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Reagalan t1_j1m3hux wrote

"I'm sorry. Our ML assistant alerts us that, due to your pre-existing ADHD diagnosis, we cannot prescribe you Schedule II medications, as ADHD carries an elevated risk of developing substance use disorders."

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carlitospig t1_j1m71az wrote

Or ‘due to your socioeconomic background, you appear to be under elevated levels of stress and are therefore no longer qualified for this type of healthcare. Please pay for your parking on your way ou.’

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EvLokadottr t1_j1pbqpl wrote

"we see that you are a middle-aged female who has survived sexual abuse as a child. Your are at risk of aberrant behavior because of this, so you will have to take ibuprofen and bite a stick whilst the burns on 80% of your body heal."

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digitelle t1_j1mogcd wrote

Right after you had your wisdom teeth pulled.

Which to be honest was the absolute worst pain. It took a few days for it to even settle in but the sheer throbbing was unbearable.

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CaptainNoodleArm t1_j1n3mkp wrote

I handled my removal perfectly with Ibuprofen (even though the procedure was 2h long). First night I used a small dose of opoids just because my doctor prescribed me only 8 tablets with 200mg Ibuprofen (and I'm huge), after my friend upped the dose to 400 I was pain-free

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thebraddestbrad t1_j1obw7e wrote

Not all removals are the same. Mine was so intense I had to be put to sleep and I looked like a squirrel hoarding nuts in my cheeks for a week

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Mejai91 t1_j1qsycg wrote

Me too, still didn’t take the opioids they gave me because ibuprofen and Tylenol are of a similar efficacy when it comes to pain control, they just don’t get you high

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thebraddestbrad t1_j1r2cn5 wrote

Not true. Opioids are better at pain control than NSAIDs. There are other options besides otc NSAIDs and opioids, too, like ketolorac.

This also isn't about who can handle more pain without resorting to narcotics. If you didn't need anything but otc NSAIDs, don't assume it's because you're more tolerant of pain. You just weren't in as much pain.

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noiamholmstar t1_j1q3uh8 wrote

And I had 4 impacted wisdom teeth that required surgical removal, and I never took anything but ibuprofen. They prescribed opioids, but I never felt the need to take them. Everyone is different.

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delirium_red t1_j1pnbr7 wrote

And this is the only thing you get if you are not based in US. No one is giving you opioids prescription for teeth removal, and I know it’s extremely painful for weeks. Not so painful to risk addiction though

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CaptainNoodleArm t1_j1pnn32 wrote

Without Ibuprofen it was extremely painful and they were kinda stingy with that. I had to take em for 4 weeks, without them the pain was so nagging that I was sick and couldn't eat all day. But as you say in America you get opoids like candy

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Bruc3w4yn3 t1_j1q46lv wrote

I believe that the prescription ibuprofen is the same as the OTC, except it's more concentrated/higher dosage. Basically, OTC has 200mg and prescription strength has 800mg, so taking four tablets OTC is the equivalent of one tablet prescription. The prescription dose has all of the same digestive and kidney complications as taking more than the recommended OTC dosage, but it's generally considered better not to advise taking higher than advised dosages of easily accessible medications because I guess they fear that increases the likelihood of future abuse.

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CaptainNoodleArm t1_j1qakcv wrote

I know, but if I'm in pain it's not properly working, also Ibuprofen abuse happens but it's far less dangerous than opoids. Also my friend was/is a doctor.

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Mixedstereotype t1_j1pxwew wrote

I must be a mutant because I felt no pain after mine and I had 9 teeth removed in one setting.

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BrandynBlaze t1_j1nuqty wrote

To be fair they do that now without ML. I told my doctor I used marijuana in college because I thought it was important to be open with them and then 2 years later they denied me pain medication after an injury because of “substance abuse concerns.”

