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Children of the Opioid Epidemic Are Flooding Foster Homes

dreamdu5t 9y ago
According to Pew Research: "National data doesn’t identify how many children are removed from their homes because of a parent’s substance abuse. And there’s no one standard for how states report substance abuse and child neglect." http://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2016/10/07/drug-addiction-epidemic-creates-crisis-in-foster-care http://www.pewtrusts.org/en/research-and-analysis/blogs/stat...
shams93 9y ago
It's interesting we could be developing whole new non addictive classes of pain killer from cannabis extracts but instead we standardize on oxyconton and opiates. With a beat up, aging population of working people with chronic pain of course it's a perfect storm. But in states that have embraced cannabis we don't see this level of crisis .
- StevePerkins 9y ago
  I think you're seriously downplaying a few variables, to reach a desired conclusion. How many coal mines and textile mills are there in Portland or San Francisco?
  - hirsin 9y ago
    And there's definitely no aging physical labor population in Washington, home of Boeing plants and a massive agricultural industry.
    - StevePerkins 9y ago
      Sure, but skilled machinist work in a Boeing plant isn't even remotely comparable to the forms of unskilled manual labor common to Appalachia. While the strawberry pickers of California's agricultural industry tend to be undocumented immigrants, and one's drug of choice is significantly shaped by demographics. I'm not arguing against the merits of cannabis, mind you. I'm just saying that it's lazy and ridiculous to argue, "We don't have strung-out hillbillies on the Pacific coast. Must be due to the presence of marijuana! (rather than the absence of hillbillies)".
      - rabboRubble 9y ago
        The loggers here might disagree with you.
    - home_boi 9y ago
      The barrier to move and change jobs is much lower
  - deleted 9y ago
    [deleted]
- dreamdu5t 9y ago
  It's a myth that heroin and opiate addiction are the result of pain killer prescriptions: "According to the large, annually repeated and representative National Survey on Drug Use and Health, 75 percent of all opioid misuse starts with people using medication that wasn’t prescribed for them—obtained from a friend, family member or dealer. "
  - throwanem 9y ago
    That certainly is the result of painkiller prescriptions - just not ones written for the person who starts using.
    - deleted 9y ago
      [deleted]
  - myleshenderson 9y ago
    The initial availability of the drugs was from a prescription. If it weren't for the ready availability of the drugs, far fewer people would be addicted.
    - notadoc 9y ago
      People are addicted to pain killers usually because they are dealing with pain, and they are either medicating or self-medicating to manage it. If mere availability of something addictive was the problem, then we'd have a nation of nothing but alcoholics and cigarette smokers considering you can buy either in an unlimited quantity at any corner store.
  - DanBC 9y ago
    that's from https://blogs.scientificamerican.com/mind-guest-blog/opioid-addiction-is-a-huge-problem-but-pain-prescriptions-are-not-the-cause/ https://blogs.scientificamerican.com/mind-guest-blog/opioid-... Which says eg > A Cochrane review of opioid prescribing for chronic pain found that less than one percent of those who were well-screened for drug problems developed new addictions during pain care; a less rigorous, but more recent review put the rate of addiction among people taking opioids for chronic pain at 8-12 percent. Let's have a look at what that Cochrane review says: http://www.cochrane.org/CD006605/SYMPT_opioids-long-term-treatment-noncancer-pain http://www.cochrane.org/CD006605/SYMPT_opioids-long-term-tre... > The findings of this systematic review suggest that proper management of a type of strong painkiller (opioids) in well-selected patients with no history of substance addiction or abuse can lead to long-term pain relief for some patients with a very small (though not zero) risk of developing addiction, abuse, or other serious side effects. However, the evidence supporting these conclusions is weak, and longer-term studies are needed to identify the patients who are most likely to benefit from treatment. This tells us that the carefully selected patients were not getting pain relief or had too many side effects; (a third dropped out because of these) and we can't say too much about addiction because not all the studies reported it: "Signs of opioid addiction were reported in 0.27% of participants in the studies that reported that outcome" It's hard to see that 0.27% (with who knows how many unreported cases of addiction) and that later 8-12% in the same paragraph. > Moreover, a study of nearly 136,000 opioid overdose victims treated in the emergency room in 2010, which was published in JAMA Internal Medicine in 2014 found that just 13 percent had a chronic pain condition. I mean, doesn't that tell you there's a massive problem with prescribing? > recent research on roughly one million insurance claims for opioid prescriptions showed that just less than five percent of patients misused the drugs by getting prescriptions for them from multiple doctors. THat para links to a document called "THE OPIOID CRISIS IN AMERICA'S WORKFORCE" http://www.castlighthealth.com/typ/the-opioid-crisis/ http://www.castlighthealth.com/typ/the-opioid-crisis/ The first para of that report says: > The use and abuse of prescription opioids continues to be a challenging and costly crisis for the U.S. The facts underscore the severity of this crisis: > • Nearly 2 million Americans are abusing prescription opioids1 > • 16,000 people die every year from prescription opioid overdoses2 > • Sales of opioid prescriptions in the U.S. nearly quadrupled from 1999 to 20103 > • 259 million opioid prescriptions were written in 2012, enough for every American adult to have their own bottle of pills4 That Scientific American writer has misrepresented every source so far. For fuck's sake, that last link specifically says: > One out of every three (32%) opioid prescriptions is being abused.
