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Bleak New Estimates in Drug Epidemic: A Record 72,000 Overdose Deaths in 2017

nytimes.com

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Re: Bleak New Estimates in Drug Epidemic: A Record 72,000 Overdose Deaths in 2017

#131

Post by village-idiot »

toomanybeersies wrote: post #18

As a comparison, the road toll in the USA is 33,000 per year. Firearms kill about the same number (including 20,000 suicides). 3,000 people were killed in the 9/11 attacks. 72,000 overdose deaths is just a staggeringly large number.

Overdosed actually overtook vehicle deaths before most public health officials realized that something horribly wrong was going on.

That we still haven’t done much about it is deeply distressing, tbh. I feel it’s a sign that we’re losing the ability to act towards unified goals, even politically safe ones like “no more drug overdoses please”.

Re: Bleak New Estimates in Drug Epidemic: A Record 72,000 Overdose Deaths in 2017

#132

Post by toomanybeersies »

ams6110 wrote: post #94
stef25 wrote: post #55

Earlier quoted context omitted.

The doctors. Anyone who spends the better part of a decade studying medicine can't be ignorant about opioids and addiction, regardless of what the slimy Purdue representative tells them. The only excuse they have for the blatant over prescribing of opioids (2 months worth of oxy for getting wisdom teeth pulled kind of thing) is that if they don't do it, the patient will just go to another doctor. But how can you just…

> 2 months worth of oxy for getting wisdom teeth pulled kind of thing Surely this is not the norm? My son had his wisdom teeth out a few years ago, they gave him about a day's worth of hydrocodone and told him to take Tylenol after that. And all the doctors my family has seen for the past couple of decades have been pretty conservative about prescribing anything narcotic for pain.

I'm from New Zealand. I had two molars pulled out when I was 15 to fix an overbite problem. It was a serious enough procedure that they gave me an IV anesthetic.

All they prescribed me afterwards was ibuprofen. The general rule around here seems to be that if they're not using a knife, they don't give you opioids. I had to get 6 stitches in my head a few years ago, and they refused to give me anything stronger than ibuprofen again.

Re: Bleak New Estimates in Drug Epidemic: A Record 72,000 Overdose Deaths in 2017

#133

Post by LeifCarrotson »

stef25 wrote: post #55
announcerman wrote: post #7

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?

The doctors. Anyone who spends the better part of a decade studying medicine can't be ignorant about opioids and addiction, regardless of what the slimy Purdue representative tells them. The only excuse they have for the blatant over prescribing of opioids (2 months worth of oxy for getting wisdom teeth pulled kind of thing) is that if they don't do it, the patient will just go to another doctor. But how can you just…

Look for the root cause,not the proximal one.

You can certainly blame one bad doctor. You could probably blame a group of associated doctors, if the problem was associated with a certain hospital or medical school.

But when the problem is something that thousands and thousands of individual doctors mess up, it's hard to blame them all.

Personally, I blame the slimy Purdue salesmen and the idiot bureaucrats who let prescription drug companies advertise prescription drugs on TV, or give kickbacks to doctors who prescribe their medicine. Without these awful incentives, you wouldn't have this widespread failure.

Re: Bleak New Estimates in Drug Epidemic: A Record 72,000 Overdose Deaths in 2017

#134

Post by village-idiot »

stef25 wrote: post #55
announcerman wrote: post #7

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?

The doctors. Anyone who spends the better part of a decade studying medicine can't be ignorant about opioids and addiction, regardless of what the slimy Purdue representative tells them. The only excuse they have for the blatant over prescribing of opioids (2 months worth of oxy for getting wisdom teeth pulled kind of thing) is that if they don't do it, the patient will just go to another doctor. But how can you just…

American doctors are persistently and openly reluctant to prescribe lifestyle changes for fear of patient anger and noncompliance. Even in cases where the medical advice is something along the lines of “get some exercise or start planning your own funeral”.

Obviously doctors continuing to hand out pills (opioids, statins, etc.) to patients who really need therapy, exercise, or dietary changes is helping to reinforce the problem.

Re: Bleak New Estimates in Drug Epidemic: A Record 72,000 Overdose Deaths in 2017

#135

Post by greatpatton »

emiliobumachar wrote: post #92
toomanybeersies wrote: post #18

As a comparison, the road toll in the USA is 33,000 per year. Firearms kill about the same number (including 20,000 suicides). 3,000 people were killed in the 9/11 attacks. 72,000 overdose deaths is just a staggeringly large number.

