6 ms·

[flagged]

by pierat 3y ago

[flagged]

curtisblaine 3y ago
I guess the central point is that us very hard to distinguish between genuine and fraudulent use cases; in absence of infallible diagnostics, doctors can choose to move the know to "stricter" (decreasing fraudulent use, but making genuine use much harder) or "looser" (viceversa). I see a similar problem with mental diseases, where the common pattern nowadays is 1) get convinced that you are neurodivergent 2) iterate n doctors until you find the diagnosis you like.
curtisblaine 3y ago
(I also don't see why "boomer" is relevant)
jdefr89 3y ago
Indeed. It’s created a system where everyone’s scared. So those who need it legitimately often cannot get it. Which honestly is a false sense of security at this point as it’s easier to get these drugs on the street rather than legitimately through a doctor and that’s what most now do. If anything, the abrupt disappearance of legitimate pharmacy grade drugs made way for the current problem Fentnyl. Taking away and restricting OxyContin literally made the issue worse. Almost no one can get their hands on pharmaceutics opioids and yet the overdose rate has skyrocketed! People just don’t learn… You take something away and people only tend to want it more. Prohibition simply does not work and we have years of experience and history to show this time and time again and yet not a single thing has changed. Never see any new approaches or ideas to fix this issue because it goes far deeper than drugs themselves. People want to self medicate because they suffer, but we haven’t discussed why so many suffered and what we could do about it. Probably because the answer to that question isn’t going to be easy and hard work will be involved.
- fifteen1506 3y ago
  Don't forget pharmacy chains use a mathematic naive formula to stop selling opioids. As seen in HN a few months ago, if one kind HNer can add the link here.
  - lotsofpulp 3y ago
    That is what happens when the government hits them with nebulous liability for political points. Government leaders do not want to clearly define the rules, but still want to pin the problem on others. If the government makes the rules clear, and the policies result in failure, then they get blamed. If the government outsources the policing, then the government leaders can point fingers and satisfy public outrage, at the expense of the affected public which is not politically powerful enough to do anything about it.
    - fifteen1506 3y ago
      [flagged]
      - lotsofpulp 3y ago
        Do you have any evidence to show the blame lies somewhere in the middle? As far as I can tell, a retail pharmacy’s role is to dispense medication per a prescription, while avoiding errors caused by mixing medicines and advising people how to take medicine. A retail pharmacy’s role is not to be the de facto front line workers for the DEA. So when our government collects fines from businesses for not policing their customers, expect the business to start discriminating against the customers, due to the lack of liability shield the government has. An even simpler way to put it is, why would a business that earns money selling things want to sell less of those things (legitimate prescriptions)? The answer has to be the risk of selling is too high.
        fifteen1506 3y ago
        Well yes, because OxyContin was oversold and the company's behaviour was unethical. https://www.nytimes.com/2018/05/29/health/purdue-opioids-oxycontin.html https://www.nytimes.com/2018/05/29/health/purdue-opioids-oxy...
        lotsofpulp 3y ago
        I cannot read the article. What is the pharmacy’s role? OxyContin requires a prescription, so did the pharmacy sell without prescriptions? Bottom line is, do you want pharmacies to be making non medical judgment calls on which prescriptions to fill and not fill? If so, then don’t complain when they exercise judgment. I, for one, would rather not deputize everyone I interact with.
jb1991 3y ago
Believe it or not, this concept of having strong pain killers available to the public is somewhat American-centric. Much of Europe does not consider the need for strong pain killers available in society, and pain tolerance is quite different in, for example Germany or the Netherlands, where it has been nearly impossible to get anything strong for pain for many decades.
- cyberpunk 3y ago
  While it’s definitely more difficult to have more pain, it also guides your recovery much better. You are much more aware of what you should or shouldn’t be doing while you rehabilitate, instead of numbing everything. Unless it’s absolutely chronic pain, I think we’ve definitely over prescribed even in Europe. (Source: german)
- TylerE 3y ago
  That’s somewhat easier to stomach when you can pop down to the doctor, even ER, for breakthrough pain without being out a weeks salary.
- chasil 3y ago
  I've actually been offered fentanyl for medical procedures that involved moderate discomfort several times. I refused it and endured the pain. The physicians had never seen anyone do that before.
  - jb1991 3y ago
    It's different for surgery, in a hospital, if that's what you are referring to. But for take-home use, it's nearly non-existent in much of Europe.
    - chasil 3y ago
      I don't think that fentanyl would ever be prescribed for home use, but I could be wrong. Hydrocodone was sent home recently with a family member after surgery, any this same person had oxycontin years before after a broken leg. I've only seen fentanyl as an injected solution in hospital settings, including my own.
giantg2 3y ago
"Oxycontin was misclassified due to fraudulent reportings of the drug's capabilities and marketing campaign. However that should have never affected people getting legit pain care, but it definitely did." What does legit pain care look like? Does it include the prescription of narcotics to outpatients on an ongoing basis, or for more than a couple days? While the safety of oxycontin was misrepresented, I assume there are still some problems with how other narcotics are administered to outpatients.
- pierat 3y ago
  > What does legit pain care look like? Oh, sure, let me just go ahead and write up a national level opiate plan here in a HN comment. I'll get right on it. /sarcasm
  - giantg2 3y ago
    What I'm saying is, if it wasn't oxy, it would have been vicodin or some other narcotic. The problem is how they are prescribed and the social environment. Sure oxy misrepresented safety which lead to some increase in outpatient prescription, but this is still a major source of the problem. Oxy is just the scapegoat for much larger systemic issue since they got caught misrepresenting safety. Nobody has any actual solution to this problem so far.
- gedy 3y ago
  > What does legit pain care look like? A sibling was on low dose hydrocodone for years for back and ankle issues. Seemed to be fine from my perspective.
  - giantg2 3y ago
    Perhaps that was the dosing or your siblings biology. Hydrocodone is also a narcotic that is potentially habit forming. The addictive potential of oxycodone is supposed to be very similar or only slightly higher than that of hydrocodone.
    - 3y ago
prepend 3y ago
I don’t think it’s puritanical at all as narcotics for painkillers are dangerous. Imagine if handguns were really good at treating pain, but had like a 30% chance of killing the patient. Would it be puritanical to not prescribe handguns to everyone with pain? And if patients who thought they would not ruin their lives were upset about not being able to get handguns and complained about engaging in “handgun seeking behavior?” Because that’s the deal here. Prescription painkillers are effective and easy, but are extremely dangerous. Pain protocols now feature OTC stuff even though they result in more pain in patients because they are equally effective but have no chance of death or life ruining addiction. OxyContin should have been used for legit pain care.
- stevenAthompson 3y ago
  >Pain protocols now feature OTC stuff even though they result in more pain in patients because they are equally effective but have no chance of death or life ruining addiction. If they were "as effective" they would not result in more pain. Additionally, pain ruins more lives than opioids and has been doing so for thousands of years. Ever tried to hold a job when you're in agony and have only slept a few hours that week? People with untreated or untreatable pain tend to just kill themselves. That is NOT a better outcome than addiction.
impossiblefork 3y ago
I don't think people should be free of pain. At present removing pain from people requires highly addictive substances that I consider to be chemical weapons or tools for destroying a person. Without a breakthrough-- some kind of non-opioid non-brain affecting painkiller, there's no way to achieve pain reduction without destroying the person. It might be puritanical, but puritanism worked. A society with opioids doesn't.

