Overdose Deaths Set a Record Last Year
nytimes.com
nytimes.com
Seem to remember us joining the Afghan war for fewer deaths.
China encouraging the flow of opiates to a western port city to try to obtain political cooperation?
Societal stuff is often natives coming into town already in poverty escaping reserves and getting into it, and also people from just across Canada in general that are maybe already addicts. Vancouver has the most mellow climate in Canada as well if you are homeless. East Hastings where it was concentrated was kind of a place hard partying loggers would go and hook up with escorts in cheap motels for a week, so it bred a bunch of bad stuff that never went away 40+ years later.
Also neighbouring districts and suburbs don't support their homeless populations so it was just concentrating. Now that there is a affordability crisis here every suburb around has a crazy homeless tent city in parks they are kicking out and moving every 2 months, and opiates def play a big part in those. But the suburbs are full of sort of white baby boomer or new landed chinese immigrant populations who aren't used to dealing with it and don't want any homeless shelters built in their neighborhoods.
The stories that make the news the most are probably the same ones in the states where it is like white kid in suburbs taking a fake xanax with fentanyl or a MDMA pill probably pressed in a same pill press or having fentanyl mixed in for whatever reason and OD'ing.
There are narcan administration classes all the time and it is given to and by night life workers because fentanyl is showing up in party drugs like cocaine and mdma. Lots of friends said they have quit their favourite extracurriculars but they get drunk and in a good mood and forget at 2am, or they know their dealer etc... Pretty scary.
I honestly and truly believe that opiates (and all drugs) should be legal. I think you would find the number of overdoses drop drastically if that were the case.
No one wants to do fentanyl, it doesn't last as long and feels weird. Heroin itself is very safe if it's not cut and the purity is known ahead of time.
Heroin might be relatively safer than fentanyl. It's a terrible drug that ruins live and families and has been for centuries. It irreversibly harms your brain, wrecks your veins, is the most addictive common drug, and is tolerance-forming.
Moreover, it only harms your veins if you shoot it.
It is addictive and tolerance forming, but that's about the only downside.
Let's take myself for example. I have a good salary and used to spend maybe 40k/year on heroin. That's a big cost for sure, that's why I quit. But because I could afford to do it, there weren't any other downsides. In fact, there were a lot of upsides.
I worked harder and longer than any of my coworkers could even dream of. I could pump out high quality code for 20 hours straight. No one knew I was addicted to anything. In fact, over the 2 years I was addicted I got promoted and got huge bonuses every year for being a quote "killer".
People think the common social effects of heroin (stealing, homelessness, etc) are inherent to the drug itself, but that simply isn't true. These negative effects have more to do with the laws and culture we have built up around the drug, not the drug itself.
Nitpick, but, heroin hasn't been ruining lives for "centuries." It wasn't even invented a hundred years ago.
What I'm in disagreement with, is the stance that "as long as one is self-sustainable and does a good job", there's no real problem to it". Now that might not be what you wanted to say, but I think it's a reasonable enough reading of the text.
I have many friends who are addicted to Cannabis, who all have good jobs and do good work. But compared to other friends I feel I can see a certain lack of grander, more personal ambitions. Now I might just be confusing the direction of the correlation here, and Heroin is probably a whole different beast. I guess, I just want to say there's more to life. And some drugs might open certain doors in your mind to deeper meaning, but my (limited) observations lead me to the conclusion that addiction to drugs tends to be more of a door-closer.
I knew a guy like that. He took heroin and cocaine and was highly functioning in his professional life. His private life was a mess though. From time to time he disappeared for a week or two but professionally he did ok. But over a few years he got more erratic and things started to fall apart.
Based on that experience I think there are a lot of drug addicts around but nobody notices. Especially in upper management I suspect a lot of people are on something to keep up with pace.
Everybody notices. Nobody talks about it. I hope you understand you are one of the lucky ones, and that it eats people and family alive. Social programs and mental health programs ... social workers involved in that area could probably write books. It's a horrible, horrible drug. I never said it was neurotoxic. It just is just a big old dopamine button and it's incredibly difficult for many people to not let it consume them (to the point of stealing and lying from whomever is necessary). The tolerance that builds up and the pain of withdrawal make people do things they would never do otherwise. A really substantial number of people can't self regulate opiates (Prince, Tom Petty, Philip Seymour Hoffman, and 70,000 other people per year) and dealers can and will trap regular people in addiction to the maximal extent they can. If it's legal, it will only get worse.
