The supreme folly of allowing politicians to be involved in the doctor - patient relationship. If they control medicine, they control your health, they control you.
I think it's a good idea to initially assume most things you read were written in good faith, just to see if it's possible. At the very least it will make your life more pleasant.
In this case, is it possible the author doesn't want you to forget about the shocking numbers of people killing themselves with opiates? Perhaps they wanted to illustrate one reason the opioid epidemic is such a difficult problem, and why doctors keep prescribing opioids in such high numbers. Maybe they wanted to demonstrate that opioids are capable of doing some good, and shouldn't be completely banned or too aggressively limited for everyone. I can't read their mind, but I think it's a useful life skill to assume everyone you meet is a generally good person until they prove you wrong.
You think horrifyingly painful medical conditions are extremely rare, or you doubt they exist? Or both?
If so (as you suggest above), what a sheltered existence you have led! Consider yourself fortunate that neither you nor your family has suffered from a painful chronic neurological condition, or cancer, or other such disease.
I've had a family member die from opiate overdose, but I've also have two family members die of cancer and who were brutally undertreated for pain because of the current regulatory insanity doctors deal with now.
I'm an inpatient physician. Once you are dying of cancer, we almost dump opioids on you where I practice. Especially if you elect hospice or comfort care. If you don't, then it becomes somewhat more difficult because escalating opioid therapy is just assuming risk of causing hypotension or respiratory depression.
We definitely undertreat acute pain. But in my circle, I'm pretty frank with patients that we generally won't use opioids for chronic pain outside of cancer-pain. It's not because of regulatory issues, it's more because the vast majority of people with chronic pain that I see don't have an obvious organic cause. Yes, it means the few that do have a good indication for chronic opioid therapy will suffer.
Also, acute and chronic pain behave differently. People with acute pain have a certain appearance that is easily recognizable. People with chronic pain will be sitting there looking comfortable, normal HR, eating and walking and watching movies comfortably on their iPads. It feels so weird prescribing opioids to those people. All the while telling you they "10/10" pain.
We need better studies on who qualifies for chronic opioid therapy and how it should be managed. Drug-monitoring databases have certainly helped, but a lot more needs to be done.
Well, let me tell you first my personal experiences with a non-terminal but severe and potentially life-threatening illness before I move on to my two relatives who died of cancer. I've had two excruciating episodes of acute pancreatitis that sent me to the ER this past 18 months. One was quite severe and left me in the hospital for a week. Pain control wasn't a problem in the hospital, but once I was discharged it become a huge problem. I got multiple other episodes of similar severe abdominal/back pain the past year but my amylase/lipase weren't elevated sky-high as they were during the two hospital stays. The whole situation lasted so long I'd assume I would be considered a chronic pain patient, and yet I can quite assure you I wasn't looking comfortable, I had elevated HR and BP, I was nauseated from either the pancreatitis or the pain (sometimes it was hard to tell). And yet the gastro I was seeing was loathe to prescribe me adequate pain relief, nor would he make a diagnosis of chronic pancreatitis all while farting around with tests like colonoscopy and gastric transit time testing. I got a months worth of pain killers from him after I was in the hospital for a week, then I was on my own though the pain was sometimes just as bad.
Finally, I fired him after getting nowhere for a year, went to a pancreas center of excellence a few hours away where they quickly ordered an EUS and found it was a bad gallbladder that was causing it (the old gastro had ordered a CAT scan and ultrasound but neither showed the sludge that my GB was packed with, although it should have shown some other issues with the gallbladder according to the pancreas expert). Had gallbladder removed a month ago and am feeling much better now, finally able to eat normally for first time in 18 months and out of severe pain.
Unfortunately, because of the pain and sickness, I've been unable to work for most of the last 18 months. Along with my considerable hospital bills (dozens of procedures, a surgery, two hospital stays), this has left my family in a precarious financial position. Luckily, so I'm now looking to return to work.
My story is not even what I was thinking about above, since I'm not 100% sure if I'd be considered a chronic or acute pain patient, but your attitude struck a nerve with me so I thought I'd share. Frankly, it pisses me off to hear you describe your patients thus, because my guess is that some of them are like me over the past 18 months.
