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Finally! All the benefits of the opioids, with none of the dangers. For clarity: I'm referring to all the previous attempts to "fix" the synthetic opioids, eac

Finally! All the benefits of the opioids, with none of the dangers. For clarity: I'm referring to all the previous attempts to "fix" the synthetic opioids, each of which ended up making a stronger, more dangerous opioid.

ViktorRay 7mo ago
The danger of addiction, which is very significant, with opioids doesn’t go away with this modified design. Unless you’re being sarcastic and referencing the lies the Sackler family used to get OxyContin popular.. That being said it is indeed quite cool that they modified the drug to decrease the respiratory depression.
- fredgrott 7mo ago
  and the fun fact, the other new drug targeting the mid-receptor of acetyl-choline that functions like mu-opioid receptor also has the same exact addiction problems.
- Nursie 7mo ago
  On the one hand, I'm sure that the post you're responding to is referencing many previous failed attempts at making non-addictive opioid painkillers. But on the other, non-sarcastic side... if addiction is the only remaining problem with them, should we care that much? I.E. if both the chronic and acute health risks are gone (which I don't think they are for a second, but follow me along on this little thought experiment)... does it matter quite so much? Clearly addiction, in the abstract, is not exactly a good thing. But if it's not coupled to risk of death it seems to me it would be a great thing to transition addicted people to, and take away some of the urgency of the situation.
  - tim-kt 7mo ago
    I agree. I would say that I am addicted to caffeine. I definitely get withdrawal symptoms if I don't have a coffee. But since it is so accessible and there are no health risks, it does not affect me negatively to "feed" the addiction.
    - cactusplant7374 7mo ago
      Tyler Cowen has said that he doesn't drink coffee and he is worried about what it might be doing to us. There is a big unknown.
      - Kurtz79 7mo ago
        I admit that I don't know who Tyler Cowen is, but millions (billions?) of people have drunk coffee daily for centuries and if there were ill effects in the same ballpark as opioids or tobacco by now we would certainly know?
        donkey_brains 7mo ago
        Hey, let’s not discount the opinion of some internet guy just because of the lived experience of the rest of humanity throughout history. /s
        cactusplant7374 7mo ago
        That's an attack on HN comments in general.
        BurningFrog 7mo ago
        There is even a decent chance that the Industrial Revolution and the phenomenal wealth and progress it's brought was caused by the introduction of coffee to Europe.
      - switchbak 7mo ago
        A professor of economics has opinions on the health effects of an extremely common substance? And I have opinions on nuclear energy - but neither of us are worth listening to outside our areas of expertise. Unless you can supply a reason I would bother listening to him as compared to an actual expert on the subject?
      - jmye 7mo ago
        > There is a big unknown. Because some dude with no health or nutrition background said uninformed things, that he isn't qualified to have opinions about, on the internet? Come on, now.
  - xikrib 7mo ago
    [flagged]
    - Nursie 7mo ago
      Ha, you won’t find me arguing addiction to meta products is harmless ;)
  - xienze 7mo ago
    > if addiction is the only remaining problem with them, should we care that much? Have you _seen_ what the streets of major cities look like these days? Ever heard of "fent zombies"?
    - Nursie 7mo ago
      I’m in one now. The problem here is meth. But then I’m not in the US and things are different in different places. It was a thought experiment about addiction if the other negatives could be removed, I doubt we’re actually anywhere close to that anyway, but it might imply that zombification had been solved.
  - temp0826 7mo ago
    I mean I guess it depends on the level of use? Do you need to be nodding off, drooling on the verge of respiratory collapse to cope with the dread of your situation? (I feel like people are mostly only considering the physical reasons for starting opiates in this post btw). Or is it a more reasonable dose that allows you to participate in society unencumbered by your pains? (Which in any case is a slippery slope with long term use)
  - tyingq 7mo ago
    There's already buprenorphine and methadone. But, using either means some degree of responsibility, punctuality, etc. So unless you mean freely distributing it with very little process, it wouldn't change much.
    - Nursie 7mo ago
      Those, from what I understand, don’t hit the same and someone needs to be ready to quit to go on them, they help with withdrawal etc, definitely, but are not always successful as they don’t scratch the full itch. A bit like nicotine replacement therapy But there’s a whole space of harm-reduction before then, which is where things like the Swiss program to provide heroin in controlled circumstances can fit in. An opioid without respiratory depresses on problems could fit into that sort of thing pretty well.
  - throwaway173738 7mo ago
