Why are opioids are so little used outside the US or Europe?

[supersonic89]

Hi folks.

I have always had this doubt. Outside of North America or some European countries (Germany especially) and Australia maybe, opioids or painkillers are very little used or just prescribed in extreme cases.

I don't know if it's because of a drug shortage issue, because codeine or tramadol are quite cheap to make (I think?). Could it be a cultural issue? Different ways of seeing and treating pain? I know about the oxycodone boom in the late 90's - early 2000's in the US and all the hype from the same labs or doctors calling it a non-dangerous, miracle drug. Or the absurdity that the United States has 99% of the world's supply of hydrocodone (I went batshit when I read this data).

Maybe it's something religious? At least in South America the majority of population are Catholic. I don't know. Heroin or fentanyl (for recreational use) has never reach here luckily (?).

In Chile, for example, opioids / painkillers are seldom prescribed. For an extraction or toothache docs would never prescribe Vicodin for example, only Ibuprofen or Ketoprofen, rest and a little ice for the swelling hahaha. In people with cancer Tramadol * is always the first option and only at the end of your life, maybe some morphine or another stronger opioid.

* and the funny thing is that they always prescribe tramadol oral solution or in drops, maybe it's stronger or faster acting?

 

[yubacity]

Opioids are used all over Asia my background is Punjab india and raw opium and poppy pods been used for hundreds of years and with no checks on chemists opioid pills are massive in Punjab . In the old days a baby with the shits would be given raw opium to stop it i was given some on a trip back in the 80s . Durind the wheat and rice harvest raw opium or pods would b e used to be able to work longer it part of our history.And with us bordering pakistan the puinjab india is in the grip of a heroin epidemic and it good shit the best i have had

 

[Jabberwocky]

In Eastern Europe opioids can be prescribed only in extreme cases, like surgery, oncology, acute high level pain. Other types of pain - forget it...

 

[supersonic89]

In Eastern Europe opioids can be prescribed only in extreme cases, like surgery, oncology, acute high level pain. Other types of pain - forget it...

Yeah, the same thing happens here. I don't know if doctors are more conservative or wise perhaps hahaha.

 

[Jabberwocky]

In Southeast Asian countries like Indonesia it is extemely difficult to get not only opioids but also benzos of any lkind, ADHD stimulants besides ritalin, or atypical anti-psychotics.

There is a strong culture there of suffering in silence and also seeing psychological and psychiatric issues as a spiritual or moral weakness. A friend of mine had a major psychotic episode and a leading psychiatrist blamed her ‘promiscuity’ and referted her on to an Imam.

 

[ControlDenied]

Personally, I think they do it on purpose. They flood us with opiates in the medical system then let in a variety of scum through the borders to establish an entire Heroin Empire. It serves two purposes for the system: a) Making money, and b) culling the herd.

The second primary cause of the North American opioid crisis is spiritual and psychological/sociological in nature. It's a diverse society experiencing an existential crisis, and all these issues correlate to the burst of opiate use, especially among working class whites in the Midwest. If what Marx said, "Religion is the opiate of the masses" is true, then "Opiates are the opiate of the masses" must be especially true during a time in which the practice of religion has practically disappeared.

Sooner or later, the issue will have to be resolved. Either they'll legalize all drugs and just embrace and even enhance the use of drugs in general, thus limiting the compulsorily "naughty" aspect of the drug culture, or completely crack down on them in some resurrection of traditional culture. The solution might also take the form of some combination or perversion of the two on the spectrum.

 

[Jabberwocky]

In Southeast Asian countries like Indonesia it is extemely difficult to get not only opioids but also benzos of any lkind, ADHD stimulants besides ritalin, or atypical anti-psychotics.

There is a strong culture there of suffering in silence and also seeing psychological and psychiatric issues as a spiritual or moral weakness. A friend of mine had a major psychotic episode and a leading psychiatrist blamed her ‘promiscuity’ and referted her on to an Imam.

Seems like my country attitude towards suffering. Catholicism at it's finest here. Except here you can get benzos, but you don't have meth to buy on the street like in Southeast Asia.

 

[supersonic89]

Personally, I think they do it on purpose. They flood us with opiates in the medical system then let in a variety of scum through the borders to establish an entire Heroin Empire. It serves two purposes for the system: a) Making money, and b) culling the herd.