By the way, although I certainly wasn't comfortable when I was in moderate-to-severe pain from the pancreatitis over the past 18 months, I would watch movies in a sometimes vain attempt to distract myself from the pain. I mention this just to clue you in as to what might be happening with your patients. And yes, some of your patients are malingering, I'm sure. But the fact that you make blanket generalizations about all your chronic pain patients tells me all I need to know about how many true cases of severe pain you're discounting.
On to my two relatives who passed away from cancer. One (my uncle, 45 of age, with lymphoma) wanted to die at home and so took home hospice care. Vastly under-treated for pain, with my aunts and uncles constantly reminding the doctors that he was terminal and pleading for more/better pain meds for him. The man was dying and his main goal, as explicitly explained to the doctors, was to die at home and do so as comfortably as possible, so I don't understand why concern over addiction, respiratory depression, or hypotension should have played a major role.
My other relative (grandfather) who passed away from cancer was a paragon of his community, retired fire chief, in-patient hospice care, 80 years old, and still struggled to get adequate pain relief for his terminal cancer pain. Luckily, after 3-4 weeks of unnecessary suffering, he had enough connections to influential people in the community that the situation was ...
I recently underwent surgery and radiation treatment for cancer at the base of my tongue (left side) which was noticed by me because it formed a lump on the left side of my neck. They took about half a golf ball out of the base of my tongue and scooped out a bunch of neck stuff but my neck never bothered me at all. Tongue surgery recovery plus 2 months of mouth and neck radiation treatment is something I wouldn't wish on anyone.
I was on morphine for 5 months and my only complaint is that they told me at refill time that I should be done with it now and they didn't want to renew my monthly prescription. I told them I agreed with them but I needed another month of pills to allow myself to wean off of them over time. They were very reluctant but after a few hours and a few different doctors talked to me they went along with it. I did a 4 one week reductions and that first week without was almost worse than the cancer recovery.
I fear the return of the cancer more because of the need to have to go through the morphine withdrawal week than the cancer itself.
This was at the West Palm Beach VA Medical Center where I received absolutely first class treatment throughout the entire experience.
I was on morphine for 5 months and my only complaint is that they told me at refill time that I should be done with it now and they didn't want to renew my monthly prescription. I told them I agreed with them but I needed another month of pills to allow myself to wean off of them over time. They were very reluctant...
This makes me so mad.
You are just supposed to quit in one day, cold-turkey?
> People with chronic pain will be sitting there looking comfortable, normal HR, eating and walking and watching movies comfortably on their iPads.
Are you really a doctor? It's hard to believe - if you were, you should know at least how the chronic pain works, how devastating it can be, how it destroys people's lives, all the while without (most of the time) making them scream and cry (or have elevated heart rate).
The chronic pain works not through how severe it is (although it can be really severe at times), but through it being chronic: it's with you non-stop, never leaving you, you can't forget it, you can't do anything about and - which is the worst - you know it won't end. It's easier to cope with the pain if you know it will subside at some point, in a week, in a month. It's incredibly devastating to know that there is really no point in you trying to bear the pain because all it gets you is more, not less, pain tomorrow.
It's incredibly hard to even imagine what the chronic pain feels like. Chances are you are mostly healthy, and the pain you experienced was temporary. You can't, at all, use such experiences to try to understand chronic pain patients. If you want to understand it, go break an arm. Wait for it to heal a bit, then break it again. Rinse and repeat, for years. Then, try to live a comfortable, fulfilling life and come back to tell us how it went.
Chronic pain patients can look alright on the outside. Especially if they are on a good painkiller, but even if not, they can look perfectly normal... for a time. They develop coping strategies and generally do their best not to show their pain when in public. You can limp for a while with a broken leg, too, before passing out. Yet, if you observe the same patients for a whole day or two, you'll see a lot of signs that they do, in fact, suffer a lot. Don't dismiss it just because some of them manage to look alright when waiting for an appointment.
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Another thing is that I don't understand what is wrong with taking opiates, at all, other than the risk of overdose, which would be non-existent if they were legally available. From what I've read, very few overdoses are intentional, most happen because people are getting fentanyl when they expected oxycodone (actually, it's crazy that they use fentanyl to fake oxycodone - it's like trying to fake coffee with amphetamine...). The less-potent opiates and opioids (basically oxycodone and tramadol), which seem to be fuelling the crisis, have a lot fewer side-effects, including mood-altering high, than morphine or heroin. I don't see a reason for banning people - even healthy ones - from using them, other than some almost-religious conviction that people "should live clean". If there's something I'm missing here, I'm all ears.
