Where are you getting the goal of fewer people taking it, and why is the number of people taking it a concern at all? Pain management is the issue at hand.
Long term pain control is a complicated and multi facaded beast. We need to invest in it. "Just take a pill" is clearly not the solution that works.
I am not sure what "addiction can be managed" is supposed to mean.
http://www.news-medical.net/news/20130415/New-research-shows...
The prevailing medical notion was that there was this bright line involving the opioids — that they were great for patients but the problems happened when they went out on the streets and were abused by kids and others. But today it’s clear that the long-term use of these drugs can not only be ineffective for chronic pain, but they also create bad side effects for patients. Not just addiction but powerful psychological dependency, depression of hormone production, lethargy and listlessness and sleep apnea, among others. These drugs do work well for some patients, but for many other patients, they’re not working well at all.
One leading expert said: “We thought the big problem with these drugs is addiction. Now we realize the problem is with patients who take them and basically opt out of life.” There is a general realization that while they do work for some patients, using them on a massive scale to treat chronic pain has had really disastrous consequences.
For instance, back pain is probably the leading workplace injury. What insurers and workers’ comp agencies are discovering is that when workers are treated with high doses of opioid drugs fairly soon after these injuries, it’s the leading predictor for them not coming back to work for long periods of time, or ever.
When you take a narcotic painkiller it sets off a natural reaction called tolerance, which means your body adjusts to it. You have to take more of the drug to get the same painkilling effect. Patients would come back to doctors and say, “This drug was working really well for me, but now I’m feeling pain again.” The doctor would increase the dose. The prevailing ideology during the war on pain was that these drugs had no ceiling dose. You could keep increasing them. The doctors kept boosting them every six months. People started taking higher and higher doses of these drugs. At a certain point it appears they create a change in the neurological system where people develop hyperalgesia and they become far more sensitive to pain than when they started out on these drug
Forever.
I disagree that opiates are not a good choice for short-term pain relief, and I also disagree that they are not a good choice for long-term pain relief.
If anything, pain is currently being under treated on a massive scale thanks to the new-wave crusaders against opiates, flying a flag of the same type of study they decry as flashy science only meant to gun for the headlines as proof undeniable.
There will always be opiate abuse. A moral backlash against abuse should not deny people in pain the quality-of-life increase they can get in return from opiates. Dependency be damned.
>Long term pain control is a complicated and multi facaded beast. We need to invest in it.
I do agree with this.
>"Just take a pill" is clearly not the solution that works.
It's the solution we have right now, though.
My grandparents, bless them, couldn't function without narcotic painkillers. without narcotics, there is no quality-of-life to speak of for them, and for a lot of people like them. Dependency be damned.
Until something as affordable and available as opiates come around, that can give them equipotent pain relief, traditional poppy derivatives can and should be used to treat pain in those who live each day in pain. Tolerance be damned.
Please go to a treatment facility (volunteer please) and talk to the patients there. It is beyond eye opening, I volunteered at one myself. I've seen pain medicine literary ruin lives, and it's so sad. These are people who have been through hell with their injuries, some of the worst I've ever seen, and then they go through hell again with the opiodes.
They can work on a long term basis for SOME (but not the majority) of patients.
Psychological treatments are also an important part of pain management.
If anything, the pushback against opiate prescribing has resulted in a lot of dependent patients (and addicted abusers) looking at heroin as a more potent, widely available, cheaper alternative.
opiates have been around a long time for a good reason. they can give an unrivaled increase in the quality of life of those suffering.
there will ALWAYS be opiate abuse. taking prescription painkillers out of the picture doesn't even put a dent into it.
do you think it makes more sense to spend time and money demonizing prescription opiates and prosecuting those who prescribe them, or use that time and money to implement programs and services that can help those who have become dependent or addicted?
My energy levels and ability to be active during an entire day was borderline geriatric before I started taking tapentadol. Opiates are addictive but are also the gold standard for pain relief. Pain reduces energy levels, its fatiguing. I would sometimes want to just cry out of how weak I felt. No one should have to 'just deal with it' when it comes to nerve splitting pain.
It's a significant cause of death in suicide so that's another reason to use less of it. It accounts for a lot of accidental death, so that's yet another reason to use less of it.
There are actual people with actual suffering involved here, remember that. Don't let your misconceptions of junkies determine public heath policy.
We know in the UK that self poisoning is the second most common method of suicide after hanging, strangling and suffocation. (and that's likely to change with the next release of numbers - self poisoning is likely to overtake hanging strangling and suffocation).
the list of meds used in self poisoning is something like
1) Opiates
2) Anti-psychotics
3) Tri-cyclics
4) Paracetamol
5) Paracetamol and opiate combination
But that's the point, it doesn't.
> are actual people with actual suffering involved here, remember that
That's entirely the point! Opiates are not effective for most of those people. Opiates work in the short term, but the patient develops tolerance and needs to take more. Opiates are not suitable for long term use. A patient can very quickly build up to dangerous harmful levels of opiate use, and they're not getting pain relief.
Calling a medication dangerous and ineffective, and pointing out safer more effective alternatives, is not moralising, unlike your "remember there are people suffering" comment.
Go to any treatment facility and actually talk to the patients there. Your attitude will change. I used to volunteer at one so I knew a lot of people who went from pain patients to addicts who were still in pain. Amputees, people with disfiguring injuries, chronic diseases. These aren't people who are seeking drugs on the streets - these are doctor prescribed drugs. The effects of the medication are terrible for quality of life and they just plain stop working!
The first is the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness http://www.bbmh.manchester.ac.uk/cmhs/research/centreforsuic...
The second are the Office for National Statistics mortality data. Here's deaths: http://www.ons.gov.uk/peoplepopulationandcommunity/birthsdea...
And here's suicide: http://www.ons.gov.uk/peoplepopulationandcommunity/birthsdea...
(Watch out. They count slightly different things. But they should both be clear enough about what they're counting).
Here's a map showing medications that are prescribed across England. You can noodle around with the data to see what's prescribed or not, and how much, and by what doctors offices: https://openprescribing.net/