
With a 10-day supply of opioids, 1 in 5 become long-term users - kolbe
https://arstechnica.com/science/2017/03/with-a-10-day-supply-of-opioids-1-in-5-become-long-term-users/
======
oaf357
The problem with the backlash against opiod use in the US is that people who
actually have to have the drugs are finding it increasingly harder to get.

As a disabled veteran with nerve damage I am rationing pain medication daily.
I cannot afford to have a manageable pain day due to the fact I might have a
week of excruciating pain.

As you may or may not know, little can be done for functional nerve damage.
Some experimental procedures are available but in general, only the symptoms
can be treated. For me this means a lot of different muscle relaxers and an
opiod for when things are beyond control.

But, the opioids have become increasingly more difficult to get prescribed
because of recent DEA rule changes and legislation affecting these
medications.

This basically means, for me at least, I will take my own life at some point
as the pain will be too unbearable and I won't be able to acquire the
medications necessary to control it.

~~~
brianwawok
So there are two big camps of people going to the doctor for pain med (gross
simplification, obvious it is more of a spectrum). People like you, that need
the pain meds to live. And people that have a "bad back" aka they grab their
back and groan and act like it hurts to get a powerful drug and be high (or
sell for a nice profit).

If I understand pain theory correctly, there isn't really a good way for a
doctor to do a test and say "you are really in insane pain" vs "2 advils will
cure you".

Then the choice is either:

a) Be generous with pain meds. Some abusers that don't need it will get them
to either use or resell. Some will lead to deaths, due to addiction or
increased supply on the black market. But all people in real pain are treated.

b) Be stingy with pain meds. Some legit people in pain could end up taking
their own life due to not being able to live with the pain. But there will be
less deaths and addiction outside of people in pain.

As a society, it seems a hard choice. Either way some very vulnerable people
are going to be hurt. Ideally we would come up with better pain meds with no
abuse potential, but that doesn't help things right now.

~~~
SomeStupidPoint
The problem you elide is that _switching_ from A to B, as the US has done, can
take a lot of time.

In the transition, you drive the usage of illegal drugs through the roof and
spike the number of deaths. It's possible that these behaviors, once
prevalent, take generations to switch out of, by which time, it's entirely
possible that our formulation of drugs will be better.

So even if B would be better now, it's possible that our transition from A to
B is pointless (the problem would have solved itself in the same time) and
leads to a worse outcome than just remaining with plan A.

This kind of secondary analysis is usually totally missing from these debates,
but is what is actually driving the harm of the opioid crisis.

~~~
brianwawok
For sure, this is true about almost any kind of debate like this.

One view is to say that you may need to have short term struggles to get to a
long term better place. Which may be true, but it also depends if the new long
term place is actually a better place - or did you do a lot of short term
struggles for nothing?

------
fragsworth
If you're given a 10 day supply of opioids, you probably have a much worse
problem than someone who is given a 3 day supply of opioids. The 1 in 5 that
are still taking opioids a year later probably had a long-term problem that
caused significant, chronic pain.

Looking at the study, they didn't adjust for this at all. Also, keep in mind:
1 in 5 are continued on _prescriptions_ , which are given by doctors who
assessed the situation and thought it was OK to continue it. It's NOT saying
that 20% of people who try opiates for 10 days become hopelessly addicted,
which the clickbaity headline implies.

~~~
smsm42
Wanted to leave the same comment and found a few here saying the same. It is
surprising how such an obvious objection has not been addressed - unless they
expected most of the readers to miss it, which is then very sad.

The deaths figure - 91 per day or about 33K per year - seems to be the deaths
of all opioids (including heroin abuse, etc.) and not the prescription
opioids, which are half that:

[https://www.drugabuse.gov/related-topics/trends-
statistics/o...](https://www.drugabuse.gov/related-topics/trends-
statistics/overdose-death-rates)

