The American Opioid Epidemic 20XX: Dropping the H-Bomb

The Something Awful Forums > Discussion > Debate & Discussion > The American Opioid Epidemic 20XX: Dropping the H-Bomb

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pangstrom: Jan 25, 2003; Wedge Regret

I think reasonable people can agree that over-prescribing opiates in large part caused the problem (which we can deduce by comparing the United States to other countries or being even mildly curious or even passingly knowledgeable about the timeline of oxy and pain as 5th vital sign or not being ideological morons, etc.) AND that pulling the rug out from that without a sensible policy about where these addicts would go would result in more OD deaths when they started doing heroin etc. Guessing narcan wasn't part of that 2011 Ohio plan, either. There would have been plenty of deaths--and even more fresh iceberg created under the surface--if they just kept the pill mills running, though. Hard to know what that lag would look like in aggregate, but if you care about human beings then another line you'd like to see on that chart is "# of new addicts/potential addicts".

# ? Mar 31, 2017 14:52

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# ? May 15, 2024 15:30

KingEup: Nov 18, 2004; I am a REAL ADDICT
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Please ask me for my google inspired wisdom on shit I know nothing about. Actually, you don't even have to ask.

pangstrom posted:

I think reasonable people can agree that over-prescribing opiates in large part caused the problem

We would not have the problem we do today if the Gov had not obstructed efforts to establish harm reduction services. You can't pin the blame exclusively on doctors.

The problem was that the government essentially banned sunscreen and sun protection at a time when doctors were recommending ppl spend more time outdoors.

KingEup fucked around with this message at 15:03 on Mar 31, 2017

# ? Mar 31, 2017 15:01

pangstrom: Jan 25, 2003; Wedge Regret

I'm not overstating things at all when I say your top-line takes are no less dumb than saying the opiate problem in 19th century China was due to government crackdowns or under supply.

# ? Mar 31, 2017 15:15

Guavanaut: Nov 27, 2009; Looking At Them Tittys
1969 - 1998; Toilet Rascal

Like Xu Naiji did when he said that China should undercut the British by establishing domestic opium plantations and taxing non-medical opium instead of the Emperor's policy of torturing addicts more and more severely and burning opium stocks to solve the problem, which famously worked great?

# ? Apr 1, 2017 17:34

KingEup: Nov 18, 2004; I am a REAL ADDICT
(to threadshitting)

Please ask me for my google inspired wisdom on shit I know nothing about. Actually, you don't even have to ask.

Another good article:

quote:

The drug war is the problem, not opioids

Making clear the dangers of drug mixing, removing politicians from doctor-patient relationships, emphasizing harm reduction, supporting the expansion of medication-assisted treatment and permitting legal access to heroin and other drugs would do more to save lives than even the most soft-hearted drug prohibition. http://www.counterpunch.org/2017/03/31/opioids-arent-the-problem-and-chris-christie-isnt-the-solution/

# ? Apr 1, 2017 23:45

BarbarianElephant: Feb 12, 2015; The fairy of forgiveness has removed your red text.

KingEup posted:

Another good article:

I used to think this. But when doctors chilled out slightly on prescribing opioids the numbers of addicts vastly increased. Legal access actually increased the number of addicts.

# ? Apr 1, 2017 23:49

susan b buffering: Nov 14, 2016

There is a difference between a doctor prescribing a drug and that drug being legally available.

# ? Apr 2, 2017 00:19

Subvisual Haze: Nov 22, 2003; The building was on fire and it wasn't my fault.

Implementing prescription opioid controls doesn't have a strong link to increased heroin use, although that line is the new favorite tactic of the drug manufacturer sponsored patient pain groups that oppose any degree of legislative action across the country. The data pretty clearly shows the shift to heroin was already occurring before the quantity of opioids prescribed in this country was curtailed or more controls were put in place. Our population being flooded with prescription narcotics definitely played the key part in creating this epidemic though. NEJM had a pretty great review article on this topic last year http://www.nejm.org/doi/full/10.1056/NEJMra1508490

quote:

EFFECTS OF OPIOID-PRESCRIBING INTERVENTIONS ON HEROIN USE
Multiple studies that have examined why some persons who abuse prescription opioids initiate heroin use indicate that the cost and availability of heroin were primary factors in this process. These reasons were generally consistent across time periods from the late 1990s through 2013.34-41 Some interviewees made reference to doctors generally being less willing to prescribe opioids as well as to increased attention to the issue by law enforcement, which may have affected the available supply of opioids locally.38,40 It should be noted that most of these studies were conducted before 2009 � a time when few policies targeting opioid prescribing were implemented.

