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America’s opioid epidemic is worsening

economist.com

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Re: America’s opioid epidemic is worsening

#81

Post by _jal »

tptacek wrote: post #75
mnm1 wrote: post #66

Earlier quoted context omitted.

"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.

I think we'd need more evidence of that before just assuming it. Some number of people with current addictions would not have developed a habit if they hadn't been supplied by their doctor. Sure, there are also folks out there with habits that "doctor shopped" or whatever, but we aren't talking about those.

Now, if "deregulation" as used above means "stocking next to aspirin at CVS", then sure. But that's not what's being discussed. Haven't done a study of it, but I'm pretty sure Denmark doesn't have many folks heading signing up as addicts to experiment.

Re: America’s opioid epidemic is worsening

#82

Post by jstewartmobile »

I'm on the gulf coast, and we just had a high-profile prosecution of a doctor running a pill mill.

What if this whole mess isn't so much a technical problem to be solved as much as it is our system functioning under its own perverse incentives? Other countries don't have this problem.

In my own area of expertise, I have seen so many non-solutions force-fed to the customer when an actual solution is not as profitable. It is not hard to believe that medicine operates similarly.

Re: America’s opioid epidemic is worsening

#83

Post by DanBC »

rwmj wrote: post #42
devopsproject wrote: post #29

Earlier quoted context omitted.

Mostly wrong. Pills were given out like candy, then restricted which caused demand for cheaper alternatives. Had the drug companies been regulated in the first place, we might be OK. The pills aren't coming from mules or cartels, they are coming from US companies. The pill supply has to lowered. edit to add: http://www.latimes.com/projects/oxycontin-part1/

The pill supply has to lowered ... in the past. However now the US made that mistake, what's the problem with continuing to give out the pills "like candy", although with tighter controls to make sure that they don't go to create new addicts?

People with pain deserve treatment for that pain.

For people with short term pain, or who are at the end of life, opioids can be a good choice.

For people with long term pain opioids can, rarely, be a good choice, if other things have been tried first, and if there's a careful package of care.

Most people with long term pain need variations of / combinations of:

1) Access to evidence based pain management specialist clinics

2) Graded strength building exercise (for musculo-skeletal, not for nerve)

3) Medication that isn't opioids

Giving opioids to people with long term pain isn't a good way of controlling their pain (they develop a tolerance) and risks severe harm (on top of addiction).

Here's a website from the English Faculty of Pain Medicine, which is part of the Royal College of Anaesthetists. They explain it far better than I can.

http://www.fpm.ac.uk/faculty-of-pain-medicine/opioids-aware

Re: America’s opioid epidemic is worsening

#84

Post by rm_-rf_slash »

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.

Re: America’s opioid epidemic is worsening

#85

Post by empath75 »

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.

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.

Re: America’s opioid epidemic is worsening

#86

Post by draw_down »

jstewartmobile wrote: post #82

I'm on the gulf coast, and we just had a high-profile prosecution of a doctor running a pill mill. What if this whole mess isn't so much a technical problem to be solved as much as it is our system functioning under its own perverse incentives? Other countries don't have this problem. In my own area of expertise, I have seen so many non-solutions force-fed to the customer when an actual solution is not as profitable.…

> What if this whole mess isn't so much a technical problem to be solved as much as it is our system functioning under its own perverse incentives?

Indeed! What if!

Re: America’s opioid epidemic is worsening

#87

Post by headcanon »

dep_b wrote: post #54
cryptarch wrote: post #44

Earlier quoted context omitted.

The Netherlands also have a few legal highs: weed, kratom and psilocybin.

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…

The legal status IMO is less important in this case than how the state treats it. In the Netherlands (correct me if I'm wrong), drugs are seen as a public health concern, and in the US its seen as a criminal problem. When its criminalized and demonized like it is here, then politicans must "crack down" on it to appear "tough on crime", and more progressive mitigation solutions (like supervised injection and treatment centers) aren't even entertained in our lust to imprison.

Re: America’s opioid epidemic is worsening

#88

Post by Clubber »

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.

Where do you see any evidence of that?

Re: America’s opioid epidemic is worsening

#89

Post by DanBC »

oxide wrote: post #40
ZanyProgrammer wrote: post #33

Earlier quoted context omitted.

I've had friends get fucked up by head shop and online Kratom. It's very far from benign.

I've gone ahead and edited my comment, not because of your comment, but just because I felt like I wasn't making a clear point. Kratom is not even mentioned anymore, sorry. While kratom is habit forming and can "fuck you up" if you have no tolerance, the true value is for the person already addicted to opiates looking to get clean. If you want to keep drugs out of the hands of kids, make them all legal and watch the…

> If you want to keep drugs out of the hands of kids, make them all legal and watch the usage numbers fall.

Doesn't the UK experience with alcohol counter this?

(I am strongly in favour of legalisation of all drugs).

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