With a 10-day supply of opioids, 1 in 5 become long-term users

[ALiberalModerate]

The longer a person uses opioids, the greater the risk of forming a deadly addiction. But just how long does it take to switch from being a short-term user—say, while you’re dealing with pain after a surgery—to a long-term, potentially problematic user? A few weeks? A month?According to a new study, that transition could take just a matter of days.

When patients get an initial opioid prescription that’s just a one-day supply, they have about a six-percent chance of being on opioids for a year or longer. But if that first prescription is for a three-day supply, the probability of long-term use starts inching up. With an initial five-day supply, the chance jumps to about 10 percent. With a six-day supply, the chance hits 12 percent. With 10-day’s worth, the odds of still being on opioids a year later hits roughly 20 percent. So, with an initial 10-day opioid prescription, about one-in-five patients become long-term users. That’s according to the new study’s lead author Bradley Martin, a professor of pharmaceutical evaluation and policy at the University of Arkansas for Medical Science. It’s a fast rise, Martin said to Ars. “We really didn’t expect that.”
And, according to the rest of the data—published Friday in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report (MMWR)—things just keep getting worse from there.

https://arstechnica.com/science/201...ply-of-opioids-1-in-5-become-long-term-users/

This is why we have such an opioid addiction epidemic in this country. They are dangerous, its much better to man up and deal with the pain than it is to risk getting hooked.

 

[nota bene]

https://arstechnica.com/science/201...ply-of-opioids-1-in-5-become-long-term-users/

This is why we have such an opioid addiction epidemic in this country. They are dangerous, its much better to man up and deal with the pain than it is to risk getting hooked.

Have you ever lived with 5+ (or worse) chronic pain?

 

[Mr Person]

https://arstechnica.com/science/201...ply-of-opioids-1-in-5-become-long-term-users/

This is why we have such an opioid addiction epidemic in this country. They are dangerous, its much better to man up and deal with the pain than it is to risk getting hooked.

I've only started sipping my coffee, but I don't see anything in the article indicating any attempt to determine what the reasons were for long-term users to be long-term users. They're just looking at amount of time an opiate has been prescribed to a given person, not why.

So it doesn't really say anything about addiction vs. need.






The writing also isn't particularly clear. Take these two sentences: "For patients who get a 30-day stash of opioid all at once for their initial prescription, the chance of being on opioids for a year rose to 45 percent. . . . . . . .People who got 30 days of opioid total—meaning they may have gotten multiple prescriptions or refills over time—had about a 30-percent probability of using opioids for a year. And they had a nearly 20-percent chance of being on them for three years."

Are they counting receiving 10 three-day subscriptions, scattered over a year, as "being on opioids for a year", then saying that if someone received those scattered doses, there's a nearly 20% chance that they will continue to get periodically prescribed opiates for the next three years? Or are they saying that in each case, there is an X% chance that, starting once the prescriptions described (a 30-day stash in one shot vs. 30 days spread out over a year) ends, the person will then start taking opioids every day for another year?

 

[ALiberalModerate]

Have you ever lived with 5+ (or worse) chronic pain?

In August I was our riding my road bike over lunch. While stopped at a stop light a woman who was looking at her cell phone plowed into me at 40 mph from behind. I work up in ICU a few hours later with a broken back, broken ribs, shattered scapula, a gash on my forehead exposing my skull, nerve damage, muscle damage throughout my body, even tire marks on the backs of my legs. They had me on IV dilaudid. I had them take me off of it after 24 hours. When I got out of the hospital they wrote me a prescription for 3 weeks of narcotics. I never filled it and instead would just take 2 Aleve every 12 hours. At first I was in so much pain I could not stand without assistance. I knew though that I would be in pain for while until I healed and there was nothing for it other than just to deal with it. I knew that I would be in pain for long enough that if I tried to mask it with narcotic pain killers, I would risk getting addicted to them. Moreover, I knew that narcotics dull your pain tolerance. So I dealt with it. I pushed myself, and according to the doctors I healed at a miraculous rate.

Humanity has been around for over 200,000 a years. We have only had narcotics for the last 200 years or so. Before that we just dealt with the pain until we healed. I am not saying there is not a role for narcotics. For 2 or 3 days after severe trauma or a surgery, they can certainly make a big difference. However, they are not for chronic pain.

