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Expert sounds alarm on new wave of US opioids crisis

theguardian.com

111–120 of 202 posts

Re: Expert sounds alarm on new wave of US opioids crisis

#111

Earlier quoted context omitted.

The harm to society of people who need them not getting pain drugs far outweighs the pain to society of those who don’t need them abusing them. I’ve had similar experiences with them not giving me proper painmeds are having all 4 of my wisdom teeth removed. They gave me 2 weeks of Tylenol #3 and some homeopathic bullshit and expected that to be good enough. Luckily my stepdad is a serious medical patient with lots of…

I don’t live in your skin, but I had all of my wisdom teeth extracted under local anesthetics without sedation. And I never even needed an NSAID. Maybe it hurt you that bad, but it’s not par for the course.

That’s great for you. My partner was also not given anything when her wisdom teeth were removed. As the dentists anesthetic wore off, on the drive home, she started crying, then screaming as we pulled into the driveway. I got her in bed and gave her Tylenol (dentists recommendation), but she was crying, curled up in a ball, unable to move and barely talk, couldn’t drink water, just grasping her legs and suffering with tears streaming down her face.

Luckily, when I called the dentist back and frantically explained the situation, they let us get an opioid. She took a minimal amount, and was able to function normally. She only used a few pills in total over the course of a couple days, but it prevented absolute heartbreaking agony.

So that’s great that it worked for you. But your case has no bearing on somebody in the other situations either, so you don’t need to bring it up as a gotcha.

Re: Expert sounds alarm on new wave of US opioids crisis

#113

A few years ago, I talked to three retired federal law enforcement agents who had each spent 20+ years fighting the cartels that were bringing drugs into the US from Mexico and South America. All three felt betrayed by the US government. They said, essentially, "We put our lives on the line many times to try to stop the flow of drugs. Then the government turned around and basically gave the pharmaceuticals license to…

The idea of someone going to a bank with a garbage bag full of cash and depositing it into a pharmacy's business account is insane. That's the kind of thing that can only happen when the system is fundamentally corrupt.

Re: Expert sounds alarm on new wave of US opioids crisis

#114
post #43

I see this as analogous to the Dust Bowl, where the politicians and coastal elite ignored or dismissed the growing problem until it was too big to ignore. - https://www.smithsonianmag.com/smart-news/1000-mile-long-sto... - https://mallhistory.org/items/show/274 100 years and more information than ever, yet we have’t figured out this out-of-sight, out-of-mind problem.

As a Scandinavian I find this an odd take on the situation. To me it seems like the US has a very, very, broken healthcare system that you’ve chosen to have by electing politicians who aren’t going to reform it into something reasonable. My wife and I presently had twins, and we spent 7 days living in the hospital with a lot of help from nurses and so on, and it cost us $130. Which was me paying for 3 days of living…

>But maybe I just don’t understand your country well enough?

You really don't. You live in a country that is either 11 million or 6 million people with fully enforceable border controls and immigration controls. You can control who comes into you country. You can control the goods that come into your country. Your population rivals one of the larger metropolitan areas of the USA.

Problems don't scale linearly. At 6 million people you can afford to fund pensions through nothing but an oil extracting operation out of your country. 7.7% Unemployment at 11 million people is, believe it or not, much less debilitating than 4% unemployment at 332 million people. There are more unemployed persons than the entire population of Sweden. And these populations cluster, and they depress local economies, and they drain their local workforce and social services. Then crime happens, and populations move, and housing prices fluctuate, and then this spreads. But here's the trick: You only need so much space to live. So much money to eat. So much space to grow food. You only have so many hours in the day you can work. Any doctor can see 20 patients a day, spending 30 minutes on each consultation. You don't need that many doctors to meet that demand at 6 million people. You need a lot more doctors to meet that demand at 332 million. Costs and living standards are relatively fixed beyond a tolerable level of comfort. Scandinavian countries achieved this comfort. But this comfort doesn't scale. Because problems don't scale linearly.

Back to borders and immigration: You control your borders. You can say that drugs don't enter your country. And they won't (at scale, at least). In the USA that's not enforceable because the country is so large. Illinois can say that they ban guns. But that doesn't stop them from going to Indiana and getting them. Or Kentucky. Or Missouri. Your local change can only accomplish so much when you are against the tide of your neighbors. You can say that you want to control your borders. But your neighbors disagree. So they go around you controls and infiltrate your economy anyway. And you don't know how bad it really is. Because statistics are an approximation of a segment of a population that doesn't want to be tracked. But these people still get sick. And some costs are fixed. So your publicly funded hospitals still need money to cover their costs by people who will flee and not pay. So you privatize and offset the burden on the patient. Because people can pay for themselves to get a blood test. You relieve your burden on the system, for the moment. But now companies charge more because they also know that certain costs are fixed and people are willing to tolerate more costs for a relatively inexpensive service. And of course, they optimize. Because there's nothing stopping them. Since you can't tell them not to do something when you can't solve the problem yourself. And here we are.

Re: Expert sounds alarm on new wave of US opioids crisis

#115
post #7

Just make high quality opioids easy to get already. It should be as common as beer. The present system is deranged.

