The Opiate and Heroin Epidemic in America (2 Viewers)

[Terminalxylem]

But what is the alternative to preemptively prescribing them in the post-op setting? Wait and see if pain is uncontrolled?

How does that strategy ameliorate Tau’s concerns?

I'm just an observer here. But I'd think one key part of the strategy in the case of your surgery would be asking the patient about their pain and trying to determine the right answer for solving the pain problem with as non serious a solution as possible.

Basically, whatever it takes to not have a patient be in the position you were in:

Despite requiring no perioperative pain meds, I was discharged with a week's worth of oxycodone. I didn't ask for them, and took none.

It’s not so straightforward, because:

1. Not everyone has the same pain threshold, or ideas about what constitutes adequate control
2. Pain can wax and wane
3. For same day surgery, residual anesthesia may dull pain for a while, extending beyond discharge
4. There is no universally accepted, objective measure of pain
5. It can be more difficult to prescribe controlled substances over the phone
6. A surgeon’s busy schedule can preclude prompt response for pain med requests after hospital discharge. Moreover, calls after hours are a red flag for drug-seeking behavior.

Considering all these factors, and the fact most unused opioids aren’t diverted/abused, many (most?) doctors err on the side of providing the medications, when a reasonable expectation of significant post-op pain exists.

I agree it's not easy or straightforward.

But I still think it's a good place to start with whatever it takes to not have a patient be in the position you were in:

Despite requiring no perioperative pain meds, I was discharged with a week's worth of oxycodone. I didn't ask for them, and took none.

And for physicians to be very concerned about short-term opioid use for acute pain.

In my brothers experience, it seemed pretty common for the addiction stories to start with, "I had a surgery..."

It happens, but isn’t common at all. That’s not helpful when your loved ones are adversely impacted, of course.

I don't know how common overall among all opioid prescriptions, but among the addiction stories, it was common in my experience talking to people with addiction struggles. Granted, that's a small sample. And they also could be lying. But sharing what I'd heard myself.

@Tau837 is far more qualified to give objective data. But again, that provides little solace.

 

[Alex P Keaton]

Also, this may be a regional phenomenon in the US.

Look at this map. Why do prescribing practices vary so much from state to state? Do southerners experience more pain than their counterparts in other parts of the country? Are more people suffering in the states with lower opioid use?

How do we determine the optimal balance?

What’s your hypothesis on why prescribing practices vary so much from state to state?

Probably regulatory differences, at least in part, as I doubt the overall experience of pain is different in Tennessee, versus Hawai’i, or Japan, for that matter.

ETA Thinking about it further, there surely are biologic/genetic differences in pain perception, which probably extend across cultures. Yet another challenge in determining the need for analgesia.

Probably some biological/genetic differences, sure.

My preliminary guess is like yours. Regulatory is a simple but likely contributor.

 

[Harry Frogfish]

How do we determine the optimal balance?

It's a difficult question.

I think one step would be changing the mindset that you say you see among physicians who are not concerned about short-term opioid use for acute pain, including in the post-operative settings. That feels like a start.

It seems to me another thing we can do is reduce the situations you said you found yourself in with opioids prescribed you didn't ask for and didn't need.

To be clear, I’m certain most physicians think about the consequences of opioid prescriptions, including side effects, and the potential for abuse/addiction.

And I believe most physicians aren’t caught up in “opioid hysteria”.

But what is the alternative to preemptively prescribing them in the post-op setting? Wait and see if pain is uncontrolled?

How does that strategy ameliorate Tau’s concerns?

Agree. The problem with "waiting to see" in the case where the patient has uncontrolled pain is that the patient would have to be able to report the pain resulting in a prescription being sent to the pharmacy without requiring another in person vist, or it becomes burdensome for the patient, who is in pain and recovering from surgery in this scenario. Even then, how would the doctor know to prescribe 2 days' worth vs. 7 days' worth to avoid the problem of overprescribing? There is no algorithm for this.

What is a somewhat "normal" daily dose you'd consider safe for your loved one or anyone with chronic pain? I know that question is impossible to know for sure but ballpark it, if you don't mind.

Or to put it differently, what would you consider too much daily?

 

[Joe Bryant]

But what is the alternative to preemptively prescribing them in the post-op setting? Wait and see if pain is uncontrolled?

How does that strategy ameliorate Tau’s concerns?

I'm just an observer here. But I'd think one key part of the strategy in the case of your surgery would be asking the patient about their pain and trying to determine the right answer for solving the pain problem with as non serious a solution as possible.

Basically, whatever it takes to not have a patient be in the position you were in:

Despite requiring no perioperative pain meds, I was discharged with a week's worth of oxycodone. I didn't ask for them, and took none.

It’s not so straightforward, because:

1. Not everyone has the same pain threshold, or ideas about what constitutes adequate control
2. Pain can wax and wane
3. For same day surgery, residual anesthesia may dull pain for a while, extending beyond discharge
4. There is no universally accepted, objective measure of pain
5. It can be more difficult to prescribe controlled substances over the phone
6. A surgeon’s busy schedule can preclude prompt response for pain med requests after hospital discharge. Moreover, calls after hours are a red flag for drug-seeking behavior.

Considering all these factors, and the fact most unused opioids aren’t diverted/abused, many (most?) doctors err on the side of providing the medications, when a reasonable expectation of significant post-op pain exists.

I agree it's not easy or straightforward.

But I still think it's a good place to start with whatever it takes to not have a patient be in the position you were in:

Despite requiring no perioperative pain meds, I was discharged with a week's worth of oxycodone. I didn't ask for them, and took none.

And for physicians to be very concerned about short-term opioid use for acute pain.

In my brothers experience, it seemed pretty common for the addiction stories to start with, "I had a surgery..."

It happens, but isn’t common at all. That’s not helpful when your loved ones are adversely impacted, of course.

In contrast, I just ended up with three unused bottles of opioids. If stored and disposed of properly, no harm caused.

How would you say most opioid addictions start?

 

[JohnnyU]

How do we determine the optimal balance?

It's a difficult question.

I think one step would be changing the mindset that you say you see among physicians who are not concerned about short-term opioid use for acute pain, including in the post-operative settings. That feels like a start.

It seems to me another thing we can do is reduce the situations you said you found yourself in with opioids prescribed you didn't ask for and didn't need.

To be clear, I’m certain most physicians think about the consequences of opioid prescriptions, including side effects, and the potential for abuse/addiction.

And I believe most physicians aren’t caught up in “opioid hysteria”.

But what is the alternative to preemptively prescribing them in the post-op setting? Wait and see if pain is uncontrolled?

How does that strategy ameliorate Tau’s concerns?

Agree. The problem with "waiting to see" in the case where the patient has uncontrolled pain is that the patient would have to be able to report the pain resulting in a prescription being sent to the pharmacy without requiring another in person vist, or it becomes burdensome for the patient, who is in pain and recovering from surgery in this scenario. Even then, how would the doctor know to prescribe 2 days' worth vs. 7 days' worth to avoid the problem of overprescribing? There is no algorithm for this.

What is a somewhat "normal" daily dose you'd consider safe for your loved one or anyone with chronic pain? I know that question is impossible to know for sure but ballpark it, if you don't mind.

Or to put it differently, what would you consider too much daily?

I just had right hip replacement in May. While still at the hospital it seemed they were giving me Oxycodone frequently. After going home I was taking it every 4 hours for a few days, coupled with Tylenol and an anti inflammatory. Then every 6 hours for a couple of weeks, along with Tylenol and an anti inflammatory. Then after 2 to 3 weeks I stopped taking the Oxy, but kept taking the Tylenol and anti inflammatory (4 weeks total). After 5 weeks or so I only take Tylenol. I had my hip surgery at the Mayo Clinic.

 

[BLOCKED_PUNT]

But for someone who literally feels like they're dying trying to score their next Oxycontin hit, they don't care. And there are plenty of people who don't mind pocketing an extra $700 a month.

wasn't really questioning the morality of it, I just don't want @STEADYMOBBIN 22 to get in trouble at least not until I can blackmail him first

but honestly I wouldn't want him in trouble

 

[BLOCKED_PUNT]

or his friend rather

 

[Tau837]

How do we determine the optimal balance?

It's a difficult question.

I think one step would be changing the mindset that you say you see among physicians who are not concerned about short-term opioid use for acute pain, including in the post-operative settings. That feels like a start.

It seems to me another thing we can do is reduce the situations you said you found yourself in with opioids prescribed you didn't ask for and didn't need.

To be clear, I’m certain most physicians think about the consequences of opioid prescriptions, including side effects, and the potential for abuse/addiction.

And I believe most physicians aren’t caught up in “opioid hysteria”.

But what is the alternative to preemptively prescribing them in the post-op setting? Wait and see if pain is uncontrolled?

How does that strategy ameliorate Tau’s concerns?