 

[ALiberalModerate]

I've only started sipping my coffee, but I don't see anything in the article indicating any attempt to determine what the reasons were for long-term users to be long-term users. They're just looking at amount of time an opiate has been prescribed to a given person, not why.

So it doesn't really say anything about addiction vs. need.

Anyone that is on narcotics long term is addicted. They may not know it, but they are. If you are taking narcotics for years to deal with pain, its pain you are fighting, its withdrawal symptoms.

 

[Mr Person]

Anyone that is on narcotics long term is addicted. They may not know it, but they are. If you are taking narcotics for years to deal with pain, its pain you are fighting, its withdrawal symptoms.

It depends on what you mean.

physical dependence --> yes

addiction (aka, psychological dependence) --> generally no.

 

[nota bene]

In August I was our riding my road bike over lunch. While stopped at a stop light a woman who was looking at her cell phone plowed into me at 40 mph from behind. I work up in ICU a few hours later with a broken back, broken ribs, shattered scapula, a gash on my forehead exposing my skull, nerve damage, muscle damage throughout my body, even tire marks on the backs of my legs. They had me on IV dilaudid. I had them take me off of it after 24 hours. When I got out of the hospital they wrote me a prescription for 3 weeks of narcotics. I never filled it and instead would just take 2 Aleve every 12 hours. At first I was in so much pain I could not stand without assistance. I knew though that I would be in pain for while until I healed and there was nothing for it other than just to deal with it. I knew that I would be in pain for long enough that if I tried to mask it with narcotic pain killers, I would risk getting addicted to them. Moreover, I knew that narcotics dull your pain tolerance. So I dealt with it. I pushed myself, and according to the doctors I healed at a miraculous rate.

Humanity has been around for over 200,000 a years. We have only had narcotics for the last 200 years or so. Before that we just dealt with the pain until we healed. I am not saying there is not a role for narcotics. For 2 or 3 days after severe trauma or a surgery, they can certainly make a big difference. However, they are not for chronic pain.

You're talking here about terrible injuries from which you have recovered. I've lived with brief--six months to a year and a half--of chronic pain, enough to appreciate how damaging to one's quality of life this white-noise pain is.

But this is very, very different from those who suffer from pain from which there will be no recovery, pain that is a lifetime sentence. Pain management then becomes very important.

 

[chuckiechan]

The medical community is FUBAR.

First of all, a few years ago they got all kinds of heat for under treating pain. So about that time, someone redesigned a cheap pain killer and renamed it Oxycodone (and it's derivitives) and coincidentally doctors were encouraged to do better pain management. So as usual, they swung the pendulum too far.

We have doctors like mine: I told her during the visit all was fine, no pain, I was hardly using ibuprofen anymore. As as I was leaving she says: "Would you like more pain pills?"

I told her no. But I could have taken them, paid a $10 co pay and sold them.

Regarding chronic pain: IMO, it's it determined that it's permanent, the addiction is a side effect to be managed until a better treatment is made available. If it's not chronic, then someone should be paying attention to how much is being issued and cap it.

As a side note: Coincidentally, heroin has become cheaper than street Oxycodone, and as far as pain management goes is as good or better. The problem is quality control and the new addition of fentanyl. It's devilishly hard to reliably mix powders reliably in a street lab, so some pills are under dose, some overdose. And with fentanyl, the margin of error is dangerously small.

 

[calamity]

https://arstechnica.com/science/201...ply-of-opioids-1-in-5-become-long-term-users/

This is why we have such an opioid addiction epidemic in this country. They are dangerous, its much better to man up and deal with the pain than it is to risk getting hooked.

I was amazed at how readily doctors prescribe opiates. No wonder so many people get hooked.

 

[digsbe]

Anyone that is on narcotics long term is addicted. They may not know it, but they are. If you are taking narcotics for years to deal with pain, its pain you are fighting, its withdrawal symptoms.

The proper term would be dependent, not addicted. Addiction would be compulsive drug use with negative consequences and a strong inability to cease the behavior. Dependence is when someone is chemically dependent on a substance to be at their abseline and without it would go into withdrawal.

