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Mussels test positive for opioids in Seattle's Puget Sound (bbc.com)
255 points by lunchbreak on May 25, 2018 | hide | past | web | favorite | 125 comments



This is pure clickbait. Sure, opioids are detectable in mussels from Puget Sound. That reflects the sad fact that Puget Sound is horribly polluted. I suspect that levels of some pollutants are high enough to damage human and ecosystem health. Organomercury compounds, for example. But what gets the focus is opioids. Because it's good clickbait.

Edit: Following pesfandiar's link about caffeine pollution in the Pacific Northwest, I found this about Puget Sound:[0]

> Of all the flavors trickling downstream, artificial vanilla dominates the sound, Keil said. For instance, the team found an average of about six milligrams of artificial vanilla per liter of water sampled.

Yes, 6 mg/L in water! That's not trace contamination. But "Puget Sound is vanilla flavored!" isn't so scarey, I guess.

0) https://news.nationalgeographic.com/news/2009/11/091112-drin...


We know there's pollution. However, we do not expect it to be a prescription drug. This isn't a factory dumping lead or some other chemical. This is enough individuals pissing oxy / opiods that it shows up "down stream."

This isn't click bait silly. This is another wake up call. So wake up.


Opioids are really easy to detect. You'll also find hormones from birth control and most likely a whole bunch of other drugs.


I've lived near Puget Sound for 18 years and I didn't know it was polluted (except gasworks park, which I know is a Superfund site).


> Sound Citizen: Students and Citizens Working Together to Evaluate Sources and Fates of Emerging Pollutants in Puget Sound

> SoundCitizen has delivered impacts in both science and education, annually engaging more than 2,000 volunteers, students, and event attendees in 2010 and 2011. In 2010, SoundCitizen tested for 37 different compounds, with the number growing to 110 compounds in 2011. Scientific findings included:

> a pattern in the cycle of ethinylestradiol (pharmacological estrogen) in the natural environment;

> the ubiquitous presence of plasticizers in Puget Sound; and

> abundant anthroquinones (dyes and bleaches) and cyclohexanones (nylons and other synthetic fabrics), which may represent previously unrecognized contaminants in the marine environment.

https://wsg.washington.edu/research/sg-sound-citizen/


No, we have known about drugs in the environment. For many years. In parts of India, it's a bloody nightmare.


But clearly we haven’t woken up enough to do something about it.


I'm not sure what there is to do. It's really hard to remove stuff from wastewater that doesn't sink, float, get metabolized by microorganisms or plants, or get removed by sand filters.


If people literally dying in the streets isn't enough to "wake" people up, an article about opioids in mussels has a very poor chance of doing so, as well.


Because of the hysteria and resulting "OMG DO SOMETHING," the US government has turned it from an opioid (pill) epidemic to a fentanyl and heroin epidemic. Of course the latter is much more difficult (if not impossible) to control, and much, much more dangerous. So as a result of "OMG DO SOMETHING," the US government did probably the worst thing they could have possibly done.

If only there was a long and ugly drug war we could have used to reflect on the success or failure of the US government and it's attempt to control drug use. /s

Every decade, there is a new boogieman drug, just like there is a boogieman -ism. Anarchism, Communism, Satanism, Terrorism. Reefers, LSD, Huffing, Cocaine, Crack, Meth, Nicotine, Jenkem, Pills, Heroin. I have no conclusions to draw, but it is an interesting phenomenon.

Here's how the current battle of the drug war is going.

https://www.drugabuse.gov/related-topics/trends-statistics/o...


That seems pretty obvious to me.

Back in the 70s, I recall that marijuana became less available, and more expensive, for a year or so. So we switched to other drugs. More acid. Cocaine. Various sedatives. And of course, alcohol.


I wouldn't be shocked if prescription drugs were detected in every body of water that is being used for human waste.

Wake up to what, exactly?


Also recreational drugs.

> In a new [~2009] review study, Castiglioni and colleague Ettore Zuccato found that illegal drugs have become "widespread" in surface water in some of Europe's populated areas.

> Likewise, in 2005, Zuccato found that a daily influx of cocaine travels down the Po River, Italy's longest river.

https://news.nationalgeographic.com/news/2009/11/091112-drin...


