Hacker News Reader

Comment by Zagill | Hacker News Reader

It's still crazy to me that I was just given hydros when I got my wisdom teeth out at 18. I didn't even need them, I was barely sore.

View on HN

I'm really glad for you, but I don't know how I would have survived my wisdom teeth removal without them. Even with the pills the pain was still excruciating. I lost a lot of weight from inability to eat or even drink.

In my opinion, giving somebody pills who doesn't need them (what used to be the norm) isn't great but the vast majority of people don't suddenly become junkies. Most people are perfectly fine. You yourself is evidence of this.

But not giving somebody pills who does need them (which is now the norm) is literal torture, and the practice disgusts me. I'm really glad you were fine, but not everybody is so lucky, and the number of people who say as you do but also have the power to enforce their views on everyone else have literally been responsible for torturing others. The only thing worse than sitting in pain and misery is knowing that the means to relieve some of that pain is readily available, but some person decided you shouldn't have them so you get to suffer.

The problem with talking about "giving somebody pills" is that it's extremely imprecise. A coworker of mine was once given a two week script for oxy after they injured their arm, they had two days of serious pain and then just mild soreness - this was an insane over prescription and my friend knew it.

They used cannabis to manage their pain for two days and never filled the script. I think a script for two or even three days would have been perfectly reasonable with a "Call me back if the pain is too much after that period".

I think one problem is people have vastly different thresholds of pain. Somebody else having the same injury might be calling their doctor back begging for a refill because they can barely function. Of course determining how much of that is a medical need versus how much is "the pills talking" is never going to be easy.

That's one of the beautiful things about Cannabis legalization - it provides a non-addictive pain management solution where the pills will talk much less.

I fully agree with you on Cannabis, but I don't think that's an argument for restricting opioid pills. I think we can and should make Cannabis widely available, and should absolutely encourage people to give it a try first, but if it doesn't work for them I think they should have the option of trying the pills.

>fully agree with you on Cannabis, but I don't think that's an argument for restricting opioid pills. I think we can and should make Cannabis widely available, and should absolutely encourage people to give it a try first, but if it doesn't work for them I think they should have the option of trying the pills.

I'd go further and say that all "drugs" should be easily available and the tiny percentage of folks who develop dependency issues should be provided treatment and support.

Not only would this reduce suffering and provide a wider range of pain management strategies, it would also significantly reduce the societal costs of substance prohibitions in terms of reduced economic impact in the following (not a complete list) ways:

1. Interdiction/enforcement is hugely expensive, and providing treatment to those who require it would cost a fraction of that;

2. Criminalization of substance use stigmatizes those who are caught in that particular net and, at least in the US, limits their ability (because many folks won't hire you if you have a criminal conviction) to increase economic activity/output;

3. Because of (2), many communities as well as the economy as a whole are negatively impacted both economically and socially;

For some reason, when it comes to "substance" use issues, we tend to examine the possible alternatives to address them, then choose the least effective, most harmful one.

I hope that changes, but I doubt I'll live to see it.

Edit: Clarified that the impacts I mention are not all of the impacts that drug prohibition has on society.

I don't understand what the problem is with the imprecision in your story. Did your coworker abuse the extra pills? Did he become an addict? If not, then why is it so bad for him to have gotten more in case he needed them? Don't you think needing them and not having them is worse than the situation your friend was in where he needed to throw them away?

He was a trained pharmacologist who knew that being on a constant dosage for that long can be habit forming so he didn't take them - a decent portion of people are handed a bottle of pain meds "Here's a two week supply" and assume they're supposed to take them at the prescribed rate continuously. It takes an active personal decision to decide not to take the meds prescribed for you and that you've already paid for.

I certainly wasn't advocating that no one should get opioids because I have a high pain tolerance, rather that we maybe shouldn't be prescribing them by default for everything.

In the same vein, I think a lot of research ought to be done into non-addictive painkillers. Then the risk would basically be zero and everybody's happy (except for pharma companies that make bank off of opioid addicts, of course)

> I certainly wasn't advocating that no one should get opioids because I have a high pain tolerance, rather that we maybe shouldn't be prescribing them by default for everything.