I do think we are inappropriately prescribing opioids enmasse. Anyone can complain of "chronic pain" and get put on opiates for life. Many people on them abuse them and seek to have their prescriptions filled early every month so they can keep a stash to use as extras. Physicians seemingly refuse to try alternatives, and there are plenty of "legal" pill mill clinics out there. The opioid epidemic was created by physicians practicing inappropriately. What starts off as 3 Hydrocodone 5/325 a day as needed turns into Oxycontin 40mg twice daily with Oxycodone IR 30mg every 4-6 hours as needed (which they take around the clock) with these patients pumping themselves up with enough opiates to instantly kill an opioid naive person. People develop a tolerance and then need higher doses and they increase them to levels that could kill an elephant. People using high dose fentanyl along with oxycodone because they said their knees hurt 5 years ago... Hell, even treating addiction with Suboxone or Zubsolv they never wean those people off of the medicine like they are supposed to. No one should be on those meds for 2+ years. In my opinion in that sense they are just sustaining addiction with a "less harmful" substance. I feel similarly about the widespread prescribing of benzos too.

The medical community should be ashamed, and patients need to understand that they shouldn't act entitled to narcotics and respect how dangerous they can be.

 

[ALiberalModerate]

You're talking here about terrible injuries from which you have recovered. I've lived with brief--six months to a year and a half--of chronic pain, enough to appreciate how damaging to one's quality of life this white-noise pain is.

But this is very, very different from those who suffer from pain from which there will be no recovery, pain that is a lifetime sentence. Pain management then becomes very important.

Narcotics are not for long term pain. They are for acute pain only. They are not even particularly effective for chronic pain. Had I managed my pain with narcotics while I recovered, it would have been a lifetime sentence for pain because every time I would have tried to get off them, my pain would have returned (as it was, I was in a lot of pain for months). That is how a narcotics dependency works. Very few people, other than cancer patients, are actually in long term severe pain for years on end. However, lots of people get dependent on narcotics and end up feeling a lot of pain any time their dosage is reduced or they try to stop taking them.

We have 5% of the world's population and take 80% of its narcotics.

 

[chuckiechan]

https://arstechnica.com/science/201...ply-of-opioids-1-in-5-become-long-term-users/

This is why we have such an opioid addiction epidemic in this country. They are dangerous, its much better to man up and deal with the pain than it is to risk getting hooked.

A couple of comments here. Up to 800 mg ibuprofen and 1 gram of Tylenol is as good as most pain pills. BUT if you are taking NORCO and some others, they have Tylenol in them, and you have to add your acetaminophen dosages to prevent an overdose, which is too easy to do when you are spaced out.

WRITE THINGS DOWN as you take you meds, because you aren't at your sharpest when taking narcotics.

Acetaminophen = Tylenol
1 gram = two 500 mg Tylenol.
Much beyond 4000 mg Tylenol can kill your liver requiring a transplant - a mistake not worth making.

Lots of med's have acetaminophen in them.

 

[ALiberalModerate]

The proper term would be dependent, not addicted. Addiction would be compulsive drug use with negative consequences and a strong inability to cease the behavior. Dependence is when someone is chemically dependent on a substance to be at their abseline and without it would go into withdrawal.

I do think we are inappropriately prescribing opioids enmasse. Anyone can complain of "chronic pain" and get put on opiates for life. Many people on them abuse them and seek to have their prescriptions filled early every month so they can keep a stash to use as extras. Physicians seemingly refuse to try alternatives, and there are plenty of "legal" pill mill clinics out there. The opioid epidemic was created by physicians practicing inappropriately. What starts off as 3 Hydrocodone 5/325 a day as needed turns into Oxycontin 40mg twice daily with Oxycodone IR 30mg every 4-6 hours as needed (which they take around the clock) with these patients pumping themselves up with enough opiates to instantly kill an opioid naive person. People develop a tolerance and then need higher doses and they increase them to levels that could kill an elephant. People using high dose fentanyl along with oxycodone because they said their knees hurt 5 years ago... Hell, even treating addiction with Suboxone or Zubsolv they never wean those people off of the medicine like they are supposed to. No one should be on those meds for 2+ years. In my opinion in that sense they are just sustaining addiction with a "less harmful" substance. I feel similarly about the widespread prescribing of benzos too.

