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Overdose Deaths Set a Record Last Year

96 points by digital55 8y ago

zunzun 8y ago
Fentanyl is not yet a controlled substance at its major global source: is this racial vengeance for the Opium Wars?
- PhasmaFelis 8y ago
  No.
- sct202 8y ago
  There's a Chinese factory that will make you almost anything imaginable some legally some illegally (violating IP or regulations). It's not part of a conspiracy that there are also illegal drug factories.
nacho2sweet 8y ago
I live in Vancouver which has always been ground zero for opiates for 30+ years. 1100 deaths a year just here over fentanyl. Constant ambulances and fire trucks on at all times just injecting narcan. Article about how China is basically using the trade as a bargaining trade and extradition chip. https://globalnews.ca/news/4658188/fentanyl-china-canada-diplomatic-tensions/ https://globalnews.ca/news/4658188/fentanyl-china-canada-dip... Seem to remember us joining the Afghan war for fewer deaths.
- mediaman 8y ago
  Very interesting. The Chinese are doing the same thing the Brits did to them: getting an entire country addicted to opiates. In that one, Britain went to war with the Chinese when the Chinese tried to stop the flow of opium. Something like 10-20% of the population of the entire country was addicted.
  - adventured 8y ago
    > The Chinese are doing the same thing the Brits did to them: getting an entire country addicted to opiates. No, that's not actually happening at all in fact, either in the US or Canada. Most of what you're seeing re China is fentanyl - because it's extraordinarily potent - killing a lot of people that would otherwise not be overdosing from heroin at anywhere near the same rate. Their culpability in the spread of opioid use and addiction is minimal, it's primarily the increase in overdose deaths that China's fentanyl is contributing to. US doctors and some specific pharma companies have the vast majority of responsibility when it comes to the opioid addiction and abuse increases we've seen in the US over the last decade.
  - sbhn 8y ago
    I suspect that the lengths US and UK go to keep influence over afghanistan is so that it can reintroduce the flow of heroin into china if they ever wants to play that card again
    - bootlooped 8y ago
      I think that ship has sailed. China's strong military and police state would prevent such a thing from happening today. The only way I could see that happening would be by first crushing China in all-out war; but if you do that first then what use would the heroin be?
      - sbhn 8y ago
        Anytime anybody critices china, you only have to replace the word with america, or england, and the story is the same. Except, using china in a sentance significantly raises the clickbait value.
- acct1771 8y ago
  Is narcan injected now?
  - bundiddly 8y ago
    It's usually given as an intramuscular injection. The intranasal form works, but is not quite as effective (though avoids the potential for a needlestick injury to the provider).
  - nacho2sweet 8y ago
    It is injected and some of the opiates on the streets are so strong here you are starting to need administer multiple injections. There is the nasal spray and that is often given out on the streets so addicts can help each other. There are narcan administration classes all the time and it is given to and by night life workers because fentanyl is showing up in party drugs like cocaine and mdma. Lots of friends said they have quit their favourite extracurriculars but they get drunk and in a good mood and forget at 2am, or they know their dealer etc... Pretty scary.
- acdanger 8y ago
  I wasn't aware that Vancouver had a significant opiate problem. Is it just a supply and demand at play via close ties with China? Or are there societal issues at play?
  - nacho2sweet 8y ago
    Both. We are/where a major port gateway to Hong Kong/China going way back so triads came in and heroin trafficking came with it. It has always been very cheap, and supposedly high quality back when. Societal stuff is often natives coming into town already in poverty escaping reserves and getting into it, and also people from just across Canada in general that are maybe already addicts. Vancouver has the most mellow climate in Canada as well if you are homeless. East Hastings where it was concentrated was kind of a place hard partying loggers would go and hook up with escorts in cheap motels for a week, so it bred a bunch of bad stuff that never went away 40+ years later. Also neighbouring districts and suburbs don't support their homeless populations so it was just concentrating. Now that there is a affordability crisis here every suburb around has a crazy homeless tent city in parks they are kicking out and moving every 2 months, and opiates def play a big part in those. But the suburbs are full of sort of white baby boomer or new landed chinese immigrant populations who aren't used to dealing with it and don't want any homeless shelters built in their neighborhoods. The stories that make the news the most are probably the same ones in the states where it is like white kid in suburbs taking a fake xanax with fentanyl or a MDMA pill probably pressed in a same pill press or having fentanyl mixed in for whatever reason and OD'ing.
