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

[rocket88]

There is much theorizing on the chemical cause of depression...but Ive yet to meet the person that loves themselves, is in a powerful and positive loving relationship, had a strong supportive relationship with their family, did not experience trauma, loves their life today and is excited about their life tomorrow that still suffers from depression. Not saying that person doesnt exist...but that I've never met that person. Which is odd if depression is due to faulty brain chemistry because that should be the case in a significant number of patients. IF that is the cause.

Depression is most often the bi-product of Crappy Life Syndrome. If yesterday sucked, and today sucks, and tomorrow looks a lot like yesterday and today...well...THATS depressing. People in that circumstance SHOULD be depressed. And yes...their brain chemistry would absolutely reflect state...but not cause.

Well, you kind of know me. My life is looking up in certain ways, I generally see good things coming...until the depression kicks in again.

 

[Nap]

There is actually very little evidence that narcotic pain meds are effective for chronic pain. We are the only nation that prescribes them for chronic pain. What they are good for is short term pain following surgeries, end stage cancer, or severe trauma.

Medscape: Medscape Access

The only reason they are not effective long term is due to people building up tolerances to them. Which is why I don't advocate anyone to use them long term and only for short term relief.

I am to the point now that anything less than Hydrocodone has little or no effect on me. I grew up on using nothing but prescription drugs for any pain and yes I did use them for recreational purposes in college.

Edit: Also, your link was behind a login. So was unable to view it.

 

[JasperL]

There is much theorizing on the chemical cause of depression...but Ive yet to meet the person that loves themselves, is in a powerful and positive loving relationship, had a strong supportive relationship with their family, did not experience trauma, loves their life today and is excited about their life tomorrow that still suffers from depression. Not saying that person doesnt exist...but that I've never met that person. Which is odd if depression is due to faulty brain chemistry because that should be the case in a significant number of patients. IF that is the cause.

What you're kind of saying is you've never a person who was not depressed but who is depressed. A lot of those positive traits just won't happen for someone depressed. And I've met a number of people who by all rights ought to be happy individuals - good job, nice family, loving spouse - but they're just not, and suffer from severe depression.

And I've experienced some of it - after sobering up I experienced pretty severe depression for a number of months as my brain relearned how to produce the right chemicals again. That's very common actually among my cohorts in recovery, and I've read some compelling evidence that many addictions start as self treatment for depression - your brain isn't getting the feel good chemicals done, but a drink does it instantly. So you drink because your brain chemistry gets to a 'normal' state when you do - has nothing to do with getting high. Problem is the more you drink, the less your body produces, and the more you need to drink to feel 'normal' again. That's the downward cycle....and the evidence is pretty compelling to me that it's part of the problem.

Depression is most often the bi-product of Crappy Life Syndrome. If yesterday sucked, and today sucks, and tomorrow looks a lot like yesterday and today...well...THATS depressing. People in that circumstance SHOULD be depressed. And yes...their brain chemistry would absolutely reflect state...but not cause.

Sure there is a lot of that, but those things you mention are some of the causes for the changes in brain chemistry that underlie actual depression. There are other causes, such as genetics, drug interactions, illnesses, addictions. I don't think it's either/or in this case.

The only really relevant point is depression, the real thing, isn't just being down and you can't just tell someone to get over it or whatever. It's a real sickness and should be treated as such.

 

[VanceMack]

What you're kind of saying is you've never a person who was not depressed but who is depressed. A lot of those positive traits just won't happen for someone depressed. And I've met a number of people who by all rights ought to be happy individuals - good job, nice family, loving spouse - but they're just not, and suffer from severe depression.

And I've experienced some of it - after sobering up I experienced pretty severe depression for a number of months as my brain relearned how to produce the right chemicals again. That's very common actually among my cohorts in recovery, and I've read some compelling evidence that many addictions start as self treatment for depression - your brain isn't getting the feel good chemicals done, but a drink does it instantly. So you drink because your brain chemistry gets to a 'normal' state when you do - has nothing to do with getting high. Problem is the more you drink, the less your body produces, and the more you need to drink to feel 'normal' again. That's the downward cycle....and the evidence is pretty compelling to me that it's part of the problem.



Sure there is a lot of that, but those things you mention are some of the causes for the changes in brain chemistry that underlie actual depression. There are other causes, such as genetics, drug interactions, illnesses, addictions. I don't think it's either/or in this case.

The only really relevant point is depression, the real thing, isn't just being down and you can't just tell someone to get over it or whatever. It's a real sickness and should be treated as such.

