Finally! All the benefits of the opioids, with none of the dangers.
For clarity: I'm referring to all the previous attempts to "fix" the synthetic opioids, each of which ended up making a stronger, more dangerous opioid.
Not just OxyContin. Also Heroin, Meperidine and Tramadol.
We get another "morphine, but safe this time" in pretty reliable 40 year intervals. I guess someone decided OxyContin doesn't count and we are due for another one
Sr-17018 is making rounds now (ok was a year ago) among people using opiates too much. On forums, it is pushed as the miracle stuff which allows lowering dosage without major withdrawal.
It's fantastic, the main Iboga practitioner I work with now mainly works with SR.Its a much easier process. Imidazenil has also come to the scene at much cheaper prices for benzo withdrawals.
0) Zero tolerance! We still remember how it ended last time!
1) But ... pain medication helps against anything. From headaches to hernia to bone cancer (of course in some cases it's in a "die somewhat dignified" sense). And in quite a few cases it's the only thing that helps ... In the medical sense of "helping", after all medicine can't make people live forever so that can't be the goal. The goal is better quality of life, ie. mostly longer life, including the ability to live (think "sing, dance and play tennis") ... and not life at any cost.
The problem here is that this is an entirely correct argument. Some diseases are either incredibly painful or long-term painful. Bone cancer or hernia can serve as examples. We cannot really help such people (by that I mean: not in a way that the pain stops). So can we at least make their life livable?
2) This pain medication sure helps these very seriously ill people well. But X suffering is at least as bad as bone cancer! X then is everything from still serious diseases, psychological suffering, and of course this then goes down and down until someone points out pain medication also helps existential dread and lackluster parties.
Again, all of that ... is true. That's not the problem.
3) The medication becomes the problem. Mostly because of what people do to get money for their fix (and the crime, prostitution, ... that it leads to). But this is not the only problem. It makes people who broke a bone last week go skiing again. And ... I'm almost afraid to say it but you can increase the effect of morphine ... by damaging yourself. You can guess how that ends.
The problem is that pain medication, irrespective of whether it's physically ("biologically") addictive is addictive. Anybody who's had a serious pain for a week, say kidney stones, knows that they would have sacrificed their favorite cat for it to stop. The problem is not just that morphine is addictive. The problem is the pain, and the fact that pain medication is a temporary non-fix.
4) The medication becomes the problem, but doesn't just affect patients. It goes from "you know this funny thing happened to my niece ... and she did it to herself ..." to it destroys families, neighborhoods, childhoods ...
Isn't the entire endgoal of studying medicine and biology to make humans live "closer to forever"? Aren't we working toward expanding human lifespan till we either hit a hard ceiling or approach infinity?
What the surgery actually does is fix 2 disks of your spinal column against each other. It lowers the pain from torture to tolerable and reduces various risks. Also: you won't be so much as sitting up for months. I don't think many people will call that repair. Perhaps mitigation.
I think you are both talking about slightly different things:
* Herniated disk in the spine
* A "hernia": is the abnormal exit of tissue or an organ, such as the bowel, through the wall of the cavity in which it normally resides.[
If you think of your abdomen as a bag full of tubes, a fistula is a hole in the tube that connects to something else. A hernia is a hole in the bag, that the tube can poke through.
To be honest I would prefer addicts could get heroin prescribed. The primary danger of street drugs is the inconsistent purity and chemicals it’s cut with. If it was pharmaceutical grade and everyone prescribed was on a list, we would have fewer overdoses and a better understanding of who to put in treatment
Most heroin overdoses happen either from a sudden increase in supply purity, or from an abstinent addict relapsing and taking their regular dose without realizing they have lost their tolerance.
Any kind of rational change in policy is not happening as long as entire lucrative industries of policing, health care and religion-as-a-social-service are dependent on the dependent.
It's such things that reveal the cruelty in our sociaties. The evidence is very clear; it reduces deaths and improves health, while also reducing crime. But its still not the default the world over because its apparently a hard sell to give addicts anything for free. The other comments here show the sentiments nicely.
There is no need to give it for free. It costs very little to produce, most of the cost is just risk and irregular logistics. Just sell it over the counter at walmart for $5 just like they do rat poison, bottles of vodka, and ammunition.
You might say they won't be able to sell enough foodstamps or welfare even then to come up with the money legally, but it'd still be way less crime.
