Comment by jrflowers | Hacker News Reader

Comment by jrflowers | Hacker News Reader

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> The only side-effect is euphoria. Please do not mention respiratory depression here, that is a non-issue

I like this point because it is complete gibberish. If you simply do not mention the side effect that makes a drug lethal, it sounds a lot like the drug does not have lethal side effects. Obviously we cannot do that with acetaminophen though, we must talk about hepatoxicity when it comes to that drug.

On the one hand we have a drug that can cause both mental and physiological dependence and addiction (so what), has an admitted side effect that encourages some users to escalate their dosage beyond medical guidance (who cares), and can cause you to either stop breathing or aspirate and choke on your own vomit if you take too much (that part is a little tricky so we just proceed as if that is not the case)

On the other hand you have a drug that is hepatoxic at several multiples of its recommended dosage. Obviously the second one is more dangerous becau

You misunderstood me, then.

Therapeutic doses of opiates do not cause respiratory depression, overdoses do, similarly to how acetaminophen overdoses cause hepatotoxicity, except this is not true, because regular consumption of acetaminophen causes hepatotoxicity, too, whereas opiates, when taken as prescribed, do not cause respiratory depression, in case of opiates, ONLY overdoses do, and therein lies the huge difference.

And then we did not even mention NSAIDs which cause from ulcers to cardiovascular events, even if taken as prescribed.

As for addiction, I would not like to get into the topic of addiction because a lot of people have an obsolete view on it and people already have their mind made up with regarding to it. Similarly to how my parents' generation think mental illnesses do not exist or that you can just "think away" depression.

Oh I know that you’re correct, your phrasing was just hilarious.

Under the caveats of a competent physician and a completely med-compliant patient, opiates are perfectly safe. Those are enormous caveats though, given the history and prevalence of incompetent physicians and noncompliant patients (at least in the US).

Generally if you see someone complaining about opiates being dangerous, they’re likely factoring in opiates as things that exist in the context of society rather than a strictly clinical context. You can’t really use the reasoning of one context to dispute the other, it looks silly because you have to say stuff like “ignore all the deaths and the mechanism of those deaths”

I appreciate your sensible and articulate responses here.

> Oh I know that you’re correct, your phrasing was just hilarious.

My bad. :P

But yeah, I agree. Eastern Europe is on the other spectrum with regarding to opiates. They do not even get prescribed codeine, regardless of severity of pain. You will get naproxen instead along with a possible stroke. :D

> context of society

I would hope so. According to my experiences here on HN, they (some people) just decided opiates are bad (because of "junkies") and that was it.

But yeah, people made opiates look terrible and it is a bummer, it is another case of "this is why we can't have nice things". Kratom is legal here (for now) and people with pain use it, but probably will be taken away from them sooner or later.

In any case, thanks for the reply, pleasantly surprising!

Acetaminophen related deaths are a few hundred a year in the US.

Opiate related deaths in the US have been around 50,000+/yr.

I don't personally know anyone who has died from acetaminophen usage or even particularly injured. I personally know several people who had their lives nearly destroyed by opiate abuse, and a few others who have died. And it's not like I'm hanging out with junkies all the time.

Yup. As someone in the US the idea that opiates are “actually really great and safe drugs, just misunderstood!” is insane.

It is safe when taken as directed, therapeutically. Much safer than NSAIDs. Misuse and abuse is bad, whether it is opiates or anything else.

As someone put it:

> Under the caveats of a competent physician and a completely med-compliant patient, opiates are perfectly safe. Those are enormous caveats though, given the history and prevalence of incompetent physicians and noncompliant patients (at least in the US).

Have you considered that your perception may have been distorted by irresponsible people? Please put that perception aside when comparing the side-effects of opioids and NSAIDs.

I think you're missing the point, though. Patients are much more likely to abuse/misuse an opiate, leading to much more than the "therapeutic" dose being taken. But most people aren't going to overdose on ibuprofen or acetaminophen. If they do, it's because they've made a foolish decision ("the pain didn't go away with one pill, so if I take five maybe it will"). When it comes to opiates, taking too much will generally be because of a chemical dependence, not a conscious choice. Even if the ibuprofen overdose is a stupid choice, it's still a conscious one.

> regular consumption of acetaminophen causes hepatotoxicity, too

That would be misuse/abuse, though. The bottle label tells you to seek a doctor's advice if you need to take it longer than a certain period of time. Sure, people can fail to read that and not know about it, or just choose that the risk of complications is acceptable given their pain situation, but that's still not as bad as chemical dependence driving the decision-making.

Don't get me wrong, I'm not saying we should ban opiates or never prescribe them, and I imagine the result of the backlash toward decades of over-prescribing has been a foolish swing to the other extreme. But I still don't think we should prefer opiates over ibuprofen/acetaminophen when the latter will do the job. Maybe that's not what you were arguing, but I do take issue with your suggestion that opiates are safer.

> taking too much will generally be because of a chemical dependence, not a conscious choice.

This is an oversimplification and not universally true, but I do not wish to get into the details of it and addiction in general. We could brush away every decisions based on "chemical imbalances", too, if we so want. :)

> we should prefer opiates over ibuprofen/acetaminophen when the latter will do the job

Yes, after a careful risk assessment. If you are likely to get ulcers, or a stroke, or any cardiovascular events from NSAIDs, then you might want to consider something safer. Tylenol would be safer in this case, but what if that does not help with the pain at all? In any case, I do not necessarily disagree, and I was not advocating for blind consumption of opioids. If Tylenol works, take it with milk thistle (with high silybilin content) and you will be fine, even if you take it on the daily.

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