The medical community should be ashamed, and patients need to understand that they shouldn't act entitled to narcotics and respect how dangerous they can be.

I agree with this, but the pharmaceutical companies producing them have a lot of blame too. Encouraging dependence on their products is a big financial incentive for them.

At any rate, considering I managed my pain after my accident with Aleve, I would find it very hard to believe anyone other than terminal cancer patients, need narcotics more than a few days at most.

 

[Mr Person]

Narcotics are not for long term pain. They are for acute pain only. They are not even particularly effective for chronic pain. Had I managed my pain with narcotics while I recovered, it would have been a lifetime sentence for pain because every time I would have tried to get off them, my pain would have returned (as it was, I was in a lot of pain for months). That is how a narcotics dependency works.

No. That is not how narcotics dependence works. Not in the least.





If someone cuts my arm off with a sword, I am given morphine, I become physically dependent on morphine, and I try to go cold turkey I am not going to suddenly feel like my arm just got cut off again. I am instead going to suffer the symptoms of morphine withdrawal:

https://www.addictioncenter.com/painkillers/morphine/withdrawal-detox/

https://addictionresource.com/drugs/morphine/withdrawal/




There is a type of pain most associated with severe physical dependence - "bone, joint, & Muscle" pain - but that isn't the pain you were being treated for returning. That's a symptom of withdrawal.

 

[digsbe]

I agree with this, but the pharmaceutical companies producing them have a lot of blame too. Encouraging dependence on their products is a big financial incentive for them.

At any rate, considering I managed my pain after my accident with Aleve, I would find it very hard to believe anyone other than terminal cancer patients, need narcotics more than a few days at most.

The pharmaceutical companies aren't really advertising or pushing for the meds, they don't have to because the physicians and drug-seeking patients do the work for them. The pill mill clinics can churn millions in profit... someone diverting the drugs illegally to sell can make over 6 digits a year too. The people on these meds get ramped up to doses so high that they risk overdose and death if they take a medicine that interferes with the metabolism of their meds or if they have alcohol. If for some reason they miss a day or two they can go into severe withdrawal. It's blatantly dangerous to medically treat people in such a way. The system works with "pain management clinics" with many being illegitimate taking on patients who say they have a bad back/knee/etc. and then get put on opioids as first line therapy. I have never, and I mean never, seen a pain management practice write a script for ibuprofen or diclofenac or another prescribable NSAID medication to try first for pain. It's almost always hydrocodone 5/325 or Oxycodone as their first line therapy. There are practices out there that don't X-ray or investigate areas of pain, they don't consider physical therapy or basically any non-opiate alternative. They go against CDC guidelines in treating pain and take a good faith "I'm hurting" response from a patient and use that to put them on opioids, for which they can have 5 minute office visits with the patient every month to issue them their new RX and make a ton of money doing so while the patient is satisfied receiving their narcotics. The way they practice is shameful.

People with documented severe injuries, cancer patients, and others I can understand. But I would say 90% of people on opiates for pain are being treated inappropriately and what's sad is that this is legal to do. Other countries do not practice like this and I don't see high suicide rates or people dying of their "chronic pain" there. Instead, we have an opioid epidemic that claims thousands of lives and has casualties via addiction and drug diversion.

 

[ALiberalModerate]

No. That is not how narcotics dependence works. Not in the least.





If someone cuts my arm off with a sword, I am given morphine, I become physically dependent on morphine, and I try to go cold turkey I am not going to suddenly feel like my arm just got cut off again. I am instead going to suffer the symptoms of morphine withdrawal:

https://www.addictioncenter.com/painkillers/morphine/withdrawal-detox/

https://addictionresource.com/drugs/morphine/withdrawal/




There is a type of pain most associated with severe physical dependence - "bone, joint, & Muscle" pain - but that isn't the pain you were being treated for returning. That's a symptom of withdrawal.

What do you think most people are taking narcotics for? Its bone, joint and muscle pain. For example, had I treated my pain after my accident with narcotics for the entire time it took me to heal, and became dependent, I would imagine that my back, joints, and so on, what hurt anyway, would have been where I would have felt pain during the withdrawls.

