5 ms·

Heroin is fueled by gateway drugs, particularly oxycodone and vikodin. This story just shows how the market will evolve to overcome barriers to sell a profitab

Heroin is fueled by gateway drugs, particularly oxycodone and vikodin. This story just shows how the market will evolve to overcome barriers to sell a profitable product in a restricted market.

aianus 11y ago
It's sad the DEA would rather watch people die in the street from heroin overdoses than just ease up on the prescription opiates. Surely it's preferable to enable junkies than kill them and feed the cartels?
- robbiep 11y ago
  people die in large numbers from overdoses from prescription opiates too - easing access to prescription opiates is a terrible solution
  - aianus 11y ago
    Junkies are junkies. At least the pills are pure, consistent, and cheap so they don't have to die or rob you and me for a fix.
    - robbiep 11y ago
      Junkies are junkies... as in... what? they are always going to chase the high? or they are less of a person than a non-junkie? The answer to heroin abuse is not prescription fast acting opiates, which themselves have significant abuse potential, but treatment programs such as suboxone, bup or methadone. The pattern of use needs to change from the epic highs and withdrawal cycles which generate the behaviour of an addict (and is still there with oxycodone due to the pharmacology of the drug) to a substance that maintains opioid receptor agonism for longer periods
      - aianus 11y ago
        It's up to them to decide to seek treatment. Until they feel they need or want to stop being a junky, restricting their access to pills will just push them to heroin. They're not going to throw their hands up and go 'whelp, can't get any more legal oxy, time to quit drugs'.
        robbiep 11y ago
        You're absolutely right that you can't make someone accept treatment. But enabling someone by giving them access to a drug of abuse when they are clearly abusing it is not the answer. The answer is to get them onto treatment programs, not further their addiction with access to drugs they are abusing
        aianus 11y ago
        If you cut off their access to the drugs, you're strong-arming them into accepting treatment or else. Like you said, that strategy doesn't work and is a net harm to addicts and society in general. Treatment programs should be available and encouraged, of course, but if the guy really wants to continue abusing his prescription medication, that's his choice and I don't see the issue in supplying him. Doctors encourage their patients to quit smoking, they don't jack up their cost of cigarettes 1000% and then shake their heads and absolve themselves of all responsibility when the patient isn't ready to quit and goes broke buying cigs instead.
        robbiep 11y ago
        firstly, if a doctor is prescribing appropriately, and a patient is using appropriately, then there shouldn't be dependence and addiction issues. So one problem is doctors prescribing irresponsibly, because just writing the script is easier than explaining to a patient how a certain level of pain should be expected post surgery, etc. But if someone wants to abuse drugs, then they shouldn't be given access to them. I really don't think you have any conception of how destructive opiate addictions are over the medium to long term. I don't accept your arguments that it is simply a factor of choice, and if someone wants to abuse a serious drug, then they should be enabled by providing them with access to a restricted drug , that is being used for the purpose of abuse. It's not acceptable in civilised society. As to your supporting argument, yes doctors do encourage their patients to quit smoking. But in Australia we have jacked up the price of cigarettes to act as a disincentive as well. And, guess what - it works. The idea that we should make it easy for patients to access drugs of abuse, for the purpose of abuse, is severely flawed and your argument is bunk. An opiate is a drug of abuse and a restricted drug for a reason, and that reason should never be the recreational consumption.
  - hollerith 11y ago
    >people die in large numbers from overdoses from prescription opiates too What's your evidence for this?
    - robbiep 11y ago
      Well, i'm a doctor so part of this is an argument from authority. But arguments from authority are stupid. So here are some references: [0] - CDC report describing epidemic in prescription opiate deaths [1] - NIH report showing overdose deaths. the relevant stats: Since 2001, prescription opiate deaths have risen from 6000 to around 16,000. Over the same period, heroin overdoses went from 2,000 to 8,000. This data is to 2013. So there is a clear problem, and in fact prescription opiates cause significantly more deaths than heroin. [2] - a report from closer to (my) home and region of practice detailing increases in prescription drug use in Australia and increase in opiate-related deaths secondary to this [0] http://www.cdc.gov/drugoverdose/data/overdose.html http://www.cdc.gov/drugoverdose/data/overdose.html [1] http://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates http://www.drugabuse.gov/related-topics/trends-statistics/ov... [2] https://www.mja.com.au/journal/2011/195/5/prescription-opioid-analgesics-and-related-harms-australia https://www.mja.com.au/journal/2011/195/5/prescription-opioi...
    - ctrl_freak 11y ago
      "Prescription drug abuse and addiction kill far more people in the U.S. every year than all illegal drugs combined." https://www.psychologytoday.com/blog/wicked-deeds/201404/prescription-drugs-are-more-deadly-street-drugs https://www.psychologytoday.com/blog/wicked-deeds/201404/pre...
      - aianus 11y ago