It appears that the shift toward heroin use among some nonmedical users of prescription opioids was occurring before the recent policy focus on prescription-opioid abuse took hold. This observation is supported by data on heroin use reported to U.S. poison control centers that show increases starting in 2006,18 as well as national surveillance data that show a rise in heroin use starting in 2007.2 Similarly, a study examining hospitalizations for heroin overdose between 1993 and 2009 showed that the rate of such hospitalizations increased 69% between 1993 and 2006 and then rose more sharply, by 44%, between 2005 and 2009.49 Furthermore, this study showed that these increases occurred in the context of continued increases in the rate of hospitalization for overdose of prescription opioids.

The results of the studies by Dart et al. and Cicero et al. suggest an association between the introduction of an abuse-deterrent formulation of OxyContin and increases in rates of heroin use.16,18 Dart et al. found evidence that rates of heroin use increased after the introduction of the abuse-deterrent formulation, but they also reported that the rate of heroin use was increasing previously.18 Cicero et al. found that a decrease in the rate of OxyContin abuse corresponded with an increase in the rate of heroin use over the 2 years after the introduction of the abuse-deterrent formulation.16 However, in a follow-up study, Cicero and Ellis found that over the ensuing 18 months, the rates of OxyContin abuse no longer decreased whereas the rates of heroin use continued to increase.50 Moreover, a separate study involving patients who were being screened for substance-abuse treatment showed no significant differences between the prevalence of heroin use before the introduction of the reformulation and the prevalence after the reformulated drug was available.51

Five recent quantitative studies provide additional insights into the relationship between opioid-prescribing policies and practices and heroin use and overdose. First was an analysis of deaths due to overdose in North Carolina between 2007 and 2013, which documented a shift toward an increasing risk of death due to heroin use.52 However, the shift began in 2009, before changes such as the introduction of abuse-deterrent formulations of opioids were in effect.52 The second study showed that heroin-related emergency department visits, hospital admissions, and overdose deaths in Wisconsin started to increase in 2007.53 Furthermore, these increases in rates of heroin overdose were superimposed on continued increases in rates of prescription-opioid overdoses through 2012.53

The third study examined deaths from overdose in Florida through 2012.13,54 Florida had a well-documented prescription-opioid problem.54 Between 2010 and 2011, Florida instituted a series of major policy changes that were designed to reduce the inappropriate supply of prescription opioids. After these policies were implemented, prescriptions were curtailed and the rate of death from prescription-opioid overdose declined 27% between 2010 and 2012.13,54 Moreover, these significant declines in prescription-opioid mortality were accompanied by an increase of only 60 deaths related to heroin, with the overall number of total deaths from overdose declining by 535 between 2010 and 2012.13

The fourth study, which examined opioid overdoses in New York, showed a 29% reduction in the rate of death from prescription-opioid overdose coupled with declines in the rates of overall and high-dose opioid prescribing in Staten Island, New York, in 2013 after the implementation of targeted and general public health initiatives, including a heavy focus on prescribing behaviors.15 Importantly, these decreases were not offset by increases in mortality from heroin-involved overdose during the same time period.15

Finally, in an investigation of deaths related to heroin and prescription-opioid use in 28 states between 2010 and 2012, Rudd and colleagues found no association between declines in prescription-opioid�related mortality and increases in heroin-related mortality.55 In fact, they found that increases in the rates of death due to heroin overdose were associated with increases in the rates of death due to prescription-opioid overdose in these states.55

Although none of these studies can disprove a potential relationship between policies that are aimed at decreasing the availability of inappropriately prescribed opioids and the motivation for heroin use in some people, the results of these studies consistently suggest that the transition to heroin use was occurring before most of these policies were enacted, and such policies do not appear to have directly led to the overall increases in the rates of heroin use.

