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With a 10-day supply of opioids, 1 in 5 become long-term users (arstechnica.com)
153 points by kolbe 218 days ago | hide | past | web | 130 comments | favorite



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.


I think what's missed most in all of the talk about opiods lately is that there are people who need them just to function, and not for reasons of addiction.

In January of 2014 I broke my hand. Not just a fracture. I completely shattered my second metacarpal in my right hand (my dominant hand) and did extensive damage to the surrounding tendons, ligaments, and skin. The surgeon who put my hand back together said it looked like a gunshot exit wound without a corresponding entrance wound. The entire top of my hand had been flayed open. After the surgery I was given hydrocodone, enough for a week. The only reason I didn't just kill myself that week was because I had pain killers. When the dose would wear off the pain was unreal, blinding, and totally consuming. The only worse pain I've ever been in was the night I broke my hand.

Needless to say I had the prescription refilled weekly until my second surgery three months later to take out all of the pins. And again for three months after that until my third surgery to release the tendons so I could use my hand again. And for three months after that while I did thrice weekly physical therapy. I cannot emphasize enough how much I needed the pain killers just to get through life for those nine months. Even with them there were some nights I couldn't sleep because the pain in my hand was so severe. Of course, by the end of the nine months I was pretty well physically addicted, but, knowing my time was up I tapered off and haven't needed them since. For another six months I still needed frequent acetaminophen and ibuprofen to take the edge off of the throbbing in my hand.

I'm not saying at all that there isn't a problem big with opiod addiction. But recent conversations I've seen about opiods leave me with the impression that most people just don't get it. They think that either people just need to deal with pain or that some sort of non-medicine alternative is what's needed for most people on opiods. And that may be true for some. But unless you've been in the kind of pain that makes you seriously consider killing yourself I don't really think you can appreciate just how important opiod pain killers are to some people. I'm afraid we're going to lose something that helps a great deal of people all because we have this idea that addiction is somehow a moral failing and we've structured drug policies around that belief.


Hope you don't mind me asking, but given how horrifying the hand injury sounds I thought I might inquire, what happened that broke your hand? The only thing I can think of that might result in an injury like that is maybe a severe cycling crash? Regardless hope you are doing well now!


So, apparently everyone else in the entire world gets the "don't touch garage door springs" talk from a parent or other responsible adult as a child. I didn't (and my brother did!!!).

About six months after moving into my house I was fed up with the janky garage door opener that came with it so I went to Home Depot and bought a new one. I managed to assemble the new one myself with only a few hiccups. It then came time to remove the old garage door opener. I first took down the actual motor unit that was attached to the ceiling and got it set on the ground with the rail still attached. The end of the rail was attached to a metal bracket that formed a right angle with lots of holes for bolts to go through[0] which was then attached to the drywall above the garage door. I got up on a ladder and set to removing the bolts. The last bolt, unbeknownst to me, was attached to a piece of metal through which the garage door spring went [1].

What happened next all tool place within maybe 1/4 a second. As soon as I turned the socket wrench enough to loosen the bolt I heard a loud pop and felt something hit my hand. HARD. I looked down at my hand and saw blood. "No big deal, I cut myself on things all the time. We've got lots of bandages." Then I noticed the subcutaneous tissue (your hand doesn't have much, but there's still enough that deep cuts look different). "Okay this is gonna need stitches, I better get down and take care of this." And then I saw the bone. "ohfuckohfuckohfuck."

I hopped down off the ladder and ran inside and started screaming "CALL 911!!!" to my girlfriend who was upstairs. I made it to the kitchen where I got a dish towel, put my hand on the counter, and clamped down as hard as I could. The paramedics arrived about 5 minutes later (we live very close to a fire station). By then I'd calmed down but was so full of adrenaline I could barely hear or see anything. At one point I blanked out for maybe 30 seconds? I'm not entirely sure. The EMT said it was an adrenaline dump and that it was fairly normal. Of course when I got to the ER every single nurse who heard the story said I was lucky to be alive. If it had hit my head it would have caved in my skull (and I was on a ladder...). Apparently that happens more than you'd think.

They eventually hooked me up with a drip of hydromorphone. "This is the good stuff." one nurse said. Bullshit. I was in so much pain it barely did anything. It brought it from 10/10 to 9.5/10. That's using my new 10 point scale. I thought I'd experienced a 10 before when one time my dentist started drilling before the lidocaine had fully kicked in. I'd put that at about a 6 now. I really cannot describe in words how bad the pain that night and the following months was.

My hand is a lot better now though. The third surgery gave me back my mobility and the physical therapy got me back up to about 60% of the strength I had before. I'll never be able to point straight with my right index finger, but I can make a fist and type. As a programmer both are very important.

[0]: Exactly like this https://mobileimages.lowes.com/product/converted/040395/0403...

[1]: Basically this, except mine is shaped slightly different http://www.truetex.com/gar913.jpg


Oh this is bad. I'm so sorry for you. I installed two of those doors (big ones, 16'x16') a while ago and while doing that I kept telling myself 'keep clear, keep clear'. The trick to this is that there is a hole in one of the retainers that you put a strong steel bar through, this will allow you to release the spring tension turn-by-turn until there is so little tension on them that you can let them go.

Very very scary stuff, large springs. Even small ones are not without danger (think old alarm clock springs, those can take an eye out when they let go).

Best of luck with your recovery, I really hope you get back to 100% functionality. And thank you for sharing the story, it just might help save someone else from doing something like this.

edit: more risky springs are found in the suspension of vehicles, don't mess with them without the right tools and knowing what you are doing.


