Inside the quest to conquer addictive drugs.
Opioid addiction can be seen as an infinite loop, a bug in the brain's programming. Take drug. Feel better. Come down. Repeat. Of the people who use opioid drugs recreationally, between 8 and 23 percent become addicted-sometimes fatally. That's true whether the opioid drug is strictly prohibited, such as heroin, or a prescription painkiller that people use illegally, such as OxyContin or Vicodin. A smaller proportion of people who take prescription painkillers get hooked - less than 1 percent of people with no prior history of addiction. From the article:
In the United States, the world's largest consumer of all types of drugs, these numbers add up: More than 2 million people are currently addicted to opioids, and nearly 5 million have taken them recreationally in the past month and may be at risk. Consequently, scientists have been searching for a "non-addictive opioid" since the 1800s - desperately seeking a compound that can match these drugs - peerless pain relief without becoming irresistible.
Some elements of the addictive loop are well understood. The primary factor being that the drugs feel alluring, dreamy, and blissful to a fraction of the people who take them. Meanwhile, about 15 percent strongly dislike them, according to research on healthy volunteers.
(Score: 0) by Anonymous Coward on Friday May 02 2014, @12:55PM
They should make larger-scale studies. I'm sure there will be no lack of volunteers. ;-)
(Score: 4, Insightful) by Lagg on Friday May 02 2014, @01:12PM
Blame the people who are prescribed the pills in the first place, and then, now just listen to me here, then we make it so hard to get those pills later that they turn to heroin! It's the perfect plan! I'll take my check written to cash please.
http://lagg.me [lagg.me] 🗿
(Score: 2) by Lagg on Friday May 02 2014, @01:55PM
I was just going to leave it at this but I may as well give you kids a little story since I just don't give a shit anymore. I had a surgery done several years back and was prescribed percocet for them. AKA Oxycodone. I knew of the addiction potential at the time and tried to avoid taking them and called the doctor and told them I wasn't comfortable with it. Know what they did? They threatened me with having to come back into the hospital to get a shot to bring down the pain if I crossed a tolerance threshold. Naturally I didn't want to rack up that bill again so I was pretty much forced into taking them. What happened? You guessed it. Addiction.
After some time dealing with this and the doctor cutting me off despite my concerns I was addicted I decided to take matters into my own hands and switch to a non-narcotic (why the fuck they didn't give me one in the first place I don't know). It was a very unpleasant process to switch down to them but I did it. I was happy at that point for obvious reasons and the fact that I didn't feel this really annoying brain-scramble that comes with being under narcotics and slowly removing my dependence even on those because I don't like taking pills. Fast forward to now, because of the "those filthy addicts" attitude most people seem to have the DEA has been choking prescriptions of narcotics.
Why should I care about that if I don't take narcotics? More on that in a moment. But first let me just say that the doctors don't mind this arrangement at all. They love making people more dependent on them and they are making an absolute killing on it. Pain management is a pretty damn lucrative field right about now. No one cares about these legal drug dealers because hey, those filthy addicts deserve it right? Right... And now we're in a situation where people turn to nasty poisonous street drugs because they're being cut off or restricted to the point of might-as-well-be cutoff and turn to things like heroin to help their situation.
So I should just be a bystander to all this right, if I don't take narcotics? Hah. I wish. I really do wish. For a time there was a trend of doctors prescribing the non-narcotics I take as a supplement to the narcotics that they were being cut off from. These people, probably stupidly but understandably in a way, thought they would get the same kind of warm relief/high from these that they did from their narcotics. So they proceeded to self-medicate the everloving shit out of themselves until a few people died.
So long story short, the DEA in their typical knee jerk reaction is apparently considering what I take a controlled substance and I now find myself right back at square one where I not only have to go to an actual pain management doctor to get non-narcotics but on top of that seeing my dosage halved. This is easier on me since I don't take narcotics but imagine the suffering people who are go through. So now you see why people are turning to worse drugs. But again the doctors don't mind because it's a pretty damn lucrative arrangement for them. They get all the benefits of a drug dealer but without the pesky legal issues. People as a whole don't mind because hey, those filthy addicts deserve it.