Moreover, prescription deaths are relatively stable for last 6 years (though
lower before that) while heroin deaths are raising quickly.

~~~
sergior
The study obviously has an agenda.

------
stevecalifornia
"The United States makes up only 4.6 percent of the world's population, but
consumes 80 percent of its opioids -- and 99 percent of the world's
hydrocodone, the opiate that is in Vicodin." [1]

I spend a lot of time listening to podcasts where addiction medicine doctors
talk about the state of their industry. Their views and their guests views,
are almost in complete alignment and those views are the exact opposite of the
comments in this thread. I find that alarming.

If you listen to addiction medicine doctors, they will tell you:

1) There is a massive epidemic of opioid addiction. Opioids are wildly
addictive and are negligently / over prescribed.

2) There is little evidence that opioids provide benefit for long term chronic
pain and evidence that long-term use of opioids actually causes many problems.
Getting off the opioids tends to reduce the chronic pain.

3) Patient surveys rule supreme and patients want pain-killers even if the
doctor does not believe they are the solution.

Anecdotally, if you watch the A&E show "Intervention", the number of opioid
and heroin cases has shot through the roof since the series started two
decades ago. There has been a titanic shift in addiction. It's painful to
watch some of these addicts lie to their doctor to get opioids, turn around
and sell them, then use the money to get heroin because the opioids aren't
strong enough anymore.

This comment thread really saddens me.

[1] [http://abcnews.go.com/US/prescription-painkillers-record-
num...](http://abcnews.go.com/US/prescription-painkillers-record-number-
americans-pain-medication/story?id=13421828)

~~~
slavik81
For me, the problem is fear. A decade or so back, I badly broke my arm in a
mountain biking crash. The event itself barely hurt at all, but the muscles
around the broken arm all tensed up, and after several hours were extremely
painful. The hospital gave me morphine.

As far as I could tell, the morphine did nothing. I remained in significant
pain for a few hours while I awaited treatment.

It's impossible for me to say why. Is morphine just ineffective for that sort
of pain? Or was I underdosed to prevent negative interactions with the drugs
they gave me later? Or was I underdosed as a precautionary measure for opiates
due to addiction?

All I know is that I'm afraid of ending up in pain in the future and being
denied effective treatment out of misguided concern that I will become an
addict.

I do not fear addiction. I fear pain.

~~~
stinos
_The hospital gave me morphine._

This seems to illustrate the US mentality towards opioids: I had a similar
accident and the fracture itself didn't really hurt but the muscle tension was
indeed very painful and all I got in a Belgian hospital was some Brufen (Advil
in the US if I'm not mistaken) - and that did work. In Belgium opioids are
generally looked at 'only if it's _really_ necessary'. Belgium does have a
severe problem with prescription antibiotics though.

------
troydavis
Here's the actual study, rather than a summary of it:
[https://www.cdc.gov/mmwr/volumes/66/wr/mm6610a1.htm](https://www.cdc.gov/mmwr/volumes/66/wr/mm6610a1.htm)

Here's what it says about adjusting for pain intensity:

> Third, information on pain intensity or duration were not available, and the
> etiology of pain, which might influence the duration of opioid use, was not
> considered in the analysis.

------
theparanoid
A strong confounder is those getting a 10 day prescription are a sicker group.

~~~
ScottBurson
Maybe sometimes. Seven or eight years ago, I had a badly ingrown toenail; my
doctor removed the left half of it under local anesthesia, and then wrote me a
prescription for 30 Vicodin tablets. (I think 3 or 4 would have been plenty;
the pain was gone in 2 or 3 days.) Maybe things have changed enough that he
wouldn't do that now.

~~~
CydeWeys
I've had similar experiences with overly speculative opioid prescriptions, and
I have to wonder, do the doctors think they're doing you a favor by being
generous??

------
rgejman
We _will_ solve the opioid crisis in this country and the solution will almost
certainly come through new scientific advances.

For instance, a recent study in Nature Medicine[1] showed that you could
decouple the positive analgesic (pain relief) effects of opioids from the
negative effects of increased tolerance to opioids and increased sensitivity
to pain. This is critical because tolerance to the effect of opioids and
increased sensitivity of pain to opioids is part of what drives increased use
and eventually abuse of opioids.

The practical upshot of this study (if validated) is that you could
potentially take a smaller amount of opioids and not have to increase your
dose over time to get the same level of benefit. This could severely limit the
mortality associated with opioids.

I am hopeful that we will get through the opioid crisis in this country if we
invest money in fixing the underlying physiological problems associated with
these drugs.

[1][http://www.nature.com/nm/journal/v23/n2/full/nm.4262.html](http://www.nature.com/nm/journal/v23/n2/full/nm.4262.html)

------
CydeWeys
I've been prescribed opioids twice in my life, once for wisdom teeth
extraction and again for a broken ankle. In the first case I filled the
prescription but ended up flushing the pills down the toilet without taking a
single one, as the pain did not override my fear of developing dependency. I
never even filled the prescription for the broken ankle, and also didn't need
it.

These should be treated as treatments of last, not first resort. In both
cases, marijuana would have been a more appropriate for pain relief anyway
(though I did not use any).

------
lutusp
About the linked study, it's important to emphasize that it's _retrospective_
\-- it tracks the behavior of people who applied for and received opioid
prescriptions. This means the stated results may not apply to a person not
inclined to use opioids.

A hypothetical _prospective_ study, obviously impractical on multiple grounds
-- one that chooses study subjects from the population at random -- might
produce a completely different result.

Or the outcome might be the same -- for ethical reasons that deserve to exist,
we may never know.

------
tmp-20150107
Sounds about right. As a heroin addict, I have seen people who are completely
clean relapse after maybe three days of taking it daily again, and I have even
noticed signs of withdrawal in people who have only taken the drug a couple of
times, but on consecutive days. In general, it is the _repeated_ consumption
without giving your body time to return to its baseline state (which can take
up to three days, depending on the drug and its half-life) that causes the
physical addiction - all the scare stories about 'one hit and you're addicted'
are just that; stories.

For anyone needing opiates as pain medication, I would suggest taking them
only in response to acute pain, not as a regular dose, although this may not
be possible for chronic sufferers. It's a difficult situation, the best
painkillers are horribly addictive and socially stigmatized.

------
tashapenguin
I broke my wrist on march 1st, and I've had opioids absolutely dished out for
me. Seemingly more easily prescribed in the US than South Africa. I was upped
on my second refill to 15mg oxycodone three hourly. Seriously hoping getting
off them isn't going to be a struggle :(

