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Mr_Venom t1_j1m7qla wrote

Reply to comment by Reagalan in Machine learning model reliably predicts risk of opioid use disorder for individual patients, that could aid in prevention by marketrent

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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