Maybe this will turn into a tobacco moment for the industry.

Of course it will, big pharma has deep pockets. Why go after the doctors prescribing the drugs? They don't have any money.

And in the end what will happen is that people that legitimately need pain killers will be told "sorry, you might get addicted, just tough it out". Not a world I want to live in.

I started encountering many doctors who blanket refuse to prescribe anything addictive, under any circumstances, about 1-2 years ago.

what about stuff like cortisone? It's addictive (you build a tolerance, you have to taper the medicine at the end), but it very far from the issue of heroin.

I am asking in good faith: I used to be prescribed cortisone, and managing the end of the treatment was a pain, I just decided to stop worrying treating my rashes altogether, because that was getting ridiculous. I am wondering if some doctors also threw the towel on that one.

Under what context, can you say? I assume not all your own doctors, etc.

exactly. This has already happened to me. I had surgery and was sent home for several days of agonizing pain with "extra strength tylenol." I was informed that it was now hospital policy not to prescribe take-home opioids due to the "opioid epidemic." ftr I have never had a problem with opiates before, and I've had them in the past when I broke my arm, and when I had my wisdom teeth removed.

I believe the solution to this isn't "let more people have opioids", it's very hard to determine abuse, and requires monitoring. Reducing the number to monitor is one way increasing safety. Long term I believe the solution will move to "let's find a safer alternative to opioids".

Based on research canibis is promising http://jamanetwork.com/journals/jamainternalmedicine/fullart... With a 25% reduction in opioid abuse by allowing patients access (not necessarily prescribing).

Kratom is an even better candidate in my opinion. It works very well for pain management and anxiety relief, and it’s both less dangerous (e.g., no respiratory depression) and less addictive (although still certainly habit-forming) than synthetic opiates. People use it to help kick addiction to opiates because it contains mild opioid receptor agonists. The DEA considered banning it late last year, but there was considerable backlash, and I doubt the new administration is going to move on it for a while.

Kratom is saving lives. When Alabama banned it, opiate overdose deaths shot up 30% (no pun intended). It really is one of the premier solutions to the country's opiate epidemic.

Yup. It’s been a massive help to me for managing anxiety, insomnia, some minor chronic pain, and a predisposition to alcohol abuse. It’s not a wonder-drug but it comes about as close as I personally could ask for.

This is exactly the same situation I am in. I found kratom in 2010 while looking for some solution to my back pain and arthritis which wasn't also a recreational drug. It ended up helping me with anxiety and depression associated with PTSD, chronic pain, and even helped me stop drinking altogether. I felt like marijuana was a pretty amazing thing before, but it isn't even on the same planet as kratom.

You're not going to get addicted from one prescription to manage short-term pain for a few days, e.g. wisdom teeth or surgery recovery.

The people who got addicted, and the subject of the lawsuit, were prescribed opioids for long-term pain management. Of course you're going to get addicted if you take them every day for weeks or months. It's the nature of the drug, and the drug companies are being sued because the purposefully downplayed that.

Out of curiosity, was the wisdom teeth removal an especially complex operation? My last wisdom tooth removal took 20 minutes for the whole visit, after which the dentist neither prescribed any painkillers whatsoever nor did I get a day off from work.

Many wisdom teeth removals involve "digging them out" where the gums need to be cut open and stitched back together. I was put under general anesthesia and given Oxycodone for a few days, and was very glad to have it because it hurt like hell.

If the teeth have come in enough though, they can be treated like regular extractions. They are still painful, but generally much less invasive / potentially complicated.

Yep, this is exactly what happened to me.

Or they will get properly informed of the risks and have their dosages monitored by a doctor who is properly informed of the risks.

Instead of getting handed opiates like they are harmless because the doctors believed the drug companies who tried to pass them off as safe for unmonitored use.

It's not mentioned in the article, but were the people who are addicted initially prescribed opioids for pain relief? Or did they initially try them recreationally?

I read that the amounts recommended by producers are often such that the effect reliably wears off before the next dose is due. This is a sure way to form an addiction.

Re: How this forms addiction - the levels prescribed are for a 12 hour period, but since the drug only lasts 8 hours, a patient is getting a dose above the recommended level that it should last.

Marketed: 120mg over 12 hours or 80mg over 8 hours

Reality: People that take the 120mg over 12 hours realize it only lasts 8 hours thus they are taking 40mg more than they should be on the schedule that makes sense to them to avoid pain.

Well, the reality seems to be even worse.

Rather than taking 40mg at the end of the day, the drugs companies caution doctors to prescribe more medication initially rather than give any indication that the drug only lasts for 8 hours.

They care more about their approach to marketing, than the efficacy of the prescription schedule.

It's this that creates addicts: the extreme high of the unneeded extra initial dosage, followed by a lower low when the drug runs out.

What nine_k meant is that 120mg is too much, so the person gets a tiny buzz at first. But instead of acclimating with a consistent dose as you suggested, they wait 12 hours until the drug has worn off, causing a crash. Then they repeat the high/low cycle, causing an addiction.

why would that form an addiction?

Psychologically. Instead of constantly feeling okay (the pain is gone, you keep getting a prescribed amount and no more), you are reminded every few hours that with the drug the life is good, and without it the life is miserable. But you cannot alleviate the pain unless you break the rules (the prescription).

Once the prescribed regime is broken, and the psychological restraint is broken, too, there's little left to stop the usage from spiraling up, to an overdose.

because you experience repeated cycles of pain, take pills, then relief, then pain, take pills, then relief.

Yes, very much so. It's resulted in a multi-fold increase in opioid addiction and consequently opioid deaths in the US over the last about 15 years or so. The general trajectory is: person gets prescribed opioids for pain, person's life falls apart due to addiction or they hit some hiccup that causes them to lose their health insurance, then they traverse a downward spiral as they become unable to hold a job and switch to heroin (same fix, easier to get), and because heroin doesn't have consistent dosing the chance of OD'ing is much higher.

Remember 9/11? Imagine that many people dying from a preventable tragedy every 4 weeks in the US. Because that's what happened in 2016 with opioid addiction.

If drugs are over prescribed in such a number that mass diversion is possible, does it matter? This is more than stealing from grandmas pill bottle, the drug companies knew how many pills they were selling to pill mills for example.

This is exactly it, and people who are complaining about access are missing the point. There is absolutely no way you can count the cash you make from the volume of these pills and think "this is roughly in proportion to the number of people dying of stomach cancer".

It's a serious problem that is killing people, and it's worth taking a shot at without being shouted down every time by someone who thinks you're trying to take their pills away.

There's this weird thing in the US where ads can say "ask you doctor for <drug brand>".

That's incredibly stupid and illegal in all but one other country in the world.

asking your doctor for oxycodone, even in the US, is a very easy way to be shown the door

Perfectly legal in Canada. Don't be hyperbolic, it doesn't help anything.

Hyperbole?

My apologies if I was wrong. I believe I got it from the nytimes article on the topic published a few months ago.

Would you care to update Wikipedia (and cite your source)? They only list the US, NZ, and Brazil.

https://www.nytimes.com/2016/02/28/sunday-review/ask-your-do... https://en.wikipedia.org/wiki/Direct-to-consumer_advertising