6 ms·

Can anyone explain why opioids are still being sold and prescribed?

by starklevnertz 5y ago

foxhop 5y ago
A large portion of the population is addicted and the street alternatives have a habit of killing poeple.
mousetree 5y ago
There are people who still have legitimate need for pain medication
- skywal_l 5y ago
  But what are the the criteria to decide legitimacy of those needs? Pain is a symptom. It is your body signaling a problem. Indeed, sometimes, there are no solution to those problems but I doubt that all those who got prescribed opioids and got addicted didn't have an underlying solvable problem. If you are obese because you eat too much and your knees hurt, the solution is not an opioid. The whole discourse about pain being a condition that must be addressed is nefarious. Except in some pretty rare case (like terminal illness), pain is a symptom for which the healthcare organizations must find the root cause of and treat properly. Using expedient like opioids is a recipe for failure and a problem of that only the medical community can address. Serious introspection for those in charge of healthcare system in the US (and many other countries) is necessary. Also, serious failures of the FDA for labeling opioids as not addictive and putting the breaks on fixing it for years.
  - najqh 5y ago
    There are lots of illnesses that cause pain for which we have no fix, just palliative care. Not everybody is a fat guy with sore knees.
  - oneoff786 5y ago
    You seem to have made up the example of obese knees with no prior knowledge of what actually causes opioid prescription as evidence that it “might” not have good foundations. You realize that’s backwards right? Throwing out a made up example with no idea if it’s representative is just distracting. This entire post would be better reduced to “what are the most common reasons for legitimate opioid prescription”
    - op00to 5y ago
      That wouldn’t let the poster signal that he’s better than others.
  - donkeyd 5y ago
    > I doubt that all those who got prescribed opioids and got addicted didn't have an underlying solvable problem. The US health care system is set up to cause exactly these kinds of issues. If you're in pain because of a bad hip, if you're uninsured, it may be much cheaper to just buy pain killers in stead of getting surgery. Once you get used to the pills, the pain is even worse if you stop taking them and might get withdrawals. Opioids are indispensable in cancer treatment and after many surgeries. In some cases they can be used to combat chronic pain or leading up to surgery. But you're right, they shouldn't be a replacement. If the US wants to fix this epidemic, just decreasing sales of opioids won't be enough, they'll have to provide the alternative. If people can't get affordable health care, they'll get affordable pain killers.
  - SamoyedFurFluff 5y ago
    Opioids are also prescribed for short term healing from major surgery, of which there is no root cause beyond having major surgery or other painful injury.
alienchow 5y ago
Fentanyl is used in epidurals, for one.
- hermes8329 5y ago
  It's used in all sorts of surgical procedures. I've had it a few times, used as a relatively minor painkiller under those circumstances. Which sounds crazy considering how much news is about how strong it is. But it works well in those controlled circumstances
  - aaronmdjones 5y ago
    You would have been given micrograms of Fentanyl. Certainly not a milligram, and certainly not 2mg, which will probably kill you. For comparison, you require more than 10 times as much Heroin to do that. This illustrates it pretty well; a lethal dose of Heroin (left) and Fentanyl (right): https://www.statnews.com/wp-content/uploads/2016/09/Heroin-Fentanyl-vials-NHSPFL-768x432.jpg https://www.statnews.com/wp-content/uploads/2016/09/Heroin-F... This is why it's been in the news and why you've read about how strong and dangerous it is. Usage in a medical setting is much safer because they have a known purity and precise dispensing and dosage schemes; something you won't find and can't achieve on the street.
  - Tuna-Fish 5y ago
    Fentanyl that you get in an OR and the "fentanyl" on the streets are actually two different chemicals. The street drug "fentanyl" is actually carfentanil, which is about 100 times more potent that fentanyl (or about 5000 times more potent than heroin). It is favored by criminals because when it's highly concentrated, you can fit ~the same amount of doses in a suitcase that with heroin would take a 20ft container. That suitcase, when bought from a legitimate Chinese pharmaceutical manufacturer, will also cost very little. Then if you can smuggle it into the states, you can run a billion-dollar drug empire from it, and never have to smuggle in anything again. This is why all supply-side measures against opiates are never going to work again. There are already enough of them in the hands of criminals in the US to cover the demand for decades, if not centuries. It's also why "fentanyl" on the street is so deadly. When the active ingredient is so potent and arrives concentrated, if the dilution process is even a little uneven, a single dose can easily be accidentally a 100 times more potent than you expect it to be. Even if you use other drugs, never use street fentanyl for any reason.
ceejayoz 5y ago
Because they can be safe and effective for treating some conditions if used cautiously. Not every opiate has the issues OxyContin does.
- i000 5y ago
  OxyContin is not significantly more (or less) addictive or dangerous than other opiates. The problem with it is that it has been marketed by Purdue as 'safe', and that it is over-prescribed. I recommend the book Pharma by Gerald Posner, which goes into this in excruciating detail - but well worth a read.
  - ceejayoz 5y ago
