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It has occured to me that while half the world is trying to stop people taking drugs (eg heroin or cocaine), the other half it trying to get people to take drugs (eg anti-retroviral medication for HIV must be taken consistently on a daily basis if it is going to work). By far the commonest reason (but
not the only reason) that people 'fail' HIV medication is that they don't take the tablets at the right times. So would there be an appropriate substance you could add to desirable drugs like anti-retrovirals such that people got withdrawal symptoms if they forgot to take them? It would have to be safe and not lead to high tolerance as people would then overdose on the anti-retrovirals but it would be like an in-built alarm clock telling a person when to take the meds and making them withdraw if they didn't. Obviously you would have to get informed consent from the patient and be able to supply the addictive substance alone should the anti-retrovirals need to be stopped but could it work????
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How would you do this, mix heroin in with the drug? |
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What was that old Hippocratic thing...? Oh, yeah: "First, do no harm." fishbone. |
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I suppose some drugs could be added to cigarettes. Tetracycline filters. Darvon longs. |
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First do no harm is a bit of a misnomer to be honest. If that was all you did you would never go to work or prescribe a drug. ALL treatments that work and many that don't cause harm ie side effects, it's a case of balancing risks and benefits. |
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I wasn't thinking of adding heroin. Something fairly safe but highly addictive like nicotiene would be OK except that people would quickly catch on that they could ease the cravings by smoking cigarettes, which would obviously be a really bad thing. I'm sure there are other candidate drugs. |
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I came in here with full intent to bone this idea to the fullest extent of the fish. I find myself scratching my head, though... in cases of transplant, one of the largest factors in failure / rejection / graft loss is non-compliance with the medication regimen. I have a neighbor who has lost two transplanted kidneys - and she's only 19. She just forgets to take her meds. |
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You'd want to do something that wouldn't create a desire to overdose, though. |
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This is a bit of a sledgehammer, surely. If
it's really that essential, and if the patient
is really that forgetful, then surely there's
an easier and more reliable way to remind
him? |
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This idea is terrible. Let me get this straight, you want to "hook" people on thier medications so they don't forget to take them??? Did you read over this at all before you posted it?
Assuming the majority of people remember to take thier medications, whether it be from development of a schedule or from self-preservation, you are proposing that we dope thier meds to keep the lazy/unorganized minority from killing themselves from an act of omission. Shall we fume the air with heroin so no one forgets to breathe? How many dehydration deaths could we avoid if we made water addictive? |
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My only regret is that I have but one bone to give. |
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//I have a neighbor who has lost two transplanted kidneys - and she's only 19.// To lose one kidney may be regarded as a misfortune... Did she look down the back of the sofa? |
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Interesting idea. Physical addiction is generally undesirable but if the alternative is worse it seems a rational trade-off. |
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Drugs which treat contagious diseases would be a good candidate for this idea since compliance benefits both the patient and the public (since the drugs can make a person less contagious, for example HIV drugs). |
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Addiction per se isn't necessarily harmful - it just
depends on what you're addicted to. Most of the
substances we get addicted to are harmful, but
they needn't be. The closest I can get to an
addiction which isn't harmful would be nicotine
(although, of course, the method by which it's
normally administered is indeed harmful). |
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Caffeine would be another one; there are no really
bad effects of reasonable amounts of caffeine.
<stands back; awaits objections>. |
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I like this idea because it does raise the question
of whether addiction has to be harmful, and of
whether we might use addiction as a powerful
tool. |
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What about simply connecting drug compliance with a small or large token reward (money, sex, food) and then re-enforcing that way, in that case both over consumption and under consumption are dealt with. Getting someone hooked on a drug that they need to take at the same level for a fixed amount of time is poorly thought out. |
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Also, MB, there are many behaviors that are quite addictive and which can actually be productive. Some people become habituated to their work, others become addicted to writing or editing. Addiction to exercise is relatively common. These things can easily take over your life, destroy your health and relationships, drain your bank account. We simply fail to make the connection between addiction and these behaviors because no substance is involved; they can be as deranging as any drug. |
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//What about simply connecting drug compliance with a small or large token reward (money, sex, food) and then re-enforcing that way, in that case both over consumption and under consumption are dealt with.// |
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That's already done. Well, money and/or food, anyway. |
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My memory of the report I saw on TV was that this greatly improved compliance with the dosing regimen for TB - which has quite a long and protracted regime of antibiotics, and a concurrent
problem with resistance.
The down-side is presumably that it's quite expensive - you don't just need the rewards, you also need someone's time to administer them. |
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Many courses of drugs can be really quite hard to manage even with the best will in the world - and that's not accounting for the tendency of people to just stop once they feel better.
What better way to remind someone than a desire to take the medicine at the appropriate time? |
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I was going to vote this idea up; it seems like a brilliantly good idea to me. But then I found that I already had. So my opinion seems to be pretty much diametrically opposed to MikeDs; Our excess buns and bones cancel each other out. |
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and now no disease to explain why he is drinking quarts of codine cough syrup. I agree, the logic seems more than a little flawish, yet in some cases we do cure one disease and cause another and the trade is acceptable. Off the top of my head I cannot think of a single case where this would have application. Maybe some sort of Chemo-Pot would make sense. |
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//Most smartphones allow multiple alarms to be set...// |
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Great. We just need to buy everyone a smartphone and ensure that they remember to carry it with them and remember to keep it charged, and the problem of them remembering things is solved!
Even if that made sense (it /does/ work for those who already have smartphones) - it still doesn't solve the issue with the subset who feel better and stop taking their medicine. |
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//Second, let's say the patient takes the medicine reliably for a year or two, and suddenly his illness is cured or sent into remission. The medicine is no longer needed, and he is directed to discontinue its use by his doctor, but the patient now has a powerful addiction to deal with.// |
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Addictions can be overcome. Since the doctor would have control of the supply, it should be fairly straightforward to wean people off, in fact.
Plus, of course, the simple fact that many drugs need to be taken for life. Immune suppressants for organ recipients, HIV retrovirals and so on. |
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