[flagged]

by pierat 3y ago

[flagged]

I guess the central point is that us very hard to distinguish between genuine and fraudulent use cases; in absence of infallible diagnostics, doctors can choose to move the know to "stricter" (decreasing fraudulent use, but making genuine use much harder) or "looser" (viceversa). I see a similar problem with mental diseases, where the common pattern nowadays is 1) get convinced that you are neurodivergent 2) iterate n doctors until you find the diagnosis you like.

curtisblaine 3y ago

(I also don't see why "boomer" is relevant)

jdefr89 3y ago

Indeed. It’s created a system where everyone’s scared. So those who need it legitimately often cannot get it. Which honestly is a false sense of security at this point as it’s easier to get these drugs on the street rather than legitimately through a doctor and that’s what most now do. If anything, the abrupt disappearance of legitimate pharmacy grade drugs made way for the current problem Fentnyl. Taking away and restricting OxyContin literally made the issue worse. Almost no one can get their hands on pharmaceutics opioids and yet the overdose rate has skyrocketed! People just don’t learn… You take something away and people only tend to want it more. Prohibition simply does not work and we have years of experience and history to show this time and time again and yet not a single thing has changed. Never see any new approaches or ideas to fix this issue because it goes far deeper than drugs themselves. People want to self medicate because they suffer, but we haven’t discussed why so many suffered and what we could do about it. Probably because the answer to that question isn’t going to be easy and hard work will be involved.

fifteen1506 3y ago
Don't forget pharmacy chains use a mathematic naive formula to stop selling opioids. As seen in HN a few months ago, if one kind HNer can add the link here.
- lotsofpulp 3y ago
  That is what happens when the government hits them with nebulous liability for political points. Government leaders do not want to clearly define the rules, but still want to pin the problem on others. If the government makes the rules clear, and the policies result in failure, then they get blamed. If the government outsources the policing, then the government leaders can point fingers and satisfy public outrage, at the expense of the affected public which is not politically powerful enough to do anything about it.
  - fifteen1506 3y ago
    [flagged]
    - lotsofpulp 3y ago
      Do you have any evidence to show the blame lies somewhere in the middle? As far as I can tell, a retail pharmacy’s role is to dispense medication per a prescription, while avoiding errors caused by mixing medicines and advising people how to take medicine. A retail pharmacy’s role is not to be the de facto front line workers for the DEA. So when our government collects fines from businesses for not policing their customers, expect the business to start discriminating against the customers, due to the lack of liability shield the government has. An even simpler way to put it is, why would a business that earns money selling things want to sell less of those things (legitimate prescriptions)? The answer has to be the risk of selling is too high.
      - fifteen1506 3y ago
        Well yes, because OxyContin was oversold and the company's behaviour was unethical. https://www.nytimes.com/2018/05/29/health/purdue-opioids-oxycontin.html https://www.nytimes.com/2018/05/29/health/purdue-opioids-oxy...
        lotsofpulp 3y ago
        I cannot read the article. What is the pharmacy’s role? OxyContin requires a prescription, so did the pharmacy sell without prescriptions? Bottom line is, do you want pharmacies to be making non medical judgment calls on which prescriptions to fill and not fill? If so, then don’t complain when they exercise judgment. I, for one, would rather not deputize everyone I interact with.

