America’s opioid epidemic is worsening
economist.com
economist.com
There were recently two shootings within a mile of my house. Several people dead. Both shootings were drug related.
I can't help but look around and believe that the needs these folks are trying to satisfy are completely human, and that forcing the users to resort to black markets leads to violence and overdoses. I can't help but think this problem in my community could be solved by simply letting people get high.
Maybe the answer isn't to make heroin available OTC at Walgreens, but supervised injection sites seem to be gaining traction[1]. I think a lot of the dark red spots on the map, like mine, should probably consider this option.
It's not like anything else is working.
[0]http://www.tribtoday.com/news/latest-news/2017/03/fri-920-pm... [1]http://www.seattletimes.com/seattle-news/health/safe-injecti...
It seems to have worked / be working. Our heroine epidemic is far behind us, the addicts are dying out.
They're just.....there?
We used to think it was the crazy US forcing the Dutch to have such a bipolar approach to drugs but pot is more legal in Colorado now than in Holland and still the Dutch laws are a mess.
You can have up to 5 plants at your home, but if the police asks you to destroy them you have to, or you can get fined, so again: as long as you're not bothering anyone or dealing you're fine.
There are is also a proposed law to decriminalize the mass-production of weed (while introducing QC regulations, like those for food) and the delivery to the dispensaries.
With that full legalization can't be far off. The idea that legalization is just the right thing to do is pretty mainstream here, and a progressive political party, GroenLinks, supports legalization and is currently 3rd in the polls.
Edit: caps
I think that's an urban myth actually. I know people that got kicked out of their house for having just three plants just growing outdoor so no tampering with electricity or fire risk. They used to be more lenient but people tended to burn their house down with illegal indoor plantations.
It's weird how in a liberal country like The Netherlands where everybody wants full legalization we somehow ended up with a government that got a lot stricter instead.
https://www.vraaghetdepolitie.nl/drank-en-drugs/drugs-en-str...
So it's not legal but if you have at most 5 plants and let them be taken away you won't be prosecuted.
Also keep in mind that the police in the Netherlands is not as trigger happy as American police by a long shot. You're not getting swatted for having a few plants because our police is not militarized at all, we have a separate branch of LE that does riots and SWAT-like tasks and they're mostly used for large drug operations and soccer riots.
AFAIK as long as you're not using high-powered lighting (and not the modern LEDs or sunlight), tapping the neighbors' electricity and therewith creating a fire hazard you're fine.
Plantations are usually found either by the electricity company or because a helicopter with IR vision (or regylar vision on a snowy day) happens to find a house with an unusually hot roof.
i was very hopeful about the obama dea backing off the kratom ban last autumn after the public backlash but i'm worried about steps the current administration may take.
The US resurgence is tied to massive over-prescription of opiates who abusers turn to heroin if their supply is disrupted / their tolerance increases. The demographics of users is very different. There's an entire chapter in Narconomics covered to this. Supervised injections etc works in Denmark because its healthcare sector is set up to support it - the US healthcare sector is still actively poisoning the populace.
There's doing what's hard (either politically, or by effort) but "best", and there's being lazy and incompetent and just doing what comes easiest. Our current administration does the latter.
It's clear that we need to do a lot more to help these problems, as you suggest. We can also do a lot to keep people from getting addicted in the first place, by choosing (and regulating) better options for pain relief.
Cannabis criminalization kills.
Sam Quinones suggests that the actual trade in Mexican heroin is distinctively less violent than in other drugs; there's a pipeline of supply and distribution designed to be low-key and customer-service driven. If violence is coming from addicts and not from suppliers, increasing supply isn't going to make those people any less desperate or violent.
And.. why not? I've got multiple friends in my age group prematurely dead from overdose. It's not like prohibition is accomplishing anything.
Actually it's really hard to keep the program going as the government doesn't like to be associated with free heroin.
None of those people quit after having been admitted to the program. But they do get a better life and are not forced to be criminals anymore.
It looks like our current President is looking at cracking down on pot again though so, I don't imagine we'll have a sensible drug policy anytime soon. Only one motivated by profits.
>Reduced the number of days spent on crimes to a third
Not all crime is committed by heroin addicts so the programs won't stop burglaries completely but they have been shown to dramatically reduce the amount of crimes committed by participants.
http://www.citizensopposingprohibition.org/resources/swiss-h...
>Crime Issues: 60% drop in felony crimes by patients (80% drop after one year in the program). 82% drop in patients selling heroin.
In the fantasy Denmark, there's no crime, all the women are hot blondes who never get fat, there's cheap weed every where (and apparently free clean heroin), the furniture is sleek, all the men are feminists who never objectify women (there's no porn), the school system is fantastic (every child is good at math), the healthcare is free and high-quality, education is universal, free and high quality, and there are plenty of jobs for everyone (and high quality ones too!).
Pretty much like the rest of fantasy Europe.
> the healthcare is free and high-quality
> Pretty much like the rest of fantasy
> Europe.
Or for any other type of intervention.
Granted, a large number of the chronic conditions people face are caused by lifestyle choices and doctors don't have the power to make people want to change how they live their lives.
Not smoking, eating less crap and exercising more would drastically reduce the amount of chronic health conditions Americans face.
High blood pressure, type 2 diabetes, COPD and a host of other problems would drop dramatically if people lived healthier.
Plus, hospitals here on the West Coast have amped up doing a bunch of skeezy stuff recently, you could easily end up with a non-functional leg at a place like Swedish or Providence (two major hospital systems):
https://projects.seattletimes.com/2017/quantity-of-care/hosp...
But robberies and pickpocketing are on the rise.
Its obvious that it means drug related burglaries went away, which is a claim we have fairly good evidence to support.
Identifying the source of the problem is easy, though. Solving the problem for the masses who already find themselves in the midst of an addiction they might not even know they're in yet is much harder and what places like these injection sites are aimed to address.
A person did. Not necessarily indicative of a trend..
Maybe if all these drugs were freely available at least some of the violence would go away and the incentives to push them would go away too ...
The question is, what costs (both financial and societal) are we willing to bear to support addicts?
Then there is the cost of health care. Even if you ignore long term problems like HIV or Hep-C infections contracted by sharing needles (hundreds of thousands of dollars per person), just responding to overdoses is very expensive. [0]
>In December 2016, the City of Vancouver approved a small property tax hike, which was intended to help address the opioid overdose crisis. Councillors passed a budget that included a 0.5 per cent property-tax increase to support front-line service providers, which is in addition to the 3.4 per cent increase already in place to deal with the fentanyl crisis.