    > .. if addiction is the only remaining problem with them, should we care that much? I think we should because it’s undignified to have people who want to stop taking them but are unable to resist the compulsion. I feel the same way about basically every addictive substance. Even if it was freely available and risk-free I still think that being trapped in a cycle of use and withdrawal is such an affront to someone’s dignity that we should still try to prevent that.
  - ViktorRay 7mo ago
    By definition addiction involves pursuing substances or engaging in behavior repeatedly despite negative consequences in one’s life. Any behavior or substance that causes serious addiction is still bad regardless of whether it causes death or other negative health effects. The addiction itself inherently causes suffering because the addict is engaging in something despite the negative consequences in the rest of their lives. The negative consequences cause suffering and the psychological pain of wanting to stop and not being able to stop also causes suffering. I know some other commenters mentioned caffeine addiction but nicotine and opioids (and also behavioral addictions like gambling) are vastly more addictive than caffeine. Negative consequences from addiction can involve more than loss of money (although loss of money is still a significant thing of course.) They can cause damage to one’s career, family relationships, friend relationships and so on. Even if the addictive behavior or substance has no other inherent negative health effects. In high school I had a really bright and motivated friend. He went to an Ivy League school. He became horribly addicted to World of Warcraft as a freshman. He spent so much time playing the game that he damaged his grades and GPA. He almost failed out of school. He had to make serious effort to stay in school. And he had to spend tremendous mental effort to avoid playing additive games anymore. That’s just one example.
- wongarsu 7mo ago
  Not just OxyContin. Also Heroin, Meperidine and Tramadol. We get another "morphine, but safe this time" in pretty reliable 40 year intervals. I guess someone decided OxyContin doesn't count and we are due for another one
  - monero-xmr 7mo ago
    To be honest I would prefer addicts could get heroin prescribed. The primary danger of street drugs is the inconsistent purity and chemicals it’s cut with. If it was pharmaceutical grade and everyone prescribed was on a list, we would have fewer overdoses and a better understanding of who to put in treatment
    - cluckindan 7mo ago
      Most heroin overdoses happen either from a sudden increase in supply purity, or from an abstinent addict relapsing and taking their regular dose without realizing they have lost their tolerance. Any kind of rational change in policy is not happening as long as entire lucrative industries of policing, health care and religion-as-a-social-service are dependent on the dependent.
      - alphawhisky 7mo ago
        This cuts to one of the more important points here. Rent seeking behavior in public health is crazy to witness.
      - apothegm 7mo ago
        Don’t forget for-profit prisons!
    - tokai 7mo ago
      It's such things that reveal the cruelty in our sociaties. The evidence is very clear; it reduces deaths and improves health, while also reducing crime. But its still not the default the world over because its apparently a hard sell to give addicts anything for free. The other comments here show the sentiments nicely.
- kvgr 7mo ago
  The chinese factories and cartels can hop on this new formula not.
bena 7mo ago
No, same. Reading the headline, I immediately thought "Aw shit, here we go again". It's like that xkcd comic about unifying standards, now we have n+1 addictive opioids.
DesaiAshu 7mo ago
Adjacent medicines have seen major improvements: eg Ketamine was a significant improvement from PCP (notably, less psychosis and safe enough to use off the battlefield / with children) “Removing the worst and most fatal danger” is a laudable goal with Fentanyl given the absurd rate of ODs
- at-w 7mo ago
  As have the opioids buprenorphine and Suboxone (buprenorphine/naloxone), which are genuinely useful treatments for addiction and have much lower risks of abuse.
at-w 7mo ago
>each of which ended up making a stronger, more dangerous opioid This is true of some early opioids like heroin, but with e.g. Oxycontin the problem wasn’t a stronger opioid, it's how it ended up being prescribed. Purdue's marketing led doctors to prescribe it to more people, in higher doses, and for longer. Oxycontin isn't inherently more dangerous than the dose of immediate release oxycodone or morphine that would have an equivalent effect. Innovation in opioids shouldn't just be written off. They're still the best (and sometimes the only effective) treatment for a huge number of people, and some new opioids like buprenorphine/combos like Suboxone have real advantages. The lesson from Oxycontin is more about deceptive marketing and prescribing practices.
- goolz 7mo ago
  [dead]
- throwaway173738 7mo ago
  I mean if there were no safe dose or usage pattern then I would expect a lot of mothers to leave the hospital with both a newborn and a crippling addiction. The epidural is an opiate like fentanyl.
  - deleted 7mo ago
    [deleted]