All the stuff you wrote also applies to alcohol and there we decided a long time that prohibition doesn't work.
I really don't care about the policy that much, either, I just wanted to strongly push back on people minimizing the dangers of heroin. It is a lethal, life destroying drug and it's one of only a few I would strongly advice people to never even try once, regardless of legality. If I can convince a single HN commenter to avoid it, then I'm happy.
Yes this would allow addicted people to participate in normal life openly and allow for therapy options. Prison is very expensive so that money could be shifted to treatment.
BTW, don't minimize the dangers of alcohol. Alcohol is often involved in traffic accidents, domestic violence, and gun deaths. It also has a lot of negative health effects. A huge number of people die from alcohol every year.
Almost everyone agrees that despite the harms caused by alcohol, we were even worse off under prohibition. Why would the same not be true of Heroin?
Overall harm between the two may be similar, but there are an order of magnitude more alcohol users, then heroin users.
(I believe that legal access to heroin for addicts will save lives.)
That is an exaggeration. In polls a sizable proportion (~20%) are still in favor of banning alcohol.
Popular assessments that we were “worse off” during prohibition are based on decades of propaganda and mythology rather than careful analysis, and a confusion between the effects of prohibition and the effects of the great depression.
e.g. from a quick web search (there are probably better resources)
https://www.nytimes.com/1989/10/16/opinion/actually-prohibit...
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1470475/
(Note: I am not personally in favor of prohibition.)
It seems that Prohibition brought about improvements in social problems rooted in self-harm, but a worsening in crime and random violence linked to the black market.
People don't want to be the victims of random violence, and they don't care about self-harm that much. Someone drinking away their liver is that someone else's problem.
But, speaking of self-harm, one thing not mentioned in the above references is that black market liquor is dangerous, due to the possibility of being contaminated with methanol. Prohibition doesn't eliminate self-harm. It may be that fewer engage in self-harm, but those who do are gambling with higher stakes.
There is a bit of a parallel there with fentanyl-laced opioids.
The claim was “almost everyone agrees that [..] we were even worse off under prohibition”, which is a clear exaggeration. Your response is a non sequitur.
> People don't want to be the victims of random violence,
People don’t want to be the victims of domestic violence either, which is very commonly caused/exacerbated by easy access to alcohol.
It’s not clear that prohibition had a large impact on the overall level of random violence, pop culture mythology notwithstanding.
I can understand why it would be more dangerous, higher binding affinities mean smaller recreational window.
Also, you can tell by the feeling.
I question this. I recently watched Netflix's Dope documentary and they talk about how an increase in overdoses due to a stronger batch (i.e. cut with more fentanyl) leads to higher demand on the street because addicts want more potent drugs.
Older doctors are aware of this. But younger doctors have been taught recently at med school that opiates must only be used for acute, post-surgical pain. So an increasing number of chronic pain patients are being cut off from licit avenues, and turning to the far more dangerous street drugs.
I think the response of younger doctors in regards to cutting down prescriptions to opiates has more to do with avoiding the moral and legal entanglements with prescribing something that will long term cause chronic pain than it does an unwillingness to prescribe.
Western medicine has long been accused of being too focused on acute conditions. The pendulum is swinging in the other direction. There will continue to be doctors that find and understand balancing these risks to optimize a life, not just a body. There will also continue to be clinics that find and understand balancing malpractice insurance, not just patient throughput.
From a harm reduction perspective, taking a patient who is, say, addicted to legal oxycodone because they were overprescribed it. Now what do you do from the perspective of what's best for the patient? Is it a good thing that they're addicted to it? No... but is it more harmful to cut them off cold-turkey? Or is it better to help work with them to figure out how to get off it in a way that doesn't result in them seeking out street drugs to handle the withdrawal?
Increased suicide rates, depressions, and loneliness seems a much more likely culprit for increase addiction behavior in a nation.