- throwanem 9y ago
  Transparently tendentious reasoning of this sort fails to serve your turn, and that's especially regrettable in this case because I agree with you that we would be very well served to look for means of addressing severe and chronic pain that don't involve the most addictive class of drugs known to man. I would esteem it a kindness of you to find a way of advancing your thesis that does more to support it than, by retreat into intellectually dishonest tactics, to make it look indefensible.
- notadoc 9y ago
  > but instead we standardize on oxyconton and opiates That's because oxycontin and opiates work for relieving pain. > But in states that have embraced cannabis we don't see this level of crisis . That's a baseless claim that couldn't be further from the truth. Take a walk around SF, LA, Seattle, Portland, etc, there are tons of strung out junkies laying around on the streets surrounded by needles. The existence of painkillers are not the reason we have drug addicts.
  - DanBC 9y ago
    > That's because oxycontin and opiates work for relieving pain. They do not work for relieving long term pain. https://www.fpm.ac.uk/faculty-of-pain-medicine/opioids-aware https://www.fpm.ac.uk/faculty-of-pain-medicine/opioids-aware > > 1. Opioids are very good analgesics for acute pain and for pain at the end of life but there is little evidence that they are helpful for long term pain > > 2. A small proportion of people may obtain good pain relief with opioids in the long-term if the dose can be kept low and especially if their use is intermittent (however it is difficult to identify these people at the point of opioid initiation). > The existence of painkillers are not the reason we have drug addicts. This is just untrue. Please provide a valid source.
    - notadoc 9y ago
      Your own citation disputes your opinion and claim. > This is just untrue. Oh are you saying this from your own research or clinical experience? Do you work directly with persistent pain patients? Are you an anesthesiologist? Or are you just Doctor Google?
      - DanBC 9y ago
        > Your own citation disputes your opinion and claim. I'm confused, please can you point out where my citation disputes my claim? Also, can you provide a citation?
    - Powerofmene 9y ago
      It seems that if opioids and opiates did not relieve long term pain the entire pain management industry would implode because health insurance would not pay for the millions of prescription pain management doctors write. I have my own opinions about pain management doctors but that aside' insurance companies are very quick to deny something with no medical benefit or no medical basis for the prescription/procedure. I know people with debilitating pain that have been on pain melds for over a decade and while the medications do not make the pain disappear it makes it manageable. Some people are not candidates for surgery and have to manage with medications. Bottom line though, individuals who have been using these drugs for so long whether for a legitimate reason or not suffer from memory issues, fatigue, irritability, impulse control, etc and those factors can certainly have an impact on children.
DanBC 9y ago
> Given the scale of the crisis, it’s not hard to understand why, when Donald Trump promised Ohioans on the campaign trail to “spend the money” to confront the opioid crisis and build a wall so drugs would stop flowing in, Have a look at this document with data from 2009. Compare usage rates in Americans for opiates with opioids with prescription opioids: http://www.unodc.org/documents/data-and-analysis/WDR2011/StatAnnex-consumption.pdf http://www.unodc.org/documents/data-and-analysis/WDR2011/Sta... Annual Prevalence of use as a percentage of the population aged 15-64 for the year 2009 Opioids 5.90% Opiates 0.57% Prescription Opioids 5.60% Those drugs are being prescribed by doctors. The cause is not illicit drugs from outside the US. The cause is the terrible healthcare for pain. Illicit fentanyl coming in from outside the US now is just a symptom - stopping that fentanyl will prevent death (because it's a very dangerous opioid) but it won't do anything about the real problem: people in pain with inadequate treatment for that pain.
- notadoc 9y ago
  > it won't do anything about the real problem: people in pain with inadequate treatment for that pain. Careful, you're sounding awfully reasonable! Harassing doctors and patients is beyond stupid, I suspect it will result in even more people turning to illegal drugs to self-medicate once their personal doctor gets some external political/media pressure to stop prescribing anything effective.
- throwaway91111 9y ago
  Also, fentanyl, which is a major illicit opiate source, mainly comes from china. A wall could have no effect at all; and in fact could spur more deaths if people turn to fentanyl.
rhspeer 9y ago
Contimplating fostering a computer nerd to do QA. I believe that is how the old apprenticeships worked. Would also move out with a savings, a marketable skill, and references at 18. Not a bad start for a Dev.
- rhspeer 9y ago
  Huh, down votes signal it is reasonable to want a pet human, but not an apprentice?
notadoc 9y ago
The "opioid epidemic" is manufactured political and media hysteria. There have always been drug addicts. The end result to all of this hysteria will be nothing but more political interference in doctor-patient relationships, more annoying obstacles and hoops for patients to jump through, and more suffering for patients.
