U.S. overdose deaths plummet, saving thousands of lives
npr.org
npr.org
While many people offered theories about why the drop in deaths is happening at unprecedented speed, most experts agreed that the data doesn't yet provide clear answers."
Not one word about marijuana legalization.
"States With Legalized Medical Marijuana See Decline in Nonmedical Opioid Use" https://sph.rutgers.edu/news/states-legalized-medical-mariju...
"Legalized Marijuana Linked to Decline in Opioid Emergencies" https://www.upmc.com/media/news/071221-drake-cannabisrcl
only absolute increases (increases that go over historical highs), relative increases (increases that do not go over historical highs), and relative decreases.
This is kind of a failure of state capacity in itself. The opioid crisis happened "out of view", and remains out of view even as the situation improves. Without more and better data it's difficult to improve.
It also doesn't help that the opioid epidemic has overlapped with COVID, stretching CDC capacity.
https://www.nbcnews.com/health/health-news/narcan-opioid-ove...
> In the fourth quarter of last year, Emergent reported $111 million in Narcan sales, a 22% increase from the year prior. The increase was mainly driven by sales of the over-the-counter version, the drugmaker said.
This article indicates there are still challenges about availability in a retail setting, which would lead me to believe that more work put into that would reduce overdose deaths further. I would think a model similar to ubiquitous access of AEDs is what is needed (vending distribution, app to show location availability [similar to the Netherlands for AEDs: https://en.zoetermeer.nl/aeds], etc).
> Narcan, when given soon after an overdose begins, reverses these effects rapidly: The person will usually wake up within one to three minutes, according to the FDA. Because the effects of Narcan do not last long, it’s essential to also call 911.
(this is a system, which appears to be working, but can be improved to lead to improved outcomes at scale)
EDIT: Also room for preventative GLP-1 agonist use in folks prone to this addiction: https://recursiveadaptation.com/p/the-growing-scientific-cas...
> We've almost tripled the amount of naloxone out in the community," said Finegood. He noted that one survey in the Seattle area found 85 percent of high-risk drug users now carry the overdose-reversal medication.
Maybe, maybe not. I know someone who just got a prescription for opioids and was given narcan as a part of it. If that's the case more frequently it seems like more and more narcan will be out in the wild.
I know a lot of addicts as well, and every single one of them was so happy when it became possible to get Narcan easily and to get it without fear of extra charges if caught with it.
However - it doesn't work if you also took xylazine with your fent-oin, so that's a whole new problem.
But you are absolutely wrong in that statement - it may just be that your group of addicts is not particularly high functioning.
$35 on some level seems like a great deal for something that can save a life (or even 2!) - I just worry that for the crowd who really needs it the most, $35 might be tough to part with. (I realize that a lot of harm reduction programs hand it out for free, though).
Still, it's extremely encouraging to see that overdose rates are falling this much. I spent a little time a few months ago watching some of Andrew Callaghan's videos covering homelessness and open air drug markets and it's grim out there.
In the mid 1990s pill mills are overdispensing pain meds. I live in a pill mill area and saw the rise and fall first hand.
In the 2000s the feds are cracking down hard; pill mills are shuttered over the next decade.
Mid 2010s cheap fentanyl is being shipped to the US and opioid deaths are climbing. News orgs notice; politicians notice. Both blame the former pill-mill problem.
Late 2010s politicians pass laws sharply limiting access to pain meds and begin signaling that health care providers can be penalized for whatever the feds interpret as "over prescribing".
Chronic pain patients are suddenly cut off from pain relief that had enabled routine living - for years.
Faced with a loss of productivity or obtaining pain relief illegally, they choose one of those. I still see this first hand.
Patients find that their doctors are strongly resistant to prescribing pain meds when indicated. State laws limiting pain meds to 3 days compound the problem. Post-op and ER patients are increasingly prescribed acetaminophen for significantly painful events.
For the past 5 years: News orgs wind-down pill mill citations; ramp up focus on Fentanyl and need for treatment. Politicians attack Fentanyl but are divided about decreasing addiction through treatment - usually along party lines.
