Just say not to drugs kids! Err ... unless the dentist gives you drugs from one of the most dangerous and addictive classes of drugs in existence. Then you can pop 'em like candy!
"But while we wait for researchers to successfully develop non-addictive painkillers ..." people who make comments like this in articles on sites with the word "science" in the name should be pelted with rotten fruit for not mentioning the obvious solution; medical cannabis. Now legal in over 30 US states. Excellent for pain relief. Well known to be non-addictive, and certainly much less habit-forming or toxic than opioids or alcohol.
@strypey cannabis is not a drop-in replacement for opioids in pain management: they are not equivalent.
Pain management is a medical practice of which drugs (opioiods or otherwise) are a part.
Japan has the same drugs available without prescription, and no problem -- so it's not the drugs: it's something else.
While it's convenient to blame big pharma (and correct to point,) the supply valve are doctors and state/private insurance prescribing and paying.
@jeremiah hey dude, the 1950s called, they heard you had their dangerous naivety about the dangers of casually handing out fatal prescription drugs like they're harmless candy, and they want it back. Also their willful ignorance about the well known applications of medical cannabis. They've got a wrong-headed War on (Some) Drugs to get started, and they're going to need those.
1) My parents are in medicine, "willful ignorance" is a strong accusation.
2) I did not suggest casually handing out anything.
3) I'm not defending the pill industry.
@jeremiah once again it seems like you've dived in to defend the pill industry without reading the linked article. 1) Nobody prescribes opioids after minor dental surgery in countries with even semi-functional public health systems. 2) after getting wisdom teeth out in NZ, you get told to take over-the-counter paracetamol or Ibuprofen. I just smoked a couple of bowls instead and I was fine. Total replacement, without the risk of addiction and death by OD.
@jeremiah 3) the pain relief properties of cannabis are some of its most studied applications. Medical grade cannabis, in prescribed doses, in an appropriate delivery system for the patient, can replace any current use of opioids. Pill sellers have to deny and block that for as long as possible, for the same reason oil companies have to with climate change and renewables, and Microsoft did with GNU/Linux; because none of the later are as easy to monopolize.
@strypey That said, I've had enough of your accusatory tone which borders on ad hominems and stuffing words / arguments into my mouth that I'm not making. Cheers.
@jeremiah look I'm sorry if my tone was aggressive, but I met a lot of junkies in my late teens and 20s, and I've seen first-hand the damage opioids do. I've also known a lot of people who smoke ganja , both for recreational and for medical reasons. The relative dangers of the two were clear to me long before Professor Nutt and co published in the #Lancet showing opioids are one of the few drugs more dangerous than alcohol, and cannabis is *much* less dangerous than either.
@jeremiah so when I see people making excuses for the people who profit from opioid proliferation - essentially parroting the key messages from their defensive PR - yeah, it pisses me off. For the same reason is does when I see people making excuses for tobacco companies, and victim-blaming the addicts they create with their highly profitable business.
@jeremiah the tobacco industry knew how harmful their products are, and covered it up to protect their profits, and the opioid pushers are exactly the same. Did you know that PR flacks working for tobacco companies coined the phrase "anti-science" to attack public health activists campaigning against tobacco, and a lot of well-meaning people took that at face value, until those whistleblowers leaked the companies' own self-condemning science. Worth thinking about.
@strypey You might want to read Bruce Alexander's works on addiction, he studies it through the lens of psychology instead of focusing on chemistry, with quite interesting results.
@jkb I'm aware of the psychological theories that self-sabotaging habits can be caused by an obsessive-compulsive condition, rather than being caused by the thing people are addicted to. This is clearly the case with non-chemical "addictions" to gambling, sex, the net, and so on. I would argue we need a word to describe these, and a different word to describe chemical dependence.
@jkb ... because it's well-established that some chemicals are physically addictive, to the point that there is physical as well as psychological suffering when they're withdrawn. It's equally clear from that research that opioids are among the most addictive substances, and that cannabis use does *not* create chemical dependence in this way, although like gambling or sex, it can be the focus of self-sabotaging habits.
@jkb I'm not talking about behaviour experiments on rats either, I don't consider such vivisection to be scientific at all, let alone produce results that can be applied to humans. I'm talking about decades of clinical observations and social science research on the experiences of people using different drugs, and trying to stop using them.
@strypey Here's a non-rodent result then: "Having found that rather low readdiction rates apply to men who had really been addicted in Vietnam and who had been back in the United States long enough to become readdicted if the wished to or were driven to it by unbearable craving, we need to rethink public policy with respect to forced treatment." Robins, David, and Nurco in the American Journal of Public Health, 1974.
> "At this point, we do not know whether their high remission rate at 8 to 12 months after return will be long lasting. To learn this, we are planning to reinterview these veterans after they have been home three years."
Was this done? Where is the article on this follow-up study?
@strypey Also interesting is the work of Zinberg & al. on addiction (or rather, non-addiction) after opiates usage in a medical environment, but I'm afraid I don't have time to fight paywalls to get you the actual papers right now.