The best interpretation: Create health specialists for managing and treating addicts so that they can still live productive lives.

You're advocating for Portugal's model, but note that it's subject to economics and politics (see https://knowledge.wharton.upenn.edu/article/is-portugals-dru...), while the withdrawal symptoms are not.

I think a two-prong approach is necessary and I worry about the perverse incentive of healthcare specialists or medication experts wanting to maintain a pool of addicts long-term.

I had an informal debate with a former roommate--and to help him along the above was the one counterargument I thought of and I still don't have a good solution. Opiods are in a class of their own.

Re: Expert sounds alarm on new wave of US opioids crisis

#116
post #43

Earlier quoted context omitted.

As a Scandinavian I find this an odd take on the situation. To me it seems like the US has a very, very, broken healthcare system that you’ve chosen to have by electing politicians who aren’t going to reform it into something reasonable. My wife and I presently had twins, and we spent 7 days living in the hospital with a lot of help from nurses and so on, and it cost us $130. Which was me paying for 3 days of living…

As a fellow Dane, you must also know how close our public healthcare is to crumbling, how long wait times are for care, our record highest cancer rate in the world of any nation, and a policy of treating only acute conditions (no cancer screenings deemed "unnecessary" etc.) I have been misdiagnosed a number of times and was finally treated in the US for a major condition the doctors missed here in Denmark. We get a n…

That's what we get for letting Lars Løkke destroy our health system for over two decades. Remember that the US way was the explicit goal of Fogh's government. Venstre is sister parties with the Democrates after all. Our issues are just underscoring the dangers of privatization, new public management, and liberalism.

Re: Expert sounds alarm on new wave of US opioids crisis

#117
post #54
post #49

Earlier quoted context omitted.

> What does legit pain care look like? A sibling was on low dose hydrocodone for years for back and ankle issues. Seemed to be fine from my perspective.

Perhaps that was the dosing or your siblings biology. Hydrocodone is also a narcotic that is potentially habit forming. The addictive potential of oxycodone is supposed to be very similar or only slightly higher than that of hydrocodone.

I'd say it probably is/would have been very difficult to stop, but the dose was low and consistent. My fear is people like that who get cut off, then resort to illegal drugs.

I realize this begs the question of is "chronic pain" basically just an addiction? I'm not qualified to answer that though.

Re: Expert sounds alarm on new wave of US opioids crisis

#118

Earlier quoted context omitted.

As a fellow Dane, you must also know how close our public healthcare is to crumbling, how long wait times are for care, our record highest cancer rate in the world of any nation, and a policy of treating only acute conditions (no cancer screenings deemed "unnecessary" etc.) I have been misdiagnosed a number of times and was finally treated in the US for a major condition the doctors missed here in Denmark. We get a n…

This is a good point but you really need to have a comparison when you say your healthcare is crumbling. Are you talking about specialized care? I think healthcare in the US is beyond messed up. In my area which is a large city in the North East US it is very difficult to be able to get into ER because rooms are filled with people who are trying to get non-urgent care. These people have no money, no insurance and the…

I'm talking about general and specialist care in the public system. Our private system is pretty good but you either need to pay insurance for it or, if the public wait-list extends beyond 6 months for surgical treatment, our public healthcare will pay for you to be referred to a private hospital.

The less said about our mental healthcare the better.

> I also did not get your last paragraph are you talking about the US or Denmark? I would be shocked to hear income inequality problem is worse in Denmark.

I was shocked too when I first heard it but live here long enough and it's very obvious. Income inequality has increased over the last thirty years with a Gini coefficient of 30 [1] in 2022.

[1] https://www.dst.dk/en/Statistik/emner/arbejde-og-indkomst/in...

Re: Expert sounds alarm on new wave of US opioids crisis

#119
post #53

A few years ago, I talked to three retired federal law enforcement agents who had each spent 20+ years fighting the cartels that were bringing drugs into the US from Mexico and South America. All three felt betrayed by the US government. They said, essentially, "We put our lives on the line many times to try to stop the flow of drugs. Then the government turned around and basically gave the pharmaceuticals license to…

Just a point - the same people who thought they were “saving” people with a drug war were destroying lives themselves over drugs that not so many years later are legal and accepted to possess. Somehow they’re not harmful anymore. It’s all BS.

Drug policy is complicated. Amphetamines and opioids certainly have very valid medical uses - but also giving the public unrestricted access to them is a complete disaster.

Psychedelics likely have various mental health treatment uses but they are for some bizarre historical reasons considered dangerous.

Mental health medication like benzos are also tricky. They are amazingly affective but also amazingly addictive and withdrawals can be fatal

Re: Expert sounds alarm on new wave of US opioids crisis

#120

The flip side of this and something that is barely ever talked about, is that for patients with severe chronic pain, access to medicine for relief has become nearly impossible. Often even if you get a legitimate prescription pharmacies will not fill it due to fear/quotas being enforced. This fear was so pervasive they had my terminally ill father on stupidly high doses of methadone which nearly killed him, simply bec…

I had surgery and the pharmacy didn't want to fill my real legit oxycodone prescription until after they'd talked to someone at the OR. We overcompensating and went too far the other way.
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