The disease of the modern age is the belief that ‘my opinion is better than your knowledge’.
An anti-vaxer is standing in the way of true knowledge. Opiate prescribing was driven by pharmaceutical interests and lobbying, as well as a misguided notion that pain is something to be conquered and abolished.
When I was in the US during medical school, I routinely saw people being discharged after simple procedures with bucketloads of opiates, things that I would discharge in Australia on simple analgesia (paracetamol and ibuprofen).
The public health stance on vaccines is not in any way analogous to the opiate crisis, and whilst I understand the layman’s distrust of medical experts arises in part from this, the two are separate issues stemming from different causes
I like this approach to explain some of antivax as well. Essentially big pharma has just finished up a massive campaign that was the opioid pandemic. Essentially there’s going to be a large correlation between people with jobs that get them injured and targeted for opioid use, and those people being right. Opioid addiction that comes from that targeting isn’t just a single victim thing, someone addicted to something as hard as opioids is going to affect entire families and likely extended families. It’s going to essentially feel like a massive economic and spiritual attack to the family, by pharmaceutical companies (after all the news that came out of that social pandemic). So it makes sense that the seeds for not trusting the medical system are there and in insanely rich fertilizer to grow by even groups previously seen as insane like antivax groups (seriously both sides of the isle used to mock those groups). The worst part is that the people taking a drink of that koolaid, are able to literally take their life experience and draw a completely sane line from A to B that Big Pharma shouldn’t be trusted.
A single letter written 40 years ago did not cause the opiod epidemic. It was part of a movement to reassess the use of pain medication to ease chronic pain. By movement I mean it was part of a change in the zeitgeist among doctors and pharmaceutical companies. No doctor read this letter and said to themselves, well I guess narcotics are not addictive anymore and I can prescribe them without concern. I don't know why people want to make reductive arguments.
> One thing that rarely gets mentioned is how abundantly SAFE opiates are. If you know what you're getting, know what dosage it is, and know it's not adulterated with other substances, you can use opiates for decades without significant health complications (aside from constipation).
But there's little evidence that opioids are effective for treating long term pain.
We know about 10% of people who take prescription opioids will become addicted, and that tends to be the people using them for chronic (long term) pain.
> Fundamentally there is one group of people who is angry that other people are using a chemical to feel good because they feel that if other people aren't suffering as much as they have then they were cheated somehow. And they've been driving policy since the 80s, costing countless lives and monumental amounts of resources. Just to make sure no one has an easier time of life than they had
No, that's wrong. There are people who see that opioids are massively over prescribed in the US, which is causing untold harm and death. Trying to cut back on that massive over-prescribing has to happen.
The problem lies with a fucked up health system that doesn't provide drug & alcohol rehab; and just cuts people off from their meds cold turkey.
I think a part of what's driven the opiate epidemic was the massive overprescription of opiate painkillers by doctors and the marketing surrounding them.
People tend to trust that their doctor is right. If the doctor gives you oxycodone, you assume that it's safe.
Tied in with that is the increased availability of heroin and fentanyl, and now decreased availability of prescription painkillers, pushing users from taking relatively safe pills to injecting drugs, which is an order of magnitude more damaging.
We see stories about that because we are a country of 330 million people and there will be some subset of any [group of people] who do bad things in such a large population. The vast majority of doctors are highly ethical.
As for opiates, I'm afraid I don't quite fit into your strawman; I think doctors should be banned from prescribing them on an outpatient basis to anyone but patients with a terminal prognosis. Chronic pain is awful, but opiate addiction is still worse. Since the action (and addictive mechanism) of opiates causes the pain to worsen over time, it's not an appropriate treatment.
The main reason for overprescription of opiates is not some evil doctor conspiracy, it's because doctors, like everyone, have a very hard time telling people "no." And there's no group of people more skilled at emotional manipulation than junkies.
I don’t find this argument compelling. We knew for a long time that opiates were addictive, they’ve been in common use forever. We’ve come to learn that much of the information they were pushing shouldn’t have been trusted and that they seriously misrepresented these newfound non-hazardous opioids.
Any doctor who believed in addiction-proof opiates wasn't worth their salt to begin with. Opiates are opiates.
Any consumer who took opiates and got addicted has exactly one person to blame - themselves for being uninformed.
I love recreational drugs, and I've had back problems that required more than NSAID's alone, but I've never taken opiates, and I never will until I'm ready to die, because I know just how awesome they are.
Blaming the manufacturer for opiate deaths is like blaming manufacturers for firearm deaths, rather than the shooters.
I think bad policy leads to bad outcomes. When people are given good information, they make good decisions, on the whole.
As a parent, I was pretty pissed off when I learned that over use of antibiotics harms my child, my society.
As a citizen, I'm pretty pissed off that (one aspect) of the opioid epidemic is because doctors changed pain management protocols, without any followup testing, assessment.
“We started it”: Atul Gawande on doctors’ role in the opioid epidemic
I have only had a chance to listen to a small portion of Dr Richard Sackler's deposition and I find it very difficult to believe what I'm hearing. For instance, when questioned about opioid addiction in the 19th and 20th centuries he responded with words to the effect that he was not a student of or wasn't knowledgeable about the history thereof.
One doesn't need to be an historian to know that the 'modern' addiction crisis started around the time of the Civil War when a confluence of factors came together. The first being that many soldiers were injured and that they needed the strongest pain relief available, the second being that around this time the hypodermic needle had just been invented and that opioid administration by this method greatly potentiated the drug's effect and thus the much greater likelihood of a patient to suffer addiction—a fact learned the hard way through terrible circumstances.