Politicians and news orgs are unitedly oblivious to the plight of pain patients.
They grow up fast.
Very little.
Narcan became approved for OTC sale at the end of March, 2023. As the numbers show, it turns out that widespread access to and timely administration of a drug that prevents people from dying from opioid overdoses prevents them from dying from opioid overdoses.
Edit: Do you know anyone who uses opiods? You might consider picking up some Narcan just in case they screw up and OD when you're around. You can buy it at Walgreens [0] and many other commercial pharmacies.
Everyone is prone to opioid addiction and overdose. If you got a prescription for Oxycontin and had no trouble weaning yourself off of it, you should consider yourself lucky, NOT special
I suppose to give weight to the idea that this the effect of greater availability of Narcan you could look at the number of users. Has it gone up or down?
Pot legalization would be trickier. Maybe rates of usage? Though you'd expect that to get up everywhere. Presumably you'd see a drop in opiate usage and a rise in pot usage.
I'm not sure how you'd quantify a shrink in the number of users because some percent realize the risk is too great - though shrinking number of users would be a clue.
If it's people prone to overdosing and dying having done so - I guess would look at the relationship between use rate and death rate. Is it the same? I'm not sure how you could differentiate (or if it matters) between people getting better and using the drugs and the deaths of people who did not use it successfully.
Drug use is usually seen as a poverty problem, and on this platform we are constantly reminded that the US has GDP figures that dwarf the European.
The US is loaded with systems that pressure resources and means upward. I spent the 2010s in hunger-level poverty, with minor children. My kids were a few of the millions, who got to experience getting their only-regular-meals in schools.
While not all, likely not even a majority, of people most likely to show up in OD stats are receiving that kind of support the share is likely high enough to be readily visible in statistics were the support to change substantially in quantity or quality.
Sure, some people hit rock bottom and get clean. Others just die. The second group is larger.
What most addicts need is some sense of stability in their lives, social/community support, and safe places to use along with clean drugs and paraphernalia to taper themselves off with. However despite being demonstrably the reliable way to get people out of the addiction hole, it offends the sensibilities of the mainstream and is therefore quite politically unpopular.
Family and friends' ability to support these people seems to be decreasing and forcing an increased number of addicts to speedrun it. People who would be moving in with a relative and casually trying to stay clean over months before backsliding, using up that support resource, spending months living on the streets and couches before deciding to fight the addiction again to in my limited view be more inclined to go all out fighting the addiction sooner now that the support is scarcer.
As I'm sure you know, a subset of people who are further along in the journey in states where public policy permit this and make it easy do sometimes use hospitals as short term shelter/food/care. Some of these people go around many times. I have decent visibility into these people by virtue of sitting 4ft from someone who spends their workday dealing in tracking this stuff for hospital regulatory compliance purposes (in the northeast where the climate is not kind to the homeless FWIW).
There are a lot more people showing up to ERs today saying "I have nowhere to go, I'm suicidal, the drugs are a problem, I need to be clean" these days than there were ~2yr (just eyeballing it on that number) ago when it was far more rare for the last part of that sentence to make a showing and it was far more routine for people to basically go through the motions to get discharged, blow off any after care and show up in the system again a few months later.
Edit: I use the distinction non-functioning in the first paragraph to separate out the functioning alcoholic and all the people who spent the 00s living a normal life while popping opioids their doctor prescribed them.
Their 1980s and 1990s actions led to the pill mill event. The feds sharply reversed it before "opioid crisis" became a trending term.
Over the last 15+ years, Fentanyl has been the (primary) physical driver. The list of social drivers is fairly unchanged.
Oxycontin was approved by the FDA in 1995.
The FDA dinged them for misleading marketing claims in 2003.
https://www.fda.gov/drugs/food-and-drug-administration-overd...
https://en.wikipedia.org/wiki/Opioid_epidemic
> Between 1991 and 2011, painkiller prescriptions in the U.S. tripled from 76 million to 219 million per year, and as of 2016 more than 289 million prescriptions were written for opioid drugs per year.
