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