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The amount of responsibility laundering that's happening is staggering. Is it the fault of the doctors for prescribing strong painkillers or the responsibility

The amount of responsibility laundering that's happening is staggering. Is it the fault of the doctors for prescribing strong painkillers or the responsibility of lobbyists for keeping the status quo as it is. Or is it the responsibility of patients to not seek strong opiates for the smallest aches? On whom falls the blame for this?

thedailymail 8y ago
You forgot to mention the drug manufacturers like Purdue, which aggressively promoted their opioids (e.g., Oxycontin) as presenting only a very low risk of addiction and abuse. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2622774/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2622774/
ryan-allen 8y ago
A few documentaries I've watched suggest that the dosages as recommended by the drug companies are designed to induce withdrawal symptoms before the next dose is due during treatment, I'd wager that's a good way to induce dependence during the course of treatment. The hypocrisy of the law when it comes to this is insane, but given how large the profits are and the power that money commands with lobbying, I'm not really surprised.
- SquareWheel 8y ago
  Honestly, that sounds very conspiratorial and baseless. It assumes doctors are idiots and drug producers are comic book villains. Reality is more nuanced.
  - oldgradstudent 8y ago
    Sadly, assuming by default (until proven otherwise) that doctors are idiots, and drug producers are comic book villans may be the smart thing to do. http://www.latimes.com/projects/oxycontin-part1/ http://www.latimes.com/projects/oxycontin-part1/ > Purdue has known about the problem for decades. Even before OxyContin went on the market, clinical trials showed many patients weren’t getting 12 hours of relief. Since the drug’s debut in 1996, the company has been confronted with additional evidence, including complaints from doctors, reports from its own sales reps and independent research. Or https://study329.org https://study329.org
  - usrusr 8y ago
    Comic book villainy quickly dissolves into nuanced realism when you distribute the elements of the "conspiracy" over the org chart. Then you end up with a lot of people who wanted to believe and mutually reassure each other that everything was fine, resulting in collective blindness to the evil they were doing.
baxtr 8y ago
Many say that big Pharma corporations have a large share of the responsibility because they began promoting strong pain killers heavily, starting in the 90s [1]. Now it has become part of American culture (doctors, patients, pharmacistse etc) to treat any pain with these pain killers. It’ll cost a lot and take a long time to reverse that [2] [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2622774/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2622774/ [2] https://www.vox.com/2017/6/5/15111936/opioid-crisis-pain-west-virginia https://www.vox.com/2017/6/5/15111936/opioid-crisis-pain-wes...
- cookiecaper 8y ago
  At the same time, know that every time a politician gets a bullet point on his re-election flier for "fighting the opioid epidemic" or "keeping our streets clean", there are real people in real pain who get stranded without the medication they need to function. After the birth of my youngest child, my wife spent the immediate recovery period blindsided by pain because new regulations meant the hospital was unwilling to prescribe opioid medication for "routine" things like an uncomplicated childbirth. She didn't have to deal with that for any of our other children, because back then, the hospital was willing to administer these medications. Medicine is already over 8% of GDP, but the political complex is not satisfied with that -- every day it gets harder and more expensive to stay on the right side of the law while obtaining necessary medications. In Florida, it is now unlawful for a physician to write for more than 3 days of narcotic painkillers (if there are extenuating circumstances, this can be pushed to a week, but the rationale must be documented and approved by at least one other physician, iirc). If your pain hasn't subsided in 3 days, you need to make another appointment -- which means paying another copay, or if uninsured, paying another out-of-pocket office visit -- to get a refill. If you require pain medication for a chronic condition, you now, by law, have to acquire a separate doctor who specializes in "pain management"; your family doctor is legally not allowed to write for more. Good luck finding an appointment at a reputable pain management clinic within 3 months. This is not a simple thing, and these medications continue to be prescribed because they help a great deal of people, relatively few of whom descend into addiction (and note that many who do go to the streets are driven there because their docs or pharmacists got spooked by the DEA and cut them off, leaving them in mind-numbing pain, or because they couldn't afford the substantial financial and social costs required to get controlled Rxs renewed and refilled on an ongoing basis).
deleted 8y ago
[deleted]
grecy 8y ago