Have I mentioned that most of said filthy addicts are older aged people with surgery pain? Oh I didn't? Well sorry for breaking your mental image of all addicts being teenage meth heads looking for a high. I wish I could say you know who to blame now if you're looking for a scapegoat and want to stop people from dying. But what do I know, I'm just a filthy addict. Right?
http://lagg.me [lagg.me] 🗿
(Score: 1) by koreanbabykilla on Friday May 02 2014, @05:22PM
Percs ARE NOT! AKA Oxycodone. They are AKA Oxycodone and a shitload of tylenol. It's almost impossible to become addicted to percs and not fucking die of liver failure LONG before really bad effects from the meager amount of opiate in them. Please expound on the amount of acetaminophen and Oxy were in the pills you became addicted to? How many per day? how many hours between?
Not that I dont believe you, but real hard to swallow. its fucking easy to become addicted to OXY 80's, but perc 10's? I dont buy it.
(Score: 1) by PlasticCogLiquid on Friday May 02 2014, @05:44PM
I buy it, Same thing happened to me.
(Score: 1) by koreanbabykilla on Friday May 02 2014, @05:54PM
How much acetaminophen were you eating every day? http://en.wikipedia.org/wiki/Paracetamol_toxicity [wikipedia.org]
I dont see how you can get enough "high" from the small dose of oxy to become well and truly physically addicted without eating a bunch of them everyday and fucking your liver up beyond repair.
"I would prefer to eat a perc 10 every 6 hours" is very different than "I need to eat a couple OXY 80's every day or I want to fucking die"
(Score: 1) by PlasticCogLiquid on Friday May 02 2014, @06:43PM
It wasn't about withdraw, never had a problem with that. I went through that after I upgraded to morphine/opana.
Addiction is addiction, when you're buying the shit off the street everyday.
(Score: 2) by Lagg on Friday May 02 2014, @06:05PM
Meh. Whether or not you believe what I said doesn't really matter to me. I don't care to have a penis measuring contest to determine which one of us was more of an addict. Though it seems rather silly that I'd have any reason to lie about it or skimp on the details.
http://lagg.me [lagg.me] 🗿
(Score: 1) by koreanbabykilla on Friday May 02 2014, @06:45PM
I haven't ever been addicted to opiates. My wife eats 1 perc 10 every day and has for years. My friend Mike eats several Oxy 80s per day and has for years. It is a VERY different beast. Alcohol and nicotine and my problems. I wasn't trying to say you were lying, I want to understand and asked a few questions. I was really under the impression the amount of tylenol in percs make it much harder to consume them in the quantity needed to become addicted without severe liver damage happening. I know if mike had same amount of oxycodone every day but in perc form, he wouldn't live long. that would be on the order of tens of grams of acetaminophen. Sorry I come across as a dick, I don't mean to, story of my life lol.
(Score: 2) by urza9814 on Saturday May 03 2014, @01:05AM
I won't deny that doctors get a hell of a profit off these things, but I think there's more to it than that. It's the entire design of the healthcare system from top to bottom.
Item 1 is that we focus on drugs rather than healthcare. Doctors are only trained to hand you drugs, so that's all they do. They're not really even trained to look at lifestyle and other factors anymore. They're not trained to consider non-pharmaceutical treatments.
Item 2 is malpractice suits. If the patient is lying and you give them drugs? Well, good luck proving they were lying. Damn near impossible to prove that a patient isn't in pain; and it's even harder to prove that a doctor knew the patient wasn't in pain. We have no better way to quantify pain than a freakin' chart with smiley faces on it! No better way than just asking the patient. No matter how many tests they run, they might miss something, or the problem could be something we don't even know about yet. It's sort of a prisoner's dilemma situation. It's very rare for a doctor to get sued for prescribing painkillers a patient didn't need because it's so hard to prove the doctor knew they didn't need them. It's much easier to get sued should a better doctor figure out what's wrong with the patient and thereby prove that the drugs were actually needed.
Until we either decide we can't penalize doctors for using their own judgement, or manage to easily measure pain signals moving through the brain, this situation isn't likely to change.
(Score: 2) by Maow on Saturday May 03 2014, @01:57AM
and this...
These scream of the "hidden" costs of not having single-payer "socialized" medicine like here in Canada.
Doctors get paid per patient here, but not by the patient. And trips to the hospital for non-elective surgery or related visits? $0.00.
We pay for our own prescriptions, although one can have insurance that helps out there. Generics are universally available as cheaper alternatives to name-brands.
It's not a perfect system, but to avoid medical attention for a serious issue due to cost? Barbaric.