>..
>According to the report, the total funds available in the 2017 contingency fund for the opioid crisis is $3.5 million and the remaining amount after the above expenditures is $1.4 million.
That is only the monetary cost, there is a mental cost as well. [1]
>A health and safety worker with Vancouver Fire and Rescue Services says he's never seen stress and anxiety so rampant among first responders.
>Acting captain of occupational health and safety Steve Fraser says the ongoing overdose crisis has many firefighters dealing with emotional and mental fallout because of their job.
>...
>Another big issue, Fraser says, is "compassion fatigue" which comes from sometimes treating the same people time after time.
>"It's that feeling of helplessness and hopelessness that what you do is not making a difference," he said. "For all of us … why we do it is we do want to make a difference. So, when we see that fail time and time again it does start to take its toll."
Heroin clinics would help solve most of these issues. [2]
>Crime Issues: 60% drop in felony crimes by patients (80% drop after one year in the program). 82% drop in patients selling heroin.
>Death Rates: No one has died from a heroin overdose since the inception of the program. The heroin used is inspected for purity and strength by technicians.
>*Disease Rates: New infections of Hepatitis and HIV have been reduced for patients in the program.
>Note: The Swiss save about 38 dollars per day per patient mostly in lowered costs for court and police time, due to less crime committed by the patients.
[0] http://globalnews.ca/news/3189393/city-releases-report-outli...
[1] http://www.cbc.ca/news/canada/british-columbia/overdose-fent...
[2] http://www.citizensopposingprohibition.org/resources/swiss-h...
So if the issue is money, then the case is even more strongly in favour of legalisation.
We don't even need to give it away for free - just giving addicts the opportunity of buying medical grade heroin at cost would massively improve things.
Even better: Heroin addicts can generally function relatively well when they don't have to chase their next high constantly. Giving them a secure supply would let many of them hold down jobs and pay taxes and cover their own costs.
The economics are all in favour of shutting down the "war on drugs" for all but the very worst drugs. Incidentally, though, most of the truly nasty drugs are not drugs people tend to want, but synthetics introduced to circumvent drug laws. Most of them will largely have demand evaporate overnight if people could legally get safer alternatives.
You say that as if it's a completely crazy line of thought. Social Security works. It's cheaper than prison, too.
No because that's not even an argument.
Now, if "deregulation" as used above means "stocking next to aspirin at CVS", then sure. But that's not what's being discussed. Haven't done a study of it, but I'm pretty sure Denmark doesn't have many folks heading signing up as addicts to experiment.
If you were an adventurous youth looking for a new high you would have been sold barbiturates, maybe, or benzodiazepines. Maybe speed. But today it would be heroin, and you can trace at least some of that back to oxy addicts desperate to feed their addiction after being cut off.
A minor nit, but how many people are overdosing on actual heroin, and how many on eg fentanyl?
> If violence is coming from addicts and not from suppliers, increasing supply isn't going to make those people any less desperate or violent.
The argument is something like: If there's a limited supply the price increases and people turn to crime to get the money. If there's a government supply as part of addiction treatment (and a package of other care) there's reduced need to find funds.
I don't see the origins of addiction relevant to arguments about containing current addiction when it moves to the illegal market. But I agree that supply-side targeting when talking about legal industry makes a lot of sense. Being legal, they also have lobbyists, which reduces the impact, same as other legal drug suppliers.
> If violence is coming from addicts and not from suppliers
Others have mentioned this, but opiate abusers don't get violent when high. Some small percentage sometimes get violent when they run out of money to score. Experiments elsewhere suggest that it is a lot cheaper (in money and in human costs) to contain, (in some way) legalize and (if they want it) help them get clean then clean up after them.
I'm not making a moral argument about legalization or even (as is being repeatedly suggested on this thread) subsidization of opiates. I'm saying that if the cause of the epidemic is prescription opioids, and the ultimate problem is "too many people are non-functional opioid addicts", then deregulation won't fix the problem.
Experience here in Switzerland would suggest that if the state takes dirty needles, expensive supply, and highly variable purity out of the equation, opioid addicts can lead a life that is, while far from ideal, considerably more functional than before.
My impression is that drugs like Heroin, taken in correct dosage, do not inherently cause massive health damage. It's not clear how deregulation would work with drugs like meth, which DOES seem to inherently cause health damage.
by what ROA ? You smoke it, and you're good until your dependence increases. Then you must smoke it to feel normal. But if you slam it, you'll get high again. Do that a while and your dependence increases just as before, now you have to slam it just to feel normal. But if you just got someone to give you their dose, then you could slam 2 doses and get high again...and now you're in overdose territory
Pure clean meth causes harm. Dirty street meth obtained using the methods addicts use would be more harmful to the addict and to society.
But I'm not making a point about decriminalization. In the same way that it's counterproductive to spend a lot of time talking about prohibition in mass incarceration discussions (significant reduction in incarceration --- which is absolutely necessary --- will require us to adjust sentencing and policies surrounding violent crime among offenders who have never been convicted of drug offenses), spending a lot of time talking about free heroin isn't going to help us if the problem underlying the opiate crisis isn't heroin prohibition, but instead overprescription and negligent formulation of opiate painkillers.
Making heroin available to those who want or need to use it may reduce deaths or even hospitalizations without changing the number of opiate users.
If they go through a months supply in a week, then suddenly heroin is the next best option.
This is the second of your posts I've read in an hour with a b^) (checking your history shows at least one more) and now I'm curious. I've never seen that face before. The first time, I assumed it was a carelessly-executed B^) "2cool4you sunglasses wearer grinning sarcastically," but I guess it's not. My best guess is that it's winking - but winking is usually light-hearted and seems odd paired with the ^) nose/mouth that I associate with black comedy/sarcasm.
If ^) is light-hearted to you, I'd guess "quirky, almost flirtatious wink and grin." If it's not, I'd guess "smirking, exaggerated and heavily ironic wink." For people I know well, I could probably tell which one they meant; for strangers on the internet, less so. Is either interpretation close to the mark?
Thanks!
Part of the issue with things like heroin is that unlike many weaker drugs the highs are brief. Heroin addicts are as a result very often highly functioning if they don't have to worry about where to get their next high and can get highly consistent doses.
