I ask because the media has been putting out stories about a new “drug epidemic”. Here in MA, the local papers claim that over 1000 people have died this year, from overdoses of prescription opioid drugs. To me this sounds like sensationalism, much like the way “crack” cocaine was portrayed in the mid-1970s:
-addictive from the first dose
-deadly when overdoses
-widely available and cheap
-purveyed by the usual evil suspects
My question: are these drugs anything new? As far as I know, they are prescribed for pain relief. Just being synthetic versions of morphine-like drugs hardly seems to make them terribly dangerous-are they any worse than naturally-derived opiates?
Finally, is this “epidemic” actually sensationalism? Or are these drugs really highly dangerous, and a threat to general health?
I think the biggest issue with these opioid drugs is their extremely high potential for addiction. The addiction is what drives people to place bomb threats at pharmacies or rob people. I think these drugs should be cheaply available to anyone who wants them, which IMO would significantly cut down violent crime.
I’m probably the wrong person to ask because I knew a 24-year old man who died of a heroin overdose. Based on the last time anyone talked to him and the time he was found, it happened in something less than 2 hours.
Also, my mother was allergic to opiates. Once an idiot doctor didn’t look at her chart and gave her Demerol. Her blood pressure dropped to 0, and if she hadn’t been surrounded by hospital staff she would have died.
Heroin IS an opioid, isn’t it?
I’ve had 7 close friends, 1 aunt and 1 uncle-in-law die of prescription drug overdose in the past 15 years, so at least in my worldview, it is very dangerous. I wouldn’t doubt that there are more deaths due to presciption opiate overdose than reported. I don’t think any of the ones that have died that I know were reported as an overdose. In fact, one was camping and took a combination of methadone/alchohol/xanax and died in his sleep, but it was officially considered death from a heart-attack.
There does seem to be an epidemic of abuse of prescription painkillers going on. They are quite addictive (although IANAD, so take what I say for what it’s worth).
Are they widely available and/or cheap? I don’t know. Addicts sometimes turn to heroin, because it’s cheaper and just as, if not more, available than the prescription stuff.
That said, it’s hardly addictive from the first dose. I’ve taken Oxycontin (with a prescription, of course), and been given morphine and demerol and others in a hospital setting, and I’m not addicted to anything.
All of these drugs can be deadly if the user takes too much. There’s no doubt about that at all.
Yep. I guess the distinction the OP was trying to make was between prescription painkillers and street drugs.
The answer to why prescription drugs can ( but aren’t necessarily are ) be more of a problem is their very ubiquity. Despite being prescription, Vicodin and its stronger cousins can be found in an awful lot of medicine cabinets and folks that might balk at going down to Mission Street to score some tar heroin can find it a lot less stressful to raid Granny’s little-used pill stash.
Yes-ish. Opioids are synthetic or semi-synthetic substances that produce the same pharmacological effects as opiates, which are substances derived directly from opium alkaloids (including heroin.) Opiates are technically opioids - they resembles themselves, after all - but I think it would be uncommon to refer to them as such since there is a narrower term available.
A thought. The “epidemic” of prescription painkillers has led to an unfortunate reluctance among physicians to prescribe painkillers when they’re really necessary.
My experience:
“Doctor, I’m going to need some painkillers for this.”
“No, we don’t prescribe painkillers. Tylenol will work fine.”
“You mean, even with this metal spike sticking out of my leg, and all the bones broken, some crushed, I won’t have any serious pain?”
“No, you’ll have pain, but we don’t prescribe painkillers. Sorry 'bout that.”
“OK, then. Thanks so much.”
Real conversation (shortened and cleaned up, of course). Happened to me. Sucks.
This: there a lot lower barriers to (mis)use with prescription meds.
On the upside, risk of an accidental death due to overdose is a lot lower, because the user can tell what the dose is.
Yeah. With heroin, you never know how potent the bag you just bought is going to be. You can be used to shooting 4 bags at a time, then the one time you get a particularly strong batch, because it hasn’t been cut as much, you shoot the same 4 bags you usually do, and OD.
