Most Doctors Are Ill-Equipped to Deal with the Opioid Epidemic
nytimes.com
nytimes.com
The basic difference seems to be in Canada, you're a patient while in the US, you're a customer... and the docs don't want their customers to be in pain. That appears to be changing.
Maybe some other difference?
How is it you and the rest of Canada (not to mention Europe) aren't opioid junkies in a national "epidemic" when you can buy 100 codeine tablets for $10 in any grocery? Meanwhile, in Russia, with bans, it's an epidemic, while in Ukraine, even Russian-speaking Ukraine, this is readily available with no epidemic.
Something about personal responsibility instead of "someone made me do it" litigiousness? Or more related to healthcare as a basic right? US versus Canada suggests these, but Russia vs. Ukraine suggests may be something else. Nanny state vs. "sheeple"?
No answers, just find it interesting relaxed restriction seems to moderate so-called epidemics without catastrophic societal breakdown.
When I had gall bladder surgery living in the US (my home country), I was told to take 7-10 days off work then have lifting restrictions for a bit. My boss would only allow for the lesser time because it was "my weekend" to work, and I had to work that sunday for a bit.
I most definitely wasn't ready to go back. I didnt' need the opiods the couple days before as it was merely uncomfortable, but being active made things hurt. I didn't lift, but was merely active. I needed pills that night.
On the other hand, I live in Norway now. If I am feeling sick, I can stay home from work for 3 days without going to the doctor and without losing my job. I'm pretty sure I could have stayed home the time necessary after surgery. Mothers have paid time off after having a child (amount depends on how long one takes, but it can be 100%).
Policies like these mean that people can actually heal. Other policies also mean folks aren't as stressed (especially when they are poor).
That's my reasoning for the rates being lower in some places than others, anyway.
https://www.vox.com/science-and-health/2018/5/15/17355722/op...
This has all completely changed in most places in the U.S., as far as I'm aware. Everyone has been well aware of the epidemic for years now and they are extremely reluctant to prescribe anything for pain at this point. You will be told to just take some ibuprofen for pretty much everything.
If you even mention that you're feeling long lasting discomfort, you will immediately be met with suspicion and resistance and assumed to be a drug seeking addict and a criminal.
This was to be expected and it is absolutely mind boggling.
People not having access to proper pain medication is absolutely abhorrent. Large parts of the world still havent recovered from world wide lobbing campaign to ban opiates. Where even terminal ill patients in abhorrent pain have to exist on paracetamol and even that only if the family can afford it.
And that kind of lobbying hasnt stopped. The last push I know of was for the ban of mean party drug ketamin, which is the only reasonable anesthetics for poor regions outside of the effective range of a hospital.
I am really hard pressed to not view people pushing for tighter regulation of pain meds as simply evil. If you have people accidentally addicted to opiates, that is of course a problem, but one that can easily be fixed with better informed patients.
You just dont fight the war on drugs on the back of chronic pain patients.
You're pushing the same line that Purdue did - that there's an epidemic of untreated pain and that it is cruel to leave people without treatment.
This point always comes up when discussing the US opioid crisis. What do we do about people in severe pain? What do we do about people in long term pain?
The US massively over-prescribes opioids. The US could reduce opioid prescribing by 80% and it would have no effect for these groups of people.
But, more importantly, for most people in long term pain opioids are the wrong choice. Opioids are a good choice for end of life care, and for short term acute pain (especially when supervised in a hospital setting). But for long term pain opioids are for most people a poor choice. The patient will develop a tolerance to the opioid which means it's not working to treat the pain. They'll need to increase the dose of opioids. This increases the risk of harm from the medication. It also increases the risk of dependency. So, you end up with someone addicted to opioids, taking very large doses, yet still in pain.
Note I'm not saying all people. Some people who are carefully selected and regularly monitored will get some benefit from opioids.
Here's a radio programme with an interview with someone who was prescribed opioids for long term non cancer pain, and how it caused him harm: https://www.bbc.co.uk/programmes/b04wv052
Here's the UK Royal College of Anaesthetists pages on opioid prescribing: https://www.rcoa.ac.uk/faculty-of-pain-medicine/opioids-awar...
If people are in pain, and professionals are shaming them - basically saying 'suck it up, sissy' - when they dare to mention this, what do you they're going to do? I can guarantee you a great many will seek relief on their own terms, i.e. alcohol (cheap and available nearly everywhere!) and street drugs-- with doctors & their staff at that point being completely cut out of the loop. Are you going to tell your dentist that you drank vodka to dull the pain after your root canal? Mostly no. Is that better for you than hydrocodone? Unless you have other non-standard risk factors, also no.
I fail to see how this is better than honest dialogue between doctor & patient where each person's treatment is realistically considered on an individual basis. By all means withhold inappropriate, ineffective and dangerous treatments-- but tell your patients what you're doing & why, and don't lose sight of how they actually behave in response to this. Sometimes that response is far worse than whatever you're trying to save them from.
My newest doctor makes me sign a sheet that he doesn't prescribe opioids at all.
https://www.nytimes.com/2018/01/27/opinion/sunday/surgery-ge...
a) They get paid to much
b) They don't do their jobs as well as they should
c) Health care is to damn expensive
d) They should magically know what they have not been taught to do.
e) They are stupid, we, writers are smart. The public thinks it is smart so let's reinforce this point of view to sell our stories.
f) We expect 100% from them and when they make a mistake we will write an article to point out the outliers.
g) We will cut the time they get to spend with patients and give them loads of paperwork and still expect them to perform to out liking.
When I met the friend who completed my education about addiction, I thought, "this woman is high as a kite." She latched on to me like a life preserver. I didn't know anything about hard drugs, and just observed and listened for the first two months -- adopted, older adopted sister was angry and picked on her, etc etc. After three months I decided that she didn't like her drug world very much, and began to encourage her to sober up. She resisted at first, then she came around. She likes me more than the drugs.
[0] https://books.google.com/books?isbn=1583944206
I want to draw attention to the bit in this article about anxiety:
The first patient, Brooke Anglin, 28, had
had a rough ride. During a turbulent
relationship when she was sagged down by
depression and severe anxiety, she soothed
herself with opioids. After the birth of
her second child, she lost both her job as
a supermarket cake decorator and custody
of her two children. Under Dr. Wlasiuk’s
care, she gradually weaned herself off the
opioids.
[...]
Ms. Anglin whispered, “I want my kids back.”
Dr. Wlasiuk grasped Ms. Anglin’s hands.
“I am amazed by your strength,” she said.
“I want to treat your anxiety until things
settle down. What are your thoughts?”
They agreed on temporary anti-anxiety
medication. Dr. Wlasiuk also taught her
breathing exercises.
The best use of the medical profession's stature would be to advocate for mostly removing addiction from the domain of criminal justice, or at least for advocating for removal of "incarceration" from the list of reasonable things to do to an addict. Cages don't help with the emotional problems at the root of addiction.
A HN comment [1] recently reminded me of "problem solving courts" [2]. Maybe a good intermediary step would be to require that all "drug" cases be treated as problems to be solved, rather than excuses to throw people away for long periods of time.
[1] https://news.ycombinator.com/item?id=17965398
[2] https://en.wikipedia.org/wiki/Problem-solving_courts_in_the_...