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As epidemic rages, ER study finds opioids no better than Advil and Tylenol

arstechnica.com

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Re: As epidemic rages, ER study finds opioids no better than Advil and Tylenol

#101

Post by dna_polymerase »

tunichtgut wrote: post #81
dna_polymerase wrote: post #11

I don't get the US stance on opioids. In Germany they are heavily regulated and can't be obtained without special prescription giving them an rather exclusive aura. No German doctor would prescribe them for headaches and people only really get them after serious surgery for a really short term. Advil (Ibuprofen) and Aspirin (ASS) are far more common here and used for pain management at a far broader extent than in th…

"And frankly so, Germany doesn't have an opioid problem." You are very uninformed obviously. As far as i know for my town, Paderborn (NRW), we have about 1.000 people receiving opioid replacement drugs under government supervision (~90.000 city population).

While opioid abuse is rising, yes even in Germany, situations are not really comparable. In the US 20.5 Million people have a substance abuse disorder. Of which 2M have a problem involving prescription pain relievers, and roughly 600k people are addicted to Heroin. [0] For Germany data on this matter is generally less available, but reports range from 1.5M to 1.9M users of prescription drugs for Germany, that number includes sleep-aids and Benzos as well though. Zolpidem based drugs actually make up for 3/4 of German prescription drug abuse. [1] The official drug report mentions 160k high-risk opioid users and 77k in substitution programmes. [2] (That's actually far far less than the 1/90 rate you report for your city. Talking about uninformed...) Also for comparison of the problem, let's look at the death rates in the US [3] and Germany [2]: 33k vs 1.2k now in relation to the population (age 15-64):

US: 0.000160 %

Germany: 0.0000226415 %

US death rate is 7 times higher than the German, while population is only 4 times bigger. That said, a look at the opioid users in Germany (160k) and US (2M+600k) is way clearer. We are talking about 16 times the abuse rate in the US compared to Germany. So yeah, Germany doesn't have an opioid problem, compared to the US.

So while Germany has heroin addicts, the US actually has a drug addict training program running. In the US there are 290M opioid prescriptions per year. [4] And while Germany doesn't have those outstanding numbers, Big Pharma is pushing for change in Germany [5 (German)]

[0]: https://www.asam.org/docs/default-source/advocacy/opioid-add...

[1]: http://www.dw.com/en/medication-abuse-a-growing-concern-in-g...

[2]: http://www.emcdda.europa.eu/system/files/publications/4528/T...

[3]: https://www.cdc.gov/drugoverdose/index.html

[4]: https://addiction.surgeongeneral.gov/surgeon-generals-report...

[5]: http://www.spiegel.de/gesundheit/diagnose/oxycodon-fentanyl-...

Re: As epidemic rages, ER study finds opioids no better than Advil and Tylenol

#102

Post by empath75 »

Anechoic wrote: post #27

Of course while YMMV, I've found the same thing - I've been prescribed opioids for pain, and I found that Advil worked just as well, without the side effects. I do understand that opioids have their place - for example I was told that Advil was not safe to take before surgery so I was stuck with the prescription meds. On example that made an impression on me: a couple of years ago, I had arthroscopic surgery on a kne…

had a similar interaction after an appendectomy, except the nurse asked me if I was an addict after i said I didn't want opiates.

Re: As epidemic rages, ER study finds opioids no better than Advil and Tylenol

#103

Post by empath75 »

katastic wrote: post #95
vrtx0 wrote: post #66

The title of this link is frustrating and misleading. The article clarifies a bit, but I take issue with Ars linking to the specific study with text stating the methodology is the gold standard. That doesn’t mean the conclusion will hold up to scrutiny, or that “extremity pain” is a meaningful dimension. The type of injury (eg. compound fractures, sprains, etc.) could be more meaningful than where the injury is. Ther…

I was about ready to chime in the same thing. I've been on opiods for six years (not by simple choice). I'm also on a literal 15 other medicines. I take around 30+ pills a day I've had multiple back surguries. I've got on average 3 doctor visits a month (those co-pays add up fast!)... for six years. And this all started in my prime... at 25 years old where I went from starting a Ph.D program... to fighting with every…

I have a very good friend with a similar story about long term back problems. He was on oxycontin for literally 10 years along with other medications. Multiple back surgeries.

Then when his prescribing doctor got arrested, he ended up detoxing involuntarily at first, and then voluntarily, and he found that he didn't have any pain after he managed to make it through withdrawal.

I honestly think a lot of people with chronic pain that they're treating with opiates are actually treating withdrawal with opiates.

Re: As epidemic rages, ER study finds opioids no better than Advil and Tylenol

#104

Post by pbhjpbhj »

baldfat wrote: post #96
chucky_z wrote: post #60

Earlier quoted context omitted.

Cannabis has pretty awful side-effects for me. It gives me absolutely incredible nausea, to the point where I've tried it ~10 times in varying doses, thinking my dosage was an issue, and out of those I was violently ill 4 of the times. The other 6 times were simply unenjoyable. It doesn't just go away like alcohol either. If I drink too much and throw up, I feel better within a few minutes. For cannabis I remain high…

I never touched the stuff, but I would end up having to take my friend to the ER. For some reason at different times it would cause an allergic reaction and he would act like he was in septic shock and have dementia. Doctors and I were convinced he was not telling the truth or his stuff was laced. Ended up that he was telling the truth and was clean other than pot. Sad thing was he would keep using pot which ended up…

If you don't understand why people would avoid the full force of their emotional response to life then you apparently have had great fortune in your emotional experiences. I note you don't have to want it for yourself to understand why others would want it.

