Bleak New Estimates in Drug Epidemic: A Record 72,000 Overdose Deaths in 2017
nytimes.com
nytimes.com
I highly recommend the book Chasing the Scream, for anyone who's looking for a primer on the War on Drugs. It traces the hysteria around drug use back to the 1930s, when race panic was used to push forward prohibition in the face of mounting evidence against that strategy.
To paraphrase one conversation that reminded me a lot of the larger national conversation "I play by the rules, why shouldn't everyone else?". It didn't matter that punishment didn't help or in a lot of cases, was costing them more and having worse outcomes, the larger (and to me, more trivial) moral and emotional argument won out.
When you take this principle into account, however, a huge segment of the world makes much more sense, although the realities that become evident are kind of horrible.
The fastest path to lead people out of this mindset, is to prove to them their own error by bringing them in on some misbehavior (such that they perceive it as a serious violation of their own personal code), for which they both benefit from, experience no consequences, and find deep tempatation to repeat.
To broach the subject of crossing some personal line with a person like this raises an eyebrow. Crossing that line in front of them reveals a mixture of feelings. Inviting them to participate is met with uncertainty. Pulling the trigger with them gives way to a period of paranoia, until the coast is clear. Then, twice then, three times. Now, they’re convinced that morality isn’t set in stone, and laws are the commands of mere mortals, to be broken at will.
But, now what you have on your hands is a convert. Once conservative, and yet still as much, but eager to experiment and challenge their own views. This is where stereotypical morally abivalent, yet superficially conservative people come from. Seduced out of their naive, obedient world view, but entertaining dubious integrity. So now it’s no longer divine authority in an imperfect world conceived by some paranormal perfection, but instead, simply might makes right. And so, you get tasteless materialism, and a ruthlessness to obtain status.
After a certain age, this sort of thing really can’t happen with some people. When you’re a teenager, transgressing certain boundaries can be harmless and naive, but after a certain age, cheap thrills don’t work. That’s why we find a broad split of sheltered, uptight squares, mixed in with smaller segments of snobby, cavalier libertines or cheesey, greedy sociopaths.
It’s a distribution of age brackets for teenage misbehavior. The cornier the yuppie, the later in college they started breaking the rules, or maybe they never broke any rules, and that’s why they’re stuck with this holier-than-thou attitude.
> Unfortunately, his misunderstanding of some of the basic principles of scientific research — that anecdotes are not data; that a conclusion is not a fact — transforms what had been an affecting jeremiad into a partisan polemic.
https://www.nytimes.com/2015/02/15/books/review/chasing-the-...
While I pretty much agree with everything you say, I take a bit of issue with this.
Overprescription of opioids is a major factor for creating addicts in the first place, and in that regard, the US is a rather obvious outlier. [0]
Afaik the legalization of Cannabis has already helped with this overprescription trend of opioids [1] and that's a very good thing. If done right, the US could turn this around from being the worst offender to being a world leader in pain treatment research and sensible application.
Yes, that would require a rather big paradigm shift on the political level, one many would consider unthinkable. Just as unthinkable as the legalization of cannabis had been for very long periods in the US.
[0] https://qz.com/1198965/the-surprising-geography-of-opioid-us...
[1] https://www.npr.org/sections/health-shots/2018/04/02/5987877...
3,000 people were killed in the 9/11 attacks.
72,000 overdose deaths is just a staggeringly large number.
That we still haven’t done much about it is deeply distressing, tbh. I feel it’s a sign that we’re losing the ability to act towards unified goals, even politically safe ones like “no more drug overdoses please”.
Stopping drug overdoses is popular across the board, but some of the tactics to accomplish that are not. We aren’t even at step zero, pretending to give a shit at the national level.
You also need to factor in the victims, or rather their demographics. To be brutally honest, past victims of heroin were often minorities who lived in inner cities. Blacks in urban ghettos and gays cut off from all social support in particular, plus homeless people of all stripes. It was easy for people to pretend that those victims were simply immoral fools who got their just desserts.
Now the victims are increasingly the children of white, suburban, middle class families. This has brought the crisis much closer to the heart of American political power, and made it much easier for the average voter to know someone who is addicted to or died from opiates.
In theory this should reduce the drive for draconian drug war tactics, since the victims are neighbors and not brown boogeymen over in the big bad city. This doesn’t seem to be happening at the political level, which is weird and disconcerting.
We are at step zero, which is we have the capability of measuring the problem.
Lets be frank: there is plenty of people who care, and those people are providing those measurements (CDC analyzing death certificates, especially for Opioid deaths). Whether or not our leaders respond is simply a matter of democracy. We need to elect leaders who care and will do something about it.
But for now, step 0 is done. The public is becoming aware of the problem, and as far as I can tell, everyone is on the same page with regards to facts. Not even Trump dares to call these statistics "Fake News".
Over the next 10 years, I bet this problem will be solved. There really aren't any political headwinds that I foresee. There aren't any political opponents on this issue.
I don't know how you can be so rosy about the problem being solved within a decade when the war on drugs has been going on for many decades already.
It's still only a drop in the bucket compared to overall drug-related deaths though. Tobacco-related deaths alone account for 500k deaths annually, and that's not even counting deaths related to third-hand smoke.
https://www.mayoclinic.org/healthy-lifestyle/adult-health/ex...
Cigs are a product for kids
I'm not sure if drugs take away more overall years of life then tobacco, but the numbers are probably not that far off.
72,000 is just the number of sudden effects, ignoring the chronic long term effects of opiate abuse.
It the same thing with alcohol. Very few alcoholics die from alcohol poisoning, it's the long term health problems that kill them.
