With a 10-day supply of opioids, 1 in 5 become long-term users
arstechnica.com
arstechnica.com
As a disabled veteran with nerve damage I am rationing pain medication daily. I cannot afford to have a manageable pain day due to the fact I might have a week of excruciating pain.
As you may or may not know, little can be done for functional nerve damage. Some experimental procedures are available but in general, only the symptoms can be treated. For me this means a lot of different muscle relaxers and an opiod for when things are beyond control.
But, the opioids have become increasingly more difficult to get prescribed because of recent DEA rule changes and legislation affecting these medications.
This basically means, for me at least, I will take my own life at some point as the pain will be too unbearable and I won't be able to acquire the medications necessary to control it.
In January of 2014 I broke my hand. Not just a fracture. I completely shattered my second metacarpal in my right hand (my dominant hand) and did extensive damage to the surrounding tendons, ligaments, and skin. The surgeon who put my hand back together said it looked like a gunshot exit wound without a corresponding entrance wound. The entire top of my hand had been flayed open. After the surgery I was given hydrocodone, enough for a week. The only reason I didn't just kill myself that week was because I had pain killers. When the dose would wear off the pain was unreal, blinding, and totally consuming. The only worse pain I've ever been in was the night I broke my hand.
Needless to say I had the prescription refilled weekly until my second surgery three months later to take out all of the pins. And again for three months after that until my third surgery to release the tendons so I could use my hand again. And for three months after that while I did thrice weekly physical therapy. I cannot emphasize enough how much I needed the pain killers just to get through life for those nine months. Even with them there were some nights I couldn't sleep because the pain in my hand was so severe. Of course, by the end of the nine months I was pretty well physically addicted, but, knowing my time was up I tapered off and haven't needed them since. For another six months I still needed frequent acetaminophen and ibuprofen to take the edge off of the throbbing in my hand.
I'm not saying at all that there isn't a problem big with opiod addiction. But recent conversations I've seen about opiods leave me with the impression that most people just don't get it. They think that either people just need to deal with pain or that some sort of non-medicine alternative is what's needed for most people on opiods. And that may be true for some. But unless you've been in the kind of pain that makes you seriously consider killing yourself I don't really think you can appreciate just how important opiod pain killers are to some people. I'm afraid we're going to lose something that helps a great deal of people all because we have this idea that addiction is somehow a moral failing and we've structured drug policies around that belief.
About six months after moving into my house I was fed up with the janky garage door opener that came with it so I went to Home Depot and bought a new one. I managed to assemble the new one myself with only a few hiccups. It then came time to remove the old garage door opener. I first took down the actual motor unit that was attached to the ceiling and got it set on the ground with the rail still attached. The end of the rail was attached to a metal bracket that formed a right angle with lots of holes for bolts to go through[0] which was then attached to the drywall above the garage door. I got up on a ladder and set to removing the bolts. The last bolt, unbeknownst to me, was attached to a piece of metal through which the garage door spring went [1].
What happened next all tool place within maybe 1/4 a second. As soon as I turned the socket wrench enough to loosen the bolt I heard a loud pop and felt something hit my hand. HARD. I looked down at my hand and saw blood. "No big deal, I cut myself on things all the time. We've got lots of bandages." Then I noticed the subcutaneous tissue (your hand doesn't have much, but there's still enough that deep cuts look different). "Okay this is gonna need stitches, I better get down and take care of this." And then I saw the bone. "ohfuckohfuckohfuck."
I hopped down off the ladder and ran inside and started screaming "CALL 911!!!" to my girlfriend who was upstairs. I made it to the kitchen where I got a dish towel, put my hand on the counter, and clamped down as hard as I could. The paramedics arrived about 5 minutes later (we live very close to a fire station). By then I'd calmed down but was so full of adrenaline I could barely hear or see anything. At one point I blanked out for maybe 30 seconds? I'm not entirely sure. The EMT said it was an adrenaline dump and that it was fairly normal. Of course when I got to the ER every single nurse who heard the story said I was lucky to be alive. If it had hit my head it would have caved in my skull (and I was on a ladder...). Apparently that happens more than you'd think.
They eventually hooked me up with a drip of hydromorphone. "This is the good stuff." one nurse said. Bullshit. I was in so much pain it barely did anything. It brought it from 10/10 to 9.5/10. That's using my new 10 point scale. I thought I'd experienced a 10 before when one time my dentist started drilling before the lidocaine had fully kicked in. I'd put that at about a 6 now. I really cannot describe in words how bad the pain that night and the following months was.
My hand is a lot better now though. The third surgery gave me back my mobility and the physical therapy got me back up to about 60% of the strength I had before. I'll never be able to point straight with my right index finger, but I can make a fist and type. As a programmer both are very important.