> You think horrifyingly painful medical conditions are extremely rare
Yes. In particular, they are much less of a concern than the epidemic of people killing themselves with opiates. This is so blatantly the case that I see this piece as simply axe-grinding of a certain agenda. The author is distressed and annoyed that sympathy is going towards this suicidal population. The author wants to direct your sympathy towards people like this guy.
And this guy's problem is not 'pain'. There's medicine for that. This guy's problem is that doctors are skeptical of his pain. And that is way, way, down the totem poll of things I care about, vs. an entire population group killing itself by whatever means are handy.
When I was eight I was worried about people not believing that I was really sick.
I have some friends who fall into this category. They end up using stuff like Kratom, which I guess is fairly effective. The DEA almost made it illegal recently, but I guess enough are helped by it, a letter writing campaign ended with a rare reversal. I've tried it for fun (and back pain); seems pretty effective to me. Suspect it's hard on the liver.
It is messed up how the medical profession is with its incentives. ~15 years ago my doctor wanted to give me oxys for just about any complaint ("doc they canceled Star Trek Enterprise" here have some oxys). More recently, a nurse ex-gf informs me half her job is saying no to people who are trying to get opiate handouts.
>> You think horrifyingly painful medical conditions are extremely rare
>Yes. In particular, they are much less of a concern than the epidemic of people killing themselves with opiates.
Wow. The only thing I am slightly comforted by is the fact that if you or someone you love lives long enough, you will likely come to regret those words. Because almost all of us will eventually suffer from severe, horrifying pain if we live long enough. I don't want anyone to suffer from severe, chronic or acute pain, but I do appreciate the compassion and enlightenment that usually results from such suffering.
By the way, I do agree that he picked a bad example patient, since there are thousands of people with horrific diseases, organic diseases, who are being denied adequate pain relief at the present.
Finally, in case it's not clear, it's completely possible to be compassionate to both people with severe chronic and acute pain, as well as to those people who are dying from addiction issues. But as we'll continue to see, eliminating prescription pain medication will do nothing to lower the opiate death toll, since most addicts are dying from illegally manufactured heroin, carfentanyl, etc.
No, you halfwit, a series of unfortunate personal experiences are never going to overturn statistics. If very few people have a leg bitten off by a shark, but then I regrettably lose a leg to a shark, it's still the case that very people have a leg bitten off by a shark, and I can still reason from there.
It's fascinating living long enough to see things come full circle.
Back in the 1980s, people were severely under-treated for pain. Things changed and being on opioids long-term was OK in certain circumstances. Now we've come full circle and people in pain are being denied effective treatments, all in the name of moral panic.
> Now we've come full circle and people in pain are being denied effective treatments, all in the name of moral panic.
A moral panic is exactly what this is.
Meanwhile, nearly a million people die in the USA every single year from obesity, dietary choices, and lifestyle decisions leading to heart disease, diabetes, etc, which is a very real and preventable crisis.
Not sure, but if you're suggesting these are from legal prescription pain pills, please read the article and look at CDC data. You'll note that most opiate deaths aren't from pills, but from illegal heroin, fentanyl, and carfentanyl. Pain pill prescriptions are down 40% the past 5 years, even as opiate deaths are up 40%.
It’s almost like... people got hooked on pain pills pushed by Perdue and doctors, then their access was removed so they switched to “illegal heroin, fentanyl, and carfentanyl,” and started dropping dead.
40% drop on one hand and 40% rise on the other... ah reckon thar maht be a connection!
This seems to underestimate the impact of prescription pain killers on the opioid crisis.
"A study of young, urban injection drug users interviewed in 2008 and 2009 found that 86 percent had used opioid pain relievers nonmedically prior to using heroin, and their initiation into nonmedical use was characterized by three main sources of opioids: family, friends, or personal prescriptions (Lankenau et al., 2012). This rate represents a shift from historical trends. Of people entering treatment for heroin addiction who began abusing opioids in the 1960s, more than 80 percent started with heroin. Of those who began abusing opioids in the 2000s, 75 percent reported that their first opioid was a prescription drug (Cicero et al., 2014)."
