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How the Epidemic of Drug Overdose Deaths Ripples Across America

111 points by tysone 11y ago

salmonet 11y ago
Interestingly high rate of OD deaths in a county on the Hawaiian island of Molokai. Access is pretty restricted and the whole island has a population of less than 10,000.
- GFK_of_xmaspast 11y ago
  With these county maps, it's easy to get very high or very low rates of anything in sparsely-populated counties (see also all those red blotches in the mountain west). Checking wikipedia, it looks like there are 90 (!!!) people in that county; you can guess what one death does to the rates-per-100k people.
- onetwotree 11y ago
  Recovery is hard in tiny communities. All your friends are doing drugs, there are maybe 2 or 3 12-step meetings a week, no outpatient programs that you can attend while working, no sober living facilities, and treatment involves a trip to the big city. Contrast this with a modest sized city like my home of Madison, WI, where there are two rehabs in town, the land of a thousand rehabs is just across the state line, hundreds of meetings a week, and there is a thriving sober living community. Small town folks make up the majority of the recovering heroin addicts I meet here. They all took the quick trip up the road to Madison for rehab, moved into sober living in town, and stayed for the recovery community. Perhaps that's more difficult on an isolated island community? If you think it's too hard to get the dope there, you haven't met an addict in need...
onetwotree 11y ago
Yep, the new face of heroin is white and affluent. While I'm all for the evidence based, treatment focused approach to addiction that this has brought about, isn't it a little telling that we only switched from punishment to treatment when white people started shooting dope?
- GFK_of_xmaspast 11y ago
  And what are the odds of switching back once the fashion moves on from heroin?
  - onetwotree 11y ago
    Hopefully low. The treatment focused approach works, and so once people see this they'll keep it even after the white suburban community gets over it's heroin problem.
    - knowaveragejoe 11y ago
      This smug commentary is shameful. There are a variety of factors involved in this problem and why until relatively recently an interdiction approach has been taken over treatment. It afflicts all demographics in the country. Get over yourself.
      - nomat 11y ago
        I think it's quite telling that only one top level comment mentions the race of the drug users, and is at the bottom of the page. Even the article itself avoids the topic although it includes statistics of all kinds.
      - onetwotree 11y ago
        I don't understand your insulting tone. What do you find smug about this comment? That white people are the primary victims in the nations current epidemic? That's a simple fact. The primary reason that black people were spared this time around is simply that doctors are significantly less likely to prescribe opiate painkillers to black folks (a bit of a positive effect of stereotypes about criminality).
        knowaveragejoe 11y ago
        If you're not picking up the smugness in his two comments then you must have a tough time with reading comprehension. Aside from that, it's not a white issue at all. Opiate addiction, including heroin, afflicts all communities, and in particular those of lesser means.
awavering 11y ago
Recommended reading if this interests you: Dreamland tells the story of intersecting prescription pill and heroin use in America. http://www.samquinones.com/books/dreamland/ http://www.samquinones.com/books/dreamland/
- MicroBerto 11y ago
  It's maddening. Prescription opiate use has gotten so bad that Big Pharma is now heavily advertising an anti-constipation pill for all these addicts, with the most ridiculous commercial I've ever seen: a woman walks around town with her opioid "bff" that happens to have muscles. https://i.imgur.com/NMn59EC.jpg https://i.imgur.com/NMn59EC.jpg Seriously, if this alone doesn't spell doom for your country and its health care system, I'm not sure what does.
  - phillipamann 11y ago
    What is the name of this anti-constipation drug and do you have a link to the commercial?
    - refurb 11y ago
      I'm guessing it's Relistor? It was recently approved for constipation caused by opioids. To be honest, opioid constipation is a huge problem. It's a great drug to have.
      - MicroBerto 11y ago
        Definitely not doubting that. I just hate to see solutions that treat the effect and not the cause. So. Many. Commercials.
      - Healthyme15 11y ago
        as
      - Healthyme15 11y ago
        I think for chronic constipation, you can also use this Digestic by Mimonis which is very good in treating constipation problem. I have been save from my long battle of constipation that is why I can say it has been proven by mine to be effective.
xyzzy4 11y ago
What they should do is sell heroin legally along with cigarettes and alcohol, and that way people won't overdose as much because they'd know exactly how much to use.
- bluedino 11y ago
  And then more people would be hooked on it.
  - rwmj 11y ago
    Do you have evidence for that? Legalizing cannabis (marijuana) has resulted in slightly reduced rates of use amongst teenagers in Colorado. Now, cannabis is not opiates, but we need to see evidence before leaping to conclusions. Going with "obvious" solutions and "gut feel" answers is what got us to the place we are now.
    - knowaveragejoe 11y ago
      I don't have any evidence of the trend, but Opiates are much more addictive than Marijuana in general.
      - rwmj 11y ago
        Would you start to use heroin if it were legal? In 1955, the UK had 48 registered heroin addicts [source 1]. Today it's a lot more -- 33,000 seems to be a reasonable figure [source 2]. The UK prescribed heroin to addicts in the 1950s. But those are just two numbers, you really need good evidence before claiming that regulating heroin, possibly by prescribing it through doctors, would necessarily increase the number of addicts. "Opiates are much more addictive" is a true statement, but not evidence of that. [1] http://news.bbc.co.uk/1/hi/magazine/4647018.stm http://news.bbc.co.uk/1/hi/magazine/4647018.stm [2] http://www.bbc.co.uk/news/uk-27235470 http://www.bbc.co.uk/news/uk-27235470
        mason240 11y ago
bluedino 11y ago
