
Painkillers now kill more Americans than any illegal drug - davidbarker
http://www.vox.com/2016/3/9/11172926/painkillers-opioids-pharma-marijuana
======
krschultz
I've never taken an illegal drug in my life. I've smoked a cigarette about 5
times. I drank in college but lately I've cut that out of my life as well. I
had a security clearance with drug testing requirements for a while and now I
just don't like the feeling of a hangover from alcohol or the risk of
ingesting random plants/chemicals made by shady people.

In short: I'm the most vanilla, square, anti-drug person you can find. I don't
want to use them, and I think other people would be better off if they reduced
their usage as well.

Yet I can not for the life of me understand why drugs are illegal. Not just
pot, all drugs. I'm totally onboard with making it our public policy that we
want to reduce the use of drugs. That makes perfect sense to me. It does not
make sense to me why anyone still believes that using the criminal justice
system as the mechanism for getting to that goal is the right path. We are
spending insane amounts of money on a failed approach while also generating
huge negative side effects by creating an enormous group of people with
criminal records. It's probably the worst thing this country has done to our
own people since segregation and it seems like all of the policy people
understand this. Why can't we get political will to do something different?

~~~
evincarofautumn
I’m an alcoholic. I’ve cut back on my use significantly, and I’m currently in
a period of abstinence. Because alcohol is legal and socially accepted, it’s
entirely my responsibility to manage my behaviour and keep my use to non-
problematic levels. Not everyone has the social support to make that happen.

I think legalisation would be beneficial, as you say, because the criminal
justice system does not serve addicts. However, while proceeding with
legalisation, we must also establish better social support systems so that
people can safely enjoy drugs in moderation.

~~~
twblalock
Why should your drug use, or anyone else's, create obligations for other
people to support you, treat you, and help you overcome addiction?

The libertarian case for legalizing drugs falls apart if society has to take
responsibility for providing support systems as a reaction to the actions of
individual drug users. Frankly, most people would rather continue to ban drugs
than pay for treatment for people who abuse them.

Yes, I know this is shortsighted because we already pay for the costs of
incarceration and law enforcement. But that's the status quo, and changing it
is going to require convincing people that the alternative is better.

~~~
justsaysmthng
Because your addiction is also your wife's problem, your parent's problem,
your company's problem.

Addiction affects more than just the addict. And addicts are in need of help -
while it is easy to think that "they like being high, it's their choice", in
fact the addicts hate their habit more than anything, yet they can't stop
using without external help.

Would you help a person with a broken leg ? Why ?

Well, that's your answer right there.

Edit: Just a couple of days ago I've watched this documentary and I guess
that's how I came to these conclusions:
[https://www.youtube.com/watch?v=k01VM1f1Akk](https://www.youtube.com/watch?v=k01VM1f1Akk)

~~~
rubicon33
If they broke their leg while doing something that endangered not only
themself, but their family, their friends, and society on a whole, I might not
jump at an opportunity to help them.

~~~
j2bax
Personally I don't consider myself such a good judge. If someone's in need, I
like to think I will help them in whatever capacity I can. Many things lead to
people making bad decisions, and they aren't all internal 1-sided factors.

~~~
rubicon33
I guess that's where we disagree. I do consider myself a good judge. If you
don't feel you have a sharp rational thought, an ability to consider a wide
range of factors, including a dose of fair human compassion, then yes you
probably should just help out everyone by default. That's a good default
position to take, and one I do commend.

Myself on the other hand, I believe in my own ability to be fair in judgement,
to straddle that difficult line between compassion and personal
responsibility. I believe it IS possible to leave someone bleeding in the
street because they chose to endanger themself, their family, their community,
and the quality of life of everyone on this planet.

That's a position that will strike many as arrogant, entitled, and downright
wrong. I can understand that position, and still choose to disagree with it.
As an ideal, I hold personal responsibility in the highest regard, while still
understanding that life hits you hard sometimes in ways you cant possible
predict.

~~~
vectorjohn
It's not just arrogant and cruel, it's also logically inconsistent. Everything
libertarian leads to an everyone for themselves hellscape. But this in
particular would indicate you shouldn't help someone in a car accident because
of driving in bad weather, or really driving at all. They took the risk, the
risk was well known, so screw them while they bleed to death in the car,
right?

