Orphaned by America's opioid epidemic | Hacker News Reader

Orphaned by America's opioid epidemic

washingtonpost.com

45 pointspmcpinto23 comments

Opioid addiction is a symptom, not the disease. The disease is a generation of people who are left behind, who don't have the mobility to go where the jobs are, who can't go back to school because there are no schools in the area. The disease is the minimum wage job at dollar general which keeps their employees at 28.5 hours to keep from having to provide all the social and economic obligations of maintaining a full time employee. The disease is a lack of psychologists who can treat the underlying despair and hopelessness caused by living in a dying county. The disease is a lack of physical therapists that can teach exercises to help keep the pain away. The disease is a complete lack of infrastructure that entraps people in these small towns. The disease is an employment system that ensure that a drug conviction from ten years ago precludes them from having any sort of decent job. The disease is stigma and stagnation. We won't stop this epidemic until we fix the broken system that let it happen in the first place, and that's going to take a lot more help and a lot more money than just blaming the doctors and drug companies.

When drugs are a problem in black communities, and the pushers are people of color, it's a criminal problem. And when it's a white problem, with corporate pushers, it's a problem of Big Systems which need fixing...

By all means, let's work on fixing unemployment and hopelessness in these United States. But let's feel free to shut down a couple brazenly unethical corporate outfits along the way.

I talk about the same thing when inner city drug problems are brought up to. The article isn't about the greater problem of the war on drugs, it's about the problem as it pertains to a very poor part of West Virginia. If you aren't going to fix the underlying problems, then bringing down the exploiters isn't going to do a damn thing, because more will just take their place.

It is in large part a cultural issue. I grew up in a rural town where a large portion of the population was drug addicted. Anti-intellectualism is rampant. I was literally the only person in town who had an interest in learning about computers. Everyone else thought they were for "nerds". The whole town was football crazy though.

The baby boomers also did an excellent job instilling sex, drugs and rock 'n roll as the core set of values in the west. Hedonism is glamorized, reading books not so much.

The infrastructure required to succeed in small towns exists. It's called the Internet and it's a one way ticket to success if you put the effort in to use it and have the strength to go against local culture.

>Opioid addiction is a symptom, not the disease.

That's an assumption on your part.

An alternate explanation is opioids have been overprescribed for decades now, and that people who've gotten hooked and then cut off by their doctors turned to illegal sources, and that as a result opioids are "around" in a way they haven't been since the 1960s and available for the more adventurous people to try.

First class!

From William S. Burroughs, a quote I often think about in this context:

"Statistically the people who become addicted to morphine are those who have access to it: doctors, nurses, anyone in contact with black market sources. In Persia where opium is sold without control in opium shops, 70 percent of the adult population is addicted. So we should psychoanalyze several million Persians to find out what deep conflicts and anxieties have driven them to the use of opium?"

This is obviously a very supply-side view of drug abuse and very likely an oversimplification. But so is the view that we should tackle underlying causes first ("fix the broken system") when there is an obvious legal pipeline openly pumping opiates into these states. This is particularly off-base as the effects of opioid addiction are now a secondary cause for more opioid addiction (i.e. 'everyone is doing it', 'there are now plenty of dealers', etc.). So much of this is a cycle. I don't disagree about treating the 'broken system' but turning off the pipeline at the corporate level is a huge opportunity to improve things.

Treating opiate addiction with suboxone (one of the most effective methods) is largely blocked by bureaucracy: http://slatestarcodex.com/2015/02/02/practically-a-book-revi...

"They are worried that suboxone, being an opiate, might be addictive, and so doctors might turn into drug pushers. So suboxone is possibly the most highly regulated drug in the United States. If I want to give out OxyContin like candy, I have no limits but the number of pages on my prescription pad. If I want to prescribe you Walter-White-level quantities of methamphetamine for weight loss, nothing is stopping me but common sense. But if I want to give even a single suboxone prescription to a single patient, I have to take a special course on suboxone prescribing, and even then I am limited to only being able to give it to thirty patients a year (eventually rising to one hundred patients when I get more experience with it). The (generally safe) treatment for addiction is more highly regulated than the (very dangerous) addictive drugs it is supposed to replace. Only 3% of doctors bother to jump through all the regulatory hoops, and their hundred-patient limits get saturated almost immediately."

Those are some great points and it probably should be more readily available. But I still have some issues with Suboxone and the way it is being used. It seems to be pushed as a lifetime substitution for illegal opiates, rather than a tool for tapering off opiate dependence. When I was involved with someone in this situation, I couldn't even find anything official about how to go off the Suboxone, just anecdotes from people who had done it themselves. The doctors seemed perfectly happy to prescribe whatever dose you wanted, as long as they got their fees. And the smallest dose available was 2mg, which is apparently too much to drop off from, meaning that to taper you have to manually cut doses into small fragments. All together, it just seemed extremely sketchy to me.

