Expert sounds alarm on new wave of US opioids crisis • Hacker News Board

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

#161

Post by rayiner » Sun, Jan 28, 2024, 5:58 PM UTC

nobodyandproud wrote: post #93

rayiner wrote: post #82

Earlier quoted context omitted.

[flagged]

Take this for what you will, but my parents (deceased) and I are immigrants to the US. I sympathize greatly--not exclusively--with the problems facing most of the non-coastal US but you're not doing any favors by not adding any nuance or thought.

I’m also an immigrant. Average Americans outside the coasts (and even many of the people on the coasts, like black people[1]) are not benefiting from immigration. Immigration is generating benefits for the top 10-15% in the form of profits, jobs in knowledge work industries, and cheaper products. It’s not a comment about individual immigrants, it’s a comment about economics and political economy.

[1] https://www.phillytrib.com/commentary/immigration-comes-at-a...

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

#162

Post by rayiner » Sun, Jan 28, 2024, 6:03 PM UTC

Loughla wrote: post #158

nobodyandproud wrote: post #149

Earlier quoted context omitted.

No way. https://www.nps.gov/articles/000/terrain-of-struggle.htm https://www.farmworkerjustice.org/about-farmworker-justice/w... I'm not knowledgeable on agriculture, but even a city-boy like myself has read-up on how much we rely on migrant labor during harvesting season.

Immigrants do those gigs because citizens won't. Those are not community sustaining jobs.

Of course they’d do the jobs if immigrants weren’t driving down the floor. Look at European countries where agriculture is done by native born people.

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

#163

Post by giantg2 » Sun, Jan 28, 2024, 6:04 PM UTC

gedy wrote: post #117

giantg2 wrote: post #54

Earlier quoted context omitted.

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.

Ideally they shouldn't be cut off. I would think we should look into a different prescription and payment paradigm where the meds required for weaning them off (based on the protocols for how long they were on them and what dose) should be part of the initial prescription. That way if you lose coverage or something you can't just be cold turkey.

I also wonder how many people, including physicians, really understand the transition required. I had an elderly friend who went on some sort of narcotic after a surgery. They were told after the fact that since they were on it for a month, it would take them a year to wean them off. I don't have the dosing or med name, but that seemed insane to me. It was ultimately a contributing factor in their death due to some side effects and other complications.

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

#164

Post by 303uru » Sun, Jan 28, 2024, 6:09 PM UTC

diamondap wrote: post #44

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…

In the early 2000s I was a pharmacist intern and then early in my career working retail pharmacy as a PharmD. I knew the pill mills around me, I would provide DEA agents with clear examples and little to nothing was done about it. What I did get were credible legal threats from patients and physicians for not carte blanche filling what was written by their doc and then I started getting pressure from my district manager (after all I was denying big fat cash payers!). At the same time I saw pharmacist going to jail for "inappropriate dispensing" while the doctors who were running the pill mills were getting in no trouble at all. I left outpatient pharmacy as fast as I could. It was clear no on wanted to do anything to actually solve the issues at hand.

I also get so frustrated with all the border bullshit. Doing anything at the border is trying to solve the problem two thousand miles from the root cause. And pretending that migrants (people trying to come to the US permanently) have anything to do with drug runners is about as stupid as it gets.

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

#165

Post by ghufran_syed » Sun, Jan 28, 2024, 6:13 PM UTC

lets not forget how the US government first forced doctors to give out more and stronger pain medications by 1)issuing edicts that “pain is the fifth vital sign” (i.e. equivalent to pulse, bp, temp, respiratory rate), AND 2) tying reimbursement to “patient satisfaction” Both ideas could have helped improve healthcare, but without safeguards, they became a way to empower drug addicts to demand strong pain meds, and empowered pharmaceutical companies to supply them - a great example of what Thomas Sowell would call “second order effects” that are almost never considered when enacting new government policies

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

#166

Post by adwi » Sun, Jan 28, 2024, 6:28 PM UTC

upleft wrote: post #156

coffeebeqn wrote: post #119

Earlier quoted context omitted.

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 an…

Having been a cannabis smoker myself for years, I can understand the danger of self-medicating with psychedelics. They aren’t entirely harmless. Any drug with a high is a dopamine button. It’s easy to hit that button instead of doing something else to feel good. It’s easy to stop doing other things in favor of just hitting that button all day. But the effects of that button diminish over time, so you hit it more ofte…

Do you still smoke? If not, how did you quit?

Quitting is an interesting grey area for cannabis; culturally and functionally people misusing the drug are able to do so indefinitely, usually not reaching the “rock bottom” emergency state that other drugs (hopefully) convince the user to seek treatment. So it feels like “just weed” isn’t serious enough to warrant a 30 day treatment center, but the behavior patterns can be so ingrained it can be hard to see breaking them without.