# ? Apr 2, 2017 00:41

Subvisual Haze: Nov 22, 2003; The building was on fire and it wasn't my fault.

Meanwhile in Wisconsin our sadistic governor wants to be to able to kick childless adults off medicaid if they fail a mandatory drug screening. He also wants to do the same for people applying for food stamps or unemployment benefits.

Now that's how you kick a drug epidemic into overdrive.

# ? Apr 2, 2017 01:00

KingEup: Nov 18, 2004; I am a REAL ADDICT
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Please ask me for my google inspired wisdom on shit I know nothing about. Actually, you don't even have to ask.

Subvisual Haze posted:

Implementing prescription opioid controls doesn't have a strong link to increased heroin use, although that line is the new favorite tactic of the drug manufacturer sponsored patient pain groups that oppose any degree of legislative action across the country. [/url]

I did not realise that RAND had ties with big pharma:

quote:

Our results imply that a substantial share of the dramatic increase in heroin deaths since 2010 can be attributed to the reformulation of OxyContin. http://www.rand.org/pubs/working_papers/WR1181.html

# ? Apr 2, 2017 06:06

sea of losers: Jun 6, 2007; miy mwoiultlh tbreaptpreude ifno srteavtiecr more

BarbarianElephant posted:

I used to think this. But when doctors chilled out slightly on prescribing opioids the numbers of addicts vastly increased. Legal access actually increased the number of addicts.

are you referring to what happened in the US in the early 2000s with oxy, or something else?

on another note honestly i think that people are going to do drugs if they want to do drugs and you should make it as safe as possible for them to do so. people wanted opioids before oxy happened and they want them now. switzerland has the right idea, im repeating myself, etc

# ? Apr 2, 2017 23:39

BarbarianElephant: Feb 12, 2015; The fairy of forgiveness has removed your red text.

big cock Salaryman posted:

are you referring to what happened in the US in the early 2000s with oxy, or something else?

Since round about then until recently there has been a lot more prescription of opioids because of a shaky study that said people in pain don't get addicted. Turns out they do, and also if there's a lot of legal opiates floating around, there is more opportunity for them to get into the black market.

There was also an issue with something called "pill mills" where crooked doctors made huge profits prescribing huge amounts of opioids to anyone who could pony up cash for a "consultation."

# ? Apr 2, 2017 23:50

pangstrom: Jan 25, 2003; Wedge Regret

~23k drug convictions are going to be vacated in Massachusetts, though it took a long time by any standard to get here.
http://www.nbcnews.com/news/us-news/stunning-drug-lab-scandal-could-upend-23-000-convictions-n739626

# ? Apr 2, 2017 23:53

empty whippet box: Jun 9, 2004; by Fluffdaddy

One of my friends died of a heroin overdose two nights ago. I don't have anything else to add I guess. He was 25.

# ? Apr 3, 2017 02:21

OhFunny: Jun 26, 2013; EXTREMELY PISSED AT THE DNC

empty whippet box posted:

One of my friends died of a heroin overdose two nights ago. I don't have anything else to add I guess. He was 25.

I am so sorry :smith:

# ? Apr 3, 2017 05:36

cvisors: Sep 24, 2003; Carnage Visors; Sugartime Jones

empty whippet box posted:

One of my friends died of a heroin overdose two nights ago. I don't have anything else to add I guess. He was 25.

I don't have the right words for you. I'm really sorry

# ? Apr 3, 2017 05:45

sea of losers: Jun 6, 2007; miy mwoiultlh tbreaptpreude ifno srteavtiecr more

BarbarianElephant posted:

Since round about then until recently there has been a lot more prescription of opioids because of a shaky study that said people in pain don't get addicted. Turns out they do, and also if there's a lot of legal opiates floating around, there is more opportunity for them to get into the black market.

