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Expert sounds alarm on new wave of US opioids crisis

theguardian.com

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

#191

Post by fbdab103 »

op00to wrote: post #53
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…

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.

That definitely stands out to me as well. How many lives were destroyed by consuming cannabis vs government retribution for attempting to get high?

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

#192

Post by fbdab103 »

vdaea wrote: post #175
BoiledCabbage wrote: post #152

Earlier quoted context omitted.

> 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. The problem is this is completely untrue. One party had been talking about coal-mining industry ending and promoting job retraining for over a decade if not longer. Federal funds were administered to pre-empt this exact problem that was forese…

Who ended the coal mining industry?

Economics? Global usage of coal is declining everywhere.

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

#193

Post by anotherhue »

rsynnott wrote: post #136
Der_Einzige wrote: post #61

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 mentioned this elsewhere, but I had wisdom teeth out recently, and took ibuprofen and nothing else (they did give me a prescription for a heavier-duty NSAID, but from past experience those are no fun). It was _fine_, there was some pain, but that’s par for the course. Opiods seem to be treated as almost essential for dental surgery in the US, and as a rare escalation path elsewhere.

Same experience. No doubt there will be exceptions but prescribing them as standard seems like negligence.

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

#194

Post by dyslexit »

polski-g wrote: post #155
dyslexit wrote: post #146

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. How do you measure that? Opioid overdoses accounted for at least 72,800 deaths last year [0] and there are countless more addicts out there whose entire lives are ruined because of that addiction. Many of those people, if they ever recover, will never take opioids again for…

How many millions of people use opioids and do not abuse them, nor get addicted?

I don't know, but even if I did you're making a weak argument. You're comparing temporary pain relief for lost and destroyed lives.

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

#195

Post by somenameforme »

nradov wrote: post #169
somenameforme wrote: post #105

Earlier quoted context omitted.

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.

There's a much more informative article available here. [1] Stabilization does not have the colloquial meaning. It's defined as, "To provide such medical treatment of the condition as may be necessary to assure, within reasonable medical probability, that no material deterioration of the condition is likely to result from or occur during the transfer of the individual from a facility, or, with respect to an emergency medical condition..."

So somebody with a serious medial condition could be discharged, but only once that condition was treated and unlikely to further deteriorate. And then there's also a bunch of other rules hospitals that accept medicare have to follow for all patients, which are similar in spirit to EMTALA. And then there are going to state rules on top of all of this. Violations are severe with penalties able to be imposed on both the hospital and the doctors/staff involved - up to and including loss of license, and they are not covered by malpractice insurance. And the courts have invariably ruled on the side of patients, so I don't think there's any doctor that's going to be looking to try to short-serve the requirements of the law. Part of the reason you can find a million negative articles about it!

[1] - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1305897/

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

#196

Post by ryan_lane »

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.

Cities see this as much as rural areas, especially cities like San Francisco. It's absurd to frame this as a "coastal elite" vs rural problem.

Politically, it's nearly the opposite, where conservatives use the outcome of the epidemic as evidence that cities are dangerous hellholes, and actively fight solutions to minimize harm (monitored usage sites, needle exchanges, etc).

In terms of generally ignoring solutions to the problem, politicians as a whole seem to be the problem, rather than it being a city vs rural thing. Most likely liberals don't care about rural areas because they aren't winning those voters, and conservatives need the epidemic to harm cities so they can use it as fodder, so they won't help the rural areas, especially since they're going to win those areas anyway.

Also, it's kind of wild to blame the dust bowl on politicians and the coastal elite when it was primarily farming practices to blame. Why are coastal cities to blame for ignoring a problem that doesn't directly affect them when the affected areas are actively causing the problem, and not solving their problem locally? In the end it was the politicians who solved that problem.

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

#197

Post by devjab »

jterrys wrote: post #114
devjab wrote: 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…

>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…

> You control your borders. You can say that drugs don't enter your country.

I’m not sure where you got the idea that we have right border control, we basically have no border control. Sometimes we have temporary border controls, but typically your only checked if you’re “suspicious” (which means non-Scandinavian looking, in a weird car or transporting goods”, or very unlucky. It’s been like this since the EU opened its internal borders. I’m usually not even checked in border control when I fly within Europe.

As far as keeping illegal drugs out, well, I imagine we’re like every country considering we can’t even keep drugs out of our prisons.

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

#198

Post by dkn775 »

hollerith wrote: post #141
rsynnott wrote: post #139

Earlier quoted context omitted.

I mean, if medical care were expensive and difficult to access, you’d certainly expect more use of opioids, because they’re a cheap solution to chronic pain relative to more measured approaches. And it certainly does seem that the US opioid crisis was worst in extremely poor areas with limited medical care available.

Sure, but opioids are also a cheap solution to loneliness and to a chronic feeling of alienation and of "not belonging" caused by living in a society optimized for individual freedom and economic efficiency. I have yet to see reasons in this comment section to believe that access to healthcare specifically is the human need whose lack is driving most of the cases addiction in the US. Most young adults have no pressin…

Addicted youth do have more unmet healthcare needs than youth without addiction.

Anecdotally: cardiologist, inpatient rehab, dental work, maintenance medication, labs/blood work, mental health meds/counseling, ER visits and ambulance rides, and more.

These are things that non-addict young people do not usually need unless they’re big athletes or suffer from serious trauma.

Having access to these things also improves the likelihood of a full recovery from addiction (IMO).

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

#199

Post by keneda7 »

Jedd wrote: post #22

From TFA: “It’s so easy to demonise Purdue and the Sacklers. I agree that what they did was terrible. I think a number of them should be in jail. But I’ve thought for some time that the issue behind it all is the structure of the system,” he said. I really do get that sentiment, but IF the USA legal system had properly prosecuted Purdue execs from the get-go - there's a reasonable chance others would have been less i…

Check out the book empire of pain. It goes back the beginning of the Sackler rise and covers how we go to where we are today.

The problem I have with your statement about the legal system is IMO Purdue and the Sacklers corrupted the justice department, legal system, and various Federal agencies. This was not some overnight thing. This took decades of works by multiple generation of the family. The system we have today is in large part thanks to the Sacklers.

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

#200

Post by n8henrie »

nradov wrote: post #169
somenameforme wrote: post #105

Earlier quoted context omitted.

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.

I'd say it's fairly accurate. It's difficult to confidently establish "stable" in a patient with possibly feigned or exaggerated symptoms based on history and exam alone. It is generally agreed that pain management is part of managing an emergency, and so if an emergency has not been confidently excluded, it is usually part of care until a workup is concluded. If one could know from the initial evaluation that an emergency could not possibly be present, one could certainly discharge without additional care, but that can be impossible to know immediately (even with highly trained and calibrated eyeballs).
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