Absolutely. Never suggested otherwise. In fact...understanding depression as a bi-product of pain is powerful. A formula for depression is H2O. Helplessness x Hopelessness = Oh **** = Depression. What we learn is we are never truly 'helpless'. And that should inspire hope.

 

[Thoreau72]

I agree about prescribing to an alcoholic...and dont get me wrong. I'm not saying there aren't irresponsible doctors. Pretty much every state has an online ethics board that you can review and prescription abuse is usually the top offense cited.

Giving a 10 day supply prevents individuals from having to make another appointment and pay for another office visit. I would bet every police/fire station or hospital in the country has a drug amnesty box where people can take their unused eds. Sometimes we have to be responsible for our own actions...including properly disposing of unused medications.

Opiate addiction is more and more treated on an outpatient basis. Unless there is a comorbid diagnosis (usually Major Depressive D/O) and an expressed risk of harm to self or others, day treatment and outpatient is becoming the standard. Extreme cases may require a 72 hour detox (whihc is approx the same for alcoholics). Its still nasty stuff...not minimizing it. And we can al agree...meds are over-prescribed. ALL meds. But I think its bigger than just pharm and lazy docs. Leaving out the corrupt pill peddlers that are a real problem, the best solution is maybe for patients and docs to work together on a treatment plan that minimizes opioid use.

Because my 1984 Merriam-Webster does not contain the word 'opioid', but does contain the word 'opiate', I assume that in 1984 there was no such thing as an opioid, and that is consistent with my memory as to how and when the latter class of drugs came to market and into use. I'm pretty sure that oxycodone, brand named OxyContin, came along in the late 80's or early 90's.

They are 2 different, but similar, classes of drug. I wonder why so many seem to write and speak as though opiates and opioids are synonymous?

 

[VanceMack]

Because my 1984 Merriam-Webster does not contain the word 'opioid', but does contain the word 'opiate', I assume that in 1984 there was no such thing as an opioid, and that is consistent with my memory as to how and when the latter class of drugs came to market and into use. I'm pretty sure that oxycodone, brand named OxyContin, came along in the late 80's or early 90's.

They are 2 different, but similar, classes of drug. I wonder why so many seem to write and speak as though opiates and opioids are synonymous?

"The term opiate should be differentiated from the broader term opioid, which includes all drugs with morphine-like effects, including opiates, semi-synthetic opioids derived from opiates (such as heroin, hydrocodone, hydromorphone, oxycodone, and oxymorphone),[2] and synthetic opioids which are not derived from opiates (such as fentanyl, buprenorphine, and methadone). All opioids, including the opiates, are considered drugs of high abuse potential and are listed on various "Substance-Control Schedules" under the Uniform Controlled Substances Act of the United States."

Perhaps its out of laziness. Perhaps its because the topic is generally similar when discussing addiction and discussing addictive response, treatment, etc. Perhaps its an apparent dire lack of OCD in most people.

 

[ALiberalModerate]

Absolutely. Never suggested otherwise. In fact...understanding depression as a bi-product of pain is powerful. A formula for depression is H2O. Helplessness x Hopelessness = Oh **** = Depression. What we learn is we are never truly 'helpless'. And that should inspire hope.

Depression can often be hormonal as well. For example, its not uncommon for men who are depressed to also have very low testosterone levels. Bring their testosterone and estradiol levels up, and they are no longer depressed.

 

[VanceMack]

Depression can often be hormonal as well. For example, its not uncommon for men who are depressed to also have very low testosterone levels. Bring their testosterone and estradiol levels up, and they are no longer depressed.

Wouldnt you say in that instance that depression is a symptom OF testosterone deficiency and the accompanying medical treatment would target testosterone levels and not depression?

 

[ALiberalModerate]

Wouldnt you say in that instance that depression is a symptom OF testosterone deficiency and the accompanying medical treatment would target testosterone levels and not depression?

Yes, obviously. That was my point though that often depression is a symptom of another condition.

 

[VanceMack]

Yes, obviously. That was my point though that often depression is a symptom of another condition.

I think we agree completely then.

 

[<alt>doxygen]

Narcotic pain meds are not "spread around by the government". They are prescribed by doctors and pushed by the pharmaceutical companies that produce them. Its a 24 billion dollar a year industry for big pharma. The government has nothing to do with it. In fact, the CDC is trying to get doctors to be more responsible about it.

^True.