Anslinger being put on the US team for the UN Committee on Drugs put paid to that, and pressured other countries with less punitive drug approaches. Anslinger has much to answer for; perhaps the one doctor who forgot "discourage" does too.
For those who don't know, the British System was once globally famous, and briefly put was "discourage, but prescribe"[0]. When it was overridden with a more recognisable war on drugs there were only hundreds of addicts in the UK. No one connected addiction to crime.
Highly doubtful we could return to that state, even if it was successfully continued.
[0] https://www.vice.com/en_uk/article/yw4nnk/when-boots-prescri...
11/30 article on topic: https://www.washingtonpost.com/business/2018/11/30/after-rec...
Data source: https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm
There is certainly far more work to be done.
And if the difference is merely dose and you're suggesting people should do it or otherwise they won't get the effective painkillers, this seems like an obvious injection of cost disease into the existing stupidly expensive healthcare system.
I never suggested people do anything. Just explaining certain changes to the system as a result of the crack down.
But I think the thought is requiring the Rx Tylenol be tried first does successfully deter people who fit drug seeking behavior and second physicians were to often writing opioids as a first line of defense to pain, whereas Tylenol will work just fine for most.
My guess is studies also show that overall healthcare costs go down and not up as you say. Maybe in those instances a patient really needs the opioid for pain they have a slight cost increase, but for many others it will save them from addiction, weed out a lot of drug seeking patients and the costs associated with addiction/hospitalization/OD/etc.... There are a lot of hidden costs in opioid abuse.
Still it’s not my rules or changes, if you don’t like it and think you can show in the aggregate these changes are driving up costs in healthcare to the detriment of patients who legitimately need opioids, write your congressman. But I don’t think to many people will give your stance a sympathetic ear so long as people who do need them can still get them.
After some emergency dental work last week, I was given Rx Tylenol. It has a low dose of codeine, which is an opiate.
> None of my pharmacist friends will even fill an opioid anymore until the patient has filled and tried using a Rx Tylenol first.
Is an oxymoron? (Opioids are a superset of opiates, for what it's worth.)
There are scales to this stuff, like you wouldn’t lump heroin or morphine (both opiates) with Tylenol with codine (then again...maybe you might), but that’s the point you said you didn’t want to have a highly trained pharmacist fill your Tylenol, but based on all the questions you have, that is probably the most appropriate course of action. Then you can get a handle on the risks of these therapies, the difference and allow that to inform your decisions.
I'd imagine you'd need some sort of formal study of the data to try to assign why deaths are starting to decline/plateau and what share a certain thing is responsible for, there are other possible causes.
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Opiate prescriptions are falling pretty significantly. Number of prescriptions is down 22% from 2012-17, and volume (mg of opiates dispensed) dropped 12% in 2017 alone. https://www.aafp.org/news/health-of-the-public/20180425opioi...
That could be contributing to a decline in the "pipeline" of new addicts. Less people starting on them and lower doses and shorter durations when they are prescribed.
It would make sense for a decline spurred by that to not show up in opiate deaths for a few years, my impression is that most people spiral downward for a while before actually dying/ODing.
see: https://www.npr.org/templates/transcript/transcript.php?stor...
The War on Drugs was, from one point of view, essentially a soft invasion of central and south American countries; we sent DEA and military "advisors" to burn the crops of farmers while the CIA treated narcos like Soviets.
Indisputable that, eg, yes mexican farmers were growing kush (or making coke, etc) at the behest of powerful cartels. They were totally doing that.
It did not spend as much effort on why and how drugs became what they are in our own country; laws had disproportionate impacts on some communities; treatment was the refuge of the privileged. Slaking the need for drugs is more than border enforcement, from this perspective.
So yeah, some dope comes from point A to point B, so stop it from making it to point B, but also look at what's going on at point B to fix the problems that aren't trafficking.
Fundamentally it's America's problem. A Chinese crackdown might impair it a bit, but this approach didn't work for Latin America-supplied drugs, and it didn't work for weed, so why do people expect it to work now?
No, the real solution involves getting to the people at risk and helping them. Which is something so completely out of character for the US political system.
