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OxyContin's 12-hour problem (2016)

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

#61

Post by stordoff »

gragas wrote: post #17
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?

>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…

Those data for opiate use, not abuse. I suspect the percentage of the population who have used any opiates at least once in the past year tells you very little about about opiate-related problems - using cocodamol once a year is obviously very different to the habitual use of oxycodone.

I further suspect that the availability of opiate-containing drugs over the counter in some countries accounts for some of the differences in those statistics (e.g. cocodamol in the UK).

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

#62

Post by Alex3917 »

blawson wrote: post #50
Alex3917 wrote: post #30

Earlier quoted context omitted.

> 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...

The article you just linked to literally says it's over 50%. The 11% statistic is the percentage of Americans who are currently in pain. Whereas chronic pain is basically pain that's intermittent.

C.f. the IOM report on pain in America: https://www.nap.edu/catalog/13172/relieving-pain-in-america-...

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

#63

Post by dismantlethesun »

Alex3917 wrote: post #12
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.

> at a societal level we substantially blame addiction on "drug abuse" which is not always an adequate model. While I agree that this model is not accurate, I'd also point out that just because you're taking a drug as directed doesn't mean you're not abusing it. For whatever reason most people in the U.S. seem to have a wildly unjustifiable level of faith in western medicine, either way too much or way too little. Be…

What do you characterize as drug abuse?

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

#64

Post by elipsey »

Alex3917 wrote: post #12
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.

> at a societal level we substantially blame addiction on "drug abuse" which is not always an adequate model. While I agree that this model is not accurate, I'd also point out that just because you're taking a drug as directed doesn't mean you're not abusing it. For whatever reason most people in the U.S. seem to have a wildly unjustifiable level of faith in western medicine, either way too much or way too little. Be…

>> just because you're taking a drug as directed doesn't mean you're not abusing it.

Yes. I put "abuse" in scare quotes, because I think it's definition should be better aligned with buisiness incentives, medical advice, and actual human behavior, especially if we put people in jail for it.

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

#65

Post by vqc »

acover wrote: post #55
merraksh wrote: post #34

Previous 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…

By that definition, most doctors aren't sensible.

All doctors are human. They probably have higher averages on [X things required to make it through med school and residency] but that doesn't guarantee they are above average on anything else. Like ethics. Or avoiding certain biases.

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

#66

Post by keyboardhitter »

pavel_lishin wrote: post #58
Alex3917 wrote: post #12

Earlier quoted context omitted.

> at a societal level we substantially blame addiction on "drug abuse" which is not always an adequate model. While I agree that this model is not accurate, I'd also point out that just because you're taking a drug as directed doesn't mean you're not abusing it. For whatever reason most people in the U.S. seem to have a wildly unjustifiable level of faith in western medicine, either way too much or way too little. Be…

If my doctor tells me to take Pill A every 8 hours, and I do so, how am I abusing it? It might be drug abuse, but it's not on my part.

I believe the point is that many people have A LOT of faith in the doctor's hands, and/or "what the label says on the prescription". For some people there is an unwavering sense of "but doc told me to take this, so I must HAVE to", or even "But the doctor prescribed this, so there's no way it could harm me". So, they may stop holding themselves accountable for the drugs they're taking and may not even notice negative side effects (dependence and withdrawal included).

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

#67

Post by merraksh »

pvg wrote: post #48
merraksh wrote: post #34

Previous 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.

Good point, done. In my defense, I did post a link to the previous discussion below :-)

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

#68

Post by DanBC »

gragas wrote: post #17
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?

>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…

Your source lists opiates - products of opium poppy - not opioids (the superset that includes poppy products and synthetic product).

Since this discussion is about synthetic opioids it's not a useful source.

Have a look here. The US has considerably higher use than each of the countries you list when we talk about prescription meds.

http://www.unodc.org/documents/data-and-analysis/WDR2011/Sta...

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

#70

Post by Alex3917 »

tptacek wrote: post #43
Alex3917 wrote: post #30

Earlier quoted context omitted.

> 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 i…

> no underlying medical pathology occurred to spur the uptake in consumer opiate products.

The uptake of opiates wasn't driven by any change in pathology, but it was partially driven by a change in how we think about pathology. The IOM report I linked to helped to popularize the idea of treating pain itself as a disease that should be treated, rather than as a symptom which shouldn't be treated until the underlying cause is known:

"Because pain often produces psychological and cognitive effects—anxiety, depression, and anger among them—interdisciplinary, biopsychosocial approaches are the most promising for treating patients with persistent pain. But for most patients (and clinicians), such care is a difficult-to-attain ideal, impeded by numerous structural barriers—institutional, educational, organizational, and reimbursement-related. [...] In addition, adequate pain treatment and follow-up may be thwarted by a mix of uncertain diagnosis and societal stigma consciously or unconsciously applied to people reporting pain, particularly when they do not respond readily to treatment. [...] Understanding chronic pain as a disease means that it requires direct treatment, rather than being sidelined while clinicians attempt to identify some underlying condition that may have caused it."

I'm definitely not arguing that opioids should be first line treatments for chronic pain, but I also agree with the IOM that they should be more accessible when needed.

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