Opioids are among the best medications for treating severe pain. If we're focusing on patients I'd much rather focus on rehabilitative strategies since the current degree of increased scrutiny is already making accessing adequate medication more difficult for groups like the elderly or people with chronic pain. Even more increased oversight is just going to escalate hesitation among doctors.
Do you feel like chronic pain patients outside the US don't get adequate treatment? Because where I live opioids are prescribed much less frequently, but I don't think chronic pain patients suffer more than in the US.
I wonder where most of the harm is coming from with opioids. Do the opioids themselves cause more harm than society does by making them illegal?
The cases I've mostly heard about seemed to be that people hot addicted to opioids and the only way to keep it going was to break the law. That eventually got them in trouble. For some drugs it does seem like the government trying to protect you from the drugs do more harm than what the drugs themselves do. Are opioids among them?
Prof Nutt made and published a universal harm scale which accounts for multi dimensional harm of drugs, and potentially allows comparisons to be made between them https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6109763/#B29. This work got him sacked from his lead advisory role to the UK govt, as it undermined the policy and caused embarrassment. Nutt still works in Imperial College researching psychedelics as novel therapeutics.
The money shot is this https://www.researchgate.net/figure/Overall-weighted-scores-...
Wow this is awesome. I’ve pondered the need for exactly this sort of thing for a while as the obvious desired basis for drug policy. Shouldn’t be surprised the Nutt has done it!
Obviously it’s lossy to reduce something with this much complexity down to a single dimension but it’s still a helpful tool nonetheless.
In the past, I've tried a lot of recreational drugs, including some opioids, and without trying to, I can't see how I could get myself addicted to opioids or benzodiazepines, but I know a LOT of people would.
As far as I remember, only 10% of people who ever used heroin get addicted to it.
But that still leaves 10% at a very high risk, because of their neurochemistry and life circumstances.
> 1. Opioids are very good analgesics for acute pain and for pain at the end of life but there is little evidence that they are helpful for long term pain.
> 2. A small proportion of people may obtain good pain relief with opioids in the long-term if the dose can be kept low and especially if their use is intermittent (however it is difficult to identify these people at the point of opioid initiation).
> 3. The risk of harm increases substantially at doses above an oral morphine equivalent of 120mg/day, but there is no increased benefit: tapering or stopping high dose opioids needs careful planning and collaboration.
> 4. If a patient has pain that remains severe despite opioid treatment it means they are not working and should be stopped, even if no other treatment is available.
> 5. Chronic pain is very complex and if patients have refractory and disabling symptoms, particularly if they are on high opioid doses, a very detailed assessment of the many emotional influences on their pain experience is essential.
Especially as it is prescribed in the US, where drugs get preferred instead of other interventions. "Back pain? Opioids. No PT, no losing weight, just opioids. No, not even NSAIDS, just go for opioids"
Remember that some drug companies pushed for their medication to be in 12h regimens which increased their dependency potential, as opposed to a shorter interval preferred by doctors?
As a personal experience, opioids don't seem to work much for me on many types of pain.
Check out therapies targeting sodium channels. I found out through my wife that her company (a major pharma corp) is working on therapeutics that can block voltage to certain sodium channels in the brain to suppress pain.
Opioids don't aid in recovery though--they're not a band-aid, they're simply a veneer. They can prevent recovery since they delays][ physical rehabilitation. I honestly think cannabis is a much better solution long-term, but good luck transitioning an opiate user to cannabis.
Not being in crippling pain is usually considered a good thing. Sure, some things like a broken arm can probably get by with weed and yes some people respond exceptionally well to weed but there is a night and day difference between the two when it comes to treating most forms of severe pain such as what people with significant spinal trauma experience or what the elderly often (for any number of reasons ultimately relating to age) experience.
I agree (it's meaningless though, I'm just pointing out the obvious above, I'm not an expert here) for acute injury it makes sense to use opioids in severe cases like you mention, however, I think we still need to find the best strains and cultivate them for pain use, we've only scratched the surface with cannabis, it's a big genus. Weed ain't what it used to be.
For chronic cases, I think chronic makes a lot of sense.
Pain helps you get moving. Opioid's don't. Too much pain is debilitating. Surely we can find a formula here (a very very large one).
Cannabis never removes all the pain. I think that's the main feature here.
Young people just make secret accounts and don't tell their parents. My younger brother is 15 and reports him and his peers are on both Snapchat and Instagram in addition to the usual suspects like Twitch, Tiktok, and Discord. The main reason I've heard for not using Facebook is largely that it's redundant when Instagram provides most of the same features in a slicker package. A lot of fb features like the event planning and facebook market aren't relevant to them yet.