    In its original formulation, the extended release oxycontin could be easily crushed without losing much potency. Other opiates have long had measures to combat this; fentanyl, for example, is frequently prescribed in patch form; extended-release morphine turns to an unusable gel if you crush it. Purdue's sales practices are important, yes, but the impact all this has had on pain patients is severe; attitudes like "why is fentanyl legal" and the comment that started this thread are hurting people with real medical needs.
jasode 5y ago
>Can anyone explain why opioids are still being sold and prescribed? If you take a look at the various alternatives for pain medication: https://en.wikipedia.org/wiki/Analgesic https://en.wikipedia.org/wiki/Analgesic ... you'll see that every pain drug has tradeoffs and opioids are still often the "best" solution even though it has potential for abuse and addiction. - acetaminophen/aspirin like Tylenol/Excedrin and ibuprofen like Advil are not addictive but they can only treat mild pain - local anesthesia can eliminate sensation of severe pain but it only lasts a few hours and also causes localized numbness and paralysis. This means you're not functional. So hypothetically trying to use it for knee pain will mean the person can't even walk around. The ineffectiveness of alternatives means doctors and patients will keep relying on opioids until science comes up with something better.
tialaramex 5y ago
The problem was never that they don't work the problem was that they're addictive. So since they do work this means it remains appropriate to prescribe them, it just isn't appropriate to give them to everybody to pop one every day before work and say it's "non-addictive". Drugs that work but have a terrible reputation are almost always still available. For example Thalidomide works, but it causes birth defects. Well, if you're a 45 year old man and the doctor can fix what's wrong with you using Thalidomide, what do you care about birth defects? You get a lecture about why child-bearing age women must under no circumstances take this drug, and then you're issued a prescription. If you were a young woman, and there was no other option, you'd get an even sterner lecture, explaining that you absolutely must not become pregnant while taking this drug, that the best way to not become pregnant is to not have sex, but that if you're going to have sex you absolutely must prevent pregnancy, and if you get pregnant you must immediately stop using Thalidomide and come see a doctor... and then you're issued a prescription. The main exception is drugs that had powerful societal bias (often driven by racism or sexism) against them, which might get outlawed even though if doctors were allowed to they'd probably sometimes prescribe them. In the UK these are "Schedule 1" drugs and it requires a specific government license to even test what they do.
- eterm 5y ago
  > You get a lecture It's stronger than that, you get a three page consent form that you sign to say that, for instance, you won't get anyone pregnant.
- GeekyBear 5y ago
  We learned the lesson that opioids are too addictive to be used to treat everyday pain back in the 1970's. However, Purdue Pharma's claim to fame with opioids was that their time release formulation was not addictive, so unlike traditional opioids these could be safely used on a daily basis. Obviously, this claim was fraudulent. Opioids still have their place, for treating terminal cancer patients, for instance. Short term use after a catastrophic event is still warranted.
  - sidewndr46 5y ago
S_A_P 5y ago
As someone who had major surgery a few months ago I am glad they are for sale and prescribed. No I am not taking opioids now but in the few days after surgery they kept me mostly pain free. Perdue deserves to be punished. Opioids are a public health crisis when abused. That doesn’t mean that they don’t have legitimate uses.
- simon_o 5y ago
  Why are Americans so ... feeble? In most other places of the world, pain is simply expected and accepted after a surgery.
donkeyd 5y ago
Because they're extremely effective in treating extreme pain. In some cases, this is necessary because pain limits recovery. Use of them needs to be managed extremely well though and when that doesn't happen it's easy to get addicted.
odiroot 5y ago
They are very very important for late stage cancer patients.
jeltz 5y ago
Because they work. When I had a relatively mild hip fracture (greater throcanter broken clean off) they enabled me to walk and sleep. I went off them as quickly as I could and switched to paracetamol only, but the first week would have been hell without them. Sure I could have survived on week of pain but one week of opiates has no risk of addiction.
sfifs 5y ago
One of my family members gets terrible debilitating migraines. When they get it, the whole day gets lost, vomiting, dehydration, maybe a trip to urgent care. An opioid based tablet they are prescribed for migraine cuts this to about 2 hours. The tablet is issued only by the clinic itself or in a major hospital pharmacy and you can't buy it in regular pharmacies. The problem in US is lack of controls and perverse profit incentives in the American healthcare business.
sniperjoe360 5y ago
Hi, I prescribe opiates often as a cancer doc. Opiates act on the central nervous system and decrease the perception of pain but don't address the pain itself. They are quite useful in the short term as bridging therapy (a few days to weeks) analgesia while you work as hard and as quickly as possible to address the physical cause of pain. On the same token, there are great alternatives too. For musculoskeletal pain, a combination of 1000mg Tylenol and 800mg Ibuprofen all at once has efficacy close to that of low dose opiates. This regimen however carries increased kidney and liver injury. There are also less addictive opiates such as tramadol (rate of addiction 1 in 100,000). But again, all of the above is simply to mask the pain. The most important aspect is quick and vigorous pain source control.
hansthehorse 5y ago
Opioids took me from suicide level pain to just tolerable pain over 6 months after I had a half golf ball sized hole scooped out of the base of my tongue due to cancer. It was a bad week when I stopped but it's doable. Opioids have a place.

