Researchers are beginning to disentangle pain relief from addiction and overdose

Interesting, but I just listened to Econtalk podcast[1] where the guest, author of the book Dreamland about opioid epidemic[2], claims that all this epidemy only started at first place because researchers at the time claimed that opioid based pain relief medicine was disassociated from addiction (and pharma companies gladly played along).

Except it wasnt.

Very worthy your time listening to this guy if you are interested in the topic.

[1] http://www.econtalk.org/archives/2017/01/sam_quinones_on.htm...

[2] https://www.amazon.com/Dreamland-True-Americas-Opiate-Epidem...

When I was 18 I had a pretty major surgery (Nuss procedure, to correct pectus excavatum, good times) which required an epidural in my spine.

When I was being prepped, the anesthesiologist joked "ready to feel the best feeling your body will ever experience?"

He wasn't joking - my entire body felt like it was floating, my mind cleared of every negative feeling, and for the 15-20 seconds I remained awake, I honestly thought I was in heaven.

I can totally understand how someone could get addicted to that feeling.

I refuse to take opioid pain relievers anymore :( After my knee surgery (subluxated knee cap, hyperextension, multiple tears, loose bodies in joint), I was prescribed oxycodone. I felt very happy, very relaxed (usually I would consider myself high anxiety). But after the dose wore off, it felt terrible and I felt a craving even know my knee necessarily wasn't hurting. That up/down cycle scared me and I realized why people become addicted to these pills and that I'm probably at risk. I flushed the rest and asked the doctor for a NSAID alternative which he was able to find a good one for me. Prescription medicine shouldn't leave you craving more.

The root of the problem may be our inability to very accurately remember pain intensity levels over long periods of time. Evolutionarily, it's important to remember that something was painful; but not that it was exactly 6% more painful than some other sensation, or even 40%. So we don't, and we therefore lack the most important bit of information to get us off painkillers.

The CDC says there's no evidence opiods reduce pain (at all) in the long run, and that's been my experience, too. But when you don't remember previous pain clearly enough to be sure you're back where you started (despite the drug) and you know that even partial withdrawal is really painful; it's easy to believe that the drug is still doing you good.

In my experience, this means that most who people taking opiods for long periods end up back at their old pain levels, but aren't able to clearer remember what their pain was like before, whereas they know all too clearly that less painkiller means more pain right away, so they stay on the drugs. Even though they may now be getting no long-term benefit in reduced pain. But once they complete withdrawal they'll tell you that they don't seem to be worse off, for pain now that they've fully quit the opiods. Their pain levels seem about the same.

Evolution has robbed us!

Prove this, and most of the arguments over opiods for chronic illness and pain may end.

For some reason, I kind'of always assumed the act of removing pain was itself the addictive part. But now it seems obvious that a drug could simply make you feel as you did right before hitting your thumb with the hammer.

So the peer reviewed work cited indicates a decreased level of nausea, but says nothing about addiction:

https://www.ncbi.nlm.nih.gov/pubmed/24954166

There's the study on monkeys later on, but that's talking about BU08028, which isn't mentioned as being an active component of Oliceridine (the main drug being promoted in this article). I actually don't see anything here that makes the claim that Oliceridine will be less addictive. It appears to just be a conclusion that people are supposed to assume is implied without a close reading of the article and information.

I'm recovering from a car accident and they gave me plenty of opiates in the hospital. Honestly I didn't see the appeal outside of pain relief.

For pain relief they are great. I went from "I'm being eaten by a bear" to "Meh" pain levels in minutes. But other than that it wasn't too pleasant. There was no euphoria just dizziness and constipation. As soon as I could switch to Ibuprofen, I did.

According to my doctor, there is a genetic component in how people respond to opiates. Guess I was lucky.

What I find weird is that it seems like the body can be in permanent pain, but it isn't able to achieve a permanent state of feeling good.

For instance, there are people with spine damage who feel chronic, unrelenting pain every day of their life. On the other hand, for any drug that makes you "feel good" (oxycodone, morphine, even Adderall), your body eventually builds a tolerance and requires more and more of that substance to achieve the same level of "happy". So why doesn't the body do that with pain — where it eventually gets used to your "average pain state" and requires ever more intense infliction to feel the same level of "hurt"?

On a domestic flight I sat next to a physician. During our chats we talked about the opioid epidemic and he pointed to a push by pharmaceuticals to make pain a distinct item that needs to be treated. And how this in part led to the runaway addictions. I had thought it was purely socio-economic reasons, but the big pharama angle was new to me. Curious if there are sources for this.

Interesting. It would be good to have more ways to relieve pain, and ways to help patients avoid addiction.

One of the best ways to help patients avoid addiction would be to decriminalize these compounds and reduce or eliminate the prohibitions against them. That's a strong statement, so please allow me to make the case.

(1) the iron law of prohibition says this: prohibition drives out all but the most potent, and hence easiest-to-smuggle, formulations of the prohibited substance. During alcohol prohibition in the USA, NOBODY smuggled lite beer. It takes the Busch Clydesdales to move the stuff around, and it's too obvious. It was ALL strong stuff like whiskey and "white lightning." The most potent formulations of opiates are easier to misuse in a way that promotes addiction.

(2) a corollary to the iron law is this: people without training in chemistry or sterile procedure will adulterate the strongest stuff so they can sell more nickel bags, or whatever, on the street. That makes the dosages unpredictable. Unpredictable dosages promote addiction by unpredictably pushing a user's thresholds. Adulterants can be be dangerous and can induce pain.

(3) if the stuff's illegal it's expensive. Then addicts have the incentive to sell some to their friends to help pay for their habits. Teenagers get addicted this way.

(4) offering the substances to addicts at reasonable cost in competently supervised circumstances allows for a variety of treatment options for addiction. At the same time, addicts' lives don't fall apart. Treatment regimes can, brought out of the shadows, be examined for their success rates by agencies like Cochrane: http://www.cochrane.org/CD011117/ADDICTN_opioid-maintenance-... . The current "state of the art" in treatment is cold-turkey twelve-step. It works for some people, but is it evidence-based? Sure it's evidence based, like reducing stress helped people with stomach ulcers until pylobacter was discovered.

(5) if the government stops demonizing addicts as they have been doing for almost a century then they can come out of the shadows and deal with their problems.

(6) decriminalization weakens the incentives for pharmaceutical companies like Purdue Labs to create supposedly "safe" time-release formulas like Oxycontin, and then promote those formulas in ways that lead to addiction. http://www.latimes.com/projects/oxycontin-part1/

(7) We won't have to hear news about people with names like El Chapo any more. Any aura of underworld glamour around this stuff will evaporate. It will become boring and fluorescent-lit like pharmacies should be.

Why is this change difficult? It challenges the narco-industrial complex. Decriminalization means lots of police will be laid off. It will cut profits for big pharma. It will cut government revenues by cutting into civil asset forfeitures. http://www.newyorker.com/magazine/2013/08/12/taken

It's also difficult because of recent successful efforts to decriminalize cannabis. The successful argument in Massachusetts USA and Colorado USA for decriminalization has been one of recreation. "It's safer than alcohol, so go for it." That's obviously a crazy argument to make for decriminalizing opioids : because it's NOT safer, and because it plays into peoples' prejudices (see point 5 above).

Before the article even begins it gives erroneous information: "Morphine is extracted from opium, a compound found in the seeds of the opium poppy."

Edit: The research looks interesting though.

This reads like an advertisement. Also, my nurse friend said only older doctors use morphine. Most hospitals use fentanyl now.

As someone with irreparable nerve damage (and has to ration pain meds as a result) this is incredible news!