Fear of opiates is causing patients to needlessly suffer severe pain | Hacker News Reader

Fear of opiates is causing patients to needlessly suffer severe pain

usatoday.com

For context, this article is an opinion piece co-authored by:

Jeffrey A. Singer - A senior fellow at the Cato institute, a republican think tank that receives much of its funding from large republican donors/foundations and corporate donors. I don't know how to sum up the Cato Institute in 2 sentences unfortunately, but their wikipedia says plenty [0].

Josh Bloom - The Director of Chemical and Pharmaceutical Sciences The American Council on Science and Health, which is a pro industry advocacy group [1] that has received large amounts of money from the agriculture, petroleum, tobacco and pharmaceutical industries as per leaked funding documents in 2012 [2].

[0] https://en.wikipedia.org/wiki/Cato_Institute

[1] https://en.wikipedia.org/wiki/American_Council_on_Science_an...

[2] https://usrtk.org/industry-pr/american-council-on-science-an...

Cato has always been very pro recreational drugs. I’d argue there s large part of the reason marijuana use has become so normalized. And people like Scott Gottlieb are a large part of the pro-vaxx lobby as well.

On the legalization front, Cato is definitely on the libertarian end of the spectrum of conservative think tanks, so that does line up

Also the fear of people abusing ADHD drugs is causing massive amounts of harm. I have a legitimate issue but the drugs are highly controlled and I am viewed with suspicion. It's very very hard to get the drugs I need and I am treated like a criminal during the whole painful process. Meanwhile I could easily buy $100 of street drugs that would last me a YEAR with much less pain and suffering and hoops.

The government needs to get out of drug prohibition. It doesn't work. Let the medical community handle things. The DEA has no business setting production limits or even existing for that matter.

I'm finding myself growing increasingly cynical on any politician's promises with regards to the "drug war" as we live through the painfully slow and stupid pullback of marijuana prohibition. How pot is still on schedule 1 over ten years after it was first legalized in Colorado and Washington is mind-boggling.

It is a bit ridiculous. Come to Canada and there are as many cannabis stores as liquor stores now.

Same regarding ADHD medication, which had a profound effect[1] on my life when I was late-diagnosed with ADHD[2] at age 34.

I did not know anything about ADHD, except being sure that I do not have it, because I can hyper-focus[3] on what I am doing. In fact, that's the only way I can get things done![4] It's very hard to switch focus away when I am in the zone, I react very badly to interruptions[5].

So, I thought, I can't have a deficit of attention - it's the opposite! What I have difficulty with is switching focus from the thing that I am doing to something else. When I finally get to do it, that is, because I have huge issues wit procrastination[6].

...it turns out that literally all of those are ADHD symptoms.

ADHD must be the worst-named condition in history[7].

If you are reading this, and find yourself relating - check out the Wiki I put together which describes ADHD with relatable memes and comics (and my own personal experience with it)[8].

This is how I found out I am ADHD: through relatable posts, comics, and memes. Sadly, after getting my math PhD - would have been much easier if I knew this years before.

It was like I was needlessly living my life on hard mode.

While medication is just a part of what made my life much better (restructuring it to be more ADHD-friendly was where most of the impact was), the medication enabled me to do it, helped me pull out of depression, and in general, takes pain out of ordinary things that are painful for me (like paying bills, doing chores, leaving the house on time, heck, doing something that I want to do, but just can't bring myself to).

And now I can't get medication because, ostensibly, of "shortage". But people on the street can get it, whereas I cannot. The pharmacy won't tell me whether they have it in stock, they will only speak to my doctor. The doctor can't be bothered to call pharmacies around to find the One Location Which Still Has It. The pharmacy (Walgreens) keeps this info secret. Another (CVS) won't accept the Rx from my prescriber because of the same, unreasonable fear.

That's for medication that I forget to take unless something reminds me to. Like, being stuck typing this comment instead of completing a task at work. Time to take my Adderall and get to work... if I had it.

Whether you think you could have ADHD or not, I plead you to read up on what I am dealing with every day[8] so that you wouldn't be part of the problem - and could help someone else like me two years back.

[1] https://romankogan.net/adhd#Medication

[2] https://romankogan.net/adhd#Diagnosis

[3] https://romankogan.net/adhd#Hyperfocus

[4] https://romankogan.net/adhd#ADHD%20Switches

[5] https://romankogan.net/adhd#Interruptions

[6] https://romankogan.net/adhd#Procrastination

[7] https://romankogan.net/adhd/#Awfully%20Described%20Human%20D...

[8] http://romankogan.net/adhd

For what it’s worth, if you’re having trouble finding your prescription amphetamines, Vyvanse might be easier to get filled. Probably more expensive, but may be better than just going without.

I had an athletic injury where I fractured my spine (spondylolysis with Grade I anterolisthesis). It hurt like a MFer. I used Mobic, an NSAID, rather than an opiate painkiller. It worked okay - the pain was still very distracting and uncomfortable, though bearable - but I'm glad I wasn't at risk of developing a dependency.

Patients are right to fear opioid addiction. It's the doctors' fear of cannabis that really makes me wonder.

None of my doctors are afraid of cannabis. But they are afraid of federal charges and losing the their license or prescription privileges.

It's legal where I live and doctors still give people the drug-seeking-behavior runaround if they so much as mention casual use. God forbid you want to manage pain with it.