Actually I think the median death from alcohol is mid-30s, with alcohol-related accidents and suicides being more common than chronic health issues.
The hypocrisy of the law when it comes to this is insane, but given how large the profits are and the power that money commands with lobbying, I'm not really surprised.
http://www.latimes.com/projects/oxycontin-part1/
> Purdue has known about the problem for decades. Even before OxyContin went on the market, clinical trials showed many patients weren’t getting 12 hours of relief. Since the drug’s debut in 1996, the company has been confronted with additional evidence, including complaints from doctors, reports from its own sales reps and independent research.
Or
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2622774/ [2] https://www.vox.com/2017/6/5/15111936/opioid-crisis-pain-wes...
After the birth of my youngest child, my wife spent the immediate recovery period blindsided by pain because new regulations meant the hospital was unwilling to prescribe opioid medication for "routine" things like an uncomplicated childbirth. She didn't have to deal with that for any of our other children, because back then, the hospital was willing to administer these medications.
Medicine is already over 8% of GDP, but the political complex is not satisfied with that -- every day it gets harder and more expensive to stay on the right side of the law while obtaining necessary medications.
In Florida, it is now unlawful for a physician to write for more than 3 days of narcotic painkillers (if there are extenuating circumstances, this can be pushed to a week, but the rationale must be documented and approved by at least one other physician, iirc). If your pain hasn't subsided in 3 days, you need to make another appointment -- which means paying another copay, or if uninsured, paying another out-of-pocket office visit -- to get a refill.
If you require pain medication for a chronic condition, you now, by law, have to acquire a separate doctor who specializes in "pain management"; your family doctor is legally not allowed to write for more. Good luck finding an appointment at a reputable pain management clinic within 3 months.
This is not a simple thing, and these medications continue to be prescribed because they help a great deal of people, relatively few of whom descend into addiction (and note that many who do go to the streets are driven there because their docs or pharmacists got spooked by the DEA and cut them off, leaving them in mind-numbing pain, or because they couldn't afford the substantial financial and social costs required to get controlled Rxs renewed and refilled on an ongoing basis).
Ive honestly considered looking into dark web markets for a different (non opioid) drug I was taking for 10 years consistently. Multiple doctor's kept trying to have someone else deal with it due to DEA paperwork. I once had a doctor actually say "who sent you here, did someone tell you about me?"... My response was "my insurance company and you are 3 blocks away from my apartment.". It was very awkward considering I said I would release any necessary medical records etc.
The public often expects strong painkillers rather than dealing with extreme pain. You can request less extreme painkillers and use less than prescribed.
Doctors can’t directly measure pain so while the have an important role, they can’t do it alone.
On top of that drug companies had a strong incentive to change the culture around pain and succeeded.
The illegal drug market thrives via specific and changeable laws.
People doping illegal drugs have a direct moral responsibility to their customers, but frankly they are already breaking the law so you can only expect so much.
Illegal drug users often seek out stronger highs resulting in their deaths. Seeking treatment is a possibility for these users.
It's personal responsibility first of all. I don't want to live in a world where I need prescription or permission to do anything that is potentially risky to my health. What happened to the idea that you are responsible for your actions? We already have too much prohibition and government picking and choosing what is and what isn't allowed in your life.
It feels like reality TV has crept into every day life, and now everything has to be turned into a drama. Stop pandering to the drama, start working on a solution already.
In particular, when you want to assign blame, you create an incentive to destroy or conceal evidence about what's actually happening. For opiates there are criminal penalties as soon as someone steps across the grey boundary between "medically necessary" and "recreational", so obviously everyone involved is going to lie about what's happening.
https://www.bbc.co.uk/news/world-us-canada-40136881
The US Veteran's Association noticed that many veterans were living with pain. They felt that this needed to be treated, and they believed that opioids were safe an effective to treat long term pain, and that the risk of addiction was low.
They introduced a thing called "pain as the fifth vital sign". They wanted healthcare professionals to i) always ask about pain and ii) always try to treat pain.
https://www.va.gov/PAINMANAGEMENT/docs/Pain_As_the_5th_Vital...
This led to huge amounts of mostly unsuitable treatment for pain. People in pain tend to reject psychological treatment ("My pain is real, it's not in my head!") and access to good quality physiotherapy is more expensive than opioids.
The other half of it was somehow deciding that opioids were the proper treatment for chronic pain, rather than temporary pain relief after surgery. Which was never really studied. And the consensus seems now to be that was a terrible idea.
One was a change to quality-of-care measurements. Lots of entities in the US health care system are evaluated on metrics around patient outcomes, and some of those look at management of physical pain. Changes to metrics for pain effectively pushed doctors toward a target of zero pain, and doctors began prescribing more medication to achieve that target.
Another is the allegation that pharmaceutical companies downplayed the risks of their newer formulations for pain medication, or even outright lied. Purdue, Endo, Allergan, Johnson & Johnson, Teva and others all are facing or have faced lawsuits over this. To take an example: Purdue marketed OxyContin as a breakthrough long-acting drug -- they claimed 12 hours of effectiveness -- which would reduce the risk of addiction. In reality, patients reported the effects wore off after as little as 4 hours, and Purdue's marketing and sales arms pushed doctors to prescribe more and higher doses. This naturally led to... addiction and overdoses.
Still another factor is that pharmaceutical companies seem to have been perfectly willing to overlook obvious abuse in order to move product and make money. It's not terribly hard to spot the patterns; there were cases of small (couple thousand people) towns where the local pharmacy would handle millions of doses of hydrocodone or oxycodone. And there have been lawsuits over that, too, with the drug companies mostly trying to reach settlements and avoid trials.