How about if everyone stopped playing the blame game (because it's irrelevant) and spent all that effort and time working on a solution instead. It feels like reality TV has crept into every day life, and now everything has to be turned into a drama. Stop pandering to the drama, start working on a solution already.
- DanBC 8y ago
  You can't defeat something if you don't understand it.
  - pjc50 8y ago
    Understanding is very different from blame - that's the main lesson from air accident investigation. In particular, when you want to assign blame, you create an incentive to destroy or conceal evidence about what's actually happening. For opiates there are criminal penalties as soon as someone steps across the grey boundary between "medically necessary" and "recreational", so obviously everyone involved is going to lie about what's happening.
DanBC 8y ago
Have a look at the letter that started it all. This letter claimed that addiction is rare in patients treated in hospital with opioids for pain. https://www.bbc.co.uk/news/world-us-canada-40136881 https://www.bbc.co.uk/news/world-us-canada-40136881 The US Veteran's Association noticed that many veterans were living with pain. They felt that this needed to be treated, and they believed that opioids were safe an effective to treat long term pain, and that the risk of addiction was low. They introduced a thing called "pain as the fifth vital sign". They wanted healthcare professionals to i) always ask about pain and ii) always try to treat pain. https://www.va.gov/PAINMANAGEMENT/docs/Pain_As_the_5th_Vital_Sign_Toolkit.pdf https://www.va.gov/PAINMANAGEMENT/docs/Pain_As_the_5th_Vital... This led to huge amounts of mostly unsuitable treatment for pain. People in pain tend to reject psychological treatment ("My pain is real, it's not in my head!") and access to good quality physiotherapy is more expensive than opioids.
- amanaplanacanal 8y ago
  Yes! That became the common wisdom: If patients are taking opioids for pain relief, they won't become addicted. Of course that article was talking about opioids given to patients in a hospital setting, not patients being sent home with bottles of them. It was taken completely out of context. The other half of it was somehow deciding that opioids were the proper treatment for chronic pain, rather than temporary pain relief after surgery. Which was never really studied. And the consensus seems now to be that was a terrible idea.
ubernostrum 8y ago
As I understand it, a combination of a few things. One was a change to quality-of-care measurements. Lots of entities in the US health care system are evaluated on metrics around patient outcomes, and some of those look at management of physical pain. Changes to metrics for pain effectively pushed doctors toward a target of zero pain, and doctors began prescribing more medication to achieve that target. Another is the allegation that pharmaceutical companies downplayed the risks of their newer formulations for pain medication, or even outright lied. Purdue, Endo, Allergan, Johnson & Johnson, Teva and others all are facing or have faced lawsuits over this. To take an example: Purdue marketed OxyContin as a breakthrough long-acting drug -- they claimed 12 hours of effectiveness -- which would reduce the risk of addiction. In reality, patients reported the effects wore off after as little as 4 hours, and Purdue's marketing and sales arms pushed doctors to prescribe more and higher doses. This naturally led to... addiction and overdoses. Still another factor is that pharmaceutical companies seem to have been perfectly willing to overlook obvious abuse in order to move product and make money. It's not terribly hard to spot the patterns; there were cases of small (couple thousand people) towns where the local pharmacy would handle millions of doses of hydrocodone or oxycodone. And there have been lawsuits over that, too, with the drug companies mostly trying to reach settlements and avoid trials.
Broken_Hippo 8y ago
There is more responsibility than this, I think. A lack of laws allowing for paid sick leave, for example. It is easier to sit at home and not take pain meds than it is to have to go to work. If people cannot afford to take time off, there might as well be no sick time. There is a fault with doctors, but I truly think that for most doctors, they shouldn't have to be the gatekeeper for such things so long as they are prescribing for medically necessary conditions. The responsibility is that they should talk about addiction and symptoms of it with the patients and be prepared to work with patients if there is trouble. This should be without treating them like criminals 5 years later if they have a real reason to have medication (like surgery, for example). To a lesser extent, yes, it lies with a few doctors for prescribing strong pain killers. But if they are the medical norm for the sort of pain you are dealing with, they aren't being irresponsible either. I'd much rather folks be able to manage their pain than to suffer. Pain centers are horrible places and not convenient enough for everyone. The ones around where I lived (the first 30+years of my life) generally drug tested people, treating folks with chronic pain like criminals. They would treat folks like an addict for having pot in their system, for example, and were likely to kick folks off the program for such things. A lack of medical based treatment centers for additiction and to an extent, for mental health. This falls squarely on insurances and government. It would take government initiative and there would be some public pushback, but there could also be a national (or even state by state) digital medical system that includes prescriptions for these (and all) drugs. This would help doctors and pharmacists catch folks shopping around for different doctors. I hesitate to deny treatment to such folks, though, but instead refer the same folks to medical testing to see the cause of their woes and/or treatment for addiction.
