
The making of an opioid epidemic - benbreen
https://www.theguardian.com/news/2018/nov/08/the-making-of-an-opioid-epidemic
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BaronVonSteuben
As someone who has chronic pain and tried everything under the sun, but only
found relief in opioids, it sucks to see this attack on pain doctors by people
who largely aren't affected by it.

I lost access to my medication because I moved to a new state and no doctors
want to take on a new patient for fear of the DEA. Pain patients are super
risky, and every script they write is scrutinized by the government. My
quality of life has dropped a lot. Thank God I found Kratom (it really works
for moderate pain), but rumor is that will be banned soon too in the US (where
we love our drug wars). Also kratom doesn't help much during flare-ups. I'm
now bed-ridden during those periods whereas before at least I could work.

Please consider the unintended consequences of a well-meaning war on opioids.
They are not evil. In fact for many of us they are the only thing that allows
us to live semi-normal lives.

~~~
dumbfoundded
Have you tried CBD? I run a CBD company and I'd be happy to send you some
products with no strings attached.

~~~
casefields
I’ve been on a Kratom regimen as well and tried CBD a few times but it didn’t
seem to relieve the pain for me. What do you think of this article that came
out the other day: [https://www.vox.com/the-goods/2018/11/1/18024806/cbd-oil-
vap...](https://www.vox.com/the-goods/2018/11/1/18024806/cbd-oil-vape-hemp)

~~~
dumbfoundded
As a consumer of CBD myself, I don't think it's a scam. I also don't believe
it's a miracle drug that solves every problem. What I do think is that it has
a remarkable safety profile. If you experience chronic pain, you should
probably try CBD before opioids. The side-effects of CBD are pretty limited
(be careful though as all interactions are unknown) compared to other
pharmaceuticals used to treat the same symptoms. In other words, I don't think
CBD is remarkable because of its effects. Morphine is a way better pain
killer. I think CBD is special because you can take it for a long time without
the same risks.

If you send me an email at evan@tryplainjane.com . I'd be happy to send you
some samples as well.

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classichasclass
When I first got my medical license about a decade and change ago, pain was
the fifth vital sign and we weren't doing enough to deal with it. I (as a
California requirement) even had to take CME to do a better job on treating
non-malignant pain. Little did we know how the profession was being
manipulated.

But what I think will happen, and some of the comments in this thread
illustrate, is that the pendulum will swing in the other direction. Medicine
doesn't know what to do with chronic pain. We can't define it, we have
imprecise anatomic correlates, and no patient wants to be told that some
fraction of it is in their head even though it's likely a combination of
neurologic and psychologic factors. I remember throwing some obvious seekers
out of my office but I had a lot of credible chronic pain patients when I left
general practice, good people laid low in difficult ways, and I wonder what's
happened to them since.

~~~
frankosaurus
Is there a better (read: objective) measure of physical pain than asking the
patient to rate it from 1-10?

~~~
SilasX
Not a doctor, but I would think that cortisol ("stress hormone") levels would
correlate pretty well with what we think of as pain, since it does stress you
out and would persist over long-term pain. And vice versa for dopamine.

~~~
wavegeek
People have vastly differing levels of cortisol response to pain and cortisol
responds to many different stressors other than pain.

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pnathan
There are lawsuits against the makers of Oxy for misrepresenting and pushing
Oxy as such a miracle cure. It seems to be well understood by now that opioids
are/were highly over prescribed, and there are a ton of addicts now whose
lives have been _ruined_.

I also want to note that drugs often make life feel better, and a lot of
peoples' lives for the past decade+ haven't been great. There _is_ a social
component to addiction that is inadequately talked about.

I would also suggest considering pressing your electeds regarding funding for
long-lived _independent_ drug studies for drugs such as ecstacy/MDMA, LSD,
etc, as well as passing legislation inhibiting regulatory capture. I would
like to see, for instance, marijuana effects thoroughly studied legally in
long-lived large-cohort studies. There _is_ potential here, but no silver
herb, er, bullet.

~~~
mistrial9
a leading example : State of Tennessee vs Purdue Pharma; case 1-173-18; filed
15May2018 in Knox County, TN

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nicetryguy
> Dentists gave them to teenagers after pulling their wisdom teeth. Not just
> one or two days’ worth of pills, but a fortnight or a month’s worth, which,
> if they did not draw the intended recipient in, frequently sat in the
> medicine cabinet waiting to be discovered by someone else in the family.

This happened to me!

I got my wisdom teeth removed circa (2005-06), and they gave me a bottle of 50
generic OxyCodone pills. Fifty!

I took maybe 3 or 4 of them over the next couple days, hated the way they made
me feel "robotic and distant", and just rode it out on Motrin afterwards. They
sat in the cabinet until i ended up selling the rest to a "friend" a few years
later.

I hate to think what could have happened if i Really liked them....

