Is there a painkiller abuse problem in the US?

Thanks to Matthias Misiewicz for the request.

Yes, unfortunately.And really violent.

Away from the front, I am a concerned layman and chronic pain patient, but not a specialist.If a doctor, especially a pain therapist or anesthesiologist, has input, I would be very grateful (Julia MacDonald Ogilvie?).

To explain, painkillers are a very wide range of fields.Actually, it’s all about opiates and opioids. Opiates are intoxicated and narcotics from the milk juice of the poppy (opium), which are used, among other things, for severe pain.Opioids are natural or synthetic substances that are chemically very similar to opiates and also attach themselves to the so-called opioid receptors of the nervous system.It is these two categories that are at stake.

Known examples of opiates:[1

  • Opium
  • Morphine/Morphin
  • Codeine
  • Thebain

Known examples of opioids[2 in Germany:

  • Fentanyl
  • Tramal/Tramadol
  • Tilidin
  • Levomethadone

Basically, these all seem similar, although there are differences in strength and dependency potential.But in general, everyone can make addicts, physically and/or emotionally.There is no fun with these substances and they should only be taken under strict medical supervision.

The use of opioids and opiates has generally fluctuated throughout history.In the 19th century, they were freely available for purchase (in the original, Sherlock Holmes injects heroin and cocaine — quite legal).

Then, in 1914, the federal government began regulating opiates and opioids, especially to prevent abuse. [3

Until the 1980s, the use of opioids and opiates became increasingly frowned upon in medicine, and more and more people relied on NSAIDs such as ibuprofen, naproxen, etc. to combat pain, or on operations to cut off nerve pathways.

Then the paper turned and various studies gave the impression that the dependence potential on the medically used substances was not as strong as with opium, heroin and the like.Concerns were largely brushed away, and from the 1990s there was a boom in prescriptions for opioids and opiates. New variants were launched, such as patches and nasal sprays, as well as mixed forms such as tilidin comp, which had added naloxone to prevent abuse.

However, these studies do not seem to have taken into account how the long-term effects of the substances affect the potential for dependence and to what extent psychological problems further increase the potential.

This boom in opiates/opioids has been particularly stark in the US because of the extremely high performance pressure there.It is not uncommon to have two or three jobs at the same time. Leave is very limited — the fewest have more than 14 days of paid leave a year — and paid sick days are also severely limited.

This means that the pressure to go to work despite illness is extremely high.It would be better to swallow a few tablets and go to work than to risk the job or give up your income.

Doctors are all the more under pressure from patients to issue such quick-shot solutions on prescription.And recipes are as they are on the way.

To a point where the doctor pulls the emergency brake.Too often, since the patient is now completely dependent, the patient begins to look for, erm, “alternative sources”. If they have health insurance at all, the insurance company hardly pays for a withdrawal with weaning. So many are starting to get opiates and opioids illegally.

With long-term use of these substances, resistance to the effect often occurs, similar to that of alcoholics.You “need” more and more and more and stronger substances in order to achieve the usual effect again. The desire is also getting stronger and stronger. Often you end up with the very strong (and extremely dangerous!) substances such as heroin and fentanyl.

(Fentanyl is one of the strongest painkillers ever, 120 times stronger than morphine, and is prescribed for extremely severe pain, but must be taken exactly according to regulation.Otherwise, the smallest overdose will be a danger to life. The musician Tom Petty died like that.)

By the way, a cold withdrawal is very painful and extremely difficult to do on its own.It can even be life-threatening.

So many Americans – especially the poorer ones, who have little health insurance and depend on income – are in a dead end.They can no longer cope without opioids and opiates and are completely dependent on medical generosity (and often negligence), cannot afford supervised withdrawal (let alone weaning) and do not make the withdrawal itself.

That is why the United States has reached dimensions that do not exist anywhere else in the world.The scale is absolutely devastating and affects the most vulnerable in society.

Trump’s crusade against Obamacare exacerbates the situation once again.After all, thanks to Obamacare, many have at least a chance of withdrawal and weaning (which, in turn, unfortunately offer only one chance, because the risk of relapse is always there). But without Obamacare, they usually have nothing. No way out and no hope.


[1 Opiate – Wikipedia

[2 Opioids – Wikipedia

[3 Harrison Narcotics Tax Act – Wikipedia

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