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America’s opioid epidemic is worsening

economist.com

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Re: America’s opioid epidemic is worsening

#201

Post by 3131s »

Kluny wrote: post #147
DanBC wrote: post #100

Earlier quoted context omitted.

> The guidelines currently say that if someone is in pain, give them as much painkiller as they want Can you point me to those guidelines please? I'm struggling to find them. I can understand the advice if it's relating to short term immediate pain - for example post-operative pain. Addiction is unlikely to result from pain medication use in that example. Here's the English advice: http://www.fpm.ac.uk/faculty-of-pai…

I went looking for you. The guidelines appear to have been updated since last I checked, and are no longer as irresponsible as I thought they were. Here's what I found: (easy version) https://www.cdc.gov/drugoverdose/pdf/guideline_infographic-a... (hard version) https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm

It's actually pretty hard for legitimate patients to get opioids in many circumstances. My mother has chronic pain from a surgery and has been on a very low dose of oxycodone for years now (10mg a day, I think), and she regularly is subjected to urine and other tests to prove that she's not an addict. My grandpa just had an operation and later at home ended up in a lot of pain, but he could not get oxycodone for two days -- the first night because he went in after 7:00 PM and apparently Indiana has some law against prescribing them past that time.

Re: America’s opioid epidemic is worsening

#202

Post by tptacek »

jessaustin wrote: post #163
tptacek wrote: post #137

Earlier quoted context omitted.

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 physi…

I'm simply saying that the point you're making is orthogonal to mine. I'm not criticizing you for being impure.

Re: America’s opioid epidemic is worsening

#203

Post by M_Grey »

taurath wrote: post #174
M_Grey wrote: post #160

Earlier quoted context omitted.

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

Its the easiest way for politicians to stay elected while not upsetting their benefactors.

Up to a point, yes. Then it becomes a mess for everyone.

Re: America’s opioid epidemic is worsening

#204

Post by ucaetano »

stagbeetle wrote: post #193
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.…

> But, if it was altered to only work at the lower pH, then it could target just the pain source at the peripheral nerves, the researchers hypothesized. Do you know how this interacts with anti-inflammatory drugs?

No idea! I'm by no means an expert in the subject.

Re: America’s opioid epidemic is worsening

#205

Post by goatsi »

djrogers wrote: post #168
delhanty wrote: post #59

Earlier quoted context omitted.

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?

Whenever this comes up it's important to realize how much addicts are already costing us. It's hard to know exactly how much because the costs are born by already existing systems - home insurance to cover burglaries, auto insurance to cover smash and grabs, law enforcement to investigate these crimes committed to feed addictions and to try to stop the flow of heroin.

Then there is the cost of health care. Even if you ignore long term problems like HIV or Hep-C infections contracted by sharing needles (hundreds of thousands of dollars per person), just responding to overdoses is very expensive. [0]

>In December 2016, the City of Vancouver approved a small property tax hike, which was intended to help address the opioid overdose crisis. Councillors passed a budget that included a 0.5 per cent property-tax increase to support front-line service providers, which is in addition to the 3.4 per cent increase already in place to deal with the fentanyl crisis.

>..

>According to the report, the total funds available in the 2017 contingency fund for the opioid crisis is $3.5 million and the remaining amount after the above expenditures is $1.4 million.

That is only the monetary cost, there is a mental cost as well. [1]

>A health and safety worker with Vancouver Fire and Rescue Services says he's never seen stress and anxiety so rampant among first responders.

>Acting captain of occupational health and safety Steve Fraser says the ongoing overdose crisis has many firefighters dealing with emotional and mental fallout because of their job.

>...

>Another big issue, Fraser says, is "compassion fatigue" which comes from sometimes treating the same people time after time.

>"It's that feeling of helplessness and hopelessness that what you do is not making a difference," he said. "For all of us … why we do it is we do want to make a difference. So, when we see that fail time and time again it does start to take its toll."

Heroin clinics would help solve most of these issues. [2]

>Crime Issues: 60% drop in felony crimes by patients (80% drop after one year in the program). 82% drop in patients selling heroin.

>Death Rates: No one has died from a heroin overdose since the inception of the program. The heroin used is inspected for purity and strength by technicians.

>*Disease Rates: New infections of Hepatitis and HIV have been reduced for patients in the program.

>Note: The Swiss save about 38 dollars per day per patient mostly in lowered costs for court and police time, due to less crime committed by the patients.