Garage door springs are a prime candidate for air spring conversions. Yes, they'll require more services, and yes, more expensive, but a lot easier to wrangle. Alternatively, you could package a counterweight that would do the same thing.

I recently helped a neighbor with his broken spring mechanism (old 60s house in San Francisco). The whole thing was made out grossly inadequate metal which had sheared. What started out as a simple welding project turned into substantial reengineering just to get the door to work to get his car out.

Final lesson: steel fatigues and cracks from work hardening and bad tolerance installation. If you have an old door mechanism, don't trust it. Replace it. They're moderately expensive, but the modern ones are not nearly as hanky as the older ones. Don't DIY a garage door unless you have good levels of hands on fabrication experience and a good practical knowledge of what type of fasteners to use to anchor the door hardware to the building substrate. (I.e. Deck screws won't work.)


Thanks for sharing your story. I never got this talk either. Next time I'm dealing with garage door repairs, I think I will call for a tradesman.


Don't touch garage door springs, got it. Never heard that before.

I hope you will improve further.


The other thing to remember about garage springs is that they can and do break spontaneously with extreme force causing parts to fly off in all directions. The springs should be replaced on a regular basis. We've lived in our house for a long time, and twice we've had them break while the door was closed and idle. The first time it occurred we heard a tremendous racket in the garage and upon inspection, we found that the spring had broken lose and whipped around causing most of the noise as it bounced off of walls. The cause of the failure was the hook at the end of the spring breaking. It shot off denting a car. I'd hate to think what could have happened if someone had been in the garage at the time. We learned that you can and should buy cables that run inside the spring so upon failure, the larger part will at least be restrained.


Thanks for sharing your story. I never got the garage door springs talk from my parents either, and only heard about this randomly on the internet last year. Hope other folks will pay heed to their potential destruction.


> I think what's missed most in all of the talk about opiods lately is that there are people who need them just to function, and not for reasons of addiction.

I think what's missed is that there's no evidence that long term high dose opioid use does anything to treat pain.

We have lots of evidence of harm caused by long term use of opioid medication.

The problem with the current US crackdown on opioids is not reduced use of opioids, but with the lack of anything else being offered.

People with long term pain need a package of care, probably provided by specialists in pain management. That package should include exercise (where indicated), psychological help, alternative prescribing, and if needed some opioid prescribing.


Anecdotal, but I've been taking opioids for over a year now, to treat pain caused by suspected nerve damage (I couldn't tolerate gabapentin and a slew of other non-opioid medications), and they still work just fine. I'm also not an addict and feel no compulsion to take them other than for reducing otherwise unbearable pain.


I'm on Gabapentin, what was it that you couldn't tolerate if you don't mind me asking?

The only thing I noticed when I started taking it (other than the fact I could actually function again) was that it makes me tired and the withdrawal if I forget to take it/forget to fill a script is pretty horrible.


For me it was like feeling sick, having blocked nose, trouble breathing, tiredness and later on having anxiety that wouldn't not go away. Oh and trouble with thinking - I was not able to formulate sentences the way I wanted and my mind was often going blank.


It made me feel like I was drunk, so I couldn't work, drive, safely look after the kids, or generally live normally. I had the same thing with pregbalin.


I tried pregabalin and it was even worse for me, I though I will die.


If I understand gabapentin can sometimes cause hypersensitivity reactions.


shame that Gabapentin didn't help you, for me (spine surgery, couple of months before they opened me up, and now in recovery) it was a lifesaver when funnily enough the opiates seemed to make no difference (post surgery expecting pain to be higher for a while they switched me, when the Gabapentin ran out and I had a very uncomfortable night!). Was really glad, given all the scare talk about opiates, how easily I have been able to get off them - if you're seen me with a bag of chocolates, or when I don't get my coffee I'm pretty obviously a candidate for addiction :) I do find the Gabapentin given me the dizzy/drunk feeling, but I'm lucky enough that I can dose late evening and sleep through most of the side-effects and remain functional (with the occasional Tylenol) during the day


This is the direct result of the "crackdown."

It only increases diversion to the black market by directly increasing demand. My own grandparents have had to buy pain pills in the past.

Doctors are terrified to prescribe painkillers to those in need lest they be prosecuted by laymen who think they know better. Pain is being under-treated now more than ever.

My ER has a massive info-poster in the lobby explaining why I won't be receiving dilaudid, fentanyl, or oxycodone.

Opiates are in the news every other day, either prescription abuse or fentanyl-laced heroin stories in local and national paper as well as cable news.

What good has it done? There will always be abusers.

Like DRM only hurting paying customers, stricter regulations and lawsuits against doctors ironically only end up hurting non-abusers.

Dependent folks, like my grandparents, who get a massive quality of life increase thanks to these drugs, especially considering the lifetime of abuse they've put their bodies through, and been through.

That's who ends up getting the shit end of the stick.

Not the junkie. Someone's Grandma. A vet.


> It only increases diversion to the black market by directly increasing demand. My own grandparents have had to buy pain pills in the past.

Yes. I know people with chronic illnesses (of many types) who've had to resort to various black markets for opioids, all this stupid "diversion control" and trying to shit-test patients in the ED to see if they're "drug-seekers" actually has a deep and nasty cost.

Of course someone who presents to the ED with a physical condition that causes immense pain is, inherently, going to be a "drug seeker". So now people need to be all "tsundere" about that (i-it's not like i WANTED you to prescribe me opioids, or anything, BAKA!), and pretend that they don't know what drug/dosage works for them (apparently, it's only opium-seeky people who know anything technical about opioids) even if they're well-versed about what works for them and their medical condition. It's a very nasty and adversarial state of affairs, that screws over everyone.

