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The_Book_Of_Harry posted:Iatrogenic addiction is more rare than folks might think. Overprescription led to diversion, however, and this gave rise to a massive epidemic. Yeah, a whole lot of people get given opiates at some point but only a small subset become addicts. About 10% of the population is addicted to drugs/alcohol and this is pretty consistent between races, regions, etc. and probably reflects a specific predisposition to addiction that exists in the population as a trait or brain type. You even hear about cross-activation, such as a different drug of abuse triggering relapses into the original drug. The opiate epidemic is also probably covering up an enormous benzo epidemic too...
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Mar 28, 2018 05:46
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I'm pretty sure Marx and Zizek wrong and the opium of the masses is heroin. Or a cheaper, more potent analogue like fentanyl
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Mar 28, 2018 05:53
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OXBALLS DOT COM posted:Yeah, a whole lot of people get given opiates at some point but only a small subset become addicts. About 10% of the population is addicted to drugs/alcohol and this is pretty consistent between races, regions, etc. and probably reflects a specific predisposition to addiction that exists in the population as a trait or brain type. You even hear about cross-activation, such as a different drug of abuse triggering relapses into the original drug. Based off my subjective personal experience, I feel like being exposed to opiates medically more frequently increases the chance of becoming an addict. I've always had a strong tendency to enjoy opiates, but the first couple times I was briefly prescribed them for stuff like surgeries the experience just sort of faded into my memory and didn't "stick" psychologically. But later on I was prescribed a significant amount of tramadol for back pain (that in retrospect really didn't need opioids or whatever pseudo-opioid thing tramadol is; gabapentin probably would have sufficed), and having that extended access for several weeks sort of ingrained the nature of the experience and how much I enjoyed the feeling in my mind and ended up leading to me seeking "grey market" opioids in the future (specifically poppy pod tea and kratom). I feel like, in the grand scheme of things, there isn't a whole lot that can be done to completely "cure" more serious/longer-term addicts, but there are at least measures that can be taken to give them a better quality of life (like in my case suboxone maintenance). And there'll be some people who, for whatever reason, are capable of becoming completely clean, and access to therapy and other support can help get them there.
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Mar 28, 2018 06:02
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pangstrom posted:Medicare is going to start limiting opiate prescriptions. My gist is: good for slowing creation of new addicts, bad for some current addicts. My gist, based on changes to benzo prescribing - it will have no impact: quote:In this issue, Ong and colleagues report on the effects of a 2006 Medicare ban on benzodiazepines for enrollees with Medicare Part D coverage. The ban was originally expected to save costs and reduce adverse drug effects. The authors found decreased benzodiazepine use but no reduction in adverse effects of the drug, and they report that overall costs for psychotropic medications increased. https://ps.psychiatryonline.org/doi/full/10.1176/appi.ps.20120p627 pangstrom posted:That 2008 meta-analysis been posted before and I said I would critique it but haven't got around to it because I haven't forgotten. Personally I think supply side drug policy has reached the limit of it's effectiveness. Time to stop worrying about supply and start thinking about other ways to reduce harm. My father has cancer and has Endone, fentanyl and Ordine for pain relief. Tons of it. He took it a few times and said it made him constipated so he'd rather suffer through the pain. Highly addictive my rear end. Still, if my brother got a hold of it (heavy user of street drugs) he'd probably kill himself... at least I could blame 'over-prescribing' doctors I guess. As long as he has some supervised place to use it (so he didn't die) I wouldn't care about him getting into it though. I mean sure, it'd be better if he quit taking street drugs but I'd be kidding myself if I thought there was some way of persuading him to stop. KingEup fucked around with this message at 06:38 on Mar 28, 2018 |
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Mar 28, 2018 06:21
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Despite how it's marketed, gabapentin is also addictive and abusable.
