# Is the War On Addiction Becoming a War On Pain? **URL:** \ **Category:** Great Debates\ **Created:** [July 21, 2021, 5:34pm UTC](https://boards.straightdope.com/t/is-the-war-on-addiction-becoming-a-war-on-pain/946989 "2021-07-21T17:34:16Z")\ **Posts on this page:** 20\ **Page:** 4
**Author:** ![puzzlegal](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puzzlegal/32/3827_2.png) [@puzzlegal](https://boards.straightdope.com/u/puzzlegal)\ **Post date:** [July 25, 2021, 1:10pm UTC](https://boards.straightdope.com/t/is-the-war-on-addiction-becoming-a-war-on-pain/946989/62 "2021-07-25T13:10:39Z")
A friend adopted a baby who was born with an opiate addiction, and he was treated in the NICU with IV opiates that were gradually withdrawn. Of course, no one casts moral aspersions on a newborn. I don’t believe there’s any political opposition to that kind of treatment, even in the US. ---
**Author:** ![Dangerosa](https://avatars.discourse-cdn.com/v4/letter/d/22d042/32.png) [@Dangerosa](https://boards.straightdope.com/u/Dangerosa)\ **Post date:** [July 25, 2021, 1:24pm UTC](https://boards.straightdope.com/t/is-the-war-on-addiction-becoming-a-war-on-pain/946989/63 "2021-07-25T13:24:09Z")
I just had an extraction (not wisdom teeth) and was offered (not automatically given) a Vicodin prescription for SIX tablets. I took the prescription and used two. The rest of the pain was managed with two Advil and one Ibuprofen, which has been shown to be as effective as opioids most of the time. The remaining four I’m hoarding for the headache that OTC pain meds don’t touch. (If you hoard your opiates for real pain, and are lying on the couch moaning “this one isn’t bad enough to dip into the precious supply” - you aren’t an addict.) I stayed with a friend who was recovering from major surgery with enough opiates for six (I think) days - the instructions said “over six consecutive days has been correlated with addiction.” She took them for three and moved to the Advil/Tylenol combination (which I now see they are selling). ---
**Author:** ![Dangerosa](https://avatars.discourse-cdn.com/v4/letter/d/22d042/32.png) [@Dangerosa](https://boards.straightdope.com/u/Dangerosa)\ **Post date:** [July 25, 2021, 1:32pm UTC](https://boards.straightdope.com/t/is-the-war-on-addiction-becoming-a-war-on-pain/946989/64 "2021-07-25T13:32:19Z")
Oh, God yes. My husband’s doctor will prescribe him anything. If I see the same doctor, I get told to suck it up. (I don’t see his doctor unless he’s the only one with an appointment and I need to be seen for something like a UTI). My husband doesn’t understand why I won’t go in to see a doctor. Then I do and come home with “I’m supposed to put ice on it” - with hip pain I’ve had for two months where I’m limping and he has started to understand. I had severe cramping and breakthrough bleeding and was told “its probably diverticulitis” (because the intestines and vagina are connected in every medical textbook) with a family history of female cancers (it was harmless fibroids, but it took three doctors to get them to look and take a biopsy - and the cramping was “take an Advil”) ---
**Author:** ![DemonTree](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/demontree/32/8646_2.png) [@DemonTree](https://boards.straightdope.com/u/DemonTree)\ **Post date:** [July 25, 2021, 1:46pm UTC](https://boards.straightdope.com/t/is-the-war-on-addiction-becoming-a-war-on-pain/946989/65 "2021-07-25T13:46:59Z")
> [@UltraVires](#): > > My question: Are there people after a car accident or other such thing that _actually need_ opioids to manage pain? Is this common or rare? Are they truly in pain without these medicines or are they just physically addicted to them? Here’s something @Qadgop_the_Mercotan said on the subject: > [@Vicodin addiction/withdrawal](https://boards.straightdope.com/t/vicodin-addiction-withdrawal/404921/23): > > You’re right. And I have a few chronic pain patients whom I have on opiates. But it’s never the first tool in my toolbox for treating chronic non-malignant pain, even in patients with zero abuse problems. Opiates tend to work better for folks with well-defined, regionalized chronic pain problems like a radiculopathy, where a specific nerve root is damaged, and causing problems, or for the painful sequella of arachnoiditis, inflammation of the brain and spinal cord lining. Opiates tend to no… IIRC he’s also said that opiates tend to stop working on chronic pain after a while, and the patient ends up taking them just to avoid the withdrawal symptoms, but I can’t find that one. ---