People getting hooked on prescription opiates is a single digit percentage of the patients prescribed. It is a large double digit percentage of opiate overdose deaths. Thats what happens when you take something reasonably safe and overprescribe it by orders of magnitude because of criminally misleading misinformation from Purdue Pharmaceuticals.
You're comparing two complex, multifactorial outcomes as though they're have a direct inverse correlation.
What about causality? Confounding? Multivariate analysis?
Nah?
You'll just assume they're causally related?
By the way, I rounded off the second of those numbers from 37% to 40%. Does that change the conclusion you reached using your statistical system? If not, what would be the threshold percentage at which you would determine there to be no direct inverse relationship between the two, after all?
Half the time, my partner can't get her Armodafinil (without which she can't stay awake enough to work) prescription auto-refilled, because of the moral panic about some techies in Silicon Valley, who don't have her medical issues, popping uppers to get 90 hours of work done in a 60 hour week.
In the 1950s, barbiturates were widely prescribed for the routine treatment of anxiety and insomnia. Eventually, we realised that they were highly addictive and extremely dangerous, so we stopped prescribing them except as a short-term treatment for acute and severe episodes. Some patients remained addicted for years or decades; many died as a result.
In the 1960s, benzodiazepines were widely prescribed for the routine treatment of anxiety and insomnia. Eventually, we realised that they were highly addictive and extremely dangerous, so we stopped prescribing them except as a short-term treatment for acute and severe episodes. Some patients remained addicted for years or decades; many died as a result.
I'd really like history to stop repeating itself. I have a horrible suspicion that it won't.
And before the 1980s, people were medicated into living like zombies. There might be a cycle of skepticism and liberalism, but what what hasn't changed is that doctors can't feel your pain for you, and they can't know where the medication goes after they prescribe it.
Both of these are technical problems.
As for where it's more desirable to be on the cycle, in a climate of skepticism you can at least argue strenuously that you really, really need it. You can improve your own situation, by your own power. In a climate of liberalism we just have to hope that someone will notice and intervene on behalf of someone killing himself with drugs. One of these climates will result in an excess of pain; the other will result in an excess of death. Since neither is desirable, I suggest you focus on technical solutions rather than rabble-rousing to advance the cycle.
> He explained that Isaiah, his five-year-old, had been especially affected by his mom’s leaving, and a few mornings earlier, still half-asleep, had grown distraught. “Do you have any idea,” he asked, “what it’s like when your son needs you to comfort him, he needs you to pick him up, and all you can tell him is, ‘I’m so sorry, I just can’t right now’?”
An absolutely chilling ending to a great read. It brings to light serious problems in how society is handling cracking down on opioid addiction, but also there aren’t many solutions available.
Obviously, in certain circumstances only traditional opioids will do, but for alternative pain management, people speak highly of cannabis and kratom.
For those who haven’t yet heard of it, kratom (variously pronounced “KRAY-tum”, “KRAT-um”, and “kra-TOME”) is a southeast Asian tree in the coffee family, whose leaves are chewed or ground into powder and swallowed in capsules or brewed into tea; it acts as an atypical opioid agonist, which appears to be less addictive and significantly less dangerous than traditional opioids, while offering comparable pain relief. The DEA and FDA have been making moves toward banning it for a few years now, lacking both sufficient evidence that it’s dangerous, and sufficient research to confirm the considerable anecdotal evidence that it’s safe and useful as a mild natural remedy for pain, anxiety and depression, and addiction—particularly opioid withdrawal.
So I hope cannabis legalisation continues to proceed and that kratom achieves secure legal status so that it can be used directly, as well as studied and used to produce derivatives, for safer and less addictive pain management.
Thousands of people claim that it has saved their lives from opioid addiction and pain. Personally, I’ve found it useful for my minor chronic pain, but it truly gave me my life back from alcoholism by greatly reducing my desire to drink. I fear that if it’s banned, it will result in needless deaths and further worsen the opioid crisis.
They're not the ones who are liable for the consequences of the opioid epidemic. Once the FDA approves a drug, unless someone can prove that the researchers knowingly misled investigators, it is nearly impossible to sue the pharma companies. The doctors who prescribe the medication (using guidelines provided by the pharma company) become their human liability shields.
They couldn't care less about bad PR because their patents are a massive barrier to entry and they're pretty much the only ones hiring highly educated biologists outside of academia and medicine.