~~~
mindcrime
_Everything libertarian leads to an everyone for themselves hellscape_

How in the world do you arrive at that conclusion? Personally, I can't imagine
anything being further from the truth...

~~~
Klinky
It seems the Libertarian mindset would lead someone who survived a plane crash
to think that they chose the right seat, and those who died must have had poor
seat choosing ability. Instead of it just being chaotic luck. The Libertarian
mindset heavily relies on survival bias.

There are a lot of things outside of ones control in life, and while you can
try to shape the direction in your life with personal choice, not everyone
starts from the same spot, not all situations are the same, and not all risks
pay off.

~~~
mindcrime
_It seems the Libertarian mindset would lead someone who survived a plane
crash to think that they chose the right seat, and those who died must have
had poor seat choosing ability._

TBH, that sounds like a complete caricature of a Libertarian thinker from
where I'm sitting. Maybe there are people like that out there, and maybe some
of them self-identify as Libertarians (or libertarians) but there's nothing
inherent in the Libertarian world-view that would lead to such a position.

 _There are a lot of things outside of ones control in life, and while you can
try to shape the direction in your life with personal choice, not everyone
starts from the same spot, not all situations are the same, and not all risks
pay off._

That's absolutely true, and of the Libertarians I know, I don't think I know a
single one who would contest that.

Source: am a Libertarian.

~~~
Klinky
Probably not all Libertarians are the same, but most I've dealt with have a
selfish arrogance about the outcome of the choices they've made, and ignorance
about the plight of others. There is also a strong desire to dismantle
regulations and safety nets, because of a belief that it would bring immediate
benefit themselves. The Libertopian ideal really does sound like a privatized
"hellscape", which the Libertarians obviously think they would be the CEOs of.

~~~
logfromblammo
There are more varieties of libertarian than there are varieties of
authoritarian. Similarly, there are more types of atheist than there are
religions.

As a class of people, there is only one factor that ties all of them together
under a single ideological umbrella. By all other measures, their opinions can
vary wildly.

The capital-L Libertarians, otherwise known as the members of the Libertarian
Party, are just the tip of the small-l libertarian iceberg. For those who have
chosen to abandon political participation and evangelism, you may never even
realize they are libertarian at all.

There are some godawful douchebag libertarians. There are criminal fraud
libertarians. And there are also libertarians that are outwardly
indistinguishable from everybody else, aside from little things like laughing
at something when a joke was not intended.

Do you remember Dennis, the 37-year-old not-an-old-woman from _Monty Python
and the Search for the Holy Grail_? Do you recall how he was attempting to
explain the anarcho-syndicalist commune to King Arthur? Anarcho-syndicalists
are a type of libertarian. Just as Arthur dismissed him as completely useless,
modern mainstream politics ignores and marginalizes most libertarian groups.
And they do it to each other, as well. No one is better at denouncing a
particular type of libertarianism than another type of libertarian.

------
disposeofnick9
I've lost at least two elderly, extended family members this way. Both applied
both a patch and took a pill, which caused an OD.

The issue is that many opioids and non opioids gap between the therapeutic
dose range and LD50% is often dangerously narrow.

Complication #0: serum bioavailable molecule assay is rarely monitored. People
metabolize and clear drugs at vastly differently rates.

Complication #1: Hospital mistakes still happen quite frequently, despite many
measures to prevent them, especially with inexperienced and overworked
nurses/assistants.

Complication #2: cummulative dosing error or interactions, especially
multiple, independent prescriptions for similar opioids with different
administration routes (patches, sprays, pills, injections)

Complication #3: overprescription of opioids because they're cheap, especially
to veterans, which also leads to prescription and hard drug addictions.

Solution: opiods need to be singularly controlled at home or in the hospital
by an integrated, blood/interstitial fluid measuring/dispensing unit to avoid
OD and push back on abuse.

Plus, anyone taking opioids should also have narcan or equivalent antidote
readily available, and wear a medalert QR code bracelet which lists relevant
conditions and medications should they be found unresponsive.

Finally, avoid painkillers as much as possible and take the least dose which
reduces stress level.

~~~
creshal
> overprescription of opioids because they're cheap

It's a bit scary how eager doctors are to prescribe them. "Hey doc, I'm in
pain" – "Here's a bottle of painkillers, NEXT" Bitch, I don't want
painkillers, I want you to figure out why my body is hurting when it's not
supposed to. It's surprisingly frustrating to talk doctors into looking for
the cause instead of treating the symptom.

Thankfully, the metamizole they kept filling me up with is not nearly as
addictive as opioids and we have free health care, so I didn't have to pay a
dime for the repeated blood analyses and CT it took find the cause. Otherwise
I'd probably have bigger problems right now.

