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The opioid crisis is a product of, ironically, crackdowns on opioid abuse. For people with chronic pain, opioids may be the only option to live with it, and the

The opioid crisis is a product of, ironically, crackdowns on opioid abuse. For people with chronic pain, opioids may be the only option to live with it, and they need frequent doses. If it gets hard to acquire them because of “abuse-preventing” bureaucracy, they are forced to turn to the black market, not out of addiction, but dependency for pain relief. There is a benefit to legal marijuana that it might be chosen instead of harder drugs, perhaps, but I don't think it should be mixed up with painkillers, which are their own issue.

jseliger 10y ago
That's not the argument of Quinones's book Dreamland: http://seliger.com/2016/10/04/review-dreamland-true-tale-americas-opiate-epidemic-must-read-grant-writers http://seliger.com/2016/10/04/review-dreamland-true-tale-ame..., and Dreamland, like most other books and articles I've seen, argues that availability and over-prescribing have been major contributors to the crisis.
- oxide 10y ago
  If you can believe it, both are true. It sounds like a contradiction, but it isn't as cut and dry as our brains might like it to be, or like a writer might like it to be. They are both over and under-prescribed. Pain is both over and undertreated every day in every state in the country. There are pill mills, there are stingy ER's and clinics, it goes both ways. It isn't one or the other. On one hand, you have doctor shopping. On the other, you have legitimate chronic pain sufferers turning to the street to make ends meet. My grandparents bought pills from the black market at black market prices to fill the gap of under treatment. At the same time, people were paying cash-only pain management clinics for prescriptions which they were filling multiple times. There will always be abusers, lawmakers and activists need to realize that you can't regulate or price someone out of an addiction (or a dependency.) There is a staggering difference between addiction (which usually involves abuse) and dependency (which usually involves no abuse) Addiction to prescription opiates leads to one of two roads. The problem road is heroin. For example: Let's say you get addicted because you abuse the pills prescribed to you after surgery. You continue to maintain your addiction with drugs purchased from the street, then at some point you remember that heroin exists and is dirt cheap compared to the dollar per milligram you were paying for oxycodone. Suddenly, heroin doesn't seem so evil. Now you have a new perspective about heroin, mainly that it's cheaper and more potent than prescription pills. Dependency, meanwhile, can be maintained under a doctors supervision for years. Pain can be managed with prescription opiates safely and effectively, increasing the quality of life of someone who suffers from pain every single day. It's a multi-faceted issue with many variables, you can't really reduce it down to one sentence or another. There is no easy solution, either. You can't under-prescribe or prosecute doctors, that just hurts the people suffering the most. I know what the solution isn't, though: banning fucking kratom. this entire thing is a complete and total structure fire, and the DEA is trying to immediately move to Schedule I a powdered leaf that stops withdrawals for addicts. For the opiate naive, taking powdered kratom leaf results in a light buzz. For an opiate addict, it's no buzz + immediate relief of withdrawal symptoms. There is always methadone and suboxone, but these drugs are extremely long-acting. Meaning that if and when you come off of them, you will be in withdrawals for weeks or even months. For comparison, short-acting opiates like heroin withdrawals last about a week, maybe two. Now that you know this, it might not surprise you to hear that methadone patients often switch back to shorter-acting drugs like heroin to attempt to get clean. Ironic, isn't it?
- zkms 10y ago
  Except people only started dying when crackdowns intensified on legal, pharmaceutical, sources and prescribers of opioids. Crackdowns on "pill mills" and "overprescribing doctors" is what denies people a safe and legal source of pharmaceutical-grade opioids and forces them onto the black market of illegal, overpriced, and fentanyl-contaminated opioids. Also crackdowns on "over-prescribing" invariably lead to people who experience chronic pain being denied medical access (or being subjected to extremely invasive and degrading treatment to weed out "drug seekers"). The DEA cracking skulls over opioids and investigating doctors is literally the only reason illicit fentanyl even is a thing. I am so very doubtful that skull-cracking and door-kicking will miraculously work after decades of it not working. Do you want even nastier and even more potent (per unit volume) opioids than fentanyl? Because more prohibition (and yes, investigating and prosecuting doctors is absolutely a component of opioid prohibition) is just gonna give that result.
  - deleted 10y ago
    [deleted]
