[inter_netuser]

>pain meds have ruined literally millions of lives through addiction

Unpopular opinion: opioids are massively under-prescribed for those that actually need them.

Addiction is a mental illness. That's whats killing so many, but why is to so few question what is actually causing such terrible emotional pain that must be self-medicated with incredibly potent medicaments?

Why is it that instead of acknowledging the rather uncomfortable root cause of those deaths, we just default to the so much simpler scapegoat, pills (the active ingredient in which has been with us in one form or another since 5000 BC), and pretend everything else is just rainbows and unicorns?

[WarOnPrivacy]

> opioids are massively under-prescribed for those that actually need them.

Absolutely.

While reports of ODs are endlessly bullhorned, millions in pain get demonized by algorithmic opioid blacklists, get ignored by news orgs/legislators addicted to opioid hysteria and get gaslighted by a public who only hears the bullhorning.

I have a lifelong friend with visibly crippling arthritis. He lost access to effective pain meds after the state passed a 3-day-max on opioids (passed >10 years after the pill-mill problem abated). Over the year that followed the law's passage, every Dr in his network (along with most Drs in the state) ~stopped Rx opioids. The (now fewer) pain mgt clinics are overloaded and not accepting patients.

His remaining avenues for pain relief no longer involve Dr's.

I had emergency abdominal surgery this year and had to convince the discharging Dr to prescribe Tramadol. Our new normal is for ERs/Hospitals to undermedicate patients in pain with OTC analgesics.

So yeah. Shout out to folks who are hand-waving away millions in pain - because pharma is greedy or because folks can't differentiate responsible Rx opioids from street fentanyl (that many in chronic pain turned to in desperation after they were cut off from safer pain relief).

[stadium]

> why is to so few question what is actually causing such terrible emotional pain that must be self-medicated with incredibly potent medicaments?

> Why is it that instead of acknowledging the rather uncomfortable root cause of those deaths, we just default to the so much simpler scapegoat, pills

Missing from these arguments is the role of criminalizing addiction versus treating it as the mental health issue you accurately described. And ignoring the pharmicuitical and lobbying industries behind the same pills.

I don't think it's a valid argument to reassign blame from the potency and availability of pills, to unmet mental health needs. They are related and intertwined, sure, but correlation != causation.

Case in point, the Purdue Pharma Sacklers settled for $billions (which also bought their immunity from future prosecution) precisely because they were pushing hard drugs and preying on those same people mental health issues [0]. Predatory, sociopathic behavior. But pill are a scapegoat? Sorry, that's a hot load of b.s.

[0] https://www.npr.org/2021/09/01/1031053251/sackler-family-imm...

[inter_netuser]

I don't disagree there are bad actors. Dissolving Purdue (I thought they were dissolved, not just fined?) is great. Bad actors should be punished. And yes, criminalizing medical issue such as addiction is terrible. All of these are fairly obvious, which is why I didn't spell them out.

As I'm sure you know, many cases of mental illness are triggered by some sort of precipitating event.

I don't believe for a minute the fact that someone gave those addicts an opioid pill was the actual trigger. Instead it was something that happened way before that: some emotional trauma, PTSD, disadvantaged background, chronic illness, no life/career prospects, war, despair, etc, etc, so many stressors this life can bless you with. The Big Bad Pill is just what the addicts came across and realized it helped them feel okay for a moment, that's all it is.

E.g. a war veteran ends up getting PTSD and becomes an addict(let's assume he has no chronic pain). Aren't the circumstances around his life that led him to enlist and then develop PTSD are the much more relevant trigger? Barring that event, would they even begin using in the first place?

Who gave them that precipitating event? Other humans did.

The ugly truth is that the cause of this all is simply us, humans stressing other humans. Like other primates, we are intelligent enough to the point it takes very little effort to provide for our basic needs, and so we spend the rest of our time engaging in social status games at the expense of others.

Most people who use opioids do not actually become addicted. Those who used heroin in Vietnam, most of them stopped after they returned and circumstances changed from war to normality: https://pubmed.ncbi.nlm.nih.gov/12873239/

"After their return, most of the men who had used heroin in Vietnam used it very occasionally or not at all."

"Possible post-Vietnam correlates of heroin injection were no job or school enrolment, alcohol problems, depression, absent or transient marriage, association with illicit drug users and other Vietnam veterans."

The real root cause is that humans are nothing but selfish machiavellian apes. We all are about me-me-me-me-me, and dig just a bit deeper, most are just as predatory and sociopathic as Purdue/Sacklers/whatever, just not as capable at getting their way.

