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My experience of losing a friend to heroin (2020)

mattlakeman.org

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Re: My experience of losing a friend to heroin (2020)

#261

Post by lwf »

stef25 wrote: post #124
wespiser_2018 wrote: post #24

Good write up. The US is really grappling with diseases of despair, and heroin/fentanyl addition is on of the biggest ones impacting the wellbeing of our society. A massive slice of talent and raw human resource is just dying every year, but the solutions that have worked in other countries are just impossible to implement here due because the the methods that are known to work are politically dead on arrival. I'm a…

It's a really complicated problem but one thing that just stands out to me is the role the doctors play: It's not normal to send people home with these massive prescriptions for opiates. Here in Europe doctors are very, very conservative with that stuff (and meds in general) while it seems to me that in the US if your "medical experience" even entails the slightest bit of discomfort people get all up in arms over it.…

(To start: Just to clarify there's a significant difference between benzodiazepines and opiates.)

> I have a friend in the US who told me they have an app on their phone where they can just tap a button and the next day they can refill their benzo prescription, and it's been like that for years without having seen a doctor again.

Is this the "request a refill" feature that every US pharmacy offers? Granted, benzodiazepines are less restricted than stimulant drugs¹, but a doctor in the US need to at least review a prescription twice a year.

Chronic (daily) of benzodiazepines is bad, and doctors will not² start new patients on this.

There's still a lot of legacy patients who are on chronic benzodiazepine treatments -- doctors should work with them to wean them off, but it's very challenging and disruptive.

Requiring a patient receiving a benzodiazepine at a non-daily level (e.g. for seizures, anxiety, occasional insomnia) to go back to see their doctor when nothing's changed several times a year is just pushing medical costs (money/time) on the disabled.

¹: e.g. Adderall, which can't be refilled

²: Providers are trained not to these days, at least

Re: My experience of losing a friend to heroin (2020)

#262

Post by gibbonsrcool »

etempleton wrote: post #133

Opioids are over prescribed in the US and that is only now starting to changed. There is too much focus on eliminating any and all pain. Sometimes you are injured or recovery from surgery is going to be horribly uncomfortable. Opioids should probably only be administered in hospitals and not sent home with patients. They are simply too addictive.

Severe pain can last quite a while after surgery. As someone who had multiple jaw surgeries, including one double jaw surgery, I know a hospital couldn’t keep me that long, nor could I afford it. Luckily for me, morphine makes me feel bad. It makes my heart pound and I just get this overall bad feeling. Oxycodone and hydrocodone pills were awesome, which is why I made a conscious effort to switch to plain Tylenol as soon as I could manage and throw them out. I haven’t felt the need to seek out pills again. Probably just a lucky feature of my brain.

Re: My experience of losing a friend to heroin (2020)

#263

Post by otherme123 »

pkaye wrote: post #220
_delirium wrote: post #152

Earlier quoted context omitted.

My recent experience in the U.S. has been that, at least at major hospitals, it's flipped to the opposite extreme, and doctors are so worried about the backlash, that they will leave patients in pain and fail to prescribe analgesics sufficient for post-surgical pain control, if they don't have non-opioid options. My partner had a post-cancer DIEP flap reconstruction last month at a top cancer center in NYC, and due t…

Are the only options doctors can prescribe NSAIDs vs opioids? There is nothing else in between?

There are other painkillers coming and going. In my country, the middle ground was, for years, metamizole. This drug is currently baned in some countries (e.g. USA) for its side effects, while is sold nearly OTC in others (e.g. Mexico). Other drugs like flupirtine or nefopam are about the same: middle ground painkillers, but too bad side effects.

The good thing about opioids is that you can dosage them precisely, and that you have plenty of opiates in a ladder of potency. Tramadol (sold as Ultram in the US) is a middle-ground painkiller despite being an opiate. Same as codeine. Slightly above is tapentadol. Curious thing is despite tapentadol has not been found addictive (at least as addictive as other opiates), it's still an opiate, and so the FDA put it in the same bucket as fentanyl and morphine.

Another analgesic is cannabis. Sadly, it has the same problem as opiates: it was deemed too fun or too good, it seems we must endure pain to make the regulators happy. It turns out people hate pain, so they end up taking fentanyl and heroing under a bridge.

