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.
Unless you’re being sarcastic and referencing the lies the Sackler family used to get OxyContin popular..
That being said it is indeed quite cool that they modified the drug to decrease the respiratory depression.
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
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 ...
Result: ONLY ONE SOLUTION! ZERO TOLERANCE!
GOTO 1.
* 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.
Im guessing English isn't your first language? Fistel is not a commonly used term.
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.
https://de.wikipedia.org/wiki/Heroin#/media/Datei:Bayer_Hero...
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.
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.
I'm curious about this sentence -- to what are you referring, and where specifically in Europe?
The government‘s not passing out drugs in the street, like US media likes to suggest.
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.
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.
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.
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.
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.
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.
Have you _seen_ what the streets of major cities look like these days? Ever heard of "fent zombies"?
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.
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.
“Removing the worst and most fatal danger” is a laudable goal with Fentanyl given the absurd rate of ODs
It's like that xkcd comic about unifying standards, now we have n+1 addictive opioids.
I've found low dose naltrexone to be somewhat effective for severe chronic pain. Not as good as opiods.
THC can also help somewhat, but its action seems so dissociative. At an effective level for chronic pain, I'm sleepwalking though the day.
Opioids or their analogues cause or complicate bowel issues. Four years of 200mg/day Tramadol really helped me, but it shredded my gut. Getting off Tramadol wasn't hard for me. I'd stay on it were it not for the gut issues.
As an aside, lacing hydrocodone with acetaminophen is truly a horrific practice. Doctors prescribe this to patients on hepotoxic drugs and are shocked when they get liver damage.
Tramadol isn't all that strong, but it does take the edge off. With a 6 week taper, my challenge was more about the resurgent pain.
I would not recommend Tramadol, the gut complications are debilitating and it's unclear ignoring the chronic pain served me well.
LDN is an interesting one since it just stimulates your body to generate its own endorphins.
LDN reduces "central amplification" of neuropathic pain, so it is a good fit for my disease profile.
When I could get 7oh, it worked well for moderate break-thru (ibuprofen) pain (muscle, joint). I also tried a month of using it regularly wasn't happy overall. I didn't get any withdrawal on stopping tho.
The problem with fentanyl is that it is easy to make and smuggle and we managed to leave a giant black market hole to be filled when we went ape shit about oxy, which was an objectively better situation than we are currently in with street opiates.
One of the big problems with anesthesia is balancing respiratory depression while medicating the patient enough to manage the symptoms. Fentanyl is used in anesthesia and it causes respiratory depression.
A strong pain medication that doesn't slow or stop breathing would significantly improve the safety of anesthesia.
If we got some safer painkillers that weren't insanely addictive, that would be Nobel Prize-worthy, in my layman's opinion.
What is it you're actually trying to say without having to say it?
With that in mind, what I'm "actually trying to say" is that
a) any time we can make a medication less harmful, that's a good thing; and,
b) if this new molecule relieves pain as well as fentanyl does, it will surely be used by people who are addicted to drugs or who are using drugs recreationally.
The bigger question that goes way beyond the scope of Scripps' research contribution is whether our society can begin to accept that people use drugs like fentanyl to treat depression, trauma, anxiety, and pain of all sorts. And that criminalizing their efforts to treat themselves does not lead to any improvement in their wellbeing or the wellbeing of our society.
I hope so because the administration is looking to really fuck over medical research by making the 7-OH stuff a schedule 1 narcotic, when it has so much potential for improving anesthesia and pain management by removing respiratory depression from the pain killing element of the anesthetic cocktail.
The crisis is one created by policy and cannot be eliminated on the pharmaceutical end. This isn't a case of methanol being sold as ethanol or SSRIs having less than ideal efficacy rates while causing widespread sexual dysfunction at a rate much higher than originally thought, or Zolpidem leading to over a hundred observational notes published in medical journals describing dangerous activity performed even on small doses followed by anterograde amnesia that certainly is a real thing that is also potentially dangerous, but incredibly difficult to study. Those effects are happening when the medication is taken as prescribed Do people take those without prescriptions? Of course, but one assumes the risk, and also, anyone ever seen a Zoloft pill mill?