Many, many people assume that if the doctor doesn't offer pain medicine, then it's because they don't need it. Once you've left the office and the pain gets bad and you realize you should have asked for them, it's too late. But also, a ton of doctors won't prescribe them anymore ever because of the extreme risk of losing their career to the DEA if they make a bad call in favor of prescribing. There's virtually zero risk for under prescribing, so human nature for self-preservation makes this decision a no-brainer for the doctor.

> In the same vein, I think a lot of research ought to be done into non-addictive painkillers. Then the risk would basically be zero and everybody's happy (except for pharma companies that make bank off of opioid addicts, of course)

I agree completely

That's changed a lot. I had hydrocodone prescribed after mine (~15 years ago?).

On the other hand, my son just had his out and got 800mg ibuprofen and 625mg tylenol alternating. Seemed to do okay as long as he kept on the schedule.

This happened about 4 years ago, people were definitely aware of the opioid problem at that time

I had the same prescription about 10 years ago, I didn't even bother filling it because I barely had any pain.

High-dose alternating ibuprofen & acetaminophen seems to be the go-to regimen nowadays, with oxycodone only for severe pain control and only in combination with acetaminophen. Apparently oxycodone and acetaminophen have synergistic effects; anecdotally, when someone I know had a major inpatient surgery recently, they said that the oxycodone made them feel like shit unless they took the acetaminophen along with it.

I don't know why they use high-dose ibuprofen instead of meloxicam, but I guess there are good reasons for it (maybe greater risk of GI damage?).

I was about 21, they prescribed 24 pills I think?

I used one, and really just a preemptive use before I went to work (I only took a half day off).

The weird thing is, though, I felt very normal at work. I had never tried a drug, so I wasn't sure what to look for, but I just felt normal. No pain, no other effects.

I have some from a dentist thing last year, too, and I would say similar now, but with a mild high.

I was never tempted to take extra. I threw them away before I moved countries.

> I just felt normal. No pain, no other effects.

Reminds me of this excellent comment from Reddit about what heroin is like:

---

Actually this is an obvious question but it's not what you might think. Let me explain it to you, I've been an opiate addict for a long time and tried many drugs. Drugs that are 'uppers' have the most 'obvious' euphoria. For example if you take adderall/coke/meth/speed/MDMA you will get this shining bright euphoria, self confidence, energy, and other drug-specific feelings (for meth like you are king or for MDMA like you love everyone). However, you owe these drugs back what they delivered to you. After a meth binge, or lots of MDMA use, or staying up all night on coke you will feel like shit. To an extent this aspect is similar to an alcoholic hangover.

On the other hand, for many people who experiment with heroin they are underwhelmed (not including IV usage, but most experimenters rarely ever IV first time). They just feel good, chill, happy, but they feel like this spooky drug 'heroin' hasn't delivered. They are just mellow. Oh obviously it has all been a lie they will think. Heroin isn't spooky, it's chill. It's not addictive like everyone else thinks. It doesn't make you do stupid shit or stay up all day and hallucinate like amphetamines or coke. It doesn't empty your serotonin like MDMA or give you a hangover like alcohol. People tend to just think oh, what a nice drug.

So the next day they wake up and everything is normal. No headache or shitty feeling--just a slight afterglow of that nice feeling. Oh it was cheap as well! It only cost $10 for a whole night of being high! I thought people said heroin was expensive? And then next weekend comes... There are all these drugs I could do but I liked heroin. It didn't 'fuck me up,' I could still think clearly. No hangover. No feeling like shit later. I still was awake. It just made me happy and content with life. Oh and it's only $10! Well, I should get some more for the whole weekend. This is great! I will use Heroin on the weekends now!