The second primary cause of the North American opioid crisis is spiritual and psychological/sociological in nature. It's a diverse society experiencing an existential crisis, and all these issues correlate to the burst of opiate use, especially among working class whites in the Midwest. If what Marx said, "Religion is the opiate of the masses" is true, then "Opiates are the opiate of the masses" must be especially true during a time in which the practice of religion has practically disappeared.

Sooner or later, the issue will have to be resolved. Either they'll legalize all drugs and just embrace and even enhance the use of drugs in general, thus limiting the compulsorily "naughty" aspect of the drug culture, or completely crack down on them in some resurrection of traditional culture. The solution might also take the form of some combination or perversion of the two on the spectrum.

Completely agree with the second cause. Myself, I am going through a kind of existential crisis and depression and have been abusing opioids for almost two years. I think it has to do with something about how modern societies work, but given that, little can be done.

It would be an interesting measure to legalize drugs and see what happens. Although I have mixed opinions about it.

Right now, I think tapentadol (aka Nucynta or Palexia) maybe will be the painkiller/opioid of the future because its low rates of abuse and analgesic potency of oxycodone. Although, personally, I also think it can be misused. In fact, when I have taken it, it has always caused me euphoria, good feeling of opioids and compulsive redosing. So I don't know, if I am one of the 1 / 100,000,000 people or those studies are bought by the pharmaceutical industry.

 

[MsDiz]

Right now, I think tapentadol (aka Nucynta or Palexia) maybe will be the painkiller/opioid of the future because its low rates of abuse and analgesic potency of oxycodone. Although, personally, I also think it can be misused. In fact, when I have taken it, it has always caused me euphoria, good feeling of opioids and compulsive redosing. So I don't know, if I am one of the 1 / 100,000,000 people or those studies are bought by the pharmaceutical industry

Yeah look, of course it can be abused by people who have previous experience with abusing opioids. It’s just that it’s perfect for people who are having severe pain that is short term. They won’t get high off it and enjoy it to the extent they will become addicted. It really is a very clever opioid and my dr recommends it to most of his patients along with a good taper method when they no longer need it.

 

[Jabberwocky]

So I don't know, if I am one of the 1 / 100,000,000 people or those studies are bought by the pharmaceutical industry.

It's not just you and yes - most of the studies are bought by pharmaceutical industry. Especially when it comes to new opioids. Or new "ways of delivery" of old ones. Gee, who knew that oxycontin is soo addictive. Who knew oxycodone is addictive as oxycodone. With that said I am for a regulated but legalised market of all substances. Only substances like carfentanyl would be prohibited the way arsenic is. Regular substances that are risk only for people who use them should be legal. Period. But then all those billions couldnt be made off such cheap products. I went off topic. I highly recommend the book "Our right to drugs" by Thomas Szasz.

 

[supersonic89]

It's not just you and yes - most of the studies are bought by pharmaceutical industry. Especially when it comes to new opioids. Or new "ways of delivery" of old ones. Gee, who knew that oxycontin is soo addictive. Who knew oxycodone is addictive as oxycodone. With that said I am for a regulated but legalised market of all substances. Only substances like carfentanyl would be prohibited the way arsenic is. Regular substances that are risk only for people who use them should be legal. Period. But then all those billions couldnt be made off such cheap products. I went off topic. I highly recommend the book "Our right to drugs" by Thomas Szasz.

Yeah, those studies seem a bit suspicious or poorly done to me. It reminds me of Oxycontin and its studies that said it didn't cause addiction in the 90s in America. I believe that even the laboratory was sued by the state and declared bankrupt because they had to pay several million dollars or something like that.

 

[Fairy of the Flowers]

Because UK doctors are tight even if you're in pain with fibromyalgia they won't give opioids as they don't care, I just commented on another similar post about same thing

 

[Jabberwocky]

In Eastern Europe, ex Yugoslavia, I am under pain management treatment for problems with lower back. Biggest problems are with the nerves L5-S1. My bones are visibly demineralised at that area, canal is tightened so it is pressing my nerve (stenosis) and my spine is not curved enough (hipo lordosis). And yeah, I also have Spina Bifida Occulta at that exact area.