It's not exactly a nonprofit enterprise. I doubt if they have personal concerns about the corporation facing criticism when they're making billions and billions of dollars.
They haven't been demonized for making opioids. They've been rightly criticized for deceptively marketing them to patients and doctors as safe and non-addictive[1]. They've been rightly criticized for allegedly bribing doctors to overprescribe opioids to patients who don't need them[2]. They've been rightly criticized for failing to properly monitor and control the supply of opioids.[3]
Some pharmaceutical manufacturers have made billions of dollars from oxycodone, hydrocodone and other synthetic opioid drugs. They used bad science, deception and outright criminality to flood the United States with powerful narcotics, sparking an epidemic of addiction. Nobody forced them to do it. Nobody asked them to do it. They should bear the consequences of their actions.
Marijuana is a great alternative to opioids for pain management. I got a couple long term injuries in college (permanently broken L5 vertebrae, a shoulder that continually dislocates) and was on opioids for quite a while. I was noticing a dependence and quickly looked for alternatives. Weed has been a godsend. I can sleep through the night, and mostly operate pain free these days. I've been smoking weed for 7+ years and I'm feeling great!
I have never found that to be true. I've been a lot of pain meds in the past, and marijuana as well, and the marijuana never did squat for the pain. Transitioning from opioids to marijuana, really? That sounds hella dubious to me.
I think this is quite dependant on the person, type of pain, cannabis strain, extraction or concentration method, ingestion method etc. As mentioned up thread, kratom provides much closer effect to the commonly prescribed opiate derivative medications than cannabis. Note about kratom legality: Indonesia and some other SE Asian countries where it's outright banned seem largely influenced by the fact that opium addiction and sale is highly profitable for the governing bodies, and mild natural alternatives are bad for business.
Basic income the solution to the opioid crisis? A lot of financially poor people working three part-time jobs would suddenly become a lot less stressed and have more time to take care of themselves and their families.
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[ 3.6 ms ] story [ 129 ms ] threadBut fuck them, right?
Check out this extremely rare case of (certain, other) people who occasionally face the unending horror of doubtful doctors.
In this case, is it possible the author doesn't want you to forget about the shocking numbers of people killing themselves with opiates? Perhaps they wanted to illustrate one reason the opioid epidemic is such a difficult problem, and why doctors keep prescribing opioids in such high numbers. Maybe they wanted to demonstrate that opioids are capable of doing some good, and shouldn't be completely banned or too aggressively limited for everyone. I can't read their mind, but I think it's a useful life skill to assume everyone you meet is a generally good person until they prove you wrong.
When a journalist writes, I only look for the narrative.
If so (as you suggest above), what a sheltered existence you have led! Consider yourself fortunate that neither you nor your family has suffered from a painful chronic neurological condition, or cancer, or other such disease.
I've had a family member die from opiate overdose, but I've also have two family members die of cancer and who were brutally undertreated for pain because of the current regulatory insanity doctors deal with now.
I'm an inpatient physician. Once you are dying of cancer, we almost dump opioids on you where I practice. Especially if you elect hospice or comfort care. If you don't, then it becomes somewhat more difficult because escalating opioid therapy is just assuming risk of causing hypotension or respiratory depression.
We definitely undertreat acute pain. But in my circle, I'm pretty frank with patients that we generally won't use opioids for chronic pain outside of cancer-pain. It's not because of regulatory issues, it's more because the vast majority of people with chronic pain that I see don't have an obvious organic cause. Yes, it means the few that do have a good indication for chronic opioid therapy will suffer.
Also, acute and chronic pain behave differently. People with acute pain have a certain appearance that is easily recognizable. People with chronic pain will be sitting there looking comfortable, normal HR, eating and walking and watching movies comfortably on their iPads. It feels so weird prescribing opioids to those people. All the while telling you they "10/10" pain.
We need better studies on who qualifies for chronic opioid therapy and how it should be managed. Drug-monitoring databases have certainly helped, but a lot more needs to be done.
