[moderating]
I am going to assume this was not intentional, but this was pretty jerky. Please avoid this in the future.
Same for this.
[/moderating]
Well, it would be necessary to isolate all the active compounds in pot, purify them in sufficient quantities, do trials with animals on them to test the effects, move those trials on to humans IF it seems there may be value in some of the compounds, run those trials for weeks or months or longer on a sufficient number of people with a specific condition/disorder/disease along with running them on folks without those conditions, and see what happens, and see if it’s statistically significant, and see what the ill effects are. And see if the benefit exceeds the risk.
Then repeat that for other conditions/disorders/diseases, then repeat that for each different compound etc. etc. etc.
Some of this was done for the drug Marinol, aka delta-9-tetrahydrocannabinol. It was found to have anti-emetic and appetite-stimulating properties which were felt to be more beneficial than its tendency to cause dysphoria, paranoia, and intractable vomiting (yes, in some patients this med AND pot can cause a syndrome of vomiting that can persist after cessation and even be life-threatening). It got approved after much time and research, but it’s never been considered a big success, and it hasn’t inspired other drug companies to invest too heavily into researching the compounds in pot, tho some are.
All this takes time, trained personnel, and takes a ton of money. And pot is still illegal under federal law, so not many researchers are willing to get a Schedule I DEA license to do the work.
What research that has been done on ‘medical’ marijuana (and there have been a fair number of retrospective and observational studies) really hasn’t demonstrated any real miracle cures or even particular efficacy for chronic pain, despite multiple testimonials. Some patients with significant chronic pain syndromes who have used pot to treat their symptoms have reported that eventually despite consuming it in large amounts daily they ended up with the same amount of pain they originally had, with loss of function because they were stoned a lot. (Which is also a common complaint with opioid use for pain).
Granted, it’s hard to OD on, and people won’t die from its use like they do with opioids. But it does not seem to be an answer to the problem of pain. Pot plant products may be shown to be very helpful for a variety of disorders, but 99.9% of the work still needs to be done.
“Pretty jerky”? My goddaughter’s death was probably fo the best is “pretty jerky”?
You grew up in a tougher town than I did.
I am profoundly disappointed to read this.
While it’s true there has not been as much research as there could be. There is no chance marujana will be shown to be as remotely effective as opioids for treating pain, in all but the mildest cases. For all the problems of addiction opioids are really really good at treating pain. Despite all the problems they’ve caused (or rather the fact they are illegal has caused) opioids have been a net win for humanity.
The current opioid epidemic wasn’t created by a few “bad apples” giving pills to any junky who turned up asking for them. It was caused by a lot of apparently reputable doctors sending chronic pain patients (most of whom weren’t recreational drug users or addicted to anything) home with a repeat prescription for opiates. That is complete unconscionable, anyone who has completed medical school should have known what would happen when they did that. That is their patients ended up being addicted to opioids.
The typical primary care doctor was being deluged by drug company ‘experts’ saying that their products rarely caused addiction when used properly to treat pain. Well-respected academic research physicians were endorsing this approach, the JCAH was punishing hospitals and doctors where the patients were not having their complaints of pain treated aggressively, and the community standard of care was shifting towards “Pain as the 5th vital sign” which MUST be treated. Treat until they were pain free was the approach pushed, and we were all told that opioids were perfectly safe at high dose if we titrated them up slowly. This was being taught to med students and residents in training as the appropriate thing to do also. Pain was the enemy, untreated pain was causing suffering, depression, premature dementia, accelerating heart disease, etc. etc. etc. We had this miracle drug, opioids, that could fix all that, yet we were denying our patients this great boon because a few people would abuse such substances.
I remember those days all too well, I knew it was a bone-headed approach headed towards disaster, and I did not get on board with it. I reduced the opioid dosage on many patients I inherited, with the goal to get them on a low dose and work to get them off of it. And I got sued a few times for not handing out unlimited opioids for chronic non-malignant pain. I didn’t lose, but it was a PITA. Other doctors who were wary of handing out too many opioids were getting low ratings on patient satisfaction surveys, loss of their ‘pleased patient panel’ bonus, and pressure from their bosses to keep the customers happy or get fired.