I worked with one years ago, and we only realised when a series of large busts drove prices through the roof and he started spending his time looking really nervous and on the phone until suddenly disappearing for two days once prices normalised and he "made up" for the stress by staying high most of those two days before checking himself into a hospital (which was when we finally found out). He was married and had kids, and neither his family or his co-workers had noticed a thing through years of addiction prior to that, despite having to struggle with an illegal supply.
There are lots of problems with heroin, but many of the worst ones are a direct result of addicts inability to meet their needs in a quick and "safe" way.
What's happened the last few years is even cheaper synthetic opioids is available from Chinese factories, and as it's legal there no connections are needed to export it, so mid-tier and lower street gangs here have made their own startups buying and exporting the cheap synthetics (Fentanyl, Carfentanil ect) directly effectively bypassing the traditional pipeline that was bringing in heroin for decades. Naturally this has lead to a ton of violence and overdoses as users get synthetic adulterated heroin instead of their usual dose and gangs fight over control of the much more profitable synthetic trade.
When China and other countries makes the synthetics illegal (China already made it illegal to export to Canada a few weeks ago, not sure about the US) it will go back to being too expensive to self import since petty gangs here will need connections there, and the heroin pipeline will resume again with overdoses falling until of course, another loophole legal synthetic is discovered.
After a minor operation I got exactly one oxycontin pill :)
Tobacco is as addictive as heroin[0], think about how much of a public health issue smoking has been. Do you think it would be that if tobacco was illegal? I could imagine making heroin legal would create many more addicts.
One of the core arguments for marijuana restriction is that it's not nearly as addictive as "hard" drugs. it's comparable to things like alcohol.
Access restriction seems like a good idea when a substance is so addictive that you develop lifelong dependence from it by default.
[0]: http://whyquit.com/whyquit/A_Henningfield_Benowitz.html
According to this, common drugs from least to most addictive (on dependence) are: Marijuana, Caffeine, Alcohol, Cocaine, Heroin, Tobacco
Why not pull a Denmark, legalize and give at no cost heroin to addicts, and get these people back to work? A junkie can be productive, despite an ongoing chemical addiction, whether it be meth, heroin, alcohol or whatever else, many middle class and upper class folks live productive lives despite these addictions.
Why can't we bring these people back into being productive, economically net positive members of society, and deal with their addictions with compassion, as any reasonable human being & the Catholic Church preaches?
I've employed many addicts before, if they have a choice of smashing windows all night to maybe get $100 worth of shit they'll fence for $60, or a gig that'll pay them $110 to pull cabling & set up hardware for 8 hours, they will pick the latter every time. Outside of work hours, don't expect them to be contactable, and watch your shit well, but beyond that this group of humans can be a net positive for our society despite the chemical dependency issues they have.
Heroin addicts get their start from prescription drugs. When the doctors cut them off, or it gets too expensive, they turn to heroin.
Actually, in UK you can get actual opioids (as co-codamol) behind the counter, without a prescription. Funny how they don't seem to have a disastrous and deadly opioid epidemic like the US has.
I'd so much rather live where people can get cheap pharmaceutical grade heroin at the pharmacy than where people who need opioids end up smashing windows to steal my laptop to buy some dangerous and overpriced fentanyl contaminated "heroin" that ends up making them overdose in the street (transnational criminal organisations tend to lack purity standards commensurate with those of prescription drug manufacturers, weirdly enough).
Crackdowns on "pill mills" and "doctors who overprescribe" is what denies people a safe and legal source of pharmaceutical-grade opioids and forces them onto the black market of illegal, extremely overpriced, dose-uncertain, and fentanyl-contaminated opioids -- all of which make drug use a lot more problematic and dangerous (for both the user and the community) and pushes people from "drug dependence" (needing a regular, constant dose of a medication to function) to "drug addiction" (problematic, damage-causing drug use).
Dose uncertainty especially contributes to the harm of drug use -- if the doses aren't uncertain (and are precisely metered like those of other, pharmaceutical-grade medications), it's a lot easier for the user to find the right dose that extinguishes the withdrawal symptoms and the pain while not ending up anywhere near an overdose. Also the ability to access pure opioids with precise doses means it's a lot easier to take the drugs as a periodic, regular dose and not have one's life disrupted by extreme highs and extreme lows and drug-craving. This allows users to maintain a normal, productive, non-criminal life with other things in their life (family, hobbies, career) than just the pursuit of opioids.
In US, the "epidemic" of OD deaths only began when crackdowns intensified on legal, pharmaceutical, sources and prescribers of opioids. The DEA cracking skulls over opioids and investigating doctors is literally the only reason illicit fentanyl (and its even nastier analogues) are common illicit products now. I am so very doubtful that skull-cracking and door-kicking will miraculously work after decades of it not working. Prohibition has given us carfentanil in illicit heroin. If you don't know what that is, it's a fentanyl analogue so potent that it's been successfully used as a chemical weapon. This is not an anomaly -- it's just the "iron law of prohibition (https://en.wikipedia.org/wiki/Iron_law_of_prohibition) at work.
> It's not like anything else is working.
Prohibition isn't working, and has caused tremendous devastation to society, and the opioid epidemic is just another instance of this. Prohibition has to get wound down, from the top (end the Single Convention on Narcotic Drugs and the statutes that give it effect) to the bottom (make it so local police can't arrest or search people for any drugs offences (possession, manufacture, use, transport, sale, purchase) regardless of the drug or quantity).
> Actually, in UK you can get actual
> opioids (as co-codamol) behind the
> counter, without a prescription.
> Funny how they don't seem to have a
> disastrous and deadly opioid epidemic
> like the US has.
While large amounts of ibuprofen aren't great for your stomach they won't kill you as fast as paracetamol.
All that assumes you aren't doing a cold water extraction.
Because it is sold over the counter, buyers have to first talk to a pharmacist to get it. This will likely involve discussing what you're suffering from, so that the assistant is sure that what you're buying is appropriate. Finally, they aren't going to sell you ten packets of pills at once, you'll get just one pack containing a few pills.
So, to get an addict's amount of codeine, you're going to have to visit all the pharmacies in town and give each of them a story about terrible dental pain or some such rubbish. It's just not going to be practical.