The whole story is in here. Pure corporate greed and a lot of doctors who put money before people:
https://www.amazon.com/dp/B00U19DTS0/ref=dp-kindle-redirect?_encoding=UTF8&btkr=1

Anyway, I have chronic pain due to a spinal injury. There is no surgery (had 2 already), PT or exercise regimen that can help (tried, failed). I've exercised almost daily my whole adult life. I take hydrocodone when necessary but I try to minimize it because I don't like the side effects (insomnia, mainly) and I don't want an increased tolerance. To be blunt, without drugs like that or something equivalent, I probably wouldn't be alive.

 

[Simon W. Moon]

There were 300 million narcotic prescriptions written in the United States in 2015 alone. Its not just a few people that take opiates that are getting addicted.
http://www.cnbc.com/2016/04/27/americans-consume-almost-all-of-the-global-opioid-supply.html

#℞/yr ≠ % who become addicted

 

[ALiberalModerate]

#℞/yr ≠ % who become addicted

Unless you believe that 80% of the pain in the world is suffered in the United States (a country with just 5% of the world's population), then we do indeed have a very big opiate addiction / dependence issue.

 

[JasperL]

#℞/yr ≠ % who become addicted

Good point - so how about this:

 

[LetsGoBrandon]

There is actually very little evidence that narcotic pain meds are effective for chronic pain. We are the only nation that prescribes them for chronic pain. What they are good for is short term pain following surgeries, end stage cancer, or severe trauma.

Medscape: Medscape Access

I appreciate the link however I am not going to create an account just to read one article. The following is from Web MD:

Myth: Taking Opioid Painkillers Leads to Drug Addiction
We’ve all read sensational stories of addiction. So it’s no surprise that many people with chronic pain fear that taking opioids will result in drug addiction. As a result, some people with terrible chronic pain refuse medication that could really help them.

"When they're taken in the short-term and used as directed, the risk of becoming addicted to an opioid medication is very, very low," Cohen says.

There are instances where doctors need to be especially careful with opioids, Oaklander says. For instance, people who have a strong personal or family history of addiction are at higher risk. "But even they can use these drugs safely in some cases," she says, "although preferably with the guidance of a pain specialist."


My point is that one size does not fit all on this issue. Opioids do have a place in treating chronic pain and not everyone is going to become addicted, especially if carefully monitored by a doctor.

 

[ALiberalModerate]

I appreciate the link however I am not going to create an account just to read one article. The following is from Web MD:

Myth: Taking Opioid Painkillers Leads to Drug Addiction
We’ve all read sensational stories of addiction. So it’s no surprise that many people with chronic pain fear that taking opioids will result in drug addiction. As a result, some people with terrible chronic pain refuse medication that could really help them.

"When they're taken in the short-term and used as directed, the risk of becoming addicted to an opioid medication is very, very low," Cohen says.

There are instances where doctors need to be especially careful with opioids, Oaklander says. For instance, people who have a strong personal or family history of addiction are at higher risk. "But even they can use these drugs safely in some cases," she says, "although preferably with the guidance of a pain specialist."


My point is that one size does not fit all on this issue. Opioids do have a place in treating chronic pain and not everyone is going to become addicted, especially if carefully monitored by a doctor.

Notice the following statement:

When they're taken in the short-term and used as directed...

Short term to the CDC is a three day prescription.

We have 5% of the world's population, yet we use 80% of the world's opiate prescriptions, some 300 million opiate prescriptions a year. We don't have 80% of the pain in the world. We just have a very disproportionate amount of patients now addicted to opiates. Not everyone will become addicted to opiates if they are prescribed them for chronic pain, but a very high percentage of patients will. That is why no other country does it and thus they don't have the opiate addiction epidemic that we do.

The problem is that people go to see their GP wanting a panacea. They want a pill, not to be told to make any life style changes and they certainly don't want a prescription for physical therapy. They don't want to be told that their knees are in pain because they have spent a lifetime of being overweight and the solution ultimately is to lose weight. They don't want to be told that their back hurts because their muscles are atrophied due to years of a sedentary lifestyle and thus the solution is ultimately exercise and physical therapy. They just want a pill so they can go about life they way they did before without making any real changes. This is combined with overworked GP's that must see more patients every day than ever before, and a pharmaceutical industry that makes 24 billion a year off of narcotics, and thus has a financial interest in creating addicts.

 

[Threegoofs]

Notice the following statement:

When they're taken in the short-term and used as directed...

Short term to the CDC is a three day prescription.

