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pangstrom posted:Well, if the bad news is that it will get worse before it gets better, then maybe you can spin this as good news. Hopefully the black tar stuff will stay popular and available in the West. Government drug policy largely to blame. Obstructed access to all harm reduction services that reduce likelihood of people dying for decades including: - Heroin assisted therapy and other OST - Needle and syringe programs - Supervised injecting centres - Drug checking services
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Jun 7, 2017 03:19
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call to action posted:More people are killing themselves with opiates because life in America increasingly sucks, as that trend accelerates expect ToxicSlurpee's prediction to play out Nah, this is off base. On the West Coast, overdose deaths are actually falling. Deaths among nonwhites are falling. White people (largely, RIP Prince) are killing themselves with opiates on the East Coast because they started with Oxy, moved on to heroin and now their dope is actually 99% Fentanyl (in lots of these East Coast areas heroin doesn't even exist anymore). Fentanyl reports doubled in both 2015 and 2016. It's the wildly varying strength of the dose that is the prime cause of the skyrocketing death rate, not the skyrocketing rate of usage (although that certainly doesn't help). If these people had actual heroin they'd be strung out, not dead. That's what freaks me out. ToxicSlurpee posted:No. There will be more addicts. If memory serves the number of addicts and how many new ones we get are also going up. Doing some napkin math here and assuming today's trends hold: if we follow the current rate of increasing users we should have about 1/125 Americans in 2027 being users, so that'll mean 2,856,000 people. At current death rate increase, we'll have 724,000 deaths over the next decade. So you are completely and totally correct. There will be a plenty of addicts to keep the slaughter going. the black husserl fucked around with this message at 04:08 on Jun 7, 2017 |
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Jun 7, 2017 04:06
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KingEup posted:Government drug policy largely to blame. Obstructed access to all harm reduction services that reduce likelihood of people dying for decades including: edit: since this post probably seems insane in isolation, those are all good approaches for getting the horse back in the barn or at least minimizing the number of people that get trampled. The chicken he's loving is that government limiting access to opiates caused the epidemic in the US. pangstrom fucked around with this message at 17:10 on Jun 7, 2017 |
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Jun 7, 2017 04:07
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Whatever happened to black tar in the east? I'm no expert but it was available in Ohio and elsewhere east of the Mississippi. Curious as to why it seems to have been displaced there by the fentanyl-laced powdered stuff.
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Jun 7, 2017 04:14
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NATIONAL DRUG CONTROL STRATEGY Data Supplement 2015 (189 pages) Exhaustive 152 page pdf containing the Institute for Defense Analysis Report on the Price and Purity of Illegal Drugs 1981-2007 This is amazing research into the US drug markets over the last three and a half decades, answering all sorts of questions we never thought to ask. I spent about half of last Thursday studying these data and I still had to skim a ton of it.
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Jun 7, 2017 04:33
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peej posted:Whatever happened to black tar in the east? I'm no expert but it was available in Ohio and elsewhere east of the Mississippi. Curious as to why it seems to have been displaced there by the fentanyl-laced powdered stuff.
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Jun 7, 2017 16:43
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The_Book_Of_Harry posted:NATIONAL DRUG CONTROL STRATEGY
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Jun 7, 2017 16:46
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pangstrom posted:The chicken he's loving is that government limiting access to opiates caused the epidemic in the US. I am only interested in reducing harm and yes, evidence shows that policy designed to limit access or deter either doesn't work or creates more problems than it solves e.g. 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 quote:Laws that restrict the prescribing and dispensing of controlled substances showed few meaningful associations with the receipt of prescription opioids... quote:“We all have a sense of desperation as the immense number of opioid deaths pile up, but the response is increasingly misdirected,” said Dr. Stefan Kertesz, an addiction medicine specialist at the University of Alabama at Birmingham School of Medicine. “A significant number of chronic pain patients are killing themselves, and that should be a concern to society at large when people die as a result of something done to care for them.” - See more at: http://www.bendbulletin.com/topics/5342867-151/opioid-crisis-pain-patients-pushed-to-the-brink#sthash.U49VzRmE.dpuf We simply would not have an overdose problem now if the gov had supervided injecting centres, opioid substitution therapy, drug checking services and a willingness to embrace other harm reduction services from the get go. Sure, we might still have lots of people hooked on opioids but they wouldn't be dropping dead at their current rate. Don't let the perfect be the enemy of the good. KingEup fucked around with this message at 00:50 on Jun 8, 2017 |
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Jun 8, 2017 00:43
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What could possibly move the government to change drug policy in the near future? I just don't see how. How much worse does it need to get? I realized the other day that I'm not even surprised to hear someone passed in their 30s anymore. I hear someone passed and I know what it is. It's just normal now. All of the oxygen is consumed by Trump. Nothing is getting done federally. Nothing can really change at state and local levels because no one can legalize and treat opiate addiction outside of federal laws.
