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Comment by wildmusings | Hacker News Reader

I remember that about a decade ago, doctors and others were criticizing the DEA for being draconian in their regulations surrounding opiate prescriptions. They were complaining that doctors often felt that they couldn't prescribe even when there was legitimate need.

I don't know what happened in the interim, whether or how the DEA's policies changed, but if only we had draconian DEA policies aggressively stopping overprescription now.

As someone who used to naively believe in legalizing all drugs for recreational use, this addiction epidemic has opened my eyes to why that's a horrible idea.

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> I don't know what happened in the interim

The VA noticed a lot of people had untreated pain. They pushed a campaign to make pain the fifth vital sign. Every time someone went into a hospital they'd be asked about pain. Pain was seen as something that absolutely must be treated.

They also said that opioids are not addictive if prescribed for pain.

It turns out that both of these are mostly wrong. If someone is in pain they'll tell you, you don't need to ask. And if someone has chronic pain they can become addicted to opioids.

The VA withdrew that document. Here's a Google cache: https://webcache.googleusercontent.com/search?q=cache:pUQ-mc...

We knew some time ago that it didn't help. Here's a report from 2006: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1924634/

Actually I agree with asking about pain. If someone's REALLY in pain they'll tell you, but if it's "minor suffering" some are predisposed to tough it out.

I can't remember having ever been in 'real pain', maybe for that the addictive drugs should be considered under a monitored regime.

For lesser pain something lighter should be used.

> but if only we had draconian DEA policies aggressively stopping overprescription now.

Not sure what the policies are now, but around me, I can not go get any prescription for any back pain (have really needed it twice in the past 3 years). "Nope, go see your GP" (vs going to a walk-in clinic). The walk-ins around here all have signs on the front door saying "no prescriptions for oxycontin, etc"

Now... yes, I could try to "see my GP", which generally means waiting a few days. (and, I don't really have a GP anymore, because I can never get in to see him).

What's strange is that about... 6 years ago, going to one of the same clinics, my wife went with an eye problem. Specifically, she'd had a small piece of sand get in her eye, and it was really sort/irritated. Home flushing wasn't working, so we went to the clinic. As she was leaving, they asked if she felt she needed any pain medication. "Well, not really, but it's a bit sore, and I do have a headache". They gave her a script for 14 oxycontin on the spot. Same place last year would not even talk to me about pain medication ("go see your GP").

Those practices (handing out oxy) are a major contributor to the current epidemic, if not the root cause.

I've gotten opiate prescriptions I had no business having without asking. I get that some people need pain medication or will suffer, but there's a whole lot of suffering that opiate addiction causes and that is not really factored into the 'do no harm' calculation doctors are supposed to be doing.

It really is a great thing to see legitimate restrictions on these prescriptions, as that should cut down on new addicts at the very least.

I guess part of this is doctors overprescribing to prevent patient complaints, based on how much patient satisfaction surveys are used to rate their year over year performance.

I don't know if its the AMA to blame for that or not, but everyone in the system seems to think its an upstream problem.

I'm hearing on the one side that these legal prescriptions are causing the problems but on the other had others say that these drugs being illegal is causing the problem and if we made them legal that people will use them in a safe manner. If people get addicted them when prescribed legally then how can making them legal have any hope?

Making them legal at least keeps the problem out in the open, where it can be regulated. Notice that the response to the opioid epidemic, as described in this thread, is that clinics have stopped giving out oxycontin. When we had a crack epidemic in the 80s or a heroin epidemic in the 60s and 70s, the response was to send troops into the regions that produced those drugs. This was both expensive and ineffective, and in many ways just made the problem worse: with the whole distribution chain being completely illegal, street prices went up, more money was made by a few outlaw kingpins, and that gave them more resources to buy arms and escalate violence.

These are highly addictive substances. If doctors can't stop the abuse now on prescribed medicines who in the regulatory agencies can do better?

And so the people that got addicted to those opiates 6 years ago that are now unable to get new ones turn to heroin.

If you go into a walk-in (or even GP office) asking for pain meds, that sets off all kinds of alarms.

If you go in with an obvious injury and they offer the painkillers without you asking, they probably feel a lot more confident that you are not drug-seeking.

> but around me, I can not go get any prescription for any back pain

Can I check: have you sought treatment for back pain, and not got it?

