The news industry was complicit in the opioid crisis
cjr.org
cjr.org
Those with Chronic Pain are being left to suffer because of abusers. In April of 2019 the CDC stated that their "guidelines" are being miss applied. Sadly the damage is already done.
https://www.cdc.gov/media/releases/2019/s0424-advises-misapp...
"CDC Advises Against Misapplication of the Guideline for Prescribing Opioids for Chronic Pain Some policies, practices attributed to the Guideline are inconsistent with its recommendations.
In a new commentary in the New England Journal of Medicine (NEJM), authors of the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain (Guideline) advise against misapplication of the Guideline that can risk patient health and safety.
CDC commends efforts by healthcare providers and systems, quality improvement organizations, payers, and states to improve opioid prescribing and reduce opioid misuse and overdose. However, some policies and practices that cite the Guideline are inconsistent with, and go beyond, its recommendations. In the NEJM commentary, the authors outline examples of misapplication of the Guideline, and highlight advice from the Guideline that is sometimes overlooked but is critical for safe and effective implementation of the recommendations.
CDC is raising awareness about the following issues that could put patients at risk:..."
Someone I love has chronic pain managed with (legally prescribed) opioids, and they have constant low-level anxiety that a bureaucratic mixup will result in their medication being denied (or heaven forbid they lose a prescription, or that they'll need a refill when their doctor is on vacation and the locum will be 'suspicious of drug seeking behavior'.
They had to sign a document that if they lost a prescription, they understood that they would be denied a refill, even though (a) there isn't actually any reason to physically hand them the piece of paper, it could all be done between the doctor and pharmacy, and (b) people with chronic pain typically also exhibit various degrees of 'being distracted' due to that same pain.
I could go on, and TBH, my friend hasn't had any gaps in getting their medication, but the current wave of anti-opioid hysteria is concerning.
This is not the media's fault, nor is this is not chronic pain patients' faults. This is the result of criminal corruption and abuse in the pharmaceutical industry and distribution system. There is a real and enormous problem https://www.drugabuse.gov/related-topics/trends-statistics/o... (opioid overdose death rates have more than quadrupled in 20 years, are at a high level already versus other causes of death at 50k annually, and are accelerating). Opioids are some of the most dangerously addictive medicines that exist, and habituation and pill selling is a huge problem that is also ruining and ultimately costing lives.
Finally the sizable majority of prescription drug abusers in this country do not source from a doctor or the healthcare system at all. The vast majority get their drugs either from the black market or a friend or relative. On the National Drug Use Survey only 18% of prescription drug abusers report doctors as their primary source. And among street prostitutes (a high at-risk group) only 5%[3].
All of this goes to show that there is very little evidence of any sort of over-prescription of opiates in America. To begin with the vast majority of the opiate crisis has to do with fentanyl, not prescription drugs. But even when it comes to prescription drug abuse, the intersection with medical users is vanishingly small.
[1] https://www.ncbi.nlm.nih.gov/pubmed/18489635 [2] http://www.ncsl.org/portals/1/documents/health/APeeples0118_... [3] http://sci-hub.tw/https://www.tandfonline.com/doi/abs/10.108...
You are correct that chronic pain patients are not a high overdose risk and that there is little to no benefit to treating their prescriptions with suspicion. (People who don't have to operate in a black market are MUCH safer.)
Here is here you go wrong:
> All of this goes to show that there is very little evidence of any sort of over-prescription of opiates in America.
There is very clear evidence for over-prescription of opioids. There is very clear evidence that the risks of addiction were deliberately minimized by drug companies and doctors were incentivized to over-prescribe for as many off-label uses as possible.
The issue is: Anyone who does develop a problematic addiction to pill they are prescribed tends to have their access cut off and are thus forced into the black market where their chances of overdose increase dramatically.
Thus while users with drug prescriptions may not be overdosing at high rates, that does NOT mean that the black market overdoses are not directly causally related to the over-prescription of opioids.