I don't doubt that fentanyl kills a lot of people today, but a lot of those currently addicted got started on pills legally prescribed to them.
Scripts written outside of pill mills were orders of magnitude lower in dosage and quantity. Lumping these very different numbers together paints a simplistic view of a complex issue.
> Between 1991 and 2011 painkiller prescriptions in the U.S. tripled
Years that include the rise/fall of pill mills.
> as of 2016 more than 289 million prescriptions
289M is a single broad number representing complex and distinct things. To determine opioid use trend, some of the things we need to know are count per Rx, dosage, med type and treatment type.
Institution (eg:ALF,hospice,VA) trends are distinct from public-facing doctors but we don't even look at them. We just lump their Rx #s into the pot.
An important number we don't have: Denial counts for reasonable need. Single-figure opioid views don't leave us room to consider it.
Chronic pain patients (who responsibly used pain relief for years) started getting shut out before 2016. That trend ratcheted one way. Their choice was losing what productivity they had or seeking illegal+risky options.¹
But as ever, the public and news orgs are much more interested in billionaires than vulnerable people in need.
¹These are things I personally witnessed.There are many reasons people try opioids. A large percentage of opioid addiction came from being prescribed by a doctor. Some people try it because they are looking for a way to make their situation in life not hurt so much. It's what their friends/family do. I'm not going to attempt to go into all of the reasons any one has ever used, but you should be more empathetic than your use of sane
I think that's the main factor which differentiates the US from the rest of the world. IANAD, but as far as I know at least here in Europe opioid painkillers are reserved for the terminally ill (mostly cancer), and the US shows why "normalizing" their use is a very bad idea...
To me, overdose deaths in people prescribed them by doctors are some of the worst. They’re frequently in younger individuals, meaning more life cut short; they were indirectly caused by a profession whose ethos is “first, do no harm”. To me, it is a sign that something has gone badly wrong in the medical profession and society at large and sows major distrust in our institutions.
Most of them transition to OTC pain management ASAP because they know the risks of addiction. I imagine people who don't know better take the full course, because that's what was prescribed, and end up at more risk for addiction?
This part still puzzles me, because the opioid crisis is really well known about. How does "my life is shitty, I'll improve it by starting on the drugs that are famous for ruining lives" add up for anyone? Is "but cousin Bert does it and seems to be OK so far, so I can too" really that persuasive? Or maybe it's all ultimately down to prescription pills, except they might be somebody else's leftover ones, and starting there seems OK because it's medical and safe-looking.
I present to you the definition of sane: 1. : proceeding from a sound mind : rational. 2. : mentally sound. especially : able to anticipate and appraise the effect of one's actions.
Being over-dramatic about it doesn't change the fact that the person doing the self-harm is not in their best condition. Yes, I have been there with alcohol and drugs abuse, I have lost friends and family members too. Treating them as people capable of deciding with their best interest in mind definitely didn't help me help them.
The thing that got him off the street was seeing a dentist, who pulled an infected tooth.
Turns out he was in extreme pain at all times, but didn't know it.
If we'd had universal health care he wouldn't have ended up homeless.
The biggest value proposition of universal healthcare (IMO) is preventive care, stopping minor issues from getting to the point of hospitalization.
From what I can tell, chronic pain eventually morphs into "background noise" in a person's life. It's there, but similar to depression or anxiety, it just becomes a new normal and people develop strategies to deal with it. Often that's drug abuse.
Quoting from this paper: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10035485/
...we found that limited information was reported on health outcomes in relation to quality of care within the context of UHC. In addition, there was a global lack of evidence on measures of quality of care related to UHC...
Anecdotally, I have had access to rather cheap healthcare almost my entire life, but opted not to visit a dentist for 15 years.
> From what I can tell, chronic pain eventually morphs into "background noise" in a person's life.
This has been my experience, personally and vicariously.
Edit: I realized the linked paper refers to lack of data on outcomes. That is not really the question here. However, it would be nice to get more data on outcomes. The question here is whether the individual would have visited a dentist without knowing there is an issue. I tried to find data on dental visits in universal healthcare systems vs non and could not find anything.
