Very interesting discussion on pain killers over at New Scientist. The basic question is what to do now that many pain killers appear to have serious and dangerous side effects. (Mainly the cox-2 inhibitors like Vioxx) They strongly urge more use of opiates. It seems an odd assumption, given the negative place such drugs have in our culture. I know many people who refuse to take them due to fear over addiction. I also am aware of the danger of addiction. A friend of mine became addicted to some commercial pain killers and eventually turned to heroin after he couldn't get ahold of black market pain killers. Needless to say this ruined his life, although honestly, I think that his own choices deserve much of the blame for this.
New Scientist deals with this worry about addiction though and it is quite a persuasive argument - suggesting that many of our worries are due more to hype than reality.
Indeed, studies have found that only about 1 per cent of patients with no history of addiction become addicted to opioids taken for pain relief. This makes sense when you consider that most addicts become hooked on drugs in their youth, whereas most chronic pain occurs later in life. Even former addicts can take these drugs for pain relief with little risk of becoming addicted again.
So why do these drugs have such a poor reputation? The fears about using opioids for pain relief stem largely from the dangers of recreational use. Yet even these have been overplayed. For example, while half of American soldiers in Vietnam tried heroin, only around 40 per cent of those who used it experienced any addiction, and just 1 to 3 per cent developed long-term addiction. In other words, at least 97 per cent of people in the highest-risk age group exposed to the scariest opioid under the most stressful circumstances did not become lifelong junkies.
The risk of overdose has been similarly exaggerated. For one thing, more than 80 per cent of deaths attributed to opioid overdoses are caused by taking a mixture of substances. Secondly, there is a harmless antidote that can neutralise an overdose, so when a patient starts using the drugs or needs to increase their dose, medical supervision can virtually eliminate any danger.
The problem is that due to various pressures the US government has been attacking the supply of opiates. Even doctors who seem to prescribe what to DEA officials deem too many prescriptions are brought up on criminal charges. I don't deny that there are doctors who provide junkies with pain killers. However from my friend's comments, most black market drugs are simply bought in Mexico and smuggled into the country. Obtaining commercial drugs in Mexico is easy. Often border crossings near retirement communities do little checking, since older people already are purchasing large numbers of various prescriptions in Mexico. (Indeed many retire to border communities on the Arizona/Mexico border precisely to obtain cheap drugs from Mexico) While one can question the wisdom of trusting cheap Mexican drugs from shady connections it does seem to suggest that doctors aren't the problem some might portray.
Even if unethical prescriptions by some doctors is a problem, one must ask whether the alternative is worse. We've seen that tens of thousands of patients have had their lives put in jeapardy due to alternative drugs. Likewise honest doctors seem caught in the net designed to catch the relatively few dishonest doctors. All to prevent the small number of addicts from obtaining these drugs - which appears to only turn them to more dangerous drugs like heroin or to robbing those who have prescriptions to percocet or oxycotton. (My own wife had her prescription stolen)
At a certain point one must ask, is it worth it? Are the small number of addicts really worth the cost to real victims who need safe, relatively side effect free, pain killers?
While I sympathize with anyone who experiences the adverse side effects of any medication, I am extraordinarily hesitant to make such a wholesale switch from cox-2 inhibitors to opiods. There is a cost-benefit to just about every medication. I realize that this is not the intent, but the emphasis on “serious and dangerous side effects” colors the debate in a shade of fear and blame. Cox-2 inhibitors do a lot of things extraordinarily well at little real risk.
I will, however, concur that the War on Drugs has imbued American law enforcement and consequently American culture with many unhealthy perspectives on both medication use and illegal drug use.
I'm not sure I agree with the "little real risk" bit. My mother was taking Vioxx and ended up with dangerous heart conditions that the doctors couldn't explain until the evidence came out. (Admittedly this might be partially her doctor since I believe that some heart risks were always associated with the product - it was more the degree that wasn't realized)
It's oxycotin, not oxycotton.
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