7 ms·

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, wha

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.
    - empath75 10y ago
      I just go laparoscopic surgery. I told them multiple times I didn't want to use opiates to manage pain, that I wasn't in very much pain, and they still gave me iv fentanyl, and about 150 Vicodin tablets to take home. They asked me if I had an opiate problem, like turning down opiates meant that I had some kind of drug issue. It was bizarre.
      - ams6110 10y ago
        I've had Vicodin prescribed a couple of times. I never felt it did much. Certainly didn't make me high. I don't see how it's a gateway to opioid addicion unless you're eating them like candy from the get-go.
    - DougN7 10y ago
      Is that true? (serious question) I can't believe that many more people, especially (and coincidentally?) in the inner cities, need pain meds. This seems like something bigger in my mind. But I also don't have any data to back it up.
      - goatsi 10y ago
        Often companies find that people don't "need" their products. When this happens they turn to advertising and sales people to correct the problem. https://theweek.com/articles/541564/how-american-opiate-epidemic-started-by-pharmaceutical-company https://theweek.com/articles/541564/how-american-opiate-epid... http://www.pbs.org/wgbh/frontline/film/chasing-heroin/ http://www.pbs.org/wgbh/frontline/film/chasing-heroin/
  - tetrep 10y ago
    > This doesn't help the root cause of people starting to use them in the first place. I don't think you can stop at drug use and claim "root cause." There's a variety of motivating factors involved in using particular drugs, and ignoring those is what leads to things like Prohibition, The War on Drugs, and other related failures. If you want to stop people from doing something, you need to look at their motivations for doing it.
tyingq 10y ago
I'm not sure anyone really knows why the demand is so huge. Unemployment seems obvious, but it's not. New Hampshire, for example, if often cited as one of the areas hit the worst by opiate addiction. Yet, it's doing well with unemployment, in relative terms. 1 year old, but relevant: http://www.nationalreview.com/corner/430841/whats-matter-new-hampshire http://www.nationalreview.com/corner/430841/whats-matter-new...
- AnimalMuppet 10y ago
  I'm guessing, but... technology? There was a tremendous amount of unemployment during the Great Depression - far worse than now. Sure, opioids weren't as available, so people didn't turn to them. (Alcohol, on the other hand...) But I think a lot of what people did then was turn to each other. They had deeper relationships with people than (many) people do today. Sure, you've got two hundred Facebook friends. How many of them can you call at 3 AM because your marriage is about to fall apart, or because you're feeling suicidal? Technology has given us more relationships, but I think that in the process, we've lost much of the depth. That leaves a huge hole, because people are wired to connect to people. We crave human contact, and we get tweets. It's not enough. So my suspicion is that we're turning to opioids to try to fill that void. But as I said, this is just my suspicion.
  - SolaceQuantum 10y ago
    I don't know, I see young people taking to each other about suicidal thoughts and making support groups do each other all the time. Teenagers making Discord chats where they can talk about how their families are abusive and they want to kill themselves, Skype chats where young adults discuss obscure chronic illnesses that the rest of the world can't empathize with them for.
    - AnimalMuppet 10y ago
      Fair enough. Technology allows people to connect who would not have been able to in the past. But I still claim that, for the average (or perhaps median) person, the net result has been dehumanizing - it has resulted in less depth of relationship.
pm90 10y ago
There has to be a some kind of change in lifestyle. Like you said, trying to cutoff supply will only criminalize the activity and make it worse. I've heard, among other solutions, recommending yoga, physical therapy etc. instead of immediately prescribing opiod painkillers. This is certainly an important problem and I'm as interested as you are in what the solutions might be.
- tylersmith 10y ago
  If yoga can help with the pain the person didn't need opioids in the first place.
devopsproject 10y ago
> Fighting the "epidemic" at the supply level seems like a losing battle Kermit, West Virginia. Population 392. They received over 9 million hydrocodone pills in a two year period. In a 6 year period, the entire state of WV received 780 million pills. Over 400 pills for every man, woman, and child living in WV. Seems like attacking the supply is great place to start. WV doesn't need this many pills.
- pnathan 10y ago
  > Seems like attacking the supply is great place to start. That is what was done, transferring the demand to heroin as opposed to oxy. Also, focusing on the supply side of things is the last 30 years of US policy: it's not worked effectively, and has a concomitant effect of incentivizing black market dealers to be wealthy and power. It'd be better to sell OTC heroin than to fund violent gangs, just in the name of limiting side effects.
  - devopsproject 10y ago
    Mostly wrong. Pills were given out like candy, then restricted which caused demand for cheaper alternatives. Had the drug companies been regulated in the first place, we might be OK. The pills aren't coming from mules or cartels, they are coming from US companies. The pill supply has to lowered. edit to add: http://www.latimes.com/projects/oxycontin-part1/ http://www.latimes.com/projects/oxycontin-part1/
    - rwmj 10y ago
      The pill supply has to lowered ... in the past. However now the US made that mistake, what's the problem with continuing to give out the pills "like candy", although with tighter controls to make sure that they don't go to create new addicts?