The DEA (and other flavours of doorkickers) targeting doctors and deputising them as law-enforcement agents who have to decide between the evil undeserving addicts and the deserving patients in pain is what has created this affair. Blame the prohibitionists, as this is a problem of their own making -- the crackdowns on "pill mills" and "overprescribing doctors" is what denies people a safe and legal source of pharmaceutical-grade opioids and forces them onto the black market of illegal, overpriced, and fentanyl-contaminated opioids (which leads, of course, to the deaths that are used to justify even more crackdowns).

Crackdowns on "over-prescribing" invariably lead to people who experience chronic pain being denied medical access (or being subjected to extremely invasive and degrading treatment to weed out "drug seekers"). The DEA cracking skulls over opioids and investigating doctors is literally the only reason illicit fentanyl (and its even more dangerous analogues like carfentanil) even is a thing. I am so very doubtful that more door-kicking and prosecutions will miraculously work after decades of it making shit worse.


While working abroad in the States, I was prescribed benzodiazepines for panic attacks. When I later came home, I went to see a GP and asked whether I could receive a refill for a medication that was running out. I told that I had used it as my last resort to alleviate panic attacks when I was unable to control my feelings otherwise. I had another abroad trip coming, so I said I would feel secure to have that last line of defense with me. The GP asked what that sort of medication might have been, and I presented the drug as "benzo" called $US_BRAND.

The doctor looked at me for a moment and said that as you are using that term, benzo, you are aware of its abusive use. In no circumstances can we prescribe the drug same drug for you, since that would include doctor supervision before, during and after its consumption. After that the GP wrote something with the keyboard and proceeded to ask me how exactly was I able to get these drugs. I told the scenario after which I has been prescribed the drugs. The doctor responded that it sounds maltreatment to prescribe the said drug in such circumstances and that my story sounds odd. He said that he cannot prescribe me any drugs at this time.

I'm now concerned what the doctor wrote to the state wide system and whether that might affect my treatments in the future. Either way, this whole paranormality over "drug seekers" is insane -- the GP did not even suggest seeing a specialist or offer alternative drug. He just declined and became anxious which I read as he wanted me out of his office as soon as possible. He was young, I give you that, but it makes me wonder what kind of horror stories do they tell about my kind of "drug seekers" in the med school.


>I'm now concerned what the doctor wrote to the state wide system and whether that might affect my treatments in the future

You have the legal right to review such entries. You also have the right to have erroneous entries corrected. If you're worried this might cause issues with future treatment, the sooner you act the better.

See: http://www.hus.fi/potilaalle/potilasasiakirjat_tietojen_sala... http://www.hus.fi/potilaalle/potilasasiakirjat_tietojen_sala...


Thank you, I have been unaware of this.


Benzos are only used for short-term treatment of anxiety. You get withdrawal symptoms after taking relatively small dosages for a few days. There are also many adverse effects like being unable to retain any new information. E.g. when I briefly took them, I was unable to memorize a 4-digit pin. I gave up after 15 minutes. I couldn't do it. It was terrifying.

Benzos are pretty terrible. That second doc did you a favor.

The only somewhat useful advice I have to offer is to quit smoking if you do smoke. Smoking increases the base anxiety level quite a bit.


> Benzos are pretty terrible. That second doc did you a favor.

I knew that when I saw the GP, hence the "last resort". My experience with the drug was morbid as well -- the world felt soft for an hour, after which I would pass out. I would wake up in 4-6 hours feeling normal again. Only later did I find out that the aforementioned side effects with the additional and overlapping prescription of codeine, I could have died in my sleep.

But the point being, I am no doctor and I was living in a confusing state of mind. So when I went to see him, I thought that benzos are the way to treat me. But instead of being referred to a mental health department or given beta-blockers as a less intrusive medication, I just received a no as an answer. It left me with mixed feelings. I mean, the doctor was right that the benzos were not the solution, but he should have told me what I need, instead of just declining what I want.

Luckily enough I was able to accept the fact that I could be mentally ill, so I sought appropriate help by myself. Luckily, my case was handled by psychiatric who taught me how to treat the pre-cursor to my anxiety, the panic attacks, instead of the anxiety itself. When I learned that I could handle the panic attacks just like any emotion -- and without drugs -- I was able to shrug the anxiety away.

Condemning a patient who seeks opioids as a treatment when they don't know for better is not much of a favor. I felt like I was treated like a drug abuser and my state wide profile most likely now states me as a possible one. All of this because I could not remember the translation of the drug and instead referred to it as what I have seen thrown out on the Internet from time to time. I would not be surprised if I would have received better treatment would I have had referred to the drug with its marketing name only, but I did not think that would have helped much in a foreign country.

Also thanks for the smoking tip! Although, I do not smoke, but I do moderate the amount of caffeine I consume nowadays. Getting over the panic attacks did require quite a few lifestyle changes in addition to self-reflection.


>I could have died in my sleep.

The risk is real, but it's more geared toward recreational users.

Taking therapeutic doses of codeine (to which you become tolerant) along with whatever benzo that doctor gave you (ativan, xanax, clonazepam, whatever) also at therapeutic dosages doesn't present a huge risk of respiratory failure, IMO.

Harm reduction communities shout DO NOT MIX because if you don't, the teenagers asking these questions on Bluelight and Reddit will say one of each is safe, why not two of each? etc until they're dead. They're abusing the drugs, see. That's the difference.

If you weren't abusing them, you had little to no chance of dying in your sleep. At least not from 30-60mg codeine + 1mg of xanax.