Agree. The problem with "waiting to see" in the case where the patient has uncontrolled pain is that the patient would have to be able to report the pain resulting in a prescription being sent to the pharmacy without requiring another in person vist, or it becomes burdensome for the patient, who is in pain and recovering from surgery in this scenario. Even then, how would the doctor know to prescribe 2 days' worth vs. 7 days' worth to avoid the problem of overprescribing? There is no algorithm for this.

What is a somewhat "normal" daily dose you'd consider safe for your loved one or anyone with chronic pain? I know that question is impossible to know for sure but ballpark it, if you don't mind.

Or to put it differently, what would you consider too much daily?

Every person's body is different. Every person's medical conditions are different. Every person's life conditions are different (e.g., support at home, economic status, mental health, alcohol use, etc.). Every person's pain levels and pain tolerance are different. There are many choices of opioid medications to use individually or in combination, each of which has different pros and cons. There are many different delivery mechanisms (e.g., tablet, sublinguial, IM, IV).

There is no universal answer. That is one of the significant issues with the CDC guidelines, which attempted to identify 90 Morphine Milligram Equivalents (MME) as a standard threshold. That might be fine for many patients/situations, but it definitely isn't for all patients/situations.

You ask what is safe. My wife has been taking more than 90 MME/day since 1998. At times, she has been on more than 2000 MME/day, but for most of that period she was likely on 800-1000. She weighs about 90 pounds. We have had medical professionals say many times they wouldn't have believed that she would be able to function normally at the dosages she has been on if they hadn't seen it firsthand.

She is certainly an extreme outlier, but she also proves the point.

 

[Tau837]

But what is the alternative to preemptively prescribing them in the post-op setting? Wait and see if pain is uncontrolled?

How does that strategy ameliorate Tau’s concerns?

I'm just an observer here. But I'd think one key part of the strategy in the case of your surgery would be asking the patient about their pain and trying to determine the right answer for solving the pain problem with as non serious a solution as possible.

Basically, whatever it takes to not have a patient be in the position you were in:

Despite requiring no perioperative pain meds, I was discharged with a week's worth of oxycodone. I didn't ask for them, and took none.

It’s not so straightforward, because:

1. Not everyone has the same pain threshold, or ideas about what constitutes adequate control
2. Pain can wax and wane
3. For same day surgery, residual anesthesia may dull pain for a while, extending beyond discharge
4. There is no universally accepted, objective measure of pain
5. It can be more difficult to prescribe controlled substances over the phone
6. A surgeon’s busy schedule can preclude prompt response for pain med requests after hospital discharge. Moreover, calls after hours are a red flag for drug-seeking behavior.

Considering all these factors, and the fact most unused opioids aren’t diverted/abused, many (most?) doctors err on the side of providing the medications, when a reasonable expectation of significant post-op pain exists.

I agree it's not easy or straightforward.

But I still think it's a good place to start with whatever it takes to not have a patient be in the position you were in:

Despite requiring no perioperative pain meds, I was discharged with a week's worth of oxycodone. I didn't ask for them, and took none.

And for physicians to be very concerned about short-term opioid use for acute pain.

In my brothers experience, it seemed pretty common for the addiction stories to start with, "I had a surgery..."

It happens, but isn’t common at all. That’s not helpful when your loved ones are adversely impacted, of course.

In contrast, I just ended up with three unused bottles of opioids. If stored and disposed of properly, no harm caused.

How would you say most opioid addictions start?

I expect the vast majority, by far, start with illegal opioid use.

 

[BassNBrew]

Bravo @Tau837 and @Terminalxylem

Reminds me of Frazier/Ali match. Excellent debate here and I'm learning a lot. Thanks.

 

[Terminalxylem]

But what is the alternative to preemptively prescribing them in the post-op setting? Wait and see if pain is uncontrolled?

How does that strategy ameliorate Tau’s concerns?

I'm just an observer here. But I'd think one key part of the strategy in the case of your surgery would be asking the patient about their pain and trying to determine the right answer for solving the pain problem with as non serious a solution as possible.

Basically, whatever it takes to not have a patient be in the position you were in:

Despite requiring no perioperative pain meds, I was discharged with a week's worth of oxycodone. I didn't ask for them, and took none.

It’s not so straightforward, because:

1. Not everyone has the same pain threshold, or ideas about what constitutes adequate control
2. Pain can wax and wane
3. For same day surgery, residual anesthesia may dull pain for a while, extending beyond discharge
4. There is no universally accepted, objective measure of pain
5. It can be more difficult to prescribe controlled substances over the phone
6. A surgeon’s busy schedule can preclude prompt response for pain med requests after hospital discharge. Moreover, calls after hours are a red flag for drug-seeking behavior.

Considering all these factors, and the fact most unused opioids aren’t diverted/abused, many (most?) doctors err on the side of providing the medications, when a reasonable expectation of significant post-op pain exists.

I agree it's not easy or straightforward.

But I still think it's a good place to start with whatever it takes to not have a patient be in the position you were in:

Despite requiring no perioperative pain meds, I was discharged with a week's worth of oxycodone. I didn't ask for them, and took none.

And for physicians to be very concerned about short-term opioid use for acute pain.

In my brothers experience, it seemed pretty common for the addiction stories to start with, "I had a surgery..."

It happens, but isn’t common at all. That’s not helpful when your loved ones are adversely impacted, of course.

In contrast, I just ended up with three unused bottles of opioids. If stored and disposed of properly, no harm caused.

How would you say most opioid addictions start?

I expect the vast majority, by far, start with illegal opioid use.

I think it typically start with diversion, from either a family member or friend. So technically illegal, but not from street dealers, at least initially.

Becoming addicted after treatment of acute pain is much less common, though both are reasons for prescribing judiciously.

ETA After a quick literature review, it’s not obvious to me how most opioid addiction starts.

 

[STEADYMOBBIN 22]

But for someone who literally feels like they're dying trying to score their next Oxycontin hit, they don't care. And there are plenty of people who don't mind pocketing an extra $700 a month.

wasn't really questioning the morality of it, I just don't want @STEADYMOBBIN 22 to get in trouble at least not until I can blackmail him first

but honestly I wouldn't want him in trouble

I think it’s awful and it’s obviously quite illegal. I’m not supportive of it.

Luckily pain killers were never my bag. Hate the feeling.

ETA - Nudes are in the mail

 

[Joe Bryant]

But what is the alternative to preemptively prescribing them in the post-op setting? Wait and see if pain is uncontrolled?

How does that strategy ameliorate Tau’s concerns?

I'm just an observer here. But I'd think one key part of the strategy in the case of your surgery would be asking the patient about their pain and trying to determine the right answer for solving the pain problem with as non serious a solution as possible.

Basically, whatever it takes to not have a patient be in the position you were in:

Despite requiring no perioperative pain meds, I was discharged with a week's worth of oxycodone. I didn't ask for them, and took none.

It’s not so straightforward, because:

1. Not everyone has the same pain threshold, or ideas about what constitutes adequate control
2. Pain can wax and wane
3. For same day surgery, residual anesthesia may dull pain for a while, extending beyond discharge
4. There is no universally accepted, objective measure of pain
5. It can be more difficult to prescribe controlled substances over the phone
6. A surgeon’s busy schedule can preclude prompt response for pain med requests after hospital discharge. Moreover, calls after hours are a red flag for drug-seeking behavior.

Considering all these factors, and the fact most unused opioids aren’t diverted/abused, many (most?) doctors err on the side of providing the medications, when a reasonable expectation of significant post-op pain exists.

I agree it's not easy or straightforward.

But I still think it's a good place to start with whatever it takes to not have a patient be in the position you were in:

Despite requiring no perioperative pain meds, I was discharged with a week's worth of oxycodone. I didn't ask for them, and took none.

And for physicians to be very concerned about short-term opioid use for acute pain.

In my brothers experience, it seemed pretty common for the addiction stories to start with, "I had a surgery..."

It happens, but isn’t common at all. That’s not helpful when your loved ones are adversely impacted, of course.

In contrast, I just ended up with three unused bottles of opioids. If stored and disposed of properly, no harm caused.

How would you say most opioid addictions start?

I expect the vast majority, by far, start with illegal opioid use.

Thanks. Why do you think that?

 

[fatness]

How would you say most opioid addictions start?

Illegal use. Stealing them from friends, family. Buying them on the street. Burglary.

This is based on 30 years of experience with an addict son whose addiction has wrecked 2 families and has badly damaged another.

 

[JohnnyU]

How would you say most opioid addictions start?

Illegal use. Stealing them from friends, family. Buying them on the street. Burglary.

This is based on 30 years of experience with an addict son whose addiction has wrecked 2 families and has badly damaged another.

My half brother spent 5 years in prison for holding up a pharmacy for Oxycontin. He wasn't a criminal before then and hasn't been one since being released. Also, a long time acquaintence died from an overdose of Oxy. I believe they said she was drinking also, but she basically drowned in her own puke.. So Oxycontin has affected a lot of folks negatively.