[0]: Exactly like this https://mobileimages.lowes.com/product/converted/040395/0403...
[1]: Basically this, except mine is shaped slightly different http://www.truetex.com/gar913.jpg
Very very scary stuff, large springs. Even small ones are not without danger (think old alarm clock springs, those can take an eye out when they let go).
Best of luck with your recovery, I really hope you get back to 100% functionality. And thank you for sharing the story, it just might help save someone else from doing something like this.
edit: more risky springs are found in the suspension of vehicles, don't mess with them without the right tools and knowing what you are doing.
I recently helped a neighbor with his broken spring mechanism (old 60s house in San Francisco). The whole thing was made out grossly inadequate metal which had sheared. What started out as a simple welding project turned into substantial reengineering just to get the door to work to get his car out.
Final lesson: steel fatigues and cracks from work hardening and bad tolerance installation. If you have an old door mechanism, don't trust it. Replace it. They're moderately expensive, but the modern ones are not nearly as hanky as the older ones. Don't DIY a garage door unless you have good levels of hands on fabrication experience and a good practical knowledge of what type of fasteners to use to anchor the door hardware to the building substrate. (I.e. Deck screws won't work.)
I hope you will improve further.
I think what's missed is that there's no evidence that long term high dose opioid use does anything to treat pain.
We have lots of evidence of harm caused by long term use of opioid medication.
The problem with the current US crackdown on opioids is not reduced use of opioids, but with the lack of anything else being offered.
People with long term pain need a package of care, probably provided by specialists in pain management. That package should include exercise (where indicated), psychological help, alternative prescribing, and if needed some opioid prescribing.
The only thing I noticed when I started taking it (other than the fact I could actually function again) was that it makes me tired and the withdrawal if I forget to take it/forget to fill a script is pretty horrible.
It only increases diversion to the black market by directly increasing demand. My own grandparents have had to buy pain pills in the past.
Doctors are terrified to prescribe painkillers to those in need lest they be prosecuted by laymen who think they know better. Pain is being under-treated now more than ever.
My ER has a massive info-poster in the lobby explaining why I won't be receiving dilaudid, fentanyl, or oxycodone.
Opiates are in the news every other day, either prescription abuse or fentanyl-laced heroin stories in local and national paper as well as cable news.
What good has it done? There will always be abusers.
Like DRM only hurting paying customers, stricter regulations and lawsuits against doctors ironically only end up hurting non-abusers.
Dependent folks, like my grandparents, who get a massive quality of life increase thanks to these drugs, especially considering the lifetime of abuse they've put their bodies through, and been through.
That's who ends up getting the shit end of the stick.
Not the junkie. Someone's Grandma. A vet.
Yes. I know people with chronic illnesses (of many types) who've had to resort to various black markets for opioids, all this stupid "diversion control" and trying to shit-test patients in the ED to see if they're "drug-seekers" actually has a deep and nasty cost.
Of course someone who presents to the ED with a physical condition that causes immense pain is, inherently, going to be a "drug seeker". So now people need to be all "tsundere" about that (i-it's not like i WANTED you to prescribe me opioids, or anything, BAKA!), and pretend that they don't know what drug/dosage works for them (apparently, it's only opium-seeky people who know anything technical about opioids) even if they're well-versed about what works for them and their medical condition. It's a very nasty and adversarial state of affairs, that screws over everyone.
The DEA (and other flavours of doorkickers) targeting doctors and deputising them as law-enforcement agents who have to decide between the evil undeserving addicts and the deserving patients in pain is what has created this affair. Blame the prohibitionists, as this is a problem of their own making -- the crackdowns on "pill mills" and "overprescribing doctors" is what denies people a safe and legal source of pharmaceutical-grade opioids and forces them onto the black market of illegal, overpriced, and fentanyl-contaminated opioids (which leads, of course, to the deaths that are used to justify even more crackdowns).
Crackdowns on "over-prescribing" invariably lead to people who experience chronic pain being denied medical access (or being subjected to extremely invasive and degrading treatment to weed out "drug seekers"). The DEA cracking skulls over opioids and investigating doctors is literally the only reason illicit fentanyl (and its even more dangerous analogues like carfentanil) even is a thing. I am so very doubtful that more door-kicking and prosecutions will miraculously work after decades of it making shit worse.
The doctor looked at me for a moment and said that as you are using that term, benzo, you are aware of its abusive use. In no circumstances can we prescribe the drug same drug for you, since that would include doctor supervision before, during and after its consumption. After that the GP wrote something with the keyboard and proceeded to ask me how exactly was I able to get these drugs. I told the scenario after which I has been prescribed the drugs. The doctor responded that it sounds maltreatment to prescribe the said drug in such circumstances and that my story sounds odd. He said that he cannot prescribe me any drugs at this time.
