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Comment by pjc50 | Hacker News Reader

> Any doctor who can be shown to have given addictive opioids to people that aren't terminally ill should be investigated.

This is a terrible idea. All opioids are theoretically addictive. They're also the most effective painkillers. Even cocodamol is an opiate. Escalating the War on Drugs like this is just going to leave a whole load more people in treatable pain.

It's a complex problem, but I think this Vice article is a good summary of how the UK has avoided a comparable crisis: https://www.vice.com/en_uk/article/ppm5eg/the-truth-about-ox...

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That article makes a curious argument: that the UK won't have an oxycodone problem because they already have 2.5x more heroin users per capita than the US — so potential demand is already saturated. I mean, right, they probably won't have any more trouble from oxycodone than they already have from heroin and tramadol, but they already have a big opioid problem. (Maybe they're better at preventing overdose deaths than we are; I don't know.)

"Already have 2.5x more heroin users per capita than the US" Based upon what data ?1

I don't know the article's sources, but it says "America has five times the general population of Britain, but only twice the number of heroin addicts." You can research this as easily as I can.

No, I still agree. If a doctor is giving someone painkillers when they aren't necessary, then that's not much different from drug dealers on the street. Just because they are doctors doesn't mean they should get a free pass. Even more so, the opposite should be true, because we expect doctors to have integrity. If there is nuance to a specific case of this, then let that be determined in court.

The OP said no opioids should be prescribed unless the patient is terminally ill - since you say you agree, are you saying that opioids are only necessary for terminally ill patients?

What I meant was very rare and exceptional cases where the side effects aren't that important. Cancer patients was one such example.

> If a doctor is giving someone painkillers when they aren't necessary, then that's not much different from drug dealers on the street.

Well, you're not wrong. However, this isn't limited to opioids. If a doctor is not following the standard of care, according to their peers, and a patient has an adverse outcome then the Doctor is subject to board review and they may have their license revoked and/or be prosecuted. This is already in place and has been for some time. This is why most Doctors are generally extremely conservative in the treatments and interventions they recommend for their patients.

You assume that there's a quantitative definition of necessary. Pain is subjective.

The main difference is that a doctor supposedly has a higher interest in your well being than your dealer does.

My understanding is that a doctor isn't going to be making more money because they're prescribing you opiods or not. But they do it anyways because it can help you through pain. Just like you can get stuff to help with your cold, even if it's not necessary

Airlines aren't the same as pillow manufacturers just because they lend you one on a flight.

I think the doctors we are discussing here are the ones that took a higher interest in the bribe than their patients.

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