There was also an issue with something called "pill mills" where crooked doctors made huge profits prescribing huge amounts of opioids to anyone who could pony up cash for a "consultation."

yeah im aware of all that. part of it was the age-old tactic of claiming that oxy wasn't addictive. i agree that it was wrong to do. my view is that the toothpaste is out of the tube and we need to provide support, because no amount of crackdowns will put the paste back in.

# ? Apr 3, 2017 06:22

ToxicSlurpee: Nov 5, 2003; -=SEND HELP=-; Pillbug

empty whippet box posted:

One of my friends died of a heroin overdose two nights ago. I don't have anything else to add I guess. He was 25.

Goondolences, yo. That's an awful tragedy no matter how you slice it.

# ? Apr 3, 2017 06:23

empty whippet box: Jun 9, 2004; by Fluffdaddy

ToxicSlurpee posted:

Goondolences, yo. That's an awful tragedy no matter how you slice it.

He was a white guy from a good family in his last semester of his undergraduate degree and he was president of his fraternity and he had a girlfriend of just about 7 years.

What I'm saying is, he's the kind of heroin death that politicians pretend to give a gently caress about.

# ? Apr 3, 2017 06:41

KingEup: Nov 18, 2004; I am a REAL ADDICT
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Please ask me for my google inspired wisdom on shit I know nothing about. Actually, you don't even have to ask.

BarbarianElephant posted:

Since round about then until recently there has been a lot more prescription of opioids because of a shaky study that said people in pain don't get addicted. Turns out they do,

They sure do!

quote:

the CDC reported that de novo addiction among patients receiving chronic opioids for pain is infrequent at lower doses, affecting 0.7% of persons receiving 36 milligrams morphine equivalent (MME), rising to 6.1% among persons receiving 120 MME.3... most persons treated for prescription opioid use disorder do not have any chronic pain diagnosis.28

http://www.tandfonline.com/doi/abs/10.1080/08897077.2016.1261070?journalCode=wsub20

# ? Apr 3, 2017 14:19

KingEup: Nov 18, 2004; I am a REAL ADDICT
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Please ask me for my google inspired wisdom on shit I know nothing about. Actually, you don't even have to ask.

This one is an interesting read too:

quote:

States have responded to rising rates of prescription-opioid overdose by adopting laws that restrict the prescribing and dispensing of controlled substances...

Laws that restrict the prescribing and dispensing of controlled substances showed few meaningful associations with the receipt of prescription opioids...

...we found that state laws that impose costly requirements on prescribers, pharmacists, and patients did not have meaningful associations with opioid use or adverse outcomes

...These results are likely to disappoint state officials who are implementing laws to mitigate the unintended consequences of opioid analgesic use

http://www.nejm.org/doi/full/10.1056/NEJMsa1514387#t=abstract

# ? Apr 3, 2017 14:21

BarbarianElephant: Feb 12, 2015; The fairy of forgiveness has removed your red text.

big cock Salaryman posted:

yeah im aware of all that. part of it was the age-old tactic of claiming that oxy wasn't addictive. i agree that it was wrong to do. my view is that the toothpaste is out of the tube and we need to provide support, because no amount of crackdowns will put the paste back in.

We also need to think about preventing future addicts as well as caring for current ones. Providing freely available opioids would help current addicts live a normal life, but would inevitably create new addicts.

# ? Apr 3, 2017 14:29

KingEup: Nov 18, 2004; I am a REAL ADDICT
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Please ask me for my google inspired wisdom on shit I know nothing about. Actually, you don't even have to ask.

BarbarianElephant posted:

Providing freely available opioids would help current addicts live a normal life, but would inevitably create new addicts.

New addicts who could live a normal life? What's the problem?

KingEup fucked around with this message at 14:51 on Apr 3, 2017

# ? Apr 3, 2017 14:44

pangstrom: Jan 25, 2003; Wedge Regret

Addicts generally don't lead normal lives and it's not just government policy that causes that.

# ? Apr 3, 2017 21:07

Ytlaya: Nov 13, 2005

pangstrom posted:

Addicts generally don't lead normal lives and it's not just government policy that causes that.