Anyway, this class of drug can steal your soul. I speak from experience. Abuse of them only leads to one path, a path that involve seizures and mood swings.


I had a similar experience before when trying to get painkillers in the UK. There's a deep institutional narcophobia here.

Thankfully I was eventually able to get a prescription for an effective opioid, after an NSAID-induced bleed almost killed me.

The experience made me write up an Advance Decision (Living Will) to make it clear that if I'm ever unable speak for myself, I want my pain or mental distress to be adequately treated. The thought of being in severe pain or anxiety, and being left to suffer, terrifies me.


It's not "narcophobia", it's a desire to actually treat pain effectively without leaving people i) still in pain and ii) addicted to a harmful medication.


It's not a choicest​ between "treating pain effectively without leaving people still in pain and addicted to harmful medication", it's a fuzzy, gray spectrum between giving out no medication, treating pain ineffectively while having no addicts, and prescribing pain medication with abandon and having many addicts.

There are a few options that let you shift the balance one way or the other, but the parent is saying that they're leaning too far towards leaving people in pain from a fear of creating drug addicts.


The US is still far and away the leading prescriber of opioid medication, so to call it "narcophobia" is alarmist nonsense.

Especially since it's not affecting end of life treatment, which is where people really care abut it.


It is directly affecting end-of-life treatment. My grandfather is jumping through more and more hoops to fill his prescriptions each month.

The insurance company has the gall to tell his doctor they know better, and often want the doctor to justify the prescriptions. My grandfather is on deaths door, he stays alive through sheer will. The doctors gave him 2 years to live...6 years ago. Fair to say that's end-of-life, right?

I moved out here to take care of them, so I'm in the thick of this day in, and day out. Insurance companies, Picking up prescriptions in triplicate in writing and hand delivering them, etc. I'm scared to pick up the controlled substances alone because of the way the clerks look at me, so I have to drag one of my poor grandparents to the pharmacy with me, again and again. every month.

Why do you think they're looking at me funny? It's narcophobia. They think I'm an addict pulling a fast one.

Keep that in mind next time you say it isn't affecting end-of-life care.

Someone's grandfather out there was and is affected, directly, by the recent upswing in what can certainly be described as "narcophobia."

A doctor shouldn't have to explain himself to a fucking insurance company, ever.

If I paid my premium, pay my fucking bill. Keep that corporate nose out of my personal medical affairs and pay the bill like I pay you to do.

I'm sorry, but you painted with such a wide brush that I couldn't help but retort.

Unless you meant hospice care. In which case you're probably more wrong. These guys are trained sticklers. The second your love one stops breathing, hospice will be there not to comfort you, or have a kind word. They're there to bag up all the painkillers and fill the bag with kitty litter.

If that's not narcophobia, I don't know what is.

You can't undertreat pain and expect the problem to go away, btw. All that does is encourage blackmarket diversion of legit meds.

The harder you make it to get them, the more money they'll be worth, the more risk people will take to steal them wholesale. Expect more delivery truck robberies, more pharmacy hold-ups and break-ins. There will always be abusers, no laws will change or reduce that.


> When I later came home, I went to see a GP

Was this in England?


No. This was in Finland, through the public sector healthcare.


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.


I'm not sure the outcome for option B is so clear cut.

Removing access to medication doesn't remove the primary cause driving people to seek drugs, be it pain or psychological issues. I suspect people with high abuse potential will just resort to alternatives: street drugs or alcohol.


Perhaps, perhaps not. It depends where you stand on the war on drugs.

It seems fairly common that professional working people get on an opioid for something (say a fall), and then become addicted. These people can live for years on the Opioid, perhaps working a professional job. Now sure, if you ban opioid they could go and buy some black tar heroine and meth... but I am doubtful 100% of people would make that jump.

Alcohol is a different beast. Obviously some people become addicted, let's call it 10%. But 10% addiction rate is a lot lower than a 99% addiction rate that long term opioid use has.

So the net benefit of less opioids is almost certainty going to be less people addicted to drugs.


The response of abusers to the reduction of everyone's access to medication does not depend on where you stand on the war on drugs; it is, or will be, a matter of fact. Maybe more evidence is needed, but pseudo-quantitative arguments with made-up statistics that support your view on the war on drugs are not evidence.


    The response of abusers to the reduction of everyone's 
    access to medication does not depend on where you 
    stand on the war on drugs; it is, or will be, a matter of fact. 
Sure. But your willingness to WANT this outcome will depend on your stance on the war of drugs. A blanket ban of all opioids with a harsh prison sentence (say, crack-cocaine level) would both decrease opioid addiction, and increase prison population. Your stance on the war of drugs will point to if you think this is a good trade off or not.

    Maybe more evidence is needed, but pseudo-quantitative
    arguments with made-up statistics that support your 
    view on the war on drugs are not evidence.
My view on the war of drugs has little to this argument. However as mentioned above, your feelings on it may influence how you feel about the broader opioid epidemic and how you want to react to it.


I would recommend an approach that is more evidence-based.


99% addiction rate? Source please.


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.


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?


Not to mention that that increase in illegal market usage gives more fuel to the fire for people to believe or be led to believe that more of the same restrictions are necessary, a self fulfilling prophecy almost. Of course its not that simple, but seems to be what happens.


Given the persistence of the completely-illegal drugs market, I do not think you can assume that option b) will reduce deaths or addiction.


There is a third choice:

c) Develop that missing test


Sure, I know nothing about this. Can you do some kind of brain scan while you poke someone in the injury, see what kind of pain registers?