I'm now concerned what the doctor wrote to the state wide system and whether that might affect my treatments in the future. Either way, this whole paranormality over "drug seekers" is insane -- the GP did not even suggest seeing a specialist or offer alternative drug. He just declined and became anxious which I read as he wanted me out of his office as soon as possible. He was young, I give you that, but it makes me wonder what kind of horror stories do they tell about my kind of "drug seekers" in the med school.
You have the legal right to review such entries. You also have the right to have erroneous entries corrected. If you're worried this might cause issues with future treatment, the sooner you act the better.
See: http://www.hus.fi/potilaalle/potilasasiakirjat_tietojen_sala... http://www.hus.fi/potilaalle/potilasasiakirjat_tietojen_sala...
Benzos are pretty terrible. That second doc did you a favor.
The only somewhat useful advice I have to offer is to quit smoking if you do smoke. Smoking increases the base anxiety level quite a bit.
I knew that when I saw the GP, hence the "last resort". My experience with the drug was morbid as well -- the world felt soft for an hour, after which I would pass out. I would wake up in 4-6 hours feeling normal again. Only later did I find out that the aforementioned side effects with the additional and overlapping prescription of codeine, I could have died in my sleep.
But the point being, I am no doctor and I was living in a confusing state of mind. So when I went to see him, I thought that benzos are the way to treat me. But instead of being referred to a mental health department or given beta-blockers as a less intrusive medication, I just received a no as an answer. It left me with mixed feelings. I mean, the doctor was right that the benzos were not the solution, but he should have told me what I need, instead of just declining what I want.
Luckily enough I was able to accept the fact that I could be mentally ill, so I sought appropriate help by myself. Luckily, my case was handled by psychiatric who taught me how to treat the pre-cursor to my anxiety, the panic attacks, instead of the anxiety itself. When I learned that I could handle the panic attacks just like any emotion -- and without drugs -- I was able to shrug the anxiety away.
Condemning a patient who seeks opioids as a treatment when they don't know for better is not much of a favor. I felt like I was treated like a drug abuser and my state wide profile most likely now states me as a possible one. All of this because I could not remember the translation of the drug and instead referred to it as what I have seen thrown out on the Internet from time to time. I would not be surprised if I would have received better treatment would I have had referred to the drug with its marketing name only, but I did not think that would have helped much in a foreign country.
Also thanks for the smoking tip! Although, I do not smoke, but I do moderate the amount of caffeine I consume nowadays. Getting over the panic attacks did require quite a few lifestyle changes in addition to self-reflection.
The risk is real, but it's more geared toward recreational users.
Taking therapeutic doses of codeine (to which you become tolerant) along with whatever benzo that doctor gave you (ativan, xanax, clonazepam, whatever) also at therapeutic dosages doesn't present a huge risk of respiratory failure, IMO.
Harm reduction communities shout DO NOT MIX because if you don't, the teenagers asking these questions on Bluelight and Reddit will say one of each is safe, why not two of each? etc until they're dead. They're abusing the drugs, see. That's the difference.
If you weren't abusing them, you had little to no chance of dying in your sleep. At least not from 30-60mg codeine + 1mg of xanax.
Anyway, this class of drug can steal your soul. I speak from experience. Abuse of them only leads to one path, a path that involve seizures and mood swings.
Thankfully I was eventually able to get a prescription for an effective opioid, after an NSAID-induced bleed almost killed me.
The experience made me write up an Advance Decision (Living Will) to make it clear that if I'm ever unable speak for myself, I want my pain or mental distress to be adequately treated. The thought of being in severe pain or anxiety, and being left to suffer, terrifies me.
There are a few options that let you shift the balance one way or the other, but the parent is saying that they're leaning too far towards leaving people in pain from a fear of creating drug addicts.
Especially since it's not affecting end of life treatment, which is where people really care abut it.
The insurance company has the gall to tell his doctor they know better, and often want the doctor to justify the prescriptions. My grandfather is on deaths door, he stays alive through sheer will. The doctors gave him 2 years to live...6 years ago. Fair to say that's end-of-life, right?
I moved out here to take care of them, so I'm in the thick of this day in, and day out. Insurance companies, Picking up prescriptions in triplicate in writing and hand delivering them, etc. I'm scared to pick up the controlled substances alone because of the way the clerks look at me, so I have to drag one of my poor grandparents to the pharmacy with me, again and again. every month.
Why do you think they're looking at me funny? It's narcophobia. They think I'm an addict pulling a fast one.
Keep that in mind next time you say it isn't affecting end-of-life care.