1 - https://fivethirtyeight.com/features/british-teeth-arent-tha...
— King Arthur, Excalibur (1981)
Second reason, ie compared to Europe is that US society is much less social, much more focused on oneself and inward, and if you fail there, you fail hard and very easily end up on street even from good white collar life. Nobody really bats an eye. Once down, its very hard to ever get up from the street, misery compounds and hard drugs offer some form of temporary 'escape'.
We're fed this grandiose American dream (at least in my generation), and when we fall short of achieving that we feel like we've lost. Nothing else matters, we're not a part of the lucky. We're inherently unlucky. Then it starts as just taking the edge off, trying to cope with these feelings, and soon enough it spirals and builds momentum, then you find yourself losing your grip on why you even got up in the morning or wanted to pursue anything at all. What's the point in trying if you'll fail again?
But the escape offered by addiction outweighs any reasonable or rational thought, it's just a foot out of this hell of trauma, depression, guilt, and shame.
Our country doesn't have safety nets (for the most part) and is survival of the fittest. It's difficult to struggle constantly, knowing that what you want to be is always out of reach.
There's still stress and anxiety, but a change of culture helped give me perspective.
For some people the drugs are better than the life they had before and so getting off them is very difficult.
They are a poor choice for chronic pain, since that population doesn't have particularly high life satisfaction. But they are an excellent choice for acute pain e.g post surgery, tooth extraction, etc. and people shouldn't be afraid of taking them in that context.
The epidemic you have heard about in the US is incentivized malpractice. Doctors giving a class of drugs which should not be used habitually to people with shitty lives.
There is also the fact that China ships an enormous amount of drugs through Mexico into the USA. They use it as a weapon to weaken society. It's sort of a payback for their humiliation in the last century and it causes issues for everyone, not just the users. Police, regular people, jails, court system, strains society and the costs of dealing with it are enormous.
It would be the same in wherever you are from if the streets were flooded with this stuff.
The second time is when I had a bulging disc pressing on a nerve. My leg felt like it was on fire 24/7. It was at this point I understood how people could get addicted. Luckily I only need the opioids for a few days until the anti-inflammatories did their thing.
There are some types of pain that are only dulled with opioids. With that said, the US overprescribed for many years. In both my cases I was given way too many Oxys that I eventually threw away.
The dangerous thing about opioids is that they're equally effective for both physical and emotional pain, and everything else we have to treat emotional pain might as well be a placebo by comparison. So some people with chronic emotional pain got prescribed opioids for their physical pain post-injury/surgery and found that the experience of life on opioids is just better, and the only immediate options they have at that point are either to manage chronic opioid use or go back to their life constantly sucking. In such cases it's tempting to pontificate about "root causes", but in my experience people tend to steer that toward their own political/sociological/psychological hobby horses and quickly lose focus on the problem at hand.
Also, while crack cocaine is far from harmless, its dangers have been overblown for political reasons, especially compared to the perception of powder cocaine.
> From conversations I've had with users, when you have internal voice that you can't make stop without the use of drugs then you look for anything.
Coming from a South american country I have to disagree. Cocaine is terrible (especially when is filthy cheap) and crack is even worse, because it costs like 1 dollar. Crackheads steal anything they can for crack and after smoking they terrorize the population like walking dead zombies, soon looking for more money, any money or anything that can be exchanged for more crack.
history will not look favorably on kicking the can down the road like this. we keep dodging the root cause to prop up a population that will cost the public an astronomical amount of money in healthcare and lifestyle cost. thats not even factoring in turning cities into hellscapes.
not only is this anti democratic (literally nobody wants to support junkies) but will lead to the rise of populists. how is it fair for middle class who have to pay tens of thousands, if not more, for healthcare cost every year?
> [describes war on drugs]
Doing this via law enforcement is going to require a level of intrusiveness that Americans are unlikely to tolerate (or be compatible with the constitution), along with considerable violence.
