
Most Doctors Are Ill-Equipped to Deal with the Opioid Epidemic - okket
https://www.nytimes.com/2018/09/10/health/addiction-medical-schools-treatment.html
======
bbunix
Moving from Canada to the US was a shock - in Canada, prescribing opioids was
rare - but you could get codeine painkillers over the counter, but that was
when things got really bad.... here, simple dental procedures were met with
Percocets and Oxycontin...

The basic difference seems to be in Canada, you're a patient while in the US,
you're a customer... and the docs don't want their customers to be in pain.
That appears to be changing.

~~~
Terretta
> _The basic difference seems to be in Canada_

Maybe some other difference?

How is it you and the rest of Canada (not to mention Europe) aren't opioid
junkies in a national "epidemic" when you can buy 100 codeine tablets for $10
in any grocery? Meanwhile, in Russia, with bans, it's an epidemic, while in
Ukraine, even Russian-speaking Ukraine, this is readily available with no
epidemic.

Something about personal responsibility instead of "someone made me do it"
litigiousness? Or more related to healthcare as a basic right? US versus
Canada suggests these, but Russia vs. Ukraine suggests may be something else.
Nanny state vs. "sheeple"?

No answers, just find it interesting relaxed restriction seems to moderate so-
called epidemics without catastrophic societal breakdown.

~~~
Broken_Hippo
I wouldn't blame personal responsibility, but rather better laws allowing for
folks to heal added with a bit of the "healthcare is a right" sort of thing.

When I had gall bladder surgery living in the US (my home country), I was told
to take 7-10 days off work then have lifting restrictions for a bit. My boss
would only allow for the lesser time because it was "my weekend" to work, and
I had to work that sunday for a bit.

I most definitely wasn't ready to go back. I didnt' need the opiods the couple
days before as it was merely uncomfortable, but being active made things hurt.
I didn't lift, but was merely active. I needed pills that night.

On the other hand, I live in Norway now. If I am feeling sick, I can stay home
from work for 3 days without going to the doctor and without losing my job.
I'm pretty sure I could have stayed home the time necessary after surgery.
Mothers have paid time off after having a child (amount depends on how long
one takes, but it can be 100%).

Policies like these mean that people can actually heal. Other policies also
mean folks aren't as stressed (especially when they are poor).

That's my reasoning for the rates being lower in some places than others,
anyway.

------
foepys
This opinion piece in the New Yorker about an American woman in Germany should
give some a new perspective on the topic:

[https://www.nytimes.com/2018/01/27/opinion/sunday/surgery-
ge...](https://www.nytimes.com/2018/01/27/opinion/sunday/surgery-germany-
vicodin.html)

------
gist
Typical bashing of physicians in line with most NYT articles or stories
general themes such as:

a) They get paid to much

b) They don't do their jobs as well as they should

c) Health care is to damn expensive

d) They should magically know what they have not been taught to do.

e) They are stupid, we, writers are smart. The public thinks it is smart so
let's reinforce this point of view to sell our stories.

f) We expect 100% from them and when they make a mistake we will write an
article to point out the outliers.

g) We will cut the time they get to spend with patients and give them loads of
paperwork and still expect them to perform to out liking.

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mgamache
How should I feel about doctors not able to treat a side-effect (addiction) of
drugs that they are prescribing in record numbers?

------
coleifer
Treating addiction as a disease in it's own right seems like a good place to
start. If the drug seeking, dishonesty, etc, are symptoms of an underlying
disease, wouldn't it be best to treat the cause rather than fiddling with the
symptoms? What would such a treatment plan look like, I wonder?

~~~
simonsarris
If addiction = a disease then doctors not prescribing opiods at every turn =
doctors learning to wash their hands.

------
tcj_phx
A very important factor for helping people with addiction is considering its
context. Gabor Maté says in _In The Realm of Hungry Ghosts_ [0] that nearly
100% of his most-hopeless addict-patients had experienced some sort of adverse
childhood experience.

When I met the friend who completed my education about addiction, I thought,
"this woman is high as a kite." She latched on to me like a life preserver. I
didn't know anything about hard drugs, and just observed and listened for the
first two months -- adopted, older adopted sister was angry and picked on her,
etc etc. After three months I decided that she didn't like her drug world very
much, and began to encourage her to sober up. She resisted at first, then she
came around. She likes me more than the drugs.

[0]
[https://books.google.com/books?isbn=1583944206](https://books.google.com/books?isbn=1583944206)

I want to draw attention to the bit in this article about anxiety:

    
    
      The first patient, Brooke Anglin, 28, had 
      had a rough ride. During a turbulent 
      relationship when she was sagged down by 
      depression and severe anxiety, she soothed 
      herself with opioids. After the birth of 
      her second child, she lost both her job as 
      a supermarket cake decorator and custody 
      of her two children. Under Dr. Wlasiuk’s 
      care, she gradually weaned herself off the 
      opioids.
      
      [...]
      
      Ms. Anglin whispered, “I want my kids back.”
      
      Dr. Wlasiuk grasped Ms. Anglin’s hands. 
      “I am amazed by your strength,” she said. 
      “I want to treat your anxiety until things 
      settle down. What are your thoughts?”
      
      They agreed on temporary anti-anxiety 
      medication. Dr. Wlasiuk also taught her 
      breathing exercises.
    

"Anti-anxiety medication" is probably code for benzodiazepines. This class of
drugs is remarkably effective in the short-term, but rapidly worsens the
patient's anxiety. "Ms. Anglin's" anxiety is caused by stress. She needs a
social worker to help her get stabilized and get her kids back, not a benzo.

The best use of the medical profession's stature would be to advocate for
mostly removing addiction from the domain of criminal justice, or at least for
advocating for removal of "incarceration" from the list of reasonable things
to do to an addict. Cages don't help with the emotional problems at the root
of addiction.

A HN comment [1] recently reminded me of "problem solving courts" [2]. Maybe a
good intermediary step would be to require that all "drug" cases be treated as
problems to be solved, rather than excuses to throw people away for long
periods of time.

[1]
[https://news.ycombinator.com/item?id=17965398](https://news.ycombinator.com/item?id=17965398)

[2] [https://en.wikipedia.org/wiki/Problem-
solving_courts_in_the_...](https://en.wikipedia.org/wiki/Problem-
solving_courts_in_the_United_States)