Re: As epidemic rages, ER study finds opioids no better than Advil and Tylenol

#105

Post by empath75 »

nimos wrote: post #71
joshgel wrote: post #62

Earlier quoted context omitted.

These are standard doses of all these medications. Its the dose of tylenol often used in the hospital and wasn't dosed every 2 hours it was dosed once. For the opiates we either give 1 or 2 pills, here they gave 1. Perfectly reasonable.

I'm not saying they are unreasonable doses but they are definitely low as far as opioid doses go. Apart from T1/T2s you can't get lower afaik. My point is I don't see that replacing opioids in this case is really useful. I'm happy to admit I don't know the answer here but I'm skeptical that people going to the hospital and getting a single 5mg percocet/vicodin or even a 3-4 over ~8-12 hours are really at risk of addi…

The more casually people treat opiates and the more that are on 'the market', the more that are going to be diverted.f

Re: As epidemic rages, ER study finds opioids no better than Advil and Tylenol

#106

Post by autarch »

Personally I'd rather take the opiates. I have GERD and other GI problems. Ibuprofen is likely to lead to extreme pain and discomfort. I've taken a variety of opiates in the past. They did work for reducing pain but I couldn't wait to stop. I hate the dopey feeling.

Re: As epidemic rages, ER study finds opioids no better than Advil and Tylenol

#107

Post by stouset »

randlet wrote: post #52
SheepSlapper wrote: post #50

Earlier quoted context omitted.

The discussion around opiate abuse isn't about the extreme cases. Yes, if I get 3rd degree burns then I want to be as out of it as possible until the pain goes away. The problem isn't the extreme cases, it's the every day ones. Opiates are being massively over-prescribed in cases where OTC medicine or a shot of whiskey would suffice, and this over-prescription is a driving force behind the addiction epidemic.

> or a shot of whiskey would suffice Not sure if you said it in jest or not but alcohol is also highly addictive, prone to abuse, and harmful to your health and IMO would really not be a step in the right direction. edit: I almost added to my comment "It's almost taboo in our society to mention this fact" but didn't. I was almost immediately down voted so I guess maybe I'm not wrong...

You’re not wrong, but the likelihood of addiction from two weeks of drinking vs. two weeks of opioids is, I suspect, not really comparable.

Re: As epidemic rages, ER study finds opioids no better than Advil and Tylenol

#108

Post by mschuster91 »

tunichtgut wrote: post #81
dna_polymerase wrote: post #11

I don't get the US stance on opioids. In Germany they are heavily regulated and can't be obtained without special prescription giving them an rather exclusive aura. No German doctor would prescribe them for headaches and people only really get them after serious surgery for a really short term. Advil (Ibuprofen) and Aspirin (ASS) are far more common here and used for pain management at a far broader extent than in th…

"And frankly so, Germany doesn't have an opioid problem." You are very uninformed obviously. As far as i know for my town, Paderborn (NRW), we have about 1.000 people receiving opioid replacement drugs under government supervision (~90.000 city population).

> As far as i know for my town, Paderborn (NRW), we have about 1.000 people receiving opioid replacement drugs under government supervision (~90.000 city population).

Whoa, that's an outsized proportion - entire Germany has 77k people in methadone substitution: http://www.bfarm.de/SharedDocs/Downloads/DE/Bundesopiumstell...

Also, the numbers are 500 methadone substituters (of total ~1k opiate users) in Paderborn (http://www.nw.de/lokal/kreis_paderborn/paderborn/paderborn/1...). What would interest me is the background why ~1% of the population are opiate abusers, though.

Re: As epidemic rages, ER study finds opioids no better than Advil and Tylenol

#109

Post by phofangor »

Anechoic wrote: post #27

Of course while YMMV, I've found the same thing - I've been prescribed opioids for pain, and I found that Advil worked just as well, without the side effects. I do understand that opioids have their place - for example I was told that Advil was not safe to take before surgery so I was stuck with the prescription meds. On example that made an impression on me: a couple of years ago, I had arthroscopic surgery on a kne…

I find it very odd that a nurse would be so cavalier about that. There are a lot of people who can't/won't take prescription pain meds for a myriad of reasons. Some are concerned about addiction, but other reasons are religious/philosophical. I've always been asked if I want those kinds of pain meds, even when they are highly recommended, it was always a question.

Re: As epidemic rages, ER study finds opioids no better than Advil and Tylenol

#110

Post by mholmes680 »

pasbesoin wrote: post #83
Anechoic wrote: post #27

Of course while YMMV, I've found the same thing - I've been prescribed opioids for pain, and I found that Advil worked just as well, without the side effects. I do understand that opioids have their place - for example I was told that Advil was not safe to take before surgery so I was stuck with the prescription meds. On example that made an impression on me: a couple of years ago, I had arthroscopic surgery on a kne…

Same here. After a LONGGG phone call cradling the receiver while trying to type, etc., I had my neck spasm severely -- so much so that the following day someone else had to drive me to urgent care (1). They prescribed a strong muscle relaxant in combination with either Percocet or Vicadin -- I forget which. I switched over to the default over the counter dose of ibuprofen, and it worked better than the combination of…

I've found through my experience that the choice of urgent care vs a non-urgent care doctor is more important than I have always thought: An urgent care center wants to focus on the shortest path to getting you relief (your story aside). They'll err towards slightly over-prescribing. The non-urgent care doc will take a more comprehensive treatment path.

A slight distinction that might not matter sometimes, but i often wonder how many antibiotics/pain killers I've taken prescribed from urgent cares that were possibly overkill.

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