5 ms·

It's a really complicated problem but one thing that just stands out to me is the role the doctors play: It's not normal to send people home with these massive

by stef25 5y ago

It's a really complicated problem but one thing that just stands out to me is the role the doctors play: It's not normal to send people home with these massive prescriptions for opiates. Here in Europe doctors are very, very conservative with that stuff (and meds in general) while it seems to me that in the US if your "medical experience" even entails the slightest bit of discomfort people get all up in arms over it. Doctors are highly educated people who can no longer play the "I didn't know it was addictive" card. I have a friend in the US who told me they have an app on their phone where they can just tap a button and the next day they can refill their benzo prescription, and it's been like that for years without having seen a doctor again. That's just criminal behavior from the part of the medical establishment.

wespiser_2018 5y ago
What's so fascinating to me, is that the current opiate epidemic is largely centered in the US, as we bear the majority of the deaths. That attitude of Drs. over-prescribing, it definitely happened in the US, to various degrees in different places, and not that long ago. Docs in the US tend to think they are above being marketed to, but Purdue Pharma knew better, and they paid their drugs reps a ton to go out to "everytown US" and convince doctors that they had made a non-addicting opiate. Enough docs bought it, and here we are. How did they do? Well, 20 years ago drug reps used to be able to take doctors on trips: to sports games, to see the dog races, to museum trips, the price of a day trip with you and one or two loved ones was to sit through an hour (or two) lecture by a rep that convinced you to to prescribe a drug. Not a bad deal! There were complex reasons why the opiate crisis started, but the environment was ripe for an upstart company like Purdue to come in, reformulate an old opiate, pretend the addiction problem isn't there, then sell a miracle drug because opiates are extremely effective short term analgesics. Long term, we're still paying for it! I've looked a lot into the opiate crisis, and it's a pretty bad stain on the US medical institution, particularly our medical science. We fucked up.
bamboozled 5y ago
I don't think it's a really complicated problem, other countries have tried different things that have worked. It's complicated for some people to admit the 'war on drugs' has failed maybe, but that's a different issues all together.
- stef25 5y ago
  What's complicated is that it's not really the drugs, it's the fact that people experience their lives in such a miserable way that oblivion through opiates is a better option. IMHO this is because of alienation, a loss of community, strong personal bonds, lack of goals. There's a famous experiment that sums it all up perfectly - the one where animals were given an unlimited supply of cocaine and they took it until they basically starved themselves to death. But when they put the animals in a nice stimulating environment with toys and friends to play with they basically ignored the drug supply. So yes, providing govt run shooting galleries will stop people from dying and you'll make them slightly less miserable but those people will still live lives that you wouldn't want for your children. They have an illness that needs to be cured.
  - tremon 5y ago
    There's a famous experiment that sums it all up perfectly I think you're referring to the Rat Park experiment (https://en.wikipedia.org/wiki/Rat_Park https://en.wikipedia.org/wiki/Rat_Park), and (as always) its conclusions are not as solid as the myth implies. That's not to say its results have been disproven, but they haven't been confirmed with other studies either.
  - bamboozled 5y ago
    Still relevant though because if you have a medical problem (addiction) and rather than be provided with care you’re treated like a criminal, you’d feel even more isolated and less part of something good.
jorts 5y ago
The amount of pain meds my wife came home with after her c-section was like 100x what she ever used. I’m sure there are some folks who need that much but I doubt it’s the median.
_delirium 5y ago
My recent experience in the U.S. has been that, at least at major hospitals, it's flipped to the opposite extreme, and doctors are so worried about the backlash, that they will leave patients in pain and fail to prescribe analgesics sufficient for post-surgical pain control, if they don't have non-opioid options. My partner had a post-cancer DIEP flap reconstruction last month at a top cancer center in NYC, and due to the nature of the surgery, couldn't take NSAIDs, which are typically most effective for her (they have blood thinning side effects and were banned for 2 weeks post-surgery to avoid risk of hematomas). So she was left with taking over the counter Tylenol plus prescription opioids. They prescribed opioids 2 days of pills at a time, which required me to constantly drive to pick up new prescriptions (since obviously she couldn't drive), and it felt like some kind of interrogation each time she'd call up and report her current pain levels. As if they assumed by default she was lying or was a drug addict or something, versus someone recovering from major surgery that doesn't heal in 2 days, and furthermore is not allowed to take anything else that's effective (NSAIDs). Hours spent writhing in pain trying to get some pills prescribed and picked up. It only got resolved once the two-week NSAID ban was up. Then she stopped calling about the opioid-based analgesic and just started taking large ibuprofen doses instead. Problem solved, since you can buy as much ibuprofen as you want. But a pretty shit two weeks up until that point. As a result, I strongly dislike a number of aspects of the anti-opioid backlash. It made our lives worse and caused us more suffering.
- jwilber 5y ago
  I had open heart surgery in the US and the doctors refused to give me opiates to take home in the few days after. They gave me opiates while I was in the hospital, quite generously, which was for four or five days, but they would not let me take any home. I even asked for just five pills in case the pain was unbearable (they literally had just broke my ribs and sternum and sawed my chest open). I don’t respond much to opiates anyways, but I still find it completely ridiculous.
- stef25 5y ago
  What you experienced is obviously the pendulum swinging too far (in the right direction). Then again, it should just be accepted that major surgery will always involve some discomfort. There's a big distance between "5 days worth of low dose Tramadol" (+ max dose of Paracetamol) and "2 months worth of Oxycodone". It's really not a hard problem to solve for the medical establishment.
jb1991 5y ago
Once, about 10 years ago, I had some mild pain in my shoulder after skiing. It was hardly debilitating, just annoying. I went to the doctor, and within about 15 minutes I walked out with a prescription for 60 Vicodin. I don’t know if things have changed in the states much in that time, as I haven’t had a need to find out. But it still strikes me as odd that they would give me that kind of a pain killer so easily.
watwut 5y ago
I can tell from experience that having to go to doctor, then wait there then having to go to pharmacy then wait there, all in pain massively massively sux. Having to do it on the regular would be just cruel.
lwf 5y ago
(To start: Just to clarify there's a significant difference between benzodiazepines and opiates.) > I have a friend in the US who told me they have an app on their phone where they can just tap a button and the next day they can refill their benzo prescription, and it's been like that for years without having seen a doctor again. Is this the "request a refill" feature that every US pharmacy offers? Granted, benzodiazepines are less restricted than stimulant drugs¹, but a doctor in the US need to at least review a prescription twice a year. Chronic (daily) of benzodiazepines is bad, and doctors will not² start new patients on this. There's still a lot of legacy patients who are on chronic benzodiazepine treatments -- doctors should work with them to wean them off, but it's very challenging and disruptive. Requiring a patient receiving a benzodiazepine at a non-daily level (e.g. for seizures, anxiety, occasional insomnia) to go back to see their doctor when nothing's changed several times a year is just pushing medical costs (money/time) on the disabled. ¹: e.g. Adderall, which can't be refilled ²: Providers are trained not to these days, at least