The same is true for sewer water in Dutch cities (Amsterdam, Utrecht, Eindhoven, etc). Scientists can trace which drugs are popular where.

EDIT quickly found some sources (in Dutch) [1] [2] [3] [4] [5]. Some are double, but its been tested for a while. Also, at least [3] and [5] are based on European investigation so English source should be available too.

[1] https://www.kwrwater.nl/projecten/drugs-in-het-riool/

[2] https://nos.nl/artikel/2148110-rioolonderzoek-meer-cocaine-g...

[3] http://www.omroepbrabant.nl/?news/213383832/Waterschap+gaat+...

[4] https://www.parool.nl/amsterdam/meeste-cocaine-in-amsterdams...

[5] https://www.ed.nl/eindhoven/cocaeniuml-ne-en-amfetamine-rest...


To the fact that you find this normal enough to not be shocking.


If I've know about something problematic for many years, it's no longer "shocking". But I don't necessarily consider such stuff "normal". The situation is still abnormal. Chronically so.


I see articles like these as useful reminders that human actions have consequences which need to be understood and mitigated if they are bad enough.

We don't want to become numb to the signs of systematic and widespread problems.

On the general topic of pollution and what it takes to organize effective responses, a friend recommended this article https://www.nytimes.com/2016/01/10/magazine/the-lawyer-who-b...


Why is it a wake up? I've seen no data to suggest this is anything more than an novel finding.


Is there an opportunity here for a startup to develop, market and sell an opioid-urine recovery kit?


Huh? "Waste not, want not?"

Most excretion occurs via urine, so it wouldn't be entirely impossible. But daily urine volume is 1-2 liters. And urine starts to smell nasty after a few hours. Also, there are thousands of widely-used drugs, legal and illegal. Even focusing the most damaging ones, that's some serious chemistry.

So filtration seems the best approach. And I see this:

> A new filter membrane based on a covalent organic framework (COF) could help clean up drug-laden wastewater (Angew. Chem. Int. Ed. 2018, DOI: 10.1002/anie.201802276).

> The medicines we take often end up in sewage. Wastewater treatment plants struggle to remove these compounds before releasing water back into the environment. Scientists worry that when these molecules end up in the environment, they might contribute to the spread of antibiotic resistance or disrupt development in aquatic animals.

> COFs are crystalline porous networks made from small organic elements covalently linked together. They are similar to metal-organic frameworks (MOFs), which are finding uses in hydrogen storage and catalysis. COFs have been used in similar applications, but Jürgen Caro of Leibniz University Hannover thought the materials could make good nanofilters.

https://cen.acs.org/articles/96/i14/COF-filters-small-organi...


I live on the water in West Seattle close to a park, and by the shore we found some seaweed that we wanted to harvest and maybe, potentially eat.

I got curious about where in the sound is safe to eat things from. Pretty much the entire sound is polluted and a hazard.

https://fortress.wa.gov/doh/eh/maps/biotoxin/biotoxin.html


My Japanese anthropology professor once told us a story about when he and his wife went to Japan for a research trip with his wife sometime in the 70s or 80s.

In Japan, when you move into a new apartment, it's customary to give a gift to your neighbors. Being a new professor, he and his wallet welcomed any chance to save a little money. When he and his wife were walking along a beach in the Tokyo Bay area, they noticed a ton of shellfish.

Thinking this would be a great gift and a budget dinner, they got some buckets, went back, and started pulling up shellfish for dinner and for their neighbors as a present.

The Tokyo Bay was much more polluted in that era (not that I know whether it would be safe to do this now), so when everyone ate those shellfish, apparently everyone got terribly sick.

So yeah, I'd be super leery of edible things in those kinds of areas in general. :(


Pollution in Japan caused a number of issues in the 60s, things were probably starting to get better in the 70s when their environmental agency was formed, but no doubt issues remained.

This maybe of interest as a reference:

https://en.m.wikipedia.org/wiki/Four_Big_Pollution_Diseases_...


I'd be surprised if even back in the 70's that Tokyo bay was so polluted that pollution-contaminated shellfish could make people sick immediately. Seems more likely that it was some kind of bacterial, algae or biotoxin poisoning (which can happen even in unpolluted waters)

With longer term exposure, sure I could see health effects, but not from a single meal. Even under stringent environmental regulation, I'd avoid seafood caught in any large city's bay, since decades old contamination can still cause problems today.


