The US Opioid Epidemic

[Playball40]

The way see it, there's a lot of blame to go around for this, and like most social problems, there's no easy answer. Doctors, pharma companies, insurance companies, and patients themselves should all claim their fair share of what's going on. Each industry would have to have a reformation and frankly, give up on some money because their current practices are harming patients. Unfortunately there's a lot of finger pointing going on by each of these groups, and no real changes taking place. The only change that has taken place (eliminating pill mills, new regulations for pain clinics, etc.) has been enacted by government, but there's little funding to make changes, and most on are on the state level.

There's also the matter of changing the circumstances of patient's lives. When your life sucks and you have nowhere to turn, a hit of opioids can make it feel like it's not so bad, and it helps you cope. Often, "addiction specialists" kick the crutches out from underneath you, and do nothing to help about your broken leg.

yup

 

[LordKiran]

So you want the US Air Force to bomb pharmaceutical companies...well that makes about as much sense as much of what you write.

We can't bomb them; it'll cause too much damage in the surrounding areas.

Says who?

 

[Playball40]

Your correct, nobody is doing anything about it even though we've known for a number of years

Manufacturers should cease using opiates in pain killers where I am sure there are a lot of alternatives.

https://www.drugabuse.gov/about-nid...ion-to-opioids-heroin-prescription-drug-abuse

The abuse of and addiction to opioids such as heroin, morphine, and prescription pain relievers is a serious global problem that affects the health, social, and economic welfare of all societies. It is estimated that between 26.4 million and 36 million people abuse opioids worldwide,[1] with an estimated 2.1 million people in the United States suffering from substance use disorders related to prescription opioid pain relievers in 2012 and an estimated 467,000 addicted to heroin.[

Unfortunately, there are not currently any drugs other than opiates that are effective in treating moderate to severe acute or chronic pain. I have worked as a health care professional for over forty years and there are many people, primarily older adults, that suffer greatly from chronic pain. Currently the few other drugs like NSAIDS, which are sometimes effective in treating inflammatory diseases, have their own set of severe side effects if used on a regular basis. They can cause severe GI bleeds as well as renal failure. I personally know of a truck drive that died of liver failure from taking acetaminophen ( tylenol ) for chronic back pain. Drugs such as gabapentin are sometimes effective in treating neuropathy, but they also have a lot of side effects, and they aren't always effective. I've read books on pain control and experienced severe pain myself. Narcotic pain killers were the only thing that helped me. Fortunately my severe pain was acute and I only needed these drugs for a short period of time.

My biggest concern is that those who need these drugs the most, including about five of my current patients, will not have access to them due to increasingly draconian regulations, which haven't been effective in reducing the misuse of these drugs. These regulations which include physicians no longer be able to write refills for any of these control drugs, have caused a lot of hardship for these folks.

I think the addiction problem is probably a lot more complicated than some seem to think. It may be partially due to many nonrelated societal problems. Making it harder for people to obtain legally written pain Rxs. is not going to fix this problem. Drugs like fentanyl are now being illegally manufactured and obtained in countries like China, for example. I don't know what the solution is to this problem but I'm very sure that the answer isn't to deprive those who need these drugs the most from living more comfortable lives.

The draconian measures you speak of have only INCREASED the incidence of death from drug overdoses. Why? Because people are turning to heroin and "online" fentanyl from China. Also, many of these overdoses are pain medication in CONJUNCTION with alcohol or anti-anxiety medications. We need to figure out how to prevent those from being prescribed together as the combination is deadly.

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Uh that's you. Not everyone responds the same way you know.

When your life sucks and you have nowhere to turn, a hit of opioids can make it feel like it's not so bad, and it helps you cope.

Opioids make me sick. I have bottles of accumulated painkillers that I've been prescribed and have either never taken or have only taken one or two out of the bottle. Most came from dentists. But as an example, I had some hip pain past year and couldn't see my primary care doc. Got in to see his PA instead. She gave me the referral to PT that I wanted, and a prescription for Vicodin. I filled the prescription... the bottle seemed to be a bit large, but that's nothing unusual, But then I opened it - she had given me THIRTY pills! I took 1½ of them over the next 2 days, then went to ibuprofen. The rest remain in a bottle in a drawer, awaiting the rueful day when I experience pain that is more unpleasant than what that shit does to me.

