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Here is a tip of the spear but there are better in the pipeline. This is just single dose ER but you get the picture. There are admittedly issues with the study and it is not a be all end all.

https://jamanetwork.com/journals/jama/fullarticle/2661581

I do think it suggests what further studies will tell us, and what many Drs. already know. The assumption that opioids are somehow unrivaled for pain is something worthy of questioning excluding the side effects and dangers. Add in the side effects and dangers and maybe it's worth rethinking the preconditioned mindset we have about them and pain. They just might not do what you think, or at least as well as you think.

I am biased too, given my previous projects and seeing doctors and patients so convinced a drug did what it doesn't and screaming like chimps when you try to take it away. Now no one misses it. It did nothing but damage.

You do not know this. You think this. There are other classes that can be better. Even if correct, it is worth thinking about and considering. Just proclaiming it does not make it true. There are many examples of this sort of truth that later is proven untrue. Don't accept this as truth. Question it. But certainly we need further study.

But IV opiod use (or even oral) in hospitals following surgery are hardly the priority in this epidemic. Until we know more, I'm not saying this is not legitimate use. End of life as well.

I do know this.

Everything else is an adjunct in true severe pain.

The problem with your study is it is hamstrung by our inability to actually measure pain. No one goes to the ed for pain and says "it's a 3/10." 7-10/10 is the overwhelming answer. I agree that most of them are probably 2-5/10 and would do best with Tylenol and anti inflammatories but for true 8+/10 opiates (unfortunately) are king by a long shot.

They are crappy medications overall and used way too much. Patients, docs, society, pharmaceutical companies and the government are complicit in the current epidemic.

You do not know this. Opioids very well may not do what you think. We are finding this out more and more. We are conditioned to think they do.

There are more studies coming. I am not suggesting I know the outcome yet. I am suggesting neither do you. You do not know this. Its faulty logic to think you do.

And yes, this study is not the be all end all and does have issues. I said as much. But it does suggest future study, and does suggest what we think we know may not be true.

Dude, I work on this issue (the opiod epidemic) every day and it's not a new issue for me. I've been working on it for years in some way shape or form. I am not jumping around, it is a multifaceted issue.

I am suggesting opioid efficacy should be challenged as a whole.

My truthful, rear-view belief about my experience with opioids and morphine are that they really did nothing about the actual pain... it was still very much there and i was still vey much aware of it....

when i was on a morphine drip in the hospital i had a clicker and i hit that thing an absurd amount of unauthorized times... i think the nurse in the morning said something like 350 times... And it wasn't because the pain was unbearable... it was because feeling high while i was in pain was way more enjoyable than just feeling the pain...

#59 many people work in this issue. Some in greater capacities than others.

#60 I'm not sure what you are asking. The data is 100 percent clear but the waters are muddy for many other reasons.

I agree, get rid of oxycontin and take the rest of them as well aside for very specific indications and for limited duration.

Opel, that's all I'm saying. I've been looking at some studies and data that are in the works that suggest what we think opioids do for pain, they indeed do not. It's a big stay tunes, but I don't think we will have to wait that long.

gummy the data is not 100% clear and in fact is starting to show the opposite of what you are saying. and yes there are other things that muddy the water.


I will say it again clearly. Opioids may very well not be effective for pain, or at least as effective as you think. I say may, because it's still being studied. If I had to choose what I believe the answer is I would say they are NOT effective. But I can't say that for sure at this point. It's fighting dogma but more and more are realizing they may be (I think are) innefective regardless of the downside.

I agree there and am heavily involved in that area. Me and my contractors are working on better ways to measure and assess pain let alone how to address it.

There is very definitely a physical as well as mental component. There are also lots of strategies from mental (midfulness, meditation etc), to physical (electrical and all sorts of voodoo LOL), to medicines (opiods, comas etc.). I'm interested in some of the physical brain approaches as well from surgery to using your mind to change the physical structure of the brain (something we believed impossible a decade or two ago... it was proclaimed a truth that it could not happen at the time)

Its a complicated subject, but opioids days are numbered as a whole I believe. I don't mean never, I mean rarely. It is difficult because many over value their usefulness.

If you break your leg and have truly excruciating pain the only way to alleviate it is an opiate or a nerve block. Period. Even a general anesthetic needs supplemented with an opiate to return vitals to baseline when the person is unconscious. Opiates are easier to administer than nerve blocks. If you disagree with that you don't have the expertise to continue this conversation.

Once again, if we are just talking about "pain" Huffington post headline style ill agree that opiates are the wrong answer for many of the questions but defining the terms and measuring variables is hard bordering on impossible.

We know how they work (mostly) and are slowly learning more about pain. Unfortunately opiates are active pretty much every where in the body, doing way more than alleviating pain (hence my assertion in this thread they are dirty medications).

Their days should be numbered but there is no great alternative yet - at least not for all cases. Their risks (small window aside) out weigh their benefits.

Minimally or non invasive pain measuring and modulation is the future.

Crazy how little we talk about cigars on a cigar forum.

meh. it's all good.

If this site carried good cigars maybe we'd talk about them more LOL

and I do suspect (not know at this point) that fentanil has little or no value.

We will see. I think it has very little value. Maybe very little is better than no.

It is a very limited scenario. Opioid use should be a very limited scenario. I suspect we are both talking past each other a bit.

I get the generalities thing. I can assure you that's not where I come from.

Ok. You don't get what I am saying which is cool. And if that's what you think about my knowledge, training and exposure I'm fine with that as well.

carry on. LOL

I get what you are saying now after you edited your post. My response was before your edit.

Let's at least be logically honest here.

What do I know. I'm just some guy who is paid to sweep the floor and sometimes takes a break to argue on the internet.

We probably agree 99.999 percent.

I just think we differ in our training and exposure.

I'd suggest looking at Kratom as a natural alternative for pain since it has shown to act in a similar fashion to opiods, But the FDA and guberment have waged a war on it since it has a "high likelihood for abuse", and stopped all research on whether it has any medicinal value. Just like MJ and the b*ll**** "reefer madness" propaganda.

But hey, opiods are cheap and easy to get. Needles are free. And if you do happen to overdose don't worry because Narcan is also free. It saves lives.

Lol cac jumps into an "opiates are bad" conversation to suggest taking an opiate as a substitute.

#90 doesn't matter if you believe it or not, what you say in your second paragraph is 100 percent correct

But you forgot to add that you have a skinny wiener ;)

gummy I do like to argue but don't mind losing if it gains me knowledge. As I said I started with the premise that opiods are effective (maybe even unrivaled) in fighting or covering pain. I have morphed based on the argument.


but as for arguing as a whole, my dad taught me to like it. We used to argue like cats and dogs (except using english and stuff) and then he would make me argue his point and he would argue mine. His way of making sure I was listening and making sure I knew he was. There is no such thing as losing an argument if you were wrong in the first place. Losing would mean winning no?

You are not everyone

You'd be surprised.