Hacker News Reader

Comment by jordanb | Hacker News Reader

This doesn't explain why people turn specifically to opiates and not to booze or weed.

A recent article suggested that Purdue Pharmaceuticals dosing guidelines pretty much guaranteed addiction to OxyContin, by advising doctors to only ever prescribe the drug at 12 hour intervals despite the fact that it wore off more quickly for a large number of patients.

When patients complained about the drug wearing off early, Doctors were advised to not adjust the schedule but instead increase the dosage.

The pain-pleasure-reward cycle when the drug wears off early is what creates the physical addiction, and increasing the dosage only made it worse.

Purdue insisted on a 12 hour schedule because that is the marketing differentiater between OxyContin and generic opiates.

http://www.latimes.com/projects/oxycontin-part1/

View on HN

People do turn to weed when it is legal [1]:

"The researchers found that doctors in a state where marijuana is legal ended up prescribing an average of 1,826 fewer doses of painkillers per year"

[1] http://time.com/4404697/marijuana-opioid-epidemic/

Moreover, certain types of marijuana do a superlative good job of providing non-opiod relief from chronic pain and aren't psychoactive, so in the same way you or a co-worker might have some Tylenol if they're feeling physical pain while at the office, you or a co-worker could use marijuana to manage chronic pain, without their mental state being noticably altered.

That's not to say marijuana cannot be abused nor is it a silver bullet, but in the middle of an opioid epidemic, holy shit, maybe something many people are illegally using to manage chronic pain without causing an epidemic; maybe it might be worth studying? The vast majority of users continue to be productive members of society; judging by the number of states that have legalized marijuana, we should be in the middle of a marijuana crisis compared to opioids, yet no such crisis exists. Yet the DEA classifies marijuana as having zero medical benefit, which makes it almost impossible, practically speaking, to study properly.

"an average of 1,826 fewer doses" is what percent?

5 patients dosed once per day... Not a lot?

Yes, but without knowing what the total number of prescriptions is... it could be 50%, or 0.005%

By the way, props to your nick :)

From eyeballing exhibits 2 and 3 in the paper, it looks like pain medication doses dropped 5-10%. That seems like a lot in only a couple of years.

Some places people seem to turn to opiates. Some places it's speed. Some places it's alcohol.

Quite what results in a given area having a given addiction of choice I'm not sure, but it can definitely vary over time - some parts of britain had a generational thing where the older addicts were all alcoholics and the younger ones were all on heroin, but my father (who worked in probation) said that among his clients other than the choice of substance affecting what sort of physical damage they suffered the rest of the issues were basically identical.

Surely the doctor is responsible for determining the dose and frequency. I have personal experience of this and when the OxyContin and OxyCodone regime was found to be inadequate the patient was kept in hospital for three nights while they tried different drugs etc. and then settled on a Fentanyl patch as the principal pain reliever with OxyContin to be taken as required by the patient. This turned a nightmare into a managable situation with Oxy taken relatively rarely except for the few days immediately following chemotherapy.

My point is that the doctors and the health system are responsible and should not take any drug company instructions as gospel.

This was almost my own reaction. I don't know how time and time again, blame goes everywhere but the providers and the system in place that ensures their almost sole authority.

It's puzzling to me how drug regulation persists in the face of examples like we have. The argument goes "oh, we need gatekeepers to protect citizen safety." But then these gatekeepers proceed to prohibit marijuana as a dangerous substance unsafe for any use, which is absurd, before turning around to recklessly prescribe oxycontin. How is the current prescribing monopoly / regulation regime really keeping people safe? To me, it's only resulted in lack of competition in health care provision, a militaristic police force, a lack of hemp, and an epidemic of narcotic addiction that benefits doctors and hospitals. A physician-police-industrial complex.

If anything, it increases the dangers, because it creates the illusion of safety and shifts responsibility onto a concentrated authority, who has their own agenda and interests that do not necessarily align with the long-term best interests of the citizen in need.

Replying to self long after the edit deadline passed: perhaps I should have mentioned that my experience is in Norway, not the US.

>Purdue has known about the problem for decades. Even before OxyContin went on the market, clinical trials showed many patients weren’t getting 12 hours of relief. Since the drug’s debut in 1996, the company has been confronted with additional evidence, including complaints from doctors, reports from its own sales reps and independent research.

Someone involved in this is getting shot into the Sun, right?

> This doesn't explain why people turn specifically to opiates and not to booze or weed.

I think this is just because they are being prescribed more frequently. Unhappy people with no opiate experience aren't just going out on the street and buying heroin, but unhappy people who are prescribed opiates may become addicted. The argument the article is making is that happy people who are prescribed opiates don't become addicted, and that it makes more sense to treat the unhappiness than to restrict opiate prescriptions.

Wow I feel lucky in a way that my nausea and lightheadedness was so bad when taking oxy that I decided to just take the pain than continue with the liver damage.

its mainly the acetaminophen (tylenol) that its cut with that would damage your liver the most. when people overdose on oxy, the biggest concern is the tylenol.

I'm not saying its great on the liver, but under normal dosage and (provided you dont have liver disease) its safe. about as safe as having a few beers at the bar at least.

People do true to other drugs, but opiates are better at numbing pain, including emotional pain, than cannabis or alcohol.

Reply on news.ycombinator.com