        This is a meaningless argument if you don't normalize for usage rates. Many times more people are on legal drugs than illegal drugs. I doubt OxyContin kills a higher percentage of its users than heroin.
        jnbiche 11y ago
  - dools 11y ago
    The problem is that the statistics (that I've read anyway) make no distinction between people who die from the use of drugs that are available on prescription, versus those that die from overdose of drugs they have been specifically prescribed. When someone is prescribed drugs they will not be prescribed 2 drugs that cause harm when taken together (such as sleep meds and pain meds) but when people have their prescription cut off and turn to the black market they're doing it in a completely unsupervised environment. What we need is to start prescribing opiates for recreational use and eliminate the black market. Opiates cause no harm (the worst side effect is constipation) so there is no reason that we should be trying to stop people from using them recreationally other than knee jerk moral panic and conservatism.
    - robbiep 11y ago
      > When someone is prescribed drugs they will not be prescribed 2 drugs that cause harm when taken together (such as sleep meds and pain meds) but when people have their prescription cut off and turn to the black market they're doing it in a completely unsupervised environment. In an ideal world, yes. But realistically patients will often be prescribed both. > What we need is to start prescribing opiates for recreational use and eliminate the black market. I strongly disagree with this concept. Opiates for recreational use is basically legalising heroin. The addictive potential is simply too great. I don't know what you are basing this argument on but my first-hand experience working with patients with opiate addictions, as well as a close friend and colleague who started using (pharmacological grade) opiates and rapidly had his life spiral into a shambles. The fact is that these debates have been had in the past. They are the basis of the harm minimisation strategies already in place by governments all over the world - Methadone, Suboxone and Buprenorphine programs, which bind opiate receptors with a long half-life meaning that users are not constantly bouncing from a crazy high to the physical sensation of pain which results from withdrawal of opioid agonism in the context of dependence. > Opiates cause no harm (the worst side effect is constipation) so there is no reason that we should be trying to stop people from using them recreationally other than knee jerk moral panic and conservatism. Again, I strongly disagree. Opiates cannot be used recreationally by the masses in a way which is consistent with normal societal functioning. This would be a disaster of epic proportions.
- lmg643 11y ago
  prescription opiates started the problem with heroin. the history of oxycontin is a sad one for the country. with the recent pharma/biotech explosion, lots of companies are trying to get in on the painkiller game as well. there's really no need for much of it. I've had multiple minor surgeries in the past few years and the doctors have never wanted to give me painkillers. Just take some tylenol. We've probably had less of a need for legal painkillers than ever - surgery and medical technology keeps getting better and better - minimally invasive and the like - and yet we have more legal painkillers than ever. Something doesn't add up.
  - aianus 11y ago
    No, the DEA crackdown on pill mills started the problem with heroin. When your choices are expensive black market oxy and cheap black tar, that's when you switch to heroin.
    - steve19 11y ago
      Step 1. Folks in society can no longer tolerate even a little discomfort. Step 2. These folks go to the doctor demanding pain relief. The doctor no longer bothers telling them to rest up and take some tylenol. Instead she hands out Oxy. Step 3. Patient will never want to give up the Oxy (at best), or craves more as the drugs effects lessen over time. An addict is created. Step 4. Patient looks to the blackmarket for supply of Oxy or alternatives. You can solve the problem by either re-educating society to toughen up (eliminate step 1) or tell doctors to stop handing out opiates like candy (eliminate step 2). Neither is going to happen. This has been going on since before opium was made illegal. There are much better ways to deal with physical pain, the problem is they require a lot of effort ... and a pill is just an Rx away. This works for short periods of pain (such as immediately after surgery) but is very bad for chronic long term pain.
      - jnbiche 11y ago
        > This works for short periods of pain (such as immediately after surgery) but is very bad for chronic long term pain. Do you have severe, chronic long-term pain?* Just curious on what basis you are making this remark. I can tell you that since the DEA crackdown, no one is handing our narcotic painkillers for any condition that could be reasonably treated with rest and tylenol. Doctors value their licenses and freedom far too much, and so meticulously document their narcotic treatments, and give them only to patients with severe pain (and even then, they undertreat). I've had two relatives die from cancer from in the past 5 years, who were terminal and over 70, and yet who were cruelly denied narcotic pain relief until their last week because doctors are scared shitless about getting arrested by the DEA. Far from what you're claiming (which was maybe the case with certain doctors a decade ago), doctors now undertreat most patients. * "Bad back" and "aching knee" do not count. I mean things like cancer and severe nerve diseases. Edit: By the way, I didn't downvote you.