IMHO there's no excuse for handing out THIRTY Vicodin for someone's pain coming from an un-diagnosed source.

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It's not the pain medication by itself.

Doctors, pharma companies, insurance companies, and patients themselves should all claim their fair share of what's going on.

I would say Pharmaceutical manufacturers bear the lion's share (Purdue Pharma especially), then doctors, then patients - but I'm not really sure how much blame should go to insurance companies. I think the ideal case is that insurance companies don't interfere with the specifics of the treatment plan a doctor recommends for their patient, and if anything they're incentivized to not pay for a prescription.

 

[Playball40]

https://www.theguardian.com/us-news...un/08/opioid-epidemic-drug-mix-overdose-death

Why isn't this the discussion?

 

[braces_for_impact]

Doctors, pharma companies, insurance companies, and patients themselves should all claim their fair share of what's going on.

I would say Pharmaceutical manufacturers bear the lion's share (Purdue Pharma especially), then doctors, then patients - but I'm not really sure how much blame should go to insurance companies. I think the ideal case is that insurance companies don't interfere with the specifics of the treatment plan a doctor recommends for their patient, and if anything they're incentivized to not pay for a prescription.

I absolutely agree. As far as insurance companies, often they won't pay for a corrective procedure, but you're still in pain. So, you're stuck on opiates for years for no good reason other to save some insurance company money.

 

[braces_for_impact]

As far as the insurance and doctor problems go, I'll share a personal anecdote.

I had been on tramadol for about 3 years because of neck joint degeneration and a bone spur which presses on a nerve. I wasn't happy about taking opiates for so long, but I sought treatment because life was getting miserable for me, and an MRI showed my problem. I took the medication as directed, and the meds made life bearable again. I could sleep, and I could function at work and at home with my two kids.

Then I lost my job and lost my insurance. Our opiate laws here in Florida mandate the doctor see their patients in person every month - and are also subject to random drug testing on a regular basis. I suddenly went from managing my pain, to dope sick when my meds ran out. I mean sick and completely miserable. Now not only was I in pain, but my body and my brain made me feel worse than anything I had ever experienced. There was also a deep depression that set in. I was unable to cope with anything. I very suddenly understood the desperation that junkies must feel. If someone had come into my home with a needle and heroine, I can't honestly say I would have turned it down. I felt as if I would do anything to get me out of feeling like I did. So, I thought, OK, this will last for a few days and I'll sweat it out and be over it. TWO WEEKS passed, I was worse, not better.

Someone I knew recommended kratom. I went to a nearby kratom bar. I was skeptical and sick and just a grumpy asshole. My girlfriend almost literally had to drag me there. I had a drink. I felt something, and my symptoms started to go away, like within a half hour. I had a second drink and felt good, like really actually good. Not the same as tramadol, that warm fuzzy feeling it gave me, but good as in having hope again. Also, the constant muscle spasms, and burning associated with my condition lessened substantially. My mood lifted, my sickness went away and I went shopping and stayed out of the house all day. Fucking amazing. I went home with some in baggie and learned how to make tea with it. Many states have banned kratom and we just fought off them trying to do so here in Florida for a third year in a row. You may have also heard recently that we fended off a DEA measure that wanted to make kratom a schedule 1 substance, which is ridiculous. Many of the states that have enacted measures against kratom also have pharmaceutical research going on with kratom. Coincidence? There's a lot of misinformation about kratom everywhere you look, and I support research into it for pain relief and getting people off of opiates. I would support measures to regulate kratom (not ban it) so that you can be assured of potency, purity, and make it safer.

I'm still unemployed, and I take a few tablespoons of kratom every day to manage my pain, and help with my depression, which it does wonders for, when I had tried several depression meds that didn't work for me or had intolerable side effects.

