5 ms·

The pharma companies have some liability, but there was a perfect storm The "war on drugs", and the racially motivated moral panic about crack cocaine and addi

by pacaro 9y ago

The pharma companies have some liability, but there was a perfect storm The "war on drugs", and the racially motivated moral panic about crack cocaine and addiction created a social attitude that casts addiction as a moral failing Inadequate safety net healthcare provisions lead people to the cheapest treatment option, generic opiates fit this bill

frozenport 9y ago
The "war on drugs" has little to do with our opioid epidemic. These are people who were given "medicine" (mostly painkillers) and got hooked.
- mattnewton 9y ago
  I am mostly with you on that and think this is a separate issue of big pharmacy pushing unsafe drugs, but there probably is some truth to GP's statement as well. The social stigma of addiction treated it as something that happened to morally deficient people, and probably lead to defunding and demphasizing public health approaches to solving it.
  - frozenport 9y ago
    In theory, its hard to say addicts don't have treatment options. If you're ensured the same guys will give you methadone, and public clinics exist. If you fall off the grid its much harder, especially because public treatment options which are mostly free, do require tedious screening. In that case its a matter of implementation. The real issue is that many treatments have a poor success rate.
- aqme28 9y ago
  I disagree. Look at Portugal, which decriminalized opioid use and started viewing it as a treatable medical condition. They went from the highest to one of the lowest rates of opioid use in Europe.
  - frozenport 9y ago
    European doctors didn't prescribe the same stuff American doctors prescribed, and unlike the US if you did get something prescribed it was easier to keep the prescription (so you didn't turn to heroin, etc).
  - x00x00 9y ago
    Portugal didn't have pharma companies and doctors selling opioids as being safe to regular people. That is what makes the USA unique - it's almost impossible to be prescribed strong opiates anywhere else in the world, let alone to be told that they're safe.
    - koolba 9y ago
      I'm pretty sure we're the only country that has commercials for "Opioid Induced Constipation" drugs as well. You know something is prevalent when the drugs to treat its side effects are worthy of prime time advertising.
      - pacificmint 9y ago
        > I'm pretty sure we're the only country that has commercials for "Opioid Induced Constipation" drugs as well. Well, we're one of only two countries in the world that allow direct to consumer advertising for drugs at all, so your statement is probably true. (New Zealand is the other one for those curious, with Canada having some limited things they allow).
        ryall 9y ago
        As a kiwi myself, I'm genuinely curious about what drugs are advertised in NZ. I can't recall any such advertisements, apart from maybe flu pills that contain pseudo-ephedrine?
        shavingspiders 9y ago
        We don't have many - panadol & ibuprofen combos, viagra generics, branded asthma drugs. Generally they purchase ad spots outside of prime time (and likely with more regularity on channels like One & Prime, where there's a slightly older audience.
- xzel 9y ago
  I disagree. If we want to get into numbers sure there is some percentage who first had a prescription. I'm also sure there are plenty of people who started using when they were flowing freely and cheaply as a recreational drug. I know where I grew up, plenty of people were using without having it prescribed. It was incredibly easy to get bulk amounts across the country, for example Florida: http://www.nytimes.com/2011/09/01/us/01drugs.html http://www.nytimes.com/2011/09/01/us/01drugs.html What the other poster is talking about is the reaction to someone being hooked, looking the other way and/or not treating it as a mental health issue and putting them in rehab instead of jail. Then, imo, if you really want to get into it, destabilization in Mexico has created the actual heroin epidemic we see now, as the pill mills and doctors involved have had their operations closed.
  - Retric 9y ago
    The numbers suggest the majority started with a prescription. The number of people given these prescriptions was staggering around 4 times as many people got hooked (2.1 million) than are using Heroin (0.4 million). 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/... "By 2002, death certificates listed opioid analgesic poisoning as a cause of death more commonly than heroin or cocaine."
- skookumchuck 9y ago
  I know people who died of opioid overdoses, and they were never prescribed it. If you take away the medical pills, they just go get heroin and OD on that.
  - base698 9y ago
    I know people who died of opioid overdoses, and they were always prescribed it. Also if you read "Dreamland" 80% of heroin addicts started addiction with prescribed drugs.
- refurb 9y ago
  Drug companies don't write scripts. That falls entirely on doctors.
- InclinedPlane 9y ago
  No. The war on drugs means that when people "fall out" of civilized society due to opioid addiction they are forced to turn to street drugs. Drugs of questionable composition and strength, making dosing dangerous. The result is 100 deaths from opioid overdoses every. Single. Day. If those people were on methadone instead, for example, hundreds of thousands of people who are now dead would still be alive.
rukittenme 9y ago