- solidsnack9000 8y ago
  Article about how China is basically using the trade as a bargaining trade and extradition chip. China encouraging the flow of opiates to a western port city to try to obtain political cooperation?
JoeAltmaier 8y ago
Off the topic: looks like the half-life (or doubling-life anyway) is about 10 years. The number of deaths double in a decade, which means of course we're setting records every year. Time until everybody in USA is dead of opiods: 120 years
- pavel_lishin 8y ago
  Joke's on you, statistics, I plan to be dead long before then.
volkl48 8y ago
It's looking like it's peaked, 2018 data is still provisional, but is currently expected to show a modest decline after the final numbers are in. 11/30 article on topic: https://www.washingtonpost.com/business/2018/11/30/after-record-number-us-deaths-opioid-epidemic-may-be-receding/?utm_term=.37f14699ff32 https://www.washingtonpost.com/business/2018/11/30/after-rec... Data source: https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm There is certainly far more work to be done.
- wgerard 8y ago
  Curious because it's not mentioned: How much of that is due to higher availability/usage of Narcan?
  - hackeraccount 8y ago
    There's research to suggest that there's an element of moral hazzard that comes with the availability of Narcan. see: https://www.npr.org/templates/transcript/transcript.php?storyId=661011560 https://www.npr.org/templates/transcript/transcript.php?stor...
  - volkl48 8y ago
    Not really something this dataset (which is just about # of deaths + drug that caused them) can tell you. I'd imagine you'd need some sort of formal study of the data to try to assign why deaths are starting to decline/plateau and what share a certain thing is responsible for, there are other possible causes. ------- Opiate prescriptions are falling pretty significantly. Number of prescriptions is down 22% from 2012-17, and volume (mg of opiates dispensed) dropped 12% in 2017 alone. https://www.aafp.org/news/health-of-the-public/20180425opioidstudy.html https://www.aafp.org/news/health-of-the-public/20180425opioi... That could be contributing to a decline in the "pipeline" of new addicts. Less people starting on them and lower doses and shorter durations when they are prescribed. It would make sense for a decline spurred by that to not show up in opiate deaths for a few years, my impression is that most people spiral downward for a while before actually dying/ODing.
- 8y ago
orasis 8y ago
Legalize psychedelics to treat addiction.
- ams6110 8y ago
  There may be something to that, but I am guessing that any form of self-medication is likely to be more destructive than helpful. Use of pharmaceutical grade psychedelics in a clinical setting might have some benefit.
  - pstuart 8y ago
    Let me make that decision myself, thank you very much.
    - aalleavitch 8y ago
      All of these overdoses are, likewise, people making these decisions for themselves.
      - all2 8y ago
        That's more than misleading. Having made poor choices in the past (drugs) they now have the neuro-chemical pathways cut into their ~brians~ brains; literal ruts that signals will prefer to get to the end-state (high/low). With enough use, heroin doesn't leave a person with choice, but rather impulse. [edit] lol, brians [/edit]
      - loeg 8y ago
        So are the smoking deaths. I think it's undisputed that there would be a lot fewer deaths per addict if the heroin available were (1) of a known concentration, (2) not fentanyl, and (3) devoid of other harmful adulterants. The problem people argue about re: legalizing heroin is that they expect the number of addicts to rise.
      - pstuart 8y ago
        I've been given the choice (that I don't plan on taking) to drink and smoke myself to death. Eat unhealthy foods. Etc. Etc. n.b. My brother died of a heroin overdose. He made that decision himself and the existing laws did not help prevent.
pjc50 8y ago
This is a tragedy, but I can already see the conversation moving away from how the problem might be fixed towards blaming it on foreign enemies. Which will absolutely not help.
- taylorswift_ 8y ago
  How do you reason such? Most if not all of the illicit fentanyl comes from China, where it is an uncontrolled substance. IMO this should definitely be part of a comprehensive conversation.
  - soundwave106 8y ago
    The problem here is the initial opioid crisis hardly involved China at all. Instead it largely involved US pharmaceutical companies like Purdue Pharma's over-aggressive promotion of Oxycontin. China and fentanyl only came into the picture later. Fentanyl is a significant issue and discussing what China intends to do about fentanyl certainly is warranted (seems like discussions are underway to schedule it in China -- https://www.cnn.com/2018/12/01/politics/fentanyl-us-china-g20-talks/index.html https://www.cnn.com/2018/12/01/politics/fentanyl-us-china-g2... ). But one compound isn't the full problem here.
