4 ms·

I think a casual understanding of history has numerous examples of opioids that were prescribed as being safe, and that people then got addicted to, and then we

I think a casual understanding of history has numerous examples of opioids that were prescribed as being safe, and that people then got addicted to, and then we all moved on to the next one. Heroin was one, after all. I find it hard to imagine too many doctors who are unaware of the history. How they have chosen to view that history (psychiatry's triumphant "this time we got it right!" or perhaps simply shrinking away from the issue) is what informs their decisions. Is it an opioid? Then it is probably addictive for some people. I know that there is some experimentation involving kappa opioid receptors, trying to essentially neutralize any euphoria or uplift with the k-receptor's dysphoria "bummer," but until that has been ironed out, they're habit-forming for many. Not all, but many.

boomboomsubban 6y ago
Asking doctors to decide which research they should and should not trust based on their understanding of history seems like a more dangerous situation.
- at_a_remove 6y ago
  I dunno, "The history of all opioids we have ever encountered has always been associated with addiction" is not a particularly difficult concept to grasp, nor can I see it taking an inordinate amount of time to cram into their education.
  - gknoy 6y ago
    A huge part of most doctors' jobs is balancing the risk of bad things with the benefits of procedures, medications, etc. One of the main reasons we have doctors is so that we can trust their educated judgment. For example, mine noted that guidance had changed on when we should test for some cancers (not as early), because the risk of false positive is higher than the risk of actually having the cancer. In the case of opioids, doctors know they are addictive. They also unfortunately happen to be _extremely effective_ (for most people) at treating severe pains, and have to balance the benefits of pain relief (both in terms of patient happiness and the healing process) versus the risk of harm. I've definitely seen a shift in doctors' prescribing habits in the past fifteen years, in favor of starting with Ibuprofen or other NSAIDs, with the option to ask for a stronger prescription if pain is too much.
    - at_a_remove 6y ago
      Oh, I am well-aware, as I have been on a somewhat niche Schedule II prescription for over a decade now. It can be quite a hassle. I am merely pointing out that the idea that medical doctors being unaware of a basic correlation between opioids and addiction, one which has progressed from one medicine to another over the decades, seems ... disingenuous? Preciously naive? Remember, I am replying to "If the companies are lying about safety, how are the doctors supposed to know?" Here, I think the doctors are supposed to know in the case of opioids because this is an ongoing historical trend. A random new class of medicine? No, they will probably trust the safety sheet, as well they should. The umpteenth opioid? I would be viewing with a gimlet eye anything saying "Nah, no addictive potential."
  - boomboomsubban 6y ago
    If doctors only prescribed opioids it would be simple, but they deal in all sorts of constantly evolving drugs where new research may overturn previous assumptions. Trusting the research and heavily punishing those who falsify data seems a lot more sane.
    - at_a_remove 6y ago
      I will counter this one with a hypothetical for you. Monsanto, or Bayer now I guess, trots out a totally safe guys we pinky-swear pesticide. Would you add a little to your drinking water every day? Safety sheets say it can't hurt. You would probably not do this because you have a historical association with pesticides turning out to be rather broader in impact than was originally let on. You understand that history. I only suggest that this historical wariness sounds completely reasonable for opioids, whereas a brand new drug class has no history associated with it.
      - boomboomsubban 6y ago
        Let me amend your hypothetical. The pesticide presentation is the twentyth such presentation on various topics you've seen today. You see this many every year, and the safety sheets have always been accurate. And, if this pesticide is not used, it is known that the people of your community will suffer and/or die. Does your understanding of the companies history outweigh your experience of the formats history?
        at_a_remove 6y ago
        I am not suggesting that they didn't know or would suddenly not prescribe any opioids at all. I have been very careful to say that some, and only some, get addicted. And I would still not add that pesticide to my drinking water. So I will ask ... would you?
        boomboomsubban 6y ago
        Given that I know people will suffer and die if I don't, yes. It's a dumb hypothetical though, as my point has repeatedly been that doctors have far too many areas to be concerned about to selectively decide that this one pain killer needs more investigation before I prescribe it regularly.

boomboomsubban 6y ago

Asking doctors to decide which research they should and should not trust based on their understanding of history seems like a more dangerous situation.

at_a_remove 6y ago
I dunno, "The history of all opioids we have ever encountered has always been associated with addiction" is not a particularly difficult concept to grasp, nor can I see it taking an inordinate amount of time to cram into their education.
- gknoy 6y ago
  A huge part of most doctors' jobs is balancing the risk of bad things with the benefits of procedures, medications, etc. One of the main reasons we have doctors is so that we can trust their educated judgment. For example, mine noted that guidance had changed on when we should test for some cancers (not as early), because the risk of false positive is higher than the risk of actually having the cancer. In the case of opioids, doctors know they are addictive. They also unfortunately happen to be _extremely effective_ (for most people) at treating severe pains, and have to balance the benefits of pain relief (both in terms of patient happiness and the healing process) versus the risk of harm. I've definitely seen a shift in doctors' prescribing habits in the past fifteen years, in favor of starting with Ibuprofen or other NSAIDs, with the option to ask for a stronger prescription if pain is too much.
  - at_a_remove 6y ago
    Oh, I am well-aware, as I have been on a somewhat niche Schedule II prescription for over a decade now. It can be quite a hassle. I am merely pointing out that the idea that medical doctors being unaware of a basic correlation between opioids and addiction, one which has progressed from one medicine to another over the decades, seems ... disingenuous? Preciously naive? Remember, I am replying to "If the companies are lying about safety, how are the doctors supposed to know?" Here, I think the doctors are supposed to know in the case of opioids because this is an ongoing historical trend. A random new class of medicine? No, they will probably trust the safety sheet, as well they should. The umpteenth opioid? I would be viewing with a gimlet eye anything saying "Nah, no addictive potential."
- boomboomsubban 6y ago
  If doctors only prescribed opioids it would be simple, but they deal in all sorts of constantly evolving drugs where new research may overturn previous assumptions. Trusting the research and heavily punishing those who falsify data seems a lot more sane.
  - at_a_remove 6y ago
    I will counter this one with a hypothetical for you. Monsanto, or Bayer now I guess, trots out a totally safe guys we pinky-swear pesticide. Would you add a little to your drinking water every day? Safety sheets say it can't hurt. You would probably not do this because you have a historical association with pesticides turning out to be rather broader in impact than was originally let on. You understand that history. I only suggest that this historical wariness sounds completely reasonable for opioids, whereas a brand new drug class has no history associated with it.
    - boomboomsubban 6y ago
      Let me amend your hypothetical. The pesticide presentation is the twentyth such presentation on various topics you've seen today. You see this many every year, and the safety sheets have always been accurate. And, if this pesticide is not used, it is known that the people of your community will suffer and/or die. Does your understanding of the companies history outweigh your experience of the formats history?
      - at_a_remove 6y ago
        I am not suggesting that they didn't know or would suddenly not prescribe any opioids at all. I have been very careful to say that some, and only some, get addicted. And I would still not add that pesticide to my drinking water. So I will ask ... would you?
        boomboomsubban 6y ago
        Given that I know people will suffer and die if I don't, yes. It's a dumb hypothetical though, as my point has repeatedly been that doctors have far too many areas to be concerned about to selectively decide that this one pain killer needs more investigation before I prescribe it regularly.