  - deelowe 10y ago
    It saddens me greatly to know that the majority of people in this world would rather let people die from overdose than allow them to get high... Is it really such a big deal? So they like doing drugs. In the grand scheme of things, isn't the more humane thing to do just allowing them to use while pursuing more humane options for getting them off drugs (rehab and education)?
  - Spooky23 10y ago
    That's one take. I've also heard that marijuana decriminalization is taking the margin out of many drug operations. Supposedly, Weed is like the ground beef of drug sales.
  - mc32 10y ago
    Looks like prescription medicine is rife with opportunity for some kind of ML analysis to find abuse and be more "just" (make better decisions) about restricting distribution and use.
  - 10y ago
- code_duck 10y ago
  The unfortunate thing is this system also denies drugs to people who really need them, while abusers can still get them legally and illegally. Recently I had to go to the ER for a painful cyst. Online sources indicate patients often receive opiates for the related pain, which was significant. They not only gave me nothing for pain while there or after, but also seemed more interested in screening me out as a drug seeker than helping me.
rubyn00bie 10y ago
I've known quite a few heroin addicts who got started because of a prescription for relatively mild but on-going pain. At some point the pain was gone, but the desire/addiction was not... Perhaps I'm just weighing my anecdotal knowledge too highly. I'm not saying opioids are always inappropriate but I think a lot of situations could do without them if marijuana was available as an alternative.
- md224 10y ago
  Something to consider: perhaps these people became addicted when they discovered that opiates provided relief from underlying depression... I have a feeling this may be one reason why some get addicted and others don't. (Believe it or not, some people even dislike taking opiates!) disclaimer: I am kind of obsessed with the self-medication theory of addiction
- Spooky23 10y ago
  When I was suffering from bad back pain, the amount opiates that was being written for me was ridiculous. I refused to take it, the side affects, even in the short term were awful.
awalton 10y ago
> The opioid crisis is a product of, ironically, crackdowns on opioid abuse. This does not mesh with reality in states like West Virginia, where drug companies sent 9 million pills in two years to a town with less than 400 people - 780 million pills in six years to a state with 1.8 million people. As the "crackdown" revved up in these states, more people have died as they've turned to replace their prescription habit with heroin, and street heroin is increasingly being laced with fentanyl analogs which cause nearly instant overdoses. Not pinning this on the drug companies or doctors that are handing out these drugs like candy to anyone willing to write a check is putting the blame way downstream of where it belongs. The DEA sure can crackdown on marijuana and molly but Rx drug abuse? Move along, citizen. Nothing to see here.
- BatFastard 10y ago
  Follow the money!
mtdewcmu 10y ago
The crackdown on OxyContin certainly seems to have made things worse. The OxyContin users were driven to switch to black market heroin. Black market heroin is much more dangerous than OxyContin.
- oxide 10y ago
  Oxycontin was suddenly a dollar per milligram when that happened. It seems obvious in hindsight what the result would be. That's 80 dollars for one 80 milligram pill, which is about 6 hours worth of a high for someone crushing and snorting it. Less time well per dollar spent if they're smoking or injecting them, more if it's being taken orally. Also, keep in mind that Oxycontin was reformulated to be resistant to crushing, meaning that suddenly a lot of addicts were up shit creek without a paddle when they couldn't snort/smoke/inject or even chew the pill they just bought. Heroin, on the other hand, is much cheaper, more potent, and more widely available than Oxycontin could ever hope to be. When you're that deep in the hole of addiction, you start thinking of heroin not as evil, but as a cheap, potent substitute for the prescription pills you've been throwing money away on. It's a fucked up path that too many have walked.
deleted 10y ago
[deleted]
MrFantastic 10y ago
Medicare Part D played a huge role in the opiod epidemic. Patients were given $3 bottles of Oxy with a street value of $10k in areas targeted by the drug companies because of high unemployment. http://www.econtalk.org/archives/2017/01/sam_quinones_on.html http://www.econtalk.org/archives/2017/01/sam_quinones_on.htm... Capitalism cuts both ways.
karmelapple 10y ago
The book Chasing the Scream is a great summary of how crackdowns on opioid abuse, and other drugs, have led to the problems we have today. I've mentioned it other times on HN, and it's still a well-written primer to why we should legalize many, and perhaps all, drugs. [1] http://chasingthescream.com http://chasingthescream.com
- ridgeguy 10y ago
  Came here also to recommend Chasing the Scream. It was an enlightening read for me.

