Some things that I learned about opioids from working with billions of insurance claims (teaching SQL at Harvard Medical School) and reading papers by Denis Agniel…
Note: All of this information relates to legally prescribed opioids after surgery (folks who use opioids illegally aren’t likely to ask an insurer to reimburse them!).
Americans are getting more prone to abusing opioids, with rates of abuse rising since 2012.
Doctors are not gate-keepers. They write nearly twice as many opioid prescriptions as patients actually filled.
After reports of opioid addiction, docs started prescribing lower doses around 2014, but they extended the number of pills/days. This increased addiction (34 percent increase in misuse rate per week), as did every refill (71 percent increase per refill). What doctors should be doing is giving high doses for less than two weeks, then telling patients to go cold turkey.
Young men are more likely to abuse opioids after surgery than young women, but rates converge around age 30.
Combining benzodiazepines with opioids puts a person at high risk for addiction.
Main take-away: Try not to take opioids for even one day longer than you need to and definitely don’t go for more than two weeks.
“What doctors should be doing is giving high doses for less than two weeks, then telling patients to go cold turkey.”
Any science behind this recommendation?
Chris: I wouldn’t say that there is any science, just statistics from the claims data. The insurers can see the prescriptions getting filled and then the ICD9 codes for treating opioid dependency. Read those Denis Agniel papers and tell us if you think it is scientific!
I think it kind of makes sense. A lot of people drink heavily at fraternity initiations and then don’t become alcoholics. But people who get used to having a few drinks to smooth out the typical day are probably at high risk for eventual dependency.
Thought this was a post about marriage. Marriage in western culture accounts for most of the use of opium, antidepressants, & other pain killers. Try not to be married for even one day longer than you need to and definitely don’t go for more than two weeks.
In the 1970s Consumer Reports didn’t think that opioids were a problem for society.
“There was very little popular support for a law banning these substances [opiates]. ‘Powerful organizations for the suppression … of alcoholic stimulants exist throughout the land,’ the 1881 article in the Catholic World noted, but there were no similar anti-opiate organizations.
The reason for this lack of demand for opiate prohibition was quite simple: the drugs were not viewed as a menace to society and, as we shall demonstrate in subsequent chapters, they were not in fact a menace.
http://www.druglibrary.org/schaffer/Library/studies/cu/cumenu.htm
A dentist wrote two Vicodin prescriptions for me and wow, that stuff was great. Give me another couple of weeks and I would’ve been totally hooked. I can’t imagine what something even stronger would feel like.