35 ms·

America’s opioid epidemic is worsening

238 points by octoploid 10y ago

deleted 10y ago
[deleted]
creaghpatr 10y ago
If you're looking for a go-to book on America's opioid crisis- Dreamland by Sam Quinones. http://www.goodreads.com/book/show/22529381-dreamland http://www.goodreads.com/book/show/22529381-dreamland The devil is absolutely in the details and it seems like it's gonna get a lot worse before it gets better.
- rrdharan 10y ago
  Haven't read the book yet but Sam Quinones was on EconTalk recently and it was pretty enlightening: http://www.econtalk.org/archives/2017/01/sam_quinones_on.html http://www.econtalk.org/archives/2017/01/sam_quinones_on.htm...
- BurningFrog 10y ago
  Yup. Not only is it very informative about the 4-6 separate trends that resulted in this slow disaster. It also really well written.
savanaly 10y ago
Given that this article only touches on the supply of these drugs, is there a tacit assumption that the demand for opioids is driven by unemployment? If so, what can be done about the demand for these drugs in the long term? "Bringing back jobs" to those people whose comparative advantage is no longer manufacturing by taxing robots or imposing tariffs is a temporary stall, and to the degree it does work it amounts to a fat, inefficient handout. Fighting the "epidemic" at the supply level seems like a losing battle, as it is for the hard drugs that plague inner cities. Addressing it at the demand level has to be the answer, but I don't see any possible answers floated.
- rrdharan 10y ago
  [Apologize for the back-to-back EconTalk plugs, but I really enjoy the show!] This EconTalk episode on Narconomics goes into a great deal of detail regarding exactly how structurally broken the supply-side attacks are; I found it quite fascinating! http://www.econtalk.org/archives/2017/02/tom_wainwright.html http://www.econtalk.org/archives/2017/02/tom_wainwright.html
- mmanfrin 10y ago
  Decriminalization and an expansion of social programs to help addiction recovery. It's hard for people to get help when they fear legal troubles. Unfortunately neither of these will happen in the next 4 years; and likely the opposite will happen, so we're in for a worsening.
  - DougN7 10y ago
    This doesn't help the root cause of people starting to use them in the first place. It's helpful to some though.
    - mmanfrin 10y ago
      The root cause was the never-allow-pain mantra of the 90s when it came to proscribing painkillers like Oxy; this was followed years later by a later tightening of prescription policy that led many to look to Heroin as an alternative.
      - oxide 10y ago
        The resulting crackdown did exactly what you said, drove people straight into the open arms of heroin. Tightening the already tightened restrictions would only worsen the issue. Diversion, etc cannot be stopped and you might just see a sudden uptick in pharmacy truck heists like the one that happened five or so years ago. Corrupt pharmacists unable to resist the temptation of easy money, etc. Or worse, heroin continues to spread like wildfire. Heroin has no QC, it's being cut with fentanyl across the country and addicts are dropping like flies. Sicker addicts have been seeking out these OD stories and score from those areas looking for the fentanyl cut H. It's bad and only getting worse, as if the government overcorrected its steering and has now spun out of control. The result is going to be a grisly accident.
DoodleBuggy 10y ago
Hard to believe there is really an "epidemic" beyond typical fearmongering and political noise. People have always used drugs, this is nothing new. Unfortunately all the hype and noise is having significantly negative consequences to the medical community, doctors, and patients who actually need these things.
- devopsproject 10y ago
  Here are some alternative facts. Red means bad: https://www.brighthearthealth.com/wp-content/uploads/OpioidAbuseRipplesAcrossAmerica.png https://www.brighthearthealth.com/wp-content/uploads/OpioidA...
  - johan_larson 10y ago
    Wonder why the northern great plains are so resistant to this problem?
    - devopsproject 10y ago
      population density? Maybe the pill mills only located in certain areas.
      - deleted 10y ago
        [deleted]
    - sparrish 10y ago
      I'm from those plains and my guess is folks there refuse such drugs, even when they may need them (like after surgery), because: 1. They're tough people. A little pain means you're still alive! 2. They don't want to get hooked - too many people/animals rely on them. 3. Social stigma associated with such drugs. I had foot surgery a couple of years ago and the Dr. tried to prescribe me opioids but I refused. I've seen the damage getting hooked on those can cause (in Dallas) and don't want that junk anywhere near my life.
    - codecamper 10y ago
redsummer 10y ago
This guy Sackler (and his family) have helped kill 100,000 people a year, by pushing Oxycontin onto vulnerable communities. You will never see anything about it in the news. https://en.wikipedia.org/wiki/Raymond_Sackler https://en.wikipedia.org/wiki/Raymond_Sackler http://www.castlemedical.com/blog/full/On-Average-How-Many-People-Die-From-Oxycontin-Abuse.html http://www.castlemedical.com/blog/full/On-Average-How-Many-P... They've managed to worm themselves into the establishment by using their vast murderous wealth to buy into various museums and galleries: http://www.asia.si.edu http://www.asia.si.edu https://www.royalacademy.org.uk/articles/tag/serpentine-sackler-gallery https://www.royalacademy.org.uk/articles/tag/serpentine-sack... https://designmuseum.org/learning-and-research/design-museum-rd/sackler-library-and-archive https://designmuseum.org/learning-and-research/design-museum... http://www.sackler.org/arts http://www.sackler.org/arts (and many others) No surprises that they were heavy Clinton donors.
pnathan 10y ago
So what is the answer here? Like another poster said, there's a demand problem. How do we as a society address this? I've seen a lot of mumbles about dealing with supply problems, dealing with overdose problems, but it'd be good to head the problems off at the pass before they descend into major trouble. I should also note, this is a burgeoning problem in the Puget Sound/Seattle region. It's not just rural people dying. Can someone knowledgeable about drug policy / sociology provide some insight in this thread?
- DougN7 10y ago
  Preventing that first time is probably the secret. It's got to be so much harder to resist once you know what you're missing. And it's not like you're rational about it and considering long term consequences when you're confronted with a second opportunity. Unfortunately, we live in a society where it's all good, live free, don't judge, do what feels good, etc. That leads to things that feel extremely good... I'm grateful to parents, teachers and some scary videos in high school health class that taught me to stay away.
  - tbrownaw 10y ago
    I remember reading somewhere about how a decent chunk of drug users just plain grow out of it as they grow into life roles that it doesn't quite work for. Nothing to do with theoretical long term consequences, just "this is more trouble than it's worth".
    - pnathan 10y ago
      I'd concur.... anecdotes from reading Reddit suggest that's true for a number of pot or hallucinogen users. They move on to more fulfilling roles in life.
      - wutbrodo 10y ago
        Well sure, for the safest, least-addictive drugs around. For more dangerous drugs like alcohol or the ones discussed in this thread, "growing out of" an abuse habit is orders of magnitude more difficult.
padobson 10y ago
I live in Trumbull County in Ohio, the dark red county in North East Ohio. We recently had 23 (non-fatal) overdoses in a two-day period[0]. That's roughly .01% of the county's total population - so yeah, it's getting bad here. There were recently two shootings within a mile of my house. Several people dead. Both shootings were drug related. I can't help but look around and believe that the needs these folks are trying to satisfy are completely human, and that forcing the users to resort to black markets leads to violence and overdoses. I can't help but think this problem in my community could be solved by simply letting people get high. Maybe the answer isn't to make heroin available OTC at Walgreens, but supervised injection sites seem to be gaining traction[1]. I think a lot of the dark red spots on the map, like mine, should probably consider this option. It's not like anything else is working. [0]http://www.tribtoday.com/news/latest-news/2017/03/fri-920-pm-23-overdoses-recorded-in-48-hours-in-trumbull/ http://www.tribtoday.com/news/latest-news/2017/03/fri-920-pm... [1]http://www.seattletimes.com/seattle-news/health/safe-injection-sites-get-ok-from-king-county-health-board/ http://www.seattletimes.com/seattle-news/health/safe-injecti...
- the-dude 10y ago
  In The Netherlands, supervised injection sites exist for ~30 years now. Also, The Netherlands provide methadone. It seems to have worked / be working. Our heroine epidemic is far behind us, the addicts are dying out.
  - cryptarch 10y ago
    The Netherlands also have a few legal highs: weed, kratom and psilocybin.
    - dep_b 10y ago
      They're not legal in The Netherlands. Magic mushrooms have been banned a while ago (but at the same truffles still are not, clueless), weed was never legal. Also all production is illegal. Coffeeshops don't pay taxes. They're just.....there? We used to think it was the crazy US forcing the Dutch to have such a bipolar approach to drugs but pot is more legal in Colorado now than in Holland and still the Dutch laws are a mess.
rwmj 10y ago
In the UK it appears that there's a Spice epidemic. It's often called "synthetic cannabis" or "(formerly) legal highs", but it in reality it's all kinds of research chemicals sprayed onto leaves to be smoked. It has some pretty hideous side effects, and seems very addictive (https://video.vice.com/en_uk/video/the-hard-lives-of-britains-synthetic-marijuana-addicts/55ccad2d2b68305332db7128 https://video.vice.com/en_uk/video/the-hard-lives-of-britain...) Oh, and the government just handed the whole market over to illegal drug dealers, with fairly predictable results.
- rm_-rf_slash 10y ago
  Spice is in some ways worse, as many U.K. prisons are reporting troubles with contraband use getting prisoners and guards alike high with secondhand smoke.
- DanBC 10y ago
  The spice epidemic is mostly prison related though. Prisons should stop testing for cannabis; and should consider prescribing cannabis of known strengths (and higher CBD rather than THC content). (Also, they need to start providing a lot more mental health support and meaningful activity).
