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> Perhaps you could include poverty and despair (and trace back from there to a collapsing education system, ideological pathology...). It's really not about t

> Perhaps you could include poverty and despair (and trace back from there to a collapsing education system, ideological pathology...). It's really not about that -- although that certainly contributes to some drug use. "The opioid epidemic began in the 1990s, when doctors became increasingly aware of the burdens of chronic pain. Pharmaceutical companies saw an opportunity, and pushed doctors — with misleading marketing about the safety and efficacy of the drugs — to prescribe opioids to treat all sorts of pain. Doctors, many exhausted by dealing with difficult-to-treat pain patients, complied — in some states, writing enough prescriptions to fill a bottle of pills for each resident." This is not about people in poverty turning to drugs -- this is about people in pain going to the doctor, and being prescribed an addictive, dangerous substance as treatment. "Over the past couple of decades, the health care system, bolstered by pharmaceutical companies, flooded the US with painkillers. Then illicit drug traffickers followed suit, inundating the country with heroin and other illegally produced opioids that people could use once they ran out of painkillers or wanted something stronger. "The other opioids arguably pose even bigger risks than painkillers. Heroin is generally more potent, so it’s more addictive and more likely to cause overdose. And fentanyl is even more potent than heroin, and it’s also often laced into illicitly sold heroin without a user’s knowledge — increasing the odds he’ll take a much bigger dose than he can handle. "The result is that as opioid painkiller deaths leveled off over the past few years, heroin and fentanyl deaths have rapidly increased." https://www.vox.com/science-and-health/2017/8/3/16079772/opioid-epidemic-drug-overdoses https://www.vox.com/science-and-health/2017/8/3/16079772/opi...

