Friday, March 17, 2017

Opiod epidemic: is it from doctors giving pain pills?

CDC report. of a survey

A total of 1,294,247 patients met the inclusion criteria, including 33,548 (2.6%) who continued opioid therapy for ≥1 year. Patients who continued opioid therapy for ≥1 year were more likely to be older, female, have a pain diagnosis before opioid initiation, initiated on higher doses of opioids, and publically or self-insured, compared with patients who discontinued opioid use in <365 days 
so the numbers are high: But the percentage is actually quite low.

and they don't include the question WHY the medicines were used:

. Third, information on pain intensity or duration were not available, and the etiology of pain, which might influence the duration of opioid use, was not considered in the analysis. 

and after a long analysis they note the elephant in the room:

Finally, prescriptions that were either paid for out-of-pocket or obtained illicitly were not included in the analysis. 

a lot of "prescription drug abuse" is from stealing medicine, or buying it on the street, but never mind.

momjones article here 

Conventional wisdom holds that overprescribing is fueling the epidemic: Someone injures himself, is prescribed painkillers, and quietly develops an addiction. But that's not the whole story: According to federal data, most people start out by taking the painkillers of a friend or family member. The best predictor of prescription opioid abuse is a history of other drug abuse, according to a recent study in Addictive Behaviors. Experimentation typically starts during adolescence or young adulthood.
and only a small percentage get them from doctors (36%). One wonders if a lot get them from "pill doctors" who give out thousands of them for any reason, but again that is not the question.

more data here.

92 percent of people do not abuse drugs of any sort.

and one wonders about the definition of "misuse". Probably they mean not prescribed by a doctor for that episode:

Among people aged 12 or older in 2015 who misused prescription pain relievers in the past year, the most commonly reported reason for their last misuse of a pain reliever was to relieve physical pain (62.6 percent), which is the reason pain relievers are prescribed (Table B.11). Even if the reason for misuse was to relieve physical pain, use without a prescription of one's own or use at a higher dosage or more often than prescribed still constituted misuse.

ditto for other drugs: it might not be "abuses" but "self medication".

As for the hype that the drug companies pushed narcotics for pain: Why, yes.

Most of the "assisted suicides" by Dr Kavorkian were in patients with uncontrolled pain. Hospice doca and those in pain clinics started using narcotics in contolled amounts because they had fewer side effects than other medicines. (NSAID mainly, which cause GI bleeds, heart and kidney problems).

If you get rid of the pain, most people can simply be withdrawn from their narcotics slowly. Some like the mild buzz from them and continue, so that is abuse. And others aren't in pain but steal/borrow or take them to get high.

The 1960's idea of getting high (along with normalizing marijuana to get high) is the precursor for the idea that if you feel unhappy that drugs will make you happy.

This is a social problem, and the cure is religion.

But that is another story for another time.

No comments:

Post a Comment