Fentanyl is a significant issue and discussing what China intends to do about fentanyl certainly is warranted (seems like discussions are underway to schedule it in China -- https://www.cnn.com/2018/12/01/politics/fentanyl-us-china-g2... ). But one compound isn't the full problem here.
I didn't know anything about Methadone until I'd taken a few people to the various methadone clinics. I thought they were just medical drop-offs... and thought it odd that their trip home was just a few minutes later. Eventually I learned these people were going for their daily dose of methadone. One fellow said he'd gotten addicted to painkillers following a car accident, and that he'd never imagined himself needing to visit a methadone clinic every day.
Towards the end of my taxi driving experience, I had a woman going from WalMart to a half-way house. She'd spent 5 years in prison for sharing a single opiate pill with a friend (circa 2010). She said something about the cop who wrote her up for prosecution chuckling as he filled out the form. Over her five years in prison several of her fellow inmates died from neglect. She'd gained a lot of weight on prison food, which isn't very nutritious.
Apparently the State of Arizona is negligent-homiciding prisoners in the name of helping them correct their behavior, which doesn't make much sense to me. I'm sure all the other states' jails and prisons have similar conditions.
They just want to punish people, they don't care about correcting behavior.
The NYT article has comparisons on the absolute level (i.e. comparing to peak car crash deaths and HIV deaths from 20-30 years ago) - but those are outdated and misleading because they not relative and don't account for e.g. population growth.
I am just trying to get a sense for the true magnitude of the problem, beyond the scary headlines.
https://www.cdc.gov/injury/images/lc-charts/leading_causes_o...
https://www.cdc.gov/injury/images/lc-charts/leading_causes_o...
I assume overdoses are classed as "unintentional poisoning" - they're the leading cause of death for ages 25-45, nearly double car accidents and 3x suicides. They're a very small fraction of deaths by cancer & heart disease, but those usually happen after 50+. In terms of "preventable" deaths they and car accidents are by far the biggest culprits. I'm surprised there's not more of a push toward self-driving cars and mass transit, but other than that it makes sense to focus on overdoses.
The other interesting thing that stood out to me in the data was how much the homicide rate has dropped since 1980. We have this perception that the world is getting more dangerous, but it's not actually reflected in the data, and by far the biggest danger to us now is ourselves.
There are groups of people who we don't care about, and there are groups that we do. What's scary to people is the metastasizing of the problem from one group to the other.
"Since 2013, the number of overdose deaths associated with fentanyls and similar drugs has grown to more than 28,000, from 3,000. Deaths involving fentanyls increased more than 45 percent in 2017 alone."
28,000 is a lot (same order as motor vehicle deaths), especially coming from 3k not long ago
there are a lot of people legitimately in chronic pain who are turned away or get the run around because we're cracking down on the wrong thing.
Time until everybody in USA is dead of opiods: 120 years
Use of pharmaceutical grade psychedelics in a clinical setting might have some benefit.
I think it's undisputed that there would be a lot fewer deaths per addict if the heroin available were (1) of a known concentration, (2) not fentanyl, and (3) devoid of other harmful adulterants.
The problem people argue about re: legalizing heroin is that they expect the number of addicts to rise.
Having made poor choices in the past (drugs) they now have the neuro-chemical pathways cut into their ~brians~ brains; literal ruts that signals will prefer to get to the end-state (high/low).
With enough use, heroin doesn't leave a person with choice, but rather impulse.
[edit] lol, brians [/edit]
n.b. My brother died of a heroin overdose. He made that decision himself and the existing laws did not help prevent.
FTFY. Since you care so much, please grant me control over your life to approve what you consume.
Videos still float around, but they seem to have this voyeristic leer to them (like malign scared-straight after school specials) that genuine footage or journalistic coverage usually doesn't carry.
On top of that, there aren't many people actually owning up to being involved in the footage that does surface, and people who claim to have witnessed instances or met individuals affected by it, only seem to be the kind to tell tall tales.
This leads me to wonder if it was largely a media campaign to get in front of a problem, and head it off, before something like its portrayal emerged.
One could say [...] benefit?
But more to the point, people are helped by information, and not perversions thereof.
If it were helpful it would neither be called disinformation nor misinformation. It would just be accurate information, applied in a practical manner.