The maps on this page aren't similar to a standard population map, so that's good in a way. Has heroin simply taken the marketshare away from meth? https://xkcd.com/1138/ https://xkcd.com/1138/
- theseatoms 11y ago
  "Good" as in "good data presentation". Not "good" as in "good that heroin use is growing proportionately across the American populace", I presume. Any "rate of change" graphic should control for the issue that xkcd mentions.
  - tgb 11y ago
    It does control for that - the rates are per hundred thousand people.
- Retric 11y ago
  There is still a tendency for smaller populations to have larger differences from the mean. Looking at those maps, the dark red areas seem to mostly be low population areas. What's interesting is how steady the picture stays even as it gets worse, which suggests the geography is actually meaningful in this case.
- deleted 11y ago
  [deleted]
sageabilly 11y ago
I only have my one anecdote in response to this story, which does not translate into data I know. I'm from one of the counties in western NC where overdose deaths have gone from 4-8 in 100K to 20+ in 100K. I graduated from high school in 2001 so I have grown up with the rise of drug use in my home county and surrounding areas and the people affected are people that I've known all my life. I no longer live in NC and, in fact, haven't lived in the area since I was 16 (went to a live-in magnet high school and then went elsewhere for college + career). 2001- my graduating class goes off into the world, half to college, maybe 1/4 to trade school, the rest go to join a family business or into an apprenticeship into a trade. A few go into the military. A few have no idea what to do and get low-level jobs wherever they can find them. Pre-2008- The economy is booming, people who've gone to college are either 3 years post graduating, establishing themselves in their young careers, or just graduating from grad school, or for those that have entered a trade they've worked long enough to start having some standing in their chosen line of work. 2008-2010 economy explodes. Layoffs, bankruptcies, consolidations, offshoring. Immensely decreased consumer spending hits trades particularly hard- welders, mechanics, electricians, construction workers- all take massive hits to their profits. Business is scarce. People who've graduated from college and who are establishing their careers get laid off and have to move back into the county because that's where their safety net is- grandma and grandpa can take care of the kids while they hunt for work or work a low-paying job because that's all they can get. Military service men and women get done with their tour and come back to nothing- no job prospects, community college has closed, trade schools have closed, the factories where their fathers and mothers worked have all outsourced to 3rd world countries and closed. In my rural county suddenly there's way more idle middle to late 20-somethings with no job and no prospects. No jobs to be found, no money to move. What I saw among the people I know/knew is that it only took a few people trying meth before it was like a powder keg going off- idle hands are the Devil's plathings, after all. People I went to high school with no hope for the future were doing meth because it was 3 minutes of bliss in stark contrast to the whirlpool of suck their lives had become. Grandma and grandpa were taking it because they couldn't afford painkillers. Teenagers were taking it because they were shithead teenagers and it was more accessible than pot. The "smarter" of the people I knew were cooking it because it was the only way they knew to make money. Once the door was open to meth then "fancier" stuff like painkillers started coming in and it was a way to feel like you were "better than" everyone else you knew who was doing meth. Oh yeah you were a drug addict, but at least your pills had a brand name. Enough meth labs blow up and the more enterprising of drug distributors can come in and sell addicts anything and everything they want, so if heroin is cheap enough that's what gets sold. This article is written from a scholarly point of view and has a lot of conjecture but I definitely don't think they had any boots on the ground to make the conclusions that they did, particularly with regards to saying the epidemic in Appalachia is a result of on the job injuries. There are no jobs to get injured on anymore. [Edit] I also absolutely agree with onetwotree's comment downthread, this is another ENORMOUS contributor to increased and sustained drug use in my tiny county: "Recovery is hard in tiny communities. All your friends are doing drugs, there are maybe 2 or 3 12-step meetings a week, no outpatient programs that you can attend while working, no sober living facilities, and treatment involves a trip to the big city." Also worth mentioning is that often those 12-step meetings are held in the basement of a church, which in my hometown means it's either your church which your whole family goes to and you grew up in (pretty damn hard to walk in there and admit to being an addict) or your friend's church that his whole family goes to and he grew up in- in both cases it's impossible to be anonymous.
ComputerGuru 11y ago
Interesting that Chicago is so underrepresented in those charts. I wonder why.
- OopsCriticality 11y ago
  My first thought is a reporting issue. Look at New York and the neighboring states for example: it is hard to believe that drug overdose deaths are so thoughtful that they respect a state border.
- linxoz 11y ago
  The drugs come from Chicago, but majority of the OD happens in the western suburbs of Chicago; mainly DuPage county. http://wgntv.com/2013/11/19/heroine-epidemic-plaguing-dupage-county/ http://wgntv.com/2013/11/19/heroine-epidemic-plaguing-dupage...
djb_hackernews 11y ago
Has anyone come across coverage of the heroin epidemic as it relates to the growth of heroin production in Afghanistan since the arrival of US forces? Seems like no one is connecting these dots and I'm curious why? Not to imply there is a conspiracy theory at all, it may just be that I'm more "fascinated" by that relationship than the average reader?
- finid 11y ago
  From my recollection, just before the invasion, meth and one other drug that I've forgotten the name where real popular, not the H. So you may be on to something, but I'll need to see real data before I subscribe.
- FreedomToCreate 11y ago