belorn 8y ago
Since the article talk exclusively about opioid use disorders, this not about using opiates for aches. It is a common replicated experiment that patient that use opiates exclusively for aches don't develop habits, and more control and choice by the patient usually result in lower doses. However I have heard constantly during the last decade that stress and depression is on the rise and also spreading to younger age groups. I thus find it very questionable to view the problem from the drug supply perspective. Is it not a more logical conclusion that more people are self medicating and the problem is the social environment (stress, depression, looniness, and so on) and possible faults in the medical system in not helping those people as effective it could?
pjc50 8y ago
My own preferred hypothesis is that this is the result of despair: https://www.theatlantic.com/health/archive/2017/04/joblessness-and-opioids/523281/ https://www.theatlantic.com/health/archive/2017/04/joblessne... Someone will no doubt reply that US unemployment is falling, and therefore so should the opiates crisis, but it's not a simple matter of economics and statistics, it's a question of what people believe about the world and their future in it. Someone who gets a bad, painful job with no agency or fulfilment will vanish from the unemployment stats but the despair remains. (Mind you, both for-profit heathcare and a punitive, moralist approach to pain relief belong in the blame picture as well)
- netsharc 8y ago
  I mean, Trump is here because of despair too. Hillary promised "more of Obama", and the desperate people not benefiting from the roaring markets thought "I've been in misery for the past x years, she's promising more of that, the other guy is saying 'change', he might be full of shit, but what if he strikes it lucky, who do I pick, more of the same, or a chance of my life improving?". Which is also why it was ridiculous that Trump (and his base) celebrated the latest GDP numbers, when on the ground the people were still suffering. And then we have Amazon, Uber, etc, "jobs"...
  - i_feel_great 8y ago
    > I mean, Trump is here because of despair too. Hillary promised "more of Obama", and the desperate people not benefiting from the roaring markets thought "I've been in misery for the past x years, she's promising more of that, the other guy is saying 'change', he might be full of shit, but what if he strikes it lucky, who do I pick, more of the same, or a chance of my life improving?". Damn this is a sad comment. You ruined my night tonight.
- adventured 8y ago
  Manufacturing jobs are booming in the US. The very people that you're implying are hopeless, that specific demographic, have access to blue collar jobs in a way they haven't in nearly a generation. The US hasn't seen this kind of sustained manufacturing job growth since the mid 1990s. The US has drug problems, and has for 50 years, that other first or second tier nations in worse structural condition never picked up. This goes all the way back to peak US economics of the 1960s and early 1970s, when the US had a standard of living that it has taken the best European nations 50 years to catch up to. The opioid crisis is the latest extension of the US being a drug abusing nation, which it has been for a very long time, even at the peak of US economic success when it had 1/2 of all global manufacturing. It has had multiple heroin waves, multiple cocaine craze waves, multiple pill abusing waves. The people of Spain didn't overdose at 2x or 4x the rate of the US despite having a drastically worse economic situation. Their economic desperation is still far beyond that of the US. The standard response to that is: yeah, but the US doesn't have a welfare state. Yes it does, it has a massive welfare state, and its welfare spending as a percentage of GDP is higher than Canada or Australia. The opioid problem has particularly hit poorer Americans. Why aren't Bulgarians or Moldovans overdosing at far higher numbers? They're radically poorer. Part of this equation is access: Americans have massive, low cost, easy access to all the drugs. People in the US have an almost unique position in the world in regards to having enough money, easy access and combining it with the way drugs get pushed to Americans. Some of this is in fact unique to the US and doesn't require there be a particular high level of stress. Every economic metric indicates Americans are doing better today than they were seven years ago, and yet the opioid crisis isn't receding and it's far worse than it was seven years ago. Japan has lost a minimum of 1/3 of its standard of living in 15-20 years. They're not overdosing on opioids like people in the US are. They've suffered far worse than people in the US have. Every culture behaves differently under stress, there's no question about that. There's also zero evidence that the on-going opioid crisis is a result of active high level desperation. That's where it started; those are not the same things. Do people in Sweden and Belgium commit suicide at higher rates than people in the US, because their standard of living is collapsing? Belgium's suicide rate is nearly 100% higher today than the US rate was in the year 2000. Does wealthy Europe have among the highest rates of suicide on earth because it's so terrible there and they're under incredible economic stress? Or is it more likely these cultural issue are in fact complex rather than simple.
