I have to wonder if Purdue is involved in some kickbacks to Dr's who (over)prescribe.
I think we need to re-evaluate how often we're prescribing this stuff. Experiencing pain has a limited risk potential in most people, especially when the pain is linked to a temporary condition. The potential for addiction has nearly unlimited risk. Much better in my opinion for someone to suffer through temporary pain using over-the-counter pain meds than risk throwing your life away to drug addiction.
In the end it was just my body protecting itself from the stupidities of the brain running it.
In some it causes nausea. You don't like it, fine. But I don't understand how people can be so pro marijuana on one hand, and so anti-opiates on the other. It's pain. It's not noble to suffer needlessly.
It's complete BS that it's harder for a dentist to prescribe a dozen Vicodin after a root canal these days. Or that many doctors will try to pass off 800mg of ibuprofen as a substitute for Vicodin for throwing you back out. That turns a couple of days of "be careful and taken it easy" into a couple of days of laying around on the couch in pain instead.
These drugs are inexpensive, very effective for short term pain management, and the vast majority of people have mild to no side effects, and almost no one has an addiction issue from using them.
It feels like the modern equivalent of Reefer Madness.
It's probably the hundreds of thousands of dead people from opiate overdoses vs the 0 dead people from marijuana overdose.
> I would guess a majority of adults in the US have had Vicodin or similar and I don't know anyone personally who ever got addicted.
You almost certainly know someone who has been addicted, you just didn't know. It is shockingly common.
Like I said, feels very hyperbolic.
It's like you're suggesting marijuana has no negative downsides at all when millions of people risk their freedom on a routine basis to consume it. Physical/physiological, doesn't make much difference when you're sitting in a cell and your family's financial future is in jeopardy. And I do know some people like that. It is shockingly common.
I don't think drug users in general should be in jail. Even if I think in general people would be better off without them outside of a medical reason.
When you start restricting people's freedom because you think you know what's best for them, and inflict needless suffering in the process, I have a hard time telling you apart from any other prohibitionist.
And if you have any pain at all after a medical procedure, I see no good reason responsible adults need to suffer at all if there's an inexpensive, effective, safe treatment for the vast majority of them.
Weed is not addictive, or even if it is in some people, to nowhere near the same level as opiates. It's also not responsible for thousands of overdose cases per year. It seems to me that THC pills would be better for pain management in these situations than opiate pills.
I also don't think you have much personal experience people who have been addicted to opiates. I have. It's not pretty. It's certainly worse than people who are merely potheads. The potheads I knew, when their source dried up or they ran out of money, were irritated, but were otherwise whole, and just waited until they could get their hands on more weed again. People addicted to opiates suffer severe withdrawal, and will do anything to get more pills. They can't simply stop using for a week.
I said as much. Which is a good enough reason to be suspicious of prohibition for me.
And to be clear, I'd find it very difficult to believe anyone gets a two week supply of opiates after surgery and goes all Reefer Madness after following the directions on the prescription. You're talking about people who abuse the drug. Most people who drink don't become alcoholics.
Now maybe you also want to abolish alcohol, in that case I just don't see any common ground.
I've tried pot for a migraine before and it only made me more nauseous. I'd be willing to try it for other types of pain but it certainly wouldn't be my first choice. I find the side effects mostly unpleasant.
I find opiates far more effective at relieving pain (tooth, back, eye pain after PRK surgery, mouth surgery after a car accident), with the fewest side effects. (I've only had light nausea once.) Running out of medication at the end of a course is a non-issue (I actually almost never finish it), and I notice lower levels of impairment than even a single beer.
But I don't abuse it. I take the larger dosage (500 vs 325? I forget exactly), in a maximum of 4 hour intervals (IIRC), and usually whatever the reason for taking them has subsided to the point ibuprofen alone works fine after about 48-hours.
And you would suggest that should end, without a viable alternative, because some other people abuse it? That seems like a very puritanical position to me.
The article is specifically about the effects of withdrawal when a 12 hour dose doesn't last 12 hours - when people are taking it by the prescribed schedule.
I'm not saying we should ban opioids. I have found them useful on occasion too. But to suggest there's no problem with people abusing them is not a helpful stance either.
I suppose in the same way I think having to pick up Sudafed from the pharmacy these days is silly.
I'm not a libertarian by any stretch but for me this is a sort of sacrificing freedom for security issue. Assumption of guilt and pre-crime is bad and I don't see any reason why people should be forced to suffer needlessly after a medical procedure, even if it's only temporary, and even if someone else found the pain tolerable.
But I think I've beat this horse to death. ;-)
People living with long term pain are at increased risk for death by suicide.
That doesn't mean we should just hand out opiates (which should not be used for chronic pain), but that we should take pain relief a bit more seriously.
Living in pain sucks.
I think that's the important point in the original comment.