I hate this argument. 1. Crack has a lighter sentence than meth does despite meth being a "white" drug and crack being a "black" drug. 2. America has always casted failure as a moral failing. Its the basis of Calvinism. It has nothing to do with the war on drugs. 3. The epidemic is new. In the 40s, 50s, 60s, when healthcare was much worse, you didn't see this level of addiction to opiates. Easier access to opiates means better access to healthcare which is the problem.
- pacaro 9y ago
  Thank you. Your 2 is an aspect I hadn't thought of at all. In reference to sentencing disparity, I was referring to the 100:1 (pre 2010, now only(!) 18:1) difference in sentencing for crack vs coke
- CydeWeys 9y ago
  In regards to #1, the war on drugs has been going on for decades now, whereas I believe you're only referring to the current situation. It was certainly true that, for decades, crack as a "black drug" was being treated way more harshly than other "white drugs", with hugely aberrant sentences. And now under Jeff Sessions we might well be reverting back to that.
- Broken_Hippo 9y ago
  #3 isn't quite true. Yes, this epidemic is new, but drug epidemics aren't. This one is likely more widespread because of widespread use. But this is most pronounced in the US. Other countries with good-or-better access to healthcare don't have nearly the same problems as the US [1]. I think it lies more in the way we treat folks when they are sick: Turning to opiods instead of other drugs (a combination of ibuprofin and paracet/tylenol is a pretty standard pain treatment here). Not actually giving folks time off when they are sick and injured. Sure, you have the FMLA, but that doesn't exactly let folks pay their bills. We (the US) could also do things like talk to patients and/or their families about ways to handle the pain, what to do if the pain relief wears off, prescribe differently so that it isn't wearing off. We could make sure to have realistic conversations about addiction. And the drug companies could be upfront about this. Lastly, we could provide addiction help, treating it with time off in a manner similar to simply being sick. [1]https://www.washingtonpost.com/news/wonk/wp/2017/03/15/americans-use-far-more-opioids-than-anyone-else-in-the-world/?utm_term=.655ff5f89f55 https://www.washingtonpost.com/news/wonk/wp/2017/03/15/ameri...
heymijo 9y ago
We can conjecture all we'd like, but Sam Quinones wrote a rather definitive history of the opioid epidemic in America. https://www.amazon.com/Dreamland-True-Americas-Opiate-Epidemic/dp/1620402521 https://www.amazon.com/Dreamland-True-Americas-Opiate-Epidem... Sam ran the podcast circuit awhile back if you want to listen to his story. I found out about it via Russ Roberts' Econ Talk. http://www.econtalk.org/archives/2017/01/sam_quinones_on.html http://www.econtalk.org/archives/2017/01/sam_quinones_on.htm...
dilap 9y ago
Our current healthcare system says, hey, if you're poor/out of work/disabled, here's some cash to buy dangerously addictive opiates that will short-term make you feel better. What could go wrong? Here's some blog posts arguing the ACA actually increased the severity of the opioid crisis: https://spottedtoad.wordpress.com/2017/03/27/some-stronger-evidence-that-the-affordable-care-act-worsened-the-opioid-crisis/ https://spottedtoad.wordpress.com/2017/03/27/some-stronger-e... https://spottedtoad.wordpress.com/2017/03/28/its-opioids-not-dying-from-despair-thats-driving-the-obamacare-effect/ https://spottedtoad.wordpress.com/2017/03/28/its-opioids-not... I'm (nevertheeless) pro-universal healthcare, but our idea of healthcare should probably not include these drugs in any but the most extreme and limited circumstances (like, I'm lying in a hospital bed). They're too dangerous. Having doctors actively prescribe them, under incentives from pharma companies to sell them, seems to me predatory in the same way we think of street dealers stalking schoolyards as predatory. Chris Arnade has done a great job documenting the crises at a personal level. I highly recommend checking out some of his articles and tweetstorms. It's gut-wrenching stuff (and obviously the problem goes way deeper than simple access). But pharma/doctors/govt pushing drugs isn't helping, and is probably making it much worse.
- kakarot 9y ago
  Do you believe a person has the right to acquire and consume whatever drug they want to as long as it does not lead to criminal behavior? Or do you believe we should treat citizens like children who can't be trusted to make their own decisions? Because this is a completely separate issue from overprescription of opiates.
  - Broken_Hippo 9y ago
    Let me say upfront: I'm pro-legalization of recreational drugs. Even the ones I wouldn't personally do. I truly believe that with access - especially to things like pot and hash - will seriously help with opiate abuse. And honestly, the correct answer (in my opinion) is that one should do both. As much as I'd like to believe better in society, the truth is that not everyone thinks things through. Not everyone gains information before they do stuff. Some drugs should have restrictions. Age limits are prudent, for example. I don't trust folks to take most prescription drugs correctly. Antibiotics and most treatment-only drugs are like this. I'd rather folks do opium than heroin or opiate pills. If there is still a market for them after legalisation, I'd rather the opiate pills that are available to the public be the mild variety. Push folks to do occasional cocaine rather than crack. Avoid meth if possible, mostly because it is hard on folks. Heroin or anything else that one injects are only available at a clinic, where you have to consume there. And above all, drug addiction treated like a medical condition... and free of charge.
vivekd 9y ago
Maybe but even if all of that were true it has no bearing on pharmaceuticals encouraging irresponsible over-prescribing and over use of their opioid based medication.