Have they offered physiotherapy or exercise?

(these might be relevant to your type of pain).

clarification - my back pain episodes were 2x in ... about 3 years. in both cases this was a sudden onset - like, standing up from a seated position, some sort of switch was flipped, and I had immediate massive pain.

In both cases, talking to a local "urgent care" clinic, "go to your GP for a referral for physical therapy" was the standard line. "we don't treat back pain".

I get it, in some sense, like... yeah, I may be an addict, etc. But in both cases, I'd been to the clinic multiple times before for other things. I had a history with them. Actually, the last time I'd been there I said I had no primary care physician, and wanted to use them as primary (3 miles from house vs 11 miles to previous dr).

In both cases, the back pain episode lasted more than a week, was debilitating to the point of not being able to walk without massive pain or sleep normally for several days. And then, it wore off, and ... 'back to normal'. Historically, I'm learning, we have some back issues in the family, but I can't get much info from anyone on specifics yet.

> why that's a horrible idea

Making drugs that people want illegal has never worked. Why should it work now?

Besides, the drugs being illegal increases the death rate from them, because users now have little idea of what they are taking, and overdose easily.

Prohibition worked pretty well from a public health perspective. https://en.wikipedia.org/wiki/Prohibition_in_the_United_Stat... It was the organized crime that was the problem.

Organised crime is bad for public health

On balance it's still a win. Alcoholism kills a lot of people.

Depends on what you're measuring. If it's pure death rates sure but throw in quality of life and it's not as clear cut.

I personally wouldn't want to live in a world where I can't enjoy a glass of whiskey.

That's not going to offset fetal alcohol syndrome or people raised by drunk parents or recovered alcoholics living with health issues for the rest of their lives.

You can make the same arguments about salty foods (hypertension), fatty foods (heart disease), sugary foods (diabetes), premarital sex (STDs), and just about anything else that people consume or partake in.

If you believe in personal responsibility then you're okay with taking some bad with the good.

What does personal responsibility have to do with fetal alcohol syndrome or kids raised badly? And how can you believe in personal responsibly when public health can change so drastically in response to policy changes?

> What does personal responsibility have to do with fetal alcohol syndrome or kids raised badly?

Both are the result of negligence of their parents. It may not be pleasant to lump that together under personal responsibility but that's the root of the problem and addressing it is the real solution.

A mother that drinks alcohol while pregnant is at fault for the harm that comes to her child. It's not society's fault, it's hers and indirectly her spouse's fault for allowing that to happen.

> And how can you believe in personal responsibly when public health can change so drastically in response to policy changes?

The fundamental disagreement is that I believe people are capable of good on their own and should not be baby sat by a nanny state. I'm willing to accept some of the adverse consequences of people making their own choices in exchange for the freedom and quality of life it brings.

But what good is responsibility? The point is this shouldn't happen in the first place. There's no way someone can make up for something bad they did in the past. Assigning blame after the fact seems hollow to me.

It's a tradeoff. "If men were angels no government would be necessary." Personal responsibility might be an ideal but it can't be an absolute. Trading lives for a "glass of whiskey" is morally bankrupt.

I'm not dealing in anyones lives but my own as nobody is getting hurt by my personal enjoyment of a glass of whiskey.

It sounds like you think that either you or others are incapable of such self control and thus nobody should be able to enjoy them. I put such lack of faith in humanity as itself being morally bankrupt.

Many died being poisoned by ineptly made bootleg liquor.

Crime is the reaction to prohibition. Its not a separate phenomenon.

Worked fine with Methaqualone.

> As someone who used to naively believe in legalizing all drugs for recreational use, this addiction epidemic has opened my eyes to why that's a horrible idea.

You may be surprised to learn that opium and cocaine used to be sold widely at pharmacies over the counter. Curiously, there was not a widespread "epidemic" of addiction. Why is that?

Alcohol and nicotine are legal and ubiquitous, where are the epidemics of their addiction? Curiously, smoking has been declining despite it being widely available and very addictive.

Blaming the existence of a substance for addiction, and then harassing doctors and patients as a result, is nearing the height of absurdity.

Don't both alcohol and nicotine have far more dependent users than opioids?

What is the comparison meant to illustrate? That easy availability will increase use and that the effects of the drug are the more important matter?

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