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Jun 8, 2017 03:13
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I have a small ray of hope only because ultra-right-wing then-SC-congressman now OMB-director Mick Mulvaney (and also slightly moderate SC congressman-R Mark Sanford) actually signed the letter asking DEA to back off of kratom E: holy poo poo Steve King R-IA as well shame on an IGA fucked around with this message at 06:15 on Jun 8, 2017 |
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Jun 8, 2017 05:48
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If the AHCA passes, people with substance abuse problems are going to be turbo screwed. Insurance can charge more for substance abuse. Medicaid may get block grants, and they can drug test. If you ever lose Medicaid, you can't get it back.
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Jun 8, 2017 06:38
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paternity suitor posted:What could possibly move the government to change drug policy in the near future? I just don't see how. How much worse does it need to get? I realized the other day that I'm not even surprised to hear someone passed in their 30s anymore. I hear someone passed and I know what it is. It's just normal now. I don't think this is true. The vast majority of people arrested for drug crimes are charged under state laws, and I doubt the federal government will actively shut down harm reduction and treatment programs. The big issue is funding, but if states had the serious political will to do what it takes to stop this problem, even if it meant raising taxes, they could get the money.
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Jun 8, 2017 08:19
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paternity suitor posted:What could possibly move the government to change drug policy in the near future? I just don't see how. How much worse does it need to get? I realized the other day that I'm not even surprised to hear someone passed in their 30s anymore. I hear someone passed and I know what it is. It's just normal now. Something is going to break. I think the idea of defunding rehab, mental health facilities, and what have you was to save money. Just turn the crazies and junkies out on the street and let it sort itself out. However it's turning out that it isn't really saving money because of how we deal with the war on drugs. Poverty reduction programs, a decent social safety net, and actual investment in society reduce addiction rates by attacking what causes addicts in the first place. It costs less to educate somebody and get them a job than it does to lock them up in jail forever. However, American society is inherently punitive; it feels better to severely punish those people when they screw up so the "tough on crime" narrative sells well. You see this shift in states legalizing medical pot, decriminalizing possession, or just outright legalizing it. Technically speaking they can't do that because the federal government declared it a controlled substance but what the gently caress else are they going to do? Locking up every single person that's ever smoked the devil's weed would put like half of adult Americans in jail. Otherwise there's the issue that the war on drugs, despite all the money dumped into it, has shown itself as a massive failure when it comes to reducing drug use. It's done a drat fine job of putting black people in jail but that's also pissing off a lot of people.
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Jun 8, 2017 09:11
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Short term, I think the only change we're going to see most places are easy bills limiting prescriptions and some slightly harder bills about lighter/no sentencing. Those are free or save money even in the short term. Safe injection sites with treatment outreach are good policy but even if you can get people on board you will get a lot of NIMBY stuff, so that's harder. You plop a site like that anywhere better off than that Philadelphia gulch and the neighborhood probably isn't going to thank you for it. The problem with treatment is it generally works to the extent 1) the addict really wants it and 2) the place knows what it's doing. Even in ideal situations people can take multiple stints, so putting resources there is going to be expensive for awhile before things start to get better. Eventually enough people and influential people are going to know a "good person" (AKA a person they know personally) who fights addiction and becomes an advocate or dies that some movement seems almost inevitable. I am not good at predicting when or if the nation is going to turn a corner and Trump for sure is never going to help here, but in the meantime talk to your friends and family about it. It's an "interesting" subject so it's easy. Most people are aware it's going on but a shocking number of people still think about it in solely in willpower and choices and morality play terms and you can help them get past that. pangstrom fucked around with this message at 16:13 on Jun 8, 2017 |
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Jun 8, 2017 12:46
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Limiting perscriptions isn't the answer, at least for existing patients. That's actually part of the problem, if a doctor suspects their patient is addicted, they have an ethical obligation to refer the patient to specialized addiction treatment and make sure they follow up. In the common case where addiction treatment is unavailable or the patient refuses it, the least bad thing may be to continue to prescribe opiods until treatment is available and the patient is prepared to attempt treatment. Of course, limiting perscriptions for new patients is something that absolutely should be done.