Someone's grandfather out there was and is affected, directly, by the recent upswing in what can certainly be described as "narcophobia."
A doctor shouldn't have to explain himself to a fucking insurance company, ever.
If I paid my premium, pay my fucking bill. Keep that corporate nose out of my personal medical affairs and pay the bill like I pay you to do.
I'm sorry, but you painted with such a wide brush that I couldn't help but retort.
Unless you meant hospice care. In which case you're probably more wrong. These guys are trained sticklers. The second your love one stops breathing, hospice will be there not to comfort you, or have a kind word. They're there to bag up all the painkillers and fill the bag with kitty litter.
If that's not narcophobia, I don't know what is.
You can't undertreat pain and expect the problem to go away, btw. All that does is encourage blackmarket diversion of legit meds.
The harder you make it to get them, the more money they'll be worth, the more risk people will take to steal them wholesale. Expect more delivery truck robberies, more pharmacy hold-ups and break-ins. There will always be abusers, no laws will change or reduce that.
Was this in England?
If I understand pain theory correctly, there isn't really a good way for a doctor to do a test and say "you are really in insane pain" vs "2 advils will cure you".
Then the choice is either:
a) Be generous with pain meds. Some abusers that don't need it will get them to either use or resell. Some will lead to deaths, due to addiction or increased supply on the black market. But all people in real pain are treated.
b) Be stingy with pain meds. Some legit people in pain could end up taking their own life due to not being able to live with the pain. But there will be less deaths and addiction outside of people in pain.
As a society, it seems a hard choice. Either way some very vulnerable people are going to be hurt. Ideally we would come up with better pain meds with no abuse potential, but that doesn't help things right now.
Removing access to medication doesn't remove the primary cause driving people to seek drugs, be it pain or psychological issues. I suspect people with high abuse potential will just resort to alternatives: street drugs or alcohol.
It seems fairly common that professional working people get on an opioid for something (say a fall), and then become addicted. These people can live for years on the Opioid, perhaps working a professional job. Now sure, if you ban opioid they could go and buy some black tar heroine and meth... but I am doubtful 100% of people would make that jump.
Alcohol is a different beast. Obviously some people become addicted, let's call it 10%. But 10% addiction rate is a lot lower than a 99% addiction rate that long term opioid use has.
So the net benefit of less opioids is almost certainty going to be less people addicted to drugs.
The response of abusers to the reduction of everyone's
access to medication does not depend on where you
stand on the war on drugs; it is, or will be, a matter of fact.
Maybe more evidence is needed, but pseudo-quantitative
arguments with made-up statistics that support your
view on the war on drugs are not evidence.
In the transition, you drive the usage of illegal drugs through the roof and spike the number of deaths. It's possible that these behaviors, once prevalent, take generations to switch out of, by which time, it's entirely possible that our formulation of drugs will be better.
So even if B would be better now, it's possible that our transition from A to B is pointless (the problem would have solved itself in the same time) and leads to a worse outcome than just remaining with plan A.
This kind of secondary analysis is usually totally missing from these debates, but is what is actually driving the harm of the opioid crisis.
One view is to say that you may need to have short term struggles to get to a long term better place. Which may be true, but it also depends if the new long term place is actually a better place - or did you do a lot of short term struggles for nothing?
c) Develop that missing test
The technology was developed for assessing pain/discomfort of unconscious people - who can't participate in the "which face best describes you" assessment game
This is an almost offensively simplistic depiction of long term pain.
Those people with the bad backs are not all faking it; it's not all in their heads; they have real pain and it's debilitating. They need something to help them live.
And your A / B choices are wrong too. You give people with long term pain access to pain management clinics which include psychological support; explanation that pain treatment will usually not be able to prevent pain; access to physiotheray and exercise (although these don't do much for some types of long term pain) and access to medication - and this will sometimes be opioid meds.
> As a society
Why is the US getting it so wrong though? Why is the US prescribing such vast quantities of opioids?
I am not sure if we agree or disagree. There ARE legit people with bad backs that need and should get pain meds. There are also millions of people with a prescription to an Opiod that have no actual pain.
For example, see
https://www.theatlantic.com/health/archive/2017/02/kentucky-...
Are you telling me almost 1 in every 2 people in that town have debilitating pain, and NEED Opiods to survive day to day? I cannot believe that is true.
> Why is the US getting it so wrong though? Why is the US prescribing such vast quantities of opioids?
Many reasons.
a) Doctors get paid to do stuff. If you refuse to give medicine, no one will come to you, and you won't get money. So in the doctors financial interest to prescribe.
b) Some people really DO need medicine. Do you risk screwing those that DO need it to spite the rest of the people?
c) Culture. American lifestyle loves pop a pill to fix a problem. If you can equally fix something with physical therapy or a pill, 9/10 people will pop a pill.