      - devopsproject 10y ago
        They don't need to be given out like candy. That's the point. The supply needs to be drastically reduced to prevent new addicts and we should be looking at what other countries are doing for their existing addicts: safe injection sites etc.
rwmj 10y ago
It helps to separate out several aspects of the demand side: - Addiction: may or may not be a problem at all, heroin isn't actually very expensive so the government can just keep giving it even to large numbers of people - Other health risks: the risk of catching Hep C or dying of an overdose. - Acquisitive crime: largely caused by the drugs being illegal. - Morality: drug users are "bad people" because they lack moral strength or whatever. (Personally I have no truck with this, but it seems to be very important for a lot of people)
mholmes680 10y ago
I think its more dissatisfaction with life in general, with unemployment maybe being one of many triggers. You're probably right about addressing at the demand level. But, I see the problem being more societal - think no one really understands everything. You take away self-reliance of people (whether they realize it or not) at many levels... its cheaper to get some good-enough quality food at 13 places near my home, so why should I learn to cook. I can get any vegetable I want at the store, so I probably don't need to learn how to tend a garden. In both instances as examples I'm losing a little control of my life. And then.... TV gives me entertainment, and the internet even more so, so maybe i'll just sit back and let it entertain me. So maybe I don't need to read anymore. Its easier to have short non-contextual entertainment bits, which rewire my brain further to think differently [wrongly?]... [0] And, now capitalism has made all margins of businesses so slim that there's no real way to enter a business and still have a safety net in case you fail. You either need to disrupt an industry, create a marketplace, find a niche, or fail hard. I think we're just starting to see the uglier stuff here. Short of some great awakening I also don't see the correct prescription. Pun intended. [0]: https://en.wikipedia.org/wiki/Amusing_Ourselves_to_Death https://en.wikipedia.org/wiki/Amusing_Ourselves_to_Death
- glangdale 10y ago
  Postman's book is now 32 years old! I read it as a teenager, which dates me... I'm not sure about the Amusing Ourselves To Death stuff or the tut-tutting about cooking and gardening, but overall, though, I think you're on the right track. I'm sure that between automation of both manufacturing and services, big-box retailers and the fact that the covering of the 'long tail' is done very well by web-based business. It's hard to picture what a lot of people are going to be able to do in this circumstance and there seems to be the real potential for a cascading unpleasantness. If you even half-believe the 'technological unemployment' worry, the scary part is that the non-automatable jobs that involved providing goods and services to those displaced by technology will also suffer. There may be plenty of spare time for people to have that 'great awakening', whatever that might turn out to be.
  - mholmes680 10y ago
maxxxxx 10y ago
One thing I have noticed with American doctors is that they are very quick prescribing heavy pain meds. Much quicker than in Germany for example.
- Kluny 10y ago
  American doctors follow national guidelines, because if they don't they expose themselves to malpractice suits. The guidelines currently say that if someone is in pain, give them as much painkiller as they want. Their ability to use their extensive training and judgement to make a better call is somewhat limited.
  - kwhitefoot 10y ago
    I'll have to take your word that the guidelines say effectively to give the patient what they want, it seems a strange idea. Here, in Norway, the doctor also tells the patient to take as much as they need but the decision on the actual type of pain relief is arrived at collaboratively between the patient and the doctor, sometimes including a short stay, two or three nights, in hospital so that multiple regimes can be quickly tried out under supervision. In some cases they can prescribe more suitable drugs and more suitable delivery methods. For instance the pain associated with cancer is often better controlled with a Fentanyl continuous delivery patch than an Oxy capsule. Oxy is good for relatively quick relief when you have a temporary increase in pain but the effect wears off so you get uneven pain relief. I'm not a doctor, just speaking from personal knowledge of someone very close to me.
  - DanBC 10y ago
    > The guidelines currently say that if someone is in pain, give them as much painkiller as they want Can you point me to those guidelines please? I'm struggling to find them. I can understand the advice if it's relating to short term immediate pain - for example post-operative pain. Addiction is unlikely to result from pain medication use in that example. Here's the English advice: http://www.fpm.ac.uk/faculty-of-pain-medicine/opioids-aware http://www.fpm.ac.uk/faculty-of-pain-medicine/opioids-aware
ThrustVectoring 10y ago
A related-ish thing I remember reading about is how doctors would ask folks complaining about back pain what career they were in. The goal is that folks who complain about back pain who are unemployed due to the local mill closing would get shunted into disability, while knowledge workers wouldn't. So there's likely a pretty big effect of society telling folks that they have to be "disabled" in order for us to support them, and one way to be "disabled" is to have debilitating pain, and so you wind up with a bunch of folks who can't work and have a pain pill prescription.
hackuser 10y ago
Unemployment has dropped quite a bit in the U.S. since the Great Recession, though how much that applies to affected areas is uncertain.