Here is the most frustrating part. She has wanted to go to rehab a few times, but since she is poor and unemployed, she has no health insurance for rehab. What are her options? My parents have no money to help her.
I'll never understand the bull-shit US policy towards drugs. Let's spend billions upon billions to "fight" drugs coming into the country, but let's turn a blind eye to the companies pumping out hundreds of millions of pills.
Why the hell don't we spend those hundreds of billions on actually treating the disease? If there was no demand, there would be no drug war to fight. Why don't we try a new way?
https://arstechnica.com/science/2017/03/tweaking-fentanyls-c...
For their chemical makeover, the researchers noted that when tissue is damaged and hurting, it becomes inflamed and more acidic. The pH drops from approximately 7.4—what’s seen in normal, healthy tissue—to between 5 and 7. Fentanyl can work regardless of the pH, so it’s active throughout the nervous system no matter what. But, if it was altered to only work at the lower pH, then it could target just the pain source at the peripheral nerves, the researchers hypothesized. And with no activity in the central nervous system, it would dodge opioid’s serious side-effects, including addiction and systemic responses that can be lethal during overdoses.
They're testing a modified version of fentanyl that only works in lower pH, restricting its activity to injured areas of the body, eliminating the risk of overdose and dependence:
In further experiments, the researchers noted that, unlike fentanyl, high doses of NFEPP weren’t lethal to the rats. And rats on the NFEPP didn’t display impaired motor activity or reward-seeking behavior linked to addiction.
No amount of throwing new molecules at these problems will solve them.
It's been a while since I took a pharmacology class, but opioids work centrally - that is, the pain relief is due to their action in the brain. That's why an opioid like loperamide (can't cross the CNS barrier) doesn't have an analgesic effect, only constipating.
If fentanyl only worked peripherally, it wouldn't have a painkilling effect.
From WP:
Opioids act by binding to opioid receptors, which are found principally in the central and peripheral nervous system and the gastrointestinal tract.
Recent investigations discovered opioid receptors on peripheral sensory neurons.A significant fraction (up to 60%) of opioid analgesia can be mediated by such peripheral opioid receptors, particularly in inflammatory conditions such as arthritis, traumatic or surgical pain. Inflammatory pain is also blunted by endogenous opioid peptides activating peripheral opioid receptors.
Here are some of the studies mentioned:
* https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4565585/
* https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4173362/
* http://www.nature.com/nm/journal/v9/n8/full/nm908.html
PS: I have no idea of what I'm talking about, just doing some basic research, so take it all with a lot of salt.
Do you know how this interacts with anti-inflammatory drugs?
Fighting the "epidemic" at the supply level seems like a losing battle, as it is for the hard drugs that plague inner cities. Addressing it at the demand level has to be the answer, but I don't see any possible answers floated.
This EconTalk episode on Narconomics goes into a great deal of detail regarding exactly how structurally broken the supply-side attacks are; I found it quite fascinating!
http://www.econtalk.org/archives/2017/02/tom_wainwright.html
Unfortunately neither of these will happen in the next 4 years; and likely the opposite will happen, so we're in for a worsening.
Tightening the already tightened restrictions would only worsen the issue.
Diversion, etc cannot be stopped and you might just see a sudden uptick in pharmacy truck heists like the one that happened five or so years ago. Corrupt pharmacists unable to resist the temptation of easy money, etc.
Or worse, heroin continues to spread like wildfire. Heroin has no QC, it's being cut with fentanyl across the country and addicts are dropping like flies. Sicker addicts have been seeking out these OD stories and score from those areas looking for the fentanyl cut H. It's bad and only getting worse, as if the government overcorrected its steering and has now spun out of control. The result is going to be a grisly accident.
I can't believe that many more people, especially (and coincidentally?) in the inner cities, need pain meds. This seems like something bigger in my mind. But I also don't have any data to back it up.
https://theweek.com/articles/541564/how-american-opiate-epid...
And now we're heading back in that direction. For some reason we can't seem to stop in the middle somewhere.
After observing this country 20+ years I have concluded that extremes rule. Nothing ever ends up done via a measured and calculated approach, always extremes. You can see that in politics, economic distributions, rules and lack of there of (deregulation). It's not just today; I've been reading a fair amount of history and it's like in the DNA of the country.
I don't think you can stop at drug use and claim "root cause." There's a variety of motivating factors involved in using particular drugs, and ignoring those is what leads to things like Prohibition, The War on Drugs, and other related failures.
If you want to stop people from doing something, you need to look at their motivations for doing it.
Unemployment seems obvious, but it's not. New Hampshire, for example, if often cited as one of the areas hit the worst by opiate addiction. Yet, it's doing well with unemployment, in relative terms.
1 year old, but relevant: http://www.nationalreview.com/corner/430841/whats-matter-new...
There was a tremendous amount of unemployment during the Great Depression - far worse than now. Sure, opioids weren't as available, so people didn't turn to them. (Alcohol, on the other hand...)
But I think a lot of what people did then was turn to each other. They had deeper relationships with people than (many) people do today. Sure, you've got two hundred Facebook friends. How many of them can you call at 3 AM because your marriage is about to fall apart, or because you're feeling suicidal? Technology has given us more relationships, but I think that in the process, we've lost much of the depth. That leaves a huge hole, because people are wired to connect to people. We crave human contact, and we get tweets. It's not enough.
So my suspicion is that we're turning to opioids to try to fill that void. But as I said, this is just my suspicion.
Kermit, West Virginia. Population 392. They received over 9 million hydrocodone pills in a two year period.
In a 6 year period, the entire state of WV received 780 million pills. Over 400 pills for every man, woman, and child living in WV.
Seems like attacking the supply is great place to start. WV doesn't need this many pills.
That is what was done, transferring the demand to heroin as opposed to oxy. Also, focusing on the supply side of things is the last 30 years of US policy: it's not worked effectively, and has a concomitant effect of incentivizing black market dealers to be wealthy and power. It'd be better to sell OTC heroin than to fund violent gangs, just in the name of limiting side effects.
Pills were given out like candy, then restricted which caused demand for cheaper alternatives. Had the drug companies been regulated in the first place, we might be OK.
The pills aren't coming from mules or cartels, they are coming from US companies. The pill supply has to lowered.
edit to add: http://www.latimes.com/projects/oxycontin-part1/
However now the US made that mistake, what's the problem with continuing to give out the pills "like candy", although with tighter controls to make sure that they don't go to create new addicts?