This was all diagnosed because after having back pains for more than 5 years, NSAIDs and excercise didn't made it any better. I couldn't seat for an hour and was in agony especially while working. My wife and my whole family wanted me to go to the doctor. I didn't want to go as I had a history of addiction. I didn't use any illegal substances durring the period of 5 yeras that I am talking about, but 10 yeras prior I had problems with stimulants. I knew I will be treated like second order citizen and I refused for years to go to check my back. Finally I caved. My doctor didn't believe me but I insisted that I want a RTG of the area that was causing most pain. After results of RTG came back my primary doctor said: "Here it is! Now you have a proof that you are in pain.". No shit... After that MRI was done (waited more than 6 months for it) and all subsequent diagnoses were made. So, once again, to recap:



-> in pain for more than 5 years without seeking help and using ungodly ammounts of all different NSAIDs and paracetamol

-> my doctor doesn't believe me due to the history of stimulant addiction

-> RTG and MRI show "Spina bifida occulta" L5-S1, spinal stenosis L5-S1, demineralisation of the bones surrounding that area and hipolordosis (curvature of the spine in that segment is to small)

At that point I was refferd to a specialist (physiatrist). After examination specialist said that I shouldn't pick heavy objects and that I should avoid walking up or down the hills (as that puts additional pressure to my spine). Also I was sent to physical therapy (exercises, magnetic therapy, electrical therapy). It didn't help a bit. So my primary doctor prescribed me 37.5mg tramadol, one tablet maximum twice daily. That's all. It didnt help. After that I tried acupuncture but it didn't help. I was exercising and trying to find excercises that would help me the whole time. After being in tons of pain I asked my doctor for something stronger. I wasnt hoping for oxycodone or morphine that I could get from the people I was hanging out during my stimulant addiction phase - I asked for codeine. I asked for low dosage of codeine. Doctor refused. Then I told him I can't keep this up as I am not sleeping and can't do my job and that he is driving me to illegal ways of trying to dampen my pain. I was refused off all further help! That was my intro to opioids as I eventually started buying MS Contin and later oxycodone. In the end I went onto opioid replacement therapy and tried out various dosages of methadone and buprenorphine - for pain problems that I have!

I forgot to mention that I also tried lidocaine injections into affected nerves and all the other non opioid medications. It helped a bit, but side effects weren't worth it.

In January, 7 years after I first visited a doctor, more than a decade of pain, few years on ilegaly sourced pills and 3 years of methadone and mostly buprenorphine - I detoxed and was for a year without any opioid medication. Now I am using kratom for this winter flair up of pain and depression. I intend to stop it in February.

For the record - I was the kind of person who after all that jazz brought over 150 8mg Subutex pills to my doctor. I returned methadone that I was given more than I should be given multiple times. Talk about a true opioid addict. But was and still am denied any opioids other than 75mg of tramadol daily.

Sorry for the long post but my back/hip/leg are hurting me so bad this morning and I needed a place to vent out.

So that's the way it goes with opioid pills here. I can get methadone and buprenorphine for addiction (I would say dependence, but hey, who am I to judge...) but not codeine for pain.

 

[shahab6]

10% of the population of Iran uses opioids. What makes you think no one outside of the USA and Europe uses opiates?

 

[finitelifeform]

Wherever the reach of big pharma is the greatest, you'll find more emphasis on the peddling of phamaceutrical drugs.
Unfortunately it's a global issue as opioids are a globally recognized drug for many things in academic/medical world and so that means a HUGE market for big pharma to dominate, of which they have successfully done so. Where it isn't so will be nuanced and likely more regulated and therefore subject to scrutiny as to their application and their availability.

Just like at anti-depressants though to see the reality of how far drugs can be pushed. It's big pharma that has pushed anti-depressants, psychiatry being the vessel by which it seems more legitimate and with more 'science' and therefore authenticity and so people trust a doctor when they are prescribed them. It's no different with other drugs like opioids. They are EVERYWHERE. And because they come under the guise of medicine, they can spread throughout society and become just as available as OTC painkillers. It's down to regulation and how a particular government and it's affiliated departments perceives the need for those drugs to be available to the public that determines whether they are prescribed like candy or alternatively reserved for more serious cases.