by stef25 5y ago

wespiser_2018 5y ago

What's so fascinating to me, is that the current opiate epidemic is largely centered in the US, as we bear the majority of the deaths. That attitude of Drs. over-prescribing, it definitely happened in the US, to various degrees in different places, and not that long ago. Docs in the US tend to think they are above being marketed to, but Purdue Pharma knew better, and they paid their drugs reps a ton to go out to "everytown US" and convince doctors that they had made a non-addicting opiate. Enough docs bought it, and here we are. How did they do? Well, 20 years ago drug reps used to be able to take doctors on trips: to sports games, to see the dog races, to museum trips, the price of a day trip with you and one or two loved ones was to sit through an hour (or two) lecture by a rep that convinced you to to prescribe a drug. Not a bad deal! There were complex reasons why the opiate crisis started, but the environment was ripe for an upstart company like Purdue to come in, reformulate an old opiate, pretend the addiction problem isn't there, then sell a miracle drug because opiates are extremely effective short term analgesics. Long term, we're still paying for it! I've looked a lot into the opiate crisis, and it's a pretty bad stain on the US medical institution, particularly our medical science. We fucked up.

bamboozled 5y ago

I don't think it's a really complicated problem, other countries have tried different things that have worked. It's complicated for some people to admit the 'war on drugs' has failed maybe, but that's a different issues all together.