ViktorRay 7mo ago

The danger of addiction, which is very significant, with opioids doesn’t go away with this modified design. Unless you’re being sarcastic and referencing the lies the Sackler family used to get OxyContin popular.. That being said it is indeed quite cool that they modified the drug to decrease the respiratory depression.

fredgrott 7mo ago
and the fun fact, the other new drug targeting the mid-receptor of acetyl-choline that functions like mu-opioid receptor also has the same exact addiction problems.
Nursie 7mo ago
On the one hand, I'm sure that the post you're responding to is referencing many previous failed attempts at making non-addictive opioid painkillers. But on the other, non-sarcastic side... if addiction is the only remaining problem with them, should we care that much? I.E. if both the chronic and acute health risks are gone (which I don't think they are for a second, but follow me along on this little thought experiment)... does it matter quite so much? Clearly addiction, in the abstract, is not exactly a good thing. But if it's not coupled to risk of death it seems to me it would be a great thing to transition addicted people to, and take away some of the urgency of the situation.
- tim-kt 7mo ago
  I agree. I would say that I am addicted to caffeine. I definitely get withdrawal symptoms if I don't have a coffee. But since it is so accessible and there are no health risks, it does not affect me negatively to "feed" the addiction.
  - cactusplant7374 7mo ago
    Tyler Cowen has said that he doesn't drink coffee and he is worried about what it might be doing to us. There is a big unknown.
    - Kurtz79 7mo ago
      I admit that I don't know who Tyler Cowen is, but millions (billions?) of people have drunk coffee daily for centuries and if there were ill effects in the same ballpark as opioids or tobacco by now we would certainly know?
      - donkey_brains 7mo ago
        Hey, let’s not discount the opinion of some internet guy just because of the lived experience of the rest of humanity throughout history. /s
        cactusplant7374 7mo ago
        That's an attack on HN comments in general.
      - BurningFrog 7mo ago
        There is even a decent chance that the Industrial Revolution and the phenomenal wealth and progress it's brought was caused by the introduction of coffee to Europe.
    - switchbak 7mo ago
      A professor of economics has opinions on the health effects of an extremely common substance? And I have opinions on nuclear energy - but neither of us are worth listening to outside our areas of expertise. Unless you can supply a reason I would bother listening to him as compared to an actual expert on the subject?
    - jmye 7mo ago
      > There is a big unknown. Because some dude with no health or nutrition background said uninformed things, that he isn't qualified to have opinions about, on the internet? Come on, now.
- xikrib 7mo ago
  [flagged]
  - Nursie 7mo ago
    Ha, you won’t find me arguing addiction to meta products is harmless ;)
- xienze 7mo ago
  > if addiction is the only remaining problem with them, should we care that much? Have you _seen_ what the streets of major cities look like these days? Ever heard of "fent zombies"?
  - Nursie 7mo ago
    I’m in one now. The problem here is meth. But then I’m not in the US and things are different in different places. It was a thought experiment about addiction if the other negatives could be removed, I doubt we’re actually anywhere close to that anyway, but it might imply that zombification had been solved.
- temp0826 7mo ago
  I mean I guess it depends on the level of use? Do you need to be nodding off, drooling on the verge of respiratory collapse to cope with the dread of your situation? (I feel like people are mostly only considering the physical reasons for starting opiates in this post btw). Or is it a more reasonable dose that allows you to participate in society unencumbered by your pains? (Which in any case is a slippery slope with long term use)
- tyingq 7mo ago
  There's already buprenorphine and methadone. But, using either means some degree of responsibility, punctuality, etc. So unless you mean freely distributing it with very little process, it wouldn't change much.
  - Nursie 7mo ago
    Those, from what I understand, don’t hit the same and someone needs to be ready to quit to go on them, they help with withdrawal etc, definitely, but are not always successful as they don’t scratch the full itch. A bit like nicotine replacement therapy But there’s a whole space of harm-reduction before then, which is where things like the Swiss program to provide heroin in controlled circumstances can fit in. An opioid without respiratory depresses on problems could fit into that sort of thing pretty well.
- throwaway173738 7mo ago
  > .. if addiction is the only remaining problem with them, should we care that much? I think we should because it’s undignified to have people who want to stop taking them but are unable to resist the compulsion. I feel the same way about basically every addictive substance. Even if it was freely available and risk-free I still think that being trapped in a cycle of use and withdrawal is such an affront to someone’s dignity that we should still try to prevent that.
- ViktorRay 7mo ago
  By definition addiction involves pursuing substances or engaging in behavior repeatedly despite negative consequences in one’s life. Any behavior or substance that causes serious addiction is still bad regardless of whether it causes death or other negative health effects. The addiction itself inherently causes suffering because the addict is engaging in something despite the negative consequences in the rest of their lives. The negative consequences cause suffering and the psychological pain of wanting to stop and not being able to stop also causes suffering. I know some other commenters mentioned caffeine addiction but nicotine and opioids (and also behavioral addictions like gambling) are vastly more addictive than caffeine. Negative consequences from addiction can involve more than loss of money (although loss of money is still a significant thing of course.) They can cause damage to one’s career, family relationships, friend relationships and so on. Even if the addictive behavior or substance has no other inherent negative health effects. In high school I had a really bright and motivated friend. He went to an Ivy League school. He became horribly addicted to World of Warcraft as a freshman. He spent so much time playing the game that he damaged his grades and GPA. He almost failed out of school. He had to make serious effort to stay in school. And he had to spend tremendous mental effort to avoid playing additive games anymore. That’s just one example.
wongarsu 7mo ago
Not just OxyContin. Also Heroin, Meperidine and Tramadol. We get another "morphine, but safe this time" in pretty reliable 40 year intervals. I guess someone decided OxyContin doesn't count and we are due for another one
- monero-xmr 7mo ago
  To be honest I would prefer addicts could get heroin prescribed. The primary danger of street drugs is the inconsistent purity and chemicals it’s cut with. If it was pharmaceutical grade and everyone prescribed was on a list, we would have fewer overdoses and a better understanding of who to put in treatment
  - cluckindan 7mo ago
    Most heroin overdoses happen either from a sudden increase in supply purity, or from an abstinent addict relapsing and taking their regular dose without realizing they have lost their tolerance. Any kind of rational change in policy is not happening as long as entire lucrative industries of policing, health care and religion-as-a-social-service are dependent on the dependent.
    - alphawhisky 7mo ago
      This cuts to one of the more important points here. Rent seeking behavior in public health is crazy to witness.
    - apothegm 7mo ago
      Don’t forget for-profit prisons!
  - tokai 7mo ago
    It's such things that reveal the cruelty in our sociaties. The evidence is very clear; it reduces deaths and improves health, while also reducing crime. But its still not the default the world over because its apparently a hard sell to give addicts anything for free. The other comments here show the sentiments nicely.
kvgr 7mo ago
The chinese factories and cartels can hop on this new formula not.

