The dragon that kills cannot be caught.

[Energize]

That doesn’t mention anything about strong opioids, you can be prescribed weak/low dose ones that still have the ability to get you hooked.

Oh come off it, your implication was obvious.

And it's still nonsense because the addiction liability of weak opioids like codeine is so low compared to alcohol, and doctors still won't give you a prescription for them like candy.

 

[Ayahuasca]

Oh come off it, your implication was obvious.

And it's still nonsense because the addiction liability of weak opioids like codeine is so low compared to alcohol.

There’s nothing to come off, you’re the one replying with crap like “utter nonsense” without being able to back up why, you clearly read my post wrong and put strong and opioid together, get some sleep.

 

[asim18]

Something bizarre I've just read on Wiki page for "heroin"....

Traffic is heavy worldwide, with the biggest producer being Afghanistan. According to a U.N. sponsored survey,[104] in 2004, Afghanistan accounted for production of 87 percent of the world's diamorphine.[105] Afghan opium kills around 100,000 people annually.[106]

In 2003 The Independent reported:[107][108]

... The cultivation of opium [in Afghanistan] reached its peak in 1999, when 350 square miles (910 km2) of poppies were sown ... The following year the Taliban banned poppy cultivation, ... a move which cut production by 94 percent ... By 2001 only 30 square miles (78 km2) of land were in use for growing opium poppies. A year later, after American and British troops had removed the Taliban and installed the interim government, the land under cultivation leapt back to 285 square miles (740 km2), with Afghanistan supplanting Burma to become the world's largest opium producer once more.

Opium production in that country has increased rapidly since, reaching an all-time high in 2006. War in Afghanistan once again appeared as a facilitator of the trade.

So basically, Afgan opium killed 100,000 people a year. Then the Taliban banned cultivation which cut production by 94% which sounds like a pretty amazing job to be fair! Then the USA took over and decided to increase production by ~90%.



is this some sort of joke? US's "war on drugs" is simply killing millions, but the taliban's war on drugs was pretty much 100% effective and targeted the root, production, but it was reversed by the US Gov to increase trade?

 

[Energize]

There’s nothing to come off, you’re the one replying with crap like “utter nonsense” without being able to back up why, you clearly read my post wrong and put strong and opioid together, get some sleep.

What is asserted without evidence can be dismissed without evidence.

 

[asim18]

What is asserted without evidence can be dismissed without evidence.

In your world perhaps. You don't speak for everyone. So bearing that in mind the following is a better phrasing for your post: "What is asserted without evidence, I dismiss without evidence."



Personally, when I see something uttered without evidence I do more research into the assertion, at the very minimum perform a calibrated probability assessment of the claim.

Simply dismissing everything which is uttered without evidence is actually a prime example of ignorance.

The things which are uttered without evidence are actually extremely interesting, and if you simply dismissed everything as such then you would never learn nor find out anything new. It's a very closed minded approach.

 

[Tefal]

Oh come off it, your implication was obvious.

And it's still nonsense because the addiction liability of weak opioids like codeine is so low compared to alcohol, and doctors still won't give you a prescription for them like candy.

Yeah this is 100% ******** the addiction potential of codine is huge compared to alcohol.

I'e drank for over a decade not addicted I was on codine for about 18 months addicted.


Physical addiction required regular use people do not regularly drink throughout the day but they do take thier painkillers throughout the day every day.

But then again energize here is addicted to his perscription and illegal drugs and passes off the withdrawl symptoms as the medical condition for which he takes them.

He is the definitive addict in denial

 

[Tefal]

Something bizarre I've just read on Wiki page for "heroin"....



So basically, Afgan opium killed 100,000 people a year. Then the Taliban banned cultivation which cut production by 94% which sounds like a pretty amazing job to be fair! Then the USA took over and decided to increase production by ~90%.



is this some sort of joke? US's "war on drugs" is simply killing millions, but the taliban's war on drugs was pretty much 100% effective and targeted the root, production, but it was reversed by the US Gov to increase trade?

You want to know the depressing reason for this?

The alternative crop for the region is cotton.

The USA will not fund or aid any crop whoch competes with US products.

So they would not help farmers grow cotton.

Opium is not a us crop.

I **** you not.


Beurocracy is the devil

 

[Energize]

In your world perhaps. You don't speak for everyone. So bearing that in mind the following is a better phrasing for your post: "What is asserted without evidence, I dismiss without evidence."



Personally, when I see something uttered without evidence I do more research into the assertion, at the very minimum perform a calibrated probability assessment of the claim.

Simply dismissing everything which is uttered without evidence is actually a prime example of ignorance.

The things which are uttered without evidence are actually extremely interesting, and if you simply dismissed everything as such then you would never learn nor find out anything new. It's a very closed minded approach.

Actually it's an old latin proverb. Which is sometimes referred to as Hitchen's razor.