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Mar 28, 2018 06:47
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OXBALLS DOT COM posted:Despite how it's marketed, gabapentin is also addictive and abusable. So are carrots: https://www.ncbi.nlm.nih.gov/pubmed/8902181 Edit: and toilet cakes: https://journals.lww.com/journaladdictionmedicine/Abstract/2014/11000/_Toilet_Cake__Encephalopathy.13.aspx (even without marketing) KingEup fucked around with this message at 07:46 on Mar 28, 2018 |
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Mar 28, 2018 07:40
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everyones so focused on fent they cant even see the metopon
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Mar 28, 2018 11:19
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KingEup posted:My gist, based on changes to benzo prescribing - it will have no impact: Yeah, I got fentanyl during a surgery, and although I didn’t feel a goddamn thing pain-wise, it made me feel awful and the side effects were terrible. My first thought was “how the gently caress is this addictive?” but then my second thought was “imagine how bad the physical addiction must be if this is preferable.” That’s what convinced me that life must be absolutely hellish for opiate addicts, where that feeling is better than the alternative. If you told me I could safely use alcohol and tobacco with zero health risk, I’d smoke two packs a day and binge drink any time it wouldn’t interfere with work. If you told me I could have clean, legal opiates with zero risk, I’d still not touch that stuff.
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Mar 28, 2018 13:25
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PT6A posted:Yeah, I got fentanyl during a surgery, and although I didn’t feel a goddamn thing pain-wise, it made me feel awful and the side effects were terrible. My first thought was “how the gently caress is this addictive?” but then my second thought was “imagine how bad the physical addiction must be if this is preferable.” That’s what convinced me that life must be absolutely hellish for opiate addicts, where that feeling is better than the alternative. Might explain it: http://anesthesiology.pubs.asahq.org/article.aspx?articleid=1933704
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Mar 28, 2018 14:13
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PT6A posted:Yeah, I got fentanyl during a surgery, and although I didn’t feel a goddamn thing pain-wise, it made me feel awful and the side effects were terrible. My first thought was “how the gently caress is this addictive?” but then my second thought was “imagine how bad the physical addiction must be if this is preferable.” That’s what convinced me that life must be absolutely hellish for opiate addicts, where that feeling is better than the alternative. That's why they talk about an addictive tendency. People who are predisposed to opiate addiction experience opiods differently. Normal people take opioids and feel sick and don't like it. A lot of addicts talk about how they first took opiates and felt great - a lot of them talk about feeling a rush of energy and feeling energized when they use instead of groggy and crappy like most people.
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Mar 28, 2018 14:20
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My sister keeps sending me stuff like this and is sold on FentDeath not being a problem. It’s infuriating b/c she is a medical advocate. https://www.painnewsnetwork.org/stories/2018/3/21/cdc-admits-rx-opioid-deaths-significantly-inflated Junkiebev fucked around with this message at 14:46 on Mar 28, 2018 |
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Mar 28, 2018 14:39
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Junkiebev posted:My sister keeps sending me stuff like this and is sold on FentDeath not being a problem. It’s infuriating b/c she is a medical advocate. In an editorial appearing in the American Journal of Public Health, four researchers in the CDC’s Division of Unintentional Injury Prevention say many overdoses involving illicit fentanyl and other synthetic black market opioids have been erroneously counted as prescription drug deaths. Thia is probably true, though. Almost all of that fentanyl is Chinese black market powders not a prescribed drug.
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Mar 28, 2018 14:51
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I agree but the conclusions drawn by that article are pretty gross: deaths don't really count if the victims bought stepped-on product from a drug dealer, had other drugs in their system, or used Fent/any synthetic opioid.
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Mar 28, 2018 14:55
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Junkiebev posted:I agree but the conclusions drawn by that article are pretty gross: deaths don't really count if the victims bought stepped-on product from a drug dealer, had other drugs in their system, or used Fent/any synthetic opioid. That's not what they say at all: quote:To be clear, one overdose is too many. But if we are ever going to find real solutions to the overdose crisis, we need to find accurate numbers to reflect what is causing so many drug deaths. Pinning the blame on prescription opioids, pain patients and prescribers has only led to a growing catastrophe in pain care – where doctors are too fearful to prescribe opioids and patients can’t get treatment.
