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PT6A posted:Honest question: do you think if heroin was legal and available at standardized dosages no-questions-asked, it could save lives? Standardized dosages of heroin already exist. Its called Morphine Glibness aside, no. Heroin is just too drat strong of a drug for that to work. If you want a weaker dose, grab morphine. But your body will catch up and you need more and the cycle continues. Someone at work theorized that coworker went to the dosage he used when he was an addict, but his body couldn't adjust after being clean for so long. There are some drugs where I think an OTC standard dosage would work. Heroin is not one of them.
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Apr 18, 2017 02:13
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Nissin Cup Nudist posted:Someone at work theorized that coworker went to the dosage he used when he was an addict, but his body couldn't adjust after being clean for so long. That's exactly what happened with my cousin, too. Apparently it's a depressingly common thing -- relapses are probably deadlier than continued use. At least with legal standard doses, you'd have a more precise idea of what you were using before, and what a standard tolerance is now that you're clean (in theory, of course; in practice, you could still easily OD). I think harm reduction is also important: safe, supervised injection sites are a great thing, and I think there should also be more messaging about relapse, because I think the unfortunate fact is that a lot of people do relapse, especially in lovely, stressful conditions: if you relapse, you aren't a lovely person and you don't deserve to die -- but you need to be careful. You need to know your tolerance has decreased. You need to know that you aren't a failure or a hopeless case; you hit a speed bump, not a wall. As a society, we get focused on complete sobriety/abstention (because it's the only way to fully eliminate the negative influence of these addictions on your life), but I think it's at the cost of making people feel even worse about a relapse, which impairs their ability to recover in a lot of cases. Guilt is a negative feeling, which can lead to further use. All in all, it's just a very lovely situation and I hope we find a way of dealing with it.
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Apr 18, 2017 02:31
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People just don't die if they are given a supervised setting to use heroin. There should be no shame in using heroin or telling someone else you are planning to use, There should be no reason to use alone. Our drug policy is killing people who have different drug preferences. The correct policy is as follows: Heroin use is removed from the criminal code Heroin is sold or given for free in a variety of formulations (nasal spray, prefilled syringes etc) in medically supervised settings and cannot be taken off the premises. Opium is sold at licenced stores for non medical use. All opioids sold for therapeutic use should come packaged with naloxone. KingEup fucked around with this message at 02:48 on Apr 18, 2017 |
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Apr 18, 2017 02:39
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So everyone is killing themselves with drugs because life as a poor in America sucks, right
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Apr 18, 2017 22:00
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Nissin Cup Nudist posted:Standardized dosages of heroin already exist. Its called Morphine  It's often found to be the superior analgesic in late stage cancer, and administered intranasally it's better at alleviating pain from fractures in young children, due to the lower dose, faster onset, and route of administration. It is about 2.5x as strong as morphine. They make the vials smaller.
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Apr 18, 2017 22:42
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Nissin Cup Nudist posted:Standardized dosages of heroin already exist. Its called Morphine Glibness aside, no. Heroin is just too drat strong of a drug for that to work. If you want a weaker dose, grab morphine. But your body will catch up and you need more and the cycle continues. Someone at work theorized that coworker went to the dosage he used when he was an addict, but his body couldn't adjust after being clean for so long. It is a huge problem when people return to old doses after time away, though. That's part of why people are so much more likely to die of an overdose right after getting out of prison.
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Apr 20, 2017 06:18
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Albino Squirrel posted:Heroin is only about 2.5x as strong as morphine; hydromorphone is 5x as strong and we use that all the time. We also use these lollipops all the time too: http://www.journals.elsevierhealth.com/cms/attachment/2037837012/2052294166/gr5.jpg A good read: https://www.theatlantic.com/health/archive/2017/04/joblessness-and-opioids/523281/ KingEup fucked around with this message at 08:18 on Apr 20, 2017 |
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Apr 20, 2017 07:49
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how about we have heroin clinics where anyone who wants to use can with the help of a doctor, but let the doctors really try to convince you to just go smoke a joint if you've never done heroin before?
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Apr 20, 2017 09:54
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https://twitter.com/StefanKertesz/status/854816331249725440
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Apr 20, 2017 10:26
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Apr 20, 2017 11:21
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What is the significance of the exemption specifically? Is it part of the crackdown on pill mills?
