7 ms·

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 deat

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.

jobu 11y ago
> 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. They may be confusing people injured in the workplace with people receiving Social Security Disability payments: http://www.dailyyonder.com/files/images/DisabilityMap.jpg http://www.dailyyonder.com/files/images/DisabilityMap.jpg If you look at the map with the percentage of Americans receiving disability it does seem to correlate rather strongly with the overdose maps - at least in Appalachia.
fweespeech 11y ago
I don't mean to detract from your anecdote but the Florida and the CDC clearly sees a link in overprescription of pain killers and the death rate. The root cause is the way we are handling opiates in general which changed in 2001 and the prioritization of "comfort" of the patient when they are in pain. Anecdotal, I've been in pain, multiple times in my life, where Doctors were literally confused by the fact I wasn't taking pain medication and immediate would prescribe opiates without a second thought. A couple even made comments [one Doctor who used to treat soldiers assumed it was a macho thing and told me I was being silly, just take the drugs]. The main reason I don't take pain killers is I've got medical allergies so I reserve the handful of things I can take for emergencies but they'll casually try to suggest/prescribe them for trivial things. > 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. Yeah, but would you agree they would turn to drinking if they wouldn't/couldn't do illegal drugs? http://www.cdc.gov/media/releases/2014/p0701-opioid-painkiller.html http://www.cdc.gov/media/releases/2014/p0701-opioid-painkill... > Health care providers in the highest prescribing state, Alabama, wrote almost three times as many of these prescriptions per person as those in the lowest prescribing state, Hawaii. Most of the highest prescribing states were in the South. Previous research has shown that regional variation in use of prescriptions cannot be explained by the underlying health status of the population. > The Vital Signs report also contains a study highlighting the success of Florida in reversing prescription drug overdose trends. Results showed that after statewide legislative and enforcement actions in 2010 and 2011, the death rate from prescription drug overdose decreased 23 percent between 2010 and 2012. Florida officials had taken these actions in response to a 28 percent increase in the drug overdose death rate over the preceding years (2006-2010). > Declines in death rates in Florida for specific prescription painkillers (oxycodone, methadone, and hydrocodone) and sedatives paralleled declines in prescribing rates for those drugs. This report was based on Florida Medical Examiners Commission data from 2006 to 2012 and IMS Health National Prescription Audit data from 2008 to 2012. They do the same with antibiotics: http://www.cbsnews.com/news/doctors-urged-to-stop-prescribing-antibiotics-for-colds-and-flu/ http://www.cbsnews.com/news/doctors-urged-to-stop-prescribin... > Despite years of warnings, doctors still overprescribe antibiotics for acute respiratory infections even though most are caused by viruses that those drugs cannot help. The consequences are serious: overuse of antibiotics is fueling the rise of drug-resistant superbugs, and patients can suffer significant side effects from drugs they don't really need. http://www.newyorker.com/business/currency/who-is-responsible-for-the-pain-pill-epidemic http://www.newyorker.com/business/currency/who-is-responsibl... > The Joint Commission, which accredits health facilities, issued pain-management standards in 2001 that instructed hospitals to measure pain—you may be familiar with the smiling-to-crying faces scale—and to prioritize its treatment. Elizabeth Zhani, a spokeswoman for the Joint Commission, told me that their standards “were based upon both the emerging and compelling science of that time, and upon the consensus of a broad array of professionals.” Yet Purdue, according to a report issued by the U. S. Government Accountability Office, helped fund a “pain-management educational program” organized by the Joint Commission; a related agreement allowed Purdue to disseminate educational materials on pain management, and this, in the words of the report, “may have facilitated its access to hospitals to promote OxyContin.” > In a policy drafted by several people with ties to narcotics makers, including Haddox, the Federation of State Medical Boards called on the boards to punish doctors for inadequately treating pain, according to the Wall Street Journal. The Federation also reportedly accepted money from pharmaceutical firms to produce and distribute narcotics-prescribing guidelines. In an e-mail, the Federation maintained: “[Our] most recent policy reflects the considerable body of research and experience accrued since our last series of formal policies related to opioid prescribing and addiction were adopted in 2004. Our latest guidelines, adopted this year, acknowledge that evidence for the risk associated with opioids has surged, while evidence for the benefits of opioids for long-term use has remained controversial and insufficient.” > In 2007, Purdue Pharma and three of its top executives pleaded guilty to criminal charges that they had misled the F.D.A., clinicians, and patients about the risks of OxyContin addiction and abuse by aggressively marketing the drug to providers and patients as a safe alternative to short-acting narcotics. (Doctors had been taught that because OxyContin was time-released, it wouldn’t cause a high that would lead to addiction.)

