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Comment by pierat | Hacker News Reader

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Indeed. It’s created a system where everyone’s scared. So those who need it legitimately often cannot get it. Which honestly is a false sense of security at this point as it’s easier to get these drugs on the street rather than legitimately through a doctor and that’s what most now do. If anything, the abrupt disappearance of legitimate pharmacy grade drugs made way for the current problem Fentnyl. Taking away and restricting OxyContin literally made the issue worse. Almost no one can get their hands on pharmaceutics opioids and yet the overdose rate has skyrocketed! People just don’t learn… You take something away and people only tend to want it more. Prohibition simply does not work and we have years of experience and history to show this time and time again and yet not a single thing has changed. Never see any new approaches or ideas to fix this issue because it goes far deeper than drugs themselves. People want to self medicate because they suffer, but we haven’t discussed why so many suffered and what we could do about it. Probably because the answer to that question isn’t going to be easy and hard work will be involved.

Don't forget pharmacy chains use a mathematic naive formula to stop selling opioids. As seen in HN a few months ago, if one kind HNer can add the link here.

That is what happens when the government hits them with nebulous liability for political points.

Government leaders do not want to clearly define the rules, but still want to pin the problem on others. If the government makes the rules clear, and the policies result in failure, then they get blamed.

If the government outsources the policing, then the government leaders can point fingers and satisfy public outrage, at the expense of the affected public which is not politically powerful enough to do anything about it.

Believe it or not, this concept of having strong pain killers available to the public is somewhat American-centric. Much of Europe does not consider the need for strong pain killers available in society, and pain tolerance is quite different in, for example Germany or the Netherlands, where it has been nearly impossible to get anything strong for pain for many decades.

While it’s definitely more difficult to have more pain, it also guides your recovery much better. You are much more aware of what you should or shouldn’t be doing while you rehabilitate, instead of numbing everything.

Unless it’s absolutely chronic pain, I think we’ve definitely over prescribed even in Europe. (Source: german)

That’s somewhat easier to stomach when you can pop down to the doctor, even ER, for breakthrough pain without being out a weeks salary.

I've actually been offered fentanyl for medical procedures that involved moderate discomfort several times.

I refused it and endured the pain. The physicians had never seen anyone do that before.

It's different for surgery, in a hospital, if that's what you are referring to. But for take-home use, it's nearly non-existent in much of Europe.

I don't think that fentanyl would ever be prescribed for home use, but I could be wrong.

Hydrocodone was sent home recently with a family member after surgery, any this same person had oxycontin years before after a broken leg.

I've only seen fentanyl as an injected solution in hospital settings, including my own.

in Germany i think there is a general bias by medical professionals against using medicine at all for the treatment of symptoms, not only pain.

I think your argument is only partly true. In Europe doctors prescribe a lot of ibuprofen, because opiates are considered "dangerous". However, ibuprofen is a really nasty medication causing kidney and stomach damage in many patients. I think especially for short term treatment, sometimes opiates would be better for public health. Also different medications treat different pain best, so choice shouldn't be limited by reluctance over false risk assessments.

But I agree, being completely pain free shouldn't be an expectation unless you are terminally ill. Much less for acute or injury related pain.

On a side note, in hospitals they probably wouldn't need as much pain medication, if they invested in better mattresses, lighting and food.

I guess the central point is that us very hard to distinguish between genuine and fraudulent use cases; in absence of infallible diagnostics, doctors can choose to move the know to "stricter" (decreasing fraudulent use, but making genuine use much harder) or "looser" (viceversa). I see a similar problem with mental diseases, where the common pattern nowadays is 1) get convinced that you are neurodivergent 2) iterate n doctors until you find the diagnosis you like.

"Oxycontin was misclassified due to fraudulent reportings of the drug's capabilities and marketing campaign. However that should have never affected people getting legit pain care, but it definitely did."

What does legit pain care look like? Does it include the prescription of narcotics to outpatients on an ongoing basis, or for more than a couple days? While the safety of oxycontin was misrepresented, I assume there are still some problems with how other narcotics are administered to outpatients.

> What does legit pain care look like?

Oh, sure, let me just go ahead and write up a national level opiate plan here in a HN comment. I'll get right on it. /sarcasm

What I'm saying is, if it wasn't oxy, it would have been vicodin or some other narcotic. The problem is how they are prescribed and the social environment. Sure oxy misrepresented safety which lead to some increase in outpatient prescription, but this is still a major source of the problem. Oxy is just the scapegoat for much larger systemic issue since they got caught misrepresenting safety. Nobody has any actual solution to this problem so far.

> What does legit pain care look like?

A sibling was on low dose hydrocodone for years for back and ankle issues. Seemed to be fine from my perspective.

Perhaps that was the dosing or your siblings biology. Hydrocodone is also a narcotic that is potentially habit forming. The addictive potential of oxycodone is supposed to be very similar or only slightly higher than that of hydrocodone.

I'd say it probably is/would have been very difficult to stop, but the dose was low and consistent. My fear is people like that who get cut off, then resort to illegal drugs.

I realize this begs the question of is "chronic pain" basically just an addiction? I'm not qualified to answer that though.

Ideally they shouldn't be cut off. I would think we should look into a different prescription and payment paradigm where the meds required for weaning them off (based on the protocols for how long they were on them and what dose) should be part of the initial prescription. That way if you lose coverage or something you can't just be cold turkey.

I also wonder how many people, including physicians, really understand the transition required. I had an elderly friend who went on some sort of narcotic after a surgery. They were told after the fact that since they were on it for a month, it would take them a year to wean them off. I don't have the dosing or med name, but that seemed insane to me. It was ultimately a contributing factor in their death due to some side effects and other complications.

I don’t think it’s puritanical at all as narcotics for painkillers are dangerous.

Imagine if handguns were really good at treating pain, but had like a 30% chance of killing the patient. Would it be puritanical to not prescribe handguns to everyone with pain?

And if patients who thought they would not ruin their lives were upset about not being able to get handguns and complained about engaging in “handgun seeking behavior?”

Because that’s the deal here. Prescription painkillers are effective and easy, but are extremely dangerous. Pain protocols now feature OTC stuff even though they result in more pain in patients because they are equally effective but have no chance of death or life ruining addiction.

OxyContin should have been used for legit pain care.

>Pain protocols now feature OTC stuff even though they result in more pain in patients because they are equally effective but have no chance of death or life ruining addiction.

If they were "as effective" they would not result in more pain.

Additionally, pain ruins more lives than opioids and has been doing so for thousands of years. Ever tried to hold a job when you're in agony and have only slept a few hours that week?

People with untreated or untreatable pain tend to just kill themselves. That is NOT a better outcome than addiction.

I don't think people should be free of pain.

At present removing pain from people requires highly addictive substances that I consider to be chemical weapons or tools for destroying a person. Without a breakthrough-- some kind of non-opioid non-brain affecting painkiller, there's no way to achieve pain reduction without destroying the person.

It might be puritanical, but puritanism worked. A society with opioids doesn't.

(I also don't see why "boomer" is relevant)

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