People don't get addicted to rat poison or ammunition (usually). But you have got a point on vodka. There is little reason to treat alcohol (and worse, nicotine) as any different than most addictive substances. Drug policy is totally irrational
alcohol is a far cry away from opiates. they should just allow everything. its actually effective in drastically reducing abuse. since use is normalized it become easier to have social control form peers etc. and that works really well actually. Additionally it would allow for stable products which means more safe products.
The US did this dance with the devil in the pale moonlight before anyone, way back in the 19th century. Tens of thousands (millions) of wounded soldiers came back from the civil war in chronic pain and addicted to morphine. They put them on "lists" and prescribed them dope and it spiraled out of control. It got so bad that they engineered Heroin to be a safer alternative. And people forget, but the temperance movement wasn't just focused on alcohol. They were the primary forces behind the Harrison Narcotics Tax Act of 1914. And these people weren't bible thumping crusaders, many were like early feminists that lost children\husbands to drugs and alcohol. I think Europe eventually comes around to this same conclusion when enough damage has been done. Metering out hard drugs has always been a road to ruin.
This seems only partially correct. If by "they" you mean Germans then yes, Heroin was engineered by them, or at least first made commercially available by Bayers. The US government had nothing to do with it. It was marketed as a less addictive alternative to morphine although I highly doubt anyone who made it actually believed it was safer. I have no source for this but I think it is a safe assumption to make.
The temperance movement was mainly related to alcohol. There were groups who wanted abstinence from everything but that was not its primary focus. They may have played a part in said act but I don't know. They were definitely not the driving force behind it though. Racism played a bigger role than the temperance movement. The government was also aware there was a very real problem with drug addiction.
Notice the word „decriminalize“, not „legalize“.
It’s about not throwing people already struggling with addiction in jail but rather offering safe alternatives (counseling, safer use, etc.).
The government‘s not passing out drugs in the street, like US media likes to suggest.
Nowadays they're just given methadone or Buprenorphine (other opioids). Having known family members that worked in the clinic, there is no plan to get most of them off of it. It is like other opiate addicts, ~most of them take it until they are dead unless they are just dead set on getting off and willing to live with the fact they might never quite feel 'right' again, although at least it is safer.
Is that such a bad thing? Plenty of people will take medications for the rest of their life -- statins, antipsychotics, antidepressants, ADHD meds, antiretrovirals. The stigma of chronic medicine use needs to go away.
I don't know it's a bad thing, just pointing out, the US does just prescribe opiate addicts more opiates basically for life without a plan to stop it. Responding to "They put them on lists and prescribed them dope and it spiraled out of control ... metering out hard drugs has always been a road to ruin" with the facts that's what we're already doing writ large. The thing many people argue shouldn't become the case is already the case and many are oblivious to it (thinking that it was just a thing in the past we stopped).
It isn't the same drug as fentanyl, but it never really stopped being the plan that we will take people from 'the list' and just keep metering opiates out indefinitely. GGP posted this in a way that seemed to allude this was not currently the case.
On the one hand, I'm sure that the post you're responding to is referencing many previous failed attempts at making non-addictive opioid painkillers.
But on the other, non-sarcastic side... if addiction is the only remaining problem with them, should we care that much?
I.E. if both the chronic and acute health risks are gone (which I don't think they are for a second, but follow me along on this little thought experiment)... does it matter quite so much? Clearly addiction, in the abstract, is not exactly a good thing. But if it's not coupled to risk of death it seems to me it would be a great thing to transition addicted people to, and take away some of the urgency of the situation.
I agree. I would say that I am addicted to caffeine. I definitely get withdrawal symptoms if I don't have a coffee. But since it is so accessible and there are no health risks, it does not affect me negatively to "feed" the addiction.
Not a great analogy. Caffeine is not as addictive as opioids. Opioids strongly stimulate the mesolimbic dopamine pathway, leading to intense euphoria, compulsive use, and severe health and social harm.
I admit that I don't know who Tyler Cowen is, but millions (billions?) of people have drunk coffee daily for centuries and if there were ill effects in the same ballpark as opioids or tobacco by now we would certainly know?
There is even a decent chance that the Industrial Revolution and the phenomenal wealth and progress it's brought was caused by the introduction of coffee to Europe.
A professor of economics has opinions on the health effects of an extremely common substance?
