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call to action posted:That game is so loving good, it's like the ultimate game for paranoid conspiracy theory people who love terrible voice acting It was a lot more fun back when I could delude myself that only AM radio nuts actually believed the sort of things the game had as plot points. Now it's still fun, but less escapist than it once was.
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Jul 26, 2017 03:02
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Gobbeldygook posted:There is no magic heroin that resists narcan. It's fentanyl. It's just loving fentanyl. The bigger the overdose the more narcan you need. Screw up with carfentanyl and 'normal' doses of narcan might not help. (Lots and lots of narcan will work)
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Jul 26, 2017 11:24
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The Lone Badger posted:The bigger the overdose the more narcan you need. Screw up with carfentanyl and 'normal' doses of narcan might not help. (Lots and lots of narcan will work) Yeah, but we already massively overdose naloxone in our overdoses anyway. The initial dose should be approximately 0.04mg IVP, just enough to relieve the worst of the respiratory depression. In reality I never have seen someone get less than 0.4mg IVP except for this one time (in the words of John Roberts, "Some time ago, outside the statute of limitations") where I had an elderly dying patient in excruciating pain from a perforated viscus who got a touch more hydromorphone than his aging respiratory system could handle, and when he became apneic I gave him just the tiniest whiff of naloxone so he would not die, but not be in pain. It is not uncommon for EMS to administer 2mg IVP, and as one might suspect from the administration of fifty times the effective dose of a reversal agent, the vomiting and diarrhea can be epic.
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Jul 26, 2017 12:33
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Nashville Mayor Megan Barry's 22 year old son died over the weekend of an apparent OD. I actually met the kid once when helping with her election campaign, so it sucks because he seemed like a decent kid. Really smart, so this is unfortunate. https://www.washingtonpost.com/news/morning-mix/wp/2017/07/31/nashville-mayors-son-dies-of-apparent-overdose/?utm_term=.37790da1893b
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Jul 31, 2017 14:30
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I'm sure he's doing it for "the wrong reasons" in the bachelor/bachelorette sense, but Trump declaring it a national emergency is at least something. https://www.nytimes.com/2017/08/10/us/politics/opioid-trump-emergency.html
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Aug 11, 2017 03:04
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i figure his response will be to "get tough on crime," because it's worked so well before
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Aug 11, 2017 05:48
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Yeah let's hope not. He trotted out the decline in prosecution as evidence Obama ignored the problem, but the decline has continued in the last six months so who knows. The state emergency plans didn't have that in their playbook, or if they did haven't implemented it yet, and I don't think the Christie panel's recommendations did, either. I don't even think it would be politically popular. Trump is an idiot though so who knows.
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Aug 11, 2017 14:48
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Declaring something is a problem is a long way from proposing solutions, and further still from allocating money to implement real changes.
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Aug 11, 2017 20:22
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Yeah, he's already indicated that he wants to fight the opioid crisis by sticking users in jail for longer, so I'm going to guess that the "national emergency" really is that for-profit prisons aren't makin' enough green.
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Aug 11, 2017 21:40
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Subvisual Haze posted:Declaring something is a problem is a long way from proposing solutions, and further still from allocating money to implement real changes. Somehow they will make dealing with C2s even more time consuming. On some of my shifts I spend a non-insignificant amount of time counting pills in the narc safe. A good use of my time, for sure.
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Aug 12, 2017 00:47
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The opioid epidemic will stand alongside the VA as a thing which politicians lament to appear compassionate to voters but ultimately do nothing at all to help manage.
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Aug 12, 2017 01:52
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I've spent the last few weeks working in Nashville, and (due to differences in regulations between the states) I chose to transfer to the (only) methadone clinic here in town. Since BHG holds a monopoly, they can hire truly incompetent staff who provide the barest minimum of service, while adopting attitudes of contempt toward the patients. At least the heroin dealers pretend to be friendly, gently caress. Anyhow, I was assigned a counselor who functions as little more than a paperwork filler. On our first encounter, she addressed the fact that I've failed drug tests for cocaine. "Can you actually still get high on cocaine while taking methadone?" she incredulously inquired. I told her that concurrent cocaine and methadone usage is quite common, and one can find online dozens of studies addressing their usage. Higher doses of methadone sometimes seem to reduce (but not eliminate) cocaine usage among many patients. The counselor looked at me like a deer in the headlights, replying "um, I don't have that [sic] study in front of me." I was pretty disenchanted by that interaction, but we stayed cordial enough through the rest of the paperwork she had to complete. Yesterday, I again saw her. "Did you see that Trump declared a state of emergency about opioids!? The previous guy wouldn't even talk about it, but Trump just said 'give me the facts' and did something about it." loving unreal. It's her job to know SOMETHING about the topic, isn't it? I'm blessed to be a patient at my Atlanta clinic, with educated and compassionate staff. Small wonder almost nobody ever gets sober when organizations like BHG (with something like 80 clinics nationwide) operate as they do. Side note: Bain Capital was an early investor.