  Do you have data to support this. Also is Afghanistan the lone producer of heroin? You have to be careful in making inferences like this without considering the multitude of other factors such as how easy has the process to create heroin become over the last decade, was there a drop in other drugs and why. To your point however, I wonder if the war has enabled Big Phrama to get easier access to make there own opioids. To me it seems like the growth of Opioids for pain lead people to seek heroin and other drugs when there prescription runs out.
  - djb_hackernews 11y ago
    data to support what? I didn't make any claims. It is widely reported that the Taliban banned growing poppy (it was un-islamic) in Afghanistan and since US forces put them on the run the local war lords, who help US forces with intel, etc., have overseen the massive rebirth of the industry. It is also widely reported that there is a heroin epidemic in the United States. To me they must be somewhat related.
    - dragontamer 11y ago
      Considering that most of the US drugs are either made in the US, or come up from Mexico, I think blaming countries that are on the other side of the world separated by the largest oceans is a bit ridiculous. http://opiophilia.blogspot.com/2013/05/heroin-in-united-states-where-does-it.html http://opiophilia.blogspot.com/2013/05/heroin-in-united-stat... US Heroin comes from South America and Mexico.
armenarmen 11y ago
They shut down the pill mills and the pain clinics, which were the one reliable source of safe opiates, and now people are dying left and right. Go figure.
- yrLS1 11y ago
  Except, of course, that people were also overdosing "left and right" due to the pill mills and illegitimate pain clinics... Edit for source: http://www.jhsph.edu/news/news-releases/2015/pill-mill-crackdown-linked-to-fewer-painkiller-overdose-deaths-in-florida.html http://www.jhsph.edu/news/news-releases/2015/pill-mill-crack...
  - armenarmen 11y ago
    Interesting, "researchers also found substantially fewer deaths in Florida from overdoses involving either prescription painkillers or heroin during 2011 and 2012" Thanks for the article. "with less access to prescription painkillers, fewer people may be developing an addiction" So we are seeing less people getting hooked on opiates. This is of course a good thing. But I still worry about those who got hooked in "the good old days" and now no longer have access to opiates in standardized doses.
    - yrLS1 11y ago
      Yeah, that part really caught my eye too. Anecdotally, many heroin addicts seem to start off with prescription painkillers and then move on to heroin once their preferred pills become unavailable (crack down on scripts, price, whatever). It would seem to make sense that by preventing some amount of painkiller addiction, you could prevent some amount of heroin addiction. I'm curious to see the full study once it's released.
    - Alex3917 11y ago
      > So we are seeing less people getting hooked on opiates. This is of course a good thing. Not necessarily. You want people in pain to be able to access opiates. And some of those are going to die from them. So the ideal number of people dying probably isn't zero.
highCs 11y ago
What conditions pushes a drug addict to overdose? Do they all reach that point at some point or what? Is this illegal drugs or regulated ones?
- redblacktree 11y ago
  Often overdoses happen when a former addict relapses. They'll take their old dose, not realizing that they have lost some of their tolerance.
- bdavisx 11y ago
  Both, but for different reasons: The "overdoses" from prescription opiates are often acetaminophen vs. the opiate (no direct sources w/ numbers, but example: http://www.medscape.com/viewarticle/820039 http://www.medscape.com/viewarticle/820039). Whereas with illegal opiates it's often from a difference in purity from one purchase to the next. This is where a regulated drug market would alleviate that issue 100%.
- joesmo 11y ago
  Varying potency. Dealers putting in fentanyl or stronger opiates to intentionally cause an overdose as marketing hype for their product (very common). Misjudging the dose of a known product. Tolerance. Using too much after some time stopped. Mixing opiates with other substances. I'm sure there are many more. If you're using street opiates, it's going to happen at some point, guaranteed. I've yet to meet an opiate addict who has never overdosed and I doubt I ever will. Sticking to prescription opiates helps, but even then people overdose often.
  - JBReefer 11y ago
    For those looking for more information, the practice is in particular making one very strong bag with a lot of fentanyl, so that a single user overdoses or dies. The idea is other users will then buy your product, thinking it's better quality. It's called a "hotshot."
  - buttcoinslol 11y ago
    I never overdosed in a year of heroin use, then again I wasn't an IV user.
joesmo 11y ago
Naloxone and clean needles should be available cheaply and over the counter, no questions asked. People who help overdose victims shouldn't be charged with drug possession. Until those things happen, I have no doubt overdoses will continue to needlessly kill people while our idiot politicians stand idly by wondering what they can do because they're too fucking stupid to implement the tried and true, tested solutions for fear of looking bad. This isn't a news story about anything else than the failure of government to implement very simple solutions (as most stories about problems in the US). Instead, these idiots keep working on filling up more jails. After all, jailing people for everyday activities is the American way.
dchmiel 11y ago
We share a lot in common with our neighbours to the south and it seems that the drug overdose epidemic has been happening in Canada as well. With some very alarming rates of increase due to Fentanyl overdoses. In the province of Alberta, Fentanyl detected deaths have risen from six in 2011 to 120 in 2014.[1] Other provinces are showing double and higher rates of increases. If you were to look at Alberta alone there is a correlation to the collapse in oil prices, since it's an oil and gas producing economy, and increased overdoses. But Fentanyl is just this monster of a drug 80 times as powerful as morphine that is being laced into so many other drugs and sold to unsuspecting customers as OxyContin or laced into it. As a response to the epidemic the government is fast tracking Naloxone to become a non prescription drug since it reverses the effects of an opioid overdose within minutes.[2] I don't remember where I read that first responders (Paramedics, EMS) will be carrying Naloxone to administer it during responses. 1.http://www.theglobeandmail.com/news/british-columbia/fentanyl-related-deaths-soar-across-canada-report-says/article25920303/ http://www.theglobeandmail.com/news/british-columbia/fentany... 2.http://www.theglobeandmail.com/news/national/government-to-fast-tract-availability-of-overdose-reversing-drug/article28196221/ http://www.theglobeandmail.com/news/national/government-to-f...