Fentanyl had been diverted in small quantities onto black market supply chains for as long as it has been available. You can absolutely get an Actiq Pop in 2006 if you really wanted it, and the thing is a lollipop for crying out loud. It didn't cause widespread overdoses, it didn't even cause any significant black market demand. It was at best a curiosity. It's hard to quantify a subjective experience, but generally it was regarded as "not fun" anecdotally. Heroin is fun. Hydromorphone is even more fun but the best ROA leaves you with a 5-10 minute high at best and takes about that much time to prep. Oxycodone was fun but since the DEA made sure that it was as difficult to obtain as possible all of a sudden and what was available was spiked with enough APAP so that your liver might give out before you overdosed, well, what does cutting off the supply but leaving the demand in place do? The crisis as we know it today was inevitable in some form. It's created by policy, which is not set by scientists, and in fact when hydrocodone/APAP was rescheduled for Schedule II a specific reply to patient access concerns was "we don't take that into account", according to the DEA. Thanks for the candor, sadly we've gotten very little of it in the years since.
But of course, even on the black market, people overdose in a manner that is to a degree predictable. Long term users with steady supplies - say, everyone who's on a benzodiazepine long term - aren't overdosing regularly (yes, the LD50 of benzodiazepines generally makes overdosing on it alone very difficult if not impossible, but kicking it cold turkey does actually cause deaths from seizures and when mixed with another depressant like alcohol it becomes almost trivial to overdose on it, arguably making it at least in theory a more dangerous drug if one takes the view of the DEA). They are mostly able to obtain legitimate, low cost, and frequently entirely legal versions of, well, name the variety. From Triazolam (3 hour half life) to Midazolam (water soluble) to Etizolam (scheduled into schedule I based on 4 cases in Norway where when mixed with another depressant patients ended up in the ER. All survived and were discharged almost immediately. The reason why the DEA laundered cases in Norway through the FDA to justify at first an emergency scheduling and then turned it into a permanent one? Because they couldn't find any cases that demonstrated the purported danger in the US or Canada.) Overdoses happen when someone takes too much of a substance, but "too much" is difficult to determine when you don't have a reliable supplier in terms of quality and adulteration, but also, because tolerance gets built up so that long term users can use prodigious amounts and be just fine. But how do we make sure that nobody knows where their tolerance is at? Non-medically assisted, pseudoscientific "sobriety help" like AA or its variants that are ordered by the court, and of course, probation, testing, in-patient medicaid fraud mills, you name it. Since none of these actually do anything except use homebrewed aversion therapy or even less efficient, shame, to achieve what is basically not even a real goal but is tied to the criminal justice system, congrats, you have the perfect storm of demand not knowing how much to actually demand for. Fentanyl being the adulterant made this last inevitable easier, but it only hastened what had been happening for quite some time. When heroin supply on streets increased, fentanyl related deaths began decreasing. Wonder why? It's correlative, but observational studies take a lot more data and a lot longer time periods, although it would certainly follow previously observed patterns.
This may be interesting as a scientific venture, but treating it as anything but that is foolhardy and misguided. We know how to control pain. We know how to reduce the harmful externalities that form part of the definition of substance use disorder since we, as in society and lawmakers elected by us, are responsible for those harmful externalities in the first place. Fentanyl is not the problem. Making sure that there's no safe way to reduce potential harm associated with, ultimately, a personal choice favored by some but certainly not all as recreation, killed the hundreds of thousands since Lou Reed sang Heroin and put it onto the Velvet Underground and Nico. Why are we still acting brand new?
However, a new type of pain medication doesn't remove the current opioids available on the street. Legalization of marijuana is one thing, it's relatively low risk but I don't see legalization of opioids ever happening because absolutely nothing can replace the warm blanket feeling that they provide.