Thanks, you've put the number in perspective. More deaths than cars and guns combined. Staggering indeed.

And that's the main reason life expectancy in the US is declining: https://www.sciencedaily.com/releases/2018/08/180815190526.h...

Re: Bleak New Estimates in Drug Epidemic: A Record 72,000 Overdose Deaths in 2017

#136

Post by stef25 »

LeifCarrotson wrote: post #133
stef25 wrote: post #55

Earlier quoted context omitted.

The doctors. Anyone who spends the better part of a decade studying medicine can't be ignorant about opioids and addiction, regardless of what the slimy Purdue representative tells them. The only excuse they have for the blatant over prescribing of opioids (2 months worth of oxy for getting wisdom teeth pulled kind of thing) is that if they don't do it, the patient will just go to another doctor. But how can you just…

Look for the root cause,not the proximal one. You can certainly blame one bad doctor. You could probably blame a group of associated doctors, if the problem was associated with a certain hospital or medical school. But when the problem is something that thousands and thousands of individual doctors mess up, it's hard to blame them all. Personally, I blame the slimy Purdue salesmen and the idiot bureaucrats who let pr…

This is like saying web developers aren't responsible for thousands of websites getting hacked through some plugin, because the authors of a plugin simply said it was cool, and they advertised it as such and the devs got some affiliate kickback every time they implemented it on a site.

The analogy doesn't work 100% but pretty close :)

Re: Bleak New Estimates in Drug Epidemic: A Record 72,000 Overdose Deaths in 2017

#137

Post by austincheney »

RGamma wrote: post #79
austincheney wrote: post #57

I have always wondered how pain killers could be so addictive. Stimulants are physically addictive. They modify signals in your physiology to increase signal performance, in some way, and the body reacts to the temporary performance boost. There is a craving for the stimulant the body has becoming reliant upon and a withdrawal in the absence of that chemical. This manner of physical addiction isn't a choice and every…

Please watch this before making other plainly wrong and unsubstantiated comments like this: https://www.youtube.com/playlist?list=PL150326949691B199 The stimulant/depressant dichotomy doesn't hold by the way. For instance alcohol's effect on the brain is not only very non-specific but also not very well understood whatsoever (see https://en.wikipedia.org/wiki/Alcohol_(drug)#Pharmacology or the lecture). Or more preci…

The physically addictive quality of alcohol has more to do with the liver and less to do with the brain even though alcohol is known to cause brain damage. The primary damage from excessive continuous alcohol consumption over a period of 8 years or more is in the liver resulting in a variety of metabolic and processing disorders. In some cases sudden severe withdrawal can be harmful and possibly fatal as the liver is incapable of processing a variety of normal functions has become partially reliant on the continued alcohol consumption to address some of this functionality.

The most clear indicators of brain damage present in withdrawal are destruction of GABA and dopamine receptors that can result in a variety of behavior problems. The dopamine receptor damage is at least partially resultant from the liver damage.

* https://en.wikipedia.org/wiki/Alcoholic_liver_disease

* https://en.wikipedia.org/wiki/Alcohol_withdrawal_syndrome

> Please watch this before making other plainly wrong

Perhaps you should have your facts together before attacking people with divisive bias.

Re: Bleak New Estimates in Drug Epidemic: A Record 72,000 Overdose Deaths in 2017

#138

Post by austincheney »

optionsguy wrote: post #72
austincheney wrote: post #57

I have always wondered how pain killers could be so addictive. Stimulants are physically addictive. They modify signals in your physiology to increase signal performance, in some way, and the body reacts to the temporary performance boost. There is a craving for the stimulant the body has becoming reliant upon and a withdrawal in the absence of that chemical. This manner of physical addiction isn't a choice and every…

Actually, amphetamines and cocaine do not cause physical dependence, while opioids and GABA agonists (alcohol, barbiturates, benzodiazepenes) do cause physical dependence. ‘Depressant’ addiction occurs because they’re physically and psychologically addictive. You may want to do 5 minutes of quick research before writing posts about subjects you are unfamiliar with in such an authoritative tone. Conversely, as a forme…

Methamphetamine - https://en.wikipedia.org/wiki/Methamphetamine#Addiction

The addictive quality of meth lies in the physical adjustment of neuron pathways in the brain. While the specific gene triggers associated with meth are known and likely specific to this drug the physically addictive pattern is not radically different from other stimulants. Essentially meth stimulates certain specific neuron pathways in the brain. The brain becomes reliant upon the drug for a greater than normal performance in the adjusted neurons. While there are behavioral results from this adjust the changes are to the physiology of the brain. Withdrawal is present when the patient is removed from the drug in a pattern similar to all other stimulants.