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Mar 28, 2018 14:58
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OXBALLS DOT COM posted:That's not what they say at all: Exactly. The fact that they mask solutions is exactly why people contiue to wrongly believe that the deaths can be stopped using a law enforcement led supply reduction based approach. People are dying because society refuses to accept that people have and will always have different drug preferences. This denial has manifested itself in laws that make it a crime to actually take some precautions like being able to inject it the presence of medical staff so you don't die or get your powder tested so you don't accidently snort a line of fentanyl that you thought was cocaine. KingEup fucked around with this message at 15:08 on Mar 28, 2018 |
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Mar 28, 2018 15:03
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Was there ever a good summary of the extent to which the "pain as vital sign" groups were astroturfed, if at all? There was a lot of talk about it and it made sense, but I can also imagine those things pretty much running themselves when you have a huge population of extremely motivated people in pain and/or addicted to opiates. Purdue supposedly funded the American Academy of Pain Management and the American Pain Society, and I know Dr. Portenoy story, but I haven't seen a good summary.
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Mar 28, 2018 15:12
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KingEup posted:FYI Slavoj Žižek has a take on the opioid crisis: https://health.spectator.co.uk/trump-wants-to-end-the-opioid-crisis-but-what-if-he-is-himself-its-prime-symptom/
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Mar 28, 2018 15:41
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OXBALLS DOT COM posted:Despite how it's marketed, gabapentin is also addictive and abusable. Not in the same way as opioids. Gabapentin doesn't really product any sort of psychotropic effect after the first couple times you take it (and even then it just makes you feel sorta floaty), and while discontinuation symptoms exist they aren't any greater than those from an SSRI or something and are completely management. Anything can be psychologically addictive, but gabapentin is probably lower risk than most things and doesn't really have any potential to escape to the point where it could cause health problems (gabapentin in particular, compared with lyrica or something, has quickly diminishing returns from higher doses). It's a good option for someone who isn't getting any help from stuff like NSAIDs but doesn't want to take opiates. PT6A posted:Yeah, I got fentanyl during a surgery, and although I didn’t feel a goddamn thing pain-wise, it made me feel awful and the side effects were terrible. My first thought was “how the gently caress is this addictive?” but then my second thought was “imagine how bad the physical addiction must be if this is preferable.” That’s what convinced me that life must be absolutely hellish for opiate addicts, where that feeling is better than the alternative. There seems to be a dramatic difference between the way certain individual react to opiates. Some people get nausea, for example, while I (and most other addicts I've met) have never remotely exhibited that side effect. I've never taken fentanyl, but presumably I would react to it similarly to literally every other opioid I've taken. If you're curious, the effect of a moderate dose of opiates for me and most other addicts I've met is virtually identical to the feeling you get after a great work-out, except of varying higher intensity depending upon the dose (which isn't surprising, given the fact the work-out feeling is created by endogenous opioids). I sometimes even refer to exercising as my "gateway drug," because in the couple years prior to using opioids I became addicted to running and exercising because of the feeling it gave me. That's part of what's so dangerous about it; the feeling doesn't involve any sort of "alteration of consciousness"* (I've never liked alcohol or marijuana for this reason), so you can function just fine while experiencing it, at least if you have the biological affinity most addicts likely have. It doesn't make us sleepy in normal doses, and actually has an opposite effect. If you've ever taken a stimulant, like adderall or ritalin, as a person without ADD, it's kinda similar to that feeling except without the "abnormal" level of energy or subsequent crash. * Unless you take such a high dose you're "nodding," which is something I never enjoyed. I've also only ever done oral opioids, so I can't speak to the "rush" you apparently get from injecting. edit: Another thing to keep in mind is that part of the reason addictions usually escalate is that it takes a while for withdrawal to become so bad it's intolerable. This means that, at first, you experience mild withdrawal and think "eh, this kinda sucks but it's not so bad, and the upsides outweigh the downsides." If you google opiate withdrawal, for example, you'll find a bunch of people recommending exercising as a way to cope with it. These people are all experiencing extremely mild opiate withdrawal, but they don't know any better because serious opiate withdrawal is basically outside the scope of normal human experience and not something you can really imagine without having experienced it. But by the time it becomes that bad, it's already too late and quitting has already becoming an almost insurmountable challenge. Ytlaya fucked around with this message at 21:09 on Mar 28, 2018 |
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Mar 28, 2018 21:01
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KingEup posted:FYI Slavoj Žižek has a take on the opioid crisis: https://health.spectator.co.uk/trump-wants-to-end-the-opioid-crisis-but-what-if-he-is-himself-its-prime-symptom/ What a bloviating nincompoop (non compos mentis) as the tedious jerk would likely supplant into his wordshitting. The American people wove the prerequisites for urgent disassociation into our lives' fabric decades (centuries?) ago. gently caress Trump, fine. But that piece hurts anyone serious about real change.
