If you ask me I'd rather spend money to save a child killed by a car, financing self driving cars, than waste money trying to save people that don't want to be saved and that, even after being revived tens of times, continue to abuse drugs until their death, as per the other thread last week.
So let me understand now that we are officially off-topic.
Letting people write that opioids are better than alcohol, so that someone will feel incentivised to try them, is not against hacker news guidelines.
Answering a direct question expressing my opinion that I would rather save a child than someone that doesn't want to be saved, as shown in the other discussion last week, is against the guidelines and off-topic.
I would say that this is the strangest interpretation of the guidelines that I ever witnessed..
I would kindly ask you to review how most opiate addicts in this current wave are created. Unfortunately, opiate medication is really the only 'easy' solution we have for many patients who have chronic, debilitating pain. I speak of patients suffering from malignancies, chronic back pain, post-traumatic injuries like motor vehicle collisions or workplace-related injuries. While there are novel attempts at cognitive behavioral therapy, setting patient expectations regarding pain and physical therapy, opiates are the mainstay of our (speaking as a resident physician) arsenal. Unfortunately, many of my colleagues prescribe ever higher doses of opiates without educating the patient on the reality and expectation of chronic pain. The patient continues to fill his/her prescription, until the point where he/she is taking heroic doses of opiates daily. At this point, many things can happen: the patient's legal provider is suddenly shocked at the amount of opiates given and stops, the patient transfers care/moves and is suddenly unable to obtain their original script, and voila - the once legal plain jane 45 year old female with chronic pain is suddenly forced to rely on the grey and black market, and since she can't obtain further legal prescriptions (because who's going to give Jane 20 oxycodone daily when seeing her for the first time), she's suddenly relying on sketchy mcsketchball who offers her illegal oxycodone... and you can imagine the downward spiral from there. So please, review how many of our opiate dependent abusers start, instead of focusing on the ugly finality of their early deaths.
From your description of tolerance buildup it sounds like you are describing a drug which is functionally ineffective for chronic pain (eventually tolerance will overtake the maximum does you can safely administer) except where the patient wont live long enough for the tolerance.
It sounds like a drug family that would be mostly useful for non-chronic pain, where the patient can be weaned off before the dosages become high.
Yes, you're right. Opioids are a good choice for short term pain. They're a good choice for end of life pain. They're a poor choice for long term pain, although they serve some use if carefully prescribed. Weirdly, the US prescribes a lot of opioid medication, and prescribes it for people with long term pain.
AFAIK, it's because, whilst opiates aren't a great choice for chronic pain, they're just aren't many options that are useful for many forms of chronic, severe pain.
You're 100% correct. However, we really don't have many other non-opiate options for chronic pain, and a lot of the other therapies (alternate modalities, adjusting perceptions/expected amounts of pain/etc) are things that require more money and time. As many providers are overworked and patients lack insurance, opiates become unfortunately a crutch in many plans.
If you really understood addiction, you'd understand that this is like saying that you don't want to treat someone with cancer, since they seemingly insist on recurring time and time again even after chemo and radiation, continuing to have cancer until their death.
But, of course, you're not thinking of addition as a medical issue. You're treating it like a moral failure.
I usually wouldn't post this sort of stuff, as it is a pretty taboo opinion that just gets buried.
But If I don't get any discourse, I can't learn anything or have my opinion changed, anyway here we go...
> If you really understood addiction.
I hear this dismissive retort a lot in the addict community. It's nonsense.
If you can't empirically analyze, measure and explain "what its like", or defend your view-point rationally -
then you've lost.
The attitude of "You just don't get it man! you need to be an addict to understand what its truly like" is complete and utter self-victimization bullshit.
> But, of course, you're not thinking of addiction as a medical issue. You're treating it like a moral failure.
I treat is as both. I guess it depends on your virtues and morals, but in my eyes; logic and rationality comes first. Responsibility lies in the human being behind the labels.
Within the journey of addiction, there are many moral struggles and choices that you'll need to make (avoiding taking action on a difficult choice, is still a choice).
Sure, physical addiction is fucked and withdrawals are fucked. But the second you commit an evil deed to feed your addiction, I lose all sympathy.
I'd rather spend my time helping those that deserve it, than those that need it - I guess that's the crux of my perspective.
Maybe its a little harsh as there are (assumption) a lot of quiet, functioning addicts that just meld into society. I don't have enough information to form a legitimate opinion on that specific subset. My distaste for addicts are purely those that have run the gauntlet and have traded in their morals, decency and humanity in ugly ways to satiate their vice.
I'm not asking you to listen to the pleas of addicts. I'm asking you to accept the medical literature and the opinions of addiction specialists.
Also, you seem inordinately focused on the physical aspects of withdrawal and the moral fortitude required to endure it. I suspect that the professionals would tell you that that's less than 1% of the struggle.
Some people have a genetic predisposition to addiction. Once you get addicted your mind gets warped - that's why it's an illness and not a moral failure.
Would you judge the deeds of a psychotic person as moral failure as well? It's a hyperbole for sure but it's definitely comparable.
I have never heard about anyone that healed spontaneously from cancer just because of the will power to stand the pain.
I heard about lots of people that managed to overcome the withdrawal pains and stopped being addicted.
Your comparison is completely inaccurate.
Eh, this is a rather poor argument, but it is one used by a majority of Americans, it seems, to justify some rather poor positions on welfare/social security. Its the same fallacy as using "welfare queens" to label everyone on welfare as someone abusing the system, whereas it has been shown that most people quickly get off it as soon as their circumstances improve.
So while there certainly will be people undeserving or who cannot be saved, a majority of "addicts" are more likely people who could be better with the right kind of therapy and social support.