Heroin is fueled by gateway drugs, particularly oxycodone and vikodin. This story just shows how the market will evolve to overcome barriers to sell a profitable product in a restricted market.

aianus 11y ago

It's sad the DEA would rather watch people die in the street from heroin overdoses than just ease up on the prescription opiates. Surely it's preferable to enable junkies than kill them and feed the cartels?

robbiep 11y ago
people die in large numbers from overdoses from prescription opiates too - easing access to prescription opiates is a terrible solution
- aianus 11y ago
  Junkies are junkies. At least the pills are pure, consistent, and cheap so they don't have to die or rob you and me for a fix.
  - robbiep 11y ago
    Junkies are junkies... as in... what? they are always going to chase the high? or they are less of a person than a non-junkie? The answer to heroin abuse is not prescription fast acting opiates, which themselves have significant abuse potential, but treatment programs such as suboxone, bup or methadone. The pattern of use needs to change from the epic highs and withdrawal cycles which generate the behaviour of an addict (and is still there with oxycodone due to the pharmacology of the drug) to a substance that maintains opioid receptor agonism for longer periods
    - aianus 11y ago
      It's up to them to decide to seek treatment. Until they feel they need or want to stop being a junky, restricting their access to pills will just push them to heroin. They're not going to throw their hands up and go 'whelp, can't get any more legal oxy, time to quit drugs'.
      - robbiep 11y ago
        You're absolutely right that you can't make someone accept treatment. But enabling someone by giving them access to a drug of abuse when they are clearly abusing it is not the answer. The answer is to get them onto treatment programs, not further their addiction with access to drugs they are abusing
        aianus 11y ago
        If you cut off their access to the drugs, you're strong-arming them into accepting treatment or else. Like you said, that strategy doesn't work and is a net harm to addicts and society in general. Treatment programs should be available and encouraged, of course, but if the guy really wants to continue abusing his prescription medication, that's his choice and I don't see the issue in supplying him. Doctors encourage their patients to quit smoking, they don't jack up their cost of cigarettes 1000% and then shake their heads and absolve themselves of all responsibility when the patient isn't ready to quit and goes broke buying cigs instead.
        robbiep 11y ago
        firstly, if a doctor is prescribing appropriately, and a patient is using appropriately, then there shouldn't be dependence and addiction issues. So one problem is doctors prescribing irresponsibly, because just writing the script is easier than explaining to a patient how a certain level of pain should be expected post surgery, etc. But if someone wants to abuse drugs, then they shouldn't be given access to them. I really don't think you have any conception of how destructive opiate addictions are over the medium to long term. I don't accept your arguments that it is simply a factor of choice, and if someone wants to abuse a serious drug, then they should be enabled by providing them with access to a restricted drug , that is being used for the purpose of abuse. It's not acceptable in civilised society. As to your supporting argument, yes doctors do encourage their patients to quit smoking. But in Australia we have jacked up the price of cigarettes to act as a disincentive as well. And, guess what - it works. The idea that we should make it easy for patients to access drugs of abuse, for the purpose of abuse, is severely flawed and your argument is bunk. An opiate is a drug of abuse and a restricted drug for a reason, and that reason should never be the recreational consumption.
- hollerith 11y ago
  >people die in large numbers from overdoses from prescription opiates too What's your evidence for this?
  - robbiep 11y ago
    Well, i'm a doctor so part of this is an argument from authority. But arguments from authority are stupid. So here are some references: [0] - CDC report describing epidemic in prescription opiate deaths [1] - NIH report showing overdose deaths. the relevant stats: Since 2001, prescription opiate deaths have risen from 6000 to around 16,000. Over the same period, heroin overdoses went from 2,000 to 8,000. This data is to 2013. So there is a clear problem, and in fact prescription opiates cause significantly more deaths than heroin. [2] - a report from closer to (my) home and region of practice detailing increases in prescription drug use in Australia and increase in opiate-related deaths secondary to this [0] http://www.cdc.gov/drugoverdose/data/overdose.html http://www.cdc.gov/drugoverdose/data/overdose.html [1] http://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates http://www.drugabuse.gov/related-topics/trends-statistics/ov... [2] https://www.mja.com.au/journal/2011/195/5/prescription-opioid-analgesics-and-related-harms-australia https://www.mja.com.au/journal/2011/195/5/prescription-opioi...
  - ctrl_freak 11y ago
    "Prescription drug abuse and addiction kill far more people in the U.S. every year than all illegal drugs combined." https://www.psychologytoday.com/blog/wicked-deeds/201404/prescription-drugs-are-more-deadly-street-drugs https://www.psychologytoday.com/blog/wicked-deeds/201404/pre...
    - aianus 11y ago