Now let's say this person works and has responsibilities. He knows he can't go into work drunk, or on MDMA, or high. So he doesn't. It's actually simple. But heroin... Well the user might actually find they do better work on heroin. Instead of being sad or grumpy or depressed with his job... he is just... happy. Mellow. Content. Everything is fine and the world is beautiful. It's raining, it's dark, I woke up at 5:30AM, I'm commuting in traffic. I would have had a headache, I would have been miserable, I would have wondered how my life took me to this point. This point I'm at right now. But no, no, everything is fine. Life is beautiful. The rain drops are just falling and in each one I see the reflection of every persons life around me. Humanity is beautiful. In this still frame shot of traffic on this crowded bus I just found love and peace. Heroin is a wonder drug. Heroin is better than everything else. Heroin makes me who I wish I was. Heroin makes life worth living. Heroin is better than everything else. Heroin builds up a tolerance fast. Heroin starts to cost more money. I need heroin to feel normal. I don't love anymore. Now I'm sick. I can't afford the heroin that I need. How did $10 used to get me high? Now I need $100. That guy that let me try a few lines the first time doesn't actually deal. Oh I need to find a real dealer? This guy is a felon and carries a gun--he can sell me the drug that lets me find love in the world. No this isn't working, I need to quit.

---

https://www.reddit.com/r/IAmA/comments/wnj2d/iama_heroin_add...

Honestly that reads like a creative writing exercise given the amount of inaccuracies in that rose-colored description.

I'd recommend anyone reading take that with a large grain of salt.

Found it incredibly accurate myself.

So if you are miserable, opiates will make you feel content. Not euphoric, but merely content, normal. But if you already feel content, opiates will not make you feel much different.

That’s sad if true. Opiate users are not chasing a high, they’re merely chasing a normal.

That's what research is starting to suggest for at least some opiate addicts.

Opiates have a very strong anti-depressant effect, that also tends to make the depression worse after coming down. Well, really it's the activation of "opioid" receptors (becoming a bit of misnomer) that have a very strong anti-depressant effect, which is the same mechanism that the anti-depressant effects of ketamine derive from despite not being an opioid (anti-depressant effect is almost entirely negated if taken with naloxone, aka NARCAN, to inhibit the opioid receptors).

This worsening of depression symptoms after coming down from opiates causes a vicious, psychological feedback loop in addition to the physical dependency. This also may be why ketamine has higher risk of addiction than other psychedelics like psilocybin.

Dissociatives seem to be in their own class when it comes to addiction, and I wouldn't compare them with your classic psychedelics that work at 5HT2A on that metric. A lot of people get addicted to dissociatives like DXM where you don't that kind of dependence and abuse with most 5HT2A agonists.

Many dissociatives also inhibit dopamine and norepinephrine transport, or induce their release, which can have rewarding and addictive results on their own.

I agree, it wasn't a great comparison. I didn't want to get too into the weeds on specifics since I figured the average person would lump them all under "psychedelics" or "hallucinogens". I just wanted to point out that the activation of opioid systems may be a contributor in its more addictive nature, but it's certainly not the only factor in its addictive potential. Especially so since those dissociatives that activate dopamine or opioid systems tends to be more addictive than their more selective counterparts.

Yeah that was basically my experience. I took a few of them but nothing noticeable happened so I just didn't bother taking more. Funny enough that was also true when I tried a couple ADHD meds. Didn't feel a difference, not even withdrawal symptoms from going cold turkey after a few months.

Maybe I'm just weird...

Same--tried adderall twice, couldn't tell the difference.

I'm not high-caffeine intake or anything either. Nothing that should mask it.

vitamin C can stop/reduce the absorption of adderall...took awhile to figure that one out when I restarted while on an orange juice/smoothie/berry kick

I got 400mg ibuprofen for 3 days and was fine. The surgery was also local anesthesia.

I know you can consume cannabis orally, but I think smoking wouldn't be good either, since it can cause dry socket.

I think in most cases, Ibuprofen would be enough.

For real, I was surprised to get Vicodin at 14 when I had mono. Only took it once and assume my parents just chucked it

Reply on news.ycombinator.com