jdietrich 9y ago
Chronic pain is strongly correlated with poverty and low educational attainment. You can't separate medical, social and economic factors - they're far too deeply intertwined. https://www.ncbi.nlm.nih.gov/pubmed/28092650 https://www.ncbi.nlm.nih.gov/pubmed/28092650
- frozenport 9y ago
  You can because some poorer countries don't have an opiod epedimic. For example, opiod use is higher in West Virginia than Mexico. Certainly true that comparative poverty plays a role but we need to first hold accountable those directly responsible. http://geocurrents.info/wp-content/uploads/2012/05/Per-Capita-Opiate-Use-Map.jpg http://geocurrents.info/wp-content/uploads/2012/05/Per-Capit...
  - jdietrich 9y ago
    Overprescribing is undoubtedly a key part of the problem, but so is poverty. The opioid epidemic is having a vastly disproportionate effect on poor communities, in large part because poor people are vastly disproportionately likely to suffer from chronic pain. Doctors didn't cause the crack epidemic in the 80s. We can't isolate any single factor, but must consider the problem in a holistic manner. Fixing the problem of overprescribing is a really important step, but the problems of poverty and addiction won't just disappear if we stop dishing out vicodin and oxcycontin.
    - Retric 9y ago
      There are several issues around that association that have little direct connections to poverty rather than more US specific issues. First lack of medical care to fix or prevent the underlying causes of much chronic pain. The second is a tendency to prescribe opiods to poor populations rather than focusing on less addictive medications. Further, non chronic pain can transform into chronic pain as Opiod uses/addiction increases pain sensitivity. Combine the above and poor healthcare more directly links to Opiod addiction than you're suggesting. EX: Mildly Injured > no medical care > working while Injured due to lack of sick leave > more significant problem > prescribed Opiod's vs surgery > addiction.
Theodores 9y ago
If I was given an infinite supply of free heroin and all the time in the world to sell it to my neighbours, friends, family, workmates and anyone else in the locality then I would struggle to make a sale. My client base would be zero and I would have to go back to the day job. If you rewind America to before the opioid epidemic then that would be the situation for anyone aspiring to sell heroin in normal America. The demand would not have been there, you would need to get a sizeable community onto crack cocaine before they need heroin too. The prescription drugs and how that worked out has changed the demand side of the situation. So it is not a matter of some external evil drug kingpins dumping vast quantities of cheap heroin onto the innocent U.S. market, it is more the vast quantities of Americans doing whatever they can to get their fix.
- KGIII 9y ago
  Err... Heroin was available before the current epidemic. It was easy to find. There were plenty of sellers and users. It may be that you are not a user? However, it was there and easy to find. A user can spot another user, though I'm not sure why. They look just like normal people, to you. Most users aren't homeless and dirty. They have jobs and houses. They have cars and families. Heroin has been here for a long, long time. The dealers were making money for as long as I've been alive. Source: Me. I started using in the 70s.
  - joe_the_user 9y ago
    You may find it hard to believe but I've been around heroin all my adult life as well (though not using). I've seen a lot of people die, whole groups of friends and so-forth. Certainly you have the fully functioning addicts. But you also have a lot of people driven by despair. Plus - the fully functioning addicts functioned a lot more when the economy functioned. Heroin, at the minimum, is one more heavy ball to keep in the air for a person juggling a lot in their lives. The state of the economy today guarantees people are going to be dropping those balls on the ground. So is it the economy make the addiction problem worse or is it that the economy makes addicts die and we see the problem more? Hey, I bet neither you nor I nor the social scientists can figure out for sure - what with the replication crisis and all.
KGIII 9y ago
I should probably use a throwaway, but I won't. I'm an addict. I was a functional addict, for many years. When I retired, I no longer needed to be functional. Things went downhill quickly. Today, I am on Suboxone. It reduces the harmful behavior. I tell you that as a way to share that I have some experience. Anyhow, it was in the early-to-mid 70s when I first started. My first exposure was to codeine and morphine. Those were relatively easy to get. There just weren't a lot of people trying to get them. Later, I'd relocate and heroin became easier to get. I'd sobered up in the Marines, mostly. But I'd still 'chip' and sometimes get morphine from legitimate sources. Off-base, heroin was pretty easy to get. It was, at that point, largely a drug used in the black communities. To pay to survive through grad school, I'd return to the military. Again, I'd sober up a bit and sometimes chip, but drug testing was becoming more popular. I'd get out, finish grad school, and continually using. I was the very definition of functional addict and did quite well for myself. I was always able to provide for my family and never had to beg, borrow, or steal my fix. Then, the 90s came. Oh, we addicts were in heaven. They were throwing oxy out like candy, to anyone who asked. The prices were so cheap. The street price for an oxy 80 was $5. It was less if you bought in bulk. It stayed like this for a while. It was like manna from heaven. Nobody used that wasn't already using, and the patients too which they were prescribed. It was not all that bad. Sometime in the mid-2000s is when it all changed. You could tell that it changed, because the prices for that oxy 80 went from $5 to $80. You can expect to pay $120 for it, today. I'm not going to speculate about what prompted the change. I'm simply giving a timeline of events. Now, these prices coincided with the start of them really cracking down on prescriptions being diverted. It is also when I noticed the color of the heroin users skin changing. It was being consumed in the white communities, more and more. The prescription drugs were, if nothing else, usually not counterfeit and consistent dosages. But, heroin was cheaper and, compared to some opiates, stronger. So, people did the natural thing and switched to heroin. I'd also notice a lot more folks buying insulin needles. People were junking out all over the place. These people were probably popping pills or snorting pills, just a few years before. Me? I'd move to fentanyl. I found a reliable source, learned to extract the drug, and would IV it. I can't complain, I had a good time. Anyhow, part of the trouble comes from the crackdown on consistent quality and dosaged drugs. It's comfortable to place the blame on the pharmaceutical companies, but I think a larger discussion should be had about the right to ingest drugs of your choosing. People are going to do drugs. It seems better to minimize the harm than it does to push the uses into engaging in riskier activities. Prohibition is woefully ineffective. We have a drug problem because it's not difficult to get drugs. It never will be difficult to get drugs. Anyhow, there's some timeline and info. If you want to understand addiction, try this: I switched to fentanyl, straight, because I learned that was what was in the dope and was killing people. My thought was that I had to get some of that. And, to be honest, it's pretty damned powerful stuff. It will knock your dick in the dirt and make you feel like you're being embraced in a loving hug. I'm not really sure what my point is. I mostly wanted to share a bit of the timeline, as I experienced it. I don't mind posting this attached to my username.

jdietrich 9y ago

Chronic pain is strongly correlated with poverty and low educational attainment. You can't separate medical, social and economic factors - they're far too deeply intertwined. https://www.ncbi.nlm.nih.gov/pubmed/28092650 https://www.ncbi.nlm.nih.gov/pubmed/28092650

frozenport 9y ago
You can because some poorer countries don't have an opiod epedimic. For example, opiod use is higher in West Virginia than Mexico. Certainly true that comparative poverty plays a role but we need to first hold accountable those directly responsible. http://geocurrents.info/wp-content/uploads/2012/05/Per-Capita-Opiate-Use-Map.jpg http://geocurrents.info/wp-content/uploads/2012/05/Per-Capit...
- jdietrich 9y ago
  Overprescribing is undoubtedly a key part of the problem, but so is poverty. The opioid epidemic is having a vastly disproportionate effect on poor communities, in large part because poor people are vastly disproportionately likely to suffer from chronic pain. Doctors didn't cause the crack epidemic in the 80s. We can't isolate any single factor, but must consider the problem in a holistic manner. Fixing the problem of overprescribing is a really important step, but the problems of poverty and addiction won't just disappear if we stop dishing out vicodin and oxcycontin.
  - Retric 9y ago
    There are several issues around that association that have little direct connections to poverty rather than more US specific issues. First lack of medical care to fix or prevent the underlying causes of much chronic pain. The second is a tendency to prescribe opiods to poor populations rather than focusing on less addictive medications. Further, non chronic pain can transform into chronic pain as Opiod uses/addiction increases pain sensitivity. Combine the above and poor healthcare more directly links to Opiod addiction than you're suggesting. EX: Mildly Injured > no medical care > working while Injured due to lack of sick leave > more significant problem > prescribed Opiod's vs surgery > addiction.