~~~
_acme
If you're taking 45mg of oxycodone an hour, you are definitely going to have
discontinuation symptoms when you stop.

------
intrasight
I see a bright future for cannabinoids - assuming that politicians figure out
that it's an obvious escape hatch for this opioid epidemic.

~~~
cmrdporcupine
I don't get it. Cannabis has always worsened my pain, not relieved it. I have
chronic often severe back pain and cannabis has always emphasized it. I spent
4 hours thinking constantly about the pain until the drug wears off. I may be
a minority, but it hardly inspires confidence in cannabis as a silver bullet.

Opiates however... they really work. They really make the pain go away. Which
is why I stay the hell away from them. :-(

~~~
cowpewter
I also have chronic pain (fibromyalgia) and have had a similar experience with
cannabis. It makes me feel spacey and like I'm dreaming rather than awake. It
didn't really reduce my pain at all, only my ability to concentrate on things
that aren't pain as a distraction from the pain. Overall it left me in a worse
place than before I had taken it.

I've never taken opiates for pain, only occasionally for cough (tussin +
codeine during a bout of pnuemonia and again when I had bronchitis, and low
dose vicodin once for about a week one winter when my asthma was extremely bad
and I couldn't sleep because of the coughing).

------
taude
I had a total hip replacement very recently. Having been given a 2 week supply
of Oxy, I took very minimal doses and was off of it after six days.

I had no idea how addicting this is for people. Personally, I didn't like how
it made me feel, so I can only wonder about different people getting different
types of "buzz" from it? I think I was irritable for a day after I stopped.

------
staticelf
I got opiods after a surgery, still have 1 left that I am saving for a rainy
day :)

I wasn't even close to become addicted. But it is a nice painkiller.

~~~
RubenSandwich
You could also take part in National Prescription Drug Take-Back Day:
[https://www.deadiversion.usdoj.gov/drug_disposal/takeback/](https://www.deadiversion.usdoj.gov/drug_disposal/takeback/).
Just a thought. :)

------
mrcactu5
every few years I get an operation, this year it was 4 wisdom teeth
extractions. they gave me 21 oxycodones, I took 18, threw 3 down the trash.
(this was on top of maximum strength ibuprophen)

for acute pain, discipline.

------
logicallee
Doing something illegal (like pot) doesn't automatically make you a criminal.
I'm serious.

For example, any time two people have sex if they drank first (are drunk) then
no matter how much they consent and really, really want to have sex it's
"technically rape" (I am serious). That doesn't make them criminals. And rape
is serious.

You have to look at the ACTUAL enforcement practices where you're located.
What do people (police) ACTUALLY do?

Also, remember: the reason it is not completely legal might have nothing to do
with your consumption of it. For example, would like advertisements for it?
Totally legit companies doing things that are "legal" today like shilling on
Reddit, trying to get people to use their (legal) drugs?

So I would encourage you not to have such a black and white view of what is
"criminal." It's a scale. Just as you're not raping a girl if you two have
great drunk sex some night and both wanted it, you're not a criminal if you
light up a joint.

