Hacker News Reader

Comment by thrownjustnow | Hacker News Reader

This may be completely unpopular opinion, but as a temporary user of pain killers I am thankful I was prescribed them. I was experiencing chronic and hard to diagnose pain. I was in a very dark and scary place and was constantly wondering how people without access to these medicines continue their will to live. I was having difficulty making it through a work day and as a desk worker I was able to tolerate them during the day.

I am thankful my doctor was so willing to prescribe them for me. Looking back on the experience in hindsight I would have preferred to stay on them longer instead of transitioning to other medicines during physical therapy. There was a lot of suffering during that time.

View on HN

I see the oncologist every three weeks. And the radiologist every few months. They always ask if I need any pills. I haven't taken a opioid in six months. And I have a ton of oxy and hydromorphone sitting in my bathroom from when I was deep into chemo. Hundreds of pills sitting there that I have no desire to take.

I found that lorazepam and a Advil helped more.

And from my experience the most egregious prescribers of opioids aren't doctors, but dentists. I got 30 hydrocodone for having a tooth pulled. That is absurd.

"I have a ton of oxy and hydromorphone sitting in my bathroom"

Not a good idea to keep them, IMO.

I have absolutely no desire to do them. The constipation is unbearable for me when I take them. I do enjoy a hydrocodone.

But it has been a year and they treat the cancer, and then another scan and there is a new spot, rinse and repeat.

Another round of radiation starts next week. So not a terrible idea to keep some pills around. But this batch of radiation should be easy. 5 treatments over two weeks. Probably won't even get a sunburn from it!. And it might seem odd to be really happy about radiation. But I was thinking it would be another few months of chemo. So radiation is fantastic.

I tend to agree, maybe because I have had a similar experience.

Went to the ER with severe abdominal pain, but took more than 24 hours to diagnose and therefore admitted and get on morphine. Even though it was only a little more than 24 hours, it was possibly one of the most miserable 24 hours of my life.

Then magically morphine goes in and things were tolerable. Over the next 10 days I was on low dose IV morphine (couldn't take anything in pill form because GI tract wasn't really working), but they wear out pretty quickly. The hour or so between the time the previous dose wears off and the next dose the morphine was definitely on my mind a lot. Although in my case it wasn't wanting to get high but rather remove the pain.

Previous to this episode I held that opinion that opioids were rarely needed and people should just tough it out. e.g. when I had my wisdom teeth pulled I was prescribed opioids but didn't take any. But this episode definitely changed my mind. Not sure what I would've done in that 10 days if I wasn't on morphine.

People who have never needed particular drugs often struggle to understand how important they are to those who actually need them. It's incredibly hard to empathise with someone's plight if you've never experienced it yourself.

I have far too many people who aren't doctors telling me that I don't really need stimulant medication to manage my ADHD and I'd be fine without it. Often they'll go on to describe how, as someone without ADHD, Ritalin or dextroamphetamine gets them all wired up.

Ritalin literally just straightens me out and makes me feel normal (unless I eat a handful). I can certainly manage without it, I did for over 20 years, but life is a lot easier when I have the option to use it. It's a tool in a toolbox of management strategies. I'm an adult and am capable of giving informed consent, I had a discussion with my doctor about potential side-effects and long term use, including dependance and what would happen if I stopped taking medication. I have a fairly comprehensive understanding of ADHD and stimulant medication, more than your average moon worshiping hippie, that's for sure.

I've gotten the same in regards to using benzos (Xanax, Valium) for anxiety. If you need them, you need them. Breathing exercises or trying to distract yourself won't work. If you've never experienced a panic attack or had serious anxiety, you can't understand how bad it is. If you take an appropriate dose, you don't become a sleepy zombie, you become a functioning human.

I have friends who are on anti-depressants and I've seen exactly the same thing happen to them. Positive thinking and yoga won't cure clinical depression.

It's demeaning and condescending to assume that someone hasn't considered actually trying to solve their mental health issues without medication or drugs. It's actually incredibly insulting to have someone with no qualifications or subject knowledge tell me how I should manage my mental health and that I shouldn't be taking medication. It's like telling someone who needs glasses, which I also do, that they should try opening their eyes and looking harder (I've actually had people tell me I should try exercising my eyes), or telling someone with asthma that they should just breathe deeper. You wouldn't tell someone in a wheelchair that if they simply think about walking hard enough they'll be be able to stand.

