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America’s opioid epidemic is worsening

economist.com

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Re: America’s opioid epidemic is worsening

#161

Post by microtherion »

digler999 wrote: post #140
microtherion wrote: post #127

Earlier quoted context omitted.

> too many people are non-functional opioid addicts Experience here in Switzerland would suggest that if the state takes dirty needles, expensive supply, and highly variable purity out of the equation, opioid addicts can lead a life that is, while far from ideal, considerably more functional than before. My impression is that drugs like Heroin, taken in correct dosage, do not inherently cause massive health damage. I…

> Heroin, taken in correct dosage by what ROA ? You smoke it, and you're good until your dependence increases. Then you must smoke it to feel normal. But if you slam it, you'll get high again. Do that a while and your dependence increases just as before, now you have to slam it just to feel normal. But if you just got someone to give you their dose, then you could slam 2 doses and get high again...and now you're in o…

By "correct dosage", I meant that there exists a dosage for each patient that neither induces withdrawal symptoms nor causes acute health risks.

Re: America’s opioid epidemic is worsening

#162

Post by cheald »

6stringmerc wrote: post #47

The first time I saw a TV commercial here in the US for a pill to battle opiod induced constipation, I realized just how many people are taking large doses of the stuff. Pretty staggering to me.

Yeah, those commercials are painful. If you're taking so many opioids that you have trouble pooping, maybe the solution is to take fewer opioids rather than adding another medication to the mix. Really damning commentary on how easily and flippantly we overmedicate.

Re: America’s opioid epidemic is worsening

#163

Post by jessaustin »

tptacek wrote: post #137
jessaustin wrote: post #128

Earlier quoted context omitted.

If we believe that some addicts can be helped to deal more productively with their addiction (personally I think that's true), and we observe that prohibition tactics don't help addicts get that help (see TFA and basically every other serious examination of this), then ending prohibition will certainly help some addicts. One might argue that more people would start using without prohibition, but that would be pretty…

I understand that it's difficult to avoid litigation of decriminalization (or, apparently, subsidization) in discussions about illegal drugs. I'm generally receptive to decriminalization. But I'm not making a point about decriminalization. In the same way that it's counterproductive to spend a lot of time talking about prohibition in mass incarceration discussions (significant reduction in incarceration --- which is…

I don't understand this "purity of argument" argument. You'd like to ignore prohibition as a cause of these problems, apparently since this other cause also exists (...conveniently ignoring that they're actually two aspects of the same cause, since pill mills are an unavoidable result of prohibition: never mind that). I contend that looking for "the one true big cause" is a mug's game. Sure, it would be nice if physicians were more skilled at pain management. Maybe they should go back to school? b^) Perhaps if they were more skilled, these problems would be reduced. Regardless, if the prohibition regime changed into more of a treatment regime, that would also reduce the problems associated with addiction, especially for existing addicts who have already received poor care from physicians!

Re: America’s opioid epidemic is worsening

#164

Post by alva »

oxide wrote: post #154
alva wrote: post #139

Earlier quoted context omitted.

You can't stop all the drug abuse but the extent of use is not a given. Amphetamine use of UK students appears to be extremely rare compared to the US, its never really been a cultural thing here. I suspect it is due to very few amphetamine drugs being prescribed, especially to children. It seems to common to hear about people selling their legitimate ADHD/ADD prescriptions to friends in the US. "Speed Paste" is the…

I completely agree. My example wasn't exactly the best, but relatively applicable to the US nevertheless. You raise many good points about drug use being different geographically and culturally. It's very much about availability, local drug culture, etc. For example, the speed paste. As you said, in the UK and in other European countries amphetamine is usually amphetamine in paste form, not crystal methylamphetamine…

What a nice response :)

I think identifying these differences between countries will bring governments a step closer to finding some sort of solution. Not exactly an easy one though when it comes to culture though. How do you break strong cultural associations?

There seems to be a number of (bad)role models that glorify different drugs in sub-cultures. Opiate use is glamorised from what I can tell in southern HipHop, Cannabis promoted all over the shop, Xanax frequently referred to in Hollywood.

Re: America’s opioid epidemic is worsening

#165

Post by ucaetano »

M_Grey wrote: post #159
ucaetano wrote: post #48

And a potential solution to it: https://arstechnica.com/science/2017/03/tweaking-fentanyls-c... For their chemical makeover, the researchers noted that when tissue is damaged and hurting, it becomes inflamed and more acidic. The pH drops from approximately 7.4—what’s seen in normal, healthy tissue—to between 5 and 7. Fentanyl can work regardless of the pH, so it’s active throughout the nervous system no matter what.…

That's great, and there are other painkillers on the horizon too, but that's "maybe" and "later". Today we could take concrete steps to alleviate this crisis which we created in the first place. Cannabis is a good choice for people addicted to opiates, along with medical detox. You also have to manage underlying mental health, social, and medical issues. No amount of throwing new molecules at these problems will solv…

Agreed, and cannabis is a good choice not only for the addicted, but to those suffering chronic pain what would eventually use opioids.

