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Comment by Mistletoe | Hacker News Reader

I mean I have been prescribed opioids many times and I just take them as prescribed and they help the pain of the surgery or whatever. I don’t even take the whole bottle. What will replace the opioids if we don’t allow them to be prescribed?

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I don't think it s a black or white on opioids. But more of a being honest in the marketing and recommended dosages. For instance, Morphine is an opioid that often gets used in end-of-life care, this is a 90 year old on hospice actively dying from terminal cancer, so morphine to ease the suffering. No reason to not give them opioids. However, before the opioid crisis became a known crisis, my dad who is a disabled vet would get like 300 pills mailed to him a month, at the time to be indefinite, from the VA. This was when marketing was telling everyone percocet and vicoden were safe and non-addictive.

These heavy hitters do have a purpose. But it should as narrow as necessary.

I understand two answers to your question:

1. Nothing will replace the opioids, but we should make most routine use illegal anyway, because the usage you described causes addiction, abuse, and death in some cases, which overrules your QOL improvements.

2. Nothing could replace the opioids, so we should keep the status quo. The addiction, abuse, and death are a relatively minor downside to an important bundle of benefits. The Sacklers marketed them illegally, but we've course-corrected as best as possible, and the new status quo is uncomfortable but OK.

These are, I think, the first two buckets of people I listed. I understand them both. I think you're in the second camp. I'm in the first. But I think most commenters here are in neither camp???

Could you have recovered without pain killers? Or maybe used a pain killer that is much weaker that doesn't kill all the pain but is much safer like marijuana?

Are there scientific studies that shows that opioids help patients recover quicker?

Why is this question important? The primary purpose of pain medication is not to facilitate recovery, but to reduce suffering and increase quality of life.

Exactly! Opioids increase suffering and ruin the quality of life for hundreds of thousands of Americans. 80k+ yearly overdose deaths, plus a percentage of those using opioids for recovery become addicted to it.

Is that a worthy tradeoff? I presume (could be wrong) but we did fine recovering with surgical operations 80 years ago without opioids.

Morphine was commonly administered for post-surgical pain 100 years ago:

"The after-treatment of surgical patients, by Willard Bartlett and collaborators." (1925)

https://babel.hathitrust.org/cgi/pt?id=mdp.39015071056918&se...

One of the first complaints made by the postoperative patient on returning to consciousness is pain. This if due to the actual operative procedure should be at once relieved. William J. Mayo taught us long ago to give morphine during the first twenty-four hours for the pain which we make; viz., by cutting, retracting, suturing, etc. The discomfort caused by such procedures is relieved best by this drug and it is given by us if there be no contraindications for its use, regardless of the amount until full relief is experienced or its physiologic effects obtained.

24 hours post operation is fine. But giving them for weeks after an operation seems unnecessary. I've also heard that oxycontin in the USA is given to pregnant women to deal with pain.

Most countries do without them now and have always done without them except in special cases such as palliative cures. You get opioids during recovery in the hospital, but not once you're discharged. You might get codeine rarely, but that's it.

Ibuprofen, paracetamol, rest?

From https://www.nytimes.com/2018/01/27/opinion/sunday/surgery-ge...: if you "no longer feel the pain you will no longer know what your body is telling you. You might overexert yourself because you are no longer feeling the pain signals".

One thinks you have never had a really damaging surgery. For obstructive sleep apnea I had the back of my tongue microwaved, my deviated septum repaired, and my uvula and back of throat removed. Ibuprofen and Tylenol would not have been sufficient for recovery from that. And that is even nothing compared to other more damaging surgeries.

The article I linked explains that you can still get opioids during recovery in the hospital in other countries, it's only once you're discharged that they're a lot more careful.

There must be something intermediate between "Tylenol and ibuprofen for everything" and "Vicodin before and after canal therapy".

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