Can anyone explain why opioids are still being sold and prescribed?

foxhop 5y ago

A large portion of the population is addicted and the street alternatives have a habit of killing poeple.

mousetree 5y ago

There are people who still have legitimate need for pain medication

skywal_l 5y ago
But what are the the criteria to decide legitimacy of those needs? Pain is a symptom. It is your body signaling a problem. Indeed, sometimes, there are no solution to those problems but I doubt that all those who got prescribed opioids and got addicted didn't have an underlying solvable problem. If you are obese because you eat too much and your knees hurt, the solution is not an opioid. The whole discourse about pain being a condition that must be addressed is nefarious. Except in some pretty rare case (like terminal illness), pain is a symptom for which the healthcare organizations must find the root cause of and treat properly. Using expedient like opioids is a recipe for failure and a problem of that only the medical community can address. Serious introspection for those in charge of healthcare system in the US (and many other countries) is necessary. Also, serious failures of the FDA for labeling opioids as not addictive and putting the breaks on fixing it for years.
- najqh 5y ago
  There are lots of illnesses that cause pain for which we have no fix, just palliative care. Not everybody is a fat guy with sore knees.
- oneoff786 5y ago
  You seem to have made up the example of obese knees with no prior knowledge of what actually causes opioid prescription as evidence that it “might” not have good foundations. You realize that’s backwards right? Throwing out a made up example with no idea if it’s representative is just distracting. This entire post would be better reduced to “what are the most common reasons for legitimate opioid prescription”
  - op00to 5y ago
    That wouldn’t let the poster signal that he’s better than others.
- donkeyd 5y ago
  > I doubt that all those who got prescribed opioids and got addicted didn't have an underlying solvable problem. The US health care system is set up to cause exactly these kinds of issues. If you're in pain because of a bad hip, if you're uninsured, it may be much cheaper to just buy pain killers in stead of getting surgery. Once you get used to the pills, the pain is even worse if you stop taking them and might get withdrawals. Opioids are indispensable in cancer treatment and after many surgeries. In some cases they can be used to combat chronic pain or leading up to surgery. But you're right, they shouldn't be a replacement. If the US wants to fix this epidemic, just decreasing sales of opioids won't be enough, they'll have to provide the alternative. If people can't get affordable health care, they'll get affordable pain killers.
- SamoyedFurFluff 5y ago
  Opioids are also prescribed for short term healing from major surgery, of which there is no root cause beyond having major surgery or other painful injury.