For people with short term pain, or who are at the end of life, opioids can be a good choice.
For people with long term pain opioids can, rarely, be a good choice, if other things have been tried first, and if there's a careful package of care.
Most people with long term pain need variations of / combinations of:
1) Access to evidence based pain management specialist clinics
2) Graded strength building exercise (for musculo-skeletal, not for nerve)
3) Medication that isn't opioids
Giving opioids to people with long term pain isn't a good way of controlling their pain (they develop a tolerance) and risks severe harm (on top of addiction).
Here's a website from the English Faculty of Pain Medicine, which is part of the Royal College of Anaesthetists. They explain it far better than I can.
https://arstechnica.com/science/2017/03/tweaking-fentanyls-c...
I learned an important lesson, however. Doctors will frequently use the amount of pain someone is experiencing as a diagnostic aid when determining a patient's diagnosis. I had a ruptured eardrum that I saw a doctor for and that doctor misdiagnosed it because I wasn't showing any signs of pain and that injury is supposed to be excruciating. The doctor explained to me that if it was ruptured, I'd be near tears and screaming for pain medication.
What are you talking about? Everything in medicine is highly regulated. Introducing a new drug is a very expensive process, run in the US by the FDA. It takes all sorts of expensive tests and trials to be allowed to sell a new medicine in the US.
Maybe the process messed up in this case. Sure. Many things are possible. But this was regulated start to finish.
Were they given out without prescription? If not, I feel like MDs have to share some blame on this.
In both cases, mandating a little common sense in how these drugs are used would potentially help a lot of people avoid a life they don't want.
no argument there. :)
The stat though about Kermit, West Virginia example has to be due to fraud and illegal sales, though? Or include vastly more people within the area covered by its pharmacies and/or doctors, which ever the data source used?
Otherwise each person in that town is receiving (on average) 31 pills/day. Maybe I wildly misunderstand hydrocodone prescriptions, but dozens of pills per day seems to be an excess.
Manufacturer seems to have played a role too by sticking to dosing they knew was ineffective and then pushing for higher doses which lead to big bonuses: http://www.latimes.com/projects/oxycontin-part1/
I agree that opioid over-prescription is an issue, but I imagine some of these numbers are being inflated by similar "pill mills" run by unscrupulous doctors.
- Addiction: may or may not be a problem at all, heroin isn't actually very expensive so the government can just keep giving it even to large numbers of people
- Other health risks: the risk of catching Hep C or dying of an overdose.
- Acquisitive crime: largely caused by the drugs being illegal.
- Morality: drug users are "bad people" because they lack moral strength or whatever. (Personally I have no truck with this, but it seems to be very important for a lot of people)
You're probably right about addressing at the demand level. But, I see the problem being more societal - think no one really understands everything. You take away self-reliance of people (whether they realize it or not) at many levels... its cheaper to get some good-enough quality food at 13 places near my home, so why should I learn to cook. I can get any vegetable I want at the store, so I probably don't need to learn how to tend a garden. In both instances as examples I'm losing a little control of my life. And then....
TV gives me entertainment, and the internet even more so, so maybe i'll just sit back and let it entertain me. So maybe I don't need to read anymore. Its easier to have short non-contextual entertainment bits, which rewire my brain further to think differently [wrongly?]... [0]
And, now capitalism has made all margins of businesses so slim that there's no real way to enter a business and still have a safety net in case you fail. You either need to disrupt an industry, create a marketplace, find a niche, or fail hard.
I think we're just starting to see the uglier stuff here. Short of some great awakening I also don't see the correct prescription. Pun intended.
[0]: https://en.wikipedia.org/wiki/Amusing_Ourselves_to_Death
I'm not sure about the Amusing Ourselves To Death stuff or the tut-tutting about cooking and gardening, but overall, though, I think you're on the right track. I'm sure that between automation of both manufacturing and services, big-box retailers and the fact that the covering of the 'long tail' is done very well by web-based business. It's hard to picture what a lot of people are going to be able to do in this circumstance and there seems to be the real potential for a cascading unpleasantness.
If you even half-believe the 'technological unemployment' worry, the scary part is that the non-automatable jobs that involved providing goods and services to those displaced by technology will also suffer.
There may be plenty of spare time for people to have that 'great awakening', whatever that might turn out to be.
two examples of many, admittedly probably too personal. Others: technology obsolescence, and the move toward not actually OWNing anything so nothing to learn to repair.
>>If you even half-believe the 'technological unemployment' worry, the scary part is that the non-automatable jobs that involved providing goods and services to those displaced by technology will also suffer.
Yes... My context is now that as a parent, I'm seeing windows closing for the kids' future that I had. I mean programming (maybe; I hope) and robot repair will be very lucrative. So will professions like plumbing and electricians.
It's not all doom and gloom, of course, and I think it's important to maintain a positive outlook esp. in front of one's kids when talking about this stuff. And of course, the growing helplessness and screen addiction of many of their peers suggests that in competitive terms, finding and holding a good job might be easier and easier (which isn't very encouraging overall, but appeals to the "amoral familism" streak I occasionally get).
While this is true, phrasing it like a critique of capitalism seems very, very weird. As if in a socialist or communist society starting a business is supposed to be easier and margins larger. (Disclaimer: I have founded two failed startups to date, still living on friends' couch after the second one now).
You're phrasing it as if you're comparing it with something. Have you ever lived in a communist country? I have yet to see a "redistribution of wealth" system that actually distributes more wealth than it lives for itself.
Here, in Norway, the doctor also tells the patient to take as much as they need but the decision on the actual type of pain relief is arrived at collaboratively between the patient and the doctor, sometimes including a short stay, two or three nights, in hospital so that multiple regimes can be quickly tried out under supervision.
In some cases they can prescribe more suitable drugs and more suitable delivery methods.
For instance the pain associated with cancer is often better controlled with a Fentanyl continuous delivery patch than an Oxy capsule. Oxy is good for relatively quick relief when you have a temporary increase in pain but the effect wears off so you get uneven pain relief.
I'm not a doctor, just speaking from personal knowledge of someone very close to me.
Can you point me to those guidelines please? I'm struggling to find them.
I can understand the advice if it's relating to short term immediate pain - for example post-operative pain. Addiction is unlikely to result from pain medication use in that example.