- veeberz 9y ago
  If you'd cared to talk to people outside your bubble, then you might've had a different opinion. And besides, the fact that there are people exploiting a crisis doesn't mean that the crisis was manufactured.
  - notadoc 9y ago
    Don't assume because you are in a bubble that others are too.
- DanBC 9y ago
  It really, honestly, is not manufactured outrage. https://www.vox.com/policy-and-politics/2017/6/28/15881246/drug-overdose-deaths-world https://www.vox.com/policy-and-politics/2017/6/28/15881246/d... > America has about 4 percent of the world’s population — but about 27 percent of the world’s drug overdose deaths The US uses far more opioids than any other country. Does the US have far more pain than any other country? > and more suffering for patients. No. You seem to think that opioids are an effective treatment for long term pain. They usually are not. The patient either stops taking them because of side effects, and is still in pain. Or the patient develops a tolerance, and needs to take more and more, and is now addicted to opioids and taking dangerously large amounts of opioids and, importantly, is still in pain. People with long term pain need rapid access to a specialist pain management clinic. Opioids might be a choice of treatment, but they will be carefully prescribed, not dished out.
  - notadoc 9y ago
    > You seem to think that opioids are an effective treatment for long term pain Because it can be. In many cases of severe persistent pain, they are the only effective treatment. There are many situations where literally nothing else works save for anesthetic infusions. > and is now addicted to opioids Those patients and doctors are making the determination that addiction is better than the alternative. Why is anyones business if that is what they decide? Frankly being addicted to a prescription painkiller is not any different from addiction to ADHD medication, a benzodiazepine (which are far worse in terms of addiction, withdrawal, and consequence), or an anti-depressant. > People with long term pain need rapid access to a specialist pain management clinic. Sure. But do you expect a patient to come back every 6 hours for another lidocaine injection? What do you think they do in pain management clinics? If you think the side effects of an opiate are bad wait until you see people on heavy gabapentin or benzodiazepenes as 'alternatives', who, btw are getting practically no relief from their pain at all but are heavily medicated.
paulddraper 9y ago
I'm a foster parent, and this is definitely a real thing. My state recently went into crisis mode for foster care, where they struggled placing kids and filled up the group facility they normal use for short term overflow. They're starting a program specializing in short-term placements. Opioids have been blamed for the recent increases. http://fox13now.com/2017/05/12/resources-stretched-thin-as-more-children-entering-foster-care-in-utah-than-ever-before/ http://fox13now.com/2017/05/12/resources-stretched-thin-as-m... And this is in a state (Utah) with an already relatively low rate of children in state custody. Surely if we are struggling, other states must be as well. I don't know what politics to sorry or what macro policy changes will "fix" this, but I know how I can help. Circumstances vary, but if yours permit you to do foster care, I recommend looking seriously at it.
- ericabiz 9y ago
  Can you say more here or offer some links on what it's like to be a foster parent? I'm adopted and had to deal with some ACEs, and being a foster parent really does call to me. My dad was an attorney and also volunteered to help with foster kids, so I had exposure to them as a child. I want to look more into it. Also, if you have biological kids of your own, how did they deal with foster kids? I have a daughter and would like to have another bio child as well.
  - esthercrawford 9y ago
    I fostered for nearly 2 years, and ended up adopting my foster daughter who was just a few weeks shy of her 7th birthday. I had a 1 yr old bio son when she joined the family. I’d say what worked best for me was doing the very hard and frustrating process of building trust between me and her birth mom & family. It was at times maddening but so worth it for her. Especially since the system itself is broken. My son was actually a plus - she was able to bond with him first and I believe that enabled her to then trust and bond with us. Now she’s 12 and is amazing. I feel like the luckiest mom in the world to be able to spend my life with her.
  - paulddraper 9y ago
    My mother was in foster care, some good, some bad, and that was a motivator for me to do it. We don't do foster-to-adopt. We do the other kinds: for situations where the goal is still reunification, or adoption by a family member. Biologically, we have a two-year-old daughter , three-year-old son, and a son on the way. We have the right to know the history of placements and say yes/no to each one. Our foster care rep knows that we can't (won't) take aggressive children or children over 12, because we gave young kids. We also only do Level 1 care. (There are three levels in our state for rating behavioral and handicapped difficulty. Levels 2 and 3 require extra training.) We do, however, take sibling groups. Our bio kids LOVE having foster kids. They now think that any friends they make should live at our house, because their other ones do. I don't have any foster horror stories though I've heard plenty of course. We've been lucky enough to have remarkably well-adjusted kids. I think poor circumstances often demands increased maturity. IMO, the hardest people to deal with are the parents, not the kids. Getting licensed involved 30 hours of in person training over a few months, a few hours online training, a house inspection (fire extinguisher, escape latter, handrails on stairs), and an interview with very personal questions (e.g. if you're married, "Have you ever considered divorce?"). The hardest parts of parenting are also the hardest parts of foster parenting. So I would expect a biological parent to have a pretty solid idea of what foster parenting would be like.
