The problem with the backlash against opiod use in the US is that people who actually have to have the drugs are finding it increasingly harder to get.
As a disabled veteran with nerve damage I am rationing pain medication daily. I cannot afford to have a manageable pain day due to the fact I might have a week of excruciating pain.
As you may or may not know, little can be done for functional nerve damage. Some experimental procedures are available but in general, only the symptoms can be treated. For me this means a lot of different muscle relaxers and an opiod for when things are beyond control.
But, the opioids have become increasingly more difficult to get prescribed because of recent DEA rule changes and legislation affecting these medications.
This basically means, for me at least, I will take my own life at some point as the pain will be too unbearable and I won't be able to acquire the medications necessary to control it.
I think what's missed most in all of the talk about opiods lately is that there are people who need them just to function, and not for reasons of addiction.
In January of 2014 I broke my hand. Not just a fracture. I completely shattered my second metacarpal in my right hand (my dominant hand) and did extensive damage to the surrounding tendons, ligaments, and skin. The surgeon who put my hand back together said it looked like a gunshot exit wound without a corresponding entrance wound. The entire top of my hand had been flayed open. After the surgery I was given hydrocodone, enough for a week. The only reason I didn't just kill myself that week was because I had pain killers. When the dose would wear off the pain was unreal, blinding, and totally consuming. The only worse pain I've ever been in was the night I broke my hand.
Needless to say I had the prescription refilled weekly until my second surgery three months later to take out all of the pins. And again for three months after that until my third surgery to release the tendons so I could use my hand again. And for three months after that while I did thrice weekly physical therapy. I cannot emphasize enough how much I needed the pain killers just to get through life for those nine months. Even with them there were some nights I couldn't sleep because the pain in my hand was so severe. Of course, by the end of the nine months I was pretty well physically addicted, but, knowing my time was up I tapered off and haven't needed them since. For another six months I still needed frequent acetaminophen and ibuprofen to take the edge off of the throbbing in my hand.
I'm not saying at all that there isn't a problem big with opiod addiction. But recent conversations I've seen about opiods leave me with the impression that most people just don't get it. They think that either people just need to deal with pain or that some sort of non-medicine alternative is what's needed for most people on opiods. And that may be true for some. But unless you've been in the kind of pain that makes you seriously consider killing yourself I don't really think you can appreciate just how important opiod pain killers are to some people. I'm afraid we're going to lose something that helps a great deal of people all because we have this idea that addiction is somehow a moral failing and we've structured drug policies around that belief.
It only increases diversion to the black market by directly increasing demand. My own grandparents have had to buy pain pills in the past.
Doctors are terrified to prescribe painkillers to those in need lest they be prosecuted by laymen who think they know better. Pain is being under-treated now more than ever.
My ER has a massive info-poster in the lobby explaining why I won't be receiving dilaudid, fentanyl, or oxycodone.
Opiates are in the news every other day, either prescription abuse or fentanyl-laced heroin stories in local and national paper as well as cable news.
What good has it done? There will always be abusers.
Like DRM only hurting paying customers, stricter regulations and lawsuits against doctors ironically only end up hurting non-abusers.
Dependent folks, like my grandparents, who get a massive quality of life increase thanks to these drugs, especially considering the lifetime of abuse they've put their bodies through, and been through.
That's who ends up getting the shit end of the stick.
So there are two big camps of people going to the doctor for pain med (gross simplification, obvious it is more of a spectrum). People like you, that need the pain meds to live. And people that have a "bad back" aka they grab their back and groan and act like it hurts to get a powerful drug and be high (or sell for a nice profit).
If I understand pain theory correctly, there isn't really a good way for a doctor to do a test and say "you are really in insane pain" vs "2 advils will cure you".
Then the choice is either:
a) Be generous with pain meds. Some abusers that don't need it will get them to either use or resell. Some will lead to deaths, due to addiction or increased supply on the black market. But all people in real pain are treated.
b) Be stingy with pain meds. Some legit people in pain could end up taking their own life due to not being able to live with the pain. But there will be less deaths and addiction outside of people in pain.
As a society, it seems a hard choice. Either way some very vulnerable people are going to be hurt. Ideally we would come up with better pain meds with no abuse potential, but that doesn't help things right now.