Yeah; even on suboxone I never felt quite the same as I did back before I had ever used. Even ignoring the psychological issues, I couldn't experience feelings like pleasure or excitement in the same way I could when clean. I know that some addicts are able to feel totally normal on suboxone, but for me it just made things tolerable and preferable to using a short-acting opioid.

# ? Apr 3, 2017 22:48

KingEup: Nov 18, 2004; I am a REAL ADDICT
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Please ask me for my google inspired wisdom on shit I know nothing about. Actually, you don't even have to ask.

quote:

I know that some addicts are able to feel totally normal on suboxone, but for me it just made things tolerable and preferable to using a short-acting opioid.

Some people don't feel normal unless they take it, some people don't feel normal unless they abstain.

And my position is that it be left up to the user to decide what is best for them.

# ? Apr 3, 2017 23:16

pangstrom: Jan 25, 2003; Wedge Regret

What would you guess is the over under on what those folks would choose if it was "just" a choice, though?

# ? Apr 3, 2017 23:21

pangstrom: Jan 25, 2003; Wedge Regret

Ytlaya posted:

Yeah; even on suboxone I never felt quite the same as I did back before I had ever used. Even ignoring the psychological issues, I couldn't experience feelings like pleasure or excitement in the same way I could when clean. I know that some addicts are able to feel totally normal on suboxone, but for me it just made things tolerable and preferable to using a short-acting opioid.

This is still a pretty good outcome, relatively speaking, though sounds like you got to an even better one. Even with perfect policy I don't know what proportion of addicts would end up doing real stable maintenance (on suboxone or methadone or heroin or whatever) and not getting other problems / be still able to meet life's normal challenges. Like the rate must be way better in Vancouver than in Cleveland, but Vancouver still has a lot of ODs.

# ? Apr 4, 2017 12:55

deoju: Jul 11, 2004; All the pieces matter.; Nap Ghost

This was news to me: Opiod addicts using massive doses of an anti-diarrhea medication for withdrawals and getting high.

# ? Apr 11, 2017 23:02

Tar_Squid: Feb 13, 2012

deoju posted:

This was news to me: Opiod addicts using massive doses of an anti-diarrhea medication for withdrawals and getting high.

I'm pretty sure some goon in TCC actually died from doing that. Can't find a link though since pretty sure the thread's been archived.

# ? Apr 11, 2017 23:09

Famethrowa: Oct 5, 2012

Tar_Squid posted:

I'm pretty sure some goon in TCC actually died from doing that. Can't find a link though since pretty sure the thread's been archived.

Yeah, massive heart attack in a movie theatre from megadosing.

# ? Apr 12, 2017 00:38

Konstantin: Jun 20, 2005; And the Lord said, "Look, they are one people, and they have all one language; and this is only the beginning of what they will do; nothing that they propose to do will now be impossible for them.

Walgreens and CVS are enabling this as well by selling 200 pill packs. There is no way someone using the product as intended could need that much.

# ? Apr 12, 2017 01:20

Ytlaya: Nov 13, 2005

deoju posted:

This was news to me: Opiod addicts using massive doses of an anti-diarrhea medication for withdrawals and getting high.

You know how opioids make you constipated? Imodium is just an opioid that doesn't cross the blood brain barrier (in normal therapeutic doses). So it's not as strange as the headline makes it sound, since all opioid drugs do literally the same thing as Imodium to your GI system.

Even in lower doses, Imodium is part of the core OTC cocktail of drugs you should take to help alleviate opiate withdrawal symptoms.

edit: Ah, the article mentions most of this. The headline is just a little misleading because it seems to imply that Imodium, as an anti-diarrhea medication, is somehow fundamentally different from other opioids.

Ytlaya fucked around with this message at 01:54 on Apr 12, 2017

# ? Apr 12, 2017 01:52

reagan: Apr 29, 2008; by Lowtax

Konstantin posted:

Walgreens and CVS are enabling this as well by selling 200 pill packs. There is no way someone using the product as intended could need that much.

You've clearly never suffered from Crohn's or some other GI malady. poo poo is awful.