**Author:** ![Drsunflower1](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/drsunflower1/32/12711_2.png) [@Drsunflower1](https://boards.straightdope.com/u/Drsunflower1)\ **Post date:** [July 25, 2021, 1:55pm UTC](https://boards.straightdope.com/t/is-the-war-on-addiction-becoming-a-war-on-pain/946989/66 "2021-07-25T13:55:23Z")
> [@Dangerosa](#): > > I had severe cramping and breakthrough bleeding and was told “its probably diverticulitis” (because the intestines and vagina are connected in every medical textbook) with a family history of female cancers (it was harmless fibroids, but it took three doctors to get them to look and take a biopsy - and the cramping was “take an Advil”) Jeez. The sexism/misogyny is doing well in our profession. Glad you eventually got what you needed but I hear you. There’s a strain of doctors who pride themselves on never actually listening to patients but always know better. Unfortunately 😒 ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [July 25, 2021, 1:57pm UTC](https://boards.straightdope.com/t/is-the-war-on-addiction-becoming-a-war-on-pain/946989/67 "2021-07-25T13:57:45Z")
> [@DemonTree](#): > > IIRC he’s also said that opiates tend to stop working on chronic pain after a while, and the patient ends up taking them just to avoid the withdrawal symptoms, but I can’t find that one. Another problem with long term opioid use is that they have an increased risk for BAD outcomes. Even with normal, stable dosing in folks that don’t abuse them or any other substances. Increased rates of sudden cardiac death, respiratory arrest, severe GI dysfunction (when matched against similar patients who don’t take opioids). Opioids are problematic in the best of circumstances, though still useful for some. I’m still a believer in opioids to treat significant acute pain and malignant pain. But both of those types of cases have definite endpoints for their use. ---
**Author:** ![DemonTree](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/demontree/32/8646_2.png) [@DemonTree](https://boards.straightdope.com/u/DemonTree)\ **Post date:** [July 25, 2021, 1:58pm UTC](https://boards.straightdope.com/t/is-the-war-on-addiction-becoming-a-war-on-pain/946989/68 "2021-07-25T13:58:27Z")
> [@Dangerosa](#): > > I just had an extraction (not wisdom teeth) and was offered (not automatically given) a Vicodin prescription for SIX tablets. > > I took the prescription and used two. The rest of the pain was managed with two Advil and one Ibuprofen, which has been shown to be as effective as opioids most of the time. The remaining four I’m hoarding for the headache that OTC pain meds don’t touch. I actually don’t remember the pain being that severe after having my impacted wisdom tooth extracted. It wasn’t as bad as an average period. (The pain during, on the other hand, was highly memorable. Everyone told me to opt for a general anaesthetic; I should have listened.) ---
**Author:** ![DavidNRockies](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/davidnrockies/32/6279_2.png) [@DavidNRockies](https://boards.straightdope.com/u/DavidNRockies)\ **Post date:** [July 25, 2021, 2:05pm UTC](https://boards.straightdope.com/t/is-the-war-on-addiction-becoming-a-war-on-pain/946989/69 "2021-07-25T14:05:01Z")
> [@Chatterbox1](#): > > For example, a small number of people who undergo laser eye surgery have a complication where nerves grow back improperly. It is undetectable under standard ophthalmology equipment. Years ago, it was considered a complete mystery. You can look it up if you want: post LASIK corneal neuralgia. That’s a very salient example. That one can be fairly reliably diagnosed these days via **[confocal microscopy.](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5607443/)** It’s reasonable to think of a confocal microscope as a ‘more powerful’ microscope. Over time, as medicine (writ large. Most of those post-LASIK eye pain patients were written off as crazy – causing no end of harm in the process – by no end of ophthalmologists) has come up with ‘more powerful microscopes’ (ie, better, more sensitive, more specific tests), it’s amazing how much we’ve learned. Well … how much _medicine_ and many of us have learned. Others are still pathologically wedded to their closely-held biases 😉 And … oh, the damage they will do … ---
**Author:** ![DemonTree](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/demontree/32/8646_2.png) [@DemonTree](https://boards.straightdope.com/u/DemonTree)\ **Post date:** [July 25, 2021, 2:06pm UTC](https://boards.straightdope.com/t/is-the-war-on-addiction-becoming-a-war-on-pain/946989/70 "2021-07-25T14:06:29Z")
> [@Qadgop\_the\_Mercotan](#): > > I’m still a believer in opioids to treat significant acute pain and malignant pain. But both of those types of cases have definite endpoints for their use. Why don’t they offer something like hydocodone when you’re in labour, rather than a codeine pill that hardly does anything? ---
