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Bleak New Estimates in Drug Epidemic: A Record 72,000 Overdose Deaths in 2017

nytimes.com

191–200 of 217 posts

Re: Bleak New Estimates in Drug Epidemic: A Record 72,000 Overdose Deaths in 2017

#191
post #26

The amount of responsibility laundering that's happening is staggering. Is it the fault of the doctors for prescribing strong painkillers or the responsibility of lobbyists for keeping the status quo as it is. Or is it the responsibility of patients to not seek strong opiates for the smallest aches? On whom falls the blame for this?

Have a look at the letter that started it all. This letter claimed that addiction is rare in patients treated in hospital with opioids for pain. https://www.bbc.co.uk/news/world-us-canada-40136881 The US Veteran's Association noticed that many veterans were living with pain. They felt that this needed to be treated, and they believed that opioids were safe an effective to treat long term pain, and that the risk of ad…

Yes! That became the common wisdom: If patients are taking opioids for pain relief, they won't become addicted. Of course that article was talking about opioids given to patients in a hospital setting, not patients being sent home with bottles of them. It was taken completely out of context.

The other half of it was somehow deciding that opioids were the proper treatment for chronic pain, rather than temporary pain relief after surgery. Which was never really studied. And the consensus seems now to be that was a terrible idea.

Re: Bleak New Estimates in Drug Epidemic: A Record 72,000 Overdose Deaths in 2017

#192

The amount of responsibility laundering that's happening is staggering. Is it the fault of the doctors for prescribing strong painkillers or the responsibility of lobbyists for keeping the status quo as it is. Or is it the responsibility of patients to not seek strong opiates for the smallest aches? On whom falls the blame for this?

"Dreamland" is a pretty amazing summary of the responsibility. https://www.amazon.com/dp/B00U19DTS0 In short: pharma companies for misrepresenting an editorial in the 80s about addiction rates, medical industry calling pain the fifth vital sign, and enterprising drug dealers setting up Domino's like delivery services for heroin.

Terrific book, highly recommended.

Re: Bleak New Estimates in Drug Epidemic: A Record 72,000 Overdose Deaths in 2017

#193
post #120

Earlier quoted context omitted.

Keep in mind that some people are at much higher risk for becoming addicted to opiates. You may have been able to take them recreationally without major issue, but the same behavior could have a much more severe consequence for someone in that at-risk group.

> some people are at much higher risk Why is that? Something in their genetic makeup? Wonder if its possible to identify these ppl preemptively.

Genetics play a huge role [0], but so do social and environmental factors.

[0] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2442454/

Re: Bleak New Estimates in Drug Epidemic: A Record 72,000 Overdose Deaths in 2017

#194

The sad truth is, the U.S. is a country that emphasizes punishment over rehabilitation, and we've brought this upon ourselves by isolating people and banning access to substances that they've become dependent on. The solution here is not complex: give addicts safe access to the substances they're addicted to and resources for improving their situation. It's disheartening, to say the least, that one of the main strate…

> It's disheartening, to say the least, that one of the main strategies for dealing with this is apparently "reducing medical prescriptions of opioids". People are in pain -- they need to be helped. While I pretty much agree with everything you say, I take a bit of issue with this. Overprescription of opioids is a major factor for creating addicts in the first place, and in that regard, the US is a rather obvious out…

Yeah, that's a fair point. I agree that prescribing opioids is overkill in most cases, and is surely creating more addicts, but what I really take issue with is how we've been completely overlooking the environmental factors in addiction. This paradigm of reducing access to drugs to reduce addiction rates has prevailed for a long time, with pretty dire consequences. There's certainly more to this than the chemical component.

Re: Bleak New Estimates in Drug Epidemic: A Record 72,000 Overdose Deaths in 2017

#195
post #143

Earlier quoted context omitted.

I can accept bizarre. I think it is safe to say all drugs modify the physiology of the user in some way. The difference is if that change to the body is what induces a craving for more from a cellular level. There is no indication that depressants, as a class, achieve addiction purely in response to cell modification. You mention cocaine versus opiates. A major difference there is that cocaine doesn't require repeate…

I don't think that section in wikipedia, or the paper it comes from, says what you think it says. It certainly doesn't claim that a single use is addictive, only gives the rates of continued use (to the point of dependency) a certain number of years after the first dose. I imagine one could come up with similar numbers for opiates. Further, you've contradicted your own point in your spiel about nicotine. I really don…

> Further, you've contradicted your own point in your spiel about nicotine.

How so? I stated that it isn't the nicotine or its addictive effects that make cigarettes addictive even though research indicates nicotine is universally addictive. A cigarette is not nicotine.

> I really don't think your ideas are supportable.

There is sufficient medical research to dictate whether or not these ideas are valid. The question I am trying to raise is to what degree behavioral medicine is more a factor in this than physical medicine, but I honestly feel you are deliberately ignoring this to prove some point.

Re: Bleak New Estimates in Drug Epidemic: A Record 72,000 Overdose Deaths in 2017

#196

As a comparison, the road toll in the USA is 33,000 per year. Firearms kill about the same number (including 20,000 suicides). 3,000 people were killed in the 9/11 attacks. 72,000 overdose deaths is just a staggeringly large number.

> 72,000 overdose deaths is just a staggeringly large number. It's still only a drop in the bucket compared to overall drug-related deaths though. Tobacco-related deaths alone account for 500k deaths annually, and that's not even counting deaths related to third-hand smoke.

The difference is that tobacco itself doesn't kill people. It's the long term side effects. You can't overdose on cigarettes (although it is possible to OD on nicotine).