Now, it is certainly safe to eat at least clam (asari) taken from Tokyo bay. Perhaps other filter feeders too.


They just dump human waste into the water. I can't even watch people eat shellfish.

"One hundred and six wastewater treatment plants, discharging as much as 97,000 pounds of chemicals each year, are located around Puget Sound."

https://news.vice.com/article/seattle-area-salmon-are-loaded...


They don't dump it in the water. They dump it in the forests.

In WA specifically, "sewage" is processed for as many contaminants as possible. Then, they put it in trucks and drive into the Cascades and spray it in the forests. They call it bioremediation - but it seeps into the groundwater, which then goes to streams. Where do all the streams end up? Puget sound.

If you wander up past the locked gates of the timber roads near Snoqualmie or Snohomish, you'll find flame retardants, opioids, caffeine, fluorocarbons, and whatever other toxins that ultimately never gets absorbed by the forests.

By the way, this practice of using biosolids in agriculture or forests is very politically charged because there's a lot of money tied up with this industry and the people who wound up writing the bulk of the EPA regulation around this industry. Every time you hear of an E. coli outbreak in some vegetable, it's because of this.

This is something I wish more people knew about, or at least stop to consider where their waste ends up.


Hmm. When you hear about E. coli outbreaks in vegetables, it's traced back to fecal contamination on the worker's or processing equipment's working surfaces.

I looked to find any sources with high quality scientific evidence showing accumulation of toxic waste in timber roads in WA. I am an open minded scientist, if you post high quality work I'll read it and change my mind.


"There are three general methods for applying biosolids to forests: 1) spray irrigation with either a set system or a traveling gun, 2) spray application by an application vehicle with a spray cannon, and 3) application by a throw-spreader or manure-type spreader. In the Pacific Northwest, the most common methods for forest applications are the throw-spreader or a vehicle-mounted cannon. Table 7.7 lists these application methods, their range, relative costs, advantages and disadvantages, and their suitability for biosolids of different solids contents."

https://fortress.wa.gov/ecy/publications/documents/9380.pdf

It was the top item of the first google search for "biosolids washington forest".

Here's pictures if you're interested.

https://www2.gov.bc.ca/assets/gov/environment/natural-resour...

Here's another article from 20 years ago about the practice: http://thewatchers.us/wef/PacNW.pdf


I was looking for articles that supported the health and sanitary claims of the up-poster. What you included shows the idea is not without merit.


This is the case pretty much anywhere near a coastline.

I refuse to eat locally caught seafood.


it’s somebodies “local coastline” elsewhere too so that might not help you


Not all fishing is coastal.


American-caught seafood has the strictest regulations in the world; and is the safest.


I very much doubt it. For example, American restaurants happily serve this crap, passing it off as "tuna": https://en.wikipedia.org/wiki/Escolar


Human calls a species 'crap' for not being good to kill and eat large quantities of... That attitude seems to me part of the problem.


I don't know if this is true or not but what do you base this opinion on?



:-/

The government recommends not to eat what is caught here.

Thanks for the high quality post, though.


To be fair, the Sound has hundreds of trillions of pounds of water. 97,000 pounds of anything isn't going to make a big difference. But it would be awesome if we could stop polluting it.


97,000 pounds of dioxin would kill lots of people. Some compounds are unbelievably toxic.


These are all compounds that have already gone through people's system. It's bad, but not the end of the world.


To be fair, part of this is natural and seasonal. Most of natural marine biotoxins are seasonal and the department of health tests regularly. I don't know to what extent the biotoxins are affected by pollution (e.g., fertilizer runoff), but they are a natural occurrence.

Separately, they also have permanently closed the tidelands near Seattle due to pollution. Crabbing is still open each summer, but bivalves are closed.

I was just out on Whidbey Island a couple of weeks ago where I found and ate raw oysters on the beach, then dug clams and brought them home for dinner. The pollution does concern me, but I do trust the government testing. Its also worth noting that the oysters & other bivalves you eat in restaurants come from the same waters.