In many ways I consider myself lucky. Who knows what I would have done to avoid that dope sickness, had I the connections or know how to get a hold of street stuff. I'm not proud of saying that, and I have no history of alcohol or other drug abuse. I've had vicodin and similar drugs before after surgeries, sometimes for a few months, and had very little difficulty after my medical rotation was finished. It seems that Tramadol also has an ssri component to it, which is scary. As I looked around online, it seems Tramadol was marketed as a less addictive type of opiate. But, from what I have been able to find, like many drugs as of late, it's turning out to be the opposite of that.

 

[untermensche]

https://www.theguardian.com/us-news...un/08/opioid-epidemic-drug-mix-overdose-death

Why isn't this the discussion?

Because alcohol and benzodiazepines are much less lethal without the opioids.

 

[Loren Pechtel]

I think the addiction problem is probably a lot more complicated than some seem to think. It may be partially due to many nonrelated societal problems. Making it harder for people to obtain legally written pain Rxs. is not going to fix this problem. Drugs like fentanyl are now being illegally manufactured and obtained in countries like China, for example. I don't know what the solution is to this problem but I'm very sure that the answer isn't to deprive those who need these drugs the most from living more comfortable lives.

I think making the stuff available by prescription to the addicts would go a long ways towards addressing the issue. Sure, they would be hooked but they wouldn't be facing unknown purity and thus unknowingly taking too much.

 

[braces_for_impact]

https://www.theguardian.com/us-news...un/08/opioid-epidemic-drug-mix-overdose-death

Why isn't this the discussion?

Also keep in mind that when they count up prescription opioid abuse, they count street use of heroin as well.

 

[Thomas II]

When your life sucks and you have nowhere to turn, a hit of opioids can make it feel like it's not so bad, and it helps you cope.

Opioids make me sick. I have bottles of accumulated painkillers that I've been prescribed and have either never taken or have only taken one or two out of the bottle. Most came from dentists. But as an example, I had some hip pain past year and couldn't see my primary care doc. Got in to see his PA instead. She gave me the referral to PT that I wanted, and a prescription for Vicodin. I filled the prescription... the bottle seemed to be a bit large, but that's nothing unusual, But then I opened it - she had given me THIRTY pills! I took 1½ of them over the next 2 days, then went to ibuprofen. The rest remain in a bottle in a drawer, awaiting the rueful day when I experience pain that is more unpleasant than what that shit does to me.

IMHO there's no excuse for handing out THIRTY Vicodin for someone's pain coming from an un-diagnosed source.

I agree 100%.

 

[Playball40]

And opioids are way less lethal without alcohol and benzodiazepines.

https://www.theguardian.com/us-news...un/08/opioid-epidemic-drug-mix-overdose-death

Why isn't this the discussion?

Because alcohol and benzodiazepines are much less lethal without the opioids.

- - - Updated - - -

https://www.theguardian.com/us-news...un/08/opioid-epidemic-drug-mix-overdose-death

Why isn't this the discussion?

Also keep in mind that when they count up prescription opioid abuse, they count street use of heroin as well.

Street fentanyl as well - typically comes from China through Mexico and is cut with who knows what.

 

[braces_for_impact]

Opioids make me sick. I have bottles of accumulated painkillers that I've been prescribed and have either never taken or have only taken one or two out of the bottle. Most came from dentists. But as an example, I had some hip pain past year and couldn't see my primary care doc. Got in to see his PA instead. She gave me the referral to PT that I wanted, and a prescription for Vicodin. I filled the prescription... the bottle seemed to be a bit large, but that's nothing unusual, But then I opened it - she had given me THIRTY pills! I took 1½ of them over the next 2 days, then went to ibuprofen. The rest remain in a bottle in a drawer, awaiting the rueful day when I experience pain that is more unpleasant than what that shit does to me.

IMHO there's no excuse for handing out THIRTY Vicodin for someone's pain coming from an un-diagnosed source.

I agree 100%.

I can understand on how this is risky, but you also have to understand how shitty our health care system is...and again, that's part of the problem. When my symptoms first started I still lived in Indiana. It started as a numbness going down my left arm, a very strong feeling you get like when a limb falls asleep. Thinking that maybe I pulled something, I didn't do anything about it. Then my left hand would get numb enough that I would drop stuff now and then. That's when I got really worried. Then my store closed shop because of a corporate merger. Oops,no more health insurance.