Oh, another benefit to socialized medicine? Free sex-change operations: a new best-in-show costume every Hallowe'en.
(Score: 1) by Ethanol-fueled on Friday May 02 2014, @02:17PM
You were probably being sarcastic and/or facetious, but are probably much [globalresearch.ca] closer [washingtonsblog.com] to the truth than you realize.
I smell a business model coming...
(Score: 0) by Anonymous Coward on Friday May 02 2014, @02:09PM
I wonder if it will take as long as it is taking our vote meisters to create the perfect runoff voting system. 1 week? 1 year? Who knows!
(Score: 3, Informative) by Dunbal on Friday May 02 2014, @02:57PM
It's not all that hard to beat. Acute withdrawal is a bitch for heroin but it's not impossible. For other lesser opioids - codeine, etc, it's not really the end of the world. A few days' worth of coughing, sneezing and agitation, a few months' worth of sniffles. Addiction can be, and has been, beaten quite easily. The problem is as always, the underlying cause of the addiction. What problems is the person running away from behind that magical warm fluffy but slightly itchy opium haze? Worse still, the social stigma that come with people knowing you are an addict tends to compound these problems. So staying in the haze seems a much better alternative than facing the music.
To be honest I think that most of the addicts' problems tend to come from social and psychological problems rather than the drug itself. "Normal" people don't turn into addicts just because they're given opioids. In fact most patients will refuse or self terminate opioid use and put up with a less effective pain medication even after being given fentanyl or demerol (meperidine) - out of discomfort from the side effects (nausea, etc) or fear of addiction. Opium and laudanum/paregoric use was widespread throughout the world as little as 100 years ago without society descending into chaos or massive addiction. So it's not just "the evil drug" that has "magical" properties that hack the brain and turn people into addicts. Today we are tainted with many years' worth of accumulated anti-drug propaganda when we look at these compounds. Most people instantly associate them with "evil". To be honest there is no more effective pain medication, cough suppressant and anti-diarrheal medication in the world. Perhaps one day we'll be rational enough to look at them as such and deal with the social aspects separately.
People who have never experienced real pain are always very quick to deny effective and completely pain relief to others. As a doctor I have seen many colleagues under-medicate their patients and leave them in agony simply because they are morally not willing to use an opioid or afraid of the possible consequences - since we are all warned repeatedly in medical school about how dangerous (in terms of cardiovascular collapse and respiratory failure) they can be. To my mind it's a shame that having the tools some people just can't use them. It is very satisfying professionally to be able to almost instantly relieve someone's pain from a burn, a broken bone, a heart attack or a kidney stone. Pain serves the purpose of informing there is a problem, but once the problem is acknowledged, pain serves no purpose. Chronic pain especially serves no purpose. Cracking down on pain medication just means that more people have to put up with unnecessary pain just because other people are unable to deal with their social or psychological issues and abuse medication. But hey, what does the bureaucrat care? Until it's his turn to have chronic pain, of course...
(Score: 2) by The Mighty Buzzard on Friday May 02 2014, @04:55PM
One problem though, opiates and the amounts of caffeine I ingest daily do NOT go well together unless you enjoy yarking up everything you've ever eaten in your entire life. Guess that means only the caffeine addiction for me.
Also, opiates have really never done anything about pain for me except make me not give a damn about it. Now an opiate and a couple Advil, that's some killer pain management.
My rights don't end where your fear begins.
(Score: 2) by Dunbal on Friday May 02 2014, @04:58PM
"opiates have really never done anything about pain for me except make me not give a damn about it."
That's exactly how they work. They don't take pain away, they just make pain not relevant, not urgent - take it out of the foreground and put it in the fuzzy background somewhere. Of course up to 15% of the population cannot metabolize codeine, get zero effect from codeine based pain-killers and wonder what all the fuss is about with this "useless" drug.
(Score: 2) by Taibhsear on Friday May 02 2014, @06:18PM
Do you happen to have a link for the source of that statistic? Mainly because I seem to be one of those 15%. I'm curious to see the reason for it. I had a big jug of the liquid form of it from the doctor when I was a teen. My mother marked the container with a marker to make sure my brother and I weren't getting high off it. I never got any relief from it. Kept upping my dose to try to get pain relief (up to like 6 doses at once) but never got it, never got a buzz or anything from it either. Ended up just dumping 75% of it and dealing with the pain.