ransom1538 9y ago
What bothers me about this epidemic is how easy it could be for authorities to stop. Fentanyl isn't created in the back of a motor home. It is a manufactured and controlled narcotic. How controlled - just see the link below. All that needs to happen is for the DEA (et al) to stop raiding homes and torturing people and to pay a visit to these out of control doctors. Why a "Nurse Practitioner" is allowed to prescribe opioids 21937 times - wtf? Opioid prescribing is totally open and public - they aren't hiding it. Here I have a list of the highest prescribing opioid doctors (sunday with beer project): https://www.opendoctor.io/opioid/highest https://www.opendoctor.io/opioid/highest (let me know if you want the sql or whatever).
- marcoperaza 9y ago
  I remember that about a decade ago, doctors and others were criticizing the DEA for being draconian in their regulations surrounding opiate prescriptions. They were complaining that doctors often felt that they couldn't prescribe even when there was legitimate need. I don't know what happened in the interim, whether or how the DEA's policies changed, but if only we had draconian DEA policies aggressively stopping overprescription now. As someone who used to naively believe in legalizing all drugs for recreational use, this addiction epidemic has opened my eyes to why that's a horrible idea.
  - DanBC 9y ago
    > I don't know what happened in the interim The VA noticed a lot of people had untreated pain. They pushed a campaign to make pain the fifth vital sign. Every time someone went into a hospital they'd be asked about pain. Pain was seen as something that absolutely must be treated. They also said that opioids are not addictive if prescribed for pain. It turns out that both of these are mostly wrong. If someone is in pain they'll tell you, you don't need to ask. And if someone has chronic pain they can become addicted to opioids. The VA withdrew that document. Here's a Google cache: https://webcache.googleusercontent.com/search?q=cache:pUQ-mcAJtGwJ:https://www.va.gov/PAINMANAGEMENT/docs/Pain_As_the_5th_Vital_Sign_Toolkit.pdf+&cd=1&hl=en&ct=clnk&gl=uk https://webcache.googleusercontent.com/search?q=cache:pUQ-mc... We knew some time ago that it didn't help. Here's a report from 2006: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1924634/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1924634/
deleted 9y ago
[deleted]
pasbesoin 9y ago
I spent the first half of 2016 helping a drug and alcohol addict kick her habit of 20+ years. 6 days inpatient detox. Would have had 30 days rehab if she'd stuck with it. Had lost her driver's license years ago. So after she checked herself out (admittedly, upon my investigating, for some legitimate reasons vis a vis that program), I spent the next couple of months driving her to meetings, providing childcare to make that possible, helping her get to the job her sister found her, then the second job. Making sure she wasn't alone in the evenings, when she would drink... My major point. 6 days at one of the area's premier hospitals. Thanks to the ACA expansion of Medicaid. The rehab program would have gone under that, as well. Foodstamps for her and her kids. A social worker and case management for her daughter (living with grandma). Etc. Etc. I had some warning signs, early on, but I hung in there -- advice from experienced friends and experts advising patience. And thinking not just of her, but of the kids; things seemed to gradually get better with them once I got involved. Anyway... Not just my support. All this public support. That I don't begrudge: Treat the problem. Take care of the kids. Come fall, she's back together with her ex-boyfriend, who was a big Cruz supporter. ("The Constitution! La la la, blah blah blah...") And she -- previously having stated her indifference to politics, except for hating Hillary for whatever gut felt reason -- starts expressing herself as a big Trump supporter. I'd explained to her, early on, that the ACA is what enabled me to keep insurance. I don't get a tax break. It just gives me the opportunity to participate, whereas before insurance companies would look for any pimple as the basis to exclude me. She gained sobriety through the support of the State, and someone who depends on the ACA for his own well-being. None of that seems to matter to her. This experience has caused me to fundamentally rethink my ideas about how the world works and how we can (or can't) tackle these problems. Writing about all this makes me feel kind of small. Laying the situation out there and sounding aggrieved. But I do it, all the same, for the point it impressed upon me: I'm no longer sure some people can be reached, through any level of action and good will. It's a pretty sobering -- and saddening -- perspective. P.S. We've been out of touch for months -- her choice. As far as I know, she's still sober. Making plans a year out. She's doing ok. But there seems to be no connection in her mind with providing that opportunity to others. I've been forced to realize and acknowledge that some people appear to be in it purely for themselves. They can exhibit charm and engagement in furtherance of this purpose. But real empathy and cooperation? And, looking around, it's not just the addicts and "miscreants". There's a significant portion of the population who really does believe and follow "I got mine". And that is all they really respect in others. It is, it turns out, a dog eat dog world. At least when it comes to dealing with these people. Who, en masse, present a formidable problem to a functioning society.