stef25 8y ago
The doctors. Anyone who spends the better part of a decade studying medicine can't be ignorant about opioids and addiction, regardless of what the slimy Purdue representative tells them. The only excuse they have for the blatant over prescribing of opioids (2 months worth of oxy for getting wisdom teeth pulled kind of thing) is that if they don't do it, the patient will just go to another doctor. But how can you justify setting someone up with fistfuls of oxy (knowing full that heroin / fentanyl and a world of misery for them and their loved ones is just around the corner) just "to make money" ? > Or is it the responsibility of patients to not seek strong opiates for the smallest aches? What the patient seeks is irrelevant. The only one who decides what prescriptions a patient should take is a doctor. Personally I suffered from lower back pain for about 10 years and went from one useless quack to the next. Eventually I found a physio who taught me how to strengthen my core, now I'm at the gym 2x a week and loving it, did couch25K (and beyond) and am pain free for 3 years. All I sought was pain relief but pills is not what I needed. If I was in W-Virginia instead of the EU I guess I'd be shooting heroin by now. The US health care system is broken in more ways than one, no doubt this is made worse by various societal factors like joblessness.
- free652 8y ago
  For wisdom teeth I got 25 tablets - that's like around a week worth. So other "patients" ask upfront for more tablets?
  - matwood 8y ago
    Wow. I had my ACL done and got 3 days worth of Oxycontin (6 tablets, 1 every 12 hours). I didn't want to finish taking them because they made me hallucinate. Looking back, I probably could have gotten by after the first day with only ibuprofen. The doctor was very concerned about staying ahead of any pain though.
  - zolthrowaway 8y ago
    Yes, many people will take the largest script the doctor will prescribe. Insurance generally helps cover the cost of the prescription, so reselling them can be really lucrative. Even in your scenario, 25 pills seems like a lot. Many people will be totally pain free in 2-3 days. No one needs 8 pills a day for wisdom teeth. Let's say they take 4 a day for 3 days, that's still 13 pills leftover. Go to any manual labor job (construction for example) in the Midwest. You will find people wanting to buy leftover prescriptions and people selling them. It's a pretty large black market. The vast, vast majority of people I know doing construction, laying asphalt, etc are all daily drinkers, potheads, or addicted to opiates. It's honestly super depressing.
MrFantastic 8y ago
These overdoses happen because society is not educated about the risks of combining opioids with alcohol and the illegal drug supply is unregulated. Imaging if beer all tasted the same but ranged from 2%-95%; 12 oz of pure alcohol would kill quit a few people.
- deleted 8y ago
  [deleted]
base698 8y ago
"Dreamland" is a pretty amazing summary of the responsibility. https://www.amazon.com/dp/B00U19DTS0 https://www.amazon.com/dp/B00U19DTS0 In short: pharma companies for misrepresenting an editorial in the 80s about addiction rates, medical industry calling pain the fifth vital sign, and enterprising drug dealers setting up Domino's like delivery services for heroin.
- amanaplanacanal 8y ago
  Terrific book, highly recommended.
qudat 8y ago
None of these. Why should we look to blame someone? At the core of this issue as well as many in the US, we are in the midst of a mental health epidemic. The medical system in this country does not care about preventative care, the primary directive is triage. Why are people using drugs at staggering quantities? Whether it is "recreational" or seemingly necessary, mind-altering substances are being used for a reason and I don't think this country has a good answer to why. We certainly do not have a good way to solve this problem.
aaavl2821 8y ago
Some people have some back pain / other pain and, if they're out of a job (commonly factory jobs) they go on disability (almost as a form of welfare), and will often get meds for their pain (this is the fault of doctors, pharma companies, generally medical culture emphasizing quick fix Rx vs other methods of dealing with pain). Obviously these drugs are addictive, and if you're already in a bad place bc you went from a great stable job in your 30s to pseudo-welfare in your 50s, you're more vulnerable to addiction
merinowool 8y ago
It is mainly responsibility of voters who keep corrupt and evil people in charge. If you voted for a prohibition supporter you have blood on your hands.
freeflight 8y ago
Like most things, probably the combination of all of them. It might be convenient to ask for that "one prime mover", but the reality is usually way too complex for that.