(Score: 2) by Dunbal on Friday May 02 2014, @11:18PM
Not exactly pub.med but here is an article [usnews.com] that explains the cause I remember reading about in some book or other.
(Score: 1) by sbgen on Friday May 02 2014, @06:30PM
I wish I had modpoints now. Some one please mod this post
Warning: Not a computer expert, but got to use it. Yes, my kind does exist.
(Score: 0) by Anonymous Coward on Friday May 02 2014, @06:06PM
Having lived with someone who was addicted to this crap. Let me tell you the other side.
Up all night because they do not have the pills. Up all night calling 20 people who have scripts, because no doctor will give her one. Up all night yacking in the toilet again. Up all night with the muscle cramps. Missing the 5000th family gathering because she cant even get out of bed. Missing work again because none of her regular contacts 'have any'.
The worst ones are the dealers. However, they never want to admit they are dealers. They are 'just helping you out'. I have seen middle aged women turn into thugs and call out her boys with baseball bats over 20 dollars. I have seen people with bottles of 1000 pills who got them from medicare and selling them for 3 dollars a pill. Real dealers who sell heroin and coke are easier to deal with and at least honest what they are.
You think its 'no big deal'. Well you are well off arnt you? You see them for 10-15 mins long enough to write them a script. Because 'its no big deal'. These fucking pills cost me nearly 40k (and an estimated 200k opportunity cost). I have a dollar amount because I kept track as she slipped further and further into it. I know I got of cheap.
She is now using metadone which is just as fucking bad. But at least its cheap. She is terrified of getting off methadone for fear of slipping back into the pill world.
unable to deal with their social or psychological issues
You want to blame everyone but the patient themselves. Here is the deal and I have talked to *many many many* addicts. You cut thru the bullshit (as that is what 99% of the time it is) you end up with one thing. They just want to get high. Not to tune out, but because it feels good. Then you suddenly find out you cant get high but feel like fucking hell because you do not have the pills anymore. My wife got into it thru speedballing. Because she liked the rush coke gave you but not the crash. The pills let you 'land' and still feel pretty good.
You act like you are helping out. Let me tell you, you are not. I would be willing to bet cold hard cash that you have a long list of 'regulars'. "My back just really hurts" "my foot is in agony" "cant lift my arm without them". Then you watch them go get into an SUV 4ft off the ground... I have met people in real pain like that. They do not move unless they have to even with the pills. I would also be willing to bet cash you have some that are 'in pain' but sell the pills. They make about 200-300 a bottle untaxed cash. The gov pays your bills and the pharms bills and they turn them and sell them. You sir are exactly the type who I would aim the 'not dealers' at to get scripts so my wife could buy pills.
(Score: 2) by Dunbal on Friday May 02 2014, @11:21PM
" I would be willing to bet cold hard cash that you have a long list of 'regulars'."
Heh and you would lose. That's not how it is at all. You don't know me. It seems that your mind is pretty made up though. So there's not much point in discussing this, is there? I don't think I could convince you.
(Score: 0) by Anonymous Coward on Saturday May 03 2014, @05:38AM
Heh and you would lose. That's not how it is at all.
Why? Because you say so? I have met more than one doctor who doesnt give a damn and just floats the script out. What do they care they are 'helping them' and they are out of the office. Did your good deed for the day and got 50-150 to boot.
It seems that your mind is pretty made up though
Yes, perhaps it is. But living with this crap for 8+ years kind of has that effect.
I don't think I could convince you.
You could try. But sounds like you just want to shut people out and write the scripts. It sounds more like your the one who has made up their mind. Not surprising. You are well educated (as am I). But I have found the more money some people make the more they think they are right. When they do not realize it is mostly 'luck' that put them into the position they are in [Luck is about knowing how to recognize an opportunity and the skills to seize it]. We can afford to be wrong and continue on with our beliefs. There are however millions of people out there today right now who suffer because of simple choices that turn their lives inside out.
Mostly I am angry and want to vent. You are but a small cog in the wheels of the pill mill. I was hoping you could see it from your fellow doctors POV. Some of them may even know about it because they have the monkey on their backs. But alas... Try volunteering at a methadone clinic for a few months or swing by a few NA meetings once and awhile. You will feel differently, or probably just feel more smug. :(
I tell every addict and dealer I come across the same thing. In life there are choices. There a good choices and bad ones. Bad ones usually seem like good ones in the short term. Good ones usually take longer to cultivate. This has no bearing on social strata you are in. It works at all levels. If you can not see what I am talking about, then yes we are done.
