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America’s opioid epidemic is worsening

economist.com

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Re: America’s opioid epidemic is worsening

#111

Post by [deleted] »

knz wrote: post #99
jstewartmobile wrote: post #82

I'm on the gulf coast, and we just had a high-profile prosecution of a doctor running a pill mill. What if this whole mess isn't so much a technical problem to be solved as much as it is our system functioning under its own perverse incentives? Other countries don't have this problem. In my own area of expertise, I have seen so many non-solutions force-fed to the customer when an actual solution is not as profitable.…

> What if this whole mess isn't so much a technical problem to be solved as much as it is our system functioning under its own perverse incentives? Other countries don't have this problem. That description could easily be applied to many aspects of the US healthcare system - an epidemic is a failing of public health.

[deleted]

Re: America’s opioid epidemic is worsening

#112

Post by knz »

DougN7 wrote: post #19
pnathan wrote: post #10

So what is the answer here? Like another poster said, there's a demand problem. How do we as a society address this? I've seen a lot of mumbles about dealing with supply problems, dealing with overdose problems, but it'd be good to head the problems off at the pass before they descend into major trouble. I should also note, this is a burgeoning problem in the Puget Sound/Seattle region. It's not just rural people dyi…

Preventing that first time is probably the secret. It's got to be so much harder to resist once you know what you're missing. And it's not like you're rational about it and considering long term consequences when you're confronted with a second opportunity. Unfortunately, we live in a society where it's all good, live free, don't judge, do what feels good, etc. That leads to things that feel extremely good... I'm gra…

While there may be some truth to this, it's also reflective of our society in general - more absent parents/latch key kids, issues with access to mental health care/health care in general, a lack of jobs/hope in deprived areas, a generation of soldiers coming back from the Global War on Terror (how many homeless people are veterans?), and the many side effects of the War on Drugs - the flawed criminal justice system, deeply entrenched gangs in some areas, and the foreign policy failings in Central/South America.

There is no single cause or solution.

Re: America’s opioid epidemic is worsening

#113

Post by nyolfen »

DanBC wrote: post #83
rwmj wrote: post #42

Earlier quoted context omitted.

The pill supply has to lowered ... in the past. However now the US made that mistake, what's the problem with continuing to give out the pills "like candy", although with tighter controls to make sure that they don't go to create new addicts?

People with pain deserve treatment for that pain. For people with short term pain, or who are at the end of life, opioids can be a good choice. For people with long term pain opioids can, rarely, be a good choice, if other things have been tried first, and if there's a careful package of care. Most people with long term pain need variations of / combinations of: 1) Access to evidence based pain management specialist…

some possibly sunny news: experiments with a new fentanyl-derived opioid that acts only as a local analgesic and doesn't cross into the brain, meaning no high, non-addictive, and one can't overdose. this is very preliminary (rat experiments) but i'm hopeful:

https://arstechnica.com/science/2017/03/tweaking-fentanyls-c...

Re: America’s opioid epidemic is worsening

#114

Post by mnm1 »

tptacek wrote: post #75
mnm1 wrote: post #66

Earlier quoted context omitted.

"Isn't the counterargument to this to point out the Oxycontin abuse epidemic?" No because that's not even an argument.

In fact, it is, because if the pathway to addiction starts with overprescription, deregulation is unlikely to alter the stats: prohibition and black markets aren't gating factors.

What is? You didn't actually argue anything. I have no idea what you're talking about. Pointing out that Oxycontin is being abused is not an argument. What is your position?

Re: America’s opioid epidemic is worsening

#115

Post by pnathan »

XorNot wrote: post #39
pnathan wrote: post #20

Earlier quoted context omitted.

> Seems like attacking the supply is great place to start. That is what was done, transferring the demand to heroin as opposed to oxy. Also, focusing on the supply side of things is the last 30 years of US policy: it's not worked effectively, and has a concomitant effect of incentivizing black market dealers to be wealthy and power. It'd be better to sell OTC heroin than to fund violent gangs, just in the name of lim…

It has value at an individual level. Plenty of people get started into this by over-prescription by doctors and blind dispensing by pharmacists. In both cases, mandating a little common sense in how these drugs are used would potentially help a lot of people avoid a life they don't want.

