This doesn't explain why people turn specifically to opiates and not to booze or weed.
A recent article suggested that Purdue Pharmaceuticals dosing guidelines pretty much guaranteed addiction to OxyContin, by advising doctors to only ever prescribe the drug at 12 hour intervals despite the fact that it wore off more quickly for a large number of patients.
When patients complained about the drug wearing off early, Doctors were advised to not adjust the schedule but instead increase the dosage.
The pain-pleasure-reward cycle when the drug wears off early is what creates the physical addiction, and increasing the dosage only made it worse.
Purdue insisted on a 12 hour schedule because that is the marketing differentiater between OxyContin and generic opiates.
Moreover, certain types of marijuana do a superlative good job of providing non-opiod relief from chronic pain and aren't psychoactive, so in the same way you or a co-worker might have some Tylenol if they're feeling physical pain while at the office, you or a co-worker could use marijuana to manage chronic pain, without their mental state being noticably altered.
That's not to say marijuana cannot be abused nor is it a silver bullet, but in the middle of an opioid epidemic, holy shit, maybe something many people are illegally using to manage chronic pain without causing an epidemic; maybe it might be worth studying? The vast majority of users continue to be productive members of society; judging by the number of states that have legalized marijuana, we should be in the middle of a marijuana crisis compared to opioids, yet no such crisis exists. Yet the DEA classifies marijuana as having zero medical benefit, which makes it almost impossible, practically speaking, to study properly.
Some places people seem to turn to opiates. Some places it's speed. Some places it's alcohol.
Quite what results in a given area having a given addiction of choice I'm not sure, but it can definitely vary over time - some parts of britain had a generational thing where the older addicts were all alcoholics and the younger ones were all on heroin, but my father (who worked in probation) said that among his clients other than the choice of substance affecting what sort of physical damage they suffered the rest of the issues were basically identical.
Surely the doctor is responsible for determining the dose and frequency. I have personal experience of this and when the OxyContin and OxyCodone regime was found to be inadequate the patient was kept in hospital for three nights while they tried different drugs etc. and then settled on a Fentanyl patch as the principal pain reliever with OxyContin to be taken as required by the patient. This turned a nightmare into a managable situation with Oxy taken relatively rarely except for the few days immediately following chemotherapy.
My point is that the doctors and the health system are responsible and should not take any drug company instructions as gospel.
This was almost my own reaction. I don't know how time and time again, blame goes everywhere but the providers and the system in place that ensures their almost sole authority.
It's puzzling to me how drug regulation persists in the face of examples like we have. The argument goes "oh, we need gatekeepers to protect citizen safety." But then these gatekeepers proceed to prohibit marijuana as a dangerous substance unsafe for any use, which is absurd, before turning around to recklessly prescribe oxycontin. How is the current prescribing monopoly / regulation regime really keeping people safe? To me, it's only resulted in lack of competition in health care provision, a militaristic police force, a lack of hemp, and an epidemic of narcotic addiction that benefits doctors and hospitals. A physician-police-industrial complex.
If anything, it increases the dangers, because it creates the illusion of safety and shifts responsibility onto a concentrated authority, who has their own agenda and interests that do not necessarily align with the long-term best interests of the citizen in need.
>Purdue has known about the problem for decades. Even before OxyContin went on the market, clinical trials showed many patients weren’t getting 12 hours of relief. Since the drug’s debut in 1996, the company has been confronted with additional evidence, including complaints from doctors, reports from its own sales reps and independent research.
Someone involved in this is getting shot into the Sun, right?
> This doesn't explain why people turn specifically to opiates and not to booze or weed.
I think this is just because they are being prescribed more frequently. Unhappy people with no opiate experience aren't just going out on the street and buying heroin, but unhappy people who are prescribed opiates may become addicted. The argument the article is making is that happy people who are prescribed opiates don't become addicted, and that it makes more sense to treat the unhappiness than to restrict opiate prescriptions.