Man-made opiates are (IMO, anyway) much more dangerous than their natural counterparts, all other things being equal. In a lab, the pharmaceutical companies can tweak something to make it actually more addictive than its natural counterpart.
I don’t have a cite, but I remember reading about (and seeing a documentary) on addiction and the ability for people to get off of various drugs. The comparison drug was methadone vs. heroin. Addicts could get methadone from a clinic for free or for a nominal charge, but most of them couldn’t stop taking the methadone. Various opinions are out there, but people who have been addicted to heroin and methadone at one point in their lives seem to agree that getting away from methadone is much harder than heroine.
This could be a product of a small sample size, or maybe addicts who know they can get free methadone don’t have the motivation they need to get off the drug, like they would if they were spending a fortune on heroine. I don’t know.
However, not all prescription opiates are cheap. A drug like oxycontin, which is still being made under patent protection, is very expensive, depending on your insurance co-pay. Percocet, on the other hand, is now made generically and it is much more affordable. Supposedly, percocets are faster acting, but don’t last as long, whereas the oxycontins are extended release.
It is unfortunate that doctors are hesitant to write scripts for opiods/opiates, but i am sure they don’t want the liability. Plus, the Pain Management industry is booming, so a regular doctor can just make you go see one of these specialty doctors instead.
From what I’ve heard, though… People with chronic pain issues are now forced to add another doctor to their list. And once you are established as a patient, the doctor doesn’t even come in to see you to write a script. A PA comes in, sees the patient for 5 minutes, and writes the scripts, and the patient is on his/her way. Insurance companies are billed for a specialty office visit, and if there is no change in meds for the patient, it resembles little more than paying for a visit to a legalized pusher.
(I have a relative suffering from chronic pain, and this info is from a conversation I had with them.). IANAD, IANAL, IANADU, IANAS.
The biggest problem with street drugs (at least in my eyes) is I wouldn’t have any way to test the drug to see how weak or strong a dose is. This would make using street drugs as a long term solution to managing pain a risky proposition at best. I don’t know how people can risk their lives by taking something they buy off someone on the street, but I guess when someone gets to that point, they aren’t all that concerned with dying as much as they are concerned with dealing with their situation.
The soon-to-be-former head of DEA is pissed because her boss (the Prez) told her to lave marijuana alone in places where it is legal.
She actually called a press conference to denounce her orders and state that marijuana was the most… (insert shrill, not-quite-current opinion).
Then she figured out the opioid 'scripts had TRIPLED in last X years.
Now all of use who require opioids for pain relief are lying quietly in bed because our 'scripts have been cut - you got it - by 2/3.
One little point - as people age (ever hear of the Boomer Generation?), they fall apart, and drug use skyrockets - especially pain meds.
Is there a crises? Only to the point that people are being deliberately denied pain relief simply because of one idiot’s irrational opinion. Fer instance: I (who hates the heat and acridity of grass) am seriously looking into it - luckily, I’m in CA.
Opioid pain relievers are certainly not addictive on first use for some of us. I’ve had occasion to use them periodically over the years and apart from relieving whatever pain I was having they had no effect whatever. So it’s a mystery to me what people get out it that causes them to become addicted.
Unfortunately it’s become like pulling teeth to get a doctor to prescribe them. I have a GP who I’ve known well and gone to for 20 years and it’s tough even to get him to prescribe them should I need some. Ditto for my dentist. How do you convince a doctor that opioids have no addictive effect on you when that’s exactly what they’re expecting you to say when they do? :smack:
That we are in the midst of a drug epidemic isn’t sensationalism, no. The media is sensationalizing aspects of this epidemic, sure, as briefly pointed out on page 4 in the NIH workgroup findings on opioids in the treatment of chronic pain (long, but good read), but we really do seem to have a problem with opioid overdose deaths now exceeding both motor vehicle accident and firearm-related deaths (at least in subsets of the population, like those in the age range of 35-54 years old). Opioids do not account for all drug overdose deaths, but do account for a hefty chunk of them. More people in the USA have died in the period between 1999 and 2010 from opioid-related causes (> 100,000) than there were US military casualties in the Vietnam War (~58,000) according to the American Academy of Neurology position paper on Opioids for chronic non-cancer pain, published last September, with 16,651 occurring in 2010 alone, and approximately another 17,000 dying from opioid-related causes in 2011, per the CDC.
