Most people addicted to opioids started with legally prescribed meds. Those meds may not have been prescribed to them, but that's the problem with the fucking stupidly large numbers of opioids being prescribed in the US: there are very many meds lying around to be diverted to recreational use.
So far almost every point you've made in this thread can be directly sourced to Purdue propaganda. Doesn't that worry you?
Here's Purdue Pharma saying, as you are here, that pain meds aren't that addictive and don't we need to use opioids to treat pain (they are addictive, and they don't work for many types of pain): https://www.feinberg.northwestern.edu/sites/ipham/conference...
Opiates are also a fun and addictive drug. As long as they exist and are generally available, some percent of the sub-population will abuse them. We can try our best to keep them only for medical use, but once the prescription leaves the pharmacy there's not much you can do. You can't blame the legal manufacturer when that happens, if they took all required steps to keep their drugs in the legal channels. Maybe you think that's true, but that the opiate manufacturers have used their power and influence to over-prescribe their products. That assumes that opiates are over-utilized in American healthcare. And that's a narrative that simply isn't borne out by the data.
Only 0.19% of opiate-treated chronic pain patients without a prior history develop any form of abuse or addiction[1]. And remember these are chronic-pain patients who take tolerance-escalating doses over years or even decades. Virtually no one develops an opiate addiction from following their medically prescribed treatment regiment.
The death rate from prescription opiates has not budged since 2006[2]. The vast majority of opiate overdoses in America are not prescription opiates, but illicit fentanyl, and to a lesser extent heroin and methadone. Nor do chronic pain patients face any major risk of overdose. The fatal overdose mortality rate for long-term opiate-prescribed patients is 17 per 100,000[3]. And that number doesn't exclude the subset of the population engaged in abusive behavior like mixing with alcohol, snorting pills, or hoarding medication.
Finally the sizable majority of prescription drug abusers in this country do not source from a doctor or the healthcare system at all. The vast majority get their drugs either from the black market or a friend or relative. On the National Drug Use Survey only 18% of prescription drug abusers report doctors as their primary source. And among street prostitutes (a high at-risk group) only 5%[4].
All of this goes to show that there is very little evidence of any sort of over-prescription of opiates in America. To begin with the vast majority of the opiate crisis has to do with fentanyl, not prescription drugs. But even when it comes to prescription drug abuse, the intersection with medical users is vanishingly small.
However what there is a major problem in America is untreated chronic pain. 50 million American suffer chronic pain[5]. And 20 million suffer high-impact chronic pain which severely impairs normal life function. More than 10% of suicides are linked to chronic pain[6]. High-dosage opiates are absolutely essential for this group to live any sort of normal life. As long as there are such massive numbers of legitimate pain patients, the law of large numbers guarantees a large supply of diverted opiates. Even under the tightest controls. There's simply no way around that except by denying most of the legitimate patients treatment for their debilitating conditions.
You're perpetuating a myth that drug use is all about personal choice. Many addicts started with prescription opioids, recommended by their doctor, and only moved to more dangerous options once their doctor's supply was extinguished. Doctors themselves over-prescribed these to attack pain, meanwhile they were being lied to by pharma about the addictiveness of opioids. On top of that, you have fentanyl being added to heroin to increase its potency, and also vastly increase the mortality rate.
Finally, it may be hard for those of us who were never addicted to opioids to understand. It no longer becomes a simple choice when your body is extremely sick if you don't get your dose. This is one reason why a drug addict might steal from those they love, their illness is literally the most important physical sensation at any moment, overcoming familial and societal norms. It's a scourge and illness, not merely a choice.
According to most of what I’ve read and seen, opioid prescriptions are contributing to the problem. It’s true that people aren’t overdosing when following their prescribed dosages, but some people are getting addicted.
A common story for opioid addicts starts with, “I was in a car accident, and they prescribed opioids to deal with the pain. Once the prescription ran out, I was in incredible pain, maybe even worse than before I started taking the pills. I started buying pills illegally. Once the pills got too expensive, I switched to heroin.”
I’ve seen far too many stories that follow that basic path. It’s definitely not the only way people get addicted, but it’s too common.
The idea that opioids are addictive is a myth. People taking them are treating “pain” that isn’t diagnosed in the medical system. For example, joblessness. It’s an easy scapegoat for politicians to let them avoid dealing with harder structural problems.
> but what is different now that makes so many more people get hooked on them?
The US VA noticed that pain was not being adequately treated. They created a campaign to make every HCP ask patients about pain. They looked at the science of the time which seemed to be saying that opioids were not addictive if you use them to treat pain. (they're less addictive if used short term for short term pain (post surgery, for example) but more addictive if used long term.) Drug companies put out new formulations that they claimed were less addictive - turns out they were more addictive. US doctors prescribe huge amounts of opioids.
The tragedy is that pain is still left untreated. The VA campaign meant people got opioids (cheap, but not particularly effective for long term pain) but didn't get access to pain management clinics.
> Routinely measuring pain by the 5th vital sign did not increase the quality of pain management. Patients with substantial pain documented by the 5th vital sign often had inadequate pain management.
