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Comment by nullc | Hacker News Reader

From your description of tolerance buildup it sounds like you are describing a drug which is functionally ineffective for chronic pain (eventually tolerance will overtake the maximum does you can safely administer) except where the patient wont live long enough for the tolerance.

It sounds like a drug family that would be mostly useful for non-chronic pain, where the patient can be weaned off before the dosages become high.

Yet its usage is the opposite?

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Yes, you're right. Opioids are a good choice for short term pain. They're a good choice for end of life pain. They're a poor choice for long term pain, although they serve some use if carefully prescribed. Weirdly, the US prescribes a lot of opioid medication, and prescribes it for people with long term pain.

Some of this is because the VA said that untreated pain was an injustice, and said that pain should be the "5th vital sign". That was pretty disastrous. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1924634/

Lots more information from England here: https://www.fpm.ac.uk/faculty-of-pain-medicine/opioids-aware

AFAIK, it's because, whilst opiates aren't a great choice for chronic pain, they're just aren't many options that are useful for many forms of chronic, severe pain.

You're 100% correct. However, we really don't have many other non-opiate options for chronic pain, and a lot of the other therapies (alternate modalities, adjusting perceptions/expected amounts of pain/etc) are things that require more money and time. As many providers are overworked and patients lack insurance, opiates become unfortunately a crutch in many plans.

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