jseliger 10y ago

That's not the argument of Quinones's book Dreamland: http://seliger.com/2016/10/04/review-dreamland-true-tale-americas-opiate-epidemic-must-read-grant-writers http://seliger.com/2016/10/04/review-dreamland-true-tale-ame..., and Dreamland, like most other books and articles I've seen, argues that availability and over-prescribing have been major contributors to the crisis.

oxide 10y ago
If you can believe it, both are true. It sounds like a contradiction, but it isn't as cut and dry as our brains might like it to be, or like a writer might like it to be. They are both over and under-prescribed. Pain is both over and undertreated every day in every state in the country. There are pill mills, there are stingy ER's and clinics, it goes both ways. It isn't one or the other. On one hand, you have doctor shopping. On the other, you have legitimate chronic pain sufferers turning to the street to make ends meet. My grandparents bought pills from the black market at black market prices to fill the gap of under treatment. At the same time, people were paying cash-only pain management clinics for prescriptions which they were filling multiple times. There will always be abusers, lawmakers and activists need to realize that you can't regulate or price someone out of an addiction (or a dependency.) There is a staggering difference between addiction (which usually involves abuse) and dependency (which usually involves no abuse) Addiction to prescription opiates leads to one of two roads. The problem road is heroin. For example: Let's say you get addicted because you abuse the pills prescribed to you after surgery. You continue to maintain your addiction with drugs purchased from the street, then at some point you remember that heroin exists and is dirt cheap compared to the dollar per milligram you were paying for oxycodone. Suddenly, heroin doesn't seem so evil. Now you have a new perspective about heroin, mainly that it's cheaper and more potent than prescription pills. Dependency, meanwhile, can be maintained under a doctors supervision for years. Pain can be managed with prescription opiates safely and effectively, increasing the quality of life of someone who suffers from pain every single day. It's a multi-faceted issue with many variables, you can't really reduce it down to one sentence or another. There is no easy solution, either. You can't under-prescribe or prosecute doctors, that just hurts the people suffering the most. I know what the solution isn't, though: banning fucking kratom. this entire thing is a complete and total structure fire, and the DEA is trying to immediately move to Schedule I a powdered leaf that stops withdrawals for addicts. For the opiate naive, taking powdered kratom leaf results in a light buzz. For an opiate addict, it's no buzz + immediate relief of withdrawal symptoms. There is always methadone and suboxone, but these drugs are extremely long-acting. Meaning that if and when you come off of them, you will be in withdrawals for weeks or even months. For comparison, short-acting opiates like heroin withdrawals last about a week, maybe two. Now that you know this, it might not surprise you to hear that methadone patients often switch back to shorter-acting drugs like heroin to attempt to get clean. Ironic, isn't it?
zkms 10y ago
Except people only started dying when crackdowns intensified on legal, pharmaceutical, sources and prescribers of opioids. Crackdowns on "pill mills" and "overprescribing doctors" is what denies people a safe and legal source of pharmaceutical-grade opioids and forces them onto the black market of illegal, overpriced, and fentanyl-contaminated opioids. Also crackdowns on "over-prescribing" invariably lead to people who experience chronic pain being denied medical access (or being subjected to extremely invasive and degrading treatment to weed out "drug seekers"). The DEA cracking skulls over opioids and investigating doctors is literally the only reason illicit fentanyl even is a thing. I am so very doubtful that skull-cracking and door-kicking will miraculously work after decades of it not working. Do you want even nastier and even more potent (per unit volume) opioids than fentanyl? Because more prohibition (and yes, investigating and prosecuting doctors is absolutely a component of opioid prohibition) is just gonna give that result.
- deleted 10y ago
  [deleted]
- deelowe 10y ago
  It saddens me greatly to know that the majority of people in this world would rather let people die from overdose than allow them to get high... Is it really such a big deal? So they like doing drugs. In the grand scheme of things, isn't the more humane thing to do just allowing them to use while pursuing more humane options for getting them off drugs (rehab and education)?
- Spooky23 10y ago
  That's one take. I've also heard that marijuana decriminalization is taking the margin out of many drug operations. Supposedly, Weed is like the ground beef of drug sales.
- mc32 10y ago
  Looks like prescription medicine is rife with opportunity for some kind of ML analysis to find abuse and be more "just" (make better decisions) about restricting distribution and use.
- 10y ago
code_duck 10y ago
The unfortunate thing is this system also denies drugs to people who really need them, while abusers can still get them legally and illegally. Recently I had to go to the ER for a painful cyst. Online sources indicate patients often receive opiates for the related pain, which was significant. They not only gave me nothing for pain while there or after, but also seemed more interested in screening me out as a drug seeker than helping me.