According to Pew Research: "National data doesn’t identify how many children are removed from their homes because of a parent’s substance abuse. And there’s no one standard for how states report substance abuse and child neglect." http://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2016/10/07/drug-addiction-epidemic-creates-crisis-in-foster-care http://www.pewtrusts.org/en/research-and-analysis/blogs/stat...

shams93 9y ago

It's interesting we could be developing whole new non addictive classes of pain killer from cannabis extracts but instead we standardize on oxyconton and opiates. With a beat up, aging population of working people with chronic pain of course it's a perfect storm. But in states that have embraced cannabis we don't see this level of crisis .

StevePerkins 9y ago
I think you're seriously downplaying a few variables, to reach a desired conclusion. How many coal mines and textile mills are there in Portland or San Francisco?
- hirsin 9y ago
  And there's definitely no aging physical labor population in Washington, home of Boeing plants and a massive agricultural industry.
  - StevePerkins 9y ago
    Sure, but skilled machinist work in a Boeing plant isn't even remotely comparable to the forms of unskilled manual labor common to Appalachia. While the strawberry pickers of California's agricultural industry tend to be undocumented immigrants, and one's drug of choice is significantly shaped by demographics. I'm not arguing against the merits of cannabis, mind you. I'm just saying that it's lazy and ridiculous to argue, "We don't have strung-out hillbillies on the Pacific coast. Must be due to the presence of marijuana! (rather than the absence of hillbillies)".
    - rabboRubble 9y ago
      The loggers here might disagree with you.
  - home_boi 9y ago
    The barrier to move and change jobs is much lower
- deleted 9y ago
  [deleted]
dreamdu5t 9y ago
It's a myth that heroin and opiate addiction are the result of pain killer prescriptions: "According to the large, annually repeated and representative National Survey on Drug Use and Health, 75 percent of all opioid misuse starts with people using medication that wasn’t prescribed for them—obtained from a friend, family member or dealer. "
- throwanem 9y ago
  That certainly is the result of painkiller prescriptions - just not ones written for the person who starts using.
  - deleted 9y ago
    [deleted]
- myleshenderson 9y ago
  The initial availability of the drugs was from a prescription. If it weren't for the ready availability of the drugs, far fewer people would be addicted.
  - notadoc 9y ago
    People are addicted to pain killers usually because they are dealing with pain, and they are either medicating or self-medicating to manage it. If mere availability of something addictive was the problem, then we'd have a nation of nothing but alcoholics and cigarette smokers considering you can buy either in an unlimited quantity at any corner store.
- DanBC 9y ago
  that's from https://blogs.scientificamerican.com/mind-guest-blog/opioid-addiction-is-a-huge-problem-but-pain-prescriptions-are-not-the-cause/ https://blogs.scientificamerican.com/mind-guest-blog/opioid-... Which says eg > A Cochrane review of opioid prescribing for chronic pain found that less than one percent of those who were well-screened for drug problems developed new addictions during pain care; a less rigorous, but more recent review put the rate of addiction among people taking opioids for chronic pain at 8-12 percent. Let's have a look at what that Cochrane review says: http://www.cochrane.org/CD006605/SYMPT_opioids-long-term-treatment-noncancer-pain http://www.cochrane.org/CD006605/SYMPT_opioids-long-term-tre... > The findings of this systematic review suggest that proper management of a type of strong painkiller (opioids) in well-selected patients with no history of substance addiction or abuse can lead to long-term pain relief for some patients with a very small (though not zero) risk of developing addiction, abuse, or other serious side effects. However, the evidence supporting these conclusions is weak, and longer-term studies are needed to identify the patients who are most likely to benefit from treatment. This tells us that the carefully selected patients were not getting pain relief or had too many side effects; (a third dropped out because of these) and we can't say too much about addiction because not all the studies reported it: "Signs of opioid addiction were reported in 0.27% of participants in the studies that reported that outcome" It's hard to see that 0.27% (with who knows how many unreported cases of addiction) and that later 8-12% in the same paragraph. > Moreover, a study of nearly 136,000 opioid overdose victims treated in the emergency room in 2010, which was published in JAMA Internal Medicine in 2014 found that just 13 percent had a chronic pain condition. I mean, doesn't that tell you there's a massive problem with prescribing? > recent research on roughly one million insurance claims for opioid prescriptions showed that just less than five percent of patients misused the drugs by getting prescriptions for them from multiple doctors. THat para links to a document called "THE OPIOID CRISIS IN AMERICA'S WORKFORCE" http://www.castlighthealth.com/typ/the-opioid-crisis/ http://www.castlighthealth.com/typ/the-opioid-crisis/ The first para of that report says: > The use and abuse of prescription opioids continues to be a challenging and costly crisis for the U.S. The facts underscore the severity of this crisis: > • Nearly 2 million Americans are abusing prescription opioids1 > • 16,000 people die every year from prescription opioid overdoses2 > • Sales of opioid prescriptions in the U.S. nearly quadrupled from 1999 to 20103 > • 259 million opioid prescriptions were written in 2012, enough for every American adult to have their own bottle of pills4 That Scientific American writer has misrepresented every source so far. For fuck's sake, that last link specifically says: > One out of every three (32%) opioid prescriptions is being abused.
throwanem 9y ago
Transparently tendentious reasoning of this sort fails to serve your turn, and that's especially regrettable in this case because I agree with you that we would be very well served to look for means of addressing severe and chronic pain that don't involve the most addictive class of drugs known to man. I would esteem it a kindness of you to find a way of advancing your thesis that does more to support it than, by retreat into intellectually dishonest tactics, to make it look indefensible.
notadoc 9y ago
> but instead we standardize on oxyconton and opiates That's because oxycontin and opiates work for relieving pain. > But in states that have embraced cannabis we don't see this level of crisis . That's a baseless claim that couldn't be further from the truth. Take a walk around SF, LA, Seattle, Portland, etc, there are tons of strung out junkies laying around on the streets surrounded by needles. The existence of painkillers are not the reason we have drug addicts.
- DanBC 9y ago
  > That's because oxycontin and opiates work for relieving pain. They do not work for relieving long term pain. https://www.fpm.ac.uk/faculty-of-pain-medicine/opioids-aware https://www.fpm.ac.uk/faculty-of-pain-medicine/opioids-aware > > 1. Opioids are very good analgesics for acute pain and for pain at the end of life but there is little evidence that they are helpful for long term pain > > 2. A small proportion of people may obtain good pain relief with opioids in the long-term if the dose can be kept low and especially if their use is intermittent (however it is difficult to identify these people at the point of opioid initiation). > The existence of painkillers are not the reason we have drug addicts. This is just untrue. Please provide a valid source.
  - notadoc 9y ago
    Your own citation disputes your opinion and claim. > This is just untrue. Oh are you saying this from your own research or clinical experience? Do you work directly with persistent pain patients? Are you an anesthesiologist? Or are you just Doctor Google?
    - DanBC 9y ago
      > Your own citation disputes your opinion and claim. I'm confused, please can you point out where my citation disputes my claim? Also, can you provide a citation?
  - Powerofmene 9y ago
    It seems that if opioids and opiates did not relieve long term pain the entire pain management industry would implode because health insurance would not pay for the millions of prescription pain management doctors write. I have my own opinions about pain management doctors but that aside' insurance companies are very quick to deny something with no medical benefit or no medical basis for the prescription/procedure. I know people with debilitating pain that have been on pain melds for over a decade and while the medications do not make the pain disappear it makes it manageable. Some people are not candidates for surgery and have to manage with medications. Bottom line though, individuals who have been using these drugs for so long whether for a legitimate reason or not suffer from memory issues, fatigue, irritability, impulse control, etc and those factors can certainly have an impact on children.