Very few in this discussion are asking to ban opioids. However corruption of the Doctor-patient relationship is a big problem.

There’s a word for this on the street - a “pusher”. I for one don’t want to wonder if my doctor is getting kickbacks for prescribing specific meds.

No one's calling for a ban on opioids because they're already banned — they're DEA schedule II. There is an extremely limited exception where they can be prescribed, by a professional cartel (AMA), to extremely limited numbers of patients in limited quantities. And people have clamored for that exception to be further limited over the past decade or so.

I think the general sense of people's objections aren't to the medications themselves, it's to the repeated revelations of just how determinedly companies lied and bribed and incentivized the use of opioids.

I for one would love to see pharma marketing info limited to nothing more than summaries of prescribing quidelines, and anything resembling sales pitches or opinion of any sort heavily penalized until the current pusher system ends.

First of all, I am not an expert on opioids nor am I a trained doctor. For what it's worth, I have lived with chronic pain, so I do know what it is like to suffer.

I do not think the problem is that opioids are evil, but that they were clearly (to the point of obvious fraud) being sold in great quantities to people to abuse for recreational purposes. Obviously it can be frustrating because now people with legitimate medical pain have one less option for dealing with their suffering (although based on studies I have read, opioids are actually not the first choice for most users), and they are the victims of the flagrant corruption of the pharmaceutical companies in question.

I am not saying doctors need to be perfect in diagnosing problems and always knowing what to prescribe, and magically predicting when a patient will become addicted (even if it is to treat a legitimate medical condition). I am saying the corruption of overprescribing drugs for the obvious profiteering should be stopped, and those found responsible should face legal consequences (I assume something like 20 years jailtime, plus forfeiture of all assets gained illicitly after thorough audits - when going after billions of dollars it is easy to come up with the money for audits).

I am glad that opioids were able to help you and I am glad you were able to get them when you needed! I understand there is a lot of villification of opioids and in the outrage some people want them banned entirely and that would likely be a loss (similar to what happened with marijuana, ketamine, and other drugs that were always suspected to have real medical benefits and we are now getting real clinical studies to support these hypotheses). But the corruption is real, and the criminals need to be punished, and the overselling needs to be stopped.

You make some excellent and sympathetic points, I assume in large part because of your own experience with chronic pain. Good doctors, who care emotionally for their patients, are more than willing to alleviate the discomfort. One of the main problems now is that States are implementing even more restrictions for opioid prescription. Many doctors feel as if they are being closely watched, and those that register as prescribing opioids, are somehow under even more scrutiny. I know many who don’t go near these substances any more, not even renewing their DEA registration.

I think "recreational" is not the correct term to use for most of the people taking opioids without a prescription.

So many addicts start out using for some pain, and become addicted. They then buy from shady doctors or people who get drugs from shady doctors. Or they might use them to feel numb because they are depressed.

I am just not sure that a majority of illegal opioid users are people who started their habit by thinking "I am looking to have a good time to night, let me take some opioids"

Wasn't it the case that oxycodone was marketed as working for 12 hours (per its patent) when it only worked for 8? And that doctors were told by the pharmaceutical company to increase the dose rather than make it more frequent?

Recreational users wouldn't be the problem since addiction is the intended result.

The problem isn't that they work to relieve pain, it's that they're addictive.

Anecdotally, I once knew a fellow who "accidentally" broke his own finger to get a prescription.

They aren't addictive to the vast majority of people.

In this respect it's similar to alcohol: only harmful to a small group of people, but for them very harmful.

I think the key is looking for commonalities of the people at risk of addiction and finding alternative therapies for them.

Can you please show a single credible source that claims that things like heroin or opium "aren't addictive to vast majority of the people"?

From everything I ever read or heard on that topic this is simply not true, I wonder what makes you say those things...

And that statement about alcohol is an outright lie in the way you state it.

Alcohol, Heroin and Nicotine. All are super addictive and after some time the body becomes chemically dependant. It's why you get "dope-sick" when you kick.

People can drink alcohol every day without being addicted to it.

Maybe some very few, or 'a glass a day' type consumption, sure.

I've seen alcoholic withdrawal and it's not pretty. Drying out from a real addiction can need medical attention.

Some people smoke cigarettes every day without being addicted to them, and I'm sure some people can smoke opium every day without being addicted to it (probably can't say the same for injecting heroin).