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.
  - empath75 10y ago
    I just go laparoscopic surgery. I told them multiple times I didn't want to use opiates to manage pain, that I wasn't in very much pain, and they still gave me iv fentanyl, and about 150 Vicodin tablets to take home. They asked me if I had an opiate problem, like turning down opiates meant that I had some kind of drug issue. It was bizarre.
    - ams6110 10y ago
      I've had Vicodin prescribed a couple of times. I never felt it did much. Certainly didn't make me high. I don't see how it's a gateway to opioid addicion unless you're eating them like candy from the get-go.
  - DougN7 10y ago
    Is that true? (serious question) I can't believe that many more people, especially (and coincidentally?) in the inner cities, need pain meds. This seems like something bigger in my mind. But I also don't have any data to back it up.
    - goatsi 10y ago
      Often companies find that people don't "need" their products. When this happens they turn to advertising and sales people to correct the problem. https://theweek.com/articles/541564/how-american-opiate-epidemic-started-by-pharmaceutical-company https://theweek.com/articles/541564/how-american-opiate-epid... http://www.pbs.org/wgbh/frontline/film/chasing-heroin/ http://www.pbs.org/wgbh/frontline/film/chasing-heroin/
- tetrep 10y ago
  > This doesn't help the root cause of people starting to use them in the first place. I don't think you can stop at drug use and claim "root cause." There's a variety of motivating factors involved in using particular drugs, and ignoring those is what leads to things like Prohibition, The War on Drugs, and other related failures. If you want to stop people from doing something, you need to look at their motivations for doing it.

tyingq 10y ago

I'm not sure anyone really knows why the demand is so huge. Unemployment seems obvious, but it's not. New Hampshire, for example, if often cited as one of the areas hit the worst by opiate addiction. Yet, it's doing well with unemployment, in relative terms. 1 year old, but relevant: http://www.nationalreview.com/corner/430841/whats-matter-new-hampshire http://www.nationalreview.com/corner/430841/whats-matter-new...

