Coroner letters changed habits of doctors whose patients died of overdoses • Hacker News Board

Re: Coroner letters changed habits of doctors whose patients died of overdoses

#71

Post by johnpowell » Fri, Aug 10, 2018, 7:33 AM UTC

pdkl95 wrote: post #48

selectodude wrote: post #35

Earlier quoted context omitted.

You were reading the bottle wrong. Those pills were either 5mg or 10mg of hydrocodone with 325mg of acetaminophen. 36 of those, while a lot, is really not more than 4-5 days worth. They only last 4-6 hours each. 325mg hydrocodone would have killed you several times over unless you’re, like, a late stage cancer patient or a severe heroin addict.

Additionally, 600mg Ibuprofen is just 3 of the common over-the-counter 200mg pills. The adult dose for OTC Ibuprofen is 1 or 2 of the 200mg pills, so 600mg is only 150%-300% larger. Whi8le that kind of higher dose can become a problem if used continuously for more than a few days (be careful with any medication), it's a fairly standard dose for a handful of days after a dental procedure. It's certainly not "absurd".…

I am not saying the ibuprofen was a problem. I'm saying it should have been the first thing recommended.

I was told to take the ibuprofen for swelling and the hydrocodone for pain.

Re: Coroner letters changed habits of doctors whose patients died of overdoses

#72

Post by DanBC » Fri, Aug 10, 2018, 7:40 AM UTC

justinjlynn wrote: post #51

DanBC wrote: post #47

Earlier quoted context omitted.

You're pushing a narrative created by opioid manufacturers: "These meds aren't addictive if used to treat pain". That's only true (if it is true) if they're used short term. People in this thread aren't talking about acute pain, they're talking about chronic (long term) pain. It's likely that opioids are addictive if used long term to treat long term pain. Here's what actual doctors say: https://www.rcoa.ac.uk/facult…

Physiological dependence is a treatment complication to be managed. Corticosteroids, hormones, and other nonpsychoactive medications feature this issue too. It is part of the risk/benefit calculation. What's important is the psychological addiction. You can taper off of a medication on which you are physiologically dependent. However, if it makes you psychologically dependent, you can never forget the high. Turns out…

The psychological addictiveness of opioids is well established.

Turns out not having pain because a medication helps and you experience it when you stop makes people want to keep taking it. Who knew?

That is not what's happening. People take the medication to treat the pain. Their pain still exists. They develop a tolerance to opioids (one of the mechanisms of addiction) and need to increase the dose. Now they're taking very large -dangerously large- doses of opioids but are still in pain.

Re: Coroner letters changed habits of doctors whose patients died of overdoses

#73

Post by zkms » Fri, Aug 10, 2018, 7:41 AM UTC

DanBC wrote: post #44

lesserroneous wrote: post #28

I will admit I'm biased: my mother died of an overdose. She was a drug addict. I, on the other hand, have a painful autoimmune disorder, but I've never taken medication. Yet every doctor I've met in the past ten years has looked at me and immediately treated me like a drug addict. Personal experience aside (as it really is not quantitatively demonstrative of anything larger) I've done my best to research this issue,…

People think that opioids are an effective treatment for long term pain. They aren't. They don't work to treat the pain and the patient develops a tolerance and so ends up taking large quantities putting their health at risk. > Patients are seeing their medication reduced without tapering, they are given no other option than to "suck it up," These are both bad, but these are both symptoms of the sometimes terrible he…

> They don't work to treat the pain and the patient develops a tolerance and so ends up taking large quantities putting their health at risk.

That's not how opioid tolerance works. As dose needed to achieve desired effect (analgesia) increases, so does does needed to cause respiratory depression. It's not like there's a single fixed lethal dose and the hapless addict is drawn into it closer and closer.

Anyway the overwhelming majority of opioid-related deaths, at least in US, occur with concomitant use of benzodiazepines or EtOH (which is something inherently dangerous) and that is, if anything, an argument against prohibition, since people potentiating their opioids with EtOH or benzos is pretty flagrantly downstream of scarcity of opioids.