~~~
quasse
This was definitely still happening as late as 2011, I had a friend who spent
two weeks basically nodding off because of the amount of opioids they were
given after a routine wisdom tooth removal.

~~~
bigger_cheese
They are scarily strong.

A few years ago. I woke up vomiting and in extreme pain. Housemate drove me to
24 hour clinic. I was stuck in waiting room for hour or so. Eventually I got
to see doctor. Clinic was not really confidant they knew what was wrong with
me and told my housemate to take me to the hospital. I was stuck for another
hour or two in waiting room at hospital all the while in extreme pain and
vomiting.

I was diagnosed with a kidney stone and I was given a morphine drip. Almost
immediately I was out like a light I don't even remember drifting off -
scarily strong stuff I went from worst pain of my life to sleeping like a
baby.

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emersonrsantos
> Portenoy toured the country, describing opioids as a gift from nature and
> promoting access to narcotics as a moral argument. Being pain-free was a
> human right, he said. In 1993, he told the New York Times of a “growing
> literature showing that these drugs can be used for a long time, with few
> side-effects, and that addiction and abuse are not a problem”.

Just very similar to what is said about benzos, marijuana and are starting to
be said about LSD, GHB and the likes. We need more scientific evidence to know
the toll these narcotics and psychotropics can cause to us in the long term,
like the same scrutiny they treated the tobacco industry.

~~~
alphabettsy
I don’t find this argument compelling. We knew for a long time that opiates
were addictive, they’ve been in common use forever. We’ve come to learn that
much of the information they were pushing shouldn’t have been trusted and that
they seriously misrepresented these newfound non-hazardous opioids.

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bill_from_tampa
Persons with chronic pain should have access to treatments that work for them.
For some, it may be exercise, or physical therapy, or tylenol, or a TENS unit.
For a few, it may be opioids in low or high doses. Treatments need to be able
to be individualized to the specific patient - one size definitely does not
fit all. Your pain may respond to meditation and tylenol, but somebody with a
pancreas that is autodigesting itself or chronic unrepairable partial bowel
obstruction with miserable horrible daily disabling pain may actually do
better with opiates. When politicians and internet experts begin dictating
medical treatment regimens, individual patients will suffer and die, or commit
suicide.

On the other hand, persons who enjoy abusing substances to get high or blasted
or whatever the feeling may be need to have some safe way of feeding their
addiction, or they will die, in large numbers. Being dependent on an illegal
supply chain stretching from Kowloon to Morelia to San Diego to wherever with
no quality control and no oversight is a recipe for disaster -- nobody who
buys stuff on the street knows what they are getting. And to boot, actual
medical treatment for addiction is not easy to obtain and limited. The much
vaunted "clinics" are for rich people who don't need health insurance to pay
the bills.

So we will continue to have problems in the US, and they won't be fixed.

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zeroname
Legalize Heroin for everyone again. If you're going to be a junkie and, let's
face it, many people will prefer that over debilitating chronic pain, it'll be
a safer and healthier alternative than these synthetic opiods.

Heroin used to be freely available over the counter and while it certainly did
cause problems for its consumers, it wasn't even close to what these synthetic
opioids are doing.

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thinelvis
Weed.

------
21
This seems to be part of a bigger trend.

Do you feel a bit of pain? Unacceptable. We got to make it go away. Medicate
it until you don't feel a thing.

Could your kid scrape a knee on the playing ground? Unacceptable, wrap it all
in rubber.

Could you be offended by some text in a classic book? Unacceptable. Trigger
warning, counseling on hand, feel free to skip it or read it together with a
group in a safe space.

Something someone said makes you feel funny? Unacceptable. Report, protest,
de-platform.

~~~
umvi
No one likes to hear "too bad, deal with it" as the response to their
perceived problem, but I'm afraid we as a society are losing the essential
skill of "dealing with" accidents, injustices, or just plain bad luck in favor
or making someone else shoulder the blame.

~~~
Nasrudith
Losing it? I personally doubt we had it in the first place. Just look at the
rich and very not new history of scapegoating.

Blame the victim rather than admit a problem. Leprosy is a result of your sin.
Smallpox however is blameless because it could happen to anyone. Lash out at
the vulnerable rather than the source of the problem.

Survival bias is what leads to the perception of this lost golden era. Where
all of the pioneer's children are healthy without doctors - nevermind the
graves of the seven children and two other wives. We didn't have PTSD before
WW1 just ignore all of the self medicating civil war veterans. This tendency
isn't a moral component so much as a result of exposure and memory. Possibly a
survival bias itself that remembering everything would be really bad for
mental health.