The sad thing about all this is that the regulators decided pain is not a bad thing, so you must endure it. But they decided anxiety is a terrible thing, so you can get as much bromazepam as you need. Even when bromazepan and other benzodiazepines create dependence and tolerance (and the withdrawal is terrible), I'm sure you now at least a dozen people taking it cronically (I do). They are as hooked to that thing as it was heroin but, hey, it's legally prescribed, so no problem here: one pill for breakfast, one before bed, and they are 24/7 high while nobody bats an eye.

Re: My experience of losing a friend to heroin (2020)

#264

Post by _qn3k »

hedberg10 wrote: post #247
tombert wrote: post #81

When I was nine years old, my cousin died of a heroin overdose at nineteen years old. Most of the grownups around me were very sad, but I didn't really know my cousin very well; he lived on the opposite side of the country, and he was a full decade older than me so the times I did see him we didn't really play together, and so I wasn't really able to feel "sad" about it. People I don't know die every day, I can't fee…

> my cousin had been taken so young? He wasn't taken. He took himself. Exercise: Everytime you remove agency, reintroduce it. "I am depressed". No, you are depressing yourself. "I am helpless". No, you are making yourself helpless. These are active processes. Let's get more controversial: "I am being bullied". No, you are letting people bully you. I know this is harsh. I know the societal memes and phrases are the wa…

I started writing out a much longer response to this, but it just got very ranty so I'll cut it short. If you insist on such a reevaluation as to why people aren't in their best state, a one word answer "lazy", "attention seeking" (okay thats two words, you get the idea), "weak" isn't going to cut it. You need to continue to ask yourself why that is the case, why are these people so apparently lazy, that they would allow it to work negatively upon them? I obviously don't buy your argument, I think the expectation of complete agency in a society run on hundreds of thousands of people is a bit of a fantasy, but you could have a point. You just don't have anything yet.

Another argument against it, why not turn the mirror on yourself. Why are you not richer, stronger, more popular, happier? Maybe you are somewhat of all those things already, but a wild guess is that your not the strongest, richest, most famous and happiest person in the world. So why not, are you weak, lazy and shallow? Or, perhaps is the truth a bit more complicated?

Re: My experience of losing a friend to heroin (2020)

#265

Post by stef25 »

pkaye wrote: post #220
_delirium wrote: post #152

Earlier quoted context omitted.

My recent experience in the U.S. has been that, at least at major hospitals, it's flipped to the opposite extreme, and doctors are so worried about the backlash, that they will leave patients in pain and fail to prescribe analgesics sufficient for post-surgical pain control, if they don't have non-opioid options. My partner had a post-cancer DIEP flap reconstruction last month at a top cancer center in NYC, and due t…

Are the only options doctors can prescribe NSAIDs vs opioids? There is nothing else in between?

You can give Codeine or Tramadol, which are opiates that produce no "high" when taken in standard therapeutic doses. People do abuse them by taking a whole box at once, but you won't end up in a scenario like in OP's story where someone discovers it "solves all their problems" after receiving them for moderate pain from a routine medical procedure, and has them shooting heroin 6 months later.

Re: My experience of losing a friend to heroin (2020)

#266

Post by hedberg10 »

Biganon wrote: post #260
hedberg10 wrote: post #256

Earlier quoted context omitted.

> depression is imaginary Nice strawman > The kids killed in Syria and Afghanistan should've helped themselves Never mentioned kids in warzones > But yeah life is harsh and the world is shit. And death is inevitable. Make an effort, coward.

Would you go to someone who has Crohn's disease and tell them "you're doing that to yourself"? No? So why do it with depression?

Never mentioned Crohn's. Why are you bringing that up? Same with the comment above above: Ask yourself, why are you deflecting, why are you removing agency?

Let's say depression is a purely biological problem, the chemical imbalance (it isn't), take a pill and be be healed! Right?

Now who sells that pill? Who lobbied to have depression seen as a disease?

Who invented the CO2 footprint? BP.

Re: My experience of losing a friend to heroin (2020)

#267

Post by newby »

ioseph wrote: post #108
karlmdavis wrote: post #48

Earlier quoted context omitted.

This seems to rather callously disregard the parent commenter’s lived experience. Perhaps, just maybe, not everyone is like you; it might be different for different people? Just a thought.

That was certainly not my intention, I was trying to say that the idea that these substances will make anyone a helpless addict if they try them once is misleading and completely ignores the social context around addiction.

I agree with you that social context matters but I want to provide one data point on how psychological setting of that person matter too.