Long-term use of pharmaceutical-grade opioids (in precisely measured doses, and without the scarcity that drives people to compound with alcohol or benzos) is far safer than you imply it is. It's prohibition that's made opioid use perilous, not the actual pharmacological qualities of the drugs (which have been used by humanity for millennia by now).

> People should have access to pain management clinics.

...pain management clinics that do what, besides prescribe opioids? Fix the actual root cause? Do surgery?

Re: Coroner letters changed habits of doctors whose patients died of overdoses

#74

Post by GordonS » Fri, Aug 10, 2018, 7:42 AM UTC

kelnos wrote: post #23

justinjlynn wrote: post #22

It had a direct impact on several doctor's prescription habits. This is a good thing. Now, did it do so while ensuring doctors maintained the same pain management outcomes for their patients? I am dubious and concerned this doesn't appear to have been addressed in their studies.

As a potential patient, I'm pretty sure I'd prefer to endure a little extra pain if the alternative is an increased likelihood of painkiller addiction that could lead to death.

I felt exactly the same. And then I ended up with chronic, debilitating, unbearable pain in my limbs.

Opioids are the only thing that has helped with the pain at all - to flip your comment around, not taking opioids could have led to my death.

I only ever take my prescribed dose, and I've been doing this for years. They still have the same efficacy. They don't make me feel good, they constipate me and make me a bit sleepy - I don't know how anyone becomes addicted to them, but amongst many others I guess there are genetic factors at play.

Re: Coroner letters changed habits of doctors whose patients died of overdoses

#75

Post by justinjlynn » Fri, Aug 10, 2018, 7:44 AM UTC

jazoom wrote: post #70

justinjlynn wrote: post #67

Earlier quoted context omitted.

Indeed, clearly we need to develop a better understanding of the causes of chronic pain and how to treat them directly rather than managing symptoms. My primary concern is maintaining or improving quality of life without impacting the length too negatively. It's difficult to justify saying "sorry, that thing you were taking to make your life bearable makes my colleagues think I'm no better than drug dealer so, uh, yo…

GP = Grandfather Post. It's a reference to the comment you replied to.

Oh. Hah. Confusing contexts.

Re: Coroner letters changed habits of doctors whose patients died of overdoses

#76

Post by DanBC » Fri, Aug 10, 2018, 7:45 AM UTC

srinivgp wrote: post #69

DanBC wrote: post #47

Earlier quoted context omitted.

You're pushing a narrative created by opioid manufacturers: "These meds aren't addictive if used to treat pain". That's only true (if it is true) if they're used short term. People in this thread aren't talking about acute pain, they're talking about chronic (long term) pain. It's likely that opioids are addictive if used long term to treat long term pain. Here's what actual doctors say: https://www.rcoa.ac.uk/facult…

Repeat after me. Addiction is not dependence. Dependence is not addiction. When I read "dependence is expected", I will not interpret it as "addiction is expected", and I will ESPECIALLY not immediately assume tolerance, drug seeking, preoccupation, or harming oneself just because of dependence.

Opioids cause tolerance, drug seeking, preoccupation, and continuance even though the patient knows they're harmful

This behaviour is long established and well known.

Re: Coroner letters changed habits of doctors whose patients died of overdoses

#77

Post by mmt » Fri, Aug 10, 2018, 7:49 AM UTC

DanBC wrote: post #52

ewjordan wrote: post #37

Opiods have been around forever; pardon my ignorance, but what is different now that makes so many more people get hooked on them? Presumably people felt the same levels of pain in the past as they do now, given the same maladies. Is the situation: A) More surgeries with extremely painful and long recovery periods are happening, where these meds are truly necessary B) Doctors are prescribing opiods more freely for lo…