Yep. My wife regularly decides to under-medicate rather than risk having to radically under-medicate later. And politicians attack the weak to appear strong, and we the weak sometimes have to cry ourselves to sleep, or die, or whatever is needed to cope.
I know that as a veteran, you are more likely to take your own life simply because you have the courage to do it. Please don't though! Anything but that. This is the only game in town, so play it all the way through.
Have you ever tried meditation? For me, it's completely redefined my relationship with pain. I realized how little of my pain was physical. The vast majority was my mind exaggerating the physical pain that I felt. I now see how monks are able to self immolate without reacting to that pain. I don't have anything approaching their ability, but I have been able to entirely stop taking pain killers and I had a serious injury misdiagnosed because the doctor didn't think I was exhibiting the pain associated with that injury.
Probably you know about the opioid alternatives, but did you try anticonvulsants [1] for your nerve pain? I had nerve damage after a surgical procedure, and opioids did not really help. A doctor suggested to try Gabapentin, which greatly reduced pain down to tolerable levels. While anticonvulsants probably have their own risks, they seem much less addictive than opioids, and are probably easier to get on prescription.
My wife is in a similar situation. I've heard pain killers only become addictive if you take them when not in pain. But when you're in excruciating pain, and the meds only dull the pain somewhat, there is no addictive euphoria taking place. So people like my wife who have been on them for a decade, and probably will for the rest of her life, could taper down and give them up very quickly if their pain went away.
You could look into pain management techniques to turn the unbearable pain into hopefully a bearable one. Meditation, breathing techniques, biofeedback,... that kind of thing.
I don't know if this applies to nerve damage pain, but cannabis has a quite a history of being effective with pain.
If you're given a 10 day supply of opioids, you probably have a much worse problem than someone who is given a 3 day supply of opioids. The 1 in 5 that are still taking opioids a year later probably had a long-term problem that caused significant, chronic pain.
Looking at the study, they didn't adjust for this at all. Also, keep in mind: 1 in 5 are continued on prescriptions, which are given by doctors who assessed the situation and thought it was OK to continue it. It's NOT saying that 20% of people who try opiates for 10 days become hopelessly addicted, which the clickbaity headline implies.
Wanted to leave the same comment and found a few here saying the same. It is surprising how such an obvious objection has not been addressed - unless they expected most of the readers to miss it, which is then very sad.
The deaths figure - 91 per day or about 33K per year - seems to be the deaths of all opioids (including heroin abuse, etc.) and not the prescription opioids, which are half that:
I was given at least a 10 day supply of opioids after laproscopic surgery even after I told them I wasn't in a lot of pain and didn't even really want them. I stopped taking them after 4 days and still almost have a full bottle left. They asked me if I had an opioid problem when I told them I didn't want them. Didn't ask me prior to that.
"The United States makes up only 4.6 percent of the world's population, but consumes 80 percent of its opioids -- and 99 percent of the world's hydrocodone, the opiate that is in Vicodin." [1]
I spend a lot of time listening to podcasts where addiction medicine doctors talk about the state of their industry. Their views and their guests views, are almost in complete alignment and those views are the exact opposite of the comments in this thread. I find that alarming.
If you listen to addiction medicine doctors, they will tell you:
1) There is a massive epidemic of opioid addiction. Opioids are wildly addictive and are negligently / over prescribed.
2) There is little evidence that opioids provide benefit for long term chronic pain and evidence that long-term use of opioids actually causes many problems. Getting off the opioids tends to reduce the chronic pain.
3) Patient surveys rule supreme and patients want pain-killers even if the doctor does not believe they are the solution.
Anecdotally, if you watch the A&E show "Intervention", the number of opioid and heroin cases has shot through the roof since the series started two decades ago. There has been a titanic shift in addiction. It's painful to watch some of these addicts lie to their doctor to get opioids, turn around and sell them, then use the money to get heroin because the opioids aren't strong enough anymore.
I'm 23 years old living in a major city in the midwest, grew up a in a middle-small town (120k population) a few hours away. Everyone I grew up with is either selling heroin or taking it, or both.
The fact that I'm a software developer (making a living legally) and not taking and/or selling heroin is an anomaly.
For me, the problem is fear. A decade or so back, I badly broke my arm in a mountain biking crash. The event itself barely hurt at all, but the muscles around the broken arm all tensed up, and after several hours were extremely painful. The hospital gave me morphine.