- spinlock 11y ago
  My cousin died of a Fentanyl overdose last year. This is the worst part of the criminalization of drugs, IMO. If heroine weren't criminalized, I'm sure my cousin would have gotten actual heroine instead of fentanyl -- which you have to be an anesthesiologist to administer properly, not a dumb red-neck. Of course, if oxy were legal (and I know that oxy is kinda legal but only while they're getting you hooked. Once you're an addict it becomes criminal) he would have stuck with that instead of moving up to the cheaper and easier to get heroine.
  - hapless 11y ago
    The therapeutic index of opiates narrows continuously as addiction proceeds. Users have to skate closer and closer to dangerous levels to reach the same level of intoxication. While dosage, purity, etc may possibly make the drug more predictable, fundamentally it doesn't matter which drug your cousin was taking. The longer he remained addicted to opiates, as a class, the greater his risk of death by overdose. You have to be an anesthesiologist to administer fentanyl not because handling it safely is so difficult, but because managing high opiate tolerance is extremely dangerous.
brooklyndude 11y ago
Living in NYC. What can I do tonite? 63 plays, 22 gallery openings, 18 meetups, 23 movies. 31,245 restaurants to choose from. Northern New Hampshire: What are we going to do tonite? Nothing. Absolutely nothing going on. Lets do some heroin. Cool. It's all we got. WTF.
- golergka 11y ago
  > Northern New Hampshire: What are we going to do tonite? There's a sale on Steam. (I haven't checked, but there's always a sale on Steam).
- jbhatab 11y ago
  New Hampshire is TREMENDOUSLY bad with heroin. I've seen it first hand and it is out of control. When I return, I always get a new list of dead people. There are a lot of factors on this one, but at this point it's mostly a cyclical cultural problem.
- api 11y ago
  An old friend of mine who grew up in Middletown, Ohio said there was "nothing to do but drugs and church." He also said there was a surprising amount of double-dipping in those things, wrecking a few stereotypes.
  - puredemo 11y ago
    I grew up in an area like that. One of my goals if I ever get wealthy is to simply open up something cheap and fun to do in small towns to combat this. Like rock climbing gyms for $30 a month. Or small indoor water parks. I wouldn't even care if that chain of businesses made much money, I'd consider it a public service.
    - gregpilling 11y ago
      How much do you think VR and Oculus Rift will impact the experience of growing up in a small town? A kid will be able to experience much of the world, no matter where they are. I hope it has a positive impact; I don't see how it couldn't.
1024core 11y ago
Has the legalization of cannabis made a difference in the number of overdoses? I don't have access to the numbers, but it would be an interesting question to ask from a public health perspective, if easy access to cannabis reduces OD deaths from more powerful drugs. Edited: I mean, if access to cannabis reduces the incidents of ODing from _other_, harder drugs like heroin or fentanyl or meth.
- peter303 11y ago
  No one has died directly of cannibus intoxication in Colorado yet. A couple have people have gone paranoid and committed suicide. And there a several ER room visits for emotional distress or catatonia every week. About of fifth of DUI convictions are now for cannabis. I presume there is a proportional fracton of drunk driving deaths.
  - 1024core 11y ago
    No, I meant if the legalization of cannabis has had an affect on the OD deaths from _other_ drugs like heroin and fentanyl, etc.
csense 11y ago
It strikes me how this article uses the language of an "epidemic," as if this is a disease that happens randomly to people. It's not. These drug users are deliberately chose to inject a substance into their body, knowing full well that this is a totally unregulated illegal industry, and there is a high risk of addiction, overdose, impurities and death. They teach kids in school that drugs are bad. Maybe they need to make the education more horrifying, with pictures and videos of people showing in gruesome detail how their minds and bodies have been permanently damaged, or the cold corpses of dead addicts. Maybe they need to better explain the nature of statistical risk, telling you that even if you're fine the first, second, and third time, the fourth, fifth, or hundredth time can still kill you. Why are people so dumb?
- tbabb 11y ago
  Brains are machines, and drugs damage them in such a way that the damage accelerates. If you think you are not driven by your own reward system, or that you are above it, you are laughably mistaken. By and large, you will do what your reward system tells you to, and your reserves to defy it are limited and finite. Be happy that yours is intact and mostly tells you to do things that are good for you (which itself is only by the grace of millions of years of random variation and selection on your ancestors, who more or less knew nothing of the potent drugs that exist in our habitat today), because once that system is damaged, you cannot simply will it to become fixed. Moreover, it looks like the Appalachian outbreak is due to patients falling into addiction as a result of established medical care, and simply falling through the cracks-- or perhaps even having dangerous addiction-risky treatments foisted on them by a drug industry overstating the safety or necessity of its products. Have a little sympathy. If the rates shown here continue, you may one day find yourself among the affected.
- fsloth 11y ago
  "Maybe they need to make the education more horrifying" To my understanding this does not succeed in modifying the risk behaviour of the intended target audience. Problematic drug abuse to me seems to be a symptom of other problems, not a lifestyle choice.
- Someone 11y ago

