Overdoses Propel Rise in Mortality Rates of Young Whites
mobile.nytimes.com
mobile.nytimes.com
> There is a reason that blacks appear to have been spared the worst of the narcotic epidemic, said Dr. Andrew Kolodny, a drug abuse expert. Studies have found that doctors are much more reluctant to prescribe painkillers to minority patients, worrying that they might sell them or become addicted.
If I read this correctly the doctors' pervasive racism is keeping young black men alive.
Some studies are intentionally deceptive, e.g. https://news.ycombinator.com/item?id=97299. I've pointed that one out a few times over the years, since it's such an excellent showcase of incentives gone wrong. The researcher ended up getting a lot of funding, partly thanks to the pretense of "rat brain flies plane." No one bothered to try to pull apart their paper.
It takes a lot of effort to do this. The only reason I spent hours reverse engineering that paper was because of how excited I was about the implications. Discovering that it was nothing more than a rube goldberg nearly shattered my faith in academia. Especially the realization that sometimes researchers have to do that sort of thing to get funding, or lose.
It's entirely possible that what you said is true. All I'm saying is, it's best to seek out the original paper. (If it's locked behind a paywall, post a request to /r/scholar and you'll usually get it in under an hour.) Sometimes the truth is quite different from appearances.
That's probably also a factor.
If a guy is rushed into the ER, you, as a doctor or nurse, don't have to believe anything. Just run the patient through the proper protocols, regardless of race, age or gender.
Otherwise what's the Hippocratic Oath all about?
But out in the real world after we step away from these screens, the futility of that demand becomes clear. You and I commit implicitly biased acts on a routine basis that we don't even notice.
Doctors don't under-treat black patients' pain because they explicitly dislike black people. They do so due to implicit bias. You cannot admonish people into shedding their implicit biases. The solution is to build a system that is resilient to implicit bias.
So your "implicit bias" is right. Most of the time we engage in it unconsciously.
Sometimes that "implicit bias shows up as racism, nepotism or some other form of favoritism.
> Doctors don't under-treat black patients' pain because they explicitly dislike black people. They do so due to implicit bias.
No necessarily true. A racist doctor will under-treat black patients simply because he's racist. And note that I'm referring to a racist doctor, because not all white doctors are racist.
There are people who will call the ambulance or show up at the ER, claiming pain, when in fact they are 'simply' looking for drugs to meet their addiction.
The only person who knows how much pain the patient is actually experiencing is the patient themself. However, blindly relying on them to accurately report that level pain is simply not an option, given the potential for abuse.
Your perception is at least partly emotional.
In other situations, confirmed by many studies, racism in emergency rooms (and hospitals in general) have been very bad for blacks.
I was fortunate enough to survive 4 hospital-trip-inducing ODs in my life.
I know it may sound flippant or glib or obvious, but when you start down that path its always "oh, that will never happen to me" or "i'm too smart to make that mistake"
Sad truth is...it pretty much happens to everyone.
It makes me wonder if simply making this fact more common knowledge would cut down on life-threatening overdoses
http://www.businessinsider.com.au/philip-seymour-hoffman-ove...
Which is why it's so critical to get Narcan into more addicts hands.
They are going to overdose either way... It's just a matter of surviving them long enough to come to the point that some other external factors drive you to get clean (which seems to be the subtext of your post).
Glad you're still around.
Bag them up before you push the Narcan and you will have much happier patients.
Disable JavaScript to get around the Empire pay wall.
0: http://www.adn.com/article/20151107/juneaus-heroin-heartbrea...
1: http://m.juneauempire.com/local/2015-11-17/one-weekend-5-dru...
2: http://m.juneauempire.com/local/2016-01-15/juneau-man-found-...
People are broke and broken. Very few decent paying jobs even with a college degree, if you are broke you don't have access to decent medical/psych care either.
http://www.nap.edu/catalog/13172/relieving-pain-in-america-a...
tl;dr - "Chronic pain conditions affect at least 116 million U.S. adults at a cost of $560-635 billion annually in direct medical treatment costs and lost productivity. [...] [It] is much more than a biological phenomenon and has profound emotional and cognitive effects. [It] contributes greatly to national rates of morbidity, mortality, and disability; and is rising in prevalence."
For most people weed is probably a better choice for chronic pain, but I also think opioids have a more negative reputation than is deserved.
http://www.bbc.co.uk/programmes/b06vkg24
> If you struggle to screw the top off a jar, or use your arms to push yourself out of your chair, that's a sure fire sign, according to Dr Philip Conaghan, consultant rheumatologist and Professor of Musculoskeletal Medicine at the University of Leeds, that your muscles are weak. And the good news is that building muscle strength will protect your joints, not damage them. Dr Conaghan tells Mark that there's a worrying lack of understanding about the impact of muscle weakness on arthritic joints.