> Finally the sizable majority of prescription drug abusers in this country do not source from a doctor or the healthcare system at all. The vast majority get their drugs either from the black market or a friend or relative.
They may not source directly from the healthcare system, but prescription diversion and fraud do indirectly source a lot of product from the the healthcare system. I suspect that crackdowns on this diversion helped spike the blackmarket opiod overdoses as it decreased the quality of the blackmarket supply (and thus increased the prevalence of Fentanyl.)
Ridiculous. It certainly does not, in any way, shape or form. Your "analysis" also excludes the very clear evidence that people get hooked on opioids from prescription pills and transition to black market products like fentanyl.
"The volumes of the pills handled by the companies climbed as the epidemic surged, increasing 51 percent from 8.4 billion in 2006 to 12.6 billion in 2012. By contrast, doses of morphine, a well-known treatment for severe pain, averaged slightly more than 500 million a year during the same period." https://www.washingtonpost.com/investigations/six-takeaways-...
Completely false. You refer to data about a subsection of opioid prescriptions (chronic pain patients), and asserting broad claims that are not accurate.
"In just 10 months, the sixth-largest company in America shipped more than 3 million prescription opioids — nearly 10,000 pills a day on average — to a single pharmacy in a Southern West Virginia town with only 400 residents, according to a congressional report released Wednesday."
https://www.wvgazettemail.com/news/health/drug-firm-poured-m...
Let's just take your example. What do you believe is more plausible? That a town of 400 people are collectively prescribed 10,000 pills a day by well-meaning doctors? Or that the pharmacy from your example is a front for organized crime to funnel prescription opiates into the black market?
That prescription opioids are significantly reduced, yet the death rate continues to climb indicates the focus on the current solution is in the wrong place.
No one, including me, denies "pill selling" is a problem. However that has zero to do with the people with Chronic Pain that are doing everything within the law.
There are bad doctors, and other bad actors, they need dealt with of course. Not at the expense that need such medication.
False. There has only been a minor reduction in sales. https://www.fda.gov/media/111695/download
Also, it just means those easy pain pill scripts are drying up, and people are turning to black market alternatives. It's cheaper and easier to import fentanyl from PRC and press it. Also leads to dosing errors (overwhelming cause of deaths).
The crisis was directly contributed by over-prescription ande the deliberate minimization of addiction risks. The crisis was exacerbated by then pushing these people off their legal prescription once they become addicted, forcing them into the black market.
> That prescription opioids are significantly reduced, yet the death rate continues to climb indicates the focus on the current solution is in the wrong place.
When you push more people into the black market, it is reasonable to expect that over-doses will rise.
> There are bad doctors, and other bad actors, they need dealt with of course. Not at the expense that need such medication
Yes, I agree. We are much better served by educating about and being aware of addiction risks than we are by limiting access to prescription medication because we are concerned a person is already addicted.
Also, as long as we're here, the reason pill-selling and whatnot exists is because of the war on drugs. But that's a larger discussion than what I/we can do here.
The thing that is the hardest is that ultimately the best pain control for me is a safe and calm lifestyle and decent healthcare in the right conditions I can survive without medication, but with the loss of health and money goes your access to that lifestyle and healthcare, increasing the need for meds, at a time and situation in which you can least get them. I've tried nearly everything, at least that I can access, and that access, mainstream and alternative just gets worse here in the USA. I just need a small flat and a simple life in a city with connections and resources. I am stuck in the opposite.
I had a great, once in a lifetime, accomodative job opportunity abroad from a member here that I couldn't get to because of worsening pain and life stability and I sunk further as a result. Should have just gone and failed and gotten it over with rather than suffering more in worse conditions. It's a pit of quicksand once you get in it. It's hard enough in countries with good systems, but in the USA it's hopeless. I am now stuck in rural nowhere in so much pain with no good healthcare and transport and a horrid quality of life. I am over the debate and the "opiod crisis" and people's judgement here...I just want out and stable if thats even possible anymore, or it over. Tired of suffering every day.