~~~
sergior
I wish it was that simple. My girlfriend said if it is not prescribed by a
doctor I shouldn't be taking it and started calling me an addict. I personally
don't recognize these laws, but I know unlucky people that were caught and did
time for it. Yes, for having a joint and they have criminal record now.

~~~
logicallee
Well, I can only try to convince you, not your girlfriend.

I can see it bothering her. For her information if you want to share this
thread, in my research marijuana is less addictive than soda: if you drink 3
liters of soda every day then suddenly stop and don't get caffeine from
somewhere else like coffee, then due to the caffeine withdrawal you would have
a headache for a day. (That's it.) it would be uncomfortable.

Have her read the comments disagreeing with this article:

[https://teens.drugabuse.gov/blog/post/marijuana-
withdrawal-r...](https://teens.drugabuse.gov/blog/post/marijuana-withdrawal-
real)

You will not be "addicted.". (Waaay less than caffeine or tobacco.)

You can read people's own reports there, including peoplr in a similar
situation as you who lead happy lives.

That said, the smoke itself could be uncomfortable, and you don't want to get
high, so I am not saying this is a solution or anything.

Also the enforcement practices in your area are a different matter, and if
people you actually know served jail time, then perhaps the enforcement is not
lax enough.

In that case I can see what you mean.

(Btw pot now figures in TV shows, like Silicon Valley, too. It's "normal".)

~~~
sergior
Thank you for that, but this will not work. She will not believe in comments
of some random people on the internet.

My choice is to leave her and self medicate, but that will be viewed as
"marijuana changed him" and I am pretty sure she will call police on me (she
did this once).

~~~
logicallee
It's very easy to see her point of view and I can see why you give it some
respect. It's particularly easy for me to empathize with as I have been quite
militant with girlfriends that they quit smoking [edit: cigarettes] if they
want to be with me - while I wouldn't call the police on someone just to
change their behavior I disagreed with, if she feels that this is in your
interests (she views it similarly to starting to do heroin, etc) then it is
very easy to see her view. it's not "crazy" or something, and she probably
wants you to be the person she's always loved.

Actually I've since learned that such changes can't be external in nature but
have to come from within.

The Internet generally gives horrible, horrible advice. I think your best bet
is to make her feel like the idea is hers. But how to do that?

I don't know.

If you want to share her email (you can send her email address to the email
address I list in my profile) I can send a letter like this:

\---

Hello,

I'm a fellow IT worker like your boyfriend. I don't have any pain problems or
use any drugs of any kind. However, there was a recent discussion on opioids
(which include many prescription medications) and your boyfriend mentioned the
prescription drugs that he deals with for his pain. Because these are tightly
controlled (for various reasons particularly due to being addictive), several
of us wondered if he has used cannabis to deal with his pain. It is well-known
that many people use it very well. It's not addictive (almost at all - you can
do any quantity and quit overnight and a couple of days later be fine. Lots of
people do this. It's not even like cigarettes or caffeine.) which is one of
the reasons that even in states that legalized it, for a long time medical
usage was allowed. I am sure you want a boyfriend who is not in pain, so I was
curious if you wanted to talk about any of the reasons that you hold such a
strong position against it? It is becoming legal in many places, has lax
enforcement, and it sounds like it would improve his quality of life? By the
way, I personally don't really like the legalization movement: I don't want
companies to start advertising it, make profit on it, or even treating it like
drug companies do (medical marijuana) which generally take money from everyone
they can - Americans pay an obscene amount on health care. If this solution
works for others and isn't addictive, what are the reasons you are against his
trying it? I'd like to emphasize that I'm not a drug user at all and just an
IT worker. I don't consider cannabis criminal the way other drugs are,
regardless of the jurisdiction. Just so you know, your boyfriend is thinking
that if his pain gets bad enough and he does not want to risk becoming
addicted to prescription pain medication (which is highly addictive: see, Rush
Limbaugh, who genuinely become addicted to prescription pain medicine and
ended up arrested due to abuse of them:
[https://www.google.hu/search?q=rush+limbaugh+pain+medicine](https://www.google.hu/search?q=rush+limbaugh+pain+medicine)
) then it might come down to having to choose between you and a pain-free
life. I don't think he should be forced to take addictive medication if
everyday non-medication (like cannabis) works for people so well that many
states allowed it for a long time before legalizing recreational use. I also
think you can be reasonable about it, so I would just like to understand your
reasoning about it better. I offered to ask you about it after he said that
you certainly wouldn't change your mind. (And would probably report him to the
police if he ever tried it, for whatever reason. That certainly seems extreme
to me.) I appreciate any thoughts you might have on the subject. I'm sure you
have good reasons for how you feel about the matter and I'd like to understand
them. Thanks!