      This is a meaningless argument if you don't normalize for usage rates. Many times more people are on legal drugs than illegal drugs. I doubt OxyContin kills a higher percentage of its users than heroin.
      - jnbiche 11y ago
- dools 11y ago
  The problem is that the statistics (that I've read anyway) make no distinction between people who die from the use of drugs that are available on prescription, versus those that die from overdose of drugs they have been specifically prescribed. When someone is prescribed drugs they will not be prescribed 2 drugs that cause harm when taken together (such as sleep meds and pain meds) but when people have their prescription cut off and turn to the black market they're doing it in a completely unsupervised environment. What we need is to start prescribing opiates for recreational use and eliminate the black market. Opiates cause no harm (the worst side effect is constipation) so there is no reason that we should be trying to stop people from using them recreationally other than knee jerk moral panic and conservatism.
  - robbiep 11y ago
    > When someone is prescribed drugs they will not be prescribed 2 drugs that cause harm when taken together (such as sleep meds and pain meds) but when people have their prescription cut off and turn to the black market they're doing it in a completely unsupervised environment. In an ideal world, yes. But realistically patients will often be prescribed both. > What we need is to start prescribing opiates for recreational use and eliminate the black market. I strongly disagree with this concept. Opiates for recreational use is basically legalising heroin. The addictive potential is simply too great. I don't know what you are basing this argument on but my first-hand experience working with patients with opiate addictions, as well as a close friend and colleague who started using (pharmacological grade) opiates and rapidly had his life spiral into a shambles. The fact is that these debates have been had in the past. They are the basis of the harm minimisation strategies already in place by governments all over the world - Methadone, Suboxone and Buprenorphine programs, which bind opiate receptors with a long half-life meaning that users are not constantly bouncing from a crazy high to the physical sensation of pain which results from withdrawal of opioid agonism in the context of dependence. > Opiates cause no harm (the worst side effect is constipation) so there is no reason that we should be trying to stop people from using them recreationally other than knee jerk moral panic and conservatism. Again, I strongly disagree. Opiates cannot be used recreationally by the masses in a way which is consistent with normal societal functioning. This would be a disaster of epic proportions.
lmg643 11y ago
prescription opiates started the problem with heroin. the history of oxycontin is a sad one for the country. with the recent pharma/biotech explosion, lots of companies are trying to get in on the painkiller game as well. there's really no need for much of it. I've had multiple minor surgeries in the past few years and the doctors have never wanted to give me painkillers. Just take some tylenol. We've probably had less of a need for legal painkillers than ever - surgery and medical technology keeps getting better and better - minimally invasive and the like - and yet we have more legal painkillers than ever. Something doesn't add up.
- aianus 11y ago
  No, the DEA crackdown on pill mills started the problem with heroin. When your choices are expensive black market oxy and cheap black tar, that's when you switch to heroin.
  - steve19 11y ago
    Step 1. Folks in society can no longer tolerate even a little discomfort. Step 2. These folks go to the doctor demanding pain relief. The doctor no longer bothers telling them to rest up and take some tylenol. Instead she hands out Oxy. Step 3. Patient will never want to give up the Oxy (at best), or craves more as the drugs effects lessen over time. An addict is created. Step 4. Patient looks to the blackmarket for supply of Oxy or alternatives. You can solve the problem by either re-educating society to toughen up (eliminate step 1) or tell doctors to stop handing out opiates like candy (eliminate step 2). Neither is going to happen. This has been going on since before opium was made illegal. There are much better ways to deal with physical pain, the problem is they require a lot of effort ... and a pill is just an Rx away. This works for short periods of pain (such as immediately after surgery) but is very bad for chronic long term pain.
    - jnbiche 11y ago
      > This works for short periods of pain (such as immediately after surgery) but is very bad for chronic long term pain. Do you have severe, chronic long-term pain?* Just curious on what basis you are making this remark. I can tell you that since the DEA crackdown, no one is handing our narcotic painkillers for any condition that could be reasonably treated with rest and tylenol. Doctors value their licenses and freedom far too much, and so meticulously document their narcotic treatments, and give them only to patients with severe pain (and even then, they undertreat). I've had two relatives die from cancer from in the past 5 years, who were terminal and over 70, and yet who were cruelly denied narcotic pain relief until their last week because doctors are scared shitless about getting arrested by the DEA. Far from what you're claiming (which was maybe the case with certain doctors a decade ago), doctors now undertreat most patients. * "Bad back" and "aching knee" do not count. I mean things like cancer and severe nerve diseases. Edit: By the way, I didn't downvote you.