Wow I feel lucky in a way that my nausea and lightheadedness was so bad when taking oxy that I decided to just take the pain than continue with the liver damage.
its mainly the acetaminophen (tylenol) that its cut with that would damage your liver the most. when people overdose on oxy, the biggest concern is the tylenol.
I'm not saying its great on the liver, but under normal dosage and (provided you dont have liver disease) its safe. about as safe as having a few beers at the bar at least.
The alcoholics I've known have all had underlying emotional problems. One can't get over the business partner who left him holding the bag - it cost hundreds of thousands of dollars for him to get the bank to leave him alone.
Another couldn't deal with her marriage falling apart. Prison also didn't help her learn how to better deal with life.
I believe the third was turned into an alcoholic by methadone. The etiology of this one's addictions is fascinating, but I think the main consideration is the lack of stability growing up. Money was never a problem, but her family life during childhood and teenage years was ... sub-optimal.
Emotionally-stable people tend to not become addicted to alcohol, heroin, cocaine, etc. I've met former cocaine users whose attitude is "been there, done that, no need to use again." That's kind of my attitude about alcohol - I don't care for it at all, no matter the price.
A wise woman once said, "... When a person feels safe, the false ego goes away." Helping people feel safe should be the #1 priority of every effort to help someone with substance abuse problems.
You're absolutely right. Good emotional state is probably the key factor in combating addiction. Yet it's important to remember that there exist other factors at play in addiction, and that we should target them too. For instance, addiction to alcohol seems to have some genetic factors. In some genetic lines, almost every person with a low emotional state might be at huge risk for addiction. And in others, almost no one might be at risk. We need to also understand why that is, and combat that, too.
> Helping people feel safe should be the #1 priority of every effort to help someone with substance abuse problems.
Exactly this thought. I've helped a lot of kids over the year through abusive homes and the greatest thing you can give them is the feeling of safety above all else. This isn't necessarily helicopter parenting, but it's attentive to the needs to help them feel like they can fail without losing the essential securities of life.
I cannot recommend mindfulness meditation (or yoga, or deep breathing,...) enough for this - it brings a feeling of safety automatically (seems to have to do with meditation reducing amygdala responses; I read something about taking 8 weeks to produce a lasting effect).
> What do you mean they were turned into alcoholic by methadone?
Of the three alcoholics I mentioned, only one was (possibly/probably) triggered by methadone maintenance therapy.
Methadone is well-known to cause sugar cravings. This one started drinking heavily after about a month of methadone. She justified this as 'okay' because she wasn't driving.
Alcohol is just another form of fuel (derived from carbohydrates) for the body to burn. The alcoholic brain preferentially burns acetate (one of the breakdown products of ethanol):
> Gin is legal today, and it is not causing social collapse.
Gin isn't legal the way it was back then. It's only sold in stores and places with liquor licenses, it's heavily taxed, and there are all sorts of rules surrounding it. If in we had gin carts every twenty feet hawking it at kids and the homeless and it only cost a few cents per shot, I'm sure we'd have all the same problems.
Over here in Europe (at least in Germany) you can buy as much Gin as you like in every supermarket - if you're over 18. I don't know if we have higher alcohol abuse numbers than countries with stricter laws but I doubt it. Does anyone have internationally comparable numbers?
EDIT: forgot: it's very cheap. If I remember correctly, you can get a one litre bottle for < 10 EUR - certainly not the best there is but "good enough" to get drunk as f* - even with little or no money
Children and youth is a key part of the GP, the younger you are addicted to something the worse off you are in terms of quitting and the more damage it's doing. Drugs with significant brain damage accompanying heavy use (like alcohol) are also going to double-fuck you by adding the bonus challenge of doing so with lower IQ, executive control, etc.
I wouldn't drink the stuff today, but in college I remember we were buying Mr Boston and Zhenka vodka for about $8 per 1.75l. That's pretty close to a few cents a shot.
People did tend to look a little like Hogarths Gin Street on Saturday and Sunday mornings.