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Apr 20, 2017 12:36
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Condiv posted:how about we have heroin clinics where anyone who wants to use can with the help of a doctor, but let the doctors really try to convince you to just go smoke a joint if you've never done heroin before? The heroin clinics that have been tried (and were quite successful) generally require the patient to have been addicted for a set number of years and to have tried and failed to quit using more traditional methods; it's not like a California MMJ card.
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Apr 20, 2017 14:38
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FreshlyShaven posted:The heroin clinics that have been tried (and were quite successful) generally require the patient to have been addicted for a set number of years and to have tried and failed to quit using more traditional methods; it's not like a California MMJ card. is there any real downside to just admitting everyone who wants to quit and getting them started on a program to wean them off? i've heard weaning people off with medical assistance works wonders, and I kind of doubt the usefulness of traditional methods since AA is still considered a useful traditional method and it sucks
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Apr 20, 2017 14:47
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Teriyaki Koinku posted:What is the significance of the exemption specifically? Is it part of the crackdown on pill mills? I have kind of the opposite reaction because yeah, tapers are loving painful which means hopefully-temporary loss of function and the BU-BUT HIPPOCRATIC OATH! response seems very disingenuously pearl-clutch-y to me.
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Apr 20, 2017 14:56
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Albino Squirrel posted:Heroin is only about 2.5x as strong as morphine; hydromorphone is 5x as strong and we use that all the time. There's nothing wrong with diacetylmorphine as a molecule, relative to other opioids; any objection to it is more about the optics than anything else. That being said, the optics are bad enough that I don't like the option of prescription heroin when hydromorphone exists, and it's a drug that physicians are much more familiar with. It does have some clinical advantages over the slower acting opioids, as per that study regarding intranasal admission in children. It is always good if physicians are more familiar with the drug, as opposed to just believing what's in the pharmacy rep presentation, but lol fucken oxycodone. There's probably less risk of that happening with diamorphine because it's so generic.
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Apr 20, 2017 15:08
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Why do so many people ignore the economic aspect of this epidemic? Look at where the epicenter of these addictions are - right in the middle of the part of the country hit hardest by the 21st century. "Doctors do this" or "pharma did that" doesn't really explain why WV has addiction rates that make California's look silly by comparison (not to mention that the addicts in CA are almost all in the poorest counties). People are killing themselves this way because they've got no hope.
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Apr 20, 2017 15:17
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I think it has pulled less focus in part for the same reason that nobody is talking about the genetic risks of addiction. It's tough to legislate genes and it's almost as tough to legislate hope. It's also kind of hard to argue that rural white Americans are uniquely hopeless and the opiate trend hasn't tracked (say) economic prospects that closely. Another aspect working against it is that the high profile deaths are all Heath Ledgers and Philip Seymour Hoffmans and Princes etc. THAT ALL SAID, yeah it's obviously part of what is going on.
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Apr 20, 2017 15:39
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pangstrom posted:I think it has pulled less focus in part for the same reason that nobody is talking about the genetic risks of addiction. It's tough to legislate genes and it's almost as tough to legislate hope. It's also kind of hard to argue that rural white Americans are uniquely hopeless and the opiate trend hasn't tracked (say) economic prospects that closely. Another aspect working against it is that the high profile deaths are all Heath Ledgers and Philip Seymour Hoffmans and Princes etc. THAT ALL SAID, yeah it's obviously part of what is going on. I agree with everything except opiate and economic prospects tracking. The recession of 2001-ish never ended in WV, as this is when outsourcing and reductions in coal production began in earnest. 
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Apr 20, 2017 18:03
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Oh, the other factor that hasn't come up I don't think is child abuse. People who were abused as kids are way more likely to become addicts. http://www.nijc.org/pdfs/Subject%20Matter%20Articles/Drugs%20and%20Alc/ACE%20Study%20-%20OriginsofAddiction.pdf
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Apr 20, 2017 20:25
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call to action posted:Why do so many people ignore the economic aspect of this epidemic? Look at where the epicenter of these addictions are - right in the middle of the part of the country hit hardest by the 21st century. quote:as the unemployment rate increases by one percentage point in a given county, the opioid-death-rate rises by 3.6 percent, and emergency-room visits rise by 7 percent. https://www.theatlantic.com/health/archive/2017/04/joblessness-and-opioids/523281/
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Apr 20, 2017 21:15
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I like how they say that "it's not all economic" but then, in the paper, say: quote:The story is rooted in the labor market, but involves many aspects of life, including health in childhood, marriage, child rearing, and religion. This is the "hillbilly culture" argument ala "Hillbilly Elegy" right? Like, I'm pretty sure your marriage, child rearing, and health prospects are heavily determined by your economic status. Even if this were true, it wouldn't explain why it only spiked in the last 15 years or so, it's not like rednecks were better people back then or something.