stef25 5y ago
What's complicated is that it's not really the drugs, it's the fact that people experience their lives in such a miserable way that oblivion through opiates is a better option. IMHO this is because of alienation, a loss of community, strong personal bonds, lack of goals. There's a famous experiment that sums it all up perfectly - the one where animals were given an unlimited supply of cocaine and they took it until they basically starved themselves to death. But when they put the animals in a nice stimulating environment with toys and friends to play with they basically ignored the drug supply. So yes, providing govt run shooting galleries will stop people from dying and you'll make them slightly less miserable but those people will still live lives that you wouldn't want for your children. They have an illness that needs to be cured.
- tremon 5y ago
  There's a famous experiment that sums it all up perfectly I think you're referring to the Rat Park experiment (https://en.wikipedia.org/wiki/Rat_Park https://en.wikipedia.org/wiki/Rat_Park), and (as always) its conclusions are not as solid as the myth implies. That's not to say its results have been disproven, but they haven't been confirmed with other studies either.
- bamboozled 5y ago
  Still relevant though because if you have a medical problem (addiction) and rather than be provided with care you’re treated like a criminal, you’d feel even more isolated and less part of something good.

jorts 5y ago

The amount of pain meds my wife came home with after her c-section was like 100x what she ever used. I’m sure there are some folks who need that much but I doubt it’s the median.

_delirium 5y ago

My recent experience in the U.S. has been that, at least at major hospitals, it's flipped to the opposite extreme, and doctors are so worried about the backlash, that they will leave patients in pain and fail to prescribe analgesics sufficient for post-surgical pain control, if they don't have non-opioid options. My partner had a post-cancer DIEP flap reconstruction last month at a top cancer center in NYC, and due to the nature of the surgery, couldn't take NSAIDs, which are typically most effective for her (they have blood thinning side effects and were banned for 2 weeks post-surgery to avoid risk of hematomas). So she was left with taking over the counter Tylenol plus prescription opioids. They prescribed opioids 2 days of pills at a time, which required me to constantly drive to pick up new prescriptions (since obviously she couldn't drive), and it felt like some kind of interrogation each time she'd call up and report her current pain levels. As if they assumed by default she was lying or was a drug addict or something, versus someone recovering from major surgery that doesn't heal in 2 days, and furthermore is not allowed to take anything else that's effective (NSAIDs). Hours spent writhing in pain trying to get some pills prescribed and picked up. It only got resolved once the two-week NSAID ban was up. Then she stopped calling about the opioid-based analgesic and just started taking large ibuprofen doses instead. Problem solved, since you can buy as much ibuprofen as you want. But a pretty shit two weeks up until that point. As a result, I strongly dislike a number of aspects of the anti-opioid backlash. It made our lives worse and caused us more suffering.

jwilber 5y ago
I had open heart surgery in the US and the doctors refused to give me opiates to take home in the few days after. They gave me opiates while I was in the hospital, quite generously, which was for four or five days, but they would not let me take any home. I even asked for just five pills in case the pain was unbearable (they literally had just broke my ribs and sternum and sawed my chest open). I don’t respond much to opiates anyways, but I still find it completely ridiculous.
stef25 5y ago
What you experienced is obviously the pendulum swinging too far (in the right direction). Then again, it should just be accepted that major surgery will always involve some discomfort. There's a big distance between "5 days worth of low dose Tramadol" (+ max dose of Paracetamol) and "2 months worth of Oxycodone". It's really not a hard problem to solve for the medical establishment.

jb1991 5y ago

Once, about 10 years ago, I had some mild pain in my shoulder after skiing. It was hardly debilitating, just annoying. I went to the doctor, and within about 15 minutes I walked out with a prescription for 60 Vicodin. I don’t know if things have changed in the states much in that time, as I haven’t had a need to find out. But it still strikes me as odd that they would give me that kind of a pain killer so easily.

watwut 5y ago

I can tell from experience that having to go to doctor, then wait there then having to go to pharmacy then wait there, all in pain massively massively sux. Having to do it on the regular would be just cruel.

lwf 5y ago

(To start: Just to clarify there's a significant difference between benzodiazepines and opiates.) > I have a friend in the US who told me they have an app on their phone where they can just tap a button and the next day they can refill their benzo prescription, and it's been like that for years without having seen a doctor again. Is this the "request a refill" feature that every US pharmacy offers? Granted, benzodiazepines are less restricted than stimulant drugs¹, but a doctor in the US need to at least review a prescription twice a year. Chronic (daily) of benzodiazepines is bad, and doctors will not² start new patients on this. There's still a lot of legacy patients who are on chronic benzodiazepine treatments -- doctors should work with them to wean them off, but it's very challenging and disruptive. Requiring a patient receiving a benzodiazepine at a non-daily level (e.g. for seizures, anxiety, occasional insomnia) to go back to see their doctor when nothing's changed several times a year is just pushing medical costs (money/time) on the disabled. ¹: e.g. Adderall, which can't be refilled ²: Providers are trained not to these days, at least