Comment by epmaybe | Hacker News Reader

Comment by epmaybe | Hacker News Reader

All the commenters thus far seem to think they know more than a randomized clinical trial that was double blinded looking at oral (not IV morphine) combination doses of opioids like codeine, hydrocodone, and oxycodone with tylenol vs ibuprofen+acetaminophen (tylenol). Here's the actual study if you would like to read more...

https://jamanetwork.com/journals/jama/article-abstract/26615...

I'd like to note that their p-value was awfully close to the statistically significant differences in pain reduction, so a larger study is definitely warranted.

We've known for a while that IV acetaminophen is just as effective at pain reduction in acute pain compared with IV morphine, as well. See this study, there are more similar to this:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4608332/

For those of you that think that a few doses of opioids can't cause addiction, think again. This study found that even after 10 days supply of opioids, 20% of patients had a dependence lasting up to a year.

https://www.cdc.gov/mmwr/volumes/66/wr/mm6610a1.htm#F1_up

Here's an arstechnica link that is more digestable: https://arstechnica.com/science/2017/03/with-a-10-day-supply...

I've seen patients get 30 day supply for appendectomy regularly, and my dentist friends have prescribed up to 50 at a time in the past.

We need to do these studies, and discuss them, and make them better, so that patients get the best care that they can. What we absolutely cannot do is rely on anectodal evidence to make clinical decisions.

> For those of you that think that a few doses of opioids can't cause addiction, think again. This study found that even after 10 days supply of opioids, 20% of patients had a dependence lasting up to a year.

The study did not find that. The study looked for long-term opioid use, not addiction, and not dependence. Long term use, addiction, and dependence (and tolerance) are all separate things.

Long-term use: simply using a thing consistently for a long time Addiction: compulsive seeking, not noted in any of your links Dependence: something bad happens when use is discontinued Tolerance: more use is required to get the same effects

You're right, thank you for the clarification and I apologize for misleading. This study did not look at addiction.

However, the study noted a few things that lead me to believe that this long-term opioid use is not intentional by prescribers. The study excluded patients with cancer, which is a common reason to be prescribed long term opioids. Additionally, they note that most of the patients were not provided long-acting opioids at the start, suggesting that the prescribers did not intend to start these patients on long-term opioid therapy.

At the very least, the data is suggestive of an increase in dependence in patients prescribed a 10-day or greater supply of opioids, as we know that when patients are on opioids for too long, you must slowly discontinue lest you initiate withdrawal.

Yup -- requesting an edit of the link title to clarify that it's about oral analgesics only, not IV analgesics, since this has indeed been a major point of confusion for several commenters.

To clarify even more, it also doesn't address cutaneous delivery of opioids or other analgesics for people who are unable to take either IV or oral applications.

In my limited experience, IV acetaminophen is never available to use because of cost which seems incredibly unfortunate.

You are absolutely correct. I was just noting that even if individuals think morphine is the best at reducing pain, there are other options related to this article.

Ok. I just think it’s important to remember that different people handle pain differently, and we shouldn’t end up refusing people something that helps them because an average in a study said it wouldn’t help. That does need to be weighed against the danger of addiction/dependence, though.

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