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Jun 8, 2017 13:14
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I agree that bouncing existing patients off doesn't generally fix anything, but the way the system is set up the choices are to pretend there is no addiction which is asking a lot of everyone, risk-wise, or to bounce them with a mostly CYA approach towards getting them treatment, maybe nudging them towards maintenance if they are in bad shape and open to that. Floating their pills only seems reasonable because the rest of the landscape is so dire, and doctors didn't sign up for that.
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Jun 8, 2017 13:41
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Konstantin posted:In the common case where addiction treatment is unavailable or the patient refuses it, the least bad thing may be to continue to prescribe opiods until treatment is available and the patient is prepared to attempt treatment. Prescribing opioids as a treatment for addiction without a specialized license is currently illegal, and the DEA will come down on you hard if they figure out you're doing it.
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Jun 8, 2017 13:59
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Lote posted:Prescribing opioids as a treatment for addiction without a specialized license is currently illegal, and the DEA will come down on you hard if they figure out you're doing it. Hilarious that the DEA has more of a say than your doctor does about the best medical care for you.
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Jun 9, 2017 03:41
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lol they're gonna try to solve this problem by banning opana. thats like solving the gun crisis by banning m249s
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Jun 9, 2017 04:50
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Doubt anyone anyone said that will solve this. The hiv outbreak is the lede but kind of unsurprising with underground IV use, but the pharma FDA stuff is also interesting. http://www.npr.org/sections/health-shots/2016/04/01/472538272/how-a-painkiller-designed-to-deter-abuse-helped-spark-an-hiv-outbreak
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Jun 9, 2017 13:44
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KingEup posted:Hilarious that the DEA has more of a say than your doctor does about the best medical care for you. Prescribing chronic narcotics without specific training and practice is many things, but it is never "the best medical care" for anyone.
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Jun 9, 2017 16:10
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It doesn't help that most doctors are just biology janitors. The whole point of things like the APA and DEA are to give some real oversight and control over a bunch of otherwise independent operators. And without oversight, I'd think the pill mills would only continue to increase, leaving piles of chud junkies once their patients run out of money/insurance.
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Jun 9, 2017 16:18
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pangstrom posted:Doubt anyone anyone said that will solve this. solve was a strong word on my part but the idea that it will help very much is laughable
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Jun 9, 2017 17:32
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FDA might finally be getting off their asses and doing something! Sort of! https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm562401.htm quote:
Most "Abuse Deterrent" mechanisms were always a sad ineffective joke mixed with lucrative marketing ploy. Purdue Pharmaceuticals was more than happy to reformulate Oxycontin into an abuse deterrent form because an abuse deterrent formulation can be sold as"safer" and is really hard to make a generic equivalent of ($$$). Outside of adding in Naloxone to deter injection like Suboxone does, I doubt any of the abuse deterrent mechanisms accomplish anything besides protecting brand name medications from generic forms. It's always been exasperating how little the FDA has done with regards to the opioid crisis. They have huge power in the form of REMS to regulate how a medication is prescribed and used. The antipsychotic clozapine requires monthly WBC counts and special prescriber training, iso-tretinoin acne products require patients of childbearing age to have regular pregnancy tests done due to risk of birth defects, Tikosyn could only be prescribed by a cardiologist with special training, Suboxone requires special training and registration to prescribe, ketorolac has a maximum duration of use of just a couple days etc. And yet the best they've done regarding opioids is to release a couple of completely voluntary prescriber education courses, and requiring pharmacies to print a special insert that nobody reads whenever we dispense?
