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Comment by jnovek | Hacker News Reader

You’re saying “created excess demand” like the people that you’re referring to weren’t chronic pain patients.

I know some of them were drug-seekers but we decided it was OK to throw chronic pain patients under the bus so we could eliminate those drug-seekers.

Now, in addition to dealing with pain every day, I also have to “prove” that I’m not an opioid seeker if I end up in the ER for overwhelming pain. Because saying that you’re hurting is clearly a sign that you’re actually an addict trying to get a fix.

This might sound cold-hearted, but as someone who deals with chronic pain I’m fine with some street ODs in exchange for people who are in pain being cared for. Now we just torture patients by doing nothing.

Recreational drugs are a choice. My pain was not. Why we punished for others’ bad choices?

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> You’re saying “created excess demand” like the people that you’re referring to weren’t chronic pain patients.

I don’t think you know the full history of how Purdue operated. They did two things: downplay how addictive oxy was & aggressively push oxy through doctors by providing kickbacks.

Chronic pain patients were actually a much smaller portion of the eventual victims. In a lot of cases, normal people would be prescribed oxy after minor procedures and they would get hooked on it and become permanent addicts. Once hooked, doctors would continue prescribing it for far longer and create a perpetual dependency. If the true effects of oxy were made public (which were known by Purdue pharma and Sackler family), oxy would’ve been prescribed with a lot more caution. And prescription of oxy for minor pain would’ve been non existent since a lot of safer alternatives existed.

I’m sorry you have a chronic condition, but not everyone who got hooked onto oxy had chronic conditions, and nor were they junkies.

You can directly count the total amount prescribed opioids through time and adjust for potency.

Purdue Pharma didn’t just manufacture a drug. They did a great deal of behind the scenes manipulating so even people who did not seek out severe pain medication were prescribed extremely high doses.

In terms of long term pain management opioids suck. People need increasing doses over time until the drugs side effects become toxic. Not such a problem in hospice or someone in an ambulance after a major accident, but handing them to people with chronic conditions guarantees a downward spiral. Perdue Pharma knew this, strait up lied about it, and even pleaded guilty to mislabeling OxyContin.

> total amount prescribed opioids through time

This... Dr were involved too!

> long term pain management opioids suck

Opioids suck. And the medical profession was complicit. For a class that is supposed to be professional and well informed most Dr's are, shockingly, not that bright.

> Dr where involved too!

The actions of individual Doctors acting on their own simply don’t explain trends.

Doctors and the FDA etc were straight up lied to. I don’t think it’s reasonable to hold Doctors accountable for when some pharmaceutical company commits fraud. That doesn’t mean every doctor was blameless, but individual Doctors have always behaved poorly it was true before the opioid epidemic and it’s still true today.

> Doctors and the FDA etc were straight up lied to

Oh please.

Doctors, did not believe the preponderance of evidence that ulcers were caused by bacteria. The reason, the person who discovered it was a vet.

They had to give the man a Nobel Prize to get Dr's to pry their heads out of their self aggrandizing asses and pay attention to reality.

Opioids were addictive. They never stoped being that. Dr's were fiscally motivated to prescribe. Nothing more nothing less.

Doctors also refused to believe the germ theory of disease because it would imply they were all incompetent before then. Lots and lots of people died from infections transmitted by unwashed hands.

> Doctors, did not .. The reason, the person who discovered it was a vet.

You’re wildly incorrect, nobody involved was a vet.

Barry Marshall shared that Nobel and is a Doctor. https://en.wikipedia.org/wiki/Barry_Marshall

Robin Warren received his M.B.B.S. an undergraduate degree focused on medical research. https://en.wikipedia.org/wiki/Robin_Warren He worked at: “SA Pathology, (formerly the Institute of Medical and Veterinary Science (IMVS)), is an organisation providing diagnostic and clinical pathology services throughout South Australia for the public health sector.” https://en.wikipedia.org/wiki/SA_Pathology

So whatever source you read that misinformation from is not trustworthy.

> Opioids where addictive

Hindsight bias here. We don’t want medical professionals to discard new information in favor of older treatments. There’s no way doctors can on their own replicate the medical research linking Ulcers with a bacterial infection and independently judge oxycodone’s effectiveness, and a dozen other drugs etc. Extended-release (ER) oxycodone was literally a new drug and described as not having the same issues associated with other Opioids on labeling approved by the FDA.

The crazy thing is how effective this all was. Medical schools were teaching students to hand out more opioids.

Chinese emporers were controlling opiates all the way back in the 1700s and the British were tied up in war for 20 years over the wreckage to the Chinese addicts.

The doctors, all college educated, some of our most studied and intelligent citizens, they knew about the history of opiates and im not talking about the dare campaign. I knew before the epidemic even got into force when I tossed the opiates I was prescribed in the trashcan.

The oxy marketing was just the wink and the nod everybody needed to convince themselves to parrot with a straight face, but they didn't actually really believe it.

“Tied up in a war” is a funny way to say “aggressively breaking Chinese law in order to hook local populations, make tons of drug money, and collapse public order.”

The Opium Wars were a cynical prototype for the modern war on drugs, which was initiated with similar designs and outcomes.

This wasn’t just marketing, this was drug labeling approved by the FDA and new guidelines for pain management they where teaching in med schools.

It's a valid point. Another valid point is at that time it was known the FDA had a history of approving addictive drugs. It is not evidence based to trust FDA over hundreds of years of history countering otherwise. I knew LOTS of people who turned down or tossed opiate scripts during that time because the long history was obvious to anyone with half a brain.

Yep, many people knew all along. Many didn't know, but doctors of all people had no excuse to be among the not knowers.

> You’re saying “created excess demand” like the people that you’re referring to weren’t chronic pain patients.

When a pain patient becomes an addict, their demand tends to be in excess of their prescription. I don't think anything you're saying is a reasonable response to the comment you're responding to.

Even the chronic pain patients should not have had the amounts prescribed to them that they were. Doctors were incentivized to give as much as possible. Creating addicts in people who may otherwise would not have been.

I personally knew people getting more than a cancer patient should’ve been given for day to day chronic pain.

I’m sorry if you were personally affected by regulation but that doesn’t mean they didn’t cause the crisis.

> You’re saying “created excess demand” like the people that you’re referring to weren’t chronic pain patients.

> I know some of them were drug-seekers but we decided it was OK to throw chronic pain patients under the bus so we could eliminate those drug-seekers.

To the GPs point, the cause of the regulation was the abuse of the sale. Many deaths were caused by aggressively selling oxy to folks who weren’t managing pain.

The fallout has resulted into harm with people that have a legitimate need for pain management.

Both can be true. The Sacklers are the culprits any way you slice it.

When I was a teenager I had my wisdom teeth removed and was prescribed Oxy. My mother was smart enough to not fill that prescription and gave me some ibuprofen instead. I was fine, the OTC painkillers were completely adaquate. Taking that Oxy would have been totally unnecessary and potentially life ruining.

Do remember that some of them were acute pain patients, who were supposed to be on oxy for a limited amount of time but got hooked.

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