thedailymail 8y ago

You forgot to mention the drug manufacturers like Purdue, which aggressively promoted their opioids (e.g., Oxycontin) as presenting only a very low risk of addiction and abuse. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2622774/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2622774/

ryan-allen 8y ago

A few documentaries I've watched suggest that the dosages as recommended by the drug companies are designed to induce withdrawal symptoms before the next dose is due during treatment, I'd wager that's a good way to induce dependence during the course of treatment. The hypocrisy of the law when it comes to this is insane, but given how large the profits are and the power that money commands with lobbying, I'm not really surprised.

SquareWheel 8y ago
Honestly, that sounds very conspiratorial and baseless. It assumes doctors are idiots and drug producers are comic book villains. Reality is more nuanced.
- oldgradstudent 8y ago
  Sadly, assuming by default (until proven otherwise) that doctors are idiots, and drug producers are comic book villans may be the smart thing to do. http://www.latimes.com/projects/oxycontin-part1/ http://www.latimes.com/projects/oxycontin-part1/ > Purdue has known about the problem for decades. Even before OxyContin went on the market, clinical trials showed many patients weren’t getting 12 hours of relief. Since the drug’s debut in 1996, the company has been confronted with additional evidence, including complaints from doctors, reports from its own sales reps and independent research. Or https://study329.org https://study329.org
- usrusr 8y ago
  Comic book villainy quickly dissolves into nuanced realism when you distribute the elements of the "conspiracy" over the org chart. Then you end up with a lot of people who wanted to believe and mutually reassure each other that everything was fine, resulting in collective blindness to the evil they were doing.

baxtr 8y ago

Many say that big Pharma corporations have a large share of the responsibility because they began promoting strong pain killers heavily, starting in the 90s [1]. Now it has become part of American culture (doctors, patients, pharmacistse etc) to treat any pain with these pain killers. It’ll cost a lot and take a long time to reverse that [2] [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2622774/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2622774/ [2] https://www.vox.com/2017/6/5/15111936/opioid-crisis-pain-west-virginia https://www.vox.com/2017/6/5/15111936/opioid-crisis-pain-wes...

cookiecaper 8y ago
At the same time, know that every time a politician gets a bullet point on his re-election flier for "fighting the opioid epidemic" or "keeping our streets clean", there are real people in real pain who get stranded without the medication they need to function. After the birth of my youngest child, my wife spent the immediate recovery period blindsided by pain because new regulations meant the hospital was unwilling to prescribe opioid medication for "routine" things like an uncomplicated childbirth. She didn't have to deal with that for any of our other children, because back then, the hospital was willing to administer these medications. Medicine is already over 8% of GDP, but the political complex is not satisfied with that -- every day it gets harder and more expensive to stay on the right side of the law while obtaining necessary medications. In Florida, it is now unlawful for a physician to write for more than 3 days of narcotic painkillers (if there are extenuating circumstances, this can be pushed to a week, but the rationale must be documented and approved by at least one other physician, iirc). If your pain hasn't subsided in 3 days, you need to make another appointment -- which means paying another copay, or if uninsured, paying another out-of-pocket office visit -- to get a refill. If you require pain medication for a chronic condition, you now, by law, have to acquire a separate doctor who specializes in "pain management"; your family doctor is legally not allowed to write for more. Good luck finding an appointment at a reputable pain management clinic within 3 months. This is not a simple thing, and these medications continue to be prescribed because they help a great deal of people, relatively few of whom descend into addiction (and note that many who do go to the streets are driven there because their docs or pharmacists got spooked by the DEA and cut them off, leaving them in mind-numbing pain, or because they couldn't afford the substantial financial and social costs required to get controlled Rxs renewed and refilled on an ongoing basis).

deleted 8y ago

[deleted]

grecy 8y ago

How about if everyone stopped playing the blame game (because it's irrelevant) and spent all that effort and time working on a solution instead. It feels like reality TV has crept into every day life, and now everything has to be turned into a drama. Stop pandering to the drama, start working on a solution already.