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Apr 20, 2017 21:40
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Like seriously, I'm 30 and it's amazing how many people I went to HS with have grandchildren.
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Apr 20, 2017 21:58
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I'm a social worker in rural Missouri. I investigate child abuse and neglect, so my life is at least 95% poor, white addicts. As somebody linked above, childhood trauma is a reliable indicator of future substance problems. But childhood trauma is also reliably linked to poverty. I've read a lot of papers and sat in a lot of lectures. Never met anybody who could comprehensively separate poverty from childhood trauma markers, or trauma from drugs. They're like the... drat it, I had something for this. edit: The Hillbilly trinity.
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Apr 21, 2017 00:09
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Unrelated, a couple pages ago I mentioned a woman who OD'd with a guy, and she survived while the guy died. Because she provided the drugs, there was talk of the prosecutor trying to get her for murder. So to update now, a couple weeks later, they are going to try to get her for some kind of manslaughter and a bunch of drug charges. It looks like she'll do serious time. I still haven't been able to get a good idea how common this outcome is around the country.
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Apr 21, 2017 00:14
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Economic inequality is the pile of kindling and prescription opioids was the match tossed on top to start the conflagration.
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Apr 21, 2017 00:18
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Childhood trauma is the pile of kindling, economic inequality is the oxygen, and government policy was the match. Which makes prescription opioids the chemical chain reaction being as we seem to have fire tetrahedrons now. Which is apt.
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Apr 21, 2017 00:34
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Condiv posted:is there any real downside to just admitting everyone who wants to quit and getting them started on a program to wean them off? i've heard weaning people off with medical assistance works wonders, and I kind of doubt the usefulness of traditional methods since AA is still considered a useful traditional method and it sucks Well yea. It would cost the poor medical insurance companies a fortune and everyone in corporate would end up with a slightly smaller Christmas bonus. There would be a significantly smaller subset of people suffering meaning my lording capabilities would be diminished. I'd get really sad if these people were somehow no longer worse off than me or maybe even doing better than me. HIV and Hep C infections would likely indirectly drop as a result which will significantly effect Q3-Q4 profits.
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Apr 21, 2017 12:42
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also property crime would probably be cut down
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Apr 29, 2017 23:38
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If you're a for-profit pharmaceutical hater, I can't think of a better recent argument than this lamebrain podcast about investing in companies with potentially-profitable "solutions" https://www.fool.com/investing/2017/04/18/can-drugmakers-cure-the-opioid-crisis.aspx
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May 2, 2017 03:51
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Guess the luminaries Trump appointed to solve the opioid crisis: http://imgur.com/Ly5z34y
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May 12, 2017 05:49
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I think reasonable people can disagree, here, but while Christie is a bad guy who should be in jail he's probably the best we could have hoped for (among plausible alternatives) in terms of being inform-able and reasonable on policy. The rest of the panel seems surprisingly decent. It probably helps that being associated with trying to fix the problem isn't exactly a plum assignment. Our healthcare system is geared ridiculously poorly to actually deal with this though so it wouldn't surprise me if the response amounted to handing out federal money to over-promising scammers but, even if they do great policy, we're still solidly on the going-to-get-worse-before-it-gets-better side of things.
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May 12, 2017 11:26
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I saw my first probable carfentanil/sufentanil overdose recently. Naloxone worked so transiently that we needed to intubate, we literally would have obliterated the pharmacy's stocks trying to run a drip at a high enough rate. We're going to run out of vents and ICU beds if a big batch of it lands.
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May 12, 2017 12:08
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tetrapyloctomy posted:I saw my first probable carfentanil/sufentanil overdose recently. Naloxone worked so transiently that we needed to intubate, we literally would have obliterated the pharmacy's stocks trying to run a drip at a high enough rate. We're going to run out of vents and ICU beds if a big batch of it lands. Going just off word of mouth and a few articles and there is a clear observation bias there but it seems batches of overpowered stuff landing in a specific location is how this often goes down... haven't heard of facilities being overrun at least.