alienchow 5y ago

Fentanyl is used in epidurals, for one.

hermes8329 5y ago
It's used in all sorts of surgical procedures. I've had it a few times, used as a relatively minor painkiller under those circumstances. Which sounds crazy considering how much news is about how strong it is. But it works well in those controlled circumstances
- aaronmdjones 5y ago
  You would have been given micrograms of Fentanyl. Certainly not a milligram, and certainly not 2mg, which will probably kill you. For comparison, you require more than 10 times as much Heroin to do that. This illustrates it pretty well; a lethal dose of Heroin (left) and Fentanyl (right): https://www.statnews.com/wp-content/uploads/2016/09/Heroin-Fentanyl-vials-NHSPFL-768x432.jpg https://www.statnews.com/wp-content/uploads/2016/09/Heroin-F... This is why it's been in the news and why you've read about how strong and dangerous it is. Usage in a medical setting is much safer because they have a known purity and precise dispensing and dosage schemes; something you won't find and can't achieve on the street.
- Tuna-Fish 5y ago
  Fentanyl that you get in an OR and the "fentanyl" on the streets are actually two different chemicals. The street drug "fentanyl" is actually carfentanil, which is about 100 times more potent that fentanyl (or about 5000 times more potent than heroin). It is favored by criminals because when it's highly concentrated, you can fit ~the same amount of doses in a suitcase that with heroin would take a 20ft container. That suitcase, when bought from a legitimate Chinese pharmaceutical manufacturer, will also cost very little. Then if you can smuggle it into the states, you can run a billion-dollar drug empire from it, and never have to smuggle in anything again. This is why all supply-side measures against opiates are never going to work again. There are already enough of them in the hands of criminals in the US to cover the demand for decades, if not centuries. It's also why "fentanyl" on the street is so deadly. When the active ingredient is so potent and arrives concentrated, if the dilution process is even a little uneven, a single dose can easily be accidentally a 100 times more potent than you expect it to be. Even if you use other drugs, never use street fentanyl for any reason.

ceejayoz 5y ago

Because they can be safe and effective for treating some conditions if used cautiously. Not every opiate has the issues OxyContin does.

i000 5y ago
OxyContin is not significantly more (or less) addictive or dangerous than other opiates. The problem with it is that it has been marketed by Purdue as 'safe', and that it is over-prescribed. I recommend the book Pharma by Gerald Posner, which goes into this in excruciating detail - but well worth a read.
- ceejayoz 5y ago
  In its original formulation, the extended release oxycontin could be easily crushed without losing much potency. Other opiates have long had measures to combat this; fentanyl, for example, is frequently prescribed in patch form; extended-release morphine turns to an unusable gel if you crush it. Purdue's sales practices are important, yes, but the impact all this has had on pain patients is severe; attitudes like "why is fentanyl legal" and the comment that started this thread are hurting people with real medical needs.

jasode 5y ago

>Can anyone explain why opioids are still being sold and prescribed? If you take a look at the various alternatives for pain medication: https://en.wikipedia.org/wiki/Analgesic https://en.wikipedia.org/wiki/Analgesic ... you'll see that every pain drug has tradeoffs and opioids are still often the "best" solution even though it has potential for abuse and addiction. - acetaminophen/aspirin like Tylenol/Excedrin and ibuprofen like Advil are not addictive but they can only treat mild pain - local anesthesia can eliminate sensation of severe pain but it only lasts a few hours and also causes localized numbness and paralysis. This means you're not functional. So hypothetically trying to use it for knee pain will mean the person can't even walk around. The ineffectiveness of alternatives means doctors and patients will keep relying on opioids until science comes up with something better.

