[tptacek]

There's no "chronic pain epidemic". As is often the case, the pharma market created (or rather, in this case, reshaped) a problem for a particular kind of product to solve.

Obviously, ceteris paribus, less pain is much better than more pain, and there will probably always be acute and chronic pain for therapeutic innovation to tackle. There's no virtue in the experience of chronic pain. But the evidence strongly suggests that patients are worse off with casual access to powerful opiates, and that these products are packaged and sold irresponsibly.

No legitimate underlying medical phenomenon spurred the uptake in opiates.

[Alex3917]

> There's no "chronic pain epidemic".

50% of American adults suffer from chronic pain. If those levels don't qualify as an epidemic, what levels would?

[tptacek]

What does that actually mean? If I stop and think about it, I'm experiencing a variety of chronic pains right now. Most of them don't warrant an aspirin, but they're pain nonetheless. Your response here is really a quibble over definitions: in context, I'm clearly talking about "chronic pain whose severity warrants powerful opiate analgesia" ("powerful" because maybe we should have T2 or something like it available in the US).

I tried to avoid this pointless debate with a second paragraph to immunize my argument from the trope that arguments against opiates are arguments in favor of pain.

My point --- I think obviously --- is that no underlying medical pathology occurred to spur the uptake in consumer opiate products.

[Alex3917]

> no underlying medical pathology occurred to spur the uptake in consumer opiate products.

The uptake of opiates wasn't driven by any change in pathology, but it was partially driven by a change in how we think about pathology. The IOM report I linked to helped to popularize the idea of treating pain itself as a disease that should be treated, rather than as a symptom which shouldn't be treated until the underlying cause is known:

"Because pain often produces psychological and cognitive effects—anxiety, depression, and anger among them—interdisciplinary, biopsychosocial approaches are the most promising for treating patients with persistent pain. But for most patients (and clinicians), such care is a difficult-to-attain ideal, impeded by numerous structural barriers—institutional, educational, organizational, and reimbursement-related. [...] In addition, adequate pain treatment and follow-up may be thwarted by a mix of uncertain diagnosis and societal stigma consciously or unconsciously applied to people reporting pain, particularly when they do not respond readily to treatment. [...] Understanding chronic pain as a disease means that it requires direct treatment, rather than being sidelined while clinicians attempt to identify some underlying condition that may have caused it."

I'm definitely not arguing that opioids should be first line treatments for chronic pain, but I also agree with the IOM that they should be more accessible when needed.

[blawson]

That sounds unbelievable. This Washington Post article pegs it at 11%:

https://www.washingtonpost.com/news/to-your-health/wp/2015/0...

[Alex3917]

The article you just linked to literally says it's over 50%. The 11% statistic is the percentage of Americans who are currently in pain. Whereas chronic pain is basically pain that's intermittent.

C.f. the IOM report on pain in America: https://www.nap.edu/catalog/13172/relieving-pain-in-america-...

[philiphodgen]

Wow. That's a spectacular claim. Almost unbelievable, and certainly in need of strong empirical support.

Anecdotal evidence over six decades of life on Planet Earth suggests otherwise.