by pacaro 9y ago

frozenport 9y ago

The "war on drugs" has little to do with our opioid epidemic. These are people who were given "medicine" (mostly painkillers) and got hooked.

mattnewton 9y ago
I am mostly with you on that and think this is a separate issue of big pharmacy pushing unsafe drugs, but there probably is some truth to GP's statement as well. The social stigma of addiction treated it as something that happened to morally deficient people, and probably lead to defunding and demphasizing public health approaches to solving it.
- frozenport 9y ago
  In theory, its hard to say addicts don't have treatment options. If you're ensured the same guys will give you methadone, and public clinics exist. If you fall off the grid its much harder, especially because public treatment options which are mostly free, do require tedious screening. In that case its a matter of implementation. The real issue is that many treatments have a poor success rate.
aqme28 9y ago
I disagree. Look at Portugal, which decriminalized opioid use and started viewing it as a treatable medical condition. They went from the highest to one of the lowest rates of opioid use in Europe.
- frozenport 9y ago
  European doctors didn't prescribe the same stuff American doctors prescribed, and unlike the US if you did get something prescribed it was easier to keep the prescription (so you didn't turn to heroin, etc).
- x00x00 9y ago
  Portugal didn't have pharma companies and doctors selling opioids as being safe to regular people. That is what makes the USA unique - it's almost impossible to be prescribed strong opiates anywhere else in the world, let alone to be told that they're safe.
  - koolba 9y ago
    I'm pretty sure we're the only country that has commercials for "Opioid Induced Constipation" drugs as well. You know something is prevalent when the drugs to treat its side effects are worthy of prime time advertising.
    - pacificmint 9y ago
      > I'm pretty sure we're the only country that has commercials for "Opioid Induced Constipation" drugs as well. Well, we're one of only two countries in the world that allow direct to consumer advertising for drugs at all, so your statement is probably true. (New Zealand is the other one for those curious, with Canada having some limited things they allow).
      - ryall 9y ago
        As a kiwi myself, I'm genuinely curious about what drugs are advertised in NZ. I can't recall any such advertisements, apart from maybe flu pills that contain pseudo-ephedrine?
        shavingspiders 9y ago
        We don't have many - panadol & ibuprofen combos, viagra generics, branded asthma drugs. Generally they purchase ad spots outside of prime time (and likely with more regularity on channels like One & Prime, where there's a slightly older audience.
xzel 9y ago
I disagree. If we want to get into numbers sure there is some percentage who first had a prescription. I'm also sure there are plenty of people who started using when they were flowing freely and cheaply as a recreational drug. I know where I grew up, plenty of people were using without having it prescribed. It was incredibly easy to get bulk amounts across the country, for example Florida: http://www.nytimes.com/2011/09/01/us/01drugs.html http://www.nytimes.com/2011/09/01/us/01drugs.html What the other poster is talking about is the reaction to someone being hooked, looking the other way and/or not treating it as a mental health issue and putting them in rehab instead of jail. Then, imo, if you really want to get into it, destabilization in Mexico has created the actual heroin epidemic we see now, as the pill mills and doctors involved have had their operations closed.
