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

OxyContin's 12-hour problem (2016)

latimes.com

Post reply on HN
Print view View original

81–90 of 96 posts

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

#81

Post by sergior »

fb03 wrote: post #15
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?

Overeagerness to prescribe. Other countries have similar problems too. Conversely, the country I live has a benzo problem. Hell, go into any doctor complaining you haven't been sleeping properly and he'll happily prescribe you clonazepam to help you with that. You have just been prescribed an addictive and strong psychoactive drug, just like that. He won't care if you have been working too much, or not eating or slee…

> and from that there's a whole slew of problems

That's the whole point - doctors have more work, so they can ask for more money and pharmaceutical companies make a killing. Doctors are not interested in curing their patients nowadays, they are interested in making money for pharma.

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

#82

Post by marcosdumay »

jschwartzi wrote: post #33
mtdewcmu wrote: post #16

Doctors should be more skeptical of pharma companies' marketing claims, right? Who believes everything they read? There's probably a case to be made that the FDA should have been more involved, too. The data on how fast OC released its drug would have been available to the FDA, if not doctors.

Every time one of these articles comes out, people say that the FDA should have been more involved. Every time we hear about some new drug that Europe, India, or China has that is still being cleared in the US, people say that the FDA needs to step back and let pharma companies innovate. Which is it? I honestly don't think the FDA is culpable in this. They're there to ensure that the manufacturer is meeting a minimum…

The article paints the FDA as very involved with this. To the point it claims the person that approved the drug moved to work in the company shortly after.

Besides, "stepping back and letting pharma companies innovate" is not the same as not participating. The FDA can make drug development cheap by many means, and the required fiscalization or catching that kind of behavior is not done by increasing the weight of the approval process.

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

#83

Post by wayn3 »

brandonmenc wrote: post #39
wayn3 wrote: post #20

Earlier quoted context omitted.

People take painkillers because they can't afford surgery. Say you have a messed up disk in your spine. Surgery is tens of thousands of dollars. Getting a prescription for opioids from a primary care physician is a bit cheaper. You don't see doctors in europe routinely prescribing hard pain killers because they try to fix the problem instead. Healthcare in america is set up in such a way that hospitals just bill what…

> Say you have a messed up disk in your spine. Surgery is tens of thousands of dollars. There are situations where risks from surgery are potentially worse than the (yes, possibly misinformed) side effects of painkillers. Is there any data on this? Anecdotally, I know a few people who are either living with pain or taking medication because surgery is too risky.

I'm not saying that everything has to be surgically repaired. Whatever the surgeons decide to do I'm cool with 99.9% of the time.

Its just that there are people who "should" have surgery who "can't" have it because money.

Another issue is that just because a doctor advises you to take opioids doesn't mean that you're not abusing them. Doctors tell you to do all kinds of things that are bad for you because they are the lesser evil. The prime example being chemotherapy.

The primary use-case of morphine-like substances is to treat acute pain. Taking any kind of opioid for prolonged periods of time leads to systemic adaptation and you end up an "addict".

Is there data on this? Probably. Depends on what you want data for. The fact that america is under-insured when it comes to healthcare is well-established fact.

I don't buy "people take opioids because their lives are lame" - because its bullshit. There are drugs that are way easier to acquire that provide a lot more "fun". You don't start on heroin and then switch to vicodin, either. A heroin addiction is treated with methadone.

If you want a really clean "feel awesome" high, you want a benzodiazepine like Lorazepam. I had a prescription for that once. Popping one of those pills, you smile from ear to ear within seconds and experience pure bliss. If you intentionally try to have negative thoughts, you just laugh harder because it feels so ridiculous. If you wanted to "trick" a doctor into prescribing those, faking the necessary symptoms is really simple.

The drug industry has a pretty good grasp on how to engineer drugs to do one specific thing really well without causing a bunch of secondary effects. Modern painkillers are good at dealing with pain, without turning people into loonies. But opioids are opioids and if you take them indefinitely, you mess with brain chemistry.

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

#84

Post by wayn3 »

hammock wrote: post #79
wayn3 wrote: post #20

Earlier quoted context omitted.

People take painkillers because they can't afford surgery. Say you have a messed up disk in your spine. Surgery is tens of thousands of dollars. Getting a prescription for opioids from a primary care physician is a bit cheaper. You don't see doctors in europe routinely prescribing hard pain killers because they try to fix the problem instead. Healthcare in america is set up in such a way that hospitals just bill what…

People also take painkillers to recover from surgery...That is how many folks get hooked, and in some cases, eventually switch to heroin (because they can't afford the pills off-script at black market prices)

You mean there's a non-trivial number of patients who are prescribed opioids to essentially self-medicate at home because keeping them in the hospital until they're recovered is "too expensive" - who are then told to deal with their addiction themselves because no doctor felt the need to actually guide them through responsibly using their drugs?

Who are THEN told that they just can't get drugs anymore because now they're just filthy addicts. That's actually impressive. For a glorious nation like the united states of america. Borderline malice.

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

#85

Post by fb03 »

tedsanders wrote: post #23
fb03 wrote: post #15

Earlier quoted context omitted.

Overeagerness to prescribe. Other countries have similar problems too. Conversely, the country I live has a benzo problem. Hell, go into any doctor complaining you haven't been sleeping properly and he'll happily prescribe you clonazepam to help you with that. You have just been prescribed an addictive and strong psychoactive drug, just like that. He won't care if you have been working too much, or not eating or slee…

What's the evidence backing the explanation of overeagerness to prescribe? I know a handful of doctors as well as pain patients, but I'm curious to get more context outside of the small bubble I know.

totally anecdotal, yes, but reading several local news articles about the 'benzo epidemic' here I think doctors just don't care. It's easier for them to just walk you out after 3 minutes of consultation instead of trying to solve the puzzle in front of them. It's also more profitable to them as well so you can see how dangerous this can turn for us... doctors aren't exempt from corruption.

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

#86

Post by kuschku »

Spivak wrote: post #19

I'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?

> 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?

Nothing. There are such pills for stuff like Adderall and Ritalin already, on the mass market.

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

#87

Post by acover »

vqc wrote: post #65
acover wrote: post #55

Earlier quoted context omitted.

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.

I meant to insult his definition. Clearly most doctors are sensible. Humans just aren't the rational logicians his standards require.

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

#88

Post by warsharks »

sloppycee wrote: post #47
Spivak wrote: post #19

I'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. The…

in terms of ADHD Vyvanse/Elvanse/Lisdexamphetamine is more interesting in my opinion, its dexamphetamine bound to lysene. your body naturally strips the lysene away releasing the dexamphetamine over a period of 12 hours.

it doesnt rely on being mixed with something to delay its action or be pressed into a solid pill, in fact you can open up the capsules and eat the powder inside and there is no change in its effects (its also ineffective intranasally or as far as i am aware even if injected) its rate of release is difficult to change, its just how long the average body takes to strip the lysene away from the chemical.

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

#89

Post by cgag »

notburnt wrote: post #21
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?

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…

Ive actually seen people take pain killers for being sore from working out as you mentioned. It's mind blowing.

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

#90

Post by cgag »

notburnt wrote: post #21
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?

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…

Ive actually seen people take pain killers for being sore from working out as you mentioned. It's mind blowing.
Post reply on HN