Many people kill themselves over chronic untreated or undertreated pain. I've seen studies showing that people with chronic pain kill themselves at twice the rate of those without chronic pain (even that seems low to me) [0] and various other similar studies. Assuming this is true, and that the two are causally related, then opiate deaths and suicide deaths due to chronic pain are in the same order of magnitude.
If you any of you are unfortunate to end up with a condition that causes significant chronic nerve pain, you'll quickly understand how this can be.
0. https://annals.org/aim/fullarticle/2702061/chronic-pain-amon...
My spouse managed to get a medical supply of mj and that has helped her get back into life, given her pain source is from arthritis and a few other issues it'll probably never be a thing she'll be without but the few studies out there on mj have a positive view of long term pain treatment on it.
Chronic pain is a very serious condition that can ruin lives, it is extremely disgusting to see what has happened with Oxy and heavier penalties are needed.
It really depends. Opiates work for some people, with some conditions. People should have the choice, just like with MJ. For me, one opiate worked, and another didn't (and made things worse. it was Oxycontin, incidentally, haven't taken it in many years).
Also, people with chronic pain take opiate breaks for the reasons of tolerance you describe.
And yes, I've heard MJ works for many people (I've never tried it for my conditions, since it's still not legal where I live. Also, I tried it a couple of times in college and hated how it made me feel, no way I could work on MJ). But I'm very happy it works for your spouse and that she's able to obtain it. Chronic pain is brutal. If MJ is ever legalized where I live I might try it just to see if it works.
In the past, throwing opioids at chronic pain patients and calling it a day was par for the course.
Now, there's a level of awareness that not only are opioids not very good for managing chronic pain all of the time, they can even make pain sensitivity worse in the long-run.
Criminalizing pain patients is disgusting, but I'm hoping we can reach an equilibrium where those who have chronic pain are able to seek adequate treatment and opioids aren't the first line of treatment or overprescribed.
As someone with family members suffering from chronic pain, I know several people who have switched to MMJ or CBD supplements with great success. One of them took pain killers for decades and hasn't needed them in years because of CBD.
CBD won't affect you cognitively, if you have the time, money and your doctor thinks it's a good idea, it wouldn't hurt to give it a go.
And yea, Canada is nice like that.
I am curious about your conclusion that "opiate deaths and suicide deaths due to chronic pain are in the same order of magnitude", though. According to my simple Googling, opioids are the cause of death for 21.7 per 100,000 people in the US, while suicide is only 14 per 100,000. So per your link, chronic pain suicide is about 10% of that, or 1.4 per 100,000. That means opioid deaths are about 10-15x more common, or am I missing something?
edit: I'm realizing my understanding of this debate is significantly out-of-date. So I apologize if anything I've written seems tone-deaf, that wasn't my intention.
You say this like it should be taken for granted, but honestly, with the amount of deaths we have from people overdosing on illegal fentanyl, it might be better at this point if we simply gave less-overdose-prone opioids to anyone who was addicted!
The answer is to give people access to better treatment for pain.
That isn't giving them opioids.
They end up addicted to opioids, with a bunch of side-effects caused by opioids, and they're still in pain. Their functioning is decreased.
The point of the article is that it's the other way around -- addiction is defined in a way that includes plenty of non-addicts. It's like the old D.A.R.E. pamphlets that tell you to watch out for teens who are sullen, sleep late, distrust authority, etc.
Of course it exists and makes sense, this was marketed to doctors. They're not dumb. Pseudoaddiction is real and important, which is why it's such a good marketing tool.
It's a really tough problem. That's why I think considering both sides is incredibly important. I'm not trying to bash the article, just provide a different perspective on why pseudoaddiction might have been bashed in the press.
edit: Apparently reading a book doesn't make me an expert! I'm realizing that it's actually pseudoaddiction that's getting bashed right now. Which makes sense, given the context of the article. I was still thinking about it from the lens of opioids being over-prescribed but it seems the pendulum has swung in the other direction. Sorry for muddying the discussion.
Not sure that's obvious, or true. The article itself recounts two situations where the patients denied meds they needed became suicidal, and a third where if the patient hadn't pushed the issue to get his meds (insulin), he would have died.
