Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

As opioid overdoses exact a higher price, communities ponder who should be saved

washingtonpost.com

Post reply on HN
Print view View original

111–118 of 118 posts

Re: As opioid overdoses exact a higher price, communities ponder who should be saved

#111

Post by dredmorbius »

refurb wrote: post #77
dredmorbius wrote: post #73

Earlier quoted context omitted.

The present drug R&D regime is remarkably ineffective . There's been little advance in overall mortality rates since the 1920s / 1930s. Much of that comes from public-health measures, including preventive care, water and environmental quality, food quality, risk reductions (e.g., safety standards on electrical and mechanical equipment, automobiles, etc.), through removal and reduction in contaminants (especially of e…

There's been little advance in overall mortality rates since the 1920s / 1930s. Going to have to disagree with you. Penicillin wasn't discovered until the 1940's. That alone is a huge benefit to mankind. Add on top of that the number of cancers who before were an immediate death sentence and are now chronic conditions (AML, HER2+ breast cancer, etc.) Are there still cancers out there we can't treat? Sure, but that do…

See: https://ello.co/dredmorbius/post/MsQfdPAn_0XUdZUoReBfbg

Specificially 200 years of mortality data as compiled by the New York Department of Health & Mental Hygiene: https://assets2.ello.co/uploads/asset/attachment/1468664/ell...

Note that from 1940 to 1950 the mortality rate actually rose. Much of the improvement since 1970, if you dig into detailed statistics, comes from traditionally underserved communities, most especially black males. There's a lot more to be had for seeing those who get little or no treatment, get more, than in increasing treatment of the most privileged.

Laurie Garrett, author of The Coming Plague: “In all, 86 per cent of the increased life expectancy was due to decreases in infectious diseases. And the bulk of the decline in infectious disease deaths occurred prior to the age of antibiotics. Less than 4 per cent of the total improvement in life expectancy since 1700s can be credited to twentieth-century advances in medical care.”

https://www.goodreads.com/author/quotes/12627.Laurie_Garrett

I'd be quite interested to know what specific outcomes progress in cancer treatment you have in mind.

Re: As opioid overdoses exact a higher price, communities ponder who should be saved

#112

Post by Quequau »

toomuchtodo wrote: post #86
Quequau wrote: post #40

Earlier quoted context omitted.

After struggling with alcoholism for decades I used Naltrexone to stop drinking five or six years ago. It wasn't a simple taper but when I had my last drink it was easier to walk away from than anything I could have ever imagined before I did it.

Thank you for posting this; it'll help me help someone who is a self destructive alcoholic.

If it helps I used the treatment program outlined in the "sinclair method" which I found online and bought his book off Amazon. In the country I now live in, using Naltrexone in this way isn't exactly unheard of but it was definitely not the status quo treatment program.

The docs that I found to prescribe it for me really wanted me to subject myself to antabuse (Disulfiram) which is a profoundly sadistic strategy that creates a major sensitivity / negative reaction to even small amounts of alcohol that can be incredibly distressing and even life threatening.

Naltrexone on the other hand simply took away most of the euphoric experience I was getting from drinking and after a 4-6 weeks of using it every time I drank, I quit after a night of heavy drinking and morning of regret. After decades of quitting only to find myself drawn back to it, it was a profoundly liberating experience to actually be sober and not want a drink at all. It still is actually (though in a different sort of way).

I have to say that drinking while taking Naltrexone was a pretty weird experience because many of the signals I'd grown accustomed to for gauging my intoxication were muted... so I "felt" kinda sober but at the same time clearly was not. I think if there is a major risk in this it's possibility of deciding to drive because of "feeling sober". So that's the thing I think people need to be really cautious about.

Re: As opioid overdoses exact a higher price, communities ponder who should be saved

#113

Post by extra88 »

Clubber wrote: post #110
extra88 wrote: post #105

Earlier quoted context omitted.

