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Comment by ewjordan | Hacker News Reader

Opiods have been around forever; pardon my ignorance, but what is different now that makes so many more people get hooked on them?

Presumably people felt the same levels of pain in the past as they do now, given the same maladies. Is the situation:

A) More surgeries with extremely painful and long recovery periods are happening, where these meds are truly necessary

B) Doctors are prescribing opiods more freely for lower levels of pain than in the past

C) People are faking pain more often

D) People who really do need pain meds are staying on them longer than they should

B) seems to be the accusation that I usually see, but have doctors really gotten worse and less careful over time? To an extent that explains the whole crisis?

My guess is that D) is the real cause, for may different reasons.

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Opioid sales quadrupled between 1999 and 2014.

> but what is different now that makes so many more people get hooked on them?

The US VA noticed that pain was not being adequately treated. They created a campaign to make every HCP ask patients about pain. They looked at the science of the time which seemed to be saying that opioids were not addictive if you use them to treat pain. (they're less addictive if used short term for short term pain (post surgery, for example) but more addictive if used long term.) Drug companies put out new formulations that they claimed were less addictive - turns out they were more addictive. US doctors prescribe huge amounts of opioids.

The tragedy is that pain is still left untreated. The VA campaign meant people got opioids (cheap, but not particularly effective for long term pain) but didn't get access to pain management clinics.

https://www.va.gov/PAINMANAGEMENT/docs/Pain_As_the_5th_Vital...

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1924634/

> Routinely measuring pain by the 5th vital sign did not increase the quality of pain management. Patients with substantial pain documented by the 5th vital sign often had inadequate pain management.

https://www.cdc.gov/drugoverdose/data/prescribing.html

> Sales of prescription opioids in the U.S. nearly quadrupled from 1999 to 2014,1 but there has not been an overall change in the amount of pain Americans report.2,3 During this time period, prescription opioid overdose deaths increased similarly.

> > Sales of prescription opioids in the U.S. nearly quadrupled from 1999 to 2014,1 but there has not been an overall change in the amount of pain Americans report

That, there, is the "money" quote. You've been criticized elsewhere in the thread for the assertion that opiates "don't work" for long-term pain, but that strikes me as a very reasonable summary in the face of this kind of evidence.

Sure, there may be exceptions, but they must be quite rare for the above to remain true. (Some of them may not even be true exceptions, if "intermittent" use for long-term pain actually looks the same as repeated use for short-term pain).

You forgot one: The companies that produce these pills figured out that it is a hugely profitable thing to be selling heroine in pill form (which is more or less what we are talking about) and have been heavily marketing their drugs to doctors and patients. As a consequence all of the things you list are happening and it is hugely profitable.

And when I say marketing here think ads on the tv, heavy lobbying with politicians, inviting doctors to exclusive events and pampering them, sponsoring studies on chronic pain, etc.

When a problem seems to be getting worse but it seems like not much has changed, consider that the problem used to be just as bad, it's just not being swept under the rug as effectively.

Have you considered the availability of cheap opioids such as black tar heroin from Mexico? Or fentanyl shipped from China?

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