Dextromethorphan and grapefruit juice can potentiate to stretch out doses in times of drought.
Sorry to hear that our medical system is failing you. Truly immoral.
https://www.fda.gov/news-events/public-health-focus/fda-and-...
Definitely risky, and not something I'd ever suggest for recreational purposes. Also important to know that many opiate tests look for non-intoxicating metabolites that are directly available in the poppy, so doctors may overestimate the amount of morphine the individual consumed: leading to overprescription in replacement therapies or overdose treatments, both of which can be dangerous.
At some point, she realized that she may be developing a bit of a pill problem. She went to her doctor, to see what could be worked out.
He listened her out, marked her down as drug-seeking, and cut her off, cold turkey.
Surprise, fucking surprise, the very next thing she did was to turn to black market oxy.
Eight years of rehab, rehab again, fighting, bargaining, threatening, and pleading, she's once again relapsed, and their marriage is falling apart.
I speculate that if it does, she'll likely be dead in a few years.
http://medicaleconomics.modernmedicine.com/medical-economics...
This is my reply to Dr Gart's editorial, edited to fit the format here the best I can.
“… First and foremost, we must bury the claim of pain being the fifth vital sign and replace it with a 21st Century pain assessment tool that incorporates objective evidence and measures of pain. …”
Dr Gart, at this moment are you hungry? In your lifetime have you ever been hungry? Hunger is a type of pain. Did you treat that pain by consuming a substance?
Please correct me if I am wrong. To my knowledge there is no objective test, no simple Pain Meter, that will show me that you are hungry. Yes we could look at enzymes and such. Will that truly tell me just how hungry you are objectively?
If there is no objective test for a pain as simple as hunger, that each of us experience most every day, what hope does a person in Chronic Pain have?
In Ohio the Governor is now practicing medicine by decreeing that there can be no more than seven days of opiate pain medication. Perhaps he should discuss that with the person that was hit by a train and survived with most every bone broken.
My wife Karen died of suicide to stop the pain she experienced for over over 20 years, due to the failure of the Medical Establishment as a whole. THIS IS THE REALITY OF Chronic Pain.
"Karen's Journal of CSF Leak Headaches and Chronic Pain: How Intracranial Hypotension and Levaquin (Levofloxacin) Killed Me"
is now required reading at Duke School of Medicine to educate future Neurologists about the realities of Chronic Pain.
A local reporter wrote in a Cover Story:
"Karen's first-hand account of her illness gave an honest, heart-wrenching depiction of what it is like to live with debilitating pain day-to-day." – http://www.kpaddock.org
May I humbly suggest you read it.
See for FDA links on the antibiotic issue [at http://www.kpaddock.com/fq ].
In book form it has been edited by a medical doctor that has the same condition has Karen had. When bought through the Spinal CSF Leak Foundation 100% of the royalties go to them, to support them, just in case anyone thinks I'm posting this to promote the book for profit myself. The book can be read for free at http://mystory.kpaddock.com for free.
I do not know what motivated you to write your article. I do know from it that far more time needs to be spent with people in Chronic Pain, to understand the realities of their life.
When a person in Chronic Pain that has been taking opiate pain medication under a competent doctors supervision for ten years, is able to function, take care of their family, hold a job, is without warning told then can not have it any more, “tough luck”. What are they to do? They resort to street drugs and become the very victims this currently policy is trying to prevent.
People in Chronic Pain have typically already tried multiple rounds of physical therapy, bio-feedback, meditation, exercise and the list goes on, with no relief from the pain. What are they to do?
Not having Chronic Pain myself, I will never claim to understand it. I did watch my wife suffer with it for 20+ years. What exactly is the agenda here? None of us such as Advocates like myself nor the sufferers have figured this out yet. Can anyone please explain? To us it appears as an attack on the most vulnerable.
This is one of the many comments I received about your article: “…Chronic problems frustrate doctors and they blame the patient rather than look at themselves. …” or support research to find real solutions to Chronic Pain. No one chooses to live with Chronic Pain each and every moment of their lives.