bena 7mo ago

No, same. Reading the headline, I immediately thought "Aw shit, here we go again". It's like that xkcd comic about unifying standards, now we have n+1 addictive opioids.

DesaiAshu 7mo ago

Adjacent medicines have seen major improvements: eg Ketamine was a significant improvement from PCP (notably, less psychosis and safe enough to use off the battlefield / with children) “Removing the worst and most fatal danger” is a laudable goal with Fentanyl given the absurd rate of ODs

at-w 7mo ago
As have the opioids buprenorphine and Suboxone (buprenorphine/naloxone), which are genuinely useful treatments for addiction and have much lower risks of abuse.

at-w 7mo ago

>each of which ended up making a stronger, more dangerous opioid This is true of some early opioids like heroin, but with e.g. Oxycontin the problem wasn’t a stronger opioid, it's how it ended up being prescribed. Purdue's marketing led doctors to prescribe it to more people, in higher doses, and for longer. Oxycontin isn't inherently more dangerous than the dose of immediate release oxycodone or morphine that would have an equivalent effect. Innovation in opioids shouldn't just be written off. They're still the best (and sometimes the only effective) treatment for a huge number of people, and some new opioids like buprenorphine/combos like Suboxone have real advantages. The lesson from Oxycontin is more about deceptive marketing and prescribing practices.

goolz 7mo ago
[dead]
throwaway173738 7mo ago
I mean if there were no safe dose or usage pattern then I would expect a lot of mothers to leave the hospital with both a newborn and a crippling addiction. The epidural is an opiate like fentanyl.
- deleted 7mo ago
  [deleted]