**Author:** ![Drsunflower1](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/drsunflower1/32/12711_2.png) [@Drsunflower1](https://boards.straightdope.com/u/Drsunflower1)\ **Post date:** [July 25, 2021, 2:09pm UTC](https://boards.straightdope.com/t/is-the-war-on-addiction-becoming-a-war-on-pain/946989/71 "2021-07-25T14:09:20Z")
> [@Qadgop\_the\_Mercotan](#): > > I’m still a believer in opioids to treat significant acute pain and malignant pain. But both of those types of cases have definite endpoints for their use. This. The definitive endpoint is very important to prevent dependency. Thanks for weighing in, I read the thread that @DemonTree bumped. Glad you’re doing okay now and good to hear from experts. I see a lot of people in chronic pain but I only treat the psych part, so I rarely have to fight over opiates. Benzodiazepines OTOH… ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [July 25, 2021, 2:11pm UTC](https://boards.straightdope.com/t/is-the-war-on-addiction-becoming-a-war-on-pain/946989/72 "2021-07-25T14:11:24Z")
> [@DemonTree](#): > > Why don’t they offer something like hydocodone when you’re in labour, rather than a codeine pill that hardly does anything? I haven’t done OB since 1990 (did a LOT of deliveries between '83 to '90) so you’d have to ask someone currently in that practice. But back then we only used very short acting IV or IM narcotics during labor, as any opioid could depress the baby as well as the mom, especially regarding respirations. I don’t recall codeine ever being used during active labor in the L & D arenas I worked in. ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [July 25, 2021, 2:14pm UTC](https://boards.straightdope.com/t/is-the-war-on-addiction-becoming-a-war-on-pain/946989/73 "2021-07-25T14:14:04Z")
> [@Drsunflower1](#): > > Benzodiazepines OTOH Ah, so glad I missed the benzo wars. I let the psychiatrists handle that. The opioid wars aren’t so terrible now, since it’s rare for me to get a patient who’s recently been on maintenance opioids for chronic pain. The current fight is over gabapentin, which is one of the most highly abused drugs in our system. More and more states are treating it as a controlled substance now, and I expect eventually the feds will follow suit. ---
**Author:** ![Drsunflower1](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/drsunflower1/32/12711_2.png) [@Drsunflower1](https://boards.straightdope.com/u/Drsunflower1)\ **Post date:** [July 25, 2021, 2:14pm UTC](https://boards.straightdope.com/t/is-the-war-on-addiction-becoming-a-war-on-pain/946989/74 "2021-07-25T14:14:10Z")
> [@DemonTree](#): > > Why don’t they offer something like hydocodone when you’re in labour, rather than a codeine pill that hardly does anything? Don’t they? We can choose from a variety of pain management options, from pethidine to epidural to remifentanil pumps and NOx. And that’s in a country where we also still do home births. Strange, i always had the impression that the Netherlands were way behind on the curve of pain management during labour, but it seems Britain is even worse 🤨 Eta not practicing ob/gyn, just have lived through two deliveries. One on epidural, one unmedicated at home. ---
**Author:** ![puzzlegal](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puzzlegal/32/3827_2.png) [@puzzlegal](https://boards.straightdope.com/u/puzzlegal)\ **Post date:** [July 25, 2021, 2:17pm UTC](https://boards.straightdope.com/t/is-the-war-on-addiction-becoming-a-war-on-pain/946989/75 "2021-07-25T14:17:54Z")
> [@UltraVires](#): > > They were in a serious car accident 30, 20, 10 years ago and have a chronic injury that simply must be managed with opiods. At some point several years ago the doctor cut them off and they bought pills on the street and then heroin when they couldn’t afford the pills. > > My question: Are there people after a car accident or other such thing that _actually need_ opioids to manage pain? Is this common or rare? Are they truly in pain without these medicines or are they just physically addicted to them? I work for a major workers compensation insurer. Unsurprisingly, we pay for the treatment of an enormous number of people who were injured in a serious car accident, or similar. We (not me, but my employer) investigated the efficacy of opioid treatment, and what we found was the the more opiates were given, and the earlier they were given after the accident, the less likely the injured person was to return to work. And yes, we controlled for severity of injury. We were one of the early voices lobbying for doctors to prescribe less opiates. What’s “needed” to manage pain is subjective. So i don’t know that there’s an objective answer to your question. I certainly think opiates have a place in the treatment of pain. But they don’t seem like they are generally a good choice for chronic pain. That being said, if someone is physically dependant on opioids, they need them, or bad things happen to them. ---