111 points by tysone 11y ago

Interestingly high rate of OD deaths in a county on the Hawaiian island of Molokai. Access is pretty restricted and the whole island has a population of less than 10,000.

GFK_of_xmaspast 11y ago
With these county maps, it's easy to get very high or very low rates of anything in sparsely-populated counties (see also all those red blotches in the mountain west). Checking wikipedia, it looks like there are 90 (!!!) people in that county; you can guess what one death does to the rates-per-100k people.
onetwotree 11y ago
Recovery is hard in tiny communities. All your friends are doing drugs, there are maybe 2 or 3 12-step meetings a week, no outpatient programs that you can attend while working, no sober living facilities, and treatment involves a trip to the big city. Contrast this with a modest sized city like my home of Madison, WI, where there are two rehabs in town, the land of a thousand rehabs is just across the state line, hundreds of meetings a week, and there is a thriving sober living community. Small town folks make up the majority of the recovering heroin addicts I meet here. They all took the quick trip up the road to Madison for rehab, moved into sober living in town, and stayed for the recovery community. Perhaps that's more difficult on an isolated island community? If you think it's too hard to get the dope there, you haven't met an addict in need...

onetwotree 11y ago

Yep, the new face of heroin is white and affluent. While I'm all for the evidence based, treatment focused approach to addiction that this has brought about, isn't it a little telling that we only switched from punishment to treatment when white people started shooting dope?

GFK_of_xmaspast 11y ago
And what are the odds of switching back once the fashion moves on from heroin?
- onetwotree 11y ago
  Hopefully low. The treatment focused approach works, and so once people see this they'll keep it even after the white suburban community gets over it's heroin problem.
  - knowaveragejoe 11y ago
    This smug commentary is shameful. There are a variety of factors involved in this problem and why until relatively recently an interdiction approach has been taken over treatment. It afflicts all demographics in the country. Get over yourself.
    - nomat 11y ago
      I think it's quite telling that only one top level comment mentions the race of the drug users, and is at the bottom of the page. Even the article itself avoids the topic although it includes statistics of all kinds.
    - onetwotree 11y ago
      I don't understand your insulting tone. What do you find smug about this comment? That white people are the primary victims in the nations current epidemic? That's a simple fact. The primary reason that black people were spared this time around is simply that doctors are significantly less likely to prescribe opiate painkillers to black folks (a bit of a positive effect of stereotypes about criminality).
      - knowaveragejoe 11y ago
        If you're not picking up the smugness in his two comments then you must have a tough time with reading comprehension. Aside from that, it's not a white issue at all. Opiate addiction, including heroin, afflicts all communities, and in particular those of lesser means.

awavering 11y ago

Recommended reading if this interests you: Dreamland tells the story of intersecting prescription pill and heroin use in America. http://www.samquinones.com/books/dreamland/ http://www.samquinones.com/books/dreamland/

MicroBerto 11y ago
It's maddening. Prescription opiate use has gotten so bad that Big Pharma is now heavily advertising an anti-constipation pill for all these addicts, with the most ridiculous commercial I've ever seen: a woman walks around town with her opioid "bff" that happens to have muscles. https://i.imgur.com/NMn59EC.jpg https://i.imgur.com/NMn59EC.jpg Seriously, if this alone doesn't spell doom for your country and its health care system, I'm not sure what does.
- phillipamann 11y ago
  What is the name of this anti-constipation drug and do you have a link to the commercial?
  - refurb 11y ago
    I'm guessing it's Relistor? It was recently approved for constipation caused by opioids. To be honest, opioid constipation is a huge problem. It's a great drug to have.
    - MicroBerto 11y ago
      Definitely not doubting that. I just hate to see solutions that treat the effect and not the cause. So. Many. Commercials.
    - Healthyme15 11y ago
      as
    - Healthyme15 11y ago
      I think for chronic constipation, you can also use this Digestic by Mimonis which is very good in treating constipation problem. I have been save from my long battle of constipation that is why I can say it has been proven by mine to be effective.

xyzzy4 11y ago

What they should do is sell heroin legally along with cigarettes and alcohol, and that way people won't overdose as much because they'd know exactly how much to use.

bluedino 11y ago
And then more people would be hooked on it.
- rwmj 11y ago
  Do you have evidence for that? Legalizing cannabis (marijuana) has resulted in slightly reduced rates of use amongst teenagers in Colorado. Now, cannabis is not opiates, but we need to see evidence before leaping to conclusions. Going with "obvious" solutions and "gut feel" answers is what got us to the place we are now.
  - knowaveragejoe 11y ago
    I don't have any evidence of the trend, but Opiates are much more addictive than Marijuana in general.
    - rwmj 11y ago
      Would you start to use heroin if it were legal? In 1955, the UK had 48 registered heroin addicts [source 1]. Today it's a lot more -- 33,000 seems to be a reasonable figure [source 2]. The UK prescribed heroin to addicts in the 1950s. But those are just two numbers, you really need good evidence before claiming that regulating heroin, possibly by prescribing it through doctors, would necessarily increase the number of addicts. "Opiates are much more addictive" is a true statement, but not evidence of that. [1] http://news.bbc.co.uk/1/hi/magazine/4647018.stm http://news.bbc.co.uk/1/hi/magazine/4647018.stm [2] http://www.bbc.co.uk/news/uk-27235470 http://www.bbc.co.uk/news/uk-27235470
      - mason240 11y ago