 

[Terminalxylem]

But what is the alternative to preemptively prescribing them in the post-op setting? Wait and see if pain is uncontrolled?

How does that strategy ameliorate Tau’s concerns?

I'm just an observer here. But I'd think one key part of the strategy in the case of your surgery would be asking the patient about their pain and trying to determine the right answer for solving the pain problem with as non serious a solution as possible.

Basically, whatever it takes to not have a patient be in the position you were in:

Despite requiring no perioperative pain meds, I was discharged with a week's worth of oxycodone. I didn't ask for them, and took none.

It’s not so straightforward, because:

1. Not everyone has the same pain threshold, or ideas about what constitutes adequate control
2. Pain can wax and wane
3. For same day surgery, residual anesthesia may dull pain for a while, extending beyond discharge
4. There is no universally accepted, objective measure of pain
5. It can be more difficult to prescribe controlled substances over the phone
6. A surgeon’s busy schedule can preclude prompt response for pain med requests after hospital discharge. Moreover, calls after hours are a red flag for drug-seeking behavior.

Considering all these factors, and the fact most unused opioids aren’t diverted/abused, many (most?) doctors err on the side of providing the medications, when a reasonable expectation of significant post-op pain exists.

I agree it's not easy or straightforward.

But I still think it's a good place to start with whatever it takes to not have a patient be in the position you were in:

Despite requiring no perioperative pain meds, I was discharged with a week's worth of oxycodone. I didn't ask for them, and took none.

And for physicians to be very concerned about short-term opioid use for acute pain.

In my brothers experience, it seemed pretty common for the addiction stories to start with, "I had a surgery..."

It happens, but isn’t common at all. That’s not helpful when your loved ones are adversely impacted, of course.

In contrast, I just ended up with three unused bottles of opioids. If stored and disposed of properly, no harm caused.

How would you say most opioid addictions start?

I expect the vast majority, by far, start with illegal opioid use.

Thanks. Why do you think that?

I’ve reviewed data on rates of addiction after receiving opioids for acute pain. It ranges from <1 to 6%. Since most courses are short, it seems unlikely this is the primary path to addiction.

I’ve also have seen a study which shows ~60% people prescribed short term opioids don’t use all their pills, and they tend not to store or dispose of them properly. As I mentioned, my personal experience aligns well with this.

For those inclined to substance abuse, the path of least resistance seems obvious: take the leftovers of a family member, friend, or acquaintance. Alternatively, accept pills from a friend who acquired them in this manner, while “partying”. Both scenarios seem far more likely than spontaneously seeking out a street dealer, or stealing from a stranger.

I mean, opioid abuse and addiction, at least when it culminates in heroin abuse, is a young person’s disease. As teens and young adults are less likely to require health care, it follows they’re less likely to have their own opioid prescriptions.

All that said, I do think there’s another set of patients at high risk for developing opioid dependence, and potentially addiction: those with chronic pain. But severe, chronic pain needs to be addressed, and opioids are our strongest analgesics. So, balancing the risk:benefit is difficult.

 

[JohnnyU]

But what is the alternative to preemptively prescribing them in the post-op setting? Wait and see if pain is uncontrolled?

How does that strategy ameliorate Tau’s concerns?

I'm just an observer here. But I'd think one key part of the strategy in the case of your surgery would be asking the patient about their pain and trying to determine the right answer for solving the pain problem with as non serious a solution as possible.

Basically, whatever it takes to not have a patient be in the position you were in:

Despite requiring no perioperative pain meds, I was discharged with a week's worth of oxycodone. I didn't ask for them, and took none.

It’s not so straightforward, because:

1. Not everyone has the same pain threshold, or ideas about what constitutes adequate control
2. Pain can wax and wane
3. For same day surgery, residual anesthesia may dull pain for a while, extending beyond discharge
4. There is no universally accepted, objective measure of pain
5. It can be more difficult to prescribe controlled substances over the phone
6. A surgeon’s busy schedule can preclude prompt response for pain med requests after hospital discharge. Moreover, calls after hours are a red flag for drug-seeking behavior.

Considering all these factors, and the fact most unused opioids aren’t diverted/abused, many (most?) doctors err on the side of providing the medications, when a reasonable expectation of significant post-op pain exists.

I agree it's not easy or straightforward.

But I still think it's a good place to start with whatever it takes to not have a patient be in the position you were in:

Despite requiring no perioperative pain meds, I was discharged with a week's worth of oxycodone. I didn't ask for them, and took none.

And for physicians to be very concerned about short-term opioid use for acute pain.

In my brothers experience, it seemed pretty common for the addiction stories to start with, "I had a surgery..."

It happens, but isn’t common at all. That’s not helpful when your loved ones are adversely impacted, of course.

In contrast, I just ended up with three unused bottles of opioids. If stored and disposed of properly, no harm caused.

How would you say most opioid addictions start?

I expect the vast majority, by far, start with illegal opioid use.

Thanks. Why do you think that?

I’ve reviewed data on rates of addiction after receiving opioids for acute pain. It ranges from <1 to 6%. Since most courses are short, it seems unlikely this is the primary path to addiction.

I’ve also have seen a study which shows ~60% people prescribed short term opioids don’t use all their pills, and they tend not to store or dispose of them properly. As I mentioned, my personal experience aligns well with this.

For those inclined to substance abuse, the path of least resistance seems obvious: take the leftovers of a family member, friend, or acquaintance. Alternatively, accept pills from a friend who acquired them in this manner, while “partying”. Both scenarios seem far more likely than spontaneously seeking out a street dealer, or stealing from a stranger.

I mean, opioid abuse and addiction, at least when it culminates in heroin abuse, is a young person’s disease. As teens and young adults are less likely to require health care, it follows they’re less likely to have their own opioid prescriptions.

All that said, I do think there’s another set of patients at high risk for developing opioid dependence, and potentially addiction: those with chronic pain. But severe, chronic pain needs to be addressed, and opioids are our strongest analgesics. So, balancing the risk:benefit is difficult.

In my post above about my half brother and a friend, both happened in Kentucky years ago. I know that a lot of the Oxy addiction epidemic seemed to originate from there, but I could be wrong. In both cases it was a result of recreational use, not starting them because of an injury, then become addicted.

 

[Joe Bryant]

AI answer to "How do most opioid addictions begin?"

Most opioid addictions begin with a legitimate prescription for pain—often after surgery, an injury, or dental work. Here’s a quick breakdown of the most common pathways:

1. Prescription Painkillers​

• A doctor prescribes opioids like OxyContin, Vicodin, or Percocet for acute or chronic pain.
• The patient takes them as directed but develops a tolerance, needing more to feel the same relief.
• Over time, this can lead to dependence—and when the prescription runs out, some turn to illicit opioids like heroin or fentanyl.

2. Leftover Pills or Sharing​

• Some people start by using leftover medication from a friend or family member—not realizing the risk.
• This is especially common among teens and young adults experimenting or self-medicating.

 

[Joe Bryant]

From the American Psychiatric Association. https://www.psychiatry.org/patients-families/opioid-use-disorder

A  study showed that roughly 3–12% of people treated long term with prescription opioids for pain develop addiction or abuse issues

 

[Terminalxylem]

AI answer to "How do most opioid addictions begin?"

Most opioid addictions begin with a legitimate prescription for pain—often after surgery, an injury, or dental work. Here’s a quick breakdown of the most common pathways:

1. Prescription Painkillers​

• A doctor prescribes opioids like OxyContin, Vicodin, or Percocet for acute or chronic pain.
• The patient takes them as directed but develops a tolerance, needing more to feel the same relief.
• Over time, this can lead to dependence—and when the prescription runs out, some turn to illicit opioids like heroin or fentanyl.

2. Leftover Pills or Sharing​

• Some people start by using leftover medication from a friend or family member—not realizing the risk.
• This is especially common among teens and young adults experimenting or self-medicating.

Right. The prescriptions are legitimate, but I believe #2 is far more likely than #1.

 

[STEADYMOBBIN 22]

How would you say most opioid addictions start?

Illegal use. Stealing them from friends, family. Buying them on the street. Burglary.

This is based on 30 years of experience with an addict son whose addiction has wrecked 2 families and has badly damaged another.

:hug:

 

[Alex P Keaton]

AI answer to "How do most opioid addictions begin?"

Most opioid addictions begin with a legitimate prescription for pain—often after surgery, an injury, or dental work. Here’s a quick breakdown of the most common pathways:

1. Prescription Painkillers​

• A doctor prescribes opioids like OxyContin, Vicodin, or Percocet for acute or chronic pain.
• The patient takes them as directed but develops a tolerance, needing more to feel the same relief.
• Over time, this can lead to dependence—and when the prescription runs out, some turn to illicit opioids like heroin or fentanyl.

2. Leftover Pills or Sharing​

• Some people start by using leftover medication from a friend or family member—not realizing the risk.
• This is especially common among teens and young adults experimenting or self-medicating.

Right. The prescriptions are legitimate, but I believe #2 is far more likely than #1.