  - neurobashing 8y ago
    I assume the parent comment's reasoning is, roughly: The War on Drugs was, from one point of view, essentially a soft invasion of central and south American countries; we sent DEA and military "advisors" to burn the crops of farmers while the CIA treated narcos like Soviets. Indisputable that, eg, yes mexican farmers were growing kush (or making coke, etc) at the behest of powerful cartels. They were totally doing that. It did not spend as much effort on why and how drugs became what they are in our own country; laws had disproportionate impacts on some communities; treatment was the refuge of the privileged. Slaking the need for drugs is more than border enforcement, from this perspective. So yeah, some dope comes from point A to point B, so stop it from making it to point B, but also look at what's going on at point B to fix the problems that aren't trafficking.
sampleinajar 8y ago
"Opioid prescriptions have been falling, even as the death rates from overdoses are rising" Gee, it's almost as if "overprescribing" and then cutting off the supply had the affect of driving some who are addicted to buy opiates with less quality control, and they are dying from it.
- presscast 8y ago
  I'm a bit puzzled by your comment. Are you suggesting that we should have continued to over-prescribe?
  - dbatten 8y ago
    Judging by the quotes around overprescribe, I'm assuming the parent comment is skeptical of the idea that we were over-prescribing. Also, they're likely criticizing the whipsaw fashion in which we allowed drug companies to convince everybody these opioids were totally safe, then drastically cut off the supply without doing anything to help people who had already become addicted.
    - deleted 8y ago
      [deleted]
  - wesd 8y ago
    sampleinajar is stating that when doctors were over-prescribing the patient became addicts. When those patients were cut-off from legally buying the drugs, they turned to black market where the quality of the drug is unknown which leads to overdose.
  - tonyarkles 8y ago
    There's a middle ground there. Cutting back on the number of new opiod prescriptions is definitely a good thing, but you've got to be careful of how you handle existing patients who have already been pulled into the problem. From a harm reduction perspective, taking a patient who is, say, addicted to legal oxycodone because they were overprescribed it. Now what do you do from the perspective of what's best for the patient? Is it a good thing that they're addicted to it? No... but is it more harmful to cut them off cold-turkey? Or is it better to help work with them to figure out how to get off it in a way that doesn't result in them seeking out street drugs to handle the withdrawal?
mruts 8y ago
I used to be addicting to heroin. The problem is with fentanyl, not heroin. I've had 2 close friends die from overdoses, and both involved fentanyl. I got close myself a couple times (or so my wife says, I was passed out), and both were fentanyl laced doses. I honestly and truly believe that opiates (and all drugs) should be legal. I think you would find the number of overdoses drop drastically if that were the case. No one wants to do fentanyl, it doesn't last as long and feels weird. Heroin itself is very safe if it's not cut and the purity is known ahead of time.
- acct1771 8y ago
  But it commonly is, and you commonly don't.
  - jlg23 8y ago
    The comment you responded to just pointed that out.
- loeg 8y ago
  Fentanyl is a problem but people definitely died of heroin overdose, or other heroin-related illness (infection, random other poisoning due to adulterants), long before fentanyl entered the picture.
  - stronglikedan 8y ago
    I think that's why OP qualified it with "the purity is known ahead of time." There are relatively not very many overdose deaths from pill versions of opiates where the dosage is known, because people generally know how much they can handle and generally don't want to die.
    - loeg 8y ago
      Totally agree. The death rate per capita between heroin users and prescription opioid users is totally different as a result.
    - 8y ago
deyan 8y ago
Can someone put this into context, or share a source that does? How does this compare to other causes of death, for example? The NYT article has comparisons on the absolute level (i.e. comparing to peak car crash deaths and HIV deaths from 20-30 years ago) - but those are outdated and misleading because they not relative and don't account for e.g. population growth. I am just trying to get a sense for the true magnitude of the problem, beyond the scary headlines.
- mruts 8y ago
