engineers couldn't interpret the information coming from the security community and due to their inability to deal with their own industry inputs they got thousands of people killed per year, it would be a far more serious deal. As far as I know, Google isn't getting thousands of people killed, but nobody is talking about reigning in the medical community. Somehow there's no egg on the medical community's face. Is medically checking the doctor now the responsibility of patients?
  - nullc 7y ago
    > As far as I know, Google isn't getting thousands of people killed per year, At google's scale it doesn't take much bureaucratic indifference to have an outsized effect. I would be surprised if google wasn't-- but it's spread out over thousands of distinct causes. Like maps effectively directing people to turn onto railroad tracks and google being unwilling to do anything about it (https://www.theverge.com/2019/8/12/20802036/google-apple-microsoft-map-rail-crossing-ntsb https://www.theverge.com/2019/8/12/20802036/google-apple-mic...), or maps and especially waze directing highway level flows of traffic through residential neighborhoods.

mirimir 7y ago

The point is that people have the right to choose what to do with their bodies. Laws against drug use are morally equivalent to laws against abortion, homosexuality, etc.