# ? Apr 12, 2017 04:11

reagan: Apr 29, 2008; by Lowtax

Ytlaya posted:

You know how opioids make you constipated? Imodium is just an opioid that doesn't cross the blood brain barrier (in normal therapeutic doses). So it's not as strange as the headline makes it sound, since all opioid drugs do literally the same thing as Imodium to your GI system.

Even in lower doses, Imodium is part of the core OTC cocktail of drugs you should take to help alleviate opiate withdrawal symptoms.

edit: Ah, the article mentions most of this. The headline is just a little misleading because it seems to imply that Imodium, as an anti-diarrhea medication, is somehow fundamentally different from other opioids.

Loperamide used to be a schedule II controlled substance. The entire DEA scheduling system is garbage, but this one always makes me laugh.

# ? Apr 12, 2017 04:12

King Possum III: Feb 15, 2016

reagan posted:

Loperamide used to be a schedule II controlled substance. The entire DEA scheduling system is garbage, but this one always makes me laugh.

Loperamide was once a controlled drug under Schedule V. (retired pharmacy tech here)

And you're right; it made no sense.

# ? Apr 12, 2017 04:24

LanceHunter: Nov 12, 2016; Beautiful People Club

King Possum III posted:

Loperamide was once a controlled drug under Schedule V. (retired pharmacy tech here)

And you're right; it made no sense.

A former girlfriend was a nurse and a pretty bad addict (opiates and benzos). She'd do a lot of morphine and such that she got from her work. She knew how they kept track of spillage at her hospital and was really good about knowing what she could or could not get away with taking when it came to opiates. When they finally busted her, it was because they were able to track some relatively benign anti-nausea meds she was also pilfering to help deal with that side-effect of her use. Sometimes I wonder how many things end up scheduled for reasons like that.

# ? Apr 12, 2017 14:54

Nissin Cup Nudist: Sep 3, 2011; Sleep with one eye open

We're off to Gritty Gritty land

One of my coworkers died of a heroin OD on April Fools Day. He had a habit in the past but managed to beat it and was clean for a decade. He ran into money/marital problems late last year and cracked. He was 49.

Heroin isn't weed or LSD. It will catch up to you one day. Don't do heroin

# ? Apr 17, 2017 22:06

King Possum III: Feb 15, 2016

Nissin Cup Nudist posted:

One of my coworkers died of a heroin OD on April Fools Day. He had a habit in the past but managed to beat it and was clean for a decade. He ran into money/marital problems late last year and cracked. He was 49.

Heroin isn't weed or LSD. It will catch up to you one day. Don't do heroin

Sorry for your loss, Nissin Cup Nudist.

One of my closest NA buddies also died about 10 days ago, apparently from an accidental OD while shooting his Rx morphine pills.

Such a goddamned waste, and I'm feeling guilty for being so pissed at him.

# ? Apr 18, 2017 00:58

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# ? May 15, 2024 15:30

PT6A: Jan 5, 2006; Public school teachers are callous dictators who won't lift a finger to stop children from peeing in my plane

Nissin Cup Nudist posted:

One of my coworkers died of a heroin OD on April Fools Day. He had a habit in the past but managed to beat it and was clean for a decade. He ran into money/marital problems late last year and cracked. He was 49.

Heroin isn't weed or LSD. It will catch up to you one day. Don't do heroin

Honest question: do you think if heroin was legal and available at standardized dosages no-questions-asked, it could save lives?

On one hand, I think there would be more addicts, which is unquestionably bad. On the other hand, I think there would be fewer accidental ODs, which is good. I'm conflicted as to what the goal of opiate policy should be: is it better to have more addicts who don't die, or fewer addicts with the risk of death for addicts massively increased? Is there a right answer?

My cousin died of a heroin overdose about 7 or 8 years ago now -- similar to your story, he was clean and relapsed and OD'd shortly thereafter -- and it seems like the problem has only gotten worse. It's such a lovely drug, and it kills far too many people.

# ? Apr 18, 2017 01:11

The Something Awful Forums > Discussion > Debate & Discussion > The American Opioid Epidemic 20XX: Dropping the H-Bomb

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