  From my personal experience, what's scary is that it's crossing all socioeconomic boundaries. I had two friends that died and both had high-paying jobs (finance and software dev) and seemed outwardly successful (much like myself I guess). There are groups of people who we don't care about, and there are groups that we do. What's scary to people is the metastasizing of the problem from one group to the other.
- nostrademons 8y ago
  It's small relative to the total number of deaths in the U.S, but large relative to deaths for that age group (< 55): https://www.cdc.gov/injury/images/lc-charts/leading_causes_of_death_age_group_2016_1056w814h.gif https://www.cdc.gov/injury/images/lc-charts/leading_causes_o... https://www.cdc.gov/injury/images/lc-charts/leading_causes_of_death_highlighting_unintentional_2016_1040w800h.gif https://www.cdc.gov/injury/images/lc-charts/leading_causes_o... I assume overdoses are classed as "unintentional poisoning" - they're the leading cause of death for ages 25-45, nearly double car accidents and 3x suicides. They're a very small fraction of deaths by cancer & heart disease, but those usually happen after 50+. In terms of "preventable" deaths they and car accidents are by far the biggest culprits. I'm surprised there's not more of a push toward self-driving cars and mass transit, but other than that it makes sense to focus on overdoses. The other interesting thing that stood out to me in the data was how much the homicide rate has dropped since 1980. We have this perception that the world is getting more dangerous, but it's not actually reflected in the data, and by far the biggest danger to us now is ourselves.
- rtkwe 8y ago
  The US has not grown that much. It's grown to 1.52x, 1.25x, and 1.22x the population for 1972 (car crash), 1993 (gun), and 1995 (HIV) respectively so it is above everything except the 1972 car crash peak. It's a big deal.
NeedMoreTea 8y ago
Maybe it's time to remember the British System, which had worked successfully for decades. Anslinger being put on the US team for the UN Committee on Drugs put paid to that, and pressured other countries with less punitive drug approaches. Anslinger has much to answer for; perhaps the one doctor who forgot "discourage" does too. For those who don't know, the British System was once globally famous, and briefly put was "discourage, but prescribe"[0]. When it was overridden with a more recognisable war on drugs there were only hundreds of addicts in the UK. No one connected addiction to crime. Highly doubtful we could return to that state, even if it was successfully continued. [0] https://www.vice.com/en_uk/article/yw4nnk/when-boots-prescribed-heroin-the-uk-did-drug-policy-right https://www.vice.com/en_uk/article/yw4nnk/when-boots-prescri...
taxicabjesus 8y ago
Overdose deaths are only a fraction of the casualties of this particular war on people. We should also count all the people who are in prison on charges of self-medicating, and all the people who die in prison while being punished for hurting no one but themselves. I didn't know anything about Methadone until I'd taken a few people to the various methadone clinics. I thought they were just medical drop-offs... and thought it odd that their trip home was just a few minutes later. Eventually I learned these people were going for their daily dose of methadone. One fellow said he'd gotten addicted to painkillers following a car accident, and that he'd never imagined himself needing to visit a methadone clinic every day. Towards the end of my taxi driving experience, I had a woman going from WalMart to a half-way house. She'd spent 5 years in prison for sharing a single opiate pill with a friend (circa 2010). She said something about the cop who wrote her up for prosecution chuckling as he filled out the form. Over her five years in prison several of her fellow inmates died from neglect. She'd gained a lot of weight on prison food, which isn't very nutritious. Apparently the State of Arizona is negligent-homiciding prisoners in the name of helping them correct their behavior, which doesn't make much sense to me. I'm sure all the other states' jails and prisons have similar conditions.
- maxxxxx 8y ago
  "Apparently the State of Arizona is negligent-homiciding prisoners in the name of helping them correct their behavior," They just want to punish people, they don't care about correcting behavior.
viggity 8y ago
God damn it, I want to know these numbers for people that have a legitimate prescription vs a "fentanyl" death from someone who bought an illicit drug that was laced with fentanyl. there are a lot of people legitimately in chronic pain who are turned away or get the run around because we're cracking down on the wrong thing.
jmts 8y ago
Based on some of the comments regarding the role that foreign countries have in the market, I thoroughly recommend people give "Narconomics" by Tom Wainright a read. It approaches the drug trade from an economic perspective, and I found it quite interesting to read about how prohibition in one market creates problems in other markets that can likely only be solved by ending prohibition.

