[bbunix]

Moving from Canada to the US was a shock - in Canada, prescribing opioids was rare - but you could get codeine painkillers over the counter, but that was when things got really bad.... here, simple dental procedures were met with Percocets and Oxycontin...

The basic difference seems to be in Canada, you're a patient while in the US, you're a customer... and the docs don't want their customers to be in pain. That appears to be changing.

[Terretta]

> The basic difference seems to be in Canada

Maybe some other difference?

How is it you and the rest of Canada (not to mention Europe) aren't opioid junkies in a national "epidemic" when you can buy 100 codeine tablets for $10 in any grocery? Meanwhile, in Russia, with bans, it's an epidemic, while in Ukraine, even Russian-speaking Ukraine, this is readily available with no epidemic.

Something about personal responsibility instead of "someone made me do it" litigiousness? Or more related to healthcare as a basic right? US versus Canada suggests these, but Russia vs. Ukraine suggests may be something else. Nanny state vs. "sheeple"?

No answers, just find it interesting relaxed restriction seems to moderate so-called epidemics without catastrophic societal breakdown.

[Broken_Hippo]

I wouldn't blame personal responsibility, but rather better laws allowing for folks to heal added with a bit of the "healthcare is a right" sort of thing.

When I had gall bladder surgery living in the US (my home country), I was told to take 7-10 days off work then have lifting restrictions for a bit. My boss would only allow for the lesser time because it was "my weekend" to work, and I had to work that sunday for a bit.

I most definitely wasn't ready to go back. I didnt' need the opiods the couple days before as it was merely uncomfortable, but being active made things hurt. I didn't lift, but was merely active. I needed pills that night.

On the other hand, I live in Norway now. If I am feeling sick, I can stay home from work for 3 days without going to the doctor and without losing my job. I'm pretty sure I could have stayed home the time necessary after surgery. Mothers have paid time off after having a child (amount depends on how long one takes, but it can be 100%).

Policies like these mean that people can actually heal. Other policies also mean folks aren't as stressed (especially when they are poor).

That's my reasoning for the rates being lower in some places than others, anyway.

[DrHuman]

Doctors in the US were getting kickbacks for prescribing opioids. This incentivized prescribing opioids for all types of cases that wouldn't normally need it, and led to "pill mills" flooding neighborhoods with drugs. Big pharma is behind the crisis in the US.

https://www.vox.com/science-and-health/2018/5/15/17355722/op...

[the_mitsuhiko]

Education and doctors behavior? Austria where I live consumes tons of opioids but it’s not an epidemic and doctors will be relictant to give opiods to you on a permanent basis.

[ransom1538]

I don't think this is true any more. I made a list [1] of high prescribing doctors (with sql). I noticed that some of the highest opioid prescribing doctors are in jail now. If you are a doctor these days you avoid opioids like the plague. [Keeping Medical Malpractice Insurance is hard enough].

My newest doctor makes me sign a sheet that he doesn't prescribe opioids at all.

[1] https://www.opendoctor.io/opioid/highest/

[slfnflctd]

> simple dental procedures were met with Percocets and Oxycontin

This has all completely changed in most places in the U.S., as far as I'm aware. Everyone has been well aware of the epidemic for years now and they are extremely reluctant to prescribe anything for pain at this point. You will be told to just take some ibuprofen for pretty much everything.

If you even mention that you're feeling long lasting discomfort, you will immediately be met with suspicion and resistance and assumed to be a drug seeking addict and a criminal.

[cf498]

>If you even mention that you're feeling long lasting discomfort, you will immediately be met with suspicion and resistance and assumed to be a drug seeking addict and a criminal.

This was to be expected and it is absolutely mind boggling.

People not having access to proper pain medication is absolutely abhorrent. Large parts of the world still havent recovered from world wide lobbing campaign to ban opiates. Where even terminal ill patients in abhorrent pain have to exist on paracetamol and even that only if the family can afford it.

And that kind of lobbying hasnt stopped. The last push I know of was for the ban of mean party drug ketamin, which is the only reasonable anesthetics for poor regions outside of the effective range of a hospital.

I am really hard pressed to not view people pushing for tighter regulation of pain meds as simply evil. If you have people accidentally addicted to opiates, that is of course a problem, but one that can easily be fixed with better informed patients.

You just dont fight the war on drugs on the back of chronic pain patients.

[DanBC]

> You just dont fight the war on drugs on the back of chronic pain patients.

You're pushing the same line that Purdue did - that there's an epidemic of untreated pain and that it is cruel to leave people without treatment.

This point always comes up when discussing the US opioid crisis. What do we do about people in severe pain? What do we do about people in long term pain?

The US massively over-prescribes opioids. The US could reduce opioid prescribing by 80% and it would have no effect for these groups of people.

But, more importantly, for most people in long term pain opioids are the wrong choice. Opioids are a good choice for end of life care, and for short term acute pain (especially when supervised in a hospital setting). But for long term pain opioids are for most people a poor choice. The patient will develop a tolerance to the opioid which means it's not working to treat the pain. They'll need to increase the dose of opioids. This increases the risk of harm from the medication. It also increases the risk of dependency. So, you end up with someone addicted to opioids, taking very large doses, yet still in pain.

Note I'm not saying all people. Some people who are carefully selected and regularly monitored will get some benefit from opioids.

Here's a radio programme with an interview with someone who was prescribed opioids for long term non cancer pain, and how it caused him harm: https://www.bbc.co.uk/programmes/b04wv052

Here's the UK Royal College of Anaesthetists pages on opioid prescribing: https://www.rcoa.ac.uk/faculty-of-pain-medicine/opioids-awar...

[slfnflctd]

There seems to be a lot of misunderstanding among policymakers and even medical staff about how this stuff works in the real world.

If people are in pain, and professionals are shaming them - basically saying 'suck it up, sissy' - when they dare to mention this, what do you they're going to do? I can guarantee you a great many will seek relief on their own terms, i.e. alcohol (cheap and available nearly everywhere!) and street drugs-- with doctors & their staff at that point being completely cut out of the loop. Are you going to tell your dentist that you drank vodka to dull the pain after your root canal? Mostly no. Is that better for you than hydrocodone? Unless you have other non-standard risk factors, also no.

I fail to see how this is better than honest dialogue between doctor & patient where each person's treatment is realistically considered on an individual basis. By all means withhold inappropriate, ineffective and dangerous treatments-- but tell your patients what you're doing & why, and don't lose sight of how they actually behave in response to this. Sometimes that response is far worse than whatever you're trying to save them from.

[FireBeyond]

For sure. If a patient of mine as an EMS provider is exhibiting physiological signs of pain I believe it is inhumane and unethical to withhold analgesia. There may be discussion of the appropriate medication, but nonetheless, we have options. That being said if you are complaining of 10/10 pain while I am interrupting you texting to conduct my exam, I may be more skeptical...

[FireBeyond]

So very true. At some point pain became "the fifth vital sign", and while as an EMS provider it is entirely valuable, hospital MBAs started using it as a metric in customer service surveys ("are you in less pain now than when you began treatment / were admitted?") and down the slippery slope we went (among other causes).

[refurb]

Considering the number of people dying from opioids in Canada is rocketing higher as well, that’s probably not the reason.

[sidcool]

I hope it changes fast. Because there is a serious opiod epidemic. In a decade we are at risk of affecting an entire generation. In this case at least, regulations need to override capitalism.