Well, let me tell you first my personal experiences with a non-terminal but severe and potentially life-threatening illness before I move on to my two relatives who died of cancer. I've had two excruciating episodes of acute pancreatitis that sent me to the ER this past 18 months. One was quite severe and left me in the hospital for a week. Pain control wasn't a problem in the hospital, but once I was discharged it become a huge problem. I got multiple other episodes of similar severe abdominal/back pain the past year but my amylase/lipase weren't elevated sky-high as they were during the two hospital stays. The whole situation lasted so long I'd assume I would be considered a chronic pain patient, and yet I can quite assure you I wasn't looking comfortable, I had elevated HR and BP, I was nauseated from either the pancreatitis or the pain (sometimes it was hard to tell). And yet the gastro I was seeing was loathe to prescribe me adequate pain relief, nor would he make a diagnosis of chronic pancreatitis all while farting around with tests like colonoscopy and gastric transit time testing. I got a months worth of pain killers from him after I was in the hospital for a week, then I was on my own though the pain was sometimes just as bad.
Finally, I fired him after getting nowhere for a year, went to a pancreas center of excellence a few hours away where they quickly ordered an EUS and found it was a bad gallbladder that was causing it (the old gastro had ordered a CAT scan and ultrasound but neither showed the sludge that my GB was packed with, although it should have shown some other issues with the gallbladder according to the pancreas expert). Had gallbladder removed a month ago and am feeling much better now, finally able to eat normally for first time in 18 months and out of severe pain.
Unfortunately, because of the pain and sickness, I've been unable to work for most of the last 18 months. Along with my considerable hospital bills (dozens of procedures, a surgery, two hospital stays), this has left my family in a precarious financial position. Luckily, so I'm now looking to return to work.
My story is not even what I was thinking about above, since I'm not 100% sure if I'd be considered a chronic or acute pain patient, but your attitude struck a nerve with me so I thought I'd share. Frankly, it pisses me off to hear you describe your patients thus, because my guess is that some of them are like me over the past 18 months.
By the way, although I certainly wasn't comfortable when I was in moderate-to-severe pain from the pancreatitis over the past 18 months, I would watch movies in a sometimes vain attempt to distract myself from the pain. I mention this just to clue you in as to what might be happening with your patients. And yes, some of your patients are malingering, I'm sure. But the fact that you make blanket generalizations about all your chronic pain patients tells me all I need to know about how many true cases of severe pain you're discounting.
On to my two relatives who passed away from cancer. One (my uncle, 45 of age, with lymphoma) wanted to die at home and so took home hospice care. Vastly under-treated for pain, with my aunts and uncles constantly reminding the doctors that he was terminal and pleading for more/better pain meds for him. The man was dying and his main goal, as explicitly explained to the doctors, was to die at home and do so as comfortably as possible, so I don't understand why concern over addiction, respiratory depression, or hypotension should have played a major role.
My other relative (grandfather) who passed away from cancer was a paragon of his community, retired fire chief, in-patient hospice care, 80 years old, and still struggled to get adequate pain relief for his terminal cancer pain. Luckily, after 3-4 weeks of unnecessary suffering, he had enough connections to influential people in the community that the situation was ...
Thank you.
I was on morphine for 5 months and my only complaint is that they told me at refill time that I should be done with it now and they didn't want to renew my monthly prescription. I told them I agreed with them but I needed another month of pills to allow myself to wean off of them over time. They were very reluctant but after a few hours and a few different doctors talked to me they went along with it. I did a 4 one week reductions and that first week without was almost worse than the cancer recovery.
I fear the return of the cancer more because of the need to have to go through the morphine withdrawal week than the cancer itself.
This was at the West Palm Beach VA Medical Center where I received absolutely first class treatment throughout the entire experience.
This makes me so mad.
You are just supposed to quit in one day, cold-turkey?
Ridiculous.
Are you really a doctor? It's hard to believe - if you were, you should know at least how the chronic pain works, how devastating it can be, how it destroys people's lives, all the while without (most of the time) making them scream and cry (or have elevated heart rate).
The chronic pain works not through how severe it is (although it can be really severe at times), but through it being chronic: it's with you non-stop, never leaving you, you can't forget it, you can't do anything about and - which is the worst - you know it won't end. It's easier to cope with the pain if you know it will subside at some point, in a week, in a month. It's incredibly devastating to know that there is really no point in you trying to bear the pain because all it gets you is more, not less, pain tomorrow.
It's incredibly hard to even imagine what the chronic pain feels like. Chances are you are mostly healthy, and the pain you experienced was temporary. You can't, at all, use such experiences to try to understand chronic pain patients. If you want to understand it, go break an arm. Wait for it to heal a bit, then break it again. Rinse and repeat, for years. Then, try to live a comfortable, fulfilling life and come back to tell us how it went.
