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Coroner letters changed habits of doctors whose patients died of overdoses

latimes.com

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

#81

Post by DanBC »

justinjlynn wrote: post #57
DanBC wrote: post #53

Earlier quoted context omitted.

https://www.rcoa.ac.uk/faculty-of-pain-medicine/opioids-awar... > 1. Opioids are very good analgesics for acute pain and for pain at the end of life but there is little evidence that they are helpful for long term pain. > 2. A small proportion of people may obtain good pain relief with opioids in the long-term if the dose can be kept low and especially if their use is intermittent (however it is difficult to identify…

Well, that's a far more nuanced argument than yours. Frankly, you'd be better off quoting that than making veridical statements such as 'does not' when your own evidence indicates it 'sometimes' does. Certainly opioids are not a front line treatment, and never were, but I would avoid going around saying they 'do not work' when clearly sometimes they do and it's a highly contextual decision. You may want to say instea…

The problem is that opioids are a front line treatment, and are being prescribed by GPs and not only hospitals or pain clinics.

Opioid sales quadrupled in the US between 1999 and 2014, and a lot of those were family doctors.

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

#82

Post by jazoom »

justinjlynn wrote: post #75
jazoom wrote: post #70

Earlier quoted context omitted.

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

Oh. Hah. Confusing contexts.

It certainly is. I probably should have thought of that and been more clear.

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

#83

Post by GordonS »

DanBC wrote: post #80
GordonS wrote: post #63

Earlier quoted context omitted.

> 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 post…

> But that involves people agreeing a plan before hand, and continuing checks

AFAIK, The only 'checks' in place for me is that I can't request repeat prescriptions more often than my subscription, just the same as for any other medication.

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

I wish it were so. The RCA and NICE are in turn supported by the government, and unfortunately many politicians pander to the ignorant outcries of Daily Mail influenced voters.

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

#85

Post by MattConfluence »

sklivvz1971 wrote: post #59

I can't read that article. "Unfortunately, our website is currently unavailable in most European countries." In common: we can't be bothered respecting your privacy. OK then.

Interestingly, the article is available to me in Norway, where the GDPR is also in effect, just as in the EU.

And the site does indeed load JS from a horrendous number of domains.

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

#86

Post by jaclaz »

I believe that this is mainly a US (or actually North America to include Canada) issue, in most of the EU (Germany being an exception) opioids are not so commonly prescribed outside hospitals or as generic painkillers (i.e. for not really serious illnesses) AFAIK.

If you check the maps here:

https://ppsg.medicine.wisc.edu/

the phenomenon seems mostly regional (the colour scale on the map makes very little sense, you need to check the single amounts as everywhere (both North America and EU zone is blue but with very different values ) example 2015, "ME minus Methadone":

Canada 661 mg/capita

US 484

Germany 517

UK 156

France 151

Spain 233

Italy 131

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

#87

Post by GordonS »

DanBC wrote: post #76
srinivgp wrote: post #69

Earlier quoted context omitted.

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.

I don't think blanket statements like this are helpful, and I think this should be prefaced with 'For some people'.

Opioids do not cause drug seeking behaviour in all people.

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

#88

Post by karambahh »

zkms wrote: post #73
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…

> 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 ov…

Pain management covers pain medication but also nerve stimulation via electrodes which can be a great relief.

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

#89

Post by srj »

cm2012 wrote: post #31
jeffdavis wrote: post #29

Earlier quoted context omitted.

What is the predominant mechanism of becoming addicted then?

"Far greater risk comes from simply being young and from using alcohol and other recreational drugs heavily. Ninety percent of all drug addictions start in the teens — and 75 percent of prescription opioid misuse begins when (mainly young) people get pills from friends, family or dealers — not doctors. Opioids are rarely the first drug people misuse."

I followed these links last night and didn't find much support for that statement. If you're going to quote something, how about the paper?
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