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In the US, Methadone also keeps people tethered to a daily drive to a Methadone clinic, followed by a relatively long wait in line. When someone is trying to ha

In the US, Methadone also keeps people tethered to a daily drive to a Methadone clinic, followed by a relatively long wait in line. When someone is trying to hang on to a job and get their life back together, this can be a significant drag on the process. Buprenorphine (with or without added naloxone) has no such restriction, and can be dispensed from a normal pharmacy in 30-day supplies. However, the DEA limits the number of patients a buprenorphine-licensed physician can take on, which leads to shortages of available care (or very high prices) in a lot of areas of the US. The article seems to blame the drug, and the delivery service, and the people selling it. But many of the people in the bottom 20% income bracket in the US are sick, isolated, have no access to health care (at least without winning their $6,250 out-of-pocket maximum on a lottery ticket), are poor enough to have to prioritize rent over food, and have little to no opportunity for social or economic advancement. As the http://en.wikipedia.org/wiki/Rat_Park http://en.wikipedia.org/wiki/Rat_Park guy said, "severely distressed animals, like severely distressed people, will relieve their distress pharmacologically if they can."

danielschonfeld 12y ago
The second half of your message, that! If only people realized here that selling the notion of work hard win big isn't working for most middle class and lower class Americans. We can keep on saying its in the name of Capitalism and that this is what this country was founded on that we keep on burying our heads in the sand but at what point does one give up old notions and adjusts to the realities of living at a particular time and stop quoting old cliches that don't work for the majority?
jschwartzi 12y ago
He's also blaming addicts for being addicts. At the end of the article he lays out a "rugged individualism" argument that addicts should just suck it up and quit being addicts. Well, they can't, and they've proven that they can't multiple times, so what does he propose we do, other than crack down even harder? Doing the same thing over and over again and expecting a different result is how some define insanity. Also, if these gangs are non-violent and their custom are non-violent, isn't that preferable to the kind of raw violence that is seen with other Mexican cartels?
- wdewind 12y ago
  No he's not, he's blaming doctors for misunderstanding the medicines they are prescribing and overprescribing them, thus exposing a lot more people to addiction than otherwise would've been.
  - velox_io 12y ago
    This may be the case in the US. However in the UK, doctors are scared to prescribe pain killers. As someone who suffers from chronic pain (accident early 2012), it took two years to get even close to adequate pain medication (from a pain specialist in the end). I work hard and if there was a better option than pain killers, I'd happily pursue it. Being tarred with the same brush as addicts is quite offensive. Also, I have a BMI in the mid 20's so further exercise isn't going to help.
    - DanBC 12y ago
      That's not being scared, that entirely appropriate prescribing. https://news.ycombinator.com/item?id=9402507 https://news.ycombinator.com/item?id=9402507 Many people in the UK end up addicted to pain medication after inappropriate prescribing of opiate meds to treat long term pain. You should be angry about the length of time it took to get you to a pain clinic, not about doctor's decision not to prescribe meds that are both addictive and often ineffective. Also, "lose weight and do psysiotherapy guided exercise" might not have been right for you but it is good advice for many people with long term pain.
    - facetube 12y ago
      I've had chronic pain in the past that's probably far more minor than yours, and it sucks. But for what it's worth, I've found that the mental effects of exercise are far more dramatic than the physical ones – paradoxically, even running until I'm sore and exhausted seems to relieve more pain over the following two to three days than it causes. Maybe worth considering. Anyway, hope you're trending toward better.