The indisputable facts are that many soldiers became addicted to their narcotic painkillers and that these facts were widely known both then and now by both the medical and pharmaceutical professions and the public at large. The fact that the media has been full of such news about opioid addiction for 150 years, one cannot not be unaware of the issues as if one were some kind of modern-day Rip Van Winkle. And for someone in Dr Richard Sackler's position, multiply that knowledge by just about any number you'd like! Even the notion that Sackler wasn't aware or knowledgeable of the facts is outrageously absurd!
The widespread knowledge of the dangers of opioid addiction led eventually to regulation then worldwide treaties on the distribution and trafficking of narcotics etc. which then led to a further tightening of laws in almost every country in the first half of the 20th Century. (It's worth reading the History section of the Wiki on heroin: https://en.wikipedia.org/wiki/Heroin. What Dr Sackler is implying that he knew none of this.)
Again, it is inconceivable that a person in Dr Sackler's position did not have at least a skeletal outline of these facts as they would have been a part of any reputable medical or pharmacology course. Even if he skipped every lecture about the dangers of narcotic opioid addiction—heroin, morphine, etc.—then he wouldn't have been able to skip the highly topical and common worldview (of the population, law enforcement, government, etc.) about opioid addiction as it has been a constant thread throughout the media across his life.
I hope for the sake of all Purdue's victims that there are sufficient forces at work with the will, determination and fortitude to expose this farce of a testimony for what it really is.
Listening to this video is hard going and there's lots of it but I'd hope many of you will listen to at least the first half hour or so of it to get a feel for what's happening—that is, how Purdue is trying to dodge and wheedle its way out of what is a huge crime against many thousands of people many of whom are now dead as the consequence.
Wasn't the problem with opioids in the US that doctors already did prescribe them too freely? The fact that there's now a backlash after it caused a massive problem cannot be the reason that doctors have historically been sceptical about pain (and not just in the US but elsewhere where prescription opioid abuse has not been a problem!)
Overall I agree with your point but I want to make a squabble with your example.
Purdue's marketing of Oxycontin definitely crossed my line of honesty, BUT there has been, historically, an enormous amount of untreated pain in the US (probably everywhere), because of the stigma around those drugs.
It's ok for someone to develop a tolerance and addiction to the drug if they have the actual pain issue. That is usually less disruptive to someone's life than living with crippling pain. In a way, getting opiate pain medication into the hands of more people is a good thing.
The problem was a little more complicated- 1) Perdue promoted Oxycontin in a misleading way. 2) This happened during an economic downturn with our post-manufacturing economy turning out tons of people on disability, and others without a clear future. 3) Legislators freaked out, making it harder for doctors to prescribe opiates without making it easier for them to prescribe opiate treatment pills like suboxone, which basically forces addicted users of pharmaceuticals onto the street to score heroin.
So it's a social, legislative, and corporate morality problem all at the same time.
Well, i'm a doctor so part of this is an argument from authority. But arguments from authority are stupid. So here are some references:
[0] - CDC report describing epidemic in prescription opiate deaths
[1] - NIH report showing overdose deaths. the relevant stats: Since 2001, prescription opiate deaths have risen from 6000 to around 16,000. Over the same period, heroin overdoses went from 2,000 to 8,000. This data is to 2013. So there is a clear problem, and in fact prescription opiates cause significantly more deaths than heroin.
[2] - a report from closer to (my) home and region of practice detailing increases in prescription drug use in Australia and increase in opiate-related deaths secondary to this
"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.
That's a either a naive, or corporate apologist opinion. It's like some sort of Libertarian fever dream. Does that hold true for corporations that produce, distribute, and over-prescribe addictive and deadly opiates? These corporations have directly contributed to 130,000+ deaths in 2016 - 2017 alone.
> The opioid epidemic has its roots in the explosive growth of prescription painkillers. Between 1991 and 2011, the number of opioid prescriptions (selling under brand names like Vicodin, Oxycontin, and Percocet) supplied by American retail pharmacies increased from 76m to 219m. As the number of pain pills being doled out by doctors increased, so did their potency. In 2002 one in six users took a pill more powerful than morphine. By 2012 it was one in three.
I find this absolutely outrageous. I'm not American, but I stumble upon articles mentioning this, and I do watch enough American TV series and movies to have an idea of how acute the problem is (it's crazy how often in TV series doctors seem to give pain killers like it's candy).
I have the impression that in Europe, painkillers are much less used but I would not be surprised if the American trend were to contaminate medical practice here.
Pain is a minor consequence of disease or trauma. Pain won't kill you, so why would you risk become addicted to very dangerous drugs just to relieve it?
We're past time for a discussion about the millions who are no longer able to get effective pain meds - that anti-opiod Rx laws (written in response to the pill mills that had already wound down a decade earlier) are bringing real life harm to millions, insuring they remain in chronic pain.
Assumptions that the much smaller number of pain-mgmnt dr.s (that only the well insured can afford) are a broadly usable replacement for the care lost, doesn't reflect reality at all.
I agree that opiates are an important medical tool. But from what I've read I get the impression that they're severely over-prescribed in the US compared to other nations.
An anti-vaxer is standing in the way of true knowledge. Opiate prescribing was driven by pharmaceutical interests and lobbying, as well as a misguided notion that pain is something to be conquered and abolished. When I was in the US during medical school, I routinely saw people being discharged after simple procedures with bucketloads of opiates, things that I would discharge in Australia on simple analgesia (paracetamol and ibuprofen).
The public health stance on vaccines is not in any way analogous to the opiate crisis, and whilst I understand the layman’s distrust of medical experts arises in part from this, the two are separate issues stemming from different causes
reply