Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

As epidemic rages, ER study finds opioids no better than Advil and Tylenol

arstechnica.com

Post reply on HN
Print view View original

71–80 of 161 posts

Re: As epidemic rages, ER study finds opioids no better than Advil and Tylenol

#71

Post by nimos »

joshgel wrote: post #62
nimos wrote: post #55

Those opioid doses are all super low, roughly equivalent to a single Tylenol 3. The alternative is a super high dose of acetaminophen. 1/4 your daily recommended maximum. At roughly 3x the acetaminophen + the fairly high dose ibuprofen I don't think there is anything really surprising about this. You couldn't take that acetaminophen dosage for more than 8 hours with 2 hour dosing without hitting your daily maximum. I…

These are standard doses of all these medications. Its the dose of tylenol often used in the hospital and wasn't dosed every 2 hours it was dosed once. For the opiates we either give 1 or 2 pills, here they gave 1. Perfectly reasonable.

I'm not saying they are unreasonable doses but they are definitely low as far as opioid doses go. Apart from T1/T2s you can't get lower afaik.

My point is I don't see that replacing opioids in this case is really useful. I'm happy to admit I don't know the answer here but I'm skeptical that people going to the hospital and getting a single 5mg percocet/vicodin or even a 3-4 over ~8-12 hours are really at risk of addiction.

For 24/7 dosing that acetaminophen/ibuprofen combo is only safe once every 6 hours which from my experience is way too long for acetaminophen. Even on every 4 hours I find the last 1 hour is definitely very noticeable.

Re: As epidemic rages, ER study finds opioids no better than Advil and Tylenol

#72

Post by blacksmith_tb »

darpa_escapee wrote: post #58
testvox wrote: post #48

Earlier quoted context omitted.

Cannabis works pretty well and has minimal side effects, at least compared to those you describe.

Perception changes with cannabis are a significant negative side-effect.

True for high-THC strains, but not high-CBD / low-THC ones. And of course opioids also famously affect perception: "do not operate heavy machinery" etc.

Re: As epidemic rages, ER study finds opioids no better than Advil and Tylenol

#73

Post by epmaybe »

aclonedsheep wrote: post #47
epmaybe wrote: post #19

All the commenters thus far seem to think they know more than a randomized clinical trial that was double blinded looking at oral (not IV morphine) combination doses of opioids like codeine, hydrocodone, and oxycodone with tylenol vs ibuprofen+acetaminophen (tylenol). Here's the actual study if you would like to read more... https://jamanetwork.com/journals/jama/article-abstract/26615... I'd like to note that their p…

In my limited experience, IV acetaminophen is never available to use because of cost which seems incredibly unfortunate.

You are absolutely correct. I was just noting that even if individuals think morphine is the best at reducing pain, there are other options related to this article.

Re: As epidemic rages, ER study finds opioids no better than Advil and Tylenol

#74

Post by DanBC »

ythn wrote: post #36
Anechoic wrote: post #27

Of course while YMMV, I've found the same thing - I've been prescribed opioids for pain, and I found that Advil worked just as well, without the side effects. I do understand that opioids have their place - for example I was told that Advil was not safe to take before surgery so I was stuck with the prescription meds. On example that made an impression on me: a couple of years ago, I had arthroscopic surgery on a kne…

> Her response was "just take the pills." There's a fairly big camp of people both online and in real life that is strongly against questioning medical authority. I've encountered it before. For example (and I know this is purely anecdotal), after doing a few hours of extensive research and photography comparisons online I came to the conclusion that my sister had shingles. I mentioned this to the doctor when I took…

A useful approach is to ask "could this be shingles?", and then "why not?", and then "if i isn't shingles what else could it be, and why is it that and not shingles?"

the UK has had a campaign recently around sepsis where people are being trained to ask these questions.

Re: As epidemic rages, ER study finds opioids no better than Advil and Tylenol

#75

Post by stefantheard »

blacksmith_tb wrote: post #72
darpa_escapee wrote: post #58

Earlier quoted context omitted.

Perception changes with cannabis are a significant negative side-effect.

True for high-THC strains, but not high-CBD / low-THC ones. And of course opioids also famously affect perception: "do not operate heavy machinery" etc.

I have heard that CBD is extremely great as a natural anti inflammatory however the strains that get recommended are so absurdly expensive. On the order of 30ml for 150$ for charlottes web for example. Is it actually worth it? How long does that 30ml bottle last for 150$?