~~~
thaumasiotes
> I don't want painkillers, I want you to figure out why my body is hurting
> when it's not supposed to. It's surprisingly frustrating to talk doctors
> into looking for the cause instead of treating the symptom.

To be fair, this is related to the symptom you're asking them about. Pain
often occurs with no apparent cause.

As an extreme example, it is normal for amputees to experience the sensation
of a "phantom hand" where their hand would be if it hadn't been amputated. The
phantom hand can feel pain. I'm fairly confident that there is nothing
physically wrong with the hand someone doesn't have, even if it is in pain.

~~~
ihartley
Phantom limb is actually an interesting case that may reveal more about
idiopathic pain as we study brain/body mapping better. If anyone is interested
check out the work of VS Ramachandran, here's a somewhat old article about his
work with phantom limb patients: [http://www.npr.org/2011/02/14/133026897/v-s-
ramachandrans-ta...](http://www.npr.org/2011/02/14/133026897/v-s-
ramachandrans-tales-of-the-tell-tale-brain)

His latest work has been investigating body integrity identity disorder which
is sort of the opposite of phantom limb: where you feel like a part of you
doesn't belong.

I believe this gist of the work is that there is a mapping between our body
and our brain (this is what enables one to 'know' where your body is in
relation to itself when your eyes are closed) that sometimes is overloaded or
malformed and can result in these issues.

~~~
disposeofnick9
Interesingly, there are antidepressant-like drugs used for pain like phantom
limb and neuropathy (like demyelinated nerves due to Shingles)... because it
can "ignored" to varying degrees. As someone who's been both deeply major
depressed, where tiny pains become an all-consuming focus and not depressed
where a hand sliced open is not a big deal... Pain definitely interacts with
mental well-being, and can lead to a spectrum of suffering between all-
consuming focus or compartmentalized item. More research needs to be done on
the functional perception of pain, because it could radically reduce pain
prescriptions by instead controlling the suffering of non-survival-beneficial
pain at its ultimate destination rather than carpetbombing patients with
addictive substances.

[http://www.webmd.com/pain-management/tricyclic-
antidepressan...](http://www.webmd.com/pain-management/tricyclic-
antidepressants-for-chronic-pain)

------
6stringmerc
I have chronic pain due to a heriditary, incurable condition. Right now one of
my ankles is in an elastic wrap to ease the irritation from arthritis. In our
home, we did have a bottle somewhere of Tylenol 3, aka codeine. Regular
acetominophen was usually what I got to help with an issue.

As I grew into adulthood, I knew the pains I experienced were directly related
to my condition, and it was my desire to not really 'cloak' the pain, but
avoid it in the first place. Preventive if you will. It helps, but it's clear
to me that I wanted to be healthy, and if I have to occasionally take
something, so be it. Naproxen sodium has worked quite well of late.

The point of all this rambling is that I simply don't want the hassle of
becoming addicted to pain pills. Or sleeping pills. Or nasal spray when it's
allergy season. I've lived with pain so long for my life that I'm kind of used
to it, and I do say so as a point of pride. It's the body I was born with and
it's the one I'll have to use for this gig, take care of it.

I don't fault people for wanting pain treatment. I think the way the system
_was_ set up with pills flooding the US was incredibly destructive, and highly
indicative of the dangers of for-profit medicine as a system. Toss in the
DEA's drug laws and it just turns patients into criminals and that benefits
only a very limited group.

When I eventually started seeing commercials on TV for a treatment for _opiod
induced constipation_ all I could think about was _Trainspotting_ and that we
have a real, genuine problem on our hands in the US.

------
musgrove
If 47k deaths per year is an "epidemic" as the author terms it, the 610k that
die each year from heart disease must be an all-out pandemic. It never was a
war on drugs. Drugs are inert and aren't capable of fighting a war. It's a war
on addiction. And good luck winning that on a national scale with "laws."

~~~
6stringmerc
If you live long enough you eventually die of something, right?

Now, if 85% of those heart disease deaths were in the 15-28 year old cohort,
that might be something quite stunning.

I agree declaring 'war' on addiction is a ridiculous concept, because it's
more than likely a statistical constant (with a range) within the human
species. A certain amount of people will get addicted, be it drugs, food, or
the internet. It's just kinda sorta what we do, and I'd be a big fan if as a
society and culture we looked toward methods to save ourselves constructively,
rather than use the authority of the state to lock people away, generally
speaking.

------
brandonmenc
Lots of comments from people who have no experience with chronic pain aghast
that doctors would fulfill patient "demands" for painkillers instead of
treating the underlying cause.

Pain is self-report, so all a doctor can do is prescribe based on patient
demand. Maybe they can't identify an underlying cause, or maybe the treatment
(ex: back surgery) is too risky.

Spine surgery that might not work and can leave you with say, loss of bladder
control? I'd take the pill every time, and if my doctor didn't just hand it
over, I'd find another doctor.