    - tmp-20150107 12y ago
      Hell, in the UK doctors often won't even prescribe addicts Methadone. For example, I had to go to a separate service, the CDPS (Community Drug Problem Service, says it all, really) where you are basically treated like criminal scum, no matter what your background is. I gave up on the scheme when my assessor didn't believe I wasn't homeless, had a real job and had never been in prison...
wdewind 12y ago
> The article seems to blame the drug, and the delivery service, and the people selling it. But many of the people in the bottom 20% income bracket in the US are sick, isolated, have no access to health care... From the article: > "the victims — mostly white, well-off and often young" > "A result has been a rising sea level of prescription painkillers that continues today, of opioids such as Percocet, Vicodin and OxyContin. Sales of these drugs quadrupled between 1999 and 2010. Addiction followed. And this has given new life to heroin, which had been declining in popularity since the early 1980s." I think your point is valid but not relevant to the article. It's not claiming the things you said. Also Rat Park is highly controversial and has failed to be reproduced and, obviously, is a rat study, so I wouldn't really rely on it as a robust narrative for what's going on with drug addiction in humans.
- wanderingstan 12y ago
  I didn't realize that Rat Park was controversial. Can you point me to some scholarly articles or discussions around it, or the latest addiction research? The wiki page indicates that there was some success in replicating the results. Searching the web is impossible, as it's mostly hype popsci articles in th vein of "you didn't know this about addiction!"
  - facetube 12y ago
    There are almost certainly some issues with the Rat Park experiment, but even exercise alone has been shown to reduce binding availability at the mu opioid receptor in humans, probably as a result of beta-endorphin being released: http://www.ncbi.nlm.nih.gov/pubmed/18296435 http://www.ncbi.nlm.nih.gov/pubmed/18296435. It wouldn't be a huge leap to hypothesize that this could decrease exogenous opioid consumption. Interestingly enough, there's also a genetic mutation that's at least loosely associated with alcoholism, a possible increased response to naturally-produced beta-endorphin, and a need for more opioids to achieve equivalent pain relief: http://www.pnas.org/content/95/16/9608.full.pdf http://www.pnas.org/content/95/16/9608.full.pdf http://www.snpedia.com/index.php/Rs1799971 http://www.snpedia.com/index.php/Rs1799971
- facetube 12y ago
marincounty 12y ago
The DEA needs to lift the 100 patient limit on bupenorpine. I don't know why this drug is regulated this way. Bupenorpine is here. We have a problem with opioid addiction. Doctors should be able to prescribe the drug without going to a class, and then limit the number of patients who can take it. The drug is expensive. Even the generic version is expensive? I'm not a conspiracy theorist, but something is not right with the way this drug is regulated, and manipulated? Some of my details are fuzzy, but the original manufacturer of this drug fought hard to extend the patent. When that failed, they scared Physicians into thinking your patients will abuse the drug if you don't use our expensive strips. Antidotal, but I can honestly state it's a hard drug to abuse. It's not a fun drug. It is addictive though. This bit about having a low affinity for addiction might be true for some individuals. The people I know on it have a hard time getting off the drug. I think people would be surprised to find out just how many people are on this drug; they shouldn't be nickeled and dimed by the cost of the drug, and endless expensive office visits. (The average patient has usually suffered in life. Why give them a addictive drug and let doctors use the 100 patient limit as a excuse/incentive to raise the cost of mandatory office visits? The office visit is essentially--ok--you showed up and payed me--I will refill your addictive medication.)