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Mar 29, 2018 00:41
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pangstrom posted:Was there ever a good summary of the extent to which the "pain as vital sign" groups were astroturfed, if at all? There was a lot of talk about it and it made sense, but I can also imagine those things pretty much running themselves when you have a huge population of extremely motivated people in pain and/or addicted to opiates. Purdue supposedly funded the American Academy of Pain Management and the American Pain Society, and I know Dr. Portenoy story, but I haven't seen a good summary. idk if the pain as a vital sign groups were astroturfed at all. I think it is a legitimately held medical opinion which was likely exploited by Purdue and others. I have seen this article going around which is basically just a record of people who've committed suicide due to their access to opiates, which they required for their severe chronic pain conditions, being suddenly cut off with just a rapid taper because their doctors are afraid of losing their licenses, or people in severe acute pain being denied access to opiates because of ER staff misinterpreting the new CDC guidelines. Article is here if you're curious. It's pretty grim though
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Mar 29, 2018 01:08
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Ytlaya posted:Not in the same way as opioids. Gabapentin doesn't really product any sort of psychotropic effect after the first couple times you take it (and even then it just makes you feel sorta floaty), and while discontinuation symptoms exist they aren't any greater than those from an SSRI or something and are completely management. Anything can be psychologically addictive, but gabapentin is probably lower risk than most things and doesn't really have any potential to escape to the point where it could cause health problems (gabapentin in particular, compared with lyrica or something, has quickly diminishing returns from higher doses). It's a good option for someone who isn't getting any help from stuff like NSAIDs but doesn't want to take opiates. Most abusers as reported are addicts/poly-drug-abusers who take it on top of their heroin, etc., to potentiate the drugs, temporize until they get more H, and bypass some of the blockers. But if you snort big doses it reportedly does produce euphoria on its own too. The mechanism is complex but it still involves the GABA receptors that are more directly targeted by benzos and alcohol. OXBALLS DOT COM fucked around with this message at 02:12 on Mar 29, 2018 |
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Mar 29, 2018 02:09
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The_Book_Of_Harry posted:What a bloviating nincompoop (non compos mentis) as the tedious jerk would likely supplant into his wordshitting. Also yeah that article is an embarrassment and it's basically worthless self-promotion on the backs of actually suffering people which is super gross - even grosser than Zizek normally os
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Mar 29, 2018 02:10
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OXBALLS DOT COM posted:Also yeah that article is an embarrassment and it's basically worthless self-promotion on the backs of actually suffering people which is super gross - even grosser than Zizek normally os Whoa whoa let's not say things we can't take back about how gross Zizek normally isn't just because this article didn't include a video
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Mar 29, 2018 03:00
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OXBALLS DOT COM posted:Most abusers as reported are addicts/poly-drug-abusers who take it on top of their heroin, etc., to potentiate the drugs, temporize until they get more H, and bypass some of the blockers. But if you snort big doses it reportedly does produce euphoria on its own too. Hm, I'm both an opiate addict and have been prescribed gabapentin for a long periods of time, and it does literally nothing remotely recreational after the first couple times you take it and isn't particularly difficult to stop (you just feel vaguely off for a couple days, but nothing that bad). I guess maybe snorting it could do something (since I obviously haven't tried), but given how high gabapentin doses are in milligrams it seems like that would be really difficult (unless it just has radically higher bio-availability when taken that way). It seems like it could be one of those situations where it's just taken by people desperate for some sort of high, and gabapentin's minimal-but-existent noticeable affects allow their minds to fill in the rest as a placebo. It seems like Lyrica would have more abuse potential, since I don't think Lyrica has the same diminishing effects as gabapentin and has the same effects otherwise. All of this being said, I've also never enjoyed the effects of things like alcohol or benzos, so I guess maybe someone who enjoys those might find it more appealing. My dad has had issues with alcoholism and had no problems with taking gabapentin, though. Either way, I guess the greater point is that it's definitely way preferable to opiates as a painkiller if it's sufficient for the individual in question. Some doctors will prescribe tramadol, but tramadol has effects very similar to opioids, so gabapentin is definitely a preferable alternative to that. Pretty much any substance that has literally any psychotropic effect is going to have abuse potential with some people, but I think there's a significance difference between things like gabapentin and stuff that both clearly and obviously produces a positive effect and causes severe physical dependence.
