Comment by PragmaticPulp | Hacker News Reader

Comment by PragmaticPulp | Hacker News Reader

I do agree that we should re-examine the nature of opioid prescribing, but at the same time I get worried when journalists start demonizing opioids altogether:

> Yet it turns out the FDA never had reliable scientific evidence supporting the claim of safety and efficacy of opioids for chronic pain

Opioids should be prescribed with great caution, but I don’t think you’ll find anyone well-versed in pain management who questions their utility in severe cases.

The problem in the past wasn’t that opioids existed. It was that they were being prescribed far too liberally and the risks were being deliberately downplayed.

We need more evidence and more regulation, but let’s not have the pendulum swing too far in the opposite direction. It’s already common to hear stories of pain patients being forced off of their stable opioid prescriptions because their doctors are concerned with keeping their numbers down.

I look forward to the day that we have better medications for pain management with less abuse liability, but until then we need to work with what we have. Regulate and educate, yes, but demonizing the substances isn’t the solution. They have their place when used correctly.

> The problem in the past wasn’t that opioids existed. It was that they were being prescribed far too liberally and the risks were being deliberately downplayed.

The other problem is that addicts were either cut off and forced to, or found it substantially cheaper, to move on to street drugs laced with fentanol and poor quality control. Instead of being given sufficient rehab to get over their problem.

I totally agree, but for a while there it was really out of control. In 2007 an oral surgeon gave me an opioid prescription after a tooth extraction! The pain was minor so I never took any but in retrospect that was just crazy. It's easy to see how many people got started on the path to addiction.

Cannabinoids

Do you want to expand on this one word answer? Why do you think cannabinoids are a good substitute for opioids?

It might have something to do with the reports from US states that legal and widely available cannabis tends to curb opioid use. No, people won’t necessarily stop using opioids, but they will use much lower doses and not as often.

Anecdotally, all of the people I know struggling with opioid addiction were potheads beforehand. I think drug addicts will abuse whatever they can, regardless of available options.

That is just simplistic labeling and stereotype. What were these individuals’ childhoods like and what was their outlook on life in general? Do you even know what their inner self was like?

Addiction usually starts from escapism, and the causality that drugs cause addiction is very far from true.

It is simplistic labeling, and I am generalizing from what I've seen. I agree it starts from escapism in many cases. From what I have witnessed it's escaping boredom and/or pain, two things that life has much of. It's a dangerous attitude (obviously).

I'm not arguing your second point, but suggest you consider that some drugs are more difficult to quit and are therefore more addictive than others. I'm arguing that people who have problems with drug addiction will likely add more legal drugs to their stack rather than curb use.

So, do you want to ban private car ownership, because some people are prone to speeding?

Do you also want to ban everything except heterosexual copulation for the sole purpose of procreation because there are sex addicts?

Shall we do away with video games, playing cards, dice and horses because some people have problems controlling their gaming and gambling behaviours?

How about making it illegal to own pets because some people neglect theirs? The same goes for having children.

Are we banning all food except reconstituted, fortified, protein—fat—carbohydrate sludge because some people have eating disorders?

I didn't say anything about bans or making things illegal. I don't mind too much that there are drug addicts, speeders, sex addicts and frivolous games.

I think you're letting emotion blind you since it seems you're not actually reading and understanding what I write.

I was trying to show by several analogies the faulty logic in ”some people have problem with X, therefore X must not be allowed for all people”.

Of course, your mentioning of polydrug use could be just a neutral observation, but why then use it as an argument?

... are not a panacea, and not a replacement for opioids for many, many uses.

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