AnimalMuppet 10y ago
I'm guessing, but... technology? There was a tremendous amount of unemployment during the Great Depression - far worse than now. Sure, opioids weren't as available, so people didn't turn to them. (Alcohol, on the other hand...) But I think a lot of what people did then was turn to each other. They had deeper relationships with people than (many) people do today. Sure, you've got two hundred Facebook friends. How many of them can you call at 3 AM because your marriage is about to fall apart, or because you're feeling suicidal? Technology has given us more relationships, but I think that in the process, we've lost much of the depth. That leaves a huge hole, because people are wired to connect to people. We crave human contact, and we get tweets. It's not enough. So my suspicion is that we're turning to opioids to try to fill that void. But as I said, this is just my suspicion.
- SolaceQuantum 10y ago
  I don't know, I see young people taking to each other about suicidal thoughts and making support groups do each other all the time. Teenagers making Discord chats where they can talk about how their families are abusive and they want to kill themselves, Skype chats where young adults discuss obscure chronic illnesses that the rest of the world can't empathize with them for.
  - AnimalMuppet 10y ago
    Fair enough. Technology allows people to connect who would not have been able to in the past. But I still claim that, for the average (or perhaps median) person, the net result has been dehumanizing - it has resulted in less depth of relationship.

pm90 10y ago

There has to be a some kind of change in lifestyle. Like you said, trying to cutoff supply will only criminalize the activity and make it worse. I've heard, among other solutions, recommending yoga, physical therapy etc. instead of immediately prescribing opiod painkillers. This is certainly an important problem and I'm as interested as you are in what the solutions might be.

tylersmith 10y ago
If yoga can help with the pain the person didn't need opioids in the first place.

devopsproject 10y ago

> Fighting the "epidemic" at the supply level seems like a losing battle Kermit, West Virginia. Population 392. They received over 9 million hydrocodone pills in a two year period. In a 6 year period, the entire state of WV received 780 million pills. Over 400 pills for every man, woman, and child living in WV. Seems like attacking the supply is great place to start. WV doesn't need this many pills.

pnathan 10y ago
> Seems like attacking the supply is great place to start. That is what was done, transferring the demand to heroin as opposed to oxy. Also, focusing on the supply side of things is the last 30 years of US policy: it's not worked effectively, and has a concomitant effect of incentivizing black market dealers to be wealthy and power. It'd be better to sell OTC heroin than to fund violent gangs, just in the name of limiting side effects.
- devopsproject 10y ago
  Mostly wrong. Pills were given out like candy, then restricted which caused demand for cheaper alternatives. Had the drug companies been regulated in the first place, we might be OK. The pills aren't coming from mules or cartels, they are coming from US companies. The pill supply has to lowered. edit to add: http://www.latimes.com/projects/oxycontin-part1/ http://www.latimes.com/projects/oxycontin-part1/
  - rwmj 10y ago
    The pill supply has to lowered ... in the past. However now the US made that mistake, what's the problem with continuing to give out the pills "like candy", although with tighter controls to make sure that they don't go to create new addicts?
    - devopsproject 10y ago
      They don't need to be given out like candy. That's the point. The supply needs to be drastically reduced to prevent new addicts and we should be looking at what other countries are doing for their existing addicts: safe injection sites etc.

rwmj 10y ago

It helps to separate out several aspects of the demand side: - Addiction: may or may not be a problem at all, heroin isn't actually very expensive so the government can just keep giving it even to large numbers of people - Other health risks: the risk of catching Hep C or dying of an overdose. - Acquisitive crime: largely caused by the drugs being illegal. - Morality: drug users are "bad people" because they lack moral strength or whatever. (Personally I have no truck with this, but it seems to be very important for a lot of people)

