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Who Is Telling the Truth About Prescription Opioid Deaths?

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Re: Who Is Telling the Truth About Prescription Opioid Deaths?

#41

Post by SiempreViernes »

cookiecaper wrote: post #8
freyir wrote: post #2

The claim here is that opioids are not as bad as you've been led to believe. I'll let the article speak for itself, but note that ACSH has been frequently criticized for taking a pro-industry stance on issues: * In 1979, the information director of the FDA said, "Whelan just makes blanket endorsements of food additives. Her organization is a sham, an industry front." * Ralph Nader claimed: "ACSH is a consumer front o…

Like most drugs, opioids are easy to demonize, at least up until you or someone close to you depends on them. It's naive to assume that the industry dislikes the focus on the "opioid epidemic". It works to their advantage in a variety of ways, but one of the biggest is the formation and reinforcement of a whole new class of specialized clinicians called "pain management specialists". In Florida for example, a law wen…

Following the first link "The Opioid Epidemic In 6 Charts Designed To Deceive You" I reach an article from 2017 that in its second paragraph states:

> ...despite the fact that the "evidence" contained in the recommendations had been carefully scrutinized[sic] and found unsupportable by FDA scientists.

where "found unsupportable by FDA scientists" is a link to a document from 2013 that reads in part

> FDA has carefully reviewed PROP's Petition and the numerous comments submitted to the public dockets by government entities, medical societies, healthcare providers, patients, and other members of the public. For the reasons described in detail in this response, the Petition is granted in part and denied in part.

Curious how "found unsupportable" turned out to be "granted in part" in the source, no?

This being the very first link investigated, and the error being intentional deception, I think it provides quite powerful validation of the ACSH's reputation as a shill.

Re: Who Is Telling the Truth About Prescription Opioid Deaths?

#42

Post by SiempreViernes »

tomcam wrote: post #12
biehl wrote: post #10

Earlier quoted context omitted.

> But, err, yeah, let's write off anyone who sees this as a pro-pharma shill... ACSH does not seem like “anyone” but rather a documented pro-any-paying-industry-shill...

Did you actually read the article? Did you actually look at any of the statistics it discusses?

Following the first link "The Opioid Epidemic In 6 Charts Designed To Deceive You" I reach an article from 2017 that in its second paragraph states:

> ...despite the fact that the "evidence" contained in the recommendations had been carefully scrutinized[sic] and found unsupportable by FDA scientists.

where "found unsupportable by FDA scientists" is a link to a document from 2013 that reads in part

> FDA has carefully reviewed PROP's Petition and the numerous comments submitted to the public dockets by government entities, medical societies, healthcare providers, patients, and other members of the public. For the reasons described in detail in this response, the Petition is granted in part and denied in part.

Curious how "found unsupportable" turned out to be "granted in part" in the source, no?

Re: Who Is Telling the Truth About Prescription Opioid Deaths?

#43

Post by a_throwaway_3 »

devwastaken wrote: post #31
dools wrote: post #7

The whole "opioid" shit fight can be summarised as: Pharmaceutical companies needed a way to profit from developing alternatives to morphine so they developed a bunch of dangerous bullshit then convinced everyone it was safer than morphine even though it's not. Morphine is awesome and has as its only long term side effect constipation. If it ain't broke, don't fix it. Prescribe morphine, including to heroin addicts w…

I think you're massively downplaying addiction. Sometimes it is physical pain at first, but you get hooked on it. Not everyone does heroin because they actually need that level of pain medication. They do it because it feels amazing. They get dependence on it, and then keep doing it. Read the Heroin diaries by Nikki Sixx of Motley Crue if you want a good look into that. I don't know where you're getting that morphine…

>> They do it because it feels amazing.

Heroin doesn't feel amazing. People say it does, but most of the time, it just knocks you off. I took the stuff maybe a dozen times or so, many years ago. I remember stumbling about town and falling asleep at cafes and bars, completely oblivious of what I looked like (an accomplished idiot, off my tits and completely ridiculous).

I remember a friend who was a full-on junkie, who used to say that heroin hooks you because it makes you very sociable and pleasant. Well, my experience is that, after he shot up, he would fall asleep on my bed. My mother would come in the room and ask why he's asleep and me and my other pals would tell her he's tired from work, him snoring throughout. But, you know- it makes you sociable, fun to be around, a real party animal.

(Edit: the other thing people say is that it makes you good at sex. Sure, except you can't get it up. But other than that, yeah, great sex.)