~~~
catshirt
there is a possible outcome of back surgery that furthers your point and is (i
guess arguably) worse than loss of bladder control, which is worse pain.

------
jrapdx3
It's troubling the way this article presents the issue. Treating chronic pain
is an enormously complex problem that clinicians have to deal with, especially
as it gets bound up with collateral pitfalls of drug dependence, politics of
health care delivery systems and conflicting pressures from patients,
government regulators and others.

While unethical prescribers (not all are physicians) contribute significantly
to rising misuse of opioids, the vast majority of practitioners want to do
what's best for patients. As the article notes, there are few options for
managing chronic pain, leaving opioids the only realistic choice in many
instances.

None of the providers I know think opioids are preferable, but more like a
necessary evil. They prescribe opioids sparingly, reluctantly, diligently.
Patients have told me it's become increasingly difficult to get prescriptions
for quite modest doses of opioid agents they've used for years without dose
escalation. The tendency to throw babies out with the bathwater is not unique
to this situation, but no less problematic.

Blaming pharmaceutical companies doesn't seem a constructive approach.
Probably there's a lot of R&D going on in this domain without much success,
meaning it's a very hard problem to solve. I'm certain that a major
breakthrough would be eagerly marketed, highly likely the profit margins would
be huge. Meanwhile, we're left with the status quo, and manufacturers are
meeting market demands. Isn't that how our economy works? Pharma sales are
already more highly regulated than nearly all other industries, what more
should be done?

Few legal drugs are as controlled in the US as schedule II opioids. If there
were no such controls it's likely that the number of overdose-related deaths
would be higher than it is. No one knows what solution will work, the need to
be being careful about changing "rules" should be obvious.

The article's advocacy of "medical marijuana" as an alternative is IMO
inappropriate. Simply enough, research on the uses of cannabis components for
pain treatment is in very early stages. Specific indications and side-effect
risks are inadequately understood. Recommending use of these components as
treatments for pain is premature.

~~~
LanceH
I dropped a glass bottle of something restricted. Dr prescribed another one
for me, but the insurance company told the pharmacy, "no" and the pharmacy
wouldn't dispense after that. Even with me paying the full price.

I'm still a little steamed to think about it. They received both prescriptions
from my doctor and made made a medical decision to withhold based upon the
word of the insurance company which should not have been a party to the second
purchase. I couldn't get the prescription back either, since it was sent
directly to the pharmacy.

I have always had a chuckle thinking about what would happen if the government
called the medical marijuana supporters claims out and legalized it. I think
it would become a pill with none of the high and turn into something quite
boring.

~~~
jrapdx3
> ... Dr prescribed another one for me, but the insurance company told the
> pharmacy, "no" and the pharmacy wouldn't dispense after that. ...

This sort of thing happens all the time where medical decisions are "second
guessed" by insurers. It may be in the form of payment restriction, or
requiring "pre-authorization", just another way to make it difficult to get
treatment that costs more than the absolute minimum. I believe such maneuvers
are counterproductive, that is, it will wind up costing more if patients don't
get what they need to improve their conditions.

Not quite sure why the pharmacy wouldn't fill the Rx for cash. Maybe afraid of
regulatory criticism for the "double fill". Of course there are instances
where people are frequently "losing" medication supplies and requesting
replacement prescriptions. Then we might rightly suspect medication misuse,
but if such requests for extra prescriptions are rare, as in your case, it's
wrong not to honor it.

------
AlleyTrotter
Simple comment What about the people who find relief from chronic pain with
opioids and have no other option? These people are the ones who will suffer
from the " we know whats best for you crowd"

------
joesmo
Send patients home with Narcan and train the people they live with to
administer it as well. Have every EMT, firefighter, and police officer in the
nation carry and know how to administer Narcan. Have it be part of every
single first aid kit sold in this country. __Remove the social stigma of drug
abuse. __Remove penalties for people who help others who are overdosing. You
'd think _someone_ would have some common sense in this country but you'd be
wrong. It will never get better the way things are going now. It's ridiculous
to even have a fucking article like this that doesn't mention the numerous
tried and true solutions that exist but are simply not being put into place
because _the people in power in this country want to see people dying_.