DanBC 8y ago
You can't defeat something if you don't understand it.
- pjc50 8y ago
  Understanding is very different from blame - that's the main lesson from air accident investigation. In particular, when you want to assign blame, you create an incentive to destroy or conceal evidence about what's actually happening. For opiates there are criminal penalties as soon as someone steps across the grey boundary between "medically necessary" and "recreational", so obviously everyone involved is going to lie about what's happening.

DanBC 8y ago

Have a look at the letter that started it all. This letter claimed that addiction is rare in patients treated in hospital with opioids for pain. https://www.bbc.co.uk/news/world-us-canada-40136881 https://www.bbc.co.uk/news/world-us-canada-40136881 The US Veteran's Association noticed that many veterans were living with pain. They felt that this needed to be treated, and they believed that opioids were safe an effective to treat long term pain, and that the risk of addiction was low. They introduced a thing called "pain as the fifth vital sign". They wanted healthcare professionals to i) always ask about pain and ii) always try to treat pain. https://www.va.gov/PAINMANAGEMENT/docs/Pain_As_the_5th_Vital_Sign_Toolkit.pdf https://www.va.gov/PAINMANAGEMENT/docs/Pain_As_the_5th_Vital... This led to huge amounts of mostly unsuitable treatment for pain. People in pain tend to reject psychological treatment ("My pain is real, it's not in my head!") and access to good quality physiotherapy is more expensive than opioids.

amanaplanacanal 8y ago
Yes! That became the common wisdom: If patients are taking opioids for pain relief, they won't become addicted. Of course that article was talking about opioids given to patients in a hospital setting, not patients being sent home with bottles of them. It was taken completely out of context. The other half of it was somehow deciding that opioids were the proper treatment for chronic pain, rather than temporary pain relief after surgery. Which was never really studied. And the consensus seems now to be that was a terrible idea.

ubernostrum 8y ago

As I understand it, a combination of a few things. One was a change to quality-of-care measurements. Lots of entities in the US health care system are evaluated on metrics around patient outcomes, and some of those look at management of physical pain. Changes to metrics for pain effectively pushed doctors toward a target of zero pain, and doctors began prescribing more medication to achieve that target. Another is the allegation that pharmaceutical companies downplayed the risks of their newer formulations for pain medication, or even outright lied. Purdue, Endo, Allergan, Johnson & Johnson, Teva and others all are facing or have faced lawsuits over this. To take an example: Purdue marketed OxyContin as a breakthrough long-acting drug -- they claimed 12 hours of effectiveness -- which would reduce the risk of addiction. In reality, patients reported the effects wore off after as little as 4 hours, and Purdue's marketing and sales arms pushed doctors to prescribe more and higher doses. This naturally led to... addiction and overdoses. Still another factor is that pharmaceutical companies seem to have been perfectly willing to overlook obvious abuse in order to move product and make money. It's not terribly hard to spot the patterns; there were cases of small (couple thousand people) towns where the local pharmacy would handle millions of doses of hydrocodone or oxycodone. And there have been lawsuits over that, too, with the drug companies mostly trying to reach settlements and avoid trials.

Broken_Hippo 8y ago

There is more responsibility than this, I think. A lack of laws allowing for paid sick leave, for example. It is easier to sit at home and not take pain meds than it is to have to go to work. If people cannot afford to take time off, there might as well be no sick time. There is a fault with doctors, but I truly think that for most doctors, they shouldn't have to be the gatekeeper for such things so long as they are prescribing for medically necessary conditions. The responsibility is that they should talk about addiction and symptoms of it with the patients and be prepared to work with patients if there is trouble. This should be without treating them like criminals 5 years later if they have a real reason to have medication (like surgery, for example). To a lesser extent, yes, it lies with a few doctors for prescribing strong pain killers. But if they are the medical norm for the sort of pain you are dealing with, they aren't being irresponsible either. I'd much rather folks be able to manage their pain than to suffer. Pain centers are horrible places and not convenient enough for everyone. The ones around where I lived (the first 30+years of my life) generally drug tested people, treating folks with chronic pain like criminals. They would treat folks like an addict for having pot in their system, for example, and were likely to kick folks off the program for such things. A lack of medical based treatment centers for additiction and to an extent, for mental health. This falls squarely on insurances and government. It would take government initiative and there would be some public pushback, but there could also be a national (or even state by state) digital medical system that includes prescriptions for these (and all) drugs. This would help doctors and pharmacists catch folks shopping around for different doctors. I hesitate to deny treatment to such folks, though, but instead refer the same folks to medical testing to see the cause of their woes and/or treatment for addiction.

