Opioids Why is America the largest consumer of opioid analgesics worldwide?

hence the shortages of OP-ER etc. etc.

I'm curious, as to why simple paracetamol with codeine products aren't used to treat severe chronic pain?

Bronson.

These are two (actually three) different questions.

1. Why is America the largest consumer of opioid analgesics worldwide?
America is probably the largest consumer of opioid analgesics because there is a great market for it, both legally, gray-market, and illegally. Opioids have somewhat of a mythical quality for many people largely due to years of prohibition. (& movies like Trainspotting etc)

2. Why are there supply shortages of some opioids?
Manufacturers started slowing down production of "older" instant-release pills and generics to stop abuse. The DEA has been cracking down on prescription drug misuse pretty heavily in the past 5 years.

3. Why aren't codeine and paracetamol used to treat severe chronic pain?
Codeine and paracetamol are effective for mild to moderate pain. They may not work effectively, or will only work effectively at toxic doses in people who have severe pain. These people require drugs with less perhipheral effects (codeine is notorious for being itchy and constipating) and drugs that lack toxicity with extended high-dose use (acetaminophen/APAP is toxic to the liver in high-doses or long-term).

True that, my friend.

I guess I'm just jealous of America's Percocet and Vicodin, which aren't available down here, which are used to treat moderate pain in the States? Correct? All we have is tramadol and Panadeine Forte, nothing nice like hydrocodone/oxycontin combined with 325 mg of paracetamol...

What planet are you on? Opioids like oxycodone, hydrocodone etc are schedule 8 in Australia. That's the equivalent of US Schedule II (ior so it appears to me). In both cases they are tightly regulated and only sold in small lots to people with a doctor's prescrition. I think your doctor just doesn't want to Rx strong opioids, which is totally understandable. (That or nobody in your social network sells them illicitly, but let's not go there)

If you thought that Perc/Vicodin are over-the-counter in USA, you're wrong. Opioids with acetaminophen are usually schedule III or II, both beign restricted to prescription-only medications. Pretty much everything but acetaminophen is controlled in the 'States, though a few states will allow the purcase of hydrocodone or codeine cough syrup over-the-counter (with photo ID etc.) - this is not really the same as buying vicodins 'cause there are other things in the syrup - Tylenol 1 (equiv. to panadiene forte) is controlled there too. As far as I know trramadol is rx only as well.

I know that in e.g. Florida there were a surplus of phoney pill-mill doctors until the recent DEA crackdown.

Also, as far as I know, Tasmania is one of the larger producers of opioid alkaloids in the world.

(Addendum: I actually live in Canada, where small quantities of codeine plus caffeine may be sold OTC.)

Yeah, your right about that. tasmania is often neglected in australia, but it's important in the role of growing opium poppies. Tasmania is the world's largest producer of opium alkaloids for the pharmaceutical market, guarded by AFP to keep junkies out of the fields of poppies.

I went down there one time, there was about 10000 hectares of poppies growing down there.

So we can deal with how fucked up our country is. Kinda numbs the pain.

I think you seem to have the idea that in America one can walk into a pharmacy, slap a Benajmin on the counter, and say "Hey bartender, gimme 150 Vicodins". It doesn't work that way unless you live in the projects. opioid abuse is definitely prevalent in USA but it is probably easier

This is almost a socioeconomics question. I personally think that developed nations would spend more per capita on entertainment and luxuries (such as drugs) compared to developing countries. But in reality it seems that countries that are capable of producing the drug are the major consumers.

It may suprise you, but America isn't actually the largest consumer of opiate drugs in the world. Nor is Tasmania the world's largets producer of opiates - Afghanistan (suprise!) is. As for pharmaceutical opiates, I cannot say. Pharma comapnies operate in mysterious ways, often to the detriment of the drug abuser.

So we can deal with how fucked up our country is. Kinda numbs the pain.

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Americans in particular seem to love their drugs, even if doing so makes them a hypocrite... the 'public image' of certain drugs has been so ingrained over the years (see: Tony Montana) that doing them becomes desirable.

Realistically, if you're an opioid user in the US you fit into one of four groups.
Those who do opioids with prescription for pain control. (legal usage)
Those who acquire opioids via prescription for gray-market resale
Those who do opioids for recreation
Those who grow/process their own (pod tea, NZ homebake labs, etc .. small fry in the grand scheme of things)

I, personally, think most modern drug policy can go take a long walk off a short pier, but that's just me.

Mod Note: This thread is rather rambling and should be folded into the social thread.

Americans are hungry; hungry for processed foods, hungry for dank nugs, hungry for drugs. I attribute their lust for drugs to intensely biased drug education classes. Americans learn that weed will make you go crazy and jump out of windows as if you can fly, then people try it for themselves and see it's not true. So, they correlate the misinformation of MJ to other drugs as well. "Well, they were wrong about the dangers of weed, they must be wrong about the dangers of heroin addiction."

It's not an american problem, it's just that we are catching up to the restrictions placed on opiates worldwide, however, big business lets it idle. Thank god.