Fertilizer runoff? Sure. At scale we would expect that to show up. And it does. The point here is, for anything to show up you need scale. So if something consumed by humans is showing up how many humans are consuming it? Or are you saying they're using opiods to fertilize their lawn?


>high enough oxycodone levels for the shellfish to test positive

That doesn't really tell me anything. Are they testing by taste or by some fancy test that can detect down to 1 ppq?


Just to do the Fermi problem math for fun, how much heroin is needed to reach detectability in Puget Sound?

Assume 1 ppq detection rates (like many spectroscopic methods claim to do).

Puget sound is 110 km^3 or 1.10E14 liters of water. That's 6.05E15 moles of water. At one ppq (1E15), you need 6.05 moles of heroin. This comes out to about 2.2 kilograms.

Now in terms of doses, that's a lot of doses. But that's not a lot if a drug runner could have just tossed a single brick in to reach that concentration (or emptied a single car boot in haste).


mussels are not in equilibrium with their environment. they are pretty good at concentrating many kinds of pollutants. so you don't need such a high concentration in water to achieve the same concentration in them.


Mussels will also flourish around the waste water outlet pipes, because there are a lot of nutrients in the water there. Where they found the opioid-containing mussels could make a big difference. I didn't read the article so maybe this was addressed.


They didn't just find them. They placed clean mussels specifically for this test, then went back for them.


Sure. The question is still: did they place them directly adjacent to treated wastewater outflow?


> they are pretty good at concentrating many kinds of pollutants

Does this mean mussels are not a good food source to begin with? Is it better to avoid them, regardless of origin?


But this is coming from human waste, how much of a filter does the human body act on heroin?

If a person puts a gram of 100% pure heroin (another good question might be how purity affects the measurements) in to their body, how much will come out the other end?

Also, from a chemistry perspective, how does water bring a solvent affect opioid molecules existing? Would the water or various things in the water break down the molecules into other non detectable molecules?


True. So if we presume all the opoids are from human bodily waste, we would need divide by 10% (the amount excreted out): https://en.wikipedia.org/wiki/Oxycodone#Metabolism

Probably the molecule does break up with a certain half life, either due to sun, or other animals metabolising it, etc. Then that 2.2 kg brick needs to be replaced once every two half-lives.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2991390/ Gives really hand-wavy half-life of many drugs in the environment as about 500 days, so the brick needs to be replaced every 1000 days.

Also 1 ppq is the lower bound. I think 1 ppt is quite reasonable for many methods though, so that can multiply the limit by 1000x.

All the factors above can increase the threshold amount of opoids, but here are some factors that can decrease it substantially:

There are people who dump unused drugs in, so that needs no attenuation factor.

Also, mussels are filter feeders, and oxycodone might accumulate in them substantially more (like 1000x+) than the background.

Finally, where they collected the mussels is probably correlated with sewage drains due to ease of human access, so the effective "volume of distribution" can be way less than the 110 km^3.

All that is to say, the real statistics are in the overdose calls for opoids. The headline is still an interesting cocktail-party line, but probably should be taken as a statement just by itself.


According to Figure 4 on page 410, it seems that 10% of ingested heroin is excreted as morphine, the other 90% as morphine glucuronides:

https://www.researchgate.net/profile/Wim_Van_den_Brink/publi...

However, it is not clear if the glucuronides would be picked up by the test. Morphine glucuronides -- particularly morphine-3-glucuronide -- can hydrolyse back to morphine. It seems that the morphine molecule is largely not destroyed metabolically; the glucuronide moiety is more like a molecular "tag" that tells the kidney to get rid of something.


What if someone flushed a bunch of it down a toilet raw, for whatever reason? Same location for concentration as excrement, and honestly makes even more sense for disposal than actually throwing it into the sound directly.


So would it be economical to extract heroin from the sea water?

Assume highest street prices.


High enough levels that workers compensation insurance would not cover these mussels in a workplace injury. The mussel's personal insurance would need to cover the loss instead.


Even the mussel's personal insurance would not generally cover situations resulting from deliberate (in the insurers eyes) drug ingestion. Unless the mussel could prove it was contamination of his environment.


It puts the mussels in a terrible place. There's no active labor unions for molluscs, and the lack of a temperature controlled brine pool in many civic courts prevents them from testifying directly.