96 points by digital55 8y ago

zunzun 8y ago

Fentanyl is not yet a controlled substance at its major global source: is this racial vengeance for the Opium Wars?

PhasmaFelis 8y ago
No.
sct202 8y ago
There's a Chinese factory that will make you almost anything imaginable some legally some illegally (violating IP or regulations). It's not part of a conspiracy that there are also illegal drug factories.

nacho2sweet 8y ago

I live in Vancouver which has always been ground zero for opiates for 30+ years. 1100 deaths a year just here over fentanyl. Constant ambulances and fire trucks on at all times just injecting narcan. Article about how China is basically using the trade as a bargaining trade and extradition chip. https://globalnews.ca/news/4658188/fentanyl-china-canada-diplomatic-tensions/ https://globalnews.ca/news/4658188/fentanyl-china-canada-dip... Seem to remember us joining the Afghan war for fewer deaths.

mediaman 8y ago
Very interesting. The Chinese are doing the same thing the Brits did to them: getting an entire country addicted to opiates. In that one, Britain went to war with the Chinese when the Chinese tried to stop the flow of opium. Something like 10-20% of the population of the entire country was addicted.
- adventured 8y ago
  > The Chinese are doing the same thing the Brits did to them: getting an entire country addicted to opiates. No, that's not actually happening at all in fact, either in the US or Canada. Most of what you're seeing re China is fentanyl - because it's extraordinarily potent - killing a lot of people that would otherwise not be overdosing from heroin at anywhere near the same rate. Their culpability in the spread of opioid use and addiction is minimal, it's primarily the increase in overdose deaths that China's fentanyl is contributing to. US doctors and some specific pharma companies have the vast majority of responsibility when it comes to the opioid addiction and abuse increases we've seen in the US over the last decade.
- sbhn 8y ago
  I suspect that the lengths US and UK go to keep influence over afghanistan is so that it can reintroduce the flow of heroin into china if they ever wants to play that card again
  - bootlooped 8y ago
    I think that ship has sailed. China's strong military and police state would prevent such a thing from happening today. The only way I could see that happening would be by first crushing China in all-out war; but if you do that first then what use would the heroin be?
    - sbhn 8y ago
      Anytime anybody critices china, you only have to replace the word with america, or england, and the story is the same. Except, using china in a sentance significantly raises the clickbait value.
acct1771 8y ago
Is narcan injected now?
- bundiddly 8y ago
  It's usually given as an intramuscular injection. The intranasal form works, but is not quite as effective (though avoids the potential for a needlestick injury to the provider).
- nacho2sweet 8y ago
  It is injected and some of the opiates on the streets are so strong here you are starting to need administer multiple injections. There is the nasal spray and that is often given out on the streets so addicts can help each other. There are narcan administration classes all the time and it is given to and by night life workers because fentanyl is showing up in party drugs like cocaine and mdma. Lots of friends said they have quit their favourite extracurriculars but they get drunk and in a good mood and forget at 2am, or they know their dealer etc... Pretty scary.
acdanger 8y ago
I wasn't aware that Vancouver had a significant opiate problem. Is it just a supply and demand at play via close ties with China? Or are there societal issues at play?
- nacho2sweet 8y ago
  Both. We are/where a major port gateway to Hong Kong/China going way back so triads came in and heroin trafficking came with it. It has always been very cheap, and supposedly high quality back when. Societal stuff is often natives coming into town already in poverty escaping reserves and getting into it, and also people from just across Canada in general that are maybe already addicts. Vancouver has the most mellow climate in Canada as well if you are homeless. East Hastings where it was concentrated was kind of a place hard partying loggers would go and hook up with escorts in cheap motels for a week, so it bred a bunch of bad stuff that never went away 40+ years later. Also neighbouring districts and suburbs don't support their homeless populations so it was just concentrating. Now that there is a affordability crisis here every suburb around has a crazy homeless tent city in parks they are kicking out and moving every 2 months, and opiates def play a big part in those. But the suburbs are full of sort of white baby boomer or new landed chinese immigrant populations who aren't used to dealing with it and don't want any homeless shelters built in their neighborhoods. The stories that make the news the most are probably the same ones in the states where it is like white kid in suburbs taking a fake xanax with fentanyl or a MDMA pill probably pressed in a same pill press or having fentanyl mixed in for whatever reason and OD'ing.
solidsnack9000 8y ago
Article about how China is basically using the trade as a bargaining trade and extradition chip. China encouraging the flow of opiates to a western port city to try to obtain political cooperation?