jb1991 3y ago

Believe it or not, this concept of having strong pain killers available to the public is somewhat American-centric. Much of Europe does not consider the need for strong pain killers available in society, and pain tolerance is quite different in, for example Germany or the Netherlands, where it has been nearly impossible to get anything strong for pain for many decades.

cyberpunk 3y ago
While it’s definitely more difficult to have more pain, it also guides your recovery much better. You are much more aware of what you should or shouldn’t be doing while you rehabilitate, instead of numbing everything. Unless it’s absolutely chronic pain, I think we’ve definitely over prescribed even in Europe. (Source: german)
TylerE 3y ago
That’s somewhat easier to stomach when you can pop down to the doctor, even ER, for breakthrough pain without being out a weeks salary.
chasil 3y ago
I've actually been offered fentanyl for medical procedures that involved moderate discomfort several times. I refused it and endured the pain. The physicians had never seen anyone do that before.
- jb1991 3y ago
  It's different for surgery, in a hospital, if that's what you are referring to. But for take-home use, it's nearly non-existent in much of Europe.
  - chasil 3y ago
    I don't think that fentanyl would ever be prescribed for home use, but I could be wrong. Hydrocodone was sent home recently with a family member after surgery, any this same person had oxycontin years before after a broken leg. I've only seen fentanyl as an injected solution in hospital settings, including my own.

giantg2 3y ago

"Oxycontin was misclassified due to fraudulent reportings of the drug's capabilities and marketing campaign. However that should have never affected people getting legit pain care, but it definitely did." What does legit pain care look like? Does it include the prescription of narcotics to outpatients on an ongoing basis, or for more than a couple days? While the safety of oxycontin was misrepresented, I assume there are still some problems with how other narcotics are administered to outpatients.

pierat 3y ago
> What does legit pain care look like? Oh, sure, let me just go ahead and write up a national level opiate plan here in a HN comment. I'll get right on it. /sarcasm
- giantg2 3y ago
  What I'm saying is, if it wasn't oxy, it would have been vicodin or some other narcotic. The problem is how they are prescribed and the social environment. Sure oxy misrepresented safety which lead to some increase in outpatient prescription, but this is still a major source of the problem. Oxy is just the scapegoat for much larger systemic issue since they got caught misrepresenting safety. Nobody has any actual solution to this problem so far.
gedy 3y ago
> What does legit pain care look like? A sibling was on low dose hydrocodone for years for back and ankle issues. Seemed to be fine from my perspective.
- giantg2 3y ago
  Perhaps that was the dosing or your siblings biology. Hydrocodone is also a narcotic that is potentially habit forming. The addictive potential of oxycodone is supposed to be very similar or only slightly higher than that of hydrocodone.
  - 3y ago

prepend 3y ago

I don’t think it’s puritanical at all as narcotics for painkillers are dangerous. Imagine if handguns were really good at treating pain, but had like a 30% chance of killing the patient. Would it be puritanical to not prescribe handguns to everyone with pain? And if patients who thought they would not ruin their lives were upset about not being able to get handguns and complained about engaging in “handgun seeking behavior?” Because that’s the deal here. Prescription painkillers are effective and easy, but are extremely dangerous. Pain protocols now feature OTC stuff even though they result in more pain in patients because they are equally effective but have no chance of death or life ruining addiction. OxyContin should have been used for legit pain care.

stevenAthompson 3y ago
>Pain protocols now feature OTC stuff even though they result in more pain in patients because they are equally effective but have no chance of death or life ruining addiction. If they were "as effective" they would not result in more pain. Additionally, pain ruins more lives than opioids and has been doing so for thousands of years. Ever tried to hold a job when you're in agony and have only slept a few hours that week? People with untreated or untreatable pain tend to just kill themselves. That is NOT a better outcome than addiction.

impossiblefork 3y ago

I don't think people should be free of pain. At present removing pain from people requires highly addictive substances that I consider to be chemical weapons or tools for destroying a person. Without a breakthrough-- some kind of non-opioid non-brain affecting painkiller, there's no way to achieve pain reduction without destroying the person. It might be puritanical, but puritanism worked. A society with opioids doesn't.