Long story short, a few months after I start my next job horrible headaches begin. I go to the emergency room, get an CT scan of my head that shown no problems. Oops, big ER bill and no insurance. No medication either. Follow up doctor is given. I'm 3 weeks later to go to it, because insurance just started. Doc diagnosis because of muscle spasm and headache is a muscle strain somewhere. Ice and heat recommended, along with migraine meds. OK. Headaches and other problems continue. Pain worsens. Back to the doc. OK, he feels me up some, and surprise it hurts when he touches it. Decides to give me an Nsaid and inject a steroid into my left shoulder. Go home. Wait a few more weeks. No help, back to doc. He wants to try another steroid shot with another longer lasting anesthetic in it. Changes migraine meds. Go home, no effect. I'm in constant and awful pain and headaches by now, and I've had enough of this doctor. I change primary care providers and go with a recommendation from a friend. She asks me a lot of questions, and orders an MRI. It should only take a few weeks to get in to get it done, but it takes a month and a half. I ask for something to help with the pain. She's reluctant to give me more than anything I've already had and apologizes. I understand and feel like an ass for asking and hope she doesn't think I'm a druggie. Cool, got MRI done, make new doc appointment, and in almost another month later I get back in and SURPRISE several deteriorated discs either bulging or collapsed, and a bone spur growing right onto a major nerve that travels down my left arm. Hooray! I feel vindicated, she prescribes tramadol, and I get my first prescription pain relief. I switched to neurontin for awhile because I'm uneasy about the tramadol but end up back on it later after I'm transferred to a pain clinic. I get a radio frequency ablation procedure done a few times after targeted steroid shots don't help, and after awhile a time release tramadol and a fast acting tramadol for breakthrough pain are prescribed. All of this makes life bearable again. But, the bottom line is I was miserable; out of sick days and vacation days at work, applying for FMLA until I got my first "street abusable" prescription. Nine months. I could have had a baby. That's a long fucking time to be in severe pain. Let me tell you. If my job loss wouldn't have occurred, it looks like it still would have taken at least 3 months. That's bullshit.

 

[T.G.G. Moogly]

I thought benzos were in fact opioids. My doc would not prescribe the original dosage, said it's too dangerously addictive. I have a good doc.

 

[untermensche]

And opioids are way less lethal without alcohol and benzodiazepines.

You are right.

The root problem is the way people increase the dosage of their pain medication without medical advise.

But this would be less of a problem without the combination of other drugs that suppress brain function.

 

[southernhybrid]

I think the addiction problem is probably a lot more complicated than some seem to think. It may be partially due to many nonrelated societal problems. Making it harder for people to obtain legally written pain Rxs. is not going to fix this problem. Drugs like fentanyl are now being illegally manufactured and obtained in countries like China, for example. I don't know what the solution is to this problem but I'm very sure that the answer isn't to deprive those who need these drugs the most from living more comfortable lives.

I think making the stuff available by prescription to the addicts would go a long ways towards addressing the issue. Sure, they would be hooked but they wouldn't be facing unknown purity and thus unknowingly taking too much.

I don't disagree with you. In fact, I support the legalization or at least decriminalization of all recreational drugs. ETOH is legal and it kills a lot of people, or makes them dysfunctional. Any drug can be abused. When drugs are legal or at least decriminalzied, you eliminate a lot of the problem such as increased incarceration, and over doses might become less frequent. If someone wants to self destruct, they will find a way, so I tend to be libertarian when it comes to things like drugs.

And, speaking of benzos, all of my patients that currently use narcotics for their pain on a regular basis, also take benzos at least twice a day. But they are all living in a long term care environment so there is less likely hood of abuse. My late father used to tell me that his anti anxiety drug helped him more than his narcotics. He took methadone and hydrocodone for about 15 years prior to his death as the age of 87. A lot of people with chronic pain also suffer from anxiety. Sometimes antidepressants help with anxiety, but sometimes they are useless for that problem.

 

[LordKiran]

I think making the stuff available by prescription to the addicts would go a long ways towards addressing the issue. Sure, they would be hooked but they wouldn't be facing unknown purity and thus unknowingly taking too much.