As far as I could tell, the morphine did nothing. I remained in significant pain for a few hours while I awaited treatment.
It's impossible for me to say why. Is morphine just ineffective for that sort of pain? Or was I underdosed to prevent negative interactions with the drugs they gave me later? Or was I underdosed as a precautionary measure for opiates due to addiction?
All I know is that I'm afraid of ending up in pain in the future and being denied effective treatment out of misguided concern that I will become an addict.
I have a friend with 'back problems' who was on OxyContin for 10+ years. His pain problems miraculously went away after he weened himself off of it over the course of a few months.
Here's what it says about adjusting for pain intensity:
> Third, information on pain intensity or duration were not available, and the etiology of pain, which might influence the duration of opioid use, was not considered in the analysis.
Maybe sometimes. Seven or eight years ago, I had a badly ingrown toenail; my doctor removed the left half of it under local anesthesia, and then wrote me a prescription for 30 Vicodin tablets. (I think 3 or 4 would have been plenty; the pain was gone in 2 or 3 days.) Maybe things have changed enough that he wouldn't do that now.
This seems so obvious a factor that I have a hard time believing mere negligence explains the failure to mention it in the article. I've seen a few hit pieces like this now and it seems to me some powerful lobby must be waging a PR war against opioids.
We will solve the opioid crisis in this country and the solution will almost certainly come through new scientific advances.
For instance, a recent study in Nature Medicine[1] showed that you could decouple the positive analgesic (pain relief) effects of opioids from the negative effects of increased tolerance to opioids and increased sensitivity to pain. This is critical because tolerance to the effect of opioids and increased sensitivity of pain to opioids is part of what drives increased use and eventually abuse of opioids.
The practical upshot of this study (if validated) is that you could potentially take a smaller amount of opioids and not have to increase your dose over time to get the same level of benefit. This could severely limit the mortality associated with opioids.
I am hopeful that we will get through the opioid crisis in this country if we invest money in fixing the underlying physiological problems associated with these drugs.
I've been prescribed opioids twice in my life, once for wisdom teeth extraction and again for a broken ankle. In the first case I filled the prescription but ended up flushing the pills down the toilet without taking a single one, as the pain did not override my fear of developing dependency. I never even filled the prescription for the broken ankle, and also didn't need it.
These should be treated as treatments of last, not first resort. In both cases, marijuana would have been a more appropriate for pain relief anyway (though I did not use any).
About the linked study, it's important to emphasize that it's retrospective -- it tracks the behavior of people who applied for and received opioid prescriptions. This means the stated results may not apply to a person not inclined to use opioids.
A hypothetical prospective study, obviously impractical on multiple grounds -- one that chooses study subjects from the population at random -- might produce a completely different result.
Or the outcome might be the same -- for ethical reasons that deserve to exist, we may never know.
Sounds about right. As a heroin addict, I have seen people who are completely clean relapse after maybe three days of taking it daily again, and I have even noticed signs of withdrawal in people who have only taken the drug a couple of times, but on consecutive days. In general, it is the repeated consumption without giving your body time to return to its baseline state (which can take up to three days, depending on the drug and its half-life) that causes the physical addiction - all the scare stories about 'one hit and you're addicted' are just that; stories.
For anyone needing opiates as pain medication, I would suggest taking them only in response to acute pain, not as a regular dose, although this may not be possible for chronic sufferers. It's a difficult situation, the best painkillers are horribly addictive and socially stigmatized.
I broke my wrist on march 1st, and I've had opioids absolutely dished out for me. Seemingly more easily prescribed in the US than South Africa. I was upped on my second refill to 15mg oxycodone three hourly. Seriously hoping getting off them isn't going to be a struggle :(
Wow, that seems like a strong dose! I had total hip replacement, I took 5mg Oxy 4x/day for 6 days. I went through a day of agitation and grumpiness when I stopped.
I don't get it. Cannabis has always worsened my pain, not relieved it. I have chronic often severe back pain and cannabis has always emphasized it. I spent 4 hours thinking constantly about the pain until the drug wears off. I may be a minority, but it hardly inspires confidence in cannabis as a silver bullet.