A lack of laws allowing for paid sick leave, for example. It is easier to sit at home and not take pain meds than it is to have to go to work. If people cannot afford to take time off, there might as well be no sick time.
There is a fault with doctors, but I truly think that for most doctors, they shouldn't have to be the gatekeeper for such things so long as they are prescribing for medically necessary conditions. The responsibility is that they should talk about addiction and symptoms of it with the patients and be prepared to work with patients if there is trouble. This should be without treating them like criminals 5 years later if they have a real reason to have medication (like surgery, for example).
To a lesser extent, yes, it lies with a few doctors for prescribing strong pain killers. But if they are the medical norm for the sort of pain you are dealing with, they aren't being irresponsible either. I'd much rather folks be able to manage their pain than to suffer.
Pain centers are horrible places and not convenient enough for everyone. The ones around where I lived (the first 30+years of my life) generally drug tested people, treating folks with chronic pain like criminals. They would treat folks like an addict for having pot in their system, for example, and were likely to kick folks off the program for such things.
A lack of medical based treatment centers for additiction and to an extent, for mental health. This falls squarely on insurances and government.
It would take government initiative and there would be some public pushback, but there could also be a national (or even state by state) digital medical system that includes prescriptions for these (and all) drugs. This would help doctors and pharmacists catch folks shopping around for different doctors. I hesitate to deny treatment to such folks, though, but instead refer the same folks to medical testing to see the cause of their woes and/or treatment for addiction.
However I have heard constantly during the last decade that stress and depression is on the rise and also spreading to younger age groups. I thus find it very questionable to view the problem from the drug supply perspective. Is it not a more logical conclusion that more people are self medicating and the problem is the social environment (stress, depression, looniness, and so on) and possible faults in the medical system in not helping those people as effective it could?
Someone will no doubt reply that US unemployment is falling, and therefore so should the opiates crisis, but it's not a simple matter of economics and statistics, it's a question of what people believe about the world and their future in it. Someone who gets a bad, painful job with no agency or fulfilment will vanish from the unemployment stats but the despair remains.
(Mind you, both for-profit heathcare and a punitive, moralist approach to pain relief belong in the blame picture as well)
Which is also why it was ridiculous that Trump (and his base) celebrated the latest GDP numbers, when on the ground the people were still suffering. And then we have Amazon, Uber, etc, "jobs"...
Damn this is a sad comment. You ruined my night tonight.
The US has drug problems, and has for 50 years, that other first or second tier nations in worse structural condition never picked up. This goes all the way back to peak US economics of the 1960s and early 1970s, when the US had a standard of living that it has taken the best European nations 50 years to catch up to. The opioid crisis is the latest extension of the US being a drug abusing nation, which it has been for a very long time, even at the peak of US economic success when it had 1/2 of all global manufacturing. It has had multiple heroin waves, multiple cocaine craze waves, multiple pill abusing waves.
The people of Spain didn't overdose at 2x or 4x the rate of the US despite having a drastically worse economic situation. Their economic desperation is still far beyond that of the US.
The standard response to that is: yeah, but the US doesn't have a welfare state. Yes it does, it has a massive welfare state, and its welfare spending as a percentage of GDP is higher than Canada or Australia.
The opioid problem has particularly hit poorer Americans. Why aren't Bulgarians or Moldovans overdosing at far higher numbers? They're radically poorer. Part of this equation is access: Americans have massive, low cost, easy access to all the drugs. People in the US have an almost unique position in the world in regards to having enough money, easy access and combining it with the way drugs get pushed to Americans.
Some of this is in fact unique to the US and doesn't require there be a particular high level of stress.
Every economic metric indicates Americans are doing better today than they were seven years ago, and yet the opioid crisis isn't receding and it's far worse than it was seven years ago.
Japan has lost a minimum of 1/3 of its standard of living in 15-20 years. They're not overdosing on opioids like people in the US are. They've suffered far worse than people in the US have.
Every culture behaves differently under stress, there's no question about that. There's also zero evidence that the on-going opioid crisis is a result of active high level desperation. That's where it started; those are not the same things.
Do people in Sweden and Belgium commit suicide at higher rates than people in the US, because their standard of living is collapsing? Belgium's suicide rate is nearly 100% higher today than the US rate was in the year 2000. Does wealthy Europe have among the highest rates of suicide on earth because it's so terrible there and they're under incredible economic stress? Or is it more likely these cultural issue are in fact complex rather than simple.
> Does wealthy Europe have among the highest rates of suicide on earth
Certainly not: https://en.wikipedia.org/wiki/List_of_countries_by_suicide_r...
Only your two examples are in the somewhat upper bound of that list, the rest of Europe are among the lowest suicide per capita countries in the world.
> Or is it more likely these cultural issue are in fact complex rather than simple
Yes, I'd agree with that. I said it was a "question of what people believe about the world and their future in it", which goes beyond the economic.
I don't think all these drug overdose deaths are counted in the plain definition of suicide, but they're clearly a manifestation of self-destructive behaviour.
This seems patently false to me and strikes me as a way to bolster your "Americans are druggies" argument without any real evidence. FYI, GDP per capita in Japan is about the same as it has been for the past 20 years, despite a falling population.
https://fred.stlouisfed.org/series/NYGDPPCAPKDJPN
Visit Japan sometime. The Japanese clearly have a standard of living that is among the best in the world.
It hasn't been a generation since the 2008 recession.. and there are still over 1 million fewer manufacturing jobs today than in 2008.
https://fred.stlouisfed.org/series/MANEMP
Since the low point, the industry has only added about 1 million jobs.. so they're only about 50% recovered by this stat.