The problem isn't that we don't have solutions. Solutions are a plenty. The
problem is that no one in America cares. No one in this country gives a shit
that people are dying. Most people want it to happen. They support the fucking
drug war. They want people to die. Until this fucking shit changes, people
will continue to die and idiots will continue to wonder what can we do? So
many fucking things, I don't even have time to write them all down. That's the
fucking sad part.

~~~
jdietrich
The Scottish government started providing naloxone (Narcan) to opiate users on
a large scale in 2010. Naloxone and first aid training was offered to users of
needle exchange services, prison leavers and other people at risk of opiate
overdose.

In the first year there were 365 confirmed uses of naloxone, but that is
believed to be a significant underestimate of overall use.

The evidence is clear - naloxone works.

[http://www.gov.scot/Resource/0045/00451251.pdf](http://www.gov.scot/Resource/0045/00451251.pdf)

------
Havoc
I try to stick to Aspirin & Paracetamol for this reason. Even Paracetamol
feels a touch dicey @ liver failure stats.

However I've been in decent pain for 1 year+ before so I know what its like &
can totally understand why people go for the powerful stuff. Continuous pain
like that slowly but surely grinds your psyche to fine dust over the long run.
Thats the part that people without chronic pain miss...

------
joveian
This seems like a particularly limited article, although a better slant than
many. The NY Times just had this (also not wonderful, but with some additional
information) article a few days ago:
[http://www.nytimes.com/2016/03/07/us/heroin-epidemic-
increas...](http://www.nytimes.com/2016/03/07/us/heroin-epidemic-increasingly-
seeps-into-public-view.html)

While the title mentions heroin, the article at least mentions that deaths are
frequently due to more deadly prescription painkillers being mixed in. One
thing I wonder that I haven't seen addressed (I'm not sure if there is even
data available) is how many overdose deaths are due to use of multiple drugs
at the same time (alcohol for example makes many drugs more deadly).

Hopefully there will be more and better reporting on the issue. IIRC (and
wikipedia agrees at least), these numbers mean that drug overdoes are now
killing non-trivially more people in the US than car accidents.

~~~
marincounty
I have a feeling it's going like this; patient goes to doctor and complains of
pain. Doctor reluctantly prescribes an opioid. Patient likes the way the
opioid makes them feel. Yea, their pain becomes tolerable because they feel
better. A lot better than any antidepressant.

Right now, a lot of people in the United States are misserable on a lot of
levels. It's not just their back pain, or the roaming pain--misery seems to
bring. It's the economy. It's finding a place other than a room in your baby
boomer's parent's home. It's even finding a shit job--a shit job used to be
easy to find. Now--shit jobs are just aweful. Plus, you are competing with
very desperate immigrants that happily work for minimum wage, and have no
social qualms living like caned Sardines. (I 'm not stereotyping. A lot of
immigrants don't see anything weird with a sharing a small room with multiple
family members.) In the U.S. it's looked down upon. Especially in the
formative years, where you are trying to prove to that perfect person you are
a Superman/Superwoman. You are the one. You are the independent winner. You
are the one he/she should marry, or just have sex with. It's not your fault
you not the big baller. And no it's not just getting the B.S. Degree. It's a
whole lot more than that.

Back to the person in pain on opioids. The drugs make them feel better. This
is what they think they need to function in this world--some Do! Physical pain
is Real?

The big problem is opioids lose their efficy over time. Doctors don't tell the
patient in pain up front about tolerance. Why--because in a lot of medicine, a
good doctor wants to induce the placebo effect, along with the effect from the
drug, and their not idiots. Some actually want you to feel better. They all
don't just don't care about the office visit fee. I think?

(While opoids do require more, and more over time in order to get the original
effect; there are studies done in Rest Homes, with older subjects where
tolerance of opoids did not materialize. The studies are numerious, and many
doctors were taught opoids are safe in med school.)

In my case, and the people I know opoids are far from being a non-addictive
drug, or tolerance resistant. But the drug has been so vilified, and
stereotyped who knows. All those addiction t.v. shows, and even well meaning
professionals have told us for years, getting off opoids is very hard. I truly
wonder just how difficult getting off opioids is--if we weren't conditions
into thinking it's the most difficult drug to kick? I know when I'm told
something is going to be a bitch to get off of--it's always worse than the
times I didn't know how difficult the withdrawal will be. And the greatest
junkie (Burrows) once said something like, 'Geting off opoids is not as hard
as they say.'