  - rwmj 10y ago
    I don't have figures so this is pure anecdote, but I was wandering around Watford last weekend and seeing people who looked like they were in the VICE documentary I linked to above. But yes, you're of course right that our whole approach is wrong.
  - alva 10y ago
    In some ways I find the drug policy hilarious. If you cannot stop drugs being used in what arguably should be the most secure, closed system, how on earth do governments expect to stop in outside? I would love to know how prisons are so incompetent when they literally control all the system's I/O.
  - goatsi 10y ago
    Artificial cannabinoids are also highly used in homeless populations because of how cheap and powerful they are. https://www.vice.com/en_ca/article/synthetic-weed-is-a-scourge-on-brooklyns-homeless-population-727 https://www.vice.com/en_ca/article/synthetic-weed-is-a-scour...
rodionos 10y ago
I watched this BBC documentary a few days ago: http://www.bbc.com/news/magazine-37992809 http://www.bbc.com/news/magazine-37992809 It seems that new painkillers such as oxycodone have something to do with the surge.
duncan_bayne 10y ago
Ooh, here comes
oxide 10y ago
Maintenance treatments with long-acting opioids like methadone tend to come with a withdrawal that lasts for months. Meanwhile, short-acting opiates like heroin have a withdrawal period that lasts about a week. Is it any wonder methadone patients switch back to heroin when they try to quit for good? Mark my words, this isn't going away or getting any better. You can prosecute doctors, regulate all you want, burn fields of poppies. None of it will affect the demand nor the supply. You can't price or regulate someone out of an addiction. If people get cut off wholesale from their prescriptions because doctors are being prosecuted for prescribing pain medication, they'll turn to heroin. Which will be available, regardless of all the opium seized, regardless of cartels dismantled. Just like when Oxycontin went under a formulation change making it resistant to abuse, which also caused the price to spike to a dollar per milligram. People turned to heroin because it was cheaper, more potent, and much more widely available than pharmaceuticals could ever be. If you think pill junkies are bad, wait until you look down an alley to see a heroin junkie injecting another junkie in the jugular because all her veins are blown out. Watch your step, though, lest you get a syringe in your foot.
- ZanyProgrammer 10y ago
  I've had friends get fucked up by head shop and online Kratom. It's very far from benign.
  - oxide 10y ago
    I've gone ahead and edited my comment, not because of your comment, but just because I felt like I wasn't making a clear point. Kratom is not even mentioned anymore, sorry. While kratom is habit forming and can "fuck you up" if you have no tolerance, the true value is for the person already addicted to opiates looking to get clean. If you want to keep drugs out of the hands of kids, make them all legal and watch the usage numbers fall. Banning a powdered leaf, that is quite self-regulating, albeit habit-forming, is a step backwards in the quest to put out the structure fire that the opiate crises has become.
    - DanBC 10y ago
duncan_bayne 10y ago
I _wondered_ what the political & law enforcement community was going to do, with the clear failure of the War on Drugs and growing demands for legal marijuana. Never fear! Here's the latest Demon Drug, which we can use to whip up popular support for another round of failed prohibition-mentality policies. No need to worry about budget cuts, reduction in the availability of military weapons, drones, etc. to law enforcement. There will still be a viable career in persecuting some of the most vulnerable members of society. Those in favour of harm minimisation need to fight for legalisation, or at the very least decriminalisation as a strating point. Not just for _their_ favourite drug, but for those causing the most harm right now.
dcroley 10y ago
There is something obviously wrong or at least strange with the data that backs that map. Look at the contrast across the border between Tennessee and Georgia or between West Virginia and Virginia. I think some states must be under-reporting things or reporting them differently. I would expect such a map to track poverty maps or unemployment maps, but it does not.
- kolbe 10y ago
  Correct. States have a great deal of variance when it comes to tracking overdose deaths.
6stringmerc 10y ago
The first time I saw a TV commercial here in the US for a pill to battle opiod induced constipation, I realized just how many people are taking large doses of the stuff. Pretty staggering to me.
- cheald 10y ago
  Yeah, those commercials are painful. If you're taking so many opioids that you have trouble pooping, maybe the solution is to take fewer opioids rather than adding another medication to the mix. Really damning commentary on how easily and flippantly we overmedicate.
  - GordonS 10y ago
    Even a low dose of less potent opioids such as codeine or dihydrocodeine can cause constipation
    - cheald 10y ago
      So get some extra fiber and pop a Colace if it's really bad. Adding another prescription medication seems like a pound worth of solution for an ounce's worth of problem.
  - rabboRubble 10y ago
    My Dad was prescribed tramadol for arthritis pain. Apparently tramadol is the entry level opioid. He reported to me zero relief from the pain and "poop like bricks". He doesn't want to take any more. I've encouraged both parents to try legal marijuana products in their state before experimenting more with anything opioid related.
ucaetano 10y ago
And a potential solution to it: https://arstechnica.com/science/2017/03/tweaking-fentanyls-chemical-structure-may-create-safer-opioid/ https://arstechnica.com/science/2017/03/tweaking-fentanyls-c... For their chemical makeover, the researchers noted that when tissue is damaged and hurting, it becomes inflamed and more acidic. The pH drops from approximately 7.4—what’s seen in normal, healthy tissue—to between 5 and 7. Fentanyl can work regardless of the pH, so it’s active throughout the nervous system no matter what. But, if it was altered to only work at the lower pH, then it could target just the pain source at the peripheral nerves, the researchers hypothesized. And with no activity in the central nervous system, it would dodge opioid’s serious side-effects, including addiction and systemic responses that can be lethal during overdoses. They're testing a modified version of fentanyl that only works in lower pH, restricting its activity to injured areas of the body, eliminating the risk of overdose and dependence: In further experiments, the researchers noted that, unlike fentanyl, high doses of NFEPP weren’t lethal to the rats. And rats on the NFEPP didn’t display impaired motor activity or reward-seeking behavior linked to addiction.
- M_Grey 10y ago
  That's great, and there are other painkillers on the horizon too, but that's "maybe" and "later". Today we could take concrete steps to alleviate this crisis which we created in the first place. Cannabis is a good choice for people addicted to opiates, along with medical detox. You also have to manage underlying mental health, social, and medical issues. No amount of throwing new molecules at these problems will solve them.
  - ucaetano 10y ago
    Agreed, and cannabis is a good choice not only for the addicted, but to those suffering chronic pain what would eventually use opioids.
- refurb 10y ago
  But, if it was altered to only work at the lower pH, then it could target just the pain source at the peripheral nerves, the researchers hypothesized. It's been a while since I took a pharmacology class, but opioids work centrally - that is, the pain relief is due to their action in the brain. That's why an opioid like loperamide (can't cross the CNS barrier) doesn't have an analgesic effect, only constipating. If fentanyl only worked peripherally, it wouldn't have a painkilling effect.
partycoder 10y ago
John Oliver spoke about this in depth: https://www.youtube.com/watch?v=5pdPrQFjo2o https://www.youtube.com/watch?v=5pdPrQFjo2o Humor aside, he managed to compile an impressive amount of testimonials and facts.
troisx 10y ago
I know the United States will never do it, but Singapore barely has a drug problem because they execute dealers and have mandatory treatment for users. I'm not advocating the ridiculous policy that the Phillipines has, but Singapore doesn't mess around if they find distribution levels of illegal drugs on you. There also needs to be much stricter control of new prescriptions for opioids, which lead to addiction.
- oxide 10y ago
  >There also needs to be much stricter control of new prescriptions for opioids Like the extremely strict controls in place? Like the prosecution of doctors who run pill mills? Like the rescheduling of hydrocodone formulations? In my local ER there is an entire framed info-poster explaining why you aren't getting your meds refilled at the ER, you won't be getting fentanyl, dilaudid or oxycodone prescribed to you no matter what. ED's work with your primary care doctor and relay info to them. States have implemented pharmacy tech that allows them to track prescriptions state-wide. (a former massive problem) Hospitals are already doing this. Pharmacies, already doing this. Doctors are terrified of the laymen telling them they know better in the court of law. Pain is being undertreated now more than ever, which is the flipside to the crackdown you don't seem aware of, which has been happening for years now. There will always be abusers. It's inevitable. The people who really suffer from this kind of over-reach are people like my grandparents who are nearing life's end. People dependent on pain medication for their quality of life. Non-abusers. Maybe quality of life means nothing to you, but to them it's all they have left keeping them going. It's the only reason they can continue to live through the constant pain, the enduring misery old age and lives of very hard work has wrought upon them.
- wklauss 10y ago
  Experts have been questioning Singapore numbers for a while now. They are probably not that low and theres plenty of evidence of drug use in the country: http://www.reuters.com/article/idUSSIN135004 http://www.reuters.com/article/idUSSIN135004 On top of that, how come other countries that have strict drug regulations and intensive prosecution (for example, Thailand) don't show same low rates of consumption?
- rm_-rf_slash 10y ago
glangdale 10y ago
