Question Concerning Pain Control & Opiates

[Flagg]

Why are there no non-addictive, non-opiate, yet opiate level pain medications? I mean it seems that might be an important thing to develop since in America, at least, the DEA has decided that their coffers are low and they need more heroin addicts, meaning dealers, meaning suppliers whose illicitly acquired assets they can seize, so they are in the process of making chronic pain sufferers (such as myself) feel (and be treated) like criminals and are making it harder and harder to get what they need to, you know, not be in fucking agony.

So what is the problem, biologically? Why are there no hardcore non-addictive pain medications? Is it that pharmaceutical companies are just happy to have people who are hooked on their shit like your average pusher and could die if cut off, or is there just something I'm missing?

[Esquire]

The very short answer is that everything is addictive, especially drugs that make you feel good (or not feel bad; they're the same thing for this purpose). There's a limited number of classes of chemical that have numbing effects on humans; even fewer have strong enough effects to address the sorts of things opioids are prescribed for. Pain medications are even harder to develop than new antibiotics, which cost billions of dollars and decades of research time. There is no conspiracy to keep the planet addicted to heroin - even setting aside the principle of parsimony, what would the motivation be? Drug asset seizures go to local law enforcement, usually, and drug funding comes from major corporations or the Federal government.

Unfortunately, since the 1970s the US medical system has gone too far towards recognizing pain as a serious treatable problem and taken to massively overprescribing opioids, leading to the current addiction and overdose epidemics. You're unlucky enough to have a genuine need for continuous prescriptions just as physicians are being pressured to cut down on new/continuing prescription. Give it five to ten years and thing should settle down, less if the media finds a new cause to be up in arms over.

[Elheru Aran]

Either it's physically addictive, or it's psychologically addictive. There's no way around that. Either the chemical builds up a dependency in the brain/body, or you start THINKING you're dependent upon it. Not sure which one is worse.

Though presumably one could come up with some sort of drug that neutralizes the effects of the addictive substance in some way without putting people through cold-turkey withdrawal. In practice this would be hellish difficult, though...

[Flagg]

The very short answer is that everything is addictive, especially drugs that make you feel good (or not feel bad; they're the same thing for this purpose). There's a limited number of classes of chemical that have numbing effects on humans; even fewer have strong enough effects to address the sorts of things opioids are prescribed for. Pain medications are even harder to develop than new antibiotics, which cost billions of dollars and decades of research time. There is no conspiracy to keep the planet addicted to heroin - even setting aside the principle of parsimony, what would the motivation be? Drug asset seizures go to local law enforcement, usually, and drug funding comes from major corporations or the Federal government.

Drug asset seizures are usually split, IIRC local law enforcement gets 10-25% and the DEA gets their cut. And there's no conspiracy, I'm not saying that. It's just simple cause and effect. There were a ton of overdoses, asshole doctors selling scripts, and something had to be done. All I'm saying is the DEA saw an opportunity to make money and feel relevant, so instead of taking a measured approach, they took a bazooka to a housefly.

There were people gaming the system and they fucked chronic pain sufferers bad.

But pharma played their part with the bullshit they spread about OxyContin being virtually non-addictive and abuse free. Surprise!

But I didn't know how hard new pain medications were to develop. So thanks for that.

Unfortunately, since the 1970s the US medical system has gone too far towards recognizing pain as a serious treatable problem and taken to massively overprescribing opioids, leading to the current addiction and overdose epidemics. You're unlucky enough to have a genuine need for continuous prescriptions just as physicians are being pressured to cut down on new/continuing prescription. Give it five to ten years and thing should settle down, less if the media finds a new cause to be up in arms over.

The funny thing is, I don't even get high off the shit. Nor do I want to. I can get weed for that.

But they are even going after hospices. It's fucking insanity. And the people gaming the system... Just don't get me started.

And as with everything, the pendulum shall swing back to a more liberal approach, I'm just hoping they won't start giving the shit away like fucking candy again.

[Flagg]

Either it's physically addictive, or it's psychologically addictive. There's no way around that. Either the chemical builds up a dependency in the brain/body, or you start THINKING you're dependent upon it. Not sure which one is worse.

Though presumably one could come up with some sort of drug that neutralizes the effects of the addictive substance in some way without putting people through cold-turkey withdrawal. In practice this would be hellish difficult, though...

I tried at one point just using medical marijuana, first as vapor, then as tea, but it just wasn't strong enough to allow me to eat and drink and I got so dehydrated I ended up admitted to the hospital for 3 days.

