https://beta.washingtonpost.com/investigations/76-billion-op...
I suffer from chronic pain and am prescribed (weak) opioids to help manage that pain. I've tried numerous other medications, but the ones I'm on are the only ones I can tolerate and that actually help at all.
I am responsible, only ever taking them as prescribed. Even with some pain management, life is not easy; with none, it is unbearable - I honestly don't know if I'd still be here without any pain management.
Opioids are plainly being over-prescribed in the US, but we have to be really careful not to withdraw them from those that actually need them.
I wonder how it compares when some truly needs pain treatment.
But, I recently got a prescription for Sativex, which is essentially a very expensive cannabis tincture.
My biggest issue with it is that you end up swallowing most of it - and eating cannabis is very different to smoking, as THC is metabolised to 11-OH-THC, which is much more psychoactive. I found it made me really anxious, which is not nice at all!
I've been experimenting with it, trying to ensure I don't swallow any of it. It does help with the pain, but only a little... and it impairs me in the process - it's really important to me that I can still function cognitively.
I also find the way it helps is different than opioids - it's kind of similar to alcohol, in that it's more like a distraction from the pain, whereas opioids actually negate some of the pain.
There is a lot of good evidence for cannabis helping with neuropathic pain, so I'd encourage others to try it if they legally and financially can.
Morphine makes life bearable and allows me to work and contribute to society.
I would otherwise be in bed all day from the chronic pain.
Having chronic pain is like being under water. And pain relief is like coming up for air.
These laws have made it so I can literally only get a maximum of 90mg of morphine daily when I really need 200mg, what I used to be on.
It's terrible that those of us who actually use these drugs responsible are being screwed over, and average joes like yourself demonize opioids when they have medicinal value.
I will agree that synthetics are bad and I specifically ask for morphine versus Oxycodone or Hydrocodone. The synthetics are pretty much just a way to make more money and they are way more addictive.
Also Oxycontin was marketed as having a 12 hour dosing schedule. But the half life is about 2/3rds if that. That sets up a yoyo dosing schedule that's known to be highly addictive.
https://www.latimes.com/projects/oxycontin-part1/
> Purdue’s researchers, meanwhile, were conducting at least a half dozen clinical trials, according to the company’s FDA application. In study after study, many patients given OxyContin every 12 hours would ask for more medication before their next scheduled dose.
> For example, in one study of 164 cancer patients, one third of those given OxyContin dropped out because they found the treatment “ineffective,” according to an FDA analysis of the study. Researchers then changed the rules of the study to allow patients to take supplemental painkillers, known as “rescue medication,” in between 12-hour doses of OxyContin.
The every 12 hour dosing was approved by the FDA which looked at the clinical trial data and approved 12 hour dosing.
After it was launched, the company kept promoting 12 hours because if they didn't, the FDA would sanction them. As a drug manufacture you can't just change the FDA approved dosing wily nilly.
And if you're Purdue, you have every incentive to lower the dosing interval because you can charge more. You make more money with every 8 hour dosing (which is still better than most drugs) than every 12 hours.
If they lowered the dosing schedule they'd be competing directly with generic opiates.
The article addresses this.
> Company officials worried that if OxyContin wasn’t seen as a 12-hour drug, insurance companies and hospitals would balk at paying hundreds of dollars a bottle. Some already were.
> If a doctor complained that OxyContin didn’t last, Purdue reps were to recommend increasing the strength of the dose rather than the frequency. There is no ceiling on the amount of OxyContin a patient can be prescribed, sales reps were to remind doctors, according to the presentation and other training materials.
In terms of price, they were quite expensive, but I've never met an insurer who is happy with the price of a drug.
They didn't do that because they decided money was more important than hundreds of thousands of peoples lives.
The FDA approves their dosing schedule after a careful examination of the clinical trial data. They are required to stick to 12 hour dosing. Based on anecdotal reports, you're suggesting they withdrawal the drug from the market?
Secondly, the bond strength is what makes them much more addictive. It's why Heroin is more addictive than Morphine. Why Fentanyl is more addictive than Heroin. And so on. Weaker drugs, one may need to take higher mg doses but tend to be less addictive.