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May 12, 2017 14:47
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pangstrom posted:That's what people pointed out to me when I said they should have used it in Russia when they gassed the hostage situation (that narcan wouldn't do the job a lot of the time). Wonder if somebody is working on a stronger molecule or if that is even biochemically plausble. My hospital had over thirty overdoses in one weekend last year. Luckily most were just slightly-fentanyl-spiked heroin or the usual stuff, so they got a single dose of naloxone and walked. A lot of them don't get counted in the official stats: people bring them in a private auto apneic, blue, and limp; we butterfly them in the seat and slam in a dose of naloxone without moving them because it's faster than trying to drag dead weight out of a car into a chair or stretcher; they wake up, refuse to come in, swear at you for loving their high; and then their friend drives them off. There are dozens and dozens or users at The Tracks pretty much all the time, and if you get a batch of carfentanil-laced dope there, well, a lot of people are going to end up intubated or dead. (My own record for reversed ODs was seven in an hour, in a Memorial Day Weekend shift in 2010 or 2011. I think we have five ventilators.)
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May 12, 2017 15:17
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tetrapyloctomy posted:My hospital had over thirty overdoses in one weekend last year. Luckily most were just slightly-fentanyl-spiked heroin or the usual stuff, so they got a single dose of naloxone and walked. A lot of them don't get counted in the official stats: people bring them in a private auto apneic, blue, and limp; we butterfly them in the seat and slam in a dose of naloxone without moving them because it's faster than trying to drag dead weight out of a car into a chair or stretcher; they wake up, refuse to come in, swear at you for loving their high; and then their friend drives them off. There are dozens and dozens or users at The Tracks pretty much all the time, and if you get a batch of carfentanil-laced dope there, well, a lot of people are going to end up intubated or dead. Maybe you have a few more in the ambulances?
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May 12, 2017 15:49
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pangstrom posted:*googles "improvised ventilator"* Yeah, techs squeezing bags while looking at clocks. =) Transport has some portables. but there really aren't any to pass around. We have no in-house ICU, so it's more dependent on getting vented patients out the door. Luckily there are a bunch of tertiary/quaternary care centers in the city -- Einstein, Temple, Hahnemann, Jefferson, and HUP all spring to mind as places where one could transport out ICU-level patients with a reasonable turnaround time to getting your truck back -- and hopefully you'd see bad batches more or less sticking to the usual neighborhoods. Unfortunately, when ICU beds get tight, they tend to get tight all over the city. I've definitely gone entire shifts where the ICU-bound patients didn't budge. At least it's not as bad as some of the floor-bound patients who can get stuck for thirty hours in the ED during really bad seasons. Edit: We should make members of Congress shadow our nurses every day for twelve hour shifts until they pass single-payer healthcare. It might take two weeks.
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May 12, 2017 16:02
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tetrapyloctomy posted:Edit: We should make members of Congress shadow our nurses every day for twelve hour shifts until they pass single-payer healthcare. It might take two weeks. Except they obviously don't care if people literally die -- especially poor people or addicts.
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May 12, 2017 16:09
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PT6A posted:Except they obviously don't care if people literally die -- especially poor people or addicts. Which is why they would have to keep working the shifts until they do. If there were an end in sight, they could tough it out. But facing the reality that this is what it is, this is what you have to do, every day, until you fix it might get them on board. Who am I kidding, they'd probably somehow walk out of it thinking that it was just more proof that God loved them more than the people who were sick every day.
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May 12, 2017 16:19
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if you're wondering, there is a more potent opioid antidote than naloxone, it's called diprenorphine and they sell it in kits along with the carfentanil for large animals. it is a weird drug, i believe it's a mixed-agonist-antagonist so while it will pull someone out of carfentanil death it may get an opioid-naive person high? not alot of data on its use.
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May 12, 2017 21:43
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Isn't diacetylnalorphine also a pretty potent and fast-acting opioid antagonist, stronger than naloxone without the agonist effects of diprenorphine? With the disadvantage that we mostly know jack poo poo about it other than it once being considered by the British Pharmacopoeia for overdose and then not.
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May 13, 2017 00:06
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