The only thing that is good about this epidemic is that it seems to have moved harm reduction onto the agenda after decades of militarized and/or "lock 'em up and throw away the key" responses. Hopefully the result will be a more rational response for all of America's drug problems regardless of the color of the users.
- rm_-rf_slash 10y ago
  Are you kidding? The attorney general of the United States is on record saying the one thing that kept him from joining the KKK was their marijuana use, stating that "decent people don't smoke marijuana." Public opinion may have shifted, but as far as the current White House is concerned, it's their way or the highway.
  - soundwave106 10y ago
    For the record I've noticed the tone of reporting these days is a little different as well, personally. It is harder for people to demonize prescription drug abuse; you don't get quite as much of the broad stereotyping and Hollywood-ization that happened in the 1980s on this subject. Yes, some people cling to old-fashioned hardened attitudes. But if you look at Gallup's poll on drugs (http://www.gallup.com/poll/1657/illegal-drugs.aspx http://www.gallup.com/poll/1657/illegal-drugs.aspx), people are way more worried about prescription drugs and the related heroin epidemic these days. Way more than cocaine, certainly. It's not in the poll, but it's hard to remember when the last time the boogeyman of the 1980s (crack cocaine) came up in reports. Support for marijuana legalization stands at 60% now, compared to the 1980s where support was at 25%. There is a large age gap in support, in marijuana at least (http://www.gallup.com/poll/196550/support-legal-marijuana.aspx http://www.gallup.com/poll/196550/support-legal-marijuana.as... -- 55+ 45% support, 18-34 77% support). Although I'm sure harder stances will linger onward, as it has in the AG's mind, the AG's stance is increasingly looking out of touch.
- Clubber 10y ago
  Where do you see any evidence of that?
tlow 10y ago
So the Federal Government should Legalize Cannabis and allow research into it's painkiller effects?
tim333 10y ago
A potential solution: >Legal Heroin Prescriptions: The ‘British System’ You Never Knew Existed Basically prescribe heroin for the addicts so they don't need to deal / steal and the thing dies out. You could link getting the prescription to doing something useful work wise if you want to be moralistic. Been done since the 1920s - tried and tested. http://www.huffingtonpost.co.uk/entry/heroin-prescription-diamorphine_uk_57fd2f6ee4b0430f66f67894 http://www.huffingtonpost.co.uk/entry/heroin-prescription-di...
- everybodyknows 10y ago
  How does the "British system" work out long-term, for the addicts as individuals -- resistance accumulation, vein damage, constipation? Do any live on to old age? Or does it "work" for the rest of society because they die peacefully, at home?
  - tim333 10y ago
    I'm not sure but I believe prescribed heroin has limited side effects and is fairly safe and many come off it eventually and live to an old age. I've not seen the data though.
  - alex_hitchins 10y ago
    There is an issue that people get 'parked' on methadone and never fully come off it. However, some people I know are now in their 70's and still managing their addiction via Methadone prescribed by a GP. They have been on this treatment since the late 80's. They would not be alive and working, paying their taxes if this wasn't about.
Clubber 10y ago
>States have since cracked down on prescription opioid abuse, creating drug-monitoring programmes and arresting unscrupulous doctors. So if you look at the chart, when they started doing this, heroin overdoses skyrocketed while pill overdoses stayed about the same. They doubled the deaths with their crackdown solution, as if that has ever worked.
ocschwar 10y ago
I'm going to comment here with a plug for the March For Science, on April 22. Why? Because the opioid epidemic started with a simple matter of scientists not being allowed to science. Purdue Pharmaceuticals marketed oxycontin as a drug that lasts for 12 hours. The evidence indicated it only lasted for 8. If Purdue's scientists were allowed to act on the evidence, i.e. to be actual scientists, the whole world would have known this years ago. People prescribed oxycontin would have been told to plan for 8 hours of relief, not 12. Instead, hundreds of thousands of patients were subjected to 4 hours of pain a day, and they sought relief with other drugs, including illegal ones. And the epidemic began. Science is important, yo.
- devopsproject 10y ago
  You forgot the best part: It made Purdue rich. Instead of changing the frequency of doses, they told doctors to up the strength which made the company more money. The owners of Purdue are billionaires now: http://www.latimes.com/projects/oxycontin-part1/ http://www.latimes.com/projects/oxycontin-part1/
- MaxfordAndSons 10y ago
  I totally agree with the spirit of your argument, but I think you're somewhat overstating the significance of the marketing/data mismatch here. You can't simply point to that and say "thus the epidemic began". There's a whole nexus of contributing factors at play: overprescription, socio-economic malaise, the ready availability of black market opioids, etc.
- 55555 10y ago
  > Instead, hundreds of thousands of patients were subjected to 4 hours of pain a day, and they sought relief with other drugs, including illegal ones. And the epidemic began. No, I believe the purpose of this scheme was to let the drug wear off before the next dose, in order to reinforce the withdrawal/pain->relief cycle. Oxycodone users typically didn't seek out illegal drugs (heroin) until several years after starting prescription usage.
jstewartmobile 10y ago
I'm on the gulf coast, and we just had a high-profile prosecution of a doctor running a pill mill. What if this whole mess isn't so much a technical problem to be solved as much as it is our system functioning under its own perverse incentives? Other countries don't have this problem. In my own area of expertise, I have seen so many non-solutions force-fed to the customer when an actual solution is not as profitable. It is not hard to believe that medicine operates similarly.
- draw_down 10y ago
  > What if this whole mess isn't so much a technical problem to be solved as much as it is our system functioning under its own perverse incentives? Indeed! What if!
- knz 10y ago
  > What if this whole mess isn't so much a technical problem to be solved as much as it is our system functioning under its own perverse incentives? Other countries don't have this problem. That description could easily be applied to many aspects of the US healthcare system - an epidemic is a failing of public health.
  - deleted 10y ago
    [deleted]
chx 10y ago
Check https://morecrows.wordpress.com/2016/05/10/unnecessariat/ https://morecrows.wordpress.com/2016/05/10/unnecessariat/ for some deep reasons and for a feel how bad it is. Don't blame this or that pharma for it, that's a distraction.
karmelapple 10y ago
Read Chasing the Scream [1], a fantastic book that documents drug prohibition in the USA, how doctors who viewed it as a health issue got chased out of their desire to help, and suggests many paths to helping people and making the world a better, safer place. I've posted this in enough threads that I probably seem like a bot advertising for it, but seriously, it's a book worth reading and that can change someone's entire opinion on the drug epidemic and what legislation we should pass. [1] http://chasingthescream.com/ http://chasingthescream.com/
lr4444lr 10y ago
I say this mostly tongue-in-cheek because I hate to apply one bad policy to fix another, but I bet if narcotic overprescription could more readily trigger medical malpractice, you'd see doctors thinking more judiciously about their use. Even if exaggerated by an order of magnitude, stats like this are just indefensible: http://www.webmd.com/mental-health/addiction/news/20160325/nearly-all-us-doctors-overprescribe-addictive-narcotic-painkillers-survey#1 http://www.webmd.com/mental-health/addiction/news/20160325/n...
- cmdrfred 10y ago
  What's funny is there is no evidence that these opioid pain killers are actually effective in the long term for the management of pain. If it wasn't for lobbying they likely wouldn't be legal to use in that way.
  - tylersmith 10y ago
    I've been taking opioids for nearly a year and they still work fine. Not sure how long-term you mean.
    - cmdrfred 10y ago
      Stop taking them for a few days and you'll see what I mean. Many studies have shown that patients who do not consume opioid medications have better long term outcomes than those who do. It simply isn't effective in managing pain long term, and also is not indicated for use in that manner.
      - tylersmith 10y ago
        When I stop taking them I'm in pain again. I think what you're trying to get at is the opioids don't solve the underlying problem. But to say they're not effective for managing pain is wrong. I use them to manage pain every day. I get regular steroidal-epidural injections to solve the issue.
sanguy 10y ago
Methadone clinics work; Zurich is a good example. Hard to manage; hard on the community; but it eventually kills off the problem.
kilroy123 10y ago
My sister is a heroin addict. To say this has devastated her life is an understatement. Her body is wrecked. She looks way older than she is, she has a pacemaker / defibrillator installed in her chest. And doctors keep saying she will die soon if she doesn't stop. Here is the most frustrating part. She has wanted to go to rehab a few times, but since she is poor and unemployed, she has no health insurance for rehab. What are her options? My parents have no money to help her. I'll never understand the bull-shit US policy towards drugs. Let's spend billions upon billions to "fight" drugs coming into the country, but let's turn a blind eye to the companies pumping out hundreds of millions of pills. Why the hell don't we spend those hundreds of billions on actually treating the disease? If there was no demand, there would be no drug war to fight. Why don't we try a new way?
- jliptzin 10y ago
  Very sorry to hear this story, it must be difficult for your family and for her. Do you know about how much rehab would cost for her?
- maxerickson 10y ago
  Is Medicaid an option?
  - kilroy123 10y ago
    Sadly she only has Medi-Cal. Which only covers care for when she is detoxing. No rehab.
- girvo 10y ago
  I became a heroin addict at 16. I got clean, for free, with my governments help (Queensland, Australia) and opiate replacement therapy, after being an addict for six years. Ive been sober for 5 years this August. If it wasn't for that program, I'd be dead twice over by now, I'm sure of it. I'm sorry about your sister, it's horrible :(