Chronic pain patients can look alright on the outside. Especially if they are on a good painkiller, but even if not, they can look perfectly normal... for a time. They develop coping strategies and generally do their best not to show their pain when in public. You can limp for a while with a broken leg, too, before passing out. Yet, if you observe the same patients for a whole day or two, you'll see a lot of signs that they do, in fact, suffer a lot. Don't dismiss it just because some of them manage to look alright when waiting for an appointment.
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Another thing is that I don't understand what is wrong with taking opiates, at all, other than the risk of overdose, which would be non-existent if they were legally available. From what I've read, very few overdoses are intentional, most happen because people are getting fentanyl when they expected oxycodone (actually, it's crazy that they use fentanyl to fake oxycodone - it's like trying to fake coffee with amphetamine...). The less-potent opiates and opioids (basically oxycodone and tramadol), which seem to be fuelling the crisis, have a lot fewer side-effects, including mood-altering high, than morphine or heroin. I don't see a reason for banning people - even healthy ones - from using them, other than some almost-religious conviction that people "should live clean". If there's something I'm missing here, I'm all ears.
Yes. In particular, they are much less of a concern than the epidemic of people killing themselves with opiates. This is so blatantly the case that I see this piece as simply axe-grinding of a certain agenda. The author is distressed and annoyed that sympathy is going towards this suicidal population. The author wants to direct your sympathy towards people like this guy.
And this guy's problem is not 'pain'. There's medicine for that. This guy's problem is that doctors are skeptical of his pain. And that is way, way, down the totem poll of things I care about, vs. an entire population group killing itself by whatever means are handy.
When I was eight I was worried about people not believing that I was really sick.
It is messed up how the medical profession is with its incentives. ~15 years ago my doctor wanted to give me oxys for just about any complaint ("doc they canceled Star Trek Enterprise" here have some oxys). More recently, a nurse ex-gf informs me half her job is saying no to people who are trying to get opiate handouts.
>Yes. In particular, they are much less of a concern than the epidemic of people killing themselves with opiates.
Wow. The only thing I am slightly comforted by is the fact that if you or someone you love lives long enough, you will likely come to regret those words. Because almost all of us will eventually suffer from severe, horrifying pain if we live long enough. I don't want anyone to suffer from severe, chronic or acute pain, but I do appreciate the compassion and enlightenment that usually results from such suffering.
By the way, I do agree that he picked a bad example patient, since there are thousands of people with horrific diseases, organic diseases, who are being denied adequate pain relief at the present.
Finally, in case it's not clear, it's completely possible to be compassionate to both people with severe chronic and acute pain, as well as to those people who are dying from addiction issues. But as we'll continue to see, eliminating prescription pain medication will do nothing to lower the opiate death toll, since most addicts are dying from illegally manufactured heroin, carfentanyl, etc.
https://news.ycombinator.com/newsguidelines.html
Is it really impossible to help one group without physically torturing the other?
Back in the 1980s, people were severely under-treated for pain. Things changed and being on opioids long-term was OK in certain circumstances. Now we've come full circle and people in pain are being denied effective treatments, all in the name of moral panic.
Rinse...and repeat.
A moral panic is exactly what this is.
Meanwhile, nearly a million people die in the USA every single year from obesity, dietary choices, and lifestyle decisions leading to heart disease, diabetes, etc, which is a very real and preventable crisis.
https://www.cdc.gov/nchs/fastats/deaths.htm
I think "moral panic" implies "nothing is wrong, but are all panicking anyway."
Something is clearly wrong. And those pills are coming from somewhere.
It seems like the true panic is over finding the right balance, if that's even possible.
Not sure, but if you're suggesting these are from legal prescription pain pills, please read the article and look at CDC data. You'll note that most opiate deaths aren't from pills, but from illegal heroin, fentanyl, and carfentanyl. Pain pill prescriptions are down 40% the past 5 years, even as opiate deaths are up 40%.
40% drop on one hand and 40% rise on the other... ah reckon thar maht be a connection!
Are their pill mills out there? Yes, and the DEA should shut them down.
But should we be undertreating real pain in order to “do something” about opioid deaths? He’ll no.