Cannabis doesn't do shit for my chronic pain, nor any other pain sufferers I know. It actually makes mine significantly worse. Nothing worse than hearing people say "have you tried marijuana!!?" for the millionth time.

Yeah, it isn't the panacea that some people make it out to be. It doesn't reduce pain for me, it "backgrounds" it -- I can still feel the pain but it no longer bothers me. That isn't going to work for everybody.

>A decade ago, most people thought of Tylenol (acetaminophen) as a medicine for fever, malaise and minor aches and pains. Nobody imagined that it would become the go-to drug for treating moderate, let alone severe, postoperative pain.

Here in Germany this is completely normal. Hospitals after surgery will generally not put you on opioids and just prescribe you normal pain meds. A NYT columnist even wrote an article about that experience a few years ago.

https://www.nytimes.com/2018/01/27/opinion/sunday/surgery-ge...

I was pretty surprised when I heard how strong pain medication in the US is after only minor surgeries that are basically tolerable with a few days of rest and some Ibuprofen.

Fear of getting caught in the injury to bankruptcies pipeline is causing people to suffer pain. They’re right to fear opiates.

So... basically you're saying that we should revoke patent and licensing protection for production of narcotics and also revoke the medical license of any doctor that took payment for prescribing them. Is that right?

This is what people were publishing before the opioid crisis as well.

I don't think the fear is unfounded; Portsmouth, OH was all I needed to see. Commonly referred to as the pill mill of America, but I will concede there's stiff competition with Florida.

I grew up in that area. Opioids destroyed the lives of my family and countless others. The health care industry in Appalachia is entirely corrupt.

If any significant number of people are afraid of opioids now, that's good progress.

The healthcare system is corrupt everywhere. It's just a matter of degree.

Do you have a similar fear of ADHD medication due to pervasive meth addiction? Because you're drawing pretty much the exact same comparison, just with a different affliction.

Fear misrepresents it a bit

Apprehension is the better term, and yes. I'm nervous about those too because they are remarkably easy to abuse and the fundamentals are similar - over prescription

This is just a visual aid, don't let it confuse you

> But what’s really fueling overdose deaths is drug prohibition and the dangerous black market that it creates.

This seems like denial of reality. Morphine abuse was one of the main drivers for regulation in the first place.

> Yet, contrary to politicians’ beliefs, data show that the addiction rate of medically used opioids has been about 1%.

A 1% addiction rate seems staggeringly high if we expect everyone to take pain killers as part of normal procedures.

Morphine abuse, not morphine deaths. The sad fact is that the illegality of these drugs is the factor fueling the creation of dangerous variants.

People gonna use their drugs.

Alcoholism is also highly prevalent (at about 6% of US adults). Yet, we don’t have public policy that is phobic of alcohol.

I think a small percentage of people are very susceptible to addiction. It would be a far better idea to improve methods of identifying and treating this subset, rather than denying beneficial treatments to the whole population.

> Yet, we don’t have public policy that is phobic of alcohol.

Depends on the state. But every state has a drinking age of 21, more than almost every other country.

> Yet, we don’t have public policy that is phobic of alcohol.

Plenty of "blue laws" still exist throughout the US: who can sell or distribute alcohol, during which hours, on which days, in which parts of town, using which licenses, etc. Some states have state monopolies on liquor stores to maximally extract taxes, but also maximally control sales. My state still has plenty of Dry Counties and plenty more "Moist" counties (stores can't sell alcohol but restaurants can to diners, except on Sundays, things like that). (This is also fun because my state is largely a net exporter of alcohol and you might be surprised how much whiskey is legally distilled in Dry or Moist counties where you aren't allowed to buy it in a regular store.)

Not to mention that the US had an entire sequence of years specifically named for their laws that massively prohibited alcohol on a national scale.

(Same applies to gambling addiction: there are lots of gambling laws in public policy. My state only allows a heavily taxed lottery and horse racing. The state next door allows casinos but only if they are ostensibly on bodies of water as if land versus sea makes gambling more addictive. The humor to that increases knowing that at least one aged resort town built a fake lake to bring back its historic casino in the "casinos must be on bodies of water" times.)

Having watched them kill a dozen or so of my friends, yea.. they can keep their heroin.

This is about sufferers of chronic pain whose only option for living life with a semblance of normalcy includes controlled opioid treatment, but are instead treated like drug seeking addicts by physicians, family, and apparently commenters on HN.

I seriously doubt even a single one of your dozen friends fell into this bucket. Extreme recreational opioid abuse is not reason to bar people from receiving proper medical care.

You’d be very wrong.. virtually of them were retired coal miners suffering from chronic pain. One crashed a 4 wheeler in high school.

They universally discover that heroin is cheaper, eventually.

Correction: "Well-founded fear of opiates"

So your position is that people that suffer treatment-resistant chronic pain that prevents them from living a normal life should be denied opioids and instead be treated as drug-seeking addicts?

My position is exactly as stated - everyone should have a well-founded fear of opiates considering the countless lives they've destroyed.

That doesn't mean they should never be used for pain management, but that anybody who uses them should be very cautious knowing full well the addiction it can cause, and to use them as sparingly as possible.

Also, opiates are massively over-prescribed.

Problem is feedback loop. Why are taking drugs, because you're sick. Why are you sick, because you're taking drugs.

More drugs, more side effect possibilities.

Fear of cannabidiol, too.

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