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The amount of responsibility laundering that's happening is staggering. Is it the fault of the doctors for prescribing strong painkillers or the responsibility of lobbyists for keeping the status quo as it is. Or is it the responsibility of patients to not seek strong opiates for the smallest aches? On whom falls the blame for this?
Earlier quoted context omitted.
The appetite for drugs or the criminalization that creates the black market? Heavy drug users have more immediate concerns than second and third order effects of their lifestyle choices. The politicians and lobbyists responsible for maintaining the status quo on the other hand, should probably pull their heads out of their asses.
I am sure a widescale decriminalization of hard drugs south of the US border will be applauded in Washington. It would solve a large part of the drug crime problems in these countries, while raining down industrial quantities of pharmaceutical grade heroin on the US streets.
I don't think supply is limiting the amount of drugs that abusers are doing.
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.
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.
The amount of responsibility laundering that's happening is staggering. Is it the fault of the doctors for prescribing strong painkillers or the responsibility of lobbyists for keeping the status quo as it is. Or is it the responsibility of patients to not seek strong opiates for the smallest aches? On whom falls the blame for this?
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.
The amount of responsibility laundering that's happening is staggering. Is it the fault of the doctors for prescribing strong painkillers or the responsibility of lobbyists for keeping the status quo as it is. Or is it the responsibility of patients to not seek strong opiates for the smallest aches? On whom falls the blame for this?
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 amount of responsibility laundering that's happening is staggering. Is it the fault of the doctors for prescribing strong painkillers or the responsibility of lobbyists for keeping the status quo as it is. Or is it the responsibility of patients to not seek strong opiates for the smallest aches? On whom falls the blame for this?
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.
The amount of responsibility laundering that's happening is staggering. Is it the fault of the doctors for prescribing strong painkillers or the responsibility of lobbyists for keeping the status quo as it is. Or is it the responsibility of patients to not seek strong opiates for the smallest aches? On whom falls the blame for this?
How about if everyone stopped playing the blame game (because it's irrelevant) and spent all that effort and time working on a solution instead. 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.
The amount of responsibility laundering that's happening is staggering. Is it the fault of the doctors for prescribing strong painkillers or the responsibility of lobbyists for keeping the status quo as it is. Or is it the responsibility of patients to not seek strong opiates for the smallest aches? On whom falls the blame for this?
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.
I'm not sure that's what people meant when they requested drugs be regulated and taxes used for the greater good...