I believe #1 is more likely. See, that was easy.

 

[Terminalxylem]

AI answer to "How do most opioid addictions begin?"

Most opioid addictions begin with a legitimate prescription for pain—often after surgery, an injury, or dental work. Here’s a quick breakdown of the most common pathways:

1. Prescription Painkillers​

• A doctor prescribes opioids like OxyContin, Vicodin, or Percocet for acute or chronic pain.
• The patient takes them as directed but develops a tolerance, needing more to feel the same relief.
• Over time, this can lead to dependence—and when the prescription runs out, some turn to illicit opioids like heroin or fentanyl.

2. Leftover Pills or Sharing​

• Some people start by using leftover medication from a friend or family member—not realizing the risk.
• This is especially common among teens and young adults experimenting or self-medicating.

Right. The prescriptions are legitimate, but I believe #2 is far more likely than #1.

I believe #1 is more likely. See, that was easy.

Why?

ETA I think it’s important, because patients sometimes harm themselves by refusing opioids, due to (unjustified) fear of addiction. Meanwhile, their pain is uncontrolled, and recovery is slowed.

Fentanyl is the drug that seems most likely to elicit this response, despite often being the best choice for severe pain.

 

[Terminalxylem]

AI answer to "How do most opioid addictions begin?"

Most opioid addictions begin with a legitimate prescription for pain—often after surgery, an injury, or dental work. Here’s a quick breakdown of the most common pathways:

1. Prescription Painkillers​

• A doctor prescribes opioids like OxyContin, Vicodin, or Percocet for acute or chronic pain.
• The patient takes them as directed but develops a tolerance, needing more to feel the same relief.
• Over time, this can lead to dependence—and when the prescription runs out, some turn to illicit opioids like heroin or fentanyl.

2. Leftover Pills or Sharing​

• Some people start by using leftover medication from a friend or family member—not realizing the risk.
• This is especially common among teens and young adults experimenting or self-medicating.

Right. The prescriptions are legitimate, but I believe #2 is far more likely than #1.

I believe #1 is more likely. See, that was easy.

To be fair, I’m biased, as the thought of taking recreational opioids holds no appeal.

Like alcohol, the few times I’ve had them, there’s been absolutely no euphoric “high”. Just analgesia, and sleepiness.

Purely from a physiologic perspective, short-course opioids pose near zero chance of promoting addiction in someone like me. OTOH, if you possesses addictive brain biochemistry, YMMV (though the absolute numeric risk is still in the single digits).

 

[JohnnyU]

AI answer to "How do most opioid addictions begin?"

Most opioid addictions begin with a legitimate prescription for pain—often after surgery, an injury, or dental work. Here’s a quick breakdown of the most common pathways:

1. Prescription Painkillers​

• A doctor prescribes opioids like OxyContin, Vicodin, or Percocet for acute or chronic pain.
• The patient takes them as directed but develops a tolerance, needing more to feel the same relief.
• Over time, this can lead to dependence—and when the prescription runs out, some turn to illicit opioids like heroin or fentanyl.

2. Leftover Pills or Sharing​

• Some people start by using leftover medication from a friend or family member—not realizing the risk.
• This is especially common among teens and young adults experimenting or self-medicating.

Right. The prescriptions are legitimate, but I believe #2 is far more likely than #1.

I believe #1 is more likely. See, that was easy.

To be fair, I’m biased, as the thought of taking recreational opioids holds no appeal.

Like alcohol, the few times I’ve had them, there’s been absolutely no euphoric “high”. Just analgesia, and sleepiness.

Purely from a physiologic perspective, short-course opioids pose near zero chance of promoting addiction in someone like me. OTOH, if you possesses addictive brain biochemistry, YMMV (though the absolute numeric risk is still in the single digits).

Me neither. I was glad to quit taking them after hip surgery. For the life of me I don’t see the attraction, but it got my brother in trouble and killed a friend.

 

[Tau837]

But what is the alternative to preemptively prescribing them in the post-op setting? Wait and see if pain is uncontrolled?

How does that strategy ameliorate Tau’s concerns?

I'm just an observer here. But I'd think one key part of the strategy in the case of your surgery would be asking the patient about their pain and trying to determine the right answer for solving the pain problem with as non serious a solution as possible.

Basically, whatever it takes to not have a patient be in the position you were in:

Despite requiring no perioperative pain meds, I was discharged with a week's worth of oxycodone. I didn't ask for them, and took none.

It’s not so straightforward, because:

1. Not everyone has the same pain threshold, or ideas about what constitutes adequate control
2. Pain can wax and wane
3. For same day surgery, residual anesthesia may dull pain for a while, extending beyond discharge
4. There is no universally accepted, objective measure of pain
5. It can be more difficult to prescribe controlled substances over the phone
6. A surgeon’s busy schedule can preclude prompt response for pain med requests after hospital discharge. Moreover, calls after hours are a red flag for drug-seeking behavior.

Considering all these factors, and the fact most unused opioids aren’t diverted/abused, many (most?) doctors err on the side of providing the medications, when a reasonable expectation of significant post-op pain exists.

I agree it's not easy or straightforward.

But I still think it's a good place to start with whatever it takes to not have a patient be in the position you were in:

Despite requiring no perioperative pain meds, I was discharged with a week's worth of oxycodone. I didn't ask for them, and took none.

And for physicians to be very concerned about short-term opioid use for acute pain.

In my brothers experience, it seemed pretty common for the addiction stories to start with, "I had a surgery..."

It happens, but isn’t common at all. That’s not helpful when your loved ones are adversely impacted, of course.

In contrast, I just ended up with three unused bottles of opioids. If stored and disposed of properly, no harm caused.

How would you say most opioid addictions start?

I expect the vast majority, by far, start with illegal opioid use.

Thanks. Why do you think that?

It has largely been covered by others. Illegal opioid use includes diversion. So people who use prescription opioids not prescribed to them fit my definition, as do all those who first try illegal opioids.

Addiction rates are generally believed to be low from opioid use. That is another reason I believe that most start from illegal use.

As far as I know, the answer to your question of "how do most opioid addictions start" is not known. I am not aware of any studies or surveys that have credibly and thoroughly addressed it.

 

[Tau837]

From the American Psychiatric Association. https://www.psychiatry.org/patients-families/opioid-use-disorder

A  study showed that roughly 3–12% of people treated long term with prescription opioids for pain develop addiction or abuse issues

This is citing a 2008 study, so it is dated. It is also mischaracterizing the results of that study. From the actual study:

For the abuse/addiction grouping there were 24 studies with 2,507 CPPs exposed for a calculated abuse/addiction rate of 3.27%. Within this grouping for those studies that had preselected CPPs for COAT exposure for no previous or current history of abuse/addiction, the percentage of abuse/addiction was calculated at 0.19%.

 

[Joe Bryant]

From the American Psychiatric Association. https://www.psychiatry.org/patients-families/opioid-use-disorder

A  study showed that roughly 3–12% of people treated long term with prescription opioids for pain develop addiction or abuse issues

This is citing a 2008 study, so it is dated. It is also mischaracterizing the results of that study. From the actual study:

For the abuse/addiction grouping there were 24 studies with 2,507 CPPs exposed for a calculated abuse/addiction rate of 3.27%. Within this grouping for those studies that had preselected CPPs for COAT exposure for no previous or current history of abuse/addiction, the percentage of abuse/addiction was calculated at 0.19%.

Sure. There were lots of people feeling the effects on this in 2008. I'm not sure the drugs have changed significantly since then. Just the awareness of the addiction risks. For mischaracterizing, I'll just say I disagree. I understand you see it differently and you're welcome to have the last word on it.

 

[Tau837]

From the American Psychiatric Association. https://www.psychiatry.org/patients-families/opioid-use-disorder

A  study showed that roughly 3–12% of people treated long term with prescription opioids for pain develop addiction or abuse issues

This is citing a 2008 study, so it is dated. It is also mischaracterizing the results of that study. From the actual study:

For the abuse/addiction grouping there were 24 studies with 2,507 CPPs exposed for a calculated abuse/addiction rate of 3.27%. Within this grouping for those studies that had preselected CPPs for COAT exposure for no previous or current history of abuse/addiction, the percentage of abuse/addiction was calculated at 0.19%.

Sure. There were lots of people feeling the effects on this in 2008. I'm not sure the drugs have changed significantly since then. Just the awareness of the addiction risks. For mischaracterizing, I'll just say I disagree. I understand you see it differently and you're welcome to have the last word on it.

Fine, I will have the last word then. The article you quoted said 3-12% develop addictions or abuse issues. For purposes of our discussion here, that is quite different than saying 3% developed addictions and up to 11.5% developed abuse issues, which is what the study actually said. Words matter, so, yes, that is mischaracterizing. Being careless with words over such a serious issue is irresponsible at best.

 

[Terminalxylem]

But what is the alternative to preemptively prescribing them in the post-op setting? Wait and see if pain is uncontrolled?