tialaramex 5y ago

The problem was never that they don't work the problem was that they're addictive. So since they do work this means it remains appropriate to prescribe them, it just isn't appropriate to give them to everybody to pop one every day before work and say it's "non-addictive". Drugs that work but have a terrible reputation are almost always still available. For example Thalidomide works, but it causes birth defects. Well, if you're a 45 year old man and the doctor can fix what's wrong with you using Thalidomide, what do you care about birth defects? You get a lecture about why child-bearing age women must under no circumstances take this drug, and then you're issued a prescription. If you were a young woman, and there was no other option, you'd get an even sterner lecture, explaining that you absolutely must not become pregnant while taking this drug, that the best way to not become pregnant is to not have sex, but that if you're going to have sex you absolutely must prevent pregnancy, and if you get pregnant you must immediately stop using Thalidomide and come see a doctor... and then you're issued a prescription. The main exception is drugs that had powerful societal bias (often driven by racism or sexism) against them, which might get outlawed even though if doctors were allowed to they'd probably sometimes prescribe them. In the UK these are "Schedule 1" drugs and it requires a specific government license to even test what they do.

eterm 5y ago
> You get a lecture It's stronger than that, you get a three page consent form that you sign to say that, for instance, you won't get anyone pregnant.
GeekyBear 5y ago
We learned the lesson that opioids are too addictive to be used to treat everyday pain back in the 1970's. However, Purdue Pharma's claim to fame with opioids was that their time release formulation was not addictive, so unlike traditional opioids these could be safely used on a daily basis. Obviously, this claim was fraudulent. Opioids still have their place, for treating terminal cancer patients, for instance. Short term use after a catastrophic event is still warranted.
- sidewndr46 5y ago

S_A_P 5y ago

As someone who had major surgery a few months ago I am glad they are for sale and prescribed. No I am not taking opioids now but in the few days after surgery they kept me mostly pain free. Perdue deserves to be punished. Opioids are a public health crisis when abused. That doesn’t mean that they don’t have legitimate uses.

simon_o 5y ago
Why are Americans so ... feeble? In most other places of the world, pain is simply expected and accepted after a surgery.

donkeyd 5y ago

Because they're extremely effective in treating extreme pain. In some cases, this is necessary because pain limits recovery. Use of them needs to be managed extremely well though and when that doesn't happen it's easy to get addicted.

odiroot 5y ago

They are very very important for late stage cancer patients.

jeltz 5y ago

Because they work. When I had a relatively mild hip fracture (greater throcanter broken clean off) they enabled me to walk and sleep. I went off them as quickly as I could and switched to paracetamol only, but the first week would have been hell without them. Sure I could have survived on week of pain but one week of opiates has no risk of addiction.

sfifs 5y ago

One of my family members gets terrible debilitating migraines. When they get it, the whole day gets lost, vomiting, dehydration, maybe a trip to urgent care. An opioid based tablet they are prescribed for migraine cuts this to about 2 hours. The tablet is issued only by the clinic itself or in a major hospital pharmacy and you can't buy it in regular pharmacies. The problem in US is lack of controls and perverse profit incentives in the American healthcare business.

sniperjoe360 5y ago

Hi, I prescribe opiates often as a cancer doc. Opiates act on the central nervous system and decrease the perception of pain but don't address the pain itself. They are quite useful in the short term as bridging therapy (a few days to weeks) analgesia while you work as hard and as quickly as possible to address the physical cause of pain. On the same token, there are great alternatives too. For musculoskeletal pain, a combination of 1000mg Tylenol and 800mg Ibuprofen all at once has efficacy close to that of low dose opiates. This regimen however carries increased kidney and liver injury. There are also less addictive opiates such as tramadol (rate of addiction 1 in 100,000). But again, all of the above is simply to mask the pain. The most important aspect is quick and vigorous pain source control.

hansthehorse 5y ago

Opioids took me from suicide level pain to just tolerable pain over 6 months after I had a half golf ball sized hole scooped out of the base of my tongue due to cancer. It was a bad week when I stopped but it's doable. Opioids have a place.