- deleted 10y ago
  [deleted]
- 10y ago
pmoriarty 10y ago
I once read of a 20-year-long study that found that when heroin-addicted UK doctors were given unlimited access to pure heroin they performed slightly better than their non-heroin-addicted colleagues, and they had no negative long-term health consequences. If anyone else has heard of this study, or especially if they have some documentation on it, I would appreciate a link.
shams93 10y ago
The states with medical cannabis don't have anywhere near this problem. They need to cover medical cannabis via medicaid that would seriously put a dent in the crisis or at least keep it from growing bigger.
vogelke 10y ago
One of the best books I've ever read on why the war on drugs is a bad idea. It's written by a UK cop who was there nearly from the beginning. https://www.amazon.com/Good-Cop-Bad-War/dp/1785032690/ Good Cop, Bad War (Paperback) Publisher: Ebury Press Language: English ISBN-10: 1785032690 ISBN-13: 978-1785032691
droopybuns 10y ago
These stories are so frightening to me that I contemplate just enduring the suffering if I am ever unfortunate enough to be prescribed oxy or dilaudid.
hackuser 10y ago
Is a war on drugs a good response? Hyper-aggressive policing? Lock up even minor participants for decades? Consider why people thought that was a good response when drugs struck other communities.
- wutbrodo 10y ago
  This is hardly news: the same dynamic played out in a different chronological order between alcohol and marijuana prohibition. Alcohol was so ubiquitous that Prohibition turned all of society (including "decent" people) into criminals, so the response was that it's clearly an unworkable solution; we can't lock up _everybody_. It's only simplifying a bit to say that marijuana shared much the same ubiquity in certain _other_ communities, so the response was.....let's just lock up everybody.
am185 10y ago
US may need to follow Philippines anti-drug campaign.
- lawless123 10y ago
  Suppose people can't overdose if they've already been murdered...
parr0t 10y ago
I'll never understand locking people up for having an addiction and treating them like criminals. I'm not too educated on how it's handled in America but in Australia you can go to your doctors and get signed up to a methadone program without worrying about any legal repercussions. My fiancé works at a pharmacy in Melbourne, Australia and says some of the most lovely and friendly people who just want to get themselves together come in regularly to get their $5 dose and it's saddening to see how badly society judges them.
- wutbrodo 10y ago
  I believe you can do the same here, but the (huge, purpose-defeating) difference is that you need to be able to afford the rehab in a country that isn't so keen on providing a safety net (somewhere upthread someone mentions his sister ruining her life with heroin, wanting to go to rehab, but unable to afford the cost, which is uncovered by Medi-Cal).
yuhong 10y ago
https://www.reddit.com/r/politics/comments/5v43rj/how_mike_pence_used_obamacare_to_halt_indianas/ddzapo8/?st=izgcbq4v&sh=d07521d3 https://www.reddit.com/r/politics/comments/5v43rj/how_mike_p... Also read other comments in the thread about history of needle exchange programs etc.
ransom1538 10y ago
Could weed slow down the opioid epidemic? It gets you high, it is way cheaper, way healthier (not smoked), it isn't addictive, curbs the urge for opioids, easier to make, easier to sell. https://www.theatlantic.com/health/archive/2017/02/marijuana-cannabinoids-opioids/515358/ https://www.theatlantic.com/health/archive/2017/02/marijuana...
hackermailman 10y ago
We have ~400 overdoses per month here. ~20% of that is fatal overdoses because those ODs are from users doing it by themselves and not inside one of the shooting galleries we have set up. The safe injection sites work as advertised but for many reasons some addicts don't go there, mainly because debt collecting gangsters and drug dealers hover all around the front doors, and stigma of standing in an addict lineup that spreads for blocks for all to see. There's a few reports here from VANDU a group run by addicts on the effectiveness of peer-run supervised injection sites and needle exchanges, meaning run by other addicts instead of government employees http://www.vandu.org/reports/ http://www.vandu.org/reports/ The problem is synthetic opioid is being used to buff out heroin so street dealers can save money by importing less heroin from India (how it comes into Canada). They keep coming up with new synthetics to bypass precursor prohibition or import laws, plus China has factories pumping this shit out legally which can easily be smuggled since it costs far less than heroin from India/Afghanistan. Whenever you talk to a street addict basically the reason they got on heroin was they had some other substance abuse problem, usually cocaine, alcohol or meth, there was a shortage of that substance because either they couldn't afford it, busts made it scarce, or they were in jail so through peers they accessed heroin instead and got hooked. Methadone doesn't work, they've already abandoned that idea here and moved to just handing out heroin to the worst cases, or hydromorphone which has a proven success rate in weening addicts off drugs. Somewhere in all this is a solution that doesn't involve enabling career bums who want free heroin for life and doesn't involve 400+ ambulance calls per month draining our resources.
moyang0913 10y ago
Speaking from Singapore here. We don't have any drug problem at all. Drug dealers get death penalty. It's illegal to consume, too. You are put in jail. I pity your poor citizens who can only resort to legalization. Addicts are not healthy for the society or for the economy. It's just a matter of very bad (crime) or bad (jobless and getting high at home, disturbing neighbors). Government use tax I paid to supply water, electricity and infrastructure. I don't agree that it's wasted on addicts.
- seattle_spring 10y ago
  You pity us. Oh please.
- zoul 10y ago
  The war on drugs doesn’t work, certainly not in the US: https://en.m.wikipedia.org/wiki/War_on_Drugs https://en.m.wikipedia.org/wiki/War_on_Drugs
- flukus 10y ago
  Speaking from Australia, I find the Singapore solution barbaric and totalitarian, no better than the new Philippines president.
- sonthonax 10y ago
  While Singapore has no issues laundering the dirty money of every scumbag around the world.
- lordnacho 10y ago
  One side effect is that people who are using drugs responsibly are executed when they forget to empty their bags on the way home. A friend of mine from Singapore had this happen to her friend. Being completely draconian is not a solution to anything. We can fine people 100K for parking illegally, and you might get fewer people parking badly, but it will never seem to be reasonable.
cowardlydragon 10y ago
I read that Medicaid is being used to fuel the black market pipeline. $3 copay gets you a $1000 street value opioids... Of course this is corporate welfare for the opioid manufacturers. I also read that one month 11% of Ohio's population was prescribed painkillers.
WhiteSource1 10y ago
What is causing this? IS this prescription drug dependence? Because this wasn't a problem 10 or 20 years ago!
grondilu 10y ago
> The opioid epidemic has its roots in the explosive growth of prescription painkillers. Between 1991 and 2011, the number of opioid prescriptions (selling under brand names like Vicodin, Oxycontin, and Percocet) supplied by American retail pharmacies increased from 76m to 219m. As the number of pain pills being doled out by doctors increased, so did their potency. In 2002 one in six users took a pill more powerful than morphine. By 2012 it was one in three. I find this absolutely outrageous. I'm not American, but I stumble upon articles mentioning this, and I do watch enough American TV series and movies to have an idea of how acute the problem is (it's crazy how often in TV series doctors seem to give pain killers like it's candy). I have the impression that in Europe, painkillers are much less used but I would not be surprised if the American trend were to contaminate medical practice here. Pain is a minor consequence of disease or trauma. Pain won't kill you, so why would you risk become addicted to very dangerous drugs just to relieve it?
- pjc50 10y ago
  > Pain is a minor consequence of disease There speaks someone young and healthy. Some conditions are extremely painful in the long term. "It is estimated that more than 100 million people suffer from chronic pain in this country,[11] and for some of them, opioid therapy may be appropriate. The bulk of American patients who need relief from persistent, moderate-to-severe non-cancer pain have back pain conditions (approximately 38 million) or osteoarthritis (approximately 17 million)." Source: https://www.drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2016/americas-addiction-to-opioids-heroin-prescription-drug-abuse https://www.drugabuse.gov/about-nida/legislative-activities/... "aggressive marketing by pharmaceutical companies" "United States their biggest consumer globally, accounting for almost 100 percent of the world total for hydrocodone (e.g., Vicodin) and 81 percent for oxycodone (e.g., Percocet)" That does make it sound like a problem created by pharma drug pushing on TV. But that doesn't mean the pain isn't real either. Really the whole thing needs to be seen as a widespread public and social health problem - which is exactly the sort of thing the US system is set up to avoid seeing. Healthcare is not just a matter of individual responsibility or a contract between someone and their employer.
  - 10y ago
ainiriand 10y ago
You know Trump's solution? Jail for everyone. No wonder why US has 25% of the world's total inmate population... [0]https://www.thoughtco.com/states-spending-money-prisons-not-schools-4068528 https://www.thoughtco.com/states-spending-money-prisons-not-...
Jun8 10y ago
What is causing the variation on the prescription opioid graph do you think? The other two graphs don't have similar patterns to such degree.
malandrew 10y ago
This article I recently submitted had some interesting stats on the relationship between opiates and the welfare state: https://www.commentarymagazine.com/articles/our-miserable-21st-century/ https://www.commentarymagazine.com/articles/our-miserable-21... Although the entire article is worth reading, jump down to the paragraph that begins with "The opioid epidemic..." and read for about ~5 paragraphs if that's all that interests you.