belorn 8y ago

Since the article talk exclusively about opioid use disorders, this not about using opiates for aches. It is a common replicated experiment that patient that use opiates exclusively for aches don't develop habits, and more control and choice by the patient usually result in lower doses. However I have heard constantly during the last decade that stress and depression is on the rise and also spreading to younger age groups. I thus find it very questionable to view the problem from the drug supply perspective. Is it not a more logical conclusion that more people are self medicating and the problem is the social environment (stress, depression, looniness, and so on) and possible faults in the medical system in not helping those people as effective it could?

pjc50 8y ago

My own preferred hypothesis is that this is the result of despair: https://www.theatlantic.com/health/archive/2017/04/joblessness-and-opioids/523281/ https://www.theatlantic.com/health/archive/2017/04/joblessne... Someone will no doubt reply that US unemployment is falling, and therefore so should the opiates crisis, but it's not a simple matter of economics and statistics, it's a question of what people believe about the world and their future in it. Someone who gets a bad, painful job with no agency or fulfilment will vanish from the unemployment stats but the despair remains. (Mind you, both for-profit heathcare and a punitive, moralist approach to pain relief belong in the blame picture as well)

netsharc 8y ago
I mean, Trump is here because of despair too. Hillary promised "more of Obama", and the desperate people not benefiting from the roaring markets thought "I've been in misery for the past x years, she's promising more of that, the other guy is saying 'change', he might be full of shit, but what if he strikes it lucky, who do I pick, more of the same, or a chance of my life improving?". Which is also why it was ridiculous that Trump (and his base) celebrated the latest GDP numbers, when on the ground the people were still suffering. And then we have Amazon, Uber, etc, "jobs"...
- i_feel_great 8y ago
  > I mean, Trump is here because of despair too. Hillary promised "more of Obama", and the desperate people not benefiting from the roaring markets thought "I've been in misery for the past x years, she's promising more of that, the other guy is saying 'change', he might be full of shit, but what if he strikes it lucky, who do I pick, more of the same, or a chance of my life improving?". Damn this is a sad comment. You ruined my night tonight.
adventured 8y ago
Manufacturing jobs are booming in the US. The very people that you're implying are hopeless, that specific demographic, have access to blue collar jobs in a way they haven't in nearly a generation. The US hasn't seen this kind of sustained manufacturing job growth since the mid 1990s. The US has drug problems, and has for 50 years, that other first or second tier nations in worse structural condition never picked up. This goes all the way back to peak US economics of the 1960s and early 1970s, when the US had a standard of living that it has taken the best European nations 50 years to catch up to. The opioid crisis is the latest extension of the US being a drug abusing nation, which it has been for a very long time, even at the peak of US economic success when it had 1/2 of all global manufacturing. It has had multiple heroin waves, multiple cocaine craze waves, multiple pill abusing waves. The people of Spain didn't overdose at 2x or 4x the rate of the US despite having a drastically worse economic situation. Their economic desperation is still far beyond that of the US. The standard response to that is: yeah, but the US doesn't have a welfare state. Yes it does, it has a massive welfare state, and its welfare spending as a percentage of GDP is higher than Canada or Australia. The opioid problem has particularly hit poorer Americans. Why aren't Bulgarians or Moldovans overdosing at far higher numbers? They're radically poorer. Part of this equation is access: Americans have massive, low cost, easy access to all the drugs. People in the US have an almost unique position in the world in regards to having enough money, easy access and combining it with the way drugs get pushed to Americans. Some of this is in fact unique to the US and doesn't require there be a particular high level of stress. Every economic metric indicates Americans are doing better today than they were seven years ago, and yet the opioid crisis isn't receding and it's far worse than it was seven years ago. Japan has lost a minimum of 1/3 of its standard of living in 15-20 years. They're not overdosing on opioids like people in the US are. They've suffered far worse than people in the US have. Every culture behaves differently under stress, there's no question about that. There's also zero evidence that the on-going opioid crisis is a result of active high level desperation. That's where it started; those are not the same things. Do people in Sweden and Belgium commit suicide at higher rates than people in the US, because their standard of living is collapsing? Belgium's suicide rate is nearly 100% higher today than the US rate was in the year 2000. Does wealthy Europe have among the highest rates of suicide on earth because it's so terrible there and they're under incredible economic stress? Or is it more likely these cultural issue are in fact complex rather than simple.