You're ignoring the fact that the current situation has been created by prescription pill misuse (in proscribing and taking) and the death toll has exceed that of automobiles largely because of Fentanyl and other synthetic opioids. Of course, a lot of the attention being paid is not because of the relative scope but because the affected population is whiter and less poor. But synthetic vs. plant-based doesn't mean sh…

From what I understand, the current state of the epidemic was exacerbated by the crackdown on pills and the current deaths is from heroin more than anything. Heroin used by people who can no longer get pills of which they know the dosage of.

Yes, restrictions on prescriptions, meant to stop people from getting hooked and cut down on illegal distribution, plus some crackdowns on pill mills have driven people already addicted to cheaper, more available opioids.

"Heroin-related deaths more than tripled between 2010 and 2015, with 12,989 heroin deaths in 2015. The largest increase in overdose deaths from 2014 to 2015 was for those involving synthetic opioids (other than methadone), which rose from 5,544 deaths in 2014 to 9,580 deaths in 2015. One of these synthetic opioids, illegally-made fentanyl, drove the increase. It was often mixed with heroin and/or cocaine as a combination product—with or without the user’s knowledge." [0]

But the rate of increase for death by prescription opioid has been greater than non-prescription so they are nearly half of all deaths.

[0] https://www.cdc.gov/drugoverdose/epidemic/index.html

Re: As opioid overdoses exact a higher price, communities ponder who should be saved

#114

Post by criddell »

DanBC wrote: post #91
criddell wrote: post #78

Earlier quoted context omitted.

How did they create it? Consumers can't buy direct, can they? There's always a middleman. Why not blame pharmacies or better yet, doctors?

> How did they create it? They mislead doctors about safe usage of their product.

I'm not sure I buy that, at least not over the long term. People on the front line are going to see the effects of drug abuse more sharply than anybody. There's no way drug companies would be able to mislead a good doctor. Maybe once or twice, but eventually any doctor will start to see problems that they are creating.

I think I would put most of the blame on doctors. IIRC, doctors themselves have a pretty bad record with respect to drug abuse and addiction.

Re: As opioid overdoses exact a higher price, communities ponder who should be saved

#116

Post by dredmorbius »

DanBC wrote: post #85
jtmcmc wrote: post #82

Earlier quoted context omitted.

You mean like poppy plants? This addiction wasn't created by drugs - drugs are merely a coping mechanism for a world that people can't fucking deal with. The root causes aren't opioid manufacturing it's whole slew of things from poor physical and mental health care in this country, worsening job prospects for people, a culture that ties worth and value to working hard and monetary prosperity, etc...

The US prescribes far more opioid medication than any other country. > Since 2002, prescription drug deaths have outpaced those of cocaine and heroin combined. Abuse of controlled prescription drugs is higher than that of cocaine, methamphetamine, heroin, MDMA, and PCP combined.

This and @panic's response, both.

Quantity and dosing of opioids.

Re: As opioid overdoses exact a higher price, communities ponder who should be saved

#117

Post by ada1981 »

Simon_says wrote: post #94
ada1981 wrote: post #88

Earlier quoted context omitted.

Addiction is fundamentally about not being able to regulate ones nervous system and looking for external triggers for dopamine release. This is almost always linked to developmental and shock trauma earlier in life.

That doesn't account for the genetic component.

You may have a person who is more sensitive in some ways, but you don't get addiction without some form of developmental or shock trauma - I've never seen it, and haven't met any professionals who have either.

Re: As opioid overdoses exact a higher price, communities ponder who should be saved

#118

Post by tcj_phx »

ada1981 wrote: post #117
Simon_says wrote: post #94

Earlier quoted context omitted.

That doesn't account for the genetic component.

You may have a person who is more sensitive in some ways, but you don't get addiction without some form of developmental or shock trauma - I've never seen it, and haven't met any professionals who have either.

> You may have a person who is more sensitive in some ways, but you don't get addiction without some form of developmental or shock trauma

I wish the justice system would consider this factor when deciding whether to send people for gratuitous punishment...

Post reply on HN