72,000 is just the number of sudden effects, ignoring the chronic long term effects of opiate abuse.

It the same thing with alcohol. Very few alcoholics die from alcohol poisoning, it's the long term health problems that kill them.

Re: Bleak New Estimates in Drug Epidemic: A Record 72,000 Overdose Deaths in 2017

#197

Earlier quoted context omitted.

> 72,000 overdose deaths is just a staggeringly large number. It's still only a drop in the bucket compared to overall drug-related deaths though. Tobacco-related deaths alone account for 500k deaths annually, and that's not even counting deaths related to third-hand smoke.

The difference is that tobacco itself doesn't kill people. It's the long term side effects. You can't overdose on cigarettes (although it is possible to OD on nicotine). 72,000 is just the number of sudden effects, ignoring the chronic long term effects of opiate abuse. It the same thing with alcohol. Very few alcoholics die from alcohol poisoning, it's the long term health problems that kill them.

> Very few alcoholics die from alcohol poisoning, it's the long term health problems that kill them.

Actually I think the median death from alcohol is mid-30s, with alcohol-related accidents and suicides being more common than chronic health issues.

Re: Bleak New Estimates in Drug Epidemic: A Record 72,000 Overdose Deaths in 2017

#198

Earlier quoted context omitted.

Eh, I think you might be injecting too much partisanship into my original point. Stopping drug overdoses is popular across the board, but some of the tactics to accomplish that are not. We aren’t even at step zero, pretending to give a shit at the national level. You also need to factor in the victims, or rather their demographics. To be brutally honest, past victims of heroin were often minorities who lived in inner…

> Stopping drug overdoses is popular across the board, but some of the tactics to accomplish that are not. We aren’t even at step zero, pretending to give a shit at the national level. We are at step zero, which is we have the capability of measuring the problem. Lets be frank: there is plenty of people who care, and those people are providing those measurements (CDC analyzing death certificates, especially for Opioi…

There are huge political headwinds, namely, that the party in charge of all three branches of government considers drug addiction to be a moral failing, not a disease. They are not willing to decriminalize drugs and pay for treatment programs -- they would rather continue the draconian approach of locking up anyone found to be in possession. Look at how much they are already railing against marijuana legalization, safe injection sites, lenient sentencing for non-violent drug offenders, and other similar measures.

I don't know how you can be so rosy about the problem being solved within a decade when the war on drugs has been going on for many decades already.

Re: Bleak New Estimates in Drug Epidemic: A Record 72,000 Overdose Deaths in 2017

#199

Earlier quoted context omitted.

This sounds exactly right to me. In discussions with a religious friend of mine some years ago, I noticed that she had a tendency to conflate law and morality, when they really have nothing to do with each other. Further, she seemed to think that because it was illegal or bad to do something, it was reasonable to expect that people wouldn't do that thing as a result. I found (and find) this ridiculous - in large enou…

The legal = moral line of thought is one of my most hated things to come across. It correlating with the highly religious makes sense, but it's by no means limited to them. It's incredibly wide spread in American culture to have at least a small degree of that, people always feel naughty when they break the law. I too find it ridiculous.

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Re: Bleak New Estimates in Drug Epidemic: A Record 72,000 Overdose Deaths in 2017

#200

Earlier quoted context omitted.

This sounds exactly right to me. In discussions with a religious friend of mine some years ago, I noticed that she had a tendency to conflate law and morality, when they really have nothing to do with each other. Further, she seemed to think that because it was illegal or bad to do something, it was reasonable to expect that people wouldn't do that thing as a result. I found (and find) this ridiculous - in large enou…

The legal = moral line of thought is one of my most hated things to come across. It correlating with the highly religious makes sense, but it's by no means limited to them. It's incredibly wide spread in American culture to have at least a small degree of that, people always feel naughty when they break the law. I too find it ridiculous.

Keep in mind that there’s actually a path to breaking people out of this point of view, but it’s a really deep, dark rabbit hole, with lasting ramifications.

When you take this principle into account, however, a huge segment of the world makes much more sense, although the realities that become evident are kind of horrible.

The fastest path to lead people out of this mindset, is to prove to them their own error by bringing them in on some misbehavior (such that they perceive it as a serious violation of their own personal code), for which they both benefit from, experience no consequences, and find deep tempatation to repeat.

To broach the subject of crossing some personal line with a person like this raises an eyebrow. Crossing that line in front of them reveals a mixture of feelings. Inviting them to participate is met with uncertainty. Pulling the trigger with them gives way to a period of paranoia, until the coast is clear. Then, twice then, three times. Now, they’re convinced that morality isn’t set in stone, and laws are the commands of mere mortals, to be broken at will.

But, now what you have on your hands is a convert. Once conservative, and yet still as much, but eager to experiment and challenge their own views. This is where stereotypical morally abivalent, yet superficially conservative people come from. Seduced out of their naive, obedient world view, but entertaining dubious integrity. So now it’s no longer divine authority in an imperfect world conceived by some paranormal perfection, but instead, simply might makes right. And so, you get tasteless materialism, and a ruthlessness to obtain status.

After a certain age, this sort of thing really can’t happen with some people. When you’re a teenager, transgressing certain boundaries can be harmless and naive, but after a certain age, cheap thrills don’t work. That’s why we find a broad split of sheltered, uptight squares, mixed in with smaller segments of snobby, cavalier libertines or cheesey, greedy sociopaths.

It’s a distribution of age brackets for teenage misbehavior. The cornier the yuppie, the later in college they started breaking the rules, or maybe they never broke any rules, and that’s why they’re stuck with this holier-than-thou attitude.

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