rubyn00bie 10y ago

I've known quite a few heroin addicts who got started because of a prescription for relatively mild but on-going pain. At some point the pain was gone, but the desire/addiction was not... Perhaps I'm just weighing my anecdotal knowledge too highly. I'm not saying opioids are always inappropriate but I think a lot of situations could do without them if marijuana was available as an alternative.

md224 10y ago
Something to consider: perhaps these people became addicted when they discovered that opiates provided relief from underlying depression... I have a feeling this may be one reason why some get addicted and others don't. (Believe it or not, some people even dislike taking opiates!) disclaimer: I am kind of obsessed with the self-medication theory of addiction
Spooky23 10y ago
When I was suffering from bad back pain, the amount opiates that was being written for me was ridiculous. I refused to take it, the side affects, even in the short term were awful.

awalton 10y ago

> The opioid crisis is a product of, ironically, crackdowns on opioid abuse. This does not mesh with reality in states like West Virginia, where drug companies sent 9 million pills in two years to a town with less than 400 people - 780 million pills in six years to a state with 1.8 million people. As the "crackdown" revved up in these states, more people have died as they've turned to replace their prescription habit with heroin, and street heroin is increasingly being laced with fentanyl analogs which cause nearly instant overdoses. Not pinning this on the drug companies or doctors that are handing out these drugs like candy to anyone willing to write a check is putting the blame way downstream of where it belongs. The DEA sure can crackdown on marijuana and molly but Rx drug abuse? Move along, citizen. Nothing to see here.

BatFastard 10y ago
Follow the money!

mtdewcmu 10y ago

The crackdown on OxyContin certainly seems to have made things worse. The OxyContin users were driven to switch to black market heroin. Black market heroin is much more dangerous than OxyContin.

oxide 10y ago
Oxycontin was suddenly a dollar per milligram when that happened. It seems obvious in hindsight what the result would be. That's 80 dollars for one 80 milligram pill, which is about 6 hours worth of a high for someone crushing and snorting it. Less time well per dollar spent if they're smoking or injecting them, more if it's being taken orally. Also, keep in mind that Oxycontin was reformulated to be resistant to crushing, meaning that suddenly a lot of addicts were up shit creek without a paddle when they couldn't snort/smoke/inject or even chew the pill they just bought. Heroin, on the other hand, is much cheaper, more potent, and more widely available than Oxycontin could ever hope to be. When you're that deep in the hole of addiction, you start thinking of heroin not as evil, but as a cheap, potent substitute for the prescription pills you've been throwing money away on. It's a fucked up path that too many have walked.

deleted 10y ago

[deleted]

MrFantastic 10y ago

Medicare Part D played a huge role in the opiod epidemic. Patients were given $3 bottles of Oxy with a street value of $10k in areas targeted by the drug companies because of high unemployment. http://www.econtalk.org/archives/2017/01/sam_quinones_on.html http://www.econtalk.org/archives/2017/01/sam_quinones_on.htm... Capitalism cuts both ways.

karmelapple 10y ago

The book Chasing the Scream is a great summary of how crackdowns on opioid abuse, and other drugs, have led to the problems we have today. I've mentioned it other times on HN, and it's still a well-written primer to why we should legalize many, and perhaps all, drugs. [1] http://chasingthescream.com http://chasingthescream.com

ridgeguy 10y ago
Came here also to recommend Chasing the Scream. It was an enlightening read for me.