If you don't eat you die. Do you die if you don't consumer pain killers? No you don't.
This is similar to the nonsense peddled by people who claim anti-depressants are the same as insulin and various other snake-oil salespeople.
Some people want to control others and just don't care what the reality is.
They would never ban alcohol, they consume it.
They would never ban cars; they drive them.
They would never ban fast food; they eat it.
They will never ban sugar; they love it.
All of these things have cause a million times more misery than opioids ever have, by all measurable statistics (deaths, injury, domestic violence, etc)
But if there is something someone is doing that they aren't, their measurement of pros and cons will change. Statistics and comparable things of pleasure/damage will never be considered.
HN is also guilty of this in otver contexts.
The issue with perception is universal. We all feel these things.
How we act though? That's a choice. We can choose to read statistics and let our 'slow thinking' brain take over. But it has to be a choice and that lies with each of us.
Do you notice you are replying to a comment about somebody that did, right?
Not every problem is simple.
Your refusal to believe that illnesses can affect the brain is obsolete thinking.
If the news reflects the medical community's POV and the medical community is wrong, that makes them "complicit"?
>Piece after piece told readers, including young doctors and medical students like me, that pain was under-treated and opioids were safe. Outlets championed a paradigm shift in the way we thought about pain relief. Pain joined body temperature, blood pressure, heart rate, and breathing rate as the fifth vital sign.
Was that untrue? I remember those stories, lots of doctors were advocating for a change on how pain was treated.
The article straight up says that the medical community thought opioids were the answer.
Should the news media have rejected the medical community's position and suggested people use something else? Essential oils? Some sort of anti vax message?
The medical community might want to think twice about telling the news media or anyone else that they should have disregarded their expertise in the past as I'm not sure they'd like it if that happened today...
By 2019 standards the news, the politicians, the doctors, are all "complicit in the opioid crisis" because they didn't predict the present state of affairs back in 1999 (or thereabouts) and work against it.
If everybody is complicit then nobody is. It makes for eyeball grabbing titles though.
The expectation is that news are independent and practice journalism and they don't just take anyone at their word.
The press's ability as an institution to contradict another institution has practical limits.
In particular, if the broader medical community is largely on board with opiods, for a journalist to write a story, they have to get comments from medical authorities.
If those comments are consistently saying that opiods are necessary and good for pain management, an ethical journalist can't just ignore all those comments and harp on a few outliers.
And for a story to catch on, other journalists have to, in effect, replicate that work: they have to do their own investigations, but they're going to get a similar distribution of comments.
The press can typically focus on an institution if there's a particular scandal involving specific people or entities because then their questions become more targeted.
They can. And they must.
Would you make this same argument when journalists cover fiance or war? In the case of the former, there is usually 'irrational exuberance' that emanates from financial professionals that inevitably leads to a crash. Journalist should just take that at face value when the finance industry says subprime derivatives are great?
How about the latter, war. Just because everyone is on-board, should journalists stop asking questions?
If all journalism is is a mouthpiece, why do we need it in the age of internet? I can go and read what the various agencies have to say without a middle-man.
Yes. A journalist's job is to report news, not make it. Activist journalism has virtually destroyed the reputation of the press.
What good is any coverage if your audience thinks you're dishonest?
> Just because everyone is on-board, should journalists stop asking questions?
They should not be distorting their coverage of the answers.
> If all journalism is is a mouthpiece, why do we need it in the age of internet?
Activist journalism is just a mouthpiece for interest groups.
You're arguing a straw-man. Who is actually defending journalists that distort the news?
How does that work exactly?
Doctor's say they're not treating pain properly and they feel opioids are a good option to do that.
What exactly should a journalist do then?
Not report it?
Do some science?
First of all, ideally you'll leave those topics for your journalist buddies that actually know what they write about because they've been in medicine. If those aren't around: talk to other doctors, preferable some that are not being paid by a pharma company, to see whether they agree.