Almost half of prescription drug overdoses are by those on Medicaid.
Medicaid patients with an opiate drug prescription had about six prescriptions on average in 2010.
Compared to people with private insurance options, Medicaid patients were much more likely to be prescribed stronger painkillers and have more prescriptions.
https://www.thefix.com/content/study-shows-40-medicaid-patie...
I was a teenager in the early 90's and i'm horrified with that heroin come-back. I don't understand how it can be, especially in western countries. What the f. is happening ? I thought we dealt with that sh. long ago ?
There are some macro economic aspects as well making heroin cheap & powerful & readily available.
In what way do you think it was dealt with? As far as I know for actions like 'The War on Drugs' it's at least debatble whether they actually did reduce the amount of use of illigeal substances (let alone amount of related crime etc)?
They don't start taking those meds because it's cool. They start taking those meds because they don't have access to pain clinics; they don't understand that exercise is effective for many forms of pain (especially musculo-skeletal); that opioids should not be used for long term pain, etc. The meds become less effective if they're used for a long time, so people increase their dose. They become addicted to the meds, and need higher doses. A couple of things happen here.
1) Doctors restrict the meds. People then either buy illicit meds, which are stronger than they're expecting; or they buy heroin because it's easy enough to get.
2) People die from liver damage caused by the paracetamol that these pain meds are often mixed with. Partly we used to think that combining paracetamol and opioids meant we could use less of each (but that turns out to be untrue), and partly some people thought that mixing a poisonous substance in with the opioid would reduce abuse. (It sort of does, by killing the user.)
With things like MDMA this control over precursor chemicals does harm, because people use "research chemicals" or bath-salts instead, and there's not much evidence of safety for those. And there's some environmental impact as illegal loggers cut down trees in rain forest to get safrole oil.
It's much more likely that over-prescription of oxycontin is the root cause of any increase in heroin use.
The trail helped mitigate issues for the park quite a bit, but the heroin problem is still huge. In Santa Cruz, I think a lot of it stems from decades of tolerance and looking the other way.
Now when people are fed up,a lack of treatment options, ease with which those living on the street can get a meal and access to cheap drugs, as well as a judiciary that is at best revolving door perpetuates the problem.
2) Our society already has mechanisms that help in case of OD: People usually try to call 911 if they see someone in a bad shape.
The question is whether we need to spend more resources on helping fixing OD cases or may be spend these resources on other good causes.
http://www.sciencemag.org/news/1998/06/heroin-relapse-ups-ov...
Living in a low income area, I am grateful every day that I do not seem to have the attraction to drugs that so many people around here seem to have. I'm not even tempted. Not patting myself on the back for that because I suspect it is just fortunate genetics in that one regard. Now put a pizza or chocolate in front of me and I have an impossible time stopping but that won't kill me of course.
Obesity kills.
Plus I know better than to keep food like that around.
I assume it is exponentially harder for drug addiction though.
I'm getting tired of this opoid problem. I'm tired of addicts overdosing. As to rehab--if you don't relapse--fine.
We have a drug for opioid dependenancy, and maybe even the a tool to combat depression, and anxiety that's very safe. Unless you are hell bent on overdosing, you don't need Suboxone, you could get by with Subutex--that is if you can find a doctor to prescribe it? Once you have just bupenorpine in your system; the physical cravings for opioids go away. Plus--you might give up a few other bad habits too--like drinking?
Physical cravings aside its a mental game to get rid of an addiction. Every time one of those friends stopped taking subutex/suboxone they would relapse. Some people took them for 4-5 years and were on such a high dose they had withdraws.
Deaths seem to be a mix of direct use or not knowing it was mixed into another drug.
Fentanyl is frighteningly powerful so little of it can kill.
That may not be as binary as it seems on idle reflection.
There certainly are drugs that used in extremes, and (occasionally) in moderation, put people in a position where day to day functioning is impossible, but equally there are drugs that cause very little harm for reasonable consumption patterns. All else being equal, who would you rather have living next door? A drunk or someone who smokes a fair bit of weed on the weekend?
There's this thing that people do - certainly that governments seem to do with respect to the issues surrounding decriminalisation and/or legalisation - where the ideal, the thing they measure success by, is getting people to stop doing something that they wouldn't choose for themselves. That metric doesn't necessarily make a lot of sense.