With opioids though, it's not hard to see how easy it is for them to be prescribed. People deal with pain everyday. Society is full of pain and we medicate in all sorts of way to sooth it.
The difference between OTC painkillers and high strength alternatives is down to how willing a medical professional is to give you the higher strength alternatives. And well, the sad truth is, it doesn't take much to find yourself with a script for some heavy drugs courtesy of your doctor. And so there is the problem. And behind it? The empire that dominates the medical world - big pharma. The people pushing policies linked to big pharma that ensure more and more people get access to more and more heavy drugs. And before you know it, you've got a situation on your hands where more people are worse off than before they came to the doctors for solutions to their issues.

 

[Jabberwocky]

And well, the sad truth is, it doesn't take much to find yourself with a script for some heavy drugs courtesy of your doctor. And so there is the problem.

Why getting and taking any drug should be a problem??? Why people like to be infantile is beyond me. It is to each and every one of us to be a grown up and take responsibility for our actions. Taking drugs is just one more action to be educated about and responsible. If one likes handing his responsibility to doctor and not think about it, ok, that's his choice. But why would being prescribed an opioid be a problem? As long as nobody is forcing you to take a substance I don't see a problem on prescribing a substance. But hey, that's just me. I really dig into that whole responsibility and being a grown up thing. Peace.

 

[finitelifeform]

Why getting and taking any drug should be a problem??? Why people like to be infantile is beyond me. It is to each and every one of us to be a grown up and take responsibility for our actions. Taking drugs is just one more action to be educated about and responsible. If one likes handing his responsibility to doctor and not think about it, ok, that's his choice. But why would being prescribed an opioid be a problem? As long as nobody is forcing you to take a substance I don't see a problem on prescribing a substance. But hey, that's just me. I really dig into that whole responsibility and being a grown up thing. Peace.

Your post doesn't make any sense. You're saying we need responsibility and yet at the same time you're saying professionals utilizing responsibility and preventing people from getting drugs IS a problem. Don't you see the flaws in your logic? We NEED everybody to have responsibility and because we live in a world where drugs are dispensed by professionals, they NEED responsibility in order to ascertain whether a certain drug is suitable based on that individuals circumstances. That's how a transformation in drug policy would work whereby drugs are decriminalized but their availability is regulated and based on the harms they cause to society. Opioids cause serious harms and have a VERY HIGH addicting potential and we could on forever comparing them to other drugs like cannabis and psychedelics for example with relatively low harms. But yet you want to be able to get drugs whenever you want and for society as a whole not to collectively shoulder that responsibility? You want a doctor to write you a script for a highly addicting drug and not care about the consequences?

What you are prescribing is precisely the problem we have in the world in regards to drugs and addiction. It's just shrouded in sherking responsibility and a positive spin put on it. Whatever way drug policy is defined, drugs will ALWAYS be regulated and their use ALWAYS regulated. Even in a world where drugs are decriminalized, being able to obtain crack or cocaine or heroin will never literally be as simple as a walk in the park.

There is a difference between responsibility and lack thereof. What you seem to be wanting is a world where people can do whatever the f*ck they want. That's not responsibility, that's a ticket to the destruction of society from the inside-out. Just let everybody do what they want, right? Let everybody run themselves into the ground and for society not to give a f*ck about them. That works, if you live in a world where nobody gives a f*ck about one another. Even with responsibility there are limits. Just because you should be able to do whatever you want with your body doesn't mean that there would be no rules. Anybody who believes a completely free and open world consists of no rules is precisely what you stated at the start of your reply - infantile. We NEED rules. Otherwise this entire thing you call society wouldn't exist for very long.

 

[Jabberwocky]

@finitelifeform I am an advocat for legally regulated drug market. Like alcohol and nicotine. If someone wants doctors opinion I have nothing against that. But the way it is it is very bad case of medical fascism. That's my take on it after considering it for 30 years. Cheers.

 

[modocmodoc]

We control the opium market by invading the highest yield growers and therefore get the fun pills. Thank the CIA for using black drug markets, selling stolen Opium from Afghanistan to pay for off-book black operations (wetwork, installing and deposing various leaders, testing high tech shit, ya know)..

WE GET THE FUN PILLS NOT YOU.

 

[modocmodoc]

And the only answer is absolute decriminalization. Yeah, that might put a dent in the fact that 85% of violent crimes are committed by or against someone intoxicated with alcohol.

Again, regulation ruined it so they legalized the most dangerous one that disinhibits the worst and is the cheapest.