How does that strategy ameliorate Tau’s concerns?

I'm just an observer here. But I'd think one key part of the strategy in the case of your surgery would be asking the patient about their pain and trying to determine the right answer for solving the pain problem with as non serious a solution as possible.

Basically, whatever it takes to not have a patient be in the position you were in:

Despite requiring no perioperative pain meds, I was discharged with a week's worth of oxycodone. I didn't ask for them, and took none.

It’s not so straightforward, because:

1. Not everyone has the same pain threshold, or ideas about what constitutes adequate control
2. Pain can wax and wane
3. For same day surgery, residual anesthesia may dull pain for a while, extending beyond discharge
4. There is no universally accepted, objective measure of pain
5. It can be more difficult to prescribe controlled substances over the phone
6. A surgeon’s busy schedule can preclude prompt response for pain med requests after hospital discharge. Moreover, calls after hours are a red flag for drug-seeking behavior.

Considering all these factors, and the fact most unused opioids aren’t diverted/abused, many (most?) doctors err on the side of providing the medications, when a reasonable expectation of significant post-op pain exists.

I agree it's not easy or straightforward.

But I still think it's a good place to start with whatever it takes to not have a patient be in the position you were in:

Despite requiring no perioperative pain meds, I was discharged with a week's worth of oxycodone. I didn't ask for them, and took none.

And for physicians to be very concerned about short-term opioid use for acute pain.

In my brothers experience, it seemed pretty common for the addiction stories to start with, "I had a surgery..."

It happens, but isn’t common at all. That’s not helpful when your loved ones are adversely impacted, of course.

In contrast, I just ended up with three unused bottles of opioids. If stored and disposed of properly, no harm caused.

How would you say most opioid addictions start?

I expect the vast majority, by far, start with illegal opioid use.

Thanks. Why do you think that?

It has largely been covered by others. Illegal opioid use includes diversion. So people who use prescription opioids not prescribed to them fit my definition, as do all those who first try illegal opioids.

Addiction rates are generally believed to be low from opioid use. That is another reason I believe that most start from illegal use.

As far as I know, the answer to your question of "how do most opioid addictions start" is not known. I am not aware of any studies or surveys that have credibly and thoroughly addressed it.

Yeah, it’s a tough question to answer with actual data. But with the information available, addiction developing in an opioid naive individual being treated for acute pain seems unlikely.

I think the misguided concern of short-course opioids creating addicts is far more prevalent amongst laypeople than physicians, however.

During the heyday of inappropriate OxyContin prescribing, different story, related to the pharmacodynamics of the drug, and dosing employed.This was compounded (pun unintended) by aggressive marketing, distribution and prescribing, by a handful of bad apples.

 

[Alex P Keaton]

AI answer to "How do most opioid addictions begin?"

Most opioid addictions begin with a legitimate prescription for pain—often after surgery, an injury, or dental work. Here’s a quick breakdown of the most common pathways:

1. Prescription Painkillers​

• A doctor prescribes opioids like OxyContin, Vicodin, or Percocet for acute or chronic pain.
• The patient takes them as directed but develops a tolerance, needing more to feel the same relief.
• Over time, this can lead to dependence—and when the prescription runs out, some turn to illicit opioids like heroin or fentanyl.

2. Leftover Pills or Sharing​

• Some people start by using leftover medication from a friend or family member—not realizing the risk.
• This is especially common among teens and young adults experimenting or self-medicating.

Right. The prescriptions are legitimate, but I believe #2 is far more likely than #1.

I believe #1 is more likely. See, that was easy.

Why?

ETA I think it’s important, because patients sometimes harm themselves by refusing opioids, due to (unjustified) fear of addiction. Meanwhile, their pain is uncontrolled, and recovery is slowed.

Fentanyl is the drug that seems most likely to elicit this response, despite often being the best choice for severe pain.

Why? Well, we were cruising along as a society with a very small percentage of people abusing opioids. Then suddenly a cottage industry (fueled partially by advice from McKinsey, my former employer) sprung up peddling pain pills to be people. It was a massive surge — and it has been fairly well documented by journalists over the years. Then there was a crackdown which massively limited pain pills availability, which pushed people to fentanyl et al. The magnitude of this impact was enough to shift the overall mortality curve of the US for a portion of the population. Does everyone realize how massive something had to be to move a mortality curve???

I saw it first-hand with friends and distant family in rural Wisconsin. Also have seen it up close in AA circles, people who were pillheads turned fentanyl or heroin users. Most of them had the same story…….had surgery, got hooked on pain meds, switched to whatever other drug they could find for cheap.

Now, are these people pre-disposed to addiction? Almost certainly. Would they have become fentanyl addicts without first taking pain pills? No idea. No way to know for sure.

But the combo of quantitative and qualitative evidence is highly suggestive of a pattern.

 

[Alex P Keaton]

But what is the alternative to preemptively prescribing them in the post-op setting? Wait and see if pain is uncontrolled?

How does that strategy ameliorate Tau’s concerns?

I'm just an observer here. But I'd think one key part of the strategy in the case of your surgery would be asking the patient about their pain and trying to determine the right answer for solving the pain problem with as non serious a solution as possible.

Basically, whatever it takes to not have a patient be in the position you were in:

Despite requiring no perioperative pain meds, I was discharged with a week's worth of oxycodone. I didn't ask for them, and took none.

It’s not so straightforward, because:

1. Not everyone has the same pain threshold, or ideas about what constitutes adequate control
2. Pain can wax and wane
3. For same day surgery, residual anesthesia may dull pain for a while, extending beyond discharge
4. There is no universally accepted, objective measure of pain
5. It can be more difficult to prescribe controlled substances over the phone
6. A surgeon’s busy schedule can preclude prompt response for pain med requests after hospital discharge. Moreover, calls after hours are a red flag for drug-seeking behavior.

Considering all these factors, and the fact most unused opioids aren’t diverted/abused, many (most?) doctors err on the side of providing the medications, when a reasonable expectation of significant post-op pain exists.

I agree it's not easy or straightforward.

But I still think it's a good place to start with whatever it takes to not have a patient be in the position you were in:

Despite requiring no perioperative pain meds, I was discharged with a week's worth of oxycodone. I didn't ask for them, and took none.

And for physicians to be very concerned about short-term opioid use for acute pain.

In my brothers experience, it seemed pretty common for the addiction stories to start with, "I had a surgery..."

It happens, but isn’t common at all. That’s not helpful when your loved ones are adversely impacted, of course.

In contrast, I just ended up with three unused bottles of opioids. If stored and disposed of properly, no harm caused.

How would you say most opioid addictions start?

I expect the vast majority, by far, start with illegal opioid use.

Thanks. Why do you think that?

It has largely been covered by others. Illegal opioid use includes diversion. So people who use prescription opioids not prescribed to them fit my definition, as do all those who first try illegal opioids.

Addiction rates are generally believed to be low from opioid use. That is another reason I believe that most start from illegal use.

As far as I know, the answer to your question of "how do most opioid addictions start" is not known. I am not aware of any studies or surveys that have credibly and thoroughly addressed it.

Yeah, it’s a tough question to answer with actual data. But with the information available, addiction developing in an opioid naive individual being treated for acute pain seems unlikely.

I think the misguided concern of short-course opioids creating addicts is far more prevalent amongst laypeople than physicians, however.

During the heyday of inappropriate OxyContin prescribing, different story, related to the pharmacodynamics of the drug, and dosing employed.This was compounded (pun unintended) by aggressive marketing, distribution and prescribing, by a handful of bad apples.

I agree with the above — today is very different than the Oxy heyday. But the damage has already been done, to a disturbing degree. Bad “actors” involved in that situation have a lot of blood on their hands. And there are hundreds of thousands of people (maybe more) still suffering the spillover effects of the immoral behavior of that era.

 

[Terminalxylem]

From the American Psychiatric Association. https://www.psychiatry.org/patients-families/opioid-use-disorder

A  study showed that roughly 3–12% of people treated long term with prescription opioids for pain develop addiction or abuse issues

This is citing a 2008 study, so it is dated. It is also mischaracterizing the results of that study. From the actual study:

For the abuse/addiction grouping there were 24 studies with 2,507 CPPs exposed for a calculated abuse/addiction rate of 3.27%. Within this grouping for those studies that had preselected CPPs for COAT exposure for no previous or current history of abuse/addiction, the percentage of abuse/addiction was calculated at 0.19%.

Sure. There were lots of people feeling the effects on this in 2008. I'm not sure the drugs have changed significantly since then. Just the awareness of the addiction risks. For mischaracterizing, I'll just say I disagree. I understand you see it differently and you're welcome to have the last word on it.

While opioids as a class haven’t changed, OxyContin’s role in treating pain has.

In general, oxycodone is more likely to create euphoria than morphine and some other prescription opioids, especially when inhaled or injected. OxyContin is longer acting than regular oxycodone, so the high lasts longer. On top of that, the pharma recommended dose strength and interval led to excess OxyContin prescriptions early in the opioid epidemic.

