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I've heard from people in the medical industry that the effect of prescription opioids is roughly split in thirds - about a third get basically no effect at all or strictly bad effects, another third get effective pain relief but no desire to do more once the pain is gone, and the final third feel dangerous addictive desires in addition to pain relief and are prone to addiction and all the resulting issues if other factors in their life line up right/wrong.
Meanwhile, it seems really weird that there is suddenly a "chronic pain epidemic". Why should there be such a thing now? Humans have been doing lots of strenuous manual labor for all of recorded history - especially before the industrial revolution. Have we all suddenly got worse somehow? Is it maybe related to signs that the modern diet is mostly terrible?
This may roughly correspond to estimates that 27% of Chinese males were addicted to opium as aftermath of opium wars and wide availability of the drug. To be honest, I do not get the whole idea of how decriminalization of drugs will be so fantastic with these and other natural experiments during 19th century. There was a reason why newly discovered drugs got banned in the first place.
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It's probably not everything, but it doesn't help that we've gotten a lot fatter and older on average.
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Pain doesn't have to be physical. Psychological pain is a thing and it is just as real a sensation as physical pain. See e.g. phantom pain which is pain experienced by an individual in a limb that has long since been amputated. Phantom pain is a very real thing we've known about for centuries so it's not some new fad or whatever.
What happens when a limb is cut off? Necessarily, the nerves that come from the central nervous system have to be cut somewhere as well. So now you have some unnatural nerve ends dangling around in your stump, which may still attempt to send signals to the brain. And since these signals are fundamentally nonsensical, they can be interpreted as almost anything - and in doubt, the brain often interprets unusual signals as simple pain.
Worse yet, even if a theoretically perfect surgeon does such a great job that these nerve ends do not send any signals whatsoever, our brain is actually wired to expect them. So now it's trying to interpret the lack of signals, which, in doubt, ....
I'm actually not against your main point - I think that modern life often does not fulfill our natural urges and fails to offer adequate alternatives, and that this can lead to depression, chronic pain and similar issues. But IMO phantom pain is quite physical in nature.
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Because the pain isn't physical, it's mental/emotional/spiritual. Look up biopsychosocial concepts of pain, or for a more classic take, Healing Back Pain by John Sarno.
As someone who has experienced chronic pain for almost a decade, I can confirm that physical issues are not the cause of my pain at least. I've become convinced that the vast majority of chronic injury and pain is not a mechanical issue either.
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Tissue damage is only one part of pain.
https://www.painscience.com/articles/pain-is-weird.php
There could be other factors that might explain a higher rate of pain today.
Looks like an interesting article, thanks! I will read later. But that, and TheDag's point would imply that any "chronic pain epidemic" is just a broader symptom of, I guess I don't really know what to call it, the broad cultural sickness we have in the West and America right now, and treating with opiates is clumsy duct-tape over the real problem that mostly won't help much.
Yeah, there's something going on besides chronic pain. Opioids are also prescribed for acute pain (e.g. after an operation) despite the fact that acetaminophen and nsaids are similarly effective. When my wife got her wisdom tooth removed, the surgeon prescribed oxycodone a week before the surgery even happened. It's crazy.
I guess I'm somewhat lucky in not having many issues with serious or chronic pain. I did get my wisdom teeth removed, and I don't think I was prescribed or took anything particularly strong for that, but I don't recall very clearly. I had to get a root canal a few years ago, and I do remember that hurting pretty badly the next day. I had been prescribed Tylenol with Codeine, which I took and worked pretty well at dulling the pain, but left me pretty zonked out. Definitely not something I had any interest in taking if I wasn't in serious pain. I think I only took that for 1 or 2 days, and the pain was mild enough after that that I didn't bother.
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And in pain much of the time. Especially as they aged. The term "backbreaking labor" isn't new.
Eh maybe. But then still, why an opioid epidemic now? Opium and derivatives have also been around for a very long time. Is it just that much more appealing in pill form and prescribed by your doctor than in smokeable or snortable form?
It is prescribed by a doctor, imparting legitimacy. And in pill form you can pop a couple in a quiet moment to yourself anywhere, something you can't do with a syringe or opium pipe. And the pharmaceutical companies only figured out in the fifties and sixties how to mass produce doses that would leave people mostly functional while still taking their pain away. Before that those drugs were prohibitively expensive and so people just drank themselves to death.
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There certainly was an opium epidemic in the 19th century US, but most addicts were middle class or wealthy, predominantly women; the poor could afford neither the drug nor the doctor to introduce it to them (you could buy it over the counter, but the poor then were very poor indeed), and it was primarily injected by said physician. There was a population of civil war veteran addicts too. It was estimated that 0.5% of the population were opium addicts, a much larger percentage presumably used opioids occasionally. Apparently there are about 2.1 million opioid addicts in the US (estimated number with ‘opioid misuse disorder’) today, which is approximately 0.6% of the population. This doesn’t seem like a huge difference.
Opium smoking only became a major issue at the very end of the 19th century, and was primarily a feature of Chinatown opium dens which were necessarily not fully geographically distributed across the whole country but concentrated in major cities. As soon as opium addiction became recognized as a major problem in the 1890s it was restricted and then banned pretty quickly, physicians were shamed for prescribing it (both within and beyond the profession) and so it was never even introduced to many working and underclass communities. There were also horror stories from Western travellers in China describing the opioid epidemic there (eg half of all young men wasting away in the opium dens of major Chinese cities) such that politicians acted relatively quickly.
Today opioids are much easier to produce synthetically, much easier to sell (eg on the dark web) and ship, global trade offers far more places to hide large volume illicit imports, and a decline in communal identity means that social pressure (around almost everything) is less than it was in 1890.
So I don't really dispute any of that, but it feels like this conversation is getting a little shifted or circular, I suppose as a consequence of it being with so many people. What I'm really arguing against is ulyssessword's point that "the 'opioid epidemic' is an appropriate reaction to the chronic pain epidemic". I find it pretty hard to buy into, humans have been doing manual labor for millennia, opium has been around for millennia at varying levels of availability, but only now somehow is blue-collar manual labor so strenuous that using opiates to dull the pain is an appropriate response.
It seems more likely to me to be something like the point that sarker and TheDag are making, that the pain is actually a symptom of broader cultural disease, not a natural consequence of manual labor.
Uh, I'm pretty sure that the laboring classes who had access to a lot of drugs have proceeded to do a lot of drugs for all of recorded history. "They drink way too much" is a pretty universal blue collar stereotype, because that's a nearly universally available drug that's priced at blue-collar affordable levels in most societies.
Opium may have existed in 1890, but it wasn't widely available in the US the way it often is now. Booze was the drug of choice for construction workers and miners suffering from nonstop pain; when we decided it was a medical issue doctors of course can't say "have you considered needing some AA?" and so prescribed oxycodone instead. I suspect that the issue will fade with the normalization of medical marijuana.
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I think it’s much more available now and at much greater purity. If you have a script, you can pop into any pharmacy and have 100 pills in minutes. You don’t even need to get out of the car. Unless you lived in a big city, you probably had a harder time getting patent medicines simply because it required a trip to those cities, and it came as a bottle of a couple of ounces mixed with all kinds of stuff. Modern medical insurance covers a lot of the cost of modern opioid drugs where the older patent medicines were comparatively expensive. Cheap easy pills that you can get in large quantities without leaving your car are probably going to be a bigger addiction risk than something that’s expensive and sold in small quantities.
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