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Jun 9, 2017 19:56
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sooo more ppl will just move to oxy/dilaudid/heroin/fent/whatever. when i look at drug use sites i see that barely anyone is finding opana right now anyway. this will solve nothing.
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Jun 9, 2017 21:32
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also it shows how interested they are in "helping" when the oxymorphine IR is going to stay on the market. i'm sure it's less abusable than ER.
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Jun 10, 2017 18:12
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Obviously its not going to fix the entire system by itself, but it shows the current head of the FDA is willing to at least mildly inconvenience the drug manufacturers, something they pretty much never did in the Obama administration. A drug company said their product was safer when actually it wasn't and instead just caused a massive Hepatitis and HIV outbreak. Now their poo poo is being called out by the FDA. That sounds like baby steps in the right direction to me.
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Jun 10, 2017 18:28
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sea of losers posted:also it shows how interested they are in "helping" when the oxymorphine IR is going to stay on the market. i'm sure it's less abusable than ER.
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Jun 10, 2017 19:58
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look, when you put it from the perspective of the fda clamping down on irresponsible marketing of pain medication, then yeah i agree its a win. i just dont think that further banning of drugs helps in the grand scheme of things. i suppose i can agree that this is a baby step towards something better. it was not my intention to be obtuse and i apologize if it came off that way if you want to look at something that could actually help alot, i've heard of canada granting suboxone prescription privileges to family doctors. that i believe could really do something positive. edit: i mean, if were looking to cut down on deaths, wouldnt buprenorphine be a good choice for prescribing for moderate-severe pain, at least as a first line? ppl already get it for that as butrans patches, and its supposed to have a roof on its effects and respiratory depression by virtue of it being a partial agonist. the only problem is the long half-life, but that might be better than short-acting drugs as it discourages redosing, as opposed to oxycodone sea of losers fucked around with this message at 22:40 on Jun 10, 2017 |
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Jun 10, 2017 22:09
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Remember how this all came about? NPR has a story about how the 2012 reformulation of opana ER led to a coating that made snorting difficult. This actually was followed by a decrease in snorting and an increase in IV usage. But was that the cause of the 'spike' in IV usage? My experience in Nashville TN seemed to indicate different factors at play. For the last 5-8 years, available quantities of oxymorphone on the market have been marked by periodic, major disruptions in supply. Causes include formulation changes, increased scutiny of doctors who prescribe medication, better awareness of addiction and frequent widespread pharmacy shortages of oxymorphone. Partly explained by supply, the prices for opana have steadily increased. In the late aughts, when opana was first gaining a toehold in the marketplace, nobody had any clue where to set the price. It was common to swap oxymorphone and oxycodone milligram for milligram, and 30mg was around $20. When I quit shooting pills in 2014, 30mg of opana was at $120 while oxycodone 30s were 'only' up to $30. Supposedly the oxymorphone prices keep going up; 30mg is reported to be closer to $200. What do addicts do when their supply is short, the prices are extreme, and they still have a prescription? some augment their prescription with heroin or street pills. Many others overcome their needle aversion with a quickness. Did I mention that the oral bioavailabilty of oxymorphone is only 10%? Cutting one's per milligram cost by 90% has an allure. Suddenly, IV makes a ton of sense for the opioid-dependent individual with access to oxymorphone through their insurance and the inability/unwillingness to procure heroin. In conclusion, the prevalence of IV opioid usage should likely continue to increase. The dent in supply caused by the new opana ER ban will probably cause some oxymorphone users to switch to the needle. Oxymorphone users have already demonstrated a marked increase in IV usage when snorting became impossible. That said, numbers of IV opioid users have already been steadily increasing, and this ban is just a tiny chapter in the story of the contemporary epidemic.
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Jun 10, 2017 23:44
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funny thing about opanas bioavailability is that the exact same applies to dilaudid, hydromorphone. even if youarea legit patient its basically a waste to not at least snort those things.