Absolutely true. The lack of a union means that if molluscs with on-the-job injuries are asked about drug use, they should just clam up.


This could also possibly fall under the dominion of the little understood maritime law.


Agreed... the good old days were better when the big mussels were only into steroids.


Depends on the country though. Those mussels would be covered for accidental injury in New Zealand, regardless of accident mechanism or drug test result. Unless they had a preexisting condition or course, then they have a real problem.


Mollusks are placed at even greater risk by their own deviant behaviors, as described in this BBC documentary:

https://youtu.be/8R2zvE615dM


It's like cocaine being on most bills. Headline is true but misleading readers.

https://www.snopes.com/fact-check/drug-money-2/


Exactly. Some analytical techniques can detect incredibly small amounts of chemicals.

It's kind of like saying "Water tests positive for arsenic!", then finding it's 5 ppb and the EPA limit for drinking water is 10 ppb.


Key para...

"What we eat and what we excrete goes into the Puget Sound," Jennifer Lanksbury, a biologist at the Washington Department of Fish and Wildlife, told CBS News affiliate KIRO.

...so enough crap going into the water from the local population to be picked up in the Mussel samples... Crazy!


Waste water treatment doesn't remove drugs, so they make it out into the water, and the filter feeders pick it up.


I’m surprised the chemicals don’t quickly break down in the salty sea water. Do ocean environments affect half-life of pharmaceuticals differently?


Water shields double bonds from UV light preventing them from breaking down. For examples of this look no further than PCBs (polychorinated biphenyls, not circuit boards)


Waste water can be tested to give an idea of population drug usage.

https://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&object...


A fun fact that a friend of mine shared is that there are trace amounts of sucralose in our water supply. It turns out that inert sweeteners that are not digested just get excreted, and since it's not a molecule found in nature they don't break down quickly.


Molecules being found in nature, or not, has nothing to do with the speed they decompose. Many unnatural compounds are similar enough to natural ones for microbes and enzymes to decompose them efficiently. And many compounds, like glass, aren't likely to decompose even though they are plentiful in the environment.


For some reason plexiglass/perspex is curiously compatible with organic tissue, more so than glass. So a fighter pilot with shards of plexiglass in his/her eyes will have a better prognosis. Naturalness isn't always the last word.


I'd be surprised if it has nothing to do with it, in that I'd expect compounds that are common in an environment to be much more likely to have organisms evolved to exploit them when possible.


It's also one of the ways for detecting the amount of pee in a pool - if people had a diet Coke before they peed then it can easily be detected. (Urea can be released via sweat I believe - so that's not a good signal)


I think that urea reacts fairly quickly with Chlorine to form various chloramines, which, in turn, degrade to N2 and chloride.


Urea is also an ingredient in a lot of lotions and other skin products.


As a member of the community to whom this particular mussel economy is very important, this is disconcerting. At the same time, it's worth mentioning that the mussels in question were cultivated out here in cleaner waters and then _transported_ to urban shorelines.

The results are a possible window into what's to come if we don't curb our rate of pollution in the region, but not representative of what's currently in the mussels that get to your plate.


I’ve been studying / beginning to practice permaculture for a little while now and one thing that is often discussed is the subject of human waste.

When you take food out of the ground and consume it, you’ve removed some fertility from the ground. Either you have animals put it back in as manure, or you use some kind of synthetic fertilizer.

When the food goes through your body, you’re also generating manure. But typically we ship it off to some central location where it becomes a massive collection of toxic waste.

The permaculture argument is that if we kept as much of that waste on site as possible, we’d be recycling nutrients rather than not only wasting them, but creating toxic hazards due to the size of the collections.

On a small scale, think of how fertile the ground over a septic field is — wildflowers and grass will grow like crazy.

The more, er, devoted will go as far as installing composting toilets.

The reason I think this is relevant is that when the waste stays local, you’re much more conscious about what’s in it. If you have a septic system, you really don’t want pills going into it — especially if you also have well water. When it’s being flushed to some unknown location it’s easy to not give it a second thought.


Does this 100% mean that humans are consuming high amounts of these opioids or could there be another explanation? Like someone dumped a boat of pills into the sound.


Depends on how many mussels they're eating...

More seriously, unless you're looking for an indirect measure of consumption, does it matter? Human action either way, and it is there either way.