- Retric 9y ago
  The numbers suggest the majority started with a prescription. The number of people given these prescriptions was staggering around 4 times as many people got hooked (2.1 million) than are using Heroin (0.4 million). 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/... "By 2002, death certificates listed opioid analgesic poisoning as a cause of death more commonly than heroin or cocaine."
skookumchuck 9y ago
I know people who died of opioid overdoses, and they were never prescribed it. If you take away the medical pills, they just go get heroin and OD on that.
- base698 9y ago
  I know people who died of opioid overdoses, and they were always prescribed it. Also if you read "Dreamland" 80% of heroin addicts started addiction with prescribed drugs.
refurb 9y ago
Drug companies don't write scripts. That falls entirely on doctors.
InclinedPlane 9y ago
No. The war on drugs means that when people "fall out" of civilized society due to opioid addiction they are forced to turn to street drugs. Drugs of questionable composition and strength, making dosing dangerous. The result is 100 deaths from opioid overdoses every. Single. Day. If those people were on methadone instead, for example, hundreds of thousands of people who are now dead would still be alive.

rukittenme 9y ago

I hate this argument. 1. Crack has a lighter sentence than meth does despite meth being a "white" drug and crack being a "black" drug. 2. America has always casted failure as a moral failing. Its the basis of Calvinism. It has nothing to do with the war on drugs. 3. The epidemic is new. In the 40s, 50s, 60s, when healthcare was much worse, you didn't see this level of addiction to opiates. Easier access to opiates means better access to healthcare which is the problem.

pacaro 9y ago
Thank you. Your 2 is an aspect I hadn't thought of at all. In reference to sentencing disparity, I was referring to the 100:1 (pre 2010, now only(!) 18:1) difference in sentencing for crack vs coke
CydeWeys 9y ago
In regards to #1, the war on drugs has been going on for decades now, whereas I believe you're only referring to the current situation. It was certainly true that, for decades, crack as a "black drug" was being treated way more harshly than other "white drugs", with hugely aberrant sentences. And now under Jeff Sessions we might well be reverting back to that.
Broken_Hippo 9y ago
#3 isn't quite true. Yes, this epidemic is new, but drug epidemics aren't. This one is likely more widespread because of widespread use. But this is most pronounced in the US. Other countries with good-or-better access to healthcare don't have nearly the same problems as the US [1]. I think it lies more in the way we treat folks when they are sick: Turning to opiods instead of other drugs (a combination of ibuprofin and paracet/tylenol is a pretty standard pain treatment here). Not actually giving folks time off when they are sick and injured. Sure, you have the FMLA, but that doesn't exactly let folks pay their bills. We (the US) could also do things like talk to patients and/or their families about ways to handle the pain, what to do if the pain relief wears off, prescribe differently so that it isn't wearing off. We could make sure to have realistic conversations about addiction. And the drug companies could be upfront about this. Lastly, we could provide addiction help, treating it with time off in a manner similar to simply being sick. [1]https://www.washingtonpost.com/news/wonk/wp/2017/03/15/americans-use-far-more-opioids-than-anyone-else-in-the-world/?utm_term=.655ff5f89f55 https://www.washingtonpost.com/news/wonk/wp/2017/03/15/ameri...

