Comment by facetube | Hacker News Reader

Comment by facetube | Hacker News Reader

In the US, Methadone also keeps people tethered to a daily drive to a Methadone clinic, followed by a relatively long wait in line. When someone is trying to hang on to a job and get their life back together, this can be a significant drag on the process. Buprenorphine (with or without added naloxone) has no such restriction, and can be dispensed from a normal pharmacy in 30-day supplies. However, the DEA limits the number of patients a buprenorphine-licensed physician can take on, which leads to shortages of available care (or very high prices) in a lot of areas of the US.

The article seems to blame the drug, and the delivery service, and the people selling it. But many of the people in the bottom 20% income bracket in the US are sick, isolated, have no access to health care (at least without winning their $6,250 out-of-pocket maximum on a lottery ticket), are poor enough to have to prioritize rent over food, and have little to no opportunity for social or economic advancement. As the http://en.wikipedia.org/wiki/Rat_Park guy said, "severely distressed animals, like severely distressed people, will relieve their distress pharmacologically if they can."

The DEA needs to lift the 100 patient limit on bupenorpine. I don't know why this drug is regulated this way.

Bupenorpine is here. We have a problem with opioid addiction. Doctors should be able to prescribe the drug without going to a class, and then limit the number of patients who can take it.

The drug is expensive. Even the generic version is expensive?

I'm not a conspiracy theorist, but something is not right with the way this drug is regulated, and manipulated?

Some of my details are fuzzy, but the original manufacturer of this drug fought hard to extend the patent.

When that failed, they scared Physicians into thinking your patients will abuse the drug if you don't use our expensive strips.

Antidotal, but I can honestly state it's a hard drug to abuse. It's not a fun drug. It is addictive though. This bit about having a low affinity for addiction might be true for some individuals. The people I know on it have a hard time getting off the drug.

I think people would be surprised to find out just how many people are on this drug; they shouldn't be nickeled and dimed by the cost of the drug, and endless expensive office visits.

(The average patient has usually suffered in life. Why give them a addictive drug and let doctors use the 100 patient limit as a excuse/incentive to raise the cost of mandatory office visits? The office visit is essentially--ok--you showed up and payed me--I will refill your addictive medication.)

> The article seems to blame the drug, and the delivery service, and the people selling it. But many of the people in the bottom 20% income bracket in the US are sick, isolated, have no access to health care...

From the article:

> "the victims — mostly white, well-off and often young"

> "A result has been a rising sea level of prescription painkillers that continues today, of opioids such as Percocet, Vicodin and OxyContin. Sales of these drugs quadrupled between 1999 and 2010. Addiction followed. And this has given new life to heroin, which had been declining in popularity since the early 1980s."

I think your point is valid but not relevant to the article. It's not claiming the things you said.

Also Rat Park is highly controversial and has failed to be reproduced and, obviously, is a rat study, so I wouldn't really rely on it as a robust narrative for what's going on with drug addiction in humans.

I didn't realize that Rat Park was controversial. Can you point me to some scholarly articles or discussions around it, or the latest addiction research?

The wiki page indicates that there was some success in replicating the results. Searching the web is impossible, as it's mostly hype popsci articles in th vein of "you didn't know this about addiction!"

There are almost certainly some issues with the Rat Park experiment, but even exercise alone has been shown to reduce binding availability at the mu opioid receptor in humans, probably as a result of beta-endorphin being released: http://www.ncbi.nlm.nih.gov/pubmed/18296435. It wouldn't be a huge leap to hypothesize that this could decrease exogenous opioid consumption.

Interestingly enough, there's also a genetic mutation that's at least loosely associated with alcoholism, a possible increased response to naturally-produced beta-endorphin, and a need for more opioids to achieve equivalent pain relief:

http://www.pnas.org/content/95/16/9608.full.pdf

http://www.snpedia.com/index.php/Rs1799971

Point taken with respect to to the original article, but it's definitely not just a well-off white people problem. Here's a different view from Crawford County, Ohio:

"Nestled between major urban hubs, Columbus and Toledo, Crawford County, with 47,000 residents, a median household income of $32,000, and a broken-down industrial base, is a sitting duck. As jobs and hope have left town, stress has mounted dramatically. “There’s never a day that we don’t see patients for depression,” says Crawford County physician and coroner Dr. Mike Johnson."

http://www.pbs.org/newshour/making-sense/a-high-for-less-eas...

He's also blaming addicts for being addicts. At the end of the article he lays out a "rugged individualism" argument that addicts should just suck it up and quit being addicts. Well, they can't, and they've proven that they can't multiple times, so what does he propose we do, other than crack down even harder?

Doing the same thing over and over again and expecting a different result is how some define insanity.

Also, if these gangs are non-violent and their custom are non-violent, isn't that preferable to the kind of raw violence that is seen with other Mexican cartels?

No he's not, he's blaming doctors for misunderstanding the medicines they are prescribing and overprescribing them, thus exposing a lot more people to addiction than otherwise would've been.

