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Interesting, but I just listened to Econtalk podcast[1] where the guest, author of the book Dreamland about opioid epidemic[2], claims that all this epidemy only started at first place because researchers at the time claimed that opioid based pain relief medicine was disassociated from addiction (and pharma companies gladly played along).

Except it wasnt.

Very worthy your time listening to this guy if you are interested in the topic.

[1] http://www.econtalk.org/archives/2017/01/sam_quinones_on.htm...

[2] https://www.amazon.com/Dreamland-True-Americas-Opiate-Epidem...




You have to remember like everything, beliefs around addiction to pain medication ebbs and flows over time.

I can remember back in the late 1990s, there was a huge push from the medical community to be more open about prescribing pain medication. A lot of pain wasn't being adequately treated.

As a result, doctors loosened their reigns over prescribing and things moved drastically in the opposite direction. People were getting strong narcotics for pain that they never would have gotten it for in the past.

As a result, we have a huge upswing in addiction.

My concern is that we're now going to swing back the other way and people will get hurt. There are people out there where narcotics are the only thing that works for their pain. Sometimes they need a lot of them as well, we're talking hundreds of milligrams of morphine per day. They will have physical withdrawal symptoms if they were to stop, but they aren't addicted in the way we think. They don't exhibit "drug seeking" behavior.

I'm worried folks like this will get cutoff and have to live a life in terrible pain. All because other patients get addicted.


My girlfriend is in exactly this situation. She has terminal pain from a Whipple and every step of the way the onus is on her to provide evidence that she isn't a drug-seeker. And there are not clear success criterion. Pharmacists can (and have) arbitrarily decide not to fill her prescription, leaving her without pain meds suddenly and unexpectedly (ie baseline pain returns + withdrawal symptoms).

Illinois won't allow sending pain scripts any more, so we have to go to the hospital to pick it up every month. They won't allow you to fill it more than a single day before you need it, and many pharmacies won't have the total number of pills prescribed in stock. If you accept a partial fill - you forego the remainder. Getting the doctors AND insurance (either of which will likely block it) to understand you had to do a partial fill and thus issue your refill before 30 days is a Sisyphean task.

All this means if the pharmacy at the hospital doesn't have enough Morphine on hand to fill her one month description the day we pick it up - we have 24 hours to play Pharmacy Whack-a-mole trying to find one that both does have enough pills and won't just arbitrarily decide to say no. Even better - while sometimes you can call ahead and ask, often they are afraid you are probing for large supplies with intent to rob them, so they won't always tell you if they have it in stock.

It's a huge pain in the ass with multiple able-bodied family members in her corner. I can't even fucking imagine how torturous this whole process is for someone in her situation without that kind of help.


+1. I found this interview highly informative about the background, scale, root causes, and complexities of opium addictions. This episode talks about -

  * What role the doctors, drug companies, and even government policies play in causing the epidemic
  * How the largest suppliers of heroin came to be, and how they compete based on customer service
  * How drug addictions can be caused by supply as much as demand.
  * In the USA, heroin overdosing now takes more lives than all homocides
EconTalk almost always has engaging discussions, and this interview is no exception.


In the USA, heroin overdosing now takes more lives than all homocides

I'd been hearing about the heroin epidemic for years. I saw articles about needles in Golden Gate park, I saw discarded needles and black-lit[1] restrooms in Vancouver, but it didn't really have weight until I read that 30,092 people died of opioid overdoses in 2015. In the US alone. Over 30,000!

Anyway, I'm just writing this on the off chance that there are others who are still blissfully unaware.

[1] black light makes it difficult to locate a vein for shooting up.


The last section of the article (title "A Dose of Caution") covers exactly this. Shouldn't get too excited just yet.


> researchers at the time claimed that opioid based pain relief medicine was disassociated from addiction

They're mostly right if they're talking about acute pain - post operative pain, for example.


>(and pharma companies gladly paid along).




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