I don't disagree with you. In fact, I support the legalization or at least decriminalization of all recreational drugs. ETOH is legal and it kills a lot of people, or makes them dysfunctional. Any drug can be abused. When drugs are legal or at least decriminalzied, you eliminate a lot of the problem such as increased incarceration, and over doses might become less frequent. If someone wants to self destruct, they will find a way, so I tend to be libertarian when it comes to things like drugs.

And, speaking of benzos, all of my patients that currently use narcotics for their pain on a regular basis, also take benzos at least twice a day. But they are all living in a long term care environment so there is less likely hood of abuse. My late father used to tell me that his anti anxiety drug helped him more than his narcotics. He took methadone and hydrocodone for about 15 years prior to his death as the age of 87. A lot of people with chronic pain also suffer from anxiety. Sometimes antidepressants help with anxiety, but sometimes they are useless for that problem.

Alternatively, a secondary prison system that focuses on the rehabilitation of drug addicts would probably be a more sound social investment.

 

[whichphilosophy]

I saw this report of some initial studies which suggests there is a much needed safe alternative to opiate pain killers

https://www.ncbi.nlm.nih.gov/pubmed...e-alternative-to-opiates-may-have-been-found/


Conclusion

This experimental study identified a new compound, PZM21, and investigated its effectiveness and safety in mice compared to morphine and TRV130. This research hopes to aid the development of an effective alternative to morphine that has none of the drawbacks, such as respiratory depression, constipation and addiction.[/I]

NB obviously given there is very little else on this, successful replicated studies are required.

 

[southernhybrid]

Drug sales on the dark web is another reason why this epidemic will never end, and it makes more sense to legalize the shit. People are going to use dangerous substances, legal or not, and the widespread availability of narcotic drugs these days makes it extremely easy to purchase them. Legalization would allow for regulations and state sponsored sales centers. That's the only thing that makes sense to me. Making draconian laws that punish users, fill up prisons etc. doesn't ever solve this problem. Selling them legally would keep the price below that of illegal sales, and allow for taxation which could be used for rehab for those that want to try and change their behavior. Blaming the problem on Rx. opiods is stupid, imo.

https://www.wired.com/2015/08/crackdowns-havent-stopped-dark-webs-100m-yearly-drug-sales/

AFTER MORE THAN four years and two giant law enforcement busts, the Dark Web's drug market is still just as robust as it was during the Silk Road's heyday. In fact, according to a new study, it's now moving well over $100 million of illegal substances a year, and it's recovering from every new scam-induced setback and government crackdown faster than the last one.
Those are a few of the lessons from a deep-dive study into Dark Web black market sales statistics that a pair of Carnegie Mellon researchers plan to present at the Usenix Security conference Wednesday. From 2013 to early 2015, they used automated software to "scrape" the visible contents of 35 Dark Web markets, counting the number of feedback ratings that the major drug sites require buyers to leave after each sale and then multiplying them by the purchased item's listed price to gauge total sales volumes. The result is the most comprehensive—if still not fully complete—picture of how contraband narcotics sales have waned and waxed during the short history of the Dark Web's online economy.
The researchers' findings, which extend to January of this year, describe a market that's no longer explosively growing, as it did in the early days of Silk Road.

Read the rest of the link for more details.

 

[Crazy Eddie]

I'm sure at least 20 people have beaten me to it by now...

But I love how rich and middle class drug addicts are "victims" of an "epidemic" but poor people in the ghettos and the trailer parks are enemy combatants in the "war on drugs."

It's actually a little bit refreshing in a way... our knee-jerk reaction is to try and shoot our way out all our problems, unless the problem affects us PERSONALLY, and then suddenly we expect people to deal with us with compassion and sensitivity.

 

[Playball40]

And opioids are way less lethal without alcohol and benzodiazepines.

You are right.

The root problem is the way people increase the dosage of their pain medication without medical advise.

But this would be less of a problem without the combination of other drugs that suppress brain function.

No sir, the root of the problem is WHY some people feel the need to increase their dosage. If we could get to that, we may be able to solve the problem.