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james_d_rustles t1_j1oylby wrote

Lot of people have this issue, most people just know that you can’t actually be honest with your doctor anymore. I have friends who told their doctor that they smoked some pot in highschool, and at 28 they still won’t prescribe them pain meds after various surgeries, won’t prescribe them ADHD meds even with a diagnosis dating back decades and long history of similar prescriptions, etc.

Straight up, do not be honest with your doctor unless you genuinely need help with something. Don’t tell them if you smoked weed a few times, or drank more than 5 alcoholic beverages at a party that one time. It’ll only make your life a nightmare years down the line when you need medicine and can’t get any.

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linksgreyhair t1_j1p87iv wrote

Except: do be honest with your anesthesiologist because not disclosing drug use can cause horrible stuff, like you waking up during surgery.

This is probably obvious but I’m not talking about stuff like smoking weed a few times in college, but be honest about your amount of current drug and alcohol use and any history of very heavy use.

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james_d_rustles t1_j1pbd3m wrote

Of course. It’s really a shame that its set up like this, because you’re right, there are times that your doctor truly needs to know. But it’s a shame that it’s up to the patient’s best judgement about what should be disclosed or not, instead of simply being able to tell your doctor the truth all the time without fearing negative future consequences.

We really need a complete overhaul of the way we view drug use and drug addiction, it seems like the standards that the medical industry follows were written by 1930s mennonites. Nobody should have to worry about their ability to receive necessary medications 10 years down the line because they smoked some weed in college, or drank too much a handful of times. Past moderate drug/alcohol use should not bar a person from various prescription medications.

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Mejai91 t1_j1qsjhf wrote

Friendly reminder that adderall and oxy are not necessary medications

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delirium_red t1_j1pn6ta wrote

Opioids are prescribed routinely after surgery in the US, much more than actual indications require. I don’t think it is in the case in other western countries, they usually ween you off in the hospital and you get something like diclofenac (voltaren) for at home (unless chronic condition / end of life of course). So maybe ones denied are the lucky ones

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Mixedstereotype t1_j1pxrl6 wrote

I refused a tramadol injection because I didn't feel I needed it(resetting broken arm) but the doctor wouldn't relent until I said, "Family history of addiction." So now every time people check my things they look at me like I'm an addict.

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Mikey637 t1_j1nqxus wrote

I mean I get it, years ago I was spiralling with prescribed codeine use to numb both back pain and ADHD symptoms, now I refuse the prescription and use over the counter doses (half strength mixed with either ibuprofen or paracetamol, the fear of stomach lining/liver damage stops me over doing it).

Even without my back pain I’d struggle to not use less than once a week, they make me calm, collected and stop most of the weird “possibly more than the ADHD spectrum but further testing required” triggers and other behaviour.

Thankfully though I am in that queue for further testing so I can hopefully stop poly usage and live a more productive lifestyle. Life sober is difficult to the point I’d rather continue being poor with a substance problem even having spent plenty of time sober.

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whoamvv t1_j1ozdt1 wrote

Why in the hell were you using codeine to treat ADHD?

How did you get off the codeine? I mean, if you simply pulled yourself off it because you realized it was becoming an issue, I don't think that counts as substance abuse.

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Mikey637 t1_j1q3oxb wrote

It numbs the symptoms more than treats them. I pulled myself off as it was becoming a problem before it became a problem, I didn’t want to have to ruin the only thing that helps my back come out of spasm but even still it’s a constant effort to not overindulge.

Luckily one of my things is having control over myself so I’m constantly making sure I eat healthy food and don’t destroy my body with substances, so many others aren’t so lucky.

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whoamvv t1_j1q4vob wrote

Damn, I just want to say congrats. Sounds like you are a truly good person, and we definitely don't have enough of those these days.

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Ok_Dog_4059 t1_j1o82zg wrote

I have too many times where the doctors and I can't explain why something is happening and the doctors either used their best judgment or knew me long enough and well enough to trust what I was telling them. I can imagine AI just saying this shouldn't happen so leave when it is actually some fluke incident not even trained professionals can explain.