People with real pain sometimes should not be given opioids.
Your suggestion (that the problem is fixed if we stop giving opioids to people who aren't in pain) misses the fact that most of the opioid problem is because people in real actual pain have been misprescribed opioids.
No, it's exactly right. There are two classes of people seeking pain medication: those who need it, and those who do not need it. Now, we can argue over who exactly needs the medication, but it is not right to suggest the second category does not exist.
And thank you for your service.
I realize you would end up "high" but I, too, am curious whether you've ever tried it. Given your description and the fact that you almost certainly wouldn't get in trouble.
I realize you work in IT and maybe don't want to get high, so I don't mean to imply that this is a good alternative - just curious, like the other poster. Thank you.
I work in the IT and being high is out of question, sadly it is difficult in the black market to obtain variety that would work for pain without such side effects. It was helpful in the evening to go through the night without waking up from pain. Other medication like for example Amitriptyline, would make you feel tired the next day which is not the case with cannabis.
But I don't want to be a criminal.
Kratom when used sparingly is a good tool, but don't abuse it.
Generally its doesn't "feel" addictive but don't assume that it is without side effects and use it lightly.
I use it about 3 times a week and I limit my dosage to one teaspoon a day. This seems to give me the benefits without the side effects. I don't feel addicted to it and have no desire to consume more than this.
Just a heads up :)
I'd give it a 1/10 on my addiction scale (with 1 - THC to 10 - A Year of Liquid Opium Poppy Daily Dose), and a 5/10 on my analgesic scale (1-Aspirin to 10-Opium Poppy).
I don't think the mechanisms are well understood. It definitely wipes out opiate withdrawal symptoms within hours of taking a small dose. And I've never had any physical symptoms from even month long cessation. I like to say 'my' scale, because efficacy and addictive properties of opiates and opiate analogs like Tramadol and Kratom vary pretty wildly. Tramadol is known to have and Kratom also seems to havem some strong SSRI actions also, not found in the other opiate analogs, Oxycodone, Hydrocodone, or nartural opiates.
I don't have the time to beyond Wikipedia, but there are sources cited in the article. A simple Google search would solve the problem here as well.
The main active substances in Kratom are Mitragynine and 7-HO-Mitragynine. According to Wikipedia[0]:
> Mitragynine is an indole-based opioid and the most abundant active alkaloid in the plant Mitragyna speciosa, commonly known as kratom[1] and biak-biak.[2] Dry kratom leaf contains roughly 1.2–2.1% mitragynine.[3]
> Mitragynine itself acts primarily via μ-opioid receptors, though its oxidation product mitragynine pseudoindoxyl, acts as an even more potent and selective μ-opioid agonist but with less affinity for δ or κ receptors.[9][10] Another alkaloid with a major contribution to the μ-opioid activity of the kratom plant is the related compound 7-hydroxymitragynine, which, while present in the plant in much smaller quantities than mitragynine, is a much more potent μ-opioid partial agonist.
Mu-opioid receptor agonism is how opioid drugs of abuse work.
Kratom contains opioids that bind to mu-opioid receptors in the brain and opioids that bind to mu-opioid receptors in the brain cause opioid addiction.
Take Kratom every day for two weeks and get back to me.
These are side effects you experience under Kratom intoxication:
> respiratory depression, constipation, histamine release and build up of tolerance (which is what leads to withdrawals upon cessation)
Each and every one of those.
Anyway[0]:
>RESULTS: More than half of the regular users (>6 month of use) developed severe Kratom dependence problems, while 45% showed a moderate Kratom dependence. Physical withdrawal symptoms commonly experienced include muscle spasms and pain, sleeping difficulty, watery eyes/nose, hot flashes, fever, decreased appetite, and diarrhoea. Psychological withdrawal symptoms commonly reported were restlessness, tension, anger, sadness, and nervousness. The average amount of the psychoactive compound, mitragynine, in a single dose of a Kratom drink was 79mg, suggesting an average daily intake of 276.5mg. Regular users who consumed ≥3 glasses Kratom per day, had higher odds of developing severe Kratom dependence, withdrawal symptoms, and inability to control Kratom craving.
> CONCLUSIONS: The findings from this study show that regular Kratom use is associated with drug dependency, development of withdrawal symptoms, and craving. These symptoms become more severe with prolonged use and suggest a stronger control of the drug.
I've been taking it almost every day for over a year.
There is no respiratory depression, and no build up of tolerance - the dose that was originally effective still is. I am not addicted; there is no compulsion to take it other than to reduce my pain.