The pharmaceutical industry failed our patients, as did many of the leaders and standard-setters in the medical community. But in the process, most rank and file doctors went along because they trusted the experts, and they really did want to do the right thing, adequately treat that terrible scourge, pain.
Read the article I linked to earlier in this thread, it recounts how it came about.
Frankly, I think the pendulum is now swinging too far, and I’m now seeing patients in agony because they get 3 days of opioid pain killer after major surgery and on the 4th day they can’t sit still or eat or sleep due to pain. At present I’m not prescribing opioids too much differently than I did back in the days when others were handing them out by the bushel. It’s a useful medication in the right circumstances, none better for certain types of pain. I prescribe more and stronger opioids than some of my colleagues now do, for those circumstances.
OK, I’d better get off the damn soapbox. But this issue has been near and dear to me for many decades, from before I became a junkie through my early recovery and now it accompanies me into early senescence. 
ETA: @Griffin1977. Not QtM.
I’ve already demonstrated that I’m definitely NOT an expert in this stuff.
But this is about the 5th time in this thread that you’ve asserted that 100% of patients receiving opioids over some duration will become addicted. That absolutist perspective doesn’t seem to be borne out by the evidence I’ve read or the anecdote of various people I know IRL & posters here.
It’s clear you feel strongly about this. But is the feeling based on fact?
It’s clear (ref QtM) that some large fraction of patients were significantly overmedicated. With ghastly consequences. But that’s far short of the absolutism griffin1977 is pushing.
I don’t have a dog in the fight. But I’m curious to have accurate info since this is going to be a big issue in our country for a long time to come.
Most of the people who are prescribed Marinol, regardless of why, refuse to take it because the side effects are nastier than the condition(s) it’s being used to treat. It cannot be titrated the way smoked, eaten, or vaporized marijuana can. The most common use for people who do take it seems to be as an appetite stimulant for people with AIDS.
My earlier statement, for which I will not apologize, is that she probably would eventually have died from her disease anyway, and simply caused less destruction to her family and society than she would have had she not OD’d at the age of 20. Sad but true.
It was also a lot of willful ignorance. Much of the change in perception of opioid traced back to an over refrenced letter to the editor published in 1980 in the NEJM.
All five sentences of the letter, which had no supporting data or details, and was specifically referring to patients given opioids in a hospital setting, can be found here.
ETA: By “willful ignorance,” I am referring to researchers motivated to find any evidence to show that opioids were not going to cause an addiction problem if they were let out of the hospital. I would like to think that many were trying to find a better solution to pain management, but some were paid for by pharmaceutical companies looking to expand their markets.
It is absolutely true that everyone who uses opioids regularly over a long period of time will develop a physical addiction. That is a basic physiological fact, everyone who takes them regularly for long periods will develop physical dependency and suffer withdrawals when they stop taking them. That is as predictable as the physiological effect of insulin or potasium.
That doesn’t mean that everyone who develops those symptoms will have a life long heroin habit, but a significant portion will.
Thanks for the clarification.
So that sounds like such a person with a physical addiction can be titrated off the stuff if they’re motivated to try. Or at least some decent fraction of them can. As with quitting nicotine, some folks find it easy enough and some find it very hard. But most are somewhere in the middle: doable for someone sufficiently motivated and effective.
ISTM Psychological addition is a different thing. Somebody in that state has little motivation to quit. Their net motivation is in the direction of continuing.
The fact is, if you hand out X long term prescriptions for opiates you will end up with X*Y life long heroin addicts. And while Y is not 100% it is a pretty significant percentage. And anyone who’s been to medical school should know that.
And it’s not a case of “being motivated”. Any more than if you handed out insulin to everyone. Everyone would suffer a unhealthy drop in blood sugar, but probably not everyone would end up in coma. but it is not that those that did weren’t sufficiently motivated to stay conscious.
Bear in mind I’ve heard the prospect withdrawing from opiates, once that physical addiction takes hold compared to going to without food for a week. Yes, you COULD do it and probably not die, but it’s a pretty horrible prospect.
One might consider bringing back opium. It might not lessen the prevalence of addiction, but it might decrease the incidence of fatal overdoses. Or so the theory goes.