(Score: 2) by gallondr00nk on Friday May 02 2014, @03:15PM
I can't speak for it personally, but I understand Kratom tea is supposed to be very good for coping with the withdrawl symptoms of opioid addiction.
(Score: 1) by Yates on Friday May 02 2014, @06:07PM
It looks like you'd be better off with this:
https://en.wikipedia.org/wiki/Ibogaine#Therapeuti
Or even this:
https://en.wikipedia.org/wiki/Ketamine#Treatment_
(Score: 1) by timbim on Friday May 02 2014, @06:13PM
Yeah, that and Imodium.
(Score: 1) by SacredSalt on Friday May 02 2014, @07:52PM
I've gone off of MSContin several times. The most helpful combination I found was: Gabapentin (at 2-3G day), lots of immodium, naproxen, and ginger tea. Its not quite completely painless to do it this way, but other than the restless legs its the easiest way I've found. The ginger tea stops the nausea for those that are curious.
I want to mention, I have chronic pain. I have a neurological autoimmune disorder that has a small chance of killing me. Sometimes it takes things away similar to MS or Lupus. Most of the time it just makes me feel like hell -- and chronic pain has been a part of that for more than a decade.
I've been on MScontin (morphine) for more than a decade now. I've had forced breaks from doctors to "see where my pain is actually at", and voluntary breaks where I wanted to see for myself what my pain level was at, and if stopping would help the fatigue I experience. Stopping never helped the fatigue, and the pain has always driven me back to taking MSContin. I've been everywhere on the dose scale from 45mg per day to 600mg per day depending upon what my disease was doing. Coming off of 600mg a day is pretty harsh, even just oral use.
To the people who say you can't get physically dependent to codeine or percocet because of the low dose -- those were what I started with. Codeine induced withdrawal symptoms in less than 2 weeks of use. Perocet (albeit 10's 6x per day) induced withdrawal after a few weeks of taking it. It might be a little milder stepping off of those because the dose is lower, but its pure hubris to suggest that physical dependence does not occur with those drugs. As far as the body is concerned in most people - an opioid is an opioid, and you develop physical dependence fairly quickly.
Even tramadol -- the so called no mu opioid -- has a discontinuation syndrome. The bottom line is there is no free lunch when trying to attack pain via this pathway.
(Score: 1) by fadrian on Friday May 02 2014, @09:08PM
I'm one of those who have a difficult time tolerating opioids. They make me constipated and nauseated, sometimes to the point of vomiting. I wish someone would come up with better non-opioid pain relievers. My wife, on the other hand? Feed her opioids all day and the worst she'll get is that she'll fall asleep.
Luckily, this is the only drug class to which I seem to have adverse effects, but then I'm not at a point where I need to take statins or beta blockers, ARB's, ACEI's, or CCB's. And I guess I'm controlling the odd psychological issues without taking SSRI's SNRI's or the newer atypical anti-psychotics they're starting to use to boost the effects of the former (I'm looking at you, aripiprazole). Nor do I need blood sugar management drugs or as of yet have arthritis or one of the other of the long lists of autoimmune crap that all of the new biologics with their string of side effects are targeting. Lucky genes I guess, but I'm sure there's still time enough to sample the delights of some of these before I become worm food.
That is all.
(Score: 2) by Reziac on Saturday May 03 2014, @02:45AM
I used to tolerate codeine well. When I was a kid we were prescribed codeine cough syrup for that horrible deep flu cough, worked a treat. In my late 20s I had my wisdom teeth out, and was prescribed a codeine painkiller. Didn't work worth a damn and gave me nausea that wouldn't quit. In retrospect, don't really know if it was due to being on the heels of the IV valium the oral surgeon used for anaesthesia, or if it's because it coincided with developing hypothyroidism (at the time, undiagnosed and untreated).
And there is no Alkibiades to come back and save us from ourselves.
(Score: 0) by Anonymous Coward on Saturday May 03 2014, @04:30AM
Kratom is pretty near flawless, and it's just one of hundreds (more like thousands) of plants with medicinal properties that are more effective than the pills for profit brands. In Thailand it was banned for tax reasons because it was so effective at weening taxable opium addicts. Big Pharma tactics are no better..