76B doses being a six month supply would mean 416M doses a day for America's 50M people with chronic pain (not all of which have pain conditions suited to opiate treatment, incidentally). Almost ten doses a day for each and every one one of them?
And it's by dosage units, so if your doctor says "take two every four hours", you'll be consuming 12 each day.
The number isn't that shocking.
> if your doctor says "take two every four hours"
That'd be weird for an Q12H drug, wouldn't it?
19.6 million people * 4 pills/person/day * 6 years ~= 172bn pills
Given that figure is significantly _more_ than the actual number prescribed, it doesn't strike me as overprescripton. Yes, there are issues with diversion, and the number of pain sufferers may be inflated by people faking pain (to get opioids or malingering for other reasons), but the volume of pills prescribed alone don't suggest there is a major issue.
Furthermore, 11.6 million 'true' high-impact chronic pain sufferers would still get you to the shipped figure[4], and I find it hard to believe that 8 million people are faking pain, especially as the data is gathered from a survey, rather than a situation that may result in opioids or any other non-clinical benefit.
[1] https://www.cdc.gov/mmwr/volumes/67/wr/mm6736a2.htm
[2] https://www.washingtonpost.com/graphics/2019/investigations/...
[3] I (non-US) am on (up to) 8 opioid-containing pills per day, so taking 4 as a rough average doesn't seem unreasonable
[4] 11.6 million people * 4 pills/person/day * 6 years ~= 101bn pills
For inflammation-type pain, paracetamol or NSAIDs (Nonsteroidal anti-inflammatory drugs) can be remarkably effective.
For neuropathic pain, gabapentoids are likely a better first-line treatment, with SNRIs (Serotonin–norepinephrine reuptake inhibitors) or TCAs (tricyclics) as second-line.
There are of course many people for whom opioids are appropriate, but they should only be used where less potentially harmful medications have been tried first. My understanding of the situation in the US is that they are often prescribed as 1st-line treatments, or inappropriately after surgeries where NSAIDs would be more appropriate.
I also wasn't attempting to do a rigorous accounting of all prescribed pills, but show that the 76bn figure _alone_ doesn't immediately point to overprescribing. It's a big number, but in context it doesn't seem out of the question. Furthermore, it doesn't rule out overprescribing, but that would require a more in-depth analysis than just looking that at the headline figure.
[1] "the dose is usually not more than 12 tablets per day" - https://www.mayoclinic.org/drugs-supplements/hydrocodone-and...
[2] "Roxicodone: Adults—10 to 30 milligrams (mg) every 4 hours as needed." https://www.mayoclinic.org/drugs-supplements/oxycodone-oral-...
[3] "At first, 15 to 60 milligrams (mg) every 4 hours as needed[...] the dose is usually not more than 360 mg per day." At the maximum daily dose, that puts you at 6 60mg pils/day, and in my non-US experience, the lower strength pills are often used to increase the dose of the combining drug (acetaminophen/paracetamol) - I am on 90mg/day, but it is still 8 pills https://www.mayoclinic.org/drugs-supplements/codeine-oral-ro...
In particular don't advertise as 2x a day with the advice to increase the prescription if there are withdrawal effects, when the correct prescription is to go to 3x a day and do not increase the dosage. The false advertising is a recipe to increase sales but create a serious drug addiction that will need to be supplemented somehow.
https://marginalrevolution.com/marginalrevolution/2019/05/ho...
>In August of 2010, Purdue Pharma replaced old OxyContin with a new, anti-abuse version of OxyContin. The new version was just as good at reducing pain as the old but it was more difficult to turn it into an injectable to produce a high. If physicians are altruists who balance treating their patient’s pain against their fear of patient addiction and downstream abuse then they should increase their prescriptions of new Oxy. From the point of view of health, the new Oxy is simply a better drug and with less abuse to worry about altruistic physicians should be more willing on the margin to prescribe Oxy to reduce pain. So what happened? Prescriptions for Oxy fell immediately and dramatically when the better version was released.