Now to the opoid deaths. I don't know about the deaths among very ill patients
whom are on patches like fentanal. I know about the guy with the bad back who
was given opoids. Then the doctor stopped the refills. That patient went to
the black market to get their opoid, usually heroin because it's cheaper. At
this point, their lives are usually a complete mess. If they are poor, they
usually have a record with the authorities. Every day becomes a nightmare.
"I'll few drinks along with the heroin--who cares?" A hit of meth--who cares?
A sleeping pill with the opoid--who cares? Who cares? I've given up. I can't
function like my parents did.

Death from overdose follows.

We have a problem. I think there's a short term solution to a drug problem,
and an out of touch society. A society that's still living in the 50's in
terms of expectations.

That short term solution is Buoenorpine. It can help a lot of these people
whom are addicted to opioids. Don't require the addict to pay a fortune for
this drug. Don't make them pay for expensive office visits. Just give them the
drug. If they sell it, or abuse it; they go back to herion.

As to people in extreme pain, let Medical doctors treat it. Leave them alone.
Let them do their jobs. No government official should be telling them how to
alleviate cancer pain, or any physical pain. Hell, they shouldn't have to take
a special course in order to prescribe bupenorpine. They shouldn't be limited
to 100 patients. Leave MD's alone. Again--leave medial doctors alone. Let them
prescribe what they feels works. If the patient abuses the drug--that's not
the doctors fault.

If you think the average doctor is willy nilly writing prescriptions for
opoids--well just see what happens when you see a doctor, and complain about
pain.

Most likely you will be offered 400 mg's of Ibuprofen. Doctors are very leary
of writing a script for any opoid. Good luck getting one. The DEA is breathing
down their backs.

As a society, the people in real physical pain are being told they can't have
opoids. It all seems fine, until you are that person in intense pain in that
exam room.

So yes we live in a country that expects a lot from its citizens. We are all
suspose to be successful. Even the poor are expected to "make it"\--whatever
that means anymore. At the same time jobs have gone away. We are in this
sharing economy. A economy that just seems to serve the wealthy?

The glow from opoids is enticing in this judgmental society. Bupenorpine might
be a quick answer to a complex problem? A real problem. What do we have to
lose at this point? I'm tired of hearing about overdose from opioids. Really
tired! A least freely provide naloxone over the counter?

------
FussyZeus
Is this really surprising? All the benefits of illegal drugs without the risks
involving prison time and public disgrace. All you need to do is figure out
what things to tell your Doctor to make him think you need one of these
things, and you have a legal (and probably insurance funded) supply.

Not saying of course that everyone who gets these doesn't need them, I'm sure
many do, but we have something like 90% of the worldwide consumption occurring
in the States, so something is clearly up.

------
user_0001
What are the rates like compared to other countries?

Does the US just over prescribe painkillers, meaning more flood to the
blackmarket?

Is it people are getting it from the Dr and accidentally ODing?

Are the Drs prescribing without care, so those who want the drug for a high
and no medical reason can?

I never knew painkillers to be used as party drug / fun drug in the UK
(outside of the heroin using demographic) nor ever heard of some one ODing on
prescribed painkillers.

Seems strange it is such a big issue in the US

~~~
user_0001
I probably should have read the article

\------- Since the 1990s, doctors have been under more and more pressure to
treat pain as a serious medical issue. Pharmaceutical companies took advantage
of this desire, marketing opioid painkillers like OxyContin and Vicodin as a
safe, effective solution to pain. \------

privatised health care and the profit incentive to prescribe high cost pain
kills. I believe the Drs get a kickback from the companies for pushing a
particular brand (could be wrong on that though).

Also, who put the pressure on the Drs to treat pain as such? Politicians? Why
would they? I imagine leant on (or the term is "lobbied" by big pharma. Would
be interesting to see the "donations"* paid to politicans from big pharma
right around that time and who profited from this.

* I always find this funny who we in the west call this "donations" but when reporting on third world countries it is termed a "bribed". Paying money to get what you want from government so you can make more money....

~~~
marcosdumay
OT, but...

> I always find this funny who we in the west call this "donations" but when
> reporting on third world countries it is termed a "bribed".

