Children of the Opioid Epidemic Are Flooding Foster Homes

The VA noticed a lot of people had untreated pain. They pushed a campaign to make pain the fifth vital sign. Every time someone went into a hospital they'd be asked about pain. Pain was seen as something that absolutely must be treated.

They also said that opioids are not addictive if prescribed for pain.

It turns out that both of these are mostly wrong. If someone is in pain they'll tell you, you don't need to ask. And if someone has chronic pain they can become addicted to opioids.

The VA withdrew that document. Here's a Google cache: https://webcache.googleusercontent.com/search?q=cache:pUQ-mc...

We knew some time ago that it didn't help. Here's a report from 2006: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1924634/

Not sure what the policies are now, but around me, I can not go get any prescription for any back pain (have really needed it twice in the past 3 years). "Nope, go see your GP" (vs going to a walk-in clinic). The walk-ins around here all have signs on the front door saying "no prescriptions for oxycontin, etc"

Now... yes, I could try to "see my GP", which generally means waiting a few days. (and, I don't really have a GP anymore, because I can never get in to see him).

What's strange is that about... 6 years ago, going to one of the same clinics, my wife went with an eye problem. Specifically, she'd had a small piece of sand get in her eye, and it was really sort/irritated. Home flushing wasn't working, so we went to the clinic. As she was leaving, they asked if she felt she needed any pain medication. "Well, not really, but it's a bit sore, and I do have a headache". They gave her a script for 14 oxycontin on the spot. Same place last year would not even talk to me about pain medication ("go see your GP").

Making drugs that people want illegal has never worked. Why should it work now?

Besides, the drugs being illegal increases the death rate from them, because users now have little idea of what they are taking, and overdose easily.

You may be surprised to learn that opium and cocaine used to be sold widely at pharmacies over the counter. Curiously, there was not a widespread "epidemic" of addiction. Why is that?

Alcohol and nicotine are legal and ubiquitous, where are the epidemics of their addiction? Curiously, smoking has been declining despite it being widely available and very addictive.

Blaming the existence of a substance for addiction, and then harassing doctors and patients as a result, is nearing the height of absurdity.

Mind you, this was told to incoming (freshmen) students, presumably the professors would be able to make the precursors in such a way that the authorities wouldn't know.

Fentanyl isn't popular _at all_ among opioid addicts. The duration of effect is short relative to morphine-like molecules and it absolutely wrecks one's opioid tolerance. Fentanyl is popular among unscrupulous heroin dealers that try to pass off a cheap synthetic opioid as $200/gram diacetylmorphine.

Realistically the only way to stop this problem besides legalization is labs for testing pills and powders like they have in Spain and Netherlands, and mobile Suboxone clinics[1] which were proven here (Vancouver, Canada) to be the best solution for addict recovery as they can pick up the phone and have somebody quietly prescribe them Suboxone treatment without having to queue up at the methodone clinics everyday. Suboxone was described to me as satisfying the 'fiend' cravings while not making you high, so you can function sober and no longer need to chase daily money to satisfy a drug addiction and can actually plan things. It also ensures you won't use again since the antagonist ingredients makes it more difficult or impossible to use other opioids at the same time, making relapse less likely.

The safe injection sites here are a double edged sword. On one hand they are helpful for street addicts but on the other hand they are more likely to take risks, knowing there's a nurse there so aren't afraid of mystery powders like they used to be, according to anecdotes of people I've talked to who frequent them. The city handed out overdose kits to street users who demanded a peer to peer type safe injection network but the junkies stole the needles out of the kits to shoot up with basically rendering them useless and wasting the hundreds of thousands it cost to distribute them.

There's some data here about the Netherlands success in drug use reduction, they put a lot of funds into prevention instead of just treatment. http://www.emcdda.europa.eu/publications/country-drug-report...

[1] https://www.theglobeandmail.com/news/british-columbia/a-bc-c...

A common story for opioid addicts starts with, “I was in a car accident, and they prescribed opioids to deal with the pain. Once the prescription ran out, I was in incredible pain, maybe even worse than before I started taking the pills. I started buying pills illegally. Once the pills got too expensive, I switched to heroin.”

I’ve seen far too many stories that follow that basic path. It’s definitely not the only way people get addicted, but it’s too common.

I’d say what worked best for me was doing the very hard and frustrating process of building trust between me and her birth mom & family. It was at times maddening but so worth it for her. Especially since the system itself is broken.

My son was actually a plus - she was able to bond with him first and I believe that enabled her to then trust and bond with us.

Now she’s 12 and is amazing. I feel like the luckiest mom in the world to be able to spend my life with her.

We don't do foster-to-adopt. We do the other kinds: for situations where the goal is still reunification, or adoption by a family member.

Biologically, we have a two-year-old daughter , three-year-old son, and a son on the way. We have the right to know the history of placements and say yes/no to each one. Our foster care rep knows that we can't (won't) take aggressive children or children over 12, because we gave young kids. We also only do Level 1 care. (There are three levels in our state for rating behavioral and handicapped difficulty. Levels 2 and 3 require extra training.) We do, however, take sibling groups.

