How much of the opioid epidemic is accidental vs. pleasure-seeking addiction?

[Ruken]

@wguy123

Did anyone take a gander at the very recent study that I’ve linked to twice

You linked to a university news release. Even worse than magazines. The study is at doi: 10.1001/jamainternmed.2018.5419

[wguy123]

@Ruken

You linked to a university news release. Even worse than magazines. The study is at doi: 10.1001/jamainternmed.2018.5419

Sorry. Does that you mean you disagree with the bit I quoted from the Stanford review?

[Treppenwitz]

@wguy123

Did anyone take a gander at the very recent study that I’ve linked to twice about young folks getting opioids from dentists? Here is a quick synopsis:

Of nearly 15,000 young people who received initial opioid prescriptions from their dentists in 2015, 6.8 percent had additional opioids prescribed between 90 and 365 days later, and 5.8 percent were diagnosed with opioid abuse during the 12 months after the initial prescription. In a comparison group that did not receive an opioid prescription from their dentists, 0.1 percent got another opioid prescription and 0.4 percent were diagnosed with opioid abuse over the same period.

Seems like it at least hooks young people.

Yep, it’s a problem. But the issue with this study, like pretty much everything that I’ve been able to find, is that it doesn’t help clarify what is happening beyond what we already know - prescribed opioids are associated with opioid addiction. In the study you highlight, the abstract concludes:

The findings suggest that a substantial proportion of adolescents and young adults are exposed to opioids through dental clinicians. Use of these prescriptions may be associated with an increased risk of subsequent opioid use and abuse.

Well, it’s more information about a different population. Thing is, the OP broadly hypothesises how this process of addiction may happen, and we’re still collectively struggling to flesh that out.

j

[echoreply]

@Treppenwitz

The findings suggest that a substantial proportion of adolescents and young adults are exposed to opioids through dental clinicians. Use of these prescriptions may be associated with an increased risk of subsequent opioid use and abuse.

This is a tautology, but it is a very important concept in addiction research: people never exposed to a substance do not show symptoms of addiction to that substance.

Limiting people’s exposure to highly addictive substances is probably in general a good idea, but such starts the path to a renewed war on drugs. I am not a pain doctor, but as a somewhat informed lay person, it would seem reasonable to try non-addictive analgesics before trying the addictive ones.

[guizot]

@Treppenwitz

Well, it’s more information about a different population.

It’s an important population.

I worked for a while in a facility for addicted young men – mostly to opioids and meth. Of course, each one had his own history, but probably the most common was that they tried some pills once and really liked it. Usually the pills were initially gotten as left-overs from a relative that were taken without permission, sometimes indirectly through a friend. Then they’d start buying them on the street, and some would eventually end up shooting up the cheap black-tar heroin coming in from Mexico. As part of my job I’d attend the yearly NCAD conference, and at that time researchers (particularly from Duke) were presenting a lot on the connection between earlier brain development (adolescence to 25 years) and greater susceptibility to addiction. Alcoholism, for example, usually takes a longer arc of sustained and heavy use to get to addiction in older adults, but they were finding that even the occasional college binge drinking—even just once–correlated with much higher risk of later alcoholism, (I think something on the order of 75% higher).

[Aeschines]

Thanks, I appreciate everyone’s replies!