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Aug 12, 2017 18:05
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Subvisual Haze posted:Declaring something is a problem is a long way from proposing solutions, and further still from allocating money to implement real changes. It depends on the actual text of the declaration and the laws he invokes. If he invokes the Stafford Act, he could allow states and localities to request money from the Disaster Relief Fund. If he orders the HHS Secretary to declare a public health emergency, he could waive certain restrictions on Medicaid that prevent those funds from being used to treat mental illness and disease. The declaration could also turn out to be a proclamation with no substance, but we really don't know yet. Obviously, actually funding a response through legislation would be ideal.
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Aug 13, 2017 04:46
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The_Book_Of_Harry posted:I've spent the last few weeks working in Nashville, and (due to differences in regulations between the states) I chose to transfer to the (only) methadone clinic here in town. It sounds like quite the dilemma, considering how much you love your family, enjoy their company, and try to visit them as frequently as possible. You've also written about how much you value your Atlanta support network, and that you feel it's critical to your long-term success. So I take it that your transfer to the Nashville facility is a temporary arrangement, and that you plan to resume treatment at your Atlanta clinic when the renovation work is completed?
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Aug 13, 2017 05:20
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pangstrom posted:I'm sure he's doing it for "the wrong reasons" in the bachelor/bachelorette sense, but Trump declaring it a national emergency is at least something. 
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Aug 29, 2017 15:44
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On the Media has a good episode on the history of The War on Drugs: http://www.wnyc.org/story/on-the-media-2017-04-14/ I knew a bit about Harry Anslinger but nothing about the Billie Holiday stuff.
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Aug 30, 2017 15:56
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trump didnt file the paperwork so no the opioid problem is not a national emergency
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Aug 30, 2017 17:55
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https://www.nytimes.com/interactive...WT.nav=top-news Overdose deaths in 2016 are around 64,000. Up from 52,000 deaths in 2015 and higher than the NY Times estimate of 59,000 deaths. The final numbers will be released in December.
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Sep 2, 2017 21:43
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I didn't find the article particularly persuasive because it didn't get into numbers (or at least the most relevant ones) and because it reads like it was placed by a Purdue PR firm (hey why won't insurance pay for our high-priced opioid patches???) and because street use is the bulk of the picture these days, but the dynamic being discussed is the result of having a really dumb healthcare system. https://www.nytimes.com/2017/09/17/health/opioid-painkillers-insurance-companies.html
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Sep 18, 2017 15:01
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pangstrom posted:I didn't find the article particularly persuasive because it didn't get into numbers (or at least the most relevant ones) and because it reads like it was placed by a Purdue PR firm (hey why won't insurance pay for our high-priced opioid patches???) and because street use is the bulk of the picture these days, but the dynamic being discussed is the result of having a really dumb healthcare system. Also because at the time the opioid crisis was starting Purdue was saying that oxy was non addictive. Why prescribe a higher cost patch with a risk of addiction when there is a "non addictive" pain killer that is cheaper?
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Sep 18, 2017 16:26
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"I know last time we said one of our drugs wasn't addictive, it started an epidemic that ravaged the country, but this time we're super doubleplus sure this one's not addictive! Why won't anyone trust us on this???"
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Sep 18, 2017 16:27
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Long and interesting regulatory capture article that names and shames. Well, names at least. https://www.washingtonpost.com/graphics/2017/investigations/dea-drug-industry-congress/
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Oct 19, 2017 14:31
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pangstrom posted:Long and interesting regulatory capture article that names and shames. Well, names at least. lol at the DEA trying to distance themselves from this colossal mess. quote:The FDA signed off on one new opioid formulation after another—patches, lollipops, and pills, pills, pills. Many observers questioned why the FDA was so compliant with the pain industry. What escaped most people’s attention was that the pharmaceutical companies had an even more dependable ally in, ironically, the Drug Enforcement Administration. How are the poor little hamstrung DEA guys going to stop this: https://twitter.com/profhrs/status/921294906680905728 The failure of drug prohibition laid bare. KingEup fucked around with this message at 10:40 on Oct 20, 2017 |
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Oct 20, 2017 07:05
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KingEup posted:lol at the DEA trying to distance themselves from this colossal mess.