Yes, although I'd point out that a dependence on a low dose of Suboxone is really not that big of a deal; it being a partial agonist means that it doesn't really have adverse side effects over the long term unlike full agonists like traditional opioids or methadone. It may prevent relapse over the longer term much more effectively than abstinence.

I definitely agree with a point you raise however about the availability of lower doses - 2mg is far too high to jump off of, or even 0.25mg for that matter. Suboxone is commonly prescribed at FAR too high a dosage, 8 to 16mg or even 24mg, when in reality 4mg is plenty for almost everyone, and 2mg will work in many cases.

The withdrawal of Suboxone can at first glance seem not all that bad compared to traditional opioids, BUT - it lasts for at least a month, if not 2 or even 3. Suffering over a long time period is a LOT harder than people think. So, I think the pragmatic - and humane, for that matter - is simply to let the dependent person choose. Many may choose to discontinue it of their own volition if they are given the space to determine their own tapering plan and see how it goes. Forcing them into something is likely to cause far more harm than any perceived (to say nothing of actual) benefit.

> Suboxone is commonly prescribed at FAR too high a dosage, 8 to 16mg or even 24mg, when in reality 4mg is plenty for almost everyone, and 2mg will work in many cases.

Says who? We tried that when I got clean. I required 26mg to hold my withdrawals at bay for a full 24 hours.

The smallest dose of buprenorphine is 0.4mg.

I was a heroin addict from 16yo, until just before my 22nd birthday. I've been clean ever since, 4 years this past August. This is entirely down to my state government's excellent opiate replacement therapy program, and buprenorphine. It literally saved my life.

The clinic builds a plan for you specifically, and adjusts it every few months. They provide counseling, advice and medical help. We don't pay them, the government does. The doses themselves cost $5 per day.

I'm impressed, it sounds like your state has a system that is almost incomparably better than mine. Grats on staying clean.

That reminds me how a lot of countries are currently in the process of making illegal "Kratom" which is used by a lot of opium addicts as a way to self-medicate their addiction withdrawal.

I can not understate how much of my little West Virginia town has been destroyed by opioid addiction. There doesn't seem to be a perfect solution to fix the problem, but I hope this will shed some light on the situation and at least bring it to the forefront so hopefully real changes can be made to combat this

I think you meant to say, "I cannot overstate".

absolutely. It's important to get sleep =)

Let's not ignore how a great many people got hooked on these in the first place: Through their doctor.

Here is a relevant article from today:

http://thehustle.co/oxycontin-global

Like tobacco, too much resistance in the US means Oxycontin is going global.

A shame the presidential candidates don't seem (as far as I'm aware) to have mentioned this epidemic as one of the important crisis facing America. Might have resonated deeper than ISIS or some other things.

> A shame the presidential candidates don't seem (as far as I'm aware)

There was a fair bit of that (particularly NH primary, I think), though a lot of it was lost in the noise of emails, FBI & the leaks.

http://www.vox.com/2016/9/21/12973740/trump-clinton-opioid-h...

I probably picked up on that was when I had to go pick up painkillers for a family member ... with all the added complications of looking the way I do.

I question the ethical culpability of big pharma. Taken from the article "Drug companies had bombarded West Virginia’s rural towns with record numbers of narcotics, according to court records: 300,000 tablets of hydrocodone to the mom-and-pop pharmacy in the town of War, population 808; half a million oxycodone pills to Kermit, population 400. During a five-year period ending in 2013, a single drug company had shipped more than 60 million doses of hydrocodone into a state with fewer than 1 million working-age adults."

I would prefer to use the term 'criminal liability' but I suspect there is none for this crime

edit - IANAL - to be defined as a crime it would have to violate a criminal law, and while this is ethically odious, it is most probably not criminal

The opioid receptors and their corresponding endorphins are truly beautiful. A work of art in its own right.

I think the epidemic here is not one of public health, but of the socioeconomic variety. If you are unemployed and don't have meaningful relationships, you will naturally try to escape your reality. Heroin is the quintessential drug of choice for those who want to dream.

This page is so poorly designed that I -- an engineer with 15 years experience and a mid 6 figure salary -- can not figure out how to read the actual article.

Why are newspapers trying this hard to implement shitty webUX gimmicks? Give me the words.

Might be a Chrome issue? There is something that locks scrolling about 500ms after the page loads. No overlay or anything, just a totally unresponsive picture of some sad kids.

Overall though, this is pretty pathetic on their part.

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