Doesn't mean it's good for you (neither is drinking every day).

You don't have to inject heroin to consume it, FWIW. You're right that intravenous use is probably more addiction prone (not to mention, dangerous for all kinds of reasons).

People can consume nicotine and heroin every day without being addicted to it, in whatever sense you are imagining that means for alcohol users.

"Roughly 21 to 29 percent of patients prescribed opioids for chronic pain misuse them. Between 8 and 12 percent develop an opioid use disorder." [0]

"According to the 2017 NSDUH, 14.1 million adults ages 18 and older (5.7 percent of this age group) had AUD (Alcohol Use Disorder)." [1]

depending on your definition of "vast", these seem to support GP's claims (certainly not an "outright lie"). the rates compared here aren't quite apples-to-apples, but they do suggest the rate of addiction to alcohol is pretty similar to that of opioids.

[0] https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdos...

[1] https://www.niaaa.nih.gov/publications/brochures-and-fact-sh...

The percentage is twice higher, and opioids are regulated and hard to get to boot.

It's plausible that we would be looking at 20%+ if you could get them at the store like you can a beer.

It's also plausible that the 8% figure is representative of unfettered access. Conceivably everyone who wants opioids has access to opioids in some form or another now, and those who want it especially badly will put in special effort to get it. Heroin and kratom are easier to obtain than prescription opioids (if you don't have a visually obvious physical trauma and health insurance).

We know the number of patients prescribed opioids each year; it peaked in 2012 (it has been declining since then)[1]. We could look at abuse / addiction data over some period where prescriptions rose, and see if the disease rate rose significantly. It would be suggestive, if not conclusive, because we prescribe opioids to something like 20% of the population each year. (For comparison, about 66% of persons >12, or 55% of the total population, drinks any alcohol in a given year; figures from 2014.[2])

> After a steady increase in the overall national opioid prescribing rate starting in 2006, the total number of prescriptions dispensed peaked in 2012 at more than 255 million and a prescribing rate of 81.3 prescriptions per 100 persons.

I don't have good figures for historical rates of opioid addiction at hand, but we can look at 2016 (roughly).[3]

> In 2016, an estimated 1,753,000, or 0.7% of persons aged 12 and older, reported a substance use disorder in the past year involving misuse of prescription pain relievers

Going back to [1], the prescribing rate was 66.5 per 100 in 2016 and (in 2017, but taking for representative) "an average of 3.4 opioid prescriptions dispensed per patient." So we get 66.5/3.4 => ~19.6 per 100 people prescribed opiates, or 19.6% of people. 0.7% / 19.6% is an addiction rate of about 3.5%. There are definitely holes in this, but it's definitely plausible that the real rate for unfettered acecss is single digit.

We could also look at Portugal as an example. Decriminalization isn't the same thing as full legalization and unfettered access, but[4]:

> It is estimated that there were 33 290 high-risk opioid users in Portugal in 2015, which is about 5.2 per 1 000 of the adult population. In the same year, the number of people who inject drugs was estimated at 13 160 (2 per 1 000 people aged 15-64).

("High risk" in EMCDDA terms is injecting drug use or any long-term or regular use; it's a reasonable proxy for addiction, although might overestimate.[5])

[1]: https://www.cdc.gov/drugoverdose/data/prescribing/prescribin...

[2]: https://www.samhsa.gov/data/sites/default/files/NSDUH-DetTab...

[3]: https://www.cdc.gov/drugoverdose/pdf/pubs/2018-cdc-drug-surv...

[4]: http://www.emcdda.europa.eu/publications/country-drug-report...

[5]: http://www.emcdda.europa.eu/data/2014/methods-hrdu

I have met people who claim to have tried various hard drugs without addiction, but they usually don't talk about it because of the taboo. As a non-using bystander I would find it interesting if both prescription and banned substances had something like LD50 but for addiction. A measure of what dosage pattern will lead to 50% of the population being addicted. An AD50.

For better or worse I know a lot of people who smoke methamphetamine. Never smoked it myself and never would.

Most of them smoke it recreationally without it causing any problems in their life or addiction. They have no issues when they're not smoking it, they can stop when they want, and they don't let it negatively affect the rest of their life (work, relationships, etc.). Some of them are weekly smokers, some of them are only once or twice a year. But around 10-20% of the people I know who smoke it have issues with dependence and addiction, and it's caused massive problems for them (and those around them) and for some of them it's destroyed their life.