Even regular caffeine intake results in physiologic symptoms when consumption is halted.

As for cocaine there are very many reports and research that describe the physiological addition attributed to the drug. This is about as well accepted scientifically as climate change and evolution. There are numerous research examples of red blood cells choosing cocaine attachment over oxygen studied from blood of addicts.

> You may want to do 5 minutes of quick research before writing posts about subjects you are unfamiliar with in such an authoritative tone.

Perhaps instead of attacking people with baseless claims you could point me in the proper direction with research.

Re: Bleak New Estimates in Drug Epidemic: A Record 72,000 Overdose Deaths in 2017

#139

Post by mercer »

stef25 wrote: post #136
LeifCarrotson wrote: post #133

Earlier quoted context omitted.

Look for the root cause,not the proximal one. You can certainly blame one bad doctor. You could probably blame a group of associated doctors, if the problem was associated with a certain hospital or medical school. But when the problem is something that thousands and thousands of individual doctors mess up, it's hard to blame them all. Personally, I blame the slimy Purdue salesmen and the idiot bureaucrats who let pr…

This is like saying web developers aren't responsible for thousands of websites getting hacked through some plugin, because the authors of a plugin simply said it was cool, and they advertised it as such and the devs got some affiliate kickback every time they implemented it on a site. The analogy doesn't work 100% but pretty close :)

To alter the analogy, perhaps these web developers might be implementing said plugin because their manager told them to, and once said plugin took off clients started demanding it.

Most web developers that I know who have this problem fit this description. they don't like doing any of this, but it's what they're told to do. Or alternatively they're barely 'developers' and care about other things instead (many designer-developers, for example).

Re: Bleak New Estimates in Drug Epidemic: A Record 72,000 Overdose Deaths in 2017

#140

Post by austincheney »

Nursie wrote: post #69
austincheney wrote: post #66

Earlier quoted context omitted.

> It's rather simplistic to view opiates as mere depressants. They also create euphoria. Perhaps for some people that is true. I was given a strong does of opiates for pain at a hospital before and I did not find the experience either pleasant or euphoric. That level of numbness and loss of motor control was actually a dreadful and even fearful experience. It really made me question which was worse between that exper…

Different stimulants have different methods of action on the various receptors in the brain. As such they have very varying addiction profiles. I think the blanket statement "Stimulants are physically addictive" is wrong (some, like MDMA or exotics like methiopropamine have a fairly low addiction rate), and the idea that somehow depressants as a class don't have this property is bizarre. I'm not quite sure what you m…

I can accept bizarre. I think it is safe to say all drugs modify the physiology of the user in some way. The difference is if that change to the body is what induces a craving for more from a cellular level. There is no indication that depressants, as a class, achieve addiction purely in response to cell modification.

You mention cocaine versus opiates. A major difference there is that cocaine doesn't require repeated use to be addictive. It is immediately addictive and may result in drug addiction even many years later: https://en.wikipedia.org/wiki/Cocaine_dependence#Risk

Opiates are not immediately physically addictive. It takes repeated dosage for addiction to set in. Typically this is a result of pathological changes resulting in a combination of modified neuron-physiology and adjusted behavior. For depressants to be addictive it seems there must be some manner of behavioral persistence that drives the user to continue consumption in addition to physiological adjustments. If the drug is not immediately addictive the user must then use it repeatedly to build addiction.

There has been research that indicates this is the pattern of addiction for cigarette use even though the primary drug present is nicotine, which is a physically addictive stimulant. While nicotine is physically addictive not everybody who smokes cigarettes becomes a dedicated smoker. It takes more than the physical addiction to nicotine. This has been identified by research as well, and much of that research indicates it is a combination of certain demographics and personality profiles that most likely triggers cigarette addiction. This research indicates these individuals are identifiable and their degree of addiction prevalence is predictable.

While cigarettes are not depressants the point illustrates the difference between a purely physically addictive quality and actual addiction in practice.

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