The same is true when your government tells you that all the intelligence sources agree and $desertCountry has lots of $wmd and is planning to conquer the world by doing $evilThing and $ourAlliance needs to invade now. Granted, the news media hasn't done a good job there either, you could say they were complicit by uncritically repeating propaganda.
A journalist that has a medical background can judge these things much better, can actually read studies and understands the monetary incentives given by pharma companies - and in most cases they are not part of the game, they are not paid to shill.
Journalists cannot be experts in every field they report on.
Maybe. There are journalists with technical backgrounds. But let's leave that aside.
Are you telling me you can't find experts to explain the nuances of the particular policies? Take the example of Theranos. While the company was getting fawning press coverage, there were many specialists that were calling bullshit on their claims, from medical professional, university professors, to even competitors.
Would those experts be... medical professionals?
Yes. The point is there is never uniformity of opinion. For every disastrous policy, in hindsight, there were multitude of voices raising concerns. A good journalist will be able to talk to with experts and get down to the meat of the matter and deliver the information to the public.
I don't really like this article's tone of press-blaming: ultimately the medical profession has to take responsibility for its treatment, both under- or over-treatment, and has its own responsbility to find out the facts and disseminate them through professional channels.
Now we've entered the "politicians/the media is to blame" stage.
When something goes wrong in this spectacular a fashion, you can bet people will try to lay blame wherever they can. But probably the truth is that this was on all of us. Doctors for prescribing without disseminating incredibly pertinent information, Parmas for creating "medicinal" opioids in the first place, politicians for not admitting the need for stronger regulation earlier, media for not covering the story better earlier, the people for being in denial about the obvious signs of addiction in their friends and loved ones. I mean the list probably goes on and on.
Our society's piss-poor ability to deal with addiction.
Once the system recognizes you as an addict, the moral crusaders in our justice system will do their damn best to limit you to provably ineffective forms of treatment, like 12-step programs. Methadone maintenance? Don't even think about it. Getting you off black-market drugs? Don't even think about it.
While everyone's busy arguing about who is at fault for getting millions of people addicted, we continue to treat addiction like we are still in the 'leeching and trepanning' stage of medicine.
It's like conspiracy theories - people WANT someone to point to and say, "that is the person in charge, they're the reason this has happened."
When in most cases, a really, truly shitty situation like this one does rely on the action of a few, powerful, bad actors, but mostly it's daily choices to simply not think made by all of us.
However, Doctors should have known better - opioids are not some new fangled treatment for goodness sake[1]
Doctors are highly trained, highly paid and their failure is central to the opioid crisis.
[1] In fact they are one of the first modern medicines - a wonder drug - then people realized the downsides. That was over 100 years ago.... https://en.wikipedia.org/wiki/Laudanum#History https://www.historic-uk.com/HistoryUK/HistoryofBritain/Opium...
I assume something similar was true in the 90s, or starting to be true, but I don't have as good an understanding of how it all worked back then.
This wasn't the age of clickbait and adtech, this was over 20 years ago. 24 hour news channels like Fox News and MSNBC were in their infancy. Isn't there some responsibility to be had to uphold journalistic integrity?
If anything, this article shows the danger of pop science and journalists writing authoritatively about things they don't understand well.
I wonder what could the difference possibly be....
Wells Fargo organized events for African Americans on "how to build generational wealth," but internally said they were selling "ghetto loans" to "mud people."
https://www.nytimes.com/2009/06/07/us/07baltimore.html
https://consumerist.com/5283290/affidavits-on-how-wells-farg...
> Paschal complained, yet Wells Fargo promoted him to area manager...
And here he is at another company...
https://www.jgwentworth.com/mortgages/about/branch-locations... https://www.jgwentworth.com/mortgages/about/branch-locations...
Most Russians were literally owned by their landlords until 1861 [1]. After that, they suffered the most deaths of any country in both world wars, and many famines and purges under Stalin, and extreme repression in general in the Soviet Union.
