I just got ACL surgery and am doing the entire recovery (day 11) without any painkillers stronger than ibuprofin. This is not because I'm so brave, but because I know the pain associated with opioids to be so much than the physical pain in my knee. We've got to aggressively pursue alternatives.
OxyContin's 12-hour problem (2016)
41–50 of 96 posts
Re: OxyContin's 12-hour problem (2016)
#42Can 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…
This! Living in the UK for the last few years, the difference is remarkable. Yes, the UK has its hypochondriacs, but the comfort culture in the US takes it to a whole other level. Great for business, I imagine.
Re: OxyContin's 12-hour problem (2016)
#43Earlier quoted context omitted.
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?
What does that actually mean? If I stop and think about it, I'm experiencing a variety of chronic pains right now. Most of them don't warrant an aspirin, but they're pain nonetheless. Your response here is really a quibble over definitions: in context, I'm clearly talking about "chronic pain whose severity warrants powerful opiate analgesia" ("powerful" because maybe we should have T2 or something like it available in the US).
I tried to avoid this pointless debate with a second paragraph to immunize my argument from the trope that arguments against opiates are arguments in favor of pain.
My point --- I think obviously --- is that no underlying medical pathology occurred to spur the uptake in consumer opiate products.
Re: OxyContin's 12-hour problem (2016)
#44For those interested in this topic and how the opiate epidemic has stretched across the US, read Dreamland by Sam Quinones (https://www.amazon.com/Dreamland-True-Americas-Opiate-Epidem...)
There are a multitude of reasons to explain how this happened but to quickly sum up an excellent book:
- Purdue created the whole "sell-direct-to-doctor" phenomena that is now the norm in the US medical profession
- One bad study that showed opiates for pain relief are NOT addictive and this study kept being cited by sales people
- Mexican drug dealers from a very tiny area in Mexico importing black tar heroin
- A prevailing idea in the US that people should never be in pain and managing it through lifestyle changes is not acceptable; a quick fix is needed
- economic depression in the Midwest and Appalachia regions
But really, read the book. It's eye opening and well written.
Re: OxyContin's 12-hour problem (2016)
#45Can 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?
>What caused it, why it is more than in other parts of the world and why so many painkillers? >Is it cultural? That's actually a really common misconception on HN. The United States ranks 27th among countries which abuse opiates, [1] behind many first-world countries like the UK, Italy, Spain, Switzerland, Ireland, and Russia, to name a few. What's the cause? A lot of HNers like to pin it on unemployment and low-wage…
I think part of it is how the social safety net is done in the US. Americans have to "deserve" help, so when the lumber mill closes down for good, the 50 year old manual laborer has to become "disabled" due to his back pain in order to access the money he needs to survive. I've heard anecdotes of doctors asking whether patients have college degrees when they come in complaining of back pain. And the ranks of the disabled have swelled tremendously in recent years.
Re: OxyContin's 12-hour problem (2016)
#46Previous discussion has this top comment ( https://news.ycombinator.com/item?id=11652159 ) by cant_kant, which I believe is worth posting here: 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 le…
Original: https://news.ycombinator.com/item?id=11652159
Also, this should probably have a "[2016]" tag in the title.
Re: OxyContin's 12-hour problem (2016)
#47I'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?
Concerta ER does something like that, I'm curious why it isn't more widely used.
"The system, which resembles a conventional tablet in appearance, comprises an osmotically active trilayer core surrounded by a semipermeable membrane with an immediate-release drug overcoat.
The trilayer core is composed of two drug layers containing the drug and excipients, and a push layer containing osmotically active components. There is a precision-laser drilled orifice on the drug-layer end of the tablet.
In an aqueous environment, such as the gastrointestinal tract, the drug overcoat dissolves within one hour, providing an initial dose of methylphenidate. Water permeates through the membrane into the tablet core. As the osmotically active polymer excipients expand, methylphenidate is released through the orifice. The membrane controls the rate at which water enters the tablet core, which in turn controls drug delivery."
Re: OxyContin's 12-hour problem (2016)
#48Previous discussion has this top comment ( https://news.ycombinator.com/item?id=11652159 ) by cant_kant, which I believe is worth posting here: 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 le…
You should probably link the comment and discussion in question instead of just lifting someone else's words unattributed.
Re: OxyContin's 12-hour problem (2016)
#49Earlier quoted context omitted.
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?
Wow. That's a spectacular claim. Almost unbelievable, and certainly in need of strong empirical support.
Anecdotal evidence over six decades of life on Planet Earth suggests otherwise.
Re: OxyContin's 12-hour problem (2016)
#50Earlier quoted context omitted.
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?
That sounds unbelievable. This Washington Post article pegs it at 11%:
https://www.washingtonpost.com/news/to-your-health/wp/2015/0...