Why do americans make so much use of opioids? For me it sounds like crack. No sane person tries crack, most people are already in the lowest point in their life when they are presented to the "opportunity". Is it similar with opioids?
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 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.
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.
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.
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.
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.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)
It would be the same in wherever you are from if the streets were flooded with this stuff.
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.