Delusional is what it makes you. You think it's making you feel good. All it does is make you feel nothing. If something hurts, I guess that feels "good". But if there's nothing broken in you, there's nothing you can get from this shit. Nothing.

Incidentally, my snoring friend died a few years down the line from a heart attack, at 34. Another friend became an addict and he's constantly in and out of detox communities since then. It's sad and it's not worh it. And I don't understand how it hooks you, because it just sucks. I stopped doing it because it was boring and pointless. If it was any good, I'd have been addicted too. But it's not. It's just dumb.

But, you know. If you're Nikki Sixx, then maybe you can have a great time even on heroin. I bet I would.

Re: Who Is Telling the Truth About Prescription Opioid Deaths?

#44

Post by maccard »

dools wrote: post #7

The whole "opioid" shit fight can be summarised as: Pharmaceutical companies needed a way to profit from developing alternatives to morphine so they developed a bunch of dangerous bullshit then convinced everyone it was safer than morphine even though it's not. Morphine is awesome and has as its only long term side effect constipation. If it ain't broke, don't fix it. Prescribe morphine, including to heroin addicts w…

> Drug policy is so stupid.

In a nutshell, yes. The solution isn't as clear-cut as you'd make it out to be unfortunately.

> Morphine is awesome and has as its only long term side effect constipation.

That's sugar coating it. Morphine is a great solution to many things, but it's extremely addictive, and has more side effects than constipation (shallow breathing for one, which combined with alcohol can make for a nasty combination). Medical advice is also that opiods as a whole generally aren't effective for long term pain management.

> The only thing that makes heroin dangerous is the fact that it's not prescribed by a licensed pharmacist.

That's also a huge oversimplification. Source of the prescription/doses is definitely an issue (see how _most_ people manage dosages of other drugs - paracetamol/asprin/alcohol when left unattended) but ultimately it's the supply of the drugs - if I buy 100mg of morphine tablets from a pharmacy, I can be reasonably sure that it's 100mg of morphine, and that it's been stored in the correct environments, but if I buy it off some guy on the street, I've no idea if it's cut with fentanyl.

> Think about it: if you're addicted to pain medication maybe you're experiencing some pain. So like, prescribe them the pain medication, then help them deal with the cause of the pain.

That's _definitely_ an over-simplification. There's plenty (too much) being prescribed when it's not needed, and the usage isn't being monitored. When people do develop addiction issues, there is no help available for them. Vox [0](best source I could find with a 5m google sorry) has a reasonable explanation of the issue (with citations), and it's definitely not "give people in pain more opiods because morphine is safe"

[0] https://www.vox.com/science-and-health/2017/8/1/15746780/opi...

Re: Who Is Telling the Truth About Prescription Opioid Deaths?

#45

Post by shabda »

DanBC wrote: post #30
shabda wrote: post #23

Earlier quoted context omitted.

> Opioids may be a good choice for some people with long term pain (I personaly don't think they are) What do you suggest be given to people with chronic pain which can't be managed with lower powered pain killers, say people with cancer induced pain?

Can I check how you're using "chronic"? You added "which can't be managed with lower powered pain killers" -- that step often isn't tried in the US. Doctors and patients are leaping direct to large quantities of opioids. I'd prefer it if doctors followed the RCoA guidance: https://www.rcoa.ac.uk/faculty-of-pain-medicine/opioids-awar... "2. A small proportion of people may obtain good pain relief with opioids in the l…

I am from India. I have two close family members who are fighting metastatic cancer.

Their pain is not manageable with lower pain killers. I am thankful we have opoids to prescribe, which is making significant improvement to their quality of life.

Re: Who Is Telling the Truth About Prescription Opioid Deaths?

#46

Post by DanBC »

shabda wrote: post #45
DanBC wrote: post #30

Earlier quoted context omitted.

Can I check how you're using "chronic"? You added "which can't be managed with lower powered pain killers" -- that step often isn't tried in the US. Doctors and patients are leaping direct to large quantities of opioids. I'd prefer it if doctors followed the RCoA guidance: https://www.rcoa.ac.uk/faculty-of-pain-medicine/opioids-awar... "2. A small proportion of people may obtain good pain relief with opioids in the l…

I am from India. I have two close family members who are fighting metastatic cancer. Their pain is not manageable with lower pain killers. I am thankful we have opoids to prescribe, which is making significant improvement to their quality of life.

Chronic is a jargon word. It means "long term pain".

Cancer pain is not long term pain, cancer pain is short term pain (or acute pain). I've never argued against using opioids for cancer patients or for end of life treatment.

Re: Who Is Telling the Truth About Prescription Opioid Deaths?