There's no possible way to guard all the borders 100% of the time, even less if there's huge profits to be made, people are smart and drug traffickers are people, they will find a way through. If you want to play a forever game of whack-a-mole then go ahead.
No, the US cannot completely stop the flow of drugs, it's not about the southern border, if that is absolutely sealed off other ways will be found to smuggle them.
Stop repeating bullshit propaganda and think for yourself, do you really believe it's possible? What would be the cost of policing 3000+ km 24/7, over and underground? How long would this policing need to happen, what would be the cost of this in total?
My go-to example is that it's apparently impossible to eliminate illegal drugs from US prisons.
If "somehow" illegal drugs are making it into an environment where The Authorities have complete control over the lives of the folks housed in that environment, there is absolutely no hope to stop them anywhere at all.
Harm mitigation and minimization are the only things that make any sense in the real world.
You can't stop 100% of it, but you can do whole lot more than what's going on now. The US has a duty to stop banned substances from entering the country, esp when they're killing people. The military budget is almost a trillion, how about reallocating that?
But if the border is too porous and impossible to defend against drug smuggling, what is your suggestion? I'll take a guess, because its a famous progressive theory, and based on your vitriol for my view: The government (or associated labs) to produce the drugs and provide them to addicts at low/no-cost, and provide even more $$ and services to addicts to continue their lifestyle? Yeah, thats propaganda and seems to be the leading theory among the technocrats.
As another comment mentioned: if you can't stop drugs getting into prisons, an environment surveilled 24/7 by authorities, full of guards, how exactly do you expect that a land border of 3000+ km can have any meaningful way to be guarded against smuggling?
> But if the border is too porous and impossible to defend against drug smuggling, what is your suggestion? I'll take a guess, because its a famous progressive theory, and based on your vitriol for my view: The government (or associated labs) to produce the drugs and provide them to addicts at low/no-cost, and provide even more $$ and services to addicts to continue their lifestyle? Yeah, thats propaganda and seems to be the leading theory among the technocrats.
The solution will never be a single thing, I cannot comprehend why you Americans are always on the lookout of an easy way out, the silver magical bullet that will solve-it-all™.
You need to address the root causes of the issue, and that's the whole issue with USA's society, you are too individualistic to have empathy, you are too individualistic to believe that helping others will help yourself.
Do you think helping addicts will cost more or less than the amount being wasted through policing and enforcement of a failed attempt? This whole sense of punishment is what drags you down, stop trying to punish someone because their lifestyle offends you and look at what causes them to fall into that hole first. Is it lack of social safety nets? Is it lack of proper education? Is it a lack of opportunities in some areas? The solution will be an immense amount of small solutions, some localised, some national, but it won't ever be "spend more money on the border!".
I'm saddened that you are so deep into this bullshit rabbit hole that you cannot think rationally about a huge issue, which requires many approaches at different levels. Be it helping addicts get safe access to their drugs, in an environment where if anything bad happens they will get help, also in a way they don't get sick with many diseases transmitted by needle sharing (which treatment for will cost even more of your tax dollars); helping addicts to get some stability in their lives: access to housing, to healthcare, to education (things that the whole of your population should have access to given how fucking wealthy your country is); help to rehabilitate functional members of society who are also addicted without costing them an arm and a leg in private rehab centres. These are just simple direct approaches, there are so many more already studied by people much more intelligent and knowledgeable in this area than me, a simpleton layman.
More empathy in your society would help a lot of societal issues you suffer from but are not experienced by other developed societies/economies, it's unfortunate you all live under a culture that doesn't value empathy towards others who you might disagree on their life choices, instead you value punishment, "personal responsibility" instead of "we are all in this together". The lack of togetherness will rip your country apart at some point, you should be working on it not only to solve the drugs issue but many other societal issues that shouldn't be so ever present in the wealthiest country in history.
You don't fix a drug epidemic by going after the symptoms: narcan and other drugs that are a bandaid only at the very last stage.
You go for the root: we've created a society where people are overprescribed pain killers, and where the general outlook is so bleak that escapism is more popular than ever. It's the same reasons people don't have children and mental health is all record lows.