Re: America’s opioid epidemic is worsening

#166

Post by jasonmp85 »

M_Grey wrote: post #160
taurath wrote: post #157

Earlier quoted context omitted.

Given the amount of pharmacetical money sloshing around every single congresspeople's coffers there will not be any meaningful reform or restrictions for a long while. The easiest path is to just go full-bore law and order against drug users.

That's then 'easiest' path on what planet? It's the absolute hardest path, and utterly defeatist.

I think people are taking away the wrong message here. It's the "easiest" as in "on the lowest shelf". It's easy just as it's easy to grab undocumented immigrant parents in pickup lanes at schools.

There's doing what's hard (either politically, or by effort) but "best", and there's being lazy and incompetent and just doing what comes easiest. Our current administration does the latter.

Re: America’s opioid epidemic is worsening

#167

Post by goatsi »

pnathan wrote: post #146
senorjazz wrote: post #70

Earlier quoted context omitted.

The problem is you have a large addicted population. Helping them get off opiates is expensive and time consuming (although orders of magnitude less than the war on drugs). Also, depending on the level of addiction that may just be no hope for some. As another commenter said, in Holland they have had legal heroin dispensaries for 30 years, with medical staff and clean rooms for injecting. The addicts can be monitored…

I'm kind of interested in the funnel prior to the addiction. How to make heroin etc uninteresting ...

Heroin clinics can be very helpful for that. By providing the heroin and requiring that it be used on site they take it out of the community. Nobody sees their friends using and gets offered a bit to try. Starting drug use is often a very social phenomenon, generally people are introduced to them by friends.

From a study on the Swiss clinics [0]

>*New Use Rates: Slightly lower than expected. 1) As reported in the Lancet June 3, 2006, the medicalisation of using heroin has tarnished the image of heroin and made it unattractive to young people. 2) Most new users are introduced to heroin by members of their social group and 50% of users also deal to support their habit. Therefore, with so many users/sellers in treatment, non-users have fewer opportunities to be exposed to heroin, especially in the rural areas.

This is only helpful for people starting from heroin though, the problem of people getting addicted to opioids from taking pharmaceutical drugs [1] is an entirely different matter to address.

[0] http://www.citizensopposingprohibition.org/resources/swiss-h...

[1] http://www.pbs.org/wgbh/frontline/film/chasing-heroin/

Re: America’s opioid epidemic is worsening

#168

Post by djrogers »

delhanty wrote: post #59
tptacek wrote: post #30

Earlier quoted context omitted.

Isn't the counterargument to this to point out the Oxycontin abuse epidemic? Doctors are prescribing years worth of opiates to patients. There have been suggestions that Purdue Pharma's formulation of Oxy practically guarantees dependence, because of the way it's dosed. Are the people dying of heroin overdoses in white rural Ohio starting on heroin, or transitioning to it after prescription opioids become too expensi…

Isn't there something in common there: drug dealers make money pushing heroin etc. and (some) doctors make money pushing Oxycontin? Maybe if all these drugs were freely available at least some of the violence would go away and the incentives to push them would go away too ...

The same argument could be made for bank and home invasion robbers - if money were freely available she of the violence would go away.

The question is, what costs (both financial and societal) are we willing to bear to support addicts?

Re: America’s opioid epidemic is worsening

#169

Post by dep_b »

cryptarch wrote: post #110
dep_b wrote: post #54

Earlier quoted context omitted.

They're not legal in The Netherlands. Magic mushrooms have been banned a while ago (but at the same truffles still are not, clueless), weed was never legal. Also all production is illegal. Coffeeshops don't pay taxes. They're just.....there? We used to think it was the crazy US forcing the Dutch to have such a bipolar approach to drugs but pot is more legal in Colorado now than in Holland and still the Dutch laws are…

Magic truffles have the same effects as magic mushrooms and are legal. Magic mushroom products are still sold at some smartshops, but not legal. Weed is not legal, but you can buy it in dispensaries ("koffieshops") and carry up to 5 grams without being fined or arrested. You can smoke publicly as long as you're not bothering anyone (like with alcohol). I think that's pretty sweet. You can have up to 5 plants at your…

> You can have up to 5 plants at your home

I think that's an urban myth actually. I know people that got kicked out of their house for having just three plants just growing outdoor so no tampering with electricity or fire risk. They used to be more lenient but people tended to burn their house down with illegal indoor plantations.

It's weird how in a liberal country like The Netherlands where everybody wants full legalization we somehow ended up with a government that got a lot stricter instead.

Re: America’s opioid epidemic is worsening

#170

Post by vogelke »

One of the best books I've ever read on why the war on drugs is a bad idea. It's written by a UK cop who was there nearly from the beginning.

  https://www.amazon.com/Good-Cop-Bad-War/dp/1785032690/
  Good Cop, Bad War (Paperback)
  Publisher: Ebury Press
  Language: English
  ISBN-10: 1785032690
  ISBN-13: 978-1785032691
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