I also stop taking it every now and then, just to check if the condition I have is showing any signs of going away - I get a very mild cold-like feeling, nothing more. Honestly, when I've stopped caffeine before, that was harder.
I was also in your shoes and told myself the same things for a long time. I had quit a few times, for long periods of time, and told myself it wasn't that bad. But each time I quit, withdrawals got worse. It won't be a mild cold-like feeling forever.
If Kratom use isn't negatively impacting your life, your dose isn't escalating and it works for you, then I'm genuinely glad that you've found something to manage your pain.
My mom has been on low doses of hydrocodone for degenerative disk disease for decades now, that works for her as well.
However, both are opioids and they carry the same risks all opioids do: opioid addiction. It would be unfair to those who are opioid and Kratom naive to pretend that addiction and all the fun facets of opioid abuse are not something inherent to Kratom. I bought into the "Kratom is safe and non-addictive" sales pitch as a teenager and suffered immensely for my naivety.
The biggest factor in how it affected me was my complete opiate-naivety. I had never once taken an opiate before, therefore Kratom was subjectively powerful to me. Much like someone taking their first drink or smoking their first joint, I became very intoxicated.
I think the latter is a likelier explanation than a multi-national, multi-continental conspiracy between 14 disparate supply chains to adulterate only my supply of Kratom and no one else's.
> seven years almost every day
After two years, my initial doses of Kratom felt much like a cup of coffee because of tolerance.
Someone who has never taken an opiate before is going to have vastly different responses to Kratom than someone who is well into their 7 year Kratom habit.
Once you've built tolerance and gone through the dependence / withdrawal cycle, you will never have the same consistent response to opiates as you did when you were opiate-naive. Last year, I had the rest of my wisdom teeth taken out. I was prescribed 5mg Vicodin. It helped with the pain, which was very bad, but it honestly wasn't noticeable that I took anything narcotic. 7 years prior I had the same operation and was given the same medication. One 5mg Vicodin has me on my ass for hours back then.
You mention tolerance, nodding, respiratory depression, histamine response and constipation... this is odd.
Constipation from kratom is nothing compared to other opioids; I just take magnesium and everything works fine. Sometimes I have to go out of the country with work, in which case I take dihydrocodeine (which is prescribed to me, but kratom works much better) - that causes far more constipation (and I also have to go through rather unpleasant withdrawals after very such trip as I switch back to kratom :(
Histamine response from kratom is also much less than other opioids - and I say that as someone with symptomatic dermographism.
And the oddest of all, respiratory depression - I'm on mobile so don't have sources to hand, but kratom has been shown to absolutely not cause respiratory depression. I know there have been cases of kratom being spiked with potent opioids such as O-desmethyltramadol, and honestly it sounds like you've had something like that. Did you buy from a head shop?
I was completely opioid-naive at the time. A teaspoon or two of Kratom had the potential to knock me out for a few hours at that point in my life.
> Histamine response from kratom is also much less than other opioids - and I say that as someone with symptomatic dermographism.
I don't have much to compare Kratom with, but I would end up scratching myself all day and night without realizing how hard I was doing it because of the analgesia.
> And the oddest of all, respiratory depression - I'm on mobile so don't have sources to hand, but kratom has been shown to absolutely not cause respiratory depression.
At that time, I would combine Kratom with the benzodiazepine I was prescribed and noticed a difficulty breathing and a drop in my breathing rate. On its own, it was pretty insignificant.
> I know there have been cases of kratom being spiked with potent opioids such as O-desmethyltramadol, and honestly it sounds like you've had something like that. Did you buy from a head shop?
I bought from different online bulk suppliers and vendors, sourced from different communities and referenced with independent rating systems. Plain leaf was pretty consistent across the better vendors.
I don't know if this applies to nerve damage pain, but cannabis has a quite a history of being effective with pain.
https://www.rcoa.ac.uk/faculty-of-pain-medicine/opioids-awar...
Self poisoning is a common method of suicide (second most common in the US) and opioid medication are the most common meds used.
Your single study is going to have to be remarkable to persuade me over that.
Looking at the study, they didn't adjust for this at all. Also, keep in mind: 1 in 5 are continued on prescriptions, which are given by doctors who assessed the situation and thought it was OK to continue it. It's NOT saying that 20% of people who try opiates for 10 days become hopelessly addicted, which the clickbaity headline implies.
The deaths figure - 91 per day or about 33K per year - seems to be the deaths of all opioids (including heroin abuse, etc.) and not the prescription opioids, which are half that:
https://www.drugabuse.gov/related-topics/trends-statistics/o...
Moreover, prescription deaths are relatively stable for last 6 years (though lower before that) while heroin deaths are raising quickly.