jobu 11y ago

> 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. They may be confusing people injured in the workplace with people receiving Social Security Disability payments: http://www.dailyyonder.com/files/images/DisabilityMap.jpg http://www.dailyyonder.com/files/images/DisabilityMap.jpg If you look at the map with the percentage of Americans receiving disability it does seem to correlate rather strongly with the overdose maps - at least in Appalachia.

fweespeech 11y ago

I don't mean to detract from your anecdote but the Florida and the CDC clearly sees a link in overprescription of pain killers and the death rate. The root cause is the way we are handling opiates in general which changed in 2001 and the prioritization of "comfort" of the patient when they are in pain. Anecdotal, I've been in pain, multiple times in my life, where Doctors were literally confused by the fact I wasn't taking pain medication and immediate would prescribe opiates without a second thought. A couple even made comments [one Doctor who used to treat soldiers assumed it was a macho thing and told me I was being silly, just take the drugs]. The main reason I don't take pain killers is I've got medical allergies so I reserve the handful of things I can take for emergencies but they'll casually try to suggest/prescribe them for trivial things. > 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. Yeah, but would you agree they would turn to drinking if they wouldn't/couldn't do illegal drugs? http://www.cdc.gov/media/releases/2014/p0701-opioid-painkiller.html http://www.cdc.gov/media/releases/2014/p0701-opioid-painkill... > Health care providers in the highest prescribing state, Alabama, wrote almost three times as many of these prescriptions per person as those in the lowest prescribing state, Hawaii. Most of the highest prescribing states were in the South. Previous research has shown that regional variation in use of prescriptions cannot be explained by the underlying health status of the population. > The Vital Signs report also contains a study highlighting the success of Florida in reversing prescription drug overdose trends. Results showed that after statewide legislative and enforcement actions in 2010 and 2011, the death rate from prescription drug overdose decreased 23 percent between 2010 and 2012. Florida officials had taken these actions in response to a 28 percent increase in the drug overdose death rate over the preceding years (2006-2010). > Declines in death rates in Florida for specific prescription painkillers (oxycodone, methadone, and hydrocodone) and sedatives paralleled declines in prescribing rates for those drugs. This report was based on Florida Medical Examiners Commission data from 2006 to 2012 and IMS Health National Prescription Audit data from 2008 to 2012. They do the same with antibiotics: http://www.cbsnews.com/news/doctors-urged-to-stop-prescribing-antibiotics-for-colds-and-flu/ http://www.cbsnews.com/news/doctors-urged-to-stop-prescribin... > Despite years of warnings, doctors still overprescribe antibiotics for acute respiratory infections even though most are caused by viruses that those drugs cannot help. The consequences are serious: overuse of antibiotics is fueling the rise of drug-resistant superbugs, and patients can suffer significant side effects from drugs they don't really need. http://www.newyorker.com/business/currency/who-is-responsible-for-the-pain-pill-epidemic http://www.newyorker.com/business/currency/who-is-responsibl... > The Joint Commission, which accredits health facilities, issued pain-management standards in 2001 that instructed hospitals to measure pain—you may be familiar with the smiling-to-crying faces scale—and to prioritize its treatment. Elizabeth Zhani, a spokeswoman for the Joint Commission, told me that their standards “were based upon both the emerging and compelling science of that time, and upon the consensus of a broad array of professionals.” Yet Purdue, according to a report issued by the U. S. Government Accountability Office, helped fund a “pain-management educational program” organized by the Joint Commission; a related agreement allowed Purdue to disseminate educational materials on pain management, and this, in the words of the report, “may have facilitated its access to hospitals to promote OxyContin.” > In a policy drafted by several people with ties to narcotics makers, including Haddox, the Federation of State Medical Boards called on the boards to punish doctors for inadequately treating pain, according to the Wall Street Journal. The Federation also reportedly accepted money from pharmaceutical firms to produce and distribute narcotics-prescribing guidelines. In an e-mail, the Federation maintained: “[Our] most recent policy reflects the considerable body of research and experience accrued since our last series of formal policies related to opioid prescribing and addiction were adopted in 2004. Our latest guidelines, adopted this year, acknowledge that evidence for the risk associated with opioids has surged, while evidence for the benefits of opioids for long-term use has remained controversial and insufficient.” > In 2007, Purdue Pharma and three of its top executives pleaded guilty to criminal charges that they had misled the F.D.A., clinicians, and patients about the risks of OxyContin addiction and abuse by aggressively marketing the drug to providers and patients as a safe alternative to short-acting narcotics. (Doctors had been taught that because OxyContin was time-released, it wouldn’t cause a high that would lead to addiction.)