I think chronic pain is undertreated, currently. I doubt it was much better-treated 20 years ago. Mainly because a lot of chronic pain can’t be treated effectively without knocking the person out. There aren’t a lot of good choices.
Acute pain was probably treated okay.
Here is the narrative the CDC has:
https://www.cdc.gov/opioids/basics/epidemic.html
This rise in opioid overdose deaths can be outlined in three distinct waves.
- The first wave began with increased prescribing of opioids in the 1990s, with overdose deaths involving prescription opioids (natural and semi-synthetic opioids and methadone) increasing since at least 19993.
- The second wave began in 2010, with rapid increases in overdose deaths involving heroin4.
- The third wave began in 2013, with significant increases in overdose deaths involving synthetic opioids, particularly those involving illicitly manufactured fentanyl5,6,7. The market for illicitly manufactured fentanyl continues to change, and it can be found in combination with heroin, counterfeit pills, and cocaine.8
Many opioid-involved overdose deaths also include other drugs9.10.
Jeez the graphs on this one need work:
I’ll think about it.
A bit to the side of this discussion:
This is not about pain medication, but psychoactive drugs.
In general, recreational drug users take their drugs at doses so much higher than psychiatric patients that they’re basically two different chemicals. A lot of our impressions of drugs, what side effects they have, and how dangerous they are, get shaped by the recreational users, not the patients. This is sometimes even true for the doctors who are supposed to prescribe to the patients and give them good advice. While studies of recreational user populations can sometimes be helpful in flagging an issue for consideration, we should be judging the clinical risks based on studies of clinical populations.
This isn’t medical advice. Don’t go out and take a mix of ketamine and amphetamine, then tell the cops that it was “just a clinical dose” and “this blog on the Internet told me it was okay”.
I’m not sure the amount of oxy prescribed for pain patients vs how much addicts like to use.
The issue with drugs isn’t really about dosage. Most recreational users know what their tolerances are. You don’t see dead people on the street often for that reason, nor do you see people die at music festivals (heck, 100k people go to EDC every year and almost everyone there is on drugs in 100 degree weather, every now and then 1 person dies from dehydration).
The issue is from mixing drugs, or having a sudden change in your dosage. Fentanyl preys on both of these effects because it’s so cheap and so potent.
For sure.
Yeah, apparently it’s depressingly common for people to get clean for a while, then fall off the bandwagon and go back to their former dose, which their bodies can no longer handle.
Yes, this is what happened to the people I knew who ODed.
Sobriety is often not a binary state of being, it’s a process and often involves success followed by relapse, and takes several tries.
I know too many stories of relapse, especially being involved in the foster system, and I think we need to teach people how to relapse more safely, because when it comes to heroin and fentanyl, something like 90% of people will relapse, sadly.
We also need to remove the shame and stigma from addiction and permit people the space to find support, and de-criminalizing drugs is an important part of that, in my opinion.
Same
We need to stop thinking about drugs as some kind of terrible thing, and treating relapse the same.
People who are on drugs are scared of the concept of sobriety because nobody likes to hear the word “never”.
Imagine someone telling you that you can “never” go to Disney World again. That just makes you want to go to Disney World more, even though you might’ve never even gone in your whole life in the first place. Especially if you’ve gone as a kid, and have fond memories of it.
Being on drugs is an enjoyable thing, much like going to an amusement park. It’s an instant euphoric gratification, and the memory is locked in, exaggerated, imprinted.
Don’t tell people they can’t do something ever again. Tell them, you can do it, but you need to treat it as a reward. Doing it every other day is a problem, doing it once a quarter, or once a year, is like going to Disney once a year. That’s fine.
Also people need to stop being hypocrites.
There are just as many high functioning users (music festivals, frat parties, wall street, techies, etc.) as there are poor addicts. The difference is, when you have responsibilities (AKA a job, or school), that keeps you in check. Everyone knows what people do when they or their kids go to EDC, Coachella, Burning Man. No one bats an eye.
My friend who works for Amazon does coke with his boss when they go out after work together. Completely normal. In fact, I don’t know anyone who works for the big techs that hasn’t done hard drugs at least once in their life. There’s a reason tech firms don’t do pre-employment drug screens. Because they wouldn’t be able to hire anyone.
Wholly, completely, viciously untrue. People literally lose their children over drugs and would never choose drugs over their kids if they had any real choice.
I have also watched people with jobs, security, families slowly lose control and end up homeless and hopeless because of drug use.
Some people don’t struggle with addiction. Some do. It’s not a class divide.
Exceptions exist.
There are people who are prone to addiction. These are the people losing their entire livelihoods.
There’s a reason people don’t become addicts even though they’re given pharm grade heroin in hospitals (to pregnant women, no less). There’s a reason not everyone become addicts after they go to a music festival.
There’s a reason not everyone lose their jobs and sanity when they work in tech and wall street.
Are there people who succumb to addiction? Sure. But they are the extreme minority. The vast majority of people fare just fine.
That’s like saying psychedelics are bad for you because some people get bad trips or become psychotic. The vast majority of the people will claim their first trip was the most memorable/life changing experience they’ve ever experienced.
Sources?
Personal experience. I interact with the gay, tech, and investment community. That’s enough source for me.
You also interact with users who aren’t addicts. Is there some survivorship bias in there?
I deal with families who are shattered because of drug use. So based on MY anecdotal evidence, everyone who uses drugs becomes an addict. Obviously not the case either.
Something like 25% of people who try heroin will become addicted, according to a stat I heard in a foster training session hosted by my state. Extreme minority?
Source? Given that opioids are given to pregnant women and in surgeries, sometimes in doses stronger than street heroin, I doubt this is true.
And no, I don’t just interact with users who aren’t addicts. I know a couple people who have lost their livelihoods due to meth.
I know plenty of people that are homeless.
The gay community is small and diverse. When you go to the clubs, it’s top 1% mixed with the bottom 1%. Successful people rarely fall victim to drugs. Wonder why? Responsibilities.
I gave my source. But I googled it, and here’s a verifiable one: https://www.livescience.com/62701-odds-of-heroin-dependency.html
I’m not engaging a debate on this. You are undermining addicts, addiction, and medical research with your claims, which only serve to further stigmatize people who ARE addicted. Because what I’m hearing from you is that they just don’t have enough in their lives to want to overcome it. If they really didn’t want to be addicts, they wouldn’t be…
That’s some vague wording. What does dependence even mean? I know people who go out every weekend to the club and do molly every week, is that dependence? Are people who go to Burning Man every year dependent? These are successful people with great jobs.
Quite the opposite. Sounds like you just want to be enraged for no reason.
I’m saying, drugs are not as addictive as people think, as more people are on drugs than the average (sober) person assumes.
The way to help those who are addicts is not to make them feel ashamed of using drugs, and push the agenda of sobriety to the extreme, because to do so is hypocritical, as plenty of successful people are not sober, and people get scared when they hear phrases like “you can never use heroin or coke or meth ever again”.