Speaking as a alcoholic with some sobriety, those laws were little more than a speed bump when I was drinking. I drank as both a child and a homeless guy with little problem.
I'm not saying those laws shouldn't exist, but they serve as a source of revenue, not as something that protects the public.
Alcoholism requires some sort of emotional trauma or personality disorder to be present in order to manifest itself. Alcoholics are self-medicating for mental issues that could be solved by therapy or other interventions. The availability of alcohol and other drugs is not the driving factor behind addiction.
I literally have struggled to come up with an appropriate question that addresses the several different misconceptions about your statement, so I'll just go with this: what?
How is anything you stated remotely analogous to what is in the article.
It's the economy stupid. Americans have nothing in their lives but their jobs. Take those away and they start self-medicating. Well that's my pet theory any way. Also have to consider the demographic most affected by job loss.
Why not weed or alcohol? Because opiates produce a high and make you feel good. Much like work might, if you had it.
Jobs are just a manifestation of a deeper problem. The truth is, the pace of change is too fast for society at large. It has eroded our traditions and ideas about life, and we have yet to rebuild them.
I agree with this statement. Especially if you look over a few thousand year timeline. Of course, the rate of technology has accelerated but also some of the earlier changes have been normalized though we still reel from them. Even the sense of community has been completely redefined (or minimized) by technology today, or the concept of society being focus on nuclear family only. Some are a direct result of technology, but some changes, like the concept of leisure time, come indirectly as we restructure our lives around this technology (capitalism and the industrial revolution).
Compare this to where we were 2,000 years ago or 10,000 years ago.
Probably. I suspect it is not a simple one but look at alcohol consumption patterns in Russia. On the other hand there are plenty of poor people in other countries who do not drink so there are probably cultural and climate influences too.
Going off tangent, visiting a friend who has a TV I could not help noticing roughly 2/3 of ads are for drugs, sometimes there was a full block filled with them.
The other 1/3 seem to be malpractice lawyers and sugar products... unless you included the sugar in the drugs category. This is why I watch sports on pirate feeds, the repetitive, inane ads replaced by a static image and bad(not worse) muzak.
Excerpt: Doctors in many parts of the world — including Canada and some European countries — prescribe more powerful opiates than their peers in the United States. In England, if, say, you get hit by a car, you may be given diamorphine (the medical name for heroin) to manage your pain. Some people take it for long periods. If what we’ve been told is right, they should become addicted in huge numbers.
But this doesn’t occur. The Canadian physician Gabor Maté argues in his book “In the Realm of Hungry Ghosts” that studies examining the medicinal use of narcotics for pain relief find no significant risk of addiction. I’ve talked with doctors in Canada and Europe about this very issue. They say it’s vanishingly rare for a patient given diamorphine or a comparably strong painkiller in a hospital setting to develop an addiction.
Diamorphine is given IV/IM/SC - not orally - which generally means that its use is confined to a short period in the first few hours/days of a hospital admission until the patient can be switched to oral medication. Noone is sent home with diamorphine unless they are end stage palliative and they are on a home syringe driver to get it.
OTOH oxycodone is almost always orally administered which means patients stay on it for longer in hospital and are commonly discharged with a prescription for more.
The doctors I work with who have done fellowships in USA state that oxycodone is (?was) given out like lollywater compared to hospitals here, where it is only prescribed if the patient has a REALLY good reason they can't have oral morphine.
Drug wholesalers shipped 780 million prescription painkillers to West Virginia over a six-year period.
In a state of 1.84 million residents, the shipments amount to 433 pain pills for every man, woman and child in West Virginia.
Although tablet formulations of diamorph also exist
>The doctors I work with who have done fellowships in USA state that oxycodone is (?was) given out like lollywater compared to hospitals here, where it is only prescribed if the patient has a REALLY good reason they can't have oral morphine.
My experience as a medical student on elective in the US was this - I couldn't believe the quantities of opiates prescribed cf. Australia
Patients (and addicts) state there is a particular euphoria that oxycodone has (and diamorph/heroin) that morphine doesn't really have. Of course oral morphine does cause addiction, but oxycodone just seems to have greatly increased rates.