Re: As epidemic rages, ER study finds opioids no better than Advil and Tylenol

#76

Post by epmaybe »

srinivgp wrote: post #49
epmaybe wrote: post #19

All the commenters thus far seem to think they know more than a randomized clinical trial that was double blinded looking at oral (not IV morphine) combination doses of opioids like codeine, hydrocodone, and oxycodone with tylenol vs ibuprofen+acetaminophen (tylenol). Here's the actual study if you would like to read more... https://jamanetwork.com/journals/jama/article-abstract/26615... I'd like to note that their p…

> For those of you that think that a few doses of opioids can't cause addiction, think again. This study found that even after 10 days supply of opioids, 20% of patients had a dependence lasting up to a year. The study did not find that. The study looked for long-term opioid use, not addiction, and not dependence. Long term use, addiction, and dependence (and tolerance) are all separate things. Long-term use: simply…

You're right, thank you for the clarification and I apologize for misleading. This study did not look at addiction.

However, the study noted a few things that lead me to believe that this long-term opioid use is not intentional by prescribers. The study excluded patients with cancer, which is a common reason to be prescribed long term opioids. Additionally, they note that most of the patients were not provided long-acting opioids at the start, suggesting that the prescribers did not intend to start these patients on long-term opioid therapy.

At the very least, the data is suggestive of an increase in dependence in patients prescribed a 10-day or greater supply of opioids, as we know that when patients are on opioids for too long, you must slowly discontinue lest you initiate withdrawal.

Re: As epidemic rages, ER study finds opioids no better than Advil and Tylenol

#77

Post by mturmon »

ianai wrote: post #33
apendleton wrote: post #24

Earlier quoted context omitted.

Agreed; I've been prescribed that combination more than once by different doctors. It's very common, and often the recommendation is to stagger them. NSAIDs are metabolized by the kidneys and acetaminophen is metabolized by the liver, so they can be safely combined. EDIT: also, this is pretty much what Excedrin is (aspirin instead of ibuprofen, but NSAID + acetaminophen, plus also caffeine)

As a migrainer, excedrin really only works part of the time. Though, opioids really only succeed in making me not care about the pain. I’m still in pain with them. The best treatments, for me, directly address whatever underlying issue.

Drifting off-topic, but have you tried sumatriptan ("Imitrex")? It seems to have a near-total effectiveness on my ~monthly migraines. Neither acetaminophen nor NSAIDs ever did anything for my migraines.

I agree that directly addressing underlying causes like stress, noise, sleep, and diet are better than a pill.

Re: As epidemic rages, ER study finds opioids no better than Advil and Tylenol

#78

Post by illegalsmile »

randlet wrote: post #52
SheepSlapper wrote: post #50

Earlier quoted context omitted.

The discussion around opiate abuse isn't about the extreme cases. Yes, if I get 3rd degree burns then I want to be as out of it as possible until the pain goes away. The problem isn't the extreme cases, it's the every day ones. Opiates are being massively over-prescribed in cases where OTC medicine or a shot of whiskey would suffice, and this over-prescription is a driving force behind the addiction epidemic.

> or a shot of whiskey would suffice Not sure if you said it in jest or not but alcohol is also highly addictive, prone to abuse, and harmful to your health and IMO would really not be a step in the right direction. edit: I almost added to my comment "It's almost taboo in our society to mention this fact" but didn't. I was almost immediately down voted so I guess maybe I'm not wrong...

I'd say it's extremely taboo to mention anything negative or even the possibility that alcohol is one of the most abused and disruptive drugs in our society.

Re: As epidemic rages, ER study finds opioids no better than Advil and Tylenol

#80

Post by Retric »

chucky_z wrote: post #60
testvox wrote: post #48

Earlier quoted context omitted.

Cannabis works pretty well and has minimal side effects, at least compared to those you describe.

Cannabis has pretty awful side-effects for me. It gives me absolutely incredible nausea, to the point where I've tried it ~10 times in varying doses, thinking my dosage was an issue, and out of those I was violently ill 4 of the times. The other 6 times were simply unenjoyable. It doesn't just go away like alcohol either. If I drink too much and throw up, I feel better within a few minutes. For cannabis I remain high…

I am not sure you actually had just Cannabis if you had those symptoms. Was this at some legal location with a proven supply chain?

PS: Not to defend Cannabis, it can trigger Heart Attacks and is associated with a host of Lung issues. I just never heard of those symptoms.

Post reply on HN