Posted by baseball55 on December 5, 2017, at 15:46:32
In reply to Re: Tolerence vs Addition of Opiods pain meds » Christ_empowered, posted by Phillipa on December 5, 2017, at 11:35:48
1. People become tolerant to opioids, addicted or not. This is why people with chronic pain conditions need higher and higher doses, even when they are not "addicted."
2. Opioids cause physical dependence, whether or not people are "addicted" (in the sense of abusing them, taking more than prescribed, engaging in drug-seeking behavior). Nobody who has used opioids long-term can simply stop them without painful withdrawal. They need to be tapered.
3. Opioids always cause euphoria. This is why they control pain. They don't stop the pain, they merely move people into a psychological state where the pain becomes tolerable. It's not that some people don't feel euphoria when on opioids. It's just that, for many (hopefully most?) people, that euphoria doesn't fulfill some psychological need that makes them want more even when the pain is gone.
4. I agree that oxycodone should not be taken off the market. It is an amazing and absolutely necessary drug for post-surgical pain and pain from terminal cancer. It is an absolutely terrible drug for chronic, non-terminal pain, like orthopedic pain. Way too addictive, builds tolerance requiring higher and higher doses and doesn't even work as well as physical therapies and mind-body work. Personally, I believe insurance companies should start covering Feldenkrais, which is the very best way, I have found, to help people with chronic orthopedic pain.5. Some countries have legalized, or at least de-criminalized opioids. Addicts need to register to get drugs, so they can be monitored medically. I don't know of any country where they are just over-the-counter legal (at least any developed country). I see this as highly unlikely in the US, where drug use still evokes these moral responses - she's lazy, undisciplined, needs to suffer for her sins. Phillipa is absolutely right. Without regular monitoring and counseling, overdoses are way too common. The problem with legalization is that, though currently illegal in the US, they are almost unbelievably easy to obtain. Maybe some form of decriminalization would allow the government to regulate what's sold - so heroin laced with fentanyl could be taken off the market.
6. Most addicts want to quit. Currently, drugs like methadone and suboxone, which make quitting much easier and safer, are very difficult to get access to. Methadone is only available through clinics, where addicts need to line up daily to get their dose. Suboxone can be prescribed, but few doctors are licensed and the DEA limits the number of patients they can treat. As a result, suboxone prescribing has become a gold-mine for licensed prescribers - few take insurance and charge hundreds of dollars for visits.
poster:baseball55
thread:1096046
URL: http://www.dr-bob.org/babble/20161215/msgs/1096197.html