 

[JohnnyU]

From the American Psychiatric Association. https://www.psychiatry.org/patients-families/opioid-use-disorder

A  study showed that roughly 3–12% of people treated long term with prescription opioids for pain develop addiction or abuse issues

This is citing a 2008 study, so it is dated. It is also mischaracterizing the results of that study. From the actual study:

For the abuse/addiction grouping there were 24 studies with 2,507 CPPs exposed for a calculated abuse/addiction rate of 3.27%. Within this grouping for those studies that had preselected CPPs for COAT exposure for no previous or current history of abuse/addiction, the percentage of abuse/addiction was calculated at 0.19%.

Sure. There were lots of people feeling the effects on this in 2008. I'm not sure the drugs have changed significantly since then. Just the awareness of the addiction risks. For mischaracterizing, I'll just say I disagree. I understand you see it differently and you're welcome to have the last word on it.

While opioids as a class haven’t changed, OxyContin’s role in treating pain has.

In general, oxycodone is more likely to create euphoria than morphine and some other prescription opioids, especially when inhaled or injected. OxyContin is longer acting than regular oxycodone, so the high lasts longer. On top of that, the pharma recommended dose strength and interval led to excess OxyContin prescriptions early in the opioid epidemic.

Yes, whenever I've had surgery it's always oxycodone, not oxycontin.

 

[Terminalxylem]

AI answer to "How do most opioid addictions begin?"

Most opioid addictions begin with a legitimate prescription for pain—often after surgery, an injury, or dental work. Here’s a quick breakdown of the most common pathways:

1. Prescription Painkillers​

• A doctor prescribes opioids like OxyContin, Vicodin, or Percocet for acute or chronic pain.
• The patient takes them as directed but develops a tolerance, needing more to feel the same relief.
• Over time, this can lead to dependence—and when the prescription runs out, some turn to illicit opioids like heroin or fentanyl.

2. Leftover Pills or Sharing​

• Some people start by using leftover medication from a friend or family member—not realizing the risk.
• This is especially common among teens and young adults experimenting or self-medicating.

Right. The prescriptions are legitimate, but I believe #2 is far more likely than #1.

I believe #1 is more likely. See, that was easy.

Why?

ETA I think it’s important, because patients sometimes harm themselves by refusing opioids, due to (unjustified) fear of addiction. Meanwhile, their pain is uncontrolled, and recovery is slowed.

Fentanyl is the drug that seems most likely to elicit this response, despite often being the best choice for severe pain.

Why? Well, we were cruising along as a society with a very small percentage of people abusing opioids. Then suddenly a cottage industry (fueled partially by advice from McKinsey, my former employer) sprung up peddling pain pills to be people. It was a massive surge — and it has been fairly well documented by journalists over the years. Then there was a crackdown which massively limited pain pills availability, which pushed people to fentanyl et al. The magnitude of this impact was enough to shift the overall mortality curve of the US for a portion of the population. Does everyone realize how massive something had to be to move a mortality curve???

I saw it first-hand with friends and distant family in rural Wisconsin. Also have seen it up close in AA circles, people who were pillheads turned fentanyl or heroin users. Most of them had the same story…….had surgery, got hooked on pain meds, switched to whatever other drug they could find for cheap.

Now, are these people pre-disposed to addiction? Almost certainly. Would they have become fentanyl addicts without first taking pain pills? No idea. No way to know for sure.

But the combo of quantitative and qualitative evidence is highly suggestive of a pattern.

You are correct, during the peak OxyContin years (late 2000s). I discussed some of the issues specific to OxyContin in my other post.

Nowadays, OxyContin is prescribed far less commonly, and not for acute pain.

But all opioid prescriptions are down, so it’s hard to pin it all on OxyContin.

I think it’s too early to know where the level of addicts will settle, in response to changes in prescribing practices (and OxyContin, in particular). But I still contend using short-course opiates to treat acute severe pain will seldom create addicts.

It’s also a little disingenuous to attribute our overall mortality trends to the opioid epidemic. The “diseases of despair” contributing include drug overdose, for sure, in combination with suicide and alcoholic liver disease.

 

[Terminalxylem]

From the American Psychiatric Association. https://www.psychiatry.org/patients-families/opioid-use-disorder

A  study showed that roughly 3–12% of people treated long term with prescription opioids for pain develop addiction or abuse issues

This is citing a 2008 study, so it is dated. It is also mischaracterizing the results of that study. From the actual study:

For the abuse/addiction grouping there were 24 studies with 2,507 CPPs exposed for a calculated abuse/addiction rate of 3.27%. Within this grouping for those studies that had preselected CPPs for COAT exposure for no previous or current history of abuse/addiction, the percentage of abuse/addiction was calculated at 0.19%.

Sure. There were lots of people feeling the effects on this in 2008. I'm not sure the drugs have changed significantly since then. Just the awareness of the addiction risks. For mischaracterizing, I'll just say I disagree. I understand you see it differently and you're welcome to have the last word on it.

While opioids as a class haven’t changed, OxyContin’s role in treating pain has.

In general, oxycodone is more likely to create euphoria than morphine and some other prescription opioids, especially when inhaled or injected. OxyContin is longer acting than regular oxycodone, so the high lasts longer. On top of that, the pharma recommended dose strength and interval led to excess OxyContin prescriptions early in the opioid epidemic.

Yes, whenever I've had surgery it's always oxycodone, not oxycontin.

As it should be, though one could argue hydrocodone, with or without acetaminophen, is a better choice, due to lower addiction potential.

 

[JohnnyU]

From the American Psychiatric Association. https://www.psychiatry.org/patients-families/opioid-use-disorder

A  study showed that roughly 3–12% of people treated long term with prescription opioids for pain develop addiction or abuse issues

This is citing a 2008 study, so it is dated. It is also mischaracterizing the results of that study. From the actual study:

For the abuse/addiction grouping there were 24 studies with 2,507 CPPs exposed for a calculated abuse/addiction rate of 3.27%. Within this grouping for those studies that had preselected CPPs for COAT exposure for no previous or current history of abuse/addiction, the percentage of abuse/addiction was calculated at 0.19%.

Sure. There were lots of people feeling the effects on this in 2008. I'm not sure the drugs have changed significantly since then. Just the awareness of the addiction risks. For mischaracterizing, I'll just say I disagree. I understand you see it differently and you're welcome to have the last word on it.

While opioids as a class haven’t changed, OxyContin’s role in treating pain has.

In general, oxycodone is more likely to create euphoria than morphine and some other prescription opioids, especially when inhaled or injected. OxyContin is longer acting than regular oxycodone, so the high lasts longer. On top of that, the pharma recommended dose strength and interval led to excess OxyContin prescriptions early in the opioid epidemic.

Yes, whenever I've had surgery it's always oxycodone, not oxycontin.

As it should be, though one could argue hydrocodone, with or without acetaminophen, is a better choice, due to lower addiction potential.

I posted this earlier I believe, but I'll post it again here. My treatment for hip replacement was "While still at the hospital it seemed they were giving me Oxycodone frequently. After going home I was taking it every 4 hours for a few days, coupled with Tylenol and an anti inflammatory. Then every 6 hours for a couple of weeks, along with Tylenol and an anti inflammatory. Then after 2 to 3 weeks I stopped taking the Oxy, but kept taking the Tylenol and anti inflammatory (4 weeks total). After 5 weeks or so I only take Tylenol. I had my hip surgery at the Mayo Clinic.".

 

[General Malaise]

My dad was discharged from the hospital after 8 grueling days and without a spleen. The pharmacy at the hospital sent him home with Oxy. We get home and I tell him he had Oxy for pain as needed and says "put it up in the cabinet next to the other ones". This old coot is sitting on a heck ton of Oxy.

I am terrified of Oxy. For one, I do have addiction issues. But I know if I ever drive down this street, I'm never coming back alive. So they'll sit there, unused and then one day, I'll have to throw them out.

Now, were I the patient with a script and a green light to take them, I would. Even if pain were minimal. But they don't belong to me and in time, they'll belong to the trash.

 

[JohnnyU]

My dad was discharged from the hospital after 8 grueling days and without a spleen. The pharmacy at the hospital sent him home with Oxy. We get home and I tell him he had Oxy for pain as needed and says "put it up in the cabinet next to the other ones". This old coot is sitting on a heck ton of Oxy.

I am terrified of Oxy. For one, I do have addiction issues. But I know if I ever drive down this street, I'm never coming back alive. So they'll sit there, unused and then one day, I'll have to throw them out.

Now, were I the patient with a script and a green light to take them, I would. Even if pain were minimal. But they don't belong to me and in time, they'll belong to the trash.

They helped my pain, but was glad not to need them. I don’t see the attraction, other than helping with pain. I don’t like being drowsy in the middle of the day. Of course now it’s Oxycodone, not OxyContin, or at least it was for me. What is the attraction when not used for pain?