> Sales of prescription opioids in the U.S. nearly quadrupled from 1999 to 2014,1 but there has not been an overall change in the amount of pain Americans report.2,3 During this time period, prescription opioid overdose deaths increased similarly.
Now this article is about something different - teaching doctors the warning signs of when already addicted patients are drug seeking, so they can avoid prescribing then. The key fact here is that almost all of the deceased had gotten prescriptions from multiple doctors.
Since this will inevitably turn to a discussion of opioids, here are some counter-narrative facts that surprised me:
1. The narrative is that some poor guy took pain meds for a legimate reason then ended up addicted. While this does occur, it's actually not very common.
> Among people who are prescribed opioids, addiction is relatively uncommon. The percentage of patients who become addicted after taking opioids for chronic pain is measured in the single digits; studies show an incidence from less than 1 percent to 8 percent. Most of the estimates are skewed toward the low end of this range, when those at risk (due to a history of substance abuse or, to a lesser but meaningful extent, a concurrent mental illness) are removed from the sample.
2. Most addicts had a history of drug abuse.
> People who abuse pills are rarely new to drugs. The federal government’s 2014 National Survey on Drug Use and Health, for example, revealed that more than three-fourths of misusers had used non-prescribed benzodiazepines, such as Valium or Xanax, or inhalants. A study of Oxycontin users in treatment found that they “were not naive individuals with accidental addictions who were introduced to painkillers by their physicians as reported by the media … [Instead they had] extensive drug use histories.”
It's hard to bring this up without straying into classism or victim blaming. The reality is that most people without comorbidities and abuse history are quite safe, and these are drugs we need.
People are addicted to pain killers usually because they are dealing with pain, and they are either medicating or self-medicating to manage it.
If mere availability of something addictive was the problem, then we'd have a nation of nothing but alcoholics and cigarette smokers considering you can buy either in an unlimited quantity at any corner store.
Never mind people who get addicted after being prescribed medication for an injury, then? Never mind that the new generations of opioids were marketed as safer/less addicting when they probably were more addicting, and thus prescribed even more out of perception of their safety?
Source? From what I have read the major cause of the opioid crisis is doctors prescribing opioids for pain [0]. Even 2 week prescriptions have 25% chance of creating an addict [1]. Remember originally these were marketed to doctors as non-addictive.
This seems to be an attempt by the states to reign in egregiously bad behavior by these businesses/ doctors that are supposed to be federally regulated (which frankly seemed to be lacking). Opioids things seem addictive enough to warrant some review on if there aren't other pain-killers that can replace them completely perhaps excepting in a few exceptional circumstances.
What makes you say that? It's trivial to get opioids on the streets and it's common to be introduced to them as a recreational drug, as I know first hand.
In fact, I don't know anyone who got addicted to opioids due to overprescription, but I know several people who didn't get prescribed opioids they needed because of the fears of overprescription, and thus were left in terrible pain. I don't know how you draw the line, but I think it's evil to leave people in pain because you're afraid they'll use the drugs for fun. Most people who take opioids do not get addicted.
not anymore, in certain parts of the country there is actually an issue of under-prescription of narcotics as an overreaction to the opioid crisis we are facing, with painkillers of course being the most difficult to access. Chronic severe pain patients and people with horrendous neurological conditions are going without the medications they need because prescribers are now terrified of heavy-handed medical boards
that said, 20 or so years ago prescribers in the U.S. were in various ways made to believe that painkillers such as oxycodone were not addictive and were these magical drugs that helped pain patients regain their lives in ways we had never seen before. Ended up in so many homes, lots of excess prescription opioids hanging around and as a result a lot of people ended up abusing them. For a significant number of people that led to heroin use, and then fentanyl came into the picture in 2015ish; so that's how we got here. heroin on its own when injected isn't actually that easy to accidentally overdose on- fentanyl however, is.
Right this is the problem. We need to ban all opioid prescriptions. 80% of heroin addicts got addicted because of the opioid prescriptions obtained legally. According to the documentary on HBO, drug companies made $5B on opioids in 2014 but the economic costs were $55B.
If people have chronic pain, we need to be more progressive and allow medical marijuana everywhere. (There are also quite a few studies that show that chronic pain is not helped with opioids anyway.) If people are in the hospital or end-of-life/hospice, then give them morphine or whatever they need but we need zero prescribable opioids.
"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.
Oxycodone was pitched as non-addicting. Opioids generally were pitched as non-addicting because they were by prescription, under control of doctors. That protection scheme obviously failed miserably.
So far almost every point you've made in this thread can be directly sourced to Purdue propaganda. Doesn't that worry you?
There was "The Letter that Started it all": https://www.bbc.co.uk/news/world-us-canada-40136881
That caused the VA to say "pain meds aren't addictive if used to treat pain": https://www.va.gov/PAINMANAGEMENT/docs/Pain_As_the_5th_Vital...
Here's the paper that rebuts this: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1924634/ (and note this is more than 10 years old)
Here's Purdue Pharma saying, as you are here, that pain meds aren't that addictive and don't we need to use opioids to treat pain (they are addictive, and they don't work for many types of pain): https://www.feinberg.northwestern.edu/sites/ipham/conference...
reply