bluedino 11y ago

The maps on this page aren't similar to a standard population map, so that's good in a way. Has heroin simply taken the marketshare away from meth? https://xkcd.com/1138/ https://xkcd.com/1138/

theseatoms 11y ago
"Good" as in "good data presentation". Not "good" as in "good that heroin use is growing proportionately across the American populace", I presume. Any "rate of change" graphic should control for the issue that xkcd mentions.
- tgb 11y ago
  It does control for that - the rates are per hundred thousand people.
Retric 11y ago
There is still a tendency for smaller populations to have larger differences from the mean. Looking at those maps, the dark red areas seem to mostly be low population areas. What's interesting is how steady the picture stays even as it gets worse, which suggests the geography is actually meaningful in this case.
deleted 11y ago
[deleted]

sageabilly 11y ago

I only have my one anecdote in response to this story, which does not translate into data I know. I'm from one of the counties in western NC where overdose deaths have gone from 4-8 in 100K to 20+ in 100K. I graduated from high school in 2001 so I have grown up with the rise of drug use in my home county and surrounding areas and the people affected are people that I've known all my life. I no longer live in NC and, in fact, haven't lived in the area since I was 16 (went to a live-in magnet high school and then went elsewhere for college + career). 2001- my graduating class goes off into the world, half to college, maybe 1/4 to trade school, the rest go to join a family business or into an apprenticeship into a trade. A few go into the military. A few have no idea what to do and get low-level jobs wherever they can find them. Pre-2008- The economy is booming, people who've gone to college are either 3 years post graduating, establishing themselves in their young careers, or just graduating from grad school, or for those that have entered a trade they've worked long enough to start having some standing in their chosen line of work. 2008-2010 economy explodes. Layoffs, bankruptcies, consolidations, offshoring. Immensely decreased consumer spending hits trades particularly hard- welders, mechanics, electricians, construction workers- all take massive hits to their profits. Business is scarce. People who've graduated from college and who are establishing their careers get laid off and have to move back into the county because that's where their safety net is- grandma and grandpa can take care of the kids while they hunt for work or work a low-paying job because that's all they can get. Military service men and women get done with their tour and come back to nothing- no job prospects, community college has closed, trade schools have closed, the factories where their fathers and mothers worked have all outsourced to 3rd world countries and closed. In my rural county suddenly there's way more idle middle to late 20-somethings with no job and no prospects. No jobs to be found, no money to move. What I saw among the people I know/knew is that it only took a few people trying meth before it was like a powder keg going off- idle hands are the Devil's plathings, after all. People I went to high school with no hope for the future were doing meth because it was 3 minutes of bliss in stark contrast to the whirlpool of suck their lives had become. Grandma and grandpa were taking it because they couldn't afford painkillers. Teenagers were taking it because they were shithead teenagers and it was more accessible than pot. The "smarter" of the people I knew were cooking it because it was the only way they knew to make money. Once the door was open to meth then "fancier" stuff like painkillers started coming in and it was a way to feel like you were "better than" everyone else you knew who was doing meth. Oh yeah you were a drug addict, but at least your pills had a brand name. Enough meth labs blow up and the more enterprising of drug distributors can come in and sell addicts anything and everything they want, so if heroin is cheap enough that's what gets sold. This article is written from a scholarly point of view and has a lot of conjecture but I definitely don't think they had any boots on the ground to make the conclusions that they did, particularly with regards to saying the epidemic in Appalachia is a result of on the job injuries. There are no jobs to get injured on anymore. [Edit] I also absolutely agree with onetwotree's comment downthread, this is another ENORMOUS contributor to increased and sustained drug use in my tiny county: "Recovery is hard in tiny communities. All your friends are doing drugs, there are maybe 2 or 3 12-step meetings a week, no outpatient programs that you can attend while working, no sober living facilities, and treatment involves a trip to the big city." Also worth mentioning is that often those 12-step meetings are held in the basement of a church, which in my hometown means it's either your church which your whole family goes to and you grew up in (pretty damn hard to walk in there and admit to being an addict) or your friend's church that his whole family goes to and he grew up in- in both cases it's impossible to be anonymous.

ComputerGuru 11y ago

Interesting that Chicago is so underrepresented in those charts. I wonder why.

OopsCriticality 11y ago
My first thought is a reporting issue. Look at New York and the neighboring states for example: it is hard to believe that drug overdose deaths are so thoughtful that they respect a state border.
linxoz 11y ago
The drugs come from Chicago, but majority of the OD happens in the western suburbs of Chicago; mainly DuPage county. http://wgntv.com/2013/11/19/heroine-epidemic-plaguing-dupage-county/ http://wgntv.com/2013/11/19/heroine-epidemic-plaguing-dupage...

djb_hackernews 11y ago

Has anyone come across coverage of the heroin epidemic as it relates to the growth of heroin production in Afghanistan since the arrival of US forces? Seems like no one is connecting these dots and I'm curious why? Not to imply there is a conspiracy theory at all, it may just be that I'm more "fascinated" by that relationship than the average reader?

