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OxyContin's 12-hour problem

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Re: OxyContin's 12-hour problem

#251

Post by _acme »

yarou wrote: post #177
guard-of-terra wrote: post #67

Why don't patients for whom OxyContin does not work 12-hours ask their doctor for some another drug? With smaller interval, generic, and much cheaper? Would a doctor refuse to prescribe different, much cheaper drug, keeping them on expensive drug that does not work? Should not they then lose licenses? The whole prescription medicine system always seemed evil to me.

Hydrocodone is relatively cheap and anecdotally quite effective. When I broke my ribs, I was told to take both Hydrocodone/paracetamol (Norco) and ibuprofen every day. However, I knew my doctor was trying to get me hooked on it. So I spaced it out, I'd do one day Norco, then the next day ibuprofen, and I didn't really develop much of a tolerance. I did notice, however, when I had some shoulder pain the other day from…

What incentive did your doctor have to "get [you] hooked" on hydrocodone? Why do you think that was your doctor's objective?

Re: OxyContin's 12-hour problem

#252

Post by MichaelGG »

capote wrote: post #250
MichaelGG wrote: post #224

Earlier quoted context omitted.

No, it's a good thing. It means people that are addicted (by choice or not) don't need to resort to crime or desperation to buy essential medicines. Less doctors "pushing" really means more doctors being very critical of patients. Which means more people in pain, scared to make too big a fuss, lest they be labeled an "addict" or "seeker". We don't accept (in theory) a legal system that condemns innocent people to suf…

> No, it's a good thing. It means people that are addicted (by choice or not) don't need to resort to crime or desperation to buy essential medicines. This seems twisted to me. Okay, so they don't do crime, but they get their stuff easier and stay addicted/get worse/die. Isn't it best to eliminate the motivation for doctors to overprescribe, but still force people to see their doctors for a fix? This way maybe the do…

Don't understate the "do not do crime". I've known addicts and the biggest damage they cause (apart from dying when they OD on unknown-quality junk) is that they become thieves and liars. No one trusts them and it tears relationships apart. Both are fixed by having more legal availability. If they were simply able to get opiate as easily as pot, then addicts for the most part would be just like potheads. Perhaps being useless, perhaps seen as a drain or whatever, but not dangerous, not bad people like some junkies turn into.

With proper availability, opiates are very well tolerated. Being addicted, by itself, is not a big deal. Apart from the negative pieces you see like this one, opiates are still a huge success for many people. Not just physical pain, but emotional pain, depression, and stress. Keep an eye out for pinned pupils and notice how many professionals have them.

There's this stigma that addiction is inherently bad. Yet it only applies to "fun" drugs like opiates. No one, in general, goes on about the terribleness it is to be addicted to antipsychotics or insulin or antidepressants. At best, you hear how annoying it is, having to always make sure you've got your gear - but I've not seen people go on about the intrinsic badness of addictions lifesaving medications cause.

What should be available is more public health awareness, and a cultural shift. People should be free to get addicted, but easily obtain services to help with it, without being labelled or criminalized. You don't need to rob people of liberty and cause suffering by requiring a paid gatekeeper to watch over everyone.

Re: OxyContin's 12-hour problem

#253

Post by blazespin »

KaiserPro wrote: post #182

There is a difference between marketing and actual use. Its a synthetic opioid, which means it has all the variability of opioids. Any decent doctor should know this, and the guides, if they were any good will indicate it. For example codamol is now not prescribed in a hospital setting for under 5s, after one child died because they had large amounts of the enzyme required to processes it all at once. This caused res…

This last bit is very true. Same thing in canada. Doctor shopping is very hard because there is no benefit to the Doctor, only risk.

Re: OxyContin's 12-hour problem

#254

Post by driverdan »

koluft wrote: post #233
groovy2shoes wrote: post #190

Earlier quoted context omitted.

Pills in tablet form typically consist of the active ingredients mixed with a buffering agent and a caking agent, followed by a coating. Those agents and coating hold the pill together as a tablet, but are not particularly strong and can easily be cut, crushed, or shaved. The "abuse-resistant" tablets are made by mixing the active ingredients with a polymer, a plastic- or glue-like substance that, when dried, is very…

What do addicts crush/shoot drugs, instead of just eating them?

Faster action, more intense high.

Re: OxyContin's 12-hour problem

#255

Post by DanBC »

MichaelGG wrote: post #252
capote wrote: post #250

Earlier quoted context omitted.

> No, it's a good thing. It means people that are addicted (by choice or not) don't need to resort to crime or desperation to buy essential medicines. This seems twisted to me. Okay, so they don't do crime, but they get their stuff easier and stay addicted/get worse/die. Isn't it best to eliminate the motivation for doctors to overprescribe, but still force people to see their doctors for a fix? This way maybe the do…

Don't understate the "do not do crime". I've known addicts and the biggest damage they cause (apart from dying when they OD on unknown-quality junk) is that they become thieves and liars. No one trusts them and it tears relationships apart. Both are fixed by having more legal availability. If they were simply able to get opiate as easily as pot, then addicts for the most part would be just like potheads. Perhaps bein…

> With proper availability, opiates are very well tolerated.