So the "best European nations" will have reached a living standard, like the US of 60/70s, by the year 2020?
I mean, I'm not even convinced the US currently is anywhere near the standard it had back then, so that claim sounds a bit bold.
Could you quantify that in any way? The UN's Human Development Index could be of great help for that, sadly they only started doing that since 1990. So how are you measuring "standard of living"?
For most people, once addicted, it's very difficult to stop. It's no longer about numbing your despair, it's a physical dependency with very unpleasant withdrawal symptoms.
I agree with you, I would also throw in nihilism and purposelessness, the general lack of vision for the future from government and elites.
[1] https://kairoscenter.org/wp-content/uploads/2017/02/Poverty-...
The only excuse they have for the blatant over prescribing of opioids (2 months worth of oxy for getting wisdom teeth pulled kind of thing) is that if they don't do it, the patient will just go to another doctor.
But how can you justify setting someone up with fistfuls of oxy (knowing full that heroin / fentanyl and a world of misery for them and their loved ones is just around the corner) just "to make money" ?
> Or is it the responsibility of patients to not seek strong opiates for the smallest aches?
What the patient seeks is irrelevant. The only one who decides what prescriptions a patient should take is a doctor.
Personally I suffered from lower back pain for about 10 years and went from one useless quack to the next. Eventually I found a physio who taught me how to strengthen my core, now I'm at the gym 2x a week and loving it, did couch25K (and beyond) and am pain free for 3 years.
All I sought was pain relief but pills is not what I needed. If I was in W-Virginia instead of the EU I guess I'd be shooting heroin by now.
The US health care system is broken in more ways than one, no doubt this is made worse by various societal factors like joblessness.
Go to any manual labor job (construction for example) in the Midwest. You will find people wanting to buy leftover prescriptions and people selling them. It's a pretty large black market. The vast, vast majority of people I know doing construction, laying asphalt, etc are all daily drinkers, potheads, or addicted to opiates. It's honestly super depressing.
If that story generalizes it may be that somehow outpatients are getting too much painkillers while inpatients are not getting enough. The latter group is, of course, much less likely to get addicted.
Most other patients demand quick and effective pain relief. When most doctors operate within a system that promotes total customer satisfaction and when they know an opioid is going to make the pain go away right now, the opioid prescription is easier. Plus this will make extra dollars for the system.
Changing this would require mindset change for patients (I need to endure the pain and follow a clean diet/exercise), and having doctors look to 360 treatments, including diet, sleep and exercise recommendations, instead of opioids
Certainly training them to prescribe less is a place to start: Doctors trained at lower-ranked American medical schools prescribe more opioids
https://www.economist.com/graphic-detail/2017/08/23/doctors-...
Surely this is not the norm? My son had his wisdom teeth out a few years ago, they gave him about a day's worth of hydrocodone and told him to take Tylenol after that. And all the doctors my family has seen for the past couple of decades have been pretty conservative about prescribing anything narcotic for pain.
What's a 10/10 on your personal score card, out of interest? I hope you understand that your 8/10 may be akin to a 2/10 for someone else.
Took those way to long over jaw issues until I got stomach problems, asked the dentist for something else and he prescribed metamizole drops.
Didn't use many of those as they sometimes give me kidney pains.
All they prescribed me afterwards was ibuprofen. The general rule around here seems to be that if they're not using a knife, they don't give you opioids. I had to get 6 stitches in my head a few years ago, and they refused to give me anything stronger than ibuprofen again.
If they wanted to, they could have gotten away with "take extra strength Ibuprofen", but what is their incentive to do that? They don't want patients telling the next guy "It hurt a lot" after.
That kind of rubs me the wrong way, but I'm not sure why. I like having the option of overriding the doctor if I disagree.
But really, when things like opiates are involved patient input is rarely useful.
Since there is no method for determining the level of a patient's pain, and opiates are for pain management, how can you conclude that?
* Removal of agency from the patient in relation to how their body is treated; anti-individualism.
* Decision making power assigned to an agent who does not have skin in the game; anti-system-thinking.
* Attitude runs counter to having a strong sense of personal responsibility; anti-some-morality-systems.
* Imposition of doctors value system overrides patient values; not-sure.
Here in Australia, I haven't been to an optometrist in 5 or 6 years. I just keep ordering new glasses for $60 a pair online, my vision hasn't changed enough that I feel that I need to go to an optometrist again. The optometrist is legally required to give me my prescription, which I can then use as I want.
I haven't bought glasses in a brick and mortar store for 5 or 6 years (last time I got an eye test), but I'm fairly sure they won't/can't refuse to make me a pair to my specifications. Actually, I did get a pair made in the shop in Vietnam 2 years ago, and they were more than happy to make them (overnight too, I might add), although they did laugh at how blind I was.
The idea that people, absent the profit motive, will work solely to the benefit of society is not correct. They're always selfishly motivated - career advancement, risk aversion, corruption, etc.
For example, if the doctor gets punished for prescribing to junkies, he's going to reduce his risk by avoiding prescribing to legitimate pain patients, just to be on the safe side.
Pray you don't get into a situation where you've got painful, terminal cancer and the doctor won't prescribe opiates because you might get addicted.
I have a little stack of benzos (valium, xanax, some others) that I use on the odd occasion, despite not being prescribed. Obviously possessing them is illegal. I know that I'm sound enough to know when to use them and when not to, and they've saved me a lot of avoidable pain. I wouldn't go so far as to say they've saved my life, but they've come damn close.