finid 11y ago
From my recollection, just before the invasion, meth and one other drug that I've forgotten the name where real popular, not the H. So you may be on to something, but I'll need to see real data before I subscribe.
FreedomToCreate 11y ago
Do you have data to support this. Also is Afghanistan the lone producer of heroin? You have to be careful in making inferences like this without considering the multitude of other factors such as how easy has the process to create heroin become over the last decade, was there a drop in other drugs and why. To your point however, I wonder if the war has enabled Big Phrama to get easier access to make there own opioids. To me it seems like the growth of Opioids for pain lead people to seek heroin and other drugs when there prescription runs out.
- djb_hackernews 11y ago
  data to support what? I didn't make any claims. It is widely reported that the Taliban banned growing poppy (it was un-islamic) in Afghanistan and since US forces put them on the run the local war lords, who help US forces with intel, etc., have overseen the massive rebirth of the industry. It is also widely reported that there is a heroin epidemic in the United States. To me they must be somewhat related.
  - dragontamer 11y ago
    Considering that most of the US drugs are either made in the US, or come up from Mexico, I think blaming countries that are on the other side of the world separated by the largest oceans is a bit ridiculous. http://opiophilia.blogspot.com/2013/05/heroin-in-united-states-where-does-it.html http://opiophilia.blogspot.com/2013/05/heroin-in-united-stat... US Heroin comes from South America and Mexico.

armenarmen 11y ago

They shut down the pill mills and the pain clinics, which were the one reliable source of safe opiates, and now people are dying left and right. Go figure.

yrLS1 11y ago
Except, of course, that people were also overdosing "left and right" due to the pill mills and illegitimate pain clinics... Edit for source: http://www.jhsph.edu/news/news-releases/2015/pill-mill-crackdown-linked-to-fewer-painkiller-overdose-deaths-in-florida.html http://www.jhsph.edu/news/news-releases/2015/pill-mill-crack...
- armenarmen 11y ago
  Interesting, "researchers also found substantially fewer deaths in Florida from overdoses involving either prescription painkillers or heroin during 2011 and 2012" Thanks for the article. "with less access to prescription painkillers, fewer people may be developing an addiction" So we are seeing less people getting hooked on opiates. This is of course a good thing. But I still worry about those who got hooked in "the good old days" and now no longer have access to opiates in standardized doses.
  - yrLS1 11y ago
    Yeah, that part really caught my eye too. Anecdotally, many heroin addicts seem to start off with prescription painkillers and then move on to heroin once their preferred pills become unavailable (crack down on scripts, price, whatever). It would seem to make sense that by preventing some amount of painkiller addiction, you could prevent some amount of heroin addiction. I'm curious to see the full study once it's released.
  - Alex3917 11y ago
    > So we are seeing less people getting hooked on opiates. This is of course a good thing. Not necessarily. You want people in pain to be able to access opiates. And some of those are going to die from them. So the ideal number of people dying probably isn't zero.

highCs 11y ago

What conditions pushes a drug addict to overdose? Do they all reach that point at some point or what? Is this illegal drugs or regulated ones?

redblacktree 11y ago
Often overdoses happen when a former addict relapses. They'll take their old dose, not realizing that they have lost some of their tolerance.
bdavisx 11y ago
Both, but for different reasons: The "overdoses" from prescription opiates are often acetaminophen vs. the opiate (no direct sources w/ numbers, but example: http://www.medscape.com/viewarticle/820039 http://www.medscape.com/viewarticle/820039). Whereas with illegal opiates it's often from a difference in purity from one purchase to the next. This is where a regulated drug market would alleviate that issue 100%.
joesmo 11y ago
Varying potency. Dealers putting in fentanyl or stronger opiates to intentionally cause an overdose as marketing hype for their product (very common). Misjudging the dose of a known product. Tolerance. Using too much after some time stopped. Mixing opiates with other substances. I'm sure there are many more. If you're using street opiates, it's going to happen at some point, guaranteed. I've yet to meet an opiate addict who has never overdosed and I doubt I ever will. Sticking to prescription opiates helps, but even then people overdose often.
- JBReefer 11y ago
  For those looking for more information, the practice is in particular making one very strong bag with a lot of fentanyl, so that a single user overdoses or dies. The idea is other users will then buy your product, thinking it's better quality. It's called a "hotshot."
- buttcoinslol 11y ago
  I never overdosed in a year of heroin use, then again I wasn't an IV user.

joesmo 11y ago

Naloxone and clean needles should be available cheaply and over the counter, no questions asked. People who help overdose victims shouldn't be charged with drug possession. Until those things happen, I have no doubt overdoses will continue to needlessly kill people while our idiot politicians stand idly by wondering what they can do because they're too fucking stupid to implement the tried and true, tested solutions for fear of looking bad. This isn't a news story about anything else than the failure of government to implement very simple solutions (as most stories about problems in the US). Instead, these idiots keep working on filling up more jails. After all, jailing people for everyday activities is the American way.

dchmiel 11y ago

We share a lot in common with our neighbours to the south and it seems that the drug overdose epidemic has been happening in Canada as well. With some very alarming rates of increase due to Fentanyl overdoses. In the province of Alberta, Fentanyl detected deaths have risen from six in 2011 to 120 in 2014.[1] Other provinces are showing double and higher rates of increases. If you were to look at Alberta alone there is a correlation to the collapse in oil prices, since it's an oil and gas producing economy, and increased overdoses. But Fentanyl is just this monster of a drug 80 times as powerful as morphine that is being laced into so many other drugs and sold to unsuspecting customers as OxyContin or laced into it. As a response to the epidemic the government is fast tracking Naloxone to become a non prescription drug since it reverses the effects of an opioid overdose within minutes.[2] I don't remember where I read that first responders (Paramedics, EMS) will be carrying Naloxone to administer it during responses. 1.http://www.theglobeandmail.com/news/british-columbia/fentanyl-related-deaths-soar-across-canada-report-says/article25920303/ http://www.theglobeandmail.com/news/british-columbia/fentany... 2.http://www.theglobeandmail.com/news/national/government-to-fast-tract-availability-of-overdose-reversing-drug/article28196221/ http://www.theglobeandmail.com/news/national/government-to-f...