Opiates however... they really work. They really make the pain go away. Which is why I stay the hell away from them. :-(
Assuming that politicians care more about the opioid epidemic and the actual well-being of their constituents than they do about their public image with their supporters. You really need everyone to catch on to the relative harm of opiates and cannabis.
I had a total hip replacement very recently. Having been given a 2 week supply of Oxy, I took very minimal doses and was off of it after six days.
I had no idea how addicting this is for people. Personally, I didn't like how it made me feel, so I can only wonder about different people getting different types of "buzz" from it? I think I was irritable for a day after I stopped.
every few years I get an operation, this year it was 4 wisdom teeth extractions. they gave me 21 oxycodones, I took 18, threw 3 down the trash. (this was on top of maximum strength ibuprophen)
Doing something illegal (like pot) doesn't automatically make you a criminal. I'm serious.
For example, any time two people have sex if they drank first (are drunk) then no matter how much they consent and really, really want to have sex it's "technically rape" (I am serious). That doesn't make them criminals. And rape is serious.
You have to look at the ACTUAL enforcement practices where you're located. What do people (police) ACTUALLY do?
Also, remember: the reason it is not completely legal might have nothing to do with your consumption of it. For example, would like advertisements for it? Totally legit companies doing things that are "legal" today like shilling on Reddit, trying to get people to use their (legal) drugs?
So I would encourage you not to have such a black and white view of what is "criminal." It's a scale. Just as you're not raping a girl if you two have great drunk sex some night and both wanted it, you're not a criminal if you light up a joint.
I wish it was that simple. My girlfriend said if it is not prescribed by a doctor I shouldn't be taking it and started calling me an addict.
I personally don't recognize these laws, but I know unlucky people that were caught and did time for it. Yes, for having a joint and they have criminal record now.
[+] [-] oaf357|9 years ago|reply
As a disabled veteran with nerve damage I am rationing pain medication daily. I cannot afford to have a manageable pain day due to the fact I might have a week of excruciating pain.
As you may or may not know, little can be done for functional nerve damage. Some experimental procedures are available but in general, only the symptoms can be treated. For me this means a lot of different muscle relaxers and an opiod for when things are beyond control.
But, the opioids have become increasingly more difficult to get prescribed because of recent DEA rule changes and legislation affecting these medications.
This basically means, for me at least, I will take my own life at some point as the pain will be too unbearable and I won't be able to acquire the medications necessary to control it.
[+] [-] careersuicide|9 years ago|reply
In January of 2014 I broke my hand. Not just a fracture. I completely shattered my second metacarpal in my right hand (my dominant hand) and did extensive damage to the surrounding tendons, ligaments, and skin. The surgeon who put my hand back together said it looked like a gunshot exit wound without a corresponding entrance wound. The entire top of my hand had been flayed open. After the surgery I was given hydrocodone, enough for a week. The only reason I didn't just kill myself that week was because I had pain killers. When the dose would wear off the pain was unreal, blinding, and totally consuming. The only worse pain I've ever been in was the night I broke my hand.
Needless to say I had the prescription refilled weekly until my second surgery three months later to take out all of the pins. And again for three months after that until my third surgery to release the tendons so I could use my hand again. And for three months after that while I did thrice weekly physical therapy. I cannot emphasize enough how much I needed the pain killers just to get through life for those nine months. Even with them there were some nights I couldn't sleep because the pain in my hand was so severe. Of course, by the end of the nine months I was pretty well physically addicted, but, knowing my time was up I tapered off and haven't needed them since. For another six months I still needed frequent acetaminophen and ibuprofen to take the edge off of the throbbing in my hand.
I'm not saying at all that there isn't a problem big with opiod addiction. But recent conversations I've seen about opiods leave me with the impression that most people just don't get it. They think that either people just need to deal with pain or that some sort of non-medicine alternative is what's needed for most people on opiods. And that may be true for some. But unless you've been in the kind of pain that makes you seriously consider killing yourself I don't really think you can appreciate just how important opiod pain killers are to some people. I'm afraid we're going to lose something that helps a great deal of people all because we have this idea that addiction is somehow a moral failing and we've structured drug policies around that belief.
[+] [-] oxide|9 years ago|reply
It only increases diversion to the black market by directly increasing demand. My own grandparents have had to buy pain pills in the past.
Doctors are terrified to prescribe painkillers to those in need lest they be prosecuted by laymen who think they know better. Pain is being under-treated now more than ever.