In my non-US jurisdiction, the big insurers used it as an opportunity to say: "Switch to something that seems less addictive than oxycodone entirely instead of switching them to some other oxycodone"
I've had severe chronic pain for over a decade from an auto accident. It's well documented as are the injuries. I've never been offered opioids and have been told by multiple doctors that surgery would be pointless and counterproductive. If I was offered opioids I'd turn them down since I understand the potential for abuse.
However it would have been nice to be asked. Fact is no doctor I've seen will prescribe them to any other than people with stage 4 cancer, people actually in the hospital following surgery, or the like.
Yet every two bit junkie creep and criminal in the area has an unending forever supply that originated in legal sources made by reputable pharma corps and sold by honest pharmacists having received a legit script.
How is this? Pain clinics. Pain clinics are prescribing these things. Not regular doctors who for over a decade have been scared to hell of prescribing them no matter how bad off a legit patient is.
So will it "get a lot more difficult for people who suffer from pain that needs opioids to actually get them"? I say no, because those people aren't getting them right now anyone. Excepting cancer, people in the hospital, and some other specific cases.
But it's OK. Because those of us with severe incurable chronic pain need to just learn to live with it. Opioids provide short term cures, rapidly develop tolerance and addiction. They are not good choices for chronic pain. Nor is anything else apparently. The field of medicine is in the medieval period, as far as how most people experience it. Propaganda about genetic cures and Star Trek like technology is fiction, mostly pushed by lying companies and speculators.
Most cancers your choice is to die without treatment since your insurance if you have it isn't going to pay for much and you'll go bankrupt on the copays. Then you die same date as you would have otherwise, probably earlier because the therapy weakens you and makes you sick and miserable. You'll also experience utter misery and horror during your last few months. Choosing to reject modern medical miracles is the best choice for most people with serious problems. Or go after stuff that at least does no physical harm, like alternative treatments, faith healing, or other quakery that's at least cheaper and less miserable. Yet the medical field peddles false hope to the overwhelming majority of people with this problem. Same goes for chronic pain. Surgery will make you worse and pills will ruin your health and may turn you into a criminal addict. Mountebanks selling such false hope really are dealers in misery and horror.
Truth be told, poppies are easy to grow. If I really wanted opioids I'd just grow them again. Yeah, it's not Oxy, but it does the job.
Did you use your poppies to make laudanum? That seems the most straightforward. If you did, was it addictive at all? Side effects, problems? Did you develop tolerance?
I believe I was lucky because after the first surgery I had, the doctor gave me the prescription, but off the record told me that he's doing that only because of hospital protocol and I should not take the pills. He told me to my face to not fill the prescription. Because of that (which was my first run-in with pain management) I never touched opioids. In my experience, the worst offenders have been the dentists. Now I do believe there are legitimate uses for this type of medication but honestly prescribing me 20-30 vicodins for a tooth extraction is a bit overkill.
If you're caucasian, you might be in the 5-10% of people that lack the genes (CYP 2D6 liver enzyme) to metabolize it into something that works well.
Conservatively is how most strong opioids should be presrcribed. The general rule is that they should not be prescribed for chronic non-cancer pain.
There's lots of safer alternatives. There could be some niche cases for it but as a general pain killer it should never be used.
US is rather unusual in allowing direct drug marketing to consumers, and "marketing" to physicians.
This is despite the dose being static for well over a year (20mg/day), and they are still effective. Going three or more days without sleep was at least a monthly incident before taking tamazepam, and missing a night was weekly - three days has only occurred once since, and missing a night's sleep is rare. This has resulted in an improvement to my other symptoms.
[1] basically anytime I see a doctor other than my regular doctors, who understand the situation
[2] I do not believe thinking you have only blinked, then looking at the clock and realising over four hours have passed is a safe situation. I suspect I just fell asleep, but I don't remember that, or even waking up -- I thought I was just checking the time, and then four hours disappeared. This happened on multiple occasions, and I'm fairly sure I didn't just misremember the time (though even that would be disconcerting), as it was also brighter outside.