Try not to frame her as completely ignorant of oppression.
Also, it is public knowledge that the government looked the other way and protected drug growers in South America in the 80s because it was more concerned with the Cold War.
There is still an obvious empathy gap and double standard.
Well, no, there isn't obviously one. You seem to be alluding the the crack epidemic and the Just Say No / DARE types.
No one was getting hooked on crack after being prescribed medicinal cocaine by their doctor.
It is an apples-to-oranges comparison.
A more apt one would be the methamphetamine epidemic that preceded the opi(ate|oid) epidemic. Plenty of moral panic in the news, precious few folks gave a damn about the redneck tweakers.
Even if opioids are prescribed legally at first - abusers are getting it illegally later.
In any case, there are large quantities of illegal drugs feeding the "opioid" crisis as well, though. Fentanyl didn't happen in a vacuum, it was pushed at people having trouble getting oxycodone. And yet we don't hear talk on FOX about the horrors of the appalachian cartels bringing this garbage across the border.
Perhaps you should do some research on the methamphetamine crisis. Plenty of hand-wringing over tweaker shake-and-bake operations and rural labs.
But agreed: hands were wrung about meth.
Half of my family goes back to Appalachia, used to very several times a year. I can tell you anecdotally that there very much was there, though I doubt anyone would say "War on Meth" since there's already the "War on Drugs." Legislations, penalties, etc. increased in that neck of the woods. I've had junkies in my family (meth, heroin, oxy, etc.) in and out of jail most of my life. Hell, one of my buddies is an old meth cook. Man never graduated high school, but if you talk to him about the chemistry you'd think he was a university graduate.
Hell, one time on my way to school we couldn't get out of the neighborhood because someone discovered a shake-and-bake setup and the police, (fire) HAZMAT trucks were blocking the entire road. Everyone had to call off work or school that day while they cleaned it up.
I don't mean to be needlessly curt, but if you think there is something magical about the opi(ate|oid) crisis it is because you weren't well aware of preceding ones.
it is the same reason a school shooting, usually in predominantly suburban non minority areas whereas many more than that die in cities weekly.
political power is all about using problems for gain, not solving problems. while it can work in outlying areas it does not have the quick payback the city machine can. go look at the social interest groups, the community coordinator type jobs, and you will see friends and family if not down on their luck politicians who know which team to be on.
You’ll never get resolution on the race baiting observation. You’ll never find it productive to try to get revenge by enacting the same failed policies “more equally”.
Yes, there are some people that are simply playing a game of power for people that look similar to them.
Now back to addressing the current problem holistically.
And the “same policies” are still in force in the inner cities and there are different policies in the burbs in rural America.
This isn't one of those cases. Minorities being prosecuted for using prescribed opioids isn't exactly what is happening en masse here.
Not that I am saying that I have ever gotten a racist vibe where I live, but let’s just say that every place we go in our part of metro Atlanta, we stand out.
Every study shows that most Blacks live in a majority minority neighborhood.
Basically I’m just not having that particular conversation with you because thats not what this thread is about, and its clear you only want to derail into your writing prompt. The irony isn't lost on anyone, lots of people have seen the Dave Chapelle "Sticks and Stones" standup.
The structure of this crisis is prescribed drugs. So consumers of any color wont go to jail, and big pharma execs wont go to jail. Perhaps some particularly excessive doctors will, and feel free to make a statistical analysis of their ethnicity and socioeconomic status to find a correlation that matches your distress.
People using unprescribed and scheduled opioids still face law enforcement pressure.
People are reluctant to think the government is capable of what they did...
https://en.wikipedia.org/wiki/Kill_the_Messenger_(2014_film)
Of course, you can't question that, especially on HN where every anti-cannabis opinion is downvoted.
For me personally, the benefits far outweigh drawbacks. In society where things like alcohol and cigarettes/tobacco are perfectly fine although they provably destroy endless stream of families, lives and bring one of the worst possible (and costly to society) ways to die, having cannabis illegal is unfair and illogical. US prisons full of small time weed offenders, an event that effectively ruins one's professional life.