My ER has a massive info-poster in the lobby explaining why I won't be receiving dilaudid, fentanyl, or oxycodone.
Opiates are in the news every other day, either prescription abuse or fentanyl-laced heroin stories in local and national paper as well as cable news.
What good has it done? There will always be abusers.
Like DRM only hurting paying customers, stricter regulations and lawsuits against doctors ironically only end up hurting non-abusers.
Dependent folks, like my grandparents, who get a massive quality of life increase thanks to these drugs, especially considering the lifetime of abuse they've put their bodies through, and been through.
That's who ends up getting the shit end of the stick.
Not the junkie. Someone's Grandma. A vet.
[+] [-] brianwawok|9 years ago|reply
If I understand pain theory correctly, there isn't really a good way for a doctor to do a test and say "you are really in insane pain" vs "2 advils will cure you".
Then the choice is either:
a) Be generous with pain meds. Some abusers that don't need it will get them to either use or resell. Some will lead to deaths, due to addiction or increased supply on the black market. But all people in real pain are treated.
b) Be stingy with pain meds. Some legit people in pain could end up taking their own life due to not being able to live with the pain. But there will be less deaths and addiction outside of people in pain.
As a society, it seems a hard choice. Either way some very vulnerable people are going to be hurt. Ideally we would come up with better pain meds with no abuse potential, but that doesn't help things right now.
[+] [-] srinivgp|9 years ago|reply
[+] [-] thret|9 years ago|reply
And thank you for your service.
[+] [-] curun1r|9 years ago|reply
[+] [-] Mo3|9 years ago|reply
[+] [-] markdown|9 years ago|reply
[+] [-] michaf|9 years ago|reply
[1] https://en.wikipedia.org/wiki/Anticonvulsant
[+] [-] DougN7|9 years ago|reply
[+] [-] ScottBurson|9 years ago|reply
[+] [-] bigbugbag|9 years ago|reply
I don't know if this applies to nerve damage pain, but cannabis has a quite a history of being effective with pain.
[+] [-] erik_landerholm|9 years ago|reply
[+] [-] DanBC|9 years ago|reply
https://www.rcoa.ac.uk/faculty-of-pain-medicine/opioids-awar...
Self poisoning is a common method of suicide (second most common in the US) and opioid medication are the most common meds used.
[+] [-] fragsworth|9 years ago|reply
Looking at the study, they didn't adjust for this at all. Also, keep in mind: 1 in 5 are continued on prescriptions, which are given by doctors who assessed the situation and thought it was OK to continue it. It's NOT saying that 20% of people who try opiates for 10 days become hopelessly addicted, which the clickbaity headline implies.
[+] [-] smsm42|9 years ago|reply
The deaths figure - 91 per day or about 33K per year - seems to be the deaths of all opioids (including heroin abuse, etc.) and not the prescription opioids, which are half that:
https://www.drugabuse.gov/related-topics/trends-statistics/o...
Moreover, prescription deaths are relatively stable for last 6 years (though lower before that) while heroin deaths are raising quickly.
[+] [-] empath75|9 years ago|reply
[+] [-] stevecalifornia|9 years ago|reply
I spend a lot of time listening to podcasts where addiction medicine doctors talk about the state of their industry. Their views and their guests views, are almost in complete alignment and those views are the exact opposite of the comments in this thread. I find that alarming.
If you listen to addiction medicine doctors, they will tell you:
1) There is a massive epidemic of opioid addiction. Opioids are wildly addictive and are negligently / over prescribed.
2) There is little evidence that opioids provide benefit for long term chronic pain and evidence that long-term use of opioids actually causes many problems. Getting off the opioids tends to reduce the chronic pain.
3) Patient surveys rule supreme and patients want pain-killers even if the doctor does not believe they are the solution.
Anecdotally, if you watch the A&E show "Intervention", the number of opioid and heroin cases has shot through the roof since the series started two decades ago. There has been a titanic shift in addiction. It's painful to watch some of these addicts lie to their doctor to get opioids, turn around and sell them, then use the money to get heroin because the opioids aren't strong enough anymore.
This comment thread really saddens me.
[1] http://abcnews.go.com/US/prescription-painkillers-record-num...
[+] [-] throwawayheroin|9 years ago|reply
The fact that I'm a software developer (making a living legally) and not taking and/or selling heroin is an anomaly.
