3 ms·

> 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'

by 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.
- Lazare 7y ago
  Both valid points. I'm pretty keen on the concept of harm reduction, but how much overlap there is between harm reduction and blindly trying to reduce the consumption of opioids remains to be seen.
  - shkkmo 7y ago
    > how much overlap there is between harm reduction and blindly trying to reduce the consumption of opioids remains to be seen. The answer is "none". "Harm reduction" has a specific meaning im the context of addiction (such as needle exchange programs, etc). Cutting people off from their access to legal opiods does not qualify as "harm reduction", but the opposite as it pushes people to unsafe street drugs.

by Lazare 7y ago

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.

Lazare 7y ago
Both valid points. I'm pretty keen on the concept of harm reduction, but how much overlap there is between harm reduction and blindly trying to reduce the consumption of opioids remains to be seen.
- shkkmo 7y ago
  > how much overlap there is between harm reduction and blindly trying to reduce the consumption of opioids remains to be seen. The answer is "none". "Harm reduction" has a specific meaning im the context of addiction (such as needle exchange programs, etc). Cutting people off from their access to legal opiods does not qualify as "harm reduction", but the opposite as it pushes people to unsafe street drugs.