 

[Mr Person]

What do you think most people are taking narcotics for? Its bone, joint and muscle pain. For example, had I treated my pain after my accident with narcotics for the entire time it took me to heal, and became dependent, I would imagine that my back, joints, and so on, what hurt anyway, would have been where I would have felt pain during the withdrawls.

I think you're being a little to loose with the terminology here. The pain associated with opiate withdrawal is of a different nature and etiology than whatever pain was being initially treated with opiates.

It's also generally only associated with the most severe types of opiate addiction, aka, heroin, and even then isn't necessarily reported by every person withdrawing. It's definitely not something anyone and everyone can expect as a certainty if they are quitting opiates.

 

[ALiberalModerate]

I think you're being a little to loose with the terminology here. The pain associated with opiate withdrawal is of a different nature and etiology than whatever pain was being initially treated with opiates.

It's also generally only associated with the most severe types of opiate addiction, aka, heroin, and even then isn't necessarily reported by every person withdrawing. It's definitely not something anyone and everyone can expect as a certainty if they are quitting opiates.

Well I have known a lot of pill heads over the years and that pain is what everyone of them experienced when they didn't have it.

 

[ALiberalModerate]

The pharmaceutical companies aren't really advertising or pushing for the meds, they don't have to because the physicians and drug-seeking patients do the work for them. The pill mill clinics can churn millions in profit... someone diverting the drugs illegally to sell can make over 6 digits a year too. The people on these meds get ramped up to doses so high that they risk overdose and death if they take a medicine that interferes with the metabolism of their meds or if they have alcohol. If for some reason they miss a day or two they can go into severe withdrawal. It's blatantly dangerous to medically treat people in such a way. The system works with "pain management clinics" with many being illegitimate taking on patients who say they have a bad back/knee/etc. and then get put on opioids as first line therapy. I have never, and I mean never, seen a pain management practice write a script for ibuprofen or diclofenac or another prescribable NSAID medication to try first for pain. It's almost always hydrocodone 5/325 or Oxycodone as their first line therapy. There are practices out there that don't X-ray or investigate areas of pain, they don't consider physical therapy or basically any non-opiate alternative. They go against CDC guidelines in treating pain and take a good faith "I'm hurting" response from a patient and use that to put them on opioids, for which they can have 5 minute office visits with the patient every month to issue them their new RX and make a ton of money doing so while the patient is satisfied receiving their narcotics. The way they practice is shameful.

People with documented severe injuries, cancer patients, and others I can understand. But I would say 90% of people on opiates for pain are being treated inappropriately and what's sad is that this is legal to do. Other countries do not practice like this and I don't see high suicide rates or people dying of their "chronic pain" there. Instead, we have an opioid epidemic that claims thousands of lives and has casualties via addiction and drug diversion.

I agree with what you are saying of course, but the drug companies have certainly played a role as well: In Guilty Plea, OxyContin Maker to Pay $600 Million - The New York Times

 

[cuban smokes]

https://arstechnica.com/science/201...ply-of-opioids-1-in-5-become-long-term-users/

This is why we have such an opioid addiction epidemic in this country. They are dangerous, its much better to man up and deal with the pain than it is to risk getting hooked.

a bit over 10 years ago I experienced a herniated L4/L5 disc in my low back.
The associated symptoms & pain were a complete b****.
At times I experienced MAXIMUM pain levels.
I had excellent health insurance but that was NOT The problem.
I nearly begged the medical folks to operate & I also repeatedly asked for prescription drugs that would help with the excessive pain levels.
The PROBLEM was no one wanted to operate to eliminate the REAL issue, that being the herniated disc.
The other PROBLEM was no one wanted to offer me prescriptions that were strong enough to combat the excessive pain levels I experienced.

IMO the medical community FAILED ME; F*** THEM ................... these people are f***ing useless ............

 

[ALiberalModerate]

a bit over 10 years ago I experienced a herniated L4/L5 disc in my low back.
The associated symptoms & pain were a complete b****.
At times I experienced MAXIMUM pain levels.
I had excellent health insurance but that was NOT The problem.
I nearly begged the medical folks to operate & I also repeatedly asked for prescription drugs that would help with the excessive pain levels.
The PROBLEM was no one wanted to operate to eliminate the REAL issue, that being the herniated disc.
The other PROBLEM was no one wanted to offer me prescriptions that were strong enough to combat the excessive pain levels I experienced.

