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Comment by dools | Hacker News Reader

The whole "opioid" shit fight can be summarised as:

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.

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I think you're massively downplaying addiction. Sometimes it is physical pain at first, but you get hooked on it. Not everyone does heroin because they actually need that level of pain medication. They do it because it feels amazing. They get dependence on it, and then keep doing it. Read the Heroin diaries by Nikki Sixx of Motley Crue if you want a good look into that.

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.

A substance's addictive ness does not equate to lethality. The reason it's dosed incorrectly is because it is manufactured and sold in an unregulated environment.

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.

>The reason it's dosed incorrectly is because it is manufactured and sold in an unregulated environment.

How do you know it isn't because more of it makes you feel more of the effects?

The addictive nature of the substance combined with the body's growing resistance to it leads to users of the substance to use larger doses to achieve the same high, in some cases not exercising any caution about dosage, leading to overdose.

wife is a social worker - she has told me that most common reason for overdoses is the first use after being sober for an extended period of time. Someone will get clean, abstain for weeks/months/years, have a personal tragedy, and (this is the important part) immediately use the same dose that they used before quitting. And it is way way too much.

This is a reason to continue to prescribe drugs through a licensed medical professional. Most long-term medications can't just be stopped without serious adverse 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.

>> They do it because it feels amazing.

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.

That was an insightful comment, and I think you've answered your own question.

> 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.

> Drug policy is so stupid.

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...

You are correct but I think the main point the parent had was that this problem was created by greed. We never had this kind of opioid epidemic when people got prescribed morphine instead of oxy. I also think we need to look at pot and other combinations of drugs that have been shown to better manage chronic pain than any opioid. I personally don't think the oxys of the world should be used outside of clinical environments and only for acute pain.

I'm not saying "give people who are dependent more opioids" I'm saying that while you're treating the problems that drove them to become dependent in the first place, it makes sense to give them easy access to clean drugs so they don't have to deal with 2 personal crises at once. For example, Heroin Assisted Treatment:

http://www.sdf.org.uk/heroin-assisted-treatment-provided-gla...

> So like, prescribe them the pain medication, then help them deal with the cause of the pain.

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'm not referring exclusively to physical pain

I think another important side effect that you neglect to mention is physical dependence on the drug and the need to constantly increase the dosage to achieve the same effect.

I don't think it's true that you always need to constantly increase the dosage.

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.

If the dosage can be safely consumed who cares if it needs to be increased?

There's no money in making it smarter.

If ever there was evidence of the appalling effects of using the profit motive as a proxy for intelligent policy, this is it.

> Morphine is awesome and has as its only long term side effect constipation.

Honest question.... Long-term morphine use will not dull the mind?

Nothing I have ever read suggests any mental impact of morphine use.

Well, there can be a very strong mental impact for some people. Vertigo, drowsiness, or a general "fogginess" common side effects some people experience. This isn't unusual: lots of medications have similar side effects, hence the common waring given on prescriptions about not driving or operating heavy machinery until you're familiar with how your body responds to the medication.

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").

That's interesting, thanks. My cousin is a recovering heroin addict, and the mental impact is clear as day. I had not considered that long-term morphine use would be significantly different/better in that regard.

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