[Aurornis]

> painkillers in amounts and at purities street users can only dream of.

It’s true that pharmaceutical purity is higher, but it’s very much incorrect to say that hospital patients routinely receive higher amounts or doses than street users.

The doses used by chronic opioid, benzo, and stimulant addicts can be absolutely insane compared to even high doses given in medical practice. Even more so after tolerance builds.

This can be a real problem for severe addicts who become hospitalized or end up in the ER because their tolerance is so high that even the high end of doses used in normal patients may do next to nothing in patients with severe addictions.

Addicts also have several factors contributing to the increased severity of their condition: Their route of administration is designed to maximize the ramp up of the dose, which leads to stronger effects, habituation, tolerance, and withdrawal dynamics.

Undergoing many cycles of habituation and withdrawal (missing doses, running out, or just abusing on weekends and trying to stay sober during the week) can actually sensitize addiction problems and exacerbate the problem, even if the doses are not extreme. This is not a problem in a hospital where doses are scheduled and regular.

Finally, the duration of exposure and area under the curve is dramatically different. An addict may be exposed to 100X or 1000X as much of a drug over years due to higher dosing and long term addiction relative to someone in the hospital who undergoes a procedure and then is tapered off.

It’s really misleading to compare opioids or benzos prescribed in a controlled hospital setting to the use by addicts. They are so dramatically different that you can’t compare the addiction and withdrawal dynamics at all.

[vintermann]

It's the same compounds, though. And we're only comparing them on one dimension - simple physical addiction. How misleading can it be?

As I said, the studies are old. With the rise of superpotent synthetic opioids in the illegal market, and probably more caution in hospital use - one of the reasons these studies were made, was probably that someone noticed "wow, they sure used a lot of opioids during the Vietnam War, I wonder if that led to a rise in street addicts?" It's possible that it's no longer true that patients get much higher doses than the typical street addict. But it used to be the case, at least, and we can still learn from what we observed back then.

I think there's still plenty of support for the conclusions, that addicts can beat physical addiction, but that they start again, and that the fear of withdrawal pains is not a big factor in what's keeping them as addicts.

[knotimpressed]

Pretty misleading, to be honest. As the parent comment to yours said, the ROA + dose schedule + AUC + peak plasma concentration differ so vastly that "its the same compounds" almost doesn't matter.

The differences between street/illicit use and hospital use are so extreme even just from a physical point of view that it is unreasonable to compare the physical addiction/withdrawal they both cause.

That being said, physical addiction/withdrawal is definitely only one piece of the puzzle of why addiction happens and addicts don't stop their use. I think that using the data of hospitalized patients being able to push through it isn't as strong as an argument for that as you've made it out to be, but that doesn't mean it isn't true.

Addiction is a very hard problem, and I'm hopeful that we'll continue developing new treatments and support methods as a society, even if its semi by accident like with GLP-1s.