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America’s opioid epidemic is worsening

economist.com

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Re: America’s opioid epidemic is worsening

#91

Post by kwhitefoot »

Kluny wrote: post #58
maxxxxx wrote: post #43

Earlier quoted context omitted.

One thing I have noticed with American doctors is that they are very quick prescribing heavy pain meds. Much quicker than in Germany for example.

American doctors follow national guidelines, because if they don't they expose themselves to malpractice suits. The guidelines currently say that if someone is in pain, give them as much painkiller as they want. Their ability to use their extensive training and judgement to make a better call is somewhat limited.

I'll have to take your word that the guidelines say effectively to give the patient what they want, it seems a strange idea.

Here, in Norway, the doctor also tells the patient to take as much as they need but the decision on the actual type of pain relief is arrived at collaboratively between the patient and the doctor, sometimes including a short stay, two or three nights, in hospital so that multiple regimes can be quickly tried out under supervision.

In some cases they can prescribe more suitable drugs and more suitable delivery methods.

For instance the pain associated with cancer is often better controlled with a Fentanyl continuous delivery patch than an Oxy capsule. Oxy is good for relatively quick relief when you have a temporary increase in pain but the effect wears off so you get uneven pain relief.

I'm not a doctor, just speaking from personal knowledge of someone very close to me.

Re: America’s opioid epidemic is worsening

#92

Post by tptacek »

_jal wrote: post #76
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? 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…

I'm not sure I was arguing that opiate addicts are violent when they're high.

I'm not making a moral argument about legalization or even (as is being repeatedly suggested on this thread) subsidization of opiates. I'm saying that if the cause of the epidemic is prescription opioids, and the ultimate problem is "too many people are non-functional opioid addicts", then deregulation won't fix the problem.

Re: America’s opioid epidemic is worsening

#93

Post by tptacek »

_jal wrote: post #81
tptacek wrote: post #75

Earlier quoted context omitted.

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…

You need to capture not just addicts who got started on prescriptions, but addicts who got started through the resale of overprescribed opiates from non-addicts.

Re: America’s opioid epidemic is worsening

#94

Post by DanBC »

rwmj wrote: post #21

In the UK it appears that there's a Spice epidemic. It's often called "synthetic cannabis" or "(formerly) legal highs", but it in reality it's all kinds of research chemicals sprayed onto leaves to be smoked. It has some pretty hideous side effects, and seems very addictive ( https://video.vice.com/en_uk/video/the-hard-lives-of-britain... ) Oh, and the government just handed the whole market over to illegal drug deal…

The spice epidemic is mostly prison related though.

Prisons should stop testing for cannabis; and should consider prescribing cannabis of known strengths (and higher CBD rather than THC content).

(Also, they need to start providing a lot more mental health support and meaningful activity).

Re: America’s opioid epidemic is worsening

#95

Post by DougN7 »

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.

Is that true? (serious question)

I can't believe that many more people, especially (and coincidentally?) in the inner cities, need pain meds. This seems like something bigger in my mind. But I also don't have any data to back it up.

Re: America’s opioid epidemic is worsening

#96

Post by wott »

DoodleBuggy wrote: post #8

Hard to believe there is really an "epidemic" beyond typical fearmongering and political noise. People have always used drugs, this is nothing new. Unfortunately all the hype and noise is having significantly negative consequences to the medical community, doctors, and patients who actually need these things.

That is like 10 or 20 times the death rate as in Western Europe. I know you guys love your bodycounts, but still...

Re: America’s opioid epidemic is worsening

#97

Post by glangdale »

mholmes680 wrote: post #41
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…

I think its more dissatisfaction with life in general, with unemployment maybe being one of many triggers. You're probably right about addressing at the demand level. But, I see the problem being more societal - think no one really understands everything. You take away self-reliance of people (whether they realize it or not) at many levels... its cheaper to get some good-enough quality food at 13 places near my home,…

Postman's book is now 32 years old! I read it as a teenager, which dates me...

I'm not sure about the Amusing Ourselves To Death stuff or the tut-tutting about cooking and gardening, but overall, though, I think you're on the right track. I'm sure that between automation of both manufacturing and services, big-box retailers and the fact that the covering of the 'long tail' is done very well by web-based business. It's hard to picture what a lot of people are going to be able to do in this circumstance and there seems to be the real potential for a cascading unpleasantness.

If you even half-believe the 'technological unemployment' worry, the scary part is that the non-automatable jobs that involved providing goods and services to those displaced by technology will also suffer.

There may be plenty of spare time for people to have that 'great awakening', whatever that might turn out to be.

Re: America’s opioid epidemic is worsening

#98

Post by karmelapple »

Read Chasing the Scream [1], a fantastic book that documents drug prohibition in the USA, how doctors who viewed it as a health issue got chased out of their desire to help, and suggests many paths to helping people and making the world a better, safer place.

I've posted this in enough threads that I probably seem like a bot advertising for it, but seriously, it's a book worth reading and that can change someone's entire opinion on the drug epidemic and what legislation we should pass.

[1] http://chasingthescream.com/

Re: America’s opioid epidemic is worsening

#99

Post by knz »

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? Other countries don't have this problem.

That description could easily be applied to many aspects of the US healthcare system - an epidemic is a failing of public health.

Re: America’s opioid epidemic is worsening

#100

Post by DanBC »

Kluny wrote: post #58
maxxxxx wrote: post #43

Earlier quoted context omitted.

One thing I have noticed with American doctors is that they are very quick prescribing heavy pain meds. Much quicker than in Germany for example.

American doctors follow national guidelines, because if they don't they expose themselves to malpractice suits. The guidelines currently say that if someone is in pain, give them as much painkiller as they want. Their ability to use their extensive training and judgement to make a better call is somewhat limited.

> 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-pain-medicine/opioids-aware

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