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

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Post by ianburrell » Sun, Jan 28, 2024, 6:33 PM UTC

swayvil wrote: post #66

impossiblefork wrote: post #55

Earlier quoted context omitted.

Opioids are almost certainly worse than antidepressants, and I don't see why you appear to believe that they are alternatives to each other. Any entity participating in an endeavour which as part of its activities distributes, markets or which through propaganda or political action defends the use of opioids must be destroyed, because opioids are a chemical weapon. They aren't 'illegal drugs'. They're a means to dest…

How are opioids worse than antidepressants ?

Opioids are highly addictive and overdoses are deadly.

Antidepressants increase suicide risks for some while decreasing for majority, saving large numbers.

More people in US die of overdose than suicide.

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

#168

Post by jterrys » Sun, Jan 28, 2024, 7:03 PM UTC

nobodyandproud wrote: post #145

jterrys wrote: post #114

Earlier quoted context omitted.

>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 m…

I want to help this train of thought along because this is interesting to me and I'd love to get a discussion going. > 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…

The ugly dirty truth is that illegal immigrants form the underclass of the USA that allow for the relative cheap formation of small (otherwise noncompetitive) businesses when it comes to manual labor. Restaurants, cleaning, construction, automotive, farming, etc. It's a complete race to the bottom. But...if you can't stop people crossing the border...why not stop the people hiring them? Put them in jail?

But that's an incredibly unpopular solution. Every politician goes around orally fellating the small business ethos because it feeds into the meritocratic delirium. So essentially, Americans will backhandedly wail about illegal immigration while eating cheap fast food and hiring them to paint their walls.

There have been attempts to implement an ID system, especially when it comes to voting locally. But it was deemed racist. Because it meant only citizens who had the ID could vote. And some citizens didn't have IDs. And a portion of those people were poor minorities. And they didn't want to get them because it infringed on some rights. Or something. So America has this contrived system of registering to vote where people get tricked into also registering their political affiliation which is often used by politicians to sling mud at other politicians and political statisticians to pull slightly more accurate numbers out of their asses.

In some locales you straight up have to register with your affiliation to be able to vote. There's a significant segment of illegal immigrants who may or may not vote to support local political constituents that have their interests at heart, and a political party that appeals to those illegal voters. This political party uses this voter demographic for their benefit, because these local political constituents that are voted in have a voice in who the party as a whole can nominate for higher political parties. Since part of the political establishment is based on elections are based on representatives who then choose other representatives. And so the cycle continues.

Also, nobody wants to fucking pay taxes

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

#169

Post by nradov » Sun, Jan 28, 2024, 7:05 PM UTC

somenameforme wrote: post #105

nsagent wrote: post #75

Earlier quoted context omitted.

My mom worked as an ER physician in Pennington Gap, VA during the early years of opioid abuse there (late nineties through through the early oughts) [1]. She would constantly complain about drug seekers there and refused to give out pain meds. According to her, she was the only doctor who would refuse to give out pain meds. Fast forward to 2022, she needed heart surgery and was in the ICU for three weeks afterward. S…

If she never explained what was happening there, public ERs cannot refuse service to anybody for any reason. So drug addicts will use ERs as an attempt to score drugs by pretending to have some illness or another. If they fail, they'll just go to another one. And then repeat the circle. Even when the people at the ER know they're faking and they're there solely to try to get drugs, they have to continue trying to tre…

That's not quite accurate. Under EMTALA, ERs are only required to stabilize patients. Once an indigent patient is stabilized and no longer at immediate risk, the hospital is free to discharge them even if they have serious medical conditions.

https://www.acep.org/life-as-a-physician/ethics--legal/emtal...

Some hospitals voluntarily do more than the law requires to treat such patients.

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

#170

Post by danny_codes » Sun, Jan 28, 2024, 7:06 PM UTC

Loughla wrote: post #30

nobodyandproud wrote: post #10

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.

Bingo. The center of this country (outside of a few major urban/sub-urban areas) is hollow. Between the loss of agriculture as a family job, loss of industrial jobs, and opioid use after decades of methamphetamine use, it's bleak. And no one really cares. As a general rule, we're told, "just move to Chicago (St. Louis, Kansas City, wherever)". That's not a solution, or a possibility for a lot of folks.

This seems like the standard shift seen in all industrialized countries. Rural areas and small towns don't have the density to maintain economic viability. There just aren't enough labor-intensive jobs to keep small towns afloat.

I would imagine the American development pattern makes the economics even less favorable. Cars are very expensive and most (all?) small towns are designed exclusively for car-dependency. Infrastructure cost scales with sprawl too, so city costs to maintain infra are presumably high per-capita.

I'm not sure what the solution is. We could subsidize rural areas more (we already do quite significantly, but clearly the handouts aren't sufficient). But I think in the end we have to accept that times change, and certain lifestyles just aren't sustainable.