238 points by octoploid 10y ago

deleted 10y ago

[deleted]

If you're looking for a go-to book on America's opioid crisis- Dreamland by Sam Quinones. http://www.goodreads.com/book/show/22529381-dreamland http://www.goodreads.com/book/show/22529381-dreamland The devil is absolutely in the details and it seems like it's gonna get a lot worse before it gets better.

rrdharan 10y ago
Haven't read the book yet but Sam Quinones was on EconTalk recently and it was pretty enlightening: http://www.econtalk.org/archives/2017/01/sam_quinones_on.html http://www.econtalk.org/archives/2017/01/sam_quinones_on.htm...
BurningFrog 10y ago
Yup. Not only is it very informative about the 4-6 separate trends that resulted in this slow disaster. It also really well written.

savanaly 10y ago

Given that this article only touches on the supply of these drugs, is there a tacit assumption that the demand for opioids is driven by unemployment? If so, what can be done about the demand for these drugs in the long term? "Bringing back jobs" to those people whose comparative advantage is no longer manufacturing by taxing robots or imposing tariffs is a temporary stall, and to the degree it does work it amounts to a fat, inefficient handout. Fighting the "epidemic" at the supply level seems like a losing battle, as it is for the hard drugs that plague inner cities. Addressing it at the demand level has to be the answer, but I don't see any possible answers floated.

rrdharan 10y ago
[Apologize for the back-to-back EconTalk plugs, but I really enjoy the show!] This EconTalk episode on Narconomics goes into a great deal of detail regarding exactly how structurally broken the supply-side attacks are; I found it quite fascinating! http://www.econtalk.org/archives/2017/02/tom_wainwright.html http://www.econtalk.org/archives/2017/02/tom_wainwright.html
mmanfrin 10y ago
Decriminalization and an expansion of social programs to help addiction recovery. It's hard for people to get help when they fear legal troubles. Unfortunately neither of these will happen in the next 4 years; and likely the opposite will happen, so we're in for a worsening.
- DougN7 10y ago
  This doesn't help the root cause of people starting to use them in the first place. It's helpful to some though.
  - mmanfrin 10y ago
    The root cause was the never-allow-pain mantra of the 90s when it came to proscribing painkillers like Oxy; this was followed years later by a later tightening of prescription policy that led many to look to Heroin as an alternative.
    - oxide 10y ago
      The resulting crackdown did exactly what you said, drove people straight into the open arms of heroin. Tightening the already tightened restrictions would only worsen the issue. Diversion, etc cannot be stopped and you might just see a sudden uptick in pharmacy truck heists like the one that happened five or so years ago. Corrupt pharmacists unable to resist the temptation of easy money, etc. Or worse, heroin continues to spread like wildfire. Heroin has no QC, it's being cut with fentanyl across the country and addicts are dropping like flies. Sicker addicts have been seeking out these OD stories and score from those areas looking for the fentanyl cut H. It's bad and only getting worse, as if the government overcorrected its steering and has now spun out of control. The result is going to be a grisly accident.

DoodleBuggy 10y ago

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

devopsproject 10y ago
Here are some alternative facts. Red means bad: https://www.brighthearthealth.com/wp-content/uploads/OpioidAbuseRipplesAcrossAmerica.png https://www.brighthearthealth.com/wp-content/uploads/OpioidA...
- johan_larson 10y ago
  Wonder why the northern great plains are so resistant to this problem?
  - devopsproject 10y ago
    population density? Maybe the pill mills only located in certain areas.
    - deleted 10y ago
      [deleted]
  - sparrish 10y ago
    I'm from those plains and my guess is folks there refuse such drugs, even when they may need them (like after surgery), because: 1. They're tough people. A little pain means you're still alive! 2. They don't want to get hooked - too many people/animals rely on them. 3. Social stigma associated with such drugs. I had foot surgery a couple of years ago and the Dr. tried to prescribe me opioids but I refused. I've seen the damage getting hooked on those can cause (in Dallas) and don't want that junk anywhere near my life.
  - codecamper 10y ago

redsummer 10y ago

This guy Sackler (and his family) have helped kill 100,000 people a year, by pushing Oxycontin onto vulnerable communities. You will never see anything about it in the news. https://en.wikipedia.org/wiki/Raymond_Sackler https://en.wikipedia.org/wiki/Raymond_Sackler http://www.castlemedical.com/blog/full/On-Average-How-Many-People-Die-From-Oxycontin-Abuse.html http://www.castlemedical.com/blog/full/On-Average-How-Many-P... They've managed to worm themselves into the establishment by using their vast murderous wealth to buy into various museums and galleries: http://www.asia.si.edu http://www.asia.si.edu https://www.royalacademy.org.uk/articles/tag/serpentine-sackler-gallery https://www.royalacademy.org.uk/articles/tag/serpentine-sack... https://designmuseum.org/learning-and-research/design-museum-rd/sackler-library-and-archive https://designmuseum.org/learning-and-research/design-museum... http://www.sackler.org/arts http://www.sackler.org/arts (and many others) No surprises that they were heavy Clinton donors.

pnathan 10y ago

So what is the answer here? Like another poster said, there's a demand problem. How do we as a society address this? I've seen a lot of mumbles about dealing with supply problems, dealing with overdose problems, but it'd be good to head the problems off at the pass before they descend into major trouble. I should also note, this is a burgeoning problem in the Puget Sound/Seattle region. It's not just rural people dying. Can someone knowledgeable about drug policy / sociology provide some insight in this thread?

DougN7 10y ago
Preventing that first time is probably the secret. It's got to be so much harder to resist once you know what you're missing. And it's not like you're rational about it and considering long term consequences when you're confronted with a second opportunity. Unfortunately, we live in a society where it's all good, live free, don't judge, do what feels good, etc. That leads to things that feel extremely good... I'm grateful to parents, teachers and some scary videos in high school health class that taught me to stay away.
- tbrownaw 10y ago
  I remember reading somewhere about how a decent chunk of drug users just plain grow out of it as they grow into life roles that it doesn't quite work for. Nothing to do with theoretical long term consequences, just "this is more trouble than it's worth".
  - pnathan 10y ago
    I'd concur.... anecdotes from reading Reddit suggest that's true for a number of pot or hallucinogen users. They move on to more fulfilling roles in life.
    - wutbrodo 10y ago
      Well sure, for the safest, least-addictive drugs around. For more dangerous drugs like alcohol or the ones discussed in this thread, "growing out of" an abuse habit is orders of magnitude more difficult.

padobson 10y ago

I live in Trumbull County in Ohio, the dark red county in North East Ohio. We recently had 23 (non-fatal) overdoses in a two-day period[0]. That's roughly .01% of the county's total population - so yeah, it's getting bad here. There were recently two shootings within a mile of my house. Several people dead. Both shootings were drug related. I can't help but look around and believe that the needs these folks are trying to satisfy are completely human, and that forcing the users to resort to black markets leads to violence and overdoses. I can't help but think this problem in my community could be solved by simply letting people get high. Maybe the answer isn't to make heroin available OTC at Walgreens, but supervised injection sites seem to be gaining traction[1]. I think a lot of the dark red spots on the map, like mine, should probably consider this option. It's not like anything else is working. [0]http://www.tribtoday.com/news/latest-news/2017/03/fri-920-pm-23-overdoses-recorded-in-48-hours-in-trumbull/ http://www.tribtoday.com/news/latest-news/2017/03/fri-920-pm... [1]http://www.seattletimes.com/seattle-news/health/safe-injection-sites-get-ok-from-king-county-health-board/ http://www.seattletimes.com/seattle-news/health/safe-injecti...

the-dude 10y ago
In The Netherlands, supervised injection sites exist for ~30 years now. Also, The Netherlands provide methadone. It seems to have worked / be working. Our heroine epidemic is far behind us, the addicts are dying out.
- cryptarch 10y ago
  The Netherlands also have a few legal highs: weed, kratom and psilocybin.
  - dep_b 10y ago
    They're not legal in The Netherlands. Magic mushrooms have been banned a while ago (but at the same truffles still are not, clueless), weed was never legal. Also all production is illegal. Coffeeshops don't pay taxes. They're just.....there? We used to think it was the crazy US forcing the Dutch to have such a bipolar approach to drugs but pot is more legal in Colorado now than in Holland and still the Dutch laws are a mess.

rwmj 10y ago

In the UK it appears that there's a Spice epidemic. It's often called "synthetic cannabis" or "(formerly) legal highs", but it in reality it's all kinds of research chemicals sprayed onto leaves to be smoked. It has some pretty hideous side effects, and seems very addictive (https://video.vice.com/en_uk/video/the-hard-lives-of-britains-synthetic-marijuana-addicts/55ccad2d2b68305332db7128 https://video.vice.com/en_uk/video/the-hard-lives-of-britain...) Oh, and the government just handed the whole market over to illegal drug dealers, with fairly predictable results.

