This study showed that a Tylenol ibuprofen combo was as effective as opioids (and with zero chance of addiction). If course it's likely to vary in effectiveness by patient and depend on the type of pain. I can't help but feel that pharmaceutical companies probably don't want a lot more studies like this coming out.
This study is so bad I don't know where to start. Apart from its small size, the other major things is there was no ibuprofen control or ibuprofen with codeine control. There is a vast difference in the effectiveness of ibuprofen over acetaminophen.
It is studies like this that have caused us Australians to lose access to OTC codeine this week.
Codeine at the dose available over the counter is not very addictive. On top of this the pharmacists record your details so that anyone addicted is picked up and helped. As far as I can determine there has not been a problem with OTC codeine in Australia.
As for why to not make it prescription only is we have universal healthcare in Australia. Shifting low dose codeine to prescription only will cause a massive increase in doctor visits at a huge increase in the cost to the Australian tax payer. I use OTC codeine to treat and catch my migraines before they become major. I maybe take codeine once a month and never visit the doctor. I will now have to visit at least once or twice a year for no reason other than to get a script for something I have been buying over the counter for the last 30 years.
If it's sufficiently low dose and it's tracked at a level that can detect and alert about potential abuse, that makes a lot of sense to me; thank you for the (much better) explanation.
Basically like lots of things in Australia we are getting caught up in the US hysteria about opioid addiction.
Yes opioids are powerful and potentially dangerous drugs, but used wisely they are very useful and effective. If there is a problem then the solution is to solve the problem, not just ban everything because there might be a problem.
On the topic of the US opioid addiction the way it has been handled is appalling. Getting millions hooked on powerful prescription opioids and then cutting them off cold turkey with effectively zero help so they end turning to really dangerous drugs like fentanyl is criminal.
When I was a kid you could purchase codeine cough medicine OTC in my U.S. state (it was same deal as you describe for Australia -- the patient would have to sign a register so the pharmacist could make sure you weren't buying five bottles a day or whatever).
Nothing works as well for a nagging cough as codeine and terpin hydrate. Nothing.
Unfortunately, you've got to go to a doctor to get it nowadays.
Instead, most people use OTC stuff with DXM (which doesn't work as well, is an abusable drug in its own right, and is quite likely more toxic than the codeine).
The question should be is their a compelling reason to make it Rx Only, and people that support making it Prescription only have the requirement to provide evidence to support making it RX only.
The fact that is "addictive" is also not enough IMO
People are neither medically qualified to evaluate opioid use nor, when in a situation where they may be necessary, personally capable of evaluating their situation. This is why trained professionals exist. This is literally why.
Asking whether there is an argument for an addictive opiate with significant health impacts and the opiate-consistent tolerance growth that leads to self-medication and increased dosage to be available without medical consultation is the "wrong question"--to somebody whose posts throughout this thread are unempathic, pull-the-ladder-up-behind-us, so-brave stances that project personal (theoretical and probably wrong) resistance to addiction onto societal policy.
>>This is why trained professionals exist. This is literally why.
Trained Professional exist to advise and recommend. Even in healthcare doctors are not dictators, they advise their patients on the best course of action it is then up to the individual to either follow that advice or not. I assume you oppose that, and believe doctors should have legal authority over their patients who should not be given any choices and should be compelled to do anything the doctor orders
So my question to you is why to you hate individualism and individual freedom? Following that how far does that extend, to you believe in a pure technocracy where decisions and public policy are selected on the basis of "trained professionals " in their areas of responsibility, particularly scientific knowledge with out considerations for personal liberty, rights or choices?
> I assume you oppose that, and believe doctors should have legal authority over their patients
This is a weakly constructed strawman. The gulf between doctors compelling behavior and society not enabling obviously self-destructive ones is wide.
Which you should know. And yet, the disingenuity is p. strong in here, so I'm gonna go with do know rather than should know.
> So my question to you is why to you hate individualism and individual freedom?
I "hate" individualism because I find selfishness to be base; in my experience the proportion of people who crow about "individualism" and who aren't in it to hurt those with fewer advantages than they have is a rounding error. And the freedom to ramp yourself into opioid dependence is not a meaningful freedom.
> with out considerations for personal liberty, rights or choices?
This degree of oh so you must believe silliness is some /r/iamverysmart stuff. C'mon.
>>And the freedom to ramp yourself into opioid dependence is not a meaningful freedom.