I also use my fair share of recreational drugs, as I've mentioned in previous comments. I know I'm good for them, I practice harm reduction strategies and rave safe. However, I am aware that not everybody is me. There are people who have amphetamine habits, or benzo habits, or {{drug_of_choice}} habits. It's by luck,good planning, and good friends that I don't have a habit and manage to use drugs without causing excessive harm.
That's something that a lot of readers here seem to forget. The average HN reader is very intelligent and usually very capable of looking after themselves (although I am aware there is a fair share of HN readers who've had struggles with addiction). Not everyone is as switched on as the average HN reader though.
If you're American - my guess is it is cultural: you don't want someone else making decisions for you, rather, they should be making suggestions and you have the final say. American culture extolls autonomy/individualism.
I think this is explains some of the differences between the US and other developed countries when it comes to drug abuse and over-prescription. In the US, the doctors tend to defer to the patient on what's good for them more than elsewhere, especially around pain management.
I saved mine after wisdom tooth/root canal combo and used them as mood enhancer later.
I am not sure I am addicted to them though. I find this theory hard to believe that opioid overdose is an end result of series of missteps starting from wisdom tooth oxy prescription.
Why is that? Something in their genetic makeup? Wonder if its possible to identify these ppl preemptively.
I haven't abused opioids for recreational purposes, but I know people who have saved their prescribed codeine and gotten fucked up on it. They aren't addicted. I also walk to the supermarket every day, past the safe injection centre filled with smackheads. I've seen dead heroin addicts wheeled into the ambulance.
Not everyone is as susceptible to addiction as others, but the more opioids/alcohol/other drugs you take, the more likely you are to get addicted.
To some extent, I can understand this rather uncharitable conclusion. It's like explaining being in love to someone who hasn't been. Addiction is difficult to explain without having experienced it.
Nonetheless, what makes me side with the addicts, so to speak, and their helplessness, is that when I look at the 'whole' of their person, many of them clearly don't lack willpower or discipline in other areas of their lives. I've either seen the addiction infect the rest of their lives, or seen them being functional, even successful, in other areas despite the addiction. The only conclusion I can draw is that some (most?) people are just unusually susceptible to certain vices.
You can certainly blame one bad doctor. You could probably blame a group of associated doctors, if the problem was associated with a certain hospital or medical school.
But when the problem is something that thousands and thousands of individual doctors mess up, it's hard to blame them all.
Personally, I blame the slimy Purdue salesmen and the idiot bureaucrats who let prescription drug companies advertise prescription drugs on TV, or give kickbacks to doctors who prescribe their medicine. Without these awful incentives, you wouldn't have this widespread failure.
The analogy doesn't work 100% but pretty close :)
Most web developers that I know who have this problem fit this description. they don't like doing any of this, but it's what they're told to do. Or alternatively they're barely 'developers' and care about other things instead (many designer-developers, for example).
Obviously doctors continuing to hand out pills (opioids, statins, etc.) to patients who really need therapy, exercise, or dietary changes is helping to reinforce the problem.
https://www.amazon.com/dp/B00U19DTS0
In short: pharma companies for misrepresenting an editorial in the 80s about addiction rates, medical industry calling pain the fifth vital sign, and enterprising drug dealers setting up Domino's like delivery services for heroin.
Why are people using drugs at staggering quantities? Whether it is "recreational" or seemingly necessary, mind-altering substances are being used for a reason and I don't think this country has a good answer to why. We certainly do not have a good way to solve this problem.
Obviously these drugs are addictive, and if you're already in a bad place bc you went from a great stable job in your 30s to pseudo-welfare in your 50s, you're more vulnerable to addiction
It might be convenient to ask for that "one prime mover", but the reality is usually way too complex for that.
So, the increase in deaths is likely because of drugs becoming more deadly. How are drugs becoming more deadly ? It seems like this is how:
> Strong synthetic opioids like fentanyl and its analogues have become mixed into black-market supplies of heroin, cocaine, methamphetamine and the class of anti-anxiety medicines known as benzodiazepines. Unlike heroin, which is derived from poppy plants, fentanyl can be manufactured in a laboratory, and it is often easier to transport because it is more concentrated.
> In some places, the type of synthetic drugs mixed into heroin changes often, increasing the risk for users
So, preventing this blending of drugs could potentially improve the situation
> The number of opioid users has been going up “in most places, but not at this exponential rate,” said Brandon Marshall, an associate professor of epidemiology at the Brown University School of Public Health. “The dominant factor is the changing drug supply.”
Not sure how this happens is explained in the article, but that could potentially be another attack vector
Drugs have infiltrated every level of society, from business leaders and politicians to white and blue collar workers, to the bums on the street.
Drugs are causing tens of thousands of deaths a year in the US alone. I dread to think the global total. The casualties of this war are mounting up rapidly. This is before we even count the criminals and enforcers killed in open combat.
Whole countries are on the verge of civil war or just plain collapse.
Yet in most countries talk of reform is either treated disparagingly or suspiciously, as if all the speaker is interested in is a quick toot, or as if they are a collaborator or traitor.
It's sick, it's weird, and it's deeply disastrous.
Meanwhile in Portugal, where possession is decriminalised, things seem to get better all the time.
It shouldn't even be a question about the morality of taking drugs or the hypocrisy of trying to stop it while carving out extensions any more - it's way more important than that.
Sure, but play this against "The legislative environment created by the War On Drugs creates such overwhelming negative externalities, in our own country and beyond, that it costs much more in terms of both tax and lives."