I don't know anyone who uses heroin, but I'd imagine that it's the same.

"Hard drugs" are surprisingly non-addictive, less addictive than nicotine and probably even less addictive than caffeine. The reason why these drugs are "hard" though is that if people do develop an addiction, it's so incredibly destructive. It becomes their life, everything they do becomes drug-seeking behaviour. They don't even like the drug any more, but they need to keep doing it just to feel normal.

> The reason why these drugs are "hard" though is that if people do develop an addiction, it's so incredibly destructive.

Eh. Do you know many alcoholics? The "hard" qualifier is mostly just arbitrary societal taboos reinforced by the federal government.

https://www.latimes.com/projects/oxycontin-part1/

"Purdue tells doctors to prescribe stronger doses, not more frequent ones, when patients complain that OxyContin doesn’t last 12 hours."

The key is better education and destigmatisation around addiction and its causes, and encouraging open dialogue. Otherwise we'd end up in a weird, accidentally classist society where poor (and other "at-risk") people aren't allowed opioids but wealthy people are.

People don't want to, or choose to become addicted, and it's not like people take a drug once and they're instantly hooked. People being prescribed potentially addictive medication (and those around them, friends and family) need to be educated on the warning signs of dependence, and encouraged to talk about it. There shouldn't be a stigma in admitting addiction, it's not a moral or personal failing, but it's treated as such by so many people.

> constantly wondering how people without access to these medicines continue their will to live

They often don't.

Do you think your doctor wouldn't have prescribed them if not for aggressive pharma marketing? Was it difficult to obtain a prescription?

If you’re all right with my asking, where was the pain located, and from what cause?

In my own case it was in the throat, literally unable to swallow anything for days due to severe pain, cause was mono.

Fun fact I discovered through the ordeal is that the very act of thinking about saliva causes saliva to secrete, so it's practically impossible once you realize you have a saliva problem to stop it, since with a problem on hand you cannot but think about it and the very act of thinking about the problem causes the very problem to worsen

Do you know at the top of your head statistically how likely are the people taking the drugs you are taking to overdose and die?

In raw numbers (so this is not a probability), half as many as alcohol.

https://www.caron.org/blog/2019/05/alcohol-is-killing-more-p...

Any serious research to back that up? But even then I have to ask so what? What does that have to do with anything? I never claimed that alcohol isn't killing people or that this is a problem that must reduce attention to other problems

My source cites numbers for opioid and and alcohol deaths according to the Center for Disease Control. Anchoring opioid deaths against alcohol provides a frame of reference for many people, since alcohol is so ubiquitous in human culture.

I tried googling for the odds of becoming addicted to those substances and couldn't readily find anything for either. Hopefully someone else sees this and can shed some light, because it would be interesting to me as well.

Calculating long-term effects is a lot harder and ambiguous than thing easy to measure like ODs, for example that post includes cardiovascular diseases and cancer but did they compare how many drink alcohol and exercise vs those who don't? And afterwards compare people that don't exercise vs people that drink alcohol and exercise, and people that exercise that never drink alcohol vs people who exercise that drink it each weekend? Are there differences between people that drink pure alcohols (Vodka, Whisky) vs non-pure ones (beer), and also how much is enough drinking to notice those negative symptoms, once a year? once a month?

> But recent studies estimate that 21 to 29 percent of patients prescribed opioids end up misusing them, and the rate of addiction actually ranges between 8 and 12 percent.

Apart from the problems about how opioids are prescribed that were touched on in the article, one of the big problems with how opioids and other potentially addictive drugs are prescribed is that there's incredibly poor eduction around addiction, and a deep societal stigma against addiction.

Drug dependance and addiction isn't a moral or mental failing. It can (and does) happen to the most virtuous and intelligent people. Patients aren't educated to recognise the symptoms of beginning dependence and addiction, and if they do recognise it, they're reluctant to communicate this with their doctor for fear of being cut off entirely. Instead of being open and up front when they start to develop a problem, because of stigma and fear of being labelled a junkie, people will hide their behaviour, causing further problems. Also, because of the attached stigma, friends and family will often be reluctant to raise any concerns they have.

Your kind of response is exactly the kind of attitude and stigma that furthers the problem.

Reply on news.ycombinator.com