Since opium is smoked, its onset is almost immediate. And the dose one gets from a single puff is very small. The result is that a user can much more closely calibrate the dose to the response. You take a couple puffs, immediately get the response you’re after, then stop. When it starts to fade, you take another puff or two. Even if you did keep smoking a lot at one time, you’d fall asleep before you got to a lethal level.
With other forms of opiate administration (swallowing pills, injecting heroin, or smoking highly concentrated opioids), you’re basically introducing a relatively huge bolus all at once, and once it’s in there’s no going back.
Nicotine is highly toxic drug, but nobody ever overdoses on it, because the amount you get from one cigarette, while sufficient to kill the craving, is tiny compared to the lethal dose.
I became a teenager in 1973 and the “establishment” (remember that term? 
) was already harping that all drugs were bad. Yet kids smoked pot, dropped acid, and snorted coke when they got their hands on it. Yet everyone in my community (white, upper middle class spoiled suburban brats) knew not to mess with heroin. Ever.
And in the early/mid 70’s heroin was still prevalent in the larger cities. It wasn’t until the late 70’s/early 80’s that it started to be replaced by cocaine.
Yup.
I’m about the same age and demographics. I had the same experience half a country away in ahead-of-the-curve SoCal.
We all “knew”: Pot was as harmless as beer, pills were bad but controllable if you were careful, and heroin was a one way ticket to an ugly death in a couple years tops.
We’re doing that up here, out of necessity, and it’s come a long way in a short time. It’s understood that the epidemic of addiction burdens the whole community. So in some places, getting help could begin at local fire or police department. Walk in, tell them you want to get off of drugs, and they will call someone to come get you or drop you off somewhere. They partner with nonprofits who provide substance abuse treatment in its different forms; the treatment orgs call in others who provide food, child care, transport, financial help or whatever is possible. This includes church groups. It is not seamless and the system is not perfect, but it represents real progress.
The county jail has begun treating addict inmates with Vivitrol and mandatory counseling prior to release. That’s huge.
A frequent problem is not being able to overcome structural deficits in health services. Personnel issues mostly. It takes time to produce trained, experienced staff, and those working in substance abuse tend to be overworked and subject to burnout. I was talking with a LADC yesterday about 30-day treatment programs, pros and cons and so forth, kind of interesting because the LDAC is currently not affiliated with any programs - he’s driving a bus. Why, because working with addicts really sucks, and you do it for as long as your emotional capacity holds out. Then you do something else.
Along with everything else, there’s a growing need to care for the people who care for others.
Now see, nothing inspires me more than a (say) 17-year old addict, whether they want help or not. I can talk to problematic teens all day long without losing my faith in humanity. I average about thirty minutes on this board on any given day until I start to lose faith in humanity. True story.
LADC? LDAC? Enquiring minds want to know. 
Doubling down on being mean-spirited, (i.e., a jerk), is not appropriate behavior in this forum. I have known several addicts who have completely recovered, so your efforts at alternative futures to rationalize your callous comments fails. Repeating it is out of line.
This is a Warning to back off.
[ /Moderating ]
One theory I’ve seen floating around goes like this:
There is no effective intervention for opiate addiction. Some people will recover. Some will not. We can throw a ton of money at the problem, but only move the–ahem-- needle a little.
Moreover, the addiction crisis is largely a consequence of prescribing practices and pill mills that are already on the way out. So we can expect heroin use rates to return to their 1995 levels once the current generation of addicts dies or makes it out.
What we can do is make sure fewer people OD or get Hep C. That means opening up safe injection sites that, among other things, will test for Fentanyl and the like (or at least tell you how powerful the dose is going to be, since Fentanyl is what some people are now looking for). It means equipping all of our first responders with narcan. It means making sure that when people are released from prison they have access to drugs and treatment through that very dangerous first six months when a ton of releasees OD.
In this view, the proper response to the crisis is basically managing the death rather than the addiction and hoping to ride out the wave of addiction, assuming that we will eventually return to people who become addicted because they decide to try heroin recreationally which will be a much lower number than the people who move to heroin from pills.
I don’t think I agree with that vision, but I see it becoming the conventional wisdom in some parts. I’m curious to hear what people who have thought about this more think.