I spend a lot of time listening to podcasts where addiction medicine doctors talk about the state of their industry. Their views and their guests views, are almost in complete alignment and those views are the exact opposite of the comments in this thread. I find that alarming.
If you listen to addiction medicine doctors, they will tell you:
1) There is a massive epidemic of opioid addiction. Opioids are wildly addictive and are negligently / over prescribed.
2) There is little evidence that opioids provide benefit for long term chronic pain and evidence that long-term use of opioids actually causes many problems. Getting off the opioids tends to reduce the chronic pain.
3) Patient surveys rule supreme and patients want pain-killers even if the doctor does not believe they are the solution.
Anecdotally, if you watch the A&E show "Intervention", the number of opioid and heroin cases has shot through the roof since the series started two decades ago. There has been a titanic shift in addiction. It's painful to watch some of these addicts lie to their doctor to get opioids, turn around and sell them, then use the money to get heroin because the opioids aren't strong enough anymore.
This comment thread really saddens me.
[1] http://abcnews.go.com/US/prescription-painkillers-record-num...
The fact that I'm a software developer (making a living legally) and not taking and/or selling heroin is an anomaly.
I honestly don't get what most of the other commenters are going on about. The stats are pretty widely reported on the massive increase in opioid abuse.
They must live on the coasts or otherwise have avoided what has been plaguing many states in recent years
http://www.economist.com/blogs/graphicdetail/2017/03/daily-c...
Here's a long but very informative article outlining a few important issues plaguing the US, drug abuse playing a significant part:
https://www.commentarymagazine.com/articles/our-miserable-21...
As far as I could tell, the morphine did nothing. I remained in significant pain for a few hours while I awaited treatment.
It's impossible for me to say why. Is morphine just ineffective for that sort of pain? Or was I underdosed to prevent negative interactions with the drugs they gave me later? Or was I underdosed as a precautionary measure for opiates due to addiction?
All I know is that I'm afraid of ending up in pain in the future and being denied effective treatment out of misguided concern that I will become an addict.
I do not fear addiction. I fear pain.
This seems to illustrate the US mentality towards opioids: I had a similar accident and the fracture itself didn't really hurt but the muscle tension was indeed very painful and all I got in a Belgian hospital was some Brufen (Advil in the US if I'm not mistaken) - and that did work. In Belgium opioids are generally looked at 'only if it's really necessary'. Belgium does have a severe problem with prescription antibiotics though.
A broken arm is not long term pain. Most doctors are not worried about opioid use for short term pain.
My personal struggles in this area, in hindsight, were not primarily fed by a desire to satiate a craving or desire or need, but rather much more by a fear of future pain.
Ideally, this comment shouldn't lessen the struggle of those who have to deal with pain, but it should increase our empathy with those who struggle with addiction, because I'm willing to bet that in many if not most cases, there's a crippling, intense fear of pain underlying it. How rational that fear is doesn't really matter.
I've seen people with a legitimate need to alleviate pain succumb to addiction. I've also seen people who 'should' be fine succumb to addiction because of less-visible, mental anguish. It seems to me both cases, and the usual murky area in between, deserve study, empathy, and solutions.
Here's what it says about adjusting for pain intensity:
> Third, information on pain intensity or duration were not available, and the etiology of pain, which might influence the duration of opioid use, was not considered in the analysis.
For instance, a recent study in Nature Medicine[1] showed that you could decouple the positive analgesic (pain relief) effects of opioids from the negative effects of increased tolerance to opioids and increased sensitivity to pain. This is critical because tolerance to the effect of opioids and increased sensitivity of pain to opioids is part of what drives increased use and eventually abuse of opioids.
The practical upshot of this study (if validated) is that you could potentially take a smaller amount of opioids and not have to increase your dose over time to get the same level of benefit. This could severely limit the mortality associated with opioids.
I am hopeful that we will get through the opioid crisis in this country if we invest money in fixing the underlying physiological problems associated with these drugs.
[1]http://www.nature.com/nm/journal/v23/n2/full/nm.4262.html
These should be treated as treatments of last, not first resort. In both cases, marijuana would have been a more appropriate for pain relief anyway (though I did not use any).
A hypothetical prospective study, obviously impractical on multiple grounds -- one that chooses study subjects from the population at random -- might produce a completely different result.
Or the outcome might be the same -- for ethical reasons that deserve to exist, we may never know.
For anyone needing opiates as pain medication, I would suggest taking them only in response to acute pain, not as a regular dose, although this may not be possible for chronic sufferers. It's a difficult situation, the best painkillers are horribly addictive and socially stigmatized.