Read a bit about history and why it was banned in US, which then pushed it to the rest of the world. Even to places like India where its used as religious plant for millennia.
I strongly welcome legalization and hope the movement comes to Europe, and rest of the world soon. Society is better off if it is legalized (and regulated for things like access to minors/psychiatric patients, strength, purity etc).
Now to advise it as panacea for mental issues is plain stupid. Go see an expert, that's why we have them. Same would go for stuff like LSD.
> How one molecule from the cannabis plant came to be seen as a therapeutic cure-all:
https://www.nytimes.com/interactive/2019/05/14/magazine/cbd-...
> More Australians are using medicinal cannabis to treat a host of health problems as reports of its supposed healing powers flood the media:
https://www.theguardian.com/society/2019/aug/11/medicinal-ca...
https://www.theguardian.com/society/2019/may/05/cbd-a-mariju...
https://eu.usatoday.com/story/news/world/2017/04/25/marijuan...
To what end though? I'm not conspiratorially asking "what was their real angle?", but the much more simple "why did they think it was newsworthy for a non-doctor audience?"
I've seen the NYT run articles on a regulated industry I happen to work in. I'm no doctor, but I can see parallels because everything is slow moving and presumably based on expert opinion. Coverage of subtle points is surrounded by laughably bad analysis that drops a line of facts that lead the reader into conclusions they don't include in the print. Because if they printed it, the counterargument would be swift and damning. But without them explicitly saying it I'm "conspiratorial" if I say they're implying it. They then go on to make a wide-ranging hamfisted policy prescription that don't make sense for the subtle issue we started with and I'm 110% on board for fixing, but do make sense if you believe the unstated intermediary conclusion.
As for why it was reported at all, a health issue of interest to many thousands of people would seem to be newsworthy.
Finally, there were articles published by media outlets that showed potential problems with these prescriptions [0][1] And those were just what I found in a minute or two of searching. All available evidence shows that media outlets used prevailing scientific opinions of the time, and still managed to raise appropriate questions when issue began to arise.
[0]https://www.washingtonpost.com/archive/lifestyle/magazine/19...
[1] https://www.washingtonpost.com/archive/local/1996/06/18/dc-i...
If there had been significant opposition to this at the time, I would agree that news media failed. But I just searched through ProQuest and Google Scholar for research journals during 1990-2000 and I didn't find much at all that points towards significant risks of increased prescribing of these drugs. Quite the opposite, they pointed towards them being underutilized and leaving patients in significant pain despite low risk of addiction.
As it turns out, doctors were wrong. But it's only in the last few years that the scope of the issue has really come to light. I can't fault the media for not knowing 25 years ago what the medical establishment has only recently come to accept.
And how many of those studies were funded by the institutions pushing the products being studied? This type of conflict-of-interest / research-funding is nothing new, cigarette companies arguably pioneered this practice decades before.
> But it's only in the last few years that the scope of the issue has really come to light.
Sure, because of a non-ignorable problem. I'm advocating for skepticism, investigative journalism, and research, rather than parroting what industry says is true. I'm seeking reporting, not cheap public-relations pieces.
Instead of waiting for a problem, how about we ask questions of how things might fail before it does.
Skepticism is all well & good, but it's not the place of news media to be blindly skeptical. This isn't about what turned out to be correct or incorrect, it's about whether any amount of reasonable due diligence by news media would have changed their reporting. And the available information at the time doesn't indicate that it would.
Of course hind sight is 20/20, but you assume that media was simply parroting, that they didn't look into available research and come up empty. Maybe some didn't, maybe some did, but the fact remains that if they did, they would have come up empty. If the medical establishment, those actually tasked with the type of skepticism you advocate for, didn't do their job, that's on them. It's not on the media to be able to predict the future. You are simply blindly repeating "They should have done something" when nothing in the historical record would have supported it.
