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America’s opioid epidemic is worsening

economist.com

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Re: America’s opioid epidemic is worsening

#71

Post by ThrustVectoring »

savanaly wrote: post #4

Given that this article only touches on the supply of these drugs, is there a tacit assumption that the demand for opioids is driven by unemployment? If so, what can be done about the demand for these drugs in the long term? "Bringing back jobs" to those people whose comparative advantage is no longer manufacturing by taxing robots or imposing tariffs is a temporary stall, and to the degree it does work it amounts to…

A related-ish thing I remember reading about is how doctors would ask folks complaining about back pain what career they were in. The goal is that folks who complain about back pain who are unemployed due to the local mill closing would get shunted into disability, while knowledge workers wouldn't.

So there's likely a pretty big effect of society telling folks that they have to be "disabled" in order for us to support them, and one way to be "disabled" is to have debilitating pain, and so you wind up with a bunch of folks who can't work and have a pain pill prescription.

Re: America’s opioid epidemic is worsening

#72

Post by dsmithatx »

ribosometronome wrote: post #52
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…

Opioid prescriptions are declining: https://www.nytimes.com/2016/05/21/health/opioid-prescriptio... . And will hopefully continue to decline. Identifying the source of the problem is easy, though. Solving the problem for the masses who already find themselves in the midst of an addiction they might not even know they're in yet is much harder and what places like these injection sites are aimed to address.

I believe most of the deaths are a result of the prescription decline. As the DEA and Florida shut down Oxycontin users were forced to turn to the cheaper more available heroin. Evil cartel members mix Fentanyl in Heroin to make profit and they are killing users (their customers) left and right.

Re: America’s opioid epidemic is worsening

#73

Post by DanBC »

tptacek wrote: post #30
padobson wrote: post #12

I live in Trumbull County in Ohio, the dark red county in North East Ohio. We recently had 23 (non-fatal) overdoses in a two-day period[0]. That's roughly .01% of the county's total population - so yeah, it's getting bad here. There were recently two shootings within a mile of my house. Several people dead. Both shootings were drug related. I can't help but look around and believe that the needs these folks are tryin…

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…

> Are the people dying of heroin overdoses in white rural Ohio starting on heroin

A minor nit, but how many people are overdosing on actual heroin, and how many on eg fentanyl?

> If violence is coming from addicts and not from suppliers, increasing supply isn't going to make those people any less desperate or violent.

The argument is something like: If there's a limited supply the price increases and people turn to crime to get the money. If there's a government supply as part of addiction treatment (and a package of other care) there's reduced need to find funds.

Re: America’s opioid epidemic is worsening

#74

Post by wklauss »

troisx wrote: post #53

I know the United States will never do it, but Singapore barely has a drug problem because they execute dealers and have mandatory treatment for users. I'm not advocating the ridiculous policy that the Phillipines has, but Singapore doesn't mess around if they find distribution levels of illegal drugs on you. There also needs to be much stricter control of new prescriptions for opioids, which lead to addiction.

Experts have been questioning Singapore numbers for a while now. They are probably not that low and theres plenty of evidence of drug use in the country:

http://www.reuters.com/article/idUSSIN135004

On top of that, how come other countries that have strict drug regulations and intensive prosecution (for example, Thailand) don't show same low rates of consumption?

Re: America’s opioid epidemic is worsening

#75

Post by tptacek »

mnm1 wrote: post #66
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 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.

Re: America’s opioid epidemic is worsening

#76

Post by _jal »

tptacek wrote: post #30
padobson wrote: post #12

I live in Trumbull County in Ohio, the dark red county in North East Ohio. We recently had 23 (non-fatal) overdoses in a two-day period[0]. That's roughly .01% of the county's total population - so yeah, it's getting bad here. There were recently two shootings within a mile of my house. Several people dead. Both shootings were drug related. I can't help but look around and believe that the needs these folks are tryin…

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 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 is coming from addicts and not from suppliers

Others have mentioned this, but opiate abusers don't get violent when high. Some small percentage sometimes get violent when they run out of money to score. Experiments elsewhere suggest that it is a lot cheaper (in money and in human costs) to contain, (in some way) legalize and (if they want it) help them get clean then clean up after them.

Re: America’s opioid epidemic is worsening

#77

Post by oxide »

mmanfrin wrote: post #31
DougN7 wrote: post #14

Earlier quoted context omitted.

This doesn't help the root cause of people starting to use them in the first place. It's helpful to some though.

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.

The resulting crackdown did exactly what you said, drove people straight into the open arms of heroin.

Tightening the already tightened restrictions would only worsen the issue.

Diversion, etc cannot be stopped and you might just see a sudden uptick in pharmacy truck heists like the one that happened five or so years ago. Corrupt pharmacists unable to resist the temptation of easy money, etc.

Or worse, heroin continues to spread like wildfire. Heroin has no QC, it's being cut with fentanyl across the country and addicts are dropping like flies. Sicker addicts have been seeking out these OD stories and score from those areas looking for the fentanyl cut H. It's bad and only getting worse, as if the government overcorrected its steering and has now spun out of control. The result is going to be a grisly accident.

Re: America’s opioid epidemic is worsening

#78

Post by Clubber »

>States have since cracked down on prescription opioid abuse, creating drug-monitoring programmes and arresting unscrupulous doctors.

So if you look at the chart, when they started doing this, heroin overdoses skyrocketed while pill overdoses stayed about the same. They doubled the deaths with their crackdown solution, as if that has ever worked.

Re: America’s opioid epidemic is worsening

#79

Post by rm_-rf_slash »

troisx wrote: post #53

I know the United States will never do it, but Singapore barely has a drug problem because they execute dealers and have mandatory treatment for users. I'm not advocating the ridiculous policy that the Phillipines has, but Singapore doesn't mess around if they find distribution levels of illegal drugs on you. There also needs to be much stricter control of new prescriptions for opioids, which lead to addiction.

Singapore is a very small and extremely centralized city-state. America is an enormous country with a long history of decentralized governments. I imagine very few dealers or addicts can slip the net in such a small place, not so much for America, perhaps.

And all of that relies on the assumption that Singapore's way is the best method that we as a culture (and to a greater degree as a species) can hope to accomplish. In my opinion, Singapore's drug policy is lacking in nuance.

Re: America’s opioid epidemic is worsening

#80

Post by ocschwar »

I'm going to comment here with a plug for the March For Science, on April 22.

Why?

Because the opioid epidemic started with a simple matter of scientists not being allowed to science.

Purdue Pharmaceuticals marketed oxycontin as a drug that lasts for 12 hours.

The evidence indicated it only lasted for 8.

If Purdue's scientists were allowed to act on the evidence, i.e. to be actual scientists, the whole world would have known this years ago. People prescribed oxycontin would have been told to plan for 8 hours of relief, not 12.

Instead, hundreds of thousands of patients were subjected to 4 hours of pain a day, and they sought relief with other drugs, including illegal ones. And the epidemic began.

Science is important, yo.

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