DanBC 9y ago

> Given the scale of the crisis, it’s not hard to understand why, when Donald Trump promised Ohioans on the campaign trail to “spend the money” to confront the opioid crisis and build a wall so drugs would stop flowing in, Have a look at this document with data from 2009. Compare usage rates in Americans for opiates with opioids with prescription opioids: http://www.unodc.org/documents/data-and-analysis/WDR2011/StatAnnex-consumption.pdf http://www.unodc.org/documents/data-and-analysis/WDR2011/Sta... Annual Prevalence of use as a percentage of the population aged 15-64 for the year 2009 Opioids 5.90% Opiates 0.57% Prescription Opioids 5.60% Those drugs are being prescribed by doctors. The cause is not illicit drugs from outside the US. The cause is the terrible healthcare for pain. Illicit fentanyl coming in from outside the US now is just a symptom - stopping that fentanyl will prevent death (because it's a very dangerous opioid) but it won't do anything about the real problem: people in pain with inadequate treatment for that pain.

notadoc 9y ago
> it won't do anything about the real problem: people in pain with inadequate treatment for that pain. Careful, you're sounding awfully reasonable! Harassing doctors and patients is beyond stupid, I suspect it will result in even more people turning to illegal drugs to self-medicate once their personal doctor gets some external political/media pressure to stop prescribing anything effective.
throwaway91111 9y ago
Also, fentanyl, which is a major illicit opiate source, mainly comes from china. A wall could have no effect at all; and in fact could spur more deaths if people turn to fentanyl.

rhspeer 9y ago

Contimplating fostering a computer nerd to do QA. I believe that is how the old apprenticeships worked. Would also move out with a savings, a marketable skill, and references at 18. Not a bad start for a Dev.

rhspeer 9y ago
Huh, down votes signal it is reasonable to want a pet human, but not an apprentice?