Here's the English advice: http://www.fpm.ac.uk/faculty-of-pain-medicine/opioids-aware
(easy version) https://www.cdc.gov/drugoverdose/pdf/guideline_infographic-a...
(hard version) https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm
Erowid puts that in the "light" category for users with some tolerance, FWIW:
Despite the evidence showing only short term benefits to opioid treatment physicians fear being sued by patients for refusing to continue prescriptions. I believe the argument is "Pain is the fifth vital sign."
So there's likely a pretty big effect of society telling folks that they have to be "disabled" in order for us to support them, and one way to be "disabled" is to have debilitating pain, and so you wind up with a bunch of folks who can't work and have a pain pill prescription.
Why?
Because the opioid epidemic started with a simple matter of scientists not being allowed to science.
Purdue Pharmaceuticals marketed oxycontin as a drug that lasts for 12 hours.
The evidence indicated it only lasted for 8.
If Purdue's scientists were allowed to act on the evidence, i.e. to be actual scientists, the whole world would have known this years ago. People prescribed oxycontin would have been told to plan for 8 hours of relief, not 12.
Instead, hundreds of thousands of patients were subjected to 4 hours of pain a day, and they sought relief with other drugs, including illegal ones. And the epidemic began.
Science is important, yo.
No, I believe the purpose of this scheme was to let the drug wear off before the next dose, in order to reinforce the withdrawal/pain->relief cycle. Oxycodone users typically didn't seek out illegal drugs (heroin) until several years after starting prescription usage.
Meanwhile, short-acting opiates like heroin have a withdrawal period that lasts about a week. Is it any wonder methadone patients switch back to heroin when they try to quit for good?
Mark my words, this isn't going away or getting any better. You can prosecute doctors, regulate all you want, burn fields of poppies. None of it will affect the demand nor the supply. You can't price or regulate someone out of an addiction.
If people get cut off wholesale from their prescriptions because doctors are being prosecuted for prescribing pain medication, they'll turn to heroin. Which will be available, regardless of all the opium seized, regardless of cartels dismantled.
Just like when Oxycontin went under a formulation change making it resistant to abuse, which also caused the price to spike to a dollar per milligram.
People turned to heroin because it was cheaper, more potent, and much more widely available than pharmaceuticals could ever be.
If you think pill junkies are bad, wait until you look down an alley to see a heroin junkie injecting another junkie in the jugular because all her veins are blown out. Watch your step, though, lest you get a syringe in your foot.
While kratom is habit forming and can "fuck you up" if you have no tolerance, the true value is for the person already addicted to opiates looking to get clean.
If you want to keep drugs out of the hands of kids, make them all legal and watch the usage numbers fall. Banning a powdered leaf, that is quite self-regulating, albeit habit-forming, is a step backwards in the quest to put out the structure fire that the opiate crises has become.
Doesn't the UK experience with alcohol counter this?
(I am strongly in favour of legalisation of all drugs).
I suspect it is due to very few amphetamine drugs being prescribed, especially to children. It seems to common to hear about people selling their legitimate ADHD/ADD prescriptions to friends in the US. "Speed Paste" is the only amphetamine properly in circulation and its use is mostly restricted to the hardcore "junkie" groups, very much frowned upon from the casual drug community.
None of the above is a solution, just to note the degree to which groups will gravitate towards and use a drug is not a given. Culture and availability probably affect use massively.
You raise many good points about drug use being different geographically and culturally. It's very much about availability, local drug culture, etc.
For example, the speed paste. As you said, in the UK and in other European countries amphetamine is usually amphetamine in paste form, not crystal methylamphetamine like we usually see here in the states.
Culture and availability absolutely affects use massively, a point I didn't mean to gloss over, and one I'm glad you raised.
I think identifying these differences between countries will bring governments a step closer to finding some sort of solution. Not exactly an easy one though when it comes to culture though. How do you break strong cultural associations?
There seems to be a number of (bad)role models that glorify different drugs in sub-cultures. Opiate use is glamorised from what I can tell in southern HipHop, Cannabis promoted all over the shop, Xanax frequently referred to in Hollywood.
But in the UK it's not even regarded as "abuse". It's perfectly normal for 15 year olds to drink alcohol with their friends. (And not against the law, if they are doing it in private.)
There may be benefits to legalizing drugs, but the idea that it will reduce usage of them is a fantasy.
And it seems that US drug legalisation has resulted in small decreases of use: https://www.scientificamerican.com/article/colorado-s-teen-m...
The only thing that's clear is that viewing drug and alcohol usage strictly as a crime problem rather than a health one doesn't work.
I'm not sure what you mean about class background. There must be very few 15 year olds in the UK, from any class background, who haven't used alcohol. I wasn't really referring to binge drinking. My point was that the fact that it's easier for young people to legally drink alcohol in the UK than it is in the US seems to have an effect.
While cannabis simple possession is very rarely prosecuted the police are still going after grow houses. I think it would have to be legitimised (properly legal) to see a decline due to losing the "rebel" factor.
I don't see any reason to believe that legalizing a drug will stop people using it, or cause them to use it more responsibly than they do currently. We have a case study in the form of prohibition in the US. There's certainly no evidence that alcohol use declined following the repeal of prohibition.
I found this a very peculiar claim. Is amphetamine misuse in colleges a big thing in the US?
Edit: never mind, I see this was already discussed.
The demand is high and the supply is there. Low doses of oral methamphetamine arent entirely uncommon either. Meth is cheaper, more potent and more widely available.
The extent to which this can be said to be driven by changes in the licensing regime versus changes in the population structure can't really be determined from this data.
See how productive this is?
I should also note, this is a burgeoning problem in the Puget Sound/Seattle region. It's not just rural people dying.
Can someone knowledgeable about drug policy / sociology provide some insight in this thread?
Unfortunately, we live in a society where it's all good, live free, don't judge, do what feels good, etc. That leads to things that feel extremely good...
I'm grateful to parents, teachers and some scary videos in high school health class that taught me to stay away.
Nothing to do with theoretical long term consequences, just "this is more trouble than it's worth".
There is no single cause or solution.
The high isn't even that great. If you are in pain when you take it, then sure. If you are dope sick from other opiates, then sure.
Addition to opiates doesn't happen from that first hit, it takes effort and dedication. You need to be using multiple times, daily for over a week before you'll get sick and even then it won't be so bad.