Well, if resolving the hypocrisy would mean calling our bribes by "donations",
please, let it unresolved.

We at third world countries gain a lot from your transparent accounting of
what happens here.

------
ashwinaj
This is why you need a counter balance to monopolistic tendencies of the free
market. Be it in the form of regulations or making companies liable for their
greedy actions.

It has been proven time and time again that systematically removing "common
sense" [0] regulations only harms society in the long run.

[0] Please don't start a mundane discussion about what "common sense" means.

------
brbsix
The really sad thing about this is that nature has a remedy for the grip of
opiate addiction, iboga, yet it is illegal as well.

------
mc32
So painkillers used against prescription kill more people than any individual
illegal drug and since people demand painkillers to treat chronic pain
physicians are looking to treat chronic pain with alternatives one such is
using MJ as one of those alternatives because misuse doesn't result in fatal
overdoses, generally.

Vox, stop with the hyperbola.

~~~
k-mcgrady
>> "people demand painkillers"

I might be completely wrong here so please correct me if I am. Why would a
doctor care what a patient demands? Tell them no. There's nothing they can do
about it. I can't demand any prescription drugs from my doctor (I'm in the UK)
- and I've tried once. Do doctors in the US worry about losing money if they
lose a patient or this that not the case?

Edit: Thanks to those who responded. Although I suspected it it still blows my
mind that people don't see how and of an idea that is.

~~~
facetube
When you inexplicably decide that health care is a "marketplace" of rational
and informed actors, patients become customers that need to be pleased, and
lost patients become lost revenue. We are in a world of hurt over here, please
send help.

------
tosseraccount
Rhetorical question: how many of these deaths also involve alcohol?

~~~
Havoc
>Rhetorical question: how many of these deaths also involve alcohol?

For opiods...few. For paracetamol...lots.

------
josefresco
Relevant: [http://www.pbs.org/wgbh/frontline/film/chasing-
heroin/](http://www.pbs.org/wgbh/frontline/film/chasing-heroin/)

------
nathanvanfleet
Just so you know, opioid pain killers are actually not useful for chronic pain
at all. Over the long term it actually makes patients sense of pain GO UP.
It's excellent for non-chronic pain however.

~~~
stordoff
Not the best choice, certainly, but I would question not useful. I suffer from
chronic pain (mostly headaches), and opioids (tramadol/codeine) are the only
drugs[1] that have given any relief. I've been using them for about two years;
they are still useful, and when I stop using them the pain is about the same
it was before.

Fortunately I don't appear to find them addictive - I stopped taking the
tramadol after about a year's usage (my consultant raised similar concerns to
you - restarted them about three months later as it had been shown they
weren't worsening the headaches) cold turkey (I was told it would be worse
than stopping heroin), and suffering absolutely no ill effects or withdrawal.

[1] Multiple others have been tried (ibuprofen/diclofenac/amitriptyline/sodium
valproate/naproxen/gabapentin and a few others I can't remember), and made no
difference to the headaches. The amitriptyline is helping with pain in my
hands though.

~~~
vidarh
Just a suggestion because it is often missed by general practitioners: If
you've not tried it already, talk to your dentist. Headaches and migraines are
often related to teeth or the jaws. Particularly grinding and clenching. Often
it can be reduced significantly or go away entirely with a simple night time
biteguard.

~~~
stordoff
My dentist did note that I seem to be grinding my teeth a little (probably at
night), but didn't think the headaches were related. I'll mention it again
next time I see him to see if there is anything worse trying, even as a long
shot. Thanks for the advise.

~~~
vidarh
If he's looked at it already he's probably right but doesn't hurt to double
check. I mentioned it mainly because I've mentioned my headaches to many
doctors over the years and none even raised the possibility or suggested I
talked to my dentist about my headaches, so I wasted a lot of time until a
dentist happened to bring it up.

If your dentist is unsure if it's worth it and you don't want to spend the
money on a custom mould on a long shot I suggest asking for a recommendation
for a cheap and crappy generic biteguard to try for a few days. It won't be
comfortable and may very well affect your sleep, but it'll be enough to verify
it there's any point without the cost.

Another long shot that you've probably discounted already: Make sure you're
not compressing your neck at night e.g. by pushing your head up against the
top of your bed. I was doing that too, and fixing that helped a lot as well.

------
cpfohl
Knowing what I know about opioid painkillers, I don't think I'd ever accept a
script for them. I'd accept them in the hospital, but never in a bottle that
goes home with me...