“The solution to pollution is dilution!”


Maybe the mussels saw a gap in the market and decided to start producing it.


on the up side at least it may make them as happy as clams[1] reproducing per the 1998 Ignobles[2]

[1] https://www.thefreelibrary.com/Prozac+works+on+clams+and+mus...

[2] https://www.improbable.com/ig/winners/#ig1998


What's interesting is that opiods are probably not Seattle's most prominent poison of choice with traces in Puget Sound: https://news.nationalgeographic.com/news/2012/07/120730-caff...


Is oxycodone altered in anyway by human consumption or do we excrete the same substance that is put into our veins?

I don't know enough about pharmacology, but I would think that this is more indicative of the dumping of unused opioids than use of.


When humans ingest opioids like oxycodone, they ultimately end up excreting traces of the drugs into the toilet. Those chemicals then end up in wastewater. And while many contaminants are filtered out of wastewater before it's released into the oceans, wastewater management systems can't entirely filter out drugs. Thus, opioids, antidepressants, the common chemotherapy drug Melphalan -- the mussels tested positive for all of them.

Source: https://www.cbsnews.com/news/mussels-test-positive-for-opioi...


Oxycodone and its metabolites are excreted primarily via the kidney. The amounts measured in the urine have been reported as follows: free oxycodone up to 19%; conjugated oxycodone up to 50%; free oxymorphone 0%; conjugated oxymorphone ≤ 14%; both free and conjugated noroxycodone have been found in the urine but not quantified.[1]

[1]https://www.accessdata.fda.gov/drugsatfda_docs/label/2008/02...


You can’t metabolize all of your medicine all of the time.



Could also mean people are throwing them down the drain. Seems that standard issue for post op pain prescription here in PNW is 20 oxy. I don't know anyone who has taken more than a few. 20 is a lot.


> I don't know anyone who has taken more than a few.

You don't need to know people who "take more than a few" for them to actually exist. At this point, the opiate problem in the US is pretty much an established fact and most certainly does not boil down to people just washing their spares down the drain.


I think the above commenter was trying to emphasize how much oxy that is rather than trying to deny the opiad crisis.


I think he’s just saying that some reasonably large amount are just thrown away. Not most or all.

I threw away at least 20 or 30 after my appendectomy.


The article says we have oxy in the ocean. I'm exploring possible causes.


Maybe I'm misunderstanding something fundamental, but why would you flush pills down the drain, as opposed to just throwing them in the garbage?


For the same reason you'd shred sensitive documents instead of just throwing them out.

If you're a government agency giving advice on discarding potentially scheduled pharmaceuticals, advising people to flush them is an easy way to make sure diversion is no longer a concern.


It's not the drain, it's your pee. Most drugs don't get fully utilized in your body, so it gets flushed out when you flush your poop.


I dunno, with as many needles that are found around parks here nowadays, I'd bet a fair amount of people are chucking them into the ocean.


Hell it could just be someone accidentally dropped an entire stash of fentanyl in the bay.


Not too long ago sex hormones were detectable in seawater. Apparently some women excrete of their birth control medications. Human drug use has far reaching side effects.


Another worthless, alarmist, innumerate article. Without data on the levels of opioids found, this article is worthless; it literally has no value, so to speak.


What a waste of drugs on an animal that doesn’t even have a central nervous system


TL;DR filter feeders concentrate chemicals, and we have very sensitive equipment.

Clickbait kid science.


I knew it! They always seemed way too happy and peaceful.


Carrying drugs inside their body is a common moule bussiness, yup. Hence their name.


I wonder if a mussel can get high


The opioid crisis is out of control. Even mussels are ODing.


As if we needed more reasons to not eat seafood. Oceans are too contaminated, especially that part of the world.


Microsofties or Amazones?


Expedians.


They're musseling into the Seattle opioid industry?


As someone who has had frequent kidney stones, I have found that many painkiller prescriptions are unnecessary. Kidney stones are more painful than childbirth and I’ve been hospitalized for then before. But prescription painkillers rarely get rid of the pain.

People seem to be reluctant to mix medications for fear of drug interactions. They want a strong dose of one substance.