[Alyrium Denryle]

Why are there no non-addictive, non-opiate, yet opiate level pain medications? I mean it seems that might be an important thing to develop since in America, at least, the DEA has decided that their coffers are low and they need more heroin addicts, meaning dealers, meaning suppliers whose illicitly acquired assets they can seize, so they are in the process of making chronic pain sufferers (such as myself) feel (and be treated) like criminals and are making it harder and harder to get what they need to, you know, not be in fucking agony.

So what is the problem, biologically? Why are there no hardcore non-addictive pain medications? Is it that pharmaceutical companies are just happy to have people who are hooked on their shit like your average pusher and could die if cut off, or is there just something I'm missing?

No, there is no massive DEA conspiracy.

This is where we enter the opponent-process theory of addiction. Opiates work partially by mimicking our own pain relievers (endorphines etc, we produce our own opioides, you see) only dialing them up to 14. Because there are all manner of little things that our naturally occurring opioids counteract (even tapping your keys activates pain receptor nerves), and their release is tied into the reward system (anything that causes an opioid release ALSO stimulates a dopamine release), and the brain stops producing its own if it has an exogenous source (like a morphine drip), you get physiological addiction AND a motivation to obtain more of that exogenous source.

There are limited ways to produce analgesia while still maintaining consciousness (when in a medically induced coma, you dont experience pain because you are unconscious, but if you get stabbed your body still goes through the whole pain-response rigmarole).

NSAIDS work by blocking the transmission of pain and stopping inflammation. Less effective. Other options include nerve blocks and local anesthesia....

There are compounds that both relieve pain and dont result in unconsciousness that are not addictive, but the ones I am aware of all have a theraputic dose that is very close to their potentially lethal dose. Some of the toxins produced by poison dart frogs come to mind. As a result, those are not used.

[Broomstick]

Opiates are definitely the go-to for acute pain, especially short-term. There's no question about that.

Problem is, we don't really have anything good for long term, chronic pain. As you noted, Flagg, a legitimate user doesn't get high from their dose, they get relief (one hopes!) Even if psychological addiction doesn't occur, though, physical tolerance goes up leading to side effects. Over time, opiates become less and less effective and it also can throw off the natural brain chemicals that are similar to opiates, which is part of why withdrawal is so unpleasant. As Alyrium noted.

But yeah, we're going through another episode of insanity. People legislating and enforcing to deny legitimate patients medication for their pain should be treated to some intense unmedicated agony themselves. Going after hospices is just... unspeakable stupid and cruel.

[Flagg]

Why are there no non-addictive, non-opiate, yet opiate level pain medications? I mean it seems that might be an important thing to develop since in America, at least, the DEA has decided that their coffers are low and they need more heroin addicts, meaning dealers, meaning suppliers whose illicitly acquired assets they can seize, so they are in the process of making chronic pain sufferers (such as myself) feel (and be treated) like criminals and are making it harder and harder to get what they need to, you know, not be in fucking agony.

So what is the problem, biologically? Why are there no hardcore non-addictive pain medications? Is it that pharmaceutical companies are just happy to have people who are hooked on their shit like your average pusher and could die if cut off, or is there just something I'm missing?

No, there is no massive DEA conspiracy.

This is where we enter the opponent-process theory of addiction. Opiates work partially by mimicking our own pain relievers (endorphines etc, we produce our own opioides, you see) only dialing them up to 14. Because there are all manner of little things that our naturally occurring opioids counteract (even tapping your keys activates pain receptor nerves), and their release is tied into the reward system (anything that causes an opioid release ALSO stimulates a dopamine release), and the brain stops producing its own if it has an exogenous source (like a morphine drip), you get physiological addiction AND a motivation to obtain more of that exogenous source.

There are limited ways to produce analgesia while still maintaining consciousness (when in a medically induced coma, you dont experience pain because you are unconscious, but if you get stabbed your body still goes through the whole pain-response rigmarole).

NSAIDS work by blocking the transmission of pain and stopping inflammation. Less effective. Other options include nerve blocks and local anesthesia....

There are compounds that both relieve pain and dont result in unconsciousness that are not addictive, but the ones I am aware of all have a theraputic dose that is very close to their potentially lethal dose. Some of the toxins produced by poison dart frogs come to mind. As a result, those are not used.

I agree, it's not a DEA conspiracy. It's just (IMO) the DEA taking this opportunity.u has dead hair follicles ) using insulin. So it's Tylenol. Just Tylenol. It works for most headaches and that's it. I can't have any prednisone (steroid that reduces inflammation and swelling) because they make me homicidally psychotic. So in my situation I'm just fucked all around.