[+] [-] slavik81|9 years ago|reply
As far as I could tell, the morphine did nothing. I remained in significant pain for a few hours while I awaited treatment.
It's impossible for me to say why. Is morphine just ineffective for that sort of pain? Or was I underdosed to prevent negative interactions with the drugs they gave me later? Or was I underdosed as a precautionary measure for opiates due to addiction?
All I know is that I'm afraid of ending up in pain in the future and being denied effective treatment out of misguided concern that I will become an addict.
I do not fear addiction. I fear pain.
[+] [-] empath75|9 years ago|reply
[+] [-] troydavis|9 years ago|reply
Here's what it says about adjusting for pain intensity:
> Third, information on pain intensity or duration were not available, and the etiology of pain, which might influence the duration of opioid use, was not considered in the analysis.
[+] [-] theparanoid|9 years ago|reply
[+] [-] ScottBurson|9 years ago|reply
[+] [-] abtinf|9 years ago|reply
[+] [-] rgejman|9 years ago|reply
For instance, a recent study in Nature Medicine[1] showed that you could decouple the positive analgesic (pain relief) effects of opioids from the negative effects of increased tolerance to opioids and increased sensitivity to pain. This is critical because tolerance to the effect of opioids and increased sensitivity of pain to opioids is part of what drives increased use and eventually abuse of opioids.
The practical upshot of this study (if validated) is that you could potentially take a smaller amount of opioids and not have to increase your dose over time to get the same level of benefit. This could severely limit the mortality associated with opioids.
I am hopeful that we will get through the opioid crisis in this country if we invest money in fixing the underlying physiological problems associated with these drugs.
[1]http://www.nature.com/nm/journal/v23/n2/full/nm.4262.html
[+] [-] CydeWeys|9 years ago|reply
These should be treated as treatments of last, not first resort. In both cases, marijuana would have been a more appropriate for pain relief anyway (though I did not use any).
[+] [-] lutusp|9 years ago|reply
A hypothetical prospective study, obviously impractical on multiple grounds -- one that chooses study subjects from the population at random -- might produce a completely different result.
Or the outcome might be the same -- for ethical reasons that deserve to exist, we may never know.
[+] [-] tmp-20150107|9 years ago|reply
For anyone needing opiates as pain medication, I would suggest taking them only in response to acute pain, not as a regular dose, although this may not be possible for chronic sufferers. It's a difficult situation, the best painkillers are horribly addictive and socially stigmatized.
[+] [-] tashapenguin|9 years ago|reply
[+] [-] _acme|9 years ago|reply
[+] [-] taude|9 years ago|reply
[+] [-] intrasight|9 years ago|reply
[+] [-] cmrdporcupine|9 years ago|reply
Opiates however... they really work. They really make the pain go away. Which is why I stay the hell away from them. :-(
[+] [-] TallGuyShort|9 years ago|reply
[+] [-] unknown|9 years ago|reply
[deleted]
[+] [-] taude|9 years ago|reply
I had no idea how addicting this is for people. Personally, I didn't like how it made me feel, so I can only wonder about different people getting different types of "buzz" from it? I think I was irritable for a day after I stopped.
[+] [-] staticelf|9 years ago|reply
I wasn't even close to become addicted. But it is a nice painkiller.
[+] [-] RubenSandwich|9 years ago|reply
[+] [-] mrcactu5|9 years ago|reply
for acute pain, discipline.
[+] [-] logicallee|9 years ago|reply
For example, any time two people have sex if they drank first (are drunk) then no matter how much they consent and really, really want to have sex it's "technically rape" (I am serious). That doesn't make them criminals. And rape is serious.
You have to look at the ACTUAL enforcement practices where you're located. What do people (police) ACTUALLY do?
Also, remember: the reason it is not completely legal might have nothing to do with your consumption of it. For example, would like advertisements for it? Totally legit companies doing things that are "legal" today like shilling on Reddit, trying to get people to use their (legal) drugs?
So I would encourage you not to have such a black and white view of what is "criminal." It's a scale. Just as you're not raping a girl if you two have great drunk sex some night and both wanted it, you're not a criminal if you light up a joint.
[+] [-] dang|9 years ago|reply
[+] [-] sergior|9 years ago|reply