Don't blame addicts for America's opioid crisis. Here are the real culprits | Hacker News Reader

Don't blame addicts for America's opioid crisis. Here are the real culprits

theguardian.com

51 pointsgreenbush18 comments

One of the commenters pinned part of the problem down: as opposed to countries like Spain, where opioids are given in hospitals, Americans are left to essentially self-medicate.

A Tale of Two Surgeries:

A good friend and I had exactly the same type of benign tumors removed, within a year of each other, around 2006-7.

Her surgery was outpatient, and she was sent home an hour after the procedure with 30 doses of Vicodin, which even back then she shied away from taking more than a few doses of. The whole thing cost over $6,000, most of which her insurance picked up, but she was still on the hook for about $1,000. She joked that she could have covered a lot of that by selling off the unused Vicodin. She didn't.

My surgery was outpatient, but my surgeon told me that she might decide to have me stay overnight for observation. I passed out when I saw the normal amount of blood, so she had me stay. I received paracetamol (Tylenol) and Tramadol (weak prescription opioid), given to me by the nurse. I went home the next day, fearing the bill for an emergency overnight. I took home a week's worth of Tramadol and instructions to write down when I took it to show my doctor who I had a follow-up with in a few days.

I shouldn't have worried: the whole thing was 1400 EUR, which my US-based insurance company paid with surprising alacrity.

My friend was a grad student at UW Seattle, treated in their system, and I was a US Army IT contractor, working in Germany, treated at a small city's hospital.

ugh I'd argue that addiction is much more so a result of America's failed medical system, failed mental health system, long slow decay and the internalization of it's populace that the american dream has always been a lie and what little of it that every existed was a cruel and dehumanizing experience.

It's so cruel and dehumanizing to have live in the wealthiest country in the world, with one of the highest standards of living.

America is indeed one of the wealthiest countries in the world, but that wealth is not spread evenly across the country. Most of the wealth is concentrated on the coasts, with incredibly skews towards NY/SF. See: http://labs.time.com/story/how-many-rich-people-live-near-yo... Many of us in tech, esp those in NY/SF tend to live in a bubble of wealth, or at least comfort -- that is not the case for all our fellow citizens.

Much of the country is not that rich at all, especially once you get to central parts of the country where industry has fled leaving people with odd jobs and insufficient healthcare. The opoid crisis centers around parts of America which are the hardest hit financially: http://edition.cnn.com/2016/09/23/health/heroin-opioid-drug-...

Finally, there is also something about expectations. For my generation, we grew up hearing "work hard, study hard, and you will live a good life, own a home, enjoy the life your father and grandfather lived." Except that formula does not work anymore -- industries which worked for our parents got offshored and we're now competing internationally. An entire generation still holds the expectations of an American lifestyle, buying a home with our 8-5 factory job, having barbecues in our backyard, playing "Where the Boys Are" but that expectation is no longer valid for all, leading to unmet psychological contract an entire generation expected to live.

Indeed!! If you look at Credit Suisse's Global Wealth Handbook, you'll find that in 2015, average wealth per american adult was 350k (on par with Norway and New Zealand), but MEDIAN wealth was just 50k, on par with Malta, Slovenia, Spain, and Israel!!

Furthermore, almost a third of Americans have less than 10k in net worth. This is not even enough to survive a year of unemployment without cutting back on essential expenses.

And what's worse, "nearly 1/3rd of Americans" is not a small number- it's 100m people!!!

>> America is indeed one of the wealthiest countries in the world, but that wealth is not spread evenly across the country.

This is the blessing and curse of capitalism.

You have winners and you have losers. In strong economic times, the rising tides will lift all boats and everybody benefits. When the shit hits the fan, those who are prepared, suffer less. Those with no safety net will suffer more, but there's plenty of government assistance to help those people when they hit hard times.