rm_-rf_slash 10y ago
Spice is in some ways worse, as many U.K. prisons are reporting troubles with contraband use getting prisoners and guards alike high with secondhand smoke.
DanBC 10y ago
The spice epidemic is mostly prison related though. Prisons should stop testing for cannabis; and should consider prescribing cannabis of known strengths (and higher CBD rather than THC content). (Also, they need to start providing a lot more mental health support and meaningful activity).
- rwmj 10y ago
  I don't have figures so this is pure anecdote, but I was wandering around Watford last weekend and seeing people who looked like they were in the VICE documentary I linked to above. But yes, you're of course right that our whole approach is wrong.
- alva 10y ago
  In some ways I find the drug policy hilarious. If you cannot stop drugs being used in what arguably should be the most secure, closed system, how on earth do governments expect to stop in outside? I would love to know how prisons are so incompetent when they literally control all the system's I/O.
- goatsi 10y ago
  Artificial cannabinoids are also highly used in homeless populations because of how cheap and powerful they are. https://www.vice.com/en_ca/article/synthetic-weed-is-a-scourge-on-brooklyns-homeless-population-727 https://www.vice.com/en_ca/article/synthetic-weed-is-a-scour...

rodionos 10y ago

I watched this BBC documentary a few days ago: http://www.bbc.com/news/magazine-37992809 http://www.bbc.com/news/magazine-37992809 It seems that new painkillers such as oxycodone have something to do with the surge.

duncan_bayne 10y ago

Ooh, here comes

oxide 10y ago

Maintenance treatments with long-acting opioids like methadone tend to come with a withdrawal that lasts for months. Meanwhile, short-acting opiates like heroin have a withdrawal period that lasts about a week. Is it any wonder methadone patients switch back to heroin when they try to quit for good? Mark my words, this isn't going away or getting any better. You can prosecute doctors, regulate all you want, burn fields of poppies. None of it will affect the demand nor the supply. You can't price or regulate someone out of an addiction. If people get cut off wholesale from their prescriptions because doctors are being prosecuted for prescribing pain medication, they'll turn to heroin. Which will be available, regardless of all the opium seized, regardless of cartels dismantled. Just like when Oxycontin went under a formulation change making it resistant to abuse, which also caused the price to spike to a dollar per milligram. People turned to heroin because it was cheaper, more potent, and much more widely available than pharmaceuticals could ever be. If you think pill junkies are bad, wait until you look down an alley to see a heroin junkie injecting another junkie in the jugular because all her veins are blown out. Watch your step, though, lest you get a syringe in your foot.

ZanyProgrammer 10y ago
I've had friends get fucked up by head shop and online Kratom. It's very far from benign.
- oxide 10y ago
  I've gone ahead and edited my comment, not because of your comment, but just because I felt like I wasn't making a clear point. Kratom is not even mentioned anymore, sorry. While kratom is habit forming and can "fuck you up" if you have no tolerance, the true value is for the person already addicted to opiates looking to get clean. If you want to keep drugs out of the hands of kids, make them all legal and watch the usage numbers fall. Banning a powdered leaf, that is quite self-regulating, albeit habit-forming, is a step backwards in the quest to put out the structure fire that the opiate crises has become.
  - DanBC 10y ago

duncan_bayne 10y ago

I _wondered_ what the political & law enforcement community was going to do, with the clear failure of the War on Drugs and growing demands for legal marijuana. Never fear! Here's the latest Demon Drug, which we can use to whip up popular support for another round of failed prohibition-mentality policies. No need to worry about budget cuts, reduction in the availability of military weapons, drones, etc. to law enforcement. There will still be a viable career in persecuting some of the most vulnerable members of society. Those in favour of harm minimisation need to fight for legalisation, or at the very least decriminalisation as a strating point. Not just for _their_ favourite drug, but for those causing the most harm right now.

dcroley 10y ago

There is something obviously wrong or at least strange with the data that backs that map. Look at the contrast across the border between Tennessee and Georgia or between West Virginia and Virginia. I think some states must be under-reporting things or reporting them differently. I would expect such a map to track poverty maps or unemployment maps, but it does not.

kolbe 10y ago
Correct. States have a great deal of variance when it comes to tracking overdose deaths.

6stringmerc 10y ago

The first time I saw a TV commercial here in the US for a pill to battle opiod induced constipation, I realized just how many people are taking large doses of the stuff. Pretty staggering to me.

cheald 10y ago
Yeah, those commercials are painful. If you're taking so many opioids that you have trouble pooping, maybe the solution is to take fewer opioids rather than adding another medication to the mix. Really damning commentary on how easily and flippantly we overmedicate.
- GordonS 10y ago
  Even a low dose of less potent opioids such as codeine or dihydrocodeine can cause constipation
  - cheald 10y ago
    So get some extra fiber and pop a Colace if it's really bad. Adding another prescription medication seems like a pound worth of solution for an ounce's worth of problem.
- rabboRubble 10y ago
  My Dad was prescribed tramadol for arthritis pain. Apparently tramadol is the entry level opioid. He reported to me zero relief from the pain and "poop like bricks". He doesn't want to take any more. I've encouraged both parents to try legal marijuana products in their state before experimenting more with anything opioid related.

ucaetano 10y ago

And a potential solution to it: https://arstechnica.com/science/2017/03/tweaking-fentanyls-chemical-structure-may-create-safer-opioid/ https://arstechnica.com/science/2017/03/tweaking-fentanyls-c... For their chemical makeover, the researchers noted that when tissue is damaged and hurting, it becomes inflamed and more acidic. The pH drops from approximately 7.4—what’s seen in normal, healthy tissue—to between 5 and 7. Fentanyl can work regardless of the pH, so it’s active throughout the nervous system no matter what. But, if it was altered to only work at the lower pH, then it could target just the pain source at the peripheral nerves, the researchers hypothesized. And with no activity in the central nervous system, it would dodge opioid’s serious side-effects, including addiction and systemic responses that can be lethal during overdoses. They're testing a modified version of fentanyl that only works in lower pH, restricting its activity to injured areas of the body, eliminating the risk of overdose and dependence: In further experiments, the researchers noted that, unlike fentanyl, high doses of NFEPP weren’t lethal to the rats. And rats on the NFEPP didn’t display impaired motor activity or reward-seeking behavior linked to addiction.

M_Grey 10y ago
That's great, and there are other painkillers on the horizon too, but that's "maybe" and "later". Today we could take concrete steps to alleviate this crisis which we created in the first place. Cannabis is a good choice for people addicted to opiates, along with medical detox. You also have to manage underlying mental health, social, and medical issues. No amount of throwing new molecules at these problems will solve them.
- ucaetano 10y ago
  Agreed, and cannabis is a good choice not only for the addicted, but to those suffering chronic pain what would eventually use opioids.
refurb 10y ago
But, if it was altered to only work at the lower pH, then it could target just the pain source at the peripheral nerves, the researchers hypothesized. It's been a while since I took a pharmacology class, but opioids work centrally - that is, the pain relief is due to their action in the brain. That's why an opioid like loperamide (can't cross the CNS barrier) doesn't have an analgesic effect, only constipating. If fentanyl only worked peripherally, it wouldn't have a painkilling effect.

partycoder 10y ago

John Oliver spoke about this in depth: https://www.youtube.com/watch?v=5pdPrQFjo2o https://www.youtube.com/watch?v=5pdPrQFjo2o Humor aside, he managed to compile an impressive amount of testimonials and facts.

troisx 10y ago

I know the United States will never do it, but Singapore barely has a drug problem because they execute dealers and have mandatory treatment for users. I'm not advocating the ridiculous policy that the Phillipines has, but Singapore doesn't mess around if they find distribution levels of illegal drugs on you. There also needs to be much stricter control of new prescriptions for opioids, which lead to addiction.

oxide 10y ago
>There also needs to be much stricter control of new prescriptions for opioids Like the extremely strict controls in place? Like the prosecution of doctors who run pill mills? Like the rescheduling of hydrocodone formulations? In my local ER there is an entire framed info-poster explaining why you aren't getting your meds refilled at the ER, you won't be getting fentanyl, dilaudid or oxycodone prescribed to you no matter what. ED's work with your primary care doctor and relay info to them. States have implemented pharmacy tech that allows them to track prescriptions state-wide. (a former massive problem) Hospitals are already doing this. Pharmacies, already doing this. Doctors are terrified of the laymen telling them they know better in the court of law. Pain is being undertreated now more than ever, which is the flipside to the crackdown you don't seem aware of, which has been happening for years now. There will always be abusers. It's inevitable. The people who really suffer from this kind of over-reach are people like my grandparents who are nearing life's end. People dependent on pain medication for their quality of life. Non-abusers. Maybe quality of life means nothing to you, but to them it's all they have left keeping them going. It's the only reason they can continue to live through the constant pain, the enduring misery old age and lives of very hard work has wrought upon them.
wklauss 10y ago
Experts have been questioning Singapore numbers for a while now. They are probably not that low and theres plenty of evidence of drug use in the country: http://www.reuters.com/article/idUSSIN135004 http://www.reuters.com/article/idUSSIN135004 On top of that, how come other countries that have strict drug regulations and intensive prosecution (for example, Thailand) don't show same low rates of consumption?
rm_-rf_slash 10y ago

glangdale 10y ago

The only thing that is good about this epidemic is that it seems to have moved harm reduction onto the agenda after decades of militarized and/or "lock 'em up and throw away the key" responses. Hopefully the result will be a more rational response for all of America's drug problems regardless of the color of the users.