 

[Alex P Keaton]

AI answer to "How do most opioid addictions begin?"

Most opioid addictions begin with a legitimate prescription for pain—often after surgery, an injury, or dental work. Here’s a quick breakdown of the most common pathways:

1. Prescription Painkillers​

• A doctor prescribes opioids like OxyContin, Vicodin, or Percocet for acute or chronic pain.
• The patient takes them as directed but develops a tolerance, needing more to feel the same relief.
• Over time, this can lead to dependence—and when the prescription runs out, some turn to illicit opioids like heroin or fentanyl.

2. Leftover Pills or Sharing​

• Some people start by using leftover medication from a friend or family member—not realizing the risk.
• This is especially common among teens and young adults experimenting or self-medicating.

Right. The prescriptions are legitimate, but I believe #2 is far more likely than #1.

I believe #1 is more likely. See, that was easy.

Why?

ETA I think it’s important, because patients sometimes harm themselves by refusing opioids, due to (unjustified) fear of addiction. Meanwhile, their pain is uncontrolled, and recovery is slowed.

Fentanyl is the drug that seems most likely to elicit this response, despite often being the best choice for severe pain.

Why? Well, we were cruising along as a society with a very small percentage of people abusing opioids. Then suddenly a cottage industry (fueled partially by advice from McKinsey, my former employer) sprung up peddling pain pills to be people. It was a massive surge — and it has been fairly well documented by journalists over the years. Then there was a crackdown which massively limited pain pills availability, which pushed people to fentanyl et al. The magnitude of this impact was enough to shift the overall mortality curve of the US for a portion of the population. Does everyone realize how massive something had to be to move a mortality curve???

I saw it first-hand with friends and distant family in rural Wisconsin. Also have seen it up close in AA circles, people who were pillheads turned fentanyl or heroin users. Most of them had the same story…….had surgery, got hooked on pain meds, switched to whatever other drug they could find for cheap.

Now, are these people pre-disposed to addiction? Almost certainly. Would they have become fentanyl addicts without first taking pain pills? No idea. No way to know for sure.

But the combo of quantitative and qualitative evidence is highly suggestive of a pattern.

You are correct, during the peak OxyContin years (late 2000s). I discussed some of the issues specific to OxyContin in my other post.

Nowadays, OxyContin is prescribed far less commonly, and not for acute pain.

But all opioid prescriptions are down, so it’s hard to pin it all on OxyContin.

I think it’s too early to know where the level of addicts will settle, in response to changes in prescribing practices (and OxyContin, in particular). But I still contend using short-course opiates to treat acute severe pain will seldom create addicts.

It’s also a little disingenuous to attribute our overall mortality trends to the opioid epidemic. The “diseases of despair” contributing include drug overdose, for sure, in combination with suicide and alcoholic liver disease.

I understand your perspective on the multitude of factors impacting the mortality curve. For sure opioids are not the only cause — and candidly, no study will conclusively apportion responsibility by category or root cause. Again, it’s qualitative but the two things that changed significantly leading up to the mortality curve shift were opioid availability / prescriptions and massive disparity in wealth and income (which in and of itself had sub-causes, like the housing bubble, stock market bubble, loss of manufacturing jobs, etc). We’ve had sizeable recessions before. We’ve had income inequality before. This was different. More extreme. And it correlated strongly with the opioid epidemic.

But definitely agree that there were many contributing factors, and my view on this is at best a hypothesis with decent to solid supporting evidence. Far from a slam dunk though.

 

[Terminalxylem]

My dad was discharged from the hospital after 8 grueling days and without a spleen. The pharmacy at the hospital sent him home with Oxy. We get home and I tell him he had Oxy for pain as needed and says "put it up in the cabinet next to the other ones". This old coot is sitting on a heck ton of Oxy.

I am terrified of Oxy. For one, I do have addiction issues. But I know if I ever drive down this street, I'm never coming back alive. So they'll sit there, unused and then one day, I'll have to throw them out.

Now, were I the patient with a script and a green light to take them, I would. Even if pain were minimal. But they don't belong to me and in time, they'll belong to the trash.

They helped my pain, but was glad not to need them. I don’t see the attraction, other than helping with pain. I don’t like being drowsy in the middle of the day. Of course now it’s Oxycodone, not OxyContin, or at least it was for me. What is the attraction when not used for pain?

Some people experience a euphoric “high”, as in other substances of abuse.

Do you get a “buzz” with alcohol? I don’t, so it blows my mind how entrenched it is in society. Just makes me drowsy, and “medicine-headed”, like taking a Benadryl.

I assume people who like drinking experience it differently. Same with those who seek out opioids. For those in the know, are the “highs” different?

 

[Terminalxylem]

AI answer to "How do most opioid addictions begin?"

Most opioid addictions begin with a legitimate prescription for pain—often after surgery, an injury, or dental work. Here’s a quick breakdown of the most common pathways:

1. Prescription Painkillers​

• A doctor prescribes opioids like OxyContin, Vicodin, or Percocet for acute or chronic pain.
• The patient takes them as directed but develops a tolerance, needing more to feel the same relief.
• Over time, this can lead to dependence—and when the prescription runs out, some turn to illicit opioids like heroin or fentanyl.

2. Leftover Pills or Sharing​

• Some people start by using leftover medication from a friend or family member—not realizing the risk.
• This is especially common among teens and young adults experimenting or self-medicating.

Right. The prescriptions are legitimate, but I believe #2 is far more likely than #1.

I believe #1 is more likely. See, that was easy.

Why?

ETA I think it’s important, because patients sometimes harm themselves by refusing opioids, due to (unjustified) fear of addiction. Meanwhile, their pain is uncontrolled, and recovery is slowed.

Fentanyl is the drug that seems most likely to elicit this response, despite often being the best choice for severe pain.

Why? Well, we were cruising along as a society with a very small percentage of people abusing opioids. Then suddenly a cottage industry (fueled partially by advice from McKinsey, my former employer) sprung up peddling pain pills to be people. It was a massive surge — and it has been fairly well documented by journalists over the years. Then there was a crackdown which massively limited pain pills availability, which pushed people to fentanyl et al. The magnitude of this impact was enough to shift the overall mortality curve of the US for a portion of the population. Does everyone realize how massive something had to be to move a mortality curve???

I saw it first-hand with friends and distant family in rural Wisconsin. Also have seen it up close in AA circles, people who were pillheads turned fentanyl or heroin users. Most of them had the same story…….had surgery, got hooked on pain meds, switched to whatever other drug they could find for cheap.

Now, are these people pre-disposed to addiction? Almost certainly. Would they have become fentanyl addicts without first taking pain pills? No idea. No way to know for sure.

But the combo of quantitative and qualitative evidence is highly suggestive of a pattern.

You are correct, during the peak OxyContin years (late 2000s). I discussed some of the issues specific to OxyContin in my other post.

Nowadays, OxyContin is prescribed far less commonly, and not for acute pain.

But all opioid prescriptions are down, so it’s hard to pin it all on OxyContin.

I think it’s too early to know where the level of addicts will settle, in response to changes in prescribing practices (and OxyContin, in particular). But I still contend using short-course opiates to treat acute severe pain will seldom create addicts.

It’s also a little disingenuous to attribute our overall mortality trends to the opioid epidemic. The “diseases of despair” contributing include drug overdose, for sure, in combination with suicide and alcoholic liver disease.

I understand your perspective on the multitude of factors impacting the mortality curve. For sure opioids are not the only cause — and candidly, no study will conclusively apportion responsibility by category or root cause. Again, it’s qualitative but the two things that changed significantly leading up to the mortality curve shift were opioid availability / prescriptions and massive disparity in wealth and income (which in and of itself had sub-causes, like the housing bubble, stock market bubble, loss of manufacturing jobs, etc). We’ve had sizeable recessions before. We’ve had income inequality before. This was different. More extreme. And it correlated strongly with the opioid epidemic.

But definitely agree that there were many contributing factors, and my view on this is at best a hypothesis with decent to solid supporting evidence. Far from a slam dunk though.

Mood disorders and feelings of hopelessness also increased, for a multitude of reasons.

I think alcohol and opioids were outlets for the despair, and both (often in combination) contributed to the excess mortality.

 

[fatness]

As far as I know, the answer to your question of "how do most opioid addictions start" is not known. I am not aware of any studies or surveys that have credibly and thoroughly addressed it.

If studies like this are going to be done (and I'm hopeful they will), they'll need to start at the beginning of the chain of custody (for lack of a better term) and end at the end of it.
Pharmaceutical company
Company manufacturing for pharmaceutical company (they are sometimes different)*
Large scale distributor *
Smaller scale distributor*
Medical networks (Blue Cross, Medstar, etc)*
Individual medical offices*
Individual doctors*
Individual patients*

Those marked * above are ones with the potential for redirecting drugs to places they don't belong.
Then on the illegal side there are
Large-scale criminal drug networks
Smaller scale dealers
Individual dealers
Individual users
Those stealing directly from a family member, friend, person for whom they're a caregiver, etc.
Robbers (people actually do wait for someone to obtain drugs, then rob them)

That's a lot of potential hands handling opioids, and rather than pick 1 or several groups to study we're going to need to know how much each group contributes to misuse of opiods in the US. Because opioid misuse affects millions of people badly, not just the users. There's a lot of hell being paid by people who don't deserve it (families mostly).

