Comment by jnbiche | Hacker News Reader

Comment by jnbiche | Hacker News Reader

Parent Full thread

I read the Washington Post comments and am discouraged. I read the HN comments - here where I see evidence of higher than average reason and compassion - and am depressed.

First, if you believe that the crack down on prescription narcotics have first and foremost hurt addicts, you're very mistaken. Addicts easily moved on to heroin, as this piece shows. People with cancer and debilitating nerve disorders like chronic shingles, CPRS, trigeminal neuralgia, and some kinds of neuropathy, who total over a million in the U.S. alone, are the ones who have suffered greatly even though opiate painkillers are safe and effective when used correctly. These are the kinds of diseases than make grown men cry in pain and bring on suicidal thoughts in previously happy, non-depressed individuals (I know, I've seen it up close).

Second, if you believe that the US can some how magically win the drug war by cracking down on the southern border, I have a bridge to sell you. Drug smugglers come in by boat to Washington State, by plane across Canada to Montana, and by submarine into the Florida coast. Wasting billions building some "impregnable" fence across our southern border will only increase the number of smugglers coming in from our other borders. And then what? We shut down all our borders?

Seriously, when I read these comments coming from HN, bastion of rational thought, I just want to curl up in a corner and cry.

As a physician, I find comments like this disturbing. Barring special circumstances (cancer related pain), there is almost no need for chronic opiates. In fact, the body rapidly becomes accustomed to opiates and will require higher and higher doses that can become dangerous. The united states uses orders of magnitude more opiates than all other countries, and that often comes from potentially a cultural aversion to pain, but also many patients specifically seek out and ask for pain meds.

In fact, the scenarios you mention, of post herpetic neuralgia, trigeminal neuralgia, and neuropathy should NEVER be treated with opiates. There are highly effective neuroleptics and medications like carbamazepine, gabapentin, and TCAs that are first line and highly effective for these syndromes. While painful, given that it is neuropathic pain, often with rapid onset and offset, opiates, even PRN medication, is not appropriate management and does not help with its treatment. Adjuvant therapy including topical creams like capsaicin as well as minor procedures like nerve blocks and injections are pursued if first line treatments do not work. Often I see people in clinic who were aggressive about opiates and got opiates for these syndromes and spiral into addiction and problems while the underlying problem is untreated.

Opiates are not a panacea for all pain, and its troubling with patients see it that way, and often insist on opiate medications.

> The united states uses orders of magnitude more opiates than all other countries,

https://en.wikipedia.org/wiki/List_of_countries_by_prevalenc...

Not that I'm for a fence, but it's disingenuous to claim that that these measures have no effect.

They ultimately all raise the price of the drugs, making them harder to obtain and thus used slightly less.

There are diminishing returns though, and at some point you have to stop pumping money into the same countermeasures.

I never said they had no effect. I agree that they have an effect, but an extremely small one in terms of cost-benefit analysis (cost-benefit in terms of both lives and money).

I've heard some of the pushback is a consequence of overprescription, and perhaps laziness on part of the medical profession. That's to say, opioids more often than necessary are the first tool a physician goes to rather then trying alternatives when alternatives exist. For some conditions acupuncture, chiropractic, as well as dietary changes. Also, some people easily continue being prescribed narcotics after the original condition has been addressed.

> First, if you believe that the crack down on prescription narcotics have first and foremost hurt addicts, you're very mistaken.

But aren't you arguing that the crackdown has hurt prescription opiate addicts?

Fair point, I should have written "addicts will go on to get opiates regardless".

I am suspicious about a lot of the comments made on this website lately. Especially leading up to a primary election, I always find myself wondering how many comments are made by various varieties of sockpuppet.

I wish that there were a more robust web of trust in place on the internet to verify that people are, well, real people. I don't like feeling like a tinfoiler just because I have these fairly reasonable bouts of skepticism.

Reply on news.ycombinator.com