If the research is biased, you'd have to start funding your own clinical trials to find the real answer, which is extremely expensive (and perhaps unethical for certain addiction questions, given that you might addict people).
Its hard to accept that the medical practice in the Americas is comprised of mostly "young doctors and students." In 2018, ~69% [1] of physicians in America were over 46 years old. I am more inclined to believe that bad actors, lobbying and general incompetence is to be blamed.
This topic reminded me of "The $100 billion per year back pain industry is mostly a hoax"[2] piece which highlighted drug companies who spent millions on marketing, borrowing a page from Big-Tobacco, doctors who over-prescribed and frustrated patients who too matters into their own hands.
[1] https://www.statista.com/statistics/415961/share-of-age-amon... [2] https://qz.com/1010259/the-100-billion-per-year-back-pain-in...
Some studies find NSAIDs are as effective in the treatment of pain [1]. You can find several other studies with a quick search, though most of the ones I've found were short-term.
An additional issue is that opioids are not a treatment for the causes of pain. Pain is generally a symptom, not the underlying pathology. Physical therapy and other reliefs (nonsurgical) can treat the causes of pain and eliminate the need for any pain treatments.
And as for an anecdote - my stepfather went from large doses of opioids after back surgery and severe pain (for an issue they wouldn't recommend surgery for anymore, but would instead recommend physical therapy) for years, to a reasonable level of prescribed marijuana consumption.
Just some things to think about, since most of voices in the room seem to be pro-opioid.
1. https://jamanetwork.com/journals/jama/article-abstract/26739...
You know, the same education which is thoroughly gutted in America.
Reporting accurately on what the medical community thought the answer was?
The loss of the doctor-patient relationship could be one.
Our trust and financial relationship with the pharmaceutical/insurance industries, or maybe our salaries in general?
>we now know that between eight and 12 percent of patients prescribed opioids for chronic pain develop an addiction
I wonder how the state of the economy influences rate of addiction?
There is no correlation between structural changes in your body and the level of pain you have to endure, and you can be fully cured from your chronic pain within months.
It is hard work, and you will have to deeply examine your life, but if you are ready I encourage you to check out Dr. Sarno and fall down the Healing Back Pain rabbit hole. Nicole Sachs has some excellent youtube videos that I recommend. As well there is Steve Ozanich's incredible book.
I suffered for a decade with debilitating back pain, arm pain, neck pain, headaches, arthritis, knee pain, jaw pain, tendinitis, all of it, every day, all day, my entire life was my pain for a decade. And like thousands and thousands of others before me, once I discovered the real source of my pain I could actually work on healing it, and within months I was fully cured, and now have a toolset to interface with stress and pain in a healthy way that will last me forever.
You don't have to suffer, but you will need to work at this.
Wikipedia has remarkably fair treatment of controversial topics such as rBST.
Drug companies amplified that theme in materials sent to doctors and pharmacists. For example, Janssen Pharmaceutica, the producer of Duragesic, called the risk of addiction ''relatively rare'' in a package insert with the drug. Endo termed the risk ''very rare'' in presentations to hospital pharmacists. Purdue Pharma, the manufacturer of the powerful narcotic OxyContin, distributed a brochure to chronic pain patients called ''From One Pain Patient to Another,'' contending that it and similar drugs posed minimal risks.
''Some patients may be afraid of taking opioids because they are perceived as too strong or addictive,'' the brochure stated. ''But that is far from actual fact. Less than 1 percent of patients taking opioids actually become addicted.''
The trouble, however, was that studies that looked at the experience of pain patients who used long-acting narcotics for extended periods of time did not exist. So narcotics advocates like Dr. Portenoy and drug companies like Purdue Pharma had looked elsewhere, at surveys of patients whose use of narcotics was limited. And those reports were not always put into proper context.
https://www.nytimes.com/2003/11/25/science/the-delicate-bala...
Stop blaming drug addiction on everybody but the drug addicts.