 

[Tau837]

As far as I know, the answer to your question of "how do most opioid addictions start" is not known. I am not aware of any studies or surveys that have credibly and thoroughly addressed it.

If studies like this are going to be done (and I'm hopeful they will), they'll need to start at the beginning of the chain of custody (for lack of a better term) and end at the end of it.
Pharmaceutical company
Company manufacturing for pharmaceutical company (they are sometimes different)*
Large scale distributor *
Smaller scale distributor*
Medical networks (Blue Cross, Medstar, etc)*
Individual medical offices*
Individual doctors*
Individual patients*

Those marked * above are ones with the potential for redirecting drugs to places they don't belong.
Then on the illegal side there are
Large-scale criminal drug networks
Smaller scale dealers
Individual dealers
Individual users
Those stealing directly from a family member, friend, person for whom they're a caregiver, etc.
Robbers (people actually do wait for someone to obtain drugs, then rob them)

That's a lot of potential hands handling opioids, and rather than pick 1 or several groups to study we're going to need to know how much each group contributes to misuse of opiods in the US. Because opioid misuse affects millions of people badly, not just the users. There's a lot of hell being paid by people who don't deserve it (families mostly).

I appreciate the effort here, but the answer to Joe's question is much simpler: what percentage of those addicted to opioids started with legit prescription opioids (prescribed to them) vs. what percentage didn't? Like I said, AFAIK there is no definitive answer to that question.

 

[fatness]

I appreciate the effort here, but the answer to Joe's question is much simpler: what percentage of those addicted to opioids started with legit prescription opioids (prescribed to them) vs. what percentage didn't? Like I said, AFAIK there is no definitive answer to that question.

I was not taking issue with you, sorry if it read that way. If you wish, I'll edit my post to take out your quote.

My point is there are multiple levels of drug providers, handlers, and dealers to study to know how all these opioids get in the hands of people who abuse them.

 

[Terminalxylem]

From the American Psychiatric Association. https://www.psychiatry.org/patients-families/opioid-use-disorder

A  study showed that roughly 3–12% of people treated long term with prescription opioids for pain develop addiction or abuse issue.

For the abuse/addiction grouping there were 24 studies with 2,507 CPPs exposed for a calculated abuse/addiction rate of 3.27%. Within this grouping for those studies that had preselected CPPs for COAT exposure for no previous or current history of abuse/addiction, the percentage of abuse/addiction was calculated at 0.19%.

I think some people are most interested in their likelihood of developing addiction when they receive a new opioid prescription, in the absence of prior problems with substance abuse/addiction. In essence, the typical post-operative patient.

The APAs reference doesn't answer that question, as it looks at people with chronic pain, receiving opioids chronically. Nonetheless, it suggests the number for acute pain patients is low.

To restate the bolded: in studies of chronic pain patients on chronic opioids, in the absence of a history of abuse/addiction, a new addiction/abuse problem developed in 0.19%.

So, if only ~2 in 1000 chronic pain patients without pre-existing addiction/abuse developed new opioid addiction while taking the drugs chronically, we can probably surmise the percentage of acute pain patients taking short course opioids is even lower, agree?

 

[Tau837]

I appreciate the effort here, but the answer to Joe's question is much simpler: what percentage of those addicted to opioids started with legit prescription opioids (prescribed to them) vs. what percentage didn't? Like I said, AFAIK there is no definitive answer to that question.

I was not taking issue with you, sorry if it read that way. If you wish, I'll edit my post to take out your quote.

My point is there are multiple levels of drug providers, handlers, and dealers to study to know how all these opioids get in the hands of people who abuse them.

I didn't take offense. I just tied it back to Joe's question. If you did not mean to tie it back to that question, no problem.

 

[DA RAIDERS]

But what is the alternative to preemptively prescribing them in the post-op setting? Wait and see if pain is uncontrolled?

How does that strategy ameliorate Tau’s concerns?

I'm just an observer here. But I'd think one key part of the strategy in the case of your surgery would be asking the patient about their pain and trying to determine the right answer for solving the pain problem with as non serious a solution as possible.

Basically, whatever it takes to not have a patient be in the position you were in:

Despite requiring no perioperative pain meds, I was discharged with a week's worth of oxycodone. I didn't ask for them, and took none.

It’s not so straightforward, because:

1. Not everyone has the same pain threshold, or ideas about what constitutes adequate control
2. Pain can wax and wane
3. For same day surgery, residual anesthesia may dull pain for a while, extending beyond discharge
4. There is no universally accepted, objective measure of pain
5. It can be more difficult to prescribe controlled substances over the phone
6. A surgeon’s busy schedule can preclude prompt response for pain med requests after hospital discharge. Moreover, calls after hours are a red flag for drug-seeking behavior.

Considering all these factors, and the fact most unused opioids aren’t diverted/abused, many (most?) doctors err on the side of providing the medications, when a reasonable expectation of significant post-op pain exists.

ETA Add Tau’s point about post-op patients potentially having limited mobility, or other difficulties retrieving post-discharge meds.

This was me when I had my acl replacement. I had a nerve block and practically danced out of surgery. The nerve block lasted into the night. I woke up in agony. The mild opioids(I asked for mild ones) i was given didn’t work and could not get out in front of the pain. My surgery was on friday. Grit my way through Saturday and now I am calling the after hours line on Saturday night in agony looking for help. Haven’t slept in 2 nights. Dr tells me to go to the ER, he can’t help me over the phone. Grit my way through Sunday, because who wants to spend 8 hours in the ER? Finally talk with my Dr on Monday. He writes a better script. All avoidable if I get the correct script to begin with, and start taking them before the nerve block completely wore off.

Everyone’s different. That’s what makes the dosage amount difficult.

 

[Terminalxylem]

But what is the alternative to preemptively prescribing them in the post-op setting? Wait and see if pain is uncontrolled?

How does that strategy ameliorate Tau’s concerns?

I'm just an observer here. But I'd think one key part of the strategy in the case of your surgery would be asking the patient about their pain and trying to determine the right answer for solving the pain problem with as non serious a solution as possible.

Basically, whatever it takes to not have a patient be in the position you were in:

Despite requiring no perioperative pain meds, I was discharged with a week's worth of oxycodone. I didn't ask for them, and took none.

It’s not so straightforward, because:

1. Not everyone has the same pain threshold, or ideas about what constitutes adequate control
2. Pain can wax and wane
3. For same day surgery, residual anesthesia may dull pain for a while, extending beyond discharge
4. There is no universally accepted, objective measure of pain
5. It can be more difficult to prescribe controlled substances over the phone
6. A surgeon’s busy schedule can preclude prompt response for pain med requests after hospital discharge. Moreover, calls after hours are a red flag for drug-seeking behavior.

Considering all these factors, and the fact most unused opioids aren’t diverted/abused, many (most?) doctors err on the side of providing the medications, when a reasonable expectation of significant post-op pain exists.

ETA Add Tau’s point about post-op patients potentially having limited mobility, or other difficulties retrieving post-discharge meds.

This was me when I had my acl replacement. I had a nerve block and practically danced out of surgery. The nerve block lasted into the night. I woke up in agony. The mild opioids(I asked for mild ones) i was given didn’t work and could not get out in front of the pain. My surgery was on friday. Grit my way through Saturday and now I am calling the after hours line on Saturday night in agony looking for help. Haven’t slept in 2 nights. Dr tells me to go to the ER, he can’t help me over the phone. Grit my way through Sunday, because who wants to spend 8 hours in the ER? Finally talk with my Dr on Monday. He writes a better script. All avoidable if I get the correct script to begin with, and start taking them before the nerve block completely wore off.

Everyone’s different. That’s what makes the dosage amount difficult.

Yup. Weekend/after hours opioid requests are rarely going to be taken care of with a phone call. Nearly every covering doctor would suggest an ER visit in that situation, which is an entirely different type of pain.

So after a major surgery, even if the patient doesn’t require post-op meds, a few days of “just in case” opioids falls well within the benefit > risk zone imo.

Chronic low back pain flare? Different story, and a much more difficult decision.

 

[Joe Schmo]

Purely anecdotal but as a one time partier who sometimes strayed but never fully dove off the deep end, even I was surprised at the ease with which you could get oxy. If you wanted coke or ecstasy you could also get pills and there are a few people I knew from back in the day that really effed up their lives with all that mess. Oxy wasn't the only thing they did but it sure didn't help. And none of us had a prescription, just enough cash. Fentanyl is the devil, btw, truly the worst.