Also, depending on the level of addiction that may just be no hope for some. As another commenter said, in Holland they have had legal heroin dispensaries for 30 years, with medical staff and clean rooms for injecting. The addicts can be monitored, I believe they have general health and mental health workers available as well.
The addicts get live a "normal" as possible, knowing when and where they can get their fix. The whole day is not spent worrying where the money will come from Due to this, the average age of addict has steadily rose for years and years and, as the other commenter also stated, they die off
From a study on the Swiss clinics [0]
>*New Use Rates: Slightly lower than expected. 1) As reported in the Lancet June 3, 2006, the medicalisation of using heroin has tarnished the image of heroin and made it unattractive to young people. 2) Most new users are introduced to heroin by members of their social group and 50% of users also deal to support their habit. Therefore, with so many users/sellers in treatment, non-users have fewer opportunities to be exposed to heroin, especially in the rural areas.
This is only helpful for people starting from heroin though, the problem of people getting addicted to opioids from taking pharmaceutical drugs [1] is an entirely different matter to address.
[0] http://www.citizensopposingprohibition.org/resources/swiss-h...
As the market is disrupted, dealers move onto other drugs as there is no profit there, so is not so easy to find any more on the illicit market.
The situation is different to the US, whose current problems seem to be mostly from over prescription of pain pills, then when that was closed the flooding of the country with heroin and fentanyl to an already addicted population.
Purely anecdotally, the US does / did seem to prescribed lots more pain meds than any other country. When I used to use drugs (recreationally) and frequent drug forums in the early 2000s pain pills were regularly mentioned by those who used drugs recreationally for parties and were mentioned the same as party drugs, whereas in Europe they did not exist (outside the heroin scene).
Now, I live in tropical South Amercia, ,where quite a few US based expats move to each year, one of the biggest problems they have is getting their medication here. A large percentage are on a huge amount of strong medication. The expats from Europe are not. I don't think the lifestyle back home was that different, I don't think US people feel pain more than others, just that the Drs prescribe lots and lots of medication. Or perhaps European Drs just under prescribe due to public health systems and not wanting to fund the medication. Or perhaps the counter, there is more profit for the US Drs to prescribe more. Whatever the cause, there is a vast difference between the two
It attributed addiction to living conditions (e.g. rats in "Rat Park" had less addicts than rats in laboratory cages) rather than addictive properties of the drug.
For humans, I think it goes beyond physical living conditions, and into the mental realm.
A perhaps related topic is Attachment Theory [2] which models interpersonal relationships imprinted on children by primary caregivers.
With the two income trap shunting child rearing to daycares and schools, the theory would predict less secure attachments in children, leading to various maladies including identity crises and drug abuse.
There's a few reports here from VANDU a group run by addicts on the effectiveness of peer-run supervised injection sites and needle exchanges, meaning run by other addicts instead of government employees http://www.vandu.org/reports/
The problem is synthetic opioid is being used to buff out heroin so street dealers can save money by importing less heroin from India (how it comes into Canada). They keep coming up with new synthetics to bypass precursor prohibition or import laws, plus China has factories pumping this shit out legally which can easily be smuggled since it costs far less than heroin from India/Afghanistan.
Whenever you talk to a street addict basically the reason they got on heroin was they had some other substance abuse problem, usually cocaine, alcohol or meth, there was a shortage of that substance because either they couldn't afford it, busts made it scarce, or they were in jail so through peers they accessed heroin instead and got hooked.
Methadone doesn't work, they've already abandoned that idea here and moved to just handing out heroin to the worst cases, or hydromorphone which has a proven success rate in weening addicts off drugs.
Somewhere in all this is a solution that doesn't involve enabling career bums who want free heroin for life and doesn't involve 400+ ambulance calls per month draining our resources.
>Legal Heroin Prescriptions: The ‘British System’ You Never Knew Existed
Basically prescribe heroin for the addicts so they don't need to deal / steal and the thing dies out. You could link getting the prescription to doing something useful work wise if you want to be moralistic. Been done since the 1920s - tried and tested.
http://www.huffingtonpost.co.uk/entry/heroin-prescription-di...
Oh, and the government just handed the whole market over to illegal drug dealers, with fairly predictable results.
Prisons should stop testing for cannabis; and should consider prescribing cannabis of known strengths (and higher CBD rather than THC content).
(Also, they need to start providing a lot more mental health support and meaningful activity).
But yes, you're of course right that our whole approach is wrong.
If you cannot stop drugs being used in what arguably should be the most secure, closed system, how on earth do governments expect to stop in outside?
I would love to know how prisons are so incompetent when they literally control all the system's I/O.
https://www.vice.com/en_ca/article/synthetic-weed-is-a-scour...
http://www.goodreads.com/book/show/22529381-dreamland
The devil is absolutely in the details and it seems like it's gonna get a lot worse before it gets better.
http://www.econtalk.org/archives/2017/01/sam_quinones_on.htm...
What if this whole mess isn't so much a technical problem to be solved as much as it is our system functioning under its own perverse incentives? Other countries don't have this problem.
In my own area of expertise, I have seen so many non-solutions force-fed to the customer when an actual solution is not as profitable. It is not hard to believe that medicine operates similarly.
Indeed! What if!
That description could easily be applied to many aspects of the US healthcare system - an epidemic is a failing of public health.
I've encouraged both parents to try legal marijuana products in their state before experimenting more with anything opioid related.
My fiancé works at a pharmacy in Melbourne, Australia and says some of the most lovely and friendly people who just want to get themselves together come in regularly to get their $5 dose and it's saddening to see how badly society judges them.
Like the extremely strict controls in place? Like the prosecution of doctors who run pill mills? Like the rescheduling of hydrocodone formulations?
In my local ER there is an entire framed info-poster explaining why you aren't getting your meds refilled at the ER, you won't be getting fentanyl, dilaudid or oxycodone prescribed to you no matter what. ED's work with your primary care doctor and relay info to them. States have implemented pharmacy tech that allows them to track prescriptions state-wide. (a former massive problem)
Hospitals are already doing this. Pharmacies, already doing this. Doctors are terrified of the laymen telling them they know better in the court of law. Pain is being undertreated now more than ever, which is the flipside to the crackdown you don't seem aware of, which has been happening for years now.
There will always be abusers. It's inevitable. The people who really suffer from this kind of over-reach are people like my grandparents who are nearing life's end. People dependent on pain medication for their quality of life. Non-abusers.