Theodores 9y ago

If I was given an infinite supply of free heroin and all the time in the world to sell it to my neighbours, friends, family, workmates and anyone else in the locality then I would struggle to make a sale. My client base would be zero and I would have to go back to the day job. If you rewind America to before the opioid epidemic then that would be the situation for anyone aspiring to sell heroin in normal America. The demand would not have been there, you would need to get a sizeable community onto crack cocaine before they need heroin too. The prescription drugs and how that worked out has changed the demand side of the situation. So it is not a matter of some external evil drug kingpins dumping vast quantities of cheap heroin onto the innocent U.S. market, it is more the vast quantities of Americans doing whatever they can to get their fix.

KGIII 9y ago
Err... Heroin was available before the current epidemic. It was easy to find. There were plenty of sellers and users. It may be that you are not a user? However, it was there and easy to find. A user can spot another user, though I'm not sure why. They look just like normal people, to you. Most users aren't homeless and dirty. They have jobs and houses. They have cars and families. Heroin has been here for a long, long time. The dealers were making money for as long as I've been alive. Source: Me. I started using in the 70s.
- joe_the_user 9y ago
  You may find it hard to believe but I've been around heroin all my adult life as well (though not using). I've seen a lot of people die, whole groups of friends and so-forth. Certainly you have the fully functioning addicts. But you also have a lot of people driven by despair. Plus - the fully functioning addicts functioned a lot more when the economy functioned. Heroin, at the minimum, is one more heavy ball to keep in the air for a person juggling a lot in their lives. The state of the economy today guarantees people are going to be dropping those balls on the ground. So is it the economy make the addiction problem worse or is it that the economy makes addicts die and we see the problem more? Hey, I bet neither you nor I nor the social scientists can figure out for sure - what with the replication crisis and all.

KGIII 9y ago

I should probably use a throwaway, but I won't. I'm an addict. I was a functional addict, for many years. When I retired, I no longer needed to be functional. Things went downhill quickly. Today, I am on Suboxone. It reduces the harmful behavior. I tell you that as a way to share that I have some experience. Anyhow, it was in the early-to-mid 70s when I first started. My first exposure was to codeine and morphine. Those were relatively easy to get. There just weren't a lot of people trying to get them. Later, I'd relocate and heroin became easier to get. I'd sobered up in the Marines, mostly. But I'd still 'chip' and sometimes get morphine from legitimate sources. Off-base, heroin was pretty easy to get. It was, at that point, largely a drug used in the black communities. To pay to survive through grad school, I'd return to the military. Again, I'd sober up a bit and sometimes chip, but drug testing was becoming more popular. I'd get out, finish grad school, and continually using. I was the very definition of functional addict and did quite well for myself. I was always able to provide for my family and never had to beg, borrow, or steal my fix. Then, the 90s came. Oh, we addicts were in heaven. They were throwing oxy out like candy, to anyone who asked. The prices were so cheap. The street price for an oxy 80 was $5. It was less if you bought in bulk. It stayed like this for a while. It was like manna from heaven. Nobody used that wasn't already using, and the patients too which they were prescribed. It was not all that bad. Sometime in the mid-2000s is when it all changed. You could tell that it changed, because the prices for that oxy 80 went from $5 to $80. You can expect to pay $120 for it, today. I'm not going to speculate about what prompted the change. I'm simply giving a timeline of events. Now, these prices coincided with the start of them really cracking down on prescriptions being diverted. It is also when I noticed the color of the heroin users skin changing. It was being consumed in the white communities, more and more. The prescription drugs were, if nothing else, usually not counterfeit and consistent dosages. But, heroin was cheaper and, compared to some opiates, stronger. So, people did the natural thing and switched to heroin. I'd also notice a lot more folks buying insulin needles. People were junking out all over the place. These people were probably popping pills or snorting pills, just a few years before. Me? I'd move to fentanyl. I found a reliable source, learned to extract the drug, and would IV it. I can't complain, I had a good time. Anyhow, part of the trouble comes from the crackdown on consistent quality and dosaged drugs. It's comfortable to place the blame on the pharmaceutical companies, but I think a larger discussion should be had about the right to ingest drugs of your choosing. People are going to do drugs. It seems better to minimize the harm than it does to push the uses into engaging in riskier activities. Prohibition is woefully ineffective. We have a drug problem because it's not difficult to get drugs. It never will be difficult to get drugs. Anyhow, there's some timeline and info. If you want to understand addiction, try this: I switched to fentanyl, straight, because I learned that was what was in the dope and was killing people. My thought was that I had to get some of that. And, to be honest, it's pretty damned powerful stuff. It will knock your dick in the dirt and make you feel like you're being embraced in a loving hug. I'm not really sure what my point is. I mostly wanted to share a bit of the timeline, as I experienced it. I don't mind posting this attached to my username.