This may be the case in the US. However in the UK, doctors are scared to prescribe pain killers. As someone who suffers from chronic pain (accident early 2012), it took two years to get even close to adequate pain medication (from a pain specialist in the end).

I work hard and if there was a better option than pain killers, I'd happily pursue it. Being tarred with the same brush as addicts is quite offensive. Also, I have a BMI in the mid 20's so further exercise isn't going to help.

That's not being scared, that entirely appropriate prescribing.

https://news.ycombinator.com/item?id=9402507

Many people in the UK end up addicted to pain medication after inappropriate prescribing of opiate meds to treat long term pain.

You should be angry about the length of time it took to get you to a pain clinic, not about doctor's decision not to prescribe meds that are both addictive and often ineffective.

Also, "lose weight and do psysiotherapy guided exercise" might not have been right for you but it is good advice for many people with long term pain.

Hell, in the UK doctors often won't even prescribe addicts Methadone. For example, I had to go to a separate service, the CDPS (Community Drug Problem Service, says it all, really) where you are basically treated like criminal scum, no matter what your background is. I gave up on the scheme when my assessor didn't believe I wasn't homeless, had a real job and had never been in prison...

> Being tarred with the same brush as addicts is quite offensive

Actually, that attitude itself is offensive. Addiction is a serious mental health problem, and should not be stigmatized.

Agree wholeheartedly. Even beyond the acute condition itself, it's been shown that there are genetic factors that likely increase cravings for certain drugs, and may predict development of dependence. For alcoholism, OPRM1 A118G has some substantial evidence behind it. Shaming people for drug addiction isn't any different than shaming a diabetic IMO.

Yes, some may have a genetic disposition, but they still have choices. There is a difference between substance abuse and treating a medical condition.

Simply down voting people because you disagree with them isn't cool IMO.

edit: Myself (and many others) have also been stigmatised from getting the correct medication because of a fear becoming addicts.

You're being downvoted for your stigmatising ignorant comments about people with addiction.

Downvote to disagree is going to happen; it's not forbidden on HN (PG has a post somewhere talking about the acceptability of using downvote to disagree) although there are a large number of people who strongly dislike downvote to disagree.

People with depression have choices. People with OCD have choices. People with diabetes have choices. People with schizophrenia have choices. Having choices doesn't disqualify something from being a medical condition.

> Myself (and many others) have also been stigmatised from getting the correct medication because of a fear becoming addicts.

No. For most people with long term pain opiate meds are the wrong choice. Those people need rapid access to specialist pain clinics; cbt for pain; short term pain meds to enable them to take part in physiotherapist guided exercise; and possibly weightloss.

Opiate pain meds for long term use are not effective for most people; and are addictive. It is wrong to give someone a med that won't work and that has side effects and that carries a risk of addiction when there are less risky, non-addicting, better solutions to try first.

I've had chronic pain in the past that's probably far more minor than yours, and it sucks. But for what it's worth, I've found that the mental effects of exercise are far more dramatic than the physical ones – paradoxically, even running until I'm sore and exhausted seems to relieve more pain over the following two to three days than it causes. Maybe worth considering. Anyway, hope you're trending toward better.

Chronic pain is very tough and opioids shouldn't just be thrown at it. I've known two people with chronic pain that have gotten addicted to their pain medication... then they didn't even work anymore. So they ended up with addition in addition to their chronic pain. This outcome in a very very real (and very common) concern.

These people didn't want to become addicts and weren't taking Oxy for thrills...

Mid-20s is borderline overweight. A naturally skinny average height person who never exercises has BMI ~24. Varies by height and build of course.

http://www.vertex42.com/ExcelTemplates/Images/body-mass-inde...

That's definitely part of the problem – especially when it comes to the amount of a particular drug being prescribed. A lot of the addiction/dependence exposure involves diversion, i.e. the people using the prescription opioids are not necessarily the people who they were prescribed to. Often someone will start by buying leftover/extra pills from a friend/acquaintance, become physically dependent, find someone else when their friend runs dry, start running low on cash, and then finally break down and go for the cheaper option (heroin).

I don't think I've ever been prescribed less than 30 of an opioid pain reliever for an injury. Sometimes with refills. Five or ten, with the ability to call the doctor for a same-day script if I were still in pain after those, would be infinitely preferable.

>Well, they can't, and they've proven that they can't multiple times, so what does he propose we do, other than crack down even harder?

Or they don't really want to (getting clean sucks), they have proven again and again that they would rather be on drugs than of drugs, so what are you going to do, other than crack down even harder?

I am not saying that is necessarily the entire truth, but addicts do quit on their own and both narratives predict the behaviour.

The second half of your message, that! If only people realized here that selling the notion of work hard win big isn't working for most middle class and lower class Americans. We can keep on saying its in the name of Capitalism and that this is what this country was founded on that we keep on burying our heads in the sand but at what point does one give up old notions and adjusts to the realities of living at a particular time and stop quoting old cliches that don't work for the majority?

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