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Oct 20, 2017 14:42
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Gobbeldygook posted:Using manufacturing quotas to cap production would be insane and unworkable. The end result would be pharmacy's raising prices on everybody. One cancer patient going on TV and explaining that they can no longer afford their painkillers because the DEA decided to cut the supply and it's over. ? There already are manufacturing quotas. This isn't a new thing.
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Oct 20, 2017 15:19
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reagan posted:? There already are manufacturing quotas. This isn't a new thing.
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Oct 20, 2017 15:38
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These limitations on quantities the drug companies are allowed to manufacture have been around for at least the last ~40 years. I'm a retired pharmacy technician, and I remember these limits being discussed when I started working in that field in 1979. The first time I heard it mentioned, a couple of pharmacists were discussing Dexamyl. Apparently there was a shortage of this product because that year's limit of dexamphetamine had already been manufactured, and there would be no more until after the first of the following year.
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Oct 20, 2017 21:23
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What mysterious tools do the DEA have in their arsenal to combat drug addiction besides cutting supply?
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Oct 21, 2017 07:41
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Here's a good, long article about the Purdue Pharmaceutical and the Sackler family who are at the epicenter of the epidemic.
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Oct 23, 2017 15:39
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KingEup posted:What mysterious tools do the DEA have in their arsenal to combat drug addiction besides cutting supply? Jail
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Oct 23, 2017 22:31
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pangstrom posted:Long and interesting regulatory capture article that names and shames. Well, names at least. This is some amazing DEA bullshitting right here. Here is the truth of it: http://www.100daysinappalachia.com/2017/10/24/ex-dea-official-blames-congress-agency-blessed-opioid-boom/
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Oct 26, 2017 13:08
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deoju posted:Here's a good, long article about the Purdue Pharmaceutical and the Sackler family who are at the epicenter of the epidemic.
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Oct 26, 2017 16:51
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Overdose among black Americans is skyrocketing: https://www.nytimes.com/interactive/2017/12/22/upshot/opioid-deaths-are-spreading-rapidly-into-black-america.html
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Dec 24, 2017 00:39
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Collection of pieces about (my editorializing) why capitalism isn't great at healthcare. https://www.nytimes.com/interactive/2017/12/27/business/addiction-inc.html
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Jan 19, 2018 16:09
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Philadelphia may get over opposition and have safe injection sites https://www.nytimes.com/aponline/2018/01/23/us/ap-us-opioid-epidemic-philadelphia.html
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Jan 24, 2018 04:00
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pangstrom posted:Philadelphia may get over opposition and have safe injection sites Prohibitionist drug laws clearly don't stop people shooting street drugs so allowing these people to take some precautions so they don't die gets the thumbs up from me. It'd be great if they could offer some onsite drug checking services too so they know whether they're about to shoot fentalogs etc.
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Jan 24, 2018 04:34
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just logged onto a chinese RC source last night and saw methoxyacetylfentanyl being sold for ~$45/gram. poo poo isnt stopping anytime soon.
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Jan 24, 2018 13:59
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pangstrom posted:Philadelphia may get over opposition and have safe injection sites Boston is considering safe injection sites but the reaction has been mixed.
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Jan 24, 2018 14:17
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Mooseontheloose posted:Boston is considering safe injection sites but the reaction has been mixed. "Mixed" is a polite way to describe how many Philadelphians are responding. My nurses, who should know by now that this is a GOOD thibg, just grouse about "enabling," blah blah blah, as though we don't have enough evidence that addicts will use no matter what the circumstances. Same with a lot of EM docs on our closed group, many of whom have actually stated that banning naloxone and post-overdose resuscitation (!!!) "would fix it all anyway." And they fight ED initiation of buprenorphine/naloxone with quick referral to rehab because they don't think it's their job -- "How is that an emergency?" Getting pretty discouraged by a good chunk of my colleagues.
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Jan 24, 2018 15:13
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People who think it's a willpower/character monocausal thing really hate stuff like this. It reads as indulging people who are already self-indulging. And you almost need some parts of the city "lost" to homeless drug addicts (or otherwise completely vacant, or completely disenfranchised) to put the sites in so residents don't go nuts. Aside but: my best friend in high school became a real alcoholic and the response among ~5 mutual friends (all intelligent, reasonably informed, mostly progressive) could be pretty well summarized by "dude he needs to stop being a weak dick" even after talking about it for an hour. The willpower/character thing is very much the default position.
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Jan 24, 2018 15:26
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