danielschonfeld 12y ago

The second half of your message, that! If only people realized here that selling the notion of work hard win big isn't working for most middle class and lower class Americans. We can keep on saying its in the name of Capitalism and that this is what this country was founded on that we keep on burying our heads in the sand but at what point does one give up old notions and adjusts to the realities of living at a particular time and stop quoting old cliches that don't work for the majority?

jschwartzi 12y ago

He's also blaming addicts for being addicts. At the end of the article he lays out a "rugged individualism" argument that addicts should just suck it up and quit being addicts. Well, they can't, and they've proven that they can't multiple times, so what does he propose we do, other than crack down even harder? Doing the same thing over and over again and expecting a different result is how some define insanity. Also, if these gangs are non-violent and their custom are non-violent, isn't that preferable to the kind of raw violence that is seen with other Mexican cartels?

wdewind 12y ago
No he's not, he's blaming doctors for misunderstanding the medicines they are prescribing and overprescribing them, thus exposing a lot more people to addiction than otherwise would've been.
- velox_io 12y ago
  This may be the case in the US. However in the UK, doctors are scared to prescribe pain killers. As someone who suffers from chronic pain (accident early 2012), it took two years to get even close to adequate pain medication (from a pain specialist in the end). I work hard and if there was a better option than pain killers, I'd happily pursue it. Being tarred with the same brush as addicts is quite offensive. Also, I have a BMI in the mid 20's so further exercise isn't going to help.
  - DanBC 12y ago
    That's not being scared, that entirely appropriate prescribing. https://news.ycombinator.com/item?id=9402507 https://news.ycombinator.com/item?id=9402507 Many people in the UK end up addicted to pain medication after inappropriate prescribing of opiate meds to treat long term pain. You should be angry about the length of time it took to get you to a pain clinic, not about doctor's decision not to prescribe meds that are both addictive and often ineffective. Also, "lose weight and do psysiotherapy guided exercise" might not have been right for you but it is good advice for many people with long term pain.
  - facetube 12y ago
    I've had chronic pain in the past that's probably far more minor than yours, and it sucks. But for what it's worth, I've found that the mental effects of exercise are far more dramatic than the physical ones – paradoxically, even running until I'm sore and exhausted seems to relieve more pain over the following two to three days than it causes. Maybe worth considering. Anyway, hope you're trending toward better.
  - tmp-20150107 12y ago
    Hell, in the UK doctors often won't even prescribe addicts Methadone. For example, I had to go to a separate service, the CDPS (Community Drug Problem Service, says it all, really) where you are basically treated like criminal scum, no matter what your background is. I gave up on the scheme when my assessor didn't believe I wasn't homeless, had a real job and had never been in prison...

wdewind 12y ago

> The article seems to blame the drug, and the delivery service, and the people selling it. But many of the people in the bottom 20% income bracket in the US are sick, isolated, have no access to health care... From the article: > "the victims — mostly white, well-off and often young" > "A result has been a rising sea level of prescription painkillers that continues today, of opioids such as Percocet, Vicodin and OxyContin. Sales of these drugs quadrupled between 1999 and 2010. Addiction followed. And this has given new life to heroin, which had been declining in popularity since the early 1980s." I think your point is valid but not relevant to the article. It's not claiming the things you said. Also Rat Park is highly controversial and has failed to be reproduced and, obviously, is a rat study, so I wouldn't really rely on it as a robust narrative for what's going on with drug addiction in humans.

wanderingstan 12y ago
I didn't realize that Rat Park was controversial. Can you point me to some scholarly articles or discussions around it, or the latest addiction research? The wiki page indicates that there was some success in replicating the results. Searching the web is impossible, as it's mostly hype popsci articles in th vein of "you didn't know this about addiction!"
- facetube 12y ago
  There are almost certainly some issues with the Rat Park experiment, but even exercise alone has been shown to reduce binding availability at the mu opioid receptor in humans, probably as a result of beta-endorphin being released: http://www.ncbi.nlm.nih.gov/pubmed/18296435 http://www.ncbi.nlm.nih.gov/pubmed/18296435. It wouldn't be a huge leap to hypothesize that this could decrease exogenous opioid consumption. Interestingly enough, there's also a genetic mutation that's at least loosely associated with alcoholism, a possible increased response to naturally-produced beta-endorphin, and a need for more opioids to achieve equivalent pain relief: http://www.pnas.org/content/95/16/9608.full.pdf http://www.pnas.org/content/95/16/9608.full.pdf http://www.snpedia.com/index.php/Rs1799971 http://www.snpedia.com/index.php/Rs1799971
facetube 12y ago

marincounty 12y ago

The DEA needs to lift the 100 patient limit on bupenorpine. I don't know why this drug is regulated this way. Bupenorpine is here. We have a problem with opioid addiction. Doctors should be able to prescribe the drug without going to a class, and then limit the number of patients who can take it. The drug is expensive. Even the generic version is expensive? I'm not a conspiracy theorist, but something is not right with the way this drug is regulated, and manipulated? Some of my details are fuzzy, but the original manufacturer of this drug fought hard to extend the patent. When that failed, they scared Physicians into thinking your patients will abuse the drug if you don't use our expensive strips. Antidotal, but I can honestly state it's a hard drug to abuse. It's not a fun drug. It is addictive though. This bit about having a low affinity for addiction might be true for some individuals. The people I know on it have a hard time getting off the drug. I think people would be surprised to find out just how many people are on this drug; they shouldn't be nickeled and dimed by the cost of the drug, and endless expensive office visits. (The average patient has usually suffered in life. Why give them a addictive drug and let doctors use the 100 patient limit as a excuse/incentive to raise the cost of mandatory office visits? The office visit is essentially--ok--you showed up and payed me--I will refill your addictive medication.)