Quod gratis asseritur, gratis negatur.

• Translation: What is asserted gratuitously may be denied gratuitously.

Uttering conspiracy beliefs and then demanding that other people provide evidence to dismiss them is not open minded, it's irrational.

 

[Tefal]

That doesn’t mention anything about strong opioids, you can be prescribed weak/low dose ones that still have the ability to get you hooked.

The figures are there in the BBC article I linked above, my view on it may be different though as from that article:

• The prescribing rate of opioid painkillers in parts of northern England is four times higher than in London.

... and I’m up north.

You are correct getting a perscription for something like zapain 30-60mg codine woth 500mg paracetamol is a rubber stamp excercise.


They only start cutting you off when you're getting through a month supply ina fe weeks.

If you have soemthing like arthritis or any chronic pain condition tramadol will be given by the bucket load withour question

 

[Tefal]

Uttering conspiracy beliefs and then demanding that other people provide evidence is dismiss them is not open minded, it's irrational.

But you are a drug seeker your interaction with a doctor is very differnt to the average person.

So have to realise this.

 

[WantoN]

Happy to see so many forum users who truly understand the dangers of prescribed opioids.

Sad to see some very uninformed posters.

Chronic pain will make you utterly desperate, and the only solutions are pain killers strong enough to leave you addicted in a very short space of time; it creeps up on you, you need to be very aware.

Deeply sorry to hear of your loss OP.

 

[Energize]

I think the pitfalls of opioids are well understood, that's why strong opioids are only prescribed for severe pain and physical dependence is inevitable with long term use, but when managed by a physician it can be handled fine.

I think that it's very important to understand the difference between physical dependence and "addiction" which is a substance misuse disorder characterised by dose escalation.

Opioids can be used indefinitely for chronic pain patients with little in the way of side effects. Quality of life is greatly improved.

 

[Zenduri]

Same can be said about Heroin then. If you give someone enough in a safe manner to "get well" they can function normally and will continue to do if you can hold off dope sickness without getting high as a kite. Doesn't really mean its the right thing to do.

Above is essentially what methadone does.

Giving someone potent opiods and managing it to as little as you can isn't really any different to methadone treatment.

Heroin, opioid painkillers and methadone.... take someone off them cold turkey... all with withdraw hard. Long term use of any even if managed properly still screws up the dopamine receptors in the brain and has long term issues

 

[Energize]

Heroin is actually prescribed as a painkiller and it doesn't make patients as high as a kite when prescribed at normal doses. There seems to be a shocking lack of understanding of chronic pain.

I'm glad I've never had to use strong opioids but some patients obviously need them such as my friend who ended up with a fractured spine after a car accident.

 

[Zenduri]

I understand chronic pain and its management but it doesnt alter the fact that any dose of opioids even managed well does have mid to long term effects on the brain.

Having seen someone close come off morphine, taken daily, and the effects it has had on them since coming off usage isnt harmless. You just need to weigh the pros and cons for taking it.

 

[WantoN]

I think the pitfalls of opioids are well understood, that's why strong opioids are only prescribed for severe pain and physical dependence is inevitable with long term use, but when managed by a physician it can be handled fine.

I think that it's very important to understand the difference between physical dependence and "addiction" which is a substance misuse disorder characterised by dose escalation.

Opioids can be used indefinitely for chronic pain patients with little in the way of side effects. Quality of life is greatly improved.

I think this is quite an insightful post, and whilst our viewpoints mostly align I don’t quite agree.

When you’re in chronic pain, and what you’re being prescribed isn’t working, desperation can force dose escalation. Let’s say you’re on 60mg of codeine, it’s particularly easy to start taking doses a little earlier, or taking cocodamol in the interim.

Personal experience, whilst anecdotal, tells me that if you’re using an opioid pain killer for prolonged periods, their efficacy diminishes.

I understand chronic pain and its management but it doesnt alter the fact that any dose of opioids even managed well does have mid to long term effects on the brain.

You just need to weigh the pros and cons for taking it.

I agree.

 

[Energize]

I think this is quite an insightful post, and whilst our viewpoints mostly align I don’t quite agree.

When you’re in chronic pain, and what you’re being prescribed isn’t working, desperation can force dose escalation. Let’s say you’re on 60mg of codeine, it’s particularly easy to start taking doses a little earlier, or taking cocodamol in the interim.

Personal experience, whilst anecdotal, tells me that if you’re using an opioid pain killer for prolonged periods, their efficacy diminishes.

Certainly over time medications can lose efficacy as tolerance sets in, this is why regular reviews of treatment are carried out, the outcome of which may result in a higher dose being prescribed or a change in treatment.

 

[WantoN]

Certainly over time medications can lose efficacy as tolerance sets in, this is why regular reviews of treatment are carried out, the outcome of which may result in a higher dose being prescribed or a change in treatment.