**Author:** ![Drsunflower1](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/drsunflower1/32/12711_2.png) [@Drsunflower1](https://boards.straightdope.com/u/Drsunflower1)\ **Post date:** [July 25, 2021, 2:19pm UTC](https://boards.straightdope.com/t/is-the-war-on-addiction-becoming-a-war-on-pain/946989/76 "2021-07-25T14:19:37Z")
> [@Qadgop\_the\_Mercotan](#): > > Ah, so glad I missed the benzo wars. I let the psychiatrists handle that. Yep that’s where I come in. And fierce it is, but nowadays we have help from our colleagues from Addiction medicine. > [@Qadgop\_the\_Mercotan](#): > > The current fight is over gabapentin, which is one of the most highly abused drugs in our system Oh seriously? I’ll need to keep an eye out then, because i do prescribe that. ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [July 25, 2021, 2:22pm UTC](https://boards.straightdope.com/t/is-the-war-on-addiction-becoming-a-war-on-pain/946989/77 "2021-07-25T14:22:30Z")
> [@Drsunflower1](#): > > Oh seriously? I’ll need to keep an eye out then, because i do prescribe that. Yeah, I prescribed buckets of gabapentin early on in my battle with the opioid epidemic for my patients, only to discover they were hoarding it, cheeking it, OD’ing on it, diverting it. Oops. Some basic [gabapentin abuse](https://www.addictioncenter.com/drugs/gabapentin/) info for those interested. ---
**Author:** ![Drsunflower1](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/drsunflower1/32/12711_2.png) [@Drsunflower1](https://boards.straightdope.com/u/Drsunflower1)\ **Post date:** [July 25, 2021, 2:25pm UTC](https://boards.straightdope.com/t/is-the-war-on-addiction-becoming-a-war-on-pain/946989/78 "2021-07-25T14:25:59Z")
Thank you! Btw I got confused. I don’t prescribe gabapentin regularly. I do prescribe pregabalin, and that gives no rush AFAIK. But thanks anyway, I like to be informed ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [July 25, 2021, 2:29pm UTC](https://boards.straightdope.com/t/is-the-war-on-addiction-becoming-a-war-on-pain/946989/79 "2021-07-25T14:29:10Z")
> [@Drsunflower1](#): > > I do prescribe pregabalin My experience with [pregabalin abuse](https://www.addictioncenter.com/drugs/lyrica-addiction-abuse/) is similar to that of gabapentin. Among my patients, the general thought is that pregabalin is preferred over gabapentin as a drug to use/abuse. ---
**Author:** ![Drsunflower1](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/drsunflower1/32/12711_2.png) [@Drsunflower1](https://boards.straightdope.com/u/Drsunflower1)\ **Post date:** [July 25, 2021, 2:32pm UTC](https://boards.straightdope.com/t/is-the-war-on-addiction-becoming-a-war-on-pain/946989/80 "2021-07-25T14:32:37Z")
A… Ha. That explains some of my previous cases. I’ll remember this! Upon reflection seems pretty logical given the effect is on GABA modulation, just like benzos… ---
**Author:** ![DemonTree](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/demontree/32/8646_2.png) [@DemonTree](https://boards.straightdope.com/u/DemonTree)\ **Post date:** [July 25, 2021, 3:01pm UTC](https://boards.straightdope.com/t/is-the-war-on-addiction-becoming-a-war-on-pain/946989/81 "2021-07-25T15:01:11Z")
> [@Drsunflower1](#): > > Don’t they? We can choose from a variety of pain management options, from pethidine to epidural to remifentanil pumps and NOx. And that’s in a country where we also still do home births. Strange, i always had the impression that the Netherlands were way behind on the curve of pain management during labour, but it seems Britain is even worse 🤨 > Eta not practicing ob/gyn, just have lived through two deliveries. One on epidural, one unmedicated at home. They offer more options during active labour, but until you get to that point you’re pretty much just left to suffer. > [@Qadgop\_the\_Mercotan](#): > > Another problem with long term opioid use is that they have an increased risk for BAD outcomes. Even with normal, stable dosing in folks that don’t abuse them or any other substances. Increased rates of sudden cardiac death, respiratory arrest, severe GI dysfunction (when matched against similar patients who don’t take opioids). Opioids are problematic in the best of circumstances, though still useful for some. What would be the best option for the person who’s had multiple back surgeries and has been using opioids long term? [Previous page](https://boards.straightdope.com/t/is-the-war-on-addiction-becoming-a-war-on-pain/946989.md?page=3) [Next page](https://boards.straightdope.com/t/is-the-war-on-addiction-becoming-a-war-on-pain/946989.md?page=5)