> a little common sense

no argument there. :)

Re: America’s opioid epidemic is worsening

#116

Post by cmdrfred »

lr4444lr wrote: post #103

I say this mostly tongue-in-cheek because I hate to apply one bad policy to fix another, but I bet if narcotic overprescription could more readily trigger medical malpractice, you'd see doctors thinking more judiciously about their use. Even if exaggerated by an order of magnitude, stats like this are just indefensible: http://www.webmd.com/mental-health/addiction/news/20160325/n...

What's funny is there is no evidence that these opioid pain killers are actually effective in the long term for the management of pain. If it wasn't for lobbying they likely wouldn't be legal to use in that way.

Re: America’s opioid epidemic is worsening

#117

Post by oxide »

DanBC wrote: post #89
oxide wrote: post #40

Earlier quoted context omitted.

I've gone ahead and edited my comment, not because of your comment, but just because I felt like I wasn't making a clear point. Kratom is not even mentioned anymore, sorry. While kratom is habit forming and can "fuck you up" if you have no tolerance, the true value is for the person already addicted to opiates looking to get clean. If you want to keep drugs out of the hands of kids, make them all legal and watch the…

> If you want to keep drugs out of the hands of kids, make them all legal and watch the usage numbers fall. Doesn't the UK experience with alcohol counter this? (I am strongly in favour of legalisation of all drugs).

Amphetamine will be abused by college students. Alcohol will be abused by highschool kids. It's a given. The allure of stuff like cocaine, with the "what else was I lied to about, what am I missing out on" mindset goes out the window when you stop lying and start letting people make their own choices.

Re: America’s opioid epidemic is worsening

#118

Post by everybodyknows »

tim333 wrote: post #69

A potential solution: >Legal Heroin Prescriptions: The ‘British System’ You Never Knew Existed Basically prescribe heroin for the addicts so they don't need to deal / steal and the thing dies out. You could link getting the prescription to doing something useful work wise if you want to be moralistic. Been done since the 1920s - tried and tested. http://www.huffingtonpost.co.uk/entry/heroin-prescription-di...

How does the "British system" work out long-term, for the addicts as individuals -- resistance accumulation, vein damage, constipation? Do any live on to old age? Or does it "work" for the rest of society because they die peacefully, at home?

Re: America’s opioid epidemic is worsening

#119

Post by narag »

tptacek wrote: post #92
_jal wrote: post #76

Earlier quoted context omitted.

> Isn't the counterargument to this to point out the Oxycontin abuse epidemic? I don't see the origins of addiction relevant to arguments about containing current addiction when it moves to the illegal market. But I agree that supply-side targeting when talking about legal industry makes a lot of sense. Being legal, they also have lobbyists, which reduces the impact, same as other legal drug suppliers. > If violence…

I'm not sure I was arguing that opiate addicts are violent when they're high . I'm not making a moral argument about legalization or even (as is being repeatedly suggested on this thread) subsidization of opiates. I'm saying that if the cause of the epidemic is prescription opioids, and the ultimate problem is "too many people are non-functional opioid addicts", then deregulation won't fix the problem .

I'm not sure "epidemic" is a good word here. When compared with infectious diseases, we see that cause (the microbe) and effect (from fever to death) are clearly related. Here we have deaths caused by a prescription. Why were opioids prescribed to start with? And if abused, why?

Re: America’s opioid epidemic is worsening

#120

Post by gozur88 »

tptacek wrote: post #93
_jal wrote: post #81

Earlier quoted context omitted.

I think we'd need more evidence of that before just assuming it. Some number of people with current addictions would not have developed a habit if they hadn't been supplied by their doctor. Sure, there are also folks out there with habits that "doctor shopped" or whatever, but we aren't talking about those. Now, if "deregulation" as used above means "stocking next to aspirin at CVS", then sure. But that's not what's…

You need to capture not just addicts who got started on prescriptions, but addicts who got started through the resale of overprescribed opiates from non-addicts.

Also, the demand from Oxy addicts created (or, I suppose, upgraded) a criminal network that supplies heroin. When I was growing up there weren't that many heroin addicts around, so the local independent pharmacies didn't stock it.

If you were an adventurous youth looking for a new high you would have been sold barbiturates, maybe, or benzodiazepines. Maybe speed. But today it would be heroin, and you can trace at least some of that back to oxy addicts desperate to feed their addiction after being cut off.

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