I see where you’re coming from, and I agree with the principal entirely. But people aren’t perfect, and nor is the system.

GPS are overworked and don’t have enough time with patients, and introducing new drugs can take time.

If the system worked perfectly, people with no prior inclination to abuse medication wouldn’t be getting addicted, but we know this isn’t the case.

Stronger drugs are often unavailable due to allergies, cautious doctors and the need to actually live life.

Patients with hypertonicity or muscle guarding are often given benzodiazepines and codeine for instance, it’s incredibly effective and dangerously addictive.

But principally we agree, it just seems you have more faith in the system and in people than me, perhaps I’m just a pecimist

I definitely feel some have a greater propensity towards addiction than others, and mindset plays a huge part.

Out of interest have you ever been on strong pain relief for prolonged periods, and did you find it affected you at all?

 

[Energize]

I see where you’re coming from, and I agree with the principal entirely. But people aren’t perfect, and nor is the system.

GPS are overworked and don’t have enough time with patients, and introducing new drugs can take time.

If the system worked perfectly, people with no prior inclination to abuse medication wouldn’t be getting addicted, but we know this is a problem.

Stronger drugs are often unavailable due to allergies, cautious doctors and the need to actually live life.

Patients with hypertonicity or muscle guarding are often given benzodiazepines and codeine for instance, it’s incredibly effective and dangerously addictive.

But principally we agree, it just seems you have more faith in the system and in people than me, perhaps I’m just a pecimist

Well I wouldn't say that I have faith in the system.

With psychoactive drugs there is always a risk that people may abuse them but that should never be a reason not to prescribe a drug when it is indicated.

When taking into account the risk to benefit ratio, the possibility of a medication inducing a substance abuse disorder in a previously drug naive patient does need to be considered, but when you look at the empirical evidence the proportion of legitimate patients that subsequently turn into drug addicts is very low.

I definitely feel some have a greater propensity towards addiction than others, and mindset plays a huge part.

Without question.

Out of interest have you ever been on strong pain relief for prolonged periods, and did you find it affected you at all?

No I haven't, I've been prescribed codeine before but it didn't have any effect on me, presumably because I fall into the poor metabolizer phenotype (the variable metabolism of codeine can be dangerous and is why I think doctors should stop prescribing it).

I've been prescribed benzodiazepines for a long time but don't use them on a daily basis so there's no noticeable impairment. I actually find them somewhat unpleasant and flattening so avoid using them where possible.

 

[Andy_82]

My Condolenses to the op - I had a friend at school who died of a opioid overdose.

Certainly over time medications can lose efficacy as tolerance sets in, this is why regular reviews of treatment are carried out, the outcome of which may result in a higher dose being prescribed or a change in treatment.

Tolerance isn't complete though, for example i've been using oral slow release morphine for 15 years or so and it still has a positive effect (i've not had a dose increase in 11 years). I know because every so often, maybe twice in 12 months i taper the dose down, this also helps to reduce tolerance (doesn't last long though), and also to test i've not developed opioid induced hyperalgesia.

Of course there are many negatives but compared to constant intractable pain they really are tiny. However strong opioids absolutely should not be the first line of treatment. I'm not sure how things work now but 15 - 18 years ago i went through many different methods and drugs including a clinical psychologist and psychiatrist before strong opioids were even talked about. In fact i had to change GP's as my original GP refused to prescribe them despite being instructed to by a pain management consultant anestheasiologist. I'm glad I did though as my original GP was terrible, didn't listen to the patient at all. Unlike the GP I now have, the feeling you have more control over things is actually very benificial in itself.

Part of the problem is people don't understand addiction, use of strong opioids for more than a week or so will cause physical dependence it is inevitable and as long as it is tapered slowly withdrawal is minimal, believe me i've done it many times. This isn't the same as addiction.

To be addicted you also need to be psychologically dependent, which when used for pain, doesn't happen very often, between 4% and 10% i think. and if your GP is doing his/her job properly they will see the signs. Things like requested reguler dosage increases (this can also be because of inadaquate management of pain though), running out to and requesting repeats early etc.

People also need to have a more realistic expectations of treatment, for most stopping pain is impossible, and opioids aren't a magic bullet.

The problem in the US though is mainly due to the tightening up of the prescription of opioids, there fore less end up in the black market, so most users end up using blackmarket heroin/fentanyl. Unlike prescription pills with known dosage and purity. Black market stuff you can only guess. It doesn't help that fentanyl is 100 or so times strong than heroin and some of the analogues of fentanyl are even stronger, some up to 10,000 times stronger.

The diversion of pharmaceutical opioids and people prescribed legally may have been addicted, but it is the war on drugs and stopping that supply that is killing people. and thats not to mention the damage done to family members and the community, and the money going to dealers and gangs in the supply chain.