notadoc 9y ago

The "opioid epidemic" is manufactured political and media hysteria. There have always been drug addicts. The end result to all of this hysteria will be nothing but more political interference in doctor-patient relationships, more annoying obstacles and hoops for patients to jump through, and more suffering for patients.

veeberz 9y ago
If you'd cared to talk to people outside your bubble, then you might've had a different opinion. And besides, the fact that there are people exploiting a crisis doesn't mean that the crisis was manufactured.
- notadoc 9y ago
  Don't assume because you are in a bubble that others are too.
DanBC 9y ago
It really, honestly, is not manufactured outrage. https://www.vox.com/policy-and-politics/2017/6/28/15881246/drug-overdose-deaths-world https://www.vox.com/policy-and-politics/2017/6/28/15881246/d... > America has about 4 percent of the world’s population — but about 27 percent of the world’s drug overdose deaths The US uses far more opioids than any other country. Does the US have far more pain than any other country? > and more suffering for patients. No. You seem to think that opioids are an effective treatment for long term pain. They usually are not. The patient either stops taking them because of side effects, and is still in pain. Or the patient develops a tolerance, and needs to take more and more, and is now addicted to opioids and taking dangerously large amounts of opioids and, importantly, is still in pain. People with long term pain need rapid access to a specialist pain management clinic. Opioids might be a choice of treatment, but they will be carefully prescribed, not dished out.
- notadoc 9y ago
  > You seem to think that opioids are an effective treatment for long term pain Because it can be. In many cases of severe persistent pain, they are the only effective treatment. There are many situations where literally nothing else works save for anesthetic infusions. > and is now addicted to opioids Those patients and doctors are making the determination that addiction is better than the alternative. Why is anyones business if that is what they decide? Frankly being addicted to a prescription painkiller is not any different from addiction to ADHD medication, a benzodiazepine (which are far worse in terms of addiction, withdrawal, and consequence), or an anti-depressant. > People with long term pain need rapid access to a specialist pain management clinic. Sure. But do you expect a patient to come back every 6 hours for another lidocaine injection? What do you think they do in pain management clinics? If you think the side effects of an opiate are bad wait until you see people on heavy gabapentin or benzodiazepenes as 'alternatives', who, btw are getting practically no relief from their pain at all but are heavily medicated.

paulddraper 9y ago

I'm a foster parent, and this is definitely a real thing. My state recently went into crisis mode for foster care, where they struggled placing kids and filled up the group facility they normal use for short term overflow. They're starting a program specializing in short-term placements. Opioids have been blamed for the recent increases. http://fox13now.com/2017/05/12/resources-stretched-thin-as-more-children-entering-foster-care-in-utah-than-ever-before/ http://fox13now.com/2017/05/12/resources-stretched-thin-as-m... And this is in a state (Utah) with an already relatively low rate of children in state custody. Surely if we are struggling, other states must be as well. I don't know what politics to sorry or what macro policy changes will "fix" this, but I know how I can help. Circumstances vary, but if yours permit you to do foster care, I recommend looking seriously at it.

ericabiz 9y ago
Can you say more here or offer some links on what it's like to be a foster parent? I'm adopted and had to deal with some ACEs, and being a foster parent really does call to me. My dad was an attorney and also volunteered to help with foster kids, so I had exposure to them as a child. I want to look more into it. Also, if you have biological kids of your own, how did they deal with foster kids? I have a daughter and would like to have another bio child as well.
- esthercrawford 9y ago
  I fostered for nearly 2 years, and ended up adopting my foster daughter who was just a few weeks shy of her 7th birthday. I had a 1 yr old bio son when she joined the family. I’d say what worked best for me was doing the very hard and frustrating process of building trust between me and her birth mom & family. It was at times maddening but so worth it for her. Especially since the system itself is broken. My son was actually a plus - she was able to bond with him first and I believe that enabled her to then trust and bond with us. Now she’s 12 and is amazing. I feel like the luckiest mom in the world to be able to spend my life with her.
- paulddraper 9y ago
  My mother was in foster care, some good, some bad, and that was a motivator for me to do it. We don't do foster-to-adopt. We do the other kinds: for situations where the goal is still reunification, or adoption by a family member. Biologically, we have a two-year-old daughter , three-year-old son, and a son on the way. We have the right to know the history of placements and say yes/no to each one. Our foster care rep knows that we can't (won't) take aggressive children or children over 12, because we gave young kids. We also only do Level 1 care. (There are three levels in our state for rating behavioral and handicapped difficulty. Levels 2 and 3 require extra training.) We do, however, take sibling groups. Our bio kids LOVE having foster kids. They now think that any friends they make should live at our house, because their other ones do. I don't have any foster horror stories though I've heard plenty of course. We've been lucky enough to have remarkably well-adjusted kids. I think poor circumstances often demands increased maturity. IMO, the hardest people to deal with are the parents, not the kids. Getting licensed involved 30 hours of in person training over a few months, a few hours online training, a house inspection (fire extinguisher, escape latter, handrails on stairs), and an interview with very personal questions (e.g. if you're married, "Have you ever considered divorce?"). The hardest parts of parenting are also the hardest parts of foster parenting. So I would expect a biological parent to have a pretty solid idea of what foster parenting would be like.