And I have opinions on nuclear energy - but neither of us are worth listening to outside our areas of expertise. Unless you can supply a reason I would bother listening to him as compared to an actual expert on the subject?
Because some dude with no health or nutrition background said uninformed things, that he isn't qualified to have opinions about, on the internet? Come on, now.
By definition addiction involves pursuing substances or engaging in behavior repeatedly despite negative consequences in one’s life.
Any behavior or substance that causes serious addiction is still bad regardless of whether it causes death or other negative health effects. The addiction itself inherently causes suffering because the addict is engaging in something despite the negative consequences in the rest of their lives. The negative consequences cause suffering and the psychological pain of wanting to stop and not being able to stop also causes suffering.
I know some other commenters mentioned caffeine addiction but nicotine and opioids (and also behavioral addictions like gambling) are vastly more addictive than caffeine.
Negative consequences from addiction can involve more than loss of money (although loss of money is still a significant thing of course.) They can cause damage to one’s career, family relationships, friend relationships and so on. Even if the addictive behavior or substance has no other inherent negative health effects.
In high school I had a really bright and motivated friend. He went to an Ivy League school. He became horribly addicted to World of Warcraft as a freshman. He spent so much time playing the game that he damaged his grades and GPA. He almost failed out of school. He had to make serious effort to stay in school. And he had to spend tremendous mental effort to avoid playing additive games anymore. That’s just one example.
> .. if addiction is the only remaining problem with them, should we care that much?
I think we should because it’s undignified to have people who want to stop taking them but are unable to resist the compulsion. I feel the same way about basically every addictive substance. Even if it was freely available and risk-free I still think that being trapped in a cycle of use and withdrawal is such an affront to someone’s dignity that we should still try to prevent that.
There's already buprenorphine and methadone. But, using either means some degree of responsibility, punctuality, etc. So unless you mean freely distributing it with very little process, it wouldn't change much.
Those, from what I understand, don’t hit the same and someone needs to be ready to quit to go on them, they help with withdrawal etc, definitely, but are not always successful as they don’t scratch the full itch. A bit like nicotine replacement therapy
But there’s a whole space of harm-reduction before then, which is where things like the Swiss program to provide heroin in controlled circumstances can fit in.
An opioid without respiratory depresses on problems could fit into that sort of thing pretty well.
I’m in one now. The problem here is meth. But then I’m not in the US and things are different in different places.
It was a thought experiment about addiction if the other negatives could be removed, I doubt we’re actually anywhere close to that anyway, but it might imply that zombification had been solved.
I mean I guess it depends on the level of use? Do you need to be nodding off, drooling on the verge of respiratory collapse to cope with the dread of your situation? (I feel like people are mostly only considering the physical reasons for starting opiates in this post btw). Or is it a more reasonable dose that allows you to participate in society unencumbered by your pains? (Which in any case is a slippery slope with long term use)
and the fun fact, the other new drug targeting the mid-receptor of acetyl-choline that functions like mu-opioid receptor also has the same exact addiction problems.
>each of which ended up making a stronger, more dangerous opioid
This is true of some early opioids like heroin, but with e.g. Oxycontin the problem wasn’t a stronger opioid, it's how it ended up being prescribed.
Purdue's marketing led doctors to prescribe it to more people, in higher doses, and for longer. Oxycontin isn't inherently more dangerous than the dose of immediate release oxycodone or morphine that would have an equivalent effect.
Innovation in opioids shouldn't just be written off. They're still the best (and sometimes the only effective) treatment for a huge number of people, and some new opioids like buprenorphine/combos like Suboxone have real advantages.
The lesson from Oxycontin is more about deceptive marketing and prescribing practices.
I mean if there were no safe dose or usage pattern then I would expect a lot of mothers to leave the hospital with both a newborn and a crippling addiction. The epidural is an opiate like fentanyl.
Adjacent medicines have seen major improvements: eg Ketamine was a significant improvement from PCP (notably, less psychosis and safe enough to use off the battlefield / with children)
“Removing the worst and most fatal danger” is a laudable goal with Fentanyl given the absurd rate of ODs
As have the opioids buprenorphine and Suboxone (buprenorphine/naloxone), which are genuinely useful treatments for addiction and have much lower risks of abuse.
For clarity: I'm referring to all the previous attempts to "fix" the synthetic opioids, each of which ended up making a stronger, more dangerous opioid.