(Actually I fundamentally disagree - health care is a common good, and society does not really get to have this oversight. If it did we'd see bans on extreme sports, for instance)
[0] Or severe alcoholics, for that matter.
Feel free to substitute "middle-class" for "bourgeois" if it sounds less political or inflammatory to your ears.
Indeed, Portugal has invested massively in the kind of healthcare and drug-treatment infrastructure that's required to effectively handle the inevitable results of decriminalisation.
Whatever you want to say about drugs or drug policy, the people who do them aren't just minding their own business. One way or the other, the rest of us have to respond to it. Complaints about the "hypocrisy" of attempts to reduce use simply are not serious.
And, as I said above, it's a position that rarely survives prolonged interaction with actual addicts.
No,, Portugal has invested massively in the healthcare and drug treatment programmes that you need whether drugs are legal or not.
The US could implement all of those tomorrow and still keep drugs illegal.
I don't quite get the hypocrisy angle. He's not making rules that apply to everybody but him.
I would guess legislation around what you can and can't put into your body is around the amount of harm and suffering caused ty you(& by you) after ingesting these substances.
Different people have varying vulnerability(changing throughout their lives) and more likely to seek escapism at certain points in their lives. Legislating against subtances stop them from being widely sold & readily available.
Seems pretty common sense to me.
(with allowances for existing(read normalised) special cases, namely: alcohol & tobacco) I can see tobacco being phased out completely in the next century.
Edit: just realized the drug death count is only for ODs, so the overlap wouldn't be significant.
[1]: https://www.nytimes.com/2017/02/15/business/highway-traffic-...
The US consumes about 99% of the world supply of hydrocodone. https://www.washingtonpost.com/news/wonk/wp/2017/03/15/ameri...
These figures are old (2015), but eye-opening.
http://www.painpolicy.wisc.edu/who-regional-office-americas-...
http://www.painpolicy.wisc.edu/sites/default/files/sites/www...
http://www.painpolicy.wisc.edu/sites/default/files/sites/www...
Here's EURO
http://www.painpolicy.wisc.edu/sites/default/files/sites/www...
http://www.painpolicy.wisc.edu/sites/default/files/sites/www...
You can use that site to compare regions. http://www.painpolicy.wisc.edu/explore-data
I worked in an inner-city setting servicing the addictions and psychiatry population as the fentanyl crisis started evolving several years ago. I would see the usual patient every day with no signs of instability, until they suddenly disappeared for a few days and were later found to have overdosed. Perfectly ordinary, pleasant people.
We try to prevent these events by sending teams around to check up on them daily. However, resources are limited and we couldn't closely monitor everyone. One of our patients had come across multiple close calls, but no amount of persuasion would entice him to use his drugs in one of those public injection sites, or to invest more heavily in drug therapy.
I have some hope for injectable hydromorphone programs being offered in pharmacies. Patients would come into a private room with a dose already measured out by the pharmacist. Pharmacies can already offer an unparalleled degree of monitoring since they see their patients on a daily basis.
It's really true that the world works backwards. That's hundred of times the deaths from terrorism, yet the US government is completely ignoring this trend.
If heroin is criminalized, so should be these practices, yet everyone is making money off of this: corporations, doctors, shareholders, politicians.
Another weird thing, there are already loads of deaths through overdoses in the inner city, but only now it is an epidemic? What changed?
I think there may be some argument for legalisation but with medically-supervised consumption in pharmacies or specialised clinics.
Overdoses could (excepting human error) be removed entirely with improved dosage calculations from experienced healthcare staff.
My understanding is the opioids are already regulated, controlled, and dosed appropriately, since most are acquired through medical prescription. Why so many overdoses, then?
My hypothesis is the drugs are addictive, and it takes more to get the same high each time, which eventually leads to accidental overdose.
Additionally, drug use can lead to feeling trapped and hopeless, and that might cause people to either carelessly or intentionally overdose.
overdoses can happen in many ways. sometimes it is genuine user error; ie, the person goes overboard and simply takes too much, or they don't properly account for the drop in tolerance after a period of abstinence.
> most are acquired through medical prescription
this might be true overall, but i'm not sure it's true of illegal/abusive use of the drugs. i can't easily find precise numbers, but prescription drugs appear to account for less than half of total opioid overdose deaths [1].
this brings us to the next (and as far as i can tell, primary) cause of overdose deaths: variance in purity. the purity of heroin varies wildly, anywhere from 10-60% strength on the street. add fentanyl hotspots to the mix, and suddenly addicts are overdosing on what they consider conservative "tester" doses.
[1] https://talbottcampus.com/prescription-drug-abuse-statistics...
That's a sixfold increase. This is the key to understand overdoses. Keep in mind the last time you went a little overboard with alcohol, coffee, or even sugar. What would have happened if, unknown to you, you had actually taken six times as much?
The US has a well-documented, multi-year history of legalized Opium (and later) heroin usage. Bored housewives would order heroin kits from Sears mail-order catalogues. There were no mass deaths due to overdoses. Political propaganda that was aimed against the Chinese immigrants of the time was used to vilify Opium and led to the passing of the very strict drug laws that continue on today.
The solution is simple: Legalize Opium and let people smoke it as they see fit. It's addictive, yes, but no more than alcohol or tobacco and much less destructive than street heroin or synthetics. Another point: Functioning heroin addicts that keep down a job are not exactly unheard of, today. Most of them have good enough salaries to afford premium heroin and they manage to blend in.
Opium is not heroin but nevertheless, I'd go as far as claim that consuming pharmaceutical-grade heroin, as has been done legally for decades in the US in the past [1], does not lead to a massive increase in OD deaths. Addiction, sure, but again people don't drop like flies. Historic fact.