That's pretty much what would be involved. "You say 'it hurts'. Let's see what your brain says". Probably in few years time these new "quantum diamond NV centers" will be able to do this in a doctor's office.

https://phys.org/news/2016-12-neural-quantum-sensors.html


Medasense seems to have a solution for that, without actually requiring a brain scan.

The technology was developed for assessing pain/discomfort of unconscious people - who can't participate in the "which face best describes you" assessment game


> 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).

This is an almost offensively simplistic depiction of long term pain.

Those people with the bad backs are not all faking it; it's not all in their heads; they have real pain and it's debilitating. They need something to help them live.

And your A / B choices are wrong too. You give people with long term pain access to pain management clinics which include psychological support; explanation that pain treatment will usually not be able to prevent pain; access to physiotheray and exercise (although these don't do much for some types of long term pain) and access to medication - and this will sometimes be opioid meds.

> As a society

Why is the US getting it so wrong though? Why is the US prescribing such vast quantities of opioids?


> Those people with the bad backs are not all faking it; it's not all in their heads; they have real pain and it's debilitating. They need something to help them live.

I am not sure if we agree or disagree. There ARE legit people with bad backs that need and should get pain meds. There are also millions of people with a prescription to an Opiod that have no actual pain.

For example, see

https://www.theatlantic.com/health/archive/2017/02/kentucky-...

Are you telling me almost 1 in every 2 people in that town have debilitating pain, and NEED Opiods to survive day to day? I cannot believe that is true.

> Why is the US getting it so wrong though? Why is the US prescribing such vast quantities of opioids?

Many reasons.

a) Doctors get paid to do stuff. If you refuse to give medicine, no one will come to you, and you won't get money. So in the doctors financial interest to prescribe.

b) Some people really DO need medicine. Do you risk screwing those that DO need it to spite the rest of the people?

c) Culture. American lifestyle loves pop a pill to fix a problem. If you can equally fix something with physical therapy or a pill, 9/10 people will pop a pill.


I'm telling you that people with severe pain need treatment for that pain, but also that if the pain is long term that treatment is probably not opioid meds.

People with real pain sometimes should not be given opioids.

Your suggestion (that the problem is fixed if we stop giving opioids to people who aren't in pain) misses the fact that most of the opioid problem is because people in real actual pain have been misprescribed opioids.


> offensively simplistic

No, it's exactly right. There are two classes of people seeking pain medication: those who need it, and those who do not need it. Now, we can argue over who exactly needs the medication, but it is not right to suggest the second category does not exist.


Right, there might be two groups ("people who need meds" and "people who don't need meds"), but the overlap of those with "people in real pain" and "people faking it" is poor. It's that simplistic, and incorrect, mapping that I'm objecting to.


Yep. My wife regularly decides to under-medicate rather than risk having to radically under-medicate later. And politicians attack the weak to appear strong, and we the weak sometimes have to cry ourselves to sleep, or die, or whatever is needed to cope.


I know that as a veteran, you are more likely to take your own life simply because you have the courage to do it. Please don't though! Anything but that. This is the only game in town, so play it all the way through.

And thank you for your service.


Have you ever tried meditation? For me, it's completely redefined my relationship with pain. I realized how little of my pain was physical. The vast majority was my mind exaggerating the physical pain that I felt. I now see how monks are able to self immolate without reacting to that pain. I don't have anything approaching their ability, but I have been able to entirely stop taking pain killers and I had a serious injury misdiagnosed because the doctor didn't think I was exhibiting the pain associated with that injury.


I have to ask, have you tried cannabis for your nerve pain?


I second this question. Cannabis is so benign it's literally legal in several states. It's less addictive than alcohol. Everyone smokes it everywhere regardless of legality: you know several recreational pot smokers (for sure), or people who did it in the past. (And then simply stopped.)

I realize you would end up "high" but I, too, am curious whether you've ever tried it. Given your description and the fact that you almost certainly wouldn't get in trouble.

I realize you work in IT and maybe don't want to get high, so I don't mean to imply that this is a good alternative - just curious, like the other poster. Thank you.


For me it worked much better than opioids, but where I live it is illegal and not all variety works the same. It is a real shame and makes me feel sad, because it could be real life changer for me. I tried things like CBD oil that is legal, but it is not the same and doesn't really work.

I work in the IT and being high is out of question, sadly it is difficult in the black market to obtain variety that would work for pain without such side effects. It was helpful in the evening to go through the night without waking up from pain. Other medication like for example Amitriptyline, would make you feel tired the next day which is not the case with cannabis.

But I don't want to be a criminal.


Just to add to this, you don't end up being high for long. As tolerance sets in, psychoactive effects decrease and CBD-related pain and anxiety effects increase.


Is Kratom legal in your state? Many people use kratom to manage pain, while others use it to get off opioids.


I have horrid anxiety ( to the point where I can literally freeze up when put on-the-spot stressful situations ) and I use Kratom lightly to deal with it. I noticed I was using a bit more than I thought was reasonable and I decided to do a hard stop and check for side effects. Well, the side effect in my case was horrid restlessness and anxiousness. It lasted for about 5 days. There is no throwing up or headaches, but basically all the anxiety I was mitigating came rushing back times 3 and it's extremely unpleasant. When researching online I did not find anyone else with this experience. When you use Kratom consecutively it's easy to build a tolerance. At the time I was consuming about 2 tablespoons a day 7 days a week for about a month.

Kratom when used sparingly is a good tool, but don't abuse it.

Generally its doesn't "feel" addictive but don't assume that it is without side effects and use it lightly.

I use it about 3 times a week and I limit my dosage to one teaspoon a day. This seems to give me the benefits without the side effects. I don't feel addicted to it and have no desire to consume more than this.