heymijo 9y ago

We can conjecture all we'd like, but Sam Quinones wrote a rather definitive history of the opioid epidemic in America. https://www.amazon.com/Dreamland-True-Americas-Opiate-Epidemic/dp/1620402521 https://www.amazon.com/Dreamland-True-Americas-Opiate-Epidem... Sam ran the podcast circuit awhile back if you want to listen to his story. I found out about it via Russ Roberts' Econ Talk. http://www.econtalk.org/archives/2017/01/sam_quinones_on.html http://www.econtalk.org/archives/2017/01/sam_quinones_on.htm...

dilap 9y ago

Our current healthcare system says, hey, if you're poor/out of work/disabled, here's some cash to buy dangerously addictive opiates that will short-term make you feel better. What could go wrong? Here's some blog posts arguing the ACA actually increased the severity of the opioid crisis: https://spottedtoad.wordpress.com/2017/03/27/some-stronger-evidence-that-the-affordable-care-act-worsened-the-opioid-crisis/ https://spottedtoad.wordpress.com/2017/03/27/some-stronger-e... https://spottedtoad.wordpress.com/2017/03/28/its-opioids-not-dying-from-despair-thats-driving-the-obamacare-effect/ https://spottedtoad.wordpress.com/2017/03/28/its-opioids-not... I'm (nevertheeless) pro-universal healthcare, but our idea of healthcare should probably not include these drugs in any but the most extreme and limited circumstances (like, I'm lying in a hospital bed). They're too dangerous. Having doctors actively prescribe them, under incentives from pharma companies to sell them, seems to me predatory in the same way we think of street dealers stalking schoolyards as predatory. Chris Arnade has done a great job documenting the crises at a personal level. I highly recommend checking out some of his articles and tweetstorms. It's gut-wrenching stuff (and obviously the problem goes way deeper than simple access). But pharma/doctors/govt pushing drugs isn't helping, and is probably making it much worse.

kakarot 9y ago
Do you believe a person has the right to acquire and consume whatever drug they want to as long as it does not lead to criminal behavior? Or do you believe we should treat citizens like children who can't be trusted to make their own decisions? Because this is a completely separate issue from overprescription of opiates.
- Broken_Hippo 9y ago
  Let me say upfront: I'm pro-legalization of recreational drugs. Even the ones I wouldn't personally do. I truly believe that with access - especially to things like pot and hash - will seriously help with opiate abuse. And honestly, the correct answer (in my opinion) is that one should do both. As much as I'd like to believe better in society, the truth is that not everyone thinks things through. Not everyone gains information before they do stuff. Some drugs should have restrictions. Age limits are prudent, for example. I don't trust folks to take most prescription drugs correctly. Antibiotics and most treatment-only drugs are like this. I'd rather folks do opium than heroin or opiate pills. If there is still a market for them after legalisation, I'd rather the opiate pills that are available to the public be the mild variety. Push folks to do occasional cocaine rather than crack. Avoid meth if possible, mostly because it is hard on folks. Heroin or anything else that one injects are only available at a clinic, where you have to consume there. And above all, drug addiction treated like a medical condition... and free of charge.

vivekd 9y ago

Maybe but even if all of that were true it has no bearing on pharmaceuticals encouraging irresponsible over-prescribing and over use of their opioid based medication.