Who Is Telling the Truth About Prescription Opioid Deaths?
acsh.org
acsh.org
* In 1979, the information director of the FDA said, "Whelan just makes blanket endorsements of food additives. Her organization is a sham, an industry front."
* Ralph Nader claimed: "ACSH is a consumer front organization for its business backers. It has seized the language and style of the existing consumer organizations, but its real purpose, you might say, is to glove the hand that feeds it."
* The Center for Science in the Public Interest stated: "ACSH seems to arrive at conclusions before conducting studies. Through voodoo or alchemy, bodies of scientific knowledge are transmogrified into industry-oriented position statements.
They previously sought funding from Philip Morris. Recent donors include Chevron, Coca-Cola, Bristol-Myers Squibb, Dr Pepper Snapple Group, Bayer Cropscience, Procter & Gamble, Syngenta, 3M, McDonald's and Altria.
It's naive to assume that the industry dislikes the focus on the "opioid epidemic". It works to their advantage in a variety of ways, but one of the biggest is the formation and reinforcement of a whole new class of specialized clinicians called "pain management specialists". In Florida for example, a law went into effect this past July that effectively barred any non-pain-management specialists from issuing an opioid Rx that exceeds a 72 hour supply.
Even before this law went into effect, the sentiment it conveyed directly impacted the willingness of ordinary docs and medical facilities to reasonably treat pain in persons without a chronic condition that would be handled by a pain management specialist, like postpartum women. My wife was left with only lightweight OTC pain relievers because the hospital said it was too risky to write anything stronger unless there were clear complications.
The outcome of the campaign against the "opioid epidemic"? There is now a specialized clique of doctors for the pharmaceutical sales reps to focus their attention on, there are more flurries of codes to bill for, and there is a niche for enterprising doctors to exploit desperate people to make literal millions for themselves while setting their own hours, just like psychiatrists. In fact, the industry is trying to reshape pain management to be the spitting image of psychiatry, which, especially over the last 5 years or so, has become astronomically lucrative for the industry all around.
The long and short of it is that restrictive regulation for this type of drug is bad news only for the sick people who depend on their medication to function. It will be much harder and much more expensive to get and keep a steady stream of the drugs that allow them to work and live a semblance of a normal life, all so the incumbent political dynasty has a talking point in the next election cycle.
But, err, yeah, let's write off anyone who sees this as a pro-pharma shill...
ACSH does not seem like “anyone” but rather a documented pro-any-paying-industry-shill...
> ...despite the fact that the "evidence" contained in the recommendations had been carefully scrutinized[sic] and found unsupportable by FDA scientists.
where "found unsupportable by FDA scientists" is a link to a document from 2013 that reads in part
> FDA has carefully reviewed PROP's Petition and the numerous comments submitted to the public dockets by government entities, medical societies, healthcare providers, patients, and other members of the public. For the reasons described in detail in this response, the Petition is granted in part and denied in part.
Curious how "found unsupportable" turned out to be "granted in part" in the source, no?
This being the very first link investigated, and the error being intentional deception, I think it provides quite powerful validation of the ACSH's reputation as a shill.
> Does anyone really believe that Vicodin is killing more Americans than fentanyl and carfentanil? I sure don't.
With all the data being shown, you would expect that he could actually make more of a claim than a belief based one.
It is a really confused article that seems to have no other purpose than to try to create confusion around statistics. The author would have you believe that elephants don't exist because one source is describing the trunk, another is describing the leg and a third is describing the tail.
>Purdue, the makers of OxyContin was fined $653 million for its former actions. Other companies are now being investigated. But this is now irrelevant. Assigning blame may score some points with the readers, and provide fodder for trial attorneys, but does absolutely nothing to keep a single OD victim alive. Whatever certain companies did two decades ago is partly responsible for starting today's fentanyl OD epidemic, but it has nothing whatsoever to do with keeping it going.
That is absurd. "Yes I poisoned the water supply, but blaming me won't fix anything. It's not like I could do it again with all the poison I still have."
https://www.acsh.org/news/2017/10/12/opioid-epidemic-6-chart...
From some sources that may themselves be biased:
"Council on Science and Health is a Corporate Front Group" https://usrtk.org/hall-of-shame/why-you-cant-trust-the-ameri...
https://www.sourcewatch.org/index.php/American_Council_on_Sc...
Pharmaceutical companies needed a way to profit from developing alternatives to morphine so they developed a bunch of dangerous bullshit then convinced everyone it was safer than morphine even though it's not.
Morphine is awesome and has as its only long term side effect constipation.
If it ain't broke, don't fix it. Prescribe morphine, including to heroin addicts who are, after all, simply addicted to morphine which isn't actually that dangerous. The only thing that makes heroin dangerous is the fact that it's not prescribed by a licensed pharmacist.
Think about it: if you're addicted to pain medication maybe you're experiencing some pain. So like, prescribe them the pain medication, then help them deal with the cause of the pain.
Drug policy is so stupid.
If ever there was evidence of the appalling effects of using the profit motive as a proxy for intelligent policy, this is it.