IMO the medical community FAILED ME; F*** THEM ................... these people are f***ing useless ............

Did they prescribe physical therapy? The back is exceptionally well supplied with blood. Often with PT, a back injury will heal rapidly. Much faster than a knee or shoulder injury.

The best way to avoid back pain are lots of pull-ups, rows, core strengthening, and dead lifts (with perfect form of course). Strengthen the musculature of the back, and the pain goes away. My back was broken in an accident last August, so I am speaking from experience.

 

[Gonzo Rodeo]

In August I was our riding my road bike over lunch. While stopped at a stop light a woman who was looking at her cell phone plowed into me at 40 mph from behind. I work up in ICU a few hours later with a broken back, broken ribs, shattered scapula, a gash on my forehead exposing my skull, nerve damage, muscle damage throughout my body, even tire marks on the backs of my legs. They had me on IV dilaudid. I had them take me off of it after 24 hours. When I got out of the hospital they wrote me a prescription for 3 weeks of narcotics. I never filled it and instead would just take 2 Aleve every 12 hours. At first I was in so much pain I could not stand without assistance. I knew though that I would be in pain for while until I healed and there was nothing for it other than just to deal with it. I knew that I would be in pain for long enough that if I tried to mask it with narcotic pain killers, I would risk getting addicted to them. Moreover, I knew that narcotics dull your pain tolerance. So I dealt with it. I pushed myself, and according to the doctors I healed at a miraculous rate.

Humanity has been around for over 200,000 a years. We have only had narcotics for the last 200 years or so. Before that we just dealt with the pain until we healed. I am not saying there is not a role for narcotics. For 2 or 3 days after severe trauma or a surgery, they can certainly make a big difference. However, they are not for chronic pain.

I'm the same way. I have been in the ER a handful of times in the last 20 years for various things: a back injury, swine flu with incredible fever/dehydration, a knee injury, and a rare case of diverticulitis in a younger, skinny person. Every time, I was offered strong pain meds, with prescriptions to take home, and every time save one, I refused the meds. It turns out that diverticulitis hurts if you try to walk it off for a couple days, and even then, I took one Tylenol III when I left the ER at 3 in the morning to help me sleep and never filled my prescription for percocet.

But it doesn't take severe conditions to be prescribed pain meds. I remember being prescribed hydrocodone when I was a kid when I had the flu; I seriously didn't need it, and my mom the nurse agreed we should throw it out after trying to get me to take it for two days. My dentist threw 30 days worth of vicodin at me when I got a wisdom tooth popped, but that only actively ached for maybe, what, 12 hours?

Doctors are either receiving training that says they should be giving people pain meds for minor things, or they are receiving financial incentives to do so.

 

[VanceMack]

Opioid dependency as a topic is so much greater than the general dialogue on chronic pain and eventual physical dependency. Opioids are over-prescribed for minor pains. Opioids are often prescribed when there is no real or actual pain. Not that chroinic pain sufferers cannot become addicted, but addiction of chronic pain sufferers is NOT the root cause or subject of the the opioid epidemic.

 

[Carjosse]

Have you ever lived with 5+ (or worse) chronic pain?

The problem is that is often not who is being prescribed opiates are. They are essentially being given out like candy for every little thing.

 

[ALiberalModerate]

Opioid dependency as a topic is so much greater than the general dialogue on chronic pain and eventual physical dependency. Opioids are over-prescribed for minor pains. Opioids are often prescribed when there is no real or actual pain. Not that chroinic pain sufferers cannot become addicted, but addiction of chronic pain sufferers is NOT the root cause or subject of the the opioid epidemic.

Narcotics are ineffective for chronic pain. They are only for severe acute pain:

Study: Ibuprofen and narcotics don't help chronic pain - Times Union

MMS: Error

If a person is taking narcotics for chronic pain, they don't realize it, but they are addicted. They pain they have when they try to stop taking it is withdrawal symptoms.