We have 5% of the world's population, yet we use 80% of the world's opiate prescriptions, some 300 million opiate prescriptions a year. We don't have 80% of the pain in the world. We just have a very disproportionate amount of patients now addicted to opiates. Not everyone will become addicted to opiates if they are prescribed them for chronic pain, but a very high percentage of patients will. That is why no other country does it and thus they don't have the opiate addiction epidemic that we do.

The problem is that people go to see their GP wanting a panacea. They want a pill, not to be told to make any life style changes and they certainly don't want a prescription for physical therapy. They don't want to be told that their knees are in pain because they have spent a lifetime of being overweight and the solution ultimately is to lose weight. They don't want to be told that their back hurts because their muscles are atrophied due to years of a sedentary lifestyle and thus the solution is ultimately exercise and physical therapy. They just want a pill so they can go about life they way they did before without making any real changes. This is combined with overworked GP's that must see more patients every day than ever before, and a pharmaceutical industry that makes 24 billion a year off of narcotics, and thus has a financial interest in creating addicts.

You're wrong on lots of levels.

Chronic pain is most certainly treated with opiates in other developed countries.

Medscape: Medscape Access


And the vast majority of opiates are cheap and generic. Not a lot of money is in selling generic Vicodin.

 

[ALiberalModerate]

You're wrong on lots of levels.

Chronic pain is most certainly treated with opiates in other developed countries.

Medscape: Medscape Access


And the vast majority of opiates are cheap and generic. Not a lot of money is in selling generic Vicodin.

And none of that changes the fact that we have 5% of the world's population, yet 80% of the opiate prescriptions, 300 million opiate prescriptions written every year, and its 24 billion dollar a year industry. That means we write exponentially more opiate prescriptions in this country per capita than anywhere else. Even the cheapest generic is $800 to $1500 dollars a year to its drug manufacturer if its prescribed to someone for a year.

Unless you can somehow show that we have an order of magnitude more pain in this country than anywhere else, its obvious we are creating a lot of addicts.

Finally, if you read your article, you will find that there is little evidence that opiates are effective for long term chronic pain due to tolerance and hyperalgesia.

 

[Thoreau72]

"The term opiate should be differentiated from the broader term opioid, which includes all drugs with morphine-like effects, including opiates, semi-synthetic opioids derived from opiates (such as heroin, hydrocodone, hydromorphone, oxycodone, and oxymorphone),[2] and synthetic opioids which are not derived from opiates (such as fentanyl, buprenorphine, and methadone). All opioids, including the opiates, are considered drugs of high abuse potential and are listed on various "Substance-Control Schedules" under the Uniform Controlled Substances Act of the United States."

Perhaps its out of laziness. Perhaps its because the topic is generally similar when discussing addiction and discussing addictive response, treatment, etc. Perhaps its an apparent dire lack of OCD in most people.

Well I do very much see your point regarding CSA and the US Code, but that wasn't really my point.

In fact, long before the word and long before chemists created "opioid" drugs, opiates existed and were used by humans, going back thousands of years.

And the word came into usage only AFTER chemists created such drugs as OxyContin. And so I'm wondering if the language is being corrupted when users of the language do not differentiate between opioid and opiate? While there is a difference between the two, a chemical difference, when language begins to combine the two, what is the end result? Confusion is the end result.

While they may be similar in some ways, they are different.

Am I being too precise with the language?

 

[Northern Light]

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.

Do you realize that long-term pain is psychologically destructive? It's not for you to decide who should "man up" or shouldn't. That's between patients and their physicians. If you think that physician prescribing needs reform then we can talk about that.

Addiction is not the same as dependence. That's the other thing you got wrong.

You also got wrong the difference between acute and long-term pain in terms of treatment. Opiates can be used for either. Treatment is not only based on chronicity but also severity.

 

[Threegoofs]

Well I do very much see your point regarding CSA and the US Code, but that wasn't really my point.

In fact, long before the word and long before chemists created "opioid" drugs, opiates existed and were used by humans, going back thousands of years.

And the word came into usage only AFTER chemists created such drugs as OxyContin. And so I'm wondering if the language is being corrupted when users of the language do not differentiate between opioid and opiate? While there is a difference between the two, a chemical difference, when language begins to combine the two, what is the end result? Confusion is the end result.

While they may be similar in some ways, they are different.

Am I being too precise with the language?

Functionally, for most purposes,the terms are used interchangeably.

We only have the term opioid because over the last few decades, we now can create fully synthetic drugs which have the same pharmacological action, but since they are not directly derived from natural opiates, it's not chemically correct to call them by that name.

