[elipsey]

Published May 5, 2016.

Article argues that OxyContin caused strong withdrawal symptoms when used as directed. Important, imo, because at a societal level we substantially blame addiction on "drug abuse" which is not always an adequate model.

[rubbingalcohol]

As withdrawal becomes more severe and patients develop tolerance to these medications, they need to take increasing doses to get the same effects, leading to more severe withdrawal - aka. a vicious cycle.

The crux of this article was that Purdue knew their dosing schedule was problematic but pursued it despite growing evidence it was reducing efficacy and increasing addiction. Then they hid behind their FDA certification as if that exempts them from acting on evidence that their shitty drug doesn't work right.

In general, no drug for acute _anything_ will last as long as the manufacturer advertises. They are incentivized to push an idealized dosing schedule, even when that makes the drug less effective for a significant number of patients. This is kind of a big deal when a drug causes severe physical withdrawal symptoms.

[Alex3917]

> at a societal level we substantially blame addiction on "drug abuse" which is not always an adequate model.

While I agree that this model is not accurate, I'd also point out that just because you're taking a drug as directed doesn't mean you're not abusing it.

For whatever reason most people in the U.S. seem to have a wildly unjustifiable level of faith in western medicine, either way too much or way too little. Belief and disbelief in various forms of medicine have been successfully marketed as personal identities, which is easy to see from reading most HN comment threads on health issues.

[pavel_lishin]

If my doctor tells me to take Pill A every 8 hours, and I do so, how am I abusing it? It might be drug abuse, but it's not on my part.

[keyboardhitter]

I believe the point is that many people have A LOT of faith in the doctor's hands, and/or "what the label says on the prescription". For some people there is an unwavering sense of "but doc told me to take this, so I must HAVE to", or even "But the doctor prescribed this, so there's no way it could harm me". So, they may stop holding themselves accountable for the drugs they're taking and may not even notice negative side effects (dependence and withdrawal included).

[elipsey]

>> just because you're taking a drug as directed doesn't mean you're not abusing it.

Yes. I put "abuse" in scare quotes, because I think it's definition should be better aligned with buisiness incentives, medical advice, and actual human behavior, especially if we put people in jail for it.

[dismantlethesun]

What do you characterize as drug abuse?

[Alex3917]

> What do you characterize as drug abuse?

I tend to think about drug misuse, rather than drug abuse, since not taking certain drugs can be just as irrational and damaging as taking too many drugs.

But basically I think people should use drugs as tools to maximize their utility based on their needs and values. And I think that drug misuse is anything that leads to significantly suboptimal utility that's clearly not justifiable by any sort of internally coherent reasoning.

[razorunreal]

That seems like an unnecessarily abstract way of saying "make good choices".

Drug abuse seems straight forwardly defined as using a drug for purposes other than as prescribed. Not following the schedule or following it when it is unwise to shouldn't be considered abuse as long as you are still using it to manage pain. Of course that boils down to intent, which is hard to determine.

[mnm1]

So it's not misuse if I can justify it internally.

[billions]

Feed anyone sufficient doctor prescribed heroin and they will start to act like the people Attorney General Jeff Sessions wants mandatory sentencing for