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Mar 29, 2018 03:18
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No seriously opioid dependent individual takes neurontin/gabapentin for fun. [redacted] had hundreds of the drat things that [redacted] couldn't even give away. They are commonly prescribed in conjunction with opioid medicines by many pain management doctors. That said, one may achieve limited relief from withdrawal symptoms by taking gabapentin during dopesickness. I've seen mixed results.
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Mar 29, 2018 04:36
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A Spherical Sponge posted:idk if the pain as a vital sign groups were astroturfed at all. I think it is a legitimately held medical opinion which was likely exploited by Purdue and others. I have seen this article going around which is basically just a record of people who've committed suicide due to their access to opiates, which they required for their severe chronic pain conditions, being suddenly cut off with just a rapid taper because their doctors are afraid of losing their licenses, or people in severe acute pain being denied access to opiates because of ER staff misinterpreting the new CDC guidelines. The American Pain Society, which does receive large amounts of pharmaceutical industry funding, came up with the "fifth vital sign" bullshit. Not coincidentally they started pushing it hard around the time OxyContin came to market. By 2001 the joint commission made sure it was forced down everyone's throats.
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Mar 29, 2018 05:15
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Rhandhali posted:The American Pain Society, which does receive large amounts of pharmaceutical industry funding, came up with the "fifth vital sign" bullshit. Not coincidentally they started pushing it hard around the time OxyContin came to market. By 2001 the joint commission made sure it was forced down everyone's throats. This is an unreasonable standard to hold the American Pain Society to. Nearly all treatment guidelines are written by societies/groups funded by device manufacturers and the pharmaceutical industry. If anything they are kept at further length by pain societies in order to avoid the appearence of impropriety. The reason that joint commision guidelines caused such consternation in the medical community is that it moved the locus of control towards the patient from the traditional paternalistic roots of medicine. It did not prescribe treatments of pain, merely required that pain be monitored and that patients be given the option to manage their pain. The simple fact that patients being given autonomy over their pain control is so controversial is a damning indictment of the medical community as a whole.
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Mar 29, 2018 06:15
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I think they were worried that if patients were given more control, some of them would overtreat their pain or even abuse pain medication.
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Mar 29, 2018 08:10
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Gabapentin 100% is being crushed and snorted for recreational use. We've been seeing a ton of it.
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Mar 29, 2018 08:49
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tetrapyloctomy posted:Gabapentin 100% is being crushed and snorted for recreational use. We've been seeing a ton of it. People are snorting the whole 300mg capsule all at once?
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Mar 29, 2018 09:26
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King Possum III posted:People are snorting the whole 300mg capsule all at once? I haven't bothered to ask whether they're doing 300, 100, or some fraction.