We just look away and walk past the addicts in meatspace. We are no saints, and the real cause of most human suffering is not some processed alkaloid - it's other humans.

Not some pharma company or some evil billionaire clan that capitalized on this, I'm sure they contributed. There would be nothing to capitalize on or sell, if it weren't for humans psychologically injuring other humans for fun and profit.

Personally, it seems to me that we can recognize and accept a physical disability/injury much more readily than emotional/psychological one. Same goes for inflicting injuries: attempts to fracture someone's limb, a grave physical injury, seem too repulsive to even think about, and hopefully bystanders will attempt to rescue the victim should anyone ever try to do this to anyone. Harassment, bullying, hazing, belittling someone "just for laughs" on the other hand? All too often, others are more than happy to join in on the "fun" and even will gleefully laugh at the actual victim.

Of course, nobody likes to think of themselves in that way, much too unpleasant, and so we point our collective fingers elsewhere. It's always "them", and never "us".

I can only hope that one day we will evolve to finally dish out just as harsh punishment for psychological harm as we do for bodily harm, and hold each other accountable for it.

[stadium]

A bunch of things are conflated here that need to be untangled. Not all trauma is going to lead to an addiction. Not all addiction is to pills or drugs. Not everyone who takes opioids is going to form an addiction. Not all trauma is intentional and deserves punishment.

The expert in this area is Dr. Gabor Maté. He is highly respected in this field. If anyone is interested learning about the role of trauma in addiction, he literally wrote the book on it, "The Realm of Hungry Ghosts" [0]

From Maté [0]:

> Turning to the neurobiological roots of addiction, Dr. Maté presents an astonishing array of scientific evidence showing conclusively that:

> 1. addictive tendencies arise in the parts of our brains governing some of our most basic and life-sustaining needs and functions: incentive and motivation, physical and emotional pain relief, the regulation of stress, and the capacity to feel and receive love; > 2. these brain circuits develop, or don’t develop, largely under the influence of the nurturing environment in early life, and that therefore addiction represents a failure of these crucial systems to mature in the way nature intended; and > 3. the human brain continues to develop new circuitry throughout the lifespan, including well into adulthood, giving new hope for people mired in addictive patterns. Dr. Maté then examines the current mainstream.

[0] https://drgabormate.com/book/in-the-realm-of-hungry-ghosts/

[fourtrees]

Having both witnessed the whole opioid debacle first hand, first the sleezy over-prescription, then the reactionary under-prescription, which has caused, in my opinion, at least, as much, if not more, suffering and death than the over-prescription. Reading these comments is the first really sensible debate over the issue I've encountered and very encouraging.

For quite a while I've thought that the via media on the Rxs and an honest, more intensive treatment of the causes of 'deaths of despair' (which would certainly only partly be medical in nature) is by far the most humane (and medically ethical) way toward treating the problem. I know MDs who feel the same way but whose agency is very limited by this opioid Thermidor -- both in acting and speaking on the issue. I hope this is a sign of a changing trend in the public and political debate on the issue.

[jdc]

> Why is it that instead of acknowledging the rather uncomfortable root cause of those deaths, we just default to the so much simpler scapegoat, pills (the active ingredient in which has been with us in one form or another since 5000 BC), and pretend everything else is just rainbows and unicorns?

Okay, I'll take mushrooms, which have actually been with us since then, and you take synthetic intravenous opioids and we'll see who fares better.

[refurb]

Opioids (opium) have been around as long as mushrooms. Just because they are synthetic variations doesn't mean they are that different.

[jdc]

Alright, go ahead and get on a regular IV fentanyl regime and let me know how that goes for you.

[snovv_crash]

It has nothing to do with the synthetic, people destroy themselves on straight-from-the-poppy-plant heroin as well.

[honkdaddy]

I think you're underestimating how destructive fentanyl is compared to almost any other opioid.

[WarOnPrivacy]

What does fentanyl have to do with people who were cut off, people who - for years/decades - responsibly used Rx opiods to manage chronic debilitating pain?

Unless you're talking about people in pain who were forced to the street, after Dr's were (en masse) hazed into stopping pain treatment. In that case, I get your point.

[refurb]

Generally I’ve heard fentanyl is a poor substitute for heroin.

[inter_netuser]

My comment was specifically about people that need them prescribed. For pain relief, injuries, chronic pain, and so on. Opioids are very effective and are vilified for no good reason, along with a few other classes of substances.

Not as in substitution therapy, like methadone. I do hope that mushrooms help people come off of long-term substitution.