The medicinal chemistry literature will make these distinctions, for all practical purposes, clinical literature uses the two almost synonymously.

 

[Thoreau72]

Functionally, for most purposes,the terms are used interchangeably.

We only have the term opioid because over the last few decades, we now can create fully synthetic drugs which have the same pharmacological action, but since they are not directly derived from natural opiates, it's not chemically correct to call them by that name.

The medicinal chemistry literature will make these distinctions, for all practical purposes, clinical literature uses the two almost synonymously.

Thank you for the accurate statement.

And I know I am making MOSTLY a semantic point, and I appreciate your understanding that.

But I think a valid question is: do they really have the same pharmacological action?

Given the addiction/abuse problem that has been so apparent and well documented, are the opioids more addictive than straight old-fashioned opiates? I may be wrong, but I cannot help but think they are more dangerous than old-fashioned morphine or heroin. I say that as a veteran of Vietnam, where opiate abuse/addiction was rampant. I saw it. More opium and morphine and heroin were used, usually by smoking and very little injecting, than cigarette smoking.

IMO, the finely tuned synthetic chemicals are more addictive for humans than the older straight opiates. I do not recall anybody in Vietnam dying from opiate use, though the use itself was widespread, but I know many, probably dozens, of youngsters who have died from the scourge of Oxy.

 

[ALiberalModerate]

Do you realize that long-term pain is psychologically destructive? It's not for you to decide who should "man up" or shouldn't. That's between patients and their physicians. If you think that physician prescribing needs reform then we can talk about that.

Addiction is not the same as dependence. That's the other thing you got wrong.

You also got wrong the difference between acute and long-term pain in terms of treatment. Opiates can be used for either. Treatment is not only based on chronicity but also severity.

1. The difference between addiction and dependence in terms of opiates is semantics. Whether you call yourself dependent on opiates or addicted to them, the withdrawal symptoms are the same.

2. There is little evidence that opiates are effective for long term chronic pain due to tolerance and hyperalgesia. This is why the CDC only recommends them to be used for short term pain relief after surgery or major trauma and only to be used for long term relief for end term cancer patients.

3. As has been pointed out many times in this thread: We have 5% of the world's population, yet 80% of the opiate prescriptions, 300 million opiate prescriptions written every year, and its 24 billion dollar a year industry. That means we write exponentially more opiate prescriptions in this country per capita than anywhere else. Unless you can somehow show that we have an order of magnitude more pain in this country than anywhere else, its obvious we are creating a lot of addicts.

Finally, as I pointed out in this post, I know what extreme pain is like: https://www.debatepolitics.com/brea...-5-become-long-term-users.html#post1067004223

 

[VanceMack]

Well I do very much see your point regarding CSA and the US Code, but that wasn't really my point.

In fact, long before the word and long before chemists created "opioid" drugs, opiates existed and were used by humans, going back thousands of years.

And the word came into usage only AFTER chemists created such drugs as OxyContin. And so I'm wondering if the language is being corrupted when users of the language do not differentiate between opioid and opiate? While there is a difference between the two, a chemical difference, when language begins to combine the two, what is the end result? Confusion is the end result.

While they may be similar in some ways, they are different.

Am I being too precise with the language?

Today...across the country, there are campaigns directed at preventing Opi-addiction. Opiate...opiod...it is seen as a joint epidemic. There is evidence that much of the opiate addiction is predicated by an opioid addiction. There is also a sense that heroin use is obviously evil and wrong but pain pill use is less worthy of concern because after all...it is doctor prescribed.



No...you arent being too precise with the language...but the problem(s) is(are) not a stand alone problem.

 

[Thoreau72]

Vance

About 100 years ago, as Johns Hopkins Medical School was in its early days, there was the case of Dr. William Halstead, a teacher there.

Hypodermic syringes were fairly new in those days, and Dr. Halstead became a morphine addict. With his medical training he understood what he was doing. He discovered then what the Swiss and everybody else discovered later--a morphine addict could be maintained on a certain dosage given at the proper interval. When so maintained, morphine (opiate) addicts can carry on perfectly normal lives and contribute to society. Just as, one might, a caffeine or nicotine addict does.

So opiate use in and of itself, properly administered, is not fatal.

The problem with heroin addicts has always been the black market brought by our dumb drug policy. Under that policy the purity and strength is completely unknown and unregulated. A large part of today's (50 years back too) heroin deaths are from contaminated drugs with no known strength.