You can cry however much you want to, but the opportunity is out there. You can take online free courses, you can get scholarships and get your college paid for. You can go to a technical college and be employed in a trade in two years if not sooner. The best thing is that ITS UP TO YOU to make it happen. You can sit around and watch everybody and life pass you by, or you can put in the effort, change things up and find a different route than your parents did to be successful.

Success is out there my friend, but nobody is going to just hand it to you.

You can cry however much you want to, but the opportunity is out there.

There are numbers on this and they don't back up your argument at all. The US has some of worst economic mobility of developed countries [1]. Its almost as bad as the UK which has an archaic class system. You're perpetuating a myth.

Also, this idea that people are "crying" about it is a myth. People are angry.

[1] https://en.wikipedia.org/wiki/Socioeconomic_mobility_in_the_...

WNYC did a five part series on poverty myths, including the myth of rags to riches for most people - http://www.wnyc.org/series/busted-americas-poverty-myths

I recently changed jobs, the new job has a 30 day waiting period, but insurance only starts on the 1st of the month following that 30 days, so effectively 50 days for me.

With the change in pay structure, holding back a weeks pay, and the fact that I changed jobs because I wasn't making enough money; I've been unable to buy a temporary policy. Cobra is out of the question at over $2.5k for the month.

Last week we suspected my daughter had an ear infection, which thankfully seems to have cleared up, but it was and is worrying to think that I really have no options if one of my kids gets sick. If I go to the ER, I'm looking at a minimum bill of around $400, any clinic wants payment up front of around $100. My budget is really tight until I get a couple paydays under my belt.

I could point out that rapacious pharma companies and corrupt politicians are key facets of the failed medical and mental health system... so in that respect you're just widening the blame rather than redirecting it.

The blame should be wide. There are tons of people with the attitude "somebody else's sick kid is not my problem." The US has this amazingly cynical, navel-gazing culture. This is part of it.

There are, not surprisingly, persons who actually truly really have chronic pain, and who benefit from use of opioids -- and miracle of miracles, some of those persons use the opioids responsibly and as directed. They may become tolerant of the medication (this is a biochemical/biological response to exposure to opioids and is NOT the same thing as addiction), but the medication can give the patient very significant relief from suffering. This type of patient should have access to opioids under the guidance of a knowledgeable physician, at whatever dose is necessary for relief of suffering.

However, this same medicine produces a sort of a buzz or feeling of euphoria desired by persons who are not truly suffering from chronic pain. Since in the USA (and many countries) opioids are restricted to prescription only and are not legally usable for the 'buzz', persons who seek this effect of opioids have 2 choices: (1) see a medical doctor and pretend to have pain that requires treatment with opioids, or (2) purchase an opioid through non-legal pathways, and assume all the legal and medical risks of doing so (arrest, incarceration, violence, inadvertent overdose via unknown content of purchased supply).

Also, in the good old USA, treatment for addiction is expensive and not available for those w/o medical insurance or other source of funding -- it is not a right or benefit of citizenship, but a private matter for negotiation with the service provider. So many persons who might benefit from addiction treatment are never treated.

So the 'blame' for the opioid crisis goes beyond drug manufacturers, and includes addicts themselves, the medico-legal system that drives addicts into doctor's offices to pretend to have pain to get an opioid prescription, the lack of treatment for many addicted persons, and the legal (public health) decision to treat use of opioids in the context of addiction as a crime and not a disease.

So don't just blame drug manufacturers. there is plenty of blame to spread around to other actors! JMHO.

... too often that addiction began by following the advice of a doctor who, in turn, was following the drug manufacturers instructions.

ok. it's the doctors and big pharma. so, let's get doctors to prescribe fewer painkillers? is that the policy proposal?

the next thing you see is a news story about the huge amount of unnecessary suffering because our evil, immature government has unjustly demonized painkillers, which are, after all, just good medicine and common sense.

these stories go around and around.

The only reason you'll see the demonizing articles you mentioned is because the news media is approximately 70% funded by pharma.

