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I wonder where most of the harm is coming from with opioids. Do the opioids themselves cause more harm than society does by making them illegal? The cases I've

I wonder where most of the harm is coming from with opioids. Do the opioids themselves cause more harm than society does by making them illegal? The cases I've mostly heard about seemed to be that people hot addicted to opioids and the only way to keep it going was to break the law. That eventually got them in trouble. For some drugs it does seem like the government trying to protect you from the drugs do more harm than what the drugs themselves do. Are opioids among them?

neuroma 6y ago
Prof Nutt made and published a universal harm scale which accounts for multi dimensional harm of drugs, and potentially allows comparisons to be made between them https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6109763/#B29 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6109763/#B29. This work got him sacked from his lead advisory role to the UK govt, as it undermined the policy and caused embarrassment. Nutt still works in Imperial College researching psychedelics as novel therapeutics. The money shot is this https://www.researchgate.net/figure/Overall-weighted-scores-for-each-of-the-drugs-The-coloured-bars-indicate-the-part-scores_fig1_47635105 https://www.researchgate.net/figure/Overall-weighted-scores-... A recent article which contextualises the work is here https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6109763/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6109763/
- ethanbond 6y ago
  Wow this is awesome. I’ve pondered the need for exactly this sort of thing for a while as the obvious desired basis for drug policy. Shouldn’t be surprised the Nutt has done it! Obviously it’s lossy to reduce something with this much complexity down to a single dimension but it’s still a helpful tool nonetheless.
263943736 6y ago
It's very much a value judgement ultimately even if I've obviously been advocating in favor of not shying away from opioids when appropriate. With the judgement being a matter of resolving immediate problems vs. minimizing exposure to potential problems. How you view the probability is important because if you are cautious and wrong you have let your patient suffer unnecessarily, they (or their family) might even seek out street drugs if you are wrong enough about their pain. Most people who are prescribed opioids do not become addicts and even amongst those who develop an attachment to the drugs most who follow their prescription will simply go through an uncomfortable period of withdrawal before moving on (though patient abuse of their prescriptions is a real problem that happens). You also have some groups for whom addiction is a simply not a concern, many elderly deemed near the end of their life for example are provided with morphine if they express a desire to focus on quality of life treatments and people with severe spinal damage can be so debilitated by the pain they can hardly function. That being said, there is still a chance of a severe addiction developing and even if it doesn't many other addicts become addicts because prescriptions often erred on the side of oversupply rather than undersupply (better to have it and not need it as the gun folks say). So for example, a person might ask a partner in their workout group who went to the hospital if they can have a couple of their spare tablets to help with muscle recovery and things then spiral from there. If there were universally acceptable substitutes it would be less of an issue but at present opioids are usually among the most effective treatments for pain even if they carry risks. I do agree that some amount of oversight is important and better methods for evaluating patient pain would be helpful too (see the recent controversey over evaluating pain in black patients) but because it's become a talking point many doctors are being much more conservative not because they think opioids wouldn't be beneficial but simply because they don't want to get caught in the shade if hammers are falling.
beenBoutIT 6y ago
They need to let people take whatever they want to take and then educate everyone about how addictive some opiates are.
- raducu 6y ago
  In the past, I've tried a lot of recreational drugs, including some opioids, and without trying to, I can't see how I could get myself addicted to opioids or benzodiazepines, but I know a LOT of people would. As far as I remember, only 10% of people who ever used heroin get addicted to it. But that still leaves 10% at a very high risk, because of their neurochemistry and life circumstances. So I don't think ALL drugs should be legal.

neuroma 6y ago

Prof Nutt made and published a universal harm scale which accounts for multi dimensional harm of drugs, and potentially allows comparisons to be made between them https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6109763/#B29 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6109763/#B29. This work got him sacked from his lead advisory role to the UK govt, as it undermined the policy and caused embarrassment. Nutt still works in Imperial College researching psychedelics as novel therapeutics. The money shot is this https://www.researchgate.net/figure/Overall-weighted-scores-for-each-of-the-drugs-The-coloured-bars-indicate-the-part-scores_fig1_47635105 https://www.researchgate.net/figure/Overall-weighted-scores-... A recent article which contextualises the work is here https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6109763/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6109763/

ethanbond 6y ago
Wow this is awesome. I’ve pondered the need for exactly this sort of thing for a while as the obvious desired basis for drug policy. Shouldn’t be surprised the Nutt has done it! Obviously it’s lossy to reduce something with this much complexity down to a single dimension but it’s still a helpful tool nonetheless.

263943736 6y ago

It's very much a value judgement ultimately even if I've obviously been advocating in favor of not shying away from opioids when appropriate. With the judgement being a matter of resolving immediate problems vs. minimizing exposure to potential problems. How you view the probability is important because if you are cautious and wrong you have let your patient suffer unnecessarily, they (or their family) might even seek out street drugs if you are wrong enough about their pain. Most people who are prescribed opioids do not become addicts and even amongst those who develop an attachment to the drugs most who follow their prescription will simply go through an uncomfortable period of withdrawal before moving on (though patient abuse of their prescriptions is a real problem that happens). You also have some groups for whom addiction is a simply not a concern, many elderly deemed near the end of their life for example are provided with morphine if they express a desire to focus on quality of life treatments and people with severe spinal damage can be so debilitated by the pain they can hardly function. That being said, there is still a chance of a severe addiction developing and even if it doesn't many other addicts become addicts because prescriptions often erred on the side of oversupply rather than undersupply (better to have it and not need it as the gun folks say). So for example, a person might ask a partner in their workout group who went to the hospital if they can have a couple of their spare tablets to help with muscle recovery and things then spiral from there. If there were universally acceptable substitutes it would be less of an issue but at present opioids are usually among the most effective treatments for pain even if they carry risks. I do agree that some amount of oversight is important and better methods for evaluating patient pain would be helpful too (see the recent controversey over evaluating pain in black patients) but because it's become a talking point many doctors are being much more conservative not because they think opioids wouldn't be beneficial but simply because they don't want to get caught in the shade if hammers are falling.

beenBoutIT 6y ago

They need to let people take whatever they want to take and then educate everyone about how addictive some opiates are.

raducu 6y ago
In the past, I've tried a lot of recreational drugs, including some opioids, and without trying to, I can't see how I could get myself addicted to opioids or benzodiazepines, but I know a LOT of people would. As far as I remember, only 10% of people who ever used heroin get addicted to it. But that still leaves 10% at a very high risk, because of their neurochemistry and life circumstances. So I don't think ALL drugs should be legal.