This is an odd question, but for people with chronic and essentially untreatable pains (which is many people, particularly older ones): What is the problem with being addicted to opiates if you are going to take them to manage that pain for the rest of your life anyway? I would want the opiates at that point.
That's not so black and white. They work to some extent as long as dosages don't keep escalating and use is intermittent. Even the link you posted says as much.
I don't understand why "give people with chronic pain rapid access to specialist pain management clinics, rather than just dumping them on ever increasing opioids" is a controversial statement.
I know a chronic pain sufferer and according to her opioids are of short term help but make everything worse in the long run. Unfortunately there are not many ways to treat chronic pain.
From what I've seen most people get started with opiates using them as an instant gratification anti-depressant. For that purpose they are effective for a while until the consequences of addiction start to set in. The worst part of this is in that period before addiction they actually are happier, more outgoing, more fun to be around, etc. So there's a sort of social dependency that goes along with the chemical dependency.
Speaking from personal experience, I completely agree with your comment. Also, I've seen people move from regular opiate use to not even caring about opiates, on account of (what I assume was) their transition from emotional instability to emotional stability. I think that a large part of prescription drug abuse is due to using them, as you said, as an instant gratification anti-depressant.
does that happen with people taking them? i felt when I took oxycodone I wanted to be left alone. it could have also been I was physically unwell, but it felt like the 'wanting to be alone' was a symptom and wasnt in pain
Yes. Depends on a person, like in your case, also depends on dosage and tolerance, but being more outgoing, honest and speaking more is certainly possible as an effect of using opiates.
What opiates do is they simply make you feel good. They give you a feeling of enjoying yourself. They don't make you ecstatic (for most people), but they give you all the pleasant feelings you could get after - for example - running and winning a race, for free. How those feelings affect your actions differs from person to person.
This article is not quantitative or scientific, although I am certain there is some validity to it's claims. Any same person would agree that trying to take these drugs away from addicts will only push them to heroin. However to become addicted one must try a substance, and or medical system has allowed far too many opiates to be sold and facilitated far too many first experiences. To the tune of 4x the number of prescriptions which should exist given US epidemiology.
The interesting question is how you could show rigorously that this type of safety net is effective.
Pharma profits are one of the reasons for the opiate crisis, which results in Heroin addiction in some cases. India is a good model where pharmas don't get a free hand.
Given that the "first story" is thoroughly misrepresented and then the key facts lack important distinctions between short and long term use, I'm going to hazard a guess that the whole of this article is bunk.
The first theory "has been endorsed by some excellent journalists and broadcasters, from Sam Quinones to HBO’s John Oliver", two die-hard liberals, and according to this article it does not make sense; the one that makes sense, though, is the one that says that people living in zones historically neglected by liberals (such as the Rust Belt) "feel more distressed and disconnected".
Drug use is almost entirely victimless. This is well studied, researched, documented.
By definition a victimless crime involves consenting parties with no harm to outside parties. There can be situations where something does impact a non-consenting party, which is when it stops being victimless.
There is often collateral damage among family (children!), friends, and coworkers of addicts. Complications caused by prenatal drug/alcohol use are also well documented.
> By definition a victimless crime involves consenting parties with no harm to outside parties. There can be situations where something does impact a non-consenting party, which is when it stops being victimless.
A recent article suggested that Purdue Pharmaceuticals dosing guidelines pretty much guaranteed addiction to OxyContin, by advising doctors to only ever prescribe the drug at 12 hour intervals despite the fact that it wore off more quickly for a large number of patients.
When patients complained about the drug wearing off early, Doctors were advised to not adjust the schedule but instead increase the dosage.
The pain-pleasure-reward cycle when the drug wears off early is what creates the physical addiction, and increasing the dosage only made it worse.
Purdue insisted on a 12 hour schedule because that is the marketing differentiater between OxyContin and generic opiates.
http://www.latimes.com/projects/oxycontin-part1/