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whoamvv t1_j1p1vmv wrote

Yeah, here I was thinking it might actually help us because it would weed out the addicted and dealing NTs and allow those of us who actually need it to get it. But, now I realize that you are right and it's just another way to screw us.

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hippolover77 t1_j1o5st9 wrote

Except they will prescribe you stimulants. Took me years to realized I was dependent on adderall

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Mr_Venom t1_j1m7qla wrote

Take the model out of that example for a second. Not prescribing drugs to people because of contraindications is a good thing.

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Masark t1_j1mc338 wrote

Except the contraindication is the condition being treated.

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Mr_Venom t1_j1mcqcj wrote

Well, yes. There's lots of treatments that would technically solve a problem but cause too many problems to be viable.

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theoccasionalempath t1_j1mwx76 wrote

Every treatment has risk factors, so we're just supposed to let people suffer in pain, even though we have the solution?

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Mr_Venom t1_j1nea2a wrote

Someone could "cure" my depression with a lobotomy, or a handgun.

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FailOsprey t1_j1nf8s6 wrote

Unfortunately, opioids are not an effective long-term solution for pain. They feel good-and anyone on them long enough will sware by them-but most objective measures show they create more problems than they fix.

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Well_being1 t1_j1nq816 wrote

Tolerance creates to their effects, as to almost any other medication. That they feel good is not a problem

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FailOsprey t1_j1nty56 wrote

The euphoria isn't a problem per say, but it will bias the patient in favor of more opioids. Drugs that modify the dopamine system have a tendency to skew opinions in favor of continued use.

For susceptible individuals, these changes can be more or less permanent. The damage was done the minute they filled their first prescription; instead of withholding opioids from those who've already been exposed, it makes more sense to prevent exposure in the first place.

... without meaningful regulations, doctors use these properties to create patients for life. A patient on opioids is much better at scheduling appointments then one on ibuprofen. Given a lack of immediate consequences, even the most well-intentioned doctor is susceptible to large enough sums of cash.

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Devil_May_Kare t1_j1phwea wrote

If the level of opioid signaling in an opioid user's brain weren't higher than a non-user's, there'd be no driving force to maintain tolerance.

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Masterlyn t1_j1nicl4 wrote

So if an AI tool becomes advanced enough to reliably predict that prescribing a patient opioids will have a 100% chance of inflicting the patient with Substance Abuse Disorder, you believe the doctor should just go ahead and prescribe them the drugs?

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james_d_rustles t1_j1p044o wrote

Every patient is different, and that’s why we leave these decisions to doctors who know each patient’s specific situation. Sometimes potential substance use disorder is by far the lesser of 2 evils.

Say patient 1 has a 100% chance of developing substance abuse disorder. Patient 1 has also just been hit by a train. They’re on the verge of death, they’re peeing the hospital bed crying, asking for god to put them out of their misery because of the unthinkable amount of pain they’re in. There’s a real chance that they’ll die soon.

Patient 2 also has a 100% chance of developing substance use disorder. Patient 2 says that they have mild lower back pain after they get home from their office job. They have no other medical problems, and they live a normal, well adjusted life.

Using your reasoning, both patients should be denied painkillers. Do you think that is a sound medical decision?

Every case is different, and every medical decision carries various risks and trade offs. It’s between a patient and their doctor to decide which trade offs are worth it, which aren’t. You’d be crazy to say that the amount of harm done by a touch of back pain is greater than the amount of harm done by a long term opiate addiction, but what about patient 1, who was hit by a train? They may or may not live to see the next month - don’t you think that the trade off for that patient when looking at a potential opiate addiction would be a little bit different than the patient with slight back pain?

Every single medical decision is like that, to varying degrees. Some decisions are easier than others, and some carry with them much less risk of harm, but nothing is free of side effects or risks. Opiates are no different. Leave the doctors to make the decisions that they’ve been trained to make, looking at individual patients and circumstances.

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Devil_May_Kare t1_j1phr7v wrote

I think in cases like this, it should be up to the patient whether the risk is worth it for them.

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