Bronson--By OP-ER do you mean OpanaER? If so, as I stated in an earlier thread you posted in, American 'overuse' has NOTHING to do with the OpanaER shortages. OpanaER shortage is because the one and only factory that produces that product (A Novartis plant in Nebraska), had to shut the whole plant down because of 3 cases of mislabeled medication since 2009. In each of these cases, pharmacists opened a package and found one or more of the wrong kind of medication. Because of this, the FDA made them shut down the whole place for fear that someone would open a bottle of childrens Motrin and give their kid a 40mg Opana (as an example). Endo also produces several other pills in that plant (Percocet and Endocet are two examples), but production of those products was easily transferred to other plants that manufacture those same pills, generics, or very similar pills. Opana is unique and has no generic (And somehow they had no fucking backup plan in place). So THAT is why there are no Opana ER pills right now, it has NOTHING to do with people over prescribing/using them.

As for your question about why the USA uses so many opiates, it is a combination of a few things: (1) We are one of the most populous countries in the world. (2) We are one of the wealthiest countries in the world (3) For the most part, our doctors are educated about pain and pain treatment, whereas many other countries still have the 'Grin and bear it' mentality about pain. (4) The USA has an unusually high percentage of our population in the 50+ year old demographic. There was a large bump in births in the 10 or so years following WW2 (We refer to it as the 'baby-boom generation). Obviously older people are much more likely to suffer from both acute and chronic pain. Personally, I think those are the top four reasons.

I wrote a whole lot more but my stupid fucking computer just highlighted the next two paragraphs as I was typing and erased it all, and I am in way too much pain to concentrate and retype it.

I believe that one big reason for this is that most of your health care is provided by the private sector. Also because of general attitudes leaning towards supporting medicalization. Who likes a doctor that doesn't prescribe pills but instead gives you sound advice and sends you home? Most people I know would be pissed and never return to this doctor leaving him with less income, even if the advice was right and you could do just fine without drugs. So instead they give you what you want, drugs. Ofc entities like DEA keep things something in check, but I believe that in the end, it's all about money.

When the healthcare system is for the vast majority public and the doctors get paid by the state/government instead of the clients (like here in finland) they turn into utter dicks. Why should they even care wether their 'customers' are satisfied or not? As long as they aren't commiting any crime, they can pretty much laugh at you and say that you'll be just fine with your back pain and write a prescription for ibuprofen which you can get without a script here anyway, it's bizarre. The restrictions on opioid drugs are extremely tight here, a private doctor can easily lose his license if he prescribes a too strong drug, too many pills or a too high dosage. If you're lucky you might get a prescription of some acetaminophen+codeine combination drug, with the doctor going crazy about how dangerous/strong drug codeine is. Terminal cancer patients do still get stuff like fentanyl patches and OC80 here as well, but these types of medication are rare and not always prescribed even after a surgery (they probably try to put you on ibuprofen/paracetamol first).

FnX, that's a great point. Doctors in the US like to take the path of least resistance, and if the patient complains of an ailment, they like to prescribe them something helpful so the patient feels like he had a complete "doctor's office experience," which ends in the pharmacy. They feel more cared for this way, even if these medications will cause more problems for the patient than non-medication approaches. I know if I went to my ortho for pain relief and he sent me out the door with an MRI referral, and didn't even offer me something for the pain, I would be hesitant to return. There are other doctors who listen to you and are not afraid to prescribe you the medications you need (or think you need).

Capitalism. All about the dollars.

ErgicMergic said:

FnX, that's a great point. Doctors in the US like to take the path of least resistance, and if the patient complains of an ailment, they like to prescribe them something helpful so the patient feels like he had a complete "doctor's office experience," which ends in the pharmacy. They feel more cared for this way, even if these medications will cause more problems for the patient than non-medication approaches. I know if I went to my ortho for pain relief and he sent me out the door with an MRI referral, and didn't even offer me something for the pain, I would be hesitant to return. There are other doctors who listen to you and are not afraid to prescribe you the medications you need (or think you need).

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Yep God bless the USA!!!

One reason isn't necessarily because the US uses too much opioids, but much of the third world underuses opioids. The war on drugs has forced many nations to rarely use opioid. Sad thing is in much of the world, if your dying you'll most likely die in horrible pain.

Well i imagine "they" dont always prescribe codeine with apap because the analhesic effects dont last that long compared to er drugs.

doppelganga196 said:

Well i imagine "they" dont always prescribe codeine with apap because the analhesic effects dont last that long compared to er drugs.

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WHats that got to do with my origina post?

^ erm cos you said you were curious as to why they dont prescribe codeine apap products to treat severe pain - because codeine isnt a good med for severe pain & the analgesic effects dont last long enough to make it suitable for many people compared to extended release drugs. Wtf dont you remember what u wrote?

& yes capitalism plays a big part in a nation of 300 million.

Everyone loves to get high, that's why. nuffsaid.

FnX said:

If you're lucky you might get a prescription of some acetaminophen+codeine combination drug, with the doctor going crazy about how dangerous/strong drug codeine is.

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Yeah, or tramadol, which is unschedulded in the US, but here (in Finland) it needs an original prescription, that cannot be given by phone/fax or to have any refills (same thing with buprenorphine, which is Schedule III in the US). Things are really upside down... 8)