ransom1538 9y ago

What bothers me about this epidemic is how easy it could be for authorities to stop. Fentanyl isn't created in the back of a motor home. It is a manufactured and controlled narcotic. How controlled - just see the link below. All that needs to happen is for the DEA (et al) to stop raiding homes and torturing people and to pay a visit to these out of control doctors. Why a "Nurse Practitioner" is allowed to prescribe opioids 21937 times - wtf? Opioid prescribing is totally open and public - they aren't hiding it. Here I have a list of the highest prescribing opioid doctors (sunday with beer project): https://www.opendoctor.io/opioid/highest https://www.opendoctor.io/opioid/highest (let me know if you want the sql or whatever).

marcoperaza 9y ago
I remember that about a decade ago, doctors and others were criticizing the DEA for being draconian in their regulations surrounding opiate prescriptions. They were complaining that doctors often felt that they couldn't prescribe even when there was legitimate need. I don't know what happened in the interim, whether or how the DEA's policies changed, but if only we had draconian DEA policies aggressively stopping overprescription now. As someone who used to naively believe in legalizing all drugs for recreational use, this addiction epidemic has opened my eyes to why that's a horrible idea.
- DanBC 9y ago
  > I don't know what happened in the interim The VA noticed a lot of people had untreated pain. They pushed a campaign to make pain the fifth vital sign. Every time someone went into a hospital they'd be asked about pain. Pain was seen as something that absolutely must be treated. They also said that opioids are not addictive if prescribed for pain. It turns out that both of these are mostly wrong. If someone is in pain they'll tell you, you don't need to ask. And if someone has chronic pain they can become addicted to opioids. The VA withdrew that document. Here's a Google cache: https://webcache.googleusercontent.com/search?q=cache:pUQ-mcAJtGwJ:https://www.va.gov/PAINMANAGEMENT/docs/Pain_As_the_5th_Vital_Sign_Toolkit.pdf+&cd=1&hl=en&ct=clnk&gl=uk https://webcache.googleusercontent.com/search?q=cache:pUQ-mc... We knew some time ago that it didn't help. Here's a report from 2006: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1924634/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1924634/

deleted 9y ago

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pasbesoin 9y ago

I spent the first half of 2016 helping a drug and alcohol addict kick her habit of 20+ years. 6 days inpatient detox. Would have had 30 days rehab if she'd stuck with it. Had lost her driver's license years ago. So after she checked herself out (admittedly, upon my investigating, for some legitimate reasons vis a vis that program), I spent the next couple of months driving her to meetings, providing childcare to make that possible, helping her get to the job her sister found her, then the second job. Making sure she wasn't alone in the evenings, when she would drink... My major point. 6 days at one of the area's premier hospitals. Thanks to the ACA expansion of Medicaid. The rehab program would have gone under that, as well. Foodstamps for her and her kids. A social worker and case management for her daughter (living with grandma). Etc. Etc. I had some warning signs, early on, but I hung in there -- advice from experienced friends and experts advising patience. And thinking not just of her, but of the kids; things seemed to gradually get better with them once I got involved. Anyway... Not just my support. All this public support. That I don't begrudge: Treat the problem. Take care of the kids. Come fall, she's back together with her ex-boyfriend, who was a big Cruz supporter. ("The Constitution! La la la, blah blah blah...") And she -- previously having stated her indifference to politics, except for hating Hillary for whatever gut felt reason -- starts expressing herself as a big Trump supporter. I'd explained to her, early on, that the ACA is what enabled me to keep insurance. I don't get a tax break. It just gives me the opportunity to participate, whereas before insurance companies would look for any pimple as the basis to exclude me. She gained sobriety through the support of the State, and someone who depends on the ACA for his own well-being. None of that seems to matter to her. This experience has caused me to fundamentally rethink my ideas about how the world works and how we can (or can't) tackle these problems. Writing about all this makes me feel kind of small. Laying the situation out there and sounding aggrieved. But I do it, all the same, for the point it impressed upon me: I'm no longer sure some people can be reached, through any level of action and good will. It's a pretty sobering -- and saddening -- perspective. P.S. We've been out of touch for months -- her choice. As far as I know, she's still sober. Making plans a year out. She's doing ok. But there seems to be no connection in her mind with providing that opportunity to others. I've been forced to realize and acknowledge that some people appear to be in it purely for themselves. They can exhibit charm and engagement in furtherance of this purpose. But real empathy and cooperation? And, looking around, it's not just the addicts and "miscreants". There's a significant portion of the population who really does believe and follow "I got mine". And that is all they really respect in others. It is, it turns out, a dog eat dog world. At least when it comes to dealing with these people. Who, en masse, present a formidable problem to a functioning society.