Opioid sales quadrupled between 1999 and 2014. > but what is different now that makes so many more people get hooked on them? The US VA noticed that pain was not being adequately treated. They created a campaign to make every HCP ask patients about pain. They looked at the science of the time which seemed to be saying that opioids were not addictive if you use them to treat pain. (they're less addictive if used short…

> > Sales of prescription opioids in the U.S. nearly quadrupled from 1999 to 2014,1 but there has not been an overall change in the amount of pain Americans report

That, there, is the "money" quote. You've been criticized elsewhere in the thread for the assertion that opiates "don't work" for long-term pain, but that strikes me as a very reasonable summary in the face of this kind of evidence.

Sure, there may be exceptions, but they must be quite rare for the above to remain true. (Some of them may not even be true exceptions, if "intermittent" use for long-term pain actually looks the same as repeated use for short-term pain).

Re: Coroner letters changed habits of doctors whose patients died of overdoses

#78

Post by jillesvangurp » Fri, Aug 10, 2018, 7:49 AM UTC

ewjordan wrote: post #37

Opiods have been around forever; pardon my ignorance, but what is different now that makes so many more people get hooked on them? Presumably people felt the same levels of pain in the past as they do now, given the same maladies. Is the situation: A) More surgeries with extremely painful and long recovery periods are happening, where these meds are truly necessary B) Doctors are prescribing opiods more freely for lo…

You forgot one: The companies that produce these pills figured out that it is a hugely profitable thing to be selling heroine in pill form (which is more or less what we are talking about) and have been heavily marketing their drugs to doctors and patients. As a consequence all of the things you list are happening and it is hugely profitable.

And when I say marketing here think ads on the tv, heavy lobbying with politicians, inviting doctors to exclusive events and pampering them, sponsoring studies on chronic pain, etc.

Re: Coroner letters changed habits of doctors whose patients died of overdoses

#79

Post by [deleted] » Fri, Aug 10, 2018, 7:50 AM UTC

cm2012 wrote: post #40

simonbarker87 wrote: post #33

Earlier quoted context omitted.

You could still draw a link: high prescription rates of opioid pain killers normalises the use of them and as such someone is more likely to be offered them by family and friends for something minor. Also, is “throughly” debunked really the case? That makes it sound like there can be no link at all, but higher levels of these in society legally could lead to an increase in abuse. On complex topics like this it is rar…

What's debunked is the very common narrative in this thread that poor Uncle Billy went to the doctor with a bad back and came back a rabid addict. Non addicts becoming addicts from regular prescriptions is very rare according to all studies. There is definitely a big complex drug ecosystem otherwise, though.

[deleted]

Re: Coroner letters changed habits of doctors whose patients died of overdoses

#80

Post by DanBC » Fri, Aug 10, 2018, 7:51 AM UTC

GordonS wrote: post #63

DanBC wrote: post #44

Earlier quoted context omitted.

People think that opioids are an effective treatment for long term pain. They aren't. They don't work to treat the pain and the patient develops a tolerance and so ends up taking large quantities putting their health at risk. > Patients are seeing their medication reduced without tapering, they are given no other option than to "suck it up," These are both bad, but these are both symptoms of the sometimes terrible he…

> People think that opioids are an effective treatment for long term pain. They aren't I don't think it's helpful to make a blanket statement like that. There is no one size fits all where pain and analgesics are concerned, and genetics play a large role in what works and what you can even tolerate due to side effects. Opioids of course should not be the first choice, but they should be an option. I've been living wi…

You're right, blanket comments aren't great.

The blanket comment of "most people are harmed by long term opioid use, and don't get much benefit" is true though.

Your experiences support the point I'm making though: if it's working, and if the dose is maintained at a low level, opioids are better than nothing.

But that involves people agreeing a plan before hand, and continuing checks. (See the links I've already posted elsewhere in this thread).

Luckily the Daily Mail have no influence on healthcare. Your use of opioids is supported by RCA, and NICE.