It's definitely not obvious, because a lot of doctors were convinced to the contrary.
By the way -- I'm not saying those individuals in the article aren't important, but whitewashed "case studies" that are full of snark and biased language and have no sources or timeframes, are not the best sources of evidence. In particular, the "pain management" space is rapidly evolving in the US and without timeframes, many of those anecdotes have negative utility.
I'm not saying "pseudoaddiction" doesn't exist, obviously, but we need statistical arguments that are more nuanced than "does it exist or not."
edit: I'm realizing that my understanding of this debate is out of date. So I'd like to apologize if my stance seems insensitive to what's going on right now w.r.t. opioid prescriptions. My gut feeling is that addiction is a bigger problem, but that varies depending on how freely opioids are prescribed. If opioids are under-prescribed then pseudoaddiction becomes a larger problem, for sure. Being dumb, I just assumed they were still being over-prescribed...
Once again, the number of deaths from prescription opiates is dwarfed by the number of opiate deaths from illegal opiates. There's not even a comparison. And the vast majority of the opiate deaths from illegal substances are from fentanyl and related substances, which are notoriously hard to dose and/or frequently spiked and/or passed off as drugs of lesser potency. Imagine the deaths we could prevent if we (as in Europe) allowed addicts to dose themselves with supervised, clean, hygienic, pharmaceutical-grade heroin while offering them treatment to get off of them if they so desired.
Edit: I looked up current data and it looks like prescription opiates like oxycontin account for about 1/3 of opiates deaths. Maybe not quite "dwarfed" like I claimed above, but a definite minority of opiate deaths are caused by prescription narcotics. And given the current growth rate of deaths from illegal opiates, it could easily be only 10% in the next 1-2 years: https://www.cdc.gov/drugoverdose/epidemic/index.html
A lot of modern economics that justifies endless financial engineering follows this model.
Fuck those doctors. They should have their medical license revoked for being fucking stupid and gullible.
One shouldn't underestimate other factors in opioid prescribing: 1) the idea that pain is the "fifth sign" and should be aggressively treated and 2) that good pain control leads to positive customer experience.
It's not as simple to say "jesus those docs are stupid to believe Purdue". Some maybe are, but most probably never even saw their rep.
His read on this was: doctors by and large knew exactly what they were doing.
Perhaps they were irresponsible. Perhaps they just didn’t want to let people be in pain.
But his take was that laying this on the pharma reps is a silly idea.
Still, you go to conferences and there are often a few Gladwell-caliber speakers at the big ones who get your head bobbing up and down for an hour. It’s very much in the drug companies’ interest to convince those speakers. Then the whole thing feels very organic, everyone’s new opinion feels like a reasoned medical choice.
I mean, this opioid crisis didn't just begin this year, or last, but it's been decades in the making. So imo doctors happen to be just as part of the problem as big pharma.
Ah, you would have been right about 10-15 years ago. Things have dramatically changed since then. I'm assuming you've not had any contact with the medical system requiring opiates for you or your relatives in recent years. Now, we've swung far, far too far to the other extreme, to the point that my WWII vet, community leader, church deacon grandfather was brutally undertreated for pain while he was dying of cancer. This is very typical now.
Either that, or the medical system is very different in Silicon Valley or wherever you live.
"Pseudoaddiction" is deliberately defined such that it's indistinguishable from actual addiction. The concept was popularized by Purdue Pharma, who were trying to market OxyContin.
At the time, providers were averse to prescribing opioids because of addiction concerns. Purdue created the "pseudoaddiction" term to teach providers that just because someone looks addicted, you can keep prescribing them opioids anyways.
At the same time, they lied with statistics to tell doctors that opioids only caused "true" addiction in less than 1% of cases.
Thus, the brunt of the message was that if you see addiction, there's a 99% chance that it's not real addiction.
Many doctors were convinced. Now the nation is dealing with an opioid epidemic driven by OxyContin.
Pseudoaddiction exists. But actual addiction also exists, and it's more dangerous and more likely to happen. Being afraid to diagnose "addiction" because of "pseudoaddiction", is just FUD.