Opiates however... they really work. They really make the pain go away. Which is why I stay the hell away from them. :-(
I've never taken opiates for pain, only occasionally for cough (tussin + codeine during a bout of pnuemonia and again when I had bronchitis, and low dose vicodin once for about a week one winter when my asthma was extremely bad and I couldn't sleep because of the coughing).
I had no idea how addicting this is for people. Personally, I didn't like how it made me feel, so I can only wonder about different people getting different types of "buzz" from it? I think I was irritable for a day after I stopped.
I wasn't even close to become addicted. But it is a nice painkiller.
for acute pain, discipline.
For example, any time two people have sex if they drank first (are drunk) then no matter how much they consent and really, really want to have sex it's "technically rape" (I am serious). That doesn't make them criminals. And rape is serious.
You have to look at the ACTUAL enforcement practices where you're located. What do people (police) ACTUALLY do?
Also, remember: the reason it is not completely legal might have nothing to do with your consumption of it. For example, would like advertisements for it? Totally legit companies doing things that are "legal" today like shilling on Reddit, trying to get people to use their (legal) drugs?
So I would encourage you not to have such a black and white view of what is "criminal." It's a scale. Just as you're not raping a girl if you two have great drunk sex some night and both wanted it, you're not a criminal if you light up a joint.
I can see it bothering her. For her information if you want to share this thread, in my research marijuana is less addictive than soda: if you drink 3 liters of soda every day then suddenly stop and don't get caffeine from somewhere else like coffee, then due to the caffeine withdrawal you would have a headache for a day. (That's it.) it would be uncomfortable.
Have her read the comments disagreeing with this article:
https://teens.drugabuse.gov/blog/post/marijuana-withdrawal-r...
You will not be "addicted.". (Waaay less than caffeine or tobacco.)
You can read people's own reports there, including peoplr in a similar situation as you who lead happy lives.
That said, the smoke itself could be uncomfortable, and you don't want to get high, so I am not saying this is a solution or anything.
Also the enforcement practices in your area are a different matter, and if people you actually know served jail time, then perhaps the enforcement is not lax enough.
In that case I can see what you mean.
(Btw pot now figures in TV shows, like Silicon Valley, too. It's "normal".)
My choice is to leave her and self medicate, but that will be viewed as "marijuana changed him" and I am pretty sure she will call police on me (she did this once).
Actually I've since learned that such changes can't be external in nature but have to come from within.
The Internet generally gives horrible, horrible advice. I think your best bet is to make her feel like the idea is hers. But how to do that?
I don't know.
If you want to share her email (you can send her email address to the email address I list in my profile) I can send a letter like this:
---
Hello,
I'm a fellow IT worker like your boyfriend. I don't have any pain problems or use any drugs of any kind. However, there was a recent discussion on opioids (which include many prescription medications) and your boyfriend mentioned the prescription drugs that he deals with for his pain. Because these are tightly controlled (for various reasons particularly due to being addictive), several of us wondered if he has used cannabis to deal with his pain. It is well-known that many people use it very well. It's not addictive (almost at all - you can do any quantity and quit overnight and a couple of days later be fine. Lots of people do this. It's not even like cigarettes or caffeine.) which is one of the reasons that even in states that legalized it, for a long time medical usage was allowed. I am sure you want a boyfriend who is not in pain, so I was curious if you wanted to talk about any of the reasons that you hold such a strong position against it? It is becoming legal in many places, has lax enforcement, and it sounds like it would improve his quality of life? By the way, I personally don't really like the legalization movement: I don't want companies to start advertising it, make profit on it, or even treating it like drug companies do (medical marijuana) which generally take money from everyone they can - Americans pay an obscene amount on health care. If this solution works for others and isn't addictive, what are the reasons you are against his trying it? I'd like to emphasize that I'm not a drug user at all and just an IT worker. I don't consider cannabis criminal the way other drugs are, regardless of the jurisdiction. Just so you know, your boyfriend is thinking that if his pain gets bad enough and he does not want to risk becoming addicted to prescription pain medication (which is highly addictive: see, Rush Limbaugh, who genuinely become addicted to prescription pain medicine and ended up arrested due to abuse of them: https://www.google.hu/search?q=rush+limbaugh+pain+medicine ) then it might come down to having to choose between you and a pain-free life. I don't think he should be forced to take addictive medication if everyday non-medication (like cannabis) works for people so well that many states allowed it for a long time before legalizing recreational use. I also think you can be reasonable about it, so I would just like to understand your reasoning about it better. I offered to ask you about it after he said that you certainly wouldn't change your mind. (And would probably report him to the police if he ever tried it, for whatever reason. That certainly seems extreme to me.) I appreciate any thoughts you might have on the subject. I'm sure you have good reasons for how you feel about the matter and I'd like to understand them. Thanks!