@jkb OK, but it seems to me that these are all edge cases. If it remains true that there are substances that when taken for more than a certain length of time, most people experience chemical dependence, and have to go through a physically unpleasant process of withdrawal when they stop. Caffeine, nicotine, and alcohol are all this category, and opioids have one of the shortest windows for establishing dependence, and most unpleasant withdrawal symptoms. Unless you have evidence this is wrong?
@jkb Anyone who has seen someone try to give up an opioid substance, or seen a friend convince themselves they have a flu so they can go get some codeine, knows how addictive opioids are. Anyone who has known long-term junkies know how hard regular opioid use is on the body, and the mind.
@strypey I'm not jumping to conclusions in either direction.Let's stay on topic: your original toot was about prescription opioids in the context of dental surgery, which to me seems like it falls in the same category as morphine usage after other surgeries, we're not talking about long-term daily users here; and we're certainly not talking about people who being beaten down by life turn to downer drugs and become junkies.
Trouble is: research on addiction is scarce and unsufficiently funded.
@strypey Full disclosure: I'm a cannabis user myself, have been for 20 years now, and smoke weed on a daily basis. When I go on vacation where it could get me into legal trouble I don't bring any and indeed I don't feel any withdrawal symptom at all. Clearly that's not addiction.
On the other hand I have a couple friends who can't sleep at all and can't focus on anything if they go a day without weed. Is that addiction? I don't know for sure, but it looks like addiction to me.
@strypey I would love to see more research being done on the subject of addiction, especially large-scale and long-term research, but I'm afraid it won't happen as long as the official policy in most countries is to keep waging the so-called "war on drugs". It's hard to get funding for research that may show that the problem isn't the drug itself but the social setting the user is forcedto live in. "It's not heroin, it's capitalism and the lack of bonding" sure sounds like a harsh truth to hear.
@jkb I'm a drug law reformer. I think no drug should be illegal to use (Portugal is on the right track), and any drug less dangerous than alcohol should be commercially available. Opioids are not in that category, according to Professor Nutt et Al in the Lancet, and their exhaustive research matches my own observations as a drug user and reform activist. Capitalism may makes heroin addiction, but abolishing it won't make opioids any less dangerous.
@jkb have you seen Trainspotting, or read the book? I have known many people on methadone, and they will tell you that Irvine Welsh was not exaggerating. Coming off opiates isn't just vaguely disappointing. It's a living hell. Speaking of which, Hellraiser is another film and book inspired by experiences of coming off opioids. I have tried many drugs but I would never go near them.
@strypey Couple years ago a cousin of mine took his life because he couldn't free himself from heroin addiction. I remembering telling me "you can do pretty much anything you want in life, but there are two things you absolutely have to avoid: heroin and prison" (he knew both from experience).
I'm curious about many things but I too won't go near any opioids, and I'm thankful I live in a country where medical practitioners are reluctant to prescribe them.
@jkb I'm sorry to hear about your cousin's death. It's those kinds of experiences that make it clear than the dangers of opioids are not just prohibitionist propaganda. In fact, it's arguable that one of the ulterior motives for starting the War on (Some) Drugs was to demonize less dangerous drugs that were already in common use for pain relief etc (see the doco ), so as to create a market for opioids. See the #Druglawed documentaries:
@strypey Thanks for these references, I'll make sure to go through them at some point.
@strypey We also agree on that, and clearly the Portugal experiment shows that decriminalizind drug usage is the first step to great public welfare improvements. Hopefully such decriminalization will make large-scale studies easier and we will have a better understanding of how these drugs work.
@jkb what you describe would also be the experience of many people if you took the internet away for a day. It doesn't even begin to compare to the physical symptoms of caffeine withdrawal, let alone opium withdrawal.
@strypey You're right, it's addiction but on a different level and scale, and that's what I meant by saying we have to do more research on the whole subject of addiction: it's not only psychological, it's not only physical, it's not well-understood enough and yet we play with potentially addictive drugs everywhere all the time (be it medical, recreative, or otherwise).
@jkb I think it's pretty clear that *anything* can be psychologically habit-forming, and that some substances are highly addictive (eg opioids, nicotine, alcohol, tranquilizers, most amphetamines), some are moderately addictive (eg caffein), some are not addictive (eg cannabis, MDMA), and some are anti-addictive (eg entheogens like LSD, psilocybin, mescaline)
@jkb I know the plural of anecdote is not data and all that. But this is the very consistent pattern that's emerged from my observations of my own drug use, and all the people I've seen use a lot of different drugs over a lot of years (I'm over 40 now), plus the stories I've heard from people about their observations. Also from the reading I've done as a drug law reform activist, including Nutt et al:
@jkb did you read the linked article? It discussed a study that showed a strong correlation between people taking opioids for wisdom tooth surgery, and becoming addicted to opioids later in life.
@strypey I hadn't, I did and two things struck me: first, the still relatively low number of abusers on the long term; second and more perplexing, thirty days of painkillers after wisdom tooth surgery? Here in Belgium you'd get at most a couple days worth of codeine after wisdom tooth surgery, nobody in their right mind would give a month worth of opiods to teenagers.
No wonder the US has an addiction problem if they prescribe Vicodin like it's paracetamol. Boy that healthcare system is fucked.