Americans feel entitled for a quick cure for any ailment that befalls them. They demand pain killers for cough and antibiotics. Norco 5/325 is the most dispensed drug in the pharmacy and is now commonly prescribed for cough here. BigPharma works because there is an open market eagerly to abuse and consume as much as possible.

I think there's another culprit : not letting patients see a doctor, and the general quality of doctors.

I was admitted to the hospital recently at 2am with a stomach (I think) issue. It hurt like hell. This was in a big hospital in the middle of a huge city. It was extremely clear what the issue was, but without a doctor, policy is, no diagnosis will be made, and of course that means, you can't get so much as a drink of water, never mind medicine.

Of course, there was no doctor anywhere near me until well past 11am (effectively the day after). He did a blood test, which showed mild inflammation, and otherwise nothing. He gave the industrial strength version of an anti-inflammation med and some stomach drugs. An hour later, everything had disappeared.

Analyzing the situation, I can only conclude that the doctor only had a few negatives to go on, and that's why he took this action. It wasn't appendicitis. It (probably) wasn't acidosis (a leak in the stomach). It wasn't an actual wound, either visible or internal bleeding. It wasn't ... But zero positive diagnoses. So he gave something against stomach cramps and a milder painkiller, and patient (me) happily goes home, not because the pain stops but because I was unable to detect the pain any longer. I don't know how they work, but I am sure he gets to add 1 to his "patients cured" tab for the quarter and the government and my insurance (and me, of course) will get billed for that.

Needless to say, issue restarted the very next day. I still have no idea what the problem is, but why go back to the hospital or GP (GP is worse than hospital).

So you might wonder, what is done to someone who is admitted to the hospital with painful, but trivial complaints, to avoid having to allocate a doctor to them ? Well, large doses of morfine (enough that I couldn't walk without toppling) combined with other painkillers (not sure which). Because that's the only thing they have permission to do.

But this allowed me to put the pieces together of things I already knew : Unfortunately there are a ton of painful ailments (just wait until you're 45 and you pull your back. It will happen, I guarantee it. But there's stomach problems, there's hairline fractures (ouch), there's heart issues, there's blood vessel obstructions (ie. the dr. house problem), there's unfixed "mild" allergic reactions, ...). They won't entirely prevent you from moving or even working, but they hurt like hell, all the time 24x7x365. You'll find out that the pain easily exceeds what you can reasonably work with, even at a desk. But there is no obvious problem.

Pray tell, what is a patient supposed to do who fails to get a decent diagnosis, but has an unidentified long term painful ailment ? Other than getting strong painkillers on a regular basis ?

Of course, these people will fight for their painkillers.

But we, as a society, have decided that saving costs by sabotaging the training of physicians, resulting in far too few available physicians (and too incompetent), and even when you have a physician, they don't have easy access to diagnosis equipment, or labs. Everything has to be shared, accounted for, and nothing can be done by the doctor. It must all instead be done by people who, in the worst cases, have no knowledge of what they're doing beyond the safety instruction video (but even in the best cases never have a physician's knowledge). I am not against specialization, but having blood tests done by people who would not be able to recognize a heart attack from a test result is strictly not an efficient use of resources. It's killing people to save 5$.

The consequence of this is a LOT of older people undiagnosed, and utterly dependent on very strong painkillers.

I am also convinced we won't fix it.

It is a long read but it is worthwile, and a(n inconvenient) point of vue which is rarely stated, thanks. My experience of medicine as a 60 years old is exactly what you wrote.

That was one of the big differences I saw in medical care here in Germany: pretty much all primary care physicians, and all gynecologists, have ultrasound machines at their practices and do the scans themselves. Sometimes the devices are a bit older, but there's such a lively market for them that I've seen old ultrasound machines at veterinary offices!

They are also very, very reluctant to prescribe opioid-based painkillers, and even the over the counter ones like ibuprofen or paracetamol (acetaminophen) are sold in 10-packs and truly from behind the pharmacist's counter, not economy-sized jars of 500 on grocery store shelves.

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