tag:blogger.com,1999:blog-6193043695356712843.post8530593110265891500..comments2023-09-02T23:55:45.583+10:00Comments on Doctor Skeptic: Opioids: the real opium of the massesDr Skeptichttp://www.blogger.com/profile/09376469049519802493noreply@blogger.comBlogger7125tag:blogger.com,1999:blog-6193043695356712843.post-78082220387060492582014-08-24T22:49:48.810+10:002014-08-24T22:49:48.810+10:00As a RN, I see opioid dependence on an almost dail...As a RN, I see opioid dependence on an almost daily basis. Usually in otherwise able-bodied people who are on disability. Other than use in cancer, these drugs should be discouraged. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-6193043695356712843.post-19093809219478118302013-04-24T21:46:24.887+10:002013-04-24T21:46:24.887+10:00Thanks Gwyneth,
I agree that we should not be thr...Thanks Gwyneth,<br /><br />I agree that we should not be throwing out the baby with the bathwater. Opioids have a role; a clearer picture of when and how they should be used is what we need.<br /><br />However, I think that our expectation to have all discomfort relieved extends into pain management, where the expectations are often too high. Chronic pain is often more related to psychosocial factors, and these should be addressed rather than covering the symptoms with long term opioids. <br /><br />Also, the patients that I see who 'rely' on long term opioids have long since lost their pain trigger (an injury which has healed) and do surprisingly well a few weeks after quitting. But I accept that I am likely to be biased by the type of patients that I see.<br /><br />Pregabalin and gabapentin are interesting. I can't work out their true effectiveness yet because of conflicting reports and the likelihood of industry bias. Dr Skeptichttps://www.blogger.com/profile/09376469049519802493noreply@blogger.comtag:blogger.com,1999:blog-6193043695356712843.post-82024448052306691032013-04-24T08:25:14.004+10:002013-04-24T08:25:14.004+10:00I have several concerns about the anti-opioid move...I have several concerns about the anti-opioid movement, not the least of which is its close ties to pharmaceutical companies keen to swap out relatively cheap pain management drugs with expensive and even less supported options. It also has very unfortunate ties to the war on drugs (a thoroughly failed venture with masses of clinical data to prove that case).<br /><br />And while trial evidence may be sparse for its use in non-cancer pain management, the epidemiological evidence would suggest it is more well tolerated than not and has long-term value in supporting quality of life for many with serious pain. Furthermore, as one example, there is good trial evidence that the use of heavy-duty opiates for the management of neuralgias does not result in tolerance or dependency.<br /><br />There are indeed abusers of prescription drugs. There are also those who are on disability or unemployment benefits for nefarious reasons as well. I am highly suspect of any argument that would suggest we punish the 90-95% of those for whom their quality of life depends upon access to these drugs just because we think that doing so will somehow help abusers to stop abusing.<br /><br />And what is to happen to all those poor and disadvantaged (most likely to be on opiates and most likely to die either intentionally or unintentionally from said opiates) when we successfully remove these relatively cheap pain management options altogether?<br /><br />Pregabalin and gabapentin are heavily marketed for neuralgias and spinal chord fusion surgery. I am sure it is coincidence that a prescription of either of those will cost 200% more than hydromorphone, by way of comparison.<br /><br />The social consequences of under-medicating pain, as we see in numerous developing nations (estimated to be about 150 countries according to WHO - http://www.who.int/medicines/areas/quality_safety/access_Contr_Med/en/) is where we will be headed if we simply swallow the savvy bait and swap to more expensive prescription pain medication under the guise that there is a moral duty to avoid prescribing opiates.<br />Gwynethhttp://www.youreatopia.comnoreply@blogger.comtag:blogger.com,1999:blog-6193043695356712843.post-54189071966213980472012-11-04T11:32:02.854+11:002012-11-04T11:32:02.854+11:00Thanks for the link John, interesting area of rese...Thanks for the link John, interesting area of research.<br /><br />As the evidence stands, I think the risk of tumour spread/growth is small, and it needs to be weighed against the benefit from pain relief in cancer.<br /><br />I also think that there are enough documented clinical harms and evidence of lack of effectiveness from chronic opioid use to think twice before prescribing or using them, without having to take into account theoretical harms.Dr Skeptichttps://www.blogger.com/profile/09376469049519802493noreply@blogger.comtag:blogger.com,1999:blog-6193043695356712843.post-67736103723012610672012-11-04T09:24:51.170+11:002012-11-04T09:24:51.170+11:00Here's a link to an article about this finding...Here's a link to an article about this finding: <br /><br />http://theramatch.com/therapy-news/morphine-may-help-tumors-spread-in-cancer-patients<br /><br />To quote: "Morphine can increase tumor cell proliferation, inhibit the immune system,promote the growth of new blood vessels (angiogenesis) that feed tumors and decrease barrier function."<br /><br />While it may or may not translate into humans, why take the risk? As a patient, it's something I'd want to know. John Lynchhttp://ourhealthcaresucks.comnoreply@blogger.comtag:blogger.com,1999:blog-6193043695356712843.post-1343541357914256192012-11-04T08:39:21.126+11:002012-11-04T08:39:21.126+11:00Thanks John,
You don't need to convince me ab...Thanks John,<br /><br />You don't need to convince me about spine fusions, see my earlier blog post here: http://doctorskeptic.blogspot.com.au/2012/08/is-lumbar-spine-fusion-just-placebo.html<br /><br />I am not aware of a clinical link between opioids and cancer, and I would discard any animal study like that unless it is supported by some clinical evidence, as most animal studies are not translatable to humans.Dr Skeptichttps://www.blogger.com/profile/09376469049519802493noreply@blogger.comtag:blogger.com,1999:blog-6193043695356712843.post-44378973290874837962012-11-04T00:35:05.377+11:002012-11-04T00:35:05.377+11:00I couldn't agree more with your analysis of th...I couldn't agree more with your analysis of the abuse of these dangerous drugs. A couple points I'd add:<br /><br />1. Many of the spinal fusion surgeries that lead to chronic opioid dependence are totally unnecessary. The Dartmouth Atlas Project has found 20-fold variations in spinal fusions in different communities across America. These aren't harmless interventions, as opioid dependence can lead to premature death, as you document; and<br /><br />2. Animal studies have shown that opioids can cause tumors to spread throughout the body. Since many of us harbor latent cancers that are undetected, this is a hidden threat with enormous consequences. Perhaps public fear of cancer can be marshaled to raise awareness of the risks of opioids and temper their use.John Lynchhttp://ourhealthcaresucks.comnoreply@blogger.com