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Jun 11, 2017 01:35
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Fentanyl now in NYC cocaine: http://www.businessinsider.com/fentanyl-cut-cocaine-causing-overdoses-2017-6
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Jun 12, 2017 20:54
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Does anyone in the thread have a recommendation for something I could read to better understand cross-addiction (where addicts often give up one class of intoxicants, only to abuse another). The addiction/recovery thread isn't exactly the most academic of places, and my methadone doctor's answer seemed really basic, but he's a busy dude. I have a long history with everything, and this last time quitting alcohol (4 months ago?) has seen me get back into cocaine in a disgusting way. I've seen plenty of articles on PubMed that link higher methadone dosages to decreased cocaine use, but I also see articles that indicate a persistent problem with people successfully treating the heroin addiction but unable to kick the crack. I can imagine social pressures may play a role, but I've switched states/cities/scenes enough time to know I can be an addict anywhere.
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Jun 23, 2017 09:27
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I know that cross-addiction is super common, almost universal among capital A Addicts if you buy that category. Not that I will know either way, but you have a specific question? Actually, anyone able to find a source (or failing that a guess) on what proportion of opiate OD deaths are Addicts vs people doing it recreationally? Looking to do a real basic interactive/dynamic forecast but don't know what to make the default there.
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Jun 26, 2017 22:44
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pangstrom posted:I know that cross-addiction is super common, almost universal among capital A Addicts if you buy that category. Not that I will know either way, but you have a specific question? Can't speak academically or for anyone else, but personally I've found there isn't an exact solid line between 'recreational user' and 'addict'. Heck recreational use is how a lot of addicts get started on their drug(s) of choice. A LOT of addicts will claim they're only recreational users. Just because they're not on skid row with needle tracks on their arms doesn't mean they are not an addict. There's a reason there is the term 'functional alcoholic' after all. A friend of a friend is right now at the funeral of a family member who was a salesman with a 200K salary, boat, nice house, etc- who died from shooting up Xanax. Which he had been struggling with for a while. Just my observations. Tar_Squid fucked around with this message at 18:03 on Jun 27, 2017 |
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Jun 27, 2017 18:00
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Oh there isn't a bright line at all, I agree, especially if you're taking people's words for it. It's also entwined with the camp people are in re: the nature of drug use and the treatment landscape (abstinence people, opiate maintenance people, Carl Hart people, etc.). Just in making a forecast model, I really shouldn't say "well X# of addicts and Y# of overdoses thus the risk of overdose per year is Z%" if a decent chunk of those overdoses are people who aren't addicts.
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Jun 27, 2017 18:55
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well about time! https://www.statnews.com/2017/06/27/opioid-deaths-forecast/
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Jun 29, 2017 02:20
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Just thought people would have choice words about Middletown, Ohio's councilman Dan Picard's overdose proposal. What a stain of a person.
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Jun 29, 2017 15:05
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tetrapyloctomy posted:Just thought people would have choice words about Middletown, Ohio's councilman Dan Picard's overdose proposal. What a stain of a person. Holy poo poo, what a hateful person. Just got yet another reminder of the scope of this problem. A friend at another group I'm a part of just had two of her son's friends decide to do some pills last week. They turned out to be cut with Fentanyl, and both of them OD'd. For reasons nobody knows but him, the father of one of the boys found the two of them- and just put a pillow under the one boy's head while he took his son to the ER. Right now the parents of the other boy are having to decide if they are going to pull the plug or not. This drug scene has gone completely insane.
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Jun 29, 2017 15:30
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the black husserl posted:Nah, this is off base. On the West Coast, overdose deaths are actually falling. Deaths among nonwhites are falling. White people (largely, RIP Prince) are killing themselves with opiates on the East Coast because they started with Oxy, moved on to heroin and now their dope is actually 99% Fentanyl (in lots of these East Coast areas heroin doesn't even exist anymore). Fentanyl reports doubled in both 2015 and 2016. It's the wildly varying strength of the dose that is the prime cause of the skyrocketing death rate, not the skyrocketing rate of usage (although that certainly doesn't help). If these people had actual heroin they'd be strung out, not dead. That's what freaks me out. This is only part of the story. The opioid death epidemic predates the widespread contamination of the heroin supply with fentanyl. You're blind if you can't see the correlation between economic and psychic pain and drug addiction in our degenerate country. Tar_Squid posted:Holy poo poo, what a hateful person. Wow, I thought this was only a scene in Breaking Bad call to action fucked around with this message at 15:44 on Jun 29, 2017 |
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Jun 29, 2017 15:42
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