Is a single dose of an opioid going to turn one into an addict? It’s possible, sure, but fairly unlikely, given the number of individuals on opioids for various types of acute pain, who don’t go on to develop an addiction. It’s more likely in the context of treatment for chronic non-cancer pain, with some estimates pegging the addiction prevalence between 14-19% of patients on chronic opioid therapy (per the above mentioned NIH report).
Opioids can be very deadly when overdosed, though for every overdose death, more than 7 times the number of non-fatal overdoses occured, according to a paper published in 2010, using data from 1997-2005, so it obviously isn’t universally fatal. Overdose (both fatal and not) is more likely the higher the morphine-equivalent dose, with doses in the 50-99mg of morphine equivalence daily (MED) increasing the chance of overdose 3.7 times versus those on a dose of 1-20mg MED. Those on 100mg MED or higher had ~9 times or greater the chance of overdose.
RNATB’s nitpick about opioid vs opiate aside (which is correct, fwiw), heroin is actually a pro-drug for morphine. Acetylation of both the 3- and 6-hydroxyl groups allows for better penetrance through the blood-brain barrier, so more of the drug gets into the CNS. Enzymes in the brain then de-acetylate one acetyl group to 3-monoacetyl-morphine (inactive), 6-monoacetyl-morphine (active), or both to morphine. Because the 3-hydroxyl group is blocked, heroin itself lacks activity.
Heroin IS an opioid.
I assume the OP means prescription drugs?
Concurring with JayRx1981’s post, I understand that more people are dying today from mis-use of prescription drugs than from street drugs, and pain-killers are the biggest chunk of that. Also I understood that opioids are most effective painkillers for acute (post-op) pain, as opposed to chronic (long-term) pain, so they have been over-prescribed in the past (which is why there is some pullback now).
Opiates/opioids are NOT NOT NOT instantly physically addictive, that is nonsense. It takes weeks to months of round the clock dosing to cause a physical addiction.
To put this in perspective, it would be like saying a single beer would cause you to be physically addicted to alcohol, in reality it takes a long time of continuous dosing to get there.
I posted before my skepticism about this so called RX drug epidemic, I knew someone with stage four cancer that was visible externally and had medical staff SHOCKED at seeing it, nurses and doctors. And the strongest opiate they ever got from their doctors was 15mg morphine tablets. So I think this idea doctors are just throwing gobs and gobs of opiates at patients is BS.
Methadone has a much longer half life than heroin, meaning the drug lasts longer in your body. Therefore withdrawal is going to be much extended and longer, which could translate to people thinking it is harder to quit.
If by physical addiction, you mean the development of a characteristic opioid withdrawal syndrome, you would be wrong, as even single doses of morphine are capable of causing a mild withdrawal, though probably not in everyone, and it’s less likely at the recommended low starting doses. If you are referring to what addiction actually is, which is the development of maladaptive thoughts and behaviors which result in maintained drug use (despite harm), inability to control drug use, craving, excessive thinking and planning centered on obtaining said drug(s), and/or misuse or abuse for a purpose not intended, then yeah, the chances of all of that occurring with a single dose or even short term use is probably absurdly low, though it’s still conceivably possible.
As for your skepticism, the truth is that no, most doctors don’t throw gobs of opioids at patients, but a small select few who do are writing for the largest chunk of controlled substances (in Ohio, currently, 24% of prescribers are writing for 84% of controlled substance prescriptions, per the OARRS semi-annual report). I can further tell you that I have patients (who don’t have a diagnosis of cancer) who regularly get anywhere from 150mg MED to almost 1000mg in one patient, and I’ve seen (and refused to fill, though not solely based on the dose) opioid prescriptions for patients on 1200mg MED. Prescribers in your area may be limiting the amount or doses they are writing for, but trust me, the same doesn’t hold true in every geographic area.