I've had several trigger point injections in a spot over my left shoulder blade caused from being rear ended and having severe whiplash. But they can't do that in my stomach because they don't know what's causing it.

So I'm just kind of fucked all around as usual I guess. if you can't laugh, you're already dead.

But thanks for all the info. I knew most of it, but there was a ton I didn't, so it's been educational. And sorry for using so much of my own expireinces.

[mr friendly guy]

For chronic pain you have pregabalin and gabapentin. Some of these chronic pain meds were originally for other uses, such as depression or epilepsy, but we found they have pain modifying properties. In chronic pain they are favoured over opiods. AFAIK they aren't addictive like opiods, and as stated they are effective for chronic pain. Not sure if they also fit your criteria of being "opiate level medications."

[Enigma]

I've never been addicted to pain meds and the strongest one I've been prescribed was Oxycodone after I had my cochlear implant surgery. I took it twice and that was it. It got rid of the pain but it also knocked me right out. So I decided to use my trusty OTC generic Ibuprofen tablets.

The closest to being addicted to meds is my daily intake of sleep aid pills. They let me sleep whereas without it I'd constantly wake up and as one with Severe Obstructive Sleep Apnea (over 100 sleep interruptions an hour), not taking those pills would tank my ability to have any sort of proper sleep.

[Flagg]

I've never been addicted to pain meds and the strongest one I've been prescribed was Oxycodone after I had my cochlear implant surgery. I took it twice and that was it. It got rid of the pain but it also knocked me right out. So I decided to use my trusty OTC generic Ibuprofen tablets.

The closest to being addicted to meds is my daily intake of sleep aid pills. They let me sleep whereas without it I'd constantly wake up and as one with Severe Obstructive Sleep Apnea (over 100 sleep interruptions an hour), not taking those pills would tank my ability to have any sort of proper sleep.

Yeah, I was the same. I'd had broken bones and took a Vicodin I'd been prescribed,, didn't like the drowsy feeling, stopped taking it and stuck with Tylenol and Ibuprophen (which I could take at the time).

But when I was so sick I had stopped eating and was barely taking in water, as well as having weird looking diarrhea, I was diagnosed with a fistula (fusion and then a hole) between my duodenum (basically the part just below your stomach that connects it to your small intestine) and some point in my colon. I was so sick they admitted me into the hospital. They did tests which they said showed the barium contrast I had to drink hit my duodenum and then show up in my colon (I saw how fast it would go from my stomach to my colon on the real-times x-ray wand the Radiologist used, so there was something going on)

Anyway, the first night I was in the hospital room (my mom and my primary care doctor had told them I didn't like taking pain meds, which were prescribed at a heavy dose every 4 hours), I had the charge nurse of the floor, every nurse supervisor, my room nurse, and every nurses assistant in the room and they said to me "You WILL take EVERY dose of pain medication EVERY 4 hours on the dot, is that understood?" So it's me at 23, scared out of my mind due to this illness that could separate, spilling shit all over my internal organs, cause septic shock, and kill me, and I've got almost a dozen people standing around my bed telling me I MUST take the paid medication as presbibed. And it was IV push, so no possibility of spitting it out. In 3 days, game over, hooked.

[Broomstick]

Flagg, there is an important distinction between physical dependence and psychological addiction.

As you know first hand, anyone who is dosed with opiates on a regular basis for a certain span of time is going to experience withdrawal symptom when they are stopped. That does not make you an addict. You are not a junkie, you did not take those drugs to get high. The physical symptoms of the withdrawal still suck, but I suspect once you're off them you're not going to go seeking to get high. You lack the psychological cravings that mark an actual addict.

There are a number of other drugs you can't stop taking cold turkey, but due to the War on Drugs and other bullshit opiates have this extra bullshit attached to them. My understanding is that the proper response to the situation you are in is to gradually reduce the dosage to minimize withdrawal symptoms. Having watched my mother go through this whole process after dealing with a non-healing wound for a year, you're not going to feel wonderful during the step-down but it should be gradual enough that you don't feel actively sick from it.

They should NOT have forced you to take pain medication you did not want. That was wrong. You are supposed to have the right to refuse ANY medical treatment. There are reasons to take pain meds on a schedule, but there are also reasons not to as well.

Of course, I am not a doctor, I'm not your doctor, and all I know is what you tell me.