JoeAltmaier 8y ago

Off the topic: looks like the half-life (or doubling-life anyway) is about 10 years. The number of deaths double in a decade, which means of course we're setting records every year. Time until everybody in USA is dead of opiods: 120 years

pavel_lishin 8y ago
Joke's on you, statistics, I plan to be dead long before then.

volkl48 8y ago

It's looking like it's peaked, 2018 data is still provisional, but is currently expected to show a modest decline after the final numbers are in. 11/30 article on topic: https://www.washingtonpost.com/business/2018/11/30/after-record-number-us-deaths-opioid-epidemic-may-be-receding/?utm_term=.37f14699ff32 https://www.washingtonpost.com/business/2018/11/30/after-rec... Data source: https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm There is certainly far more work to be done.

wgerard 8y ago
Curious because it's not mentioned: How much of that is due to higher availability/usage of Narcan?
- hackeraccount 8y ago
  There's research to suggest that there's an element of moral hazzard that comes with the availability of Narcan. see: https://www.npr.org/templates/transcript/transcript.php?storyId=661011560 https://www.npr.org/templates/transcript/transcript.php?stor...
- volkl48 8y ago
  Not really something this dataset (which is just about # of deaths + drug that caused them) can tell you. I'd imagine you'd need some sort of formal study of the data to try to assign why deaths are starting to decline/plateau and what share a certain thing is responsible for, there are other possible causes. ------- Opiate prescriptions are falling pretty significantly. Number of prescriptions is down 22% from 2012-17, and volume (mg of opiates dispensed) dropped 12% in 2017 alone. https://www.aafp.org/news/health-of-the-public/20180425opioidstudy.html https://www.aafp.org/news/health-of-the-public/20180425opioi... That could be contributing to a decline in the "pipeline" of new addicts. Less people starting on them and lower doses and shorter durations when they are prescribed. It would make sense for a decline spurred by that to not show up in opiate deaths for a few years, my impression is that most people spiral downward for a while before actually dying/ODing.
8y ago

orasis 8y ago

Legalize psychedelics to treat addiction.

ams6110 8y ago
There may be something to that, but I am guessing that any form of self-medication is likely to be more destructive than helpful. Use of pharmaceutical grade psychedelics in a clinical setting might have some benefit.
- pstuart 8y ago
  Let me make that decision myself, thank you very much.
  - aalleavitch 8y ago
    All of these overdoses are, likewise, people making these decisions for themselves.
    - all2 8y ago
      That's more than misleading. Having made poor choices in the past (drugs) they now have the neuro-chemical pathways cut into their ~brians~ brains; literal ruts that signals will prefer to get to the end-state (high/low). With enough use, heroin doesn't leave a person with choice, but rather impulse. [edit] lol, brians [/edit]
    - loeg 8y ago
      So are the smoking deaths. I think it's undisputed that there would be a lot fewer deaths per addict if the heroin available were (1) of a known concentration, (2) not fentanyl, and (3) devoid of other harmful adulterants. The problem people argue about re: legalizing heroin is that they expect the number of addicts to rise.
    - pstuart 8y ago
      I've been given the choice (that I don't plan on taking) to drink and smoke myself to death. Eat unhealthy foods. Etc. Etc. n.b. My brother died of a heroin overdose. He made that decision himself and the existing laws did not help prevent.

pjc50 8y ago

This is a tragedy, but I can already see the conversation moving away from how the problem might be fixed towards blaming it on foreign enemies. Which will absolutely not help.