#47

Post by DanBC »

GordonS wrote: post #32
DanBC wrote: post #20

This article misses several points. When we ask people with a substance misuse disorder who use opioids what they started on we find, very often, that they started on meds prescribed by a doctor. Those meds may not have been prescribed to them - they may have been prescribed to a neighbour or family member - but they were prescribed. This is why the massive over-prescription of opioids is a problem. It floods America…

> Opioids may be a good choice for some people with long term pain (I personaly don't think they are) They definately are for some people, because I'm one of them. I've tried everything else, and nothing even touches the pain. I've tried numerous anticonvulsants (carbamazepine, lamotrigine, topiramate, levetiracetam, gabapentin, pregbalin...), tricyclics (amitriptyline, nortriptyline, dosulepin...), muscle-relaxants…

> > > Opioids may be a good choice for some people

> I realise I'm probably a statistical outlier,

Do you think you might be who I'm referring to to here?

The US massively over-prescribes opioids. They could probably reduce prescribing by 75% and it wouldn't affect people like you, other than having to go to a specialist pain clinic. Since you have specialist pain you deserve best quality treatment from specialist.

> Opioids should of course not be the first choice for chronic or neuropathic pain, because statistically other things are more effective and safer

Isn't this just agreeing with what I said?

Re: Who Is Telling the Truth About Prescription Opioid Deaths?

#48

Post by pdkl95 »

dools wrote: post #36
bionoid wrote: post #29

Earlier quoted context omitted.

> Morphine is awesome and has as its only long term side effect constipation. Honest question.... Long-term morphine use will not dull the mind?

Nothing I have ever read suggests any mental impact of morphine use.

Well, there can be a very strong mental impact for some people. Vertigo, drowsiness, or a general "fogginess" common side effects some people experience. This isn't unusual: lots of medications have similar side effects, hence the common waring given on prescriptions about not driving or operating heavy machinery until you're familiar with how your body responds to the medication.

However, those are acute effects that go away as the drug wears off. With long-term use, this type of negative effect often reduces with the increase in tolerance, eventually reaching an equilibrium at some lower level of effect (tolerance works both ways: both negative and positive effects go down as ability to tolerate the drug increases).

Most of the native effects from chronic use of morphine is sociological ("increased risks of being arrested").

Re: Who Is Telling the Truth About Prescription Opioid Deaths?

#49

Post by GordonS »

DanBC wrote: post #47
GordonS wrote: post #32

Earlier quoted context omitted.

> Opioids may be a good choice for some people with long term pain (I personaly don't think they are) They definately are for some people, because I'm one of them. I've tried everything else, and nothing even touches the pain. I've tried numerous anticonvulsants (carbamazepine, lamotrigine, topiramate, levetiracetam, gabapentin, pregbalin...), tricyclics (amitriptyline, nortriptyline, dosulepin...), muscle-relaxants…

> > > Opioids may be a good choice for some people > I realise I'm probably a statistical outlier, Do you think you might be who I'm referring to to here? The US massively over-prescribes opioids. They could probably reduce prescribing by 75% and it wouldn't affect people like you, other than having to go to a specialist pain clinic. Since you have specialist pain you deserve best quality treatment from specialist. >…

> Do you think you might be who I'm referring to to here?

That sentence continued with "(I personaly don't think they are)".

> Isn't this just agreeing with what I said?

Well, no, because you explicitly stated that you personally didn't agree.

I realise that the US has a huge problem with over-prescribing opioids. I think that great care needs to be taken in how that is reduced - there are many instances of a heavy-handed approach being used, and those that have a genuine need have their pain relief removed. The consequences of this can be disastrous.

Re: Who Is Telling the Truth About Prescription Opioid Deaths?

#50

Post by GordonS »

shabda wrote: post #45
DanBC wrote: post #30

Earlier quoted context omitted.

Can I check how you're using "chronic"? You added "which can't be managed with lower powered pain killers" -- that step often isn't tried in the US. Doctors and patients are leaping direct to large quantities of opioids. I'd prefer it if doctors followed the RCoA guidance: https://www.rcoa.ac.uk/faculty-of-pain-medicine/opioids-awar... "2. A small proportion of people may obtain good pain relief with opioids in the l…

I am from India. I have two close family members who are fighting metastatic cancer. Their pain is not manageable with lower pain killers. I am thankful we have opoids to prescribe, which is making significant improvement to their quality of life.

That kind of pain management is more technically referred to as "palliative care", which often involves both acute and chronic pain. I don't think anyone here would argue that palliative care is a bad use of opioids.
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