Nor is that a freedom I am speaking of, however the idea it should be a crime to "ramp yourself into opioid dependence" is unethical on its face as that is more of a medical and mental health problem not one that should be solved with criminality
I do however think it is a "meaningful freedom" for one to be allowed to judge for themselves what medication and/or pain management they should use in a given situation.
Further the War on Drugs as a directly result of prohibitionist policies have directly lead to more suffering and lose of "meaningful freedoms" for non-drug users than the abuse of the drug ever did.
I think it selfish is prohibitionist to not look at the big picture, to not see the Failure that the War on Drugs is, to not see the Extreme Harm the war on drugs in inflected not only on the US but the world, and double down on failed prohibitionist policies
>> in my experience the proportion of people who crow about "individualism" and who aren't in it to hurt those with fewer advantages than they have is a rounding error.
I must be in the rounding error then, I support many things that help people with fewer advantages, I believe these goals can be accomplished with liberty and respect of individual,
I also have a good understanding of history, and know that Authoritarian policies like the one you advocate for are often hardest on those not in the majority, on those that as "fewer advantages", Contrary to rose colored opinions authoritarians have, authoritarian polices are harmful to the less fortunate this has been proven countless time by countless authoritarian governments through out world history
Freedom and Liberty leads to prosperity, not Centralized Authoritarian Control
This is why you could only buy OTC codeine at pharmacies after you talked to the pharmacist about your condition and they checked and recorded your details in a database to see if you had been buying excessive amounts of OTC codeine.
We are moving from a system where we recorded who was buying codeine and making sure they were not needing help, to a system where there are no controls. The GPs in Australia lack any database on who has been prescribed codeine so it is now possible to doctor-shop around and abuse the system where previously it was regulated. About the only “winners” out of this change are the GP’s as they will now get more business from people like me.
Makes total sense. In the United States, despite their training pharmacists are mostly considered to be pill monkeys rather than meaningful medical professionals--what you get instead is an emoji shrug as the their-definition-of-freedom-lovers (the GP is a good example) froth out at the idea that their medical data should be available to medical professionals, leaving it an ongoing pain in the rear to try to get one pharmacy chain to talk to another (or to an independent pharmacist).
I sometimes forget that other countries have systems that actually work because the incidence of people trying to destroy societal systems is generally less; in that context what you describe certainly seems like an own goal to me.
On the contrary, since nobody in the US is willing to prescribe opioids any more, hospitals are doing Tylenol IV drips, and pharma is now charging 10x for acetaminophen.
They’re just fine with the hysteria and the studies, they still get paid.
In fairness my wisdom teeth removal wasn’t exactly textbook. I had to go to an oral surgeon and he had to dig into the lower jawbone to remove one of them, breaking it into pieces to get it off the nerve. I had a lot of damage to the gums and quite a few bone fragments migrated out over the next few weeks.
I was however even offered opioids for a root canal once (different dentist). I didn’t fill that prescription.
I had this done two time (jawbone cut, tooth extracted in fragments, stitches thereafter) and while the healing process was annoying, it wasn't painful unless I tried eating solid foods with the wrong side of the mouth or something like that (which was a good indication of the fact that it was too early to do so, which helped healing faster, which is why - even discounting addiction issues - taking painkillers for avoidable pain is dangerous).
The "quite a few bone fragments migrated out" part sounds pretty bad, on the other hand; that's not really supposed to happen as far as I know.
I agree that the opiates probably weren't needed. I took the recommended dosage at first and just completely passed out for hours, so I have no idea how much pain I would have been in. After that, I cut the dose in half for the next day, until I got really sick of feeling foggy and just stopped entirely. (I found the whole "high" to be really annoying and not particularly pleasant, aside from the pain dulling properties. All I wanted to do was read and I couldn't do that.) I suspect ibuprofen would have been sufficient but I don't really know, either, since I took the surgeon's advice and took the opiates at first.
I do still have one wisdom tooth left. If I ever get that one out, I'll see how it goes without the opiates.
Bone fragments migrating out are apparently not that uncommon. Any bone piece that breaks off but doesn't get completely removed will eventually migrate out of the gums.
Having had a bunch of dental work done, sometimes it's not unreasonable - I had my wisdom teeth out and was given hydrocodone for afterward, but I was fortunate and didn't have any pain warranting it after.
Being given opiates for a root canal seems insane, though - if you have crippling pain _after_ a root canal, I think that means the dentist did something horribly wrong.
https://www.healio.com/family-medicine/pain-management/news/...