mholmes680 10y ago

I think its more dissatisfaction with life in general, with unemployment maybe being one of many triggers. You're probably right about addressing at the demand level. But, I see the problem being more societal - think no one really understands everything. You take away self-reliance of people (whether they realize it or not) at many levels... its cheaper to get some good-enough quality food at 13 places near my home, so why should I learn to cook. I can get any vegetable I want at the store, so I probably don't need to learn how to tend a garden. In both instances as examples I'm losing a little control of my life. And then.... TV gives me entertainment, and the internet even more so, so maybe i'll just sit back and let it entertain me. So maybe I don't need to read anymore. Its easier to have short non-contextual entertainment bits, which rewire my brain further to think differently [wrongly?]... [0] And, now capitalism has made all margins of businesses so slim that there's no real way to enter a business and still have a safety net in case you fail. You either need to disrupt an industry, create a marketplace, find a niche, or fail hard. I think we're just starting to see the uglier stuff here. Short of some great awakening I also don't see the correct prescription. Pun intended. [0]: https://en.wikipedia.org/wiki/Amusing_Ourselves_to_Death https://en.wikipedia.org/wiki/Amusing_Ourselves_to_Death

glangdale 10y ago
Postman's book is now 32 years old! I read it as a teenager, which dates me... I'm not sure about the Amusing Ourselves To Death stuff or the tut-tutting about cooking and gardening, but overall, though, I think you're on the right track. I'm sure that between automation of both manufacturing and services, big-box retailers and the fact that the covering of the 'long tail' is done very well by web-based business. It's hard to picture what a lot of people are going to be able to do in this circumstance and there seems to be the real potential for a cascading unpleasantness. If you even half-believe the 'technological unemployment' worry, the scary part is that the non-automatable jobs that involved providing goods and services to those displaced by technology will also suffer. There may be plenty of spare time for people to have that 'great awakening', whatever that might turn out to be.
- mholmes680 10y ago

maxxxxx 10y ago

One thing I have noticed with American doctors is that they are very quick prescribing heavy pain meds. Much quicker than in Germany for example.

Kluny 10y ago
American doctors follow national guidelines, because if they don't they expose themselves to malpractice suits. The guidelines currently say that if someone is in pain, give them as much painkiller as they want. Their ability to use their extensive training and judgement to make a better call is somewhat limited.
- kwhitefoot 10y ago
  I'll have to take your word that the guidelines say effectively to give the patient what they want, it seems a strange idea. Here, in Norway, the doctor also tells the patient to take as much as they need but the decision on the actual type of pain relief is arrived at collaboratively between the patient and the doctor, sometimes including a short stay, two or three nights, in hospital so that multiple regimes can be quickly tried out under supervision. In some cases they can prescribe more suitable drugs and more suitable delivery methods. For instance the pain associated with cancer is often better controlled with a Fentanyl continuous delivery patch than an Oxy capsule. Oxy is good for relatively quick relief when you have a temporary increase in pain but the effect wears off so you get uneven pain relief. I'm not a doctor, just speaking from personal knowledge of someone very close to me.
- DanBC 10y ago
  > The guidelines currently say that if someone is in pain, give them as much painkiller as they want Can you point me to those guidelines please? I'm struggling to find them. I can understand the advice if it's relating to short term immediate pain - for example post-operative pain. Addiction is unlikely to result from pain medication use in that example. Here's the English advice: http://www.fpm.ac.uk/faculty-of-pain-medicine/opioids-aware http://www.fpm.ac.uk/faculty-of-pain-medicine/opioids-aware

ThrustVectoring 10y ago

A related-ish thing I remember reading about is how doctors would ask folks complaining about back pain what career they were in. The goal is that folks who complain about back pain who are unemployed due to the local mill closing would get shunted into disability, while knowledge workers wouldn't. So there's likely a pretty big effect of society telling folks that they have to be "disabled" in order for us to support them, and one way to be "disabled" is to have debilitating pain, and so you wind up with a bunch of folks who can't work and have a pain pill prescription.

hackuser 10y ago

Unemployment has dropped quite a bit in the U.S. since the Great Recession, though how much that applies to affected areas is uncertain.