taylorswift_ 8y ago
How do you reason such? Most if not all of the illicit fentanyl comes from China, where it is an uncontrolled substance. IMO this should definitely be part of a comprehensive conversation.
- soundwave106 8y ago
  The problem here is the initial opioid crisis hardly involved China at all. Instead it largely involved US pharmaceutical companies like Purdue Pharma's over-aggressive promotion of Oxycontin. China and fentanyl only came into the picture later. Fentanyl is a significant issue and discussing what China intends to do about fentanyl certainly is warranted (seems like discussions are underway to schedule it in China -- https://www.cnn.com/2018/12/01/politics/fentanyl-us-china-g20-talks/index.html https://www.cnn.com/2018/12/01/politics/fentanyl-us-china-g2... ). But one compound isn't the full problem here.
- neurobashing 8y ago
  I assume the parent comment's reasoning is, roughly: The War on Drugs was, from one point of view, essentially a soft invasion of central and south American countries; we sent DEA and military "advisors" to burn the crops of farmers while the CIA treated narcos like Soviets. Indisputable that, eg, yes mexican farmers were growing kush (or making coke, etc) at the behest of powerful cartels. They were totally doing that. It did not spend as much effort on why and how drugs became what they are in our own country; laws had disproportionate impacts on some communities; treatment was the refuge of the privileged. Slaking the need for drugs is more than border enforcement, from this perspective. So yeah, some dope comes from point A to point B, so stop it from making it to point B, but also look at what's going on at point B to fix the problems that aren't trafficking.

sampleinajar 8y ago

"Opioid prescriptions have been falling, even as the death rates from overdoses are rising" Gee, it's almost as if "overprescribing" and then cutting off the supply had the affect of driving some who are addicted to buy opiates with less quality control, and they are dying from it.

presscast 8y ago
I'm a bit puzzled by your comment. Are you suggesting that we should have continued to over-prescribe?
- dbatten 8y ago
  Judging by the quotes around overprescribe, I'm assuming the parent comment is skeptical of the idea that we were over-prescribing. Also, they're likely criticizing the whipsaw fashion in which we allowed drug companies to convince everybody these opioids were totally safe, then drastically cut off the supply without doing anything to help people who had already become addicted.
  - deleted 8y ago
    [deleted]
- wesd 8y ago
  sampleinajar is stating that when doctors were over-prescribing the patient became addicts. When those patients were cut-off from legally buying the drugs, they turned to black market where the quality of the drug is unknown which leads to overdose.
- tonyarkles 8y ago
  There's a middle ground there. Cutting back on the number of new opiod prescriptions is definitely a good thing, but you've got to be careful of how you handle existing patients who have already been pulled into the problem. From a harm reduction perspective, taking a patient who is, say, addicted to legal oxycodone because they were overprescribed it. Now what do you do from the perspective of what's best for the patient? Is it a good thing that they're addicted to it? No... but is it more harmful to cut them off cold-turkey? Or is it better to help work with them to figure out how to get off it in a way that doesn't result in them seeking out street drugs to handle the withdrawal?

mruts 8y ago

I used to be addicting to heroin. The problem is with fentanyl, not heroin. I've had 2 close friends die from overdoses, and both involved fentanyl. I got close myself a couple times (or so my wife says, I was passed out), and both were fentanyl laced doses. I honestly and truly believe that opiates (and all drugs) should be legal. I think you would find the number of overdoses drop drastically if that were the case. No one wants to do fentanyl, it doesn't last as long and feels weird. Heroin itself is very safe if it's not cut and the purity is known ahead of time.

acct1771 8y ago
But it commonly is, and you commonly don't.
- jlg23 8y ago
  The comment you responded to just pointed that out.
loeg 8y ago
Fentanyl is a problem but people definitely died of heroin overdose, or other heroin-related illness (infection, random other poisoning due to adulterants), long before fentanyl entered the picture.
- stronglikedan 8y ago
  I think that's why OP qualified it with "the purity is known ahead of time." There are relatively not very many overdose deaths from pill versions of opiates where the dosage is known, because people generally know how much they can handle and generally don't want to die.
  - loeg 8y ago
    Totally agree. The death rate per capita between heroin users and prescription opioid users is totally different as a result.
  - 8y ago

deyan 8y ago

Can someone put this into context, or share a source that does? How does this compare to other causes of death, for example? The NYT article has comparisons on the absolute level (i.e. comparing to peak car crash deaths and HIV deaths from 20-30 years ago) - but those are outdated and misleading because they not relative and don't account for e.g. population growth. I am just trying to get a sense for the true magnitude of the problem, beyond the scary headlines.

