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Comment by dkarras | Hacker News Reader

As a non-American I'm also curious about the mass necessity of opioid painkillers to begin with. From what I hear, people are prescribed opioids post surgery etc. which is bonkers to me as a foreigner. I'm a middle aged person and I have never seen anyone using opioid painkillers anywhere in my life. They give stuff to you when you are having surgery, and when you are in hospital's care, but something very extraordinary has to happen here to have access to those medications outside of a hospital setting. In the USA it seems to me like most people are prescribed these painkillers at least once in their life between 1-50 years but here, it is very exceptional and people are doing just fine.

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>As a non-American I'm also curious about the mass necessity of opioid painkillers to begin with.

The necessity is a result of big pharma lobbying activity, there is generally no medical necessity for opioids.

Big pharma money ensures things like marijuana remain a class 1 narcotic at the federal level meaning there is no known medical uses of the "drug." This allows pharma regulatory capture for their opiates which makes doctors, pharma, pharmacies and insurance money, so it simply becomes the norm to prescribe patients these highly addictive and euphoria inducing painkillers. So long as the patient remains insured, can pay and claims they are in pain, the Doctor will give them their drugs.

One astonishing fact is nearly 90 of the top 100 opioid prescribing doctors are in Florida, and 85% of all oxycodone a highly addictive variety of opioid therapy is prescribed in Florida.

In 2007 an oral surgeon gave me a prescription for opioid painkillers after a wisdom tooth extraction, just in case I needed it for pain. The pain wasn't very bad and I never filled the prescription, but in retrospect giving me that prescription in the first place was just crazy!

Another doctor gave my wife an opioid painkiller prescription upon hospital discharge after a normal childbirth, just in case she needed it. Also never filled or used.

In the past few years doctors and pharmacists have become more aware of the risks and now write fewer opioid prescriptions. But for a while it was totally out of control. (I don't think either doctor was using Practice Fusion.)

this is to prevent you from going to the ER and getting an enormous bill. sometimes after tooth extraction a condition called "dry socket" can develop and it will cause enormous pain. opioids solve that until your next regular visit to a doctor. otherwise you could feel terrible pain and go to ER in the night with all the consequences

https://en.wikipedia.org/wiki/Alveolar_osteitis

Thanks but I'm already familiar with the potential complications. The reality is that many people have become addicted following dental procedures.

https://med.stanford.edu/news/all-news/2018/12/opioid-prescr...

if teenagers wanna get wasted, they will find plenty of junk on the streets. That's why kids should have parental oversight. You may fill the prescription with opioids - but you dont have to use them. I went to dentist couple times, and filled the opioid prescription once just in case, but never used them.

One should always have scripts both for pain killers and anti-nausea meds at the ready after major procedures.

And avoid scheduling anything right before your surgeon takes time off (weekends, vacation).

Those 'just in case' scripts are usually combined medications that are short enough in duration that they don't pose much risk of dependency.

Recent research indicates otherwise.

https://med.stanford.edu/news/all-news/2018/12/opioid-prescr...

It’s a crafty way to pass on the responsibility of making the choice to the obviously oblivious “client”.

There's no accurate alternative. Different people often experience different pain responses to the same condition/procedure.

Worse, I went in for a consultation prior to having my wisdom tooth removed.

I was on the fence whether to have the procedure done or not. The doctor used the fact that I would be prescribed “really good painkillers” as an incentive for me to schedule the procedure.

You're premise is likely incorrect. As a non-American there is a very good chance there is an opiate available over the counter with no prescription in the form of codine.

https://www.oecd.org/health/health-systems/opioids.htm

It's not an American problem, its a "First World" problem.

But usually in small amounts, in small containers at high prices. And mixed with far more toxic ingredients.

It doesn’t stop everyone. But for those it doesn’t, they risk succumbing to the paracetamol or ibuprofen before the codeine.

They could separate them, but I don’t think it’s common.

Also, poppies are stupid easy to grow, but nobody seems to bother recreationally, suggesting that ease of access was never a root cause.

That graph puts things in perspective. It turns out that I'm living in a country where opioids are not very available compared to other nations. Here you can't even get cough syrup with codeine in it without a prescription and even then doctors won't generally prescribe that.

'Opioids' is a pretty wide category though.

I don't think something like a short-term prescription for low dose codeine/acetaminophen cough syrup is really a big deal. Stuff like that can even be over the counter in a lot of developed countries.

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