Our bio kids LOVE having foster kids. They now think that any friends they make should live at our house, because their other ones do.

I don't have any foster horror stories though I've heard plenty of course. We've been lucky enough to have remarkably well-adjusted kids. I think poor circumstances often demands increased maturity. IMO, the hardest people to deal with are the parents, not the kids.

Getting licensed involved 30 hours of in person training over a few months, a few hours online training, a house inspection (fire extinguisher, escape latter, handrails on stairs), and an interview with very personal questions (e.g. if you're married, "Have you ever considered divorce?").

The hardest parts of parenting are also the hardest parts of foster parenting. So I would expect a biological parent to have a pretty solid idea of what foster parenting would be like.

Attitude is an issue. The girls grew up in a refugee camp where they didn't have much, but nobody had to do anything. Now they've been dumped into an complex alien society where they have to become self-supporting. It doesn't help that the girls think their role is to find a man and be supported by him. The girls have strong ideas about the role of women, and despite being fostered by lesbians who do home remodeling and industrial design, they have zero interest in learning those skills.

The people who supervise the foster child program think they're doing a great job. The kids have sort of learned to read, and one of them got a job at an ice cream store. They got high school diplomas, only because California stopped requiring the high school exit exam at the beginning of 2016. This is better than average for the program.

Both girls can use a smartphone for entertainment purposes.

Because it can be. In many cases of severe persistent pain, they are the only effective treatment. There are many situations where literally nothing else works save for anesthetic infusions.

> and is now addicted to opioids

Those patients and doctors are making the determination that addiction is better than the alternative. Why is anyones business if that is what they decide? Frankly being addicted to a prescription painkiller is not any different from addiction to ADHD medication, a benzodiazepine (which are far worse in terms of addiction, withdrawal, and consequence), or an anti-depressant.

> People with long term pain need rapid access to a specialist pain management clinic.

Sure. But do you expect a patient to come back every 6 hours for another lidocaine injection? What do you think they do in pain management clinics? If you think the side effects of an opiate are bad wait until you see people on heavy gabapentin or benzodiazepenes as 'alternatives', who, btw are getting practically no relief from their pain at all but are heavily medicated.

Which says eg

> A Cochrane review of opioid prescribing for chronic pain found that less than one percent of those who were well-screened for drug problems developed new addictions during pain care; a less rigorous, but more recent review put the rate of addiction among people taking opioids for chronic pain at 8-12 percent.

Let's have a look at what that Cochrane review says:

http://www.cochrane.org/CD006605/SYMPT_opioids-long-term-tre...

> The findings of this systematic review suggest that proper management of a type of strong painkiller (opioids) in well-selected patients with no history of substance addiction or abuse can lead to long-term pain relief for some patients with a very small (though not zero) risk of developing addiction, abuse, or other serious side effects. However, the evidence supporting these conclusions is weak, and longer-term studies are needed to identify the patients who are most likely to benefit from treatment.

This tells us that the carefully selected patients were not getting pain relief or had too many side effects; (a third dropped out because of these) and we can't say too much about addiction because not all the studies reported it: "Signs of opioid addiction were reported in 0.27% of participants in the studies that reported that outcome"

It's hard to see that 0.27% (with who knows how many unreported cases of addiction) and that later 8-12% in the same paragraph.

> Moreover, a study of nearly 136,000 opioid overdose victims treated in the emergency room in 2010, which was published in JAMA Internal Medicine in 2014 found that just 13 percent had a chronic pain condition.

I mean, doesn't that tell you there's a massive problem with prescribing?

> recent research on roughly one million insurance claims for opioid prescriptions showed that just less than five percent of patients misused the drugs by getting prescriptions for them from multiple doctors.

THat para links to a document called "THE OPIOID CRISIS IN AMERICA'S WORKFORCE" http://www.castlighthealth.com/typ/the-opioid-crisis/

The first para of that report says:

> The use and abuse of prescription opioids continues to be a challenging and costly crisis for the U.S. The facts underscore the severity of this crisis:

> • Nearly 2 million Americans are abusing prescription opioids1

> • 16,000 people die every year from prescription opioid overdoses2

> • Sales of opioid prescriptions in the U.S. nearly quadrupled from 1999 to 20103

> • 259 million opioid prescriptions were written in 2012, enough for every American adult to have their own bottle of pills4

That Scientific American writer has misrepresented every source so far.

For fuck's sake, that last link specifically says:

> One out of every three (32%) opioid prescriptions is being abused.

They do not work for relieving long term pain.

https://www.fpm.ac.uk/faculty-of-pain-medicine/opioids-aware

> > 1. Opioids are very good analgesics for acute pain and for pain at the end of life but there is little evidence that they are helpful for long term pain

> > 2. A small proportion of people may obtain good pain relief with opioids in the long-term if the dose can be kept low and especially if their use is intermittent (however it is difficult to identify these people at the point of opioid initiation).

> The existence of painkillers are not the reason we have drug addicts.

This is just untrue. Please provide a valid source.