But nothing has worked for me better than mixing acetaminophen with ibuprofen or with naproxen. All are cheap, available over the counter, and have fewer side effects than prescription pain killers.

I also find that, after the initial pain subsides, I can more quickly reduce the dosage of these drugs than I could with prescription painkillers.

By all means, use oxy if you need it. But please consider trying alternatives first so you can avoid addiction.


> mixing acetaminophen with ibuprofen

It's a well-documented (in scientific literature) phenomenon that the mix of a standard dose of both acetaminophen and ibuprofen provides the same or better pain relief as opioids. This is what medical schools currently teach. You can read Maxigesic sales forecasts if you'd like a glowing review.

> use [OxyContin] if you need it

As far as I know, no one "needs" it (for pain relief, unless already addicted). By suggesting so, you're creating a placebo effect.

> [@Kenji] it depends on the person

Responding to a dead sibling comment: There are some differences observed for anesthetic response. The "red head rule" is interesting and suggests that different people might have different responses to various drugs. However, I'm not aware of any differentiation known for acetaminophen or ibuprofen response.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1362956/


mixing acetaminophen with ibuprofen It's a well-documented (in scientific literature) phenomenon that the mix of a standard dose of both acetaminophen and ibuprofen provides the same or better pain relief as opioids

If you had said some types of pain, I would agree, but your statement as-is is not accurate.

If just had a leg amputated or some other major surgery, I doubt you'd be ok with just Tylenol and ibuprofen.

The only info could find concluded it better for dental pain.


True. Interestingly, from what I've read, people often rate dental pain worse than other kinds when asked "How much pain are you in, from 1 to 10?" Nasty toothaches and kidney stones are just about the worst pain someone can experience. Maybe the data on losing limbs isn't good because the question gets asked at the wrong time.

Also, a large portion of the opioids prescribed are for dental pain. At least historically.


There are useful cases for opioids, but it's a tiny percentage of the cases where they are being prescribed today. think treating traumatic amputation, for example.


The reason that ibuprofen works for kidney stones is that it actually treats the cause, which is swelling in the ureter caused by a sharp rock ripping it up from the inside. For many types of severe pain, ibuprofen won't do much.

Strong pain killers are still somewhat useful for kidney stones however; When I had one a few years ago I was unable to keep any larger dose in my stomach long enough to metabolize it before the pain made me vomit. I got prescribed dilauded which was able to act fast enough to give the ibuprofen time to kick in.

But definitely consider destroying your opioids if you no longer need them, I think there are some common household chemicals which will break them down to a non-potent form, so we don't end up with them in places like puget sound.


Or take them back to a pharmacy - when I have asked I’ve been provided a receipt too.


Ibuprofen decreases inflamation which passes the stone faster which increases the pain. Ibuprofen alone makes the pain worse. But, even with stones too large to pass, ibuprofen and acetaminophen works better than prescription pain medicine. I can’t say it works better for everyone. But it would for most if they tried it.


Too late for some! When trying to kick opiods, I recommend cannabis. Any narcotic works wonders through opioid withdrawal, and cannabis is so safe.

Although you might become 'addicted', it's easier than controlling opioid intake.


By all means, use oxy if you need it. But please consider trying alternatives first so you can avoid addiction.

An amusing anecdote that I hope doesn't make light of your suffering... I once had some severe pain from a pinched nerve, and my doctor prescribed Oxy. I tried one pill at bedtime to help me get to sleep. It was when we were just beginning to hear about how dangerous that stuff is, and I was worried about it.

Then my wife said to me: "You're not having any alcohol with that stuff, are you?" Shit. I realized that a good stiff drink would probably have put me to sleep too. So I asked her to get me a bottle of whisky, and I flushed the Oxy. My pain went away about the same time I ran out of whisky.


Considering the respective risks of addiction, overdose, withdrawal symptoms and dangers, health deterioration, and general functional impairments, I think you may have been safer with the Oxy.


To be honest, I think alcohol is the strongest painkiller that's readily available. When I was in pain for weeks, none of the pain killers did anything but when I drank one large beer, the pain was pretty much gone for the next couple of hours. Of course you cannot stay drunk forever but you also cannot stay on painkillers forever, and both are taking a toll on your liver.

I don't know, maybe it depends on the person, how your body reacts to different substances.




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