Just a heads up :)


My friend who takes Kratom for his severe anxiety also suffers from the same amplification effect during withdrawal. From his discription, "unbearable agitation and electric bolts". I'm taking 1tsp/6hr daily but will typically stop taking it entirely when I can get the inflammation in my back down and the pain subsides. I've never really experienced more than a couple of days of what I would describe as mild agitation and unsettled feeling. I can' t even compare it with my opiate withdrawal symptoms of years past: 14 days of electric body, vomiting bile, uncontrolled bowls, violent chills and spending half the day in the tub and the other half in bed with a high fever, and etc. So you're not alone in your experience, and I always wrote it off as Kratom's actual metabolic action not being really well understood, and why I always think the comparison to Tramadol is better than other opiates.


As a counter point, I've been taking 4x 3g doses almost every day for over a year, and there hasn't been any development of tolerance.


I use Kratom to manage lower back pain. It is about as effective as Tramadol with less side effects and contraindications for me.

I'd give it a 1/10 on my addiction scale (with 1 - THC to 10 - A Year of Liquid Opium Poppy Daily Dose), and a 5/10 on my analgesic scale (1-Aspirin to 10-Opium Poppy).

I don't think the mechanisms are well understood. It definitely wipes out opiate withdrawal symptoms within hours of taking a small dose. And I've never had any physical symptoms from even month long cessation. I like to say 'my' scale, because efficacy and addictive properties of opiates and opiate analogs like Tramadol and Kratom vary pretty wildly. Tramadol is known to have and Kratom also seems to havem some strong SSRI actions also, not found in the other opiate analogs, Oxycodone, Hydrocodone, or nartural opiates.


Kratom is indeed not an opoid but still is a painkiller. However, unfortunately, it still can be addictive.


Kratom is 100% an opioid and is addictive in exactly the same way opiates and opioids are.


Could the next person please source their comment. Kratom seems a bit controversial.


There is no controversy unless one is fooled by Kratom peddlers' "non-addictive" rhetoric.

I don't have the time to beyond Wikipedia, but there are sources cited in the article. A simple Google search would solve the problem here as well.

The main active substances in Kratom are Mitragynine and 7-HO-Mitragynine. According to Wikipedia[0]:

> Mitragynine is an indole-based opioid and the most abundant active alkaloid in the plant Mitragyna speciosa, commonly known as kratom[1] and biak-biak.[2] Dry kratom leaf contains roughly 1.2–2.1% mitragynine.[3]

> Mitragynine itself acts primarily via μ-opioid receptors, though its oxidation product mitragynine pseudoindoxyl, acts as an even more potent and selective μ-opioid agonist but with less affinity for δ or κ receptors.[9][10] Another alkaloid with a major contribution to the μ-opioid activity of the kratom plant is the related compound 7-hydroxymitragynine, which, while present in the plant in much smaller quantities than mitragynine, is a much more potent μ-opioid partial agonist.

Mu-opioid receptor agonism is how opioid drugs of abuse work.

Kratom contains opioids that bind to mu-opioid receptors in the brain and opioids that bind to mu-opioid receptors in the brain cause opioid addiction.

[0] https://en.wikipedia.org/wiki/Mitragynine


It's a bit more nuanced than you state - kratom also contains mu-opioid antagonists. Furthermore, mitragynine and 7-OH-mitragynine are G-protein-biased agonists of the mu-opioid receptor - which also do not recruit β-arrestin following receptor activation. It is β-arrestin recruitment that is responsible for the main side effects of opiates - respiratory depression, constipation, histamine release and build up of tolerance (which is what leads to withdrawals upon cessation). This is a very big deal, and may well go some way to explain why for many kratom has no withdrawal symptoms or addictive properties.


> This is a very big deal, and may well go some way to explain why for many kratom has no withdrawal symptoms or addictive properties.

Take Kratom every day for two weeks and get back to me.

These are side effects you experience under Kratom intoxication:

> respiratory depression, constipation, histamine release and build up of tolerance (which is what leads to withdrawals upon cessation)

Each and every one of those.

Anyway[0]:

>RESULTS: More than half of the regular users (>6 month of use) developed severe Kratom dependence problems, while 45% showed a moderate Kratom dependence. Physical withdrawal symptoms commonly experienced include muscle spasms and pain, sleeping difficulty, watery eyes/nose, hot flashes, fever, decreased appetite, and diarrhoea. Psychological withdrawal symptoms commonly reported were restlessness, tension, anger, sadness, and nervousness. The average amount of the psychoactive compound, mitragynine, in a single dose of a Kratom drink was 79mg, suggesting an average daily intake of 276.5mg. Regular users who consumed ≥3 glasses Kratom per day, had higher odds of developing severe Kratom dependence, withdrawal symptoms, and inability to control Kratom craving.

> CONCLUSIONS: The findings from this study show that regular Kratom use is associated with drug dependency, development of withdrawal symptoms, and craving. These symptoms become more severe with prolonged use and suggest a stronger control of the drug.

[0] https://www.ncbi.nlm.nih.gov/pubmed/24698080


> Take Kratom every day for two weeks and get back to me

I've been taking it almost every day for over a year.

There is no respiratory depression, and no build up of tolerance - the dose that was originally effective still is. I am not addicted; there is no compulsion to take it other than to reduce my pain.

I also stop taking it every now and then, just to check if the condition I have is showing any signs of going away - I get a very mild cold-like feeling, nothing more. Honestly, when I've stopped caffeine before, that was harder.


We've had __very__ different experiences with Kratom, then. I was an active Kratom user for 2 years and was very addicted to it. Tolerance, cravings, nodding, respiratory depression, histamine response, constipation, the whole nine yards.