"A study of young, urban injection drug users interviewed in 2008 and 2009 found that 86 percent had used opioid pain relievers nonmedically prior to using heroin, and their initiation into nonmedical use was characterized by three main sources of opioids: family, friends, or personal prescriptions (Lankenau et al., 2012). This rate represents a shift from historical trends. Of people entering treatment for heroin addiction who began abusing opioids in the 1960s, more than 80 percent started with heroin. Of those who began abusing opioids in the 2000s, 75 percent reported that their first opioid was a prescription drug (Cicero et al., 2014)."
https://www.drugabuse.gov/publications/research-reports/rela...
That doesn’t mean you should be denying pain medication to people who need it.
What about causality? Confounding? Multivariate analysis? Nah?
You'll just assume they're causally related?
By the way, I rounded off the second of those numbers from 37% to 40%. Does that change the conclusion you reached using your statistical system? If not, what would be the threshold percentage at which you would determine there to be no direct inverse relationship between the two, after all?
A moral panic is a feeling of fear spread among a large number of people that some evil threatens the well-being of society.
In the 1960s, benzodiazepines were widely prescribed for the routine treatment of anxiety and insomnia. Eventually, we realised that they were highly addictive and extremely dangerous, so we stopped prescribing them except as a short-term treatment for acute and severe episodes. Some patients remained addicted for years or decades; many died as a result.
I'd really like history to stop repeating itself. I have a horrible suspicion that it won't.
It was commonly seen in homes in the 1980s, successor to meprobamate of the 1960s.
https://en.wikipedia.org/wiki/Mother%27s_Little_Helpers
Both of these are technical problems.
As for where it's more desirable to be on the cycle, in a climate of skepticism you can at least argue strenuously that you really, really need it. You can improve your own situation, by your own power. In a climate of liberalism we just have to hope that someone will notice and intervene on behalf of someone killing himself with drugs. One of these climates will result in an excess of pain; the other will result in an excess of death. Since neither is desirable, I suggest you focus on technical solutions rather than rabble-rousing to advance the cycle.
This has never really not been true. E.g. the IOM's current recommendation is for easier access to pain medication, including opioids:
https://www.nap.edu/catalog/13172/relieving-pain-in-america-...
An absolutely chilling ending to a great read. It brings to light serious problems in how society is handling cracking down on opioid addiction, but also there aren’t many solutions available.
Properly funding mental health and rehabilitation services would be a start.
For those who haven’t yet heard of it, kratom (variously pronounced “KRAY-tum”, “KRAT-um”, and “kra-TOME”) is a southeast Asian tree in the coffee family, whose leaves are chewed or ground into powder and swallowed in capsules or brewed into tea; it acts as an atypical opioid agonist, which appears to be less addictive and significantly less dangerous than traditional opioids, while offering comparable pain relief. The DEA and FDA have been making moves toward banning it for a few years now, lacking both sufficient evidence that it’s dangerous, and sufficient research to confirm the considerable anecdotal evidence that it’s safe and useful as a mild natural remedy for pain, anxiety and depression, and addiction—particularly opioid withdrawal.
So I hope cannabis legalisation continues to proceed and that kratom achieves secure legal status so that it can be used directly, as well as studied and used to produce derivatives, for safer and less addictive pain management.
Thousands of people claim that it has saved their lives from opioid addiction and pain. Personally, I’ve found it useful for my minor chronic pain, but it truly gave me my life back from alcoholism by greatly reducing my desire to drink. I fear that if it’s banned, it will result in needless deaths and further worsen the opioid crisis.
They couldn't care less about bad PR because their patents are a massive barrier to entry and they're pretty much the only ones hiring highly educated biologists outside of academia and medicine.
Some pharmaceutical manufacturers have made billions of dollars from oxycodone, hydrocodone and other synthetic opioid drugs. They used bad science, deception and outright criminality to flood the United States with powerful narcotics, sparking an epidemic of addiction. Nobody forced them to do it. Nobody asked them to do it. They should bear the consequences of their actions.
[1]https://www.nytimes.com/2007/05/10/business/11drug-web.html
[2]https://www.bloomberg.com/news/articles/2017-10-26/insys-the...
[3]https://www.justice.gov/opa/pr/mckesson-agrees-pay-record-15...
Disclaimer: I work for Eaze.