The issue I have with this opiate epidemic is the part in which a subset of people are suffering for no good reason. Some people require opiates to live a normal life as they go by day to day in chronic, unrelenting, moderate to severe pain. Chronic pain, especially severe chronic pain, is terrible, it’s draining and it can suck the joy out of everything.
People are panicking over opiate abuse, the resulting effect is a crackdown on prescription opiates which in turn causes people who suffer from chronic debilitating pain to be left suffering as the government clamps down on doctors prescribing opiates.
Im not trying to downplay the risk of opiates, they are highly addictive drugs, some more than others, with a high potential for abuse. It can sometimes be difficult for a doctor to differentiate between a chronic pain patient begging for relief and an addict begging for “pain relief” as both are quite similar, the difference being that typically addicts will usually try to convince the doctors to prescribe instant release opiates rather than slow release formulas (other differences as well).
The bulk of opiate abuse doesn’t come from doctors prescribing the substances, I’ll post a study when I get the chance but most people who abuse opiates acquire them first off a dealer or steal them from someone else who has acquired them.
The consequences for those who abuse opiates and the surrounding family members can be devastating, and I apologize if anyone has or has friends/family who have suffered consequences of opiate abuse is offended by this post, I’m giving my perspective on the issue. Opiate induced hypogonadism is a huge issue among those taking opiates for chronic pain, however a small body of evidence now exists suggesting tapentadol (an opiate pain medication with two mechanisms, one being acting as an agonist of the U opiate receptor and another as a norephedrine reuputake inhibitor, similar to tramadol but much stronger as tramadols main active metabolite is desmethyltramadol, the metabolite is primarily what gives tramadol pain relief I believe and tapentadols metabolites such as desmethyltapentadol have no analgesic activity and the unmetabolised product is what gives the pain relief.) Doesn’t cause a statistically significant drop in Testosterone levels compared to other opiates like Oxycodone and morphine, it also appears the potential for abuse of tapentadol is lower than that of other opiates, but that isn’t important just pointing out an interesting piece of information. Other issues with opiate pain medication include but are not limited too, profound respiratory depression, immunosuppression, nausea, drowsiness (impaired motor skills) etc. However it’s better than living in constant crippling pain, it’s all about the perceived benefit to risk ratio, and a life spent in crippling pain for many isn’t a life worth living, and these medications can provide adequate quality of life for those people.
My proposed resolution would be for pharmaceutical companies to employ more abuse deterrent mechanisms for opiates. Many slow release formulas are slow release because of a coating on the pill, people looking to get high can simply chomp down on the pill or suck off the filler to get essentially an instant release pill, this practice may be particularly dangerous as instant release formulations can be dosed much higher than instant release formulations, therefore giving the user a dose higher than they are used to and causing an overdose. Slow release formulations should be literally somehow impervious to abuse, now sure how the pharmaceutical companies could do this but I’m sure there’s a way. Anotherdeterrent of naloxone to opiates. Targin (Oxycodone/naloxone) has this and due to the addition of naloxone to the tablet, users cannot crush and inject the opiate effectively as naloxone blocks the effects of opiates, therefore significantly reducing the chances of overdose and abuse, however targin can still be crushed and taken orally, and from what I remember although I may be wrong is that a certain dose can be taken orally before naloxone kicks in to any significant degree therefore still giving a risk of a abuse as it could still provide a high. Slow release formulas should be uncrushable to prevent people injecting or snorting the compounds.
The fact that chronic pain patients are now suffering in terrible pain doesn’t help the opiate epidemic, some of these sufferers will turn to heroin or street drugs to help them cope with their pain, this is the opposite of what the government is trying to achieve. Alternatively many say marijuana helps with chronic pain. A new study just came out claiming it doesn’t benefit chronic pain however I believe it may as too many people say it helps, whether it actually reduces pain or makes people merely care about the pain less I don’t know. The fact chronic pain sufferers are getting punished for having chronic pain is ludicrous, similar to how people with low testosterone are getting punished for having low T.
Finally the argument for tolerance to opiates, Yea people build tolerance however periodically switching opiates (same morphine equivalent doses) may help stop the development of a tolerance, I’m not a doctor but This is my opinion on the opiate epidemic…