"Opioid" mortality has nothing to do with consuming Opium or pharma-grade legalized heroin, and everything to do with synthetic chemicals controlled by drug cartels, black markets and varying, unpredictable street substance purity.
[1] http://old.puaro.lv/media/images/Dzeltena_zemudene/nar3.gif
There's more people who use opiates than are prescribed here. Much Much more. OD's here happen because they can't get those drugs anymore, and go towards the black market. They don't bother testing anything from there, so they never know what theyre getting. That's the recipe for disaster here.
(may not be everywhere, but it's definitely at a lot of places)
People addicted to Oxy find it's cheaper to buy unregulated opioids that vary in potency. The overdoses happen because prohibition ensures their street supplied drugs are Unregulated.
Framing the problem is not just a matter of arbitrary mental games. Empirically, there is a real phenomenon, that people are dying more than they used to, and blaming doctors is the consequence of not reasoning properly about it. Unregulated drugs have always had the potential to have bad things in them, but if that is an increasing problem, we need to find out the root cause. Assuming doctors or drug companies have become greedier, assuming victims have become more susceptible to addiction, strike me as refusing to acknowledge what an explanation would even look like.
I don't think supply is limiting the amount of drugs that abusers are doing.
https://news.ycombinator.com/item?id=17608261
It's been effective in the countries that have tried it since. Overdose is the failure of dose management. Harm reduction is less profitable than addiction. Wars create jobs and huge profits. Collateral damage is the human cost. Success wasn't the goal.
"Analysts pointed to two major reasons for the increase: A growing number of Americans are using opioids, and drugs are becoming more deadly. It is the second factor that most likely explains the bulk of the increased number of overdoses last year."
And they are becoming more deadly because the street drugs are being laced with fentanyl.
At the same time the news is constantly full of stories about a rise in opioid overdoses.
Curious what a longer term chart would look like. This only charts 3 years. Is it normal, having such big annual changes?
I'm not sure that's what people meant when they requested drugs be regulated and taxes used for the greater good...
why should i have any respect for the legal system again? as opposed to seeing it as a dumb bully with no moral authority?
Off top of my head: The Pineapple Express, This is the End, Harold and Kumar go to the White Castle, Jay and Silent Bob strike back.
Studies show that legal marijuana is associated with decreasing opiate prescriptions
https://jamanetwork.com/journals/jamainternalmedicine/articl...
Advertising on television was a resounding success. Some "social media influencers" can hit $1M per ad post.
Going out and buying something would definitely qualify under "peoples' behaviour"
Stimulants are physically addictive. They modify signals in your physiology to increase signal performance, in some way, and the body reacts to the temporary performance boost. There is a craving for the stimulant the body has becoming reliant upon and a withdrawal in the absence of that chemical. This manner of physical addiction isn't a choice and everybody is roughly equally at risk. Even laxatives are equally physically addictive in this manner even though there is absolutely no modification to behavior from laxative consumption.
Pain killers, and other depressants, on the other hand, don't work this way. With a very narrow exception to extreme alcohol consumption depressants are not immediately physically addictive. They require a modification to behavior to be addictive. In this way marijuana, which has no known physically addictive properties, has shown to be addictive to a small segment of users.
I have always wondered how depressant addiction occurs. Unlike with stimulants we are not all created equal. Some people are more prone to addiction from depressants than others. Some few people do not find depressants at all addicting and even detest their use. It makes me wonder what is the primary behavioral switch that enables this manner of addiction.
I also don't think you'll find everyone is equally at risk from stimulant addiction in the way you describe, or that you can generalise across multiple, vastly different families of drugs like this...
Perhaps for some people that is true. I was given a strong does of opiates for pain at a hospital before and I did not find the experience either pleasant or euphoric. That level of numbness and loss of motor control was actually a dreadful and even fearful experience. It really made me question which was worse between that experience and the pain it relieved.
> I also don't think you'll find everyone is equally at risk from stimulant addiction in the way you describe
Are there exceptions?
I'm not quite sure what you mean by "They require a modification to behavior to be addictive". If you take opiates for a while, you're likely to become physically addicted as the receptors in your brain start to regulate differently due to the presence of the drug. If you take crack cocaine for a while, you'll likely become physically addicted (or at least dependent) in a very similar way (though with very different withdrawal effects).
You mention cocaine versus opiates. A major difference there is that cocaine doesn't require repeated use to be addictive. It is immediately addictive and may result in drug addiction even many years later: https://en.wikipedia.org/wiki/Cocaine_dependence#Risk
Opiates are not immediately physically addictive. It takes repeated dosage for addiction to set in. Typically this is a result of pathological changes resulting in a combination of modified neuron-physiology and adjusted behavior. For depressants to be addictive it seems there must be some manner of behavioral persistence that drives the user to continue consumption in addition to physiological adjustments. If the drug is not immediately addictive the user must then use it repeatedly to build addiction.
There has been research that indicates this is the pattern of addiction for cigarette use even though the primary drug present is nicotine, which is a physically addictive stimulant. While nicotine is physically addictive not everybody who smokes cigarettes becomes a dedicated smoker. It takes more than the physical addiction to nicotine. This has been identified by research as well, and much of that research indicates it is a combination of certain demographics and personality profiles that most likely triggers cigarette addiction. This research indicates these individuals are identifiable and their degree of addiction prevalence is predictable.
While cigarettes are not depressants the point illustrates the difference between a purely physically addictive quality and actual addiction in practice.
Further, you've contradicted your own point in your spiel about nicotine.
I really don't think your ideas are supportable.