I am an anxious person prone to depression. In one especially bad period of my life I was prescribed Lexaurin (anxiolytic used to handle panic attacks). Taking that was a shocking experience - it made me feel calm, optimistic... and maybe for the first time in my life it made me aware of the ever-present baseline of anxiety that I was living with, like always. Lexaurin made me feel not anxious at all and it felt awesome. I kept asking myself - is that how other people feel all the time? I would give anything to live like that. If I had free access to it all the time, it would be really hard to resist the temptation not to use it. At the same time I can imagine that for many people - like you maybe? - taking Lexaurin would do absolutely nothing, because they live on that anxiety-free baseline their normal lives.

Re: My experience of losing a friend to heroin (2020)

#268

Post by rawoke083600 »

This is terrible and I don't have any answers or clues, but I was thinking how "hard" it will be to fight this (addiction etc).

I mean you have on the one side "HIGHLY motivated/addicted individuals" that are willing to break into their parents houses to steal TV's for drug money (and much worse).

On the other hand you have law enforcement, policy makers,medical personal (lets call them ppl with jobs - yes some do it with a lot more heart and care but it is still a 'day job') that needs to "fight" this epidemic.

I almost feel until you have the police breaking into their parents house to steal bullets, the doctors breaking in to steal stethoscopes and policy makers dying at their computers because they read EVERY study and evaluated every model to combat the epidemic it is going to be very hard on all of the ppl that is fighting this.

And I'm not even saying they should do it, it just that how do you "battle" a group that is 100% consumed by their cause 24/7 (drug use) ?

Just to be clear, I'm not saying the ppl that are enforcing, combating or helping drug addicts are 'not working hard enough'. I'm saying even if they do work overtime to help and have the correct model and proxy drugs.

The drug users will always "outwork" them in the search/use for drugs.

Re: My experience of losing a friend to heroin (2020)

#269

Post by toyg »

SuoDuanDao wrote: post #49
aazaa wrote: post #4

> I wish I had a happier note to end this on, but honestly, my biggest takeaway from the whole experience is that maybe some puzzles just can’t be solved. We can try to attribute Jack’s problems to intrinsic biological/psychological issues (social phobia, migraines, etc.) or to environmental causes (super high rate of heroin use and OD in the community), but both sides seem fundamentally lacking in explanatory power.…

I heard a story - can't find the reference now - of a doctor who got addicts to replace their drug addiction with exercise addictions. From what I recall the program was quite successful at making the patients functional, but didn't really do much for the underlying issues - just made the addiction itself less damaging.

That's the "Trainspotting 2" theory: we're all addicts, just replace one addiction for another. Film director and comedian Kevin Smith once said his friend Jay Mewes manages to stay away from his heroin addiction by drinking gallons of energy drinks.

Re: My experience of losing a friend to heroin (2020)

#270

Post by otherme123 »

kenneth wrote: post #252
otherme123 wrote: post #245

Earlier quoted context omitted.

This puzzles me. The Medication Assisted Treatment (metadone and buprenorphine) started in 1991. The Heroin Assisted Treatment (HAT) started in 1994. People that failed the MAT were enroled into the HAT. Limited first HAT experiments were found sucessful, and thus expanded in 1999. In 2008 both approaches entered the law. All data from here: https://doi.org/10.1186/s12954-020-00412-0 , but you can found it in a lot o…

The first phase of the experiment was to have a free zone in the Platzspitz park, with a needle exchanges, and no interference to drug sales and use. The park became known as "needle park." https://en.wikipedia.org/wiki/Platzspitz_park They shut it down in '92, which led to junkies spreading throughout the city, particularly on and around Langstrasse. It wasn't until a real crackdown that things got better. They trie…

When a non-Swiss person talks about "the Swiss heroing/drug experiment", they are referring specifically to the HAT program, and not to a free-for-drug park.

It's obvious that if you put all the junkies of a county in a single park, without even the minimal hygienic measures, you create a mess. That's not laissez-faire, that's a mess, but to their credit at least they tried something different than the cycle "heroin user -> scum to jail or to cemetery". It would happen with anything imaginable: "now all homeless are allowed in the Platzspitz Park and nowhere else", a month later the park is covered with homeless trash to nobody's surprise.

The HAT is a step further (not backward) in decriminalization: you are hooked to heroin, metadone doesn't work. But you are not a criminal, and thus we will take a medical approach.

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