~~~
Igglyboo
No one ever got hooked with the bottle of Tylenol 3 they send you home with
after you get your wisdom teeth out.

But when it's oxy or hydromorphone I'd agree, also I don't even want to think
about having morphine or fentanyl patches in my possession.

~~~
evincarofautumn
Still, when I had my wisdom teeth out at 17, I threw away the painkillers. I
knew that they would be problematic for me, so I decided to not even go there.

------
c3534l
This isn't really surprising. Opiates have long been used as both recreational
drugs and effective analgesics. All the major opiates people abuse besides
opium itself were created at one point or another as a painkiller. It's
unfortunate, but they're also really good at their jobs. I think that if you
need prescription painkillers you should have them. Taken without wanton
disregard they're actually fairly safe, although physical addiction is always
possible.

------
cplease
100 million Americans struggled from chronic pain in the 1990s? (linked video)
One in three men, women, and children, suffered from pathological, chronic
pain? How can they quote a ludicrous statistic like that straight without
comment?

Or is that straight statement supposed to distort some watered down,
meaningless figure factoid like 100 million people have lingering pain due to
some cause at some point in their entire?

------
lazyant
Are there any alternative treatments of pain that don't involve drugs? for ex
[http://www.570news.com/2016/03/06/waterloo-man-praises-
local...](http://www.570news.com/2016/03/06/waterloo-man-praises-local-
company-for-their-pain-management-device/)

~~~
corysama
VR simulations of cold environments are seeing success for burn victims.

[http://www.firsthand.com/portfolio/pain.html](http://www.firsthand.com/portfolio/pain.html)

[https://www.hitl.washington.edu/projects/vrpain/](https://www.hitl.washington.edu/projects/vrpain/)

I've heard of Mindfulness Meditation being used to change the experience of
pain from an act of suffering to an act of simple awareness. I don't know how
widespread that technique is deployed though...

------
yarou
For some reason, I never saw the appeal of opiates.

Granted, I use them somewhat occasionally (as needed) for pain, but they don't
really cause in me the compulsive, addictive behavior I've read about. My
internet addiction (HN included) is far worse than any chemical substance I've
ever used.

------
njharman
Joining cigs and alcohol, eh?

------
swillis16
All it takes is one or two extra pills to get high from the standard opioid
pain prescription. It would've been nice to see this mentioned in the article
but it seems pretty light on content.

~~~
mapt
All it takes is the standard opioid pain prescription. That's getting high.
Opioids get you high. That's what's necessary for pain relief: Altered
neurological states in which pain coming in from the nervous system doesn't
have such a strong effect on the conscious mind. It's that simple. Deal with
it.

Drugs have effects. Usage doesn't cross some threshold dose and instantly
become abuse.

~~~
encoderer
Oh, I disagree. There is most certainly a difference between therapeutic use
for pain reduction, and the euphoric response normally associated with an
opiate high. Most people using opiates on-label are not getting high from
them. Even if they do the first couple times they take them, that passes.

~~~
daodedickinson
I definitely got stratospheric on my prescribed dose of one single Ambien pill
(couldn't recognize myself in a mirror, saw kaleidoscopic visions, 2d videos
became 3d portals into other dimensions). Absolutely some people could get
high on one opiate pill. I understand your skepticism, but I'd like to assure
you there is tremendous metabolic diversity.

~~~
encoderer
I didn't say anything about one pill not being enough to get you high. Also,
that's not even the question I addressed. The GP said "That's what's necessary
for pain relief." \-- which is an overstatement.

------
julie1
Prescribing opium ... a trend that have not been seen in the world since
victorian era in the UK.

Opium having the reputation to make people amorph losing their will to rebel.

The new trend is opioid are now cheap and not prescribed to the rich but the
poor.

Religion used to the opium of the people they said, and now that opium is
cheap, religion is not needed anymore to make people servile.

I love this new era of progress.

Tomorrow we make an application to help parents poor sell their kids body part
on the internet for the cure of richer people?

I mean, let's try to make even more dystopic. We can do better. That is what
progress is. Making system more efficient.

------
trophycase
But illegal drugs destroy many more lives.

------
fapjacks
Kratom can solve this problem, but the FDA won't have it.

------
bobby_9x
It makes sense just based on statistics. Americans have more access to pain
killers than any illegal drug and just based on this, will result in more mis-
use (and death).

If illegal drugs were all made legal tomorrow, we would see something similar.