A lot of pain, most pain probably, does not have a cause.
It is this type of long term pain that is hardest to treat. We know psychological therapy helps people live their lives with pain (it's used with cancer patients), but patients reject it because "my pain is real, not in my head". We know weight loss and exercise helps some people (especially those with musculo-skeletal problems), but we know how hard weight loss is and a year of weight loss and physical therapy is rejected by some patients (a few say "ignore the fat, treat the illness", and a few can't cope with the idea that treatment is being "paused" for a year).
And it's this group who are being most poorly served by opioid meds: they develop a tolerance for opioids until they're taking very high levels. So now they have an opioid addiction, all the side effects of the meds, and they're still in pain.
I've been on the same dose of dihydrocodeine for years, and effectiveness is just the same today as when I started.
I do take magnesium daily, as opioids cause constipation and this helps. Magnesium is an NMDA antagonist, and there is a lot of evidence that these prevent the buildup of tolerance.
Honest question.... Long-term morphine use will not dull the mind?
However, those are acute effects that go away as the drug wears off. With long-term use, this type of negative effect often reduces with the increase in tolerance, eventually reaching an equilibrium at some lower level of effect (tolerance works both ways: both negative and positive effects go down as ability to tolerate the drug increases).
Most of the native effects from chronic use of morphine is sociological ("increased risks of being arrested").
I don't know where you're getting that morphine isn't dangerous. It's highly addictive and deadly if dosed wrong, and you absolutely build tolerance over time which changes your dosing.
That is the cause of its lethality.
Also I'm not referring exclusively to physical pain, but trauma or lack of emotional and social connection.
How do you know it isn't because more of it makes you feel more of the effects?
By and large, drugs will be a large social problem until going to the doctor to get a monitored, controlled dose is the easiest way to get a fix. If we keep pharmacists and doctors in control, they can ween dependent users off in a controlled, gradual environment.
Prohibition keeps drug abuse firing on all cylinders until the addict slams into a brick wall (which, very often, is simply death), instead of giving them the equivalent of a "runaway truck" ramp that will allow them to gradually slow the pace and return to a normal existence.
Heroin doesn't feel amazing. People say it does, but most of the time, it just knocks you off. I took the stuff maybe a dozen times or so, many years ago. I remember stumbling about town and falling asleep at cafes and bars, completely oblivious of what I looked like (an accomplished idiot, off my tits and completely ridiculous).
I remember a friend who was a full-on junkie, who used to say that heroin hooks you because it makes you very sociable and pleasant. Well, my experience is that, after he shot up, he would fall asleep on my bed. My mother would come in the room and ask why he's asleep and me and my other pals would tell her he's tired from work, him snoring throughout. But, you know- it makes you sociable, fun to be around, a real party animal.
(Edit: the other thing people say is that it makes you good at sex. Sure, except you can't get it up. But other than that, yeah, great sex.)
Delusional is what it makes you. You think it's making you feel good. All it does is make you feel nothing. If something hurts, I guess that feels "good". But if there's nothing broken in you, there's nothing you can get from this shit. Nothing.
Incidentally, my snoring friend died a few years down the line from a heart attack, at 34. Another friend became an addict and he's constantly in and out of detox communities since then. It's sad and it's not worh it. And I don't understand how it hooks you, because it just sucks. I stopped doing it because it was boring and pointless. If it was any good, I'd have been addicted too. But it's not. It's just dumb.
But, you know. If you're Nikki Sixx, then maybe you can have a great time even on heroin. I bet I would.
> I don't understand how it hooks you
> If something hurts, I guess that feels "good"
Some people hurt from within. People with troubled childhoods or deep problems numb their mental pain with drugs. It works for them.
The other factor is that there's a genetic component to addiction. Some people enjoy certain drugs more than others, while being more susceptible to addiction than others. You might be one of the lucky ones who can try heroin, not feel anything and not feel addicted either. Good for you.
In a nutshell, yes. The solution isn't as clear-cut as you'd make it out to be unfortunately.
> Morphine is awesome and has as its only long term side effect constipation.
That's sugar coating it. Morphine is a great solution to many things, but it's extremely addictive, and has more side effects than constipation (shallow breathing for one, which combined with alcohol can make for a nasty combination). Medical advice is also that opiods as a whole generally aren't effective for long term pain management.
> The only thing that makes heroin dangerous is the fact that it's not prescribed by a licensed pharmacist.
That's also a huge oversimplification. Source of the prescription/doses is definitely an issue (see how _most_ people manage dosages of other drugs - paracetamol/asprin/alcohol when left unattended) but ultimately it's the supply of the drugs - if I buy 100mg of morphine tablets from a pharmacy, I can be reasonably sure that it's 100mg of morphine, and that it's been stored in the correct environments, but if I buy it off some guy on the street, I've no idea if it's cut with fentanyl.
> Think about it: if you're addicted to pain medication maybe you're experiencing some pain. So like, prescribe them the pain medication, then help them deal with the cause of the pain.