spinlock 11y ago
My cousin died of a Fentanyl overdose last year. This is the worst part of the criminalization of drugs, IMO. If heroine weren't criminalized, I'm sure my cousin would have gotten actual heroine instead of fentanyl -- which you have to be an anesthesiologist to administer properly, not a dumb red-neck. Of course, if oxy were legal (and I know that oxy is kinda legal but only while they're getting you hooked. Once you're an addict it becomes criminal) he would have stuck with that instead of moving up to the cheaper and easier to get heroine.
- hapless 11y ago
  The therapeutic index of opiates narrows continuously as addiction proceeds. Users have to skate closer and closer to dangerous levels to reach the same level of intoxication. While dosage, purity, etc may possibly make the drug more predictable, fundamentally it doesn't matter which drug your cousin was taking. The longer he remained addicted to opiates, as a class, the greater his risk of death by overdose. You have to be an anesthesiologist to administer fentanyl not because handling it safely is so difficult, but because managing high opiate tolerance is extremely dangerous.

brooklyndude 11y ago

Living in NYC. What can I do tonite? 63 plays, 22 gallery openings, 18 meetups, 23 movies. 31,245 restaurants to choose from. Northern New Hampshire: What are we going to do tonite? Nothing. Absolutely nothing going on. Lets do some heroin. Cool. It's all we got. WTF.

golergka 11y ago
> Northern New Hampshire: What are we going to do tonite? There's a sale on Steam. (I haven't checked, but there's always a sale on Steam).
jbhatab 11y ago
New Hampshire is TREMENDOUSLY bad with heroin. I've seen it first hand and it is out of control. When I return, I always get a new list of dead people. There are a lot of factors on this one, but at this point it's mostly a cyclical cultural problem.
api 11y ago
An old friend of mine who grew up in Middletown, Ohio said there was "nothing to do but drugs and church." He also said there was a surprising amount of double-dipping in those things, wrecking a few stereotypes.
- puredemo 11y ago
  I grew up in an area like that. One of my goals if I ever get wealthy is to simply open up something cheap and fun to do in small towns to combat this. Like rock climbing gyms for $30 a month. Or small indoor water parks. I wouldn't even care if that chain of businesses made much money, I'd consider it a public service.
  - gregpilling 11y ago
    How much do you think VR and Oculus Rift will impact the experience of growing up in a small town? A kid will be able to experience much of the world, no matter where they are. I hope it has a positive impact; I don't see how it couldn't.

1024core 11y ago

Has the legalization of cannabis made a difference in the number of overdoses? I don't have access to the numbers, but it would be an interesting question to ask from a public health perspective, if easy access to cannabis reduces OD deaths from more powerful drugs. Edited: I mean, if access to cannabis reduces the incidents of ODing from _other_, harder drugs like heroin or fentanyl or meth.

peter303 11y ago
No one has died directly of cannibus intoxication in Colorado yet. A couple have people have gone paranoid and committed suicide. And there a several ER room visits for emotional distress or catatonia every week. About of fifth of DUI convictions are now for cannabis. I presume there is a proportional fracton of drunk driving deaths.
- 1024core 11y ago
  No, I meant if the legalization of cannabis has had an affect on the OD deaths from _other_ drugs like heroin and fentanyl, etc.

csense 11y ago

It strikes me how this article uses the language of an "epidemic," as if this is a disease that happens randomly to people. It's not. These drug users are deliberately chose to inject a substance into their body, knowing full well that this is a totally unregulated illegal industry, and there is a high risk of addiction, overdose, impurities and death. They teach kids in school that drugs are bad. Maybe they need to make the education more horrifying, with pictures and videos of people showing in gruesome detail how their minds and bodies have been permanently damaged, or the cold corpses of dead addicts. Maybe they need to better explain the nature of statistical risk, telling you that even if you're fine the first, second, and third time, the fourth, fifth, or hundredth time can still kill you. Why are people so dumb?

tbabb 11y ago
Brains are machines, and drugs damage them in such a way that the damage accelerates. If you think you are not driven by your own reward system, or that you are above it, you are laughably mistaken. By and large, you will do what your reward system tells you to, and your reserves to defy it are limited and finite. Be happy that yours is intact and mostly tells you to do things that are good for you (which itself is only by the grace of millions of years of random variation and selection on your ancestors, who more or less knew nothing of the potent drugs that exist in our habitat today), because once that system is damaged, you cannot simply will it to become fixed. Moreover, it looks like the Appalachian outbreak is due to patients falling into addiction as a result of established medical care, and simply falling through the cracks-- or perhaps even having dangerous addiction-risky treatments foisted on them by a drug industry overstating the safety or necessity of its products. Have a little sympathy. If the rates shown here continue, you may one day find yourself among the affected.
fsloth 11y ago
"Maybe they need to make the education more horrifying" To my understanding this does not succeed in modifying the risk behaviour of the intended target audience. Problematic drug abuse to me seems to be a symptom of other problems, not a lifestyle choice.
Someone 11y ago