rm_-rf_slash 10y ago
Are you kidding? The attorney general of the United States is on record saying the one thing that kept him from joining the KKK was their marijuana use, stating that "decent people don't smoke marijuana." Public opinion may have shifted, but as far as the current White House is concerned, it's their way or the highway.
- soundwave106 10y ago
  For the record I've noticed the tone of reporting these days is a little different as well, personally. It is harder for people to demonize prescription drug abuse; you don't get quite as much of the broad stereotyping and Hollywood-ization that happened in the 1980s on this subject. Yes, some people cling to old-fashioned hardened attitudes. But if you look at Gallup's poll on drugs (http://www.gallup.com/poll/1657/illegal-drugs.aspx http://www.gallup.com/poll/1657/illegal-drugs.aspx), people are way more worried about prescription drugs and the related heroin epidemic these days. Way more than cocaine, certainly. It's not in the poll, but it's hard to remember when the last time the boogeyman of the 1980s (crack cocaine) came up in reports. Support for marijuana legalization stands at 60% now, compared to the 1980s where support was at 25%. There is a large age gap in support, in marijuana at least (http://www.gallup.com/poll/196550/support-legal-marijuana.aspx http://www.gallup.com/poll/196550/support-legal-marijuana.as... -- 55+ 45% support, 18-34 77% support). Although I'm sure harder stances will linger onward, as it has in the AG's mind, the AG's stance is increasingly looking out of touch.
Clubber 10y ago
Where do you see any evidence of that?

tlow 10y ago

So the Federal Government should Legalize Cannabis and allow research into it's painkiller effects?

tim333 10y ago

A potential solution: >Legal Heroin Prescriptions: The ‘British System’ You Never Knew Existed Basically prescribe heroin for the addicts so they don't need to deal / steal and the thing dies out. You could link getting the prescription to doing something useful work wise if you want to be moralistic. Been done since the 1920s - tried and tested. http://www.huffingtonpost.co.uk/entry/heroin-prescription-diamorphine_uk_57fd2f6ee4b0430f66f67894 http://www.huffingtonpost.co.uk/entry/heroin-prescription-di...

everybodyknows 10y ago
How does the "British system" work out long-term, for the addicts as individuals -- resistance accumulation, vein damage, constipation? Do any live on to old age? Or does it "work" for the rest of society because they die peacefully, at home?
- tim333 10y ago
  I'm not sure but I believe prescribed heroin has limited side effects and is fairly safe and many come off it eventually and live to an old age. I've not seen the data though.
- alex_hitchins 10y ago
  There is an issue that people get 'parked' on methadone and never fully come off it. However, some people I know are now in their 70's and still managing their addiction via Methadone prescribed by a GP. They have been on this treatment since the late 80's. They would not be alive and working, paying their taxes if this wasn't about.

Clubber 10y ago

>States have since cracked down on prescription opioid abuse, creating drug-monitoring programmes and arresting unscrupulous doctors. So if you look at the chart, when they started doing this, heroin overdoses skyrocketed while pill overdoses stayed about the same. They doubled the deaths with their crackdown solution, as if that has ever worked.

ocschwar 10y ago

I'm going to comment here with a plug for the March For Science, on April 22. Why? Because the opioid epidemic started with a simple matter of scientists not being allowed to science. Purdue Pharmaceuticals marketed oxycontin as a drug that lasts for 12 hours. The evidence indicated it only lasted for 8. If Purdue's scientists were allowed to act on the evidence, i.e. to be actual scientists, the whole world would have known this years ago. People prescribed oxycontin would have been told to plan for 8 hours of relief, not 12. Instead, hundreds of thousands of patients were subjected to 4 hours of pain a day, and they sought relief with other drugs, including illegal ones. And the epidemic began. Science is important, yo.

devopsproject 10y ago
You forgot the best part: It made Purdue rich. Instead of changing the frequency of doses, they told doctors to up the strength which made the company more money. The owners of Purdue are billionaires now: http://www.latimes.com/projects/oxycontin-part1/ http://www.latimes.com/projects/oxycontin-part1/
MaxfordAndSons 10y ago
I totally agree with the spirit of your argument, but I think you're somewhat overstating the significance of the marketing/data mismatch here. You can't simply point to that and say "thus the epidemic began". There's a whole nexus of contributing factors at play: overprescription, socio-economic malaise, the ready availability of black market opioids, etc.
55555 10y ago
> Instead, hundreds of thousands of patients were subjected to 4 hours of pain a day, and they sought relief with other drugs, including illegal ones. And the epidemic began. No, I believe the purpose of this scheme was to let the drug wear off before the next dose, in order to reinforce the withdrawal/pain->relief cycle. Oxycodone users typically didn't seek out illegal drugs (heroin) until several years after starting prescription usage.

jstewartmobile 10y ago

I'm on the gulf coast, and we just had a high-profile prosecution of a doctor running a pill mill. What if this whole mess isn't so much a technical problem to be solved as much as it is our system functioning under its own perverse incentives? Other countries don't have this problem. In my own area of expertise, I have seen so many non-solutions force-fed to the customer when an actual solution is not as profitable. It is not hard to believe that medicine operates similarly.

draw_down 10y ago
> What if this whole mess isn't so much a technical problem to be solved as much as it is our system functioning under its own perverse incentives? Indeed! What if!
knz 10y ago
> What if this whole mess isn't so much a technical problem to be solved as much as it is our system functioning under its own perverse incentives? Other countries don't have this problem. That description could easily be applied to many aspects of the US healthcare system - an epidemic is a failing of public health.
- deleted 10y ago
  [deleted]

chx 10y ago

Check https://morecrows.wordpress.com/2016/05/10/unnecessariat/ https://morecrows.wordpress.com/2016/05/10/unnecessariat/ for some deep reasons and for a feel how bad it is. Don't blame this or that pharma for it, that's a distraction.

karmelapple 10y ago

Read Chasing the Scream [1], a fantastic book that documents drug prohibition in the USA, how doctors who viewed it as a health issue got chased out of their desire to help, and suggests many paths to helping people and making the world a better, safer place. I've posted this in enough threads that I probably seem like a bot advertising for it, but seriously, it's a book worth reading and that can change someone's entire opinion on the drug epidemic and what legislation we should pass. [1] http://chasingthescream.com/ http://chasingthescream.com/

lr4444lr 10y ago

I say this mostly tongue-in-cheek because I hate to apply one bad policy to fix another, but I bet if narcotic overprescription could more readily trigger medical malpractice, you'd see doctors thinking more judiciously about their use. Even if exaggerated by an order of magnitude, stats like this are just indefensible: http://www.webmd.com/mental-health/addiction/news/20160325/nearly-all-us-doctors-overprescribe-addictive-narcotic-painkillers-survey#1 http://www.webmd.com/mental-health/addiction/news/20160325/n...

cmdrfred 10y ago
What's funny is there is no evidence that these opioid pain killers are actually effective in the long term for the management of pain. If it wasn't for lobbying they likely wouldn't be legal to use in that way.
- tylersmith 10y ago
  I've been taking opioids for nearly a year and they still work fine. Not sure how long-term you mean.
  - cmdrfred 10y ago
    Stop taking them for a few days and you'll see what I mean. Many studies have shown that patients who do not consume opioid medications have better long term outcomes than those who do. It simply isn't effective in managing pain long term, and also is not indicated for use in that manner.
    - tylersmith 10y ago
      When I stop taking them I'm in pain again. I think what you're trying to get at is the opioids don't solve the underlying problem. But to say they're not effective for managing pain is wrong. I use them to manage pain every day. I get regular steroidal-epidural injections to solve the issue.

sanguy 10y ago

Methadone clinics work; Zurich is a good example. Hard to manage; hard on the community; but it eventually kills off the problem.

kilroy123 10y ago

My sister is a heroin addict. To say this has devastated her life is an understatement. Her body is wrecked. She looks way older than she is, she has a pacemaker / defibrillator installed in her chest. And doctors keep saying she will die soon if she doesn't stop. Here is the most frustrating part. She has wanted to go to rehab a few times, but since she is poor and unemployed, she has no health insurance for rehab. What are her options? My parents have no money to help her. I'll never understand the bull-shit US policy towards drugs. Let's spend billions upon billions to "fight" drugs coming into the country, but let's turn a blind eye to the companies pumping out hundreds of millions of pills. Why the hell don't we spend those hundreds of billions on actually treating the disease? If there was no demand, there would be no drug war to fight. Why don't we try a new way?

jliptzin 10y ago
Very sorry to hear this story, it must be difficult for your family and for her. Do you know about how much rehab would cost for her?
maxerickson 10y ago
Is Medicaid an option?
- kilroy123 10y ago
  Sadly she only has Medi-Cal. Which only covers care for when she is detoxing. No rehab.
girvo 10y ago
I became a heroin addict at 16. I got clean, for free, with my governments help (Queensland, Australia) and opiate replacement therapy, after being an addict for six years. Ive been sober for 5 years this August. If it wasn't for that program, I'd be dead twice over by now, I'm sure of it. I'm sorry about your sister, it's horrible :(
deleted 10y ago
[deleted]
10y ago

pmoriarty 10y ago

I once read of a 20-year-long study that found that when heroin-addicted UK doctors were given unlimited access to pure heroin they performed slightly better than their non-heroin-addicted colleagues, and they had no negative long-term health consequences. If anyone else has heard of this study, or especially if they have some documentation on it, I would appreciate a link.