I was also in your shoes and told myself the same things for a long time. I had quit a few times, for long periods of time, and told myself it wasn't that bad. But each time I quit, withdrawals got worse. It won't be a mild cold-like feeling forever.

If Kratom use isn't negatively impacting your life, your dose isn't escalating and it works for you, then I'm genuinely glad that you've found something to manage your pain.

My mom has been on low doses of hydrocodone for degenerative disk disease for decades now, that works for her as well.

However, both are opioids and they carry the same risks all opioids do: opioid addiction. It would be unfair to those who are opioid and Kratom naive to pretend that addiction and all the fun facets of opioid abuse are not something inherent to Kratom. I bought into the "Kratom is safe and non-addictive" sales pitch as a teenager and suffered immensely for my naivety.


Sounds like you had some kratom that was sprayed with an opiate adulterant. I've been taking kratom for going on seven years almost every day (with short breaks once a month and a longer break in the summer), and I source my kratom directly from an Indonesian farmer cooperative. This is an unfortunate thing happening by unscrupulous kratom vendors: They'll sell whatever they get their hands on, and in order to give it a bit of a kick, they'll spray it with tramadol or some other opiate adulterant. This is actually what happened with the handful of hospitalizations and deaths in Sweden: These teenagers had gotten a hold of kratom that had been sprayed with strong opiates. It sounds like whoever darpa_escapee was buying from was adding a little something extra. Without any tests, it's impossible to say that darpa_escapee was buying actual kratom and not something completely different and much more dangerous. Which happens, and is one of the reasons that the kratom community is starting to push for more stringent controls (and testing) on the supply chain: So that people can know for certain they're buying kratom and not just some shit sprayed with dangerous opiates that gives them all the telltale signs of some kind of regular opiate addiction like darpa_escapee here. Sorry you had such bad luck with your "kratom" supplier, darpa_escapee.


Given this was over the period of two years, with numerous vendors (my email history shows over 14 vendors and bulk suppliers) that were cross referenced with independent rating systems, some invite only to prevent manipulation and investigation, I highly doubt it.

The biggest factor in how it affected me was my complete opiate-naivety. I had never once taken an opiate before, therefore Kratom was subjectively powerful to me. Much like someone taking their first drink or smoking their first joint, I became very intoxicated.

I think the latter is a likelier explanation than a multi-national, multi-continental conspiracy between 14 disparate supply chains to adulterate only my supply of Kratom and no one else's.

> seven years almost every day

After two years, my initial doses of Kratom felt much like a cup of coffee because of tolerance.

Someone who has never taken an opiate before is going to have vastly different responses to Kratom than someone who is well into their 7 year Kratom habit.

Once you've built tolerance and gone through the dependence / withdrawal cycle, you will never have the same consistent response to opiates as you did when you were opiate-naive. Last year, I had the rest of my wisdom teeth taken out. I was prescribed 5mg Vicodin. It helped with the pain, which was very bad, but it honestly wasn't noticeable that I took anything narcotic. 7 years prior I had the same operation and was given the same medication. One 5mg Vicodin has me on my ass for hours back then.


Anecdotally, different people do seem to have different degrees of withdrawal effect - I'm not really sure why that would be though, perhaps genetics?

You mention tolerance, nodding, respiratory depression, histamine response and constipation... this is odd.

Constipation from kratom is nothing compared to other opioids; I just take magnesium and everything works fine. Sometimes I have to go out of the country with work, in which case I take dihydrocodeine (which is prescribed to me, but kratom works much better) - that causes far more constipation (and I also have to go through rather unpleasant withdrawals after very such trip as I switch back to kratom :(

Histamine response from kratom is also much less than other opioids - and I say that as someone with symptomatic dermographism.

And the oddest of all, respiratory depression - I'm on mobile so don't have sources to hand, but kratom has been shown to absolutely not cause respiratory depression. I know there have been cases of kratom being spiked with potent opioids such as O-desmethyltramadol, and honestly it sounds like you've had something like that. Did you buy from a head shop?


> You mention tolerance, nodding, respiratory depression, histamine response and constipation... this is odd.

I was completely opioid-naive at the time. A teaspoon or two of Kratom had the potential to knock me out for a few hours at that point in my life.

> Histamine response from kratom is also much less than other opioids - and I say that as someone with symptomatic dermographism.

I don't have much to compare Kratom with, but I would end up scratching myself all day and night without realizing how hard I was doing it because of the analgesia.

> And the oddest of all, respiratory depression - I'm on mobile so don't have sources to hand, but kratom has been shown to absolutely not cause respiratory depression.

At that time, I would combine Kratom with the benzodiazepine I was prescribed and noticed a difficulty breathing and a drop in my breathing rate. On its own, it was pretty insignificant.

> I know there have been cases of kratom being spiked with potent opioids such as O-desmethyltramadol, and honestly it sounds like you've had something like that. Did you buy from a head shop?

I bought from different online bulk suppliers and vendors, sourced from different communities and referenced with independent rating systems. Plain leaf was pretty consistent across the better vendors.


The main problem is that the controversy involves a lot of anecdote. Critics can't prove they've actually not been consuming some dangerous adulterants because they aren't testing their supply (since testing is pretty expensive). Here's at least one paper discussing kratom: https://www.ncbi.nlm.nih.gov/pubmed/22133323


Isn't kratom for musculoskeletal pain ? Would it work for nerve pain ?


Kratom isn't indicated for anything. If the pain-relief can be mediated with drugs such as hydrocodone, tramadol, oxycodone and maybe even SSRIs, it is within the realm of possibility for Kratom to work for that type of pain.