This just is not true. With proper availability people develop tolerance, and require higher doses. That does becomes high enough to become dangerous, and so they need to change to a different, stronger opiate. They develop a tolerance to that too.

Eventually they're cycling through 2 or three different opiates (sometimes at the same time) at very high dose. And their pain is not being managed.

> addicted to antipsychotics or insulin or antidepressants

No tolerance, no seeking, no preoccupation, no continuing to take them when you know they're doing you harm -- those things are not addictive.

Re: OxyContin's 12-hour problem

#256

Post by enraged_camel »

pfarnsworth wrote: post #195
ceejayoz wrote: post #189

Earlier quoted context omitted.

You're saying if you could get rid of 10% of auto accident deaths with a one-off injection in childhood you wouldn't ?!

You should educate yourself better. There are 3 doses, and at the monetary cost and health risks of vaccinating every single child in the US? I would definitely not. The vaccination is not risk free, there have been health issues and deaths associated with it. It's not a freebie.

What health issues and deaths?

Re: OxyContin's 12-hour problem

#257

Post by sgnelson »

MichaelGG wrote: post #218
OliverJones wrote: post #202

Earlier quoted context omitted.

Sure, it's an opioid. That's not the point. The point is that it's made from an inexpensive generic opioid feedstock: oxycodone. The supposed value-add isn't the painkiller, it's the timed-release agent. Unless these reporters are simply lying, there's evidence of great variability in the effectiveness of that timed-release agent. But the company's market position depends on the 12-hour dose. If the drug's needed eve…

Isn't NA mandated by courts? Even for pot sometimes? A growing group could easily just mean a change in law enforcement or sentencing.

It could, but I guarantee you it's not. In case you haven't heard, there is a very real heroin epidemic in a large part of the country. (largely caused by the over prescription, and then cutting off, via a change in regulations and practices of prescribed painkillers).

But I wasn't being (intentionally) being an asshole when I say "In case you haven't heard." It's being reported in the news, but it is largely a local story, and even in a lot of cases, its kind of like "There's a Heroin Epidemic, it's now affecting white rich kids, nobody knows what to do." I don't know if it is a function people being tired of the drug war or what, but it just seems like there's a quiet epidemic that's tragically killing (and/or negatively affecting) millions of Americans out there.

Re: OxyContin's 12-hour problem

#258

Post by mbrutsch »

dang wrote: post #238
mbrutsch wrote: post #210

Earlier quoted context omitted.

Ooh, comments not visible when not logged in. Very 2009.

I assume you're talking about https://news.ycombinator.com/item?id=11651039 , which was flagged by users. However, since you don't seem to want to use the site as intended, we've banned your account.

Still too chickenshit to delete it, I suppose. Fuck you.

Re: OxyContin's 12-hour problem

#259

Post by [deleted] »

DanBC wrote: post #255
MichaelGG wrote: post #252

Earlier quoted context omitted.

Don't understate the "do not do crime". I've known addicts and the biggest damage they cause (apart from dying when they OD on unknown-quality junk) is that they become thieves and liars. No one trusts them and it tears relationships apart. Both are fixed by having more legal availability. If they were simply able to get opiate as easily as pot, then addicts for the most part would be just like potheads. Perhaps bein…

> With proper availability, opiates are very well tolerated. This just is not true. With proper availability people develop tolerance, and require higher doses. That does becomes high enough to become dangerous, and so they need to change to a different, stronger opiate. They develop a tolerance to that too. Eventually they're cycling through 2 or three different opiates (sometimes at the same time) at very high dose…

[deleted]

Re: OxyContin's 12-hour problem

#260

Post by cant_kant »

Sensible doctors do not believe drug company marketing.

I get large amounts of ad-junk from drug companies that ends up unread in the bin. I refuse to meet with drug company representatives. I smile politely at them if I bump into them in the corridor and suggest that they leave their ad-junk with my secretary. My staff then file their ad-junk in the trash bin.

On Friday, I had a drug company representative attempt to tell me ( he was hanging around my coffee area ) about the joys of Targin, a fixed-dose combination of oxycodone and naloxone. I gently shook him off, and directed him to my secretary.

Drug company representatives are usually decent human beings with lives and families. However they are poorly educated, poorly informed salesmen and women with sales targets to meet and product managers to keep happy. Even worse, they and the drug company have no accountability if a patient dies because of their recommendations. If avoidable death supervenes or if there are non-lethal complications or even just therapeutic failure, I am accountable.

Instead of relying on marketing, I rely on information from good, well performed randomised controlled studies published in reputable peer reviewed journals ( I like the NEJM ) and on meta-analyses of these. I view the results of these through a filter of scepticism, cynicism, pragmatism and a modicum of hope.

Many of my colleagues do likewise. I trust that you do the same in your respective vocations. Regrettably, there is a bell curve. I am sure that the drug companies find enough gullible prescribers out in the wild for their purposes.

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