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Mar 29, 2018 10:12
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tetrapyloctomy posted:I haven't bothered to ask whether they're doing 300, 100, or some fraction. i've heard it tastes terrible so i cant imagine it does anything nice to your nose/throat
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Mar 29, 2018 11:06
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Ytlaya posted:Hm, I'm both an opiate addict and have been prescribed gabapentin for a long periods of time, and it does literally nothing remotely recreational after the first couple times you take it and isn't particularly difficult to stop (you just feel vaguely off for a couple days, but nothing that bad). I guess maybe snorting it could do something (since I obviously haven't tried), but given how high gabapentin doses are in milligrams it seems like that would be really difficult (unless it just has radically higher bio-availability when taken that way). It seems like it could be one of those situations where it's just taken by people desperate for some sort of high, and gabapentin's minimal-but-existent noticeable affects allow their minds to fill in the rest as a placebo. It seems like Lyrica would have more abuse potential, since I don't think Lyrica has the same diminishing effects as gabapentin and has the same effects otherwise. There's a reason I avoid opiates and opiodes like the plague. I know what they do to the brain. And I did once, ONCE experience an opiod drug. I was in pain, terrible pain [sorry I'm drunk right now] I can't even remember the organ and I consider that a blessing. But if the pain scale is logarithmic base 4, and breaking a toe is two of ten, then this was a seven, and I cannot speak of a ten]., so I stole the drug from my parents. And it wasn't enough. I took well beyond the prescibed dose. It took well beyond the entire packet. The pain cut through. Like it didn't even notice it. I was well high on Endone, and the pain cut through. The opiod that is Endone helped, but very very little. My first high, it should have been my first high. The thing addicts are always reaching towards. But no, not for me. My first high was during layers of impossible pain that broke me, while I was still able to walk and down another full packet of Endone. And while that was happening I had...it hurt. Whatever I was then, is dead. That's how much it hurt and how much is gone. How much of me is gone. And that's fine. I don't remember. I think I won. I'm less than I was before that happened. Sorry there are legal things and such, but hey, I'm not actually sentient anymore, so if you kill me it's not morally wrong! Also not American so I do not apply to this thread! Wheeee!
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Mar 29, 2018 16:25
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tetrapyloctomy posted:I haven't bothered to ask whether they're doing 300, 100, or some fraction. It’s the 100 mg ones more likely than the 300 mg caps because they’re tablets and easier to crush
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Mar 29, 2018 18:39
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https://twitter.com/latimes/status/979445617801007104?s=19
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Mar 30, 2018 11:54
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Lote posted:It’s the 100 mg ones more likely than the 300 mg caps because they’re tablets and easier to crush It looks like it's 100, 300, and 400 caps, 600 and 800 tabs, and an oral 250 mg / 5 mL solution. There are 50 mg microtabs for veterinary use, though. I'm going to go with "crushing up whatever's available and snorting it." Folks in my catchment area don't seem super-discerning when it comes to drug titration. A huge number of our polysub overdoses never can even tell us what exactly they took, though sometimes they remember the colors of the various pills.
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Mar 30, 2018 12:39
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My girlfriend had major foot surgery last month where they cut and lengthened one of her tendons to fix planar fasciitis along with sawing off an inch of bone in her big toe and rearranging poo poo, bolting it back together with metal plates, to fix her severe bunion problems. She has to get the same surgery done on her other foot next year. She was prescribed 90 Oxys and it really hammers home just how addictive that poo poo is when she was taking them as prescribed by the surgeon for pain and after a week of using them, she had loving withdrawal symptoms. A week of Oxys six times per day to control the pain of having her foot shattered and rebuilt and she got the shakes, sweats, and nausea. loving opiates, ugh. She stopped taking them entirely because of the nausea they caused even when she wasn't withdrawing because she got tired of vomiting profusely and decided the pain was easier to handle than the side effects and withdrawal.
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Apr 19, 2018 21:44
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redosing oxy 6 times a day for a week will absolutely cause problems
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Apr 20, 2018 11:19
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Good piece about pharma sales reps, doctors, opiates (mostly about fentanyl spray Subsys), the law and the various consequences that flow therefrom. https://www.nytimes.com/interactive/2018/05/02/magazine/money-issue-insys-opioids-kickbacks.html
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May 2, 2018 16:56
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I see the thread title has been updated from 2016 to 2018. Has there been any improvements or statistics showing notable trends between addiction rates/opioid prescription/other happenings since then under the Trump administration's proclamation of attacking the opioid epidemic?
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May 11, 2018 01:16
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