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OxyContin's 12-hour problem (2016)

latimes.com

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Re: OxyContin's 12-hour problem (2016)

#21

Post by notburnt »

panzer_wyrm wrote: post #7

Can somebody give some context on the root cause of the problem - the chronic pain epidemic in US. What caused it, why it is more than in other parts of the world and why so many painkillers? Is it cultural?

Something I've noticed: in the US people generally have an aversion to being even mildly uncomfortable.

And, it's culturally acceptable to be on medication so people take it for basically any inconvenience.

Sweating a little? Crank the AC. Small headache? take a pill. Bad day? Have a drink. Workout left muscles sore? Another pill. Sprained ankle? Obviously you need pain medication!

It's easy to see how there is a low threshold to abusing pain medication.

Re: OxyContin's 12-hour problem (2016)

#22

Post by billions »

elipsey wrote: post #8

Published May 5, 2016. Article argues that OxyContin caused strong withdrawal symptoms when used as directed. Important, imo, because at a societal level we substantially blame addiction on "drug abuse" which is not always an adequate model.

Feed anyone sufficient doctor prescribed heroin and they will start to act like the people Attorney General Jeff Sessions wants mandatory sentencing for

Re: OxyContin's 12-hour problem (2016)

#23

Post by tedsanders »

fb03 wrote: post #15
panzer_wyrm wrote: post #7

Can somebody give some context on the root cause of the problem - the chronic pain epidemic in US. What caused it, why it is more than in other parts of the world and why so many painkillers? Is it cultural?

Overeagerness to prescribe. Other countries have similar problems too. Conversely, the country I live has a benzo problem. Hell, go into any doctor complaining you haven't been sleeping properly and he'll happily prescribe you clonazepam to help you with that. You have just been prescribed an addictive and strong psychoactive drug, just like that. He won't care if you have been working too much, or not eating or slee…

What's the evidence backing the explanation of overeagerness to prescribe?

I know a handful of doctors as well as pain patients, but I'm curious to get more context outside of the small bubble I know.

Re: OxyContin's 12-hour problem (2016)

#24

Post by eropple »

Spivak wrote: post #19

I'm sure this is an easy question to answer, but it was bugging me during the whole article. What's preventing a pill that releases a dose immediately and one after 6 hours? Or something like a diabetic pump that dispenses medication continuously? Surely such systems have the potential to be safer and more effective for patients?

> What's preventing a pill that releases a dose immediately and one after 6 hours?

Being plopped into a bath of hydrochloric acid makes this a little tricky, I am led to understand.

> Or something like a diabetic pump that dispenses medication continuously?

And this led me down a brief Google walk for what these are, and...huh, that's a really good question...

Re: OxyContin's 12-hour problem (2016)

#26

Post by rubbingalcohol »

elipsey wrote: post #8

Published May 5, 2016. Article argues that OxyContin caused strong withdrawal symptoms when used as directed. Important, imo, because at a societal level we substantially blame addiction on "drug abuse" which is not always an adequate model.

As withdrawal becomes more severe and patients develop tolerance to these medications, they need to take increasing doses to get the same effects, leading to more severe withdrawal - aka. a vicious cycle.

The crux of this article was that Purdue knew their dosing schedule was problematic but pursued it despite growing evidence it was reducing efficacy and increasing addiction. Then they hid behind their FDA certification as if that exempts them from acting on evidence that their shitty drug doesn't work right.

In general, no drug for acute _anything_ will last as long as the manufacturer advertises. They are incentivized to push an idealized dosing schedule, even when that makes the drug less effective for a significant number of patients. This is kind of a big deal when a drug causes severe physical withdrawal symptoms.

Re: OxyContin's 12-hour problem (2016)

#27

Post by yborg »

panzer_wyrm wrote: post #7

Can somebody give some context on the root cause of the problem - the chronic pain epidemic in US. What caused it, why it is more than in other parts of the world and why so many painkillers? Is it cultural?

Read the article. It's economic - the makers of these opiate drugs have large marketing budgets they employ to encourage physicians to prescribe these addictive drugs and there has been essentially no governmental oversight on these marketing efforts because these marketing budgets also fund lobbying activities.

There have been a few prosecutions of individual sales/marketing people for knowingly supplying pill mills, but it's just a cost of business expense for large pharma companies.

Re: OxyContin's 12-hour problem (2016)

#28

Post by snissn »

panzer_wyrm wrote: post #7

Can somebody give some context on the root cause of the problem - the chronic pain epidemic in US. What caused it, why it is more than in other parts of the world and why so many painkillers? Is it cultural?

Hospitals are funded based on patient satisfaction and pain was added to patient satisfaction scores. To boost their ratings and funding hospitals and their doctors started heavily prescribing pain killers - in a way that pushes the problem from their hospital.

https://www.medpagetoday.com/publichealthpolicy/publichealth...

Re: OxyContin's 12-hour problem (2016)

#29

Post by gragas »

mowenz wrote: post #10
panzer_wyrm wrote: post #7

Can somebody give some context on the root cause of the problem - the chronic pain epidemic in US. What caused it, why it is more than in other parts of the world and why so many painkillers? Is it cultural?

Yes, it is cultural. Money/greed on the supply side. Lack of happiness on the demand side.

>Money/greed on the supply side. Lack of happiness on the demand side.

You have nothing to back that up. In fact, all the evidence I've seen points towards the opposite: the places with the least opiate abuse are (1) not happy countries (2) with very strict laws. See Qatar, Saudi Arabia, Singapore, etc.

If money and greed on the supply side, and lack of happiness on the demand side is the true cause of this, surely those countries would be ravaged with an opiate epidemic. But they are not. The problem is much more nuanced than you make it out to be.

Re: OxyContin's 12-hour problem (2016)

#30

Post by Alex3917 »

tptacek wrote: post #11
panzer_wyrm wrote: post #7

Can somebody give some context on the root cause of the problem - the chronic pain epidemic in US. What caused it, why it is more than in other parts of the world and why so many painkillers? Is it cultural?

There's no "chronic pain epidemic". As is often the case, the pharma market created (or rather, in this case, reshaped) a problem for a particular kind of product to solve. Obviously, ceteris paribus , less pain is much better than more pain, and there will probably always be acute and chronic pain for therapeutic innovation to tackle. There's no virtue in the experience of chronic pain. But the evidence strongly sug…

> There's no "chronic pain epidemic".

50% of American adults suffer from chronic pain. If those levels don't qualify as an epidemic, what levels would?

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