The medical community focuses too much on symptom/treatment, and not enough on quality of life. I'm not saying that marijuana is an answer here, and I completely accept anyone who says I'm just using my pain as an excuse to get high, but it lets me feel emotion again, something you wrap up so tight in order to deal with the pain, you forget how to laugh and cry.
Personally I do not believe that GP's should prescribe pain killers. They either under prescribe (fearing everyone will become an addict) or over prescribing (often the wrong drugs).
Pain is a very complex subject (people of different thresholds and biological responses), it should be left to specialists.
They are not substitutes. Just options that may work for patients depending on just what manifests the pain and how they need to manage or cope with it.
One significant consideration is how well a person can function in a cognitive sense on both options. This varies extremely widely among people, and it's not simple to understand what will work for who.
They (opiates) are effective, but do require education and management. I am short on time, but one thing near completely ignored in this discussion is the pain trigger for medication and how that differs from other triggers and addiction.
Secondly, there are natural and effective addiction treatments out there that can work extremely well to get people off opiates. We don't talk about these because money and morals...
I have got myself off them, right along with a dozen others. The tolerance, once understood, and combined with things that work to marginalize withdrawl, is a solvable problem for most people.
Frankly, I've been asked to publish by medical practitioners and so far have not for fear of a legal option being scheduled away for profit.
Just know this dialog is not inclusive. There are powerful interests aligned against making this all workable.
The oxy manufacturers want to sell. The moral authority don't want people to get high, and cannot differentiate that from legit pain management.
Both do not want to face remedies and education needed to keep people out of trouble, and society contributes with an irrational dialog about these things.
In the 90's, I ended up there, did research, solved it for myself and to date, many others.
The dialog is broken. We can manage this to a net benefit for the vast majority of problem cases today. That we don't have THAT discussion is the problem, not the drug.
BTW, it has a 4 hour effective life, not 12. This is widely known. The whole 12 hour relief line of discussion is avoidance. True. 4 hour relief being bad is also avoidance, given there are meaningful, workable options out there today.
https://news.ycombinator.com/item?id=11649447
https://news.ycombinator.com/item?id=11649653
I'm not saying "Don't ever prescribe opiates". I'm saying "Don't prescribe opiates as a first option".
> Personally I do not believe that GP's should prescribe pain killers. [...] it should be left to specialists
I agree. I didn't point it out, but that's what the guidance that I posted earlier says.
If you're in your twenties, and you fracture a bone, the really bad pain will last for a day or two max. It's better to take over-the-counter pain meds and suffer through what pain remains than to jump immediately to the dangerous opiates and potentially risk your life going a lot more off-course than just dealing with some pain.
And to reiterate, I am a wuss as far as pain goes. I'm not the kind of person who pushes himself to suffer through pain. But in these kinds of situations, I look at the various paths, and potential opiate addiction is way more frightening than temporary pain.
I've tried gabapentin, pregabalin, duloxetine etc, but had terrible side effects with them all. I was at my wits end before I was put on opioids.
While I may have agreed with this years ago, I'm pretty sure the research shows otherwise.
Also, I'm not sure why pain is considered less important than other medical outcomes. For example, would you rather live in constant pain or lose a pinkie finger? I'd lose the finger and get on with my life.
So to answer your hypothetical, yes, I absolutely would rather deal with some temporary pain and get on with my life in another week than lose a body part for the rest of my life. Who would make the other choice?!
Contrast with getting hooked on opioids and entering a downward cycle of addiction -- the potential outcome there is the very loss of your life, with a higher chance than losing your life from a simple bone fracture. A lot of people die from opiate overdose every year in the United States; it's actually a few thousand more than from being murdered with a gun. http://www.cdc.gov/drugoverdose/data/overdose.html
The problem with opiate addiction is that a lot of people are introduced to it through benign means, like starting off with a prescription from their doctor, or their friend giving them some for a legitimate pain-related reason. The gateway drug argument for weed is bunkum, but the gateway drug argument for some opioid use sometimes leading to more opioid use is very real, and is borne out with the statistics. The CDC has lots of information you can read. It's the biggest and deadliest drug epidemic in the US right now.
My solution: ban all of that. Let doctors learn about new drugs via means funded by the doctors themselves. Before the Internet, that would have been difficult. But now you can imagine specialist medical journals, or special AMA committees. Manufacturers would still try to manipulate that, but doctors wouldn't be grossly outgunned.
That being said, I always used to wonder if it was because I can't take any NSAIDs- it's acetaminophen or nothing for me. This usually means where they could get away with a big dose of Ibuprofin for pain and anti-inflammatory I wind up with oxycodone and prednisone. Which means I usually just gut it out after the first day or two.
I've also heard just the opposite: dr's being afraid to prescribe them or being skeptical of patients' claims of pain out of fear they are just trying to score some pain pills.