[0] http://globalnews.ca/news/3189393/city-releases-report-outli...

[1] http://www.cbc.ca/news/canada/british-columbia/overdose-fent...

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

Re: America’s opioid epidemic is worsening

#207

Post by BurningFrog »

creaghpatr wrote: post #3

If you're looking for a go-to book on America's opioid crisis- Dreamland by Sam Quinones. http://www.goodreads.com/book/show/22529381-dreamland The devil is absolutely in the details and it seems like it's gonna get a lot worse before it gets better.

Yup. Not only is it very informative about the 4-6 separate trends that resulted in this slow disaster. It also really well written.

Re: America’s opioid epidemic is worsening

#208

Post by hive_mind »

interfixus wrote: post #133
dsmithatx wrote: post #67

Earlier quoted context omitted.

Checkout Denmark. They had a huge problem with robberies and started giving legal pure Heroin shots to users. They also helped them find jobs. No more deaths and no more black market for Heroin. Hence burglaries also went away. It looks like our current President is looking at cracking down on pot again though so, I don't imagine we'll have a sensible drug policy anytime soon. Only one motivated by profits.

Which Denmark is this? Doesn't resemble the one I live in. Neither the robberies problem nor the legal pure heroin, and most certainly not the disappearance of burglaries - not statistically, not anecdotally, and not according to the several people of my acquaintance who have had it happen to them.

In the USA, there's a fantasy Denmark that exists in the media.

In the fantasy Denmark, there's no crime, all the women are hot blondes who never get fat, there's cheap weed every where (and apparently free clean heroin), the furniture is sleek, all the men are feminists who never objectify women (there's no porn), the school system is fantastic (every child is good at math), the healthcare is free and high-quality, education is universal, free and high quality, and there are plenty of jobs for everyone (and high quality ones too!).

Pretty much like the rest of fantasy Europe.

Re: America’s opioid epidemic is worsening

#209

Post by ams6110 »

empath75 wrote: post #85
mmanfrin wrote: post #31

Earlier quoted context omitted.

The root cause was the never-allow-pain mantra of the 90s when it came to proscribing painkillers like Oxy; this was followed years later by a later tightening of prescription policy that led many to look to Heroin as an alternative.

I just go laparoscopic surgery. I told them multiple times I didn't want to use opiates to manage pain, that I wasn't in very much pain, and they still gave me iv fentanyl, and about 150 Vicodin tablets to take home. They asked me if I had an opiate problem, like turning down opiates meant that I had some kind of drug issue. It was bizarre.

I've had Vicodin prescribed a couple of times. I never felt it did much. Certainly didn't make me high. I don't see how it's a gateway to opioid addicion unless you're eating them like candy from the get-go.

Re: America’s opioid epidemic is worsening

#210

Post by soundwave106 »

rm_-rf_slash wrote: post #84
glangdale wrote: post #65

The only thing that is good about this epidemic is that it seems to have moved harm reduction onto the agenda after decades of militarized and/or "lock 'em up and throw away the key" responses. Hopefully the result will be a more rational response for all of America's drug problems regardless of the color of the users.

Are you kidding? The attorney general of the United States is on record saying the one thing that kept him from joining the KKK was their marijuana use, stating that "decent people don't smoke marijuana." Public opinion may have shifted, but as far as the current White House is concerned, it's their way or the highway.

For the record I've noticed the tone of reporting these days is a little different as well, personally. It is harder for people to demonize prescription drug abuse; you don't get quite as much of the broad stereotyping and Hollywood-ization that happened in the 1980s on this subject.

Yes, some people cling to old-fashioned hardened attitudes. But if you look at Gallup's poll on drugs (http://www.gallup.com/poll/1657/illegal-drugs.aspx), people are way more worried about prescription drugs and the related heroin epidemic these days. Way more than cocaine, certainly. It's not in the poll, but it's hard to remember when the last time the boogeyman of the 1980s (crack cocaine) came up in reports.

Support for marijuana legalization stands at 60% now, compared to the 1980s where support was at 25%. There is a large age gap in support, in marijuana at least (http://www.gallup.com/poll/196550/support-legal-marijuana.as... -- 55+ 45% support, 18-34 77% support).

Although I'm sure harder stances will linger onward, as it has in the AG's mind, the AG's stance is increasingly looking out of touch.

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