That's _definitely_ an over-simplification. There's plenty (too much) being prescribed when it's not needed, and the usage isn't being monitored. When people do develop addiction issues, there is no help available for them. Vox [0](best source I could find with a 5m google sorry) has a reasonable explanation of the issue (with citations), and it's definitely not "give people in pain more opiods because morphine is safe"
[0] https://www.vox.com/science-and-health/2017/8/1/15746780/opi...
http://www.sdf.org.uk/heroin-assisted-treatment-provided-gla...
When we ask people with a substance misuse disorder who use opioids what they started on we find, very often, that they started on meds prescribed by a doctor. Those meds may not have been prescribed to them - they may have been prescribed to a neighbour or family member - but they were prescribed.
This is why the massive over-prescription of opioids is a problem. It floods American homes with opioids that people keep "just in case" and that are experimented with by family members or handed out to neighbours to help out.
Opioids may be a good choice for some people with long term pain (I personaly don't think they are), but that would be in a carefully controled setting being closely monitored by a doctor. It's definitely not using opioids that your neighbour has given you for your dodgy back.
The article makes an incoherent point about what is classed as a CPD. Benzos are dangerous (especially in combination with other meds or alcohol) but far fewer people are dying from benzos than from opioids.
What do you suggest be given to people with chronic pain which can't be managed with lower powered pain killers, say people with cancer induced pain?
You added "which can't be managed with lower powered pain killers" -- that step often isn't tried in the US. Doctors and patients are leaping direct to large quantities of opioids.
I'd prefer it if doctors followed the RCoA guidance: https://www.rcoa.ac.uk/faculty-of-pain-medicine/opioids-awar...
"2. A small proportion of people may obtain good pain relief with opioids in the long-term if the dose can be kept low and especially if their use is intermittent (however it is difficult to identify these people at the point of opioid initiation)."
Their pain is not manageable with lower pain killers. I am thankful we have opoids to prescribe, which is making significant improvement to their quality of life.
Cancer pain is not long term pain, cancer pain is short term pain (or acute pain). I've never argued against using opioids for cancer patients or for end of life treatment.
If you take a look at /r/ChronicPain/, you'll find lots of people who have been unfairly affected in exactly this way, some even becoming suicidal because of it.
They definately are for some people, because I'm one of them. I've tried everything else, and nothing even touches the pain.
I've tried numerous anticonvulsants (carbamazepine, lamotrigine, topiramate, levetiracetam, gabapentin, pregbalin...), tricyclics (amitriptyline, nortriptyline, dosulepin...), muscle-relaxants (tizanidine, diazepam...), anti-depressants (venlafaxine, reboxetine, duloxetine...), as well as NSAIDs like diclofenac, and assorted things like topical capsaicin and topical gabapentin. A lot of these made me dizzy and uncoordinated, where I couldn't function normally, and some made me extremely nauseous - while not touching the pain. The rest did nothing.
I realise I'm probably a statistical outlier, but I resent the idea that I should be left to suffer because my body and genetics don't conform to some p value from a meta-analysis.
Opioids should of course not be the first choice for chronic or neuropathic pain, because statistically other things are more effective and safer (e.g. pregbalin) - but doctors should not be prohibited from prescribing opioids when pain cannot be adequately controlled by other means.
If I had to deal with my chronic pain 24/7 without any pain relief... well, opioids have likely saved my life. I've been taking them for years now, and while I will obviously be physically dependant on them now (that's just how receptors work), I feel absolutely no psychological addiction to them whatsoever.
> I realise I'm probably a statistical outlier,
Do you think you might be who I'm referring to to here?
The US massively over-prescribes opioids. They could probably reduce prescribing by 75% and it wouldn't affect people like you, other than having to go to a specialist pain clinic. Since you have specialist pain you deserve best quality treatment from specialist.
> Opioids should of course not be the first choice for chronic or neuropathic pain, because statistically other things are more effective and safer
Isn't this just agreeing with what I said?
That sentence continued with "(I personaly don't think they are)".
> Isn't this just agreeing with what I said?
Well, no, because you explicitly stated that you personally didn't agree.
I realise that the US has a huge problem with over-prescribing opioids. I think that great care needs to be taken in how that is reduced - there are many instances of a heavy-handed approach being used, and those that have a genuine need have their pain relief removed. The consequences of this can be disastrous.
I mentioned in another comment that I take magnesium, which is an NMDA antagonist, and there is a lot of evidence that these prevent the buildup of tolerance. I don't know if that's why I can remain on the same doseage, or if it's simply that I always stick to the prescribed dose.
Agmatine is a more potent NMDA antagonist, but is unfortunately no longer available in the EU, due to the fairly 2017 Novel Food Regulation[1]
[1] https://ec.europa.eu/food/sites/food/files/oc_oof_analysis_main_outcome_en.pdfHmm.
One can seriously question whether "stigma" is that most effective way.
Whether that happens or not doesn't matter. My point is that if people are getting hooked on these drugs and overdosing, the fault lies with who gets them the drugs and no one else.