(edit: in fact you can find figures for the percentage of people who, having tried heroin once, go on to develop dependency - it's around 23%, far higher than for cocaine.)
How so? I stated that it isn't the nicotine or its addictive effects that make cigarettes addictive even though research indicates nicotine is universally addictive. A cigarette is not nicotine.
> I really don't think your ideas are supportable.
There is sufficient medical research to dictate whether or not these ideas are valid. The question I am trying to raise is to what degree behavioral medicine is more a factor in this than physical medicine, but I honestly feel you are deliberately ignoring this to prove some point.
> The question I am trying to raise is to what degree behavioral medicine is more a factor in this than physical medicine,
Well that didn't come across at all in your earlier posts, and I think you probably have a lot more reading to do.
I very clearly did not say that and expounded on it in pretty good detail. Again, cigarettes are not nicotine.
But that is the main addictive chemical within them, and you tried to make some sort of distinction that it was unusual that addiction was dependent on circumstance for cigarettes and nicotine as compared to other things you consider, wrongly, to be immediately addictive. You also said this -
> it isn't the nicotine or its addictive effects that make cigarettes addictive
Which is just bollocks.
I'm not disputing that there are behavioural and personal differences in drug response, that much is immediately obvious in that some people get addicted while others don't, and that people have preferences for different drugs.
It's your wide categorising and weird ideas about addiction that are unsupported.
Honestly I think I'm done here. You've got some very strange views which really aren't valid.
In science nothing is obvious and everything is open to scrutiny. Obvious is synonymous with oblivious or foolishness.
> Which is just bollocks.
Why? Blaming only the stimulus and simultaneously ignoring identified behaviors is not scientific. There is more to addiction than that. It also suggests the addict isn't not an important part of addressing or curing addiction.
> It's your wide categorising and weird ideas about addiction that are unsupported.
Everything you have said to me hinges on your claims of "obviousness" and emotional distress at broad categorization. Unfortunately, you don't describe either in any meaningful way.
Nobody's doing that. Nobody is ignoring that behavioural factors contribute to addiction.
But you are making weird unscientific claims and spouting utter nonsense like "it isn't the nicotine or its addictive effects that make cigarettes addictive"
I mean seriously, that's utter, utter nonsense that can't be dressed up scientifically in any way at all. Nicotine is highly addictive. Nicotine is addictive in cigarettes, in e-cigs, in snuss, chewing tobacco, gum, inhalers, patches, all forms that people take it. Yes, addiction to any of these has a social and psychological aspect as well as a variable physiological aspect depending on the individual.
But to claim that nicotine isn't what makes cigarettes addictive is so insanely far wrong that, really, it's just stupid and goes against the evidence on this subject.
> Everything you have said to me hinges on your claims of "obviousness" and emotional distress at broad categorization.
This is also wrong. I've pointed out that you are factually wrong in your categorisation of drugs into two groups, factually wrong in declaring that one group is magically instantly addictive and one not, I've explained to you that your ideas on cocaine were not only wrong but weren't supported by your source material.
The vast majority of what you have said has been just plain incorrect. This is not emotional distress - you just haven't got a clue, and you can't back up your weird assertions and distinctions with evidence.
What it seems like is that you empathise with addiction to stimulants, possibly having had experiences and addiction issues with them yourself. But you don't empathise with people who use what you call depressants. You're taking subjective judgements and unscientific ideas and trying to dress them up or justify them as scientific.
‘Depressant’ addiction occurs because they’re physically and psychologically addictive.
You may want to do 5 minutes of quick research before writing posts about subjects you are unfamiliar with in such an authoritative tone.
Conversely, as a former heroin addict and alcoholic who also used cocaine and amphetamines without developing addictions to either, I wonder how people develop addictions to substances with no physically addictive qualities.
The addictive quality of meth lies in the physical adjustment of neuron pathways in the brain. While the specific gene triggers associated with meth are known and likely specific to this drug the physically addictive pattern is not radically different from other stimulants. Essentially meth stimulates certain specific neuron pathways in the brain. The brain becomes reliant upon the drug for a greater than normal performance in the adjusted neurons. While there are behavioral results from this adjust the changes are to the physiology of the brain. Withdrawal is present when the patient is removed from the drug in a pattern similar to all other stimulants.
Even regular caffeine intake results in physiologic symptoms when consumption is halted.
As for cocaine there are very many reports and research that describe the physiological addition attributed to the drug. This is about as well accepted scientifically as climate change and evolution. There are numerous research examples of red blood cells choosing cocaine attachment over oxygen studied from blood of addicts.
> You may want to do 5 minutes of quick research before writing posts about subjects you are unfamiliar with in such an authoritative tone.
Perhaps instead of attacking people with baseless claims you could point me in the proper direction with research.
The stimulant/depressant dichotomy doesn't hold by the way. For instance alcohol's effect on the brain is not only very non-specific but also not very well understood whatsoever (see https://en.wikipedia.org/wiki/Alcohol_(drug)#Pharmacology or the lecture). Or more precisely it (dose-dependently) acts directly or indirectly inhibitory or excitatory simultaneously in various parts of the brain.
And whatever mess mixed intoxication causes in your head...
The most clear indicators of brain damage present in withdrawal are destruction of GABA and dopamine receptors that can result in a variety of behavior problems. The dopamine receptor damage is at least partially resultant from the liver damage.
* https://en.wikipedia.org/wiki/Alcoholic_liver_disease
* https://en.wikipedia.org/wiki/Alcohol_withdrawal_syndrome
> Please watch this before making other plainly wrong
Perhaps you should have your facts together before attacking people with divisive bias.