Probably you know about the opioid alternatives, but did you try anticonvulsants [1] for your nerve pain? I had nerve damage after a surgical procedure, and opioids did not really help. A doctor suggested to try Gabapentin, which greatly reduced pain down to tolerable levels. While anticonvulsants probably have their own risks, they seem much less addictive than opioids, and are probably easier to get on prescription.

[1] https://en.wikipedia.org/wiki/Anticonvulsant


I was prescribed Gabapentin for neuropathic pain and it did little for the pain but brought in a whole lot of nasty side effects. I was feeling terribly sick and everyday getting more depressed and thinking I am going to die and then severe anxiety came in that lasted for months after I stopped taking this medication. I am back on opioids now.


Sorry to hear that. For me the only side effect was some drowsiness, but I heard that it can come with more severe side effects for others. Best of luck with your further pain management!


I also tried gabapentin for suspected nerve damage, and it made me feel like I was drunk - that's not a state that would allow me to live a normal life, working, driving etc


My wife is in a similar situation. I've heard pain killers only become addictive if you take them when not in pain. But when you're in excruciating pain, and the meds only dull the pain somewhat, there is no addictive euphoria taking place. So people like my wife who have been on them for a decade, and probably will for the rest of her life, could taper down and give them up very quickly if their pain went away.



You could look into pain management techniques to turn the unbearable pain into hopefully a bearable one. Meditation, breathing techniques, biofeedback,... that kind of thing.

I don't know if this applies to nerve damage pain, but cannabis has a quite a history of being effective with pain.


Have you tried CBD?


There is no evidence of efficacy of high dose opioids for long term pain.

https://www.rcoa.ac.uk/faculty-of-pain-medicine/opioids-awar...

Self poisoning is a common method of suicide (second most common in the US) and opioid medication are the most common meds used.


Actually, I came across a paper recently which did find long term opioid use effective. I'm on mobile now, but if I remember later I'll post a link.


Cool, but I linked to a review of many papers, including systematic reviews.

Your single study is going to have to be remarkable to persuade me over that.


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.


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...

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


The study obviously has an agenda.


I was given at least a 10 day supply of opioids after laproscopic surgery even after I told them I wasn't in a lot of pain and didn't even really want them. I stopped taking them after 4 days and still almost have a full bottle left. They asked me if I had an opioid problem when I told them I didn't want them. Didn't ask me prior to that.


"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...


I'm 23 years old living in a major city in the midwest, grew up a in a middle-small town (120k population) a few hours away. Everyone I grew up with is either selling heroin or taking it, or both.

The fact that I'm a software developer (making a living legally) and not taking and/or selling heroin is an anomaly.


I'm seeing similar increases in heroin use in my small midwest hometown. Multiple overdose deaths monthly, as well as arrests.

I honestly don't get what most of the other commenters are going on about. The stats are pretty widely reported on the massive increase in opioid abuse.

They must live on the coasts or otherwise have avoided what has been plaguing many states in recent years

http://www.economist.com/blogs/graphicdetail/2017/03/daily-c...

Here's a long but very informative article outlining a few important issues plaguing the US, drug abuse playing a significant part:

https://www.commentarymagazine.com/articles/our-miserable-21...


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.


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.


The old standard for morphine is give however much stops the pain. They should have pushed up to the max they're allowed, if you were still in pain. I was in an accident, and the docs gave me as much morphine and dulaudid as it took and explained that opiod reception varies greatly when in pain. The amount of dilaudid that would make you loopy now may do nothing while you're hurt, and the amount to make you comfortable while hurt would easily kill you now. Effectively the LD50 varies with pain levels.


Parent poster is talking about the problems of opioids for long term pain.

A broken arm is not long term pain. Most doctors are not worried about opioid use for short term pain.


Sadly, in my experience addiction is often fed, if not caused, by pain avoidance. This in no way is meant to reflect on your particular situation, but I just want to point it out for the benefit of those who struggle with addiction and opt for it over alternatives.

My personal struggles in this area, in hindsight, were not primarily fed by a desire to satiate a craving or desire or need, but rather much more by a fear of future pain.

Ideally, this comment shouldn't lessen the struggle of those who have to deal with pain, but it should increase our empathy with those who struggle with addiction, because I'm willing to bet that in many if not most cases, there's a crippling, intense fear of pain underlying it. How rational that fear is doesn't really matter.

I've seen people with a legitimate need to alleviate pain succumb to addiction. I've also seen people who 'should' be fine succumb to addiction because of less-visible, mental anguish. It seems to me both cases, and the usual murky area in between, deserve study, empathy, and solutions.


I have a friend with 'back problems' who was on OxyContin for 10+ years. His pain problems miraculously went away after he weened himself off of it over the course of a few months.


Here's the actual study, rather than a summary of it: 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.


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


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.


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??


This seems so obvious a factor that I have a hard time believing mere negligence explains the failure to mention it in the article. I've seen a few hit pieces like this now and it seems to me some powerful lobby must be waging a PR war against opioids.


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


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).


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.


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.


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 :(


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


Wow, that seems like a strong dose! I had total hip replacement, I took 5mg Oxy 4x/day for 6 days. I went through a day of agitation and grumpiness when I stopped.


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


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. :-(


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).


Assuming that politicians care more about the opioid epidemic and the actual well-being of their constituents than they do about their public image with their supporters. You really need everyone to catch on to the relative harm of opiates and cannabis.


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.


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.


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


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.


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.


We detached this subthread from https://news.ycombinator.com/item?id=13907668 and marked it off-topic.


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.


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...

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".)


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).


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 ) 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!




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