mruts 8y ago
From my personal experience, what's scary is that it's crossing all socioeconomic boundaries. I had two friends that died and both had high-paying jobs (finance and software dev) and seemed outwardly successful (much like myself I guess). There are groups of people who we don't care about, and there are groups that we do. What's scary to people is the metastasizing of the problem from one group to the other.
nostrademons 8y ago
It's small relative to the total number of deaths in the U.S, but large relative to deaths for that age group (< 55): https://www.cdc.gov/injury/images/lc-charts/leading_causes_of_death_age_group_2016_1056w814h.gif https://www.cdc.gov/injury/images/lc-charts/leading_causes_o... https://www.cdc.gov/injury/images/lc-charts/leading_causes_of_death_highlighting_unintentional_2016_1040w800h.gif https://www.cdc.gov/injury/images/lc-charts/leading_causes_o... I assume overdoses are classed as "unintentional poisoning" - they're the leading cause of death for ages 25-45, nearly double car accidents and 3x suicides. They're a very small fraction of deaths by cancer & heart disease, but those usually happen after 50+. In terms of "preventable" deaths they and car accidents are by far the biggest culprits. I'm surprised there's not more of a push toward self-driving cars and mass transit, but other than that it makes sense to focus on overdoses. The other interesting thing that stood out to me in the data was how much the homicide rate has dropped since 1980. We have this perception that the world is getting more dangerous, but it's not actually reflected in the data, and by far the biggest danger to us now is ourselves.
rtkwe 8y ago
The US has not grown that much. It's grown to 1.52x, 1.25x, and 1.22x the population for 1972 (car crash), 1993 (gun), and 1995 (HIV) respectively so it is above everything except the 1972 car crash peak. It's a big deal.

NeedMoreTea 8y ago

Maybe it's time to remember the British System, which had worked successfully for decades. Anslinger being put on the US team for the UN Committee on Drugs put paid to that, and pressured other countries with less punitive drug approaches. Anslinger has much to answer for; perhaps the one doctor who forgot "discourage" does too. For those who don't know, the British System was once globally famous, and briefly put was "discourage, but prescribe"[0]. When it was overridden with a more recognisable war on drugs there were only hundreds of addicts in the UK. No one connected addiction to crime. Highly doubtful we could return to that state, even if it was successfully continued. [0] https://www.vice.com/en_uk/article/yw4nnk/when-boots-prescribed-heroin-the-uk-did-drug-policy-right https://www.vice.com/en_uk/article/yw4nnk/when-boots-prescri...

taxicabjesus 8y ago

Overdose deaths are only a fraction of the casualties of this particular war on people. We should also count all the people who are in prison on charges of self-medicating, and all the people who die in prison while being punished for hurting no one but themselves. I didn't know anything about Methadone until I'd taken a few people to the various methadone clinics. I thought they were just medical drop-offs... and thought it odd that their trip home was just a few minutes later. Eventually I learned these people were going for their daily dose of methadone. One fellow said he'd gotten addicted to painkillers following a car accident, and that he'd never imagined himself needing to visit a methadone clinic every day. Towards the end of my taxi driving experience, I had a woman going from WalMart to a half-way house. She'd spent 5 years in prison for sharing a single opiate pill with a friend (circa 2010). She said something about the cop who wrote her up for prosecution chuckling as he filled out the form. Over her five years in prison several of her fellow inmates died from neglect. She'd gained a lot of weight on prison food, which isn't very nutritious. Apparently the State of Arizona is negligent-homiciding prisoners in the name of helping them correct their behavior, which doesn't make much sense to me. I'm sure all the other states' jails and prisons have similar conditions.

maxxxxx 8y ago
"Apparently the State of Arizona is negligent-homiciding prisoners in the name of helping them correct their behavior," They just want to punish people, they don't care about correcting behavior.

viggity 8y ago

God damn it, I want to know these numbers for people that have a legitimate prescription vs a "fentanyl" death from someone who bought an illicit drug that was laced with fentanyl. there are a lot of people legitimately in chronic pain who are turned away or get the run around because we're cracking down on the wrong thing.

jmts 8y ago

Based on some of the comments regarding the role that foreign countries have in the market, I thoroughly recommend people give "Narconomics" by Tom Wainright a read. It approaches the drug trade from an economic perspective, and I found it quite interesting to read about how prohibition in one market creates problems in other markets that can likely only be solved by ending prohibition.