shams93 10y ago

The states with medical cannabis don't have anywhere near this problem. They need to cover medical cannabis via medicaid that would seriously put a dent in the crisis or at least keep it from growing bigger.

vogelke 10y ago

One of the best books I've ever read on why the war on drugs is a bad idea. It's written by a UK cop who was there nearly from the beginning. https://www.amazon.com/Good-Cop-Bad-War/dp/1785032690/ Good Cop, Bad War (Paperback) Publisher: Ebury Press Language: English ISBN-10: 1785032690 ISBN-13: 978-1785032691

droopybuns 10y ago

These stories are so frightening to me that I contemplate just enduring the suffering if I am ever unfortunate enough to be prescribed oxy or dilaudid.

hackuser 10y ago

Is a war on drugs a good response? Hyper-aggressive policing? Lock up even minor participants for decades? Consider why people thought that was a good response when drugs struck other communities.

wutbrodo 10y ago
This is hardly news: the same dynamic played out in a different chronological order between alcohol and marijuana prohibition. Alcohol was so ubiquitous that Prohibition turned all of society (including "decent" people) into criminals, so the response was that it's clearly an unworkable solution; we can't lock up _everybody_. It's only simplifying a bit to say that marijuana shared much the same ubiquity in certain _other_ communities, so the response was.....let's just lock up everybody.

am185 10y ago

US may need to follow Philippines anti-drug campaign.

lawless123 10y ago
Suppose people can't overdose if they've already been murdered...

parr0t 10y ago

I'll never understand locking people up for having an addiction and treating them like criminals. I'm not too educated on how it's handled in America but in Australia you can go to your doctors and get signed up to a methadone program without worrying about any legal repercussions. My fiancé works at a pharmacy in Melbourne, Australia and says some of the most lovely and friendly people who just want to get themselves together come in regularly to get their $5 dose and it's saddening to see how badly society judges them.

wutbrodo 10y ago
I believe you can do the same here, but the (huge, purpose-defeating) difference is that you need to be able to afford the rehab in a country that isn't so keen on providing a safety net (somewhere upthread someone mentions his sister ruining her life with heroin, wanting to go to rehab, but unable to afford the cost, which is uncovered by Medi-Cal).

yuhong 10y ago

https://www.reddit.com/r/politics/comments/5v43rj/how_mike_pence_used_obamacare_to_halt_indianas/ddzapo8/?st=izgcbq4v&sh=d07521d3 https://www.reddit.com/r/politics/comments/5v43rj/how_mike_p... Also read other comments in the thread about history of needle exchange programs etc.

ransom1538 10y ago

Could weed slow down the opioid epidemic? It gets you high, it is way cheaper, way healthier (not smoked), it isn't addictive, curbs the urge for opioids, easier to make, easier to sell. https://www.theatlantic.com/health/archive/2017/02/marijuana-cannabinoids-opioids/515358/ https://www.theatlantic.com/health/archive/2017/02/marijuana...

hackermailman 10y ago

We have ~400 overdoses per month here. ~20% of that is fatal overdoses because those ODs are from users doing it by themselves and not inside one of the shooting galleries we have set up. The safe injection sites work as advertised but for many reasons some addicts don't go there, mainly because debt collecting gangsters and drug dealers hover all around the front doors, and stigma of standing in an addict lineup that spreads for blocks for all to see. There's a few reports here from VANDU a group run by addicts on the effectiveness of peer-run supervised injection sites and needle exchanges, meaning run by other addicts instead of government employees http://www.vandu.org/reports/ http://www.vandu.org/reports/ The problem is synthetic opioid is being used to buff out heroin so street dealers can save money by importing less heroin from India (how it comes into Canada). They keep coming up with new synthetics to bypass precursor prohibition or import laws, plus China has factories pumping this shit out legally which can easily be smuggled since it costs far less than heroin from India/Afghanistan. Whenever you talk to a street addict basically the reason they got on heroin was they had some other substance abuse problem, usually cocaine, alcohol or meth, there was a shortage of that substance because either they couldn't afford it, busts made it scarce, or they were in jail so through peers they accessed heroin instead and got hooked. Methadone doesn't work, they've already abandoned that idea here and moved to just handing out heroin to the worst cases, or hydromorphone which has a proven success rate in weening addicts off drugs. Somewhere in all this is a solution that doesn't involve enabling career bums who want free heroin for life and doesn't involve 400+ ambulance calls per month draining our resources.

moyang0913 10y ago

Speaking from Singapore here. We don't have any drug problem at all. Drug dealers get death penalty. It's illegal to consume, too. You are put in jail. I pity your poor citizens who can only resort to legalization. Addicts are not healthy for the society or for the economy. It's just a matter of very bad (crime) or bad (jobless and getting high at home, disturbing neighbors). Government use tax I paid to supply water, electricity and infrastructure. I don't agree that it's wasted on addicts.

seattle_spring 10y ago
You pity us. Oh please.
zoul 10y ago
The war on drugs doesn’t work, certainly not in the US: https://en.m.wikipedia.org/wiki/War_on_Drugs https://en.m.wikipedia.org/wiki/War_on_Drugs
flukus 10y ago
Speaking from Australia, I find the Singapore solution barbaric and totalitarian, no better than the new Philippines president.
sonthonax 10y ago
While Singapore has no issues laundering the dirty money of every scumbag around the world.
lordnacho 10y ago
One side effect is that people who are using drugs responsibly are executed when they forget to empty their bags on the way home. A friend of mine from Singapore had this happen to her friend. Being completely draconian is not a solution to anything. We can fine people 100K for parking illegally, and you might get fewer people parking badly, but it will never seem to be reasonable.

cowardlydragon 10y ago

I read that Medicaid is being used to fuel the black market pipeline. $3 copay gets you a $1000 street value opioids... Of course this is corporate welfare for the opioid manufacturers. I also read that one month 11% of Ohio's population was prescribed painkillers.

WhiteSource1 10y ago

What is causing this? IS this prescription drug dependence? Because this wasn't a problem 10 or 20 years ago!

grondilu 10y ago

> The opioid epidemic has its roots in the explosive growth of prescription painkillers. Between 1991 and 2011, the number of opioid prescriptions (selling under brand names like Vicodin, Oxycontin, and Percocet) supplied by American retail pharmacies increased from 76m to 219m. As the number of pain pills being doled out by doctors increased, so did their potency. In 2002 one in six users took a pill more powerful than morphine. By 2012 it was one in three. I find this absolutely outrageous. I'm not American, but I stumble upon articles mentioning this, and I do watch enough American TV series and movies to have an idea of how acute the problem is (it's crazy how often in TV series doctors seem to give pain killers like it's candy). I have the impression that in Europe, painkillers are much less used but I would not be surprised if the American trend were to contaminate medical practice here. Pain is a minor consequence of disease or trauma. Pain won't kill you, so why would you risk become addicted to very dangerous drugs just to relieve it?

pjc50 10y ago
> Pain is a minor consequence of disease There speaks someone young and healthy. Some conditions are extremely painful in the long term. "It is estimated that more than 100 million people suffer from chronic pain in this country,[11] and for some of them, opioid therapy may be appropriate. The bulk of American patients who need relief from persistent, moderate-to-severe non-cancer pain have back pain conditions (approximately 38 million) or osteoarthritis (approximately 17 million)." Source: https://www.drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2016/americas-addiction-to-opioids-heroin-prescription-drug-abuse https://www.drugabuse.gov/about-nida/legislative-activities/... "aggressive marketing by pharmaceutical companies" "United States their biggest consumer globally, accounting for almost 100 percent of the world total for hydrocodone (e.g., Vicodin) and 81 percent for oxycodone (e.g., Percocet)" That does make it sound like a problem created by pharma drug pushing on TV. But that doesn't mean the pain isn't real either. Really the whole thing needs to be seen as a widespread public and social health problem - which is exactly the sort of thing the US system is set up to avoid seeing. Healthcare is not just a matter of individual responsibility or a contract between someone and their employer.
- 10y ago

ainiriand 10y ago

You know Trump's solution? Jail for everyone. No wonder why US has 25% of the world's total inmate population... [0]https://www.thoughtco.com/states-spending-money-prisons-not-schools-4068528 https://www.thoughtco.com/states-spending-money-prisons-not-...

Jun8 10y ago

What is causing the variation on the prescription opioid graph do you think? The other two graphs don't have similar patterns to such degree.

malandrew 10y ago

This article I recently submitted had some interesting stats on the relationship between opiates and the welfare state: https://www.commentarymagazine.com/articles/our-miserable-21st-century/ https://www.commentarymagazine.com/articles/our-miserable-21... Although the entire article is worth reading, jump down to the paragraph that begins with "The opioid epidemic..." and read for about ~5 paragraphs if that's all that interests you.