Maybe quality of life means nothing to you, but to them it's all they have left keeping them going. It's the only reason they can continue to live through the constant pain, the enduring misery old age and lives of very hard work has wrought upon them.
http://www.reuters.com/article/idUSSIN135004
On top of that, how come other countries that have strict drug regulations and intensive prosecution (for example, Thailand) don't show same low rates of consumption?
And all of that relies on the assumption that Singapore's way is the best method that we as a culture (and to a greater degree as a species) can hope to accomplish. In my opinion, Singapore's drug policy is lacking in nuance.
Public opinion may have shifted, but as far as the current White House is concerned, it's their way or the highway.
Yes, some people cling to old-fashioned hardened attitudes. But if you look at Gallup's poll on drugs (http://www.gallup.com/poll/1657/illegal-drugs.aspx), people are way more worried about prescription drugs and the related heroin epidemic these days. Way more than cocaine, certainly. It's not in the poll, but it's hard to remember when the last time the boogeyman of the 1980s (crack cocaine) came up in reports.
Support for marijuana legalization stands at 60% now, compared to the 1980s where support was at 25%. There is a large age gap in support, in marijuana at least (http://www.gallup.com/poll/196550/support-legal-marijuana.as... -- 55+ 45% support, 18-34 77% support).
Although I'm sure harder stances will linger onward, as it has in the AG's mind, the AG's stance is increasingly looking out of touch.
http://www.pbs.org/newshour/bb/there-was-no-wave-of-compassi...
This not to say that harm minimization is now successfully mainstream, but the shift in attitudes and rhetoric is huge.
Here is a year over year incarceration map.
http://www.businessinsider.com/how-the-war-on-drugs-changed-...
Here's prison population by country:
http://news.bbc.co.uk/2/shared/spl/hi/uk/06/prisons/html/nn2...
Incarcerate is the only hammer many of our state governments will even consider using for most social problems.
So if you look at the chart, when they started doing this, heroin overdoses skyrocketed while pill overdoses stayed about the same. They doubled the deaths with their crackdown solution, as if that has ever worked.
I find this absolutely outrageous. I'm not American, but I stumble upon articles mentioning this, and I do watch enough American TV series and movies to have an idea of how acute the problem is (it's crazy how often in TV series doctors seem to give pain killers like it's candy).
I have the impression that in Europe, painkillers are much less used but I would not be surprised if the American trend were to contaminate medical practice here.
Pain is a minor consequence of disease or trauma. Pain won't kill you, so why would you risk become addicted to very dangerous drugs just to relieve it?
There speaks someone young and healthy. Some conditions are extremely painful in the long term.
"It is estimated that more than 100 million people suffer from chronic pain in this country,[11] and for some of them, opioid therapy may be appropriate. The bulk of American patients who need relief from persistent, moderate-to-severe non-cancer pain have back pain conditions (approximately 38 million) or osteoarthritis (approximately 17 million)."
Source: https://www.drugabuse.gov/about-nida/legislative-activities/...
"aggressive marketing by pharmaceutical companies"
"United States their biggest consumer globally, accounting for almost 100 percent of the world total for hydrocodone (e.g., Vicodin) and 81 percent for oxycodone (e.g., Percocet)"
That does make it sound like a problem created by pharma drug pushing on TV. But that doesn't mean the pain isn't real either.
Really the whole thing needs to be seen as a widespread public and social health problem - which is exactly the sort of thing the US system is set up to avoid seeing. Healthcare is not just a matter of individual responsibility or a contract between someone and their employer.
I'm wondering what that means, concretely. How exactly do they convince GPs to prescribe pain killers even when it's not really appropriate? They can't just pay them, can they?
https://www.amazon.com/Good-Cop-Bad-War/dp/1785032690/
Good Cop, Bad War (Paperback)
Publisher: Ebury Press
Language: English
ISBN-10: 1785032690
ISBN-13: 978-1785032691Even if exaggerated by an order of magnitude, stats like this are just indefensible: http://www.webmd.com/mental-health/addiction/news/20160325/n...
$3 copay gets you a $1000 street value opioids...
Of course this is corporate welfare for the opioid manufacturers.
I also read that one month 11% of Ohio's population was prescribed painkillers.
I've posted this in enough threads that I probably seem like a bot advertising for it, but seriously, it's a book worth reading and that can change someone's entire opinion on the drug epidemic and what legislation we should pass.
https://www.commentarymagazine.com/articles/our-miserable-21...
Although the entire article is worth reading, jump down to the paragraph that begins with "The opioid epidemic..." and read for about ~5 paragraphs if that's all that interests you.
Consider why people thought that was a good response when drugs struck other communities.
https://www.theatlantic.com/health/archive/2017/02/marijuana...
[0]https://www.thoughtco.com/states-spending-money-prisons-not-...
It seems that new painkillers such as oxycodone have something to do with the surge.
Humor aside, he managed to compile an impressive amount of testimonials and facts.
Also read other comments in the thread about history of needle exchange programs etc.
Never fear! Here's the latest Demon Drug, which we can use to whip up popular support for another round of failed prohibition-mentality policies. No need to worry about budget cuts, reduction in the availability of military weapons, drones, etc. to law enforcement. There will still be a viable career in persecuting some of the most vulnerable members of society.
Those in favour of harm minimisation need to fight for legalisation, or at the very least decriminalisation as a strating point. Not just for _their_ favourite drug, but for those causing the most harm right now.
1. They're tough people. A little pain means you're still alive!
2. They don't want to get hooked - too many people/animals rely on them.
3. Social stigma associated with such drugs.
I had foot surgery a couple of years ago and the Dr. tried to prescribe me opioids but I refused. I've seen the damage getting hooked on those can cause (in Dallas) and don't want that junk anywhere near my life.
[0] https://morecrows.wordpress.com/2016/05/10/unnecessariat/
Epidemic may be a strong word, but the rate of opiate overdose deaths certainly does seem to be increasing, and it's likely that cracking down on the supply of pain pills is a contributing factor to this.
Not arguing that treatments shouldn't be made available but it's important to keep all this in mind if someone ever suggests that all are equal in the eyes of the law when it comes to drug offenses.
1 - https://www.nytimes.com/2015/10/31/us/heroin-war-on-drugs-pa...
2 -http://www.cleveland.com/open/index.ssf/2016/02/heroin_vs_cr...