stef25 8y ago

The doctors. Anyone who spends the better part of a decade studying medicine can't be ignorant about opioids and addiction, regardless of what the slimy Purdue representative tells them. The only excuse they have for the blatant over prescribing of opioids (2 months worth of oxy for getting wisdom teeth pulled kind of thing) is that if they don't do it, the patient will just go to another doctor. But how can you justify setting someone up with fistfuls of oxy (knowing full that heroin / fentanyl and a world of misery for them and their loved ones is just around the corner) just "to make money" ? > Or is it the responsibility of patients to not seek strong opiates for the smallest aches? What the patient seeks is irrelevant. The only one who decides what prescriptions a patient should take is a doctor. Personally I suffered from lower back pain for about 10 years and went from one useless quack to the next. Eventually I found a physio who taught me how to strengthen my core, now I'm at the gym 2x a week and loving it, did couch25K (and beyond) and am pain free for 3 years. All I sought was pain relief but pills is not what I needed. If I was in W-Virginia instead of the EU I guess I'd be shooting heroin by now. The US health care system is broken in more ways than one, no doubt this is made worse by various societal factors like joblessness.

free652 8y ago
For wisdom teeth I got 25 tablets - that's like around a week worth. So other "patients" ask upfront for more tablets?
- matwood 8y ago
  Wow. I had my ACL done and got 3 days worth of Oxycontin (6 tablets, 1 every 12 hours). I didn't want to finish taking them because they made me hallucinate. Looking back, I probably could have gotten by after the first day with only ibuprofen. The doctor was very concerned about staying ahead of any pain though.
- zolthrowaway 8y ago
  Yes, many people will take the largest script the doctor will prescribe. Insurance generally helps cover the cost of the prescription, so reselling them can be really lucrative. Even in your scenario, 25 pills seems like a lot. Many people will be totally pain free in 2-3 days. No one needs 8 pills a day for wisdom teeth. Let's say they take 4 a day for 3 days, that's still 13 pills leftover. Go to any manual labor job (construction for example) in the Midwest. You will find people wanting to buy leftover prescriptions and people selling them. It's a pretty large black market. The vast, vast majority of people I know doing construction, laying asphalt, etc are all daily drinkers, potheads, or addicted to opiates. It's honestly super depressing.

MrFantastic 8y ago

These overdoses happen because society is not educated about the risks of combining opioids with alcohol and the illegal drug supply is unregulated. Imaging if beer all tasted the same but ranged from 2%-95%; 12 oz of pure alcohol would kill quit a few people.

deleted 8y ago
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base698 8y ago

"Dreamland" is a pretty amazing summary of the responsibility. https://www.amazon.com/dp/B00U19DTS0 https://www.amazon.com/dp/B00U19DTS0 In short: pharma companies for misrepresenting an editorial in the 80s about addiction rates, medical industry calling pain the fifth vital sign, and enterprising drug dealers setting up Domino's like delivery services for heroin.

amanaplanacanal 8y ago
Terrific book, highly recommended.

qudat 8y ago

None of these. Why should we look to blame someone? At the core of this issue as well as many in the US, we are in the midst of a mental health epidemic. The medical system in this country does not care about preventative care, the primary directive is triage. Why are people using drugs at staggering quantities? Whether it is "recreational" or seemingly necessary, mind-altering substances are being used for a reason and I don't think this country has a good answer to why. We certainly do not have a good way to solve this problem.

aaavl2821 8y ago

Some people have some back pain / other pain and, if they're out of a job (commonly factory jobs) they go on disability (almost as a form of welfare), and will often get meds for their pain (this is the fault of doctors, pharma companies, generally medical culture emphasizing quick fix Rx vs other methods of dealing with pain). Obviously these drugs are addictive, and if you're already in a bad place bc you went from a great stable job in your 30s to pseudo-welfare in your 50s, you're more vulnerable to addiction

merinowool 8y ago

It is mainly responsibility of voters who keep corrupt and evil people in charge. If you voted for a prohibition supporter you have blood on your hands.

freeflight 8y ago

Like most things, probably the combination of all of them. It might be convenient to ask for that "one prime mover", but the reality is usually way too complex for that.